Dear Kevin,
I agree completely! Why is it only for the spine that chronic pain or
patients that don't seem to improve immediately as a result of our treatment
that we automatically assume that it must be psychological? We know very
little about the spine, so instead of trying other treatment methods or
referring the patient to another practitioner who may try another approach,
we automatically lay the blame to the patient, i.e. not compliant, is under
too much stress, isn't following PT's advice, or has some underlying
psychological issues that must be addressed. Could it be (dare I say it)
that we tend to say anything to our patients except the truth- maybe we
don't exactly know what's going on, why they're not responding to our
treatment, that maybe we just don't know?
How does it help the patients when we dump all the blame on them? (When it
may or may not be an issue). As physiotherapists (speaking from my
perspective), we are not pop psychologists and should not let psychological
issues be in the forefront of our minds every time we evaluate a new back
patient just because they're back patients. For example, one of Wadell's
signs is tenderness in more than multiple locations or more tenderness than
would normally be expected. If your patient has multiple level disc lesions
along with sacroiliac malalignments, is it that odd for a patient to be
tender along most of the paraspinal musculature in addition to sacrum,
spinal processess, gluts, and piriformis in addition to having radicular Sxs
elsewhere (or perhaps aggravating the pain in some of the same already
muscle tender locations)? If we're so fast to jump to non-mechanical
conclusions, we could easily miss many of these problems (I know firsthand
that this happens).
How many patients with other pathologies at other joints do we treat,
knowing the patient is fairly non-compliant & has other issues, etc, and yet
our patient still gets better? This should tell us something.
Jill Kison, ATC, SPT
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