Kevin,
I have replied to this on two occasions but owing to little hands my replies
got deleted !
However briefly to an altogether complex multifaceted problem Kevin I will
offer some thoughts ......
Using a different model for the assessment of psychological V's physical
dysfunction may be worthwhile and make one aware of the complexities and
multifaceted nature of the person before you. Wherever possible I try to use
Louis MOM approach, analysed from this perspective the model may serve to
minimise dualistic interpretations of facet/imbalance or whatever else is
in vogue in physio circles V's supratentorial ...
However with this in mind it is certainly advisable for a person interested
in manual therapy to be aware of the issues outside their interpretation of
physical dysfunction .... It is so easy to search endlessly for a tissue
based solution to explain benign low back or for that matter cervicobrachial
pain before the patient trundles off somewhere else or ends up at a pain
management clinic .
If the literature is to be believed and my clinical practice certainly
reflected this, Kendalls work on yellow flags for poor outcome should be
widely disseminated .
Simple questions on presentation should be what do you think is wrong with
you ? If you give a purely mechanical structural answer or solution many
people will become disabled .... which is exactly what has happened read
Zussmanns excellent essay, Waddells back pain revolution or ask patients
what they were told ......
However this again is a complex issue as many people obviously respond to
the analogies of things being pushed in and out and some therapists make a
fortune doing and telling people this ( depends who is doing the probing/
how expensive/ distance travelled and impressiveness etc etc)....
Additionally as a culture the usual response is to treat ones body like a
car and the intervention is usually analysed in this fashion too --- in
grey areas like musculoskeletal pain the intervention certainly is not
simplistic as we all know ....but people like simple solutions to complex
problems therapists/patients alike...
We should as a profession be much more aware of the complex interaction as
people becoming disabled with benign 'mechanical' problems are increasing
not reducing in number ?
However this requires in many instances a shift to happen in therapists
education and the issues associated with musuloskeletal pain to be better
understood or at least be valued ......This doesn't mean being a
psychologist but often a subtle shift in intention during treatment not
slotting people into boxes because they fit into categories who may or may
not become chronically disabled.....
If the epiemiology statistics were to be believed no patient in my last
place of employment would have got better at all ( poorest health in UK,
massive unemployment, little if any place of leisure , and family
dysfunction++ typical of many nhs deepest in inner cities I am sure).
It does have to be said that depts as above do need multidisciplinary teams
to have a chance with this common group . In order to be therapeutic and to
have a successful outcome with more patients it is necessary for therapists
themselves to be healthy . Knowledge is one way forward but it has to be
said that treating people who have been around the houses, given erroneous
information and who are often at their wits end is a thankless task
.........
all the best to you
Ian p.s I am looking for a new job!
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