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What's YOUR line?
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What's YOUR line? - May 28, 2004 4:49:00 AM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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I am sure we all believe the fact that education of our patients is a very integral part of the rehab. If they have a good understanding and belief of their problem, why it may have occurred, and why we are doing our PT a certain way can help the overall process.
I would like to hear what each of you tell your patients with regards to certain injuries. I do not want this to become a debate about what someone posts in his/her thread, and let's keep the chiro argument out of this one (it always seems to sneak into even the most innocent posting)
I was recently chatting with Eric Nabors, MD, a local prominent spine orthopaedic surgeon. He tells people this with regards to nerve root trauma and pain: "If you push on your normal finger, it does not hurt. If you smash your finger, and it become inflamed and swollen, then pushing on it will cause pain, and continued pushing will continue the pain and inflammation"
I found this a good analogy for nerve root irritation, especially with all the current information regarding DRG and root inflammation/histochemical changes and pain.
I personally use the front end of an automobile for many of my anecdotes, and will bore you with some if asked. I am sure there are some great ones out there that would help us all become better!
So, what do you guys use to explain certain conditions to patients?
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: What's YOUR line? - May 28, 2004 12:58:00 PM
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bonmar
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Joined: August 15, 2000
From: Boston, MA
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Re: impingement of the shoulder, I compare it to putting your finger in a door and then closing it. If you repeatedly do this, your finger will become sore and swollen and you will not be able to close the door as much.
Re: P/F tracking and lateral tracking/chondromalacia, I equate it to a desk drawer gliding in its track. However, if you take the desk drawer out of its track and put it back in, the drawer will still work, but it will be wobbly, and the underside of it may get scraped.
Like you, John, I could continue with the analogies but do not want to bore anyone.
I do love hearing other PT's analogies, however, so let's hear em!
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Re: What's YOUR line? - May 28, 2004 5:28:00 PM
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Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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LBP (for flexion related injury)
"Imagine you cut your finger, right on the back of it, on the middle knuckle. (hold up finger --no... the index finger). If you repeatedly bend that finger, while the cut is trying to heal, you're going to rip it open. It is never going to heal, now is it. Well, that is what happens each time you bend over, (or slouch, or whatever) to reproduce your pain. Let it heal,(stop bending it until the wound closes) then slowly start to bend it, with gradually increasing amounts of strain/motion, and voila, you no longer have a problem".
I also teach people with low back pain how to sneeze. That is, to sneeze without the jolting pain that negates whatever progress they had made up until that point.
Im big on getting people to stop doing the things that they blindly do that perpetuate their symptoms. Makes me look like a genius, even thoughthe advice itself is pretty darn simple.
_____________________________
Steve Hill PT
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Re: What's YOUR line? - May 30, 2004 2:05:00 PM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
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The Icy Pond (re: healing)
Imagine a pond that is trying to freeze. If you run out and jump on the ice too soon, you break through the ice and the freezing process must begin again. If you keep doing this the ice will become slushy. Instead, think about gradually testing the ice. A little pressure at first, until you can put all your weight on it, and eventually jump up and down without disrupting the ice. Same holds true with healing. We need to gradually test the healing tissue as its strength and position in the healing process allows.
_____________________________
PRC
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Re: What's YOUR line? - June 13, 2004 1:54:00 PM
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ianwvu
Posts: 71
Joined: June 11, 2004
From: Glendale, AZ
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for Relieving Nerve entrapment:
I found myself trying to decypher what a patient was telling me when i was assessing treatment effect of traction, or positional distraction, and there was some confusion. If a patient has no sensation(numb) then starts to feel tingle, then an increase in that intensity, they may see that as "getting worse". SO i use a garden hose analogy. I.e. A kinked hose with no water flow is Numb, (no sensation), with a slight unkinking and a little flow, can be tingle, as the hose is becomes unwound the tingle may get more noticeable (more water flow) , until there is full water flow, and hopefully a return to fairly normal sensation.
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Re: What's YOUR line? - June 13, 2004 2:07:00 PM
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nari
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From: Australia
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When I am trying to educate patients about pain and activity/movements, I tell them about reverse parking in a tight spot:
If you move slowly, it is OK to 'nudge' the car behind (that is, their pain) but not OK to hit it sharply - it damages both cars.
So when they do an activity, they must experience the nudge, but NOT a bang. The only way to achieve this is by slow movement; and when they have nudged, back off and try again. If they have to try more than five times - give that space away and find another safer one.
This applies, I think, to all pain, whether acute or chronic, Pushing through pain repeatedly is a disaster and a recipe for central and peripheral sensitisation and more pain for some people.
Nari
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Re: What's YOUR line? - June 14, 2004 5:58:00 PM
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mcap56
Posts: 619
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From: New York, NY
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I find myself trying to explain the LBP biopsychosocial model often so that patients don't think I am accusing them of malingering or having a psychological problem. Here is the analogy I use in class using two of the students........
Two people cut their fingers.......
One avoids moving it for a couple of days, let's it heal and then starts to use it normally. As he moves it and uses it, the range of motion and mechanics of the finger are restored. As stress is applied to scar the healing is enhanced and the scar becomes stronger. Everything heals normally and it ceases to bother him.
Person two has the same cut. However, person two is afraid that if he moves it, he will become disabled. So...person two never starts to move it and becomes preoccupied with what makes it hurt. Despondent, person two sees a doctor who takes an X-ray. He is diagnosed with degenerative finger disease!! Now #2 is in a panic. He is degenerating and does not want to put any stress on the joint.
The scar does not heal properly because of lack of stress. As he keeps his finger straight and protected, he looses range of motion and the muscles atrophy. With the finger changing, it seems to take less and less stress to set off a painful episode. Pretty soon it just hurts when he even tries to use it a little.
As things progress, the finger is inteferes with work. His boss is not being supportive of his finger issues. His job requires use of his hands but he avoids it as much as possible. It is also causing problems at home as his wife is having a hard time adjusting. The finger seems to be all he talks about. He isn't helping as much around the house.
As the weeks and months pass, he becomes depressed. No one seems to have an answer for finger disease. He hears conflicting reports in the news and on the internet. He has read stories of people who have lost everything because of finger disease. The therapists, doctors and chiropractors he has seen have all promised a cure but each has only provided temporary benefits. Each has told him not to push things with the fragile finger. They also thinki that MRIs and electrodiagnostic testing would be necessary if things continue.
There seems to be a thousand theories out there. One famous doctor who has written a book seems to think finger disease is all psychololgical.
What is #2 to do???????????????????????
A silly example....I know. But....to lesser degrees....it does happen with LBP patients. Contrary to opinion, many of the psychosocial problems occur after and because of the pain.
mcap
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Re: What's YOUR line? - June 15, 2004 12:08:00 PM
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UTDC
Posts: 222
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MCAP,
Excellent example, thanks.
Jeff
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Re: What's YOUR line? - June 15, 2004 5:58:00 PM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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I like the responses, and need to remember these! Those who know me will remember how I use the front end of a car as my example for so many things:
1. If your wheels are slightly out of balance, the tire pressure low, and your front end not in alignment, you may be able to drive around town and not even notice a problem. Ask that car to go 70mph on the highway, and all kinds of shaking and shimmying may occur. The same goes for the shoulder in athletes. For normal activity, the 5 -10 degree lack or IR or ER may not be a problem, but ask that same shoulder to throw 80 pithces in a game, and the problem may become apparent
2. Your shoulder capsule is not much different than a CV joint boot on the front end of a car. It has folds and wrinkes to permit motion, and is filled with oil (synovial fluid in humans). If you take that boot and adhere the folds together, or take the front of your shirt and sew all the folds together in the front of the shoulder, movement cannot occur (I visually take my shirt, grab all the anterior shirt folds and pinch together, and show how I cannot raise my arm with them in that situation)
3. The spinal disc is like tires on a car. Some tires are good with good warranties, and others are just fair. When you are born, you don't know what kind of disc/tire you have. Some people are born with strong discs and can get away with all kinds of stupid activites and have no problems. Others do everything right and by the book and still have problems. Treat your disc as if you were given a set of tires that will be the last you ever get. However, you don't know the quality and warranty, so make every mile count.
4. The disc is like a tire on your car. Microtrauma after microtrauma leads to macrotrauma and failure. This is why some tires just "blow out" for no apparent reason...the straw finally broke the camels back. Some discs just blow out finally....usually with some simple activity such as a sneeze or bending to pick up a paperclip.
5. When slouching all the time, you place your rotator cuff into a position where it does not have mechanical advantage. (I then slouch and flex my arm to 90 degrees and have them break the contraction while I resist maximally. I then sit up straight, get my shoulders back, and have them try again, and usually they cannot break the contraction) Doing things with your shoulders while slouching is like driving around with 10lbs of air in your tires. The car drives OK around town, but you are trashing your tires!
Kind of obnoxious, but they usually get the point across!
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: What's YOUR line? - June 16, 2004 6:07:00 AM
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tucker
Posts: 182
Joined: May 24, 2003
From: Texas
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I'll throw one in that relates to stroke, forced-use, and neural plasticity.
The brain carries messages to the muscles so that you can move. There are several pathways that the brain can take, but over time, it has developed the fastest route to get there. This is like taking I-45 from Houston to Galveston...it's fast. A stroke is like closing down that interstate where the messages can't get through to the muscles. Now...is there another way to get to Galveston if I-45 is closed? (patients answers yes) Sure you can take...ex. This is what occurs in the brain when you force yourself to use that arm/leg. The brain searches for another pathway to get to the muscles. If you never use the arm/leg, the brain will never search. Once you begin to see a flicker of movement, that means the brain just found an alternate route. If you do it more and more, that little pathway will turn into a road, with better movement. Pretty soon that road will turn into another highway and you may be able to move the arm as well as you did before.
Patients generally understand this concept and the need for forced-use to prevent learned disuse.
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Re: What's YOUR line? - June 16, 2004 6:55:00 AM
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chiroortho
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To illustrate the effects of axial compression on discs, and how incorrect biomechanics can result in a ruptured disc, I use jelly donuts. Not real jelly donuts, figurative jelly donuts. I know, I know, but hear me out...
'Your discs are kind of like jelly donuts, all stacked up on top of each other. When we lift, or even stand up, we are causing some compression on the stack. If there is a weakness in the disc, like the hole in the jelly donut, and we lift wrong, we'll cause the jelly to squirt out of the weakness (the hole) in the disc (the jelly donut). Just like if I push down on top of the stack of jelly donuts, you'll see jelly coming out of the holes.'
Greg
_____________________________
Greg Priest, DC, DABCO
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Re: What's YOUR line? - June 17, 2004 7:01:00 AM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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I use the jelly donut and the road detour examples all the time. They are quite perfect. Living here in Western Pennsylvania, people really understand the detour example, as orange construction barrels are a way of life. Come to think of it, after viewing most of the waistlines, so are the donuts..
Duffy
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: What's YOUR line? - June 17, 2004 11:32:00 AM
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chiroortho
Posts: 655
Joined: February 18, 2004
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And another one: Explaining to patients that they need to understand the healing process to some extent for best results (read: compliance).
'John, it's not a question of whether or not you're going to heal. Even if you choose to do NOTHING you'll heal. The only question in my mind is HOW will you heal? Will you get lucky and heal well or will you heal badly? It may be worth it to you to take your chances, but it wouldn't be worth it to me. I've seen too many people that have healed badly.'
'If I break my arm, and don't get it in a cast, it'll heal anyway. And it won't hurt. But it will heal crooked, and it won't work right. This is why I'm interested in more than just your pain. I'm interested in doing what I can to help you heal BETTER.'
_____________________________
Greg Priest, DC, DABCO
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