The Monday Memo
October 26, 2015 PITT DPT STUDENTS
“Fear and Education”
Patients can be much easier to treat once we find their impairments. This is not groundbreaking. If they are weak, then those muscles should be strengthened. If their tissues are tight and limit their range of motion, then those tissues should be stretched. But what about pain? Often when a patient does not understand what is causing their pain, they will become fearful, which creates countless barriers to resuming activity. Some professionals will gladly prescribe opioids and other pain medications to inhibit the neural processes and mask the symptoms, but we as physical therapists do not have a single go-to method to directly affect a person’s pain. So, does this mean that physical therapists are not capable of improving a person’s fear of pain?
Pain of a musculoskeletal origin is what is typically seen in orthopedic clinics: it follows a movement pattern, is reproducible, and ideally responds to specific manual muscle test. However, anyone that has ever had a patient with low back pain might agree that this is rarely the case. Many times patients may report sensations that do not necessarily follow a common pattern. Patients may respond that they are very fearful that they will never feel well again, and that their pain is going to keep them from enjoying life because they cannot move without discomfort. In this type of patient, the major impairment is not purely a weak muscle or a stiff tissue, rather it is the pain and the associated fear that are impairing the individual’s function. Therefore, educating such a psychologically-involved patient about what is physically happening to them is key to a successful outcome.
While we should be educating all of our patients every day that we see them, it is especially important that time is spent with the fearful patient. Emphasis should be placed on instilling confidence, or self-efficacy, in the patient. Be sure to explain that degenerative changes are “normal,” that bulging discs do not necessarily mean pain, and that the terms arthritis and stenosis can be used loosely by some professionals. It can be extremely helpful for these patients to see models, diagrams, and learn about the anatomy of some of these structures to understand what may be occurring. As long as the therapist is sure to put it all in language the patient can understand, this can curb the patient’s fears as well as build the patient’s respect of the physical therapist as a competent clinician. Patients should be receiving an education as well as therapeutic exercise every day they come to the clinic, and it is up to the therapist to act as both a teacher and a healthcare provider. The simple task of teaching a patient empowers them with self-efficacy, curbs their fears, and can lead to better outcomes in both the long-term and the short-term.
– Michael Turnwald
SPOTLIGHT: Great job representing the University of Pittsburgh, Margaret Acton and Bethany Trotter, at the National Student Conclave in Omaha this past weekend! Also, embodying professionalism and student advocacy this weekend was David Pastrana at the national PTCAS Application Work Group Forum in Boston, discussing alterations to the general application!
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Social Media Updates
- #DPTstudent – WEDNESDAYS , 9-10pm EST! Check out #DPTstudent page for details!
- Unite Physical Therapy Students – If you haven’t yet, please check out the “Doctor of Physical Therapy Students” Facebook page. More than 9,500 students have already joined!
- Our own page! Pitt Physical Therapy, thanks to the Social Media Team, has created an official PittPT Facebook page!
- #SolvePT (meets on Tuesdays Twitter from 9-10pm EST)