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Is this consistent with what they teach you about chronic spinal pain in PT school today?
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We were taught that pain could originate from many different causes. We're supposed to use special tests and things that recreate the pain in question to try to arrive at possible diagnoses. But we were also taught that physical pathology doesn't always result in pain.
I like some parts of it and definitely think it's a move in the right direction. Neurophysiological input has shown potential to have huge impacts on back pain, but I think it's more than just ignoring the pain and doing some exercises. But I do like the fact that they go into some detail about the prevalence of physiological pathology without perceived pain.
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Yes, the quote above is pretty consistent with what we have been taught. We had a few lectures on pain sciences and the very abridged version of it is "pain is a subjective experience which is not always consistent with radiological / physical findings"
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Agree with the other two that replied thus far! They hit it the nail on the head!
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Of course it's more than just ignoring the pain and doing some exercises, but I think the author was struggling with how to best portray the treatment approach in a way that a layperson might understand it. Unfortunately, even when put into common terms it looks like a lot of health care providers don't "get it" if you looks at the comments section of the article.
I'm encouraged about current students' responses. Less than five years ago this was barely, if at all, touched on in the schools of my PT students.
Now the next question I have is how do you treat a patient with chronic spinal pain when so many of the treatment interventions we have all been taught are about "this joint is stuck/hypermobile and I'm going to push on it" or "this muscle is in spasm and I'm going to release it"?
Im only a 2nd year...but my answer to your question jesspt is identify the activity limitations / participation restrictions of that patient (pain with running for example) based on that, identify which impairments are contributing to those (hypomobile segment, trigger points, etc..) and some contributing factors such as maybe tight hip flexors for example. And based on that we already have some potential treatment options
Am I completely off the mark here?
Am I completely off the mark here?
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The exam will often reveal motions or tests that relieve patient symptoms. Manual therapy should still be incorporated with these patients where applicable to provide neurophysiological input that can often help to relieve pain. It's important to educate them that about the role of physical therapy in back pain and physiological damage doesn't mean that they need to suffer forever save going under the knife.
A lot of these patients will be fearful of movement so education alone can have profound effects. I see nothing wrong with manual traction, stm, and possibly even central/unilateral PAs if they help decrease pain levels.
A lot of these patients will be fearful of movement so education alone can have profound effects. I see nothing wrong with manual traction, stm, and possibly even central/unilateral PAs if they help decrease pain levels.
How to treat them? You could fit the patient into a treatment classification group
http://orthopedicmanualpt.files.wordpress.com/2012/11/slide21.jpg
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Strange, since 99% of patients you will see in the outpatient setting will have pain as their primary complaint
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I think you are listing impairments that a) have poor reliability of being detected, and b) may be highly prevalent in asymptomatic people. How many people in this sedentary culture of ours likely have tight hip flexors?
jesspt, my school teaches us the following: when conducting an exam we take into consideration the following:
1. activity limitations / participation restrictions
2. patient perspective
3. pathobiological mechnanism (this is where we try to make a determination as to the pain mechanism so either like peripheral nocioceptive pain mech or central sensitization)
4. physical impairments
5. contributing factors
6. contraindications / precautions
7. management / intervention
8. prognosis
So based on that, my interpretation is that we: identify the act limitation / part restriction is the most important for the patient, which impairments we best believe are preventing the patient from doing those things, and what we think are some contributing factors to those impairments. Based on all of those things, we formulate the treatment plan.
1. activity limitations / participation restrictions
2. patient perspective
3. pathobiological mechnanism (this is where we try to make a determination as to the pain mechanism so either like peripheral nocioceptive pain mech or central sensitization)
4. physical impairments
5. contributing factors
6. contraindications / precautions
7. management / intervention
8. prognosis
So based on that, my interpretation is that we: identify the act limitation / part restriction is the most important for the patient, which impairments we best believe are preventing the patient from doing those things, and what we think are some contributing factors to those impairments. Based on all of those things, we formulate the treatment plan.
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I wrote too soon. We just completed the first week of our semester, which includes PT Management of the Neck and Spine. From what I have gathered on the few lectures thus far, apart from classification and differential diagnosis, pain is characterized and influenced by input from multiple domains. We also look at the biopsychosocial aspect of the patient. Pain>attitudes and beliefs>psychological distress>illness behavior>social environment. So in terms of treatment, we are being introduced to multiple classification systems to PT differential diagnosis and treatment, with added emphasis on yellow flags that my prevent or hinder patient progress. Yellow flags, such as occupational and psychosocial factors must be addresses by the PT as reasonably as possible. Learning to communicate this to patients is key. This may include addressing patient beliefs that back pain is harmful and disabling (thus not participating), fear avoidance, belief of passive Rx > active, social withdrawal, etc.
I hope this better answers your question.
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Hi JessPT,
I graduated one year ago, so hopefully i'm still able to comment on this. When I was in school, we spoke extensively about the nervous system's ability to rearrange in response to chronic pain. We were taught to focus on regaining of function while minimizing focus on pain itself. I guess its a fair amount of addressing the fear avoidance behavior rather than feeding into the focus of pain. Unfortunately i haven't had that much success using this strategy yet - most chronic back patients I have have already been shuffled around in the medical system so much and had so much invasive stuff already, its hard for many of them to focus on anything except the pain...
-Quasi
I graduated one year ago, so hopefully i'm still able to comment on this. When I was in school, we spoke extensively about the nervous system's ability to rearrange in response to chronic pain. We were taught to focus on regaining of function while minimizing focus on pain itself. I guess its a fair amount of addressing the fear avoidance behavior rather than feeding into the focus of pain. Unfortunately i haven't had that much success using this strategy yet - most chronic back patients I have have already been shuffled around in the medical system so much and had so much invasive stuff already, its hard for many of them to focus on anything except the pain...
-Quasi
