Chronic pain

After just two weeks at my musculoskeletal clinic im surprised by just how much I've learnt. All those prac classes taught us the tecniques needed and the lectures taught us the conditions but I've found that theres nothing like seeing the actual problem. Feeling the abnormal end feel, the really really tight joint and the results that one treatment can have on pain and decreased function. There is however patients whom you don't really understand why they are coming to a physio, when their pain is more serious and yellow flags are present.

A recent patient I saw had been coming to the physiotherapy clinic for a couple of years for more than one problem. Her problems had gone from bad to better with physiotherapy treatment, of course, but she seemed to have plateaued even with weekly treatment. After assessing her, I had planned on just giving her the same treatment that had been working - STM, PPIVMs and going over her HEP, changing/increasing it depending on my assessment. My supervisor however talked to me about the yellow flag, chronic pain side of her problem and told me how to help with this, treatment had to become less hands on (a nice massage and her back loosened each week) and handed over to the patient. On inspection of her home exercises, she reported she was doing her TA/PF exercises and her Lower traps exercises but she was just doing the set exercises and hadn't applied them to everyday life. She was therefore still experiencing lower back and neck pain and relying on physio every week to get her pain relief.

I used my supervisors advice and although i still gave her the STM as in previous treatments it had a great effect on her pain, i spent most of the treatment talking over functional uses of the exercises she had been given. She picked it up straight away using TA/PF for STS, rolling, bending and even got in before me when she bent over to do up her shoes "tighten those pelvic floor muscles". I went through sitting and standing posture and how correct posture stems from the pelvis. Its position aswell as switching on her TA which made her stand/sit straigher, her chin retract and her "chest bone lift" slightly, automatically using her upper traps. I ended the session by rebooking her for 2 weeks time to break the every week trend.

I do realise that chronic pain does not go away that easily but by handing the information and treatment over to the patient I feel she will feel powered to get herself better and be in control of her pain.