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Thursday, October 13, 2011

A Chronic Pain Specialty

One thing I've noticed since opening my small PT clinic (A Balanced Approach) 3 years ago, is that many of my clients are people "at the end of the road" or at wits end with their pain or disability. This is the facet of people who are in chronic pain; pain that lasts 6 months or beyond--or really any pain that is just not healing. Thats when some doctors refer folks to me-when exercise based approach treatments at other places have not worked, or made things worse. Or when surgery has failed.

I do a manual therapy treatment (Strain Counterstrain) which is very gentle, and yet highly effective at reducing muscle spasms and promoting healing. Treating clients who have more complex cases going on really has become, in many ways, the meat and potatoes of my practice. The End of the Road Physical Therapist. Every physical therapist has their forte or strength; for some it may be post-surgical conditions, or treating shoulders. For me, its treating people who have been in pain for many, many months.

Working with people who have been in chronic pain can be more of a challenge, but one that I really enjoy. The reason it is more of a challenge is because the body has inflammatory pain chemicals that have set into a joint or an area, and it takes a little longer to get that inflmmation down. Also, from what we know about brain chemistry, someone in chronic pain actually has physiologic changes in their brain due to the pain. It is a very complex process of the body processing and accomodating to the pain. Also, we have to establish a treatment relationship so I understand who they are, what they've been through and they understand the approach I take in treatment. It takes a little more time to get that relationship established, and I think its a big part of why people succeed; because they have trust built. They're not seeing various therapists every session. They don't have to tell their same story over and over and over again. This is a big relief to people.

When I got out of physical therapy school, if a client told me that their neck, low back and hip all hurt, I was completely overwhelmed and thought, "Oh I can't treat all those joints at once!". I think back to that and cringe in disbelief at how "inflexible" I was at treating the whole body.

Now, as I sit during that initial interview with a client, and they have multiple body parts circled on the pain chart, I"m all over it. My favorite pain to treat is neck pain--I could work on peoples necks and headaches all day. Seriously. The manual therapy technique that I do works fabulous for neck pain and people see movement differences within 1 session (typically, not always). The client reports back "When I left the clinic and backed the car out, I was able to turn my head around." Thats the reason I enjoy this line of work; when I make even a little bit of a difference, clients are thrilled, because they had been stuck at the same place for so many months (or sometimes years).

Often my clients are ones who are DONE with the health care shuffle. Going to different doctors, different specialists, different physical therapists...
I love the more complex cases such as "abdominal pain of unknown origin; CT scan negative", "Low back pain and chronic leg pain...", "Chronic headaches/migraines". Its these cases, an exercise based approach has failed at a prior facility and people are willing to try just "one more therapy" and they end up in my treatment room.

On so many levels, I'm so thankful to these clients for giving one more thing a try. I've never experienced pain like that myself (knock on wood) and so I can't imagine how disappointing, debilitating, discouraging it would be. I appreciate them letting one more person ask all the same questions that they've been asked and to trust me and my treatment hands to try to get to the source of the pain. I am glad they are willing to see if a "different approach" it will help. I"m big into finding out what is causing the pain; why isn't it healing, and setting the body up with manual therapy, body mechanics, education, so it can heal. There is nothing like the sense of accomplishment when a client leaves the room with a smile on their face and says, "This is the best I've felt in a while. Even to have the pain down a little feels so great. Thank you." At times as they walk off, I have small tears of joy in my eyes and I am reminded why I love my line of work.

I also LOVE it when people are referred to me after 1-2 months of non-healing discomfort, pain. Sometimes people say, "Oh maybe I came in too soon" and I tell them, "no, no, came at the perfect time. We don't want chronic inflammatory chemicals setting into the area. This is the perfect time to treat this problem." People are encouraged by that. I love those cases, because I feel like my involvement perhaps helped reduce the chance of them having chronic pain.


Top is of me in my treatment room about 2 years ago
Second one is a picture shortly after graduating from PT school when I worked at Providence PT (where I worked for 8 years).
Group dinner picture with my providence PT team. On the far right is Skip, the therapist I volunteered with in high shool and later worked with upon graduating from school. He was my manual therapy guru!

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