Today in PT

It's All Connected

Have you ever noticed just how delicate the balance of the body is? This fact was brought home to me recently, when a patient who was rushing to get off her walker and onto a single point cane ended up with a calcaneal bursitis and rotator cuff tendonitis on the uninjured side, caused by shifting her weight too vigorously onto her good side and pushing too heavily on the cane. No one can blame a patient, especially a young one, for wanting to get off a walker — but she had plenty of compensation going on for her healing hip, and the race to gain more independence gave her a nasty setback.

Another patient who is in anticipation of a knee replacement surgery has just realized that he had better attend to his CMC osteoarthritis problem, or he won’t be able to push up from a chair or use a walker easily after surgery. And another patient with stress and urge incontinence is hurrying to schedule her bladder sling surgery before her upcoming hip replacement, for fear of not being able to make it to the toilet in time postoperatively.

Like most of you, I look at each patient as an entire person, rather than as just an injured body part, but it’s often amazing which systems and structures will become stressed along the road to recovery … it’s all connected.

Have you noticed any compensatory changes in your patients lately?

Anne Ahlman, MPT

Virtue in Patience?

Today’s society seems to emphasize instant gratification, from instant messaging and fast food to finding a rapid cure for whatever ails us. And in many ways, who can blame a patient for wanting to feel better, faster? But although not every injury can become pain-free in a hurry, sometimes there are limits to delayed gratification.

A friend of mine who is also a PT injured her back nearly a year ago, acutely tearing her L4/5 and L3/4 posterolateral discs, with a little tear at L2/3 for good measure. At the time, the pain was bad — really bad — as the frayed, nerve-rich annular fibers reacted to the damage. “It was like I blew out the sidewalls of my tires!” she said, as she valiantly staggered around trying to continue treating her patients. No amount of stabilization exercises could help reduce the reactivity of her beleaguered load-sensitive discs, and despite two spinal injections that failed to calm the chemical irritation, she seems to be stuck — her repeat MRI showed that if anything, the tears are actually a little worse than a the time of the accident.

Although my friend can now sit down (albeit leaning away from the affected side much of the time), statically stand for up to five minutes, and walk for up to 30 minutes without exacerbation of her symptoms, triggers continue to include axial loading and translational/shearing forces. Performing resisted PNF patterns, applying certain types of joint mobilization, and lifting a patient’s limb for PROM exercises — not to mention assisting with transfers — all reproduce her sharp lumbar pain and aggravate her unilateral lower extremity radiculopathy. She faithfully does her daily lumbar stabilization exercises, unloads her spine whenever possible, and has modified her schedule and her life, but what’s a PT to do? She tells me the experience seems like endless night.

It’s all intensely frustrating, but despite all this my friend is not ready to use chronic pain medications, have surgery, sign up for disability, or retire. However, she confides that she is tired of trying to be patient with being a patient as well as a PT! Unfortunately, I’m fresh out of ideas — do any of you have suggestions for our friend and colleague?

Anne Ahlman, MPT