On Patient Education

How’s everyone going with their 1^st week of placement?

I’m currently doing musculoskeletal outpatient placement. During the past 1 week, I saw a few knee, ankle, shoulder and lumbar cases.

One case which I would like to share is a lady who was referred for low back pain. She complained of I/T LBP, dull ache, unilateral on the (R) side. Agg factors included prolonged sitting and standing, relieved by rest. Nil neuro-related symptoms. On initial examination, flexion, extension ROM was reduced. L3-5 region was hypomobile. Motor Control functional test revealed that she was unable to activate TrAb and pelvic floor without bracing the whole abdominal wall and holding her breath.

During the treatment session, I explained to her my plan and the possible causes for her problem. One of the treatment included teaching activation of TrAb in crook-lying. During the exercise, she found the activation difficult and “tedious”, and wanted to give up. She said “Oh no, I’m not coming for Physio anymore.” She started commenting on how age makes a difference – “you are young, when you reach my age, with the weight put on around the tummy, it will be difficult.” And she even apologized for not being able to do the exercise, n how she is a “nuisance”, and that she’s “wasting my time”, how she did not “understand why the doctor did not refer (me) earlier on, why wait until now?”

I had to spend the whole session on educating her, explaining to her that she’s not a “nuisance” and she is referred for a reason. The doc probably thought that her I/T LBP is a recurrent issue for her and physio may help to alleviate the problem. At the end, I taught her how to do pelvic tiltings in sitting and good sitting and standing posture.

From this case, I felt the impact of psychological factors on the compliance of treatment. I also realized a treatment session may not necessarily consist of hands-on therapy or exercise prescription, (loads of ) patient education is equally important. N also, sometimes from patient’s point of view, she may not see the use of “activation of TrAb” and starting off with something functional may be more useful.