Glad to see you made it through the holidays and are ready to go for 2018! Given the nature of the holidays, family was a major component of my break this year. That gave me the chance to talk with some people who have no problem being honest with me about what was going on in their lives. As we sat around mounds of food or opening presents I, of course started asking people how they have been. With most of my family knowing I am going into physical therapy at this point, typically the conversation turns to what ails them and they then ask my opinion.
I am sure this happens much more frequently for licensed physical therapists, however I am already starting to see a trend. My blog today will go through some of the frequently heard reasons for not seeing a physical therapist and my opinion on them. I would love to discuss with anyone on this topic as I think we as physical therapists have done a rather poor job at expressing the value we can bring to most people with pain.
#1: "I don't want to go to physical therapy because I don't have that kind of time"
This perception I feel is a barrier we have developed ourselves with the 3x/week for 6 weeks idea of years past. In my clinical experience thus far I have seen very few patients who have needed this high frequency of physical therapy. If the pain is mild and not limiting your daily function but is something you are just curious about, a physical therapist has the knowledge basis (and hopefully is willing) to explain to you what is going on. From listening to physical therapy podcasts such as Pain Reframed, The Ask Mike Reinold Show, and the Duck Legs Podcast, there has been newer research showing the importance of understanding pain and modifying fear related to pain in the absence of tissue damage. Like in many situations, once the fear of the unknown has been removed, it is easier to address the underlying cause.
An example of this would be talking with a family member who was having some shoulder pain. Without going into much detail, the onset of pain was insidious with no fall or mechanism of injury. I started looking at the cervical spine and noticed her shoulder strength and pain seemed to improve with cervical retraction (if you do not know what this is please message me!). While my assessment was not as thorough as it would be in clinic, I then explained the importance of performing this motion because it could greatly improve the shoulder pain. Hopefully this helps improve a problem that has lasted 7 months and may even lead her to seeing a physical therapist (or at least a continued discussion with me) down the road.
To completely address the issue of not having the time to see physical therapy, I understand that most people do not want to spend 3 hours a week in the middle of the day doing exercises. However, of the 168 hours in a week, it may be worth at least seeing a physical therapist once or twice to see if they can start to explain what is causing your pain.
#2 "I have gone to physical therapy before and it didn't help at all"
Oh boy do I love this one... by this logic if you have ever gotten a bad cappuccino from a coffee shop you should have given up coffee a long time ago. This is what sociologists like to call over generalization. While I know it is much easier to blame someone for not fixing your pain on the first, second, or third try, I ask you to sympathize with us. The body is a very complex thing that no one 100% understands. While there are common causes to people's pain, you may be an outlier and it may take a little time to rule out other options. I do not think there are many people in the profession of physical therapy who are intentionally trying to make your pain worse or not improve your symptoms.
However, if you have seen a physical therapist and the level of care was more similar to an assembly line than a health care facility, I would expect you to try another location. Just like there are good and bad with every profession, there are good and bad therapists. With the new insurance laws leading to an increase in case load, sometimes the quality of care is decreased. Though this is unacceptable in my mind, therapists are under pressure from their boss to see a certain number of patients in a day to meet productivity standards. If you find yourself in a clinic such as this I can understand your frustration with the system. That being said, I would hope you would look elsewhere as there is no need for you to continue to live with your pain and no understanding as to what is causing it.
#3 "Well I was going to try physical therapy but I already saw a chiropractor"
While I am not opposed to someone seeing a chiropractor if they are seeing results, just because one style of treatment did not work doesn't mean that another won't be of benefit. When asked by my relatives if chiropractic care really works my honest response is typical of any physical therapy student..."it depends". If you are the right patient for a chiropractor to see and your goals are in line with their theory of practice then by all means go see them.
However, if you are being told that your spine is coming out of alignment and need to be adjusted several times a month then maybe it is time to try something different. The thing with back pain is that it comes in waves, even when you think you have found the cure for it...it is likely to return. Physical therapists SHOULD show you a way to manage your back pain whether that is by hands on manual work, finding a directional preference, or giving a set of exercises that help to "stabilize" your spine. With all of the different causal factors and responses to treatment for patients with back pain, sometimes the approach is more managing the pain when it does occur and teaching you how to take the pain from a 7/10 to a 2/10 so that you are able to function.
Even though there are many reasons to avoid going to see a physical therapist, most are based on a stigma against needing the assistance of a physical therapist only when someone is "broken" or after a surgery. I would love to one day be able to teach pain science to a room full of individuals curious as to why their shoulder hurts after a softball game, or why their back gets sore after working all day and then explore possible treatments for these common ailments alongside them.
One of the major things I have learned in physical therapy school is that pain is common. It is a real sensation that most people have but no one can really relate to. While I have had back pain, our experiences are likely not the same. It is so difficult to relate to patients who are in pain and to get them to believe that you sympathize with them...at least in one visit. With that notion in mind, I ask that anyone reading this gives their therapy team a fighting chance to help them. This idea that 10 months of pain can be cured in one visit is not very likely. While we would love to cure you of your pain with our touch, sometimes managing one's symptoms can be a longer process with peaks and valleys along the way.
If you have any questions please feel free to contact me via Facebook or Twitter as I would love to have a discussion. Please if you feel like this post may help someone you know make that step towards seeking care for their pain feel free to share it. Even though it can be hard to express to others, physical therapists understand that your pain is real and the vast majority of us will do anything we can to help manage or eliminate your symptoms.
Thanks again to anyone who takes the time to read what I am writing. Hopefully one-day it will reach someone and make an impact on their life.
Until next Friday my friends.
I am a new graduate DPT and am interested in personal growth and becoming a connector within my profession.