Physical Therapy Page

I have to tell a lot of my patients that very thing. “It just looks like pain”. And I usually get a “What does this guy know about me and my pain” look from them. Of course they don’t believe me. They live with this feeling 24/7. Its them that can’t lift a milk carton without pain. It’s them that have to fit a place to sit as soon as they get into the store from the parking lot. Its them that have to take a handful of medications just to get going in the morning, or get through the day. Who am I to tell them “it just looks like pain”?

Since I have been practicing, I have found that a lot of people fall into certain categories when it comes to physical rehabilitation. You can usually see which category a person fits into as soon as you see them walking into the clinic. See if you recognize any…

Old School – Some of the most amazing patients of mine that are in pain, and have been in pain for a long time go about their daily doings without missing a beat. When asked about their pain and how it affects their life they say something like: “I just deal with it”. These people are typically older and have seen a whole lot in life.

Does anyone remember “The Predator”, the old Arnold Scwarzenegger movie? Arnold’s friend, Jesse Ventura’s memorable line after catching a bullet or shrapnel in a fire fight: “I ain’t got time to bleed”, typifies the old school patient. Old School patients generally show up to the therapy clinic after a long time of “dealing with it” because their lifestyle is finally being affected by their discomfort. While Old School patients are generally motivated and responsible, it can be difficult to work with Old School Patients because they have to learn some new tricks.

“I’m Okay, You’re Okay” – These are people are similar to old school patients because they do not slow down and they are determined that they are going to “fix” themselves. Have you ever heard the scenario where the patient is in the doctor’s office for shoulder or arm pain and they say “ Hey Doc, my arm hurts when I do this (some particular motion)” And the doctor’s reply is “Well, don’t do that then”.

You will typically find them working out in the gym, lifting weights, running and working hard, harder, and hardest. These types of patients say to themselves, and most everybody else, something like this: “ If I can just work it out it will get better”. However, when you ask them how long they have been “working it out” they generally say something like “oh, for about 6 months or so”. Your follow up question is usually, “well, is it any better”? And their response is usually, “Well,…it’s a little better”. Keep in mind, anyone one who has been “working it out” for 6 months without any significant change in their condition for the better should probably try another approach. These patients have the “no pain, no gain”

“Pharmacists” – These patients generally present to the clinic with a long history of pain. Many times their story starts with some sort of event, either a surgery or an injury, that began their journey into the land of chronic pain. Usually, they have “tried everything” to relieve their discomfort but without any success. A lot of times, they have had one or more surgeries in an attempt to relieve their pain.

Unlike the “I’am Okay’ers”, these patients are almost paralyzed by their pain and so, they are not interested in “working it out”. It is all they can do to get out of bed and go about the daily household chores or go to work. With this attitude, they feel that the best way, if not the only way, to reduce their pain is to cover it up with pain medications. Many times, people in this category have tried several types of pain medications, not realizing that their bodies are getting used to each of them. They generally find that they need more and more medications and at higher dosages to deal with their pain. Because they have been is so much pain for so long many of these patients aren’t motivated to take responsibility for their health. For this reason, it is difficult to convince the “pharmacist” that there is any hope for pain relief outside of medication.

“Rodney Dangerfields” – “The doctors were just practicing on me and that’s why I am where I am today”. “My job doesn’t care about how they treat their employees. I have been telling them that my desk is not set up right for me and they didn’t do anything about it. Now I am hurt”. “I know that my sciatica is because I weigh too much”. “I don’t have time to exercise because I have too many things that I have to do”.

Do any of these (or any variation) sound familiar to you? We have all been in this boat in one form or another I am sure. This has to do with responsibility, doesn’t it? Many patients with pain or an injury find a way to blame what they are feeling (and the interpretation of it) in their bodies on someone else. In my career, patients in this category seem to be bit more angry than the others. The anger is something that the patient has got to get past in order to really participate in their own health care and see some real progress.

But, dispite of each valid coping mechanism, most people don’t understand that alot of what they feel as “pain” can be solved by changing a couple of things, namely: 1) How they react to the pain. What they think about it. And, 2) How they move. And what I mean by that is that many people change the way that they move in attempt to avoid pain and as a result, they create more pain for themselves.

There will be more posts about that in the future. Right now, the only thing that I would encourage readers to consider is that a persons pain level can be controlled to a degree by the way a person reacts to it both mentally and physically.