Physical Pain: Who Do You Turn to?

Denise’s sharp leg pain, which was produced by a nerve in her low back, was 100% improved from the previous week. Yet, she was fuming. But not at me.  She was frustrated with her medical doctor.

“I wish he had sent me to you first.”  This was a dramatic change of tune from the previous week.

Three weeks prior, the general practitioner gave her a course of steroids to alleviate what was diagnosed as nerve pain, but it didn’t touch it. So the “Guess you need physical therapy,” was interpreted by Denise as he was shrugging her off. Which annoyed Denise.

She landed in my office, with candid exasperation, “I don’t know why he sent me to you.” Translated, “I don’t know what you can do for me” which I was not offended by, because really, further translated she was saying, “I don’t know what the heck PT actually does.”

I smiled. “Well let’s start with the X-ray films he had taken of your back. Did he explain the results to you?”

No, he had not taken the time to do that.

That was his job. Now I was frustrated with him.

Time for a Rant

Allow me a rant.

The role and responsibility of any health care professional with at least a masters’ degree is to educate and treat. By Educate, I mean that we the healthcare professionals explain what we are ruling in and out, and the reasoning why, with options for treatment and the reasoning behind the options.

We don’t make it complicated or overwhelm with information, but we do owe our patients an explanation for what the heck we are doing to their bodies. We treat our patients respectfully, like intelligent human beings.

Providing treatment without education is essentially being a medical technician. No offense to technicians; my point is they are not required to analyze and evaluate or teach. That is the responsibility of the person with the advanced degree and training. Lack of analysis and explanation in my opinion is equivalent to mindless implementation. You are no longer practicing healthcare. You are vomiting it. Healthcare has become a reflex.

Rant over.

Putting Puzzle Pieces Together

So, I went over the results of her films and explained what they meant. I pulled the puzzle pieces together.  And explained why PT was exactly what she needed.  The MD got that right.

Her instability in her back, also known as spondylolisthesis, could be due to a number of things, but we know that building strength and better motor control improves and can manage this diagnosis of mild slipping of a vertebral segment, aka spondylolisthesis. I explained the good news that it hadn’t moved much, and wasn’t putting too much pressure on the facets, the boney arms of the spine segment. I recommended a TENS unit to re-direct her pain and distract her brain. And I gave her 2 core isometric exercises.

Finally, I addressed the emotional and mental components that were also at play. She was frustrated with her body, feeling like it was betraying her in some way. The pain signals that were meant to communicate to her vital information were getting shut out by her response of “Shut the heck up!”

I broached the subject by asking her “What if one of your preschool students kept pulling on your pant leg, and you turned to them and shouted, ‘Shut the heck up!’? How would that go over?”

She cringed.

“Yeah, that’s what you are doing to your brain and body. It’s trying to communicate and you are reacting impatiently. Rather than getting frustrated or impatient, I recommend a technique that 1. Recognizes that yes, there is pain. 2. Rather than have an emotional response, keep things objective, no judgment; just assess the situation. Then 3. Investigate. “What is going on? What is the real message here? and then 4. Nurture. Be kind in your response. See what you can do. Do you need more fluid? Are you hungry? Do you need to move more?”   This method is called RAIN by Tara Brach.

We have reasonable evidence that negative emotions can reduce the release of serotonin and dopamine, neurotransmitters that are responsible for calming us and making us feel happy. Turns out they are powerful painkillers too. Getting angry or frustrated or deeply disappointed can shut the gates, preventing their release. Holding off on our judgmentalism can keep those gates open. Being positive and grateful allows those chemicals to flow more freely, and participate more in our management of pain.

“You’ve got this,” I told her. “Your pain is in on its way down and out the door. And the reason is because now you are paying attention to specific needs in your body that had been overlooked for oh, quite a while.”

The next week, sitting in my waiting area, she not only was much improved, but she also was sleeping better.  Win-win!

Now, however, she was aggravated with her MD. “Why didn’t he send me to you in the first place?  I wasted 2 weeks in unspeakable pain and exhaustion. Why was it, ‘Oh well. Go to PT. I can’t do anything more for you?’” She mimicked Eeyore’s voice.  “That should’ve been his first go-to.”

Again, I smiled. This time in agreement.

Physical therapy can do so much in optimizing a person’s ability to live effectively in their body. It is far-reaching in its scope and effectiveness. Check out the nearly 20 sections of practice:

Acute Care
Cardiovascular and Pulmonary
Clinical Electrophysiology and Wound Management
Hand and Upper Extremity
Health Policy and Administration
Home Health
Pelvic Health
Private Practice

Yet it appears to be, even in 2021 when I am writing this, that Physical Therapy is still underestimated and not very well understood.

Physical therapy seeks to improve the health of society by optimizing movement in a variety of ways.  This clearly is a concept that flies in the face of a sedentary culture whose priorities are comfort and safety.

And when you consider that the current culture of medicine often, but not always, appears to be about drug prescription or surgery, patients essentially are taught that medicine and surgery are the best treatment options, evidence-based, and more important than movement. While there is a time and place for medication and surgery, even my medical colleagues agree with the evidence that it often is best to go conservative first before going for the Big Guns.

Translated: seek out Physical Therapy for any variety of pain you are experiencing, especially if you are reaching for the bottle of Tylenol or ibuprofen.  The physical therapist should be someone whom you know to be skilled, knowledgeable, and evidence-based, as well as compassionate.

You can thank me later.


In the meantime, I ask you, what do you do when you are in pain? How do seek to solve the problem of your pain?  And when you seek help, do expect the person or the pill to erase your pain, or have you considered that you have a role in the healing of your pain? Talk to me; I’d love to hear your thoughts on this.

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