Explaining pain is an art and science, like anything else in our profession. It's certainly not the panacea some make it out to be, but then again, nothing is.
However, when present something in a novel way, with an analogy, humorous story, or metaphor, sometimes things just click and BAM, fear avoidance lowers. Here are 5 recent cases I have evaluated and things I said that made it click
1) Gymnast with wrist pain after fracture
- at the end of her season, she fell off a scooter, landed on out stretched wrist, but did not think anything of it
- after an entire day of practice the next day, she complained of wrist pain
- she wore a brace for 2 weeks, then after no improvement, had an MRI, diagnosed with distal radius fracture, and was immobilized for 6 weeks
- currently c/o stiffness and pain with active wrist extension and WB wrist extension (very important for gymnastics)
- I told her about pain/threat, etc, then said, when you fell and fractured your wrist, you had no pain, not until you actually practiced using your wrist
- it hurt worse after you got your MRI and were immobilized, and now you are clear after x-ray and you still have pain
- hurt does not equal harm - this she got because of the lack of pain immediately after fracturing it - no threat, no pain
- patient in mid 50s, saw me 8 years ago (when I was a much different PT) for chronic lumbar pain
- currently had insidious onset of severe and painful loss of shoulder elevation
- after explaining pain as an output related to perceived threat, I said, "One of the best pain researchers in the world asks if you can feel two pains at once."
- this immediately clicked because it turns out, her chronic lumbar pain went completely away upon fracturing her foot - which she now knew as her brain doing threat prioritizing
3) Full thickness rotator cuff tear with shoulder pain
- was recommended surgery but did not want it
- very worried and anxious about his surgery
- is a 5 star chef
- I explained a full thickness tear as a piece of steak, and a knife happens to go all the way through, possibly in the middle, and leaving the rest of the steak intact
- thus it's full thickness, but overall the muscle can still function, and why PT can work to restore movement and function
- he said this explanation was why these 2 visits of PT worked, and his previous 8 weeks of PT did not
- I have been working at restoring her function and her gradual threat reduction for 3 years now
- after repeated visits, sometimes weekly, sometimes less, she finally "got it" regarding pain as a threat and not as harm or damage
- she actually needed to read a similar message on a CRPS website and newsletter for it to click - so it was not just me
- the lesson learned here is, if you are not reaching the patient, you may want to have them view one of these videos, read Why Do I Hurt, or this ebook by Dr. Greg Lehman, so you're not beating a dead horse
- but an A-Ha moment we both had when I was recently doing some PNF on her hip in a fully flexed position to reduce the threat of an FAI like pain, she said, "This would hurt if I did not trust you."
- so she even knew that the pain was an output, and not based on position or movement
- tried to do his own cervical retraction and self treatment, was working on breaking up prolonged sitting etc
- no relief with any self treatment
- I had about 20 minute pain science session with him, also describing that sometimes patients need hands on treatment to reduce threat and dissociate pain with movement/position
- after demonstrating improvement in cervical and mandible motion, and making it so he could perform cervical retractions without irradiation of scalenes and upper trap, he felt much better
- turns out he is a OT/CHT who does GMI, is into pain science, uses mirror boxes, but said, "Even though I explain pain daily, I couldn't get it out of my head!"
- I told him even Lorimer Moseley had a very painful frozen shoulder experience he blogged about - even though he more found it fascinating rather than disabling
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
Keeping it Eclectic...