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| For Wellness, Treat the Main Cause of the Problem |
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by Matthew Goodemote MPT, Dip MDT - October 26, 2010
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For the last several weeks, I have been writing about how to determine an accurate diagnosis. This past week, I saw several difficult-to-diagnose people whose history included conflicting information or multiple complaints. This is where listening is vital to the patient’s recovery. When I say listening, I mean on the part of both the medical practitioner and the patient, because if only one listens and not the other, it will often lead to a dead end. Early in my career, I got stuck believing something so strongly that I closed down to the possibility that there was another possibility. Over the years, I have learned through experience to keep my mind open because I may have missed something. If the resolution of a patient’s symptoms is not complete, I can hopefully identify the missing piece of the puzzle by listening hard.
In my job, listening to a patient’s history is the foundation for an accurate diagnosis. The testing we do is to confirm what we think we already know. However, one patient in particular proved to be the exception to this rule. My patient, I’ll call her Mrs. Jones, came to the clinic with multiple complaints. She had foot pain, knee pain, hip pain, and low back pain, mid back pain, neck pain, shoulder pain and hand pain. She told me she “hurt everywhere,” that is, until I asked how her ear lobes felt. Then I explained that understood that it felt like the pain was everywhere because so many places hurt.
Anyway, Mrs. Jones told me that I was her last hope. She had been scheduled for surgeries but didn’t have the support at home to manage her day-to-day affairs post-surgery so she kept putting off her own well-being (sound familiar?). As she suffered, her activity level diminished and her pain levels increased. So did her stress levels.
I think it is important to take a minute to point out how common it is for us to avoid activity because we hurt, only to find out that the decrease in our activity leads to MORE pain and diminished function. There are appropriate times for rest, but in most cases, rest should only be part of a day, not days or weeks in a row.
Mrs. Jones’ history was filled with signs and symptoms consistent with arthritis and/or degeneration. During my physical examination every joint I manipulated made noise and I could feel the “Rice Krispies…snap…crackle…and pop!” Every joint, that is, until I got to her neck. Her history told me that arthritis was the source of her neck pain, but the examination showed me something else.
When I checked her motion something unexpected happened- her movement didn’t match her history. Then an even stranger thing happened- I my head, I heard that Sesame Street song again…(cue the music) “One of these things is not like the other. Which one is different? Do you know?…” I was onto something important!
Mrs. Jones had little to no motion turning right and left but was able to extend nearly all the way. This is inconsistent with what I would expect from degeneration or arthritis. Typically, a degenerated spine will have limitations extending when there are limitations rotating in both directions. So Mrs. Jones’ movement screen didn’t fit her history. Mrs. Jones had pain turning her head both right and left and had significant losses of motion in both directions. But her extension was nearly normal in movement and she had little to no pain with this movement.
(Note: Before you check yourself, please understand that the movement screen mentioned is only a small part of the evaluation and by itself is generally not enough to diagnose a problem. )
What does this all mean? First and foremost, I still suspect that Mrs. Jones has arthritis/degeneration that is contributing to her pain, but the main source of her neck pain is more likely muscular. This is extremely important because if you are treating the condition that is secondary to the main issue, you will only find limited success. It is like climbing up a ladder to put out a small fire on the top of a building when the real fire is at the bottom of the building. Sure, the water will trickle down into the main blaze, but it will not put it out even if it diminishes it a bit. In other words, if you are trying to stop the burn, you need to go after the main source!
When you extend, you shorten your muscles. When you shorten your muscles, they go into a more relaxed position. So this is why Mrs. Jones’ extension was better than rotation. Her joints were not in perfect condition, but her muscles were more likely the main source of her pain. This is extremely important because the treatment is different and the focus of therapy is different.
For Mrs. Jones, her neck solution was fairly easy. We started her in our warm pool where almost instantly, her muscles began to relax. The buoyancy and warmth of the water allowed her to move in a way that is simply not possible on land. In addition to aquatherapy, we set her up with our physical therapy/massage therapist to receive a massage. Then for home, we taught her exercises for range of motion, posture and stretching. By the time she left after her first visit, she told me that her neck was feeling a lot better.
In the end, I was able to find a solution for Mrs. Jones because I stayed open to the main source of her problem. Unlike in the old days, I was able to stay open and allow the patient to direct me, to guide me to the solution. Mrs. Jones’ history pointed to me to the “fire” and the physical examination during her initial evaluation showed me where to put out the fire. Wellness requires both patient and medical practitioner to listen and trust that the solution will found by remaining open to identifying the main source of the problem.
 Matthew Goodemote is the founder and owner of Community Physical Therapy & Wellness in Gloversville, NY. He has degrees in Exercise Science, Health Science, Physical Therapy, and he is one of just over 250 in the world with a Diploma from the McKenzie International Spine Institute. Matthew is recognized as an expert in the fields of Physical Therapy, orthopedics, spinal disorders, sports medicine, and wellness. He is routinely called upon to offer tips and suggestions relating to health and wellness. His unique approach makes him a highly sought after expert at different ends of the media spectrum. He has received requests to participate in studies for scientific journals, and to write articles for trade magazines and popular press magazines such as Fitness to offer proven recommendations that stand the test of time. More of Matt’s blogs can be found at http://www.matthewgoodemote.com/blog/.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Linda Meneken, PT (San Francisco/Concord, CA) |
on 30 Oct 2010 at 3:46 pm |
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Brilliant, Matthew! What a great article! And you probably saved this poor lady from the knife! I just observed a very involved spine surgery, fusion at multiple levels in a 74 year old lady, and it was not pretty! Took 6 hours plus? Anyway, keep up the great article-writing! (Incidentally, I took one of Robin McKenzie's courses, and he too is a brilliant guy. I have used his extension principles on hundreds of spine patients in my career.
Thanks again,
Linda Meneken, PT
lmeneken@astound.net |
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