One of the difficult aspects of applying current research for treating various pathologies is that not everyone experiences an injury the same. Not only do we have to incorporate injury-based research, but we also should consider aspects of pain science research. Each component of the pillars of evidence-based practice should be incorporated in patient management.
Have you ever wondered why two patients with the exact same diagnosis can present completely differently? While one might retort that the severity of pathology (amount of arthritis or tendon degeneration), imaging studies regarding pain science have found that often presenting with a worse experience can easily present with minimal pathoanatomical findings. Pathology does not equal injury and hurt does not equal harm.
When an individual experiences pain, there are many different factors that go into it. Pain is actually that, an experience. Have you ever noticed how a baby looks to their parents to see how to react when hurt? Or how an individual might describe their pain differently based on the setting? Past experiences (their own or family members), social expectations, individual expectations, fear and much more can influence a patient's injury experience. Because of that, we cannot address every patient with "achilles tendinopathy" the same. We must incorporate their individual expectations, beliefs, and stressors into consideration when managing their care. While it can be upsetting that we aren't able to treat based on pathology alone or even regularly apply pathology-based research to our care, we are fortunate to understand WHY not all people experience an injury the same way. By further developing our understanding of pain science, we will hopefully be better able to treat our patients in the most efficient and successful way.
-Dr. Chris Fox, PT, DPT, OCS
As part Optim Manual Therapy's COMT Program, we have weekly case discussion sessions online. Below is a sample of a recent session on a patient with chronic low back pain. How would you have handled the case differently? While we include the typical didatic material, manual assessment/treatment techniques, OCS prep, online courses, and exercise prescription, regular mentoring is the essential component that sets us apart. It helps to develop clinical reasoning and decision making. Check out www.optimfellowship.com for more information or feel free to reach out to me.
-Dr. Chris Fox, PT, DPT, OCS
"How is my leg doing that?"
How to Perform
To perform Mirror Therapy, patients place their intact/uninvolved extremity in front of a mirror. Doing this visually super-imposes the hidden/involved extremity (Ramachandran et al 1996). In the video to the left, the woman has chronic right knee pain. Therefore, the mirror faces the left knee (super-imposing the involved right knee.)
If you are looking to improve upon your clinical skills, orthopaedic knowledge and clinical decision making, consider joining OPTIM's COMT program. With OPTIM, you can expect a residency-like learning experience without breaking the bank, all while learning from highly skilled physical therapists. Check out optimfellowship.com for more information!