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Picture

Further Evidence Regarding the Dangers of Imaging

3/18/2015

4 Comments

 
Picture
We all have the patients that are obsessive over their diagnostic imaging findings. They are fearful for you to even evaluate them without reading their MRI reports. Some of the most distressing words we hear as clinicians can be, "have you seen my imaging reports?" Immediately, the patient is at risk for becoming a slow responder due to the presence of perceived threats from the reports. Recently, I had a patient who had an MRI that revealed some disc herniation in her lumbar spine. I tried to educate both the patient's family and another involved health care practitioner on how disc abnormalities can be normal in teenagers and twenty-year-olds as many are asymptomatic with those same problems. No matter what I said, there was a level of fear in that patient's family (likely heightened by the confirmation from the other practitioner) that could not be shaken. Recently, a study came out showing just how common disc bulges can be. Between 70-78% of asymptomatic individuals in their twenties have a disc bulge in their cervical spine. This further increases the evidence of how it is a normal aging process. The fear instilled by imaging can be difficult to treat. It is by far my weakest area as a physical therapist. I used to think it would apply to a small population, but it appears to become ever more important with the progression of pain science. I currently am reading Therapeutic Neuroscience Education and have read Explain Pain in order to develop my methods of educating patients on pain science. What other sorts of resources or methods do you use in this area?

-Chris

4 Comments
Andrew S. Rothschild link
3/18/2015 01:04:47 am

Chris,
You highlight one of the more challenging scenarios we face in outpatient PT. I frequently employ the same tactics you mentioned and sometimes it works great, and sometimes the reaction is a negative one. The same is true with the pain neuro education. Pain is such a challenging concept even for us as clinicians to fully grasp that it's hard to expect patients to embrace it as well.

There are times when if my read of the patient and the situation is such that I feel like a negative response to my attempt to educate them will result, then I will almost ignore or not validate their comments on MRI results. With my eval and treatment, I will hope to foster a good rapport and trust scenario to set up for that conversation in future treatments. Not the method I prefer but it has worked in those similar situations. Hope this helps.

Great post.

-Andrew

Reply
Steve
3/18/2015 01:58:32 am

JAMES---any chance you are now 'experienced' enough to be a CI?

Reply
Erson Religioso III link
3/18/2015 02:35:28 am

I find using logical arguments to make people realize pain is not a threat (or imaging) works well. For example, in that case, like many, pain is intermittent, it may take a bit more questioning for them to realize that. If they end up saying their pain is worse in the morning, but better as the day goes on, you can ask them, "Do you think your MRI looks worse in the morning, and then improves as the day goes on?" Replace that with movements, positions of ease and irritation and most people realize the MRI is just what their spine looks like when they're lying in a tube.

Reply
Erson Religioso III link
3/21/2015 09:28:38 pm

Starting up my stopthoughtviruses.com again with infographics for the public and clinicians. http://www.stopthoughtviruses.com/2015/03/low-back-pain-and-imaging.html

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test