28 May Habits
This is a case study which will hopefully give you a glimpse as to what we help with at Connected Physio.
The patient has come via an insurance company referral. She has been having physiotherapy treatment for ongoing lower back pain since January this year after being involved in a car accident. Her symptoms are improving but she has a stubborn area of pain which she continues to get on the right side of her lower back. I suspect that it continues because of habits that she has picked up throughout her life for example, standing with all her weight going through her right leg, sitting with increased weight through the right side, being right side dominant in all that she does. You get the picture the right side of her body has become so over active, her muscles have become short and the joints in her lumbar spine I suspect have some wear and tear due to this life-long habit. Changing these habits is the best thing she can do for this type of pain, so the first port of call in physiotherapy is creating awareness of this. Explaining her habitual tendency to and giving her a simple exercise to create awareness on a daily basis, every time you look at your clock/watch check your weight bearing status no matter what your doing, then correct it make it equal both sides.
The next thing we have to do is correct any muscle shortening she has through the area so in combination with some deep tissue massage and joint mobilisation she has been doing some exercises daily to help with lengthening these muscles and to help maintain mobility in the lumbar area.
She often finds that after her massage treatment her back feels improved but unfortunately this is only short lived until her symptoms return.
We ask why this is the case, we have to go back to the start in this situation. We discuss awareness of her habitual patterns, we discuss her commitment to her exercises. We discover on reflection that her awareness exercise is done only once or twice a day when she remembers! The contradiction here is amusing! And that her active lumbar exercises are done 2-3 times per week. What we’ve got to remember is we are trying to counter act activity that is happening constantly, 100% of her living breathing time, particularly when she is active throughout the day. Unless something is being done regularly to break these habits then the underlying patterns will not change.
After a long discussion today I’m hoping that this is clearer to the patient, that unless we change patterns and create new ones regarding the right type of exercise things will not change.
What may surprise many of you is how little the massage and joint mobilisation are mentioned. These have a massive impact in kick starting the bodies healing response which is why they are important aspects of treatment but they are not the most significant part of treatment what patients do outside of physiotherapy is the most significant part of treatment.
So remember when we ask you to change certain things or do exercises it’s not just for the sake of doing it, it’s for the sake of your pain. However the psychology of changing is for another blog!!