“Why do patients come to us?” What is it that brings them to us that pays our mortgage? Predominately that answer is PAIN. If you are a good therapist, you have to understand pain. Truly understand the language of pain. It doesn’t matter if the injury was 24 hours ago or 24 years ago; if you listen to them carefully and give them a chance to talk, they will give you the picture that you are up against. By the time you get to our advanced courses, you will get to the level where you feel confident treating chronic patients. Let me first challenge you to define “chronic” not as someone who has been pain for a long time, but someone who has been unable to find a PT who can fix their problem. That is a chronic patient. Hopefully, by the time they reach you, that chronicity will end because you are able to FIX their problem.
DIRTY CANVAS: Every time that you treat a chronic patient, I want you to think of a dirty canvas. In studying old paintings, some of the most famous artists, including Picasso and Van Gogh were the poorest artists. They would spend all of their available money to buy a canvas. They would paint a picture and put it up for sale. If no one bought it, they would paint over it and put it up for sale again.
The way they discovered these layers of paintings was when they started to use
x-ray technique pioneered by Dutch scientists Joris Dik and Koen Janssens to see if the painting was genuine. In one of the paintings, there were 4 pictures, each one a masterpiece.
HOW DOES A DIRTY CANVAS CORRELATE TO A CHRONIC PATIENT?
When you hurt yourself as a 5-year-old, you “recover” (get back to the normal activities) but you do this with your neuromuscular skeletal system “coping with the insult. You never abolish the insult. You learn, but the memory remains. Now you are a teenager, you have a neck injury and once again you get better “by coping.” Then you have another injury, and another injury, so like a painting- you have layers. You are a dirty canvas. Like the painting, you have layers. Then suddenly you have a motor vehicle accident and you cannot cope “recover” because your body is unable to bounce back because your body is no longer capable of coping. They come to see you-what do you look at, the latest one? Their pain may have NOTHING to do with the injured tissue. How do you get pain from UNINJURED tissue?
BY VALERIE COOLMAN
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