January 3, 2010
My new year’s resolution is to get my thoughts on the web.
I was watching The Biggest Loser Finally the other night. The final 3 contestants lost on average of about 45% of their body weight. I was obviously moved by their physical transformation but what struck me was the obvious change in their persona. To my knowledge they did not receive any psychological counseling during their stay on the ranch yet they now exhibited confidence, joy and peace with their bodies and their minds.
America watches as these people are put through grueling workouts. We watch as these people want to quit, even beg to quit. Although I realize that show is edited and the participants are closely monitored, these workouts even scare me a little. It is at these moments that I believe that these psychological transformations take place. It is the doing, even when we don’t want to and not quitting even when we want to that elicits change.
In many of the course evaluations for my Fall Prevention class students have requested that I demonstrate the treatment techniques on an appropriate patient. This week I choose to film my treatment a family member who was visiting for the holiday weekend. This is not the first time that I have treated this individual and there were many a year when I have swore never to treat him again. He is the type of patient who hurts all over, he is vague with the triggers of his pain and I believe a symptom magnifier.
In the past I have treated him as any manual therapist would, patient lying down, me palpating and utilizing various release techniques. This would elicit the usual moans and groans, oohhs and ahhs that would drive me crazy and truth be told would not yield the results that I had hoped for. All of the before mentioned factors along with my personal relationship with this person made my treating him a nightmare, but for the sake of my students, inspiration from the biggest loser, and renewed confidence as a therapist from teaching my class I decided to try again.
I kept my evaluation and treatment functional for several reasons. I was able to keep the patient focused on what he was doing and not his pain. I would critique and correct his technique and a keep my hands on him to mobilize, evaluate and facilitate. By doing this I was able to note that he was significantly more stable and strong than he appeared to be. Because he needed to focus on the functional tasks at hand he was less able to focus on his pain and if he experienced symptoms, I was able to immediately note when they occurred to identify triggers as well as area that required treatment.
I was able to perform 3 sessions which included his evaluation. At our post treatment filming he choose to walk without his cane, was able to perform sit to stand and stand to sit transfers without holding on and with control, and was able to get out of bed unassisted and using proper form. During his entire stay I required him to sit on a foam wedge to keep him in good alignment. I caught him not doing so only once when I returned from snow shoeing. Incidentally, when he got up after not sitting on the wedge he experienced pain to his left buttock.
I sent him home with the following instructions:
DAILY TO DO:
MAKE SURE THAT IF YOU ARE IN ANY CHAIR FOR LONGER THAN 15 MINUTES THAT YOU ARE SITTING ON A WEDGE. PERIODICALLY WHEN YOU ARE SITTING ON THE WEDGE PUSH BOTH FEET INTO THE FLOOR TO FEEL YOUR BELLY GET HARD.
1. GETTING UP AND SITTING DOWN FROM A CHAIR, 15 TIMES A DAY.
Remember to:
A. Focus on a point on the floor about 3 feet in front of your feet.
B. Place your hand or hands on the front of your thighs, bow and let your hands drop to your knees. When your hands touch your knees then bend them to sit with control.
C. When you go to get up push into the floor with both feet, find a point on the floor 3 feet in front of your feet, bend at your hips and stand.
2. PRACTICE GETTING UP FORM THE BED, 10 TIMES.
Remember to:
A. Reach with your arm across your body to the edge of the bed and
B. Turn and nod your head at the same time
C. Bend your knees up toward your chest
D. Slightly straighten your knees so that your feet and lower legs are off of the bed.
E. Push your elbow into the bed and
F. Push your ass down to the bed as you move into a sitting position at the same time.
If you choose not to do any of the above you are harming your body! No matter what medication you take or what surgery you may have you will still be harming your body if you choose not to do these things above.
From this experience I had learned several valuable pieces of information:
1. This person was at a significantly less risk for falling that I had thought based upon his gait pattern and subjective complaints/vocalizations.
2. I was able to target the appropriate dysfunctional areas that would allow for maximal functional improvement.
3. He had dysfunction and instability around his left pelvic region which concurred with his subjective report of pain to the left buttock.
4. He lacked appropriate motion to perform certain functional activities which needed to be treated.
5. When he was able to perform the activities with proper form he was asymptomatic. When he did not he would present with “Charley Horse” or “pain”. This allowed me to examine his form and correct as needed.
6. I was able to allow him to experience the difference in how it feels to perform an activity with appropriate form and dysfunctional technique.
7. I was able to express to him that even though his has physical challenges he is able to function with less pain by changing the way he does things and when he continues to do these activities wrong he is harming himself. Therefore, regardless of any medical or pharmaceutical intervention he will continue to harm himself.
8. Like the Biggest Loser it is not about what you have been given it is how you choose to use it.
I plan to follow up with him upon my next visit home in about 2 weeks. I plan to follow up daily to inquire about compliance, reevaluate, and hopefully work on gait and stairs.
