Being Your Own Worst Enemy

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[00:01:19] Welcome back to Untold Physio Stories Podcast and when you're host, Dr. Erson

[00:01:22] with Modern Manual Therapy, Edge Mavilion System that are four month online mentoring program,

[00:01:27] Modern Rehab Mastery. So sometimes you can be your own worst enemy.

[00:01:34] I would say there is one of my biggest pet peeves is a thought virus filled,

[00:01:41] no seabake message like your hips are out of place and you need me to rotate them,

[00:01:47] put them back into place. In this case the patient was told in the past that she had a leg

[00:01:54] like this pregnancy due to a posteriorly rotated anonymous and this was corrected and alleviated

[00:02:00] completely with a muscle energy techniques, flash fancy isometric, hip flexor contraction,

[00:02:08] a couple reps used to be one of my favorite techniques. I had not seen this patient in maybe

[00:02:16] at least 12 years or so. She had gone in the past to other cryopractors massage therapist,

[00:02:22] even though she was asymptomatic in her lower quarter and she had gone to see a cryopractor

[00:02:28] for some upper quarter acute pain and he adjusted her mid-thrasic spine which alleviated

[00:02:35] some of her pain but not her bilateral arm pain. She came to me for her bilateral arm pain

[00:02:40] but in the past had seen me for her lower quarter. She was told by the chiropractor, even though

[00:02:46] she was asymptomatic currently in her hips and low back that she had a leg length this

[00:02:50] cup and see and she had a rotated pelvis. So she wanted me to correct it and she had referenced

[00:02:57] a technique I had done in the past so I had to spend a good 10-15 minutes explaining why no longer

[00:03:03] believe it using all my examples of you know a car accident tends to fracture the femur before

[00:03:11] the pelvis goes out of place and that the SI is typically fused after 18 years and that I think

[00:03:17] techniques still work to modulate pain but pain is all about sensitivity and things don't

[00:03:23] easily go out of place. After I was you know after I had spent quite a bit of time on this

[00:03:30] she basically said well the older person would have done this and I said well I'm not opposed

[00:03:34] to doing the technique I just don't want you to think that you easily go out of place or that you

[00:03:39] need me to put you back in the place me or anyone else for that matter and I just thought that

[00:03:47] you know after this visit I gave her sidelines in case it happened again for her unilateral low back

[00:03:54] pain which I'm confident will help. I didn't really do a full assessment because mostly

[00:03:59] assessment was for her upper quarter which was a simple cervical retractions over pressure to

[00:04:04] centralize the bilateral arm pain. I saw upper limb neurodenamic tests were with the normal limits.

[00:04:12] So even though I'm confident that the saglides are most likely going to help based on the fact

[00:04:17] that she has a sitting job and she doesn't get up often. I thought you know the the worst

[00:04:23] enemy in this case was myself being the negative, nellie practitioner that filled a patience full of

[00:04:31] thought fires. It was a lot harder to argue when it came for me greater than 10 years ago

[00:04:37] and especially then it was successful in a relatively short period of time. Andrew let me know

[00:04:41] what you think. Hey, you're saying that is certainly an interesting story I was just trying to think

[00:04:46] if I had had any similar experience to the one you described and nothing is really come to mind.

[00:04:54] And I definitely get your argument that it's hard to argue with someone especially when that

[00:05:01] is that someone is yourself based on what you had done with that patient and what you had said

[00:05:07] about the treatment and what it did at a certain time. However, I think at the same time it's also

[00:05:14] one of the things where you can present in a way that you've updated your views in light

[00:05:21] of current research and that's what you would hope that all medical professionals would do

[00:05:27] that the patient would see that obviously if things are people are doing this things at the exact same

[00:05:32] way that they've always done them especially over the amount of time that you've been practicing

[00:05:37] that in itself should be a little bit of a flag because our practice should always be updated

[00:05:42] as we learn more things. And like you said it's not that the technique itself was an helpful

[00:05:48] it was more the messaging and the rationale behind the technique. I could certainly see how that

[00:05:55] was a challenging situation. The whole thing about the older and what it would have done that

[00:06:04] I mean it's a little bit slightly disrespectful I think in my opinion that yes we should always

[00:06:10] be learning and growing and all aspects of our lives right not just in our clinical practice but in

[00:06:15] our personal habits and personal growth and all those kinds of things we should always be

[00:06:19] growing and learning from our mistakes and updating as we learn new information. So hopefully

[00:06:26] you respected the information that you provided and I said a lot of times we don't always know

[00:06:34] why certain hands-on techniques works we also don't always know why sometimes certain exercises work

[00:06:40] especially when it comes for pain modulation it's a lot of complex processes that are happening

[00:06:46] but you know the patient can know oh this word for me or this word for that word for me when

[00:06:51] it comes any kind of manual therapy or exercise but I think it's important as health care providers

[00:06:58] that we sometimes admit we don't always know why something doesn't work which is you know

[00:07:03] sometimes hard with patients because patients really do want definitive answers but at the same time

[00:07:08] they should also respect the fact that we didn't admit that we don't always know why things work

[00:07:14] but are still happy to do them especially if we know that it's safe but as long as we keep

[00:07:19] given information about what we kind of do know what isn't happening in certain cases like you

[00:07:24] described we're not putting bones back into place we're certainly not putting

[00:07:28] pelvis is back into place and SI joints back into place but it is sort of like a wake-up call

[00:07:35] too for those of us physios who've been out long enough who have definitely had opportunities

[00:07:42] update our practice from when we certainly started that's a good lesson I think for

[00:07:47] PT's who are just joining the profession as well if you found this case interesting or have any similar

[00:07:52] cases you have a story a big physiophilia you want to come on the podcast make sure to DM me or reach out

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