As the title suggests, my thought process when I assess a patient has changed tremendously from when I was a PT student and during my initial months of practice to where I stand now; a year and a half of experience, a few courses and certifications under my belt and countless hours of studying (for all the physio students out there, sorry to burst the bubble but if you want to stand out in your profession, studying will be a life long endeavor). Back in Physio school, all my assessments and therapy were based on treating the site of pain for the most part. The good old routine of electrical stimulation, some ultrasound, a few strengthening and stretching exercises to the local area along with a sign of hope in my heart that the patient would get up from my treatment table with considerable relief resulting in a pat on my back from my clinical instructors and general happiness and satisfaction all around. I would jokingly tell my non physio friends that in my OPD, on a regular day I would ultrasound more people than an OB/GYN clinic (obviously both the ultrasounds being different). Unfortunately, this tunnel vision approach left me and my patients with much to be desired. Having realized early that i was missing a piece of the puzzle I have changed my strategy and started investigating globally and so should you. The body does not work in isolated units. So now, my shoulder impingement patients are not just assessed and treated for the site of pain at the shoulder but also screened for posture especially thoracic kyphosis, rotation and extension. My back pain patients will be evaluated not just for the back but for hip ROM, core stability and thoracic mobility. A chronic knee pain patient especially with non-traumatic history of onset of pain will be assessed for the joint above and below (hip and ankle). I have seen far too many patients with over pronated feet and valgus collapse of the knee go under the surgeon’s knife for an investigative arthroscopic procedure without being assessed for foot mechanics to last me a lifetime leaving me looking like this
The take away messages is this, while treating the site of pain is a good start, finding out ‘WHY??‘ it hurts and correcting it will bring long term resolution to the problem. In my next few blogs I will discuss some of the above stated examples with mucho details. Please feel free to leave comments. Until next time.
Abhijit Minhas PT