Patient Education is Crucial
Musculoskeletal Consumer Review’s editor, Cindy Tan, took an opportunity to sit with Sylvia Ho, a Principal Physiotherapist at Core Concepts to discuss about what she thought were some key issues facing patient today to help themselves get better.
MCR: What are some of the key challenges facing someone with back problems?
Sylvia Ho: The first and perhaps largest hurdle is simply first understanding the problem. Back problems are extremely common. Statistics have shown at that any one point in time, some 20% of the population is having some form of back or neck pain within the past few weeks. Perhaps the fact that it is so common, people tend not to dwell on it. Of course until they experience it themselves.
Plus the fact that quite often, the pain resolves itself after some days of rest. The human body is quite an amazing machine that heals itself. Also, one rarely falls very ill from back pain, though there are certain cases where you can. But by far, back pain is not a life threatening disease though it can be life-limiting.
MCR: Why is understanding the problem important from a patient’s perspective?
SH: Understanding what’s causing your pain is very important with musculoskeletal conditions - that is problems with your muscles, joints, nerves and skeletal structures. A large of part of the treatment or recovery process requires very active participation from the client. Meaning there are things to do for the client.
Take for example when a problem is caused by some movement dysfunction caused by using the wrong set of muscles. This could happen because the correct set of muscles is not working too well or the nervous system is having problem getting them to respond. After finding out what’s wrong, we need the patient to begin to re-learn using the right set of muscles. And they have to continue doing so after they leave the clinic between their sessions. They need to know exactly what they need to do and what they must not do. This is what’s going to get them better in the long run. And they are only going to be able to do this if they understand what has happened, why the change is needed and what to do and change in their lifestyles. Understanding here is key.
Movement dysfunction can be as basic as not breathing right. There are quite a few ways to breathe using different sets of muscles. Using one particular set could affect muscle activation in your lower back. If the right set of muscles supporting your lower back doesn’t function properly, you will over time have lower back problems. Breathing using the right set of muscles and how that affects your low back pain is not generally intuitive for most people.
MCR: What if they don’t understand?
SH: Well, firstly at our end we try to make it as simple as possible. At Core Concepts, we don’t throw out a lot of jargons. We make it a point to communicate clearly. If someone throws a lot of jargons at you, don’t get intimidated. Stop them and ask for simpler terms.
Don’t get thrown off by terms like ‘idiopathic scoliosis’. ‘Idopathic’ simply means ‘cause is not known’. Technical terms are important. They help professionals communicate faster and more precisely with each other. But often they don’t help patients to understand their conditions better.
Secondly, we layer the solution; working on the important bits first, before moving on so as not to overwhelm the client. Usually, we have one to two approaches for a particular problem and we will try to see which one works best for the client.
MCR: What about treatment that involves electrotherapy devices such as traction and short-wave diathermy?
SH: Our approach compared to using electrotherapy devices is fundamentally different. Most electrotherapy devices are focused on relieving the immediate pain symptoms. We obviously care about relieving your pain but also making sure that you stay pain-free. We do use such device usually at the early stages of acute pain before moving to use what is known as manual therapy.
A therapist that is more dependent on electrotherapy aides usually don’t need a high level of patient education on the client’s part. Very much like if you have a fever, you just take some medication. You don’t really need to know how the pills work but just that you need to take them at the prescribed times at the right amount. Pills are fixed quantities; it is harder to get them wrong.
With more a complicated disease like diabetes, you need to know more – about the symptoms, what to do when your blood sugars get too high or too low. If you just depend on the doctor handling your condition, you are going to run into problems at some point.
MCR: Based on your experience, what’s the level of patient education these days?
SH: Obviously, there is an entire spectrum of clients with different levels of patient education.
But overall, the level has certainly risen over the past few years. I believe that the internet has made a big impact in making more information available. There are also more health talks, magazines and newspaper articles today on health. We often find clients today asking us deeper and sharper questions. They have done their research before hand. We love these sorts of clients as we usually progress faster with their treatment.
But this is a double-edged sword. With more information out there, there is also more misleading information. Some are just plain wrong.
Massages are also another method of relieving pain. Increasingly, we see more massage ‘techniques’ appearing to solve more and more complicated problems. Often with conditions related to the muscles, joint and other supporting structures, muscles will get tight and tense. They will feel achy. Massage will help relieve that pain. But it does nothing to solve the underlying problem. If patients don’t understand this, they will walk thinking that their condition is better.
MCR: If someone is already suffering from pain, what can they do to help themselves?
SH: Seek help. Unresolved pain that lasts more than several weeks is not likely to get resolved on its own.
Find out more about your condition. Besides reading up on your own, asks lots of questions. A good doctor, physician or therapist will be more than happy to explain it to you.