There is a reason we ask our patients about their weekend....
Written by Keryn
In the past, I was discussing the treatment plan and exercise therapy with a patient. I asked what their plans were for the weekend. The response was a brusque – “why do you want to know?” I then had to explain to the patient why I was asking about the weekend plans - and I genuinely wasn’t being a nosy parker at all.
You see, when we treat patients, we treat them as a whole, we look at them as an entire person – a person with beliefs, ideas, emotions, good and bad habits. It’s called the biopsychosocial model of healthcare.
Pain levels fluctuate and are affected by stress levels. Lorimer Moseley, the pain guru, famously said: “Pain is modulated by any evidence that implies danger”. Pain can therefore be worse when there is an increase in stress – not because there is more trauma, but because the nervous system, is already primed and prepped for its flight or fight mode – is primed for danger, and stress = danger. So, your back pain that was manageable last week is going to be worse this week because you are having a hard time at work. It’ll probably feel better the week you go away on holiday: not because it magically got better but because your state of mind changed and you removed the stress and danger from your life for a bit.
My colleague, Dani, wrote a super article about chronic pain here and he explained a lot about the homunculus and how we perceive pain. The brain has an amazing ability to control pain and our emotions affect pain. But let me stick to my random list of questions and why we ask them…
We ask, sometimes in a roundabout way, what your home situation is like. People who have adequate support at home have faster healing times and are less likely to relapse, and more likely to do their rehabilitation.
We ask what you do for a living, because that gives us an idea of what you spend 8 to 10 hours a day doing, not because I really mind if you work for the zoo or for Tesco. Office jobs are not always the same as office jobs – sometimes you stand more, are in meetings more, maybe you even work from home. We ask a bit about your job and what kind of levels of stress you are under, again, because it gives us an idea of your ability to cope and heal. Maybe you’re on shift work and have irregular sleep patterns.
We ask about your sleep patterns. Pain studies have shown that poor sleep affects pain levels and coping mechanisms. To be honest, I don’t mind if you sleep on a concrete floor, I just want to know if you sleep. Undisturbed for a few hours a night. The days of fancy orthopaedic beds and fancy memory foam pillows are a little early 2000’s for us. Your actual sleep period and duration is important.
We ask what your goals are and what sports you take part in so we know what a time scale of your rehabilitation and what we need to aim for. We want to help you return to your sport and hopefully keep you injury free in the upcoming season. There is nothing nicer than working with a goal driven, dedicated patient to achieve an aim.
We ask what YOU think is wrong with you. Your belief system affects your mind set (not because I don’t know). If your mum had a bad back and you saw how she suffered, your back pain, probably with a totally different cause to your mum’s, is going to feel worse, because you saw how bad it was for her. If you believe you’ve torn a muscle, then sometimes we need to scan it or do a muscle test to check it. If you are worried about the dreaded C word then we need to know so that we can find these things out.
We ask about your previous injuries and what worked, not because we are trying to take a shortcut in therapy but because you as patient have experienced your healing processes and know that you may take longer, or respond well to massage or stretches. Sometimes injuries are linked: calf injuries precede hamstring injuries and vice versa. Achilles tendon injuries have a link with lateral epicondylitis (tennis elbow) in the opposite limb (I know – it’s weird, it’s got to do with kinetic chains). If you have had a heel enthesiopathy or plantar fasciitis, you may develop another form of it somewhere else – patellar tendons, frozen shoulders.
We ask what medication you are on. Not because we are being nosy again, but because certain medications have side effects. A few years ago, an antibiotic caused spontaneous Achilles tendon ruptures (it’s not used anymore but certainly gave us physios some good work). Statins have side effects that make our jobs quite challenging. Blood thinning medications mean we can’t do certain modalities in treatment. Beta blockers mean you’ll probably fall asleep during physio.
In addition to knowing your emotional state, we like to check what your plans are so that we can modify your treatment or exercise plans accordingly. Sometimes there is an element of post treatment soreness, and if its your daughter’s wedding tomorrow, I’d rather not have you feeling the after effects of a particularly vigorous physio session.
And sometimes, I ask about your dog. Or your kids. Or your holiday. Again, not because I am being nosy, but because speaking about something that relaxes your mind relaxes your body and muscle tone which makes my job much easier than trying to fight with a particularly stressed and anxious muscle. Today, while doing fascial stretches on a particular patient they just tensed up and could not (would not?) relax into it. Just by asking them about their beloved dog, they exhaled and relaxed and started speaking to me about it making his whole body and fascial chain easier to work with. My Patient left, hopefully happier, but certainly more stretched out.
So 95% of the time, I’m asking you questions about things because it gives me clues to how you are doing, how the healing is going and what works for you. 5% of the time, I’ll admit, I just like a good chat.