Most of the people who have come in to see me since PRIDE Physiotherapy opened have had a story. When I say ‘story’ what I really mean is ‘baggage’; not their own baggage either, but a pile of rubbish another well-meaning therapist has sent them home with.
What we tell our patients and how we communicate with them is incredibly important. If it doesn’t determine the outcome, it most certainly has a significant impact upon it. There is abundant evidence of this.
The postural-structural-biomechanical model of assessment and treatment already seems likes archaic reasoning, and I graduated less than 4 years ago. Yet some clinicians are still stuck in this out-dated model of practice. We have Osteopath Eyal Lederman to thank for tipping that boat over in 2010 and more recently Adam Meakins for trying to keep it under water and causing a stir labelling those trying to keep it afloat as clinical dinosaurs.
The list of nonsense beliefs that people have had is depressingly lengthy: I have pain because of my…[insert at-fault structure] – pronating feet, tight/short/weak muscle, leg length difference, hip being out, pelvic angle/position/movement, disc bulge/degeneration, sciatica, posture, weak core, muscles not activating in the right order, blah blah blah These may have been an accepted norm in decades gone by (and I taught it all as fact myself for many years), but collectively, we know better now. For anyone who’s not been treating under a rock for the past decade, there’s solid evidence that these labels are invalid, irrelevant, unhelpful or all three.
Therapists and clinicians labelling their patients with these issues are making the problem worse or creating problems that never existed in the first place.
In layman’s terms, for someone who is experiencing persistent (“chronic” – we’ve moved away from that term too) pain, ‘self-efficacy’ is someone’s belief that *they* have some control over their recovery, and that they have the internal resource to be able to return to doing whatever they want to be able to do.
The common scenario is for a patient/client to be assessed and labelled (diagnosed) with a structural dysfunction, to be taken through a series of tests which confirms the condition they apparently have, then ‘treated’ with a manual technique which appears to work like magic; the apparent improvement attributed to having ‘corrected’, fixed or changed something mechanical.
This literally robs the client of their self-efficacy; their most important asset. Whether through ignorance or lies the outcome is the same. The unwitting patient is set on a path of dependency upon the clinician, anxiety, fear avoidance behaviour, catastrophising, kinesiophobia and a whole raft of unhelpful baggage they’re burdened with until someone else points out that none of those issues has been correlated with pain. Disempowering a client/patient in having them believe that their health lies in our hands is irresponsible and wrong.
We have Canadian Chiropractors David Bereznick and Kim Ross to thank for demonstrating that the premise underlying the vast majority of manual therapy techniques aren’t valid either, and that was in 2002!! That doesn’t mean the techniques aren’t helpful or shouldn’t be used, but the explanations and justification for using them which are being given to the client/patient, needs to reflect our current understanding of neurophysiological changes and pain science. Adam Meakins (episode 10 NAF Physio Podcast) and Jack Chew (episode 16 Physio Matters Podcast) have both interviewed Chiropractor and Physiotherapist Greg Lehman on the same topic. Paul Ingram has been posting articles for years which refute much of the mechanical nonsense – fascia is a good place to start if you want to have a look.
Episode #1 of the Pain Science and Sensibility podcast with Cory Blickenstaff and Sandy Hilton is entitled ‘self-efficacy’. There are lots of great podcasts out there, but I think this one in particular should be compulsory listening for every student and practitioner of manual therapy.
How we each see our profession and our role as a clinician and therapist is called naive realism (episode #62 of the You Are Not So Smart podcast) and being able to consider alternative and often conflicting views frequently creates a feeling of inner conflict, called cognitive dissonance.
Very little about someone’s physical health is black and white and we as clinicians aren’t healers. The sooner we get comfortable with being a little uncomfortable in the knowledge of what’s plausible and what’s not, the better.