The Long(ish) Term Effects of Care - A Follow Up
As I return to my clinical practice after a summer filled with adventure and academic endeavor the familiarity of the clinic and weight room welcome me. The routine of my practice as an AT and S&C Coach fall into rhythm as if I was not absent for nearly three months, while new patients, colleagues, and students promise stimulating challenges in the year to come. Off season training seamlessly transitions into pre-season practice, SCAT-5, FMS, and performance testing metrics ensue as we establish baselines, assess improvement, and collect data for future research. I also resume the roll of watcher during these first weeks, briefly exiting my care model for coverage, as I take stock of dynamic movement patterns, confidence, sport knowledge, athletic acumen, and team and coaching dynamics while observing newcomers and veterans as they practice and play. Throughout this process I noticed one curiously missing face from the volleyball team. The chronic lumbopelvic pain patient mentioned in blogs titled ‘Chronic Lumbopelvic Pain - The Coccyx, sacrum, Lumbar Spine and Innominate’ and ‘When it Goes Right: A Quick Update to Chronic Lumbopelvic Pain - The Coccyx, Sacrum, Lumbar Spine and Innominate.’ from last year was missing.
After several days back at work I walked into the weight room to find this particular patient engaged in the training designed for the volleyball team. She looked leaner, more muscular, taller, and was moving more efficiently, with better movement patterns, balance, and coordination than she had just three short months before during the outdoor track and field season. I approached her and with a good natured smirk asked her why I hadn't heard from her all summer. (Like many of my patients she, and her parents, have my cell phone number in case of emergency). She smiled and replied, "I didn't need you, my back is fine." My response was to immediately ask if fine meant she had no problems. She replied with "yeah, if it feels off I just do what you told me and it is fine right away" Self care in her case involves checking her ability to elevate or depress her hips and a self check of her ASIS position followed by MET in 90/90 with activation of the hamstrings and quadriceps in opposition of any ASIS asymmetry and/or activation of the adductors in both unloaded and loaded positions. She will often notice cavitation at the pubic symphasis and in one of the SI joints followed by immediate relief of symptoms. I then inquired as to if she were playing volleyball, to which her response was; "no I feel so good I have been able to focus on horses and I'm going to get ready for basketball season". High fives are at an all time high in my clinical practice.
If we recall from the introductory blog post regarding this patient, her case last year at this time was described as follows:
"Including the use of prescription pain medication and muscle relaxers the patient claims that she has been in constant pain rated on a Numerical Pain Rating Scale (NPRS) at a 6-9/10. She also reports having almost constantly interrupted sleep since her injury. She has continued to play sports and engage in activity as usual over the course of her injury despite her pain. At the time of evaluation she had largely stopped seeking medical attention for her pain."
The psycho-social effects on this patient were also becoming quite profound as described in the original entry:
"10/13/2017: The patient was asked if she felt that she was viewed as ‘the girl with the back pain’ and if her pain was ‘becoming part of her identity’. To both of these questions she responded ‘yes and I do not like it’. This prompted me to begin using the Tampa scale for Kinesiophobia in order to try to gain a grasp of her understanding of her pain."
While the pyscho-social issues quickly resolved and the patient's function and pain improved with intervention, as evidenced in entry number 1 and 2, the changes evident over the summer were profound. Through diligent and compassionate clinical practice and commitment from the patient, it appears that this active teenager was able to regain her lifestyle, mental and physical well being, overall health, and autonomy. These long(ish) term effects of care also have smiles at an all time high in my clinical practice.