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Raising the Bar in Rehab

When Physical Therapy Fails

Published May 30, 2013 3:31 PM by Lisa Mueller

My mom has struggled with back pain for more than a year. I didn't know about it until it had been bothering her for a few months; right about the time that she started going to physical therapy. Unfortunately (or fortunately, however you look at it), my mom lives about two hours away from me, so I'm not able to provide much treatment for her other than a short assessment when I visit or discussions over the phone.

A quick summary of my mom's symptoms: The pain runs along her right T12 rib and was originally one specific area of pain. The pain location has now spread to above and below that area, roughly from her mid-thoracic right side to her mid-lumbar spine on the right. Pain is constant. Kidney and liver pathology have been ruled out (more than once, I believe). MRI of the thoracic spine was negative. Pain with deep inhalation. Significant sharp pain with any tactile pressure or palpation. History of right thoracic outlet syndrome, well managed with home stretching program.

Mom went to a physical therapist for a total of nine visits for her back pain with no improvement in symptoms. She says, "If anything, the pain is now worse." I'm not entirely sure what her treatment included. I know she was given some stretches to do and some manual therapy was completed -- my mom described the therapist also checking the alignment of her ankles, hips and sacrum. "Posteriorly rotated left pelvis" with self-mobilization stretching to correct was included in her home program instructions. Tightness of the left quadriceps was noted; she was given stretches that made the pain worse.

My mom takes a lot of notes during her sessions and had written down words such as "serratus anterior" and "core strengthening." My understanding is that her therapist thought those were areas of weakness contributing to her symptoms. She did have some relief of symptoms after visiting a massage therapist, although mom says now that "it really didn't help that much."

She was given a diagnosis of complex regional pain syndrome recently and started on gabapentin. After two weeks of medication (with an increased dosage the second week), she felt no change in her symptoms. She mentioned to me when I was home two weeks ago that one of the biggest irritations for her is getting in and out of her car, so we swapped cars for a while as it was easier for her (and less painful) to enter and exit my small SUV.

This whole situation is tricky for me. I'm sad to know my mom is in pain. I'm disappointed that physical therapy didn't help. I'm a little surprised that the physical therapist would continue treatment even after four treatments if there was still no improvement in her symptoms. Every time a patient walks into my treatment room, I ask her if she is any better or worse than the previous treatment. This helps me judge if my treatment is effective and we're progressing toward the patient's goals.

My mom said the therapist never asked her specifically how her symptoms were until the seventh or eighth visit, when she told him she felt worse. But, I don't know the whole story of her treatment and I'm only hearing things from her perspective. Maybe the therapist was trying a different approach each time, each of which was unsuccessful. I wish I could be at some of her treatment sessions, but that also may not be appropriate.

Her plan is to now consider either chiropractic care or acupuncture. I hope either of them can provide her with some significant relief.

As my parents age, I'll need to figure out what my role is in assisting with their care. I'm clearly more sensitive to this situation because it involves physical therapy, and I'm a physical therapist. Reminds me of my professor's sage advice, "Treat every patient as if they were your mother." What do you think? Have you ever been frustrated with an unsuccessful treatment of physical therapy? How do you handle cases when your patient doesn't improve?

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