2007-11-23 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

"Patience is a virtue" is a proverb that can be traced back to the 1377 work, "Piers Plowman," by William Langland.

The dictionary defines patience as "not hasty or impetuous, steadfast despite opposition, difficulty, or adversity." Virtue is defined as "A particularly efficacious, good, or beneficial quality; advantage." So, why the English lesson for today's column?

I often find that patience is not only a virtuous quality, but an absolute necessity for receiving health care. I find myself wondering from time to time if the term "patients" originated from those receiving our services having patience in the waiting room, or for having patience with health providers who are "practicing" the art of medicine. In either case, today I comment on the need for having the virtue of patience, of not being hasty despite difficulty or adversity.

For those of you kind readers who follow this column, you know that I have waxed poetic in the past about physical therapy as stretching what is tight and strengthening what is weak. To have a positive outcome in physical therapy, changes must be effected upon the body to balance those joints and muscles which are out of balance. In many cases, those who have pain have no traumatic onset of pain, no injury. The pain seemingly comes out of no where. This is often the result of poor posture and imbalance over a prolonged period of time. A good example:

I recently had a lovely young woman who suffered from neck pain. We started her program that included moist heat, electric stimulation to decrease muscle spasm, soft tissue massage to increase flexibility and decrease tone. We started therapeutic exercises to stretch the muscles in that region as well as strengthening exercises, to not only increase strength but, to increase blood flow through sore and inflamed muscles. Finally, we added postural reeducation, to prevent further prob- lems. Lo and behold after four to five weeks she was not making the progress I had hoped.

I started to question her as to her sleep habits, work habits etc. Her job entailed transcribing handwritten notes into a computer. Those handwritten notes were on a clipboard to her left while her monitor was directly in front of her. As you may know, those that can really type, not hunt and peck as I do, look at the paper they are transcribing, not at the keyboard or monitor. You can imagine how that after eight hours a day, five days a week, and 50 weeks a year of having your head cocked about 40 degrees rotated to the left, may cause the muscles and ligaments on one side to be short and tight and on the opposite side to be stretched out and weak. I immediately recommended switching her hand written page to the right side of the monitor.

Although her pain had started just one day, "out of the clear blue sky", the cause of the pain had built up over a period of time. These changes to her system did not come overnight, and they will not be fixed overnight. If she was at her job for three years, it took three years of being in that position to cause the onset of pain. Would you agree that it may be unrealistic for her to comment that she is not feeling better after two sessions? Muscle changes, whether stretching and flexibility, or strengthening, take about four to six weeks to become evident. Be patient! As you know, it is a virtue.

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