2009-03-20 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

One of the most amazing aspects of being a physical therapist, or any health care professional for that matter, is the ability to learn and observe people's behavior when faced with adversity. For some with injuries and pain, the need to know the cause for their injury is paramount. In fact, for them the outcome of their intervention is linked to their understanding or comprehension of the nature of their condition. Their favorite question is "why?"

"Why did this pain in my back develop out of nowhere?" "Why did my meniscus tear, if I did not fall or injure it?" "I woke up one morning with a frozen shoulder, why?" These questions are normal and expected by health care providers. For a small percentage of patients these questions are repeated every visit. I am guessing that my answers are not satisfactory, thus necessitating the repeated questioning. For those who know me, I am not one to just make up an answer to placate the patient. I am also not afraid to say, "I don't know." I am quite sure that the recipient of that golden nugget of wisdom is frustrated to say the least. I usually put forth at least two theories as to why their condition started and a theory as to the progression and a prognosis.

The knowing "why" can help a patient rest a little easier. It certainly can help prevent a future occurrence of the same condition. The sad truth is that in many cases, barring a traumatic onset such as a motor vehicle accident, or a fall, there is no way to truly know why a condition developed. For those who treat these conditions it is less important than it is to the patient. Our job is to treat what we see. Our job is to alleviate pain and inflammation, correct underlying movement dysfunctions, and improve strength and ROM.

After close to 13 years of practicing, I can usually pick up on non-verbal cues from patients who "need to know." Without a satisfactory answer to "why," they usually progress very slowly, if at all. It is as if healing cannot take place if this question is not answered. For those reading today's column, I suggest not to worry so much about the why. In a sense, the why is in the past and today is for treating and healing. The future will include a plan to prevent a reoccurrence. Our task is the "how"; how are we going to make you better.

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