As a followup to my last post, “Miracles”, I’ve been thinking a lot about fear and how it effects us and our patients. The example I gave in this previous post should be obvious to all, but what about the more subtle suggestions that we give to our patients? Can these backfire and create fear?
Traditional physical therapy often links a patient’s success to their performing their home exercise program. If the patient fails to improve, blame is often placed on them, since they did not “follow through”. There are a great deal of assumptions made on the part of the therapist that allows them to deflect the blame onto the patient, first of which should be will strengthening exercise truly diminish pain. The evidence is rather scant on this. Failure to improve becomes a source of shame on the patient. Fear of not improving creates the desire to do what the therapist asks.
When I ask a patient if they have done the myofascial stretches that I have taught, a common response is one of embarrassment; that they did not do them as often as they felt that they should. (My home programs never consist of strengthening exercises). I tell them not to be ashamed, I am simply trying to check their response to all of what we’ve done, both in session and out of session.It is their choice whether they are going to do them or not. It is my responsibility to work with them in such a way that we make changes, whether or not they do the home myofascial stretches.
What about other things that we ask or tell our patients? How many of you have told them to drink a lot of water after a session to flush the toxins or to keep from being sore? The scientific research has shown this not to be true. But by telling a patient this, aren’t we potentially setting them up? I know, most of us were taught this in our various trainings, but they simply don’t hold water…
Drink at least eight glasses of water a day. Really?
I know I have to stop somewhere, as anything that I tell a patient can induce an emotion. But why pass on our own beliefs if that is all they are?
Walt Fritz, PT
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