This is the eighth post in an ongoing series. If you would like to start from the beginning, click here.
The last post in this series was the hardest to write, and that’s why, of course, it took me so long.
I was just starting to get a handle on things by my sixth visit. I had gotten brave enough to use the elliptical trainer at home for short periods of time, and was starting to go on short 45-minute hikes. I was no longer afraid of every little ache and pain in my body, but I was holding my breath; afraid it was too good to be true, that one little thing would change and all the pain would come rushing back.
This is the point at which Tim told me my next visit would have to be my last. He said he had done his best asking for extra visits from the insurance company, but they had finally put their food down with this next one.
He reassured me that I already knew everything I needed to know, but promised that I could email him if I had any questions.
Despite all my fears, everything was fine for the next few months. I increased my time on the elliptical trainer, and started going for longer hikes. I knew that if something started to hurt, I would ask myself, “Is this really dangerous?” But I didn’t even seem to really need to– most of the pain was gone, and the pain that I did have didn’t seem to snowball out of control like it had in the past.
Except for my knee.
Knee pain was actually the original reason for my referral to physical therapy. Chondromalacia patella, or inflammation of the cartilage under the kneecap, was the diagnosis I’d gotten from my orthopedist.
But Tim had viewed the knee pain as part of my overall problem with a revved-up nervous system. He told me that chondromalacia patella was sort of a “catch-all” diagnosis, and sometimes doctors just gave that diagnosis when they didn’t know what else could be causing the problem.
So he hadn’t done anything specific to treat the knee. Once he’d seen the 20 X’s I’d marked down on the form that asked where I had pain, he’d switched immediately over to a chronic pain/nervous-system mindset, and had treated me with the protocol he’d learned for that.
I believed Tim of course, because he had helped me more than anyone else ever had. But the fact of the matter is that, even though he was right about the other 19 X’s on the paper, he was wrong about the knee.
I didn’t want to freak out and rush back to the orthopedist, of course. I had taken a leap of faith in trusting Tim when he told me the pain in my back and my ankle was safe to ignore, and I didn’t see why the knee should be any different. I didn’t want it to be different. I wanted everything to be fixed; I wanted to be cured. After years of wandering from specialist to specialist, I wanted my problems to have one answer.
Much of Neil Pearson’s teaching focuses on not beating yourself up mentally, on not forcing yourself to keep going through a pain that doesn’t melt away with the “Is this dangerous?” dialogue. This is, of course, precisely what I did.
I tried to rest my knee, but it didn’t seem like there was any amount of rest that could make it better. I tried ice, and I tried Advil, and I tried to just forget about it. I heard my parents’ voices in my head from all the years of unexplained pain and injuries before: You worry too much. You dwell on things. Why do you have to get so intense about exercise? Just relax.
But ignoring my knee didn’t make it better. In fact, it got worse and worse, rapidly, until even the act of lowering myself down onto a chair was painful. It was high time to admit I had another problem; one that changing my perception of pain couldn’t fix.
So I went to a second orthopedist. Sure enough, I had chondromalacia patella, and it was worse now because I hadn’t treated it. It was bad enough for the inflammation to actually show up on an X-ray, which, I learned, not everyone’s does. But luckily, it wasn’t so bad that I was likely to have permanent damage or need surgery. I just needed to go back to physical therapy, and actually treat it this time.
For a while, I wasn’t sure whether to include this last part of the story. After all, I really believe so strongly in the potential of this approach to help people with chronic pain, and I hate to end this series on any kind of a negative note.
But it’s important to remember that nothing is a silver bullet; that just because one thing might fix 95% of our problems, it won’t necessarily fix that last 5%.
For this approach to truly help a patient, it has to be implemented in a setting that allows for the type of injuries that won’t go away just by fixing a revved-up nervous system.
The therapist should be looking for two kinds of pain: the pain caused by a revved-up nervous system when nothing is physically wrong, and the kind of pain caused by particular biomechanical issue that needs to be treated. In fact, it’s pretty likely that both will exist in any chronic pain patient, since chronic pain usually develops after a person has been through some sort of extreme injury or medical event.
You might have noticed from my other posts that I harbor a lot of anger and resentment towards the medical professionals whose judgmental attitudes and lack of compassion cost me months, if not years, of normal life when I was younger.
But to be honest, I don’t really blame Tim. He was doing the best he could in an extremely limited setting. He was attempting to implement an approach that he didn’t have a ton of experience with, and that most pain management specialists in this country still even haven’t heard of. And he was going up to bat against both a billing department and an insurance company who didn’t have any idea what he was doing.
I mean yes, technically, he shouldn’t have told me to ignore the orders of my orthopedist. But I know from my own experience as a patient that physical therapists often fill in the gaps left by a physician who was rushing, or who didn’t really care.
And I also know from my own experience working at the mental health agency that everything is different when you’re actually on the job. It’s easy to have the right answers when you’re a student; when you have time to sit and think and put the pencil to the paper and write the right thing.
It’s a whole different story when you’re actually in the field; when patients and coworkers and bosses are all asking something different from you. When you have too much to do and not enough time to do it in; when you’re trying to help a patient as much as you can before her insurance company cuts her off.
The reason I decided to include this part of the story is that this approach to physical therapy has the potential to help people even more than I was helped. I am so incredibly grateful for the help I received, and I don’t mean for this to be a negative thing.
Instead, I am excited. What would happen in a setting where the physical therapist had all the time in the world and didn’t have to rush? If he knew he wasn’t the only one who knew about this approach to pain management, and didn’t have to feel like he was going out on a limb or deceiving the insurance company by explaining pain concepts to a knee patient?
Of course, I don’t mean to make it sound like there aren’t already great physical therapists out there who are already doing all of these things. I know from all of the reading I do online that they’re out there; I just haven’t been their patient.
I’m just excited about all of the potential there is to build on what I learned in my experience, which–even with its limitations–changed my life.
***Photo Credit: Elliot Cable on Flickr***