I had a patient come in this week because of a recent acute episode of low back pain. This patient has never been to see a private physiotherapist ever but has been seen by an NHS physiotherapist on a couple of occasions in the last 10 years for her knee and needed urgent help and advice.
This patient was really struggling with mobility, walking was very difficult and effortful; her face was expressing pain with each step. Her main concern was her back and she wanted me to ‘fix’ it and that was her expectations of me by the end of the session. So like most acute episodes of low back pain, I gave her a lot of assurance to not to panic and that after a few days (she was 3-4 days in) the pain should settle and will be able to continue her normal activities. I gave her some treatment for her lower back in the form of some manual therapy to help settle the pain and did some deep relaxation breathing exercises to stop her from bracing at the stomach and let the muscles around the spine to relax. This had helped and we made some really good in session changes to her back pain and movements. I also gave her some (two) exercises to do at home to keep the back moving and stop her from over protecting it. The patient was happy her back pain eased up in the session but her knee was giving her a lot of pain.
I wanted to hear her story and about her knee pain so we sat down and talked. The patient said that she has bone on bone osteoarthritis in both her knees and has previously cancelled three operations for a total knee replacement because she is afraid. Her fears are that she will be worse off after the operation and that nobody will look after her and be bed ridden for the rest of her life. These are very extreme and intense fears and a lot of it was down to speaking to people where their outcomes were not successful. She said she can no longer tolerate the pain and that her quality of life has gone down over the last 2 years and now is on the waiting list again for a total knee replacement. She said she does not want the operation but she has no other choice the pain is too much. This was obviously a very tough situation to be in and thousands of people around the UK and the world are going through something similar. This patient told me that her back pain had developed after she got the news by post that she is on the waiting list for her operation. She told me she got really anxious and was thinking the worst every time she thought about the operation. By talking to her in depth gave me a really good picture of what was going on and the challenge of getting this patient to change the story she was repeating to herself over and over.
I first explained to her was that stress, worry, anxiety, lack of sleep, are all strong factors that can contribute to back pain and also could be contributing to your knee pain. A lot of research that has been done by the likes of Peter O’ Sullivan in Australia and Kieran O’ Sullivan (Physiotherapists) in Ireland talk about all these factors that can cause back pain and are strongly linked to people who suffer from chronic pain especially low back pain. The patient thought that something was wrong with her back and that something may have ‘moved’ in her back. This is what most people with back pain think but often this is not the case and that the above factors play a major role when someone suffers an episode of back pain and continues to get pain for months and even years. This patient recognised that she is stressed out and is worried about her knee operation and her sleep is affected too.
The next step was to dampen down those deep fears about her knee operation and what if it goes ‘wrong’. I explained to her that I have seen many patients in the NHS post-surgery after total-knee moving well, riding a bike, independent and experiencing so much less pain and thankful for getting the operation done because of the effect it has on their quality of life. I explained to her that there are no guarantees but there is a good success rate of a good outcome providing you are willing to put the work in after by going to physiotherapy and carrying it over at home. I think a lot of the worry and stress comes from the unknown and asking ourselves the what if? Question. It is very important to get some balance into our thinking, we sometimes cannot help to think the worst and being in pain for such a long time makes us think that there is no way out. My advice to her was speak to people who have had a successful outcome and to speak to them about what to expect and the rehabilitation process, this would get her out of the pattern of thinking the worst case scenario and less anxious. This woman left my clinic a lot less stressed and worried and more confident about her future. I know it won’t be easy for her but with the right support and setting some realistic goals we can change our lives around.
