Our good friend Wouter Ramboer has shared some powerful and educational stories from the clinical coalface in the past. He recently shared this with us:
Whiplash number 5
A number of months ago I had a patient in my practice – a woman with severe neck pain after recently experiencing her 5th whiplash injury. All the muscles in her neck were tensed up, she reported headaches, fatigue, cognitive problems… you name a symptom, she had it.
She had undergone (amongst other treatments) infiltrations into her trapezius muscles with anti-inflammatory stuff, botox infiltrations, and external TENS – to test if she would be a candidate for a neurostimulator – it didn’t work. Nothing really worked. She was really afraid of her neck. Any manual techniques worsened her pain for a few days before her pain returned to normal.
We tried to find a position for her that she could move her head a little better, and we did – sitting forward, elbows resting on knees and head forward. She could turn her head left and right to almost full range of motion – she cried (but not as a result of pain) as she did this.
I explained to her the idea of context – all of the accidents had occurred with her sitting in an upright position, head back, arms out… We slowly built from here, adding some neurodynamics along the way, all with little to no discomfort.
When I got to know the patient a little bit better, she told me she was trying to conceive again, but had experienced multiple miscarriages at three months. The gynaecologist just told her, “your body refuses to accept the baby” – there was nothing wrong with her fertility nor with her husband’s. “It’s all my fault” she said – she felt very guilty. I told her a story about stress (from her childhood, car accidents etc etc), and the impact on conception (a biological process). She has gone on to consult with her psychologist too.
From there on, her neck pain decreased dramatically. But it still took some time for her neck to get moving again – I saw her every few weeks and kept in touch by phone in between over a number of months.
A couple of days ago she was on the phone with her son while he was driving home from work (he was hands-free of course). He was waiting at a red traffic light, when all of a sudden she heard her son say “Oh SHIT!”, and heard a crash through the phone.
She knew that her son had been involved in a car crash – it turned out that a small truck had ran into the back of his car. After the accident her son was able to speak with her and told her that he was fine, but as soon as he did she instantly had all of her neck pain and headache back – as if she had been hit by the truck.
In the end all was ok with her son – he didn’t even have any aches or pains after the accident, which turned out to be relatively minor.
She came back to see me in the practice today, and said, “now I really get what you mean with ‘hurt does not always equal harm’ – my son had the car accident but I got the neck pain.”
Physiotherapist, West Flanders, Belgium
Wouter is a very active Twitter user and can be found by his Twitter handle @neuromanter, where he will be regularly posting links to some of the latest and most interesting articles related to pain and neuroscience, and discussing the future of the physiotherapy profession with others from around the globe.
Thanks so much for sharing this great ‘painful yarn’. As has been mentioned by David Bolton in comments before, modern pain science has given us the foundations to build accurate, biological stories that can explain these experiences – experiences that just a few years ago would have been, at best dismissed – derided at worst.
I love your humble, respectful and educational approach to treatment, that so clearly comes across in your clinical tales.
There’s so much to take from this story – the power of context as you point out, as well as the need to go with the patient- to enter their story, to take the time to listen, and take the time (and show the respect) to educate well.
An intriguing link between the position of comfort that you found and neurodynamics too! Good to see clever clinicians being able to combine knowledge of a continuous nervous system with mechanical properties with quality education and BPS treatment overall.
Lovely experience Wouter and your case history fully demonstrates the power of treating beings and not parts…..
Thanks Wouter – this is a great educational story to refer patients to..
Anniversary pain is yet another experience that can be explained………Yes I’m in Sardinia at the moment…….Yes I am over indulging …….Yes I have a history of oesophageal pathology…….Yes it has been quiescent for years……….Yes I was gripped by the most horrendous chest pain in the middle of last night……..Yes I was close to calling an ambulance thinking I was having a heart attack…….Yes I then remembered it was the anniversary of my mothers passing, she died in the middle of the night from a massive heart attack……My pain remained strong for a while but my fear diminished……..
On location 🍷🍰🍕🍝🍻😎
Night two………. No pain………This scenario powerfully supports that which I often say to patients who experience “an acute flare” of their pain…………”Considering your pain do you think, if your body was really that broken that it could be healed 24 hours later?”
On location 👍😎