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When pain arises...
Your first reaction should never be to panic. Not only because it will prevent you from taking quick and rational decisions, but also because your fear will often be unfounded, whilst always impairing your recovery.
Your therapist will need to know about your symptoms, so take the time to formulate clear and complete answers. Try to characterize the pain.
- Is it a first episode of pain or a recurring one? If it is recurring, when was the first episode? How often do you feel the pain? How long does each episode last? What seems to be the trigger of each episode? If it is a first episode, how did it come: Suddenly or progressively? After an usual, or unusual effort?
- How would you define the pain? Is it burning, hitching, needle-like, tension like? Is it rather numbness, tingling, loss of strength, coldness?
- Where is the pain located? Does it move throughout the day or night?
- Which daily movements or activities are impaired by the pain? This will help you and your therapist to evaluate the effect of the treatment. Some typical examples are: Opening a jar, buttoning your shirt or pants, lacing your shoes, wearing your socks, cycling, climbing stairs, combing your hair, sitting in front of TV, sleeping, going out of bed, vacuum cleaning, peeling vegetables, reaching high, etc.
- Do you feel like you need to stretch or move in a given direction? Is there something (cold, warm, rest, immobilization, etc.) that seems to reduce the problem?
If the pain is recurrent or remains overnight, you need to consult a specialist. A general practioner may be a necessary point of contact to get a prescription, but GPs are usually no specialists of occupational disorders. They may still be able to orient you towards the most apropriate therapist.
Different therapists
There are numerous (para-) medical specialists dealing with occupational health disorders (RSI, CANS, low back pain, etc). It is important for you to know the specialty of your therapist, as understanding the treatment is utterly important with these disorders.
A few preliminary remarks:
- Keep in mind that there is a major difference between solving the symptoms (pain, anatomical findings) and solving the causes of the problem. Both require different approaches, often complementary;
- Skeletton and soft tissues (nerves, tendons, ligaments, etc.) are interconnected: Acting on the muscles necessarily has an effect on the joints, and conversely. Therefore, there is nothing such as a muscle-only-therapist or a joint-only-therapist. Choosing a treatment is rather defining where the focus should be to reach the maximum effect;
- It is usually not wise to have two different therapists dealing at the same time with the same body, unless they do it on purpose;
- The education of therapists varies from country to country;
- All main specialities have a certain overlap. This overlap depends on the individual therapists' cursus and experience.
The list below is therefore necessarily schematic, but it may still clarify the situation in some respects.
- Physiotherapists are "hands-on" specialists: Their main focus is to restore the body's normal ability to move, which they see as a central element of human health. For that purpose, they use different therapeutic modalities (massage, heat, electricity, ultra-sound, etc.);
- Manual orthopaedic therapists are "hands-on" specialists too, specialists of the skeletton (bones and joints, incl. the vertebral column). Their main tool is their hand: They litterally manipulate their patients;
- Chiropractors are manual therapists focusing on the spine, which they see as a central place for the onset of disorders, which then spread throughout the body via the nervous system;
- Osteopaths believe that disorders at the level of the internal organs appear at musculo-skeletal level too, and converserly. They use this relationship to restore the body's normal functioning;
- Mensendieck and Caesar therapists are the only purely "hands-off" therapists in this list. Their treatment is based on individualized exercises programs, aiming at improving the patient's posture and body awareness, so as to relieve overloaded tissues.
Many other therapists deal with symptoms: Acupuncturists, massage therapists, etc. Rheumatologists, orthopaedic surgeons, and other medical doctors may also be involved in some cases. Note that the Alexander technique is not a treatment or a therapy, but a mere discipline among many others e.g., Pilates.
There is a consensus between all specialists that the body has a natural ability to recover by itself. Their intervention hence forms only part of the treatment.
Although hands-on therapists inevitably have a certain knowledge of the causes of occupational disorders, their main focus is not to reeducate their patient, but to solve the symptoms. The patient has a rather passive role to play: "Sit here, and I'll treat you". In that sense, it has to be carefully analysed whether the causes of the problem have been removed by the treatment, or if they are still latent and therefore require further treatment by a hands-off therapist. An ergonomist may also be helpful at this stage e.g., because the work environment has a direct influence on the worker's posture.
Therapists' competence
Patients who do not recover as expected tend to doubt the competence of their therapist. Although this may sometimes be partially true, it is not the complete picture: It is sometimes difficult to foresee just after the intake which approach will work best, so that some trials and further investigations may be needed during the course of the treatment.
However, a competent therapist should be able to recognize his own limits. For example, "cracking" a spine every week for 2 years is dangerous, as it affects the rigidity of the ligaments, therefore the stability of the whole skeletton. In that sense, a competent therapist can identify when his treatment does not work, and can refer his patient to another specialist who may be able to help differently or to pursue further investigations (e.g., an MRI).
Your role as a patient
As a patient, you have to actively play a central role in the treatment. As such, you first have to accept that the human body is not a mere machine that can be fixed overnight: Healing takes time.
Occupational disorders are usually related to overuse (incl. misuse) of certain body parts. Your therapist will assist the natural recovery mechanism of the body; This is the symptomatic part of the treatment. However, you will not be protected against new episodes of pain as long as their causes are not discovered and fixed: Why is there overuse?
To approach an answer, it is important that you understand the issue and the treatment: Which tissues are overused, how can such overuse occur at the workplace, at home or in the car, how can it be caused or aggravated by a wrong posture? There will be no certainty in the answers. However, you have to help identifying and qualifying a number of risk factors, and fixing them one by one. It is therefore your responsibility to carry out the exercise program shown by your therapist, to take sufficient breaks during your working time, to pay attention to your posture and to your work environment, etc.
Understanding your pathology and its mechanism will also participate in reducing your anxiety (pain catastrophizing). Remember that emotional stress is counter-productive during recovery.
I strongly recommend that every patient reads this information flyer: screen / print version.
