Four Things Good Physical Therapists Understand About People With Chronic Conditions
4 minute read
In the decade since being diagnosed with multiple sclerosis, I've seen a number of physical therapists.
And in that time I've realized that the best PTs have understood that working with patients with chronic conditions involve a different mindset from the traditional physical therapy patient.
Given that the typical course of physical therapy treatment is limited in sessions, one of the most beneficial things that PTs can do is give patients with chronic problems information, support, and guidance beyond the exercises themselves that patients can continue to use on their own. In other words at some point, because of the frequent mismatch between the amount of treatment needed and the amount covered, patients with chronic conditions are likely to have to become their own PT. To the extent that they can understand the thinking behind a course of physical therapy, it can help them be more successful on their own.
I realize that patients vary in how active they want to be in managing their condition. But for me, living with an unpredictable chronic problem is both tedious and frustrating, and I am eager to do anything that I possibly can that may help me to live a full, quality life.
I know others with MS who feel similarly. As such, rehabilitation goals may be different for people with chronic conditions, and success may have a different definition. Especially for people with degenerative diseases, even if we can't get back to normal, we still value maintaining function and any improvement, even if small. Many of us are not looking to run marathons or climb mountains; we are looking for better balance and mobility as we navigate our homes, stores, and other ordinary spaces.
The following is my insight for today's students and future clinicians for working with patients whose problems will likely outlast the course of treatment. While my points may apply to any patient, those with chronic conditions may particularly benefit from feeling like a true partner in the rehabilitation process.
It helps to know why I'm doing a particular exercise, and what it is supposed to accomplish.
When my shoulder froze a few years back, I didn't want to know the details of shoulder rehabilitation. I believed my shoulder would eventually get better and just wanted to get it working again. But I've had MS long enough to realize that maintaining functionality over time requires active involvement and thought on my part.
If I know how and why a particular exercise strengthens a given muscle or supports balance, it helps me stay focused. As I've discovered, it's easy to do an exercise wrong. Knowing why I'm doing it reminds me do it correctly.
It helps to see exactly how I need to change what I'm currently doing.
Partly because MS can affect proprioception and partly because I never paid attention to the mechanics of movement before my diagnosis, sometimes I'm not clear on how correct movements are supposed to feel or look. I don't realize what I'm doing incorrectly.
For example, I found that I can get by without using core muscles. It took me a long time to sense what an engaged core feels like and to understand how it assists me in moving more efficiently.
What may seem obvious to a PT is not always obvious to me. So for key movements, showing me what I am doing wrong, and perhaps filming me for a few seconds with my phone, will make things much clearer to me. Along those lines, the more you can show me how movements should look using skeleton or muscles models, the more I'll grasp what you are saying.
It helps if you can point out what look like bad habits.
In my case, bad habits of movement and posture predated my MS diagnosis. Although these habits feel difficult to change, mentally it is easier to think that I am working on a habit rather than only addressing neurological damage.
People with MS often get into a pattern of thinking that everything is an MS-related problem; sometimes we need reminding that it's not.
Pointing out any improvement, no matter how small, is a morale booster.
With a chronic condition, improvement is often incremental and undramatic. During a short course of physical therapy, change may be limited. However, I appreciate recognition of any progress, and it helps me build a sense of confidence and control. With the subtypes of progressive MS, little improvement is expected, so any change for the better, no matter how small it seems, is a big deal.
One frustrating aspect of conditions like progressive MS is the lack of a direct relationship between the amount of effort that goes into rehabilitation and the results. However, working with patients like me to develop a sense of understanding of what they are doing and to see the control they can have, can help keep them motivated long after the formal course of therapy ends.
Joan F. Peters, JD, MPH. Connect with Joan via email at email@example.com.