The desperate patient causes the desperate clinician to do desperate things | Hacker News Reader

The desperate patient causes the desperate clinician to do desperate things

thehonestphysio.com

49 pointsropable16 comments

I can attest to being a slave to "treatment" for a while. I used to clock into my local physician, who'd have a go at my back with manual therapy (post-op fractured vertebrae, ruptured vertebrae, and massive scar tissue from surgery) until we got "rid of all the knots" and I'd leave, skipper as anything - until they came back over the course of the next two weeks.

Eventually, after about 6 months of this bi-weekly physical therapy, I quit going because I knew it wasn't doing anything to deal with the underlying problems. I swapped to a different physio, who I complained to about having to go to physio so regularly but nothing changing. He gave me a list of exercises and told me "You want to cure your back pain? Do these until you can touch your toes. Don't come here back till then." Came back after breaking that hurdle. He gave me a new list, and said "Do these until you can touch your hips to the ground in downward-dog". Next one "Do these until you can hold a bridge for a minute." Rinse and repeat, until 18 months later, after about 10 appointments, I no longer had any back pain.

If you're struggling with injuries, I highly recommend shopping around for physiotherapists until you find something that works for you. I'd have been getting manual therapy on my back for the rest of my life if it weren't for testing the waters.

Most white collar workers have very weak “core” muscles from sitting all day. This is basically everything between the bottom of your ribs to your thighs — abs, obliques, and everything in the pelvic area. It’s pretty obvious how changing from a life that requires us to stand / walk / run to one where we sit for long periods of time would work those muscles FAR less than sitting at a desk.

Weakness in your core leads other muscles — like those in your back — to overcompensate. For me, it started as hip pain, for others it’s knee pain (yup, weak core muscles can cause knee issues too!) But back pain is probably the most common, and is usually caused by weakness in the obliques putting the weight of stabilizing your head / torso almost entirely on your back muscles.

Fortunately treatment is easy. Bridge poses, crunches, kettlebell workouts (particularly good for the obliques) and yoga are probably the best exercises to work your core. Consider your PT a personal trainer: one your health insurance carrier is more than happy to pay for given the link between physical fitness and overall health.

Barbell squats and deadlifts are probably a more direct and effective way of making your muscles stronger, including your "core" muscles.

I know you mean well but let’s not optimize too much. If you do something, really anything, you are already way ahead.

Well, not necessarily. If you have a muscular dysfunction then performing a big compound lift might just exacerbate the issue. I'm speaking from experience.

Hanging out on HN, it is not surprising that I have a desk job. And, I do have a very weak core (despite having a very short back). Why? Because I have tremendous trouble activating it as other muscles take over.

Case in point, whenever I started doing back squats my hips would start (still happens sometimes - which is when I reincorporate my rehab/prehab-exercises) to hurt. Specifically my right side, near my hip flexor.

After visiting numerous physios that just told me that back squats probably weren't for me I found one that identified that I wasn't flexing my abdominal muscles properly during the movement and instead my hip flexor was trying to take over and stabilise my core at that point.

I could have continued with deadlifts and squats, but would probably have torn something.

With exercise, I find that we need to adopt several modalaties to see the greatest benefit. Kind of like how we should have a varied diet, your training should include strength, mobility, and activation work. Yoga is dope, it'll open up your thoraic spine, which will let you do overhead squats. Just trying to do overhead squats if you lack the prerequisite mobility is not ideal...

Right but those require a lot more equipment. Deadlifts and squats all day if you know how to do them safely.

I went through the same thing. Unfortunately in my case the result was disc degeneration that ultimately required a spinal fusion.

IMO for serious back issues you need go to neurosurgeon, not an ortho, and get imaging done asap. I spent months screwing around with a mediocre PT acting on lousy instructions from a doctor. Frankly in the ortho practice, I felt like I was in a sales funnel with an end goal of big $ surgery vs getting healed. Different experience in the other practice.

I was incredibly fortunate with the treatment for my injury. I woke up in A&E with the worst hangover of my life, a shattered tibia that was held together with some external rods, and an inexplicable back pain that I mentioned to doctors as soon as I woke. They took me in for a CT scan, and seeing the images did an operation on my spine the same day - it was major trauma that had the potential to cause paralysis (so I managed to skip the queue!) Basically, they put in some rods that kept the L1-3 verts spaced apart and pinned the lot while it healed.

I was given the option to take it easy for 18 months and get the rods removed, or go for fusion. I took the prior decision and had the metalwork taken out around 3 years ago this month. The physiotherapy followed that whole fiasco. Today I'm at about 80-90% back to pre-injury back health, bar some scar tissue and flexibility issue.

Luckily I'm British. 3 initial surgeries, 3 months in a hospital bed, 1 year of physiotherapy, 2 surgeries to remove the metalwork in my leg and back, 6 months of physio following that, various follow up appointments with doctors and surgeons, and enough medication to tranquilize an elephant - I didn't have to pay a penny. God bless the NHS.

Glad to hear it went well for you.

I didn't appreciate how awful health insurance is until this experience. I'm fortunate to have an awesome employer with generous leave and benefits.

When I was in recovery, hearing the personal stories of my fellow patients was heartbreaking. I was paying $20 copays while these folks were selling possessions to keep their homes. In one case, a guy had to shell out $5,000 for a back brace, and then fight workers compensation for reimbursement.

My only surprise was after surgery, I received a $350k invoice, because my insurer decided that my back injuries were due to a car accident I didn't have, which was tied to an ER admission for food poisoning 5 years prior. That was resolved in a few weeks.

I wish there was a culture for people to do some basic exercise everyday. The same as it is expected to go to work daily you should also do some exercise. I have been doing a daily routine of 30-45 minutes almost every day for the last 15 years and it’s very noticeable how my body decays when I even skip them for a week or so. My exercises are very basic but they cover most parts of the body that an office worker would never touch.

I wish that people were given a daily routine before any kind of surgery, pain killers or other treatments were given. Something in the culture makes it not ok to ask people to exercise but it’s ok to give them surgeries and other treatments.

Also don’t fall into the trap of going extreme. If you walk half an hour a day and do some basic stretches and strengthening stuff you are already way ahead. No need to do CrossFit or running a marathon.

A Minimum Effective Dose of training and sound diet instilled into our next generation would save a bunch in the healthcare system.

And we never found out what happened to Paul :(

I think the writer is fishing for comments from people wanting more paul :)

I’m desperate to know!

Recognise the power of the white coat (to most) and use it wisely.

This also shows how easy it is for people (and medical people) to imagine there is some magical potion that will make everything perfect again, even if it is imaginary. I think in software we do things repeatedly thinking they are making thing easier or better when in reality the machine isn't even turned on.

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