How do I define a Complex Physiotherapy case?
When people ask me what I specialise in or who I like to help out the most, I often reply by saying complex or chronic injuries or issues; but what does that mean?
In this post we are going to discuss 'the complex’.
I define complex injuries as cases that require very specific and careful management as there are a number of things to consider at the same time. If their management plan is not finely balanced or tweaked for them then they won’t make progress or have a increase in their symptoms.
People often picture that this group of people have had a traumatic injury like a car accident and have had very intensive surgery, but they are not typical type of complex case I see. The most common type of complex case I see is someone who has several symptoms, locations of pain occurring at the same time. For example, lower back pain, discomfort in their hip, pain in their knee and plantar fasciitis.
They have usually seen numerous people before seeing me with varying levels of success. But the unifying feature is a feeling of frustration. A frustration at not understanding what is going on and being able to use that to make progress.
Often this person presents with a conflicting pattern of what makes then feel better and worse. This means that, for example, their knee pain feel better when they are sitting and resting, but this increases their back pain. Essentially, they cannot find a way of managing their symptoms without making at least one thing worse.
Another common feature is that they have treatment that feels amazing, but it only lasts for one hour or so, After which they feel exactly the same as before. In som cases I have seen people that fall into this category go from their chiropractor who treats their back pain, to their massage therapist who helps the neck tension and then to an acupuncturist who needles their knee. Each time something is treated, another gets worse. They are stuck in a cycle that just goes round and round.
I have seen people come in to see me for a second, third (or once a 9th opinion) as their collection of symptoms are just not improving; and when asked about their rehab plan, they present me with a list of 17 exercises. 5 for their back, 5 for their neck, 3 leg strengthening exercises and 4 stretches they have to do twice a day everyday. I don’t know about you but there is absolutely zero chance I could fit that into my day! No wonder they are not consistent with it and ultimately, feel the same as when it started. No wonder that people feels frustrated and defeated.
Sound familiar? Well, there is hope!
For all of these people, without exception they require two things. These two things will unravel the mystery and finally allow us to understand what is going on. They are:
Listening - letting them tell the whole story. Not just the story of the most painful area. Not just the bullet points. I mean listen to everything going back to their childhood and what sports they played, what injuries they had, what is the chronology of symptoms and importantly, what do they believe is the issue!
Conducting a whole body assessment - not one that focuses on one area of pain. We need (and this is non-negotiable) to look at every single part of the person and their body. How they hold themselves and how everything moves. By doing this we can see how one area influences another. How the foot and knee and back are related. What is their relationship to each other?
By doing these two things and doing them well, we can connect dots that otherwise felt completely random. We can see how the body is working as a whole and identify what we can do to help.
This is what I mean by a complex case. They do not respond to an off-the-peg rehab plan. They need tailored intervention that is designed around them. If you or someone you know is struggling to make progress with their therapy - get in touch and we’ll see how we can help!
