As I reflect on this last week, I'm reminded of something that I seemed to have forgotten.
I'm currently treating a previous patient from a few years back who returns, this time, after a laminectomy. My initial thoughts: neural irritation. I had this patient mildly active in his care. Okay... I was more focused on passive interventions - don't shoot me. I learned Thursday, as I reassessed his situation because he just wasn't progressing as I was expecting, I needed to change one thing... only one thing. I had to get him more active in his care. He concurrently has some proximal weakness that could be contributing to his pain experience. Addressing the proximal weakness should decrease neural irritation and should change the outcome.
The last lesson I learned this week was with another patient. This lady had multiple ankle fractures, multiple corrective surgeries and complications. Unfortunately, she was told she would never walk without an assistive device. She happened upon me due to a previous patient who was told the same thing (the never walk without an assistive device thing). This current lady is very, very motivated and determined. She had mainly been using a wheelchair for the last two years. Her goal is to ambulate without an assistive device. No matter how hard she tries, she doesn't seem to be able to walk without a cane and maintain reasonable gait characteristics. Without an assistive device she typically kind of lunges forward to her right and then tips slightly to her right. Changing one thing... only one thing... changed her gait. On a whim, I happened to ask what would happen if she walked as fast as she could safely walk with her cane. Then, what I saw delighted me! Changing one thing... gait speed... improved her gait characteristics.
Until next time,