Physical therapy.

Yesterday I hung out in the PT department and got to see some fairly interesting things. Not knowing very much about PT, I found the experience quite informative:

1) Physical therapy is big into "referred pain," meaning that, for example, pain in someone's arm may not in fact indicate something wrong with the arm, but with the area of the spine which controls the arm. This is apparently an area of contention between physical therapists and physicians, because the latter are usually uninterested/unpersuaded by the referred pain theory.

2) The first case of the day was a 32 year-old male who slipped on ice and had pain in his neck and right shoulder area. The patient was placed on his back and the therapist manipulated the neck and spine with his hands; at one point there was a rather jarring, audible click as the patient's cervical vertebrae slipped back into their proper alignment. Following this alternation, the patient regained a lot of mobility in his neck and back. The visit was concluded with a round of TENS, which hopefully prolonged the effects of the initial adjustment for 4-6 hours after the patient left the hospital.

2) The day continued with more patients complaining of various aches and pains. The therapist typically started with a thorough medical evaluation (if dealing with a new patient), asked the patient to perform some basic movements to diagnose the cause of the pain, then had the patient lie in various positions on the table and manipulated the patient's spine and limbs. Sessions usually ended with the therapist prescribing exercises designed to facilitate movement in the weak areas of the patient's body.

4) The most unusual case of the day was a young man (in his mid 30s?) who had been experiencing unexplained hip and leg pain for nearly a year, and who has been under PT and chiropractic care for most of that time, to no avail. The poor man couldn't even bend his legs without experiencing excruciating pain, which made the physical therapist's job supremely difficult because he couldn't make any adjustments to the patient's spine or legs. What was particularly odd was that the man's pain was always on the opposite side of the moving limb, i.e, the therapist would bend the left leg and the man would have pain along his right hip. Because of that weird reaction, the therapist concluded that the pain must be caused by something other than a simple musculoskeletal displacement, and that continuing PT would be useless. The patient had made an appointment with a neurologist for later in the week, and as he left the PT office, the therapist turned to me and said, "I hope the doctor can piece that one together, because it's like nothing I've ever seen." Phrases like "possible femoral head necrosis" were exchanged between the therapists, which only made everyone feel even more badly for the poor patient. I too hope he gets some answers when he visits the specialist.

5) As I was leaving in the afternoon, the therapist warned me, "[When you get to med school], beware of losing your critical thinking." This is advice I've received before, so there must be some truth behind it: with the massive amount of information med students are required to know, it's hardly surprising that many of them turn into little more than robots, spewing facts but completely unable to analyze a situation and deal with it in a logical manner. I hope I won't become one of those doctors.

In all, it was a pleasant day; as I have found everyone else so far, the PT staff were friendly and genuinely interested in teaching. I certainly have a greater appreciation for what these therapists are capable of doing to relieve a patient's pain.