A point in time….. some thoughts
At a point in time a patient comes for advice and treatment. Often this is at or around the time of a peak in symptoms hence most troublesome and limiting, whether it be a new problem or an acute on chronic scenario. Any consultation is at a point in time and that comes as a result of where we have been, our history. Our history to date is not just about how the injury occurred or the pain started. It includes these important factors but also the preceding circumstances, prior injuries, what we know about injury and pain, what we don’t know that we know (that comes from Lorimer Moseley), what is going on in the body systems (e.g./ nervous, immune, endocrine), our culture, past experiences, beliefs that we develop and learn from significant others, gender and genetics to name but a few. History taking is a vital part of the evaluation and attention to detail can make a real difference. Through verbal and non-verbal communication (e.g. pain behaviours) about the problem, observing movement and posturing, we can build a picture from where a treatment programme can intervene to change the experience of pain and enhance healing. The questions ‘how has this person got here now?’ and ‘what is the wisest course of action?’ are at the forefront of reasoning.
What is it that really brings someone along, often repeatedly over some weeks? The desire to be free of symptoms, to be able to play sport again, to go back to work, to be able to pick up the children or to start going out with friends again perhaps. How has this situation arisen? Perhaps an injury or the gradual build up of symptoms to a point where life becomes difficult. In all of these cases we look at the story, the pathway that has brought the individual to date. What has influenced and moulded the experience and in particular the experience of their body now, in pain, with discomfort and suffering? Work has been done to look at this albeit not under one title, but Maria Fitzgerald considers the effects of early painful experiences in the neonatal period. Arguably we need to understand the patient’s early life, a time when the system that detects danger is developing.
In summary, my assessment is about understanding the current experience (pain & injury) on a background of the functioning of all our systems: body, brain & mind. The systems have reached the present moment via genetics, learning, thoughts, beliefs, cultural memes, movements and many other influences that mould us to who we are at the current time. A point in time…