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Pain Medication is the Answer

Pain medication is the Answer (bear with me).

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Take yourself back to high school when you get home too late or when you get home the next morning and the dreaded questions start flowing:

“Where were you?” “What did you do last night?”

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You can go a couple different directions with your answer.  For the sake of this blog, let’s go with the answer that achieves a solution in the short term, the “lie.”

You tell them you were at Johns house.  John is that friend who wouldn’t harm a fly.  Your dad would let him take your sister to prom.  John could do nothing wrong in your parents eyes.

This answer was a lie but it achieved a few things. You avoided a fight or argument, you avoided being grounded, you kept their trust, and you kept your freedom.

Parents talking to teen

Little did you know at the time, they probably knew you were lying and eventually you will get caught (which will not be pretty).  You don’t want to hear about how telling the truth now will be better in the long term.  For that moment, in order to keep short term peace and based on what was important to you, lying was the answer.

Fast forward 20 years, now you are heading to your primary care with complaints of lower back pain.  You can’t sleep, you can’t pick up your 3 year old daughter, you can’t play catch with your 10 year old son.  You can’t even take your dog for a walk.  The doctor prescribes you medication and [as he is leaving the room] says, “you can also give PT a try.”

Back Pain.

You choose to start taking the pain medication.  Immediately you can sleep again. Your daughter comes up to you in the morning and says, “daddy pick me up” and you can with no pain.  Your son begs you to play catch and you go outside with absolutely no pain.  You can now take your dog for a walk.  You have your life back.

Little did you know at the time, your back pain will return with a vengeance. The pain medication will no longer be effective so you will need to take more, it will catch up to you (which will not be pretty).  However, for that moment, in order to get your life back and do what you want to do, pain medication is the answer.  You know deep down that it is not right, but it is okay until you have more time to address the problem.

Fast forward 5 years.  You finally go in for physical therapy and tell the physical therapist the laundry list of medication you have been on. The physical therapist “educates” you with the following: “Pain medication is not the answer, it is not a solution to a problem.”

Game Over.  Wall is built between you and them.  It will be very hard to gain trust at this point.

As a PT myself, I’m here to say for the person sitting in front of us, pain medication is the answer.  Just not a long term one.

This is an important realization.  This is an important shift in our thinking that in my opinion needs to happen.   This realization shows that we are able to truly put aside our knowledge on the topic and put ourselves in their shoes. This thought process allows us to have consideration for their feelings.  This is a position of understanding.  Not a position of the strict parent coming down on their teenage kid who came home too late.

Doctor sitting in office with patient talking and smiling

This allows us to come alongside the person and have a sense of understanding for where they are coming from and where they want to be.  Blanket comments like, “well you know pain medication is not the answer” and “you should stop taking medication, you know they are bad for you” should be dropped. When the patient in front of us senses that we are coming from a position of understanding, open dialogue will be achieved.  Barriers and walls will be torn down.

Trust will be built.

The likelihood of healing will improve.

It is then that you will form a relationship of trust and will be able to influence them and work with them on a gradual strategy to achieve the long term answer (which does not involve pain medication).

I’m a huge believer that in the long term, better movement beats pain medication every time.

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But I wonder how many times have we been robbed of the opportunity to journey with our patients down this path of finding their long term solution due to our lack of understanding on the front end.

Always keep this at the foundation of which your communication with each patient is built on:

“No one cares how much you know until they know how much you care.”

WHAT IN THE WORLD IS GAPOSIS?

Gaposis
If you want to improve your jump shot in basketball you would work on dribbling. You would dribble the ball for hours, practicing behind the back, between the legs, two balls, both hands. You would dribble non stop. Hours and hours of dribbling has been shown to improve one’s jumpshot.Confused-Baby

…What??
I hope you are wondering, “What in the world is this guy talking about, if you want to improve your jump shot you would shoot the ball.” When Gary Gray coined the phrase “gaposis” this is what he was talking about. Gary was looking around at the field of physical therapy while scratching his head.  He listened to the gentleman having pain with walking yet we were spending 85% of the treatment session with him on the table. He was listening to the elderly woman with lower back pain as she bent over to pick up her grandchild, yet was left on the table in physical therapy to do ball squeezes. He was observing the man doing theraband straight plane external rotation who had shoulder pain keeping him from playing catch with his son. Gary was discovering an alarming truth. People were coming to physical therapy to get back to what they want to do, yet while in physical therapy there was no resemblance of the task they wanted to return to. This is gaposis.

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In much of traditional physical therapy there is major gaposis present. We are working with the patient on dribbling when they want to improve their jumpshot. We are not listening to their frustrations and limitations in life, we are not listening to their goals of walking with their wife along the beach or picking up their grandchild from the ground. We are giving them the same 6 exercises to do as the person the next table over.
Major gaposis.
Our profession is in a transformational time period. Gaposis has to stop.transformation

The problem is, up until now we have not had an effective and efficient way to assess where the patients functional limitations were and how this was limiting their daily activity.
We had no way of sniffing out where the dysfunction truly was that was causing their pain. The waters were far too muddy.
When John came into the clinic complaining that he can’t walk along the beach with his wife because his back hurt we did not have an effective and efficient assessment program that allowed us to quickly get to probable suspects and potential culprits.
We were left to fall back on our traditional protocol of bridges, clamshells, monster walks, straight leg raises and posterior pelvic tilts. We all questioned if what we were doing was really helping.
3D MAPS is an assessment tool that can give us the confidence to know that what we are doing is most definitely helping. Now we have an opportunity to identify exactly why Johns back is hurting while he is walking. We can get to this answer effectively and efficiently in an environment that resembles his functional limitation.

3Dmaps

3D MAPS is the tool developed by the Gray Institute that allows us to do this.
Gary Gray “The father of function” always thought this was impossible. He thought it was impossible to develop a functional movement assessment because of the fact that function is task dependent and infinite. You can’t possible put movement into a “box” and call it functional because it completely depends on the task the person desires to be able to do. Well, after 40 years of trying to come up with an assessment tool, Gary and his colleagues have come up with a tool that resembles something as close to function as we are going to see click here to read the

3DMAPS E-Book.
In our podcast with Gary, he goes into detail of the story behind 3D MAPS and how valuable it can be for movement professionals to use in the clinic.
Gary was so gracious that he is offering 30% off to anyone who simply listens to the podcast.  Listen to the podcast!

Claim your 30% discount here!

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Get out of the protocol mindset. If your patient wants to dance with their wife, observe the movement they need to go through while dancing. Sit back and synthesize biomechanically what is going on through the use of 3D MAPS.
We encourage you to leave gaposis in the rear view mirror.  Be the one who encourages functional transformation with each and every patient.

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When was the last time you were somewhere and felt like you totally wasted your money or time?  You can probably vividly remember the way it made you