I am currently on my musculo prac and have encountered a very complex patient who presents with complex regional pain syndrome (CRPS). My understanding of this syndrome was limited so I managed to find some handy info from www.podiatry.curtin.edu.au/encyclopedia/crps1. Although it helped with my understanding of the syndrome, I could not find much info from other sites regarding ways that physiotherapy would help recovery.
The pt is an obese female who is in her late 30s who sustained musculotendinous injury to her (R) gastrocsoleus and Achilles after her dog ran into her 3 months ago. Initial Rx consisted of pressure bandaging, icing, gentle gastrocsoleus soft tissue massage and gentle AP/PA glides to improve ankle DF and PF. Initially she rated her pain as 10/10, and it remained this severe for the following 3 weeks. From this point onwards the pain began to improve and currently she has a pain rating of 5/10 (without analgesics at rest), however does report occasional night pain which may worsen to 10/10, which then requires her to take analgesics. Her main source of pain currently is the (R) Achilles tendon and calf, which is restricting her active DF (0deg DF) and WB DF (5deg DF). In my initial session with her my treatment consisted of AP mobs of TCJ (pain free at 0deg DF) and soft tissue massage of gastrocsoleus. Compounding her problem of CRPS is the fact that she also has chronic fatigue syndrome, limiting the amount of exercise she can do at home to improve her ankle joint ROM. Her personality is also quite cynical and cares very little for her health. She is a heavy smoker and claims that she does not have time to prepare healthy meals for herself as McDonalds is much more convenient. My supervisor has recommended that I encourage her to be more active and that the line ‘no pain, no gain’ may actually apply in her case. How do I go about educating my patient to be more proactive in her recovery and convince her to take up a healthy lifestyle?
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A tricky one indeed! I believe, as you suggested for my patient, rapport and patience are the way to go in this case. Once the patient gets to know one particular physio a little better they will be more open to suggestion. Gentle exercises may be best in the short term, with accompanying pain relief advice. As, if you make them worse after the initial session they are less likely to respond positively to anything else you suggest. One physio once told me that patients with chronic pain (and I assume it also applies here) should do an exercise until their pain goes up 2 points on the VAS, then settle it back down to baseline, and start again. Also take ANY gain in function / decrease in pain / decrease in med's as awesome and emphasise just how good that is!
As for the healthy lifestyle changes, subtle suggestion is the path I would most probably take. Recommend small, but significant changes, and gradually a healthy lifestyle may follow. For example, if you can get her to swap one meal a week from McDonalds, to a freshly prepared meal, or even a frozen weight watchers meal (these are very nice, or so I’ve been told), you will be on the path to a healthier lifestyle. There are also many classes available in the community and some hospitals that cater for all types of patients. Some of which include dietician input. I would be very interested to see how she progresses! Best of luck.
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