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Chronic pain treatment – Client-therapist communication

In this article I will address the theme of communication between client and therapist, and its increased importance within the context of an active treatment approach for chronic (persistant) pain.

As part of assessments and treatments, other than gathering information such as the medical history, the description of the traumatic event and of its context, the pain-aggravating or relieving factors, etc., it is also important for the therapist to comprehend the client’s own perception of the physiological phemomena related to his injury (eg: inflammation, pain and other sensations), to his disabilities (work, daily and leisure activities), as well as any other related information, which may be of physical or psychological nature.

On this point, a client may occasionnally be inclined to refrain from mentionning his concerns about his injury. It is possible that he maintains some misconceptions about it, possibly following attempt(s) at self-diagnosis using data found on the internet, or given by well-meaning peers who lack the appropriate scientific knowledge. Such erroneous informations could not only be a source of needless worries, but also of behavioral modifications: posture & motor pattern changes, avoidance of certain movements, and a cessation of participation in leisure activities. Some of these modifications may be superfluous, others, highly detrimental. Sharing one’s concerns allows to open a dialogue with the therapist who can then explore the client’s comprehension of his trouble, and correct any erroneous concept or refer to another health professional if necessary.

A client could also be inclined to refrain from mentionning worries resulting from a slight increase in pain during or following a treatment session, for example, for the sake of showing trust to the therapist. On the contrary, transparent communication between therapist and client is paramount – pain being a personal experience that the therapist cannot feel. The therapist must modulate the sollicitation level according to the physiological and psychological response of the client and his tolerance level. Essential, therefore, to create a receptive environment so that the client may be comfortable with sharing his thoughts and feelings.
And if it happens, notably in chronic pain treatment, that some therapeutic exercises may generate a normal, temporary increase of pain (due to the presence of hypersensitisation in addition to the musculoskeletal dysfunctions and disabilities), this increase must be moderate, properly modulated, and tolerated by the client.
Under these parameters, and conditionnal to judicious programming, exercice favors functional improvement of the affected region(s) and of their neighbouring regions (who often learn to incorrectly compensate). It favors the reintegration of physical activities participation and work, and finally, in the majority of cases, a relatively slow, but durable, pain lowering.
In response to the aforementionned temporary increase in pain, the client’s questionning and therapist’s teaching allow to lessen the stress level of the client, which we know has significant repercussions.

A therapist’s transparency allows his clients suffering from chronic pain to make the informed choice of investing himself in his exercices and rehabilitation process, while recognizing and accepting the difficult efforts required.

I also note that the fact that the therapist does not feel the client’s pain but understands his suffering has an advantage: the therapist can build his interventions following scientific data, adapt them to the individual needs of his clients, and this with less risk of being himself affected by pervasive worries that confuse the mind, and are unfortunately normal when intense and prolonged pain is experienced.

The importance of proper communication is particularly high in the context of kinesiology treatments because the kinesiologist’s interventions are not direct (eg: mobilization, massage, etc.) in which the client has a passive role. The role of kinesiologist working in rehabilitation is to develop the physical capacity of the client, to address the dysfunctions, impairments and disabilities, and to prevent relapse by teaching adapted therapeutic exercices and changing lifestyle. In this mode, the interventions of the therapist are indirect; it is the client who plays the active role in his rehabilitation.

The advantages of such an approach are undeniable:

  • Neuromotor system retraining – only exercises, performed by the client himself, can fully sollicit this system, which is necessary for proper execution of movements
  • Physical exertion retraining
  • Respect of the individual tolerance level and rate of progression
  • Renewed autonomy in daily life, and even progressive autonomy in executing one’s own treatment

Indeed, through understanding the actual mechanisms behind the injury, the pain and the disabilities, and in knowing the therapeutic tools which he may himself use, the client becomes the master of his condition abd can modify the factors which influence his condition (eg: postures at work) that cannot directly be observed and corrected by the therapist in the clinical setting.

Teaching is a therapeutic tool in itself, but it can only be effective if the client feels comfortable in transmiting all relevant information used to guide the interventions, and if he feels the openness of the therapist in recieving feedback on his interventions.

Patrick Roy-V., B.Sc. Kin

Training Specificity and Motor Patterns

Weight lifting movements should not attempt to replicate sports movements too much. Attempts to do so will necesseraly fail, even if one tries to recruit the same muscle groups and have the same, more-or-less, movement trajectory. The difference in movement speed alone, caused by the load, changes the timing, duration and intensity/amplitude of each impulsion and muscle contraction. If specificity cannot be total, then I am of the opinion that it is better to have less specificity so as to not negatively affect motor schemes. Add more overload instead.

The “unhealthy running impacts” Myth

Myth: Running is a bad exercise because of impacts.
FALSE.

We must identify what type of impacts are present, as well as evaluate the physical condition and the motor patterns of the practitionner (“how” that person moves) before we are able to determine if a physical activity is appropriate. While it is possible that running be discouraged for a portion of the population*, it must be known that this myth’s statement, because it is abusively overgeneralizing, is certainly false.

Change process – Relapse and acceptance

It sometimes happens that a person who has recently modified her lifestyle experiences a relapse: reverting to old habits. After having undertaken an increase in her level of participation in physical activities, after having learned a new exercise program, having executed it and adapted it to herself, and even having already observed improvement in her physical condition, suddenly motivation seems to fall. Absenteeism at training sessions, apparently with no justification. Or perhaps looking for reasons explaining why training is temporarily on “hold”, knowing well that it is still possible for continue training, in modified fashion and perhaps having to make sacrifices for it. Discouragement. And mostly: Fear of returning to training.

On Change

A key concept in Kinesiology, and life in general, is the change process. Within Kinesiology, theories on the change process are most often used to guide the practice of encouraging healthy liftestyle choices. Concerning the mutiple phases one might go through as part of the change process, and what possible resistance to change there may be, there are already multiple exhaustive references on those sub-topics within the field of motivation study in psychology. Although I shall revisit these later, for now let us concentrate more on change itself, rather than resistance to change.

Embracing change does not merely mean not being resistant to change. (double negativity does not suffice; positive affirmation is necessary)
It certainly does not mean to force oneself to act against one’s Self. (self-defeat does not lead to successful change)
What then, constitutes embracing the change process ?