Yet Another Failure

by twofiftyorless

Yesterday, Betty felt wonderful after her physical therapy visit. A nurse visited her later and reported that she was “cheerful” and that her blood pressure was lower still (I take this to mean that she is under less stress from pain, but could be mistaken).

Today, however, Shirley did not respond as well.

Shirley has an “arthritic” knee that limits her ability sleep at night; she cannot find a comfortable position to sleep in. She has pain that is located over her anterior thigh, knee and (sometimes) shin. It is pain-free in sitting and supine hook-lying. Her pain is provoked in standing and lying flat in supine. She has full knee extension ROM in the left knee in sitting, but has significant pain when she tries to straighten the same knee while lying on the bed. SLR did not reproduce her symptoms. Hip flexion to 90 degrees in supine (with knee flexed at 90 degrees throughout) becomes painful, but she can assume the same position in sitting comfortably.

I understand that her pain is from mechanical deformation in her nervous system. I understand that her “arthritic” knee cannot signal pain to the brain. I also understand that I may not help every patient, every time. This was the case with Shirley, today.

The good news is that she did not feel any worse when I left today; the bad news is that she did not feel any better.

When I see Shirley again next week, I will continue to try not*

*(hat tip to Barrett Dorko, PT)

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