As a physiotherapist, I sometimes look at a patient and am forced to confess, “I can’t fix that. I’m sorry, but it’s been too long.” Professionally this weighs heavily on me, as a person it just baffles me.
The scenario is consistent, repeatable. The door to the physio clinic opens. A woman wiggles in, her bag is looped uncomfortably around her neck, atop her grimy sling. Her sling is draped improperly over her casted arm. Her digits are plump sausages, an ugly black-purple, stiff and erect. Her elbow is locked, cocked, almost fused. Her shoulder looks painful. Her face looks weary.
Soon after her, a father and daughter muscle through the mechanised door. Dad pushes the handicap button and edges his way through the door. The daughter awkwardly slips in before the rebound. He would move faster if it were not for the crutches and the hip-to-ankle, fuzzy, hospital-issue, blue leg brace.
These people are followed by a stream of others. Patients. And why are they coming to see me? Because they fractured their humeral neck? Because of a high ankle sprain? A whiplash injury? No. These individuals so often walk through a physio’s door because of the after-effects of their injury. Their injury has resolved, but their body never returned to status quo.
Why do they look and move and feel so wrong? Because no one took the time to pull up a chair, sit down and explain why the body reacts so poorly to immobility, bracing and inflammation. Because no one looked at the fractured wrist and said, “Your wrist will heal. Now let’s talk about keeping that elbow and shoulder mobile while it does.” Because no one told that girl in the emergency department that the knee immobiliser was only a short-term solution designed to prevent her from hurting herself while waiting for her physio appointment and that she must remove it and move her leg. Repeatedly. Because no one thought a patient would be ‘ignorant enough’ to leave a sling on 24 hours a day (hey, it was us who told her to wear it religiously).
So many front-line healthcare providers forget this simple fact: information that is ‘common knowledge’ to us, the professional, can be a mystery to the patient. Worse, loss of follow-up is a common problem in orthopaedic trauma and the patient only surfaces again after a minor injury has exploded into a full on assault.
The human body is forgiving. It can recover from almost any insult in four weeks to three months. Yet, if that same body part is neglected, or immobilised, or moved incorrectly, a simple injury can blossom into a lifelong regret.
I have a dream. In that dream, I find myself on a first name basis with every triage nurse in the emergency department, every doc on ortho, every family doctor who refers to a specialist. In that dream, I see myself mouth these words:
“Fuzzy blue knee immobiliser? Bad choice. Send them down to see me and I’ll talk them through the next three weeks.” Or, “Nurse Emma. Could you send her to me? In a single session, I’ll show her a program she can do at home to maintain her shoulder and wrist mobility, without disrupting that elbow set.”
In that same dream, I also eat everything I ever wanted—twice—but that’s a story for another day.
In that dream, I never see another fuzzy, blue knee immobiliser on a knee eight weeks after the patient should have taken it off. In fact, I never see a fuzzy, blue knee immobiliser again. In that dream, I don’t ever have to tell another patient, “I can’t fix that”—because they received competent instructions right from the start.
Andrea Salzman, MS, PT graduated from the University of Alabama at Birmingham with a Master’s degree in physical therapy in 1992. Over the last two decades, she has held numerous prominent leadership roles in the physical therapy field, with a heavy emphasis on academic writing and administrative functions. Between 1995 and 1998, Salzman served as the Editor-in-Chief of an American Physical Therapy Association (APTA) journal. In 2010, Salzman received one of the highest honors given to a physical therapist from the American Physical Therapy Association, the Judy Cirullo Leadership Award. Between 2012 and the present, Salzman has written 12 physical therapy courses for Care2Learn, Relias Learning and reviewed over 100 other course offerings. Currently, Salzman continues in her writing, leadership and administrative roles at Aquatic Therapy University and 10K Health.