What is an expert?

I have been reading various magazines and watching news shows that feature supposed experts on back pain or strengthening abdominals. Each time a new expert appears with a cute work out outfit and a new exercise routine, I wonder where they came from. What are the credentials of that expert and how long have they been giving advice?

It is true that a pretty face may be more fun to look at on the Today show or on Oprah but when you see that pretty face inflicting pain and potential damage to that person’s back or shoulder, you know that the pretty face can more damaging than doing nothing at all.

An expert on the body should be someone who has an advanced degree and many years of experience working with patients. A novice should not be giving advice about back pain in a magazine or on the screen if they don’t have the training to do so. Are they a physical therapist? Have they had special training on back pain or shoulder pain? How many years of experience have they had? A good body and a pretty face are great if they come with the above qualifications as well.

An expert on television needs to have the credentials to support what is being told to the public. The show that chooses poorly may be responsible for causing pain or injury to its readers. Readers need to be ware and ask for credentials before following bad advice. An expert may or may not be the most beautiful but the information given must be well documented and evidenced based.

Should treatment of all types of pain be the same?

As the chronic pain physical therapy specialist at our hospital, I was asked to speak with the newly admitted chronic pain patient on our rehabilitation floor. The program is designed to help get a patient moving as much as possible and to help the patient wean off of drugs if that is a goal they have chosen. Those treating this patient were looking at her through a standard physical therapy lens.

A full evaluation was done yesterday and the patient was sufficiently flared up to make it difficult to touch her. I performed some relaxation and gentle manual therapy techniques and the muscle spasms started to decrease. I told her that the “no pain no gain” philosophy was not mine and we would go slowly. That helped her to relax some more.

We had a great first session and trust was the result. There is a big difference between chronic and acute pain. With acute pain patients, you can address the problem directly and then fix it. With chronic issues, trust is even more important. Gentleness in treatment is also crucial. If you scare someone away at first, you may not get another chance to gain their trust again.

Treatment of all types of pain should not be the same. You can’t fix chronic pain with a quick manual therapy treatment or a few modalities. It takes slow, small steps and lots of patience.

Can using a cane or walker be addictive?

I was visiting in Florida this past week and I noticed a woman hobbling on obviously uneven hips while holding onto the furniture. It not unlike a child that cruises when learning to walk. I asked the woman if she was experiencing back pain and she answered that she was. I asked her why she wasn’t using a cane and she said that she was told that she would get too used to it and would not be able to walk without it. She said that she could become addicted to the cane.

This particular woman had undergone a total hip replacement recently and the legs were of different lengths. She was obviously causing back pain due to the uneven height of her hips. In addition, she was unsafe in her walking which was evidenced by her need to hold onto the furniture to walk safely. Walkers and canes are not addictive. There is no chemical that will cause withdrawal if you stop using them.

When someone who needs an assistive device stops using it because of vanity or worry about addiction, they become more dependent on others, can potentially cause back pain and even more seriously can potentially cause a fall due to lack of safety while walking. There is no good reason not to use an assistive device if one is needed.

Using a cane or walker is not addictive but it is the safe alternative for the individual that wants to be independent. A broken hip or even a head injury from a fall can be far more damaging than a bruised ego from using an assistive device.