WHERE IS MY MAGIC WAND?

There seems to be a misconception about physical therapy.  Many folks must believe that we have a magic wand and we wave it over you on the first visit and all is better.  I admit we are awesome, we do make people feel better and function better and we can do amazing things as well as maintain our humility.  However,  there usually is a little homework for the patient, exercises or change of some habits that will aid in the recovery. Without the homework progress will take longer and possibly will just be too slow for some.

Here is a typical conversation......
"Good morning, how are you today?"  I might say.
"Not much better" the patient might say and then add, "those exercises do no help."
"Really?" I reply and then ask "did you do them 3 times a day everyday?"
"Well..... No.......,  But I did them once and they did not help"

WHERE IS MY MAGIC WAND?

My favorite was from a young boy about 10  years old.  He was shown a few simple exercises to be done at home 3 times a day. His mother was also given the written instructions so she could help him if necessary.  His response to the question of doing his exercises regularly was....
"Yes, I did the exercises....... one time, in the car on the way over here and I don't think they helped."

WHERE IS MY MAGIC WAND?

A few of the exercises given to a patient maybe hard to do or a little uncomfortable.  Those are usually the most important exercises to do because they address the problem.  Therefore a response I have heard several times goes like this.
" Yes I did my exercises, but not all of them.  A few of them were too hard to do and made me hurt a little so I just did the easy ones."

WHERE IS MY MAGIC WAND?

Lastly, I like to catch the individual in their little white lie when they say they did the exercises and I know they did not.  Here is a fun conversation.
"Go ahead and start the exercises that you are doing at home" I say at the beginning of a session.
The patient will ask "Which exercise do you want me to start with?"
" Oh just do them like you do them at home."  I reply.
After sitting on the table for a few seconds, looking a bit lost and not knowing what to do, the patient will finally reply "Ok, I did not do my exercises at home.  I don't know what to do."
Busted and

WHERE IS MY MAGIC WAND?

BLESS THE MOTOR MORON; FOR THEY JUST SIMPLY CAN NOT DO IT

Oh, the motor moron.  All you physical therapists out there have worked with a motor moron.  This is the poor soul who can just not do it.  You instruct them to do a lunge forward, which seems to be a simple task.  However, the activity you get is undescribable. Let me explain with an example.

To strengthen the hamstring muscle post knee surgery, a fun activity to do is sitting on a stool with wheels and just walking.  High school age patients liked this activity and occasionally would race me or another patient just for fun.  On one specific day, I had 2 high school post knee surgeries patients, one male and one female, in the afternoon consecutively.

The young man had a crush on the young lady so he stayed after his treatment for a bit to talk to her. Feeling a bit cocky and wanting to show off, the young man challenged the female teenager to a stool race.   Now I had seen this young man walk on the stool and it was not pretty.  He went all over the place and just could not coordinate his legs to walk forward. I was worried.

Despite my misgivings, the race was on.  The distance was 20 feet.  "Ready, set, GO!"

The young woman stool walked directly to the finish line at an amazing speed with no problem.  The young man could not get the  stool to move forward. He was weaving all over the place.  He lost his balance and boom, he fell off the stool.

Of course, I tried not to laugh.  I asked him if he was okay. But, I could not help it and I started laughing as did the female teenager.   The young man snickered a little, stood up and said he needed to leave.

Being a motor moron can be difficult and humiliating and .............hilarious!

THE TRIFECTA

For about 3 years, I worked in an industrial medicine physical therapy clinic.  Functional Capacity Evaluations or FCE *,was a test we administered here.   Acquiring a medical disability or social security disability was one of the purposes for administering this test. . Occasionally a client will walk into the department for an FCE and will not be completely truthful about their condition.  

One day a  young man around 30 years of age, walked into the physical therapy clinic for an FCE to determine the need for medical disability. As he walked through the department to the testing equipment, he was dragging his left leg and grimacing with pain.  He was asked to rate his pain in the leg prior to beginning the test  on a scale of 0 to 10.  0 being no pain and 10 being emergency room pain and if rated at 10, 911 would be called to take him to the hospital. 

As he sat that calmly he responded with "9 1/2" and described the pain in his left leg.   Hmmmmm, magnifying the pain a bit? 

This was documented and the test began.   During the first half of the test, it was noted that the young man dragged his left leg  as he walked from activity to activity and continually complained of severe pain.  During a repetitive activity lasting for about 5 minutes he must have forgotten his leg was hurting and started showing no signs of pain.  After the task was over and he began walking to the next activity, a light bulb went off in his head and he remembered that he had said his leg was hurting.  However he must not have remembered which leg, because....

Yep that's right, he started  dragging the right leg.   The second half of the FCE he dragged his right leg around, grimacing with pain.  I  just observed and documented what I actually saw without questioning the client.   When the individual left the clinic, he probably thought he had pulled off the lie.  But he was busted big time. This young man  lied, magnified and was malingering or not wanting to get better.  I guess you could say he hit the trifecta.

GOAL SETTING

Physical Therapy treatments are suppose to be goal oriented.  Goals can be based on physical limitations such as strength or range of motion; pain level; job demands; and even recreational activities. Sometimes, it is hard to put the goal into words appropriate for the medical documentation.

One individual I treated had neck pain, head aches and some jaw pain.  I was thinking she had a TMJ (temporomandibular joint) * issue but I needed a bit more history to be sure.  So I asked, "When does your jaw hurt?" and she replied in an even toned voice, with a matter of fact expression on her face, "when I have oral sex".

Now, my dilemma, do I set a goal that reads "pt will be able to have oral sex without pain"?


After setting goals for another patient,  I realized I had set the wrong goals. This 21 year old female had a different goal in mind and I was not aware of  it  until after it was accomplished.

She came to see me with right shoulder pain.  She had been in a fight and when she threw a punch she dislocated her shoulder. Appearing to be a nice young lady, I felt this was probably an isolated incident and she was  provoked in some way.  She had difficulty sleeping and dressing, therefore the goals I set for her were;
1. Pt will be able to sleep through the night without pain.
2. Pt will be able to reach behind her back to fasten bra and tuck in her shirt.

After 6  weeks of treatment her symptoms were decreasing and she was sleeping and dressing much better.  Then one day she arrived for her therapy session smiling and extremely happy.

I address her saying  "You are happy today.  Your shoulder must be feeling better."
Her reply was "Yes I feel great.  Last night, I was in a bar and got into another fight.  I threw a punch with my right arm and my shoulder did not hurt at all.  Thank you so much."

Obviously, my goals were not her goal.  Her goal was met.