One of the clients today mentioned that she feels the same now compared to before she started seeing us. Her colleagues asked why she is she coming back then? (It was her third session.) She replied, “because I can do more than before.”
It doesn’t seem like much but this client would have lived with carpal tunnel syndrome for NINE years! It got to the point that using chopsticks and opening canned drinks hurt.
While it is true musculoskeletal (muscle, joints) pain alone can never kill you, the influence it exerts on your quality of life is not insignificant.
Transient effects of non evidence-based pain relief
This client – like many of other clients before – would have tried other treatments before coming to us.
Common treatments among for carpel tunnel syndrome patients include: chiropractic adjustments, massage, dry needling, cupping, IASTM (or gua sha). Some would have seen a physiotherapist for exercise + manual therapy (massage, assisted stretching, active release technique).
Like other patients, she described her past treatment experiences as being helpful for pain relief but it never fully recovers.
To understand why this is often the case, you have to understand that pain is a perception and that it is 100% an output of the brain.
This is why soft tissue therapy such as IASTM – while seemingly delivers immediate pain relief – doesn’t work in the long-term. Chiropractic adjustments, believe it or not, delivers comparably poor outcomes in the long-term as well. These treatments facilitate a short-term neurolophysiological change that provides the illusion of recovery.
The truth is nothing changes. It’s like how rubbing your elbow after hitting it against the wall makes you feel better. The act of massage, IASTM, chiropractic adjustments, and even stretching does not accelerate recovery – yes, you heard that right.
Function has a greater impact on quality of life than pain
By the second visit, this carpel tunnel syndrome patient would have seen remarkable progress.
She could now effortlessly open a can of soft drink. Chopsticks usage also seem easier. However, her pain experience was still significant.
At her third visit (today), her pain experience still largely remained unchanged. The client was informed us that she hasn’t been compliant with the exercises or the lifestyle advice we recommended – cut down on chopstick use for two weeks.
To her surprise – despite her non-compliance plus rest – she was able to perform exercises she couldn’t at her previous visit. When timed correctly, rest – to be precise, effective load management – does have a positive effect on recovery.
The patient was literally happier. While her symptoms still persist, the current improvement in her qualify of life now has a way more meaningful effect than the pain relief she experienced previously with non evidence-based treatments.
We took a moment to celebrate her improved function despite her not doing her exercises. I explained to her why that might be the case.
I further explained these improvements would not stay in the longer term.
Her results were still exceptional. I really couldn’t fault her. She worked hard for the first two weeks. She had a little setback because of unexpected changes in her lifestyle. She was still doing well.
Re-think recovery; put in the effort
I am so thankful that most of our clients are willing to work with us on a collaborative basis.
The effort doesn’t stop at compliance to our exercise program. The effort put into building an effective therapeutic relationship also matters. This means the client puts in the effort to update us on their day to day progress. This means the client puts in the effort to understand our recovery model and process. This means the client puts in the extra effort to complete our suggested readings so they know more about their current condition.
At the end of the day, good treatments come with three major components: exercise, education, and advice.
Recovery is not always smooth sailing
Just two three days ago, we blogged about the unsuccessful patient.
It is an unfortunate situation. To some degree, we failed as healthcare professionals because we did not succeed at driving the correct health behaviours necessarily to facilitate the changes required for symptom improvements.
But this doesn’t have to be you!
Another client that we are working at the moment is also having a nerve-involved condition. This client experiences leg pain, as commonly seen in radiculopathy as a result of slipped disc, on a daily basis.
Her recovery was particularly challenging at the start because her function was limited and her pain intensity was high. On her second visit, she asked for my advice regarding taking time off work on a short-term basis (4-12 weeks).
We strongly, strongly, strongly advised against it.
After the visit with us, was prescribed with medical leave for a week by her orthopaedic surgeon. To our encouragement, she decided to go back to work for half days through that period.
In the following week, she made it to work full time. In the same week also, the exercise program we prescribed her started making her symptom worse!
Because she took control of the situation, and decided to take action to give us meticulous recount of her daily pain experience, we were able to make some minor changes to her exercise program to help alleviate the symptom.
At the following visit (treatment #3), we were able to make some drastic changes to her program in view of her new progression.
She came in for her #4 visit yesterday and she reported feeling 80% better than before she started seeing us.
She was also largely pain-free. She experiences minimal neurological symptom. She could go back to work full time WITHOUT feeling like a train wreck at the end of the day. She also took our advice to stop wearing her back brace, which to her surprise made her feel better.
All of these improvements in such a month!
Your recovery will likely suck at some stage and that is okay!
The moral of the story is simple: Recovery is almost-never smooth sailing.
Your improvements from visit to visit will most likely NOT follow a linear pattern! That is also okay!
In fact, that is likely the reality of good clinical practice.
Yes, we are largely tooting our own horn again – but not without purpose.
We hope you find comfort in our success stories. In these success stories often come setbacks, challenges, perceived failures (that are often just part of the process) that perhaps we do not talk enough about.
If you are receiving treatment that is consistently making you feel better every visit – but only for the short-term – you’re most likely never going to get better. When in doubt, seek out an evidence-based chiropractor or even a physiotherapists.
At the end of the day, the truth is that we are better. And we have the results to show you.