Buying In

[Farisshd]

For this discussion post I am reflecting on a recent interaction with a cervical radiculopathy patient. I had seen her one week prior for her initial evaluation, identified that she had C7 cervical radiculopathy, and sent her home with some basic exercises. We discussed how she displayed a flexion preference, with peripheralization noted with L side bend, extension, and back left quadtant, as well as with compression, but to a lesser degree. I reviewed her exercises and explained that for now, avoiding end range extension may be beneficial for her. We also had a discussion of sleeping positions and avoiding excessive passive side bend from too many or too few pillows and trying her best to avoid sleeping fece down in the pillow with her head rotated to an extreme position.Typically I would have brought her back sooner for her follow up, but she wasn’t able to get back in for another week. She thanked me, left, and forgot her exercises.
When she came back to see me this week, she told me her symptoms were down to her hand, but less painful in her neck. She initially thought it may be good because neck and shoulder were less painful. I asked about her exercises and how they were going, and she explained that she had forgotten them and had just been doing the ones her doctor said. She described doing several rounds of full ROM rotation, flexion, extension, and side bending in EVERY direction (which was not the recommendation). She looked at me and said, “Do you think this is really going to help? I really don’t want to waste either of our time.”
After some reassurances and discussion I brought her to the table to begin manual therapies in an effort of finding some relief. Following some distraction and some PPIVMs and PAIVMs to open up the left foraminal spaces in her lower cervical segments, she endorsed decreased intensity in her hand, and eventually centralization to near the level of her elbow. I then took the time to review the positive indication of the centralization, and reviewed the motions I had been encouraging her to do and why. We reviewed the prescribed exercise, made some tweaks because some just weren’t easy for her to grasp well enough, and reinforced her learning with practice of these exercises. She was amazed to notice the symptoms below the elbow were gone at the end of the session. She looked at me again and said “I think this really might help me”. This was a great time to drive home the patient education and give her her new exercise print out.
Where I went right with her was a thourough exam and appropriate exerciser prescription, where I went wrong was not ensuring she had the sheet in her hand leaving and not offering to send them to her in a secure electronic format as well. Although she expressed understanding in her initial eval of her exercises, did them properly on day 1, and indicated she understood the simple anatomical explanation I gave her at the intitial evaluation, I clearly did not drive home the key points well enough. Luckily in this case we were able to calm things down on her first follow up rather quickly, and this served to help gain some buy in from the patient into the importance of performing her exercises as directed in these early phases of care.

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