Managing Fear Avoidance and Clear Communication

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For this reflection I wanted to discuss a case that really helped me understand just how important it is understand the patient’s perspective and beliefs regarding their injury. This patient was referred to me for a lateral patellar subluxation with a subsequent MPFL strain while dancing with her child in the kitchen. From the subjective interview I discovered that she was informed by the doctor that she was weight bearing as tolerated, but for the entire month leading up to seeing me she had kept her brace locked in extension and remained non-weight bearing. Her fear of re-injury had led her to completely avoid any utilization of her injured extremity. At this point she reported not having any pain while the leg was extended but had only tried to bend it a couple times and it was painful. Because of this, she could now only flex her knee about 60 degrees. Going into the objective I knew that I needed to get a baseline for how much she could tolerate and started with some progressive weight bearing on a scale. The patient was very hesitant, but I reassured her that it was safe to put weight through the leg and she had control of how much weight she placed on it. I was finally able to get her on the scale and she quickly realized that she could tolerate her full weight and stand without the crutches. We followed this up by transitioning to her gait mechanics and she was again able to progress to full weight bearing with walking.

This was a fairly straight forward case, but it made me think about previous patients who had either a traumatic and/or a chronic injury. I remembered a few patients that I had avoided doing certain activities with because I let their fear and hesitancy to perform them lead me to avoiding progression towards those activities. This has challenged me to really think critically about tissue healing time frames, severity/irritability, and appropriate tissue loading to help patients understand that certain activities are safe and how to progress them. These experiences have also helped me understand the importance of clear instructions. This is important when discussing restrictions/precautions and respective time frames. I had a patient that had a cervical fusion a few years ago and he told me that his previous therapist told him to avoid overhead motions. He took this literally and is now working with me to regain his overhead function. Now the previous therapist may not have said that he will always have to avoid this motion, but that is how the patient took the information. This experience has really helped me reflect and make sure that I am very specific with my instructions and that I make sure that the patient is understanding what I am conveying.

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