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15 Apr 2018

What to do when your patient feels worse after treatment?

Flare Up

Inspiration from:

https://mikereinold.com/worse-after-treatment-con-ed-plan-current-thoughts-on-blood-flow-restriction-training/

 

This is really a good question.  And it comes from new-grad PTs in the human field as well as newbies to the animal rehab field.

 

Essentially not all ‘next day’ pain is bad.  Firstly, you must consider what is the diagnosis?

If it’s a fresh post-op and what you did made the dog worse the next day, then perhaps you over did it.  The same would apply with a case of suspected nerve root impingement.  However, if it’s a tendinopathy case, then GOOD!  You need to make those ones feel a little worse in order to stimulate healing and make them better.  If you have a patient and you are trying to increase ROM of a joint and you did a lot of manual therapy and stretching, then some worsening is likely expected.  If you are doing some late stage strengthening following a post-op cruciate… then the exercises you do should push muscle growth (like how your legs feel after ‘leg-day’ at the gym!)

 

As a general statement, much of our job as rehab practitioners (and physical therapists in human medicine) is to load the tissue.  Load is needed to stimulate healing.  If you are always staying below the pain threshold, you’re not likely progressing the patient enough for them to actually get better!  As practitioners, we are always trying to find the happy medium. 

 

Additionally, you need to be aware that another component of your job is ‘calming the patient down’… and don’t YOU panic!  It’s important to give lots of education – what you’re doing, and your expectations (i.e. you may feel a little bit sore the next day.)  As a ‘human’ physiotherapist, I would always tell my new patients to expect to be a little sore the day after their assessment.  Of course!  Because I’m poking and prodding to see what’s painful.  In dogs, I do that even more because the dog isn’t telling me I’m sore ‘here’, and so I have to poke more spots and look for the dog’s reaction!

 

Bear in mind as well, that sometimes what we do is a little bit experimental.  Our job is to push our patients a little.  So, be open with your clients and tell them, “if your dog seems a bit sore the next day, or flared up, just let me know and we can adjust from there.”  If it’s case where you expect the patient to be sore, tell the client.  “I expect him to be a bit sore tonight and tomorrow.  That will be a good sign.  Don’t panic!”   

 

And over the course of a year in rehab, and in starting to push your patients a little bit more and a little bit more… you will come to distinguish between what’s a good sore and what’s a bad flare up. 

 

Until then, just keep on trying!

 

Cheers!  Laurie

 

 

 

Tags: treatment made me worse , what to expect , dealing with clients , dealing with owners , what to do
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