Physio phone assessment

Vix

Hi all

I had an assessment over the phone with a senior physio. I came off the phone feel worse than I did before it. I was diagnosed with mild arthritus in my hips and lumbar 6 yrs ago via an xray and all the symptoms. It has slowly got worse but manageable , until the past 1-2 years where im in pain daily but my pain can become unbearable. I also get neck and shoulder pain, that cause a nerve related headaches( gp diagnosed). I get pain in my knees, groin, and numbness in my leg and hand. My knees and neck crack all the time. I havent had any investigations on these parts of my body.

Mri on my lumbar in march diagnosed 'moderate to severe bilateral facet joint hypertrophy in L4 and L5'. My gp shouldve included my hip in mri requested but she didnt so arranged an xray in may. Weirdly that came back as no real change since 2016?. I dont get it as my pain now is horrendous compared to then. The physio said that looking at the xray thats normal for a person my age. I asked about the MRI diagnosis and she said I wouldnt expect you to be in so much pain? I feel absolutely rubbish she has said this. I have been being treated for these conditions yet she said "sometimes when youre in a bit if pain your brain receptors can make this pain feel worse" It was like she was saying I dont even have arthritis ? actually cried on the phone. I feel lost, stuck and dont know what to do. I feel as if Im not being taken seriously or as Im making it up. I actually have a high pain threshold too.

Has anyone else been made to feel like this from a physio or any other clinician thats never met you?

Also does anyone else have moderate to severe bilateral facet joint hypertrophy?

Sorry for the long post but I feel so down now. Appreciate any feedback

Thankyou

Lilymary

Hi @Vix , I’m sorry you've had such dispiriting consultations. One of my ortho surgeons made me feel like that, plunged me into the most awful depressions simply because his patient handling skills were so awful. He may be a brilliant surgeon for all I know, but he only saw his patients as X-ray images to be fixed, not people, he was so breathtakingly insensitive. Luckily I managed to change surgeon, and it was a whole different experience after that.

Your physio’s comment sounds to me like it was poorly considered before she spoke. To say that damage is “normal for a person of your age” is pretty meaningless if all people with that level of wear at your age are probably in some degree of pain! This is precisely what Versus Arthritis are trying to change, that it’s NOT ok for us to just put up with it because it’s common, or just a sign of “wear and tear” or ageing. It makes me very cross. I don’t even let my vet think like that about my ageing cats! If someone’s in pain, do what you can to sort it, whatever their age.

the thing is, (in my humble and medically untrained opinion), I have learned that everyone feels pain in different ways. We’ve got the same basic layout and wiring so to speak, but the fine detail is different for everyone. My left leg was grumbling mildly and randomly for years, but it was only after a fall the my GP sent me for X-ray, as the pain was ramping up. The X-ray shiwed my hip was so bad they referred me straightaway for hip replacement. I didn’t even know I had arthritis. By rights I should have been in pain for years, (I almost feel guilty that I wasn’t), but due to the way my nerve endings were wired, I got away with it till the fall knocked off the last bit of cartilage and left me in level 10 agony, with referred pains right down the leg. The pain increased exponentially over the next few weeks to the extent that I was sent for a second X-ray, as they wondered if I’d broken something in the fall, but it was exactly the same. It was just the bits of debris floating around in the joint that were causing the pain, hitting all sorts of nerve endings, and these wouldn’t have shown up on X-ray, and even if they had, the outcome was the same, pain relief and surgery.

Then when I had hip replacement 12 weeks ago, I was still in agony for the first few weeks post surgery, just in slightly different places. The surgeon was surprised and said I shouldn’t really be in that much pain (sound familiar?), but I was, and I’m now only making a very slow recovery. One of the lovely ortho nurses, who was happy to fill me with painkillers on demand, also confirmed that everyone’s experience of pain is different, they see it all the time, very different responses for exactly the same surgery in terms of pain and discomfort experienced. Even after my 12 week review my surgeon’s still slightly baffled as to why my leg has reacted so badly to the op, (but says it will get better eventually).

you don’t mention what pain relief you’re on, and whether you’ve been referred for surgery (which can depend on age). If you are on pain relief, it sounds like it’s not working. Ask your GP to refer you to a pain clinic to help you manage it better. But also it’s important to do the exercises your physio recommends, as this can also help to manage pain by stopping you stiffening up and strengthening the muscles around the affected parts of your body to support your joints better.

There are a few other things that help, have a look at this link below. Your physio is right in some respects (but may have put it across clumsily), if you focus on the pain and feel stressed about it, it can make it feel worse. Distraction is really helpful, ie lose yourself in something you enjoy, also meditation or mindfulness, anything to take your focus away from how your body is feeling.

https://www.versusarthritis.org/about-arthritis/managing-symptoms/managing-your-pain/

There are also exercises on this site specific to your conditions, which you may find helpful. But don’t overdo it, as that can make the pain worse,

Coming on this lovely forum has kept me sane through some awful times, so keep posting on here, there’s loads of experience and tips, or come on just for a moan or a natter. We all know how rubbish this can feel.

Take care LM

Mike1

I find it really odd that a physio can assess anyone properly over the phone. I have been referred to them on three separate occasions and each time they merely said that there was nothing that they could do for me!

Lilymary

I’m also surprised that so many physios aren’t seeing patients. Mine has been doing so for months, while wearing PPE and cleaning down the consulting room after each patient.

Vix

Thankyou all for your comments. The physio arranged an appointment to see me the middle of August. I take naproxen, paracetamol, capsaicin cream, and ibroprufen gels. I also take amitryptiline when the pain gets worse. What im annoyed about is I told her that its affecting my daily life now and some days I really struggle. I keep moving as to not stiffen up. The fact she said you shouldnt be in so much pain has annoyed me so much. How can anyone judge the amount of pain someone is in, especially when my facet joint showed moderate to severe. I get what she said about "if someone thinks about pain all the time then they feel more pain" but I dont feel she should be saying these things to someone she hadnt yet met or examined.

DaveVW

https://community.versusarthritis.org/discussion/comment/682899#Comment_682899

"if someone thinks about pain all the time then they feel more pain"

I call that, "woo". There's a lot of woo about. I won't be able to talk myself out of pain. And distracting myself so I don't notice it is woo, because what about the times I'm missing out on because I can't get sufficiently distracted? This isn't a phantom pain, it's a real problem.

Pain itself, is a disease that needs treating. The underlying cause is where long-term resolution is, but in the mean time the misery of living life in pain is impacting everything we do, day in and day out. It affects us, and everyone around us. And it doesn't have to be this way.

Of course, there's no way to know how much pain someone is suffering. I feel like I'm pretty resilient, but I don't know really know how I compare to others, because there's no way to truly know what they're feeling. What I do know is, constant pain robs you of your peace of mind and hounds you when you're awake or asleep.

I've come across a lot of woo. I have mental health issues too, and the amount of woo in its treatment is (ironically), crazy. I won't go into detail, but the fact is, we think there are great services out there to cure our ills, but in reality we've a long way to go in learning to treat pain, and mental health. Not medically, but as a culture.

Lilymary

@DaveVW , I haven't found distraction to be woo at all. Ironically, however much pain my hip was causing pre THR, I could happily spend an afternoon working in the garden, getting myself into positions I would normally consciously avoid because of the high Potential for Ouch (PfO) Factor. I was distantly aware that my hip was hurting, which prompted a lot of grunting and swearing, and the occasional yelp, but a few hours getting grubby in the garden, somewhat counter-intuitively, took my mind off the pain in my hip, gave me a good physical work out and lifted my mood no end. This and a few indoor pastimes, or even concentrating on work, got me through a year of ghastly unrelenting pain prior to surgery a few months ago, and has helped me through a protracted and painful recovery. . Oh, and drugs of course, lots of them, but all they did was knock the edge off the pain. So I needed more in my armoury and that involved a lot of”woo”.

You mention the distractions you're missing out on due to pain. Many find it helpful to replace everything you can no longer do with something else, maybe something new, and to focus on the things you CAN still do. Yes, you will grieve for the things that are now out of reach, but there is so much more out there.. Before my hip packed up in early 2020, I used to be a regular fell walker, attended yoga and Pilates twice a week, did heavy labouring in my garden and my job is very physical at times. I had to give up the classes, and by the end of 2020 could no longer enjoy even level country walks, a trip round the supermarket was my limit. I had to adjust how I worked, and being self employed, that almost halved my income. But I made sure I found different small pleasures every day to keep my spirits up and my mind off the pain and what arthritis was doing to my lifestyle. It really helps to think outside the box (more woo? Sorry!) to stop ourselves going into meltdown, because that helps no one. Sadly arthritis goes hand in hand with depression sometimes, so we need to be kind to ourselves and ask for help; finding both physical and mental adjustments and compensations can be really helpful to getting through this.

Speaking as someone who suffers from depression and ME/CFS, I agree that treatments for mental health are very individual and what is “The Answer” for some may be, well, a pile of woo to others. Like pain, mental health is different for everyone and unquantifiable for comparison purposes, but some of the coping strategies for pain are more broadly successful than others.

Sorry to hijack your post @Vix , but I hope you find some of this helpful too.

Vix

https://community.versusarthritis.org/discussion/comment/682901#Comment_682901

I totally agree, I still cant quite believe the things she said to me. The thing is living with this condition and pain can be a knock on effect on your mental health too 😞

stickywicket

On the subject of pain and distraction from pain, I have to agree with @Lilymary and, just for once😀disagree with @DaveVW . Distraction is my main weapon against pain and, when, some time ago, we asked on these forums what others did for pain, distraction was the most popular answer.

It doesn't mean the pain isn't real: only that we can cease to make it our main focus at least for a while. After all my THR and TKR operations I've been able to delay the next pain meds for a couple of hours by getting absorbed in many things. cricket always works for me but, really, whatever does it for you - reading, TV, puzzles etc. It's a proven technique. https://www.aci.health.nsw.gov.au/chronic-pain/painbytes/pain-and-mind-body-connection/how-can-distraction-be-used-to-manage-pain

To go back to @Vix 's original topic, I've never had a physio assessment by phone but I've had a useful phone call with a pysio to determine which exercises would suit. It was harder than the usual ones as I had to explain my body to her whereas, usually, they can just take one look and see. (And think 'Crikey! What do I do here?😁) But we both asked and answeed questions, she was very thorough and later sent me some exercises. She gave me her phone number so that I could ring with any problems and followed up with anther call 6 weeks later. There were no problems, just one exercise I cóuldn't manage and another for which we sorted a different starting position. All told, very useful.

I should add that I did once have a hip pain which no distraction helped. It was excruciating. Only standing was at all bearable and other arthritic bits meant that my standing time was limited to about 10 minutes. My ortho surgeon reckoned a lump of cement must have broken off my THR and lodged on a nerve. And would, eventually either move on or be absorbed. It did but i was half-asleep for two months on strong opioids. Not recommended!