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Walked In and Wheeled Out

Posted Dec 27 2009 5:01pm

Stretcher Her eyes were wide, mouth open, and arms waving. My physical therapy student looked like an emotional hurricane.

"You have to come now. Something really bad happened. I mean, oh my God, I didn't think this could, I mean it was just regular electrical stim, I, I, oh you have to hurry!" said my student.

"Ok, slow down. Take a breath. Tell me what happened," I said.

My student took a couple of deep breaths. "Mr. Williams came in for his appointment. I went to the waiting room and met him. He said his back hurt but it always seems to hurt. I showed him to an exam room and he got up on the table and I hooked up the electrical stim machine like I did the last time. I set it for pain relief and checked him and he was ok. So, I left the room to check on someone else and when I came back, when I came back he, he just..." and my student started crying.

"It's ok. Did you remove the machine?" I asked.

"Yes, yes, I did but he's, he's paralyzed!" my student blurted.

Paralyzed? Really? From electrical stimulation? There are very few things that produce that kind of injury in physical therapy. I was sure she was exaggerating. I walked into the exam room. Mr. Williams was lying on the exam table on his back.

"Hi Mr. Williams. So, what's going on?" I asked.

"I can't feel anything in my legs and I can't move them. I'm trying right now but I can't make'em work," said Mr. Williams in a calm, steady voice.

"Can you wiggle your toes for me?" I asked.

"I'm trying. Right now," he said.

"Ok. Just relax. Stay still for now and let me check a few things," I said.

I checked the reflexes in his legs. Nothing. I checked his sensation in his legs. Nothing. I took a small pin from a reflex hammer and pricked the bottom of his foot . Nothing. I pinched his skin. Hard. Nothing.

Mr. Williams was paralyzed from the waist down. He had no sensation, no reflexes, and no movement.

"Mr. Williams, we're going to get you an ambulance and get you over to the hospital as quickly as we can. The doctors there will sort this out for you," I said trying my best to be calm.

This happened almost twenty years ago. Mr. Williams walked into our office and on the same day was wheeled out on a stretcher.

What happened? Did my student zap all of Mr. Williams' movement with an electrical stimulation device? Did he have some sort of rare disease? No. Mr. Williams' mind converted an emotional pain into a physical reality. His mind shut his body down.

Psychosomatic symptoms are hard to accept. It's hard to believe that we seemingly have so little control over our bodies; that our aches and pains could actually be more emotionally based than physically based. When you feel pain in your back, you of course assume that something in your back must be wrong. And sometimes that's true. But, sometimes, it's not. And what makes this even more complex is that in most cases there is a physical injury or surgery as well as emotional injuries that are blended together. It is this blending that leads to prolonged recovery. A purely physical source responds to physical measures (or medications). An emotional source is not so easy to tame.

Sometimes of course clinicians will tag patients with, "It's all in your head" when the clinician can't figure out what's wrong. It's a difficult process and the healthcare system doesn't make it any easier. Doctors are not paid much to listen, sort out symptoms, examine thoroughly, and then deal with emotional sources of physical pain. Doctors are paid by procedure (and this is true of most healthcare practitioners - not just doctors). They're paid to do stuff. This leaves the patient feeling alone and anxious which of course just makes things worse.

What do you do if you are faced with both emotional and physical injuries? Be brave. You have to accept that the symptoms could have an emotional source and be willing to look at it and talk about it (or some may prefer to write it out). Sometimes you have to get professional assistance but many times just accepting that there is an emotional source frees you to face it. And facing the emotional pain will lower the the pain you feel.

So, I'll share something with you. I get hurt. I have stress. I avoid some things and face others. I'm a work in progress and I have right shoulder pain. I have the signs and symptoms of something called "impingement syndrome". The problem is I don't recall doing anything in particular to cause it. It just showed up one day. It's as if the Wicked Witch flew in on her broom one day. "Hello, my pretty. Would you care for a dose of shoulder pain?"

So, I of course ignored it for a while. Well, I didn't ignore it really I just didn't sign up for shoulder rehab right away. I thought I could handle it (and yes, you can insert here,"Man, you are a slow learner!"). I couldn't handle it actually so I asked Christine to help me. She thinks I have biceps and rotator cuff tendonosis and maybe even a small cuff tear. Really? That's what I said. Really? From what?

This is reality. Over this past summer, my regular and consistent physical training became sporadic. There was a lot of "stuff" going on which impinged on my schedule and drained my energy. After about three months, I was able to get back to a more regular routine but I knew I had to go easy. So I did. Or at least I thought I did. So, perhaps the resumption of my training overloaded my shoulder? Or, was it something else in addition to that?

In October, I acquired 100% of my practice and recently started seeing clients again after almost a three year hiatus. I love helping people but after a three year break from the processes and procedures of healthcare, I felt rusty in spots. There's a reason we use phrases like, "a heavy load on your shoulders" or "can't shoulder the load". 

See where I'm going with this?

Pain is almost always a blend of physical and emotional "stress". The question is how much of each? I probably overloaded my shoulder in some way when I resumed training and the "load" of returning to clinical practice found an outlet in perhaps an already weakened area. The shoulder pain showed up around the time I purchased the practice and my resumption of training shortly before that. Hmmm...what do you think?

If I only look at the physical aspect, it will take a long time to get better. Yes, I have impingement, pain with certain movements, weakness in the arm and all of that has to be addressed. And if I'm really honest about it, I don't like it. I just want to get on with training and doing what I want to do when I want to do it. But, that's not reality. I have to do the work. If I only look at the emotional aspect, it will likely take a long time too. I have to face both potential sources and deal with them.

The process works as long as you work the process.

So, if you find your self in this boat along with me, be brave. You can recover and feel good again. But, you have to do the work.

And, by the way, Mr. Williams was released from the hospital two days later with a pair of fully functional legs.

*****

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