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Pain in the Neck | notes from a neck pain clinic I heard some wonderful opening lines waft through the thin cubicle curtains (as if privacy were just a visual thing) in my time as an NHS physiotherapist, but nothing beats the pain of 'Shall we share a story?' - an intrusive frown to boot I bet - delivered by an eager early adopter of the psychosocial aspects of our work, back in the late nineties. But where and how should we begin our sessions - and does it matter? Is it possible that the first words of the session carry greater import than we care to acknowledge? And do our initial muttered utterances have implications for the trajectory of the entire 'therapy'? Roberts and Langridge (2018) have recently noted that surprisingly little attention has been given in the literature on how 'best' to open the clinical encounter, but one study does at least shed some light on the variety and preferred 'openings' that physiotherapists use. Chester et al (2014) audio-recorded 42 initial consultations (and 17 first follow-up encounters - but we won't be discussing those here, interesting though they are) between qualified physiotherapists and individuals with back pain, in an adult musculoskeletal, primary care outpatient setting. Eleven different opening questions were identified which were then used to determine clinicians' preferences in a national survey from a broad range of physiotherapy professional networks (Sports Medicine, Orthopaedics, Massage and Soft Tissue Therapy, and Pain Management). A selection of the openings used by physiotherapists from Chester et al (2014). The preferred opening question for an initial encounter among the physiotherapists who responded was: 'Do you want to just tell me a little bit about your problem first of all?' Although the survey response in this study was small, the paper apparently generated much debate. I don't know about you but some of these opening phrases sit rather awkwardly with me: talk of a 'bit of a chat' and 'a little bit about your problem' are hardly suggestive of a forthcoming expansive discussion. Personally, I tend towards usually opening with a 'so what's the story?' and then sitting in silence until the narrative has run dry, before engaging with the conversation. Doctor and writer John Launer has also discussed openings in his wonderful book 'Narrative-Based Practice in Health and Social Care' (2018). He suggests there is no reason to avoid one of the conventional questions, such as 'How can I help you?' but does counsel against the use of formulations such as 'What's the problem?' arguing that this 'already closes down possibilities - for example there may not be a problem or there may be several'. He also notes that trained mentors and coaches often start meetings with the question: 'What are you hoping to get out of our conversation today?' Asking this can save a lot of time that might otherwise be spent barking up the wrong tree, and the answer is often quite unexpected, he notes (Launer 2014). In another fascinating piece - 'The Three Second Consultation' - Launer (2009) spends over an hour reviewing the first three seconds of a recorded consultation - concluding that the best conversations, whether social or professional, are unconstrained by any prior expectations of where they ought to go. Rita Charon - in her book 'Narrative Based Medicine' - describes using 'tell me what you think I should know about your situation' followed by 'a commitment to listen and not to write or speak'. Charon describes how foregoing the urge to order the narrative leads to her absorbing what is being said without ' deranging the narratives into my own form of story.' She describes listening 'as hard as I can.' Indeed Charon cites work suggesting that warmth and intimacy between clinician and patient tend not to build over time, but achieve whatever level they will achieve at the first meeting. And what do we do after the initial response to our opener? According to Roberts & Langridge (2018) physiotherapists interrupt the patient whilst they are answering the opening question in 60% of cases! Marvel et al (1999) found nearly half of patients were interrupted whilst describing their problem and - wait for it - patients were given on average just 23.1 seconds to describe their problem before being interrupted. But how long does it take a person to describe their problem? Langewitz et al. (2002) reported that people will take on average 92 seconds to explain their problem in an outpatient setting (if they are not interrupted!). Peter O'Sullivan has discussed the benefits of staying silent after his initial opener of 'tell me your story'. He says 'everyone who comes to me has a story. Usually in that first minute you'll hear something really important about their story - if you just don't say anything - and that will lead you down a path.' (Pain Reframed Podcast 2017). So, whatever opener you decide upon - hush and hold thy tongue dear clinician and LISTEN AS HARD AS YOU CAN! References Charon, R 2006 Narrative Medicine: Honoring the Stories of Illness Chester, E.C., Robinson, N.C., Roberts, L.C., 2014. Opening clinical encounters in an adult musculoskeletal setting. Man Ther, 19, 306-10 Langewitz, W., Denz, M., Keller, A., Kiss, A., Rütimann, S., Wössmer, B., 2002. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. , 325 (7366), 682-3. Launer J (2009) 'The Three Second Consultation' Postgrad Med J 2009;85:560 Launer J (2014)'Good Questions' Postgrad Med J 2014;90:121–122 Marvel, M.K., Epstein, R.M., Flowers, K., Beckmanm H.B., 1999. Soliciting the patient's agenda: have we improved? JAMA., 281 (3), 283-7. Pain Reframed Podcast 'Caring Deeply and Dropping Your Ego' Dr. Tim Flynn and Dr. Jeff Moore with Dr. Peter O'Sullivan Roberts, L. and Langridge, N. (2018) Principles of communication and its application to clinical reasoning. In, Petty, N.J. and Barnard, K.(eds.) Principles of musculoskeletal treatment and management: a handbook for therapists: a handbook for therapists. (Physiotherapy Essentials) 3rd ed. Edinburgh. Elsevier, pp. 209-233. If you are interested in learning more about Narrative-Based Practice in Health Care, John Launer and colleagues are running a three day workshop at the University of Hertfordshire, UK in Summer 2019. Further details here: Conversations Inviting Change
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Home - Zen Japanese Massage Hi! I''m Jack, a Tokyo trained, licensed and qualified massage therapist and physiotherapist. Wanting to share my authentic massage techniques with Australians, I am now also the proud owner of Zen Japanese Massage, Sydney''s premier Japanese massage experience. As a firm believer in the power of manual therapy, our aim here at Zen Japanese Massage is to rectify your physical ailments with the use of hands on techniques, which as studies show, can evaluate your individual condition unlike machine operated physio devices. Due to that fact, remedial massage can help tailor make the most suitable short term or long term treatment specifically for you. With that in mind, we choose to hire only the most skilful therapists based on the quality of their work as Zen understands our clientele desire more than a fleeting ''moment of relief''; they genuinely crave alleviation of pain. In true accordance with our strict Japanese traditions, we call for nothing short of perfection. To support that claim, our team of therapists are all extremely professional, having worked as professional massage therapists in Australia and Japan for a combined total of 53 years experience. Striving to stay ahead of competitors and wanting to continually improve the quality of our own massages, we here at Zen are always eager to achieve higher techniques and better solutions for you. Thank you. We very much look forward to helping you find the physical peace you deserve.
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Home Hi, my name is Sanna Lee Solem, Oregon LMT#17613 & I help people experience profound changes in their bodies & lives through the healing touch of bodywork & massage. My practice of Soma 10-Series Structural Integration (Rolfing tradition), Fascial Stretch Therapy & Cranial Sacral Bodywork, gives me a powerful, effective & integrative approach to bodywork & massage ~ from transformative structural/deep tissue work, to dynamic tractioned stretching, to gentle, clarifying energetic work. I consider bodywork & massage an art form as well as health & wellness care. I utilize the highest quality paraben-free vegan lotions & pure essential oils in my practice because the body is sacred & plants have healing medicine for us. My highest intention is to hold welcoming, honoring space & create a therapeutic, blissful & transformative experience for every client. Limited or decreased mobility, Anxiety, headaches, depression, Auto Injury Chronic pain, Spinal compression or curvature, Improve Posture, balance, confidence & flexibility, Surgical preparation & recovery, Pre&Post Natal wellness Relaxation, rejuvenation, personal growth, transformation Working in Lake Oswego, West Linn & Milwaukie, Oregon since 2009... My clients are all ages, shapes & sizes - from women with significant scoliosis who want to keep their spines as healthy as possible, to elders improving posture & balance, to runners, bikers, computer workers, spa-savvy ladies, patients preparing for or recovering from surgery, golfers or others passionate about their sport wanting to sharpen their game, people recovering from auto accidents & anyone who needs some simple relaxation & rejuvenation. Working collaboratively with each client, I treat chronic neck & back pain, carpal tunnel, headaches, joint pain, TMJ, numbness in arms, scoliosis, plantar faciitis, anxiety & depression, sports/auto injuries. Additional benefits & outcomes include improved athletic performance, increased energy, less tension, better balance, greater clarity, focus & vitality.