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Therapeutic analogies

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Analogies are a great tool to explain a difficult, complex, or unfamiliar topics.  Much of what we try to communicate to our patients took years of foundational education, scientific inquiry, and clinical training.  Somehow we’re supposed to relay all this information to a patient within a short visit, and we’re attempting to do so with varying levels of background knowledge.  In short, clinical communication is a challenge, and something I’m always trying to improve.  Quality communication improves efficiency and outcomes.  Poor communication creates confusion, nocebo effect, and fosters disability and dependency (see last paragraph, but read the whole post).

I will try to remember to share more of the analogies I use, in hopes others will post theirs as well.  All analogies inherently have flaws, but if we can communicate concepts quickly and efficiently our patients and athlete’s will benefit.

Today’s therapeutic analogy:

“Your leg is the scoreboard and your back is the crowd noise.  We need to stay focused on the score, as this is a game we can win.”

After this analogy, the patient’s facial expression revealed immediate comprehension and understanding.  The path to victory was clear.  Other times I’ve spent longer than I care to admit struggling to communicate this idea.

Trying to explain centralization phenomenon to a patient can be a challenge.  Particularly when local pain gets worse and tinging/numbness in the extremity improves (ex.  back pain intensifies, but leg numbness resolves).  Numerous times patients tell me they can live with the numbness they just need the pain to go away.  Our pain centric ideas often get this one backward.  The extremity symptoms need to be resolved — a concept well taught in MDT (McKenzie) training.

Focus on what is important.

Ignore the distractions.


Summer Reading List

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Every now and then I compile the books that I’ve recently read from around my house and bring them to the office for careful storage and future reference.  For those looking to add to their summer reading list, here’s some highlights that may be interesting. 

  1. The Brain That Changes Itself Norman Doidge, M.D.

    A great read.  Sharp examples of neuroplasticity and a quality discussion of the early discoveries combined with explanation of why it took so long to catch on.

  2. Predictably Irrational Dan Ariely

    Of similar topic: Also enjoyed How We Decide, Why We Make Mistakes, and the most research-anchored of them Thinking Fast & Slow.
    For those who are offering advice, prescribing self-care and wondering why some people make a quality decision and others don’t these books were insightful.

  3. How Children Succeed: Grit, Curiosity, and the Hidden Power of Character Paul Tough

    One of many along the talent lines from Coyle’s Talent Code and Colvin’s Talent is Overrated.  This one took an interesting perspective, but perhaps is limited in its scope like so many in this category; the Sports Gene and The Rise of Superman offer a different perspective and are really enjoyable for anyone who’s read one or more of the above.

  4.  The Body Bears the Burden Robert Scaer, M.D.

    I found this one a bit slow to read, but the subject matter is worth digesting.

  5.  Talent Identification and Development in Sport   Edited by: Joseph Baker, Steve Cobley and Jorg Shorer

    Also Developing Sport Expertise

  6.  The Sports Gene: Inside the Science of Extraordinary Athletic Performance David Epstein

    I opened this one expecting to disagree with some of its content, based on the title.  I was pleasantly surprised to find one of the most honest assessments of what we know, what we think, and what we don’t know on the topic of elite performance.  From the role of genetics, LTAD, and societal implications, it was truly a balanced offering on this subject.
    online review:  Mr. Epstein provides a careful and nuanced discussion of how nature, nurture and sports interact.  (I couldn’t have said it better.)

  7. The Rise of Superman: Decoding the Science of Ultimate Human Performance Steven Kotler

    Perhaps I started reading it just because it said Superman in the title, but this one was great.  It was a bit slow to read, but I think this was more due to my schedule than the writing style or content.  It unapologetically challenged many of the held beliefs from other talent and performance books, acknowledging that genes, parents, financial reward, etc do play a role in peak performance and accomplishment, but the fail to explain much of the explosion in alternative sports.  It offers a Flow perspective and uses this as a possible basis for these groundbreaking and barrier shattering performances.

  8.  Clinical Rehabilitation  Dr. Pavel Kolar

    An english version of a prior publication.  The book offered some unique information along with some general review of quality clinical rehabilitation.  It is short of a DNS laiden textbook that so many are in search of to fill in the gaps in our understanding, but it is a great resource.  Book preview…
    Also the DNS posters have been great communication tools for patients.

  9. Why Do I Hurt: A Patient Book about the Neuroscience of Pain Adriaan Louw PT, PhD, M.App.Sc

    Along the same lines as Explain Pain, but I’ve found this one to be more concise and approachable for patients than the abstractness of Explain Pain.  The straightforward wording and imagery has made this one a useful tool.  Thanks to BSMPG for introducing me to Louw’s work.

  10. Inner Fish  by Neil Shubin

    A unique look at the anatomy of evolution.

 

 





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