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Physical and occupation therapy

Treating Back Pain in Physical and Occupational Therapy Burnout

Ari Ginsberg, PT, DPT, MSIOP

Treating Back Pain and Body Mechanics

Preventing Burnout for Physical and Occupational Therapy is being taught in this course. Back pain is a common ailment in the adult population. People often experience pain after excessive bending or heavy lifting. Some people feel back pain after playing sports or exercising. In many of those cases, back pain could be avoided by using proper body mechanics. Proper body mechanics that are commonly taught by PTs and OTs include:

  • Bending at the knees and not at the back
  • Keeping the object you are lifting close to your body
  • Maintaining a wide base of support – is also important to preventing falls

Sometimes patients experience back pain spontaneously. An individual will wake up one random morning and feel symptoms ranging from feeling slightly achy to being unable to get out of bed. The important question physical and occupational therapists need to ask is where does that spontaneous pain come from? Most physical and occupational therapists naturally gravitate toward an answer tying the source of pain to poor posture. The thought process is, if you sit at your desk with slumped shoulders and a forward protruding head every day, it will catch up to you in the form of neck or back pain. Another common culprit suggested by physical and occupational therapists is sleeping posture and type of mattresses. A PT or OT might ask a patient, do you sleep on a supportive mattress, if not, you will pay the price in the form of back pain. What I have discovered in my experience is that an overlooked source for back pain is psychology. Physical and occupational therapists have been trained to view physical pain as a byproduct of a physical condition, such as; herniated discs, scoliosis, and stenosis.

Dr. Sarno, Stress, and Physical and Occupational Therapy Burnout

Dr. John Sarno was a famous researcher and clinician dedicated to treating chronic and acute physical pain. He authored many books on the topic of pain highlighting his unique approach to pain management. According to Sarno, the human psyche is responsible for a significant amount of the pain we experience. He theorizes that repressed anger and stress often manifest themselves as physical pain including but not limited to; joint pain, back pain, and headaches. The more stressed and anxious a person feels, the more likely it will manifest in physical pain. In fact, studies have demonstrated that if you take a random sample of the population, a significant amount of people will show herniated discs on an MRI scan. However, only a small percentage of those people will express pain. The explanation Sarno offers is that those who are prone to stress and anxiety are the individuals who experience back pain within the population. Those who are not stressed may have the same physical diagnosis of a herniated disc but will have no symptoms. According to Sarno, people who have “Type A” personalities are far more likely to feel back pain than others. He names pain caused by the human psyche, TMS, and Tension Myositis Syndrome. It would follow that job burnout like physical therapy burnout or occupational therapy burnout would contribute to back pain.

Dr. Sarno had an interesting relationship and take on Physical and Occupational Therapy. When he first developed his treatment technique which focused on teaching the patient about the psychological origins of their pain, he would prescribe physical therapy to supplement his treatment system. In fact, Sarno frequently writes about his admiration for the professionalism of the physical and occupational therapists he worked with. However, as time went on, he believed that physical and occupational therapy undermined his whole approach to pain management. His treatment focused on demanding that patients push through the pain and not refrain from normal motions. Sarno believed that patients have to acknowledge that their pain was evoked by stress and anxiety. On the other hand, physical therapy approaches pain as physical in nature and origin, and as a result, suggests that a back pain patient should avoid certain movements. The physical or occupational therapist will probably recommend a lack of BLT:

  • Bending
  • Lifting
  • Twisting

They will also provide treatments and modalities to reduce back pain. Spinal decompression, massage, electrical stimulation, and ultrasound are all examples of ways that PTs and OTs treat back pain. Physical and occupational therapists focus on the pain being physical in nature and tailor their treatments to treat the pain as physical.

My background as a physical therapist with a Master’s degree in psychology gives me a unique perspective on back pain. It is my opinion that some patients’ pain is psychological and others come from poor body mechanics and unhealthy physical motion. One suggestion to best treat patients with back pain would be that physical and occupational therapists should screen patients and analyze their personality types to determine whether or not their pain is primarily physical or psychological. If it is psychological, then refer the patient to a psychologist. If it is physical, then treat the pain as you are trained to treat the pain.

Physical and Occupational Therapy Burnout Webinars

In my physical and occupational therapy burnout webinar, Preventing Burnout in Rehab: For Clinicians and Administrators, I discuss some of the unique causes of physical and occupational therapy burnout. One of them is body breakdown caused by consistently transferring patients, especially patients who are categorized as obese. Also, I mention that I started my career as a pediatric physical therapist and had to get down on my knees to treat the children. I am 6 foot 5 inches tall and squatting every day to treat children definitely resulted in pain. Over time, lifting, bending, and getting down on my knees took a toll on my body, as I am sure it does for other PTs and OTs. Even if you use proper body mechanics, repetitive lifting will inevitably have negative effects on your body.

Treating Back Pain: Physical and Occupational Therapy Burnout Causes

The question I have thought about is: what is more responsible for physical and occupational therapy body breakdown, the physical or psychological? In addition to all the lifting and bending did, there are many emotional reasons for physical and occupational therapy burnout. Emotional dissonance and compassion fatigue are 2 topics I speak about in Preventing Burnout in Rehab: For Clinicians and Administrators that are very relevant to physical and occupational therapy burnout. Therefore, it might be equally as likely that body breakdown and the resulting pain are psychological in nature. Also, higher productivity demands in the current healthcare environment is a significant source of stress amongst physical and occupational therapists. Maybe that stress if somewhat responsible for body breakdown.

What do you think? Is physical and occupational therapy burnout sourced related to body breakdown and pain caused by physical or psychological reasons?

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Let's Get Ethical: Ethical Boundaries for PTs/OTs

A 2.5 hour webinar approved for CEUs by the

AOTA – # 02517 

NY Board of Physical Therapy

The Ohio Physical Therapy Association # 21S2571

The NJ Board of PT # 2110-14

Meets Requirements for PTs/PTAs in:

AL, AR, AZ, CO, CT, DE, FL, GA, ID, IA, IL, KS, KY, MA, MD, ME, MI, MN, MO, MS,

MT, NC, ND, NH, OR, PA, RI, SC, SD, UT, VA, VT, WA, WI, WV, WY

due to recognition of approval from another state chapter of the APTA (Ohio PTA)

or another state board of PT (NY, NJ)

Objectives to facilitate clinician ethical practice

 

1. Define ethics and the Code of Ethics of the APTA/AOTA to practice in an ethical manner

2. Analyze the boundaries of ethical priniciples for PTs/OTs to solve ethical dilemmas

3. Apply APTA ethical principles to professional practice through case studies

4. Apply AOTA ethical principles to professional practice through case studies

A posttest/survey will be give after live and on-demand webinars. After purchasing an on-demand webinar you will be redirected to a webpage with the webinar and posttest links. A CE certificate will be emailed following posttest completion

Optimizing the Patient Experience

A 1 hour webinar approved for CEUs by the

AOTA – #02034

NY Board of Physical Therapy

Pending Approval by the NJ Board of PT – 2022 – 2024

Meets Requirements for PTs/PTAs in:

AL, AR, AZ CO, GA, IA, IL, KS, NC, NE, NH, ND, NM, OR, SC, WA, WI

Objectives related to professional development

1) Identify the components of bedside manner/ patient satisfaction and their link to healthcare outcomes

2) Apply strategies using social psychology to optimize the patient experience

3) Implement an organizational approach to improve patient satisfaction scores

A posttest/survey will be given following live and on-demand webinars. After purchasing the on-demand webinar you will be redirected to a webpage with the webinar and posttest links A CE certificate will be emailed following posttest completion

Improving Patient Adherence to Home Exercise Programs

 1 hour webinar approved for CEUs by the

AOTA – #02036

NY Board of Physical Therapy

The NJ Board of PT # 2111-80

Meets Requirements for PTs/PTAs in:

AL, AR, AZ CO, GA, IA, IL, KS, NC, NE, NH, ND, NM, OR, SC, UT, WA, WI

Objectives to facilitate patient/client goal achievement

1. Identify the benefits of home exercise programs

2) Define differing theories of motivation/influence

3) Apply social psychology to HEP prescription/plan

A posttest/survey will be given following live and on-demand webinars. After purchasing an on-demand webinar you will be redirected to a webpage with the webinar and posttest links. A CE certificate will be emailed following posttest completion

The Science of Bedside Manner and Patient Satisfaction

A 2 hour webinar approved for CEUs by the

AOTA – #02037

NY Board of Physical Therapy

Ohio Physical Therapy Association # 21S2565

The NJ Board of PT # 2110-15

Meets Requirements for PTs/PTAs in:

AL, AR, AZ, CO, CT, DE, FL, GA, ID, IA, IL, KS, KY, MA, MD, ME, MI, MN, MO, MS,

MT, NC, ND, NH, OR, PA, RI, SC, SD, UT, VA, VT, WA, WI, WV, WY

due to recognition of approval from another state chapter of the APTA (Ohio PTA)

or another state board of PT (NJ, NY)

Objectives to facilitate patient/client goal achievement

1. Develop and improve empathy skills

2. Identify the link between bedside manner/patient satisfaction and health outcomes

3. Measure patient satisfaction in a valid/reliable manner

4. Apply social psychology techniques to improve patient satisfaction

5) Integrate organizational strategies to improve patient satisfaction scores

A posttest/survey will be give after live and on-demand webinars. After purchasing an on-demand webinar you will be redirected to a webpage with the webinar and posttest links. A CE certificate will be emailed following posttest completion

Effective Leadership and Communication in Rehab

A 1 hour webinar approved for CEUs by the

AOTA – #02299

NY Board of Physical Therapy

Meets Requirements for PTs/PTAs in:

AL, AR, AZ CO, GA, IA, IL, KS, NC, NE, NH, ND, NM, OR, SC, WA, WI

Objectives related to professional development

 

1. Define leadership and various leadership styles

2. Identify successful leadership styles in healthcare/rehab

3. Implement effective leadership communication strategies in rehab

A posttest/survey will be given after live and on-demand webinars. After purchasing an on-demand webinar you will be redirected to a webpage with the webinar and posttest links. A CE certificate will be emailed following posttest completion

The New World of Rehab: Addressing Burnout

A 1-hour webinar approved for CEUs by the

AOTA – #02035

NY Board of Physical Therapy

Meets Requirements for PTs/PTAs in:

AL, AR, AZ, CO, CT, DE, FL, GA, ID, IA, IL, KS, KY, MA, MD, ME, MI, MN, MO, MS,

MT, NC, ND, NH, OR, RI, SC, SD, UT, VA, VT, WA, WI, WV, WY

due to recognition by another state board of PT (NY)

Objectives related to professional development

 

1. Identify the causes of rehab burnout

2. Recognize the signs of rehab burnout

3. Apply strategies to prevent/reduce rehab burnout

A posttest/survey will be given after live and on-demand webinars. After on-demand purchase you will be redirected to a webpage with the video link/posttest link. A CEU certificate will be emailed following post-test completion