Why Symptom Chasing is a Dead End in Physical Therapy - Episode 30

The Marrón Pelvic Health Podcast episode, hosted by Dr. Kari Roberts, explains the comprehensive process for treating complex pelvic symptoms. Dr. Roberts describes phase-driven strategies that prioritize the root causes of pelvic discomfort, such as pelvic floor issues, before addressing secondary symptoms. This method prevents scattered efforts and ensures focused, measurable progress is made without giving in to symptom chasing. By clearly defining treatment plans and engaging the patient in the process, she advocates for setting realistic therapy goals to achieve sustained improvements. The podcast invites listeners to seek professional help if they're facing chronic pelvic issues.

• Episode Transcript

  Dr. Kari: Welcome to the Marron Pelvic Health Podcast. Hi, I'm your host, Dr. Carrie Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education,

  personal experiences, and a blend of tips you can apply to have a healthier pelvis. The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence.

  And today I wanted to talk about what my treatment philosophy is with patients that have more involved cases.

  I want to say difficult, because I feel like difficult patients are not difficult.

  Well, wait a minute.

  Patients can be very difficult, but I will call patients difficult based more off of their personalities more so than their diagnoses and their conglomerate of symptoms.

  Now, when patients are more involved with their symptom presentation, let's just say, and they've got a lot going on,

  there can be like, you don't know which way to go. Which is probably why, if you're the patient, you decided to seek some professional help.

  Now, as the provider,

  sometimes we may be like,

  we may not know which way to go first. I'll say that first. A lot of times we know what to do. We just don't always know which order we need to go.

  But we rely on our clinical reasoning skills. There's always a method to the madness.

  We rely on clinical reasoning skills. We might rely on experience. We might rely on things that worked for another patient, something that we picked up from a colleague, something we learned from a mentor,

  something we read in a book or we learned in class. Either way, there is usually always a specific reason why we did what we did in that particular order.

  So let's just keep it very simple for the sake of getting through this conversation.

  Let's say you have back pain with your pelvic pain and hip pain. Which are we going to do first?

  Let's say for you we're going to do,

  we're going to resolve your back pain first because the back pain ends up being the main cause for your pelvic pain.

  And that's what we're going to go with. Okay. And then the hip pain is just a tertiary issue.

  Now, one thing,

  the way that I treat patients when you come in to see me at Maron Public Health is I do a comprehensive assessment. I actually follow a four phase process to walk my patients through what they're, how they're going to be treated.

  I walk them through a four phase process. The first phase is the discovery phase.

  And I usually tell them that the first phase is usually broken up into the first couple of visits, and I usually break the eval up into the first couple of visits because I want to save time to send you home with something,

  whether it's a homework assignment, an exercise,

  a log to fill out. I usually send you home with something so you can bring back more information, report it back to me so then I have more information, more data as I finish the assessment on your second visit and really fine tune what I think your root cause is.

  But that's how I do things here at Marron Pelvic Health.

  But once we get through that, you go home with an action plan. And on the action plan, it's very simple. It's a list of the things that I found.

  It's a list of your goals and what the plan is as far as the frequency and the duration that we're going to start off with.

  Now,

  we could find a ton of things, but there's only three things listed for the things that we find. And I do that on purpose so that it helps you, the client, know.

  Fine tuning this helps me stay focused, too, as the provider.

  Now, you might come in with, I might say, okay, you've got pelvic pain, you've got back pain, and you got this head pain. We might have found something that's going on with your big toe.

  You've got an old shoulder injury,

  you might have had a concussion and from an old car accident. And all of those things might be playing a part,

  but we've got to have some sort of focus. So we're like, okay, we're zeroing in on what's going on with the pelvis, low back and then the hip.

  As we're talking through that, on your initial assessment, I am looking to you for physical cues and verbal cues that you are in agreement with what we decide the plan is going to be.

  Okay.

  Once we decide these are the three things that we're working on,

  then I will tell you.

  I think we should start at the pelvic floor for these reasons,

  whatever the reasons are. Okay, let's say for this example, I think we should start at the pelvic floor because your pelvic floor muscles are overactive and they are very short, and they just don't have the flexibility that they need and they're causing a lot of pain.

  Okay.

  I think we've got to get these more flexible and not be so overactive so that we can calm down some of the tension before we move on to the back.

  Okay. That's what we're going to do.

  That's the plan we're sticking to now.

  You might come in three weeks from now and say, carrie, my back is killing. Did you forget about my back? Because that's usually what. Did you forget about my back?

  Did you forget about my hip?

  No, I did not. Thank you for telling me. Thank you for keeping me abreast of what's going on in your body.

  And I. And I like to tell people,

  you are the expert of what you feel in the body that you live in. No one else knows that but you. No one can tell you how you feel or how you don't feel.

  So thank you for continuing to give me that information.

  I appreciate it, and I'm glad that the symptoms are the same and they have not changed, they have not gotten worse. That is a good thing.

  However,

  we need to focus on this, because if I jump ship and go to treating your low back, but I think the root cause is the activity in your pelvic floor, and I don't see that to the end.

  And I just go in your low back,

  and then you come in two weeks later. Remember that hip? My hip was bothering me. And I jump ship from your lower back, and I go to your hip.

  And then you come in in two weeks. You know what you're gonna say.

  Remember that pelvic pain, it's not any better.

  So now, instead of eight weeks of focusing the root cause and really getting that under control and functioning properly first before we move on, what's happened is we've done four weeks at one thing, two weeks at something else, and two weeks at something else.

  And in the moment,

  the patient might feel validated and gratified because it seems like I'm listening to you. It seems like I'm doing what you ask,

  but in actuality, we're not really moving the needle forward because we're not really following any real plan.

  And when that happens,

  in the rehab world, we call that symptom chasing.

  And when we symptom chase, what ends up happening is we're never really making any ground. And ultimately,

  as an effort that we're changing the plan or we're taking a detour in an effort to make the patient happy and to appease them in the long run, what we're doing is we're just frustrating the patient because now we've done eight visits, and now nothing is better.

  You know, we did four visits on the floor, on the pelvic floor. We did two visits on the back, and we did two visits on the hip,

  and everything's marginally better when we could have done all eight. Focusing on the pelvic floor, getting those muscles to relax, getting that range of motion to really engage. Before we moved on to the layered.

  Layered in the next thing.

  So I just wanted to talk through that because sometimes when people are in physical therapy, it can seem like the therapist is just doing what they want to do because they just want to do things on their terms.

  Now, granted, we are very type A and we can be very opinionated. And sometimes that happens. And if that happens, go ahead and call your therapist out or ask if it feels like that's happening.

  There's no harm in asking at all.

  But a lot of times what's happening is we are just trying to steer that boat and we are trying to see that course to the end.

  So then that way at the end of that six weeks or the end of the eight weeks, you've got some good progress and you've made some really good changes. That body has responded to the plan.

  So when we layer on to the next thing,

  pelvic floor is done. Check.

  That is no longer an issue. So now when we switch over to the low back, the low back is going to be easier to to tackle because the pelvic floor is not an issue.

  And now we're just fine tuning the low back. Maybe because we know the pelvic floor impacts the lower back, we're fine tuning that a little bit. Get that under control.

  Maybe two or three visits. Okay, now that's under control. We're seven visits in.

  Now we can switch gears and see what's going on with the hip. We might not even need to do the hip for that many visits because the pelvic floor is already dialed in.

  The low back is dialed in. We might need to just tweak a little bit, do some behavior modifications or what have you for the hip. And see, that's where it comes in, where we are being very methodic and very systematic.

  So it might seem in the moment that we're not listening to you, or might seem in the moment that we're not taking in what you're saying. But we really are.

  We're just trying to follow the course that we believe is the best course, that when it's all said and done, we all of you, feels better and we are really following this whole plan.

  Instead of symptom chasing from one symptom to the next, Every time you come in, something different hurts. We change your plan in the moment you feel like you've been heard in the long run, nothing's gotten done.

  So hopefully talking through that process of what we're doing,

  when we're seeing you for a long time in physical therapy, hopefully that kind of sheds a light into what we're thinking with that.

  If you have never been to physical therapy and you're like, whoa, we didn't know so much goes into it, or I've got a pelvic floor issue and a chronic low back thing,

  maybe it's time to pick up the phone. Maybe it's time to send a text message. So go ahead and reach out to me. I would love to help you. 770-626-0050 and I would love to reach out to you and see what I can do to help you.

  If it's not me, then I would love to be able to get you in contact with the person.

  I will be back in a couple weeks with another episode and until then, stay safe and I'll talk to you soon.

  Thank you for listening to this episode of the Marron Pelvic Health Podcast.

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