I always give a little inward sigh when a new patient begins with a phrase like "well, when I was 12 I fell on my tailbone..." Unless you are currently under the legal drinking age, or that fall was off a multi-story building, it is very unlikely that such accounts will effect your symptoms and your treatment today.
I get it though. As a patient, it can be very difficult to know which details are significant and which are inconsequential. Why not share every single one you can think of and hope that the important ones stick?
Unfortunately, time is a limited resource for us all. If your elementary school health history takes 5 minutes to tell, you haven't even gotten to your high school track years, and you are coming in for an ankle sprain that happened yesterday on your 40th birthday after one too many cold ones... well we are taking up quite a bit of time here. I've had people show up to their evaluation with binders (yes, plural) of every test and medical visit they have had since the invention of the printer.
It's not that I don't want to hear the intricacies of your life! If I could sit and chat all day, and have endless time to treat, I would! Yet would you even let me? We are a society of busy people. When patients recall every minute detail of their health history, I become increasingly anxious. Again, I love to talk. I love to listen. I just want to make sure that you get every bit of treatment time available to you. I'm sure you want the same! The idea of wasting your time makes me a little damp under the armpits. (gross, sorry)
So what details are important to share? Let me preface this by saying if there is something you feel is important for your physical therapist to know, tell them! Do you love knitting, which is completely unrelated to your knee pain, but you just feel in your bones that your PT should be aware? Share that! Don't let me cramp your style! However, in general, the most important things to tell your physical therapist (or any healthcare provider for that matter) include:
- The duration of your symptoms. How long has this been bothering you? Did it come on gradually over a certain period of time, or did it come on suddenly? Was there a trauma or fall? Have you had it for months or years and it recently worsened? Knowing the duration of your symptoms will help your PT decide which exercises and treatment techniques you will best respond to. A very new injury will respond much differently than an injury that you have been battling on and off over a long period of time.
- The nature of your symptoms. What words would you use to describe your symptoms? Is it constant? Sharp? Dull? Achy? Tingling? Numb? Again, this gives your PT a clue into what structure is causing your issue, such as muscle, nerve, ligament, tendon, and/or joint.
- "Stuff" that makes you better, and "stuff" that makes you worse. When do you really notice your symptoms? Going downstairs? Waking up in the morning? At the end of the day? After a run? When lying on a certain side? It is equally important to note what reduces your symptoms. For example, does ice, heat, medication, rest, stretching, foam rolling, or drinking gallons of goat milk while meditating in a headstand position help? Great! Tell me.
- How do your symptoms progress? The easiest way to explain this one is to use a running analogy: If you have pain with running, does your pain come on after a certain distance? Does your pain get better as you warm up? Does it hurt when you start your run and just get worse as you go? Do you feel fine when you run but notice your symptoms after? These details help your PT assess the severity and stage of your injury.
- What have you already tried, and did it work? Are you currently going to a chiropractor? Have you already been to a physical therapist for this injury? Are you trying exercises prescribed to you by Dr. Google? If so, I need to know these things! It's ok to have a few cooks-in-the-kitchen so to speak, but I need to know who seasoned the soup already otherwise we are going to have an outright salty dinner. Stay with me now.
- History of the same, similar, or related symptoms. I realize how subjective this is. Do you feel like your fall as a 12yr old really did contribute to your current day symptoms? Then spill the beans! If not, go ahead and skip over it. If you have had episodes of similar symptoms, have a history of re-occurring injury on a specific side, or a history of the same type of injury on both sides...you can go ahead and bet that I will want to know. Patterns like this indicate what type of root cause may be contribution to your symptoms. They also help your PT determine the most appropriate intervention to break your cycle of injury.
- Have your hobbies or normal activities changed? Are you unable to run, buckle your seatbelt normally, or put on a bra? Are you unable to grip a coffee cup or shake a hand firmly? These details help set concrete goals and measure your progress. Did it hurt to swim more than 10 minutes originally, but you swam 30 this morning before your shoulder started pestering you? Great! We are not there yet, but we are making objective progress!
- Are you training for anything or would you like to be? If you have your dream race coming up in 2weeks we may approach your situation much differently than if your race is 3 months away and you have just started training. I will always aim to get my patients well as soon as possible, but the best path to doing so differs on a case per case basis.
- Have you had any images (MRI, x-ray, etc) or are you on any notable medications? I can certainly take an educated guess as to what is going on in your joints, but if you already coughed up the money for an image why would I? Share the knowledge! Did you get an x-ray and it came out clean? Great! Now we know you don't have a fracture and can be more aggressive with your exercises. Do you take medications for your heart, lungs, blood pressure, or are you on prescription anti-inflammatories? Do you have asthma? Yeah, I probably need to know all that. If any medication changes the way you are able to exercise or the way you feel your pain/symptoms, I want to know.
- How is your health in general? Do you burn the candle at both ends, or do you get a solid 8 hrs of sleep every night? Are you generally bullet proof, or do you feel like you are always injured and sick? Do you live on a diet or Starbucks, Halloween candy, and wine or are you the same weight as you were in high school, thank-you-very-much?
- Is anything weird. Do you have any radiating pain? Numbness or tingling? Unexpected weakness or dis-coordination? That's totally normal...NOT. You guessed it, I need to know that too. Let's rule out some of the Big Scaries before we just assume that your symptoms are a run of the mill injury.
So let's save the story of your 12yr old fall for a get together at Frothy Monkey. I can tell you a few embarrassing moments from my own childhood. During your treatment time though? I'm focused on you, what's going on with your body, and your recovery. Be a good historian, and help your physical therapist help YOU! Get the treatment you deserve!
Stay thirsty, my friends.