DOCTOR PADDLE – Biomechanical Pain

DOCTOR PADDLE – Many years ago, I was following an appointment at the athletics track of an athlete, performed by a physiotherapist friend. Her coach appeared, at the Brazilian national team level and asked what happened. The athlete replied that she had been in pain for a while and asked the physical therapist to evaluate it. And he said to her:

– Girl, pain is your best friend. If you have pain, you have a problem and if you have a problem, you have to treat it.

My uncle has lived in the US for many years. One of the few times he came to Brazil, he asked to do Shiatsu on him. Finishing up, he said that I should go there, I would only get rich in the building where he works, he liked it a lot. He said that the American people, pay not to get sick, have to work and produce, they are right. Brazilians, on the other hand, pay to be treated and it doesn’t matter how much.

The first thing we do when we have pain is to do radiological exams. This is normal, as a matter of course. The fact is when the exam does not match the problem or does not justify the reason for the pain. This happens a lot, more than you can imagine.

We are used to the nosological diagnosis, which is based on tests according to the symptomatology and they tell you a name, usually ending in pain. Physiotherapy works with the functional diagnosis, which is also based on the radiological examination, plus the symptomatology, palpation, postural assessment, gait, postural vices, daily life, repeated movements, work activity, the use of shoes, the ergonomics of the workstation and a few more. With all these signs, symptoms and information, we perform the functional diagnosis, which will show the reason and origin of the pain and/or injury.

In my clinical practice, it is much more complicated, I am more focused on emergency pain care, using oriental resources: acupuncture, shiatsu, cupping with bloodletting, moxibustion and spinal adjustment. Often, patients do not have radiological examinations, have not had time to do them or have forgotten them at home or are too old. I have to assess the possible sites, the likely changes and injuries, and resolve the patient’s pain, so I can at least go home and sleep. This is my choice of acting and working.

Regardless of whether it’s an emergency or not, many patients come to Physiotherapy, after a long journey of radiological exams and with bags of medicines. Some of these medicines, helped to find the lost village of the Smurfs (couldn’t miss the joke).

Functional diagnosis is taught at the Faculty of Physiotherapy and extensively explained in specialization courses. Each resource or therapeutic technique has a way and a way of evaluating and also showing different views of the problems. This is really cool. In congresses, courses, in Whatsapp groups and in everyday conversations, we change figures and build the patient’s functional clinical reasoning.

I took the patient out of the pain crisis, which is very high and interferes with daily life and quality of life, another stage of treatment begins. Knowing that you have functional dysfunctions, I refer you to making an insole, for postural assessment, for functional kinetic assessment (assessing posture, shortening and muscle strength and joint limitation), pilates (focusing on stretching) and depending on the case and the problem for osteopathy or chiropractic are adjustments I can’t make.

Finally, I really like to tell my patients and students: wrong diagnosis, wrong treatment.

Happy paddling guys!!!

Fabiano Bartmann
Physiotherapist
Professional in Physical Education
Master in Biosciences and Rehabilitation
Member of the Rabbit SUP team

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