What is a muscle?

The other day I was explaining pathology to a patient in the outpatient clinic and she interrupted me to ask, "What is a muscle?" I am not trying to be funny - such questions are not all that uncommon in my everyday clinical practice. (And YES, I know how to properly pronounce "muscle" in Spanish!) Lack of financial or transportation resources affect my patient care and progress, but a generalized lack of education is another key challenge I face in my work here. Thus, patient education begins at a very basic level.

In addition, the concept of going to the gym or working out to promote health or lose weight is especially foreign in my community. My patients associate all muscle soreness (following exercises) with a worsening of their condition. Many have a pre-conceived notion that PT will be a long massage followed by the application of a machine or two, which is what PT services often consist of here. Imagine their surprise when I introduce concepts like manual therapy, functional training, and home exercise programs into their plan of care!

 

The outpatient care can be quite frustrating, because in general Peruvians treat their health in “responsive” mode and are not proactive or engaged in preventative care. If they have unbearable pain, they come in, but the moment it starts to go down, they tend to stop coming- generally citing that they can’t afford it. It's common to have a patient suddenly stop coming, but then they’ll randomly stop by weeks or months later asking for a session! Of course, this doesn’t happen with everyone, and the patients who are better off financially rarely miss a visit.

At first I worried it was my “unconventional” therapy techniques – but I’ve had a lot of feedback from patients and their doctors, and colleagues at the clinic insist that it’s a cultural thing- this is normal. The expectations for all types of medical care seem to be "one-stop shopping" - a quick fix. Thus, it’s hard to gauge success and it turns into a chronic pain cycle for many patients, because they only ever reach the point of a semi-functional status. “Make every visit count – who knows when I will see this patient again!” seems to be my motto. Hence, I spend a good amount of time on patient education and ensuring a good home exercise plan basis.

The mind-body connection is very noticeable in my outpatient care experiences. Depression and stress are common, and life is hard for the people of La Esperanza – it’s written all over their faces. Many of my patients confide all sorts of things in me, and I really get to know their stories and their lives. Sadly, many stories involve physical abuse, insurmountable health co-morbidities, death in the family, etc. For most, injury = no work = no food for the family, so you can imagine the psychological impact this can have on one's well-being. It seems that simply by providing an empathetic listening ear, many are already 50% better physically by the end of the session. I’ve also had some unusually rapid successes with certain patients after just one session of manual therapy – there’s definitely something to be said about the power of human contact!