Communicating With Physical Therapist About Trauma Issues

[greenleaf]

Does anyone have ideas and/or experience in communicating with physical therapists or similar folks about trauma-related issues, especially when dissociation sorts of issues might be slowing down one's ability to relax and make "normal" progress?

I have been working with a great person and find it very helpful in both continuing to function at times but also can feel a lot more of my back and neck muscles... However I am worried that either she, the insurance company, or whoever might stop the treatments because it's so slow.

I have a habit of reading things from peoples' facial expressions and making catastrophic conclusions though, then have to catch myself... but I feel confused after lots of doing that, what is the reality...? Yes, I know, I'm supposed to ask the person, but what if the person isn't a regular T and maybe isn't supposed to cross into the "psychology" stuff per legal issues?

I've been in the PT work for about 2 years; I had really awful posture, muscle knots that just recur... I have also been getting massages which has helped a lot in feeling safe with feeling the muscles.

The DSM-V addition to PTSD for dissociative stuff is so new that I suspect many medical people here in the U.S. still haven't heard of it, unlike parts of Europe... In spite of the dissociative stuff being really common for those of us with long-term childhood trauma a lot of us just hid it or I guess our therapists thought we were "treatment resistant" or whatever.

I'm thinking of printing out some of those studies showing the differences in brain changes between "regular" PTSD and the dissociative PTSD subtype(s) for the PT.

If you're working with people who are professionally supposed to be working with physical -- not psychological -- issues, where is the boundary given that our brains are physical and have been affected/damaged/whatever?

Wouldn't they feel ok working with someone who'd had a brain injury from a baseball bat? If ours was from repeated threats with the same bat but we have neurological/structural brain changes from the experience, not the bat, somehow it's different...?

Some background on my issues...

My sense is that some of the muscle problems causing my joint problems is from tension from childhood stuff that I'm just very slowly starting to deal with in regular therapy. I am not really aware of how tense I am a lot of the time though I think I'm making progress. I exercise regularly which has helped my body not fall apart totally. :-)

I only got a therapists who really "gets" dissociative parts (like DDNOS probably) last year in spite of 25 years in therapy... the others helped with lots of stuff, I function well in a lot of ways, but I think the dissociation kept lots of other stuff from being treatable. I consciously thought I was really trying to heal all that time. It's like some traumatized "parts" would just vanish in therapy sessions but I never thought of them as parts, I would just feel differently different times but various fears/stress/(derealization?) just kept coming back -- so I'm really glad for the new "structural dissociation" model, very helpful mentally. I have been sort of partly in "derealization" chronically most of my life I think, it's just normal, the "really being here" feeling was the weird feeling for me. As I understand it from some new studies, that might mean my brain functions abnormally but there's no test for most of us.

So, how to describe/communicate this mess to a professional who has neurological/physical training but who maybe our culture's separation of physical from psychological has affected... sorry for the bad sentence structure.

 

[Friday]

My god brother is a PT. I had no idea the depth and level of education that goes into that job (masters degree at a minimum)... Which is kind of stupid, since I've been in and out of physical therapy since I was 11.

About 1/5th of his education was in psych, since psych issues follow injuries, and in order to deal with injuries a good PT has to be half psychologist.

My god brother has actually given me a lot of tips/tricks on how to manage disassociation & other trauma related psych stuff. I never, in a million years, would have thought of him as a resource. Even knowing that he did his internship at Walter Reed. He caught me grounding at a family wedding 2 years ago, and was like; "Hey girl! That would work better if you drummed your fingers on the table or your leg instead of clenching your fists. Better yet, come dance with me, yeah? Get your whole body moving for a minute." My god brother is the shit. ((Technically I've never told anyone in my family I have PTSD. Including him.)) He's also the one who noticed a habit I had no idea I did... When I'm faking normal, but freaking out, I do this thing with my hands... That if I do it on purpose is actually calming.

Rather than assuming ignorance, and printing out a bunch of info... I would test the waters. Ask how much she knows about trauma related stuff, or trauma related disassociation. You might be surprised.

& if she doesn't? Then that's perfect priming the pump to tell her you've been studying it lately, and thinking about how it's relating to your physical therapy, and offer to bring in some info your next visit.

 

[jaccat]

I agree. I think anybody who's done more than a little work in that field must have realised that a lot of physical injuries are wrapped up with pyschological stuff. I see a massage therapist and a chiropracter for the same reasons and my recovery is slow. I have told my massage therapist just enough to let her know that there's a reason I don't relax easy. Enough, but not too much. Mostly she got it out of me by asking the right questions and that was that. I doubt very much that I'm the first person she's dealt with whose muscle tension is caused more by what's going on in their head than what's going on in their life.

 

[scout86]

I also agree. I've seen several PT's over the years. (Kind of goes with wrestling large animals for a living.) NONE of them saw the body and mind as separate things. They seem to get the connectedness way better than regular doctors. The woman I've been working with lately probably had a feeling I had some challenges before I said anything. She was recommended by my T, who says she's a magician. (She's actually even better than that.) She knows enough of my background to know to how to get along (which isn't much), but she deals with a lot of people who've had some kind of trauma. I'd say bring up your concerns, in any way you're comfortable with and see where the conversation goes. You'll probably be pleasantly surprised.

 

[City Slicker]

I recently started to see a sports physiotherapist. The first session, you get this big questionnaire to fill out in the waiting room. Since I wasn't sure I was staying with this p/t I didn't answer any of the questions that I felt were related to mental health.

When we were face to face she said, 'I notice there are some questions you didn't answer'. I replied that those questions crossed a personal comfort line and were quite private and until I understood why they were being asked I would leave them blank. She said, 'fair enough'.

During that first session I told her I was a trauma survivor, both physical and psychological, and that I believed my body and brain had adapted in ways that were trauma related. I stated it as a matter of fact, not something to be open for discussion. I asked her if she dealt with a lot of trauma - she said gently, 'that's all I deal with'.

That's all we really needed to discuss. I stayed. I don't describe, explain or go into the trauma at all.

Sometimes she will ask for specific details as she works on an area. I know she is only asking for the 'physics' of the injury so that she can ensure she knows enough of the history to treat the area properly. She isn't asking that I tell her 'the story' - she only needs the details of the injury itself.

However, I ask her a lot of questions about what she feels specifically in my physiology when she is manipulating my neck or spine and she tells me what she feels - i.e., she'll say, 'I can feel this tendon right here - this area is inflamed' or something - and she will make suggestions on how I can best treat the area - and then I go away and research the hell out it.

Best wishes on your journey.

 

[Seasounds]

I, too, have been disappointed by the lack of comfort that many professionals have with PTSD. Whether a PT, MD, Psychologist, or Psychiatrist, I've found that it depends on the individual's comfort with the topic.

If the professional isn't comfortable with trauma, they usually tighten, then I tighten and start to disassociate. Not good. Since I can't change anyone, I move on to find someone who can stay in their easeful coordination, while I bring up related abuse issues.

So many professionals are so left-brained, logical minded, that they have a really hard time relating to an emotionally charged topic, like trauma. And early childhood trauma is even more difficult.

There are some professionals who are forewarned to not validate early childhood abuse because it makes them vulnerable to be involved in lawsuits. And, I've had had professionals who told me that telling them about my abuse was "invasive" to them, since it was unexpected, and since they didn't know how to process it, as a professional.

In the end, I look for professionals who can be empathetic when I speak about abuse. Currently, Alexander Techinique Teacher, and Physical Therapist are best able to 'be with' any related traumas that may surface in our work.

 

[The Albatross]

Not PT, but my chiropractor has a sister with PTSD... he and his group have been very accommodating and recognize the nuances and adjust accordingly. I have also had other though more obscure professionals help me to deal with this... cranio sacral, acupuncture, rolfing, etc. I only seem to choke up with M.D.s now and hesitate or decline to share... but with others, no problem. No problem and I've received a lot of acceptance, understanding and compassion.

 

[Chava]

So, how to describe/communicate this mess to a professional who has neurological/physical training but who maybe our culture's separation of physical from psychological has affected

If you are at a point where it would help to have them know, I'd find a simple way to say it...I assume even most PTs understand trauma to some extent since they are working with bodies all day, and traumatized people do have a lot of similar postures and tension patterns. You might just mention that you have PTSD and that for you part of your early trauma makes it hard for you to sense your own body or feel okay in your body (or something like this, explaining your body experience in simple terms)...so it takes longer to process new body info and stay connected, etc.

I've quit PT for some of these reasons. I'd make progress to a point and then feel like I was really left with a posture or tension pattern that I was honestly not ready to give up. So doing exercises, or having someone do some kind of manipulation of my back, became pointless. If you aren't making progress or feel like you are resisting on a psych level, it's okay to take a break. But maybe finding a way to explain it will help you move slower or in a slightly different direction.

For me Alexander Technique was a little more helpful because those people are a little more clued into movement patterns and what they mean. I actually learned that it's okay for me to curl in and enjoy my horrid posture. The important thing was that I learned I had choices. I experienced my more supported posture and can use that when I feel safe and okay. But I can allow myself to crawl into a tiny shell if needed. I also don't have to fix my pain. It's mindset stuff that has helped me actually feel less pain intolerant. Not sure if I'm making sense though...

I do get the connection and if you have a PT you like and trust, it's probably worth finding a way to bring up. It is important to learn that you have other options, but not feel like you have to push your body to places you cannot consistently go...

 

[greenleaf]

Thanks everyone for the great replies; I didn't realize that PTs get a lot of psychology training.

In this case I think that they might have had more training with the type of PTSD with lots of flashbacks etc. from an adult trauma, but possibly not much with what would now be called the "dissociative subtype". (Not that anyone's is the same within any category anyhow but...) The dissociative subtype research seems pretty new in terms of general acceptance; the fMRI studies may be helping a lot since the brain activation patterns are almost opposite. It seems like even among therapists, understanding of (or even belief in) people with ptsd and dissociation issues has been very slow in the U.S. It's not like they didn't see dissociation I guess, but that they didn't understand how it interferes with "normal" treatments.

The latter bit is my worry with, not just the PT, but the insurance company... I am worried that I'm too slow and I'll go over their "normal treatment length" and lose treatment... I really only started to work on dissociation stuff last year, and the muscle stuff feels involved with that.

Not necessarily much evidence for my worries, just a little and hints, but I'm good at expecting people to act the way they did when I was a kid. It's a skill I have. :rolleyes: Yes, maybe I should ask more directly, but why take that risk when I can just expect the worst? It's more efficient!:rolleyes::rolleyes:

I am thinking I will take in a couple of studies with long words about brain parts and dissociation, they can always just recycle them...

 

[Chava]

Not necessarily much evidence for my worries, just a little and hints

I am thinking I will take in a couple of studies with long words about brain parts and dissociation

I guess I'm not sure why you feel like you need scientific evidence or long words to explain your experience. In some ways, that reads as if you don't trust your reality enough all by itself...if that makes sense. Do you think that will justify it to your PT or do you trust your PT to advocate for you if you give them a little more of your background? I wouldn't personally talk about "sub-types" because if nobody has heard of it and it isn't in the DSM, it does not sound as creditable and simply saying you have PTSD with dissociative symptoms...that's honestly not hard for many body workers or medical people to grasp. Fear is connected on the freeze end to dissociation.

Anyway, I try to avoid feeling like I might be schooling any of the people working with me too much....but I fill in some blanks and have been doing a better job of explaining my experience where needed (not the science so much as my subjective experience...that's what they work with) ....then letting them advocate for me. Two years is a long time for PT since it's geared toward acute injury in so many clinics, so somebody is already advocating for you, right? If you think dissociation is connected to your muscle stuff is that an issue a PT should be able to help you through anyway, or is that a matter for something more like Somatic Experiencing or other body-focused trauma work? Is that an option for you?

I don't mean to suggest you aren't approaching this right, because I'm more just trying to understand. Will you look for evidence of the dissociative sub-type symptoms that relate to where you are at and use it to support your subjective experience (which comes first)? Are you looking for PT help with what might be dissociated into muscles? Do you have some inkling of trust that your PT is a good person for understanding this, advocating for you, and moving you through your own process?

 

[scout86]

The latter bit is my worry with, not just the PT, but the insurance company... I

With the insurance company, that's probably a legitimate concern. In my experience, they are WAY more interested in collecting premiums that paying for treatment. But, as far as the PT goes, if there's a problem that can be worked on, there's still a reason to keep working on it. It takes as long as it takes, in the "real" world. One of the cool things, for me, with the person I've been working with lately, is I will spend weeks convincing myself something isn't a "real" problem and thinking I should just tough it out. Go in to see here, tell her it's probably nothing, only to have her tell me that it is, in fact "something". That, all by itself, has been an interesting experience.

 

[greenleaf]

@Chava -- trusting my own reality is a really complicated issue for me and hard to explain -- I need some sleep so will try this weekend I think. It's not even "yes or no". It's been different realities simultaneously, but shifting awareness of them, and not questioning that for safety/lack of support/lack of words/who knows.

However the PTSD with dissociative subtype really is in the DSM-V. People argued for a lot of related things to get in there but at least this one did.

http://www.ptsd.va.gov/professional/PTSD-overview/Dissociative_Subtype_of_PTSD.asp

I actually really value scientific studies for dealing with certain of this issues in my adult, everyday "reality"... Without that I have had too many people for too many years, apparently think I was not trying to work on issues.. the not-directly-abusive family members minimized my experience. I never brought up "derealization" after sometime in the 90s when I heard something about that being a symptom of psychosis (not the current thinking, but I never researched it until this year after that old definition.) I just ignored the feelings and detachment, the sense of feeling more real was rare anyhow, so I guess I just assumed at some level that that was normal, or I never even thought about it much?

What worked for people with probably non-dissociative ptsd in the years of support groups etc. that I was in never got to a lot of my issues. So yes, I do personally value evidence that there was a physical reason why I couldn't do in decades what dozens of women I know with adult traumas pretty much did in a year or two. Also I couldn't cry and get support with pretty much anyone, couldn't stay with my emotions around them... all safety problems that I had no words or help with until recently. It didn't really occur to me that it was a problem either because the worlds were so separated for me. Well, that makes no sense... unless you have read about dissociation stuff I think... the world with the abuse in it still seems doubtful to me when I'm walking down a sunny street sometimes, other times the happy people seem like aliens.

Also, professionals who are hostile to folks like me for whatever reason aren't going to be swayed by a few studies. I bet some of them have their own issues. There was just a psychiatrist a couple of years ago on NPR saying that DID is basically fabricated... so if a PT has little knowledge in advance of this stuff but can read a scientific study with fMRI evidence, I think it likely that scientifically educated folks would more fully accept it than it being "my experience" (but maybe I'm kind of nuts, but of course they have to be nice to the crazy person...) Their education is very medical, different from a social worker...

well now it's late, must get sleep, sorry if this is disjointed.