Healing Hands – A Clinical Inservice by Lindsay Pendleton

For their first clinical experience, our students have the option to present an inservice, or mini-presentation about something they are interested in, to the clinic. Lindsay had the unique honor of being published in WGH Heartbeat, the official publication of Wilbarger General Hospital, where she just completed CEI. We congratulate Lindsay on this achievement and thank her for sharing with the Regis community as well!

“My interest in Physical Therapy came from the personal interaction we get to have with patients. It is arguably one of the most unique relationships in healthcare. In order to be able to do our jobs effectively, it is of the utmost importance that we convey empathy and maintain a relationship that does not lack sensitivity. The patient that has sought our services has to share what is likely their biggest fears, worst insecurities and greatest mistakes. It is our job to be receptive to that and create an environment in which they feel safe to do so. How we create this bond with others is personal and will vary from patient to patient. One of the best ways we can do this is through touch. Touch is now recognized as a cross-modal sensory system transmitting signals through proprioceptive, exteroceptive and interoceptive pathways.

The one which is the most familiar is proprioception. This is the basis of skilled manual therapists to overwhelm the nervous system, desensitize an area or acquire much needed information on soft tissue integrity and joint mobility.

Less well known is the exteroceptive touch pathway which gives the patient ownership of their body. It is how they relay information on what the touch means. Is the touch threatening, is it comforting, how does it make them feel? This pathway is associated with ownership of self and the ability to see their problem, their pain as within their control. Touch promotes positive emotional responses such as feelings of safety and relaxation and reduces negative affective feelings, avoidance and stress-related biomarkers.

The third and least well known is the interoceptive networks which convey emotionally relevant information through low mechanical threshold unmyelinated C fibers. This has been linked with pain inhibition, ANS regulation and an increase in pleasant sensations. In short, touch connects us to our patients in a physical, cognitive and emotional way. This can make us uncomfortable as we seek boundaries to keep us safe and distanced from potential transgression. Yet, as a collective, therapists at times are not adapting in a manner that fits the current needs of patients, especially during COVID.

Finally, perceptions regarding touch incapacitates us and limits our ability to treat. As touch without a the widely accepted researched justification is beyond the scope of practicing therapists. This could not be more backwards. Touch conveys a kindness, a kindred spirit to another person that improves mood and life satisfaction. When there are instances, where you can either touch the patient or use a machine, consider the power of your touch. When there are patients that baffle you, or refuse to get better despite your best efforts, consider that you can help them with the gift that is human contact.”

Sources:

1. Gutiérrez, Abbey. Interoception, mindfulness and touch: a meta-review of functional MRI studies. Int J Osteopath Med. (2019).

2. Bishop, Torres-Cueco, Gay, Lluch-Girbés, Beneciuk, Bialosky. What effect can manual therapy have on a patient’s pain experience? Pain Manag. (2015).

3. Geri, Viceconti, Minacci, Testa, Rossettini, Manual therapy: Exploiting the role of human touch. Musculoskeletal Science and Practice. (2019).

4. Nicholls, Holmes. Discipline, desire, and transgression in physiotherapy practice. Physiotherapy Theory & Practice. (2012).

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