Experiences of a physiotherapist

Since a few weeks, I’ve been treating a young woman suffering from Bechterew’s syndrome. As I’m always trying to spent the time with a patient as efficient as possible, I failed to reveal the background of the treatment. My promise to her was that I would clarify the essentials of the treatment background on my blog. In other words, this article is not only interesting for her, but may also support other therapists (to get new insights) and their patients.

What this disease is all about, can be found on many internet sites. With this post I’ve chosen to describe a different vision on the pathology and the specific fascia-therapeutic approach in practice. For now, let’s keep it to this: Bechterew’s syndrome is a rheumatic disease that affects mainly the spinal column. In almost all cases there are acute inflammation stages followed by intermittent stages of rest/recovery. An inflammation stage usually causes structural changes to the joint. As a consequence of this, the mobility of the joint reduces gradually and the spinal column stiffens. The patients ends up in a vicious circle: Due to the continuously decreasing mobility more inflammations will occur, and these will limit the mobility again.

The disease appears in various gradations, and thanks to the evolution in treatment (a.o. anti-TNF medication) the extreme final stage, when the whole spinal column is bent and totally immobile, shows up less often than it used to do. My patient’s diagnosis was made only recently. Fortunately the spinal column hasn’t stiffened yet. (Read the article)

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Almost daily I refer patients to my development-coaching colleagues. Not only because our agendas are coming apart at the seams, but also because the people demanding support often seem to have a good coach living in the neighborhood and practical circumstances need to be considered seen the fact that most children have to practice for half an hour twice week during an average period of one year.

Sometimes parents give me feedback on the coaching course. I am always disappointed when, in these rare cases, it appears that no connection could be made with the child and that this young patient was not feeling comfortable with the coaching.

To find out why a child, per definition, should feel comfortable with going to the coaching and what it holds if this does not happen to be the case, please read below. (Read the article)

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Last week I treated a young man suffering from the loge syndrome in both lower legs.

About one and a half year ago he started having problems with his lower legs. In a first surgery the aponeuroses of the lower leg were opened in order to give the muscles within the fascia more space.

After a long rehabilitation period he still wasn’t able to play soccer though. He had to undergo a second surgery. All fascias, even the attachments to the periost of the tibia and the fibula, were cut loose from the lower leg. After rehabilitation the operation appeared to be not successful. He still wasn’t able to play soccer. After the first three training sessions the pain in both lower legs had become unbearable and he was forced to end physical exertion. He is being treated by a sports physical therapist five hours a day. A fascia therapy student introduced the young man to me.

This situation is a disaster to a guy of this caliber. He’s at a top sports school, has made it to the B-team of a first-division soccer club (not the right one though ;-)) and aspires to a professional football career. An injury of this nature could ruin his dreams. Will he ever be able to do sports without pain again? Will he be able to reach the top level? Should he better focus on his studies or give his all to soccer? (Read the article)

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At the beginning of a new school year the media pay a lot of their attention to school-related subjects. The headlines are usually being thrown at us. On September 5 of this year the most important Belgian newspapers wrote that one out of three children would suffer from learning difficulties. On the VRT evening news (VRT = the Belgian Dutch-speaking public broadcasting) of yesterday there was a report on multi- and highly gifted children. The report showed that this group of children find only little challenge in traditional education and that in the so-called Kangaroo Class these children are being brought together to learn at a higher level.

I always find it difficult to watch this kind of broadcasts. The issue is more than often elucidated in a one-sided way. This was also the case in yesterday’s report, where the multi- and highly gifted child’s situation was being romaticized: In the picture came the successful child, the child that (exceptionally) functions well, the stable child, the child that is able to handle the challenges that life is bringing to him.

Unfortunately, the good life is only reserved for a (small) part of the multi- and highly gifted children. These reports do not reveal the whole issue. The children that we are being faced with do suffer a great deal from their situation (and not only the child, but its whole environment as well). You could say that the problem level is directly proportional to the intelligence of the multi-gifted child (We make a distinction between multi-gifted, highly gifted and exceptionally gifted children). (Read the article)

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Two weeks of peace and quiet … During my vacation, though, I still try to spend some time usefully. The hard discs of my computer are bulging and urgently need a fresh-up.

Year after year I store all information onto my computer. Of each problem analysis performed in my office I take a series of photographs from the motion intention of the child. Besides this, I examine a child at the rehabilitation centre every week. In order to write the report for the team meeting more quickly and accurately, I put these problem analyses on tape. I make recordings of all Prof. Hendrickx’ classes as well. After all these years of archiving video material, I’ve gained a mine of information. This archive will be the main source to this blog.

Today, while browsing through old images, I came across these pictures. I remember that these were the images that brought me to shoot pictures at problem analyses systematically. These images appear to have become very important in objectifying the results of our work.

   (Read the article)

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This morning we (Ruben, Caroline and me) took some of our patients to a problem analysis session by Prof. Hendrickx at ‘De Wilg’ in Hasselt.
I can’t stress enough the importance of good problem analysis and synthesis when treating a child. This should be the starting point for every intervention. Thorough problem analysis looks inside the ‘system’ of a person, explores the basic patterns of his being. It always starts from the person’s capabilities and strenghts. Next to this, it also examines where, how and why the system is blocking, what the weaknesses are and which compensation the system uses to answer the needs revealed to this system. (Read the article)

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In a first contact with parents, when they consult me with an aid request for their child, I always discuss the specific position that the Hendrickx method has on the accompaniment of children. This vision determines the approach, the direction of which you look at the problem of the child and therefore also your intervention that connects to it.

To make this position clear I refer to the article ‘About good and not so good teaching accompaniment’ that professor Hendrickx wrote in ‘Tetraheder’, the journal of the ‘Association for the encouragement of the Critical Development Accompaniment, method Hendrickx’. In this article he made the distinction between task oriented – function oriented and system oriented interventions.

During these parent conversations, I like to exaggerate, so that, by contrast the specificity of each method becomes clear. So forgive me for simplifying. Despite the exaggeration, I try not to be judgmental about other approaches. It are the parents who decide what approach is best suitable at that particular time for the needs of their child. (Read the article)

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Yesterday, my son in law to be, Julien, came to the practice for the last time.

Julien and Michelle have become close friends in the nursery. They’ve really taken on eachother’s rhythm: if one of them cries, the other will also start crying; if one goes to sleep the other wants to go to bed as quickly as possible; if one is hungry, the other is hungry, etc… A true couple.

When we signed Michelle up for the nursery and the person responsible heard that I work with a lot of baby’s, she was very interested. I restrained her enthusiasm by telling her that this certainly did not mean she could refer children to me, given my practice is already bursting from the joints.

A few weeks ago she spoke to Ann, in a bit of a panic, and asked if I could take a look at Julien. His head was a little flattened out. The pediatrician had referred them to a specialist and he suggested making a headpiece that Julien would have to wear 23 hours a day. Perhaps therapy would offer a less radical alternative.

(Read the article)

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On a regular basis one of the students following the fascia therapy course, will join me treating some patients in
my cabinet. Although this means an extra effort from our behalf, we encourage this. Jointly using the techniques on a patient helps the students advance: they get a better knowledge about how to use the method practically (which is the aim of this blog) and we can put them in the right direction. You could say they get a private lesson.

Yesterday I got a visit from Marijke, a motivated therapist who just finished her first year of training. Because of professional circumstances she was not able to attend the first two days of the previous seminar (cervical spine and introduction to cranial fascia therapy). Those first two days are crucial to construct the specific perception needed for the real therapeutic work done on the third and fourth day. To help her integrate the new knowledge, I proposed her to treat a patient with shoulder-neck – thorax pain, the two of us together.

(Read the article)

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