Dr. Paul Lonnemann explains how he approaches patients with chronic low back pain based on his experiences. He gives us several things we must recognize with our patient interactions and goes on to describe how he addresses particular patient situations.
Dr. Paul lonnemann has been practicing for 25 years with a background in orthopedic manual therapy. I asked Paul to share his experience when it comes to treating low back pain and in particular, chronic low back pain.
I was curious how he learned his style when is comes to approaching these patients and what all has changed as he gained experience in this area.
Paul said back when he started, the process of evaluating and treating back pain was based more on who the experts where that you learned from.
Shortly after he graduated he realized he needed to have a better handle on these patients and Paul then chose to go with the University of St. Augustine.
Paul continued to say how interesting it was that what Stanley Paris was saying in 1992 about patients pain, chronic pain, and patients understanding of pain was really ahead of his time. A lot of pain specialist are now confirming what he said.
Paul recognizes that manual therapy is an integrative approach that allows you to get your hands on the patient and for the patient to recognize that you’re a concerned care giver. He said that can not be overemphasized because it seems like the pendulum is swinging to the biopsychosocial side of things. Paul feels like in some instances it’s getting to the point where hands on experience is really not necessary and all you need to do is talk to the patient. He believes that the utilization of manual therapy is an important, integral part of connecting with these patients.
“Don’t just address the patients needs, you also need to address the patient perspective. Get a perspective on where they stand with the understanding their pain.”
When patients come to Paul, who resides in Indiana, most of the time they may have already seen a primary care doctor, a massage therapist or other discipline. Paul will integrate his understandings of chronic pain, manual therapy, and exercise into his patient interactions while figuring out how to connect with the patient for them to better understand their problem.
“In most cases of low back pain, there is something that we can identify that is making their symptoms worse and if we can get a better handle on that then we can empower the patient to control it.”
“Don’t let the pain tell you when to change your behavior, change the behavior before your have the symptoms.” Paul says if you can predict to the patient what things make them worse, they’ll try it because they want to prove you wrong! Paul will challenge them by saying, “I bet if you got up four times each hour your back pain would be decreased, I bet if you slept in a better position your back pain would be decreased so on and so forth.” Paul tells his patients, “if you come in and tell me that none of those work we will stop therapy.”
“We have to recognize that some of our outcomes are related to the patients decision on whether or not they change their behavior more than anything else”.
Tread lightly on the first evaluation if your patient has a high Oswestry score, in the danger zone on the FABQ or Start Back Screening Tool. You don’t want to overwhelm them with a new set of responsibilities but if you can get them to recognize their own behaviors and inform them about changing behavior in general, it’s a great start.
I asked Paul what suggestions he had for younger therapists, students, or someone who isn’t confident in their abilities to effectively treat chronic low back pain.
Paul says that it’s really important as a new graduate to have good mentors that you can bounce ideas off of. Being able to run your thoughts by someone more experienced and getting their thoughts and perspectives is critical. You’re biggest mistake is not making a connection with the patient. You need to set up a contract with realistic goals and let them know what you expect. “Get confident and comfortable in your skill set with the help of mentors and those you respect.”