Life Is Like A Box Of Chocolates
Most of you guys would know that I am a massive fan of good old fashioned, pull your socks up, fine tuned communication with patients. I am certain that the better you communicate with your patients the better their outcomes will be. We have discussed the importance of great communication previously, its importance in improving your patient rapport, improving patient compliance or even improving your application of Mobilisation with Movement techniques. In this post I want to discuss a technique that many of us sports physiotherapists would use on a daily basis to improve our communication with patients; the mighty analogy.
Why An Analogy?
a·nal·o·gy/əˈnaləjē/: A comparison between two things, typically on the basis of their structure and for the purpose of explanation or clarification. (http://en.wikipedia.org/wiki/Analogy)
Simply put analogies are awesome at making things that are complex for people to understand seem simple. I think we as sports physiotherapists can become a little desensitised to the complexity of the wonderful human body and world of physiotherapy. When explaining diagnoses, treatment options etc with patients we are discussing some pretty heavy stuff. Whilst it is just another day in the salt mines for us, frequently for our athletes it is their finals series, season or even career hanging in the balance! This should emphasise the importance of clear, concise and simple communication.
Think about the last time you spoke to your mechanic/IT guy/Arborist… did everything they say make sense to you? When you did not understand, how did you feel? Intimidated? And that is only your car/computer/phycus… not your body or career!
Imagine if they had used a simple analogy. I love the moment when you perform a well-rehearsed analogy and the patient has that evident “Ohh, I get it now!” moment!
The Jam Donut Analogy
An example I frequently utilise (which I definitely did not make up) within my clinical practice is that of the “Jam Donut” as an analogy for the anatomy of the Intervertebral disc. Patients who are frequently catastrophising about a likely ‘disc’ injury can frequently be relieved by an improved understanding of their pathology through the use of this simple analogy. Coming from an Mechanical Diagnosis and Therapy (McKenzie) paradigm of thought I would suggest to the patient:
“Your disc is built a little bit like a jam donut. It has a soft jam centre and a firmer outer casing. It has been suggested that this jam centre can shift depending on the forces you put through your lower back during your day….”
IVD: Like A Delicious Jam Donut
This non-sense continues to apply to the concepts of a posterior derangement and helps explain in a simple fashion the rationale for curve reversal and repeated extension movements.
Share The Analogy Love
As I have suggested this is one of the analogies that I use to improve my communication with patients. I want this site to improve the clinical practice of everyone who reads it, so, if you have an analogy (no matter how simple, stupid, woeful, etc) I would ask you to take 2 minutes and share it with our community of sports physiotherapists. Please leave it in a comment below or on Facebook or Twitter. Even post anonymously if you like. Thank you in advance!!
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Comments
Great article. The power of a good analogy can not be underestimated!
When explaining the relative instability of the glenohumeral joint – ‘it’s like placing a bowling ball on a golf tee’ (or other variations to make the point there isn’t all that much joint to joint surface area).
Awesome Dave. Great way of showing the relative incongruency of the joint surfaces. Thanks for the input!
Great stuff TSP! An analogy I often use about explaining neuromuscular activation to tradies/mechanics is similar to an engine with misfiring/broken spark plugs. Great for hamstring rehab and core activation
Nice one Bryan – all my sparky patients will love that one. Cheers!
Joints in the thoracic spine are hypomobile causing increased pain and muscle spasm of the periscapular muscles with functional activity. Imagine a stolen car with 2 passengers and a driver. The Physical Therapist is the sharp shooter/sniper. You can take out both passengers/treat the muscle spasms, but until you take out the driver/the cause of the problem, joint hypomobility, the car/your pain will continue on it’s course.
I love it Chris. Any excuse to refer to myself as Jason Bourne is welcomed…
Muscles stretches are like pulling on a rubber band.
Pull and hold for a short time and it springs back in place at exactly the same shape.
Stretch the rubber band for a long time and it springs back, but its much longer.
Beautiful Jay – a great analogy to explain the importance of hold times for stretches! I can see myself saying that one this afternoon! Thanks.
One I’ve found useful recently for disc bulges; imagine the intervertebral disc as a bar of soap.
Apply pressure to one side and it’ll bulge in the opposite direction, totally normal, but if too much pressure’s applied, then it moves that little bit too far giving you a cause for symptoms.
Nice one Alex, soap seems like a cleaner analogy than jam donut…
It might be geeky but if I can really get a kick out of tailoring an analogy so that it closely resembles a concept out of the patients work or one of his hobbies.
I once used the definition of statistical mean and standard deviation as a way to explain the importance of keeping neutral spine during activities to a math teacher. Something like: “your lower back needs to be ‘mean’ (=neutral) ±2SD 96% of the times” or “it should never be outside “the margin of error” i.e. in flexion or extension give”.
I might explain the same concept as “keeping a door from either flying open (flexion give) and damaging the wall it slams into or slamming a door shut (extension give) damaging the lock and hinges to a carpenter, or in terms of over and under exposure to a photographer, …
I’m almost sure that you can find a fitting analogy for every concept in physiotherapy if you just look hard enough!
Thanks Tom, definitely geeky, but I’m sure all the patients love it!
Fantastic Point TSP
What about the concept of neuromobility –
“You can imagine nerves like a garden hose in grass – you can’t stretch a garden hose, but it does move freely through the grass. However the hose can get stuck on the edge of the house and is no longer able to move freely through the grass.
Beautiful analogy Scott. The neural impulses can also be compared to water flowing through the hose, as when the house is kinked the water cannot reach your beautiful Birds of Paradise along the back fence!
For the degenerative tendinopathy …
Imagine a healthy tendon like a bungey jump rope …
Yours is a bit like a piece of rope and we need to make it more stretchy again!
I like the Jam Donut analogy. One ive used for IVD is a water ballon. pressure at front of ballon pushes to back, more pressure and ballon can stretch, even more pressure and ballon can ‘blow out’.
these are gold! i often use the ‘dimmer switch’ analogy (turning the light switch down, but keeping some light on) with muscle activation to encourage reduced activity with an attempt of using less energy… until a sparkie once told me it wasn’t quite the case! i still use it at times and it gets a good laugh as well as the point across!
Hi
I agree analogies are great, a common one I use for motor control problems in the body is I relate it to their home internet connection. I describe that the brain normally talks to and controls the muscles on a broadband connection and when their is dysfunction and or pain it can go back to a dial up connection so it does not control things as well and as quick. I then feel this gets them away from the focus of strength and more about timing and control.
Cheers
Mark
At Rehab Trainer, we have been explaining shoulder anatomy and dysfunction (to exercise professionals and clients) as a ‘house needing renovation’….scapular muscle imbalance results in the roof collapsing onto the furniture; while gleno-humeral instability is like the floor of the house excessively moving underneath. The furniture (soft tissue structures) is slowly destroyed by either or both of these forces.
See our library of articles on shoulder muscle imbalance / rehab for further elaboration: The Gym Junkie’s Shoulder on http://rehabtrainer.web2ic.com/library
i like for just people who delay injury treatment all together:
If you have a flat Tyre on your car or the radiator blowing steam you don’t get in it and drive it to Melbourne you get it fixed.
So why with would treat your body with less respect by leaving an injury for 3 months in the hope of it getting better? why not take it to a ‘body’ mechanic straight away
To again explain the importance of extension in posterior derangement injuries of lumbar discs I came across a great analogy recently…
“imagine that you have a cut on the back of your finger… If you continually bend it (flexion) it will just continue to spread open and worsen, however if you straighten it (extension) it will allow the cut to heal”
I think analogies can be fantastic ways of communicating with our patiens and simplifying often complex issues. For me, education is my number one tool, so having a nice toolbox of analogies is a great thing. One note of caution though…Lets not forget how easy it ist o instill fear into our patients with well meaning anaolgies. I’ve heard of people referring to a tendinopathy as like a rope that is fraying and about to ‘ping’…which it is clearly not. These words can have really negative consequences for patients and actually push them into fear avoidance behaviour due to fear of injury. Anyway, didn’t mean to put a downer on some of the great analogies you have come up with…just a litle note of caution
Ps…i love this website. I’ve only found it recently and the contributions are excellent! Thanks to everybody that contributes
At the heart of the physiotherapy profession is the exercise of clinical judgement and informed interpretation – a physiotherapy degree graduate should be a clinician, educator, evaluator and manager. You will require a wide range of skills.
Physiotherapy degree graduates should also be good communicators, be interested in solving problems in a logical way, be able to motivate and educate people and be able to work both independently and as part of a team.
The BSc physiotherapy degree course at the University of Southampton can be undertaken over three years full time or five years part time.
In order to learn more about the BSc physiotherapy degree at the University of Southampton please log on to the Health Sciences homepage at http://www.southampton.ac.uk/healthsciences
Great article, good job.