From certain surgery to happy camper

I had a great day in the clinic yesterday. My very first patient of the day is doing extremely well. He came in with neck and radiating arm pain and paresthesias of less than 30 days. Looking up did not aggravate his symptoms. He was still working and not afraid of working or doing other activities due to his neck and arm pain (although he wanted to make sure that what he was doing was not going to make anything worse). He had limited neck extension and his thoracic spine was stiff and flat. He told me that the neurologist he went to told him that he would have to have surgery to help him with his pain and especially the numbness and tingling he was having in his arm. He did not want to have surgery and asked the surgeon if there were any other options. The surgeon told him plainly that that surgery was his only option. Luckily, the patient decided that he would try physical therapy first and he called the surgeon and asked if he could do that and the surgeon reluctantly gave him a script for physical therapy but told him that physical therapy would not help him and that he would see him in a month when they could schedule his surgery.

Well, it has been less than a month and my patient is very close to being completely free of his symptoms. He occasionally gets some neck pain but his arm pain and paresthesias are gone. He told me yesterday that he was really scared when the doctor told him that surgery was the "only solution." When I saw him on first visit I knew that I could help him. Why did I know? Because I followed a clinical prediction rule that states if the patient has at least 4 of 6 matching criteria my success with thoracic manipulation and cervical exercises goes from flipping a coin (54%) to 93% success rate. He matched and I was certain I would help him. And I have. It is great to have a day like I did. It is really good for me when I can use evidence to guide me to be solid physical therapist and even better for my patient who avoided a costly and risky surgery that may or may not have even helped him. He is a happy camper and so am I.