It was the end of a fun-filled bank-holiday weekend and we were returning home from the park. My husband and older daughter had gone ahead and I was running with my younger daughter who had just learnt to ride her ‘big-girl bike’. She was going quite fast, then swerved in front of me. Partly to break her fall and partly to avoid falling on top of her, I catapulted myself over the top of child and bike, landing on (and bending back) my right-hand fingers.
“OUCH!” was not exactly the word I used in front of my 3 year old!
After an hour and a half in A&E, I was relieved when it was my turn to see the nurse practitioner. She asked me to score my pain level out of 10 – something I frequently ask my own patients to do. I gave it 6/10. She then gave me some paracetamol, examined my hand and sent me for x-ray.
What I found interesting was that within 5 minutes of entering the cubicle, I noticed my pain level had dropped significantly from 6/10 to a mere 2/10. Paracetamol in tablet form typically takes 20-30 minutes to be absorbed into the bloodstream and take effect. So aside from the placebo effect – what was going on here?
Pain and the Brain
Well, this was a brilliant example in action of how factors aside from the actual tissue damage to my hand were contributing to the intensity of my pain. As an osteopath, my hands are my tools and my livelihood, so damaging my dominant right hand was leading to a cascade of catastrophising thoughts: “How much time will I have to take off work? Is my business going to go down the pan? What if I can never work again as an osteopath?” Catastrophising is a key factor known to intensify, and prolong people’s pain experience.
So, how did 5 minutess with the nurse practitioner have so much effect on my pain? There are many ways it helped:
- Her gentle touch and help to move my hand and fingers through all ranges was comforting and reassuring, therefore decreasing my anxiety levels.
- Sending me for x-ray was reassuring that any fractures would be ruled out or in, but would be dealt with swiftly.
- Talking to the nurse distracted me from my pain and catastrophising. I had been sitting alone with my thoughts and pain in A&E for 1.5 hours with nothing to avert my attention from my pain. This is why mindfulness and meditation can be so helpful for people in pain.
Two days later, I saw the consultant who diagnosed a suspected hairline fractured metacarpal (one of the long bones in the palm between the wrist and the knuckles). This was not what I wanted to hear. He strapped it up, told me to keep it moving, but not to work for 6 weeks.
Given the value I place in my hands, and my need to get back to work as soon as possible, I decided to seek a second opinion from an orthopaedic hand specialist. He told me it was going to be fine and that I would do no harm if I started to use it for work. I felt like God had spoken (even though I am not religious).
What interests me, is that even consultants at the top of their game can differ in the advice and prognosis they give. People and their clinical presentations do not usually fit neatly into black and white boxes, as evidence-based practice would have us believe. A good health practitioner will always base management of their patients on a combination of best evidence, clinical judgement and experience. Different practitioners will often come to different conclusions. As patients, we usually choose to believe the version of the story we most want to hear.
In my work, I believe in functional rehabilitation exercises (ie. movements orientated towards getting people back to doing what they want to be doing in their lives). So after the first couple of weeks, resting my hand, I have been using it as much as possible to do anything and everything. As I advise my patients, “you are the expert of your own body”, so accordingly I let pain and fatigue guide me as to how far to push my own rehab.
Of course, osteopathy has also helped with my recovery! Osteopath, Rosie McCauley has done some brilliant work on easing muscle tension and improving joint flexibility in my hand and up through to my right shoulder and neck. Impact injuries like this, rarely just affect one part of the body, as our hands don’t work in isolation from the rest of us.
I also got some brilliant advice, reassurance and exercises from Elaine Carr, a local physiotherapist specialising in hand therapy. Whilst I do treat hands and wrists in my own practice, I don’t see many people for post-fracture rehabilitation. So her expertise was incredibly helpful.
One of the most interesting things she showed me using a ‘gripometer’, was that the grip in my injured hand had reduced to less than 50% of my non-dominant uninjured hand through lack of use. Theraputty and a squeezy father Christmas ball have been invaluable in building my grip strength back up.
I have also been taking a Vitamin C supplement to speed up fracture and soft tissue healing (Source), and been getting as much rejuvenating sleep as possible.
Back To Work
Five weeks later and I’m starting back at work. Its been a frustrating month, but as ever I believe there are positives which accompany the negatives. I have refreshed my knowledge of detailed hand anatomy and been reminded of the body’s amazing capacity to heal itself.
Most importantly, as an osteopath, I have developed my sense of empathy with the people I treat. This experience has reminded me how it feels being unable to do the things that make you ‘you’, and how pain can make you feel vulnerable and low. Oh, and I’ve also had time to get fully up to date with paperwork, write a couple of blog posts and even get a sunburnt face!
- To osteopath Rosie McCauley who has provided emergency locum cover to keep my practice ticking over, and osteopathic treatment to help speed my recovery.
- The nurses, radiologists and orthopaedic consultants at Warwick hospital
- Peter Wade, orthopaedic consultant at Nuffield Hospital.
- The man who scraped me up off the ground and carried my daughter’s bike home.
- Physiotherapist and hand therapist Elaine Carr.
- My wonderful husband who has had to do extra cooking, cleaning and carrying.
- My friend Fay for lending me her squeezy father christmas ball and looking after my daughter while I went to my hospital appointment.
- And last but by no means least, my patients for their patience while my hand has been healing.
Emma Lipson is Principal Osteopath at Feel Better Osteopathy in Warwick, Warwickshire.