Journal of Novel Physiotherapies
Open Access

I have been working as a sport therapist and treating movement dysfunctions for more than 20 years. During 2019, I start questioning about what my therapeutic approach should be and the reason for the results obtained during my career. That is why I decided to come to China in order to challenge myself in a different language and culture where is has different methodology towards the treatment I used to work.

Although other therapist and players who worked with me can verify that most of my treatments got overwhelmingly including in those case where the odds were against, I started to doubt it whether those good results were due to my diagnostic skills my capacity to choose the right treatment and its execution or my ability to listening and explaining to my patients the reason for their pain.

For all the reasons explained before, I decided to travel to China and figure out if my previous succeed was whether my ability as a physiotherapist or my biopsychosocial skills that each one of us should carry according to our background.

Do not worry if you think if I have gone crazy or if I have lost my mind. Let me explain, as I have been working and with all the experience, I realized that two people with the same diagnosis and same treatment does not have the same evolution. In addition, other athletes with similar diagnosis treated under radically opposite approaches both obtained very good results, which made me think if the important thing was the treatment or the key to it was the physiotherapist.

As far as I am concerned, the therapist only let our patient talk around 17 seconds without any interruption. It is well known that the clinical history should be really important for our intervention, but in most of the cases it takes no longer than 10 to complete it.

When we ask our patient about their injuries, we should not forget that in our brain we have neurons called Mirror neurons [1]. Neurons mirror are motor cells found in the premotor cortex and the inferior parietal lobe of our brain [2]. These allow humans to understand the feelings of others and establish connections between other people. When a person watches another how they act, think or feel, small electrical shots are produced in the brain that activate that received signal. They play an important role in imitation, learning, and empathy. That is why when we listen to our patients serenely, with full attention, and we explain to them calmly, clearly and without drama what the root of their problem is, when we act by relaxing their expectations towards their pain, this is in itself one of the best painkillers.

In most of the cases the fear to pain, to a disability and therefore to social rejection, role change in the group or even the feeling to get threaten out of the group. Could generate us a state of struggle or flee, avoiding the proper activation of the amygdala.

The amygdala is a subcortical structure located in the inner part of the medial temporal lobe. As a result, it is the main nucleus of control of emotions and feelings in the brain. It also controls the responses of satisfaction or fear. The connections created not only produce an emotional reaction, but due to its connection with the frontal lobe, allows the inhibition of behaviours. In this aspect, one of the main functions of the amygdala plays an important part of survival, stimulating or inhibiting the fight or flight response in front of a hazardous situation. The fight or flight response [3], also known as the acute stress response, refers to a physiological reaction that occurs in the presence of something that is “threatening”, either mentally or physically. The response is triggered by the release of hormones that prepare the body to stay and deal with a threat, or to flee to safety.

The sympathetic nervous system stimulates the adrenal glands, triggering the release of certain catecholamine hormones, including adrenaline and noradrenaline or cortisol, which at high levels and maintained over time generate an inflammatory response and changes in the immune system [4].

Having explained that, I deeply believe that the way we communicate to our patients will be a key point in their recovery process. It is, obviously, not as simple as it looks.

As Human beings we need a strong coherence between our beliefs, attitudes, and actions.

There is a brain concept developed by psychologist Leon Festinger known as a Theory of Cognitive Dissonance [5]. According to this American specialist, cognitive dissonance occurs when we have two contradictory thoughts or feelings or when we act differently with which we are rationally satisfied. That is to say, that what we think and feel do not go hand in hand. The result is a state of anxiety, nervousness, and discomfort.

That is why our treatment has to be consistent with the explanation given by the patient. We cannot tell our patient that they do not have a serious injury and treat them with passive treatments such as electrotherapy, massage, manual therapy or persuade them to stop performing any type of physical activity. This will send a contradictory message to the brain, generating a state of doubt and uncertainty at the brain. As we have mentioned before, this kind of procedures will turn into high levels of anxiety, nervousness, and discomfort, which won’t help to solve the injury. That is why the prescribed physical activity in any of these modalities will help us to convince the patient that they are not is so bad condition as they might believe.

To sum up we should listen to our patients carefully, without any interruptions, we also should give them confidence and security. It is also really important to push and motivate them to do controlled physical activity and inform them in advance about some difficulties that might appear during the process, such pain. The patient should understand that those adversities are part of the treatment. As a result, we could decrease the level of anxiety.

We should be more focused on when we talk to our patients and explain them the nature of their expectations, beliefs and fear, how this things works in order to control their pain. Controlling this thoughts and expectations about the pain can decrease the pain sensation.

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