Suitability for physio

Recently I was on my musculoskeletal placement and had a 26 yr old female English patient referred to me from her GP for low back pain. On assessment, I found that she had developped this back pain insidiously about a month after the birth of her first baby. Her husband works full time and she is a stay-at-home mum. They have been in Perth for six months. There were no significant findings on objective assessment which could fully explain her LBP. It also did not follow a pattern of conpression or stretch and her posture was reasonable.
On initial session, I educated her about posture and the lasting effects of pregnancy on the body (relaxin, decrease muscle tone) as well as the importance of strengthening TA and pelvic floor to support her lower back. I went through basic TA retraining with her and also good lifting techniques and positions for changing, bathing baby.
After seeing this patient, I spoke to my supervisor as something just didn’t seem to add up. I discussed my findings and session with him as I felt that perhaps there was something else going on as I didn’t have enough assessment findings to explain it. My supervisor suggested that I investigate further at the next session. On the next session she presented with similar low back pain as well as pain up into her thoracic spine. I also found out that she is not coping well at home with her husband working. She doesn’t have family in Perth and doesn’t have many friends here as she moved recently.
I asked if she had sought any help or support to which she replied that she wasn’t aware it was avaliable. (I had talked to my supervisor the previous week about the nature of her chronic pain and the potential for something such as PND to perhaps be contributing or causing her problem. My supervisor agreed it was a possibility and to talk to her about it next time.) I explained that I had recently also been on a womens health placement and that it is not uncommon for women to feel overwhelmed with a new baby, I also explained PND and asked if she had heard of it. She said that her sister had it with her second baby. After talking to my supervisor we decided to refer her back to her doctor for an assessment and I wrote a letter to him explaining the assessment and findings and querying another cause of the chronic pain.Two weeks later, I recieved another letter from her doctor explaining that she had been diagnosed with mild PND and reffered on. This made me realise how important it is to keep in mind that some patients may not be fully appropriate for physiotherapy even though sometimes it seems like they are. I suppose it is always been in the back of my mind, but after this patient, I was certainly more aware!