The check book theory (of health) developed and taught by Tim McGonigle, PT, Folsom Physical Therapy
Just a couple of days ago, I chatted with a friend about her frustrations in working with a client who kept hurting their body through athletic pursuits. She sighed “I get this person to the point where they are feeling pretty good, and then they go out and go off jumps on their bike* and come back to me in a heap”.
I nodded on the other end of the line (super unhelpful when you’re on the phone it turns out), in empathetic frustration, reflecting on similar clinical cases.
A couple of years ago, I was working with a client who was recovering from a spinal surgery. We were stumbling through his rehabilitation- every time we met, we would discuss the phase of healing he was presently in, activities/ behaviors to modify and I would progress him through therapeutic exercises and hands on work to restore his soft tissue mobility and promote fluid exchange. The clients’ biggest challenge was his behavior modification. He had such a tough time accepting the phase of healing he was in and his limitations, that he kept challenging them. Each meeting, he would share an illicit activity: helping a friend move furniture, taking a long mountain bike ride on single track trails, trying out running. On and on.
I spoke with my mentors about his case and my concerns with his self-harming actions during mentoring sessions via emails, and on more than one occasion. We hatched a plan around providing education and information to help him with behavior modification. Barring success in these interventions, they encouraged me to reconsider working with the client- to refer him back to his doc, to refer him to a different PT, if I couldn’t get him on board with modifying his behavior. Through the lens of their expertise, the writing was on the wall that this person was going to “fail” rehab.
The day of our last meeting was a long one. I was having a strange week, and I met with him at my last appointment of a long day. He limped into my office, in much worse shape than when I had seen him last. He explained that over the previous weekend he had gone to an indoor trampoline center, done flips and had fallen off the trampoline, onto the floor- contacting the hard surface with his freshly operated spine*.
(Events have been slightly modified to protect identities).
I felt hot anger pulse through me like a fever. I felt fearful for the injury this person had subjected themselves to- for seemingly no reason. I felt angry about all of the resources spent: all of the money, time and work on his back- from the surgery on through to the rehabilitation, was potentially gone in an instant.