A patient with back pain who is out of work. Joe was a 35 year old married father of 2 who had worked for 10 years as a police officer when he was injured in a training class. A disc in his back was ruptured and he received surgical treatment but the pain continued. Joe had not been able to get back to work as a police officer and had lost much of his identity that came from being a strong leader in his job, to his wife and children and in the community.

The Evaluation: Creating Joe's Clinical Path When we first met Joe he was looking for a cure. Like so many he just thought that the right doctor or treatment would be able to make his pain go away and allow him to get his life back on track. However, this belief had been fueling Joes approach through the medical care system for nearly 5 years. He had seen 6 different specialists. Each of them either said they could not help or tried and failed.

He had two disappointing operations on his back leaving him with new, painful artificial discs. He was taking 12 different medications prescribed to help him, but he couldn't tell which one did what. All he knew was that he was in pain with sleep disturbance, sexual dysfunction, nausea and stomach problems.  When Joe came to us he was angry and frustrated. During our evaluation we determined that one of our treatment events needed to be teaching him why he had pain and why his pain was not going to go away. This medical event was the first of many steps on Joe's clinical pathway. Once the event of Joe's learning about what his pain is being caused by has been achieved he will move to the next event in his path.

The first event on Joe's clinical pathway: What is causing Joe's pain?

This step requires that the HELP medical team educate Joe about what an artificial disc is, how the surgery is done and how his tissue healing around an artificial disc proceeds. Joe's x-rays and MRI scans held part of the lessons that Joe needed to learn. HELP's anatomy models and surgical illustrations complimented the lessons to allow Joe to learn. As Joe's knowledge increased about what was causing his pain the next treatment event of helping him learn about what his pain meant emerged.

The second event on Joe's clinical pathway: What does Joe's pain mean?

Throughout life pain is a warning. Pain usually tells us about new or potential tissue damage. However, each time there is an injury healing occurs. With healing there are different levels of imperfection. The presence of a scar on your skin after a simple cut is evidence of this imperfection. As Joe applied this information to what he had learned about the healing of his disc replacement he began to understand that his pain was a consequence of imperfect healing and not a message of new or potential damage. With this learning event completed Joe's clinical pathway expanded to encourage his return to a more active life.

The Life skills goal setting event: What are Joe's roles?

These events in Joe's clinical pathway lead to his progressive awareness of how he could be safe doing things even with his pain. As he understood that his pain while real, was not dangerous he learned that when things were important to him he could choose to do them safely even with pain. This knowledge and awareness coupled with the Life skills analysis to identify the most important roles in Joe's life. The treatment event of life roles analysis revealed his role as husband and father as most important. The exploration of those treatment events allowed for the identification of yet more detailed information about the activities that Joe wanted to get back to with his spouse and kids to feel like a father again.

Functional activities, learning to perform important activities.

Joe started with his need to help his wife perform some of the chores around the house. Cleaning dishes, helping with laundry and taking out the trash were all activities that he used to do before his injury but the pain of standing and reaching had kept him from returning to them. With the help of the trainers, physical and occupational therapists Joe learned how to improve his body mechanics and posture, to employ a foot lift to off weight his spine to perform these activities again. Through progressive observation changed the way that he performed each of his important tasks to minimize pain while still getting the job done.

Fitness activities, learning to strengthen your body.

During his functional activities the treatment team members noticed that the years of Joe's inactivity lead to tremendous atrophy in his healthy tissues. As he began to simulate his chores at the HELP program we taught him to build strength in those healthy tissues to support the damaged ones. His daily fitness routine quickly gave way to a regular exercise program that allowed each day to be experienced with greater physical strength.

Nutrition training.

Like many patients Joe's injury had made him inactive and caused him to gain weight. His dietary habits had deteriorated and he was 30 pounds heavier than when he was injured. At age 35 years he had already experienced a decline in his metabolism that caused him to gain weight faster when he ate the same amounts he had been accustomed to. Joe needed to lose weight. He wanted to learn what to eat and how much he could consume while still reducing his waist line. At a lower weight Joe realized his back would probably hurt less and he would be healthy.

Remote treatment events, HELP when you need it.

During the day treatment at HELP Joe was introduced to the remote teaching modules that are available to patients thru the internet via HELP remote care. The individual video programs and live video broadcast provided an orientation to the way that these same lessons could be used by Joe when he returned home. Whether he needed the instruction available through the familiar voice of a care coach or reminders of the same content that he received from his direct treatment.