What Physiotherapy ISN'T

October 5, 2018

This blog is intended as an opinion piece. I will do my best to make it obvious when I am stating an opinion and when relaying evidence. Hopefully they shouldn’t differ too much. #disclaimer.

 

I decided to write this piece for a 2 reasons.

  1. There are still, so many myths and misconceptions about physiotherapy, exercise and the human body generally that I hear on a daily basis from patients and other health professionals alike -A rant or several for another day.

  2. FaceBook, Twitter and other social media is very inconsistent in the message regarding interventions for problems such as back, neck and knee pain.

 

The World Congress of Physiotherapy defines it as:

 

“providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan”.

“This includes providing services in circumstances where movement and function are threatened by ageing, injury, pain, diseases, disorders, conditions or environmental factors.  Functional movement is central to what it means to be healthy.”

 

The Chartered Society of Physiotherapy in the UK has a nice addition to this:

 

“At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.”


So physiotherapists should be there to show how you can get your body to perform a task or movement that you currently can’t with or without pain, injury or disability.

The key parts in this is “patient’s involvement in their own care” and “empowerment and participation” we’ll come back to this later on.

 

‘What Physiotherapy ISN’T’

Unfortunately, I regularly listen to patients come into a clinic having seen a GP, consultant, other physiotherapist, chiropractor, osteopath, energy healer (true story) and say that they now need ‘some physio done to them’ or to ‘just try some physio’.

 

 

Physiotherapy is a ‘profession’ not something you ‘get done to you’

 

 

It makes sense, when was the last time you got some doctoring or some nursing done. Sounds daft right? What you do is go to a qualified professional get the best advice and go on with your day.

 

Opinion Alert!!!

The particularly large elephant in this remarkably small room however, is that physiotherapists appear to still want to spend more time ‘doing stuff’ to patients on a treatment table than getting them back to what want to do.

 

This keeps fuelling the idea that physiotherapy is something you get done to you.

 

Comments I’ve had this month from patients were;

 

“I’ve had ‘physio’ already and it hasn’t worked” (when questioned they elaborated that they had manipulation, massage, and dry needling no actual rehabilitation).

 

‘I felt okay after the session but it came back in an hour’

 

‘I feel like I’m not getting better’

 

…Sound familiar???

 

The Olive Branch.

This isn’t saying that the poking and rubbing can’t be used to reduce pain … sometimes. Even the guidelines for back pain allow for some use of manual therapy but ‘only’ as part of a treatment package. (NICE guidelines for lower back pain; 2016) https://www.nice.org.uk/guidance/ng59

 

I primarily use manual therapy to guide a person through a movement that they find uncomfortable, painful or difficult.

 

This may or may not help!!

 

The effect of these techniques are generally short lived and is subject to a lot of contextual factors such as ‘trust in your physio’ and how stressed you might be that day. This can quite often make the techniques look like magic or not work at all.

 

So going back to our earlier statement, is having something done to you being ‘involved in your own care’

 

So if physiotherapists shouldn’t be spending their and your time rubbing, poking and cracking you, what do physiotherapists DO?

 

Musculoskeletal physiotherapists are there to:

 

1. Work alongside the body’s natural ability to heal its self.

- No we don't have magical hands

-The human body is not fragile!!!!!

 

2. Identify any dangerous problems you may have that require further investigation.

- Rare but necessary to check

 

3. Identify what it is you can’t currently do and set out a plan to get you back to doing it.

How are you going to get back to climbing the stairs pain free by having your leg rubbed for 20-30 minutes?

 

Summary

Simply put that is what Musculoskeletal physiotherapy should be. It should be disseminating evidence based knowledge and encouraging people of all ages to move more, get stronger and trust their bodies more.

 

Life’s too short to be a patient, take control.

 

Thanks for reading

 

Sam

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