New patients who have never had physio before are always filled with a little trepidation when coming through my door as they have no idea what to expect so I thought I would just fill you in on what to expect, and what you SHOULD expect from a visit to the physio...
On the first appointment, physios ask a LOT of questions in order to get the best possible idea of the patient in front of us. Some of these questions might seem really random... like ‘what do you do in your spare time?’ Despite this seeming a little nosey, it is really to build up the perfect picture of what your body is required to do on a week by week basis... so we’re not asking about your employment so that we know if you can afford the physio bill! It’s more about whether you sit all day at a desk, or dig ditches for fifty hours a week.
It also really helps to know ALL your medical history... operations, drugs you take, accidents and injuries you’ve had in the past.
Through questioning physios are trying to find out:
• What has happened to you
• How long you’ve been in pain
• What the possible causes are
• How severe the pain is and how long it lasts for. This is important as a condition that is easily flared up has to be treated cautiously by the physio.
• The type of pain: this gives a good indication of possible pathology
• What makes it worse, and what makes it better: these are like handy little hints from the universe as to what might be used for treatment, or avoided!!
• What restrictions you have as a result of the injury
Every injury has its unique features, but there are usually similarities and patterns that are followed, which is why the clinical picture presented is so important. By the end of the ‘subjective examination’ the physio should have a good idea of what he/ she needs to focus on assessing in the allotted time, and also starting to have a think along the ideas of what type of treatment will be done.
The physical examination will be most thorough on day 1, but will happen to some extent on every appointment, and is ongoing throughout treatment, so nothing to be worried about. It usually consists of
Looking: at posture in sitting or standing, how you walk, the affected area checking for swelling or bruising or redness. Don’t be alarmed if you have a sore ankle and your physio has you stripped down to your boxers, as anything could be the cause of your pain (see previous blog http://www.thesportingjoint.com/blog/2O1 2/02/05/where-injuries-come-from!).
Moving: This could range from you showing the physio a painful movement in your golf swing to the physio gently moving your arm if you have a frozen shoulder. We need to see the movement you have, and how you make t happen (sometimes how your body cheats!) and how this is contributing to the issue.
Feeling: A good physio uses their hands A LOT in assessment. Feeling for muscle tightness/ stiffness, joint stiffness, fascial tightness and various lumps and bumps that can be found with an injury. Just because something is painful to the touch doesn’t necessarily mean there is something dramatically wrong with you, it’s all just part of the information the physio is gleaning from your body.
Treatment (very much dependent on the pathology!!!) should consist of
· Soft tissue treatment: this is mobilisation of the muscles, tendons, ligaments and fascia (the covering of the muscles). Most physios will get pretty offended if you think all they do is ‘give you a rub’ or a ‘massage’. I don’t ever recommend irritating the person who has their elbow stuck in the trigger point in your calf by trying it!! We are searching around for tight areas that our assessment led us to believe should be further assessed/ treated, and a good physio can feel when something is tight without you having to tell them!
· Joint mobilisation or manipulation: This is to decrease stiffness or pain at a joint, and sometimes you don’t even know it’s happening (but it is!). Manipulation doesn’t always result in a ‘click’ or a ‘pop’, but it should increase the range of the joint, or the pain when moving it or pressing on it!
· Neural mobilisation: your nerves can get tight too, particularly if they get all wound up in tight muscle/ fascia. Stretching these out can be a little tingly sometimes, but let your physio know if everything is going numb!!
· Other treatments: This can include dry needling/ acupuncture, taping, ultrasound, TENS, interferential therapy (although not as many physios are using electrotherapy these days)
· Exercises: Your physio should give you strengthening/ stretching exercises at the end of each treatment, and if not, there should be a reason given as to why not!! This helps to maintain the good work that’s been done during the session, and helps to correct some of the imbalances that brought you in in the first place! The goal of physiotherapy should be to alleviate pain, improve function and prevent recurrence of the issue as much as possible. If you literally have one leg shorter than the other there is not a lot a physio can do about this, but hopefully can strengthen you up to deal with this as much as possible.
My advice to you is:
• Ask your physio anything you don’t understand, it’s your condition, and if you want to know, then they should help you to find out!
• If you don’t feel comfortable with your physio then ask to see someone else, it’s your right!
• See someone recommended to you. It’s scary out there, and just opening the Yellow Pages isn’t necessarily the best way to find the best person to take care of you.
• Check your physio is suitably qualified. In the UK you can do this on the HPC register http://www.hpcheck.org/. If you have chronic back pain try to find someone who specialises in that area, and the same goes for sport... if you are serious about your sport, your physio should be too, and should show a good understanding of what you put your body through.
• see a physio about a musculoskeletal injury before you see your GP, as physios have more training in this area.
I hope that helped to put your mind at ease a little about what to expect, please feel free to fire any questions at me.