Physio can mean many different things to many different people . . .
For some it is about going to see someone who will put their hands on them, manipulate joints and muscles to ‘put things right or back into place’.
For others it’s about feeling tight and sore and going to see a physio for a massage or soft tissue work.
Some might go to see a physio expecting the treatment to be painful and to leave sessions feeling worse, hoping to get benefit further down the line. While some expect to immediately feel better after seeing physio.
Occasionally people will complain that a physio didn't do anything and just gave them exercises to do at home.
Some people go to a physio looking for reassurance and advice, others look for a quick fix.
Some people want to see a physio as soon as possible after they first experience symptoms, others wait and wait and wait, until they can’t put up with their nagging partners any longer.
So which is it?
Should a physio be doing things to people or giving them advice?
Should physio hurt? Or should it have instant benefits?
Should a person aim to see a physio as soon as possible or wait for as long as possible?
Well the truth is: there is no right or wrong. All of these things can be true of physio and yet many can also be false.
Physio can consist of hands on treatment such as mobilisation or manipulation of joints, massage, taping, acupuncture and many more things. Yet physio can be just as much about exercise, advice, reassurance, compassion and empathy.
Neither is right or wrong.
But what every physio will do is sit down with a person and listen to their story.
They will listen for clues, obvious and subtle to possible causes of the symptoms. They will listen to that person’s beliefs and concerns, without judgement. They will aim to understand the impact the symptoms are having on that person’s life and the importance of reducing the impact of the symptoms.
A physio will look at the person as a whole, and not just as a stiff back or dodgy knee. They will look at how the body moves and will try to understand why it is moving the way it is. They will look to see which structures are being placed under load and whether those structures are the best suited to carry that load and whether they are capable of managing that load efficiently. Whilst acknowledging the impact of the nervous system, including the person’s thoughts and feelings. Sometimes a person’s beliefs about posture, or fear of movement can be the cause of symptoms just as much as the joints and tissues.
A physio will share their thoughts and ideas with the person, and try to help them to understand why they are thinking those things, so that together they can test the hypothesis by making changes. Sometimes this change may be to try the same aggravating movement again after a mobilisation of a stiff joint, other times this maybe about lifting with a different technique, at times it maybe about helping a person to see unhelpful patterns in their behavior that contributes to the symptoms they are experiencing. But the physio will always look to see what impact the changes have made to the persons symptoms, and is not afraid to change the approach if there is no improvement.
So the factors involved in a person’s symptoms can be complex, involving parts of our bodies, tissues, joints, nerves; our thoughts, pushing too hard to achieve a goal, fear of damage; the way we hold ourselves or the way in which we move. Every problem as an element of all of these factors. A physio will aim to identify which of these factors are contributing to a person’s symptoms, and will trial possible solutions and management strategies to help eliminate or minimise them.
At times physio can be painful. At times physio can seem like a miracle and provide instant relief from terrible pain. However most of the time physio is neither painful or a miracle cure, but instead steady progression of improved function, and in most cases a return to full activity.
For some people and some symptoms physio assessment is most appropriate as soon as possible after the onset of symptoms. For others there is little benefit in being assessed so quickly. An impact injury sustained in a fall may need rapid assessment if significant trauma is suspected such as fractures, dislocations or concussion. However, in the majority of cases physio assessment so early after the onset of symptoms is largely about ruling out serious injury and providing advice on the early management of the injury. If you have just twisted your knee and it has become swollen, assessment with a physio maybe useful to determine whether any structural damage has occurred, however it is unlikely that you will get any immediate symptom relief despite seeing the physio as soon as possible. Sometimes an injury can be too painful to usefully assess initially, and it is more helpful to allow a little bit of time to pass before trying to assess the problem. However, if the knee is still causing problems 2-3 weeks later a physio will be able to assess the likely causes of the ongoing symptoms and suggest a plan to help regain function. If in doubt, speak to a physio, tell them your concerns, ask them whether they think an early assessment would be beneficial, or whether giving the body a little bit of time to begin the healing process first would be a better choice.
So what is physio? Physio is about identifying all the factors that play a role in a person’s problem, helping the person to understand the factors involved, and working together to produce a plan that will produce a change in those symptoms.
So I truly believe that physio can include all of these things and more. Everyones experience of physio will be different, and so it should be, we will all have our different problems, with different factors influencing them. But the aim should always be the same, to listen to a persons story, understand what impact the problem is having on them, to use their knowledge to identify the factors contributing to the symptoms, helping the person to understand these factors, and working together with the person to produce a plan that helps to reduce the impact of symptoms and return to function.