Hello!
This is my first attempt at blogging, so here goes! I hope, at the very least, this gives you some food for thought.
I’ve worked as a physiotherapist now for almost 10 years having qualified in 2008. I’ve treated lots of patients with lots of different conditions and illnesses in a range of different settings. I’ve worked in acute hospitals, community hospitals, care homes, patient’s homes, intermediate care centres, day centres, outpatient clinics and more recently gyms and private clinics. I’ve treated people with strokes, Parkinson’s disease, multiple sclerosis, back pain, ankle pain, muscle injuries, balance disorders, vestibular impairment, COPD, osteoarthritis and people recovering from orthopaedic surgery (I couldn’t put the whole list on…we’d be here forever!).
When I reflect on the above I consider myself a pretty experienced clinician. I've had the privilege of working with some really fantastic educators and colleagues along the way. I’ve completed a shed load of post graduate study and have now started working privately in the West Midlands. I really enjoy what I do, I believe I am good at what I do and take pride in helping people.
But for those who have never met a physio or seen us work, do you actually know what we do?
Massage? Back rub? A bit more than that…
The Chartered society of Physiotherapy states the following: “Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They maintain health for people of all ages, helping patients to manage pain and prevent disease”.
Once you qualify as a physiotherapist you do have options of where you can work. Some of the options are the NHS, private clinics or sports clubs/gyms. Most generally begin work in an NHS hospital as a junior therapist and begin working rotations. These are periods of time, usually between 4-6 months, where you work in different departments and specialities to gain experience.
Once you have decided what patient group you enjoy working with, you then aim to ‘specialise’ in that area. This could be working specifically with musculoskeletal conditions, neurological conditions or respiratory conditions. Other areas such as elderly medicine, Intermediate care, community rehabilitation, involve a therapist having to combine skills and knowledge to treat patients with a combination of issues.
Depending on which area you work in you will then utilise different assessment and treatment techniques to help the patient with their individual problems.
Treatment techniques you may have heard of include…
Manual therapy, joint mobilisation, trigger point release, acupuncture, Passive stretching, gait re-education, postural exercises, balance re-education, breathing exercises, manual respiratory techniques, relaxation….and this just scratches the surface.
Depending on the area you specialise in, you will use certain treatment techniques more often. For example, a Physio working with stroke patients may not ever use acupuncture but will focus more on retraining movement, walking and functional ability. Whereas a physio working with musculoskeletal conditions may use acupuncture, soft tissue and manual therapy to help manage pain and injury. Both are still physios, but different specialities. Physiotherapists also play a large role in managing respiratory conditions. They use a combination of exercise, manual techniques, breathing techniques and specialist equipment to improve patient’s ability to manage their breathing pattern, help them to clear excess secretions and general management of conditions such as cystic fibrosis, COPD and emphysema. A physiotherapist should have a good knowledge of anatomy and physiology, understand the importance of exercise, have a good eye for movement analysis and then apply this to the relevant patient group.
It is important to understand that physio is much more than treating pain and sports injuries. Each area is of value and importance.
We use evidence-based practice to support what we do. This means using existing scientific research to back up our current practises and treatment methods. This is a sound thought process and I completely value the backing of scientific evidence for our profession. On the contrary, I also know we do not have solid scientific backup for absolutely everything we do, even though there maybe countless number of clinicians that vouch for a particular thing working. If we wait for scientific evidence for absolutely everything we do or recommend, we would be waiting an eternity. Is there any evidence for the application of common sense?
So why private practice?
I believe the NHS is a great place to learn from senior therapists and other healthcare professionals, gain valuable clinical experience and to refine assessment and treatment skills. I have worked with a number of unbelievably skilled therapists who I have a great deal to thank for taking the time teach me. The quality, intelligence and ability of the therapists that work in the NHS is not in question here. Some people I have worked with, who choose to stay in the NHS, could easily work in high level sport if they chose to do so.
During my time in the NHS I began feeling more and more frustrated with staffing issues, an ever increasing workload and being asked to contribute to meetings about meetings. In my humble opinion, this detracted from effective use of clinical time, reduced efficiency and didn't give patients what they needed. There are a lot of highly skilled therapists working a system that isn't ideal. But as most physios do...we suck it up and get on with it and do the best we can in situation that is frankly, shite.
Some people grin and bear it, some of us don't (or can't). So here I am....that's why I'm here writing this, treating patients privately, doing things the way I think they should be done. With time, diligence and common sense. Patients want time, to be listened to, not to wait an eternity to get help and then to be rushed out of clinic so the next one can be seen.
So.... what’s my philosophy on rehabilitation?
Here goes….a list of thoughts I go by when assessing and treating people. I didn’t realise I had so many! This is not a clinical list, but more of an expression of what I consider important.
PHYSIOTHERAPY IS NOT AN EXACT SCIENCE
I think the profession does it's best to be backed by scientific research but its not a pure science. It’s a mixture of science and art. A mixture that if not balanced correctly will not be effective. Doing a treatment without any sound reasoning or putting the patient at risk is just ridiculous and should never happen. Being arrogant, over confident and a self-professed miracle worker should also never happen. The 'art' bit of therapy is the ability to connect to the human being you are treating. Not the shoulder or the knee. Combining good clinical skills with top notch communication skills, listening ability and understanding is what the person in front of you really needs. To get all that right, every time, for every individual you treat is an art.
ESTABLISHING RAPPORT IS THE FIRST STEP IN THE REHAB JOURNEY
Being listened to and understood is one of the things that most people desire and crave when they are faced with difficulty. This is a way of establishing trust and is the foundation of any successful relationship. If your patient doesn’t trust you then the results are not going to be positive. Physios should spend more time understanding their patients, giving reassurance, motivating and promoting self efficacy.
HOW I USE LANGUAGE HAS AN IMPACT ON OUTCOMES
“Your posture is really bad, it’s contributing to your pain and will take a really long time to improve” vs “Although you have pain, there is definitely things we can try to make the situation better, posture and movement are two of the things we can start to work on”. A change of words and focus in a statement can give a person hope, or could make them feel even shittier then they did before they came to see you. The idea is not to make people feel worse about their body than they do already! The idea should be to offer hope and solutions.
PROMOTING SELF MANAGEMENT IS THE KEY TO LONG TERM HEALTH
As a patient Physio/Rehab/therapy is not something that get’s done to you, it’s something that you do. Encouraging individuals to take personal responsibility of the body, mind, emotions and thoughts they have is key to that person’s healing and recovery.
I DON'T KNOW EVERYTHING (AND DON'T CLAIM TO)
I don’t care who you are, what profession you are in it’s not possible to be 100% right all of the time. It’s not possible to have all the answers all of the time. And that is absolutely fine. As long as patient’s needs are managed in an open, honest and safe manner I think we’re all good.
LEARNING IS ENDLESS
I enjoy learning now more than I ever did at school, college or University (my lecturers will vouch for this). When assessing a body I do my best to assess what the body is actually doing rather than having a pre conception of what I may find. People and problems don't always fit into boxes. Every body is different.
I DON'T FIX PEOPLE!
I help people to fix themselves. The body does the hard work and is very good at healing itself. We should be humble about this before we start spouting this nonsense that we 'fix people'. Medicine would not work without the body's innate ability to repair, regenerate and recover. Sometimes it needs a little help and guidance to be pointed in the right direction. It may need some help understanding that danger has actually passed, that it’s a safe place for movement and healing to take place. We are facilitators of the body’s natural processes. Old injuries, illness and general life can sometimes take its toll on the body. But it is important to remember there is always room for improvement and always opportunity for change, if there is willing. Helping people understand their bodies better through advice, education and experience is one of the most important gifts we can give to people.
As a human being you have to take personal responsibility for your health. If you eat crap (not literally), never exercise, drink too much, sit too long watching Netflix show after Netflix show, ignore your body and then wonder why you’re in pain or you don’t feel healthy……well what can I say? When you waltz into my clinic you’ll get your assessment as well as getting some straightforward life advice too.
USE THE RIGHT TOOL, FOR THE RIGHT JOB, AT THE RIGHT TIME.
I take an active approach. I aim to get you moving a quickly as possible. Do not expect a nice lie down and back rub when you come to see me. I'm not running a spa here. But please don't worry I'm not some scary trainer that's going to get you plank for an hour or force you to do anything that's unsafe.
I use a combination of treatment methods to help you with your problem, with a simple common sense approach, explained to you in language you can understand. My experience and skill helps me work out what you need. You will have homework. Stuff you need to do in your own time. It is going to be your adherence to the advice and consistency to stick to an agreed plan that will make the change in your body and life you want to see. There's no miracle cure here. Look after yourself, for your own sake.
So there you have it…my first blog! My own take on things and piece of my mind. I’m sure this will continue to evolve with time and the more experience I gain so don’t hold me to this page forever! I hope to scribble down my thoughts more often so watch this space. If there is anything you'd like me to talk about then let me know!
Thanks for reading.
Bhav
ps: If you haven't done already follow me on Instagram @thecurlyphysio and on Facebook www.facebook.com/thecurlyphysio.