March 13, 2016

Blog

Essentially, physiotherapy aims to restore normal movement and reduce pain. Many therapies have a similar remit so what would you experience coming to see me?

I work with people who have musculoskeletal pain and injury: Anything from headache, neck, back and pelvic pain, hips, knees, ankles, feet and hands.

Physios have a good understanding of the other body systems as our training includes neurological, cardiovascular and respiratory care so this really helps us to know when something needs further investigation or referral to other areas of healthcare.

I treat all ages but tend not to see young children, as this is a specialist area. Personally, I have a special interest in longstanding pain and pre and postnatal pelvic and back pain.

Broadly the process is 1,2,3,4,5, Listen, Assess, Diagnose, Plan and Treat

  1. Listen

Physios will often have more time allocated for an initial meeting than most GPs or even specialist consultants. This is a fantastic opportunity to listen to the whole story or history of pain and injury.

A free flowing open conversation to discuss any worries, things that have happened in the past, things that may or may not be relevant but paint the whole picture of your pain experience. Even things that you might not consider to be relevant often lead to a greater understanding of the condition and subsequently a swifter process to fully understand and diagnose the pain.

People tell me that it is a relief just to be able to tell their whole story in a safe, non-judgmental, and unhurried space.

  1. Assess

A physio assessment will involve looking at how you move. This may be at a micro level, looking at the individual joints and muscles, and on a more global level, at the way you bend, walk or run.

I look at active normal movements such as crouching down or reaching up above the head. I look at how the whole body interacts during movement. I might find that the back is compensating for stiffness in the hip or that the shoulders are affecting the movement in the neck so it is always a good idea to look at whole body movements.

The next step is to observe individual joint movements both moved by you (actively) or moved by me (passively) I look at muscle strength and muscle length to see if anything is short, long, tight or stiff or weak.

There is usually a gentle palpation (touching) of the skin and underlying muscles, this helps to judge how the body responds to light or deeper pressure from touch to see if it is sensitive or painful. Sometimes there is also an assessment of the nervous system to see if there is any change in sensation (numbness or increased reaction), reflexes or loss of strength related to nerves.

For an assessment it is best to be able to view the body so I recommend that you wear loose or stretchy, comfortable clothes. Sometimes for example the back and hip you may be asked to remove outer clothes and just be in underwear. I would always make sure that you are comfortable to do this.

  1. Diagnose

All of the conversation and assessment will lead to a clinical diagnosis (letting you know what is going on with your body)

I like to give this information as a medical diagnosis and also in easier to understand layman’s terms. For example, the diagnosis of pubic symphysis dysfunction (SPD) might sound quite scary, however it is really just a medical label for soreness at the joint in the middle of the pelvis that has become a little more mobile in pregnancy.

Some pain or injury might require further investigation such as scans or x-rays however, generally a clinical assessment will give a fairly accurate idea of where the pain is coming from. I would always refer on to other professional if I felt that the particular injury or pain symptoms did not fall into my knowledge base. When a team approach is required I would liaise with any other practitioners involved in your care.

  1. Plan ands set goals

Physiotherapy is a partnership between the practitioner and the patient so I like set meaningful goals with you. Ask the question “what would you be doing if you did not have this pain or injury?” do you want to get back into a particular sport or just to be able to wash your hair without pain, do you want to achieve even more that your current normal. Anything from running marathons to strengthening the pelvic floor so that you can laugh without worrying about wetting yourself.

Goals are so important because that can shape the plan of treatment. Knowing what your goals are will also help to give meaning to any homework (exercises or techniques) that have been set to do outside of the treatments sessions. I can honestly say that the best results are achieved if you do your homework.

I am honest about timescales, there may not be a quick fix (sometimes there is) often an injury will need 6 to 8 weeks or even months to fully recover but if you know that from the outset then there is less room for frustration and loss of motivation. Long tern goals are great but we can also break them down into step-by step shorter term achievements that will rewards the efforts in the lead up to achievement the final destination.

  1. Treat

By this stage you should have a really god idea what is going on with your body and how we are going to get you better. Then we begin the treatment itself.

This could be some form of manual therapy: soft tissue massage type techniques, joint mobilization (moving the joints in particular ways), joint manipulation (cracking) but only with explicit agreement from you. Sometimes I use acupuncture needles for pain relieve and to help the body relax and achieve a restorative state in the nervous system, again this is solely with consent from you.

The second main area of treatment is exercise. This might be a specific home program of exercise to move, strengthen, improve range, improve muscle co-ordination or balance, or change the way you habitually move. It might also take the form of guided exercise in a one to one environment. I use the Pilates reformer, mats, weights and other small equipment in my clinic based rehabilitation space.

Finally there might be some talking therapy to help with re-framing your pain or injury. This is similar to CBT and can also use breathing techniques, relaxation techniques or therapeutic writing/journaling for you to do at home.

I love my profession and love the work that I do on a daily basis helping people to recover from pain.

jo@jocoulter.com

07855942486