I recently wrote and article about the top 3 biggest mistakes I see people make when it comes to approaching their pain and injuries. (you can check it out here)
so I thought I’d add the biggest 3 mistakes that I think people make with their physio treatment.
1. Not having a goal or a plan
Let me give you an example. A few months back I saw a lovely 78 year old lady who her GP had referred to us to help with her low back pain. Now she has had quite advanced arthritis and persistent back pain for 30 years. (not that arthritis always means pain, but in this case it was pretty severe). She said to me at the start of the session:
“I don’t know why I’m even here. You aren’t going to be able to fix my back – nothing is”
No she wasn’t exactly wrong. I can’t change her arthritis. But in many cases I believe that’s not the most important thing. I asked her
“In a perfect world – ideally what would you want to achieve out of your treatment with us? How is this impacting your life that you wish you could change?”
Her answer was “I just wish I could wish the dishes or vacuum the floors without having to stop, or sit down for an hour after because my back was hurting. If I could get to a point where I could do that I would be so happy”
This is a completely different goal, and outcome for her than “curing her back”. Realistically in this case it’s unlikely we will be able to get her completely pain free, but now we had a goal and a plan, and this was ABSOLUTELY achievable for her. We worked out a plan for some hand on treatment and a lot of exercise work to be able to build her up to a point where she could do those things. And you know what? she can vacuum the floors without stopping now. Once we had a goal and a plan we were able to work together towards impvoing her quality of life and getting her where she wanted to be.
2. Expecting Miracles
The unfortunate truth is usually the longer you’ve had a problem, the longer it will likely take to resolve. This is because you get neurophysiological changes, more stiffness, more weakness, protective patterns, altered movement patterns, etc, etc.
(Happily the opposite is true too. A study in hamstring injury came out last year which found that if you start treatment within 48 hours of injury then, on average, you would get back to sport 2 weeks quicker than if you started treatment later).
Some problems can get better very quickly, but by and large it takes time and work.
for some reason people often have two conflicting view points. They are very concerned that their problem will never get better, but then they also expect it to be cured immediately. In most cases neither of these are true.
3. Not following through
Another unfortunate truth is that there is often a big difference between feeling “ok” and being actually 100% better. Pain is a warning system (and a very complex one at that) so it is unreliable to base our management entirely on if you have pain or not.
As a good example – we know that following an ankle sprain you are at 50% risk of re-injuring that ankle within the next 12 months. That’s 1 in 2 ankle injuries that are destined for multiple sprains! That’s a terrible outcome. (How would you feel if you got a new battery for your car but 1 in 2 of them would fail?)
BUT – if we ensure you do at least 6 weeks of neuromuscular retraining (that’s strengthening, balance and stability retraining) after the pain resolves then your chance of re-injury is more like 10%. It is actually irresponsible of us to not ensure that your are not only pain free, but back to 100% strength, movement and function AND ensuring the problem is not going to recur or become ongoing. Anything less is, I believe, poor management.
Now you (the public) don’t know these facts and statistics, so once you start to feel “ok” the motivation to continue doing the work can wear off. This unfortunately leave a large percentage of people who are out there only 70-80% better and likely to have further problems down the track. And it’s true that many health professionals don’t necessarily communicate these facts very well to help you understand WHY you need to keep doing the work (or having further treatment) once you are starting to feel ok.
If you were an athlete, and you suffered a hamstring injury – you wouldn’t stop all management once you could move around without pain and run. you need to be able to sprint from a cold start 100 times in a game, and jump, and stretch, and back that up with training every day or two, and keep that up for 6-9 months without a break. This is the difference between many elite athletes and regular people. Everyday people can end up with dodgy hamstrings (or knees, or ankles, etc) because they never get to fully rehabilitating their problem. Elite athletes do the full amount of work to give them the best chance of 100% long term recovery.
Bonus: Not doing your share of the work
The reality of life is people are busy (and a bit lazy) so we find a lot of people don’t get around to doing their homework. We may see you for something like 1/168th of the week, so that’s a very small impact we can have on your life time wise. That’s why you will often get ‘homework’ from your physio. Things you can do for the other 167/168ths of the week that are going to significantly accelerate your progress and mean optimal recovery and avoiding recurrence.
There was some research done over 15 years ago that showed that about 1 in 10 people completed there home rehab exercises! That means 90% of our clients aren’t getting the fastest or best outcomes because they aren’t holding up their end of the bargain.
Everyone who comes into the clinic just wants to lay down on the treatment couch and have someone else “fix”them. Sometimes there are issues that only require this, but usually there is some work to be done to improve capacity, endurance, mobility, strength, etc.
We help those who help themselves
(Actually we’ll try and help you even if you don’t help yourself at all… But it would make our job a bit easier if you do a bit too)
Julian is the Director and Principal Physiotherapist at EMC Physiotherapy. He has spent over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues. He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries.