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Some FAQs concerning Physiotherapy- Part 1

Trying anything for the first time can be stressful, then add in the PAIN factor and understandably concerns are greater. Physiotherapy can be daunting especially when you hear comments such as NO PAIN NO GAIN, or the thought of grueling exercise session. However the purpose of physiotherapy is simply to work out the cause of the problem and pain and sort it. It is normal to have some apprehensions and question when you attend physiotherapy, why, what, how? So some Frequently Asked Questions or FAQs :

Will I be better after one session?

In most cases NO. It all depends on the type of injury and whether the problem is acute or chronic. Lets take the analogy of when a preson is ill and requires antibiotics for an infection. You would not just take one pill and expect to get better? You would be expected to complete the full course of antibiotics similarly physiotherapy to treat a musculoskeletal problem will entail more than just one session. In the acute phase initial treatment will focus on protective measures to reduce inflammation and scarring. In chronic patients, the nature of chronicity will mean changes to posture, movement patterns, muscles, joints as well as anxiety levels. All these things will therefore take time to change. In most cases, there will be a combination of both muscle and joint involvement. Muscles are tight, stressed, strained all describing the same phenomena. Muscle can also be weak and therefore painful when exerted. In this instance a person may benefit from strengthening and stretching exercises all which will take a little time to achieve. If the joint is the source of pain, it may be mal-aligned, stiff, bruised and in the worst case scenario be sore due to a fracture. Again it is the role of the physiotherapists to decide what he/she feels is the best treatment modality to reduce the joint abnormality and thus the patients symptoms. However one session of joint mobilising may not be enough or be too painful, if for example the joint has been stiff for a year. Therefore more often than not a several sessions are required to loosen and mobilise the joint effectively. After the initial assessment the physiotherapist should have a good idea about the prognosis of your condition and should be able to provide you with a rough estimate of how many session you will need and over what period.

Can you not see me once a week?

Well the answer is of course yes and obviously depends on the problem itself, but would you like to feel better after 2-3 weeks or drag your symptoms out over 6-8 weeks? Expanding on the previous analogy whilst taking antibiotics you would not suggest taking the pill once a week only, instead of the recommended daily suggestion; you would follow the prescription that the doctor or pharmacist best advises for you. Spreading sessions out on a weekly basis especially during the initial phase can mean that any loosening of stiff joints, stretching of muscles achieved during the session of physiotherapy may be lost in 7 days of you doing the “incorrect activities” that caused your pain in the first instance. This may mean that each week you return for physio potentially back at square one with slower and smaller progression. So more frequent sessions in a shorter period will allow the therapist to keep a close eye on your symptoms, activity and achieve faster progressions. The frequency of sessions may tail off as a person is closer to being discharged. In addition shorter session of physio (half hourly) may be more useful than hourly sessions during the acute and inflamed stage of an injury in particular, as too much mobilising, stretching and strengthening of aggravated tissue may worsen symptoms, so gentle and often is often the better approach. [caption id="attachment_5704" align="aligncenter" width="280" caption="Image physiotherapy sydney"][/caption]

I Feel 90% better and wish to discontinue treatment?

Now this is something which you may think, and in some instances 90% is as best as you are going to get, as is the nature of some injuries. Again drawing on the antibiotics analogy you would have to complete the full course of treatment for the full effect of treatment, you would not stop taking the antibiotics as soon as you think your feeling better if your GP/ Phramacist has advised you to take the course of antibiotics for ten days. Similarly in physiotherapy, if your someone who comes in for a quick fix, an example being a low back strain, your initial sessions will consist of reducing the symptoms and pain. This will be mobilising the joint that is stiff, releasing the muscle spasms and inflammation, and this alone may require 2-3 sessions depending on its severity. At this point you may feel your back is pretty much better, however your back has not been strengthened and is therefore at great risk of recurrent injuries. You may also not have received all the information for normal movement; you may not be aware of what faulty movement actually caused your strain or not had the chance to process it due to the previous pain. This could mean you return to your normal day-day activities with a weaker back and continue to do the things that may be strain your back. The problem with repeating this cycle, is each time you strain your back, it produces scar tissue in the affected ligaments and muscles. Scar tissue at its best, will never be as strong or as tensile as muscle tissue and therefore will further compromise the integrity of the affected structures leading to an even greater risk of recurrent injuries. Hence it makes more sense to reduce your initial symptoms, learn how to look after your back, discover what is straining your back and strengthen your core muscles with individually prescribed exercises. So here’s hoping that some of your questions have been answered. Look out for some more FAQs next week. Bottom line: if you don’t ask, you don’t know, so if you are not sure, just ask !

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