Physiotherapy Best Practice
How to do you know you are receiving the best physiotherapy service available?
Nice is not necessarily good.
There are a lot of physiotherapists and others healthcare providers offering a service to ‘fix’ your problem.
The wrong choice can be costly or even harmful.
We have some tips on what you should look for when choosing a physiotherapist
A recent systematic review, which is a study about a collection of many studies, found 11 consistent recommendations for qualities that define best-practice for managing musculoskeletal pain. As such, I thought I would provide a summary of these recommendations for you to compare with the services you are receiving (or looking for). Hopefully your therapist ticks most, if not all, these boxes.
- Care should be patient centered
- Treatment should be focused on your individual needs and goals.
- Therapists should be screening for serious pathology and/or red flag conditions
- Sometimes (not often) your pain may be attributed to something that requires medical attention.
- Your therapist should be asking specific questions to attempt to rule this out.
- Psychosocial factors should be assessed or monitored
- More recently, research has highlighted the impact psychological variables, such as depression or anxiety, that can affect your course of recovery from pain.
- If not explicitly asking about this, your therapist should be vigilant for signs of psychological distress and address these signs when warranted.
- Advise against radiological imaging (X-Ray, CT scans, MRI) unless serious pathology is suspected, there is unsatisfactory response to conservative care or unexplained progression of signs and symptoms, or it is likely to change management
- Routine medical imaging can waste healthcare resources and is often unwarranted for you to improve.
- Conversely, it is important your therapist recognizes the above 3 exceptions for when it may be warranted rather than trudging along with the same ineffective treatment.
- Therapists should perform a physical examination which may include a neurological screen, mobility and/or muscle strength tests
- This one is self-explanatory. If your therapist doesn’t do a thorough assessment, how will they know what is wrong and how will they treat what they don’t know?!
- Evaluate patient progress with the use of outcomes measures
- How can you track progress if nothing is being tracked?!
- This can be done through continual re-assessment via clinical tests and questionnaires.
- Educate and inform patients about their condition and management options
- Patients often want to know 3 things: What is wrong, how long will it take to get better, and what can I do to get it better.
- Your therapist should educate you on the diagnosis, prognosis, and treatment options available to manage your condition.
- Include physical activity and/or exercises as part of a management plan
- We know through research that “passive” treatment i.e. having something done to you rather than you doing something for yourself doesn’t provide great outcomes on their own.
- Although passive modalities may have a time and place, they should be an adjunct to an exercise-based program.
- Use manual therapy as an adjunct to other evidence-based treatments
- This goes in-line with the above recommendation. Manual therapy can involve massage, assisted-stretching, joint mobilization or manipulation etc.
- If that is the only thing you receive at your treatment sessions, you could be getting a better service elsewhere.
- Unless specifically indicated, offer evidence-based conservative treatment prior to surgery
- Surgery is often an intervention that many patients believe will provide a quick fix. However, under most scenarios, conservative management can have just as good of an effect with less risk, time, and healthcare resources.
- Facilitate continuation or resumption of work
- Individuals that return to work in some capacity, even while in pain, do better than those who don’t.
- Your physiotherapist should also advise you on any temporary modifications needed to do this.
As you can see, there was no mention of a state-of-the-art facility, specific/specialized intervention (other than exercise), or mention of guru-type experience. If your therapist is hitting most/all of these topics, you can be confident you are in the right hands.
Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., … & O’Sullivan, P. P. (2019). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med, bjsports-2018.
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Caleigh ( Athlete and student )
“After two sprained ankles within twenty-four hours of one another, intensive physiotherapy got me off crutches and to an overnight snowshoe camp and European soccer tour within weeks.”
Nell (Educator and (again, thanks to Ross) considerably more knowledgeable Cricket Spectator)
“I was referred to Ross by my doctor, originally, for treatment of shin splints. When Ross could see my progress was not as expected, he communicated with my doctor regarding the possibility of a tibia fracture – a subsequent CT scan confirmed it was. Thanks to Ross’s professional experience and keen attention to underlying symptoms, my injury was more accurately diagnosed and is now, with his physio support, healing well. Ross’ quiet sense of humour and steady encouragement have made my physio treatment experience very positive”.
Peter ( still strolling along. )
“Ross took the time to understand the impact heel pain had on my activities and analyze the mechanics and footwear that aggravated the pain. With therapy and the custom orthotics he prescribed and recommended footwear I was able to happily stroll through the villages and countryside of Italy this Summer.”
Paul Gray ( active dad and running enthusiast )
“My experience at PhysioPlus was extremely positive. 3 days after tearing my ACL playing soccer I had my first visit. I walked in on crutches and was wearing an immobilizer knee brace for stability. Ross was able to help me regain confidence to bear weight on my injured leg and I was able to walk out with the crutches in one hand and the knee brace in the other.
Ross was able to confirm from his assessment of my knee that I had, in fact, ruptured my ACL which had not yet been confirmed, being prior to an appointment with the orthopaedic surgeon or an MRI.
Ross had me work through a program pre-surgery to regain as much mobility and stability I could without having the ACL intact. After the reconstructive surgery was completed we worked through a program to continue to increase mobility and strength. Having access to the exercise room complete with equipment was extremely helpful. Ross was able to explain and demonstrate how to effectively work through the exercise routines.
Within one year of my surgery I have returned to running and have started some hiking. I would highly recommend PhysioPlus to anyone requiring treatment. The atmosphere is calm and everyone is extremely friendly and caring.”
Lisa Wren (Age 55)
“After completing an extensive painting project, I ended up with a frozen right shoulder, which was extremely painful and debilitating. This is when my introduction to Physioplus occurred. My physiotherapist, Ross Baines, was instrumental in getting me back to good health. Ross used various interventional techniques to encourage movement in the shoulder joint, always providing me with ample information about each. He was always professional and communicated thoroughly with the rest of my medical team. I have every confidence that the care Ross provided expedited my return to normal activity. I would not hesitate to recommend Ross and the entire team at Physioplus!”
Bruce Cook – previous hard core triathlete
“Most highly recommended for physio and rehab. Ross is a knowledgable and caring practitioner, going above and beyond to help you. Easy going personality and very supportive. Ross is easy to talk to with incredible results. A+ from me.”