If only I knew then what I know now! Physiotherapy Reflections
If only I knew then what I know now! Physiotherapy Reflections
I once heard a wise university lecturer say that as humans every five to seven years we naturally evolve into a new season of life. Our focus changes, our objective changes and subsequently the tone of our life changes. In my fifth year as a Physiotherapist I certainly agree with this and feel as though my career and work life is building and changing more now than it ever has. I wanted to take the time in this blog to reflect on some of the biggest and steepest learning curves I have had over my short career and some of the pearls of wisdom I wish I could have told my younger self.
1. You will never be everything to every one
I am naturally a people pleaser. Every single person I have had walk through my doors I have wanted to please, to cure and to send back into the world a changed happy person. If only it were that easy. As a new graduate I struggled to put clients into a neat little box of a simple injury and a simple solution. I found myself getting discouraged and frustrated when I couldn’t fix them. But the truth is that there are a never ending list of reasons completely out of your control as a physiotherapist that can prevent someone from making a full recovery.
Sometimes people don’t have the time or money to commit to physiotherapy rehabilitation, sometimes they just aren’t ready to get better (not a high enough priority in their life), sometimes the mechanical nature of the injury will prevent a full recovery, and sometimes people would just prefer to seek someone else’s opinion instead of yours, and that’s OK.
2. Complex pain disorders require complex solutions
I can distinctly remember sitting through lectures on pain at university and feeling like my brain was going to melt trying to get my head around the complexity of the information being taught. We are fortunate that pain, and in particular persistent pain, is an area that has been well researched.
As a new graduate physiotherapist I was often overwhelmed by peoples persistent pain stories and even though they had seen 3 physiotherapists, 4 chiropractors, 2 osteopaths and 20 doctors before arriving to see me I thought if I could only try sending them for one more scan to check for ‘this’, and if I could push hard enough on that structure it just might fix them.
I still hadn’t grasped the biopsycho-social model approach to treating clients. This model recognises the social and psychological influences on pain as well as the biological. And this is where I now tend to look at peoples pain as a recipe. For someone who has just rolled their ankle* the recipe is likely going to have a lot of biological ingredients influencing their pain, as opposed to someone who has persistent lower back pain when sitting in a stressful work environment with a history of depression and stress at home.
As physiotherapists we are not trained in how to manage all these contributing factors, but we are ethically and morally obliged to tailor our treatment/management to address these contributing factors and refer the patient on where possible and necessary to involve additional therapists in the patient’s care and overall rehabilitation.
*For detailed information on the best way to recover from an ankle sprain click HERE>>
3. Movement is healing
The old maxim if you don’t use it you lose it is true. The body needs movement to function and maintain homeostasis. A normal functioning joint, muscle, ligament needs to be moved to maintain its state of health.
As a new graduate physiotherapist with persistent pain clients I would often get them into pilates just to get them moving again. Initially I though it was the combination of all the right exercises for the right muscles but I slowly observed that it was a series of interactions. People were enjoying the exercise, they were being encouraged by people around them who had recovered from similar conditions, it reduced their social isolation, it encouraged normal movement patterns and reduced fear avoidant behaviours, it improved their sleep patterns and overall well-being, and most importantly empowered them to know they were curing themselves. This was not just isolated to clinical pilates (for more information on clinical pilates as an exercise modality click HERE>>) as there are studies that demonstrate that as long as people like the exercise, feel that they can do it, and it doesn’t hurt then it is going to be beneficial.
4. Take time off work to rest and recover
In my first two years of private practice physiotherapy I worked tirelessly to build and maintain a client base. I remember getting to the point where I felt like I could not take time off because I was concerned about what my clients would do without me. I was on the verge of burn out and felt so exhausted that I booked 3 months off work rather than a normal break just to get away from the profession. You are no good to anybody when you are running on empty yourself. Taking time to ensure you are fit, healthy and motivated is one of the biggest favours I have discovered I can do for my clients and my career in the long term.
5. You are being paid to be a practitioner first and a friend second
Finding the balance of this relationship has been something I have struggled with my whole career but feel I am slowly getting better. As beautiful as my clients are, I am not being paid to be their mate, I am being paid to be their physiotherapist.
That means that as a physiotherapist I might need to be open with clients about the fact that they might need to get serious and do their exercises, or have that difficult conversation about persistent pain, or not feel guilty we tell them they might need to make a considerable investment in a scan or a piece of equipment. It is our job and if we can go to bed at night knowing we have done the best by that person and given them the same recommendation we would give our own family, then we have done well.
Lindsay Christie (APAM)
Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A., & Perri, L. M. (2004). Psychological aspects of persistent pain: current state of the science. The Journal of Pain, 5(4), 195-211.
Taylor, S. J., Taylor, A. E., Foy, M. A., & Fogg, A. J. (1999). Responsiveness of common outcome measures for patients with low back pain. Spine, 24(17), 1805.
O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British journal of sports medicine, 46(4), 224-227.
O’Sullivan, P. B., Twomey, L., & Allison, G. T. (1998). Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. Journal of Orthopaedic & Sports Physical Therapy, 27(2), 114-124.
O’Sullivan, P. (2005). Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual therapy, 10(4), 242-255.