Seeing A Physio: Hints & Tips

Today I have a guest post featuring two lovely ladies who have agreed to share some info on seeing a physio when you're injured.

Hilary Billie Wilson gives the physio's perspective...

Background:
I graduated from the University of Otago in 2005 and have been working as a Sports and Orthopedics physiotherapist since. I started working in the private sector and for Rugby teams in New Zealand and Australia before moving to the UK in 2012. I have worked both in the public and private sectors in London. Currently contract to an NHS Specialty Musculoskeletal service, as well being team physiotherapist for the Old Haberdashers RFU 1st XV.

I am a keen runner, climber and diver, and previous ballerina, snowboarder, surfer, netball player and cyclist. My dream is to figure out how to combine working as a Physio and playing all of these sports at once, whilst watching as much Rugby as possible. Oh, and achieving a perfect downward dog.

Let’s be honest, being injured sucks. Having to take time away from work or leisure time to get the injury diagnosed and treated is also not a lot of fun, particularly not when you also have to pay for it. As a physio and a runner I genuinely appreciate this and understand that trying to explain an injury to a complete stranger can be a daunting process, so I’ve tried to put together a list of tips to help make this as metaphorically painless as possible, I unfortunately can’t guarantee there won't be actual pain during the session.

Pre-appointment:

1. Spend some time thinking about your injury. The practitioner you see (whether physiotherapist, osteopath or chiropractor) will want to ask you a lot of questions in the first appointment. Things that are great to have clear in your head are:

a) When does the pain occur? Is it during your run or after? And at what point during/after is it? How long does the pain last for, and what types of things can you do to make it better or worse? Is there any particular quality to you pain, eg: sharp, dull, throbbing, burning etc.
b) Also don't feel silly and weird when you are explaining this, lots of people stop ½ way through and ask if they are weird or making sense. Just be honest in what you feel, we've probably heard something similar before.

2. Bring any investigation/blood test reports you already have with you, despite most things being digitized it seems to be a pretty rare day that these reports get to me on time!

3. Think about your clothing before you arrive, please don’t wear skin tight jeans if you have a lower limb issue, bring some shorts something else that is easy to move in and that will allow us to visualize the area. Same goes for shoulder/back issues, dresses aren't ideal here.

4. Make sure you have tried some simple self-management strategies first, RICE/simple analgesia and gentle exercising.

During the appointment:

1. We will ask A LOT of questions, just try and answer openly and honestly.

2. There is a strong likelihood we will ask you to remove clothing during the assessment, we actually need to SEE the skin around the affected area. Please be prepared for this.

3. Testing: in order to diagnose your condition we will need to perform a series of tests, sometimes these can bring on your pain. Do what you can, but please report pain when you feel it, sometime we will ask you to continue to move if you can, sometimes we will ask you to stop.

4. Do not ask for an MRI straight off the cuff, particularly within the NHS. We have clinical guidelines we need to follow regarding ordering imaging and investigations. If you meet these guidelines we will discuss it with you, ordering unnecessary investigations can slow your appointment/treatment time and potentially delay your return to sport.

5. Goal setting: we work towards functional goals, unfortunately with many injuries there are no hard and fast healing ‘times’ as there are so many variables that can affect this. We try to give guidelines but these can often be wrong. What is more helpful is using functional measures to predict returning to sport. Eg: when you are able to hop 10 times with no pain and sound biomechanics (don't quote me here, every injury is different).

6. Make sure you discuss any events you have coming up.

7. Discuss any expectations you have regarding treatment/time frames with the practitioner, this can help us avoid disappointment down the track.

8. At the end of the appointment make sure you are clear about any exercise technique, frequency or dosage. Ask if heat or ice may help or if there are any other home remedies you can try.

After the appointment:

1. Sometimes we cause a thing called ‘treatment pain’. Sorry. In order to assess you sometimes we have to poke and prod and bring your pain on in order to do this. Your practitioner will warn you of this and give you some guidelines to follow to minimize it.

2. Exercises: We appreciate that you are a busy person, with often little free time. However if you want to see the benefit of your treatment, the exercises are vital. There is very little we can achieve in 30mins a week that will heal you, what we can do is teach you how to heal yourself.

3. Here’s some tips for getting exercises done:

a) Try and get into a routine AS SOON AS YOU CAN!

b)Set an alarm on your phone as a reminder

c) If you have some simple exercises you can do standing, try to do a few each time you wash your hands/go to the bathroom. For girls the same can go with sitting exercises!

d) If you miss a day its ok, just get back on to them tomorrow!

4. Be careful when people tell you their stories of their similar injury. It’s human nature to compare ourselves to others, but please remember that every person and every condition is unique. Just because Joe down the road had a knee injury and ended up having surgery/using electrotherapy/got better and ran a marathon within a month doesn’t mean that you are going to as well! It’s so easy to let our minds run away with us!

Laura Stewart on treatment under the NHS...

Background
Laura is a keen runner, cyclist and all-round fitness lover, who blogs at lifelauralondon about trying to maintain some sort of balance while living in London..

I had quad/knee pains for about 6 months that would come and go. However I still ran and trained for 4 half marathons in that time. Finally, I got sick of the annoying pain that wasn't going away so booked to see my GP.

I went into the GP appointment with the aim to get an MRI so I could see if anything was wrong in the knee. I'd been to seen a very knowledgeable sports masseuse and he said he couldn't see or feel anything major wrong but an MRI is always a good idea when dealing with the complicated knee joint.

I explained detailed pain to the GP and said I was worried about a MCL tear (based on where pain was) or Mensicus tear and she agreed that an MRI would be a necessary first step. I think this is the key to be confident in what you think the problem is and if that problem can be solved by looking in the knee with an MRI then you'll get one.

She referred me for an MRI and Physio at the same time. The physio called me that day to set up my first appointment on the telephone. The first appointment is on the phone so they can do a quick assessment of your injury and then make a decision to see you. While I don't know if this is the best, it is more efficient for the physio's time. My phone appointment was when I was on the bus so everyone got to hear about my knee!

The hospital called the next day to set up my MRI appointment and there was a space for one the next week at a location only 5 miles from my house. All very efficient. The MRI itself only took 15 minutes and I showed up early, was seen early and was out before my original appointment was scheduled to start!

I "passed" the phone physio appointment and was seen the next week at a clinic in Kings Cross (very convenient) and had a great appointment with a very knowledgeable physio who listened to me and didn't automatically blame "weak glutes" or "heel striking running style" which was refreshing. She gave me some acupuncture treatment and some stretches until the next appointment in 2 weeks time!

All in all I am really happy with the NHS physio system. I think you do have to do your research before and be confident in your body and how it feels (a good suggestion for everyday life!) and clearly explain that to your GP to start the process off right. I'm sure private physio's are great too but for me to spend upwards of £80 per appointment I would want to try all the other available services first.

One thing I will say is see someone, anyone! There is so much information out there on the internet that you can get sucked down a physio-hole of despair. Most of the information is general and when it comes to running injuries your treatment has to be 100% personal.

Thanks guys!

My physio experiences have been varied, and I think my problem a lot of the time is lack of confidence in knowing what to say/do so it's very helpful to have some tips from a physio's point of view! Laura's focus in helping her to get what she wants to sort out her injury is definitely something I need to work on.... But I totally agree with her on the overwhelming amount of information available on the internet- it can be very easy to self-diagnose with the worst possible scenario and get totally depressed!