Many people, used to a passive relationship with a health professional, are surprised to find that the physiotherapist expects them to work hard at getting better. A physiotherapist will make sure that the treatment is appropriate to your particular condition.
In most countries, state-registered, or licensed, physiotherapists are trained to degree level and work in hospitals, community clinics, industry, sports organizations and clubs and in private practice. Family doctors can refer people directly to a physiotherapist, but most are sent for this form of therapy by their hospital consultant. As the demand for complementary medicine grows, some physiotherapists are broadening their skills and learning therapies such as acupuncture and aromatherapy.
Regardless of whether or not a physiotherapist offers such therapies, there is a fundamental similarity between physiotherapy and complementary medicine – the patient takes an active role in the healing process.
Seeing a physiotherapist
Physiotherapists are experts in their own field and although your doctor will have sent your medical notes, the results of any tests that have been performed and a diagnosis, he or she will leave the physiotherapist to decide what sort of treatment is the best for your condition.
At your first visit, the physiotherapist will spend a considerable amount of time compiling a detailed history of your symptoms and general health and will give you a thorough physical examination. Treatment is tailored to your individual condition and you will probably be taught specific exercises that you must undertake at home on a daily basis in between sessions. The physiotherapist will probably also give you detailed advice on posture, movement, lifting and carrying, as well as general lifestyle and exercise.
Physiotherapists use a variety of techniques depending on where they trained and their own personal preferences, but all fall into the following broad categories.
Various forms of massage are used, both as therapy in their own right and as a warm-up procedure to relax mind and body and relieve pain before treatment such as mobilization. Various massage techniques may be used.
Mobilization techniques are used to gradually increase the movement in stiff and painful joints in the spine and elsewhere. Gentle rhythmic movement is used to stretch the ligaments and move a joint or groups of joints near to the limits of their normal range. During mobilization you have a great deal of control and if the movement becomes painful, you can usually stop it by simply tensing your muscles.
Mobilization techniques are graded depending on how much force is exerted by the physiotherapist. The most forceful involves a deliberate thrust to push the joint or joints beyond the point at which movement stops in normal day-to-day activities. However, even in this technique the joint is never moved further than it can naturally go.
Various exercises that you perform with the help of the physiotherapist and which are designed to strengthen muscles around joints are described as movement techniques. In some exercises, known as assisted movement, you work the muscles with the help of the physiotherapist and in others, known as resisted movement, the therapist pushes against you as you exercise.
Some simple exercises you can do at home are given at any physiotherapist.
Traction can be as low-tech or high-tech as you like. At the do-it-yourself level, many people have found at least temporary relief from their back pain by hanging by their arms from the top of a door. At the other end of the scale there are various sorts of specialized equipment that you can use to apply traction while you lie horizontally or that allow you to hang upside down by your feet. Other equipment can apply traction specifically to the neck. The more advanced techniques should only be done under the supervision of your physiotherapist.
This is widely used by physiotherapists to treat injuries to muscles, tendons and ligaments. Ultrasound can relieve pain by reducing muscular spasm and areas of swelling. It uses ultra-high frequency sound waves, inaudible to the human ear, which penetrate the skin harmlessly. The sound waves are emitted by a device that looks like a microphone and is passed slowly over your back. The procedure is completely painless.
Electrical devices can relieve back pain, but the benefits appear to be generally short-lived. The principle behind this therapy is that applying tiny amounts of electric current to areas around the pain site stimulates nerve endings in the skin and signals from these override the pain messages being sent to the brain.
Exercising in water can have excellent results for back-pain sufferers. Warm water eases pain and takes the weight off aching joints, making it easier to exercise.