Why Have Physiotherapy?

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. So, in my mind when I was thinking about this blog I had the idea of doing a short piece on the topic of "Does Physiotherapy Work?" where I would simply look at each of the areas that our physiotherapists are involved with and then explain what the research evidence showed in this area. In my mind this sounded like it would be a nice short physiotherapy blog and might be of use to both other physiotherapists reading this blog and patients looking for or considering having physiotherapy. Then I started to write the blog and quickly realised that physiotherapy is a profession and practice that encompasses such a large number of areas, writing a quick blog covering how effective it is in each area was going to be impossible. Instead I thought that it might be better to simply look at what physiotherapy is, the areas that it is involved with and some of the reasons that you might want to consider having physiotherapy. 

What is Physiotherapy?

Okay, before looking at why you might want to have physiotherapy and its benefits, it is probably a good idea to be clear about what physiotherapy is and what do physiotherapists do. Well the Chartered Society of Physiotherapy defines it as:

 "A healthcare profession that works with people to identify and maximise their ability to move and function."

Helpful? No, it never really seems to help me be any clearer about exactly what physiotherapists do!! Possibly its better just to look at some of the areas that physios work in and the things that they do:

The Main Areas of Physiotherapy

Although physiotherapy is one of those jobs that when at a party and someone asks you: "what do you do?" you can confidently state "I am a physio" and most people will easily understand what you do and you won't have to do lots of explaining about your role. It turns out that when trying to list all of the areas that physiotherapy encompasses and that physiotherapists are involved in that this is an enormous area. Below are (I hope!) most of the areas that physiotherapists are involved in:

1. Musculoskeletal Physiotherapy

Musculoskeletal physiotherapy simply means anything that is to do with the muscles and bones (and tendons and ligaments!). Mostly this involves issues such as back pain, neck pain, shoulder impingement, trapped nerves, sciatica and golfer's elbow to give some examples. Musculoskeletal physiotherapy is a wide ranging part of being a physio and can involve being the first person that the patient sees and making referrals based on what you see or taking referrals from GPs. Often patients will want a clear diagnosis of their problem as well as treatment and being a musculoskeletal physiotherapist will often involve completing a very detailed and thorough physical examination of strength, balance and movement. When discussing physiotherapy with anyone who is not a physiotherapist, this is the part of the work that most people will think of as being physiotherapy. 

2. Neurological Physiotherapy

Another key area is neurological physiotherapy which involves physiotherapists working closely with patients with neurological problems such as Multiple Sclerosis, Parkinson's Cerebral Palsy and those recovering from a stroke in order to improve mobility, strength and general function. Often physiotherapists will be working with patients for a long period of time with individual patients to help them recover and build up their strength and maximise their function. This can be in a variety of settings from an acute stroke ward (where patients have literally just had a stroke) to out in the community visiting patients at home and working on their function and quality of life. Some patients having neurological physiotherapy will have very few issues and will be working and living a normal life and are simply trying to ensure that they keep on top of any issues. Other patients having neurological physiotherapy however will have significant difficulties and may be using a wheelchair, unable to mobilise and have significant muscle weakness. 

3. Elderly Mobility

Another key area that physiotherapists work in is that of elderly mobility. Often physiotherapists will be involved with helping elderly patients regain or maintain their mobility and independence by prescribing exercises. This reduction in mobility that the physiotherapist is helping with may have happened in a number of ways: possibly it was a slow decline that most family members and even the patient themselves did not notice at first or potentially the patient has had an illness that has meant they have had a lengthy hospital stay and this has reduced their mobility. Either way, physiotherapists will be presecribing exercise programmes and working with individual patients regularly to attempt to maximise their recovery and quality of life. 

4. Orthopaedic/ Post-Operative Physiotherapy

After many orthopaedic procedures such as a hip or knee replacement physiotherapy and physiotherapists play a key role in helping the patients mobilise and make a full recovery. Nowadays, with a population that is living longer and needing more joint replacements this is a huge part of the role of physiotherapists. Often a physiotherapist will see a patient the day after a joint replacement whilst they are still in hospital and will then work with them in hospital to get them home as soon as possible. Once home, the physio will then work with the patient to maximise their recovery from their hip or knee replacement which can often take a lengthy period of time.

5. Sports Injuries

For the general public sports injuries is the area where physiotherapists are most closely associated and cretainly anyone watching premier league football or rugby will have seen a physio running onto the pitch.  Physiotherapists play a key role in assessing sporting injuries in both professional and amateur sports people and assist with both diagnosis and treatment of sporting injuries. For professional athletes they will often have a physio as part of their general team and certainly major professional sports team will often have severeal physios in their teams. In amateur sports, players and athletes will often need to go to a loca physio clinic and pay to see a physio to get their injury diagnosed and treated. 

6. Paediatric Physiotherapy

When explaining to people what our service provides when I talk about paediatric physiotherapy I get some strange looks. However physiotherapists play a key role in helping children who are having difficulties from a variety of ailments or neurological conditions such as Cerebral Palsy, delayed development, torticolis and plagiocephaly to name but a few. Paediatric physiotherapy is a specialised part of being a physiotherapist and can provide invaluable help to children and the families of children with difficulties. Often paediatric physiotherapists will be involved with children in special needs schools. 

So How Can Physiotherapy Help and Why Have Physiotherapy?

Okay, now we have had a look at each of the areas of physiotherapy and what they involve it might be good to have a look now at how each area of physiotherapy can help and why you might consider having physiotherapy. It is probably best to do this under the same headings as before and look at how a physiotherapist might be helpful in each of these areas.

How Can Musculoskeletal Physiotherapy Help?

As mentioned musculoskeletal physiotherapy involves assessing anyone with pain that comes from the muscles, bones, ligaments or tendons. Musculoskeletal physiotherapy can be very helpful for anyone that has a pain that they are fairly certain does not need a doctor to see. For example: if you are generally feeling unwell then you would go and see the doctor whereas if you have a bad back then most patients would recognise that a physiotherapist would be the best person to see. Seeing a physiotherapist for a musculoskeletal problem can be extremely helpful to get a clear diagnosis of what is going on, find out what you can do about it yourself (e.g. exercises, stretches, things to do, things to avoid) and get some treatment in the form of hands on manual therapy. 

Possibly an example of a typical musculoskeletal patient might help illuminate how things work:

Our patient has been having shoulder pain for a few weeks after lifting a heavy object in the garden and feeling a pull in the shoulder. Since then they have had pain when lifting anything above shoulder height and can't lie on it at night. So, they decided to see one of our physiotherapists. On assessment their shoulder was weak and painful on any movements above shoulder height and the physio was able to diagnose a common musculoskeletal issue: a rotator cuff tendinopathy. The physiotherapist then used some manual therapy to ease some of their muscular pain and gave them a program of exercises to follow to strengthen their rotator cuff up. Over the next 6 weeks they saw the physio about 4 more times and were given progressively more difficult exercises and slowly their shoulder improved. At the end of the process the patient was extremely hapy as they understood what had happened to their shoulder and how to sort things out themselves. 

How Can Neurological Physiotherapy Help?

Neurological physiotherapy involves helping anyone with a neurological problem such as a stroke, Multiple Sclerosis or Parkinson's Disease. Neurological physiotherapy can be extremely helpful for anyone that has an ongoing neurological condition such as Multiple Sclerosis or has suffered from a stroke recently. For example if you have recently had a stroke and have now come home but are still recovering from the effects of the stroke having neurological physiotherapy can be vital in ensuring that you fully understand your condition, what you should do and making sure that you ahve the right exercises and management plan to help you recover. On the other hand you may have a long term condition such as MS which means that you will have ongoing physiotherapy over a long period to ensure that you retain as much mobility, strength and independence as possible. 

Again, an example of a patient with a neurological problem might help show the benfeits:

In this example our patient has Cerebral Palsy (obviously a long-term condition) and has in general been managing well and living independently. However, recently they have noticed that they feel a bit weaker and things have been feeling in general more difficult. So, they have asked one of our physiotherapists to visit them at home. On assessment it becomes clear that although they have been doing well, they have not been following a good exercise program and have let things go a bit and have develeoped weakness in a variety of areas. As such the physiotherapist gives them a series of targeted exercises to do and then over a period of several months sees them regularly to check that things are improving and make any changes needed. After potentially six months, things have improved sufficiently for the patient then to simply begin seeing one of our physiotehrapy assistants who continues with the exercises at regular intervals and checks if anything is changing. Every few months the patient then has a joint review with the physio and the physio assistant to determine if anything needs changing and make sure everything is proceding well. 

Someone reading this section now, may well be thinking that if everything has improved: "why do they still need seeing?" This is a valid question and in some cases the patient may well not want any further involvement with our physiotherapist and will call them if needed. However, other patients may feel that by having one of our physio assistants visit every few weeks and check up on things that this keeps them focused and motivated to do their exercises and stops them getting lazy. Every patient is different and as physiotherapists our role is to give the patient options as to how to manage their condition. 

How Can Physiotherapy Help Elderly Mobility?

Physiotherapy offers a number of benefits to anyone worried about their mobility and can make an enormous difference to anyone getting older and who finds that their mobility and strength is declining. Clearly, the earlier help is sought the better the result tends to be with physiotherapy. For example a physiotherapist can assess anyone whose mobility has declined and determine what is happening and what needs to be done about it. The physio can then work with the patient over a period of time to ensure that they have a good exercise routine and are building up their strength and mobility. 

Hopefully the example of a typical elderly patient with mobility problems below will help show physiotherapy can be helpful:

In this case our patient is in their mid 80s and has recently had a hospital admission and has returned home with significantly reduced mobility and the family who were very concerned have asked a physiotherapist to visit their mother at home. The physiotherapist does an assessment and finds that the patient is very weak and struggling to stand and gives the patient and family a series of exercises to complete and then visits the patient several times a week for about a month in order to get her back on her feet and mobilising again. At this point sessions are reduced in frequency and slowly the patient needs less support as they return to a more normal life. 

How Can Physiotherapy Help With Orthopaedic /Post-Operative Recovery?

Physiotherapy is vital after any large orthopaedic operation such as a hip or knee replacement and can make an enormous difference to quality of life, speed of recovery and joint movement. After having a knee replacement a patient will have reduced range of motion and find that their knee is very weak and painful. Having physiotherapy at this point can make a massive difference to the patient in terms of getting back on their feet, strengthening their knee and giving the patient knowledge about how to manage things themselves and what to expect.

The example below shows how physiotherapy can be beneficial to anyone who is recovering from a hip replacement:

In this example our patient is a usually active male in his 70s who has had a hip replacement last week and been discharged home from hospital with no complications. He is generally doing well but is worried about what he should and shouldn't be doing and what exercises he should try. So, he books an assessment with a physiotherapist at his home. The assessment shows that his current exercise program is not sufficiently challenging and that he needs to push himself much harder. As such the physiotherapist gives him a more challenging exercise program that he follows himself for about a week or two before having another session, at which point the physio sees how he is doing and progresses his exercises further. This process continues over the next few months until such point as he is back to where he was before his hip replacement and the patient is able to self manage. 

How Can Physiotherapy Help With Sports Injuries?

Physiotherapy for sports injuries such as muscle strains and ligament tears is very widely accepted as being beneficial and you would only have to look at a small amount of professional sport to see a physiotherapist or discover how they work with the coaches, players and staff to ensure that the players are fully fit. Most people who see a physiotherapist for a sporting injury are however not professional sports people and are in fact just normal people who like playing sports but have got an injury and are worried about how to manage it. By seeing a physiotherapist they are able to get a clear diagnosis, understand how best to manage it and then hopefully slowly return to their chosen sport. 

The example below shows how a typical person with a sporting injury might benefit from physiotherapy:

Our patient here is a female in her 30s who has decided to run a marathon for the first time, she has been following a program that she found on the internet and has been building up her running over the last 3 months. She has however recently developed knee pain and is worried that she won't be able to do the marathon. So, she books an assessment with a physiotherapist to find out what is going on and what she can do about it. The assessment shows that she has a weak hip which is causing her to be unstable in gait and is irritating her knee, it also shows that she has built up her running too fast and needs to take a steadier approach. So, the physio gives her some strengthening and stabilising exercises for her hip and also advises her on how best to build up her running. Over the next few months she sees the physiotherapist a few times to alter her exercises, discuss progress and have some manual therapy on her leg and hip and slowly things improve until she finally does her marathon. 

How Can Paediatric Physiotherapy Help?

Paediatric physiotherapy involves a specially trained physiotherapist assessing and treating children from very young toddlers to adolescents. It can be extremely beneficial to both the children involved and the family themselves. Paediatric physiotherapists often work with children with complex needs or with childdren who are not achieving their gross motor milestones such as walking or crawling at a certain age range. The physiotherapist will assess these children and then provide advice, exercises and therapy aimed at helping the children develop and the family manage the situation.

Potentially an example of a typical child having physiotherapy might help:

Our patient in this example is 2 year old boy who is having difficulty walking and has in general been delayed with achieving his motor milestones. He is currently waiting for NHS paediatric physiotherapy but his parents have become very concerned and want help sooner. After assessment the paediatric physiotherapist gives the parents advice and a series of exercises and tasks to practice with their son and then vsiists them regularly every few weeks or so to check on progress and change exercises as needed. The family find that their son develops and begins walking and that they understand what they need to do to help him. 

Okay, I hope that you have enoyed reading this blog and have a better idea of what physiotherapy is, what physiotherapists do, the areas that physiotherapists work in and how physiotherapy can be beneficial.