"Do You Know Any Good Physios?"
It has always kind of confused me how a person will need to see a physio and they then choose the one closest to their house/work etc. Choosing a physio based on proximity, hours of availability, etc. has always seemed odd to me, because the thing about our profession is that it is so incredibly varied, with different therapists having different skill sets. I work in a clinic with 7 different therapists, and we each are very different from one another. The way I kind of compare it is: you wouldn’t just choose an accountant or hairdresser based on proximity or convenience, you’d ask people for recommendations and why they like that professional, and then choose based on your specific needs. Especially as physiotherapy becomes increasingly popular, I believe people should be informed about what to look for when choosing a healthcare practitioner.
So how do you choose a “good” physio?
I don’t think there’s a more complicated question that could be argued amongst physios, because we seem to be in a bit of a professional dilemma regarding what it is we do and why we should do it (believe me, I have like 5 draft blogs devoted to this). In general, one might say the amount of education the physio has would determine how “good” they are. At one point I would have wholeheartedly agreed with that statement, but now I think it matters more because it shows the physio is committed to professional development, not that they have necessarily have more knowledge or skills than another physio. Inter-professional disputes aside, in general; the best advice I can give to the internet in the form of my little blog is the same I would give to friends/family who don’t live close by to me.
You have a good physio if…
They make you feel capable.
This is by far the most important criteria I can think of. You should feel like you have options for movement and activity and are working towards improving your strength and limitations each visit. You should not feel nervous to do certain movements or that you can cause damage to your body by moving a certain way***
Bonus points for your physio if they get you a little excited about being more active.
***Example: I had a patient 2 weeks ago who had been told that her hip “goes out” by another healthcare professional and so she was nervous to do any activity when she felt an ache in her back or hip, for fear that she was walking and putting pressure on a hip that wasn’t aligned in her body properly. She stopped doing any form of physical activity. As she told me, she felt lopsided all the time, despite getting “adjusted” 2-3x a week for 3 months.
You like them.
This may seem silly, but if you enjoy spending time with your physio and you trust them, and you leave feeling empowered, it’s a great sign. A therapeutic relationship is important for increasing confidence while you begin to exercise again, and as much as physio isn’t a popularity contest, it’s still helpful if you enjoy your appointments. Also, I know if someone says “I really like my physio” it’s because they trust them and often times they feel that their concerns are being heard.
You feel you are progressing to your functional goals, whatever they may be.
You may need to take a break and have modified activities for a bit, of course. The clear end goals of our physio treatment, however, should be your physical goals. If you desperately want to carry your golf clubs and walk the whole course, I might recommend that we start with a push cart for the short term, but absolutely my goal is that we get you there in the end. Progressive loading is key.
The following are very general guidelines to some warning signs I will give friends/family. Again, these are personal opinions tied in with my professional experience, so take this as you will.
If anyone first offers to treat you with a machine/barely spends time with you… reconsider.
Anyone using strictly passive therapies that aren’t even hands on therapy, is literally looking to make you feel better with the least amount of effort on their part. Passive modalities of ANY kind have only been proven thus far to reduce pain. I’m of the opinion this is still important (hands-on therapy), but it should not be the primary component of your treatment for your long term health.
If the physio insists on rest for more than a week
This relates to point number 1. The most consistent, evidence-based treatment we have at our disposal is EXERCISE. If you are not given some exercises within the first session, I don’t think this is best care. There are ALWAYS exercises you can do to improve your condition.
If the physio does not work WITH you, to establish your goals and create a plan to get you there, please leave.
If you have a task/activity you desperately want to do, please don’t accept that “people your age can’t do this”, or “this is an extreme sport” or “you have too much degeneration”. A good physio should be working on a path to restore your functional goals as much as possible. This doesn’t always mean “pain free”-but more on that later.