Misconceptions about physiotherapy

“I often make the mistake of thinking I can manage my injury on my own and I know what my body needs.”

Let’s get on the same page.

Physiotherapy is not just for when you are injured or ill. However, it is most common when you are, and physios use a holistic approach to improve movement and function (NHS).

Physiotherapists can work in big teams and all types of settings, treating a range of conditions. We are most commonly thought of as treating injuries in sports or general life.

You will rarely see a physiotherapist working alone; most of the time we work in multidisciplinary teams (a fancy word for a team of all medical and sporting professionals).

In a sports setting, it can include your sports coaches, strength and conditioning coaches, nutritionists, massage therapists, and sports psychologists for example.

In a hospital/medical setting, it can include doctors, nurses, occupational therapists, imagining specialists (MRI, X-ray, CT etc.), midwives and of course other physiotherapists.

A common misconception is that physio’s ‘just massage the pain and it goes away’ – this is wrong!

“I’ve had a recurring injury over the past few years and I would often think I can do it on my own and I know what my body needs. When I finally decided to go and see a physio they may find something which i would have not thought of, and they know far beyond what I have or can google.”

Helena, Henley Royal Regatta Wargrave Winner 2023 and Thames Rowing Club Athlete

Physiotherapy can also be used for functional movement screening (FMS) – where you go through different movements under the watchful eye of a physio.

The evidence of FMS for predicting injuries is generally low and conflicting because the tests used and populations tested on are varied (Moran et al., 2017).

That is not to say it can’t produce useful information!

One rowing-related study investigated if 5 specific tests can screen for potential low back pain in female collegiate rowers. The results showed that specific tests with specific population groups can be useful to highlight asymmetries, impairments, and weakness – useful information! However, they can not be relied on to predict injuries (Gonzalez et al., 2018).

That being said, it can be useful in the bigger picture and when combined with other objective information.

“If I had an injury and went to see a physiotherapist, what would happen? Can you talk me through it?”

Of course! Seeing any medical professional can be anxiety-inducing – especially when you are in pain and discomfort and unable to do what you love.

A general initial physiotherapy session will consist of a chat with you to gather as much information as possible about what is going on, how it happened, your symptoms, and what movements you can and can’t do.

Also, talking about your ideas of what has happened, your goals, concerns and expectations of physiotherapy help us to understand you more and how we can best use our skills to help.

The best thing you can do is to tell the physio everything you think is important and be transparent about how much you complete your rehabilitation program, your expectations, lifestyle and concerns.

Sometimes individuals have unrealistic expectations which is where talking about them more in depth can be useful to get everyone on the same page and help to not get frustrated during your treatment.

Similarly, education is a key skill that we use to communicate important things which helps people to understand topics and debunk physio myths – a popular topic is thinking that you only have to do your management for a few weeks and you will never get the problem again.

After a chat, physios will want to do some tests. This could be anything from functional movement tests (to assess strength, mobility, flexibility and see if your symptoms get provoked) and neurological tests to specific tests to help diagnose the issue. Depending on how sensitive your injury is it can sometimes be uncomfortable and reproduce your symptoms.

After this, the physio should have a pretty clear idea about what is going on and the next steps. They will use all this information from the chat and testing to create an individualised rehabilitation plan with your goals and lifestyle in mind.

A combination of skills is used once the problem has been identified during treatment. Movement and exercise form the foundation of rehabilitation and management. The following levels order are subjective to different physiotherapists. I personally think education is the next level.

“This season I had an injury which I’ve never had before and after seeing Sophie it gave me confidence and I learnt things I didn’t know before. I learned something when I go to see a physio whether it’s about my body or physiology and recovery in general, I found that understanding the different parts of my rehabilitation plan has been crucial for self-management and recognising signs early.”

Helena, Henley Royal Regatta Wargrave Winner 2023 and Thames Rowing Club Athlete

Then it’s manual therapy, which includes massage, joint mobilisation, stretching and deep pressure (BISE ET AL., 2016).

Then there are specialised adjunctives which include fancy machines like functional electrical stimulation (FES). They are most effective in the long term when done with exercise and movement.

Remember to listen to your body and work within your capabilities; don’t overdo it – little and often is better than too much too soon.

Your rehabilitation program may include specific exercises that are appropriate to you, the number of reps and sets to complete, how often and how long to do them for.

It may also include stretches, mobility exercises, strengthening exercises, an educational component, manual therapy or other specific treatments. They will talk to you about the importance of rest and recovery to help maximise your recovery. Other things can also be included, these are just a few ideas.

After your first session, you may have regular check-ups and the frequency will vary. In your checkups, the physio will see how your body is responding to the rehab, how your pain is, and how you do when retesting some movements. This helps plan your next steps.

Gradually as improvements are happening, the physio and you may start your return to sport (yay!). This is very exciting! All the hard work from the earlier stages gives you this opportunity and it is very important not to rush this because otherwise you may get a flare-up or re-injured.

In a nutshell, the return to sport protocol is where sport-specific movements are included and the duration, intensity and frequency are gradually increased back to your normal level.

Things to remember about physiotherapy!
1. Physiotherapists work in lots of different settings: hospitals, clinics, sports clubs and independently. We manage and treat all types of conditions like cystic fibrosis and lung problems, surgical rehabilitation, and musculoskeletal problems (injuries …)
2. Rehabilitation differs for everyone and every injury. It takes your body time to calm down from the injury, manage the stress, and begin to heal. All of this has to happen before you can start to rebuild back up. Don’t rush it! Good things take time!
3. Check in on your friends, teammates and athletes when they are injured. It can take a big mental toll on people and it is hard to know how you’ll respond until it happens to you.
4. Successful rehabilitation includes incorporating it into your lifestyle and being consistent.

Sophie Hudson (@sophiehudsonphysio) is a registered physiotherapist.

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