Good physio vs bad physio: how you can tell
My heart sinks and I want to whisk them straight into my physio consultation room so I can get them better, I know I can get them better from my experience but also from knowing the research that backs my treatments. It’s the depressing tale I hear over and over, the person I am talking to has had physio, it didn’t work and now they are still in pain, they are going to have unnecessary surgery, injections or other invasive treatment or have simply given up on their beloved sport or activity.
It’s bad enough hearing it from a stranger, it breaks my heart when it is a friend. It’s depressing because if I could have seen them before they saw that physio that didn’t do the right things to make them better, they would not be in pain, they would not be having surgery, they would not be suffering. It’s depressing because there are so many others out there suffering unnecessarily, it’s depressing because these stories seem to be everywhere including all over the media, it’s depressing because my profession is one that I am so deeply proud of and I hate it when it is done badly and it’s depressing because I feel so helpless to do anything about it.
I can’t treat everyone, so I try and do as much teaching as time allows, I have tried to create a website with tonnes of info and exercises showing what good physio looks like and here I am again, trying to give you the knowledge to know if you have had good physio and, ultimately, whether to bother to seek out a second physio opinion.
Here are the key components of knowing if you have had good physio:
- They listen to exactly how your symptoms are effecting your life and use a scale to give a number to EACH AND EVERY activity you are experiencing a problem with whether it’s sitting at work, running, wearing heels, playing rugby etc. (We use a scale called the PSFS.) This gives a baseline so you and your physio know if you are improving (a simple 0-10 pain scale is too simplistic and does not focus on all elements of your pain.)
- When they tell you what is causing your symptoms it makes COMPLETE sense.
- They observe how you do the movements or components of the movements that cause your pain. They then analyse and make adjustments to these activities e.g. the way you walk, lift things, go up and down stairs, throw the ball, run, sit in the office/at home/in the car. These things can often make immediate improvements.
- They modify your activity levels instead of telling you to rest. Complete rest is very rarely beneficial.
- When they are doing hands on techniques you feel comfortable with why they are doing them and feel confident you can ask them to stop at any time.
- The exercises you are given make total logical sense and can be easily related to your painful or difficult activity e.g. if one of the activities that is painful is sitting then there should be an exercise in sitting, if one of them is running then the exercise should be standing up (ideally on one leg,) if it’s serving in tennis then it should be with your arm above your head, if it’s going up or down stairs then it should be up or down stairs, if it’s using your mouse at work then it should be with your arm in this position. Lying down exercises have their place but you need need to understand how they relate to your activity and have functional exercises along side them. (Functional exercises = exercises that look like or mimic parts of your painful activity or ‘function’.)
- They give you the ideal treatment plan with clear time frames including number of sessions and frequency of visits and tell you why you need to see them for those sessions. Then they ask you if this is realistic for you time and budget wise, and together you make compromises.
- They tell you when they don’t know the answer and refer you to someone who does. If they say they want you to have a second opinion or ask one of their peers to join a session with you then you know you are in safe hands.
- They never ever see you more than three times without you showing SUSTAINED and SIGNIFICANT improvement.
- They never tell you that you need ongoing treatment.
I hope this helps. I would love your feedback.
Lucy Macdonald, Chartered Physiotherapist (and proud.)
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