Physical Therapy: Good vs Bad

As a respected Performance Soft Tissue Therapist, and before my current career was a client losing hope over pain, I have a good perspective in what to look out for when looking for a decent therapist. We all have aims and goals, we should all be able to strive and achieve them.

I frequently get clients who have been receiving treatment elsewhere for some time with no real improvement, and are consequently dissatisfied, and sometimes losing hope that they will ever live pain free again!!! This is bad practice from the therapist whether it be Sports Massage, Chiropractic or Physiotherapy for example, as it is our job to ensure you improve and reach your goals. This could be from putting your own socks and shoes on, gardening, sitting at a desk for long periods, performing a Human Flag, playing rugby or running a marathon. No matter what the aim or goal is, your therapist should help you get there.

THINGS TO LOOK OUT FOR BEFORE BOOKING:

- Look at what the therapist is qualified in, to what level, where they qualified from, and their regulatory body.

- See what previous experience the therapist has and read any testimonials.

- How does the therapist treat, such as what techniques do they use, and does this suit what you require?

- How much do they charge and does it reflect their level of qualification and experience?

- Does the therapist continually research and stay up-to-date within their work?

THINGS TO LOOK OUT FOR DURING THE TREATMENT:

- An important characteristic for each therapist is the ability to listen and take it on board. What the client says should indicate how the therapist should adapt the treatment. If you want a strong or powerful treatment, have an area of localised pain, how long you have had such pain, and anything you feel relevant is important for the therapist, so say it!

- A Client History and Assessment Form is regarded as normal practice, Postural and Biomechanical Assessments however are rarely done. Injuries from childhood COULD, not will, impact your body as an adult, and pain is usually accompanied by compensations so ignoring the compensations and solely focusing on the area of pain is insufficient as those compensations would soon bring back that pain!

A prime example of this is how I once treated a Lebanese Basketball Player at AIMAG 2017 who presented with left ankle pain, I managed to find the cause of the pain coming from the left jaw!!! I recommend reading my previous blogs, and also watching this video I shared on my Facebook Page from Co Kinetic as to why postural and biomechanical assessments are so important in physical therapy: https://www.facebook.com/MoveWellNottingham/posts/1607031946077250

- Post assessments and pre treatment, the therapist should explain what they have found, what they feel is the issue, and how they aim to treat you, whilst ensuring throughout that you understand. Many occasions I hear clients say how they were never really told what the cause of the pain/issue was, I myself experienced this, and it can leave a person feeling hopeless and helpless, so it is VITAL that you know and understand what, why, and how for both cause, and treatment aims, and be confident in asking questions.

- During the treatment, your joints should be supported. Lying face down (prone), head, shoulders and ankles are mandatory, with optional support for hips or lower back by placing a cushion under the gut for example. Lying face up (supine), support is required at the head, and knees, with examples of optional support being for the lower back by placing a cushion under the glutes, and under the ankle when working on the superior/front aspect of the joint. Sideline needs support of the head and upper leg, with options for the back. This is important as with no support, the joints are placed under strain, which is augmented when being treated on.

Bad examples:

- Nicely linking in with the above point, the therapist should ALWAYS ensure you are comfortable, it is NOT good practice to have bruises due to the treatment as the whole point of the treatment is to reduce inflammation, not cause it! Mild small bruising sometimes occurs, but it should not be deep bruising. If you are unsure as to why the therapist is doing something, just ask!

THINGS TO LOOK OUT FOR POST TREATMENT:

- How you feel is one of THE most important things post treatment, as you should feel confident, happy, content, and feel able to contact the therapist after the treatment with any questions or queries if forgotten to ask during the treatment.

- Home care should involve exercises and stretches which are realistic and suitable for your lifestyle. Such advice should NOT be ignored as it will help you recover and/or reach your goals quicker, thus, saving money too!

- Being able to predict the full recovery time to a certain amount of treatments, particularly if the therapist markets these bulk buy treatments, this is regarded as bad practice. Every client is individual and their pain and goals should always be considered subjectively, for example, whilst some people can recover from ACL surgery in less than 6months and be living pain free and a normal life again, some can take over 12months. I often explain that if someone has been seeing the same therapist for more than 3months with no real improvement, then they should consider seeing another therapist!

- Does the therapist recommend any other forms of treatment or therapy such as yoga, Chiropractic, Physiotherapy, Feldenkrais, or Cranio-Sacral Therapy? Not all cases require other forms of treatment, but it is important that the therapist has a network of renowned professionals in which to recommend if needed.

- The ultimate aim is for each client to reach goals smiling and looking for the next challenge!

So, a life of pain, or a life pain-free?

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