What to expect from your physiotherapist?

I felt compelled to write a blog about what to expect from your physiotherapist, because I feel it’s a topic not often touched on, yet so important for soon-to-be physios as well as prospective clients.

Over the last 5 weeks I’ve been mentoring a Masters of Physiotherapy student from UTS where I do some lecturing for the subject “Transition To Practice.” In term 2, 2018 I touched on what we as physios should be delivering to our clients, as well as our expectations of them such as clients listening to our advice, doing the exercises we prescribe and attending their follow up consults on their journey to resolving their injuries. But what should clients expect from us in return?

The first thing I did before writing this blog was google “what to expect from your physiotherapist” and I have to say I had to laugh at all the answers: a thorough assessment, diagnosis, interferential, ultrasound, accurate exercise prescription, cupping, massage, dry needling, and the list goes on! While I’m not having a go at any of these treatments, I thought that’s not really the answer.

So, what should you expect from your physiotherapist?

Hi, Hello, How Are You?

Firstly, I believe you should always be greeted with a warm welcoming smile and hello, whether it’s from the front of house staff or the other practitioners. I myself don’t run a reception model so it’s on the physiotherapists to greet the clients and make them feel comfortable because I really think this sets the tone for building rapport.

Good Communication & Trust

Good communication is the basis of all good relationships. You want to feel comfortable enough with the physiotherapist to share your personal information. That doesn’t mean sharing your relationship status or other personal details but disclosing the details of your injury. This is an incredibly a private and vulnerable moment for some where trust is a key factor in the exchange of this information between client and physiotherapist.

The truth is injury affects many components of our lives. More often than not there are psychological factors in addition to the physical pain or limitations we experience so feeling comfortable to share this information with your therapist can help in your recovery.

A Holistic Approach

There’s a lot of talk about the biopsychosocial model on health, which I think is flawed. My reasoning behind that is we are giving a label to it – health shouldn’t necessarily require everything to be labelled! I look at the biopsychosocial model and the first thought that comes to mind is treating your clients with respect, as we expect from them. That model is basic human behavior. Take the whole person in front of you into account.

That’s what a good physio does – they look at the holistic picture not just the injury.

Alternative Options To Exercise

Unfortunately, this holistic approach isn’t used often enough. I can’t tell you how many times I’ve had clients come to me from the other local physiotherapists saying “they just told me to rest, not to do anything for 2 weeks, and come back twice a week. But without exercise I go nuts!!! It’s my only stress release, what do I do?”

This statement above has been one of the many failings of physiotherapy. The whole “just rest” phrase, and in some cases, I don’t disagree! However, for a majority of injuries we can find a way to let them do some form of exercise while still allowing the injury to settle down.

So, going back to what you should expect from your physio? Well you should expect:

1. To be greeted upon arriving and made to feel comfortable.

2. Treated with respect and NOT as if you don’t know anything. A good physio will listen to your opinions on your body and take them into account.

3. Unearth any information you might have dug up on Dr. Google, dispelling inaccurate information and providing education into the pathology of the injury, which is always a vital part of the recovery process.

If you look at those three points above, there’s a common theme: a good physio listens more than he/she talks.

A Complete Story NOT just a Subjective Examination

As physios we are really good at asking questions, diving into assessment of injuries through our subjective and objective examination process that we are all taught at uni.

But I think it’s also one of the problems – we’re too laser focused on asking the ‘right’ questions in our subjective assessment, instead of getting a well-rounded story of the person sitting in front of us. I remember back to my Uni days when we had assessments on our subjective assessments. I always hated this process, and I used to get so nervous thinking about which question was the right question to ask!

Then as I became more experienced in my practice I transitioned away from this approach – in fact I don’t think I’ve actually done a “subjective examination” in years! But then you ask, “well how do I find out what’s wrong?” It’s actually quite simple: I just have a casual conversation with the client. It’s more of a relaxed discussion that doesn’t always dive straight into the injury itself. I want to find out:

• About the client
• Their personality
• Their traits
• And THEN what brought them into see me

In that process I might not ask one question about the injury, but I just let them tell me what they think is relevant. I don’t like to put a label on this process. Again, it’s all part of building rapport and trust between the therapist and the client – it doesn’t have to be straight into the “subjective examination”, instead it should be a relaxed comfortable environment to communicate.

Then of course there is the assessment, diagnosis and treatment, which I’m not really here to discuss that part of what to expect from your physio. This is because every therapist has a different process, and a different tool kit of treatments. My only comment is they should be evidence based, effective and not misleading.

Honesty & Transparency

My final point on what to expect is honesty. I’ve worked in practices driven by KPI’s and performance indicators, where clients are seen as just a number. There are even practice acceleration programs out there that, in my opinion, advise physios on how to mislead clients. They focus too heavily on developing treatment programs, protocols and spiels on how to rebook your clients and seem to be all about the money.

I’m not saying your physio shouldn’t advise a follow up consult, because that’s not true; very few injuries get better “after one session”. It’s often a longer process, but your therapist should be discussing a treatment plan with you and advising you why you need a follow up. This plan should include a prognosis, exercise progressions and, if needed, a return to sport or activity plan. There is no way in hell you should be buying 10 packs of therapy or having 3 – 4 passive treatments a week for 6 – 8 weeks!

My point around this is your physio should be constantly reflecting and reassessing your progress with follow up appointments, so you see improvement and progress over time.

I hope I’ve effectively touched on what to expect from your physiotherapist because its not all just assessment, diagnosis and treatment. Remember, there’s much more to a good physio than their ability to identify and treat your injury.

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