In my final article in the WHOLISTIC runner series I want to challenge everyone to step up and own our WELLNESS journey.
Starting out as a physiotherapist in the late 1990's it was very apparent that most patients referred to receive treatment came with a pre-conceived idea that I would fix them. They expected to have some type of treatment applied to them, involving either soft tissue work, a machine (Ultrasound or interferential), or joint mobilisation at every session. In the early phase of my physiotherapy career, I obliged - I would get caught up in what patients expected and dive down the rabbit hole of applying treatment at every session and the home exercises were just an add on. I felt fully responsible for "fixing" the problem when a more patient intergrative, global approach was needed; especially the longer the dysfunction had been present.
As I've gained more knowledge and confidence I am now able to treat more effectively with applying whole patient focused treatment. Eighty percent of the time a therapist is able to glean the diagnosis from an effective subjective interview. Using motivational interview techniques to sew the seed that a patient has the ability to tackle the problem with progressive direction, and that any hands on work is secondary in the process. The last thing that health professionals should want to convey to patients is that they have to be therapist reliant for long term, ongoing, hands on treatment. With an effective assessment, correct diagnosis, and a thorough home programme the patient can start working on tightness, weakness, poor firing patterns, then blend the independent rehabilitation into daily life in a way that allows progression, empowerment, and a long term solution.
To make this work it is imperative health professionals understand the patient's occupation, sporting pursuits, and daily activities - that means knowing exactly what they do during the work day - not just the job title; and what their sport involves.
"I feel it is very important for athletes to visit health providers that have a real understanding of their chosen sport."
This is coupled with specific guidance on what activities can be completed, and what needs to be modified to allow the rehabilitation plan to gain traction. The goal is to make the occupation, sports training, and daily activities the most important part of the rehabilitation process. REAL movements allow REAL results. Patients should not be shielded from this with reductionist gym or non-functional rehab exercises for too long. There is a place for these at the start of the treatment process then full body, real movement is important as soon as possible. I am personally a big fan of full body weight exercises - these are time efficient and will improve full body, functional strength when started within capacity.
I am very fortunate to have referral sources (GPs, orthopaedic surgeons, and sports medicine specialists) that understand the way I operate. They pave the ground work referring the patient with the words "the physio will show you exercises to help you help yourself". Mixed messages from medical professionals can create massive barriers to a patient applying the home exercises with dedication. If there is no buy in, or a lack of confidence shown along the referral chain then injured patients will continue to search for someone to "fix" them taking them further away from a self management, empowered, long term solution.
As a general rule the longer the patient has had the problem the less likely a healthcare professional should use "hands on" as the first line of treatment. It is important to use touch and feel to help with the diagnosis but then it is far more important to set the patient up with a detailed plan addressing all the issues, including "tools" they can employ on a moment to moment, and day to day basis. With long term pain the therapist needs to empower the patient, not get them set in the rut of therapist reliance with 2-3 weekly visits, decreasing to once a week then once a fortnight until the ACC funded treatment sessions run out. Once the patient is settled into a routine then any hands on work is secondary to the independent home programme. Follow up treatment sessions are started with a discussion on how the exercises are going - not how the pain is (the focus should always be functionality), and if there is need to go over anything off the home programme sheet before progression is made. Application of correct technique is EVERYTHING. If a patient has a poor kinesthetic (body awareness) sense then extra time is needed going over the exercises until the correct form and "feeling" is obtained. If the mind and body are not in sync then no progress will be gained.
Every patient should have a detailed home programme sheet broken up into posture, micropause work (helping offload tissue and recalibrate the correct posture), flexibility work, core/strength work, and then what daily activities, sports training, or work roles will enhance or discourage progress. Pictures need to accompany the written direction with cues that remind patients of the specific points of the exercises (I try to get the patient to give me the cues that work best for them) ALL these facets need to be modified and progressed. I find myself now talking and demonstrating much more than laying hands on patients than I ever used too. Athletes usually take to home exercises better than non -athletes so more education about the benefits of the exercises can be required for the non- athletic group. Motion is LOTION - our bodies are designed to move.
Patients receiving treatment need to have a working diagnosis matched with a home programme sheet, that is modified on EVERY visit. Having a patient visit often just for hands on treatment without advancement of a home rehabilitation programme can create a therapist reliance. As a patient it is important you are actively involved in the treatment process and not just a passenger. At the end of the day it is your body and taking responsibility is paramount.
Our health care system is fantastic for treating and caring for us with acute disease, sickness, and accidents BUT it is poor when dealing with longterm lifestyle disease and chronic pain. Health professionals need to put more emphasis on the patient making lifestyle changes. People aren't living longer, they are dying longer. We need to treat fire with fire : LONG TERM disease needs to be treated with LONG TERM wellness habits (Move more, get strong, sit less, eat more plants, prioritise quality sleep, invest in your relationships, live with passion, strive to be more and have less, and be of service to a cause greater than yourself)
I believe all health professionals* should aim to see people as little as possible by giving them exercises dovetailed with education about the diagnosis, so there is a shared determination to address the problem; then keep it managed in the long term with blending in daily wellness habits . If we all have a greater platform made up from enhancing daily habits that are sustainable, then the capacity to be more functional and independent deeper into old age with less incidence of injuries is enhanced. Health professionals shared mission needs to be to educate and empower people to make lifestyle choices that work for them.
*I am speaking from my point of view as a physiotherapist, but I believe all therapists and health professionals (including GP's, medical specialists, surgeons, naturopaths, nutritionists etc) can take something away from my musings and shift the focus towards patient empowerment in wellness. ALL healthcare providers need to be on the same page - "When you replace I with we even illness becomes wellness." Malcolm X.
Hippocrates (the founder of medicine) had the correct idea over 2400 years ago. Health professionals need to get back to basics to lay the empowerment platform for wellness. The power is not in the hands of the therapist, the power is in the patient's hands through life choices.
"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health."
"A wise man should consider that health is the greatest of human gifts"
"Let food be thy medicine and medicine be thy food."
"Walking is mans best medicine."
Points to promote involvement in your WELLNESS -
The longer the problem has been affecting you the less likely hands on treatment should be the first option. Using hands on therapy (eg massage, adjusting, and acupuncture etc) as part of your restorative training is recommended but NOT as ongoing treatment for an injury.
After the first session a working diagnosis should be found and a full home programme sheet should be written up. This needs to modified at every session with technique adhered too.
Ask questions about your home exercises plan. Don't just take the home programme sheet and file it away. Put it on the fridge - understand it, and follow it.
Athletes will sometimes ask "how long do I have to do these exercises for?" - the answer is until the body has recalibrated and the injury has been sorted out. This should not be a chore as EVERYONE ideally should be doing some form of strength/cardio/restorative exercise on a daily basis. Your body is the most incredible machine you will EVER own - invest in it now with daily enhancing habits.
Athletes need to be prepared to STOP running with certain injuries to allow rehabilitation to gain traction. Training and racing with injuries that affect quality movement patterns will reinforce deficiencies that will take longer to undo. When you continue to stress the body with underlying niggles you just layer more issues on top. Think LONG TERM function rather than SHORT TERM performance when ever you are treating training injuries.
You should never feel like you are a passenger in the treatment journey. You should know the diagnosis, the timeframe (this can be fluid) for tissue healing, and by listening to your body (plus therapist consultation) when you can increase your training and/or daily activities to allow functional progression. Please remember listen to everyone but follow no one. At the end of the day you are an individual and you need to take responsibility, learning to listen to your body above all else, to move towards wellness.