Hi this is Yanek here doing my bit for the Movement Team's Blog. We have had a great selection of blogs recently from the team and I must admit I was initially a bit stumped as what to write about next. The quality of the previous blogs has definitely set a high standard!
So I thought I would talk about something that I am exceptionally passionate about: Results-based Physiotherapy.
I am now 11 years into my Physiotherapy career which has spanned 2 continents and also a variety of Physiotherapy environments. I have worked in private practices, in sports clubs (from grass roots all the way up to the English Premier League) and in the complex rehabilitation environment with tri-service personnel in the British Armed Forces.
I am very proud of all of my previous work, though I must admit that the place where I have seen the most problems in terms of how Physiotherapy services are provided (and thus the results that clients get) is within private practice.
The Movement Team journey really started nearly 2 years ago now when Tim and I sat down and discussed both the problems we saw with Physiotherapy and also where it worked best.
It was our insights that Physiotherapy works best when:
- a clinician spends a good amount of time with a patient,
- the Physio and client are working towards a specific goal that is driven by the patient, and not something vague like "to feel better",
- the Physio has access to a wide range of equipment and space, and has the flexibility to utilise the full spectrum of physiotherapy interventions, and
- when the entire service and team is focussed on creating change for the patient.
When a Physiotherapy service is not working well, we do see some common issues, for example often the patient:
- has little idea what is wrong with them and they don’t understand what is going on.
- is not an active participant in the treatment process.
- does not have a good plan and doesn't know an expected time-frame to get improvement.
What Physiotherapy Isn't
Physiotherapists have a wide ranging set of skills to help a variety of problems. We have been taught a wide breadth of skills across key areas of the human body including Neurological, Cardiothoracic, Musculoskeletal, Paediatrics, Geriatrics and a variety of subsets within.
In private practice most consultations take place within a clinical setting (i.e. in a room). Perhaps when therapists are limited to a small space they have difficulty using the breadth of our true skills and this has contributed to a perception that:
For me, to simply equate physiotherapy to hands on soft tissue work is simply incorrect. Physiotherapists have a wide spectrum of skills that range from education, to hands on soft tissue work, to teaching motor skills, to direct manual therapy...all the way through to high-end strength and conditioning. Additionally we have a huge range of assessment and treatment skills specific to various conditions and presentations.
An individuals expectation of Physiotherapy depends largely on their previous experiences. It is not uncommon for people coming to see our team to have an expectation that they will simply lay down, get treated and then be fixed. This is very rarely true and if this expectation is held, it can lead to some of the most frustrating sessions for both Physio’s and their patients.
A hands on approach is a great way to get things moving and also to alleviate short term pain- however a single hands on session is never going to create long term change and results for patients.
From a business perspective it's great for practice owners to have lots of patients coming back week on week getting “treated” despite the fact they are not making significant progress. Along with a nice health fund rebate this creates a great system of simply processing people, but it rarely has clients progressing well towards what they want: to be better, functionally improved and stronger.
Physiotherapy should be far beyond having a therapist place electrotherapy machines on someone, a heat pack and 10 minute massage and being told to come back next week. As Physiotherapists we have a great ability to help change peoples lives. We can help people be better at and do more of what they want and with less pain or risk of injury. I'm more than happy to admit that no one wants to spend more time than they need to at a physio practice, doctors surgery or hospital - regardless of how nice I think our clinic is!
The Acceptance of Lower Standards.
So why is it ok to accept a standard of practice below what we know is possible. Especially when we know that there are models where it works really well (think of athletes and soldiers who can receive top level care that is goal based and progressive).
From a Physio's point of view, the ability to make the right decision for the right client is an extremely important skill to develop. When I was working at Tottenham Hotspur in the English Premier League (EPL), if my boss at the time asked me for a treatment plan for any of our players and I said “What I would like to see them a few times a week for 3 weeks and predominantly to focus on electrotherapy and massage. Then I'll see how things go...” I would simply have been out of a job within a few minutes and told politely to never come back.
When working with infantry soldiers wanting to get on the next tour of Afghanistan (who had to carry 40-80kg packs whilst taking enemy fire) if my Officer in charge asked how they were progressing and I said “well I have done some soft tissue work with them over 4 weeks” I would be endangering that soldiers career and also I would have a size 8 boot firmly placed somewhere on my anatomy and would swiftly be told “please make sure they are moving better and getting better” (The threat of endless burpees from the PTI’s would also be very scary!).
So if this is the expectation for athletes and soldiers, why do we sometimes accept a far lower standard for private patents? Is it just because we don't know we can expect better? I can guarantee that everybody would benefit and feel great for 6-12 hours after a hands on session with a Physiotherapist, and if thats what the patients need then that's great. But when we have the ability to help create significant and long lasting change (on top of feeling good for short periods)... shouldn't we do that!?
By taking this approach, you can visit a Physiotherapist who is an expert in movement and they can both treat your acute symptoms and take you all the way through to helping you with achieve great goals. Want to set a personal best with your squat and deadlift? Want to finish a work day pain free, or perhaps you want to improve your running technique so you can take part in the “Bridge to Brisbane”.
Proactive treatment instead of passive treatment can help a mother of 4 with a bad back and instead of simply settling her acute symptoms, it can address the cause of her back pain and avoid future flare ups! You could even take that further and help her build strength so she can out lift her husband.
So What Is Physiotherapy?
Physiotherapy is one of the best ways to help people progress towards their movement goals. Those goals may be anything...they may be about reducing pain and symptoms from injury, preparing for an event, getting stronger, addressing secondary impacts of other health conditions, avoiding injuries, or even helping a child learn to move for the first time. A Physio then might be your initial treatment, your goal achievement coach, your chance to train with a true movement and exercise expert, or simply your chance to improve your physical being.
Physiotherapy is in the industry of creating change for our clients and patients. Its having a specific working hypothesis thats agreed with the patient who is fully involved with treatment and fully understands what's wrong with them.
We have several key things in place at The Movement Team to ensure this happens.
- Our physio's are in charge of their own time with no time limits or patient limits set on them by the management. This allows each patient interaction to be treatment and result based, not one of a financial/business need. Your physio wont be telling you to come back to see them unless its absolutely needed.
- We do not treat more than 1 patient at a time.
- You will be hard pushed to find a TEN”s, Ultrasound or any other electrotherapy machine used at the clinic unless it has a clear an obvious goal attached to it. (There are many applications of electrotherapy which a very valid, however 90% of patients will benefit another type of intervention more!).
- We have a fully stocked gym where you can do both early stage exercises all the way through to high end strength and conditioning and all equipment is from the best manufacturers in Australia who work with elite sports teams and cross fit gyms. For me a swiss/gym ball and pilates reformer doesn't cut it as a rehabilitation gym.
- We do small training groups based on function- these are low cost and simple to get into and are led by our team.
- We work one on one with people specifically to train for strength and performance improvements. I have 8 clients who solely see me for one on one training as they move towards a high level goal. Your health insurance can be used with a physiotherapist in our gym to help work towards your goals.
So in answer to my blog post headline, Physiotherapy isn’t simply a hands on massage that hurts, its not a 20 minute electrotherapy session, its not being given “stretches”, its not being treated along with 2/3/4/5 other people at the same time (whilst you still pay $70 plus), its not having no end point in treatment, nor is it being one of 20 clients your Physio is simply processing to help achieve the clinics “income and revenue targets”.
We pride ourselves at The Movement Team on thinking differently. We constantly challenge what we do and will not settle for the average or the status quo. Our belief is that our results are the only thing that keeps us busy and are the reason why people will refer to us.
Yanek has 10 years of Physiotherapy experience, across 2 countries, including invaluable experience working in the English Premier League (EPL), military rehab centres and private clinics.