Training

What Physiotherapy Isn't

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.

Myself (with a touch more hair) and the rest of the coaching staff after winning the Puma Cup In the US. 

Myself (with a touch more hair) and the rest of the coaching staff after winning the Puma Cup In the US. 

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.

Tim was super excited when we finally nailed some of our core principals!

Tim was super excited when we finally nailed some of our core principals!

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:

Physiotherapy= Massage. 

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.

Messing around on the rings at the clinic.

Messing around on the rings at the clinic.

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.

Working with 2 coaching staff and also our Polish translator in Poznan.

Working with 2 coaching staff and also our Polish translator in Poznan.

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!).

What My OC's face would have been if I had told them my treatment plan!

What My OC's face would have been if I had told them my treatment plan!

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.
Chari and Issy working in our gym with 2 clients. 

Chari and Issy working in our gym with 2 clients. 

  • 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.

Think Different

IN CONCLUSION

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. 

Keep rocking!

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.

The Beauty of Doing The Small Things

As someone who is the same as every other human being- things can get put off. I, as I’m sure many of other people do, get great ideas and plans for things and think “one day” or “I’ll get around to it”, only for that day to never come.

Lately I’ve tried to get a bit better with myself and actually just do the things I plan on in my head. I know that while sitting there in bed or on the couch, probably binge watching a show on Netflix it may seem like a lot of effort and something that can wait, especially with that cliff hanger at the end of the last episode! But honestly, even just doing a little bit can go a long way.

Meme of how watching netflix quickly passes hours!

Meme of how watching netflix quickly passes hours!

In my last blog post: “My strength Journey (or start of)” I mentioned that I was planning to start training again, which I have done. Even though some days have been hard, (physically or mentally) they have made such a difference for me. 

Over the last couple of months I have noticed quite a few changes in myself from the training, including less tightness and soreness throughout my body, feeling more positive, having better posture and more energy. I’ve also never been a long distance runner, but was pleasantly surprised by the one day every three months where I decide to go for a jog, that I could actually run a lot further than I used to be able to, all from just a bit of strength work!

I was about to go for a jog but it looks like it might rain so I'm gonna stay home and play it safe

I was about to go for a jog but it looks like it might rain so I'm gonna stay home and play it safe

I used to think that strength work was more just for people who wanted to get buff, I had no idea how much doing it myself would benefit me in such a short amount of time. 

Seeing such satisfying results has made me start doing some of the other things that I’d always planned on doing in other areas of my life. Even if that’s just been a small step. I was recently told that if you aim high, then even if you miss you’ll still be somewhere near where you wanted to be and definitely not where you started.

If we aim high and fall short we still achieve more than by aiming low and falling short

If we aim high and fall short we still achieve more than by aiming low and falling short

Something I’ve been telling myself is to stop waiting for the right day or moment to do it, because it may not come around. Like I’ve said before, life happens, but if there’s anything I’ve learnt in the last couple of months it’s that if you put your mind to something, and even just by working a little bit towards it, it can amaze you how far you can get towards your goals.

I know this probably sounds like a cliché and something that is supposed to be all inspirational, but I just want to say how much making even the littlest of steps has benefitted me so much. And in the off chance this may help you to start even making the tiniest of steps to achieving your goals (whatever they are), well then that’s all I can hope for.

Lucy

 

"Lucy is part of our administrative team. Give our clinic a call if you have any questions about how we might be able to help you! Our admin team are excellent in helping our clinicians and clients keep doing what they do best!"

 

Stand Up and Be Strong

Just go from sitting to standing and back again…sounds simple right? To get up from a seat. But for some it’s quite difficult. 

This motion is one of the crucial elements in maintaining quality of life as we get older. The less we perform this action, the more we are reliant on aids to get us out of a chair, using our arms to pull ourselves up, changing our living spaces to accommodate (often a costly process), reliant on others to perform actions we once thought of as simple tasks, or worse yet, having to leave your home all together. 

Small daily improvements are the key to staggering long-term results

Small daily improvements are the key to staggering long-term results

The muscles involved in a sit to stand are crucial for maintaining balance while standing and walking. This means having difficulty controlling getting up and down from the couch can be a warning sign for other, more risky difficulties. Reduced muscle mass in the lower extremities equates to less stability which means that an individual’s gait becomes wider and shorter. More simply, the way we walk is not fixed, if we have weak leg muscles, we walk more slowly and have to have our feet further apart to reduce the risk of falling over. Additionally a reduction in muscle mass in the hips and this change in body mechanics commonly contributes to overuse injuries such as hip, knee and lower back pain. 

Over and over I have seen patients drastically improve their quality of life simply by practising ‘sit to stands’ every day. By performing this simple exercise you can improve your strength, reduce the risk of injury and make some simple things easy again. This can seem daunting, especially if this has been an almost impossible feat in the past. Here are some tips to help you start your journey to a better quality of life.

Make the impossible possible

Make the impossible possible

Let’s start with getting the technique right.

Start from the seated position. If you start here you know the seat will be there when you return. Your feet should be parallel to each other (or as close to parallel as possible), the knees should always stay over your heels, chin up, chest out, shoulders back while sticking the backside out to allow the activation of the back muscles to maintain posture. You should always be pushing through the heels. Try wiggling your toes when performing. This will tell you whether you are on the balls of your feet, or on the heels.

Stand to sit avoiding plonking

Stand to sit avoiding plonking

Don’t go too hard too soon!

A phrase that I commonly use is “avoid the plonk”. It’s important to maintain muscle activation through the whole movement and not cheat by letting gravity do all the work. If you ‘plonk’ on the way down, the way back up is likely to be hard work! ‘Plonking’ while lowering down into a seat is a sign that you were not able to (or out of the habit of) controlling your own weight. This will mean that you won’t be working the muscles, which is the whole point. So pick a height that means you are able to dictate the pace of the sit to stand. It may be high at first, and the range small, but you can always progress to a lower seat as the muscles strengthen over time.

Little by little, a little becomes a lot

Little by little, a little becomes a lot

Volume without pain

The more often you are able to perform the sit to stand on a weekly basis the more improvements you will see over a shorter space of time. It’s no use doing 5 sets of 15 on one day then being incapacitated for the rest of the week. This is meant to improve your quality of life not hinder it. Start with a very easy range that produces minimal muscle soreness but is still challenging. Look to increase these repetitions over time. 

A little puppy who got too tired to tired to finish the walk

A little puppy who got too tired to tired to finish the walk

Start in front of the mirror

Perform the sit to stand in front of the mirror. What you are doing here is coupling how good technique looks with how it feels. As a result of giving yourself different forms of immediate feedback, mastery of the technique will be obtained much quicker. You won’t have to do this forever, but it is important in the beginning. 

Kitty thinks he's looking in a mirror!

Kitty thinks he's looking in a mirror!

Get coaching

It’s important to make sure you feel safe when you perform a sit to stand. If you’re unsure of your ability, see an Exercise Physiologist to establish safe ranges of motion, rep ranges and any coaching of techniques that may be required. If practicing this movement causes pain or discomfort, perhaps the first person you need to see is a Physiotherapist. Either way, and whatever your starting point, it is never too late (or too early) to get stronger.

So stand up for yourselves!

MIKE

Michael Pegg

Exercise Physiologist

B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM

Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease.

Beautiful sunset

Beautiful sunset

You've decided to exercise more, now what?

You've decided to exercise more, now what?

We are bombarded with so much information on what is the best form of exercise, how often to do it, when to do it, why to do it aaaaand the list goes on….. and on. It can be pretty confusing at the best of times, but especially so if regular exercise is not your forte. So lets simplify things a little.