How Does A Physio Think?
Updated: Feb 8, 2018
Have you ever wondered as you have gone to the GP, or stood around whilst a tradie has wandered around your house what they are thinking at any given moment? I'm sure the same applies to physio - "Why am I being asked to explain my pain earlier in the morning compared to later in the afternoon? Surely it's a completely irrelevant question?"
This post is hopefully going to shed some light on a couple of these details - let's dig in!
The Biopsychosocial Model
First up, it's important to understand the core concept that (I think) any health professional bases their thinking around. The biopsychosocial model sounds confusing, but it is actually relatively simple to understand:
This model of thinking assumes that there are 3 core components to an individual's health.
Biological - are the tissues in the body healthy? Does this person have any other diseases or conditions? How old is the patient? All of these are important for a physio to think about when considering a diagnosis (it would be rather daft to diagnose a 13 year old child's painful knee with arthritis wouldn't it?)
Psychological - Mental factors play a huge role in the outcome of any pain disorder. If you consider 2 people with the exact same low back pain - one person is extremely worried about it, scared to move the back, thinks about any little jolt of pain they feel. The other person is not too worried about their pain - they feel it now and then but try to move as naturally as possible. You can see how the beliefs and the personality of the person can influence the pain that they experience, as well as their recovery.
Before I move on, I just want to clarify that just because somebody might be seen as having a lot of psychological factors involved with their pain, does NOT mean that this person's pain is "in their head"!
Social - Does this person sound like they have a strong support group around them, or do they seem to be isolated from supportive people? Do they work? Are they desparate to get back into work in order to make sure that they can pay the bills? Perhaps the work situation is quite a stressful one for them?
For each person that comes through the doors, any competent physio should be thinking about these 3 broad aspects of the person health. At times, the biological factors involved will play a far greater role than any other, although there are certainly some people who come through the doors where we need to consider the psychological and sociological factors in play.
I said at the introduction of this section that the concept was quite easy to understand, which it is. The true difficulty is applying it correctly to each individual that comes through the doors. We're all so different, the factors involved change from person to person!
What is causing this pain?
This is really the million dollar question, isn't it? If your physio can identify the problem causing your pain or even better, can PUSH on the spotand reproduce your pain, you are thinking you're onto a good thing!
There are certainly times where your body wants to be difficult though and even though you might be convinced that your pain is from your knee, it might perhaps still be coming from your lower back! This is why as physios we take time to look at other areas as well as purely the "sore spot". We don't want to waste our time and your time treating the wrong body part.
A quick anecdote on this topic: A couple of years ago, I was playing quite a bit of 1-on-1 basketball and it was causing my right shoulder to become really achey and sore. I did all of the shoulder tests on myself but work out where the pain was coming from... It took me 2 days to realise it must have been coming from my neck! If someone had come into my office and explained the pain to me, I would have thought neck instantaneously, but because it was my own pain all I could think was "Well my shoulder is sore, it must be coming from my shoulder!"
Can I Treat This Problem?
I, for one, am not the type of person who is comfortable treating someone if I don't believe I can help them get better. There have been plenty of examples that I have seen over the years where after diagnosing a particular problem, I have encouraged the client to look into other options for their treatment.
This might include injection - DeQuervain's Tenosynovitis of the wrist is a great example of an issue where as a physio my treatment is highly unlikely to help. Rather, lets get the inflamed area of the wrist to settle down by injecting cortisone into the area. This often works very well - as long as it is in the right area of course!
Other examples might include referral to a surgeon for a particularly nasty meniscus tear, or back pain that is no longer responding to treatments provided (this is highly dependent on the cause of the pain... surgery really should be the last resort for back pain!).
What Is The Most Appropiate Way To Treat This Issue?
Contrary to popular opinion, physio don't simply just find the sore spot, and push harder... (I'm looking at you, Sophie!). If there is (for example), a stiff joint in the neck causing the pain then there are several ways in which to treat it. This dependent on several factors:
How sore is the neck?
How sore does it stay after I have stopped working the stiff joint?
How stiff is this joint? Do I need to work really firmly to get it moving, or does it just need a bit of encouragement?
Is there anything else, such as the surrounding muscle, that is contributing to the joint becoming tight?
...and this is just for a simple, stiff joint! Imagine the increased number of things to consider if the issue is more complex, such as a sensitised nerve root in the lower back!
Is There Anything That Could Be Done At Home To Help This?
Typically the answer to this question is "yes!", but it is important to give exercises which do not run the risk of making the issue worse - particularly if they are not performed correctly. This is why you might feel your physio is being particularly pedantic about movements that you are doing - the last thing I would want to see is somebody flare up their lower back because they have been performing the exercise wrong for the last week and a half. Rather, it is worth taking the time to explain the exercise, demonstrate it correctly, and then watch you do the movement to make sure it doing exactly what it is meant to do.
I have found at times over the years, that some health professionals often neglect this aspect of the treatment session. They prefer to focus on improving the person themselves, in the session. From my perspective, that's 30 minutes out of your whole week! what you do for the other 6 days, 23.5 hours is pretty important to me, in regards to getting you better!
When Is The Best Time To Have Another Look At This?
Too soon, and it may not be enough time to notice any really significant changes to the problem, but too long and you might be starting from square one, because the joint has stiffened all the way back up again!
I think the typical person might think that their physio is trying to book them in more times than they feel is necessary, but in my experience your typical physio is more likely to lean towards booking you in as few times as possible. As a general rule we want everyone to get better in as few sessions as possible, not to take people for a ride and book them in way more times than is necessary. We want to make sure you get better as quickly as possible, but at the most efficient use of your time (and money) as well.
...And there you have it! Just a quick snapshot of what your physio may be thinking and asking themselves while you have a typical treatment with them! Perhaps it was more than you were thinking? The human body is incredibly complex and when it is not working exactly as it should, it deserves all the attention to detail and care that it gets!