What to Expect

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What to expect

Many of my patients are a little unsure about what to expect before their first consultation –what questions I’ll ask, what treatments I’ll use, how they should dress and so on. I hope that this piece will give you some of the answers. It’s taken from my latest book The Back Bible and is reprinted here by kind permission of the publishers. And if you’d like to find out more, you can always buy the book!

Physiotherapy is often the cornerstone of treatment for a range of musculoskeletal problems that cause pain and limit movement. It is delivered by a physiotherapist (physio) and deals with any physical dysfunction or injury that prevents the body from functioning to its full potential, using a personalised programme of therapeutic exercises
and other techniques.

What you can expect Physiotherapists work in many settings, such as hospitals, clinics, schools, workplaces and sports centres. Depending on your circumstances, you can either see one privately or following referral by a doctor.

A physio will look at your medical history and the results of any medical tests, together with any doctor’s report, before conducting a thorough physical examination. This may involve asking you to perform a variety of physical movements. After making an assessment, your physio will devise an individual treatment plan, following recommendations that are called ‘protocols’. With orthopaedic physios – the ones who treat musculoskeletal problems and provide rehabilitation programmes – this usually includes exercises, postural education (page 148) and general lifestyle advice, such as on lifting and relaxation techniques.

The initial assessment and treatment normally lasts at least an hour; subsequent sessions are likely to last between 45 minutes and an hour. Wear loose, comfortable clothing so that you can move easily.

How it works An important part of physio is a full explanation of what the problem is, what can be done about it, what the treatment programme entails and how it can help. Your programme is likely to consist of some or all of the following:

Exercise Three main types of exercises are used in physio treatments: active, passive and isometric. Active exercises – that you perform yourself - are the most frequently used, particularly for back problems. You will be prescribed graded exercises that are initially performed under supervision, and extended into a home exercise routine.

In passive exercises the physio moves your joints through their full range of movement to ease joint swelling, relieve tension and promote mobility. Isometric exercises – in which the joint in question remains still – are used when movement produces pain or muscle spasm, or to maintain muscle strength. You will be asked to contract the appropriate muscle without causing any movement, hold the contraction and then relax the muscle.

‘The McKenzie method’ is also used. Robin McKenzie, a physiotherapist in New Zealand in the 1960s, realised that when your spine is lengthened, any pain from the upper limb or leg often ‘centralises’ to the neck or lower back. McKenzie method exercises aim to lengthen the spine and relieve the focus of the pain (a McKenzie exercise is shown on page 138). An advantage of this method is that, after the physio has prescribed an exercise routine, you can manage your own back problem and return to your normal routine. The method is not suitable where pain does not ‘centralise’ or if you have spinal stenosis or osteoarthritis.

Mobilisations and manipulations Mobilisations are gentle repetitive pressure movements performed by the physio to restore full range of movement, loosen joints and ease muscle spasm. Manipulations are more forceful movements to correct the alignment of the spine. There are two types of spinal manipulation and mobilisation:

Maitland’s mobilisations Geoffrey Maitland, an Australian physio, developed a system of passive mobilisations (during which the patient does nothing) that is used throughout the world. Mobilisations are a manual therapy designed to restore your range of movement by gently easing a joint so as to achieve its full mobility. The technique is used on both synovial and nonsynovial joints. Maitland stressed that every patient needs a careful and thorough evaluation before treatment, and that the treatment itself should be tailored by the information gained from continual assessment by the physiotherapist.

Mulligan’s mobilisations Brian Mulligan, a New Zealand physio, built on Maitland’s mobilisations and developed the concept of spinal mobilisations that are ‘sustained natural apophyseal glides’ (SNAGS), focused on the facet joints. SNAGs involve a gliding mobilisation of an affected joint by the physio with a simultaneous corresponding movement by the patient. After a few repetitions, you will be asked to make the movement on your own to discover if your range of pain-free movement has increased.

Cold Cold packs are often the first thing a physio uses. The application of cold can reduce local inflammation, swelling, bruising and pain.

Heat Heat can relieve pain, muscle spasm and stiffness, and increase blood flow. A physio can apply the superficial tissues to ease muscle tension and spasm; short-wave and microwave diathermy machines aim to heat the deep tissues by means of electromagnetic waves, although the scientific basis for this is unproved.

Ultrasound An ultrasound machine emits high-frequency sound waves that are inaudible to the human ear. The waves penetrate the skin – they're completely painless – and help fight the local inflammation that is caused by many musculoskeletal problems, relax muscles that are over-tight or in spasm and so relieve pain.

Hydrotherapy Hydrotherapy consists of an exercise programme that is performed in warm water under the supervision of a physiotherapist. Water provides buoyancy and support for the body, minimising weight-bearing pressure on the joints, and is especially useful for people who suffer from problems affecting the lower back because the supportive effect of water permits the patient to perform exercises that might be too painful to try on dry land.

Ready for work

All physiotherapists stress rehabilitation and getting back to work as part of their treatment. They will often work in coordination with doctors and occupational therapists to devise a detailed rehabilitation plan involving exercises and other treatments that may be considered appropriate in your case.