Did you know that physiotherapists are “first contact practitioners”? This means that we are trained in the assessment and diagnosis of musculoskeletal pain disorders, and therefore you do not have to wait for a referral to come and see us!
Check out these 2 scenarios
A middle-aged person starts experiencing stiffness in the low back in the mornings, at work, and after driving. This hangs around for 3-4 weeks before beginning to turn into pain. They take some simple pain medication that they have around the house, which helps, but the issue doesn’t go away. Eventually, they book in with their family doctor for a check-up, but they can’t get in to see them for another week because of work and schedules, and the symptoms are getting worse. The appointment with the doctor is 10 minutes, symptoms are discussed and quickly they check to see if you can touch your toes. They prescribe some pain-killers and organise a series of x-rays. It takes a few days to get the Xrays done, then the person receives a phone call from the doctor's office told they have some arthritis in the spine, and that they could try some physio. Now we are around 4-6 weeks since the stiffness started, and symptoms have worsened since then, no treatment for the issue has begun.
A middle-aged person starts experiencing stiffness in the low back in the morning, at work, and after driving. After 2-3 days it is still there, so they call their local physiotherapists office. They manage to get in to see them the next day after work. The physio spends 1 hour assessing the person, asking them questions about their symptoms, and getting an understanding of the impact it is having. They also do a thorough physical screening and exam. The physiotherapist is able to triage the person and decide if it is necessary for them to see the doctor and get imaging or is able to start treatment straight away, giving the person strategies they can use to help with the issue straight away.
I made both of these scenarios up, they are very generalised, and there are lots of other factors involved. But the premise is clear and the first scenario is what I often hear when clients come to my office. In fact, the first scenario would be quite fast, it usually takes longer than this for people to see the physio.
You don’t receive treatment in the doctor's office, and you are just delaying the inevitable referral to physio or another rehab specialist. Why don’t you do it the other way around, speak to the physio first, and if they have concerns they will send you to the doctor. In fact, in most cases, I will be able to tell you if you need to see the doctor by speaking to you on the phone even before our appointment with some simple questions!
Physiotherapy is underused in the assessment, diagnosis, and triage of musculoskeletal conditions. Now don’t get me wrong, medical doctors are amazing and an integral part of the healthcare system, but they actually spend only a small amount of time during school on the musculoskeletal system and it is not their only focus, they have so much else to learn as well!
Physiotherapists are experts in the assessment and treatment of musculoskeletal pain conditions, but we are not used like experts at the moment. So here are my recommendations as to when to see a physio (or another registered health professional) and do not wait to be told to go!
The onset of pain that is impacting simple activities of daily living
Pain that impacts hobbies or physical activity
Persistent feelings of stiffness
Before (if able) and after surgery
When aging for falls prevention
During a concussion
When struggling with headaches
When wanting to start an exercise program and/or looking to increase activity levels
“A Stitch in time saves nine” means that sorting a problem out immediately can save a lot of work in the future. This is completely relatable to a lot of issues that we see in physio, and any physio will tell you how much easier it is to manage a new and acute injury than it is to manage something that has been persistent for a few months.
In my opinion, there are a number of things that have to change in order for physiotherapists to be used in this capacity.
1. Physiotherapists and clinics have to offer triage and acute services more. Whether this is walk-in clinics, or phone consultations, or something similar, there has to be a way that someone can easily get in contact with a physio for a quick conversation to determine the appropriate course of action. I think an issue is that someone has a “simple” sprain of the ankle, but doesn’t want to spend $90+ to have an assessment for 1 hour on something that may well resolve itself and is completely manageable for them. But it is free to get into the doctor's office for them to just check it if it lasts longer than expected. It would be ideal if they could get it checked by a physio very quickly, and advice was given for self-management, and they were made aware that if symptoms don’t improve after X amount of time then treatment would be appropriate.
2. The general public has to have a mindset change. The number of people that walk around on pains and aches etc that are completely unnecessary blows my mind. Now don’t get me wrong, pain is a normal part of living, and not everything can be resolved, but I am sure there are a lot of people who experience unnecessary pain because they are not doing anything about it. You can lead a horse to water, but not make it drink. Physios can make themselves available in this manner, but if people don’t reach out and use them nothing changes! There has to be a huge strategy to educate the public on using physio and other rehab health care professionals in this manner.
So how do I approach this in my practice?
Put simply, I am available to talk to! I run a solo practitioner, this means it is just me. I send the emails, I pick up the phone, I answer the messages, and I do the treating! What I love about this is that I am able to start creating the rehab process from the very first point of contact that you have with me, i.e. on the phone. I speak with all of my clients before their appointment, even if they book online without talking to me I will call them. The reason for this is I don’t want to waste any time. We speak on the phone and I get to ask you a few simple questions so that I am getting a head start on your condition before we even meet. If it is straightforward I can advise a strategy over the phone before we meet and answer simple questions like “should I ice it?”. I can (and have) advise clients to organise a doctor's appointment, or go to ER because the condition sounds severe and it is worthwhile being checked medically before we meet. I do this with people who haven’t even booked an appointment, I am happy for you to email me if you are unsure about physiotherapy and organise a time for us to speak about your options and if I think I can help. This is all part of what I do, and part of my goal to provide an educational and personal approach to physiotherapy.
Also, I have plans to do a walk-in clinic. There are some logistic difficulties to this especially with recent changes in protocol due to COVID-19, but I am trying and hopefully, that will be another way that my services can benefit the Collingwood community! So stay tuned :)