We’re going to get honest here, people. Potentially, uncomfortably so. Let this first bit be a disclaimer that we have no intention to offend or get “into it” with you or anyone else for that matter. If you read something here that gets you bothered and you feel the need to really let us have it, please send all angry correspondence to trashcan@hityourstride.ca. – haha kidding. Send it to greg@hityourstride.ca – haha kidding again. info@hityourstride.ca will work just fine. Or better yet, if you read something you dislike, stop and follow this handle on twitter of cats wearing trousers to calm down and remind yourself that we really do mean no harm.
We just want to share with you what we as physiotherapists are often thinking…and what we’re talking (and sometimes frankly, venting) about in the staff room on occasion. You can consider this information as a public service announcement, if you will. We ultimately are a profession hell bent on helping people, and the truth is, we can’t help you if we’re not honest with you sometimes. So, here we go…real talk…
1) Your legs not being clean shaven at an appointment isn’t something we think twice about and nor should you.
And we sure as heck don’t want you to feel the need to apologize to us for it. Yes, we are experts in observation, but in the style of our favourite Fab Five member, Jonathan Van Ness, your appendage follicular growth living its best life just ain’t something we care about, henny. So, go ahead and shave…don’t shave. We honestly don’t care. We are not judging you. In that same vein, no need to worry that your fingernails aren’t perfectly manicured, that your feet are in need of callous removal, or that you just came from the gym. We have seen it all, and believe me when I say, nothing phases us.
2) When you use the phrase “My back/hip/rib etc. is out,” we truly have no idea what you’re talking about.
Out where? Out for coffee? Out of joint? You see, to our profession, this means one of two things to us: 1) nothing at all or 2) you have a dislocation and you best be seeing our good friends down at the emergency room because (super-real-talk-alert) anatomically, if your neck is truly out of place, you’ve got yourself an emergency on your hands. Our interpretation of this statement when we hear it, is that you don’t actually have a dislocated joint, you simply feel like something isn’t quite right and that you want something to “crack” or “pop” in order to feel better.
While we’re going down this rabbit hole…We agree that manipulation can be very effective in some cases, and this is a technique that we are trained and qualified to deliver; however, the science shows that spinal manipulation does not put bones back in that were out of place; rather, it may create a non-specific neurophysiological effect that may transiently improve pain, ROM, and function about the spine. (1) What does the science say is making this popping sound then? Probably, gas. Our joints have fluid in them that contains oxygen, carbon dioxide, and nitrogen and when a force is applied to a joint, the compression causes the gas to escape and we hear a pop or a “cavitation.” (2) So, in this way, sure, manipulation may be helpful (you may temporarily feel better), but let’s be real here, people, none of us are putting anything back into anywhere and you likely don’t have anything “out” that needs to be put back “in” in the first place. (This might be a good time to remind you of that twitter handle with the cats wearing trousers…)
3) We really wish you weren’t so hung up on the natural process of aging.
Over time, mountains erode, paint weathers, and even Brad Pitt’s face begins to show a laugh line or two. Our joints, in the same way, wear down. Incidental findings of “degeneration” on imaging are often normal and expected and of no cause for concern. In fact, studies show 30% of 20 year olds and 80% of 50 year olds will show signs of degeneration even when they don’t have symptoms on MRI. (3) And the flip side of this scenario is also true. It is probably not necessary to image under every circumstance. Positive findings of degeneration are not necessarily useful in changing the course of your treatment since most of these findings are normal and expected anyway…you get what we’re saying here?
So, don’t be too hard on your doctor that’s suggesting a course of physical therapy before exposing you to radiation that you might not need. We (they and us) won’t leave you hanging, I promise. If you don’t respond appropriately, something worsens, or you’re demonstrating more sinister signs or symptoms when we assess you, we’re going to suggest a follow up with your doctor to determine whether imaging might be warranted. Believe you us, the last thing we want is to have something more medical in nature on our tables that we are not supposed to be treating!
So, if your doctor doesn’t x-ray your back, don’t panic. Let’s try some conservative management for a bit and see where it goes. Likewise, if your doctor does x-ray your back and findings suggest something like “L4/5 degenerative changes,” don’t panic then either. The days of treating things like this with absolute rest and a long term pill regime are over. It’s time to get strengthening and stabilizing that region, so you can continue to move and participate fully in your life. Come see us and we’ll figure out the best plan for your specific case. We’re here for you either way.
4) There is an EXTREMELY high chance that there is no shortcut, no gimmicky device, no snake oil treatment that is going to “fix” your issue just like that *snaps fingers awkwardly*
Many times, we see people at their worst (“I’ve tried everything and nothing works”) as they sit desperately in a chair across from us looking for some sort of salvation. Believe us when we say, we’re flattered; but we are in fact, not magicians. There is no magic here. Frankly, there probably is no magic anywhere. Someone peddling magic is more than likely someone in which to be highly suspicious. Our goal is to have you come in, be properly assessed, and then together create a strategy that suits your personal situation best. And yes, this is more than likely going to include you doing some form of “homework.”
Speaking of…
5) The homework we give you isn’t random.
And the education we provide you in our sessions isn’t a canned response we necessarily tell everyone (although as humans, there are often patterns we all need to improve). We spend time thinking about what is best for you. Oftentimes, it may seem like your homework is trivial or too easy or small to be helpful. This is likely because you are missing some fundamental things that require some correction first. Do your best to trust us and the process, and if you can’t do that, try to humour us and do it anyway and see what can happen. While we’re at it, “working hard all day” does not substitute you doing some very specific exercises that are tailored by us for your unique situation. We love that you’re active in your day, so continue to be active AND do the homework we suggest!
6) Save time by just telling us the truth.
If you haven’t done your exercises since we last saw each other, be honest, and tell us that. It’s very likely we can tell whether you have or haven’t done them anyway. And even if you do fool us, you could potentially change the course of your treatment in a detrimental way if we think what we’ve provided so far isn’t useful when maybe the reality is, we don’t know yet if our plan is working because you haven’t given it an honest try.
7) If we’ve helped you in the past, please don’t hesitate to come see us the next time you run into some sort of issue.
We cannot begin to tell you how many times we’ve all heard it from former clients whom we have successfully helped in the past, come back, weeks, months, even years after another issue arises…only to tell us “I tried x, y and z and nothing works.” Why are you waiting so long to come back? Especially after we’ve helped you in the past? Why are we your last resort? It is one of our biggest pet peeves as a profession, and we are likely largely to blame for it ourselves: so many people don’t understand what it is physiotherapists do. We need to do a better job as a profession to advocate for ourselves. Here are probably two of the most common misconceptions the public often has about us:
- That you need to be referred by a doctor to come see us. False. We are primary health care practitioners and anyone can access our services anytime. We do a comprehensive subjective and objective assessment at your first visit that includes ruling out more sinister signs and symptoms that would warrant medical referral to your physician.
- We only see people after they have been in a significant accident for things like learning to walk again. Or that we typically work with only the athletic population. False on both accounts. While yes, these are both areas physiotherapists are definitely involved, we see people of all ages under all sorts of circumstances. High end athletes, suffered an injury at work, just had surgery, have a chronic condition, just coming out of a cast, have a motor development delay, experience urinary incontinence when you sneeze, rolled your ankle, have mechanical back pain, experienced a concussion, have a repetitive strain injury, suffer from vertigo, TMJ dysfunction…these are all examples of types of things we treat every single day.
8) This isn’t a spa session.
Our time together may include some things that are uncomfortable – we ask a lot of questions, sometimes there is physical discomfort in a session, and sometimes we’re going to tell you things you may not want to hear. The phrase “this isn’t a spa session” is something I say in my treatment rooms often. We truly mean that. Physical therapy at our facility isn’t a passive approach. You need to participate fully in your recovery in order to see the maximum benefit. Having a one-off session with us is extremely rare (read: you are most likely not going to be “cured” after the first initial appointment and this is not a failure on either of our parts – having said this, we also promise not to have you book more often than is necessary), homework from us is inevitable, activity modification may be warranted for a period of time, etc. If you aren’t going to commit to more than just the first session, have no interest in doing any sort of the homework, or implementing any of the advice we offer, that’s completely fine. What you do when you leave our sessions is your business. We will do our best to meet you where you’re at and do as right by you as we can. But please, don’t go back to your physician or tell all your friends that “physio didn’t help” in this case. We assure you, we are not so obtuse to fully admit, we can’t and don’t help everyone that comes through our door, we just ask that you be real in your expectations and consider your level of commitment to your own program. If you didn’t follow up, follow our advice, or regularly do any of your homework, how do you know if any of this “works” or not?
While all that may sound harsh…
9) We truly care about you more than you probably realize.
We are grateful to be working with you and want nothing more than to help you out. We see our job as what it truly is: a great privelege. We get asked all the time “why did you choose this profession?” Ask any of us this question and you’ll likely hear some common themes that involve wanting to work with people, help people, improve their lives in some way. And as much as we try not to, sometimes we even take our work home with us and worry about you instead of doing other things we should be doing like sleeping or spending time with our own families. You see, we take our responsibilities seriously and spend a lot of time as professionals, self reflecting on what we could do differently to make sure we’re giving you the best possible chance at succeeding toward whatever functional goal you bring to us. True story.
So, like we said from the beginning of this post, this is simply a light-hearted look at what we’re really thinking sometimes. Bottom line is, we’re happy to help and work alongside you in improving your life. And as facetious as some parts of this post are, we’re ready and willing to meet with you wherever you’re at, whatever commitment you can give, and however hairy your legs are. We’ve got your backs.
– Jodi, PT
References:
(1) Machado LA, Kamper SJ, Herbert RD, Maher CG, McAuley JH. Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology (Oxford). 2009 May;48(5):520–7.
(2) Olszewski, et. al. Knuckle cracking and hand osteoarthritis. J Am Board Fam Med March-April 2011 vol. 24 no. 2 169-174.
(3) Brinjikji, et. al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015 Apr; 36(4): 811–816.