Do you ever eavesdrop on someone’s conversation?
This morning as I was waiting to play tennis I found myself doing exactly that. Two gentlemen beside me were comparing notes on their recent knee surgeries.
Gentleman number one was saying how he was pleased to be back to tennis and had been religiously going to physiotherapy. I was about to interject with a smile and a pat on the back until gentleman number two said “I don’t bother with physiotherapy anymore. I don’t find it does much for me, so now I go straight to the gym. I had surgery on a Wednesday and was back in the gym four days later.”
Now I have no idea what he was doing in the gym but in many cases that could be really unsafe.
That’s ok Melanie. He is not your client. This is Sunday morning and you are clearly listening in on a conversation where you were not invited. Stay in your own lane.
Then gentleman number one contributes “I did find it useful in the beginning but now it is more like going to the spa. Someone puts some machines on my knee that make it go all tingly and then they wrap me in hot towels. It is lovely.”
ARE YOU FREAKING KIDDING ME?……USELSSS?!!!!! THE SPA?!!!!!
I love the spa but I’m pretty sure none of the clients I have treated in the last 18 years would equate one of my treatments with a spa experience.
I was about to launch into a rant about how physiotherapy is an integral service in post surgical healing, about how it should be based in evidence and a successful treatment plan should involve more exercise than hot towels but I realized I was getting a true consumer perspective (and again, on a Sunday morning, was none of my damn business).
Physio can mean a lot of things for a lot of people but what this conversation really told me was that as a profession, we had not done a good job of educating and demonstrating the importance of effective, efficient and evidence based therapy.
I am certainly not telling anyone how to do their job and this post might land me in hot water but just like in any other profession, there is a wide range of what makes up a good practitioner. I can only control my very small corner of the world.
That being said, physio is an expensive service. Too expensive for just hot towels and machines and too important to be passed over as useless. However if our consumers don’t know how to choose a great therapist, how can we expect them to believe any differently?
For the record, here are my criteria for what you should look for when choosing a therapist who is going to help you reach your goals and give you the tools for a successful recovery:
Be Wary of Machines
There are some great modalities that have a very specific purpose for very specific conditions but you should be concerned if machines make up the bulk or entirety of your session. Current, high-quality research rarely supports modalities as a stand alone treatment. Our best evidence suggests that the most effective treatment is often a multimodal approach involving manual (or hands on) techniques and carefully prescribed and supervised exercise both applied in a biopsychosocial framework. Here is an insider secret: machines often buy a busy therapist time. Sorry hot towels and tingly machines.
Research Your Physiotherapist’s Qualifications
Upon graduation, most physiotherapists are generalists. If you have a specific need, it often behooves you as a client to be picky and ask about post graduate specializations. It is similar to the difference between a family doctor and specialist. Some therapists have specialized skills such as spinal manipulation or pelvic health training which are not common to the profession as a whole. If you are in need of those skills, you need to make sure you are going to a rostered physiotherapist and that they are qualified through advanced training. If in doubt, you can check a therapist’s qualifications through the College of Physiotherapists of Ontario Website.
A Good Therapist Will Put You to Work
Passive treatments have a lot of value but patient engagement and participation are key components of a successful treatment plan. A great therapist should enable their clients with the tools to manage their injury independently. That is hard, and costly, if you are completely dependent on your therapist to feel better. Whether it is exercise, stretching, mindfulness or behavioural and lifestyle modification, expect to go home with some homework. We are not magic (busted). 30-minutes every week will do nothing if you don’t continue the work at home.
A Great Treatment Has Its Roots in Evidence
I always encourage my clients to ask lots of questions and I aim to be able to give them an answer and a treatment based in clinically evaluated research. There are techniques I learned as a new graduate that have no relevance or effectiveness 18 years later. Fact. A great therapist is always learning and reading to deliver the best course of care to their clients. Don’t be afraid to challenge us. If we can’t give you an answer to your question it is a great opportunity for us to learn together.
Sole Practitioner Versus Multidisciplinary Team
There is nothing wrong with sole practitioners. However, a multi-disciplinary team that communicates really well creates many different perspectives and options that can contribute to client success. It is also important to note that some clients will be more responsive to different types of treatments. The availability of a team of different specialities broadens a client’s treatment options and can often extend financial accessibility to treatment.
Treatment Should Not Go On Forever
The ultimate goal of a great therapist should be to discharge their client. A great treatment plan should see results. If your success plateaus, your therapist should be willing to look at different options and approaches. Under no circumstance, should a client be going to a therapist repeatedly (and believe me, I get some clients who have gone elsewhere for YEARS) without results.
A Great Therapist Will Recognize If They Are Not a Good Fit
This is a hard pill for many of us to swallow but sometimes practitioners and clients are just not a good fit. A healthy therapeutic relationship should be built on trust and open communication. If that is not possible or even if you can’t find any common ground to lay the framework for engagement, you may need to consider another therapist. If you are feeling that way, please speak up. Great practitioners will openly recognize and acknowledge this and provide an alternate solution. I hate nothing more than not being able to help someone but sometimes the healthiest thing I can do is to refer onto someone who can and not take it personally.
Quality clinics and physiotherapists (for that matter, all of our of team members) will be happy to discuss all of the above. As a client you invest a lot of time, energy and money in your rehab. That should be reflected in the quality of both the clinic and therapist you choose. Don’t accept useless. Don’t go to physio for a cuddle and a snooze. You owe it to yourself to choose wisely and as a profession we owe it to you to give you better options.
Melanie Stevens Sutherland, Clinic Director & Senior Orthopaedic and Pelvic Floor Physiotherapist
Melanie is a graduate of McMaster University and brings 17 years of experience as a senior physiotherapist to Body Co. She has enjoyed a long tenure working with active populations at prestigious sport medicine clinics. Past clients include Provincial, National and Olympic level athletes as well as members of the National Football League, the Canadian Football League, the Ontario Hockey League, the American Hockey League, the National Lacrosse League and Major League Soccer.
Following the birth of her own children, Melanie developed a strong interest in women’s health. She has taken specialized courses in pelvic floor physiotherapy and women’s nutrition. She is passionate about helping women find strength and confidence in their post-natal bodies following pregnancy and delivery.