Physios and physios – 5 point guide

[Image description: anatomical drawing of human shoulder joint showing humerus, scapular and collar bone. Labels point to swollen bursa and inflamed tendon.]

There are physios and physios.

In my experience with a long term recurring shoulder (now cured) only one out of four has the slightest clue. Here is my 5 point guide (check out the warnings in points 4 and 5 too).

1. Get a solid diagnosis from a competent DOCTOR first.

2. Look for a physiotherapist who knows ANATOMY incredibly well. A physio, rather than a physio, will know anatomy better than most GPs. How to check a physio’s anatomical knowledge: 1. ask about the names of the muscles he/she is focusing on and why. 2. ask them the name of the bone or where on the bone a muscle attaches. 3. ask what bursas you should be concerned about. 4. a physio will know the importance of human variation in anatomy, which is much more common than you think. Search your own issue and add “human variation” (glenoid “human variation”). It doesn’t take long to find out if your physio is a “little rusty” on anatomy and if they are, find a physio.

3. Look for a physio who says it’s up to YOU to retrain your posture and/or remould your muscles via a long term exercise program and sensible stretching.  Plenty say this, but if they lack basic anatomical knowledge OR want to proceed without a solid diagnosis, make sure you exclude them straight away. And make sure you understand and do the set of exercises they will give you.

4. BEWARE physios who want to massage you and “fix” you that way. Temporary relief is not what you need and inappropriate massage can be incredibly damaging. I know because one arsehole money grubbing physio failed to send me for proper diagnosis of what turned out to be a very badly ripped shoulder. It took me ten years, lots of pain and lots of recurrent injury on the badly healed and weakened rip to get proper treatment.

5. Avoid anyone whose methods aren’t evidence-based. ie avoid acupuncture, osteopathy, chiropractors, Bowen Therapy, magnetic blankets or any other whacko mumbo jumbo. They are all based on the placebo effect.*

6. Yes I know there are only supposed to be 5 in this list, but what the hell. It’s time for an update. So, number 6. Avoid physios that are in the same practice as the good physio you find; they may not be as good.

After I broke my ankle badly on 25 July 2017 I needed physio. The ankle had three fractures, and both tibia and fibula were broken. It was line-ball as to whether I should have pins inserted. The surgeon said it was my choice – nice guy. I decided against an operation because I also factored in the risk of hospital acquired Staphylococcus aureus infection – Methicillin-resistant S. aureus (MRSA).

The new physio at my favourite physiotherapist practice gave me a set of exercises and didn’t answer my email asking for clarification on the exercise sheet he gave me. He also discouraged me from riding my bike which I felt was an acceptable risk and had started already. But he didn’t give me this exercise:

BTW the stretch is meant for the leg on the chair. Eleven weeks after I saw the new physio I discovered this exercise. It was instant relief for my “frozen” ankle that I hadn’t been able to push off from despite walking up to 6 kms per day.

I had had the same instant relief years ago when I had been to 2 different doctors and a specialist smelling of alcohol. I had been seeking relief for bad hip pain and possible early arthritis. The first two doctors and the specialist didn’t know what was wrong. Finally, after a couple of years of pain, I went to another doctor who took a good history and then said, with a knowing smile on his face, “Stand up and touch your toes.”

I could barely reach half way down my shins. Next he said, “You may be a good runner and pretty fit, but you sit in front of your computer all day working. Your hamstrings are getting shorter and shorter. They are pulling your hips out of alignment. And you’ve been born with short hamstrings anyway. Here’s the name of a physiotherapist who will give you some exercises. See you later.”

The internet age had just begun, so I didn’t go to the physio. I found some exercises on the internet (gluteal stretch etc) and it was instant relief. Instant!

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* The PLACEBO EFFECT is incredibly powerful but poorly understood. You may think your favourite whacko altmed treatment works and your practitioner may even sincerely believe it too. BUT what is probably happening is that your body is naturally healing itself despite your wasted money on anti-science quackery or a bad physio. As a friend said about his herniated disk, “The body can heal itself, it just takes time. But the last person who touched you gets the credit.”