With the Covid-19 pandemic raging around us it's easy to feel the locus of control slip out of our reach. Interestingly though, many people are also learning to do more for themselves - becoming more self-reliant in many areas of their lives. This applies to aspects of healthcare too.
Prevention
The idea of needing to go into your local hospital, GP, dentist or physio clinic fills most people with dread at the moment even though these appointments are recommended for essential services, all important routine health screening and monitoring of chronic conditions. This has meant that people's attitudes towards injury and illness seem to have shifted towards prevention - something I've always been a fierce proponent of. If you can prevent a problem from arising in the first place, then you won't need to rely on somebody to help you fix it - saving you time, money, potential exposure to this new virus as well as saving you pain or ill health. This means you can keep those appointments for unavoidable visits rather than for things that can happen to any of us, but which are by and large avoidable.
DIY-nearly-everything
It may be that tasks you would never think possible to tackle pre-pandemic are now second nature to you - whether they're day-to-day household tasks, growing your own food, mending clothes or learning new IT skills. So while this isn't an easy time and is full of uncertainty, anxiety, stress and tragedy for many - it's also an opportunity for some to learn new skills, look at life differently, prioritise what's important and recognise what isn't. The same approach is possible with physiotherapy.
Physiotherapy - delivered differently
I've always explained to my patients that thirty minutes of hands-on therapy from me in the clinic could make them feel and move better, but on its own is often just a temporary improvement. It's a rare thing to be able to deliver a 'quick fix' for most musculoskeletal conditions eg tendon or muscle injury, nerve pain, joint tightness, muscle weakness. Few things are that simple in life. I might be able to deliver a manual treatment which is helpful, feels like an immediate 'fix', but which wears off after hours or days. It would be wrong to give the impression that a quick fix is always available.
The body is not an inanimate mechanical device - it isn't possible to simply tighten a bolt or replace a part to get the engine running smoothly again. Instead it's a complex, multi-faceted, sensitively balanced, responsive and co-ordinated system, influenced by external factors which we apply, physical pressures and strains, often low-level everyday loads which are seemingly harmless, but which accumulate to cause pain or dysfunction. Ultimately this can cause structural change - just like with an acute injury, but over a longer period of time. Although we know the body is complex, we tend to expect a lot from it in return for not much input.
We know that a car needs regular checks, services and work to be carried out in order to be reliable. Yet we often expect our bodies, even though they're far more complex and sensitive, to adapt, manage or recover to loads that we would never expect from a mechanical object. Before Covid-19, my approach would be to use hands-on manual therapy if appropriate to ease symptoms, then emphasise essential rehabilitation to treat the cause so as to solve the problem and avoid reliance on this hands-on treatment - therefore avoiding the need for repeat visits to the clinic.
The take away point here is that while hands-on physiotherapy can assist recovery in many situations, it rarely resolves the problem. Instead it's nearly always the rehabilitation, along with the awareness and avoidance of aggravating factors like prolonged sitting, that 'fixes' it. This requires people to learn about their injury or pain, understand it and then to actively participate in their own recovery. The effort required to apply ourselves in our own recoveries isn't always something we feel we can commit to, for many different reasons. Which is why your recovery plan has to be fitted to your individual time constraints, work and home pressures, so that it is achievable, perhaps with an altered recovery time-line.
Many aches or injuries are caused by activity such as running, playing sport or lifting heavy items. However, these activity-related injuries can often be traced back to periods of inactivity - such as sitting for too long. This is especially true when inactivity is in combination with a poor position for your body, like sitting on a low couch with your feet up, looking down at your phone.
Modern life itself is the cause of a lot of musculoskeletal conditions that need physiotherapy treatment. The solution to your pain can nearly always be found with guidance from a health professional and a change in the way you do things, in addition to addressing weakness and/ or tightness. A tailored physiotherapy video assessment is designed to give you the best personal assessment and treatment strategy to put the control into your hands while under expert guidance. This way you can be proactive, improving your pain to make the best recovery possible, all from your own home.
As a sportsperson myself, I've experienced my fair share of acute musculoskeletal impact injury through equestrian sport, including broken bones, surgery, muscle contusions, tendon injury, ligament ruptures, concussion and dislocations. Despite their seriousness, I've only needed around four episodes of physiotherapy hands-on treatment. This is because I know how to rehabilitate, how to strengthen effectively, when and how to stretch (or avoid stretching) and what activities and behaviours to avoid or do. So I can successfully rehabilitate from aches, pains and injuries without physical help from another physiotherapist.
Of course, like everyone, I experience some aches and pains from times when I lapse - sitting for too long or if I take a short cut when warming up for sport - and inevitably I pay the price for doing so. But I understand the risk when I make that decision ie to sit for longer or shorten my warm up. I like to help people to understand the risks they take if they make a decision like that - explaining what's in your control and what isn't. Because without that knowledge, you might think all injuries are out of your control - just bad luck - and that there are no further decisions to be made. But by having knowledge, you can take control and responsibility, plan ahead and if things go wrong, you can understand where and why, before you even seek help to put it right.
Active treatment solutions (where you do the 'doing') has longer lasting, better outcomes than passive (where the physio does the 'doing')
So how is this relevant to a world with Covid-19? You might initially think that you'd prefer to go to your physiotherapist, get some hands-on treatment rather than being assessed and treated via video call. The health crisis has pushed people to become more involved in their own recovery from musculoskeletal injury or pain. Being pushed to do something by circumstance might sound like it won't be as good as the thing it's replacing. But this isn't always the case.
I suppose my point here is that often the treatment we're seeking or think we need to receive from a physio in order to get better, doesn't always equate to the best result for our pain or injury. It's crucial to understand that just because a form of treatment makes you feel better at that moment, it doesn't necessarily mean it's going to help you to achieve your goals.
Just because we've always done something a certain way, it doesn't mean that a different approach to the same problem won't be as good - we might even find it's better.
I've noticed more patients, whilst being aware they need careful professional guidance, want to take greater responsibility for their own recovery compared to a year or two ago. In addition, lots of people are taking up some form of new regular exercise where they would have been more sedentary before the pandemic - often wanting to get things right from the start to avoid injury. Having a specialist who can monitor and advise you makes sure that your rehab (or prehab) is both effective and efficient, giving you greater confidence and better results.
This is really where the silver lining shines the brightest. Long established research data from studies exploring patient outcomes following different types of physiotherapy intervention have clearly shown that the best outcomes and the longest lasting therapeutic effects are with active patient participation such as exercise therapy, strength and conditioning, rehabilitation, activity modification, improving movement technique, biomechanics and gait.
When it comes to the other end of the therapeutic spectrum, passive treatments on their own, such as manual therapy or electrotherapy (anything where you have something applied to you with the physiotherapist doing the 'doing') have been shown to have poorer outcomes and fewer long term positive effects. Passive treatments might assist symptom reduction, where they have the most benefit, but this does not mean they will solve the overall problem. It's like containing the smoke while ignoring the fire that's raging.
The more prepared you are to put regular time aside to gain knowledge, get stronger and more flexible, move better and sit less, the better your long term outcome is likely to be. This means you're less likely to need hands on treatment and you'll be better able to manage more-or-less independently - with intermittent guidance from a physio who can get you back on track if things slip a little.
Imagine passive forms of physiotherapy treatment (eg manual therapy, electrotherapy, acupuncture) like snacking on chocolate, fizzy drinks and crisps. It might make you feel good for a moment and you think of it as a treat because it gives short-term satisfaction. However, it doesn't improve long term health. Why then do we still eat these foodstuffs or look for passive forms of treatment?
First of all, it's easy to convince ourselves that something is a treat - perhaps it's a reward for working hard - that if we're feeling tired with low energy levels, we might reach for an ice-cream rather than treating ourselves to an early night. I'm not saying that we shouldn't occasionally enjoy food like this or book in for some passive treatment. But we should recognise it for what it is, because it's a very different story when we expect it to solve the problem.
When we first identify the problem, then change our habits, we can go on to treat the cause of our 'need' for it. In the case of refined sugar for example, it could be lack of sleep, stress or that we're actually just buying the wrong types of food. By actively changing these causative factors, taking the time and effort to create new habits - ones that are healthy and sustainable - we can take back control, feel good about our decisions and more importantly, feel healthier and more energetic.
Similarly, by actively participating in your own rehabilitation rather than expecting a passive treatment to solve your musculoskeletal pain or injury, not only are you going to feel better (becoming fitter, stronger and more flexible), but you'll grow in knowledge and understanding. This way you're more likely to be able to fully contain future episodes of the same problem, reduce time spent in discomfort, get back to activities you love quicker, as well as having more cash in your pocket at the end of each year.
Summary
There's no getting away from the fact that finding ourselves in a pandemic is stressful, disruptive, life-changing and a financial and health threat to our families, friends and to ourselves. However we must try to look at the positives where they exist.
Many people are becoming
more pro-active, self-reliant and interested in preventing injury and pain before it starts
taking up new activities and sports in an effort to get outside and feel better
eager to learn how to manage problems independently and are more receptive to key information regarding their injury so they can do more towards their own recovery
more motivated to make a change to their old routines for the better
more aware of the superior outcomes with active treatments - ones where you 'do the doing' (eg strengthening exercises), rather than passive ones - where the physio 'does the doing' (eg manual therapy, electrotherapy)
keen on physiotherapy delivered via video call - which has been shown, through years of research (Australia, Canada and Scotland), to have outcomes matching face to face physiotherapy
more aware of what matters to them - prioritising their own and their family's health and wellbeing.
If we can each become more knowledgeable and pro-active, incorporating a daily emphasis on prevention, then we can become far more self-reliant, self-confident and capable. This would reduce musculoskeletal pain and injury, while making potentially life-changing improvements to our quality of life as an added benefit.
These are attitudes and behaviours that we can share with our friends, family and children - to help them to improve their quality of life and independence.
What's more, these professionally supervised active strategies help not only our musculoskeletal health but also our cardiovascular, respiratory, psychological and metabolic health as well.
Any one action that can result in five benefits has to be worth a go, don't you think?
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