Physiotherapy 'Real Talk': Demystifying Rehab and Recovery

What is Physiotherapy?

When you google “physiotherapy” or when you think of the profession, what images come to mind first? A quick search reveals a lot of massage-type photos, all kinds of modalities like a shock wave therapy machine, all kinds of gels and banded exercises.

However, contrary to popular belief, physiotherapy is predominantly about giving advice, educating and providing a plan of action.

I will explain this further in this article, as we will cover:

1. Assessment
   

2. Reassurance and Advice
   

3. Plan of action

Before jumping into this, I want to state that everyone is different. All this means, is that with a different history, a different set of genes, different lifestyle choices, different habits and different beliefs, it is likely that some things are more effective than others. What is effective and how to implement this is essentially the job of your physiotherapist.

That being said, I used to believe everyone is so different that it is an impossible task to ‘generalise’ and provide ‘general advice’ because how could I possibly squeeze people into boxes and categories and simplify it to the point of generalisations? Then, I realised that even with differences everyone can follow general concepts, make the adjustments to tailor their treatment plan to their goals and needs.

You can be complex without being complicated.

Most of all, if you are willing to become a more active part of your recovery, then the power to become better really is in your hands.

The number one reason people seek physiotherapy treatment

The last point I want to cover before getting into the nitty gritty, is the topic of pain.

In the end, most injuries revolve around this. Yes, we have restrictions or stiffness, maybe some weakness or feelings of instability. But the most common reason people seek help is because they experience pain. It is exactly what pain was designed to do - urge you to make a change, to pay attention to something, to avoid and learn from something.

The thing with pain is it is a protective system, an alarm system of sorts. It keeps us safe and makes sure we protect ourselves. More on this in a pain blog post soon to be posted but for now we will just briefly touch on two sorts of pain onset.

Generally, there is acute or gradual onset pain.

With acute pain or injuries, these often happen with a sudden movement, an incident on a sport field, a fall or other accidents. For most acute cases, pain is usually hard and fast meaning it can be intense but it usually also settles quite quickly.

With gradual onset pains, they can be building for a while, come here and there until they are un-ignorable, or be in the background until something pulls them forward. This can sometimes transition to a chronic or recurring issue and sometimes we become complacent and accept or assume that we will just always kind of have it.

Assessment

Whether acute or gradual pain, the first thing your physiotherapy will do is get a good thorough history of your issue. This is because knowing your limitations, goals and the behaviour of your issue gives us most of the details that we need to know!

When it then comes to assessing someone we are mostly looking for your current function and what we can start you off with. Here we will be looking at your:

Range of motion

Load tolerance

Pain (kind of)

I say “kind of”, because it can be a guide in what we can or can’t do, but it’s not the most accurate one. This is because pain is an experience produced in our brain. We don’t have “pain sensors” per se. Instead we collect information from our “threat sensors” our touch and pressure sensors that can, in accordance with a lot of other information, result in the experience of pain. It is our bodies alarm system. One that throughout our years of growing up and testing the abilities and sometimes limits of our body has kept us safe. It has prevented us from getting burned on the stove (again) or warned us not to touch the pointy thorns on a plant, or told us to wear shoes on a hot pavement under the summer sun.

That being said, pain is not a great indicator of the presence or extent of damage, but rather a system to warn of potential and apparent damage. I want to emphasise “potential” here, because especially when seeing clients that come in for back pain, knee pain, neck pain, shoulder pain - these things often feel worse than they are. This is not to de-value your pain, but rather to assure you that your body is not as fragile as you may think it is. It is also to encourage you to test out your movements and load tolerance, as we can often assume there will be pain and limit our function based on that assumption.

Assessment: Range of Motion

Our range of motion can often be decreased after injury due to

• guarding of motion to reduce the stress through the structures that have been affected

• swelling that happens due to the injury and reduces the range because there is less space to move

• pain because again our body wants to bring attention to the area and tensing already injured structures can be painful

Any reduced range ideally should be gained back. It’s a combination of time injected to allow the swelling and pain to settle, as well as actively testing and encouraging the range so that the reduced range doesn’t become our new normal. Here you want to move in the range that is comfortable frequently throughout the day and test the range that is somewhat uncomfortable a few times in the day. Here you want to test what is tight or uncomfortable but not push into more than a low level of pain. Pain is different for everyone but let’s say a low level would be below 3/10 (with 0 being no pain and 10 being the worst pain ever). Here, pain serves as a guide to identify the limits but not push past them.

What kind of movement should you do?

Think of the planes of movement involved in the injured structure. For example, for an ankle, you can move your foot up and down, tilt it side to side (a little), and rotate it drawing a circle with your toes. With the knee, it’s mostly bending and straightening with next to none or very little rotation possible.

Movement can be introduced by moving the affected area without load. For the ankle this could be sitting and doing ankle circles. Movement can also be introduced with load, such as doing a squat that pushes your knees over your toes, forcing the ankle into dorsiflexion with the weight of your body.

This brings us to our next point.

Assessment: Load Tolerance

Load can be anything from walking to running or jumping, or from bearing your own bodyweight to adding a barbell and 100kg to your exercise. The load is the demand you put through the structures affected.

Here, you want to start small. Whether you hurt your back, your knee or your ankle, test the usual movements without load and if those feel good you can keep re-testing as you gradually add more and more load. For example, if moving your knee can bend and straighten without issues, then you might want to test a bodyweight squat. If that feels fine too, how to several reps feel? How does it feel to add a bit of load? Is there a sticking point where it gets uncomfortable?

Perhaps it’s comfortable through half the range and becomes painful towards the end range. Perhaps it’s comfortable up to a certain amount of weight but doing 5kg starts to get uncomfortable. These are all things that can be modified, by for instance, dropping the weight to a level where the full range is comfortable, giving you cues to adjust the way you’re performing the squat or it can be reducing the range you work towards (though this is usually the ‘last resort’ or a temporary solution).

As you are progressing your range and your load you want to be guided by pain, but not let it dictate your every move.

What does that mean?

Pain as a Guide

As mentioned before, pain is not a great indicator of damage. It is more accurate with acute events and usually drops off in accuracy as time passes. Pain is also not the bad guy. It keeps us safe and can guide us in our recovery.

Generally speaking, a low level of pain is acceptable when going through rehab. If there is a low level of pain (as discussed, say anything < 3/10) you are usually good to continue as long as that pain either drops off or stays the same without a spike after the exercise. However, if it climbs up its a good idea to scale the exercise or activity back (e.g. walk slower or less distance, squat less weight, perform a movement slower or do fewer repetitions).

If you use these general principles as a guide, you are already on the right track with your recovery. A physiotherapists can guide you with this and give you exercises to do, especially if there are specific actions you want or need to perform in your daily or weekly routine. There are thousands of different exercises you could do and there are no movements that are necessarily right or wrong. Rather, it’s about which exercise or movement is the most appropriate for the level of your rehab you are at, for the functions you perform in your life and for the goals you set for yourself.

Reassurance and guidance

Reassurance comes through education and clarification.

The scariest part is usually the uncertainty, the not knowing. If you’ve ever watched a horror movie you will realise that the anticipation, the building of tension, the sounds, the music building to the crescendo is the scariest part! Once the monster/ ghost/ serial killer/ alien comes into view they often actually… look kind of ridiculous. It’s the uncertainty and the unknown that is what makes us feel scared and sick and tense and cover our eyes (can you tell I hate horror movies… ).

Understanding what is going on, why you’re feeling pain, what you can do to help it - this is valuable information that will lift the veil and make your situation a lot less scary.

Another part of this is that you will often only see me or your health provider for and hour or two maximum in a week right? A very small part of your day, your week, your month! So if you understand what is going on and whys and hows of your rehab, then you are much better equipped to make good choices during this time. Choices that will accelerate your rehab and help you get where you want to be!

Plan of Action

And this leads us to the last point which essentially is already interwoven in the points above. Throughout all this, we will come up with a plan of action. A rehab plan, guidelines on 'dos' and 'donts', fielding questions throughout and having goals to set and hit!

You want to hit those wins on the way to recovery and no matter how small, they are steps to success. So having a plan to follow will produce results.

My goal is to empower you to be an active part of your rehab, understand what is going on and give you autonomy over your future, your body and your health.

I hope you found this helpful and perhaps you have a better idea of what to expect from your rehab and recovery and some guidance in how you can accelerate your recovery!