With each year of clinical physiotherapy experience and knowledge, the need to reflect and ‘box in’ what works and what doesn’t is so important for growth in our profession. I have been forming my own book of what works and what doesn’t for myself and my patients; never missing an opportunity to acknowledge mistakes and new ideas. The mantra ‘never stop learning’ is so important to us as clinical practitioners. Something I have been struggling through lately is how to properly reach my patients with education that is understandable. We know that education and empowerment is invaluable to success of a treatment program, but how exactly do we educate. There are many models out there, but just the other day I managed to put a finger on a model that for me makes sense.
The body is a living, breathing, ever changing organism.Simple as that. A pathology or movement dysfunction is not like a quick fix at your local car garage. The human body is not a machine, we cannot tighten the bolts and replace the water pump and expect everything to have improved. No, the human body and all its tissue (bones, muscles, cartilage, ligaments, tendons, etc.) needs time to adapt to the demands placed on it (Wolff’s Law). So we should not be telling our patients that we will loosen up here and strengthen here, and there will be a rapid change in their symptoms. Instead, we should help them understand that recovery from pain or injury is a process, and that gradual adaption needs to occur in the structures of the body. The end goal being the ability to handle the required load. I explained this is terms of a plant that sits in our assessment room here at our workplace. Basically, I likened the body to the plant that without water and sunlight will likely start changing its colour and eventually wither away. The same can be said for the human body. Without regular loading in whatever form it may be, body tissue will weaken and eventually certain movements will become painful, and perhaps injuries will occur from not being able to withstand that load. A great example was that in a recent study, it was shown that ACL thickness increased during heavy loading cycles during a sports season, and decreased during the off-season. Simply put, the body increases strength and tolerance to a load when needed. Just the same, with constant exercise and movements over time, the body will burn up fat and change shape. Again, adaptability to changing demands.
We should always consider this notion of adaptability in recovering from injuries or painful movements. This is also important when preparing for an athletic season. We can’t expect to go from zero to hero in the space of two weeks. Progressive overload over time is the key. On that note, another essential key to successful physiotherapy treatment is goal setting. Again, the body is not a machine that is the same for everyone. At the start of a therapeutic relationship, we should always identify what the patient would like to achieve from attending physio and beyond. Initially it may be to be pain-free, which is great. But there may be a greater goal in mind, like running a 10km race in one month’s time without the pain. We cannot than simple say “do this exercise because it will solve this, and then you can run your race”. We should take time to plan a progressive loading program, with the goals of the patient in mind, using various exercises to achieve the goal of running that 5km race. Again, this will be different for every patient that we treat.
To summarise, consider the body as a living organism that adapts over time to any demands placed on it. Explain this to your patients and plan a progressive load tolerance program, instead of just giving them standardised protocols you have used before. Most importantly, set patient driven goals to plan for a successful physiotherapy experience.