After the unprecedented popularity of our post The Top 5 Physio Myths it seems rude not to follow it up with a sequel. Having toyed for hours, or at least a couple of minutes, I came up with imaginatively tittle 5 More Physio Myths. I figured that was more appealing than the Not Quite Top 5 Physio Myths.
The title changes but the mission stays the same to continue to right the wrongs of perceptions about physiotherapy, sports therapy and injury treatment in general. Now I’m all for audience participation so if there’s anything you’ve been told previously that just doesn’t sound right and you’d like a different opinion on it then please do drop me a line at info@BrightonSportsTherapy.co.uk and maybe we’ll include include it in volume 3 of physiotherapy myths – the ongoing saga!
1. Exercises Are All Physiotherapy Has To Offer
Many of our clients on their first visit to the clinic expect to be shown a few exercises to do and then told to toddle off and fix themselves. Whether they’ve searched for Physiotherapy or Sports Therapy doesn’t seem to matter – this is the expectation of large proportion of people. So it can come as quite a surprise when we start prodding (it is a little more technical than that I promise!) people in parts of their body that are a long way away from ‘the bit that hurts.’
Whilst exercise prescription can be a useful part of physiotherapy treatments it is not the magical panacea. As therapists we need to find something else because between 75-90% of you lot (depending on which research you read) don’t do your exercises anyway. You can read more about the merits of this is our post Does Exercise Based Physiotherapy Actually Work? If we’re honest we don’t do the exercises ourselves so how can we expect you lot to do them! We’d all just rather have a bit of treatment and be able to crack on with life right?
We add muscles activation, sports massage and joint mobilisation to our treatments. Mostly because that’s what we’re good at. There are lots of techniques and approaches. Some more alternative than others. If it works for you don’t knock it. Though you do need to remember that placebo works in 30% of cases!
The key thing for me is that it is not a one size fits all approach. Your condition should be treated as unique condition to you. Obviously there are similarities in the way people present with their conditions but be wary of any therapist that is just churning the same stuff out without explicitly listening to you and fully assessing how your body works and how this feeds into your symptoms.
2. Walking Sticks Are A Good Idea
Now of course sometimes crutches are a good idea. I’m not that obtuse. If you’ve broken your leg then they’re pretty handy for getting around. The kind of walking stick I’m talking about is the ones you see the old guys brandishing – like the picture on the left. You do of course see some young folk resorting to the walking stick all too soon. They are particularly when walking sticks are bad.
One of the things we work really hard on at the clinic is to get people out of avoidance behaviour. Or compensatory movement patterns if you want to put it another way. We find that when we move to avoid pain we actually make the situation worse not better. Muscles do different things to what they were designed to and don’t work as well as they should. ultimately putting more, not less, pressure on the painful bit.
A walking stick or even a set of crutches that are used too long post injury are exactly that. Devices to avoid pain. This only serves to make the movement pattern worse. Bearing weight on the walking stick and not through their body only serves to confound not only the movement pattern but also the pain avoidance mentality and we get stuck in a vicious cycle.
Now I’m not suggesting all the grannies and granddads reading immediately ditch their walking sticks… but there are alternative options!
3. X-Rays and MRI Always Have The Answer
As we discuss at length in our last blog post: Does Imaging Always Have The Answer? The short answer is no. Whilst they are great for checking out the extent of damage post injury and great too for ruling out any urgent pathology they are not definitive in their diagnosis of where the pain is coming from.
The science of pain is way too complicated for that. You can have two conditions that look very similar on x-ray and MRI. One person may be in agony, the other completely oblivious there is anything going on! It’s just the way things work.
4. Neoprene Braces Help Conditions
Whenever I see someone wearing a knee support my eyes always light up. I see someone who we could really help and I promptly run over with business card in hand! Not entirely true. But that’s what I’m thinking. My simplistic view on braces is that if there is dysfunction in the tissues then wearing a brace to patch things up really isn’t a long term solution to the underlying cause.
I mean surely. If you are getting pain in your knee due to muscle weakness in the muscles that support the knee is it not a better option to make those muscles stronger. Either through a lovely bit of treatment from our good selves or training the weak muscles. Ideally both.
This is my opinion. It works well in the clinic. As always I’ve tried to back this up with evidence so support my beliefs. To be honest there’s not a lot out there. There’s research and counter research that contradict each other. Most of the research that is out there has been done on preventative protective bracing. My point is more relating to underlying issues that aren’t going away. If you’ve got something that is nibbling away at you get it sorted before if comes back to bite you!
5. Scary Latin Names Means Pain!
Now I’m all for using Latin to make myself sound clever but I do so sparingly and only when I feel it will genuinely benefit the client in front of me. A lot of these Latin names can sound really scary and people may associate them as the cause of all their ills. More often than not, as least in the physiotherapy world, these Latin names are not as serious as they sound and we shouldn’t get too hung up on them.
One that we hear of frequently is scoliosis. Curvature of the spine. Which doesn’t sound great. But the truth for the vast majority of us is that this is an incidental finding. Scoliosis rarely gets worse after adolescence and chances are you had the scoliosis long before you had the pain you are currently experiencing. So whilst it may be a factor in how you hold yourself it is just a finding for something that should be easily preventable.
The list of scary physio conditions is pretty much endless. Torticolosis is one of my favourites. Sounds terrible. Effectively it’s just a stiff neck. Granted a very stiff neck. But these things are easily straightened out – quite literally! Snapping Hip Syndrome is another one. In physiotherapy and medical world always be wary of anything ending in syndrome. It basically means no one really knows what it is! I’ve just realised that one isn’t even in Latin but it still sounds bad. It simply means that something goes click in your hip usually without pain.
For those interested in snapping hip syndrome it is thought to be one of three tendons flicking across a bony prominence – but no one really knows for sure. For me in the clinic it’s best to consider which muscles act across this joint, assess them, treat them and see if the ‘snapping’ stops. It usually does. If it doesn’t, so long as it’s not painful, it doesn’t really matter!
Hyper-mobility is another bugbear of mine. We discuss this in our previous article here. Since writing this article I have seen a number of people with Ehlers-Danlos syndrome which is a hyper-mobility condition. Note the word syndrome again! It can be very mild or can be very severe. It’s certainly in vogue at the moment to explain away complex pain cases. I still stick to my original point that hyper-mobility is hugely over diagnosed and is not an explanation for all pain in your body – even if your joints do go too far.
N.B. As an aside for any sufferers with Elhers-Danlos and / or other hyper-mobility conditions I met a lovely lady recently who was a sufferer. She put her experience so succinctly and I wanted to share it. Her experience was that Yoga actually made her condition worse whilst Pilates made it better. When you consider that yoga looks to increase your flexibility whereas Pilates looks to train your muscles to better control your joints this makes absolute sense. Often the best insight is the simplest! This would tie in with our experience in the clinic. With our muscles activation techniques we are looking to optimise muscle length to give greater muscle strength and control. This might explain how we are able to help people with such conditions.
More Physio Myths Conclusion
So there you have it. Another blog done. More questions asked. None answered! I prefer to question the norm rather than find answers. Offer opinions and ideas as what works for one person won’t necessarily work for others. I don’t believe there are any definitive answers. It’s just fun trying to work out what works for each individual. That’s why we do what we do.
So my advice to you is to question everything. Sometimes it’s nice to accept that something you have been told is right. But sometimes it’s best not to accept things. Would you rather be someone who had scoliosis and put all of the pain in their body down to their condition.Or would you rather be the person who has a condition that has been told ‘there’s nothing that can be done’ but seeks alternative ideas and options. Ultimately leading to a less painful and more enjoyable existence.
If you’ve been told you’re a lost cause or you’re starting to doubt whether you’ll hit the heights of previous performance – even if that’s just walking to the shops – then please do give us a call as we’d love to chat about how we might be able to help you with our Physiotherapy and Sports Therapy treatments. We’ll soon tell you if we can. Equally we’ll soon tell you if we can’t. It’s important to know your limitations.