In a nutshell, physiotherapy is the assessment and treatment of musculoskeletal injuries!In order to prevent you from falling asleep in bed and potentially hurting yourself as you drop your iPad on your face, I am going to split this post into a few segments. There is a lot behind physio and how it works. The last thing I want to do is lull you into a coma with a massive monologue.
But before we continue, let’s take a quick commercial break. I should mention that physiotherapy covers a broad scope of injuries – musculoskeletal injuries are just one part of that spectrum. There are ton of physios that work in hospitals, long term care facilities, schools, etc. These guys deal with a large assortment of problems and diseases like strokes, spinal cord injuries, or Parkinson’s. My blog is going take you through the life of a private practice physio.
And now back to our regularly scheduled programming! In private practice, I come across a variety of musculoskeltal (or orthopedic) injuries. Almost every muscle and every joint in your body can be hurt (unfortunately) and therefore treated. When someone walks into the clinic, my first step is to assess their injury so that I can form a diagnosis. My second step is to treat their injury based on my diagnosis.
So first off is the assessment. My assessment is broken down into two equally important parts: patient history and objective testing. Let’s take a look at patient history.
- “WHAT HURTS?” Obviously, I want to know what body part is causing Brad to limp. Is it a painful hip? Or maybe a bummed knee or ankle? Brad tells me it’s his knee. I secretly do a dance inside because knees are my favourite joint to work with. But I don’t get carried away, I’m still going to ask questions about his low back, hip, and ankle because all of these areas can cause knee pain.
- “HOW DID YOU HURT IT?” There are hundreds of ways someone can hurt their knee and each of these ways will lead my objective testing in different directions. What was Brad’s mechanism of injury? Brad doesn’t recall a specific accident that triggered his knee pain. He says his symptoms began when he returned to running and have been gradually worsening. This information is crucial in weeding out what the potential problem could be.
- “WHEN DID YOU HURT IT?” Getting an idea of the timeline helps to determine that injury’s prognosis. Brad mentions that his knee has bugged him for over three months. This sounds like a chronic issue to me. Problems that have lingered around for long time without any real trigger are known as chronic and are often related to overuse. On the other hand, if Brad said there was an incident in fight club when someone kicked his knee, I would then consider his problem as acute. Acute injuries have a known mechanism of injury. Chronic issues tend to be more complicated to treat due to compensations the body develops to take pressure off the damaged body part.
The answers to these questions – the “what”, “how”, and “when” – are vital in diagnosing the injury and also guide me in my objective assessment. For example, it’s probably not necessary to test Brad’s knee ligaments but I definitely want to check out his meniscus. Knee ligaments are damaged when there is a traumatic force that impacts the joint (e.g. a kick to the knee). Meniscus are more susceptible to “wear and tear” and overuse. I am unlikely to find any damage to Brad’s ligaments but his meniscus may be torn.
It is important to understand that there will never be two problems that are 100% exactly the same. Injuries are like fingerprints – you never see two identical injuries!
That is why the assessment part of physio is so essential. Getting all the relevant information plays a big role in figuring out the diagnosis. Without the right diagnosis, the problem may never completely go away!
So concludes this post. Our next adventure will tackle the more hands-on and objective part of the assessment!