Exploring “Physiotherapy”

The social identity of our profession is vital, both in respect to how we see ourselves, and also how the public views us.  It sets the expectations of us as a profession and also the sociocultural context of our patient’s expectations of the profession.  Our social identity can drive our own personal and professional strategies that may lead to challenging tensions that exist between how the public may judge us and how we evaluate ourselves and our colleagues, from within and between the healthcare professions.

From the viewpoint of the public, they may assume that our role is to massage sore limbs, prescribe exercises, hand out walking aids, run out on sports fields, and prescribe medications, list for surgery or just helping people recover with advice and guidance.  In whatever way they may perceive us, there will be numerous accurate or inaccurate views.

This short blog looks to consider the word Physiotherapy and its two elements – Physio (nature, natural or physical) and therapy (treatment, counselling, healing).  A real life viewpoint of a patient of Neil’s has made him consider the therapeutic element within the patient narrative. All clinicians are blessed to be invited into a patient’s story, and in so many cases, this can be a very humbling experience. This story was one of those, and it led us to reconsider the name of the profession – Physiotherapy.

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When we describe ourselves as a “Physio” it seems fairly clear to us and it sets an expectation of physicality translating to recovery. We may not describe ourselves so easily as a “therapist” because there are a range of therapists in healthcare and this therefore fails to distinctly identify ourselves, however being “therapeutic” and offering “therapy” is an integral part of person-centred care.  I am sure that there are many of us who have experienced the confusion in how the word ‘physio’ is used as a treatment as opposed to a professional title!

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So, what is the “therapy” we offer? Exercise on its own has physiological benefits; helping people move helps numerous biological, psychological and social system changes.  In the realm of human biology for example, movement behaviour changes, observations can be made with respect to the tone of muscles, the strength of a contraction, the biochemistry within the soft-tissues, or due to alterations of the nervous system, things change. How that change is experienced, perceived, acknowledged and understood contextualises those physiological reactions within the emotional context of the individual, and this is where the “therapy” may happen in the cases that we see. The biopsychosocial model has been unintentionally interpreted as three distinct components and there may be the tendency to treat through the bio lens, an example being how exercise may strengthen the individual to improve their physical capacity and potentially ignoring other psychological and social contexts.  However, there is the recognition that a key component to integrated the biopsychosocial approach is through the provision of a cognitively informed practice to enhance recovery.  Although our language, through its inherent limitations, has to separate this complex and dynamic systems approach, it is very difficult to come to terms with the understanding that these systems cannot really be separated and treated as such, as they are inextricably intertwined.

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As we will all appreciate, every interaction, intervention and communication will, in some way, have an emotional effect on that individual, we are human and fundamentally social beings.  And so, that interaction whether it is the prescription of an exercise designed to help improve the capacity of a tendon for example, using the most up to date isometric technique may be shown to change a range of difficult to pronounce chemicals, or giving advice to move and stay active, or perhaps using hands to help someone, or whatever, the “therapy” is the emotional interaction and understanding that enhances the observable physical changes.  The ‘objective’ changes without the emotional context, become just observations without the translation of a positive lived experience.

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So, as someone who trained many years ago and initially believed the physical treatments produced the physical responses, it is always a humbling experience to put the pen down, sit back, and listen to the story. To hear how the agency of a person is lost and to really appreciate the emotional cost associated with that.  Hearing the impact of how “physical” treatments have failed and in order to make sense of the situation is truly bi-directional within an intersubjective space.  The way in which progress can be made and enhance the biology of recovery in instances such as these, was to offer the “therapy” within the patient story and not from an externally situated and objective physical sense (Physio).

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We would like to thank Neil’s patient for kindly sending this, allowing us to publish it, and being so open in their discussion.

Matthew Low and Neil Langridge

“Hi Neil,

As we discussed, here is the story of my back problems, I hope it isn’t too long winded, but once I got started it was quite therapeutic!

I’m 53 years old and can’t remember a time when I haven’t had to careful with my back. Almost any little thing could trigger painful spasms and more prolonged periods of stiffness and pain. Besides that I kept myself reasonably fit walking my dogs, horse riding when I was able and had a pretty normal life. Just before Christmas 2001 I think, I bent to get something from the oven and “wow” the pain was so bad I couldn’t move, general opinion that followed was a disc issue which took about 6 weeks to improve. After that it made me even more conscious and nervous about everyday movements and actions. New Years Eve several years later and I got a virus which led to Sarcoidosis my particular symptoms being respiratory, bronchitis and constant coughing and vomiting through that. Needless to say I hurt my back badly with that, and after the operation to remove a lump from my lung I had awful pain, not from the operation site but of course from lower back.

Very soon after returning to work in a job I loved and had been in for years the company folded, I was redundant and not exactly a fit candidate for anything! Shortly after that my dog had a bad accident which then meant 6 months of treatments and care at home and vet visits every week. At this point my husband of 20 years decided that a friend of ours would be a much better option for a fun life than that with a sickly woman and her crippled dog. Enter depression , stress and more back pain, and add financial worries into that too, I was in a bad way. So that was my life for the next 10 years, ups and downs, living in total fear of my back going completely and then being rejected by those around me in my work, new relationship, and family. The whole time I tried to hide my feelings as to how bad I really felt, how often is it said those with depression outwardly laugh and joke so you would never know?

 I think probably the worst part was when both my parents died within months of each other, my Dad on Christmas Day 2012, and my Mum Good Friday 2013. Things had been very difficult with them for a few years as my Mum had dementia and I felt so guilty that my back pain prevented me from doing more for them. The day after my Mothers funeral my back was so tight and sore I went for a long walk and tried to forget things and have a good day, but that evening going upstairs something “went” over my right hip and into my lower back, and that was that, pretty much permanent pain that ruled my life.

So then you try everything don’t you? Regular medications didn’t work or made me ill, physiotherapy made it worse! Chiropractic worked to some degree but then ended up making it worse and being treated for free, I had acupuncture with some success, then again it got worse, hydrotherapy which was good but was not affordable after the NHS treatment. Just after my parents deaths I even went to a faith healer who laid hands on my back whilst a white dove of peace, ironically a right vicious individual, flew about crapping on everything, particularly a 7ft black statue with a massive afro and colourful robes. I guess he had some significance, but it was lost on me, no results! The only thing I found helpful was a tens machine which blocked the pain messages from the brain, I also found distraction such as a good play on the radio at work, or a night out with friends would give me something else to think about and the pain eased. Generally though I lived my life in fear and pain, anxious about anything and everything and even about what may happen, I was totally negative and an absolute pain to be around. Thank goodness my GP recommended me to someone who understood what was happening, and you turned everything I’d been told and believed upside down.

You diagnosed PTS going back years, then think phantom limb syndrome whereby my brain was now hardwired to send pain signals when there wasn’t any pain! Sure I still have irritation to my nerve endings which give me grief from time to time, but I am learning to deal with these set backs, not an easy thing to do. I needed to de stress, I took a month off work, anti depressants, and learnt to relax and stop running about. During those 4 weeks I had one day of pain! Taking myself out of the situation broke the cycle of pain = stress = pain. I took up gentle yoga, having never attended an exercise class in my life I was scared to death I wouldn’t even be able to get on the floor. I needn’t of worried everyone had some problem or another and we help and encourage each other. I’ve found it a very positive thing to do as after not moving for so long I found after a week or 2 I was improving and doing more than I ever thought I could.

I know it can be really difficult to realize that actually the very real pain you are feeling is in fact manufactured by your mind, and to many people it just doesn’t make sense, it takes a while to get your head round, but once I did I haven’t looked back and have apparently achieved such a lot in the couple of months I have tried to turn things round. I am naturally a pessimistic and negative person, but I really do believe now that if you can open your mind to the possibility that you have it in yourself to change then anything is possible, and the sense of achievement you get from doing the very things that challenge you is a great feeling!”

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