New patients who have never had Physio before are often filled with a little trepidation when coming through our door, as they have no idea what to expect. With the current madness of Covid 19, a visit to the Physio has changed for all of our patients. I thought that I would you share with you what you should expect from a visit to the Physio as Lockdown unfolds and we are able to see patients again.
Following professional and government guidelines, we at Ashburton Physio are now providing a ‘Virtual First’ policy to treatment. When you call us for an appointment we will initially offer you phone advice and send you exercises, or a Video appointment to initially assess your needs. Covid-19 is still present, and still life-threatening to both patients and therapists. As such, the clinical need for face-to-face consultation must outweigh the significant risk to both.
Before you attend for a session you will be asked to fill in a Health Questionnaire online to ensure that you do not have Covid symptoms, this will be checked, along with your temperature, on arrival at your appointment. You will need to sign a form at this stage declaring that you understand the risks of attending, please bring a pen to avoid contamination.
The clinic has been adapted to allow us to treat in a socially distant and more clinical manner. The soft furnishings have been removed and the beds and chairs re-covered to allow us to be able to clean all surfaces between patients. Please wear a mask if you have one, if not, one will be provided for you. We also ask that you use the toilet prior to leaving home as guidelines suggest that we close our facilities to patients. We ask you to come alone if possible to reduce the footfall to the clinic, to arrive on time, and not early so that you will not come into contact with other patients. If you do need to bring a chaperone, they will be asked to sign a health questionnaire and their details recorded in case the Track and Trace team need information about who has attended the clinic.
Personal Protective Clothing
Your Physio will be wearing PPE according to Public Health England Guidelines. This includes a mask, apron, and, unfortunately, it is a requirement that we wear gloves. This is going to make the session less pleasant for both the Physio and the patient but it is important that we adhere to the rules. During the session, we are advised to reduce the length of time that we are less than 2m away from the patient to less than 15 minutes, but this will be on a case-by-case, need basis. Please remember that we are not currently able to see you for routine face-to-face appointments until the alert level changes.
What should I wear?
Please wear loose comfortable clothing which is easy to remove if required. For a back or lower limb problem, shorts (or big pants) are recommended. You will probably need to remove your top for a back or upper limb problem, so ladies, a supportive and comfortable bra or and a vest top is a good idea
On the first appointment, Physios ask a LOT of questions in order to get the best possible idea of the patient in front of us. As you will have had a virtual assessment first, many of these questions will already have been asked in order to reduce the length of time that you are in the clinic. Some of these questions might seem really random… like ‘what do you do in your spare time?’ Despite this seeming a little nosey, it is really to build up the picture of what your body is required to do on a week-by-week basis… so we’re not asking about your employment so that we know if you can afford the Physio bill! It’s more about whether you sit all day at a desk, or dig ditches for fifty hours a week.
Through questioning, Physios are trying to find out:
- What has happened to you
- How long you’ve been in pain
- What the possible causes are
- How severe the pain is and how long it lasts for. This is important, as a condition that is easily flared up has to be treated cautiously by the Physio.
- The type of pain: this gives a good indication of possible pathology
- What makes it worse, and what makes it better: these are like handy little hints from the universe as to what might be used for treatment, or avoided!!
- What restrictions you have as a result of the injury
Every injury has its unique features, but there are usually similarities and patterns that are followed, which is why the clinical picture presented is so important. By the end of the subjective examination, the Physio should have a good idea of what he/ she needs to focus on assessing in the allotted time and also starting to have ideas of what type of treatment will be done.
The physical examination will be most thorough on day 1, but will happen to some extent on every appointment, and is on-going throughout treatment, so nothing to be worried about.
It usually consists of
Looking: at posture in sitting or standing, how you walk, the affected area checking for swelling or bruising or redness. Don’t be alarmed if you have a sore ankle and your Physio has you stripped down to your boxers, as anything could be the cause of your pain.
Moving: This could range from you showing the Physio a painful movement in your golf swing to the Physio gently moving your arm if you have a frozen shoulder. We need to see the movement you have, and how you make it happen (sometimes how your body cheats!) and how this is contributing to the issue.
Feeling: A good Physio uses their hands A LOT in assessment. Feeling for muscle tightness/ stiffness, joint stiffness, fascial tightness and various lumps and bumps that can be found with an injury. Just because something is painful to the touch doesn’t necessarily mean there is something wrong there, it’s all just part of the information the Physio is gleaning from your body. Remember that your Physio will be wearing gloves at the moment.
Treatment (very much dependent on the pathology!!!) should consist of
Soft tissue treatment: this is mobilisation of the muscles, tendons, ligaments and fascia (the covering of the muscles). Most Physios will get pretty offended if you think all they do is ‘give you a rub’ or a ‘massage’. I don’t ever recommend irritating the person who has their elbow stuck in the trigger point in your calf by trying it!! We are searching around for tight areas that our assessment led us to believe should be further assessed/ treated, and a good Physio can feel when something is tight without you having to tell them!
Joint mobilisation or manipulation: This is to decrease stiffness or pain at a joint, and sometimes you don’t even know it’s happening (but it is!). Manipulation doesn’t always result in a ‘click’ or a ‘pop’, but it should increase the range of the joint, or the pain when moving it or pressing on it!
Neural mobilisation: your nerves can get tight too, particularly if they get all wound up in tight muscle/ fascia. Stretching these out can be a little tingly sometimes, but let your Physio know if everything is going numb!!
Exercises: Your Physio should give you strengthening/ stretching exercises at the end of each treatment, and if not, there should be a reason given as to why not!! This helps to maintain the good work that’s been done during the session, and helps to correct some of the imbalances that brought you in in the first place! The goal of physiotherapy should be to alleviate pain, improve function and prevent recurrence of the issue as much as possible. Exercises might be done using a gym ball, some stretchy band, or all manor of things!
Here at Ashburton Physio you will always be given ‘homework’ in the form of exercises. We have an exercise software programme that emails you video clips of common exercises. If your exercises are unique to you, we can video them on your mobile phone so there are no excuses to forget!
Other treatments: This can include dry needling/ acupuncture, taping, ultrasound, TENS, (although not as many Physios are using electrotherapy these days)
My advice to you is:
- Ask your Physio anything you don’t understand, it’s your condition, and if you want to know, then they should help you to find out!
- Try to manage your condition with the advice and exercises initially, the risk of Covid 19 to you and others is still very real
- See someone recommended to you. It’s scary out there, and checking Google isn’t necessarily the best way to find the best person to take care of you.
- Check your Physio is suitably qualified. In the UK you can do this on the HPC register http://www.hpcheck.org.
- see a Physio about a musculoskeletal injury before you see your GP, as Physio have more training in this
I hope that helps to put your mind at ease a little about what to expect, please call or email us if you have any questions 01364 652883.