It’s frustrating that most people don’t actually know the answer to this question. You’d think that as a healthcare professional, there would be clear transparency as to what we do. You know that a doctor prescribes meds, a dentist fixes your teeth, a pharmacist dispenses meds. But a physiotherapist, um… wait, what does a physiotherapist do?
Here’s why I think there’s confusion: many types of physiotherapy exist. Given that we have practices in hospitals, rehab wards for stroke/brain injuries, and general clinics, it’s no surprise why the question often asked is “what is physiotherapy”? What I’ll do is explain this from my clinical perspective.
Orthopedic clinics (where I work) are designed to address non-emergency issues such as neck pain, back pain, shoulder injury, rolled ankle, twisted knee, post-orthopedic surgery, etc. So without further ado, here’s my best explanation of “what does a physiotherapist do”?
WHAT DOES A PHYSIOTHERAPIST DO?
Depending on who you ask, you might get a slightly different answer. In my opinion, it’s a combination of addressing the physical issues and the mentality behind the human body. People who walk through my clinic doors come with some form of pain or restrictions. They typically present with one of the following:
1) a recent injury that had a high level of pain/decreased function, or
2) a lingering injury/restriction they haven’t been able to resolve themselves
So what is physical therapy and how does it start? On a patient’s first visit, I complete an initial assessment with them. This helps me figure out exactly what body structures were affected, what biomechanical issues it created, and what types of physical therapy treatments are required. This session is broken down into the interview, the assessment, and the treatment.
STAGE 1. THE PHYSIOTHERAPY INTERVIEW
The first thing I need to do is determine the history of the pain. This includes how it initially happened, what happened next (e.g. swelling?), how the was function afterwards (e.g. able to walk?), were there any previous injuries to the same area, was any imaging done for it (e.g. x-rays?), and more.
Now a lot of the time, people come in not because they’re necessarily in pain but because it’s stopping them from doing something important. This can be anywhere from playing a sport, going to work, or spending time with family. Learning what it’s stopping them from doing, especially things that matter most to them is paramount. When asked “what is physiotherapy?”, this is what I think of as a crucial moment.
STAGE 2. THE PHYSIOTHERAPY ASSESSMENT
Next is the physical investigation. What does a physiotherapist do with all the information he/she gets from an interview? He/she puts it to use. I take everything I learned about the individual to guide my assessment of them physically. The following is a list of things I examine, the first being posture.
Posture – If the human body is a story, then the posture is a book that tells that story. A lot can be deciphered about what a person does on a daily basis simply by looking at their posture. From head to toe, hundreds of positions can tell me exactly what’s going on as well as what might be related to their injury.
Movement – The next biggest giveaway as to what is causing problems is movement. When someone moves, they do so in the path of least resistance unconsciously. When in pain, it’s usually in a way that avoids pain. However, this becomes a faulty strategy eventually and needs to be reversed.
Strength – It’s not the strength you’re thinking about. First I apply resistance to motions I believe may have issues. Then I observe if there’s any unexpected weakness or pain in resisting these motions. This gives me an idea of what might need strengthening or stabilization.
Stress Tests – I do these towards the end because of how specific they are. Once I have information from the things assessed before (posture, movement, and strength) I determine a list of stress tests to rule in/out injuries I might think are present. These help to create a running diagnosis of what I think may be happening.
STAGE 3. THE PHYSIOTHERAPY TREATMENT PLAN
So what is physiotherapy treatment planning? It’s mapping out what needs to be done for treatment. I consider the method, timeline, and expectations for recovery. At this point, the patient has been educated about the condition they’re currently dealing with. The types of physical therapy treatment strategies I use are evidence-based. Careful research was used to determine which methods produced the most significant positive outcomes for the patient. These methods include myofascial release, active soft tissue release, mobilizations, manipulations/adjustments, posture correction, workplace modification, and corrective exercises.
The combination of these methods is dependent on the patient’s condition and other factors including age, pain-tolerance, and compliance to exercises I may decide to give. But one thing I make sure to tell all my patients is that their therapy is a team effort. This means that I’ll need them to do their homework outside the clinic, just as much as they need me to fix them in the clinic. Without this teamwork, their recovery may get delayed.
WHAT IS PHYSICAL THERAPY? THE CONCLUSION
We’re a group of health care practitioners who aim to make you feel better so you can move and function better. Having peak physical health is the foundation you need to accomplish anything else – without it, you’re at a huge disadvantage. Helping people achieve these health outcomes and seeing what it does to everything else in their life is my best answer to “what is physical therapy?” in my opinion.