FREQUENTLY ASKED QUESTIONS
IF THERE'S ANYTHING NOT ANSWERED JUST CALL
I have seen a physio before but all they did was give me exercises to do. Won’t it be the same with you?
No, not unless a doctor’s referral is required by your insurance company - you must check with them - or you have any concerns about your symptoms that you wish to discuss with your doctor. Otherwise you may come direct to us. If you are wondering whether Physiotherapy will be of use for your condition come talk to us about it - we guarantee that we will give you an honest appraisal of the likely benefit of Physiotherapy treatment.
If we have any concerns about your presentation that we feel you should discuss with your doctor we will advise you to do so. One of the great strengths of Physiotherapy training - something that sets us apart from Chiropractors, Osteopaths, Sports Rehabilitators and Trainers, and everyone else who professes an expertise in injury management - is that our training is very broadly medical and hospital based. We have all had experience of all aspects of healthcare and are best-placed amongst these specialities to identify non-musculoskeletal problems.
We are registered and covered by all the UK private health insurers, and Physiotherapy treatment is covered by virtually all health insurances. You should contact your insurer to check the details of your policy before coming for treatment. Some insurance companies require you to be referred by a doctor; others handle the claim generation themselves. Some will give you a claim or pre-authorisation number that we can invoice against so please bring it with you.
On most policies there will be an excess that you must contribute yourself to the cost of your treatment each year, and limits on the amount you can claim. In many cases a specific number of treatment sessions will be authorised initially with the possibility of requesting more if necessary. Data protection means that we cannot find out these details for you so please ask your insurer. Another factor you should be aware of is the renewal date of your policy: your excess will have to be contributed each insurance year.
The $60 million question! Will you get better and how long will it take. There are many answers to that question but overall be assured we will strive, and try everything, to get you better as quickly as possible.
In fact; we aim to do more than that. We will try to get you better than you were before the pain started. The rationale of that promise is that pain doesn’t happen by accident - there is usually a predisposing cause. Even in traumatic events like a fall you will “go” at your weakest point - that weakness having developed as a result of posture, movement, activity and muscle control. There are aspects of that predisposition that we can change - we can loosen immobile joints to even out movement load; we can inhibit and reeducate muscle activity to reduce local “stiffness” and improve local control. There are also things you can do - reestablish coordination between muscles, improve your posture and the use of your body.
Obviously there is a “piece of string” component to the question because it depends on what you have wrong. Some problems resolve as soon as movement is restored, some problems require specific muscle retraining, some take time for muscles to get stronger and some depend on the physiology of the natural healing process. Tendons and nerves, for example, heal slowly. That doesn’t mean that you’ll be having treatment for ages - it just means the full benefit of treatment might not be apparent for a time. Particularly this might be true for problems that involve nerve irritation - we can ease the pressure on the nerve but then the nerve needs time to heal. Sometimes lots of time.
And of course there are some people we can’t get better. Not many, but some. Either because the tissues are beyond healing or because of other physiological or health issues. Or maybe because they need surgery. What we do then is refer you on to the best person or give you strategies to manage the problem. It is still always worth getting professional advice.
...is a very interesting question! We can’t cure a prolapsed piece of disc, for example, but we can usually solve (with your assistance) the movement problem that caused it to be painful and therefore resolve the symptoms. We can’t get rid of osteoarthritis but that doesn’t mean we can’t get rid of the pain because arthritis is not what gives you pain, but “your body’s natural response to abnormal loading”: a consequence of an underlying problem, just as pain is. So, if we can get rid of the abnormal loading - by redistributing the movement, and/or improving the muscle control or strength for example - we might not only resolve the pain but also arrest the arthritis response. So sometimes yes and sometimes no!
Everything that is relevant and a period of reflection on your problem! Unlike many places we expect to assess you, treat you and answer all your questions in that first session - many places seem (oddly) to not bother providing treatment on your first visit.
So, for that first session please could you:
1.Have a good think about the problem. We will be asking you to be as specific as possible about where it hurts, how it hurts and when it hurts. Is it worse in the morning, in different chairs or dependant upon the weather and stuff like that. Don’t get obsessed for goodness sake but all that information will help us treat you more effectively.
2. Always consider the “it might not be related / relevant but…” bits. Let me explain: 90% of the time I hear a patient say that, it’s the crucial piece of information. Things like symptoms elsewhere, problems as a child, seemingly unrelated bits of history. It will be related: that’s why you’ve thought of it!
3. Bring appropriate clothing. We need to get to the bit we need to assess and treat. You don’t have to get undressed if you don’t want to but if we at least can get close the the bit it would be very helpful! We have pairs of shorts in all (well, most) sizes if necessary.
4. If you’re under 16, bring a parent / guardian / adult who can stay with you, and on that point, you are most welcome to be accompanied for your treatment at any time if you are over 16 too.
The first thing you should realise is that everyone has wear and tear! One study in Adelaide asked radiologists to report on back xrays and 80% of Xrays were found to show “signs of wear and tear”. What the radiologists weren’t told was that they were Xrays of teenagers. So it starts early, virtually everyone has it and not everyone has pain.
In fact it appears that there is no relationship between degenerative changes and pain unless the degeneration is very severe. Research into knee arthritis for example shows that it’s not the level of degeneration found on Xray that correlates to pain but strength - use it or lose it it seems. Likewise, you can have pain and have absolutely no signs of degeneration on an x-ray, (see next question).
So what does degeneration indicate? Degeneration, in the words of one prominent Physiotherapist and author, “...is a normal response to abnormal loads.” Joints change and degenerate because the loads at the joint are either too great or too small, altered because of a change in the architecture of the joint (if the joint is fractured, for example) or because the loads are poorly controlled. We can help a lot to restore more normal joint loading and control, and therefore make a difference to the pain.
This is a very common question and I think many patients feel at a loss to understand how they can be in so much pain but have nothing showing on their scan or xray. The answer is simply that these forms of investigation can’t see everything. In fact it’s probably fair to say that most sources of pain can’t be seen. Imagine stabbing your finger with a pin - you know it would hurt but there’s no way the damage done could be seen by a scan. Scans and Xrays are sometimes very helpful in helping to determine what’s wrong but often they are valueless and misleading.
Yes, all our Physiotherapists are registered with the HCPC (Health and Care Pofessionals Council - the new name for the HPC). You can check out registrations here.
I have seen a Physio before but it didn’t help. Why would it be worth trying again? / I have seen a physio before but all they did was give me exercises to do. Won’t it be the same with you?
Let us deal with both these questions at the same time. Not all Physios are the same and your expectations of success at Wilmslow Physio should not be based on the failure of others. It is a very broad profession and different physios will have different levels of experience and training and different philosophies of treatment. This is nowhere more evident than in the refusal of many physios to put their hands on their patients at all - and therefore all they do is give exercises to their patients, something we at Wilmslow Physio find completely mind boggling and bizarre. We are most definitely a hands-on practice.
This is not to say that giving exercises is wrong. Specific exercise prescription is, we believe, vital to correct movement faults, but we at Wilmslow Physio believe that patients given an exercise-only treatment are missing out on a very important part of treatment. Things like joint mobilisation, manipulation, stretches, soft-tissue techniques, acupuncture and trigger point release and needling for example can help redistribute loads and help your body overcome the inhibitory processes that stop your muscles working properly, so giving you a head-start in overcoming the pain and getting back to normal.
In a recent audit of new patients at Wilmslow Physio we found out that 75% of Consultant referrals we saw had received treatment elsewhere prior to coming to see us…..presumably their previous care hadn’t worked for them...
There are definitely problems that need to be rested and there are definitely others that can be “worked through” without harm, and sometimes it helps. Then there are the rest that are somewhere in between! So it’s a difficult question to answer specifically but some pointers are as follows:
- Don’t just assume it should be “worked through”. Many problems will get worse if you work through the pain - you are just injuring yourself. You need to evaluate for yourself the effect of activity on your problem, which means having a good understanding of your symptoms - how much it hurts, how long it hurts, how it feels at night, in the morning and as you do things - so you can notice changes.
If it gets more painful the more you do, or takes longer than a short time to ease, or is worse every time you are active, you are being too active. Some things take a while to hurt after activity - it might not be sore immediately - it might be next morning you notice - so progress slowly and carefully
- If you have to rest, do!. Current guidelines on how to manage back and neck pain for example encourage you to stay as active as you can be. The key words there are “as you can be”. If activity makes your pain worse it’s the wrong activity. If you can do some activity without making it worse, do that, but not the things that make it sore.
- Long-term, complete rest is not helpful. Complete rest for long periods is harmful. Activity and loading makes the tissues repair and become stronger.
- Be careful when you return to activity. If you’ve rested from painful activity for a while be careful when you return to activity - don’t expect it to be good as new - that might take a while
- If it continues, seek help! Come and ask.