Physiotherapy: What to expect

You may have an injury or be experiencing pain from arthritis or other age-related diseases when your doctor, or even a colleague or friend, recommends physiotherapy. What is physiotherapy and what can you expect?

What is physiotherapy?

According to the Canadian Physiotherapy Association, physiotherapy is a client-focused health profession dedicated to:

– Improving and maintaining functional independence and physical performance

– Preventing and managing pain, physical impairments, disabilities and limits to participation; and

– Promoting fitness, health and wellness

Physiotherapy is an evidence-based discipline: rather than being rooted in a particular philosophical point of view, physiotherapists are trained in techniques that can be scientifically proven. This makes it a good match for Western-based medicine, and indeed physiotherapists are often fully integrated as a part of a team in hospitals and rehabilitation centres.

Physiotherapists provide assessment and diagnosis services, planning and implementation of interventions to address issues found in assessment and diagnosis, evaluation of success and education of clients, the public, and other health professionals.

Physiotherapy interventions include:

Strengthening and therapeutic exercise programmes: A physiotherapist can work with you to develop a tailored series of exercises to strengthen muscles around the site of an injury, to prevent further injury, or to minimize stress and pain in a particular area. As an example, a 2003 Cochrane review of 17 studies found that exercise had a positive effect on pain and self-reported physical function for those suffering from osteoarthritis of the knee. Aerobic home walking and quadriceps strengthening were also found to help with the same condition in a 2005 review.

Mobility and flexibility improvement: Physiotherapists are trained to assess the range of motion of a particular joint or area of your body. They can show you exercises designed specifically to help maintain or restore flexibility in a joint’s muscles and tendons. They can also help to evaluate your lifestyle to help you get the most of your day.

Improvements in muscle imbalances and alignment: If a muscle has diminished strength, perhaps due to an injury or repetitive motion, you may find that you have a muscle imbalance. Over time the core stabilizing muscles can become weak, and dynamic muscles try to provide stability – which both increases the risk of injury and can make some motions or tasks difficult or painful. Physiotherapists are trained to assess imbalances and to guide you through exercises or treatments to redress the balance.

Balance retraining and movement coordination: Individuals who have a loss of balance or loss of surefootedness can experience a serious reduction in quality of life, as well as being more vulnerable to falls. And those who have suffered an event like a stroke may have trouble coordinating movements. Physiotherapists can help to develop strategies and exercises to deal with these losses, incorporating both practical solutions and retraining.

Manual therapy – intervention to reduce pain and stiffness: This aspect of physiotherapy is very “hands on” as the physiotherapist him- or herself guides the client’s body through a motion, manipulating joints and stretching muscles.

TENS (electrical nerve stimulation), ultrasound, and hot and cold treatment: Physiotherapists can also offer other methods of addressing pain. TENS is the most common of a broader type of treatment for pain where electrodes are placed on or near the area of pain and soothing pulses are sent via the electrodes through the skin and along the nerve fibers. The pulses, which are controlled by the user at all times, suppress pain signals to the brain. It has been in use since the 1960s.

Ultrasound treatment uses sound waves that cause a vibration of local tissues and is often used to treat tendonitis, non-acute joint swelling, and muscle spasm. This can warm a particular area of tissue, increase tissue relaxation and local blood flow to promote healing, and break down scar tissue. A typical treatment takes 3 to 5 minutes.

Hot and cold treatments (either individually, or applied in succession) have also been found to be effective in lessening pain and inflammation. A physiotherapist can also apply these therapies or give advice on their application.

Physiotherapist training and role

The minimum requirement to practice physiotherapy in Canada is a bachelor’s degree, but a professional master’s degree is becoming the entry-level standard in 2010. Graduates of physiotherapy programs in Canada are required to successfully complete the Physiotherapy Competency Examination (PCE) in order to work in most Canadian provinces. Individuals educated outside of Canada must apply to the Canadian Alliance of Physiotherapy Regulators to have their credentials evaluated, and must also complete the PCE.

Physiotherapists are primary care practitioners who offer direct access to physiotherapy services without the need for physician referral. However, some extended health insurance plans require a physician’s referral in order to reimburse you for claims. As primary care practitioners, it is the physiotherapist’s role to act with integrity, accountability, and judgment, as well as respect the autonomy and dignity of the client.

First visits

On your first visit your physiotherapist will reviews your injury or condition and plan a treatment program for you:

– You will be asked questions about your present condition and health history.

– A physical examination will be completed to assess your injury or condition.

– Your physiotherapist will review the assessment and discuss the recommended treatment goals and program.

– You should have an opportunity to agree or disagree.

During any physiotherapy treatment you should feel comfortable discussing any discomfort or pain, and to ask any questions that you have.

Photo © Pamela Moore

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