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"Old School" Physiotherapy can be Dangerous

If you're like many people, you probably think physiotherapists are a one size fits all arrangement. They rub stuff, they show you a few stretches, hand you a sheet of exercises (which never get done!) and tell you to come back next week for more of the same treatment. Unfortunately, this couldn't be further from the truth. In reality, physio is an extremely important form of treatment for many different conditions and many physiotherapists have unique skills for the type of clients and conditions they treat most often. It is important to remember, that not all physios are created equal - some are exceptional, some are good, some are ineffective and some are downright dangerous. So, how do you know if your physio is any good?

Firstly, a good physio will always take a comprehensive history and conduct a thorough physical examination. They will ask you about your symptoms, how long you've been experiencing them, what makes them better or worse, etc. They will also want to know about your medical history and any other treatments you're currently receiving. A good physio will take all of this information into account when developing a treatment plan.

Secondly, a good physio will use a variety of different techniques. They will not just rely on one modality (e.g. massage or dry needling) but will use a combination of different approaches to achieve the best possible results. If you receive a recipe-generated exercise sheet to take home - be Highly Suspicious that your physio is simply copying and pasting from software program without really unraveling the mystery that is YOU. No two bodies are ever the same and printed exercise sheets imply they are. I much prefer video prescriptions of movement sequences.

And yes, I am the first to admit that my unique exercise prescriptions are often complicated -

But usually there is only ONE movement prescribed. That one movement is designed to challenge your BRAIN and has been strategically crafted to balance all of your uniquely dampened and dysfunctional sensory inputs. Balancing and stimulating sensory inputs to the Brain changes how we move. When we learn to move in new ways, we stimulate new muscles and load tissues differently. This gives worn out body parts a chance to heal, and under utilised body parts a chance to re-awaken and strengthen.

Finally, a good physio will always be open to new ideas, research and will LISTEN. They will keep up to date with the latest developments in their field and be willing to try new things. Any physiotherapist who is not aware of Brain-based Training, Neurology, Sensory inputs, etc has not kept up with the latest developments in neuroscience. This means whatever they are teaching you, whilst done with great intention, is now outdated, ineffective, and often keeps you in the very painful situation you are seeking help to escape from.

Let's take the example of back pain to highlight the dangers of "old school" physio management. If you go to an outdated physio for back pain, they will likely give you a massage, dry needle some hot spots, show you a few stretches for your hip flexors, and then suggest exercises to strengthen your 'core'. The thinking behind this is that if your core muscles are strong, they will support your spine and prevent further injury. Nice in theory, but in reality, this routine advice creates more pain than relief. For a great understanding of the complexity of "core stability training" read this. It's just not that simple, and if you are one of the rare ones that has responded well to this regime, be grateful. If this routine works well for a few weeks and then the pain returns, I promise you are missing something and the faster you figure it out, your body will thank you!

In my eyes, this standard approach is LAZY and lacks integrity for the wisdom that is our body.

For the physio dishing it out though, there are many perks. You don't have to think, you don't have to assess anything properly, and it's a steady stream of income with a diary full of people in pain, who never really get any better, but are addicted to the " massages "' and "needles" for that "spike of relief". Am I getting Sarcastic with age ? The lack of job satisfaction would kill me.

Side note - I am always astounded at how long some clients attend a physiotherapist who is not getting them results. Rule of Thumb - 6 visits. If you cannot see progress in 6 visits - get the hell out of there. * Exclusions apply - but that is another blog topic!

The "lazy physio" approach is almost always entirely focused on the pain zone. Which might make sense to the person in pain, who just wants a band aid on it, but unfortunately, every time you "patch and despatch" a body, you miss an opportunity to FIGURE IT OUT and the body has zero choice but to ESCALATE it's pain, and /or spread it to other areas, restrict even more movements, until one day - the whole body hurts. The pain is everywhere because the warning signs were "patched and dispatched" instead of being properly explored. What does the "patch and despatch" physio do now ? You have become too hard to handle because your pain is everywhere. Off to the Doctor for more pain killers, perhaps a visit to a pain clinic ?

I say this approach is dangerous because suddenly those little niggles that were opportunities missed, are now gigantic problems causing the movement system to crumble. When our movement system fails, often our mental health follows. The cycle of anxiety, depression, etc kicks in.

So if your physio says stuff to you about your painful part - start asking 'Why" ?

Be that curiously annoying 4 year old.

If a core is weak ? ask why ?

If a hip flexor is tight ... ask why ?

If your right L4/5 Facet joint has worn itself out ... ask them to figure out why ?

Why only this facet joint ? Why on my right side ?

So many why's ? requires exploration - like a treasure hunter digging for gold.

As anyone with stubborn back pain will tell you, there is often no quick fix. If it were easy, it would not be "stubborn, persistent pain". A thorough assessment will also hear the client's language, notice their emotional states, their habitual movement habits. The movement assessment at a minimum should explore eyes, ears, feet, knees, hips, ribcage, skull, the way the client walks, reaches, balances, etc.

A simple ' touch your toes, now lean back, to the side, etc " just doesn't cut the mustard, and is another RED ALERT that all your physio is interested in is the PAINFUL Spinal part.

An Exceptional Physiotherapist understands that the painful part is often painful because something else in the movement system is MISSING. It is nice to treat the pain and create relief for our clients. However, often a good massage can do that equally well and for half the price.

So why see a physio if all they are doing is patch and despatch work ? I really can't answer that.

I personally would see a good remedial massage therapist instead.

Exceptional Physiotherapists are driven to understand the movement dysfunction, (or sub-conscious belief block or emotional addiction, or spiritual disconnect ) which is perpetuating the pain cycle.

This is not the kind of stuff covered in undergraduate physiotherapist training. Therefore, it is not common. It is highly uncommon. To seek additional knowledge in any profession requires a therapist who is passionate about their "calling", who is dedicated to getting results for their clients (not simply an income stream), and who is committed to an eternal future of learning. They also need to be open and accepting of the limitations of one body of science. Physiotherapy is a great base science. However, on it's own, it is not enough in my opinion to get consistently great client outcomes.

My client outcomes soared when I added Postural Neurology, Anatomy in Motion, Pilates Rehabilitation, Feldenkrais, Neuro-bio-feedback, etc The more we learn, the more the body starts to make a little more sense. (Some days!)

So If you are in pain, seek physio. But not just any physio - Seek Exceptional Physiotherapists.

Both Isobel Barak & I (Marion McRae) have additional qualifications in whole-body movement assessment and strategies for bio-hacking the mind-body connection to facilitate rapid healing.

We are invested in your outcomes. We are able to "Patch and Despatch" if that is all you are seeking, however if you are truly keen to listen to your bodies signals, then we can help you see the opportunity in every pain.

We are available for Online Telehealth Consultations (Worldwide) , Home visits in the Margaret River Region and of course, you are welcome to visit us at our beautiful studio on the river !

Pilates Margaret River | Margaret River Physio | Massage Margaret river

To book an appointment go here

We are located at 26/14 Willmott Ave, Margaret River.

Or email:

Or phone 0433554253

physio, physiotherapy, pain management, movement dysfunction, mind-body connection, healing

Photo by Annie Spratt on Unsplash

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