Three times a week, for six weeks.

My one faithful reader just got on my case about not publishing a blog post in a century and a half so I figured I would throw a quick post up so I can stop dealing with his chirps.

I was recently doing some education sessions in conjunction with Okanagan Hockey Academy and the Edmonton Oilers for young hockey players aged 9-16. I opened my presentation with the same question everytime:

What does a physiotherapist do?

As you can imagine I got all sorts of answers from that group of developing brains. Many described my profession as massage therapy. Many said physios fix people. Some kids even brought up modalities such as ultrasound, TENS, and IFC (which was the equivalent of them standing up and kicking me square in the crotch). Not one single child gave me the answer I was looking for. So I figured I would ask the same question of the parent group that I was lecturing. Their brains had fully developed, they had a lifetime of experience, they would be able to answer my question.

Nope. Same answers.

Which now got me thinking, what is the state of physiotherapy in the community? When someone walks into a clinic, what are they being told? What’s happening?

 Lets do a case study, because I love those.

Braun Swisscheese is unfortunate enough to hurt his medial collateral ligament in his knee. It is not a full tear, but it’s enough that it’s going to take 4-6 weeks of healing for Braun to start to feel normal. Braun gets great advice from his family doctor to pursue physiotherapy. At this point it’s choose your own adventure, and Braun can go to clinic A or clinic B. Lets see what happens next:

Clinic A: 

  • Assessment of Braun’s knee and entire lower chain
  • Education about diagnosis, healing times, gentle exercise program
  • Home exercise program taught
  • Follow up in 1 week

Clinic B:

  • Assessment of Braun’s knee and entire lower chain
  • Diagnosis given
  • TENS, IFC, ice
  • Follow up in 2 days.

Lets fast forward to three weeks into his treatment

Clinic A:

  • 3rd follow up
  • Continued education regarding healing times
  • Exercise program progressed as appropriate

Clinic B:

  • 8th or 9th follow up
  • TENS, IFC, hands on therapy
  • Home exercise program

And now lets fast forward six weeks into his treatment:

Clinic A:

  • 4-5 visits total
  • Functional testing and return to play
  • Education on next steps
  • Discharge to home exercise program

Clinic B:

  • 10-12 follow ups total
  • Functional testing and return to play
  • Discharge to home exercise program

So which Braun had the better outcome?

It might surprise some of you to know, that Braun had a fairly identical outcome at both clinics. Physiotherapists do not change the natural history of an injury- A partial MCL sprain is going to heal in 6 wks as long as you do not abuse it. The key difference here is that Braun B paid significantly more for treatment and invested a significant amount more time.

This is not to say that physiotherapists do not help. It is our job to return people to full function while their body does the healing. We help people move better and keep moving. It is our job to educate the masses on their injuries, and tell them what their prognosis is.

Physiotherapists are under constant pressure to see patients at a higher frequency, whether they need to be seen or not. This feature of private practice is running rampant and it drags us away from patient centered care. At a clinic I used to work at, a large chain, my performance was measured by how many follow ups I could squeeze out of a patient. Think about that- I was judged not by patient outcome or satisfaction, but by how much money they spent before being discharged. Disgusting.

Now, some therapists will argue with me and say “my patient is in so much pain, they need me to see them so they can make it through the day,” and I agree, those patients are out there- but they are few and far between. Do we really still believe that the only way people will get better is with treatment 3x a week for six weeks? Who believes that anymore?

In my mind we need to entirely shift how physiotherapists and other rehabilitation professionals are viewed in society, and that happens in two ways:

1) Patient’s need to be better. Inform yourself going in. Demand education. Demand Evidence.

2). Physiotherapists need to be better. It’s not about your bottom line, it’s about helping people.

Thanks for reading! Please leave a comment or provide feedback to mgoertzenpt@gmail.com.

 

 

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