By Don Williams
One of the circumstances we run into from time to time at Institute of Sports and Spines is patients reporting that their GP said they need to see a physio for their problem, “it’s not a chiro problem”.
There can be a tendency for people to question whether a problem is joint or muscle related.
It is always both.
Every muscle in the body crosses and moves at least one joint, and every joint in the body is crossed by one or more muscle. So it goes without saying that if a muscle is injured, the joint it crosses will be impacted and by the same reasoning, if a joint is injured, the muscles that cross it will be affected. It is then reasonable, if not expected then, that treatment should always address both components. The issue that arises is the belief that Chiropractors only treat joints, whereas physiotherapists treat muscles. In my experience the top tier practitioners from both professions always address both.
So why is it then that GPs feel the problem is a physio problem?
Firstly, as an interesting fact, physiotherapy is the single biggest referral point for the average GP clinic. This has been well fostered over the last couple of decades with the Physiotherapy Association actively working to develop this relationship. Our team has a health working relationship with a large number of GP clinics and surgeons who we work closely with to help patients achieve their goals. As a credit to our team this is a relationship built on mutual respect and trust. Some of the reasons for a poor working relationship between some GPs and Chiropractors is historical. Unfortunately, there are a lot of skeletons in the Chiropractic closet where quite a number of practitioners only do manipulation and nothing else. In our belief system at Institute of Sports and Spines, this is a limited way of treating patients.
The Chiropractic team at Institute of Sports and Spines follow a diagnostic cascade of working out what the problem/diagnosis is, what are the causative factors or behaviours that perpetuate the problem and what weakness or imbalances in the system potentially contribute to the problem? So what this means to a patient is that we rule out evident red flags and cross off the simple complaints, identify the most likely diagnosis, then start treatment and rehabilitation exercises. If the response is not what we expect or the condition worsens, then we did deeper. For example, if a teenage athlete presents with a back complaint, we normally want to ensure they are giving themselves the opportunity to recover. Are they still training? Do they keep doing the same things that aggravate the complaint. Is this a simple complaint or is it more sinister? If they don’t start to recover with active rest, then we start to cross off more significant causes for their problem. These are called differential diagnoses and good practitioners will have a list of these written down at the end of the first visit.
There is a tendency in the modern era for practitioners to organise advanced imaging at times when it is probably not indicated. Every patient with low back pain shouldn’t have an MRI. They are an expensive investigation and sometimes are a little too sensitive and may show a pathology that is not actually the cause of the pain or even cause for concern. Statistically 50% of the adult population will have a disc bulge or prolapse on an MRI whether they have symptoms or not.
- A good treatment program should always incorporate home rehabilitation exercises to help you achieve the outcome you want.
- The program should be flexible and change as you respond as a patient, or fail to respond.
- A good practitioner, irrespective of their title, will have a pathway or journey back to good health that they take the patient on.
So next time your GP or a friend tell you it is a physio problem, ask them if they know the practitioner you are seeing or plan to see. Our team incorporate rehabilitation, soft tissue work, exercises, dry needling, taping, manipulation and a range of other treatment strategies into our treatment programs to best fill the needs of the patient complaint.