Am I a Good Physio?

A key metric on whether or not I am a good physio is: "Do my patients get better?"...

​Most patients do get better (unfortunately not all***), and I'll ask them at the end, what made the difference? Was it the hands-on treatment?, taping?, ice?, heat?, tablets?, stretching? strength exercises?, or natural recovery?  It's not always obvious to the patient what made the biggest difference to recovery and patients will tell me all sorts of things. However, I'm very confident the most important component of whether or not they get better is "Do they do the rehab exercises I give them?".

So I think, whether or not I am a good physio, comes down to:

• Can I give you an explanation of the problem and the solution so you understand it well enough to want to do what I recommend?
• Can I make the rehab exercises simple enough so you can realistically get it done?

There are some very good physios around who prescribe very thorough rehab programs, working on this-or-that stabiliser, or this-or-that kinetic chain. 20 exercises, head to toe. Gold plated. Which is great, except I'm just never going to get 20 exercises done. "Doing" the one most important exercise is always going to be more effective than "not doing" 20 thorough exercises.

So my recommendations are always:

• "What are the most important 1 or 2 things to do that give you the best bang for your buck?"
• "How can we make it stupidly easy to do, so you can do it anywhere, any time?"

So you've got one job to do. You'd think that would work?...

Nope.

It's really hard to get something done. One exercise - it should be easy, but it's not.

And it's not that it takes too long, or it's inconvenient. You can do it anywhere, anytime.

The problem is remembering to do it. You remember to do the exercise when you're in the middle of something else, you think "I'll do it later", and you just don't remember. You crawl into bed at the end of the day: "Bugger. Didn't get that exercise done. I'll do it tomorrow".

Then you've missed a day. Maybe you've missed a whole week. 

So how do you remember to do the exercise?

Set an alarm? - The alarm goes off when you're in the middle of doing something else. "I'll do it later."

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I think the best way is to "marry" the exercise to something that happens regularly in your day already. I've heard people recommend doing their exercises when they brush their teeth. Your doing it twice a day already.

But quite often you're running late for work in the morning and don't have time, or you're too tired before going to bed... 

​"I'll do it later."

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I suffer with a tendinopathy from time to time. I reckon I'm good for one a year. Sore Achilles, or a tennis elbow. It's a peroneal tendinopathy at the moment. I've got a pretty good routine for them to settle in a week or two if I do isometrics. I try and get 10 reps/day of a 30 second contraction. It works well for me.  But how do I remember to get them done through the day when it's not constantly sore and pain isn't reminding me?

I marry the exercise to having a drink. I know I'll have about 10 drinks through the day; a couple of coffees in the morning, glasses of water through the day, a couple of cups of tea in the afternoon, and maybe a beer at night on the weekends.

Having a drink reminds me to do the stupid exercise. And I'm only going to have a drink when I've got a minute spare, so it's also the opportunity to get the exercise done.

​Memory aid, opportunity, and hydration, wrapped into one.

Cheers to that.

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*** Not all patients get better...

Is it my fault or their fault? I'd like to blame them, but I have to acknowledge it's probably my fault. Some disappear and are never heard from again. I can only presume they've (1) gotten better, or (2) didn't like me. I do try and give them all a call to find out. Some people don't get better and I think it's often a failure of mine to find the explanation of their problem that resonates with them enough, so that they do the rehab exercises I recommend. I don't find the "hook" for them and It ends up frustrating for both of us.