It is a privilege when patients ask for our help. Often people come to us to sort out an injury which is stopping them doing something be that golf, running or playing with their grandchildren. Others come for help with pain that has troubled them for many years, often having sought care from many different practitioners but not getting the result they want. And others come because they have realised they are becoming less fit so are more likely to not join a friend for a walk because they don’t want to reveal they might not manage the hills or make the distance. And all of these people will be feeling vulnerable in one way or another. Asking us to care for them and putting their trust in us is humbling.
Sometimes the conversations we have in clinic can be difficult. A runner training for a marathon may have signs of a stress fracture. Hearing that they probably won’t be able to run can be devastating. Others will have heard of bad experiences of friends and be in denial as to what the best management will be. I have had a couple of patients who have greeted me at our first appointment with words to the effect of ‘I know you’ll tell me I need a new hip but I won’t have one.’ And others will have poor general health which adds to their problem.
It is therefore important that we are able to look at the wider picture, to support people through their presenting issue by looking at the circumstances around their complaint. A study I recently read about took place in private physiotherapy clinics in Australia looking at those who presented to the clinic with pain which appeared to have a musculoskeletal cause.
On measuring various health factors, over a third were found to be suffering from a condition called metabolic syndrome. This condition occurs when three of five of the following are present - abdominal obesity, hypertension, elevated triglycerides, lowered high-density lipoprotein cholesterol, and elevated fasting glucose, ie cardiac, precursor or actual diabetes, high blood pressure and obesity measured by standard criteria. This condition causes poor long term health as well as high health care costs.
Interesting to physiotherapists is that one of the mechanisms of metabolic syndrome is chronic low-grade inflammation. This low-grade inflammation also exists in musculoskeletal conditions such as osteoarthritis, osteoporosis and tendinopathy and can be the A privileged career Sarah Babbs explains that physiotherapists treat many different conditions and sometimes have to have difficult conversations presenting complaint of those in physiotherapy clinics.
In fact, 25% of the general population of Australia has metabolic syndrome which increases to 37% in the study in physiotherapy clinics. Metabolic syndrome can be improved with physical activity and exercise alone, as well as changes to diet and lifestyle. As physiotherapists we are well placed (and have a duty) to help people with their general health. It is important that we have those difficult conversations. The recommendation is for adults to do 150 minutes of moderate activity a week or 75 minutes vigorous intensity as well as two weight sessions. This can be incorporated into exercise programmes for our patients.
Other factors, known as the biopsychosocial picture are always important. Stress plays an enormous role in pain, as does expectation from the patient, family and society. Talking about and helping patients to understand this context is vital. Often the simplest things can help: breathing techniques, improving diet, even simply walking outside with the sun on our faces.
Physiotherapy can have a wider remit than many think, as I say, a privileged career. And my ladies who didn’t want their hip surgeries - once they understood and were gently helped to make the decision to go ahead - wonder why they didn’t do it sooner. The improvement to their life and activity levels was immense.
I don’t know who first said this but I rather love the saying: ‘If doctors save lives, then physiotherapists make them worth living
