The Value of Hands On Therapy

In recent times a recurring theme I have encountered is the patient disaffected by the idea of physiotherapy. Amongst these many individuals you can see a repeated pattern arising. It is a disappointing pattern and not one I wish to be a part of. Allow me to expand. As I have talked about in previous posts I am a supporter of the use of manual therapy, it has its place as a modality/intervention in the physiotherapy profession even though the evidence base supporting it is far from perfect. In the world of physiotherapy, it can be a divisive issue but it continues to have its supporters and detractors. However, most importantly, on a personal level, when done correctly it continues to yield me very good results. At the end of the day, without nit-picking, a successful clinical outcome is still a successful clinical outcome nonetheless.

While it may not be a silver bullet in every scenario, manual therapy has its uses with a large demographic of patients.  While not every physiotherapist may love manual therapy most patients will have a large appreciation for it.  Too often, I will be given feedback from patients regarding how they felt about being treated in a ‘hands off’ type manner. Perhaps they were given just home exercise, maybe they were placed under a machine for the duration of their treatment session and were left for the majority of it. In one case I have had incidences of patient’s being placed under a heat lamp and told 20 minutes later to get up off the bed and get dressed and that their physiotherapy is complete for the day. Maybe this final example is a tad extreme but it does sadden me when I hear things like this because to me that isn’t physiotherapy. 

Accordingly, the patients who received this approach have regularly rated their treatment to be unsuccessful or unfulfilling. These patients have been treated in a somewhat sterile manner, literally at arm’s length with minimal therapist contact and consequently their treatment outcomes have been poor. In some cases, poor patient compliance to home exercise can be sited as a reason for poor outcomes but it must be recognised that in today’s life, if something does not provide instant results we feel there is little value in repeating it. After all, doing the same thing over and over again and expecting different results was once defined as the definition of insanity.

It is no wonder patients can quickly become disaffected and left doubting the ability of their physiotherapist and the principles of physiotherapy in general. If you lose the patient, then the ability of the physiotherapist to successfully treat them is reduced. A large part of a successful outcome can sometimes hinge on whether the patient believes in what their physiotherapist has said and done with them. This is part of the reason actual ‘hands on’ manual therapy is so important. Manual therapy has a tangible quality to it, it can be felt working, there is actual physical contact and patients can buy into that more easily because it is something physical and real.

But let me get back to the crux of the issue. Too often I am hearing about the physical aspect being taken out of physiotherapy. I will see a new fan-dangled machine or gadget fulfilling the role that the physiotherapist is perfectly capable of filling. I am not against progress, but progress for progress’s sake is not really progress at all, it is just a different way of doing something with no change in the end results. It may be old fashioned and quaint but there is something gratifying for both the physiotherapist and the patient about a hands on approach. You can develop a strong rapport with the patient as both time and effort has been spent with the patient. This is important when many patients may feel they have not been given the time of day in the hustle and bustle of a physiotherapy department and have just been given two pages of Physio Tool’s finest.

One last thing I would like to touch upon is that I recognise physiotherapists working in some settings, in particular the national health service, may be constrained by what interventions they can deliver (usually by time) and as a result a conscious decision will be made to choose the approach that sits in between being time effective and effective in practice. But, if the opportunity exists to take this approach, there is no harm in trying (once the obvious contraindications have been considered). I touched upon this subject in my prior blog post, and while manual therapy is not a Calpol cure all, employing the use of manual therapy in the correct situation can have enormous value. It won’t solve everything and it is important to remember the mantra, the right treatment for the right patient at the right time.

Alex Curran

 

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