Since the start of the lockdown, I’ve had to switch from seeing patients in clinic, to treating patients online. It’s been an interesting process! England rugby physio Dave O’Sullivan has been massively helpful in coaching me through how to translate my hands-on skills into the online arena, and I also practised on a handful of patients and other therapists before officially offering it as a service. And while it’s not the same as treating patients in clinic, I’ve certainly had some of my own assumptions about the benefits of online physiotherapy challenged, so I thought I’d share what I’ve learned so far.
Assessment
Working out why someone’s in pain is definitely the most complicated part of online physiotherapy! Most acute injuries aren’t that complex and can be largely diagnosed and treated through pattern recognition (for example, if you twisted your ankle, we consider which structures are most likely to have been overstretched) but around 30% aren’t quite that simple and take a bit more digging to work out. Where I would usually get feedback through using my hands to feel how my patients move, Dave has been developing a series of movement based tests that can help me to work out visually which body parts aren’t doing their fair share of the work as you move, which is usually the reason that the overloaded bit starts to hurt.
When I’m in clinic, I usually spend an awful lot of the initial assessment session just talking, and learning my patient’s story. Dave agrees that this is vital, especially when I’m working with a patient who’s had a problem or a series of problems for a long time. One of the best questions I’ve learned from him to ask is to get a patient to “fill in the gaps” of the statement “I haven’t been the same since…” – of course it’s not foolproof, but it’s interesting how often that uncovers the real source of the problem.
Referrals
Although a lot of services are closed, some of the main private MRI centres in London are still running, albeit a reduced service to maximise social distancing, and with a super-strict cleaning routine. Imaging centres that are still open include Vista Diagnostics in Waterloo, HCA at 31 Old Broad Street, or Oryon in Wimpole Street.
I’m also in touch with a number of my usual consultants who are still working, albeit online like me except in the case of emergencies – they are still able to operate if you have an injury that’s life or limb threatening!
So if you have a physio appointment and it looks as though you need to see a consultant or have a scan – these are not normal times, but these things are still doable.
Reassurance
One of the scariest things about injuries is not knowing why you’re in pain – and we all know that the longer you Google your symptoms, the more you’ll eventually be convinced that you have some sort of rare disease. When I’m working with someone with big health worries, my job is to help them rationalise how realistic those worries are, with the benefit of my 20 years of practice. The truth is that, good as I like to think I am as a physio, I can’t actually cure cancer – so if I can change your symptoms or make your pain go away with online physiotherapy, then we can both be pretty sure that it wasn’t cancer!
“Hands-on treatment”
Something I’m always happy to do in clinic is to give my patients the option to bring someone else into your treatment session, to learn how they can help you when I’m not around. I’ve found that this can help people to feel more in control of their injury treatment, can increase the amount of carry-over between sessions – and also saves money! And as long as you’re sharing a house with someone who’s prepared to help you, this is something we can still do. This week, over an encrypted videolink, I taught a mother how to stretch and mobilise her daughter’s hip; and a husband how to help his wife’s back – and I followed these up with videos to remind the “temporary physios” what they need to do going forward.
As long as the body part needing treatment is something you can reach for yourself, I can also use online physiotherapy to teach you some hands-on techniques to use to help yourself – just as I would in clinic.
Exercise
Again, I usually use my hands as a guide to see how well my patients are progressing with their exercises and to give feedback and guidance – for example, to remind a hunched shoulder to drop back down, or to provide resistance. Now, I’m doing this more visually, so I’ll be asking you for more feedback about what you can feel and when – but I can still see you moving, and you can still see me. And I can still make you videos to remind you of what you need to practise – either I can film you over the video link, or I can film me afterwards – so you still have me in your pocket telling you what to do, just like normal!
There are even (whisper it) some advantages…
The biggest of these is definitely the fact that you don’t have to travel further than your laptop to see me! I’m always conscious that there are some patients for whom travelling to and from the clinic is difficult, stressful or painful; and there are also others who simply live too far from London to make it viable. Hopefully I will have more opportunity to help those people now that distance isn’t an issue!
In summary, we all know that online physiotherapy is not the same as being in clinic. However, as you can see, even when I can’t touch you, I can probably still help you. So why not call my team on 0207 175 0150, book an appointment, and find out for yourself?