The Myth Of Maintenance
Below is the abbreviated version of a conversation frequently heard with patients in our clinic. We hear stories along such lines on a highly regular basis, these stories encompassing experiences with chiropractors, osteopaths, and physiotherapists alike.
Patient; “I see my therapist every month for maintenance, since I hurt my back some 10 years ago. He does some work on my back, and that keeps me going until I see him again a month later”
Physio; “But you don’t have any symptoms? And you’re fully participating in all the activities you wish participate in?”
Patient; “No, I feel absolutely fine”.
As physiotherapists with high professional standing, ethical approaches to practice, and honesty of endeavor in all we do with our patients, the above conversation and the underpinning scenario does not sit comfortably.
When any new patient comes through our doors, the aim of our physiotherapy care is always the same, always two fold – 1) to reduce symptoms to a level the patient is comfortable with, be this minimal or no symptoms whatsoever, and 2) to empower the patient to independently maintain this improvement in symptoms, effectively aiming to ensure they do not have to return to physiotherapy in future with the same issue, unless due to misfortune or negligence on the patient’s own behalf.
In short, we seek to empower the patient to independently manage their health and lifestyle, without a perceived need to attend physiotherapy for any form of “maintenance” of “after care” following discharge. Why? Well, because generally, this post-discharge “care” is not necessary. Not only is it not necessary, but it can actually create a harmful cycle of dependence of clinical care, when, in fact, the patient is wholly capable of maintaining their pain free state should the physiotherapist do their job correctly and honestly. Unfortunately, this is not always the case. Why so? Well, we’ll leave that right there for you to figure out…and we won’t charge you for the time you spend doing so!
We empower patients to self manage, so they don’t have to come back to us unnecessarily, paying their hard earned cash for treatment they don’t need. This is simply an issue of honesty and professional integrity, as we follow a patient-centered approach to physiotherapy, rather than a financial model, where profit margins are king.
So how do we empower? Simply! We educate. We field our patients questions until they understand their bodies, until they understand why they are sore, until they understand what they can do to prevent this issue from happening again in future…without coming to see a chiropractor, or, or osteopath, or physiotherapist. We underline how not sitting all day can be the sole change in preventing pain onset. We prescribe a patient-specific course of basic home exercises to each patient – to strengthen what is weak, to free off what is stiff, to correct movement patterns that have deteriorated over time. We provide kit which the patient can use to keep their body in a healthy state, be it foam rollers, ankle weights, taping, or heat packs. We advise on pertinent exercise to engage in, focused on the patient’s body type or specific to their injury, be it yoga, Pilates, swimming, or Tai Chi. Leaving our clinic upon completion of your treatment programme, you will be armed with enough knowledge and resources to not to have to come back with the same issue.
The possible creation of a dependency by your therapist can ultimately prove harmful and prevents patient empowerment with regard to their own health. The concept that you cannot independently manage your own body should be dispelled, for it is a myth in the vast, vast majority of cases. Your body is resilient, adaptive, ever progressing in response to the demands placed on it. It can look after itself, but just needs you to give it the opportunity to do so by taking care of it. It is not vulnerable, worthy of distrust, likely to let you down at any minute. As a result, you do not any individual to maintain your body for you!
We deem two of the aforementioned to be of particular importance – the prescription of a handful of simply, easily undertaken home exercises, and lifestyle education. Performance of these exercises, frequently at first, but laterally on a more occasional basis in the subsequent 3 to 4 weeks, will likely be sufficient to ensure symptom do not return. No exercises provided by your therapist? Perhaps this is based on self-interest, as if you can help yourself, you are less likely to come back to see them!! These exercises initially, accompanied by education, lifestyle changes, better ergonomic habits at work, and more varied exercise activities laterally, with provide the “maintenance”. For free. In your own home. At a time that suits you. No need for any therapist!
It’s your body. You should have total control over it!