PHYSIO: RAW, REFINED
I was a 3rd year Physiotherapy student, sitting with a fully fledged physio who was working with a western suburbs soccer team in the Premier League in Adelaide. This was exciting. Sports Physiotherapy was where I wanted my career to head, and as a 3rd year this kind of gig was as good as it gets. It was a Tuesday night and the squad were carrying a few injuries from the weekend.
We got to it…
First, left lateral ankle sprain. I watched as the physio navigated his way around the ankle, looking at its range, swelling, palpating and finally diagnosing it as a Grade 1 ATFL sprain. Now what? …He waved an ultrasound over it for 5 mins and then applied the pads for IFT (Interferential Therapy) and set that going for 10 minutes while we assessed the next patient.
He had copped a knee in his thigh during the game, he’d played through it but was unable to train tonight because range and strength had been well overtaken by pain and weakness. We assessed him, then the physio decided the best course of action would be to apply ultrasound followed by IFT.
Next, low back pain. Ultrasound. Interferential.
Witnessing this, on the back of reading articles such as Baker et al (2001) and another related article, I was suspicious of the usefulness of this treatment choice. For 3 different pathologies. In 3 different parts of the body. Particularly when these articles basically argue that ultrasound treatment is about as useful as rubbing jelly on someone with a hammer.
And while this kind of treatment was widely accepted as the norm, as I started my professional career my quest moved towards finding what works better. The answer was simple – manual therapy and exercise. This had a more convincing evidence base (i.e. Miller et al, 2010). The answer was raw, old school therapy with no gimmicks and no shortcuts. This was not only much more effective clinically it also fed the hunger for precise clinical reasoning and relevant, specific and refined treatment.
Hard thinking, and the treatment that is worthy of backing it up.
This is how the journey began for me.