One of the most common queries we get when people ring up our clinics is “I’m not really sure if this is a physio thing, or a doctor thing, or maybe I just need a massage, but . . . ?” so I thought it would be good to spend a few minutes talking about what sort of problems go to what sort of profession.
The number one symptom that would result in a person ringing either a doctor or Allied Health clinic is Pain. As we now understand better than we have in the past, not all pain is the same, and certainly not all pain is a sign of actual injury. The type of pain may give some indication as to whether it is something we can help with, or something we’d suggest you either go to a GP or hospital first, so let’s unpack that a little bit.
The Obvious Stuff
Do you have a definite moment the pain started – you rolled your ankle, twisted your knee, lifted something heavy, landed on your wrist or hand, fell on your hip, or heard a pop and then a muscle feels weak and funny?Does it feel better when you don’t move, and hurt when you move? Is there obvious swelling and or bruising? You see a physiotherapist.
We are skilled at diagnosing muscular / ligament / bony / soft tissue injuries, usually with no need for medical imaging (in fact, it can make you less likely to get better, more on that later). In these situations usually a Doctor is going to either send you for imaging or send you to a surgeon or a physio, as they generally have less training or interest in musculoskeletal diagnostics.
What if it is a broken bone? Highly likely we’ll be able to tell that, and can refer you for X-ray to confirm if we need to. In fact, Physiotherapists can also refer for MRI, and for all but 4 conditions it will cost you the same as if a GP refers you. So if you need imaging (which almost always you don’t), we’ve got you covered.
Should you wait until the swelling has subsided to see a physio? Hell no! Acute injury management is where we can be most helpful in giving you up to date and evidence based advice on what is normal, how to make it feel better and heal optimally, and how long it will take to feel normal again. The sooner you see us, the better.
Is your pain radiating down a leg, arm, face, or around your chest? Does it feel like it’s shooting, burning, electrical? Does it also seem to involve some weakness or numbness or funny feelings of heaviness or cramping? You see a physiotherapist.
Most causes of nerve pain are not serious, usually to do with irritation due to overuse, compression due to swelling, muscle guarding or lack of movement, and a physiotherapist is going to be able to run you through a battery of movement tests and questions to determine if this is something to worry about or not. Even some of the serious ones (focal disc prolapse for instance) have been shown to commonly (>60%) self resolve over 12 weeks or so. Immediate referral for medical imaging and surgical opinion may end up in a knee-jerk reaction for surgical intervention (which often doesn’t compare favourably to conservative management in the long term). The really quirky stuff happens when nerve-like pains can actually occur due to changes in the sensitivity of your brain, spinal cord or nerves, meaning you can have these symptoms due to stress, poor sleep or nutrition, or unhelpful ideas about what’s going on in your body. We can help with that too.
Sometimes treatment is necessary in the early stages for pain control, but often just reassurance about the natural course, advice about helpful movement and stretching can be enough for full resolution in a few days or weeks. If it is NOT responding to this approach in a normal timeframe, we will send you to your doctor or medical imaging with a letter to guide the investigation process, meaning you’ll get answers and solutions quicker.
The Questionable Stuff
Do you have pain, plus a high temperature, hot or red skin that is spreading, feelings of nausea or vomiting, dizziness (though this on it’s own is a good reason to see a physio), incontinence, feelings of anxiety or depression, suicidal tendencies or other mental or psychiatric condition? See a Doctor first.
Some of these other symptoms are signs that you may have an infection or other systemic disease which might need timely attention, and wasting time going to see your physiotherapist first could delay you getting the treatment you need. If you have back pain and incontinence, this may be a sign of Cauda Equina syndrome (compression of nerves that supply the pelvic organs) which is a medical emergency and requires urgent surgery or the incontinence can become permanent. If your pain seems to follow periods of extreme anxiety or depression, especially if you have thoughts of hurting yourself, this may be a sign that your pain is a result of the mental health issue, and you may need to see a professional who is trained in diagnosis and management of these sorts of conditions, which physiotherapists are not.
Nerve Pain Plus
Do you have spreading, burning or electrical pain – plus a rash, blisters, or skin discoloration? See a doctor. These may be a sign of a viral or bacterial infection affecting the nerves that supply the skin, or just an infection of the skin that is irritating the cutaneous nerves. Either way, we WON’T TOUCH YOU! Not only that, we have no idea how to treat it and your GP is highly trained in recognising different sorts of infections, and whether they’ll benefit from antibiotics, anti viral, UV therapy, cortisone etc.
As a good example of the above, if you waste time seeing a physio and you have Shingles (Herpes Zoster) you may miss the 72 hour window for getting the appropriate anti-viral on board, and then essentially have to ride-out the disease running it’s course, with nothing but opiates for pain relief (and a recent release from the IASP recommends against opiate prescription for neuropathic pain, so even this is a waste of time really).
Here’s the controversial one. What if you have pain in your chest, difficulty taking a deep breath, and possibly have pain radiating into your arm? The conventional answer is call an Ambulance! And given that the consequences for getting this wrong can be death, this is still the correct answer. As most people know, these are the cardinal signs of Acute Myocardial Infarction, or Heart Attack.
They are also symptoms, however, of a completely treatable musculoskeletal condition called costochondritis, or Rib Joint Irritation. We regularly have patients who present to their GP with these symptoms who are otherwise well, have no history of heart disease or high-blood pressure, have no family history, do not have any other signs of autonomic dysfunction (clammy, sweaty, pale skin, weak or irregular pulse). They have also had the condition for days or even weeks prior to the presentation at the doctor, and yet this scary triple-threat of symptoms often results in the GP (arguably correctly) pulling the trigger on calling an ambulance, and sending the patient straight to Emergency for ECG and blood tests, which often come back clear.
Now, if even one of those patients EVER shows positive signs of heart attack, then that doctor has just saved their life. BUT, there are a couple of very simple movement tests and palpation that can (in combination with the lack of history, and other cardiac symptoms) make us more confident that the pain is less serious.
So, if you have a sore chest, maybe pain between your shoulder blades, and feels a bit difficult to breath in deep, but you are otherwise well, have no history of heart problems, have a normal pulse – particularly if the pain has been the same for days and you haven’t died yet – we can probably help with that. But if you’re in doubt, call 000.
With the rapid advancement of technology in medical imaging, we are getting better and better images of the internal structure of the body. For a few decades now, we have typically sent people in for a scan of only the joint that is painful, or the body part assumed to be damaged or diseased, however, we’ve not had anywhere near the same number of scans of normal, pain free people, or even scans of the non-painful side on the same person with one painful body part. When the radiologists report comes back reporting on some abnormal structure, we leap to the conclusion that this is the cause of the pain. However, we can’t image pain.
Over the last 4-5 years, and the growing body of research has compared the “abnormal” findings with scans of the non-painful side.
In most cases almost the same findings on the non-painful side. Also, as people age, a large percentage of the non-painful population also have disc bulges, spinal joint arthritis, knee joint cartilage loss, bony spurs, meniscal damage, rotator cuff tears, labral tears in the hip . . . . . the list goes on. All of the things we’ve blamed over the years for joint pain and dysfunction are just as common in people who have no pain. So what does this mean?
These are a normal consequence of time related change in the body, and are not necessarily a reason to have pain (and certainly are not a reason for surgery, unless a reasonable amount of conservative management has been attempted and failed).
If your doctor gives you a referral for a scan, it is reasonable to ask if it is really necessary.
Will Massage Help?
Remedial Massage Therapist
Do you suffer from stress related tightness and pain in your neck, shoulders or back? Getting stiff and sore from sport, gardening or work? Do you have lymphoedema from infection or removal of lymph-nodes? Feel like your body needs a “tune-up” or general maintenance? These are the primary reasons that a person would ring up and book in for Remedial massage, and this type of therapy provides a high value, affordable way of improving well-being and quality of life.
If your condition has been treated by a Remedial Massage therapist and they have concerns about it, or it is not improving with this treatment, they will refer on to a therapist (such as a physiotherapist) with higher training in diagnosis and rehabilitation.
Myotherapy is “muscle therapy”, and the qualification is Advanced Diploma of Remedial Massage (Myotherapy). What you can expect from a session with a Myotherapist is a higher level of understanding of managing more specific conditions (than a Remedial Massage therapist). If your pain is a bit more localised than general stiffness and soreness, or you have a old injury that needs maintenance, Myotherapists are very skilled with manual therapies and some corrective exercise to have you feeling yourself in no time.
A Myotherapist may work in tandem with your physiotherapist, or a stand alone service depending on your needs.
Whatever your needs, if you are sore, injured, suffering, or banged-up – feel free to call us to see whether you need to see us, or whether we might recommend a more appropriate professional to see first, or instead of us. Sometimes the best service we can give is to direct you to a more appropriate service.