A Hands On Approach

27 August 2013

Helen Mussett joined Elite Rehab & Sports Physiotherapy in 2013 after working in Canberra since 2001. Her main interest continues to be found on post-operative shoulder rehabilitation. She also works with patients following hip and knee joint replacement surgery. Helen is an APA titled Musculoskeletal Physiotherapist, which recognises her high level of expertise. This month we asked Helen to reflect on her vast experiences and share some of her 'pearls of wisdom'. Enjoy!   I have been a Physiotherapist for nearly 38 years, longer than half the world?s population has been alive. I have enjoyed my career for many reasons. It has been enriching in that it has enabled me to travel and work overseas. It has allowed me to do some teaching, to work in a variety of settings and to meet people from all walks of life. I have had the privilege, as do many physiotherapists of working very closely with people. Patients can be surprisingly candid and honest in that face to face situation. Being a physiotherapist means that apart from all the practical skills you learn, you need to be empathetic enough to communicate well with your patients. Having them onside, having their compliance is essential to the successful outcome of treatment. I believe that there is ?art and science? in the practice of physiotherapy. The practice of physiotherapy has changed dramatically since I first graduated. The most important change being that we are now first contact practitioners. This places much greater responsibility on us for patient care and has led to major changes in the education of physiotherapists. Research and evidence based practice i.e. 'the science', are core requirements of best physiotherapy practice today. Despite all this, for me one of the most important aspects of my practice, apart from communicating well has to do with the 'art' side of the art and science equation. It is the 'hands on' aspect of my work ¬†feeling what the tissues can tell me about their condition and how pain behaviour relates to what I feel when I move the joints and tissues. I sometimes feel that this skill of palpation is not used to advantage for it plays a large part in forming our treatment choices. I work in musculo-skeletal physiotherapy and in recent years, mostly in the area of post-operative orthopaedics. Treatment after most surgeries follows a prescribed course where progression is associated with the degree of healing in the tissues and the amount of load the structures can take. Failure to move smoothly from one stage to the next can be a barrier to progress overall. It is here that what we feel when moving or testing the tissues can tell us how to overcome the barrier. When treating the shoulder for example, the joint can be painful to move actively and passively. But feeling the quality of the passive movement tells us how the pain is related to movement. Failure to recognise pain caused by stiffness, as opposed to pain caused by impingement or inflammation, and dealing with the stiffness using adequate 'hands on' passive stretching and mobilisation, will slow progression even if the patient continues range of motion exercises. A joint that can't move fully, can't strengthen fully nor function fully. My point here, and it is only an opinion, is that we need to have enough time with our patients to avoid so called ?recipe? treatments. We need to have adequate time to assess, using clinical reasoning and ?hands on? skills to provide optimal treatment for our patients, so they can progress to a more active programme and complete their rehabilitation. I believe our manual ?hands on? skills in assessment and treatment, along with well honed clinical reasoning skills, are what provide us with a unique point of separation from other practitioners. They are an essential part of the 'art' in the art and science of physiotherapy practice.