Then & Now - How has the physiotherapy changed over the years!
Having worked as a physiotherapist for over 25 years, I do reflect on what I knew then, and what was available at the time in terms of treatment, courses available, equipment and views on rehabilitation and prehabilitation. I often wonder how some of my more complicated patients ever got better! What remains the same though is my strong belief that if you assess thoroughly, come to an accurate diagnosis, and do the simplest things well, paying attention to detail, you can improve and fix most musculoskeletal injuries.
Although some of my case load is different now, with more complex clients, presenting with a more detailed previous injury history. These cases often require an even more thorough assessment to find the key in unlocking them and enabling a good recovery. Boiling it down though through constant learning (many postgraduate courses later), years of experience, and still applying the rule of paying attention to detail for both treatment and rehabilitation, I am able to help most clients.
The sporting arena has changed vastly, with jobs in athletics years ago being few and far between, and like gold dust if you were lucky enough to get one; whereas with the advent of lottery funding, the setting up of the English Institute of Sport and greater funding for National Governing Bodies, jobs in sports have become more plentiful, meaning you can now have a career in sport as a physiotherapist, rather than just as a volunteer. Many athletes are lucky enough these days to work “full time” at their job of being an athlete, hence keeping them healthy is vital to enable to do their jobs well, especially when some athletes train for as many hours as those at a desk job, if not more!
In terms of treatment, things have come on in many ways. I was lucky enough to have had really good student placements, with lots of hands-on practice time and great clinical educators, and was able to build a lot of confidence from this, which carried over into my professional life. The last two years has not been as kind to the students and clinical staff as they have been under so much pressure due to the pandemic.
Scans at the time were less easily accessible, and were not as well designed as they are now, so over the last 30 years there has been a massive change in the detail that can be seen, and therefore the accuracy of diagnosis. The scientists, anatomists, physiologists, pathologists, neurologists and therapists, to name but a few, have all made huge contributions to the way we treat, and the science behind why what we do works. We continue to demonstrate that our bodies are incredible pieces of kit, with an extraordinary capacity for healing, when pointed in the right direction.
Similarly, the development of operative procedures to allow many things to be done by keyhole surgery has made a big difference to post op recovery, no matter what the ailment.
There has also been the development of much equipment over the last few years- We got taught how to use a number of items of electrical equipment at college, some of which I have never used again. Ultrasound is still used today, with lasers and interferential therapy used by some clinicians, although less so. Electrical stimulation equipment to prevent muscle wasting was mainly used in clinic as it was expensive, whereas there are now such items that can be used for rent or bought more reasonably these days. Other items, which can provide hot and cold compression, have provided an upgrade to ice packs/ frozen peas and a hot water bottle for contrast. Machines are also available to help improve the speed of healing of bony injury. Shockwave machines are more commonplace now to help break down chronic scar tissue, and can be a great adjunct to treatment to help with chronic injury. DEXA scanning, with which bone density can be measured, has also become more commonplace to help highlight bone density issues, not just in the older and vulnerable populations, but useful to identify younger people who may be putting themselves at risk in later life.
And of course, shoes- for any runner, a great pair of shoes that is just right for their own biomechanics and helps to prevent injury and maximise foot function is a must, and so important to find. Shoes have changed over the years, but the basics needed in a shoe for the customer have not! The shoe needs to be right for fit, comfort, your biomechanics, and for function. The right shoe, and ideally the right shoe for the surfaces you are going to be running on, so possibly a good winter shoe to stop you slipping, can be the best spend ever. Shoes seem to have gone from basic, to a range of support options, to minimal and barefoot versions, and now to the other end of the scale, with carbon fibre plates and built-up stack heights, which no doubt can cause a lot of wondering “what is the best for me”. My advice is to aim for something that helps you get the most out of your feet and your running, helps to stop you getting injured and needing any of the fancy machinery that is out there! And of course, to ask for specialist help to make the right choice.
So, in summary, where does that leave me? Yes, there has been a lot of research over the years, and as a result, new diagnostic equipment, and treatment techniques. But the core basics remain the same- quality assessment, the application of this in a holistic, yet evidenced based way aligned to the clinical signs and symptoms, alongside the pillars of principles of tissue healing, good nutrition, strength, conditioning and rehabilitation, biomechanics, with along with the right shoes and training load, are all needed to get the best performance out of any of us, no matter the level we are aiming for. Just imagine where the technology and research will be in the next 30 years
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