Updated October 2019
Physiotherapy is a form of rehabilitation which focuses on decreasing pain and restoring optimal movement. It begins with a detailed assessment, which helps the physiotherapist and patient discuss options for a treatment plan. In private practice physiotherapy services often include a combination of manual therapy and soft tissue techniques, therapeutic exercise, modalities (e.g. ultrasound), and education. In Canada, Physiotherapy is now a professional Master's program. Following the training, to receive a physical therapy license to practice, candidates must pass both a written and practical national exam. Physiotherapists have extensive training in a variety of areas of healthcare. Where private practice is concerned, this form of rehabilitation focuses largely on the musculoskeletal system.
What should I expect on my first physiotherapy appointment?
The first appointment is an initial assessment. At Royal City Physio, your therapist will have a dedicated 40 minutes of one-on-one time with you on this appointment. This allows your physio to be able to obtain a detailed subjective history as well as perform an objective examination of your injury. The subjective part of the assessment involves the physio asking questions and listening to the client describe details about the history of their injury or condition. The objective component involves observation of movements such as walking, and a series of active and passive tests (e.g. range of motion, ligament testing, nervous system testing). For sports physiotherapy, more time is spent on specific demands of the sport. Each question your physios ask, and each test they (or you) perform, helps them understand where potential dysfunction may be coming from. After the assessment, your physio will discuss their findings with you and begin treatment according to those findings.
Initial appointments require more one-on-one time than follow-up sessions, so that your physio has time to gather as much information as possible before making a diagnosis and constructing a specific treatment plan. To best prepare for your first visit, it is helpful to think of what information you would like to share with your physio about your injury. For example, if you are experiencing pain, can you recall what makes your pain worse? What makes it feel better? Additionally, it is helpful to dress according to your injury when possible. For example, if you have a shoulder injury, wearing a tank top will help your physio gather information about how your shoulder and arm are moving. Wearing clothing and shoes suited for exercise is recommended, as exercise is often a part of the treatment plan.
What should I expect at follow-up appointments?
Follow-up appointments at Royal City Physio involve about 20 minutes of one-on-one time with your physiotherapist. During this time, you can discuss any progress or issues that have come up since the previous session. The physio will then reassess some of the tests (and perhaps add new tests) that were performed during the first session, continue with the treatment plan, and progress both manual therapy and exercises depending on the progress you have made. Your physio may also spend a portion of the session providing education about your injury or condition. For example, for people experiencing chronic pain it can be helpful to have a better understanding of the contributing factors within our nervous system and the environment (see the following video for some great information on pain by a renowned researcher in the field: https://www.youtube.com/watch?v=1ylbrkstYtU).
If your schedule allows, we generally recommend giving time for a 60-90 minute session. At Royal City Physio we like to leave enough time to go through your exercise program where we have specialized equipment, and where your physio is nearby to ask questions. Often, we conclude the session with ice and an electrical modality.
How often should I come to physiotherapy?
The frequency of visits depends the nature of the injury, as well as our patients’ schedules. Ideally, and most commonly at Royal City Physio, we begin treatment with 2 sessions per week.
If a client presents with significant stiffness in a joint after surgery, for example, it may be beneficial to have 3 sessions per week to address this restriction early on. We are also interested in any recommendations from our patients’ surgeons. You and your physio can discuss options and come up with a plan that accommodates both your injury or condition and your schedule.
How long before I recover?
Length of recovery is highly variable, and depends on many factors. First, it depends on the type of tissue that has been injured. Simple soft tissue injuries (e.g. ligament and muscle) generally take about 6-8 weeks to heal. However, a surgical reconstruction of the ACL (a ligament in the knee) will take anywhere from 6-12 months before the individual can return to high speed multidirectional sports. Second, it depends on how long the pain or dysfunction has been occurring. The more chronic an injury, generally the longer it takes to heal. Third, everyone is different. People can have different experiences with a similar injury. Furthermore, people differ in their goals for future activity level. For example, following an ankle sprain, it will likely take longer to return to playing a high level of soccer than it would to return to daily walking. Further information on recovery times and healing will be reviewed in our upcoming blog.
How will I know what to do at home between sessions?
Exercise is almost always an integral part of your treatment program. During your sessions at Royal City Physio, your physiotherapist will take time to explain, demonstrate, observe, and correct your exercises. They will send you home with reminders regarding which exercises to do, how many of them, for how long, and how often it is best to go through them. You and your physiotherapist work toward your recovery as a team. For example, your physio may spend a portion of the session performing manual therapy on your shoulder to help increase the mobility around the joint. In order to maintain or increase this new range of motion, hard work is required outside of the clinic. The same is true for progressing an exercise program. To ensure we are progressing each session, mobility exercises need to be performed 5-7 days per week, multiple times per day; strengthening exercises need to be performed 3-5 days per week.
My doctor recommended physio or massage – what should I do?
Physiotherapy and massage therapy complement each other. Your physio can identify which muscles may be weak and require strengthening, and which muscles are tight and require more extensive soft tissue work. While some of your physio session may involve soft tissue work, if muscle tension is identified as a primary contributor to your pain or dysfunction, allowing time for massage will leave more time for other forms of treatment during your physiotherapy sessions (e.g. biomechanical corrections, manual therapy). Massage therapists are skilled in muscle release and relaxation techniques. Physiotherapists are trained in mobilization and specific strengthening of stiff or injured joints. For example, following a neck injury, it is often helpful to have massage therapy to promote release of muscles, and physiotherapy to work on restoring normal movement and then strength of these specific joints.
Riley Bay began her undergraduate studies in Victoria and graduated with a degree in psychology. She then completed her Masters of Physical Therapy at the University of British Columbia. Riley has gained further training in manual therapy techniques including Mulligan's Mobilization with Movement and The McKenzie Method. Through a combination of individualized therapeutic exercise, hands on manual therapy, and education, Riley is passionate about working together with her patients to help facilitate their return to the sports and activities that are important to them. Book with Riley today.