Changing the experience of problems of the musculoskeletal system requires both the patient and the physio to understand the problems at hand. At the initial appointment understanding the issues begins with talking through current symptoms, how the symptoms came about, what aggravates and what eases them in conjunction with a medical history. This discussion (with some pointed questions from the physio) leads into a physical examination. The discussion and physical examination work together to enable a clinical hypothesis to be formulated, what is likely to be at the root cause of the issues and what factors may be contributing at that time.
By the end of the initial assessment the clinical hypothesis can be tested by applying some treatment aiming to help the problem and then re-testing pertinent parts of the examination. The treatment forms an ongoing part of the re-assessment process with constant evaluation and reassessment during and in-between sessions. It is vital therefore that the physio and patient maintain good communication to facilitate the treatment process and achieve the goals of the patient.
Solving puzzles of the musculoskeletal system may require various combinations of treatment modalities:
‘Hands on’ techniques: moving joints, working into muscles, stretching, manipulation.
Exercise therapy: specific exercises tailored to the specific problems identified, this may include movement exercises, stretching, strengthening, conditioning, walking and running programmes.
Rehabilitation: in combination with exercise therapy, exercises to target specific goals in a staged process with a functional goal in mind.
Advice: Strategies specifically for the patient to adopt away from the physio clinic to enhance recovery and potentially avoid the problem from being exacerbated. These strategies are vital considering patients are not in physio all day ever day.
It is through a constant process of understanding the problem at origin, how it evolves through time and through treatment, the application of the right treatment for the right clinical hypothesis, re-evaluation and reassessment that symptoms can be helped. It is vital therefore that patient and physio communicate as the treatment process goes on towards the common goal of getting better.