At Physiologic Physiotherapy we often get asked “Should I see the doctor or come straight to physio”? Traditionally doctors have been the first port of call when a person injures themselves or requires advice and management of an injury. The field of musculoskeletal and sports type injury has become somewhat of a specialised area in recent times. In medicine we now have Sports Physicians (Specialists) and in physiotherapy we have titled sports physios and sports specialist physios. In a private practice type setting such as Physiologic physiotherapy our “bread and butter” very much is in the management of musculoskeletal injuries both in sports people and the general public. So to answer the original question – The truth is that either is acceptable. For those of us who have been to a doctor and seen a physiotherapist for a musculoskeletal injury – often the experience can be quite different. The following will help answer some common questions
DO I NEED A REFFERAL TO SEE A PHYSIO ? -You dont require a formal referral to see a physiotherapist. Physiotherapists are known as “first contact” practitioners which means that we have the necessary skills to examine, DIAGNOSE, treat and advise our patients with no previous input or referral from a doctor
WHO IS BETTER EQUIPPED TO DIAGNOSE MY INJURY ? – Both doctors and physiotherapists have the necessary skills to diagnose your injury. Interestingly the most important thing is that there is a DIAGNOSIS made ! Often we see clients who have been sent to physiotherapy from the doctor with no formal diagnosis. in my experience it is very difficult to treat a patient without a diagnosis. Can you imagine trying to make a cake without knowing that it was a cake ? it doesnt matter who you see so long as the diagnosis is made clear to you.
WHO IS BETTER EQUIPPED TO MANAGE/TREAT MY INJURY ? – In summary it depends on the injury. Often both parties have input into an injury. For example it is not uncommon for the physio to refer to the doctor to ask for a script for some anti inflammatories as these are not able to be prescribed by a physio. In general you will usually get more detail and coverage under the guidance of the physio where a musculoskeletal injury is concerned. Our range of skills in this area is extensive and we are able to correctly advise you also.
WHO IS ABLE TO PRESCRIBE EXERCISES ? – Typically this is the physiotherapy domain. Most people who see us will know that we commonly give out drills/exercises to help with your rehab. I have no problem in saying that doctors do not readily do this and probably arent great at doing it either !
WHAT IF I NEED “HANDS ON” MANUAL THERAPY ? – again this is a limited scope for doctors. Physios typically recieve the manual training needed to administer this type of treatment.
WHAT IF I REQUIRE SCANS ? – There are two options here. Both parties can send for scans although the rebates through medicare are different for some scans if a physio send you. The physiotherapist can either refer directly for a scan or send you to the doctor to get a referral for one. In summary it depends on the scan ! Interestingly a large part of our training centres on referring appropriately for scans. They can be costly and some scans have a radiation dosage associated with them. It is important that scans are adminstered correctly and the physiotherapist can direct you on this as well as most doctors.
HOW DO PHYSIOS AND DOCTORS WORK TOGETHER ? – Above all things the most important thing is the well being of our patients. We work closely with doctors for some of the following reasons. Referrral for scans, injections, to specialists, to other health professionals, for medication etc. Most good physios will recognise the need to refer to doctors and likewise most doctors will see when physiotherapy is indicated.
If you are unsure about who to see send us an email firstname.lastname@example.org or call 55787155 and chat to one of the physios.
CORTICOSTEROID (cortisone) INJECTION – Some facts behind the myth
At some point many of us have had or heard of someone who has had a “cortisone” injection. In my talks with patients over the years cortisone often gets a bad rap! The truth is , if used correctly and in the hands of an expert it is a powerful and effective way of managing some inflammatory conditions. So much so that we often see instant relief of a condition that has proven stubborn to many other types of more conservative treatment such as physiotherapy.
Corticosteroids are a class of medications that are related to cortisone, a steroid. Medications of this class powerfully reduce inflammation. Corticosteroids are not pain relievers. They reduce inflammation. When corticosteroids relieve pain, it is because they have reduced inflammation associated with that condition.
While the inflammation for which corticosteroids are given can recur, corticosteroid injections can provide months to years of relief when used properly. Examples of common conditions that an inection of CS may be useful for would be bursitis (hip, knee, shoulder), osteoarthritis (hip, knee) and painful foot conditions such as plantar fasciitis.
The most important issue accompanying CS injection is to realise that the injection is merely a powerful anti-inflammatory medication. It will not change any of the underlying risk factors or causes (“drivers”) of the condition. For this reason CS injection can have several outcomes
1. Full resolution of symptoms with no recurrence
2. Full resolution of symptoms for minimum or moderate period followed by recurrence
3. Minimum -Moderate resolution of symptoms followed by 2-3 further injections at varying intervals
4. No change in symptoms
It is likely that people who experience 1 or 2 will give CS injections a great rap! At the other end of the spectrum these people will likely give CS injection a “thumbs down” and usually go on to tell their friends and anyone else who might be having an injection about the negative experience they have had. Reasons why an injection may not have worked could be as follows
– the condition did not warrant an injection
– the injection missed the inflammed structure
– the structure did not have an inflammtory pathology within it
In my experience people who show either of 2,3 or 4 (above) need to explore further into the underlying “driver” of the condition. This is where physiotherapy can be of most assistance. Our background training is to understand and manage the underlying causes and associated risk factors for various conditions. Exercises, retraining, advice and hands on therapy are all techniques that will aid in correcting the “driver” of a condition and give you a far better outcome.
I had a client recently who had a stubborn shoulder condition and was unable to perform some of their necessary drills for rehab – i subsequently referred them to our on site sports doctor – Dr David Hart. He performed a CS injection which gave 50-60% relief – enough to enable the exercises to be performed with more comfort which successfully changed the underlying cause of the condtion and allowed recovery.
In many cases now doctors are sending people for guided injections (ultrasound or CT guided). This ensures greated accuracy and thus better relief.
If an injection is something you have been asked to have it is important to understand the risks and benefits associated with the procedure. Injection and repeated injection into tendons has shown to be a dangerous practice as the CS weakens the tendon structure and has been implicated in tendon rupture.
So if you are unsure about CS injection for a condition you might have feel free to discuss it with any of the team at Physiologic