About physical therapies

There are a huge range of physical therapies: physiotherapy, osteopathy, chiropractic, acupuncture, Pilates, hydrotherapy, massage, craniotomy-sacral therapy, yoga, Bikram yoga, McTimoney Chiropractic, Mackenzie, Alexander technique, Bowen technique, Reiki therapy, CHEK therapy, podiatry, myofascial release, Rolphing, neural glides, core muscle exercises...... an already almost endless it is expanding daily. In addition, there are many other active, passive and preventative strategies and techniques to apply: ergonomics, Mindfulness, cognitive behavioural therapy, nutritional therapy .…… again a long and expanding list. Some address multiple aspects of life such as CHEK therapy, whilst others address specific elements of a condition as in Myofascial Therapy, and yet others combine several with Body Balance doing this to music! Some are actually “Mental Exercises” and have been included as they are often an important element of any good programme. Look them up in the Encylopaedia.

It is common for the “big three” physical therapy disciplines of physiotherapy, osteopathy and chiropractic to utilise multiple techniques in an overall package of care.

Essentially these therapies can be divided into three groups. We call these the three pillars of spinal care.

The Three Pillars of spinal care

Any successful treatment strategy has three core pillars. They are the minimum requirement – try standing on a two legged chair.

1. Passive physical therapy.
2. Active physical therapy.
3. Preventative(Ergonomic) strategies.

Passive physical therapy means you lie there and they do things; heat, massage, ultrasound, strapping/taping, acupuncture, manipulation etc. They aim to provide pain relief, rather like tablets; if they work, they work for a while, wear off and you need some more. They do not of themselves make you better. They provide pain relief and allow you to address the problems with a combination of active physical therapies and preventative/ergonomic strategies. They are an important part of any strategy but not the full answer. The injections doctors do, (epidurals, root sheath injections, facet joint injections and denervations), and the operations surgeons do, (discectomy, decompression, fusion) may be considered as “big boy” passive therapies.

Active physical therapy is exercise based. The therapist teaches you stretches and exercises to change posture, improve flexibility, strengthen muscle control and improve fitness. You are the one doing the work. It is only this active exercise which addresses the underlying treatable causes of the problem and ultimately stands any prospect of making you better. This may include stretching exercises to improve flexibility. To work on posture and strength it may include Pilates, Mackenzie exercises, yoga, gym work, or hydrotherapy. This is a rather black and white separation from passive therapy in what can be a complex mix of physical therapy interventions. Stretching exercise often requires a hands on technique to help fully. Additionally, the devil is in the detail. How you do the exercise is all important; it is their skill to teach you. It takes time, your time, to learn, perfect and then to do it in sufficient quantity for it to effectively change and improve you. Other active techniques can be learned and added that are not “physical” but “mental” therapies such as Mindfulness or cognitive behavioural therapy. As with the physical therapies they take time and commitment to learn. They too aim to make you stronger. Much of this involves learning – exercises, stretches and mental techniques. Likewise actively learning about your condition, its causes, natural history (what happens if nothing is done) and the treatments surrounding it is vital.

Prevention and ergonomics You also need to stop doing whatever got you into trouble in the first place. Otherwise, history will repeat itself – in you! This is so often the forgotten pillar. Ergonomics is the science of doing things better. You need to look at what you do and change it. This does not mean giving up the things you do and love but doing them in a more back friendly way. For example, the thing most of us do most of, is work. Most offices are inactive environments. We sit too long. With some simple alterations we can change that and so live more comfortably and do more of the things we like – see “Back Friendly Ergonomic Office” page on The Spine Surgery London website. Click here to visit that page. Failing to address this end of the seesaw will result in you needing more treatment and living with more pain than is necessary. Missing out this pillar is simply daft; it dooms all efforts on the other two pillars to failure. Expensive, it also risks unnecessary harm from treatment you should not need. Would you carry on simply filling up a car that leaked petrol? You may already be in trouble and prevention would certainly have been better than the cure you now need but it is absolutely essential that you make prevention a part of that cure. The most common omission in the treatment plans offered by therapists lies here.

What Therapy do I need?

For any condition, (back pain, neck pain, sciatica etc.), you need three things: a diagnosis, prescription of an appropriate treatment plan and the dispensing/delivery of that plan. As we have seen there are a myriad of treatments and specialists involved in spinal care. We hope here to provide guidance on how to make a sensible selection from the pool of experts available. To simplify the process we lay out the three needs you as a patient have and the three questions you must ask about the individual or clinic you choose.

The Three Needs

Spinal patients may have a variety of symptoms: back pain, sciatica, neck pain or brachalgia.

Whatever the problem all patients have three fundamental needs:

1. Diagnosis of what is causing it.
2. Prescription of all “three pillars” of treatment required to correct what is causing it.
3. Dispensing of that treatment.

So, when assessing if you are going to see the correct specialist you need to ask the three questions of them or their clinic.

The Three Questions

You should consider the following three questions of the individual or clinic you are going to see:-

1. Do I already know what is wrong and if not can they tell me? Click Here for more.
2. Are they able to work out what is needed to correct it? Click Here for more.
3. Do they offer the range of skills required to treat it? Click Here for more.