Physical Therapists and Practitioners: which one is right for me?

There are a whole host of people out there offering a service to improve your physical being. Some have virtually no training, others have trained for years. Some provide a diagnosis, others just relieve stress. Some are very different, Pilates vs Indian head massage, while others are confusingly similar, osteopathy vs physiotherapy vs chiropractic. Some provide regular exercise, others are more remedial. So which one is right for you?

To look at it another way, for what should I go to each person? Or, what can I expect from each visit? Unfortunately, and possibly surprisingly there is not a straight forward answer to this (except possibly for GPs). Mainly because each therapy is practiced by an individual and your experience will vary greatly, even within a single discipline, depending on that individual’s experience, capabilities and beliefs. The best thing to do is book a consultation session so the practitioner can explain what services they offer, what you can expect to experience with them and a recommendation as to what would be best for you. Alternatively talk to someone who has been to a session and get a recommendation.

To help you choose which is right for you we can identify some basic information about each therapy.

1 Medically qualified and registered practitioners.

• GP – For diagnosis and medical knowledge. Your GP is the first place to go for any diagnosis. If your GP cannot complete a diagnosis he will be able to send you to someone who can.
  • Physiotherapy – For injury rehabilitation with medical knowledge. A physiotherapist will work generally on a specific site on your body. They may use manipulation techniques and suggest exercise programmes.
  • Chiropractic – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. They use manipulation and movements beyond your normal range. They tend to do this quickly, many people will recognise this as “clicking”.
  • Osteopathy – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of healing based on the manipulation of bones or other parts of the body. This is a more holistic approach than chiropractic, but they also use movements beyond your normal range. They tend to do this slowly, manipulating and stretching the muscles and tendons.
  

Bear in mind that, with the exception of GPs, you might have a very similar treatment from any of the above therapies and differentiation can be quite difficult. They all undertake many years of training in their own discipline and are required to be registered to practice.

2. Exercise Methods:

• Yoga – An ancient teaching from India. It is as much a way of life as an exercise class. There are many types. Some will include extreme positions and movements to improve strength and flexibility. Some include meditation, breathing, and relaxation techniques. Some will use flowing movements through a range of positions to achieve strength and flexibility. Try to talk to your yoga teacher prior to attending a class to establish whether the class will suit you. Generally you can expect a Yoga class to be physically challenging and involve a lot of stretches, balances and quiet reflection.
  • Pilates – Invented in the early 20th century by Joseph Pilates. This concentrates on the development of the “core” musculature. Again there are a number of variations from the pure, following exactly the original moves and approach, to fitness based and hot Pilates. Generally you can expect a Pilates session to be full of small slow movements coupled with balance. The focus is on correct technique to ensure the engagement of the important “core” muscles of the body.
  • Gym Training – A range of strength and cardio-vascular training equipment can be found in most gyms. Trained staff are on hand to explain the use of the equipment, and you would expect to have a personal programme to follow developed by one of the trainers. The staff are usually fitness experts but may not necessarily have any more specific training or expertise. Generally you can expect to be left to follow your own programme at your own pace in your own way.
  • Exercise classes – There are a large range of general exercise classes from circuit training to spin, from British Military Fitness (BMF) to Zumba. They are normally quite large classes (8 to 30 and more) and can be very social. There is usually a large cardio element to these classes, some also include strength work. You can expect to work hard, work up a sweat, and gain stamina.
  • Personal training – Otherwise known as one-to-one or consultancy. This category covers a wide range of services from specific sport training, through weight loss and life coaching, to back care and post-operative exercise. Some personal trainers are also qualified in massage techniques and a one-to-one session can help enormously to get the best out of classes such as yoga and Pilates. You can expect personal and tailored interaction but make sure you understand the qualifications of your trainer and that they match your goals. These one-to-one sessions are usually invaluable in helping people to meet their goals by selecting the best therapies and explaining the important techniques.
  

Once again it is a good idea to discover what qualifications and experience your trainer has, for any of these exercise therapies. Do remember that an inexperienced therapist can be just right for you, and an experienced, well qualified therapist may not suit your requirements. That situation is rare, it would be more normal for you to get a fuller, more effective and more enjoyable class from a more qualified and experienced instructor. In other words, to some extent, you will need to “suck it and see”. Just because you went to a Pilates class and it made your back hurt, that doesn’t mean that all Pilates classes would make your back hurt.

3. Massage Therapy (soft tissue therapies).

• Sports Massage – Despite its name this is not just for fit and active people. It is a deep massaging technique that focuses on areas of tight or knotted muscles and aims to release them by manipulation and the use of pressure. It can be quite painful, and often the massaged areas can be worse for a couple of days. Generally there is noticeable improvement after that. Having said that, very often it is not painful, and the improvement can be immediate. It is unlikely to be a relaxing experience although some people do find it so. Look for a sports massage if you have muscles that are knotted. Deep massage can encourage a healthy circulation before strenuous activity and a sports massage therapist can also provide post exercise or event massage.
  • Myofascial Release – Your whole body is covered with the fascia. It is under the skin, but over the muscles. If you look at a joint of meat the fascia is the white fibrous covering. In the best circumstances the fascia is taut yet flexible. In most people it has areas where it is attached to muscles, or damaged, or affected by scar tissue and so on. It can be like having a large rubber band holding your body out of alignment. As a result you may have pain in a shoulder that is cause by tight fascia running down your leg. A Myofascial massage is different from any other soft tissue therapy and feels gentle. The aim is to free the fascia to allow the body to align itself correctly. Look for a fascial release massage to ease those aches and pains, or to correct a postural anomaly.
  • Manual Lymphatic Drainage – Generally known as MLD. The body’s lymph system is just as important as the blood system, although not many people realise just how essential it is. Without lymph your blood would not get oxygen from the lungs, and your muscles would not get the oxygen from the blood. Not only that, but the body’s immune system would not work at all properly. It is lymph that is normally responsible for swelling at injury sites. Lymph is circulated around the body, but it doesn’t have pipes and a pump like blood, it relies on muscle movement and gravity to get around. There are specific sites around the body that process lymph, called lymph nodes. It is here that the lymph is processed to allow it to fulfil its many functions. The movement of lymph around the body can be adversely affected by inactivity, injury, illness and pressure. You should consider MLD if you have swelling, such as post joint replacement surgery, joint pain, or sinusitis. Since the lymph system is in the skin MLD is extremely gentle, but its effects can be immediate and dramatic.
  • Swedish Massage – Probably the best known massage. There are a wide range of generic massage techniques, such as this, that have general positive effects, but are not targeted like the techniques covered so far. They range from light to deep massages, some involve slapping and or drumming actions, others are done with the feet. Swedish massage will stimulate the circulation and be both enjoyable and very relaxing.
  • Hot Stone Massage – The use of pre-heated stones helps in many ways to increase the effect of massage. Hot stone massages are extremely relaxing. The heat from the stones encourages circulation and the muscles to relax. Using a hot stone to massage with has the effect of a deep massage without the need for so much pressure. Try one of these if you are stressed, or if you have any particularly stiff or knotted muscles.
  • Indian Head Massage – Although it is called a head massage you will normally get a head, face, neck and shoulder massage. It is said to stimulate hair growth, but it is definitely a most relaxing massage. It can be done with the client in a sitting position, and fully clothed, so it is ideal for an office environment, or anywhere away from a massage couch. When I have given these types of massage it is quite normal for my client to fall asleep, such is the relaxing effect of the technique. It is very good at reliving the tension in the shoulders that results from sitting at a desk working a computer. Try one of these if you are stressed, have a stiff neck, have a head ache or just fancy a good old pampering.
  

Which massage may suit you is very difficult to identify, a particular massage for one person can be brilliant, the same massage for another person can be debilitating. Have a conversation with your chosen therapist about your own preferences and any medical conditions you may have. If you have a bad reaction after a massage it is worth letting the therapist know and going back for another try. Most qualified soft tissue therapists will have a range of techniques at their command and will be able to take an alternative approach to avoid any bad reactions.

4 Other specialist areas

• Postural Assessment
  • Therapists with a postural assessment qualification will be able to identify any postural issues that may be causing pain, or imbalance. They will have a thorough knowledge of the musculature that is essential to correct stance. This is applicable to both exercise and massage therapists.
  Bio-Mechanics
  This area is a whole profession in its own right. Usually employed to gain the maximum performance from athletes and sports people, it has an application for everyone. A therapist with bio-mechanics training will be able to help anyone to a better understanding of their body and, generally, to identify an alternative approach to solving issues such as back pain, knee pain and the correction of running or walking style (gait).
  GP Referral
  This qualification enables exercise therapists to understand and make allowances for chronic conditions presented to GPs which would benefit from exercise. A therapist with this knowledge can support not just GPs, but any of the medical therapists (osteopaths, chiropractors and physiotherapists). Often this support can be in the form of specific exercise plans, but may also be particular massage techniques.
  Back Pain
  The causes of back pain are myriad. Sometimes there is a medically identifiable issue (e.g. herniated disc), but often there is no specific reason for the pain. Where this is the case therapists with specific training in dealing with back pain are able to help with targeted exercise plans, manipulations and massage.
  

In short, look at the qualifications of your chosen therapist and make sure that they meet your requirements.
Remember that you can get a good result from a newly qualified therapist, but if you have a recurrent problem to solve, look for qualifications, experience and evidence of on-going training, as research continues to improve the way we treat physical conditions.