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Self referral to Physiotherapy- take control

Updated: Mar 10

#physiotherapy #physio #evidencebasedpractise #selfreferral #rehabilitation #roadtorecovery

Patient who has self referred to Physiotherapy

So you have a pain- perhaps affecting you back, shoulder or knee. This pain has persisted for a few days now and is not getting any better. It may have come on on its own, or it may be following a particular event or injury. What do you do?

The common pathway in the UK is we go and see our GP. We are likely to have to wait 2-3 weeks for this appointment where we know that it is not a priority to the GP vs. those presenting with illness and more serious pathology. When we see the GP, the GP may prescribe analgesia and encourage gentle exercise and movement. They may provide you with an information sheet with some exercise you can do at home. You give this a couple of weeks. Unfortunately painkillers and the exercises on the sheet are not helping. You book and wait for another GP appointment.

This time the GP does a bit more of an examination and refers you to Physiotherapy. Unfortunately you have to wait a few weeks (30% of GP consultations are musculoskeletal related). You might be lucky and find that symptoms settle down on there own is this time, or pain my persist and scupper your plans for the summer.

You then get to see the Physio- the Physio does a great, thorough assessment and gives you a good overview of the problem. You may be given some treatment and them some exercises to do before your next appointment. Depending on the service, the number of Physio sessions may be limited to just 2/3 sessions. You then get referred back to your GP due to lack of improvement, or MSK services. Here they will assess the problem again and consider if diagnostic tests are needed and discuss other management options with you…….

Here is a different scenario and one that is actually a priority for the NHS in England

Self referral patient getting assessed by Physio

You have a back/ neck/ shoulder pain- you want to know what is causing it, how long it will take to get better and what you can do to help yourself. You call your local physiotherapy clinic- they endeavour to get you booked in within 48hr. You see a specialist musculoskeletal Physiotherapist who has wealth of experience in this very condition. They do a thorough assessment, screen for any serious pathology and explain to you what the problem is. Further investigations or imagining will be considered if needed. You discuss management options and healing times. Your goals are also discussed (getting back to golf, walking at the weekend or doing a house project) and a management plan formulated. You get started on some treatment. You are reassured and given a rehab program to follow at home. You are then rebooked depending on your symptoms and when is appropriate for you. Progress is closely monitored and you are working towards you goals.

Self referral patient doing rehab with Physiotherapist

This is a much more proactive approach and one that supported by a hefty evidence base. What we often see in clinic is that as pain persists (as in the first scenario), we develop more worry associated with the problem, more compensations in movement and we become less active, as we are not sure what to do for the best. This feeds into the problem and it becomes a lot more complex to treat, where it is a pain not just driven by tissue injury but by sensitised neural pathways and poor loading patterns.

Have a look at this lovely infographic of the NICE guidelines for the management of low back pain- the nice guidelines outline the highest levels of clinical evidence for the management of a particular condition https://www.bmj.com/content/bmj/suppl/2017/01/06/bmj.i6748.DC1/beri151216.w1.pdf

Also have a look at care and management of osteoarthritis https://www.nice.org.uk/guidance/cg177/chapter/1-Recommendations#education-and-self-management-2

Evidence supporting conservative management for the treatment and management of numerous other musculoskeletal pains including rotator cuff pain syndrome and tendinopathy is also well documented.

So why wait? Give yourself the best opportunity for recovery and self refer to Physiotherapy today. Book today at embracetherapies.co.uk

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