Gareth and I talked about whether to share his story online, he didn’t hesitate for a second, “let’s do it”. Like myself, Gareth is a medical health professional. He is part of a highly respected and prestigious group of clinicians that help people in pain every day. When was his turn to be in pain he wasn’t 100% sure what to do.
“I work hard to provide the very best care for my patients”
We all get sore, that’s part of being human. As a physio it’s my job to give the right advice and guidance. People often think that a ‘good physio’ is whoever does a good massage, but massages don’t do much (no matter how much you love them). I work hard to provide the very best care for my patients, but usually that isn’t any magical treatment or impressive device with flashing lights. When Gareth contacted me I promised him one thing… good advice.
I’ve worked in a lot of different settings through private practices, sports medicine settings, and several NHS departments. Building experience is important, knowledge and skill are important, but I feel that most important of all is putting the patient’s needs first. That doesn’t mean the patient is always right of course, often people want their back rubbed better when really it’s a complete lifestyle change they need, that’s never an easy sell! But Gareth isn’t one of those people, a GAA player in his early 30s who goes to the gym, he wouldn’t be the type of person who typically develops chronic back pain. He did, however, hurt his back. That’s pretty common though, people hurt their backs all the time. Most back pain isn’t serious and goes away on its own, it can be a good idea to have it assessed and get some advice for how to deal with it properly. By the time Gareth came to see me he was so twisted, so bent and shifted and rotated, that I honestly thought he was winding me up! I’ve looked after a lot of people with back injuries… A LOT! But I can’t think of another time when a person resembled a mangled body from The Walking Dead quite like this. He was exhausted looking and in obvious agony, but this never should have gotten this far.
“Physiotherapy has to do better than wacky and immoral placebo approaches”
To bend down and feel a little twinge in your lower back is a familiar complaint. Gareth wouldn’t be alone in his approach to just keep going and try and get through it, in fact, that’s probably the best thing for it. He tried to go to football training but wasn’t able to fully participate. After chatting to some friends he was recommended the name of a ‘Physio’ to go see. Now you can tell from the ‘…’ business that I’m letting you know that this person wasn’t a physio. You might ask “so what?” or say “I’ve been to loads of physios and they didn’t help me!”. I would be the first to say that many physios aren’t doing a good enough job, anyone who knows me will agree that I have a low tolerance for these folks who rub your back 50 times and just take your money and those who stick magic needles in your skin to cure a hamstring tear. Physiotherapy has to do better than wacky and immoral placebo approaches. But there is a big problem brewing, a huge variety of self-professed ‘Therapists’ have emerged & every town now has multiple ‘clinics’ offering all sorts of ‘treatments’. These are mostly unregulated and using unprotected titles. I cast my mind back to the comedian Dara O’Brian quipping about going to see the ‘Toothiologist’ instead of the Dentist.
Gareth fell victim to a person who calls himself a physio but who isn’t one. This person runs a “spinal clinic”. He was told that his “pelvic joint is out of place” and a short time later he was given a manipulation to put it back in. Let me just state for the record that these explanations, despite being common, are ABSOLUTE BOLLOCKS!
“there seems to be far more people out there now with barely a clue what they’re talking about”
A couple of days later is when Gareth came to see me, now I’m not bragging that it was me who made a difference or anything like that, I know tonnes of top quality physios and doctors who do a great job of looking after backs every day. But there seems to be far more people out there now with barely a clue what they’re talking about when it comes to physical medicine, and they’re not just down the pub talking shite, they’re cracking backs in YOUR neighbourhood. Gareth had started with a very minor lumbar disc injury, which would have settled with some time and movement, and ended up with a large disc proplapse – a serious injury. Even the tiniest disc injuries can be very sore, but applying high speed & high force manipulation to an injured structure is a recipe for catastrophe. He needed an MRI scan to show the extent of the injury, which was now compressing his spinal nerves, and he spoke to a spinal surgeon.
I have been in that scenario – chatting to a spinal surgeon about the risks vs rewards of opening up the spine to cut off a bit of disc. No matter how smart/educated/brave/whatever you are that chat is scary biscuits. The surgeon shared my clinical view, to only proceed if absolutely necessary. Mr Surgeon briefed him about a special set of Red-Flag symptoms to watch out for, Gareth responded that I had already talked him through these and he joked about being asked so often if he had lost control of his bowels. Now was a tense waiting game, gentle treatments and exercises while seeing if the symptoms got better or worse. They got better but it was very, very slow progress. It’s over a year later and big G is finally back playing football, going to the gym, and working away. But like I said before it never should have gone that far, what happened to Gareth is tantamount to assault. An unregulated quack performing an unsafe technique on a vulnerable member of the public, taking a year of his normal life away from him and charging him for the experience! How many work days lost? What about the number of opportunities lost to play with his kids? That same quack wanted him back for a repeat session, one can only imagine what kind of wheelchair Gareth’s poor wife could afford on a carer’s allowance. He was unlucky, but it was so close to being infinitely worse.
“how do we all tell the difference between what’s real and what’s not?”
So if this can happen to a smart guy who works in healthcare, how do we all tell the difference between what’s real and what’s not? It’s definitely getting harder. The Health & Care Professionals Council (HCPC) is a good place to start though. http://www.hcpc-uk.co.uk/ . They regulate allied health professionals and you can check the register online. If they’re not on the register then they’re not a physio! Many people will have been to other varieties of therapist, and many people may have been helped, but I recommend you are very picky about who you trust your life with! Gareth may have narrowly avoided a spinal cord injury but if it had been his neck he might have suffered a stroke (the carotid artery to the brain runs through the spine).
At least physios (actual physiotherapists) are externally regulated. That means they are answerable to independent bodies if anyone has a genuine complaint. You’ll need to find a good one, and that might be tricky, but please avoid the unregulated and unsafe quacks.