Physiotherapists in demand

Image by Matias Maiztegu, www.pixabay.com

Every day I walk anywhere, I silently thank the physiotherapists who got me back on my feet after a serious motorcycle accident in 1969. Too long ago and yet still traumatic to relate, so I’ll skip the detail of the accident and fast forward to the rehab centre.

Once out of plaster, able to use crutches and manage a flight of stairs, those with serious injuries were packed off to a rehabilitation centre. Those physios, I remember well, were relentless in the quest to restore flexibility and muscle strength to wasted limbs.

I’d fractured both kneecaps and had them removed, so on release from hospital had limited movement. My quads were so far gone I could hook an umbrella around my thigh.

Enter the first physio who introduced me to the pedal-driven lathe, on which we made wooden collection plates, cheese boards, wine goblets and other items that required hours of repetitious pushing up and down, first one foot then the other.

Then it was into the (heated) pool to developed further flexion through weight-bearing exercise. There were sessions with muscle-stimulating machines, weights and frequent massages to break up the scar tissue.

We were given three good meals a day and then sent off to bed at 8.30. One night we all sneaked out and found a pub down the road; discovering it was by no means an original idea.

My knees got better with time, although I still can’t squat down and kneeling is something I’ve learned to do as seldom as possible. If I get a flat tyre I call the RACQ.

I was musing about this on day three of the great rose garden refurbishment project, spending more time on my knees than I’m used to. Once the day warmed up, I’d shower and retire to the lounge to watch the Australian Open. I’m a fair-weather tennis fan and only get engrossed when we’re into the quarter finals.

He Who Was Deported for not Being Vaccinated is back again, and, despite a troublesome hamstring, seems destined to take home the AO trophy. As all the leading tennis pros do, he brought his own physio. He may even have brought two if you peruse this story.

No doubt you have all had dealings with a physio at one time or another. It doesn’t take much. Common complaints referred to physios include lower back problems, broken wrists, ankle sprains, knee injuries, shoulder conditions, achilles tendon and pectoral strains, tendinopathy, arthritis and the dreaded hamstring strain. Novak Djokovic has had a dodgy hamstring since he set foot in Australia but his physios are obviously skilled at keeping him on the court. He is in superb physical condition too, which helps.

Given the dominant form he displayed against Alex de Minaur (6-2 6-1 6-2), his hammies are just fine.

As Novak said early on: “It’s up to God, and my physio to help me. Let’s take it day by day, I hope I’ll be able to recover.”

The hamstrings are the muscles at the back of the thigh, attaching above the hip joint and below the knee joint. Adequate resilience of the hamstring muscles and their tendons, which attach the muscle to bone and are essential for movement, is essential and fostered by sport-specific exercise.

Retired ballet dancer Martin Collyer has just finished undergraduate studies at UQ for a degree in physiotherapy. One of his placements was at a former workplace, Queensland Ballet headquarters in West End. Like all elite athletes with a retirement age around 35, he made plans, initially working as a yoga teacher.

He said he chose to study physiotherapy despite some disappointing experiences with physios on the few occasions when he suffered injuries as a professional dancer.  He related an anecdote from a group he was teaching about a long-term yoga teacher who was studying for a bachelor of physiotherapy. She chose to stop, after four years and much effort.

The reason cited was that physiotherapy was, “too focused on individual joints and muscles; too narrow,” leaving the individual feeling that yoga was a more ‘holistic’ approach. Martin was asked for an opinion.

“I said that while there are tremendous physios, the individual may matter more than the modality. There are great chiropractors working from the evidence base and using exercise as treatment, just as there are physios who may disregard the evidence base.

“Physio’s origins are in massage, but the profession has evolved a great deal over the years. Increasingly, the evidence supports exercise as best-practice management for a majority of musculo-skeletal conditions. This means that the training physios receive, with an emphasis on manual therapy and other passive techniques (e.g. ultrasound), may not adequately support them. While exercise was covered in my physio undergraduate degree, it was arguably insufficient.

“Because of my prior experience in movement and movement coaching, I feel confident with this aspect of practice, but what about the individual who had little experience with sports and exercise prior to studying physiotherapy?”

Through four years of study, Martin said it dawned on him that the issues physios treat are public health problems.

“If more people were more physically active, far fewer people would suffer from musculo-skeletal complaints. The best sort of exercise is the sort you’ll keep showing up to.”

The popularity of physiotherapy as a study course appeals both to those who want to be practitioners and those who use it as an entrée to medical school.

The Australian Physiotherapist Association (APA) tabled recent data that showed there were 35,290 registered physiotherapists in Australia. Physiotherapy continues to be a female-dominated workforce (66%) and a Gen-Z profession with the majority of registrants aged 25–40.

The stumbling block for most people who are referred to a physiotherapist is the cost. Typical fees for a 30-minute or 60-minute session are between $80 and $120 per session. Your GP can issue a chronic condition treatment plan (subsidised) but this has limitations.

The Grattan Institute recently released a paper advocating a review of Medicare arrangements for allied health services.

Grattan Institute author Anika Stobart advocated scrapping the existing Medicare items for allied health and re-directing funding through local Primary Health Networks. These networks would contract providers to perform services with no (or very low) out-of-pocket fees for referred patients.

Stobart says that even though services are subsidised, they can still be very expensive.

“Last year, only 56 percent of allied health services were bulk billed, and patients paid on average $55 out-of-pocket per appointment.

Just this week there were news reports of a pending review of Medicare and its funding model. The Albanese government’s Strengthening Medicare Taskforce recommends moving from subsidising GP consultations alone to wrapping in care provided by nurses and paramedics.

Health minister Mark Butler said the current system is “no longer fit for purpose” and flagged changes in the May budget. Given that one in six GP presentations are for musculo-skeletal conditions, there’s a good case to review the Medicare treatment plan system.

I ran into the treatment plan limitations when seeing a physio for a rotator cuff (shoulder) injury some years ago. I quickly used up my “free” sessions but opted to keep going at around $70 a session. My physio claimed credit for the reduced inflammation and increased mobility over time. I said the symptoms eased once I started taking magnesium tablets. She politely but firmly disagreed.