The Prescription for Physiotherapy

“I wish I would have come in long ago.”  These are words that I hear frequently in the clinic.  They are words uttered by patients that have come in for physiotherapy, sometimes for the first time and, often, after dealing with pain and reduced quality of life for several months.  Sometimes even longer.

All too commonly, patients will visit their physician for pain in their shoulder, back, knee or another area of their body.  Commonly, they are advised to rest the area, perhaps to try ice or heat, and often provided with a prescription for analgesics, anti-inflammatories and/or muscle relaxants.  Pop these pills, apply this cream, take it easy.  If you have had a musculoskeletal issue, I know you’ve probably been there.  If it’s really bothersome, you may be sent for an x-ray or ultrasound to further investigate the area.  Sometimes mention is even made of a cortisone injection. 

Indeed, all of these interventions – the pills, the cream, the imaging, the injections – they do have their place in certain circumstances.  But, in the majority of musculoskeletal problems, the first prescription should be physiotherapy. 

Why physiotherapy?

Well, first of all, those pills you are prescribed are not risk free.  NSAIDs (nonsteroidal anti-inflammatory drugs), which are often prescribed to reduce pain and inflammation, are notorious for causing stomach pain and ulcers as they also impair the protective lining of the stomach.  In addition, some NSAIDS have been shown to have a detrimental affect on tissue and bone healing.  Additionally, I’m sure you all have heard of the opiod crisis.  Opiod painkillers are highly addictive and responsible for a growing number of prescription drug addicts and deaths due to overdose.  While considered safe under normal use for short durations, most drugs used for musculoskeletal pain have risks and side effects that we’d rather avoid when possible.

As for cortisone injections, these can be helpful in some cases, but also carry risks and potential side effects, particularly with repeated injections. 

Physiotherapy, on the other hand, will not cause stomach pain or ulcers.  And although attending physiotherapy can be an enjoyable experience, I can assure you that you won’t become addicted.  What physiotherapy can do is provide education about your injury/condition and how to best manage your symptoms.  Treatment may include manual therapy, dry needling and modalities to help relieve your pain and stiffness without drugs or, in some cases, in conjunction with your physician’s recommended pharmacological management.  Finally, and most importantly, therapeutic exercises will be taught to help you recover your mobility and strength. 

Studies have shown that adequate physiotherapy produces outcomes comparable to surgery in many orthopedic conditions, without the risk of surgical complications.  In some cases, such as rotator cuff tears and osteoarthritis, physiotherapy can often help patients avoid surgery and, not surprisingly, there are a number of orthopedic surgeons in the province that will only consider surgery for patients that have already undergone a course of extensive physiotherapy. 

Even if your condition does end up requiring surgery, undergoing preoperative physiotherapy to maximize your strength and mobility will greatly improve your postoperative recovery.  For instance, for those undergoing joint replacement surgery, physiotherapy beforehand can help to improve the joint’s flexibility and the strength of the muscles around the joint.  Your physiotherapist can also teach you how to best perform daily activities to reduce strain on the affected area.

Fortunately, a lot of our local physicians know this and are doing a great job of referring patients to physiotherapy.  My hope is that the tendency to refer first to physiotherapy continues to grow.  However, you do not need to wait to be referred.  You can see a Physiotherapist at any time without a doctor’s referral.  So, the next time your shoulder pain wakes you up, your knee sidelines you from your training, or your back pain prevents you from picking up your grandchild – save your doctor the visit and call your local Physiotherapist.  We can help you get moving again!  Don’t be that patient that says “I wish I would have come in long ago.”  Come in today.


Teresa Waser, RX Physiotherapy