Does virtual physiotherapy work for shoulder and elbow problems?
With face-to-face appointments limited under the current pandemic lockdown, many physiotherapists have had to deliver care by virtual physiotherapy. For most shoulder and elbow conditions physiotherapy is an essential first line of treatment and needs to be exercise based although other modalities such as massage, manual therapy, taping, acupuncture etc may be used as adjuncts to help with pain and improve outcomes. Virtual physiotherapy is well suited to exercise based treatment as the physiotherapist can asses your movements, demonstrate the necessary exercises, and identify any problems with your technique. Some injuries or conditions may require surgery as a first-line treatment, however, physiotherapy is needed after all shoulder and elbow operations to aid in rehabilitation and recovery. It is therefore essential that patients give physiotherapy a good go and try to get the most out of their physiotherapy treatment. While face-to-face appointments for physiotherapy have been the tradition, many physiotherapists have been able to deliver great care to patients virtually throughout the pandemic lockdown.
I’ve tried physio before and it has not worked why should I try video physiotherapy now?
Physiotherapy like medicines or surgery should be evidence based so it is important that the treatment modalities you receive are evidence based. As mentioned before, most shoulder and elbow conditions require exercise based physiotherapy and virtual physiotherapy is almost exclusively exercise based. Ultimately the right therapy depends on having the correct diagnosis so if physiotherapy isn’t effective it is worth checking that the diagnosis is right and that the therapy is evidence based. A surgeon can often help in confirming the diagnosis.
How do I choose a physiotherapist?
This is a difficult one. Some patients prefer to have a physio who is close to home or work. Some patients already have a physio from a previous operation or injury. Some patients have insurance companies who limit which physiotherapist they can see. Some shoulder and elbow conditions or operations are complex and your shoulder surgeon may want you to see a physiotherapist who specialises in shoulders or elbows, or in that specific condition. Your shoulder and elbow surgeon will usually have a good network of experienced physiotherapists who are knowledgeable and have an evidence-based practice so ask your surgeon if you’re not sure who to see. Previously patients may have had to travel to see a specialist physiotherapist, however virtual physiotherapy means that access to good physiotherapy is no longer limited by geography.
How often do I need to see a physiotherapist?
The number and frequency of physiotherapy sessions depends on your condition, the stage of your treatment, and whether you have any complications with your rehab. A good analogy is to think of physiotherapy like a drug. The physiotherapist will assess you and prescribe your physiotherapy (the drug). You then need to go off and do the physiotherapy (take the drug). The physiotherapist may need to see you to change the dose (intensity of exercise) or change the drug (different exercise). They may also need to see you more regularly if you’re having any side-effects or complications. As you get towards the end of your rehab they may need to see you less frequently. Some insurance companies will limit the number of sessions you can have, and you may need to get authorisation for more sessions when you’ve used up the first lot.
How long should I give it before knowing if physiotherapy has worked?
Most conditions require at least 12 weeks of physiotherapy to see long term improvement and after this some patients may need to carry on exercising even after being discharged by the physio. Some injuries, conditions, or operations can require several months of physiotherapy to improve and your surgeon can give you an estimate of what is the normal expected recovery from certain injuries or operations. If physiotherapy is making you worse, or there has been no improvement at all after 6 weeks it is worth asking your physiotherapist their thoughts.
I find my physiotherapy painful should I be worried?
Most physiotherapy exercises are going to have some element of pain. Moving or stretching tissues that haven’t moved for a while, or strengthening weak muscles is painful. It is important to make sure your pain is well controlled in order to get the best out of your physiotherapy so be sure to take any prescribed painkillers about half an hour before your physio session or exercise. Sometimes muscles may ache after exercise due to fatigue and painkillers may be needed again. If the physiotherapy is causing severe pain, bruising, swelling, or setting you back in terms of movement it may be wise to back off a bit, try icing and pain killers and see if things settle down. If not do seek a review with your surgeon.
I can’t remember all my exercises or carry around sheets of paper what should I do?
We live in a modern world were almost all of us have smart phones. Some physiotherapists can use apps to prescribe your physio, with demo videos for you to do at home, and some apps can even track your compliance or progress. If your physio doesn’t use an app, that’s ok too, they can you’re your phone to video you doing the exercises using they want you to do, and you can play these back at home as a reminder. You can use these videos or apps if you’re travelling, so that holidays or work trips don’t interrupt your rehab.
How do I find the time to do all these exercises?
If you have a hectic work schedule or home life, speak to your physiotherapist about how they can help make your exercises practical for you to do at home or at work. Most rehab exercises shouldn’t need gym kit and shouldn’t take more than 15-20 mins at a time to do. It should be possible to squeeze in your exercises before work, in work breaks, after work in front of the television, or just before bed. Ultimately you need to make the time to do the exercises (take the drug) in order to see the benefits.