So I’m fully prepared for a fall out on this one but bare with me because it is personal. In the 9 years it took to get a diagnosis on AS (ankylosing spondylitis) I have seen 3 physios (plus lots of other professionals). 1 local NHS (ordered an x-ray, never touched me), 1 private (mix of assessment, exercise modifications and manual treatment) and 1 from the hospital (only talk). Guess which one actually helped??
A physio who is not prepared or equipped to offer assessment, advise AND hands on therapy in my opinion is not helpful and I’ll tell you why; NONE of them will admit that exercises can only get you so far with chronic conditions like mine. There is no silver bullet, there is no magical plank time that, once reached, the back pain will be forever banished! You absolutely need a mixture of care and relief, even if it’s temporary, so, prescribe all you like but give people a bit of a squeeze at their appointments too! One of the most powerful things I have heard from my doctor is “look, I get it, the prospect of living another 40 years like this is pretty terrifying”- truth is appreciated. Help people navigate maintenance and stop spouting off in general terms about “pain” like it’s all the same and can be remedied. Now, of course, not exercising is just not an option and I would never dream of telling people not to bother. I genuinely would not be walking around right now if I did not have my own rehab-based Pilates practice, but I have developed this ON MY OWN. On discharge from hospital in a wheel chair in 2018 I was left to my own devices with nothing but a pair of crutches, so thank god for upper body strength and my ability to pay for private care when I could get out the house (2 months later!).
It’s Therapy Live tomorrow, an annual expo featuring lots of therapists giving talks on all things rehab. I have chosen not to attend this year for 2 reasons, 1; women are woefully underrepresented and 2; a lot of the speakers are the ones who shout loudest on Twitter getting into spats over straw man arguments. I recently purchased a booklet from someone I did admire in the rhelm of rheumatology but was SO disappointed when it arrived. It was a thin hand-out, 5 pages of easily googleable bullet points and contained incorrect information. I was furious, and the only reply was an offer to return it. I’m sure many women let their imposter syndrome keep them from speaking more at such events but all this really shone a light at what some people feel is OK to charge for and who is seen as an ‘expert’. Letters after your name mean nothing is you don’t care about people. Anyway, I digress…
The ‘specialist’ hospital physio I have now spoken to twice is perfectly nice but offered me absolutely no help. We chatted on the phone 6 weeks ago and from reading my notes told me about my hip pain and, without asking me about it, went on to suggest I strengthen it but “trying to do glue bridges on one leg”. I explained that the hip was actually fine, that it was just the first symptom I had many years ago and that being a Pilates teacher I regularly do this exercise on one leg, on a Swiss ball while holding a weight in the air. Silence. Does this mean I have ‘passed’ or ‘failed’ physio?
The 2nd appointment yesterday was on video, so I set myself up on my mat so we could move and maybe try something new. He logged on, sat behind the screen as if in a Zoom meeting. He asked how I got on with the exercises he suggested, I reminded him they were very basic and way below my normal level of practice. He asked what I wanted to get out of physio, perfectly valid. I said I was open to advice and maybe in his experience of dealing with people with these long-term inflammatory conditions that there would be some nugget of wisdom that I have overlooked. *deep intake of breath* he said to make sure I reduce the intensity when I get a flare up but don’t stop moving because exercise in itself is anti-inflammatory. No shit Sherlock. Double cheers to that incredible insight.
So that’s that, what do I do now? Give up? Hell no. I continue my regime of mobilisation and strength work to keep me on top of things as best I can. But I have to accept that there is no answer to making my situation better than I already have. My all-time plank record is 10:34, yes that 10 minutes 34 seconds… did my back still hurt at the time, yes it bloody did. Using resistance bands REALLY works for me because I find free weights too aggravating. However, a young dancer client of mine disagrees because she started dead-lifting at age 16 to deal with back pain from her scoliosis and it’s worked wonders. However she still comes to see me as the imbalance in her hips responds really well to some good old deep tissue work. The exercise alone does not suffice for how she wants to feel, not to mention the human aspect of a therapeutic hour with a friendly face who can reassure you that your discomfort is real but not to worry.
Yes, you can’t go wrong getting strong, but manual therapy is bloody awesome too. Not everything works for everyone, so let’s stop shouting generalisations. I don’t know anyone sensible in the MT world who would suggest that massage/Osteo in isolation can fix things (especially given how all these professions now tend to overlap) but it sure as hell makes you feel cared-for while you try to keep your creaky body moving.