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6 Reasons to See a Physiotherapist First
Sadly, it’s a common occurrence: Patient Z, arrives at the clinic for their initial appointment 2-3 months late.
Z sustained an ankle sprain while playing soccer 10 weeks ago. That night, Z went straight to the urgent care clinic where they were X-rayed and learned there was no broken bone in their ankle. They were instructed to follow-up with their Family Doctor from that point on.
Z called their Doctor later that week because they were still crutch-walking, in pain, and unsure if they should be using a brace. It took Z >1 week to get an appointment and they were told to wean off crutches, take advil when sore and follow-up in 6 weeks if needed.
6 weeks later Z shows up at their Doctor’s office again still limping, with a sore back as well as a stiff and sore ankle. They don’t feel anywhere close to returning to soccer. At this point, they receive a referral to see a Physiotherapist.
Orthopedic Problems from Waiting
When Z arrives in our clinic, 9-10 weeks post-injury, there is now a laundry list of orthopedic problems to address:
- Stiff and chronically swollen ankle
- Tight and sore back from prolonged limping
- Deconditioned core and hip stabilizers
- Deconditioned ankle with poor balance/movement control
- Deconditioned cardiovascular system (needed for return to soccer)
- Sensitive peripheral nervous system in leg due to chronic soreness
At 10 weeks, Z should be back on the soccer field. In reality, Z is another 6-8 weeks away.
Physiotherapists are Primary Care Practitioners
The experience of Patient Z happens in part because there is poor public awareness of the fact that Physiotherapists are Primary Care Practitioners (1). This means that Physiotherapists have the appropriate training and skills to provide “first-contact” healthcare services (1). The Physiotherapy Act, c. 1999, legislates specifically that patients do not need a Doctor referral to see a Physiotherapist and thus, have “direct access” (2). In hindsight, Patient Z should have seen a Physiotherapist the day after their X-ray in urgent care.
In 2011, a study was done in the USA, to analyze the benefits of this direct access model of physiotherapy (3). Researchers looked back at data from over 60 000 patients who received out-patient (community clinic) physiotherapy (3). One group had a Doctor’s referral for physiotherapy whereas the other group attended physiotherapy on their own initiative (“self-referred”) (3). The patient groups were very similar in demographic and injury-type (3). The findings of the study noted that the self-referred group required less physiotherapy sessions (less healthcare money!) to recover when compared to the Doctor-referred group (3). Thus, a quicker return to soccer for Patient Z!
Due to the type of study (retrospective analysis), we can not directly state why the self-referred group recovered sooner, yet we can likely infer that quicker access to physiotherapy services are indeed necessary for many!
The point of this blog is to inform patients that as Primary Care Practitioners, we at Movement Solutions Physiotherapy, are ready and able to provide care to you directly after an injury. Certain insurance companies may still be a barrier to you gaining direct access (as some still want a Doctor’s referral to pay out) but this is changing! Thus, if you feel like Patient Z, and have any questions or comments for us about this topic, please comment or call.
- Position Statement: Primary Health Care. Canadian Physiotherapy Association. November 2006. https://www.physiotherapy.ca/getmedia/623371a0-4f99-4b25-bbc9-2c58db9a6072/Primary-Health-Care_en.pdf.aspx. Accessed February 27, 2016.
- Direct Access. Canadian Physiotherapy Association. 2012. http://www.physiotherapy.ca/Advocacy/Legislation/Direct-Access?lang=en-ca. Accessed February 27, 2016.
- Duffy PA, Freburger JK, Kliethermes SA, Pendergast J. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Services Research. 2011; DOI: 10.1111/j.1475-6773.2011.01324.x