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Q: What is the difference between NHS and private physiotherapy?
We all have the same standard of basic training and training fees are subsidised by the NHS. The professional codes of conduct are the same but some physiotherapists feel they have more scope for their personal, professional development when working privately. Some people choose private physiotherapy because they like to know who they are going to be treated by and something about their particular skills. They also appreciate the quick and flexible appointment times and know they will receive ‘hands on’ treatment if both patient and therapist feel it is suitable. People sometimes have private physiotherapy whilst waiting for an NHS appointment.
Q: Could you send me for an MRI?
Yes but the radiographers and radiologists like to know what to look for and sometimes it is better to see a specialist first as MRIs can be done in different ways. The information the specialist wants might actually be better from an x-ray at a specific angle. MRI scans can be an amazing tool but do require skilled interpretation and they do vary in price in different centres.
Q: Can I claim the cost of treatments from my health insurance?
This depends on your policy. There is no problem if they just require the physiotherapist to be registered with the Health Professionals Council, all you will need is a PhysioFettle receipt. I am registered with BUPA so if you have insurance with them check your policy. They often require a referral from your doctor then PhysioFettle will invoice BUPA.
Q: Should I have acupuncture or physiotherapy?
When a physiotherapist trains in acupuncture it becomes another ‘tool in the toolbox’. It can be very effective for some people and for some conditions but I rarely, if ever, just use acupuncture.
Q: Should I see a doctor first?
If you have a musculoskeletal problem it is usually better to see a physiotherapist first unless it is a very recent traumatic injury. Physiotherapists are trained to assess problems and refer for medical investigations if there is any doubt. If I recommend the patient sees a doctor I would write a letter explaining my reasoning and how the patient has reacted so far to treatment. This makes it easier for the doctor in deciding on tests or specialist referrals.
Q: Can you refer me to see a specialist?
Yes, although NHS referrals will have to be through your GP so I would send a letter to your GP first. There are some specialists I particularly recommend and they really appreciate a report from a physiotherapist. Sometimes I may suggest a different type of therapist such as hypnotherapy or Alexander Technique or another physiotherapist with suitable special training.
Q: How long will the treatment take?
Generally about 45mins. It is best to arrive a little early the first time to fill in your name, address etc.
Q: How many treatments will I need?
I can advise and discuss what we are aiming to achieve but, ultimately you decide……..it is your body! Some people only need to come once and, perhaps, have learnt to manage a condition with a new approach.
Some people find benefit from regular ‘top-ups’ rather like going to the dentist.
Most people have a few treatments close together, say two in the first week, then increase the intervals until they are better, the average total being about six.
Q: Which types of headaches can you help?
I believe, along with other manual therapists specialising in this area, that most chronic headaches have some upper cervical spine involvement even if it is not the only cause. This includes all types of migraines, sinus pains and hormonal headaches. This may surprise many people but if you consider that head pain can be a result of accumulation of factors of which some are easier to alter than others it makes sense to work on the ones we can do something about. The upper cervical spine can be treated effectively using subtle muscle balancing techniques, a very safe and easilly controlled method. Even if the headache is believed to be stress related, hormonal etc. once the upper cervical spine is freed the other factors may not build up into full blown headaches. One of the great things about this approach is that it is usually clear on the initial assessment if it is the type of headache which can be helped by physical methods.
Q: I have been told my migraines are triggered by dilating blood vessels to my brain as a reaction to my hormonal changes. How can treating the neck affect this?
Recent research on blood velocity around the brain has shown that the dilatation associated with migraines is more of a result of the biochemical imbalance rather than a cause. This imbalance can be brought on by a number of factors which could include a reaction to changing hormones but also often includes irritation from the nerves which have a direct connection with the upper cervical joints. Reducing this neural irritation by balancing the neck joints gives more scope for hormonal fluctuations without leading to head pain.
Q: I have heard acupuncture is good for migraines. How can needles affect headaches?
There has been more research in recent years into acupuncture than any other single modality in physiotherapy. This is one of the reasons why the NICE guidelines recommend consideration of acupuncture for migraines. We now know that acupuncture tends to increase 'feel good' hormones such as endorphins and this is now considered one of the mechanisms in reducing pain levels. Also acupuncture directly into muscles tends to release tension so, if a muscle which passes over the upper cervical spine is needled, it can relieve stress on these joints. For some people acupuncture is extremely effective but not everyone! This is similar to the way some types of medication work better for some people than others and is somehow connected with our genetic make-up but not fully understood yet. People who do respond well to acupuncture often report a sense of well-being and good night’s sleep after a treatment.
Q: Could you treat my next hangover headache?
No. The cause of the toxin overload would need to be sorted first.
Q: How many treatments will it take to cure my headaches?
One of the best aspects of Dean’s approach is that an accurate assessment can usually reproduce the familiar headache pattern which gives a good prediction of the effectiveness of the treatments on the first visit. The average headache may benefit most from three treatments in two weeks then gradually spaced out to a total of about six. Each one is different and some may need a ‘top up’ every six months.
Q: How does medication affect the treatments?
I always advise patients to make sure they understand how to manage their medication from discussions with their GP or pharmacist. I will record levels of medication taken and advise on not cutting out regular medication too quickly if suddenly feeling a lot better after a treatment. Usually people know how to reduce analgesics naturally as the pain levels drop.
Q: I have been told I have tension-type headaches but how do I learn to relax?
The tension in neck muscles is thought by some to be a result rather than a cause of the headache. I find the whole treatment package tends to reduce them both.
Q: Would improving my posture help?
This is a fascinating area of debate. Generally 'yes' but someone with lots of pain and tension often finds good postures very difficult. The challenge is to find ways around problems which vary from person to person.
Q: Can I expect improvements at my age?
We all know tissues take longer to heal, there is more of a history of things going wrong and generally more arthritis as we age BUT...........trials have been done which show that, if people exercise as they age, the 'downhill slope' is much shallower and can have 'uphill bits' if managed well. Older people often have more time to find suitable exercises and more wisdom to do jobs mindfully. People who age fastest are the ones who: 1. Do not exercise 2. Drink too much alcohol 3. Smoke 4. Have an unsuitable diet 5. Are over stressed or depressed. So, if we want to make the best of our precious human lives, it is often recognising what we can and and what we cannot change. PhysioFettle aims to help you with this.