When physiotherapy is more that just exercises

This week, Mental Health Awareness Week, the Mental Health Foundation is raising awareness of the positive effect of exercise and physical activity on mental well-being. Reading about this (it is really so much more than just endorphins!), I am beginning to realise that when the Chartered Society of Physiotherapy talks about "physiotherapy helps to restore function", it means more than the function of limbs, it means the function of me as a person, both mentally and physically.

I have been very fortunate to be seeing an excellent neuro-physiotherapist for the past nine months or so. I feel compelled to write about my time with her, our journey together, because I believe that out of all the healthcare professionals I have seen, her input and support has made the biggest difference.

I initially met the neuro-physios after one of my first big relapses. With very weak legs and no post-discharge support from the original hospital I had been admitted to, my GP arranged for an quick appointment with them to see if there was anything they could do. They gave me a pair of orthotics to support my walking. These simple bits of velcro and plastic that wrap around my ankles have enabled me to walk when I wouldn't have been able to, walk further on good days, and importantly, given me the confidence to get back on my feet (literally and metaphorically) earlier after each relapse - which has helped my rehabilitation no end.

After being inspired by the Paralympics, I was keen to get back on the water and go sailing, and reclaim one of the main aspects of my life that my illness had taken away. A neck-brace was needed for this (following medical advice), and I was referred back to the neuro-physiotherapist. She referred me on to the local Orthotist (see this blog post about it) for the neck-brace, but didn't just stop there. Unlike every other healthcare professional I had seen, she didn't just deal with the presenting issue, but saw me as a whole person with multiple long-term conditions and saw that there was greater potential in my body - something that everyone else had been blind to.

We began a learning journey together - learning about my body and how it reacts, learning about my conditions and what they mean, and learning about what I enjoy doing and what I can fit into my lifestyle. It was shared decision making in practice. I don't think it is any coincidence that of all the 'treatment/care plans' I have been put on, that this is the one I have adhered to most closely and been the most compliant!

So I filled in the weeks between our precious hour long appointments with exercises, stretches, pain and fatigue diaries, recording my heart rate and progressing towards my goals. I can not possibly mention "our hour long appointments" without stating just how rare that is among my other appointments - a squeezed 20 minutes where I feel I am clinging on for every extra minute with them, before being thrown out, questions still unanswered. Time is so precious when you are a patient, and my physio afforded me the absolute luxury of her time and attention. It gave us permission to explore the deeper issues and made our work together that much more successful. It gave her time to understand me.

Jardin des Plantes, Paris

I am writing this post having just spent a four day holiday in Paris, enjoying the sights. Although I am now paying the price with a big relapse (a price worth paying!), I don't think I would have had the stamina (or confidence) to do that if it hadn't been for the last few months of work with my physio. But this was a holiday in every sense of the word! A holiday from work, emails, the internet, and every-day life, but also a holiday from pilates/Alexander Technique/weights/exercise bike/stretching/heart rate monitor...
She understands the motivation needed to maintain all these self-management tasks each day and the fact I having to sustain this for ever. Recognising that, we discussed "exercise holidays" - far from a yoga retreat on a beach somewhere, these holidays are to not do any of these tasks for a few days and give my motivation the chance to refresh itself. Exercises were more that just a simple prescription to her . . . something that her patients had to somehow weave into their everyday lives. Acknowledging that, she appreciated the issue of motivation - a personal challenge for me, that I have written about before here.

The Chartered Society of Physiotherapy describes physiotherapy as:

"Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and wellbeing, which includes the patient’s general lifestyle. At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment."

That was what I had - I was empowered, and at the core of everything we learnt, discussed and planned. The idea of patients participation in their treatment is a founding principle I believe in, but is critical to physiotherapy, where the treatment frequently involves the patient fuelling whatever motivation they may have into activities and exercises.

The exercises have no doubt had benefits for my nervous system and muscles, but I have experienced first hand the positive impact it has also had on my well-being. Part of it is taking control and doing something to help myself, and part of it is just the endorphins, but either way, its a very good medicine! My physio has been just as important for my mental health as my counsellors!  

She gave me exercises to do, but she also gave me confidence, support, hope and a much needed psychological boost.