Are Scans Actually Making Your Pain Worse | Old School vs New School

Are Scans Actually making Making Your Pain Worse | Old School vs New School

Welcome to old school versus New School. It’s a physio podcast that we’ve put together with me, John, and me Sophie. So we’re physios with different, at different ends of our career, me with them. 30 years plus I’ve been speaking speaking and treating patients, and obviously Sophie being new grad, a really qualified apprentice, a slightly different route into the physio world, which we’ll talk about at some stage.

It’s a really good route to, to get into physio and so we wanted to discuss. And share really, like what I know and how I learned, and obviously how I’ve been able to share that with Sophie. And Sophie in her way has been able to teach me more of how the modern the younger people.

Tend to think. Yeah. So coming back and being checked, trained by John from university, there was lots of new ideas. I was thrown into the mix and into the clinic itself. So we’ve reflected on that. Now I’m qualified and wanna share that with you guys. So here we go. Here we go. So where do we go from here?

So what would we like to discuss? I think probably the difference in language that you were taught versus what I came back with. Yeah. How would you describe that? So we were taught very much so at university that people weren’t wearing out, they weren’t brittle, they weren’t crumbling. It wasn’t just. A thing that happens naturally, there is something we can do to avoid it.

And a scan is not always the right thing to move the right thing to do. And that’s a big concept, isn’t it? Within the clinic, a lot of people will come and see us and say, I want to scan for this and I want to scan for that. And knowing and having a physical picture can be of use hundred percent.

But sometimes a, it’s not the best. Best route, and B, it doesn’t always give us the best information. It’s having a scan for the right reasons, really a hundred percent. I think sometimes we can lean on it a little bit too much. Yeah. We know our clinical signs, we know what we can do physio wise, and that was a very large proportion of what was taught at uni.

You don’t just throw a scanner, everything. So coming back into clinic and we will say a private clinic, so it is slightly different. When scans are something we do lean on sometimes. It was interesting the conversations me and John were having regarding it. Yeah. And of course the, there’s a couple of kind of almost like caveats really with a scan.

Because a scan is only as good as the scanner that’s producing the scam. ’cause it’s like a, what’s a good camera and what’s not such a good camera? They’re not bad cameras, but they’re cameras. None the, nonetheless. But they’re different. It was some years before I realized that.

And then of course, the expert who’s reading it we’re not experts at reading scans. So you need an expert who reads scans all day who can then give us an interpretation. ’cause that’s what it is. It’s a. Interpretation of different shades of gray, white and black really, isn’t it? And then on our aspect, it’s their interpretation of a picture.

But we’ve got the patient in front of us with the symptoms, and then you marry the whole thing up a hundred percent. And we’ve had people, and there’s research that shows. You get a scan, it shows degeneration. Doesn’t always mean pain, goes along with it. And that’s not always what we are looking for. So a symptom led decision is where we wanna go with things.

And I think that’s a really important point, isn’t it? So that just because something might appear on a scan. Doesn’t mean arthritis, doesn’t mean that it’s a problem. Let’s be honest, there’ll be arthritis in my joints at the age of 50 something that, and there’ll probably be some signs of arthritis in soap in their twenties, but it doesn’t mean that it’s a problem per se. It’s marrying the whole thing up and the language also that we get. We see in the scan reports moderate, mild, severe. What does that actually mean for the patient? If they said that, I don’t know. My wrist had moderate arthritis, but I have no symptoms.

Fantastic. Yeah. Built up enough strength that, that you can cope and it’s not symptomatic, but that might send a patient’s. Into a spiral, make them feel they’re breakable, et cetera, et cetera, which is not what we’re trying to promote with physio anyway. And that’s where, I think back in the day.

We’d get the scans, we’d get the x-rays and the terminology would be, oh, it’s worn out. Yeah, the joint’s worn out. Bone on bone. Bone on bone worn out, crumbling. We don’t use that. Now I’ve seen bone on bone scans, x-rays of, and and people who are absolutely fine. Yeah. And other people who haven’t got as such a bad bone on bone severe findings.

Yeah. And they’re in all sorts of pain and discomfort and I suppose that’s where our job comes in. Doesn’t it, to be able to determine what’s going on, like you say with the with the symptoms, but then work out how we can aid that patient whether they’ve got bone on bone. With no symptoms or bone on bone with loads of symptoms.

Yes. That’s where we, yeah. Yeah. And building that musculature around it is so important. And that’s what we are here for. We are not here just to read a scan and tell you’re worn out. That’s not productive in any way, shape, or form. And I think that’s the, where we’ve moved on really that actually.

Because the scan says that, it doesn’t mean there’s not stuff strengthening, like you say, that we can do to help it. Yeah. Yeah. And I think one of the biggest phrases I bought back from uni to you John, but it was new to me, is hurt doesn’t always necessarily equal harm. And that’s a massive line we play with rehab is it might be uncomfortable, shouldn’t be agony, but it is going to get you somewhere for strengthening the muscles.

And help your joint or help your back neck, whatever it is. So it’s interesting to see that we don’t just read a scan and go, yep. Bone on bone. That’s you hurt doesn’t equal harm if we’re getting you to move the joint and build all the muscle support around it. So I think that’s where we are quite lucky, especially again going back to my age, which I don’t really want to keep doing, but of course I’ve picked up a few injuries over the years there.

Various injuries, but all sorts of different reasons why, why wouldn’t I? But the good news, because I’ve got an understanding of what’s going on with my body, I can then relate that pain, which helps. For me to be able to relate to the patient. So when the guys, when the physios in the clinic do pick something up, it’s yes, it’s not great, but it’s good information.

Yeah, it’s good information for what you can feel and then what you can start pushing through because you’re absolutely right. So with the whole a little bit of discomfort when you’re doing exercise, when you’re being active that’s not always the end of the world. Like you said, we don’t want agony.

I’m not a big fan of the no pain, no gain thing. That’s probably taken too far the other way. Either way to the line. Yeah. Yeah. But actually we do need to stress the muscles to be able to build ’em. If you look at the. Again, we’ll really get boring and technical, which we try not to do here.

But actually, if you think about how muscle is going to increase it, it is effectively trying to just break it down in a controlled way to be able to build it up so that it can become stronger, yeah. So yeah, and that’s where we jump in with another boring little idea of the fear avoidance model.

So when people are told they’ve got bone on bone or they’ve got this joint issue. It becomes scary, so they do less. They move less. That muscle wastes the pain is more ’cause the joint’s not supported and then we get this nasty cycle. That’s where we are trying to jump in here and say, look, hurt doesn’t equal harm.

We need to push you a little bit to break that cycle. That will end up with your mobility being worse or your quality of life being worse. That’s why we encourage people to keep going and of course we’ve got the clinics, not littered, that’s not the right word. But we’ve got loads of patients that we’ve seen over the years of, all ages and at the latter end of their life cycle, if you like, who’ve stayed active all the life and are still fit and active and doing all those things.

And they’re the kind of people who look 10 years younger, 15 years younger, because they’re the ones that keep in active, because of course keeping active then is gonna help with all the other kind of things which aren’t particularly physio, but. But affect you, like your overall health.

Yeah, your overall health, like weight, the your lifestyle. It’s gonna affect those things. So hundred percent. And there there’s some really good slash scary stats about weight being such an important thing. Now, 30 years ago physiotherapists wouldn’t have dreamed of talking about a patient’s way.

However, it becomes more and more of a thing in your. Learnings, wasn’t it? Yeah, it’s massive, and especially with preparations for things, so like preparations for joint surgeries, replacements, et cetera. It is a massive. Number one, infection risk, honestly, I’m sorry, but also post-surgery rehab potential is more difficult ’cause there’s more load through the joint.

However, we tread that line carefully because we can’t expect you to try and shift weight when your knees and agony and you can’t do it sustainably with activity and diet. So it is a balance. There’s a real balance. It’s a real balance. We can’t just say, your knee hurts. Oh, go and lose some weight. That’s a massive cop out.

But it, it absolutely is for us as physios, but we wouldn’t have even there, there would be instances where we might, we’d be having a discussion around that. 30 years ago, we wouldn’t, no, we’d be going, oh, we with the physios we’re gonna do, or the surgeons. We’re gonna fix your knee without even taking that into account, without even recognizing it.

It’s a wraparound care now, isn’t it? Absolutely. We’re trying to go 360 instead of just, you’ve got a poorly knee call, let fix it. Book. Exactly. Let’s just go with your knee. There’s lots of other factors around it. Like I said, some stuff that we don’t want to get into but some stuff that, that really is I had a good expression.

It’s almost like a meal, isn’t it? You, your knee’s the main course, but we need to get some side dishes in there. Around it as well, the lifestyle like that, how much, ’cause it might be that you are doing a little bit too much if you’ve got a sore knee and that you are running every day and you’re making it sorer.

Yeah. That’s not gonna be great anyway. And we see plenty of people in the clinic who might then think, actually I’ve gotta keep going. I’ve gotta keep going. I’ve gotta keep going. I’ve gotta get it stronger. That’s again, when we come in and say, actually we’ve gotta modify that a little bit.

Yeah. We’ve gotta control. How strong we get it. And we can’t just overload it massively. It’s one of the things that probably the most frank conversations we have is the people that are doing too much, and we have to cap that expectation while keeping them strong. Yeah. It’s almost the other side of the calling.

It’s the real balance. And we’ll say this in the clinic it’s getting the balance right. We don’t need to do too much. We don’t need to do too little. And so it’s getting that balance right. And that’s what we do really, isn’t it? Yeah. It’s all a balance. And another thing about preventing people or slowing people down with activity, we understand it’s a massive mental health thing as well.

And that’s also a big conversation through my learning that John, perhaps 30 years ago when you were training, didn’t have at uni wouldn’t be, is the mental health aspect that. Your psyche your mental health massively impacts your recovery. So if we aren’t even considering that pulling you off your sport, which is also your social life, your sort of safety net and saying, just stay at home.

Do your exercises, don’t do anything else, we can’t expect you to make leaps and bounds in that. So again, balance is our favorite word, but balance with mental and physical health is also part of our job now, which I don’t think was as much It. I it. Where the time’s a dull. I don’t remember it being a conversation.

I do not remember it being a conversation. But like you say, if we, if somebody likes to go for their runs or their walks or their football or whatever, yeah. And we’re saying don’t do that. How good’s that gonna be to helping them get their recovery? It’s just absolutely not. No. So again, balance, that’s what we’ve gotta focus on always with you guys.

And you’ll probably find us using that word balance, which can get a little bit tedious when we have, we need some other words for it, but it is our main one so the reality is there’s lots of things, coming out all the time. I think one of the things that physiotherapists will be able to give you is the fact that we are able to look at the whole, and again, you hear that term quite a lot, don’t you?

Looking at the whole, because we do have a depth of training and depth of knowledge that other, people, other people might be able to apply an exercise or give you an exercise or tell it to do this or tell it to do. It’s actually us having that knowledge of and background as to why we might be doing that.

Yeah. And that’s where kind of physio really has been. And I think that was a big learning for me at the start of my career. Fresh outta school, coming in thinking, okay. Physios exercise. It’s. 5% of what physio is, it’s trust, it’s balance. It’s making sure people’s mental health, physical diet, sleep neutral, everything is balanced.

And that’s why it takes three years and a degree to train for it. But I think we can make it look easy, which is our job, but we have to consider so much of your life and everything around that. I think what you might not realize because why would you is how much our brains tend to be going.

You might hear silences in the, in, in the treatment room. Yeah. It’s ’cause our brains are going ’cause there’s so many considerations. We’ll all ask all sorts of questions, which might, depending on your answers, take us all down a particular path. But we have to consider those things a hundred percent.

That’s the thing. And I think that’s, again, if you think about the 30 years difference, it’s more and more of those are being taken on in, in the, the new. The new perspective of physiotherapy. Yeah, a hundred percent. So be because physiotherapists started, because they were physical trainers.

That’s how it all started. But it has moved on. Such a lot and a massive proportion of my degree was advice and education, which is where I’m quite blended with the manual therapies with learning from John. But the advice and the education now is. Probably more of the degree than the physical therapy is.

Yeah, absolutely. Which again, that communication with patients is the right questions, leading us around the right path is getting to get the right solution. Yeah, a hundred percent. A hundred percent. And us saying, no heavy lifting, but someone’s just had a baby and needs to put them down. You’ve got to be a human as well as a physio and a friend to the patients themselves.

So it’s. Advice and education, but considered Yeah. Advice and education With that, we go to that, that saying again, that with the whole Yeah. Patient, as a whole not just a poorly knee or a poorly ankle or Yeah. Or a poorly back, so there’s lots of different lots of different things that we’ve been able to learn from each other.

We use the phrase, and you will have heard it before, it’s not a new phrase. It’s all, every day is a school day, and it really is every day a school day. And every patient is a different perspective on. So people might come in with a bad back, but no two bad backs are the same.

There’s, there, there’s always different aspects with everybody. I think Sophie made the point about when she was started her degree, I still remember starting my degree thinking, I’ll know everything about physiotherapy by the time I’ve done my degree, and then get to the end of it thinking, crikey, I don’t know anything about physiotherapy.

Yeah. And that’s when the learning starts. I think that’s the other thing that the degree gives itself is the ability to question yourself. That problem solving and reflection. Yeah. Yeah. And I think that’s possibly the biggest takeaway, isn’t it? From the degree to be able, you’ve got the foundations and you know what to do with information you find, but it’s ever changing.

So you can’t know it all anyway. Even if you left uni until the day, knew all the evidence, the next day you wouldn’t. So it is ever changing and ever changing. And I suppose that’s the bit that keeps me going. ’cause I do love to see what keeps evolving. That’s quite interesting because a lot of stuff goes outta fashion and then when you’ve been around, it come, comes back into fashion if you like and thoughts and concepts come in and out, which is interesting.

Always interesting to me that, oh, okay, I’m, that, that’s some, yeah. Back to eyes or back to acupuncture or whatever it is. But I suppose that comes down to the fact that. There’s no right or wrong, that, there tends to be a good reason behind most of the stuff that we’ve done, especially if it’s appearing time and time again.

Like Sophie says, you can’t remember everything all the time, but actually these things do come round. So there’s been lots of things up there that we’ve picked up that actually brought back and brought back, brought together, but actually being able to develop new learnings as well.

We were looking boring sideline, but the outcome measures the other day in the team meeting. Outcome measures of how we can work out if you are getting better or not, like a tracking process. And I found 2021 and John goes, I’ve got one here from 2001. It’s the same thing, worded differently, so it shows again, I’ve got a shiny new paper.

Say, look, this is what I found and John’s gone. I’ve had this for years. So even if it seems new, we’re still using the same foundational principles. Absolutely. So there’s a brief introduction to our first podcast. It’s the new physio old school. Hopefully that has been of interest to you and we happy to see you again.