Let’s Talk About Health (Episode 2): Physiotherapist

[Music] hi there and welcome to let's talk about health i'm dr madeline mant and today we're speaking to ali sawyer who's going to tell us all about the life of a physiotherapist so welcome ali thank you so much for being here hi thank you for having me so ellie let's get right into it what is your job what is a physiotherapist so i think when most people think about physiotherapists they probably think about sports physio i get asked if i do massage most of the time so i can categorically say no that's not only what a physiotherapist does um it was perhaps the um the way that i thought about it prior to going to university and actually if you can think about any aspect of a hospital or any aspect within health there's probably a physio team there so a good example there are physios that do uh deal with neurology so if someone's had a stroke has got parkinson's they'll have a physio as part of their team to help you date them um of course there is msk physio which is part of my job i would say broadly speaking if we were talking about physio as a profession it's about looking after a person holistically and helping to rehabilitate them to live their best life so that would be in a nutshell i would say well that's super fascinating and so how do you how does one become a physical therapist how did you like what was your journey to this and kind of what sort of skills did you gather along the way so coming into physio i decided quite young that i wanted to be a physio and the reason it was was because i told my parents probably when i was a touch younger that i wanted to be the first female england football manager as one does um and and my parents as supportive as they were thought that was possibly not the career that i was gonna go down and i was very very much into sport um so i played football and i played a lot of sport at school as well and so rehabilitation side of things um seemed much more interesting to me and again particularly it was sport that got me into it i came very very close to applying to do fine art or history of art instead and so it was actually a conversation with my dad who said well you know you can do art as a hobby you know you can still enjoy doing art but actually it would be really good to have a career when you come out of university which actually i thought was really great advice um the slight problem was as i graduated in 2008 which is when we had a huge recession in the uk and there were no physio jobs so you know i was sort of thinking great thanks dad i could have been painting pictures for three years but you know here we are 12 years later and i'm still a physio so yeah that's gonna be good so in the end it seems to have worked out okay whichever kind of journey we like to hear about but i i've heard you use some of these words already but i'm really interested to hear a little bit about the language of physio so we talk in anthropology of health about how we use terms like health and illness and sickness and wellness and you know disease and that sort of thing so could you give us a sense of how some of that language is used in physiotherapy so in terms of health and illness so i would say within msk physio and in pelvic health physio i don't remember the last time i used the term illness which i mean again that probably says something about the areas of physio that i'm within because again if perhaps i was working within a more acute hospital environment that might be quite different but again i think that comes down to um how we treat patients and we're trying to treat them holistically and so i think that's for me that's what health is and that's how i would describe health to my patients so yes we want this to be moving better we want that um as i said are we getting enough sleep if we're not getting sleep our cortisol levels are going to be higher we know that causes inflammation or the experience of pain worse um are we exercising regularly and again not exercising necessarily from a weight perspective but actually a mental health perspective for that endorphin release um are we exercising to move our body to make it stronger um you know and getting all of those good health benefits and then having all of the the other things such as weight loss for example being a happy side effect of that and so i think that's where within physio um we've moved along quite a lot in terms of our view on health and looking much more as i said before from a biopsychosocial perspective so um not just honing in and being tunnel visioned on a knee or on a bank no i really like i'm really interested in talking about holism because that's a big anthropological thing is pulling the body and thinking about the body as an embodied experience and it's political it's social and it's physical it's all those things but i like hearing also about physiotherapy not only as like a reactionary thing of like you said i've hurt my knee and now i must focus upon it but um kind of the more the whole body look at movement that's a really powerful message and so thank you for bringing that to our students into this today because i think that's a great example of we can be defensive and offensive with the way in which we are thinking about maybe our movement for sure and i think um exactly as you said there actually you know we we should be looking at preventative care you know we shouldn't we shouldn't just be looking at reacting to a situation so can we um you know be as healthy as we can be whatever that may look like for that particular person who are we moving well are we sleeping well as i've said there and actually if we've got those things in place are we going to potentially prevent certain things from happening i would probably say so examples of the language that we perhaps have changed is looking at things like arthritis and the way that arthritis is described to a patient so for example we've we've always used the term wear and tear and actually again to certain people that can have a really negative connotation that their joint is wearing out and actually we know that arthritic changes they're normal you know that is just it's the normal aging process of the body and actually if we you know scanned and something i always say to my patients if i scanned 100 people of age 55 for example at least 50 of them would have arthritic changes and not even know about it and so i think that's where it becomes really important that a patient's knowing what is normal um but b being really conscious of the types of of language that we use around our patients because what we will often find is if they've got this negative connotation if they think for example my back is wearing out they become fearful and it's that fear then that stops them from moving so of course they become stiffer they become weaker so when they try to do something it hurts um and then it kind of perpetuates that um that notion they've got that movement is dangerous if we're supposed to move and we need to get moving um and our language can play a really big part in helping just disseminate some of those fears that that patients have so for example something like urinary urge incontinence certain types of incontinence um overactive bladder different types of pelvic pain um one of my specialities for example is is sexual pain so people who can't have sex because it's painful and a lot of these issues arise from habits that we've picked up from a young age and actually my big thing for this next year hopefully fingers crossed uh to sort of couple of years um is to look at getting better and sex education within schools that is looking around those habits and actually can we therefore a save money um for the for the government which ultimately that's what they're going to be interested in but also b save these you know save these people from having some really quite distressing symptoms down the line that if we put some good preventative care in place um you know we may not have had an issue with no that's fascinating i do think about when you said we don't talk to people about bowel movements like i think maybe during toilet training would have been the last time somebody specifically spoke to me about you know how are you doing how everything's feeling and that's you know it's intimate and it feels sort of private and all sort of things but as you say if somebody's having painful sex or is having to pee eleven times a day and it's you know they're not sure what's going on having somebody like you to be able to talk about it in a way that is like yes it's intimate and private but also it's normal and there's a chance actually not normal to have certain pains but normal to be able to speak about those areas and have it be safe i think the idea of sort of safe places has been a really important topic in these conversations i've been having with other specialists as well that we have to be able to talk about our bodies otherwise we'll never be able to move forward so when you're talking about female pelvic health how are you starting some of those conversations so i think it's and there's definitely been a challenge during covert for example because i'm doing all of my work on the majority of my work virtually at the moment so again starting those conversations online um is perhaps a little trickier i like to do a lot of my you know it's it's something intimate to talk about so i'm about to do a lot of my treatment face to face because i think you can you know you can get a better um rapport with the patient which is a really important part of it they need to trust you to be talking about something so intimate because i think of course if you're uncomfortable your patient's going to feel that they're going to feed off of that and again that's where language comes into it as well and and being able to talk about things and name them and actually so for some patients i think putting a name to something is so important because they they feel actually they can take ownership of it and there is hope for them to sort of move forward and that something can be done particularly within pelvic health we see a number of patients who have been around the houses you know they've been to various different specialties that perhaps necessarily picked something up not through any fault of their own but just because it's not their specialty and so we often see patients who've been you know two three four you know for someone with endometriosis for example 10 years plus um who end up coming to see us yeah and so i think that um building that rapport and being comfortable to talk about things that are delegate a delicate upon me is is probably the first thing i would say i personally will attack things pretty head-on because i think for me in this in in pelvic health line of work that's the only way to do it yeah and i think you start to learn from your patients what they're comfortable talking about so for example you might have someone initially who you gage isn't really all that comfortable and so you're going to start peppering things in you're going to build up to those confidence for example within pelvic health um sorry pardon me with our pelvic pain patients we have to talk about things like sexual abuse because of course that can have a huge influence on it now that might not be something i i um tackle as it were in the first conversation if i can see that they're being a little more reticent however if they're feeling a little bit more open and i can hear from their language that they are quite comfortable talking to me then that might be something that i tackle again i would say it's all very patient dependent and there isn't there isn't a right or a wrong it's just depending on how they're presenting to you at the time yeah no this is fascinating because as somebody who has never received physiotherapy in my mind kind of going into it there's a feeling of as we talked about before reactive medicine or treating something that's sort of gone wrong so the idea of this really important relationship building is something that i'm learning about right now that's really really important and the idea that there's so much trust involved because it is your body no matter what part of it we're talking about particularly as you're saying in the pelvic and genital regions these are regions that might have shame attached or somebody could just think of it being too private so i think that's a really powerful discussion of language is really important for not only the kind of biomedical side of things but also for us to consider potentially going in as a patient realizing that there's a that that trust should be built that rapport is important absolutely and i think particularly when it comes to so for example within pelvic health we have to do internal examinations you know and that you know simply just because it's you know we're looking predominantly at the pelvic floor um you know when we're assessing females uh obviously men have a pelvic floor as well so important still to do your exercises um but um you know when we're doing something like an internal examination that level of trust that needs to be there for a patient to feel comfortable particularly if they do have pain around the genital region as well and that's where i feel this sort of full explanation of what you're doing is so important because i've had a number of patients that have had poor experiences for example with something like a smear test because they weren't relaxed you know they they they are sometimes rushed in and rushed out a little bit you know again for various reasons approaching it with explaining what we're going to do and more importantly why we need to do it as well because i think if people understand why something is necessary actually even though it might not be the most comfortable of experiences they can get on board with it and they can see that it's important as part of their their um you know return to better to function or return to being more comfortable yeah no this is all super fascinating and so if somebody's watching this video and now they're convinced that physiotherapy is for them uh what advice would you give somebody who maybe wants to get into this field so i think i would definitely say going with an open mind i i certainly went in thinking sports sports is where i want to go and yes i have worked with in sports and i have worked within musculoskeletal medicine for a very long time but i think you'll be surprised in perhaps what you you enjoy that you didn't expect the pelvic health was a big one for me my first exposure of pelvic health was at university in one of my rotations and then it was something i always sort of touched based on and then had the opportunity to to sort of specialize in a bit more later on down the line which was great i think try and get as much experience as you can so even if that is going and volunteering at a hospital so you can do for example in the uk and you can become a health care assistant um and a lot of physios personally i actually didn't go down that route but a lot of physios will do some work in a hospital as an hca initially and even sometimes whilst they're doing their degree as well so actually just learning the way that a hospital works or the way an outpatient department works is really helpful because whilst at university they can teach you an awful lot they can teach you the bare bones intended of all of the um you know the anatomy they can teach you the neurology but actually until you start seeing people that's when you learn that's when you're getting your patient mileage that's when you start to recognize patterns of okay so this person responded in this way so maybe i will try that again another time because it's worked experience if you're if you're fortunate enough to be able to do so um my third thing and this is something that i feel really strongly about um is when you do graduate is going into an environment where you are going to be well supported so i'm straight into private practice simply because of the my my situation at the time and and the recession and there there weren't there just weren't any nhs jobs they'd put a freeze on them um what that then meant um is i wasn't hugely well supported in the environment i was in at the time now i can only of course speak to the the practice i was working in at the time and not for every single one but i certainly know a couple of my colleagues now who are in a similar environment and have reported the same thing so i would say when you graduate if you can go into your local hospitals in the uk we have a rotation scheme again i suspect it's probably not dissimilar in other countries the learning and the support you get there is invaluable you know i think that's that's that's that's a good route to go in and if you choose to perhaps decide to go down a different route later on fantastic not a problem at all but you've got that grounding you know how to deal with those patients you're seeing those different types of patients come through your door no that's really powerful that's really powerful i think it's so important to emphasize the idea that it always takes two with a patient to practitioner relationship and if the practitioner isn't supported or isn't well and during that wholeness and health that's also really important and it could it could have a negative effect on that relationship so i'm glad you brought that up i think that's really important to think about what does support mean what do you need as a practitioner how can you move through your through your career in a way that feels supportive and also feels like it's healing for you i would be remiss if i didn't recognize that it has been much tougher because we're all in a situation we've never been in before um but it has been so much more important to be looking after ourselves and i like i like hearing the idea that everybody has to be supportive of everybody to ensure that the system can continue to be supportive in a way that is meaningful absolutely thank you so much ali for helping us understand physiotherapy a little better i know i've learned a whole lot i'm sure the audience has too so thank you guys here and thank you so much to the audience for tuning in and we will see you all next time on let's talk about health [Music] you

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