Shake N’ Bake Physio
The rest of my family tried to hide their surprise when I told them that I wanted to be a physiotherapist. They are, and have always been, incredibly supportive, but even I could see their hesitation. Both my father and my grandfather had very poor experiences going to physiotherapy, and it must have been hard for them to understand why I would want to become a physiotherapist.
My dad developed a severe herniation in his L5-S1 disc while lifting some heavy equipment for work. I remember how he grimaced as he moved, and that he had to lay face-down in bed to relieve the pain. In an effort to avoid surgery, he went to a physiotherapist for help. He didn’t have any benefits at the time, so he paid for everything out of his pocket, and unfortunately, he was given very poor care. His therapist performed aggressive joint manipulations and deep tissue massages that increased his pain, and attached him to machines that did nothing to help. His condition actually worsened after a few sessions, and he eventually underwent a discectomy. Needless to say, he didn’t have a great opinion of physiotherapy.
My grandfather’s experience was similar. His doctor recommended that he go to physiotherapy to help with his shoulder pain, but his treatments consisted of some painful massage, time on the TENS machine, and a generic list of exercises that never helped despite the fact that he did them daily. His therapist insisted that they just needed to trust the process and that it would work eventually, so my grandfather continued attending his weekly appointments for almost two months before giving up. He joked that his physio was nothing more than a “soba hombros”— a “shoulder rubber.”
We have a term for this kind of physio: shake n’ bake. You get some “shake” in the form of massage and manipulation, and you get some “bake” in the form of electric modalities. I want to make it clear that I’m not against manual therapy or therapeutic modalities as they can certainly be helpful in the right contexts, but it’s no secret that they are widely misused by therapists who are either too busy or too lazy to provide personalized and evidence-based treatments for their patients.
If you’ve read the About page of this site, you’ll know that physiotherapy didn’t help me with my sciatica either, and that what ultimately helped me was a random Youtube video that challenged what I knew about the body and encouraged me to explore movement in a different way. In the end, this was what actually inspired me to become a physical therapist because I saw it as an example of what physiotherapy should be.
If your perception of physical therapy has been tainted by a shake n’ bake therapist, I’m sorry. Part of going to a healthcare provider is that you can’t know what kind of approach your therapist is going to have, and unfortunately it can be hard for most people to know whether their therapist is adhering to best practices. To help clear things up, your physiotherapist absolutely should:
Take the time to fully understand your symptoms
Know your past medical history
Perform a thorough physical assessment
Clearly explain what they think the problem is
Develop a plan to solve the problem
Answer your questions
Provide you with a movement program that follows their plan
There is absolutely a time and place for manual therapy and therapeutic modalities, but your therapist should be able to clearly explain how those therapies fit into your therapeutic plan. There are very few, if any, contexts where passive treatments are the primary approach. In the vast majority of cases, your treatment should primarily consist of movement as the “medicine”, with passive treatments only being used insofar as they support your ability to move.
And yes, my family is fully and entirely supportive of my work as a physiotherapist. I think it’s cathartic, in a way, for them to see me living out my passion and standing against the kind of poor care that they received. I hope I can continue to make them proud.