Almost everyone will experience some kind of injury at some time, whether it is due to tripping or falling, overuse, a degenerative condition or a sports injury. The important thing is to ensure that the condition is diagnosed correctly by a health professional so that suitable treatment can commence and further problems avoided.
Who to See for Your Injury
Whether you go to see a doctor or a physiotherapist about your injury depends on various factors. Naturally a severe injury needs the attention of an emergency doctor without delay, but for many injuries, visiting your GP or a physiotherapist can be the best choice. Which you choose can be a matter of personal preference, since both are able to diagnose your injury and organise treatment. Traditionally, a doctor would be the first port of call, but all too often a GP will refer a patient with an injury directly to a physiotherapist without a formal diagnosis. In the case of sports injuries, your GP is likely to refer you to a Sports Physician or a Sports Physiotherapist for further diagnosis and treatment.
Both physiotherapists and doctors are able to diagnose your injury. Like doctors, physiotherapists are “first contact” practitioners so they do not need a referral from a doctor in order to examine, diagnose and treat injuries. In effect, it is unimportant as to who carries out the diagnosis provided that it is made and you are clearly informed with regard to the diagnosis.
Both GPs and physiotherapists can request scans to aid with diagnosis, but a physiotherapist may send you to your GP to be referred for a scan as they can be quite costly and there may also be a radiation dosage from them.
Some injuries simply need a period of rest and the management of inflammation to heal, and these are known as self-limiting conditions. A physiotherapist will sometimes also recommend the use of an appropriate orthosis such as a brace or special support in order to protect and support the affected area whilst it heals.
Osteoarthritis and other degenerative conditions are caused by wear and tear and usually worsen over time. Although they cannot really be treated, they can be managed in various ways to minimise pain and disability.
Injuries to ligaments can occur through sport activity or falls. There are three grades of ligament damage that require different types of treatment. Grade 1 damage should be a self-limiting condition but grade 2 damage needs physiotherapy to restore full function and movement. A serious tear or rupture, known as a grade 3, will usually need surgery to repair or replace the ligament.
Treatment or management of your injury also depends upon the specific injury, and both your GP and physiotherapist can share input into this. In the case of musculoskeletal injuries, the physiotherapist will often possess a more extensive set of skills and is able to offer “hands on” treatment. However, your physiotherapist is unable to prescribe medication such as anti-inflammatory drugs, so if these are required they will refer you to a doctor.
Exercise is the key to recovery from many injuries, and your physiotherapist will be able to prescribe and demonstrate appropriate exercises to help with your rehabilitation. The exercises will help you to improve movement by addressing muscular imbalances and strengthening specific muscles, which in turn reduces pain. Exercise is also important following recovery, to ensure you remain healthy. Unlike physiotherapists, GPs rarely prescribe exercises and will usually refer you to a physiotherapist for specialist exercises.
Hands-on manual therapy for injuries is a form of treatment that physiotherapists rather than doctors are trained to administer. It can involve massage, stretching and strengthening exercises which re-educate the muscles and joints so that proper mechanics and movements are re-established.
Ice can be very important in treating injuries that involve swelling and inflammation. Because the application of ice can constrict blood vessels, it can reduce inflammation and swelling and leave joints more mobile so that manual therapy becomes easier to perform.
Injuries that involve muscular spasms or tightness can often benefit from the application of heat. Again, this is something that will be covered by your physiotherapist in order to increase mobility and reduce pain in the kind of soft tissue injuries that involve tendon, muscles and ligaments. Heat can make these soft tissues more pliable so that the physiotherapist is able to stretch the affected area.
In this form of therapy, sound waves which are undetectable to humans are used to generate heat in the deep body tissues in order to loosen them up prior to manual therapy. Sound waves are applied to the skin by a wand and are thought to increase the speed of healing in ligaments.
Connective tissue and muscular injuries often respond well to low level laser therapy. Specific light wavelengths are used to stimulate healing. It can help in the reduction of muscle fatigue, pain and inflammation as well as allowing the physiotherapist to move the joint more easily and with less discomfort to the patient.
In the case of disc herniation, traction can be used to separate the vertebrae, so that the disc cartilage is less compressed and more space for the nerves is allowed. It can reduce the pain caused by a herniated lumbar disc without surgery.
Transcutaneous electrical nerve stimulation can reduce pain from sports injuries and other injuries by using a mild electric current. Electrode pads are attached to the skin and connected to a small battery-operated machine that delivers electric impulses to the area. These reduce pain signals to the brain and the spinal cord, relaxing muscles and relieving pain. The signals can also stimulate the production of endorphins.
The electrical signals are felt only as a minor tingling sensation, and the treatment is generally a very safe way of reducing pain in some people. Your physiotherapist can sometimes lend you a TENS machine for treatment. This treatment is not a cure, but can relieve pain in some conditions for some people.
Whether your first port of call with your injury is your GP or a physiotherapist, in many cases they will work together for the well-being of their patients. GPs will often refer patients with injuries to a physiotherapist for treatment when this is indicated, and physiotherapists will refer to a doctor when medication, injections or scans are needed.
For many sports injuries, it will be quicker to see a physiotherapist directly rather than going to your GP as a referral to a physiotherapist can sometimes mean having to wait until an appointment is available. In some areas self-referral to physiotherapy services is available on the NHS, but in other areas you will have to go through your GP.
If you want faster treatment it may be advisable to go to a private physiotherapist. In this case you should check that they are chartered and have MCSP after their name. You can check that your chosen physiotherapist is registered with the HCPC (Health and Care Professional Council) online at www.hcpc-uk.org.