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Chronic Pain

Physiotherapy for chronic pain

People with pain are often referred to a physiotherapist more often in the early stages of their pain problem although sometimes later on.

Physiotherapists are specialists in human movement, who aim to help people keep active. They give advice and instruction on exercises to mobilise joints, strengthen supporting muscles, regain and maintain fitness and other techniques for managing pain (see also 'Learning about pain management').

Some provide a number of different physical therapies (see also 'Physical therapies') including manipulations, mobilisations, massage, electrical stimulation (TENS), acupuncture, heat and cold treatment and ultra sound. These are usually given in combination with exercise and are used to reduce pain so people can get mobile again.

Usually people attended NHS physiotherapy once a week for a set period, typically six to ten weeks. A few people attended longer, more intensive physiotherapy but this was unusual. People who had suffered an injury or undergone surgery were often referred to a physiotherapist as part of their rehabilitation. The main purpose of this was to get them moving and set goals for their recovery. At physiotherapy people were often given exercises and sometimes used equipment in a special gym.

People who felt that they had benefited from physiotherapy were pleased to have been referred to a knowledgeable professional who understood their pain and could advise them on exercises and practical changes that made a real difference to their daily lives.

Some said their physiotherapists were wonderful, looked forward to their appointments and felt bereft when they stopped. Many found the advice about exercise helpful although in retrospect some felt they could have done with more advice and to have learnt earlier about the benefit of pacing their exercise (see also 'Pain management: pacing and goal setting').

Those who were less impressed with NHS physiotherapy said that the physiotherapist had not listened to them or seemed not to understand their pain, or that the exercises they were given were too painful. One commented that standard physiotherapy only treated the painful area and did not look at the whole body.

One person felt her physiotherapist hadn't listened to her when she discovered that she'd referred her to a surgeon with a note saying she was keen on surgery when she definitely was not. Some were annoyed at the sporty demeanour of physiotherapists who wore tracksuits and shorts or commented that it was difficult to take advice from a fit healthy person when your mobility was so impaired.

One person who was self-motivated to exercise did not see the point in traipsing back and forth to the hospital and stopped attending appointments.

Several people had been repeatedly referred for physiotherapy but experienced little long-term benefit, which they had found frustrating. Nowadays it is more common for people to attend physiotherapy for a limited number of sessions and if there is no improvement it may be necessary to refer them to another specialist. Some people found this upsetting as it could feel like they were being 'given up on', and some continued to have private physiotherapy or went to complementary therapists instead.

Some had been referred to more specialist physiotherapy including intensive rehabilitation, back pain exercise classes and hydrotherapy - guided exercises in heated water. A woman found the back class very helpful and said she was able to continue the exercises after at a local gym.

 

Found back exercise classes very helpful and has been able to continue with the exercise at the gym.

Found back exercise classes very helpful and has been able to continue with the exercise at the gym.

Age at interview: 38
Sex: Female
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Tell me a little bit about the physiotherapy?

What happened there?

Well, when I went to the physiotherapy, initially when I first did my back, they did, as I said to you, they didn't do anything, I went to see my osteopath. But as time's gone on, it has got worse and I had been to the hospital, back to the GP sorry, and they referred me for physiotherapy and they sent me, as I say, to this back class and, I think it was about 6 or 7 weeks.  

And you basically, there was about 15 different exercises and you were timed on each one for about 2 minutes. And there were things like, on a bike, you sat on a bike and you just pedaled the bike. You had, there was a trampoline, there was very small weights that you sort of lifted to your shoulder and above your head and back down again and it was, it was a very relaxed atmosphere you know. It wasn't a race or anything.  

There was a set of steps that you had to walk up to and then down to and back up to and back down to again, which is quite hard work actually, you don't realise. And that, and I did that, it took roughly an hour a week that I did that for. And what they were trying to do was to get to my inner muscles in my back, the ones that you can't actually feel, to strengthen those muscles and I do have a list of exercises that I brought away with me that, when I go to the gym, I do try and do, certainly some of them. I do a lot, quite a bit of cycling anyway, well try to, time permitting, to help anyway. 

So, I mean I do go to a gym. People say 'You've got a bad back, how can you go to a gym?' Certain things I don't do. I don't run and I don't go on the rower, rowing machine, and things like that. But there are' My philosophy is that if it's hurting then I'll stop doing it or I avoid doing it in the first place. But there are quite a lot of exercises that I can do that a) help obviously keep fit but also does help my back as well. So I do as much as I can to try and help myself as well.  

A man who had been to hydrotherapy found it very good but commented that it was difficult to get referred to and he only had six sessions. Others felt the same way and whilst some found that they could do the exercises in a normal swimming pool others found it difficult to get to a pool or felt that they were too busy (see also 'Exercise and activity').

 

Attended hydrotherapy which he found very helpful because water supports your body weight and...

Attended hydrotherapy which he found very helpful because water supports your body weight and...

Age at interview: 56
Sex: Male
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Well again that all comes into movement, like gentle exercise and if you do it in the water, and if you can get a spell with the physio in the hydro baths at the hospital. Its like walking into a bath, you can have maybe 3 or 4 people in at a time. 

With physio the water is up to your shoulders, depending on your height, and you're in there and its roughly like bath temperature, you go in there in your trunks or your shorts whatever and you do your exercising in the water so that's taking a lot of your body weight, so then your movement and exercise is easier. 

You can use the water to your advantage by moving it and bringing it towards you, you can bend your back and your knees, its actually wonderful, unfortunately there is not that many so you only get a short period of time, you get about 6 lessons, its not everybody that can get in, you've really got to need to go in it. 

But again you can do a lot of that in the ordinary baths, if you can go in and out of swimming baths, you can do a lot of the exercises yourself, and it becomes quite enjoyable, because its gentle movement rather than an exercise, but its too easy to overdo it and then you come out and you're sore, so if you can get that experience on the water then you can do a lot of that for yourself because I was doing it for myself but I find it very hard to get in and out myself, I don't know how they could help you out, if I went to one in [Name of home town] again so I haven't got that far yet. But it works for you.

Others had been referred to Pain Management Programmes, which included exercise sessions usually run by a physiotherapist (see also 'NHS Pain Management Programmes').

Last reviewed August 2018.

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