Injury treatment: Who to see to get help with injuries
So you have a problem…who should you go and see to get help? Well obviously that depends on the problem you have. Working out who to see for injury treatment can be difficult. There are just so many different practitioners and well established disciplines out there.
I am often asked by my clients questions such as “What’s the difference between a Chiropractor and a Osteopath?”. To which I often answer “About $7-$15 per session around here!”.
The purpose of this article is to loosely explain a little about each discipline so you can make the appropriate decision on who to see.
This list is not exhaustive as I am only going to reference the particular practices that I have experience with. I will also provide you with some tips on how you can choose the right practitioner for ‘you’.
The most important thing is, if you hurt go and see somebody. Don’t try to hero it out! Even if they can’t help you they may at the very least be able to point you towards someone who can.
First call: Your Doctor
Your doctor should always be your first point of call. They may not have the specialist knowledge to be able to help you directly but they can rule out some of the more sinister illnesses that could be causing your problem. They should at the very least be able to either refer you to someone who can help you.
In my part of the world doctors generally prescribe rest, anti-inflammatory medications and a ‘Come back and see me in a week if you’re not better” approach to injury treatment.
To be fair, this can often be all it takes to get over some problems. If however you are not back to normal in a week either go back and see them for more help/advice or approach one of the following manual therapists.
Don’t leave it any longer than a week as problems can often ‘bed in to stay’ which can make them harder to correct later on.
Therapists who provide diagnosis & treatment.
Before I am attacked for misrepresenting a particular method of practise or being biased, I would like to point out that I am not a chiropractor, physical therapist or Osteopath. The information below is based on my own personal experiences with the following professions (Very touchy some of these manual therapists when you compare them!).
It’s also important to point out that there are differences between qualification, certification, regulation, approach and even title dependant on what part of the world you are in. There can even be differences between practitioners of the same discipline in the same country. It just depends on where the Therapist was taught and their particular area of specialization.
I recommend that you check this out yourself before finding out that the person you have chosen to treat you qualified at the Mickey Mouse school of therapy. For a more thorough explanation check Wikipedia for regional variations.
I personally believe there is no magic specialism that cures all ills. There are just individuals who are passionate and generally obsessed with their work (you know, the people who you are warned to stay away from at parties). These are the people you want to see if you can!
As physical therapy has been around for a very long time and is so well established there are many different specializations. The disciplines that are probably most relevant to injury treatment are; Neuromuscular (nerves & muscles), Musculoskeletal (muscles & bones), Sports, Neurological (nerve problems) and possibly even Geriatric.
Qualification varies from state to state and country to country but all therapists have at least a Bachelor’s degree at the very minimum. In most parts of the world, therapists will also have had to undertake training for several years in a clinical setting.
Personally, I would describe Physiotherapy as a science based health care profession as it is used more often in hospitals than the other manual therapies listed here. Therapists are also found in private practices.
Primarily, Physical Therapists work on assessing and restoring normal bodily movement and the function of muscles, joints, limbs and sometimes nerves. The techniques employed to accomplish this include (but are not limited too); massage, joint manipulation, ultrasound, lifestyle evaluation, electrotherapy, exercise and stretching.
I recommend going to see a Physical Therapist if you have a muscular problem as opposed to a joint problem.
Chiropractic is a complementary and alternative medicine primarily concerned with assessing and correcting disorders through treatment of the spine using manipulative manual therapy.
It was founded in 1895 by magnetic healer (Don’t ask!) David Daniel Palmer in Iowa USA. Chiropractic is very similar to Osteopathy is many ways but in simple terms Chiropractors specialise more in bad backs and disorders that may emanate from the back.
Like Physiotherapists, Chiropractors will hold a degree at the very minimum. Again, qualifications vary from place to place but generally Chiropractors will have trained for a minimum of 5 years before being licensed to practise. Chiropractors in some areas work in hospitals, but generally they operate in private practices.
Note: Chiropractors are far more integrated into traditional health care in Europe than they are in the US.
The main thing people think of when you say the word chiropractor is being ‘clicked’ and yes, this is a big part of the treatment they employ. However, most of the Chiropractors I have known also do a fair amount of soft tissue work (i.e. massage) and are very holistic in their approach.
Chiropractors are probably the best people to see if you have a problem with your back that is being caused by a misalignment or a lack of mobility.
Like Chiropractic, Osteopathy is a complementary and alternative medicine. Osteopathy varies regionally more than any other of the aforementioned manual therapies. In the US it can be split roughly in to two branches. ‘Osteopathic physicians’ (Hold a doctorate, can prescribe medicines and perform surgery; more science based than normal Osteopaths, in my opinion) and practitioners of ‘osteopathic medicine’.
The level of education required to become a practicing Osteopath varies enormously dependant on where you are in the world. It ranges from certification (sometimes from online study) to doctorate. In the US and UK, the level of education required is very well-regulated, in other parts of the world it’s a bit more sketchy! Personally I would check the qualifications out prior to going to see someone if you’re in doubt.
Osteopathy was founded slightly before chiropractic in 1874 by Andrew Taylor Still a surgeon and physician who lived is Baldwin city US. In fact, A. T. Still & D.D. Palmer (see chiropractor) actually knew each other ( I don’t think they got on with each other too well though!).
Osteopathy is probably the more holistic of the approaches I have detailed here. Like Chiropractors Osteopaths employ manipulative manual therapy techniques to adjust joints. As mentioned before, Chiropractors tend to concentrate on the spine. Osteopaths however work on all joints of the body and also place emphasis on the nerves and fluids.
In my opinion you should consider seeing an Osteopath if you have a problem with a joint other than the spine. A chiropractor is usually the best bet for backs.
In the UK the terms Chiropodist is used to describe someone who works in more routine foot care (corns, nail problems etc). A Podiatrists (in the UK) tends to specialize in assessing and correcting biomechanical problems of the foot and lower limb. It’s important to point out that even in the UK, these terms are becoming more synonymous. In the rest of the world, there is not a lot of difference between the titles. Chiropodist was the original title but since the 1950’s the term Podiatrist has become more commonly used.
Again, I’m going to concentrate more on the type of Podiatrist that most people are likely to visit. As qualifications vary greatly I am not going to list them here. If it matters to you, research the person you are going to see before arriving at their practice.
Podiatrists assess, diagnose and treat abnormalities and diseases of the foot and lower limb. The techniques employed to accomplish this include (but are not limited too) massage, joint manipulation, biomechanical screening, gait analysis & the fitting of orthotics (shoe inserts, often made specifically for the individual).
I recommend going to see a Podiatrist if your suffering foot or ankle problems. You may also want to consider seeing one if you are told by another therapist that you have a structural abnormality such as a leg length discrepancy.
Other complimentary treatments
It’s important to point out that the following are not qualified to diagnose a medical problem in most parts of the world. On rare occasions though you do get people who are multi-disciplined for example, a Masseuse who is also a Physical Therapist but it’s pretty rare (dry needling may be an exception).
None of the complimentary therapists listed below should be your first port of call. Go to your doctor, then one of the therapists above if required. You can always ask the therapist if they think any of the following treatments could be beneficial.
There are many different types of massage but I’m going to reference the two most relevant ones in relation to injury treatment. Traditional massage works on relaxing the body through gentle palpation and manipulation of soft tissues. This type of massage generally makes people feel a little better for a while but has very little long-term effect when it comes to injuries or pain.
Sports massage is more of a injury treatment technique. It is a lot more specific and concentrates on locating and treating areas of pain or dysfunction. As mentioned above, a practitioner of sports massage cannot diagnose a problem themselves. They can however, find a problem through touch and work on it.
Masseur’s (male) & Masseuse’s (female) often work hand in hand with Therapists in private practices. This offers a distinct advantage as a therapist can guide a Masseuse/Masseur to areas of the body that require work to help restore proper function. Conversely, a Masseuses/Masseur can feedback to a manual therapist to let them know about problems areas that the therapist might not have been aware of.
Massage is a useful tool, and can sometimes fix problems outright. This does however, entirely depend on the nature of the problem.
If a therapist tells you that you have a short/tight/stiff muscle then massage treatment is, in my opinion, a must. I personally find massage works best when it is incorporated in to an exercise program. Identifying the cause/source of the problem is still paramount though as without correcting the lifestyle factors a problem usually returns.
Acupuncture uses a collection of different treatments to stimulate points on the body known as meridians. Typically this involves the use of needles that are inserted shallowly into the skin (sometimes electrical stimulation is used). It’s an important component of traditional Chinese medicine as has been in use since at least 1600AD (it may have actually been practiced back as early as the stone age).
My personal experience of this treatment is quite limited. I have had around eight clients over the past 10 years who have been treated by Acupuncturists for a wide variety of problems. Four of my clients said that their pain symptoms were reduced for a short period of time following treatment but returned later. The other four said they got nothing from it at all. This seems to be in keeping with most of what I have read on the subject.
Dry needling (often carried out by some Physical Therapists) is similar to acupuncture in that it targets key areas of the body. The difference between the two is the areas targeted. Acupuncturists target meridians to correct the flow and balance of qi (not a physical substance in case you were wondering) whereas Dry Needing targets trigger points (painful knots within muscles/often worked on by massage therapists too).
Like acupuncture there is no solid evidence that dry needling has any real benefit at all (none that I have managed to find anyway).
Personally, I believe Acupuncture or Dry needing may be beneficial to some people for temporarily reducing pain (I don’t believe it is all placebo). Pain is a symptom of a problem though and not the cause. I don’t believe that Acupuncture or Dry Needling really addresses the problems, they just may treat one of the symptoms. Admittedly if eliminating the pain helps you address the problem then that’s great!
Often when a client tells me that a Therapist has suggested Dry Needling or Acupuncture I tend to think it’s because the Therapist has run out of ideas. To be fair to the Therapists, if there is a chance it may work why not give it a shot?
If credible information or studies come to light which prove that these treatments are beneficial I will happily modify my opinion. Until then, to each their own!
How to choose who to see for injury treatment:
Here are a few tips on choosing the right Therapist for you!
Recommendations are great but always question the recommendation!
Recommendations are without a doubt the best way to find yourself a good therapist. I personally think that you need to question the objectivity of the person making the recommendation though before you go to see someone. This may sound a little harsh but consider the following:
You may have come across this scenario yourself at some point. Someone walks in to the office and winces before explaining that they have hurt their backs. Instantly several people pipe up with recommendations on who they should see and where they should go.
Comments such as “You should go and see ………….. my friend went to see them and they sorted them out straight away” or ” Go and see my chiropractor they are great! I have been seeing them for years and they always help me.”. People make these suggestions because they want to help and there is nothing wrong with this.
If someone recommends someone to you, question the recommendation and ask the person making the recommendation questions.
Did the person who was treated have a similar problem to me?
If they didn’t have a problem with their back and you do then the recommendation isn’t really that relevant to your problem.
Is the therapist the right person to see for my specific problem?
For example a Chiropractor probably isn’t the best person to go to if you are suffering with shoulder pain. Yes the Chiropractor may work on shoulders as well as backs but I will bet you can probably find a local physical therapist that works on shoulders all day long.
Is the therapist just managing pain?
This is something I come across all the time. The conversations usually goes something like this
“So they fixed you and you don’t have any problems at all anymore?” the person usually answers with something like this “Well….eh..no I still have problems but they stop me hurting when I go and see them.”.
People are incredibly loyal to people who have reduced their pain even if its only temporarily. If the person has been seeing someone for years a level of gratitude and trust will have been formed. This person simply stops them hurting, who wouldn’t be grateful?
Obviously, this person is then likely to recommend the therapist to others. Yes, getting rid of pain is a vital component. Remember though, pain is just symptom. If the pain keeps coming back then the real cause of the problem is probably not being addressed.
Don’t choose someone who is trying to sell you stuff!
This is something I am seeing more and more these days. My inbox and answer machine is filled every week with emails and messages from companies trying to get me to sell miracle cures to my clients to increase my revenue.
If you walk into a practice and someone tries to sell you magic Amazonian turd berries that will cure all your aches and pains and stop you aging, walk straight out. Don’t let people profit from your pain.
Obviously this is a personal decision, if you want to go and see ‘Miss Information’ (Thank you South Park!) that’s fine but be prepared to be in exactly the same position you were after the placebo effect has worn off!
Try to find a multi disciplined clinic
It stands to reason that if you have a group of professional from different disciplines working together, they will all learn from each other. This often means that they are more likely to think outside the box and be able to help patients with trickier problems.
Making sure your injury stays fixed
Sometimes the cause of an injury is obvious. If you fell down the stairs and landed on your shoulder, it’s pretty obvious what caused your injury.
Too often though, an injury seems to come out of nowhere. One day you are getting out of your car, then BAM, your back has gone and your in some serious pain. People hurt themselves just getting out of bed or while brushing their teeth. I hear these kind of stories all the time from my clients.
Your joints are designed to last a lifetime (100 years +). Therefore, if the cartilage in your knee has worn out you need to question why. It could be that something as simple as crossing your legs has caused all this wear and tear.
The same thing applies to your muscles. If you pull a muscle in your neck while you are spitting your tooth paste out then something is definitely wrong. Maybe your sleeping position has caused one of your neck muscles to shorten. Question, question, question!
When an injury just seems to come out the blue try to work out what could have caused it to happen in the first place. Ask the Therapist you are seeing what could have caused the injury. Search the internet and use this website to find possible causes.
You need to ask yourself this question:
Do you want to just get rid of the pain and keep your fingers crossed that it doesn’t come back or do you want it gone for ever?
The main purpose of this site is to help you identify what you are doing that is damaging your posture and stop doing it. This way when someone helps you fix a problem it stays fixed!
For more advice on injury treatment please see:
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