UKH

Do you have a feeling about whether physios will be able to start treating again soonish? Any physios feel they can manage the risks through PPE and changes to workspace (better ventilation etc)?

I have an issue which is causing more and more other issues. Stretching and yoga are managing, although not solving, the secondary issues, but it will keep being problematic until the primary issue can get treated hands on. 

I am doing care home work just now, so on my feet all day for 12 hour shifts. But also realise that I am a bigger risk to the physios due to this work! (We are all getting tested again this week, but given the false negative rate of this I am not putting too much weight on the results of it)

Any thoughts? I am fed up of being in pain and limited by it!

In reply to Dave the Rave:

This is a long-term back problem which I usually get straightened every 6 months. I have a sculliosis, so one half of my back works harder than the other, which pulls my hips out of alignment which has allsorts of knock-on effects in my lower body and shoulders. I was due a straighten up just as everything shut down!

I usually go to a Mctimoney chiropractor to get sorted, then a physio if I have any further pains once I am straight. 

I have had video calls with physio to try to alleviate the leg issues, and she has given me stuff which is allowing me to manage that (but it isn't going to solve it.) But i keep getting new issues as my hips will keep moving further out of alignment I guess.

I need hands on to fix it, but just trying to get a grasp of whether physios etc are likely to be some of the earlier people to restart when allowed of if it will be deemed too risky for a long time yet.

I was being treated by NHS physios prior to lockdown. At lockdown all appointments were cancelled. This week my physio has restarted but only through video calls. They have a huge backlog that is likely to take months to recover from. I think face to face appointments may restart in some format next month, but starting with the highest priority. 

I see.

There are signs locally that some NHS outpatients will be open in 4-6 weeks but that is optimistic. 
You may have more luck privately.

Is this in Scotland of England? 

I always go privately. It costs half a days wages and gets me back to work far more quickly.

Osteopaths have been able to treat patients hands-on throughout the lockdown for emergency or essential treatments - they were classed as key medical workers right at the start.  Quite a lot decided they wouldn't do so and went online only, but some have continued to see emergency patients. 

So you might well be able to find an osteo? This is in contrast to chiropractors, who were told to close up as non-essential; my osteo was quite chuffed about this!  Not sure what the situation is with physio; if osteos are allowed to practice I'd have expected that physios were too?

This is the big question at my wife's work - although their patients tend to be older, and more vulnerable, perhaps changing the balance of which discretionary treatments can be justified.

They really don't know yet. Sorry that doesn't help you much!

Are osteos also people who do bone cracking stuff? The reason I use a Mctimoney chiropractor is that there is no bone cracking. She works with soft tissue to straighten the skeleton.  Very gentle and highly effective. I am wary of the more "violent" treatments!

I've used an osteopath for a back problem.....it was all deep tissue massage, some manipulation and the odd crack (more of a quiet thud in my case)...all good stuff and very helpful after 3 sessions...

Yeah, and the answer might be moving to bigger spaces, full PPE including visors (particularly with older clients) and shorter sessions. Sounds like 15 mins is the key time. So maybe 10 mins treatment, air the room (for how long? Dunno), then another 10 mins. 

Fwiw, we have been doing personal care on people with confirmed Covid for weeks and weeks with PPE which has largely been deemed insufficient. The nurse is the only staff member who has had it, and she wasn't wearing a mask prior to contracting it! 

I'm not saying there is no risk, but with careful hygiene (my arms are red and sore with so much washing!) and fairly basic PPE, we seem to be doing ok. We have windows open all the time, which might have an impact? Obviously, we might just have been lucky! Some NHS bank staff who have been in to help us have commented on how well organized we are and how dilligent we are being with hygiene etc. Probably will be having an impact. 

I guess if your wife is starting to think about reopening, maybe encourage her to find a good care home who have managed to have very few deaths etc and chat to them about it. Might be a good source of information.

Personally, I've always found joint cracking (whether by an osteopath, physio, or massage therapist) to be highly beneficial, however it's far from the only tool in an osteopath or physio's box, and if the osteopath didn't want to engage in a conversation about how you would like to be treated then they wouldn't be worth visiting.

I think with all of these branches, the main thing is the skill of the practitioner rather than which area they focus on. Although everyone had their preferred way of working, the best physio's will borrow from the reviewed and studied areas of osteopathy and vice versa. The main thing is to find someone who you can trust to work well with your body.

When I lived in Stirling, I used to see an osteo called Keith Robertson - he was very light on the back cracking and had a very gentle, soporific approach to treatment... Half the time I felt close to falling asleep during the sessions, and I was pretty sure that most of the effect he had was down to the deep state of relaxation he managed to put me into.

I just looked him up, he's also not working just now. I can't see any in our area who are working. I certainly wouldn't want to go towards Glasgow or Edinburgh for treatment, the risks there will be much higher.

Not a physio, but just wondering what shoes you are wearing and if there is anything you can do to improve the support from there?  Insoles maybe or more supportive footwear.

I have a couple of pairs which are better at the moment, but it's all just pain management. I have kept running as much as I can, and have bought more cushioned trail shoes which helps. At work I have to balance the heat vs support issue. I have found a pair which seems to get the balance to be manageable.

Yep, good point, I'll suggest that to her.

The problem is around non-essential treatment, though - as with personal care in a care home, which clearly has to happen, essential physio is also still happening.

How do they balance non-essential treatment? They're risking killing their patients just by visiting them; not all treatments are worth that. In the end, I think there is going to have to be a fair bit of patient input as to what should go ahead, what's worth it to the patient - but the service can't simply ignore the risks they put people at, particularly those in vulnerable groups, by treating them.

But they're not at the stage of being able to restart yet anyway.

Yes, I guess though there comes a stage where if treatment doesn't happen then some conditions risk becoming chronic, so the order of priority has to go up. So at that point the need to decide when that is the case (maybe with video call first?) and then work out how to then do those cases safely

Pretty much as Ciro said; osteopathy does use manipulations, but they're by no means the whole point.  My current osteo is a physio as well, and the two disciplines overlap a lot.

And unlike chiropractic, osteo is known to be safe - it's regulated, and available on the NHS.  I've never been worried by anything an osteo has done to me, but I'd never go to a traditional chiropractor.  I don't know much about McTimoney.

I just did some reading on it and Mctimoney seems to be fairly close to osteo, as far as I can see. 

Seems fairly academic now though, as i can't find any in my area who are working. 

It does sort of look like chiropractic with the dangerous bits taken out, so I wouldn't be surprised it it was pretty similar to osteopathy!

Bugger.  Sorry.  I know too well what it's like to have to keep going when you're in need of treatment.