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What goes on in a typical treatment session?

Sessions last for 60 minutes. We ask our patients to wear suitable clothes (e.g. shorts and a vest-top) so that we see more about how their joints and muscles are aligned and working and because it is more comfortable for exercising.

We make sure that our treatment rooms are always warm!

We will first ask how the patient has got on since the previous session, how the home exercise programme has been going and whether they have had any particular problems.

We will then feel the body and move an arm or leg or the trunk as we can tell a great deal about how a person is using their body to move by doing this. We would look for areas of stiffness, tightness, weakness, under-activity or overactivity, all of which would cause movement problems.

Depending on what we find and in conjunction with the overall treatment plan, we then provide treatment which could involve:

• moving a stiff joint

• getting a still, short muscle to lengthen

• getting a long, floppy muscle to shorten so that it is in the best place for the muscle to be active

• realigning and activating muscles

• giving support to muscles when they perform actions like reaching for a cup, bending down or standing up. This support is useful both in terms of encouraging movement and in helping a patient’s brain to become more aware of what is involved in the movement

• helping the patient to trust a leg which they are worried won’t take their weight

• helping a patient to focus their mind to concentrate on activating their leg at the right time so they can produce the appropriate contraction.

The aim is always to increase a patient’s repertoire of movement. The physiotherapist moves them to give them the experience of movement which they either couldn’t do for themselves or would do wrongly.

The patient joins in with the movement, with the aim being that when the physios withdraw help, the patient can do it on their own.

Assessment is continual so that, as we see how a patient is reacting to a particular activity, we can then make it harder or less hard so that the patient can get the maximum benefit out of it.

The role of the physiotherapist is to identify the right challenges so that exercises are not too difficult, because the patient might find them overwhelming.

Excessive difficulty also means that a patient may try too hard and use muscles which shouldn’t be used in that particular movement. However we also make sure that exercises are not too easy either, because patients need to be challenged in order to learn.

We aim to take our patients to the limit and keep them there so that they can get accustomed to new experiences and so that hurdles they felt were excessive can shrink down to a more manageable size.

Our job is also to help people understand what they need to focus on in their movement and what they need to ignore, so that they can learn to move more efficiently.

Progress can fluctuate, so that what a patient can do one week, they may not be able to do the next week. Therefore it’s important that they don’t feel a failure if this happens.

Sometimes treatment will involve helping a patient to unlearn inefficient treatment habits before helping them to develop more effective habits, so time is needed before progress can become apparent.

In addition, the physiotherapist may need to work on different skills as building blocks and therefore it may be a few sessions before all the building blocks can be brought together.

As a session comes to an end, we will discuss progress and what exercises the patient needs to do before the next session.

Then the physiotherapist will write up the notes for the session.

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