Oops. You did it again. You've gone and scrapped that knee - that precious knee. You're sitting at the computer reading this post as you intermittently massage away at the throbbing pain. So the question is, who do you see about this? With all the people out there claiming they can kiss your pains away with pixie dust, who's the best man for this job?
Well for those of you thinking about physiotherapy, this one's for you. During my stint at Totum Life Science, I worked with Mary-Catherine Fraser Saxena, a sharp woman with two of the most adorable kids I've ever seen and a wily husband who moonlights as a chef. In any case, I had the idea to get her voice on Gymnazein, so I shot MC an email and here's what she had to say.
So what's your name and what do you do again?
Mary-Catherine Saxena, and I'm a physiotherapist who works in an out-patient orthopedic setting.
Has physiotherapy been around since the Dark Ages?
Pretty much...it began in earnest after the WWI and WWII, helping soldiers recover from their injuries. Throughout the 1950's and 60's, the universities taught a combined degree of physiotherapy and occupational therapy, and then you chose which vein you wanted to focus on in your practice. Since the late 1960's or so, physiotherapy has been a bachelor degree. More recently, programs are requesting a bachelor degree prior to admission, and then you graduate with a master's degree in physio. In the US, more programs are shifting to a D.P.T. program, from which you come out with a doctorate in physical therapy.
Where were you educated? How long have you been practicing?
I did a four-year bachelor degree at the University of Ottawa, which is the only bilingual program in Canada. I graduated in 1993. In 2005, I completed a master's in Rehabilitation Science from the U of Toronto. I have now been practicing for , gulp, 15 years!
How important would you say physiotherapy is in the larger framework of healthcare? Does it have ties with other healthcare professions/institutions?
The most visible part of the physiotherapy profession for the public at large are those of us working in out-patient clinical settings. However, a large proportion of our profession continues to work in hospitals, in a variety of settings and varying levels of care. You will find physios in tertiary care centers, assisting patients in the ICU with intubation and respiratory challenges. In the neurological injury setting, physios play a large role in the post-stroke and post-spinal injury populations, from immmediate interventions to long-term rehabilitation. As hospitals have downsized their out-patient clinics, therapists working in home care settings are creating an important bridge between the medical community and successful returns to independant living at home.
Physiotherapists work closely with physicians, surgeons, nurses, social workers, occupational therapists and psychologists to complete a patient's healthcare team and successfully return that person to an independant, mobile life. We are the exercise and mobility specialists.
How is it different from what a GP does? A chiropractor? An osteopath?
A medical doctor can order radiological exams, interpret blood test results, prescribe medication and refer on to other specialists. They are not skilled at doing differential diagnoses for musculoskeletal exams. For example, they can diagnose an ankle sprain, but are unlikely to be able to know if the talus is sitting forward in relation to the tibia as a result of the sprain.
A chiropractor can also order radiological exams, however they can not prescribe meds or refer to medical specialists. Chiropractic medicine has it's basis in the subluxation model, and tends to use manipulation as a common approach to many ailments. This, however, is changing...
An osteopath is also skilled in spinal and peripheral manipulation, however they have a deep belief that many ailments are due to changes in the craniosacral rhythm due to fascial and dural restrictions.
Now let's get to the juicy bit. For those of us who have no idea, what sorts of problems do you treat?
At Totum Life Science in downtown Toronto, we see a variety of acute, sub-acute and chronic musculoskeletal injuries.
I would estimate a third of my clients have neck/shoulder issues, another third have knee issues, and the rest is a mix of lumbopelvis, TMJ, ankle, wrist and elbow. Of these, approximately 25% are post-operative, meaning they are recovering ligament repairs, fractures, or arthroscopic surgeries.
Are your treatments based on scientific evidence or do you place a special potato on patients' heads through which you funnel your healing energy?
I am a big believer in evidence-based practice. In fact, my master's thesis was looking at the use of clinical practice guidelines for knee osteoarthritis by physiotherapists in Ontario. However, the dilemma in physio is that the evidence for many of the things that we do isn't there. This is where the concept of 'clinical reasoning' must take over. It's important to take the evidence that is available and incorporate it into your clinical decision making, and where there is no evidence, to use reason your way through why something should or shouldn't work. No potatoes required.
What sorts of problems don't you treat?
Due to the funding structure, I don't treat injured workers or many MVA patients.
On average, how many treatments does it take to see noticeable difference? What does this depend on?
Unfortunately, the answer to this is 'it depends'. The acuity of the injury, a client's history, the degree of the injury, the compliance of the client to follow through on their exercises...I would say a client should note a positive change from their treatment within the first 2 treatments. One of the keys to successful rehab is frequent re-assessment; if the initial approach isn't working, then a re-assessment is required to ensure that nothing was missed on the initial assessment.
What would you say are signs of a great physiotherapist - so we know what to look for?
Brown hair, 5'8"...kidding! Look for someone who takes the time to listen to your history and takes a detailed account of factors contributing to your injury. Be wary of someone who hands you a pre-printed exercise sheet used for all neck/low back patients without modifications for your specific condition. Look for someone who provides 30 minute treatment sessions - this will ensure enough time for re-assessment, hands-on treatment and exercise prescription/modification/demonstration, as applicable.
And finally, would you be kind enough to divulge your training secrets to us - tell us how you keep in such incredible shape?
Haha...My own training? Run 2-3X/week, weight-training 2-3X/ week, lots of core/medicine ball work and a yoga class thrown in when time allows. Eat when you're hungry, avoid meat unless it's organic and of the best quality, and have a little chocolate every day.
And listen to whatever advice Varun gives me :) [I told her to say that]
If you live in the Greater Toronto Area and would like to contact Mary-Catherine, you may view her professional profile here and contact the King Street location to book your initial consultation.
Totum Life Science is a boutique gym and sports medicine facility offering a variety of services including physiotherapy, chiropractic, therapeutic massage (RMT), and acupuncture.
If we were to apply that to our upper body, there must be muscles in there responsible for moving our torsos in each of those directions. So a good core training program manages to hit all planes of movement, thereby leaving out none of the muscles that give us the power of Adonis over women. Now think about what you've been doing for the past 10 years - crunches. If you notice, crunches only work one of these three planes, leaving you weak in two others. Someone's been a bad, bad boy. 
