Frequently Asked Questions (FAQ)

Physiotherapy is a science-based profession that involves the prevention, assessment and treatment of disorders of human movement due to

• physical disabilities
• trauma or
  
• illnesses

It helps patients relieve pain, improve muscle strength, joint range and mobility, increase exercise tolerance and improve respiratory function. It considers the patient as a ‘whole person’ approach to health and well-being, which includes the patient’s general lifestyle.

Physiotherapy is based on principles of medical science and it is not related to any specific “technique” as typically associated with some of the alternative medicine treatments.

Physiotherapy as a health professional field employs any medically proven technique that is effective and “documentation-based” i.e. verifiable results from research and tests.

While it is well-known that physiotherapists treat injuries, increasing numbers of people are also turning to physiotherapy because they want to take control of their health and stay well.

Physiotherapy extends from

• health promotion to injury prevention
• acute care
• rehabilitation
• maintenance of functional mobility
• chronic disease management
• patient and caregiver education and
  
• occupational health.

Everyone can benefit from Physiotherapy whether you are living with a chronic illness, recovering from an injury, or preparing for childbirth (women's health).

See your regular doctor (GP, physician) IF your pain improves or settles with basic treatments, but we find that it's often good to discuss and consult your regular doctor:

1. mild-moderate pain
2. pain is on-off
3. your painful neck, shoulder or hand pain feels stuck or unstable
4. the affected areas feels warm
5. no improvements after a week

Seek urgent medical attention if / when

1. you felt or heard a popping or cracking sound when you got your pain or injury
2. the bone, muscle or joint pain or injury has an awkward shape
3. you cannot move the painful joint or structure
4. your pain is getting worse or not improving
5. your pain is severe or suddenly got worse
6. there is a lot of bruising, swelling or color changes in the skin

Physiotherapists always seek to minimize pain and discomfort, even if it is chronic or long-term.

They work within your pain threshold to help you heal, and restore movement and function.

Your therapist may utilize modalities such as

• clinical massage
• trigger point (myofascial) release
  
• deep and light functional stretch
  
• exercise therapies
• ultrasound therapy
  
• radio-frequency Indiba physiotherapy
• dry needling
• electrical stimulation
  
• strengthening
• stretching exercises
• Grayson's techniques
  
• joint mobilization and soft tissue glide/mobilizations
• and more
  

during your treatment with us and these modalities may sometimes cause zero or slight discomfort depending on the severity of your impairments (usually no).

It is therefore important that you communicate the intensity, frequency, and duration of pain to your therapist so that he/she can adjust your treatment plan if required.

Yes.

Specifically, physiotherapists are governed by the Allied Health Professionals Act. Physiotherapists are required to be registered with the Allied Health Professionals Council to practice in Singapore.

All of our senior therapists go through a very strict screening process and are recognized and regulated by the Allied Health Professions Council of Singapore.

We have a multi-disciplinary team with specialists who are experts in their own fields. Their strong expertise allows for internal referrals and collaborations to provide a holistic care that best meets your needs.

We are always happy to work with an extended medical network but please note that a doctor’s referral for physiotherapy is NOT necessary as physiotherapy can be your first option.

In fact, if you do need referrals to surgeons/sports physicians we will be more than happy to refer you to them as well, based on your specific area of pain (ie if you have shoulder pain, we can refer you specifically to shoulder specialists).

Research has also shown that if you hurt your lower back, starting back physiotherapy within the first 14 days can save you on average of $2,700 - a sizable sum (this is from

• decreasing pain from escalating
  
• decreasing risks of exacerbation or worsening
  
• decreasing costs of medical care including injections, medicine, hospitalizations etc
  

Self-referral can help you to eliminate costs and time when you get direct access to the right care for your condition.

Physiotherapy is generally a degree-based profession.

In Australia and the UK, it is very extensive 4-year full-time bachelor degree programme, similar to an engineering degree.

In the United States, to practice as a physical therapist is today requires a Doctor of Physical Therapy.

There is a trend today to require an increasingly higher academic requirement to practice for new practitioners. Australia for one is gradually moving to a Master’s requirement (following a bachelor degree  in physiotherapy).

This is a result of the amount of learning needed to be competent.

Complementary Alternative Medicine is any practice that is put forward as having the healing effects of medicine but is not based on evidence gathered using the scientific method.

Examples of alternative medicine include

• homeopathy
• naturopathy and
  
• chiropractic

Physiotherapy on the other hand is Evidence-based medicine (EBM) (also called evidence-based health care (EBHC) or evidence-based practice (EBP) to broaden its application from medicine to the allied health professions) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

• How is it different from massage?
• How is different from gym exercises?
• They also ‘cracked’ my neck.

This is perhaps the most confusing aspect of the profession when compared some of the CAM like massage or tui-na.

The simplest analogy is to think about traditional herbal medicine and modern pharmacology.There is often something going for a specific traditional herbal medicine for a specific condition but can often also be hit-and-miss.

In some cases, the patient would have recovered regardless of any treatment. The human body is designed to heal on its own after all.

Modern pharmacological studies these case to see if they work (empirically and not because of random chance) and if yes, to understand why it works, what it is that is working (active ingredient) and is specifically what situations they work best such a dosage and if there are any side-effects with or without other medication.

Physiotherapy is similar in the sense that is take and distills down what works with Evidence Based Medicine. A general massage may seem to work but a physiotherapist may be more effective by focusing on very specific muscles (there are lots of them) and applying very specific techniques.

Sometimes the understanding of the underlying problem is not based on scientific evidence such as innate intelligence.

Sometimes a general approach may be good enough.

Other times, you may required a much more targeted approach to cross over a healing hurdle towards getting better.

This ranges from therapists - it ranges between 30-60 minutes.

I've been practicing since 2005, and I can tell you this comfortably that:

• too short a session (typically less than 20 minutes) tends to have less results AND
• too long a session (eg more than 40-45 minutes) wont have any extra benefits...in fact, there many be some detriments due to overtreatment

In very rare cases, yes...but in most cases NO.

It all depends on the type of injury and whether the problem is acute or chronic.

Lets take the analogy of when a preson is ill and requires antibiotics for an infection. You would not just take one pill and expect to get better? You would be expected to complete the full course of antibiotics similarly physiotherapy to treat a musculoskeletal problem will entail more than just one session.

In the acute phase initial treatment will focus on protective measures to reduce inflammation and scarring. In chronic patients, the nature of chronicity will mean changes to posture, movement patterns, muscles, joints as well as anxiety levels.

All these things will therefore take time to change.

In most cases, there will be a combination of both muscle and joint involvement. Muscles are tight, stressed, strained all describing the same phenomena. Muscle can also be weak and therefore painful when exerted. In this instance a person may benefit from strengthening and stretching exercises all which will take a little time to achieve.

If the joint is the source of pain, it may be mal-aligned, stiff, bruised and in the worst case scenario be sore due to a fracture.

Again it is the role of the physiotherapists to decide what he/she feels is the best treatment modality to reduce the joint abnormality and thus the patients symptoms.

However one session of joint mobilising may not be enough or be too painful, if for example the joint has been stiff for a year. Therefore more often than not a several sessions are required to loosen and mobilise the joint effectively.

After the initial assessment the physiotherapist should have a good idea about the prognosis of your condition and should be able to provide you with a rough estimate of how many session you will need and over what period.

Well the answer is of course yes and obviously depends on the problem itself, but would you like to feel better after 2-3 weeks or drag your symptoms out over 6-8 weeks?

Expanding on the previous analogy whilst taking antibiotics you would not suggest taking the pill once a week only, instead of the recommended daily suggestion; you would follow the prescription that the doctor or pharmacist best advises for you.

Spreading sessions out on a weekly basis especially during the initial phase can mean that any loosening of stiff joints, stretching of muscles achieved during the session of physiotherapy may be lost in 7 days of you doing the “incorrect activities” that caused your pain in the first instance.

This may mean that each week you return for physio potentially back at square one with slower and smaller progression. So more frequent sessions in a shorter period will allow the therapist to keep a close eye on your symptoms, activity and achieve faster progressions.

The frequency of sessions may tail off as a person is closer to being discharged.

In addition shorter session of physio (half hourly) may be more useful than hourly sessions during the acute and inflamed stage of an injury in particular, as too much mobilising, stretching and strengthening of aggravated tissue may worsen symptoms, so gentle and often is often the better approach.

Now this is something which patients may think, and in some instances "achieving" 70-90% recovery is as best as you are going to get, as is the nature of some injuries.

Again drawing on the antibiotics analogy you would have to complete the full course of treatment for the full effect of treatment, you would not stop taking the antibiotics as soon as you think your feeling better if your GP/ Phramacist has advised you to take the course of antibiotics for ten days.

Similarly in physiotherapy, if your someone who comes in for a quick fix, an example being a low back strain, your initial sessions will consist of reducing the symptoms and pain. This will be mobilising the joint that is stiff, releasing the muscle spasms and inflammation, and this alone may require 2-3 sessions depending on its severity.

At this point you may feel your back is pretty much better, however your back has not been strengthened and is therefore at great risk of recurrent injuries. You may also not have received all the information for normal movement; you may not be aware of what faulty movement actually caused your strain or not had the chance to process it due to the previous pain.

This could mean you return to your normal day-day activities with a weaker back and continue to do the things that may be strain your back.

The problem with repeating this cycle, is each time you strain your back, it produces scar tissue in the affected ligaments and muscles.

Scar tissue at its best, will never be as strong or as tensile as muscle tissue and therefore will further compromise the integrity of the affected structures leading to an even greater risk of recurrent injuries.

Hence it makes more sense to reduce your initial symptoms, learn how to look after your back, discover what is straining your back and strengthen your core muscles with individually prescribed exercises.

Depending on your diagnosis and the severity of your impairments, you may require just one visit or you may need weeks and months of care. It really depends on your:

• Injury/Condition Severity - Mild cases may take less amount of sessions, and severe ones typically will take more
• Age & Recovery Rate - These two factors are often intertwined: older age usually means lower recovery, but there are some patients whose recovery may be hampered/delayed due to issues like illnesses, severe injuries, reinjuries, etc
• Compliance - Patients who comply with the exercises, turn up for physiotherapy diligently will recovery faster than those who don't.

Please arrive 10-15 minutes earlier for your first appointment to complete registration.

It's best that you dress comfortably and if possible, wear loose clothing that covers the area to be treated. For instance, jeans are not advisable if you have a knee-related condition.

You are also advised to bring along any

• referral letters (if available)
  
• medical records (if available)
• and medical imaging such as X-rays (if available)

During the first consultation, your physiotherapist will assess your condition by understanding your health history and conducting an evaluation of your posture, muscle and joint motion and performance.

After which, your physiotherapist will provide a clinical diagnosis, prognosis, plan of care and discuss short and long-term goals.

Treatment using modalities such as mobilizations, manipulations, exercise therapy, clinical deep tissue release and sports massage, ultrasound therapy, Indiba and electrical stimulation may be performed dependent on your condition.

You can also expect to receive self-management recommendations with home exercises and physical aides prescribed if required.

Yes, you can.

However, do let your massage therapist know so that he or she can avoid going full on with the massage.

Too intensive a massage will result in your muscles being too relaxed.

This effect muscle recruitment later during your event. You will experience a lack of power and slower firing of the muscles. A full deep sports massage is fine 48 hours before your event.

For pre-event massage, like an hour before the event is usually light and aims to limber up the muscles. Not relax it as in the usual sports massage sessions.

If the underlying cause of your injury is unknown, it is advisable to seek an opinion of a health professional like our senior physiotherapist to first assess and identify it. 

Reason being if the massage therapist (and I've good deal of respect for their work) dont know any differential diagnosis or potential injuries, there is a chance of causing more harm and damage.

It is always possible for a massage to further aggravate your condition if massage is not the appropriate approach for relief.

Sports massage aims to release muscle tightness and/or help it recover from intense training.

Sports massage does not correct or indentify causes of injuries such as bio-mechanical faults, issues with the joints.

Nonetheless,  some sports massage therapist have gained additional training and or accumulated significant amounts of experience with certain injuries.

But rehabilitation is not a area of focus and training for sports massage therapists.

This will depend generally on the coverage of your corporate and/or personal insurance that covers you. Things that you need to ask:

• how much is covered? (This is usually in SGD)
  
• what is the procedure? (Eg they may want you to get a physician or orthopedic surgeon referral first)
• some insurance companies may allow direct billing but subject to agreements with you/your company, and in some occasions may need pre-authorization first

Usually it's a pay-and-claim approach if there is no direct billing agreement.