What happens at a physiotherapy appointment?
Physiotherapist Bhanu Ramaswamy suggests ways to make sure you get the most from your first physiotherapy appointment.
It’s important to understand why you’ve been referred to a physiotherapist (physio), as that will affect the services they can provide and the kind of tests they will do.
You may have been referred by another health professional, especially after a fall. You may be looking for help with a specific problem such as movement or pain.
Or someone might have made the appointment for you because they have heard that physiotherapy is good for people with Parkinson’s.
Before your appointment
Your physiotherapist will probably ask you lots of questions. Making sure you have the answers ready will give them more time to examine you, and give you more time for your own questions. Ideally, take the answers with you and have a copy you can leave with them.
Bring as much information as you can about:
- your symptoms, whether they’re related to Parkinson’s or not
- how much and what type of physical activity you do
- any discomfort and pain
- whether you have had this issue before and what you did that helped it
- any medications you are taking (not just the ones for Parkinson’s)
- any other medical conditions you have, including surgeries or broken bones in the past
- your life and living circumstances that might be affected by Parkinson’s.
If you are seeking help outside of the NHS, it can help to take copies of any relevant investigations such as scans or X-rays. Some people track symptoms for a few days before their appointment. This can give the physio a clearer idea of how their Parkinson’s affects their lives, and any times or places which are especially difficult.
What to wear
It’s best to wear loose-fitting clothes and shoes that are easy to take off. If you have pain in a certain area, it is likely you will be asked to remove the clothes in this area so the physio can look at that part of your body. If you are uncomfortable about this, or you have trouble taking clothes on and off, it can help to take someone with you.
Medication timing
If an assessment requires a lot of movement, it is better to do this when your medication is working at its best. So if possible, ask for an appointment at a time when you’re likely to be moving well.
At the assessment
Most physios will want to check how your body and limbs move as you sit, stand, walk and turn. Some tests are designed to be challenging, to help them see how your Parkinson’s symptoms affect you. If you are going for a general check-up, they may test or measure your posture, balance, flexibility and co-ordination. They may also check whether you can get down onto the floor and back up again. This is especially important if you have poor balance.
If the physio is looking at your fitness, they may add a timed endurance test. If you are in pain, the therapist will spend some time asking questions about the pain before they ask you to move.
They will ask:
- whether you know what causes the pain
- how intense it is
- what triggers it
- what makes it feel better.
For some people with Parkinson’s, pain can be made worse by rigidity (stiffness) and anxiety. That means that some exercises may be uncomfortable to start with. But the physio will work with you to reduce any discomfort during the session.
Before you leave
Often, the physio will have given you a lot of information, including things you might not remember later. If you find writing difficult, don’t be afraid to ask the physio to write down the main issues to remember, as well as what they wanted you to do.
You could also ask them to record important points on your smartphone’s voice recorder for you to listen back to later. They could even use your phone’s camera to record a short video demonstrating a particular exercise.
Following the assessment and any treatment, you will be sent home with some exercises or activities to do. You should have agreed a realistic plan that is clear about what you should be working on first and why, what exercises to do, and for how long.
To get the best from physiotherapy, you will need to practise what your physio has taught you between appointments. Sticking to the plan can be tough, especially for people who are not used to exercise, or who have problems with apathy or low mood.
If you think you will find this difficult, tell the physio. They can help you work on a solution.