Inside Medicine: The physiotherapist

http://news.bbc.co.uk/go/rss/-/1/hi/health/7219344.stm

Version 0 of 1.

Up to 84% of the population has back pain at least once in their life

In a series focusing on medical specialties, BBC News meets physiotherapist Hubert van Griensven.

Physiotherapy is the branch of medicine which helps improve movements in the body, which have been lost following illness, accident or ageing.

<a class="bodl" href="#table">Hubert van Griensven's CV</a>

WHAT IS YOUR JOB?

I work with patients with musculoskeletal problems.

My main interest is in helping people with persistent pain and I am doing a PhD investigating pain after surgery.

WHAT IS THE MOST COMMON CONDITION?

I see many people with low back pain, who make up around 50% of our referrals.

Research suggests that up to 84% of the population has back pain at least once in their life, while some 11% are disabled by it.

Sometimes there is a clear diagnosis but this is rare.

In most cases there is no identifiable injury or damage, so we know that surgery or injection is not going to help.

Hubert is also interested in acupuncture

Luckily most back problems resolve, either spontaneously or with a helping hand from physiotherapist or GP.

It is important for patients to keep moving, but many find this difficult because of their pain.

It is my challenge to explain what pain is acceptable as part of the recovery process, and what is a signal to ease off.

Back care is a combination of treatment, education and coaching.

WHAT IS THE MOST COMMON PROCEDURE?

We use a range of options for patients with low back pain. It is essential that a patient understands how to manage their condition.

Another important aspect of back care is exercise, which again can be done individually or in a group. All this can be supplemented with, for instance, manual techniques or acupuncture, depending on the condition.

Occasionally a patient has a problem that needs further investigation and the opinion of a surgeon.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

It is such a multi-faceted job, it can be hard to give equal attention to all aspects.

These days I try to focus on certain tasks for a period while I put other things on hold. If I don't do that, all the little day-to-day things keep taking precedence and the bigger long-term projects don't get done.

WHAT IS YOUR MOST SATISFYING CASE?

There is not one single case, but I really enjoy problem-solving. When I see patients with complex or long-standing problems, the challenge is to find a diagnosis, explain to the patient what is going on and agree a way forward.

It is always exciting to see someone do well and get their life back. Even if I cannot treat the problem, many patients find it enormously helpful if I take the time to explain what is going on.

It is important for patients to keep moving, but many find this difficult because of their pain Hubert van Griensven

After all, it is their body and their life, and they need to know.

There are many evidence-based guidelines these days which are based on what works for the population as a whole, so they apply to everybody but at the same time to no individual patient.

I enjoy finding out how I can make them work for the person that I'm seeing. If you can't connect with the individual as a therapist, you are unlikely to be able to help them.

WHY DID YOU CHOOSE THIS SPECIALITY?

I'd say that physiotherapy chose me rather than the other way around.

I developed my interest in pain during my training, when I had very inspiring lecturers who made me realise how important pain and the nervous system are. The nerves can change how things feel, so pain can be felt in one area but have its cause somewhere else. This makes my job fascinating.

I was lucky enough to get a job as clinical specialist in pain at St Thomas's Hospital, which got me hooked even more. I then did an MSc in pain.

While I was at St Thomas's, I discovered that my colleagues struggled to help patients with longstanding pain.

They often got frustrated and so did the patients. I began to realise that I had developed an approach and a way of thinking about pain that made it easier for me to help these patients without frustration.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALITY?

No, physiotherapy is an interesting profession, because there are so many areas and approaches. I have learned about neuroscience, psychology, business management and research. I have been able to incorporate these into my work, so there has always been something to keep my interest.

WHICH SPECIALITY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

I have no idea! Neuroscience has been an interest for a long time, but I don't know whether full-time science would be for me. I have always had a broad range of interests, so I always find new angles on my work.

On the whole I'd say that physiotherapy has allowed me to develop and use these interests without losing my core profession. It is likely that the PhD will open up new possibilities, perhaps in health research.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

I'd like to think that physiotherapy has a great future ahead of it, with increasing numbers being trained in specialist skills such as injection therapy. This pushes the boundaries of what we can get involved in.

Unfortunately the changes in the NHS have meant that newly qualified physiotherapists find it very difficult to find work.

Hopefully this will change, because there is a risk that therapists don't get a chance to practice following their training.

At the moment there is a big drive to promote physiotherapy and other services to primary care trusts, so we have to clearly describe what we are able to offer.

It is becoming clear that physiotherapists are involved in almost every aspect of healthcare, either directly or indirectly.

I can see the way that physiotherapy is delivered change in the future, but there will always be a demand. It is up to the profession to keep abreast of new developments and use them to our advantage.

<a name="table"></a> <a class="bodl" href="#top">Click here to return</a> CV - Hubert van Griensven 1990 - 1993: Worked as physiotherapist in UK, both in NHS and private practice 1993 - 1996: Diploma in Chinese Acupuncture - Chung San Acupuncture School, London April 1997 - September 2003: Guy's & St Thomas' NHS Trust, London Clinical Specialist in Pain Management. August 2004 - present: Southend University Hospital NHS Foundation Trust -Consultant Physiotherapist