Regardless of their level, if your child plays a sport there is a good chance you're going to need a physiotherapist (or physical therapist) for some kind of injury or rehabilitation.
Just like mechanics and surgeons and waiters, there are better physiotherapists and some that are not as good.
With all the complicated words and theories, it can be difficult for a parent to know if their Physio is any good.
Below is a list of factors that could help you have a more informed opinion based on almost 2 decades of working with physiotherapists.
Heuristic: The closer the physiotherapists facility looks like a gym the better.
If you only see beds and tables crammed into little cubicles this will give you a clue as to the type of rehab your child will have (see point no. four).
There should be space to move and exercise.
There should be equipment that is conducive to improving strength (think: dumbbells, barbells, weights, benches, etc. Don't necessarily think: machines & elastic bands).
Is there space to hop and jump and run freely?
Look for a stationary bike too.
- Green Flag: Looks like gym with space to run.
- Amber Flag: Some space, some equipment but mainly machines or Pilates).
- Red Flag: No space, limited equipment. Mainly crammed cubicles.
2) Principle v Employed?
When physiotherapists graduate they often are employed until they've gained enough experience to branch out on their own. Then they'll typically taken on other young physios until they too have gained enough experience to move on.
In other words, if you want the most experienced physiotherapist working on your child, you're probably going to want to see the principle physio at that practice.
Chances are you'll pay more to see the principle and they're usually more booked up. Often, there is a reason for this: they're better than the new grad.
However, this isn't always the case.
Question: How good are they if they can see you easily?
It's up to you to make the decision.
- Green Flag: Might take a week for the appointment.
- Amber Flag: Can see you in a day or two.
- Red Flag: Can see you any time from now.
3) Diagnosis? Talk, Test, Scan
Once you've made the appointment and you're in the room with the physio, take a look at the diagnostic process they're going through.
Most of their diagnosis should be through asking your child questions (please, let your child answer!) and listening to their answers.
The therapist should be listening for clues as to what the pain or the injury is.
If the pain is worse in the morning than the evening... That's a clue. If the pain is minimal at the beginning of training but gets progressively worse... That's a clue. If the pain is described as bring sharp, dull, searing or stabbing... These are all clues.
At this point the physio should have a fairly good idea what the issue is: perhaps two to three options for the diagnosis.
The next step should be to physically assess your child to gain a greater insight into the problem.
They'll ask your child to perform certain movements, changing a few things (example, shoulder angles) to rule some of the potential issues it could be.
If they do this, MOST of the time they should have an exact idea of what the issue is but SOMETIMES they might need additional confirmation. It is only then should they request a scan (MRI, etc.).
- Green Flag: Thorough discussion and movement testing.
- Amber Flag: Rushes through diagnostic phase.
- Red Flag: Sends for a scan in minutes.
Most of the rehabilitation they give your child should be exercise- (or at least, movement-) focused.
(See the importance of point no. 1?)
If, in the initial stages, the exercise portion isn't the main component of the rehab, don't stress. BUT every session should have progressively and substantially more movement added.
This movement should be 'overloaded' often - more repetitions, great range of movement, more speed, more weight or any combination of the preceding list.
They should give your child a Home Program to complete, with specific goals to achieve before the following session.
If they spend most of the time massaging (yup, it might feel good) or with a machine sending some electrical/light/sound waves into the area it's probably best to change therapists.
- Green Flag: Mainly movement based. Gets a sweat going.
- Amber Flag: Some movement, some soft tissue work.
- Red Flag: Soft tissue work and machine.
5) Sport/Training Recommendations
In addition to the Home Program, the therapist should give your child specific instructions on what they CAN'T do and what they CAN do.
For example, if you child has a knee injury the therapist should seldom say 'No training'.
Rather, they should say 'No sprinting' or 'No squatting below horizontal' and then follow it up with '...but you can jog' or '...but you squat above the horizontal' or even '...but you can do single leg squats on the other leg.'
We have a philosophy in our gym of 'Injured one limb? Train the other three!'
Continuing with the knee example above... The knee might hurt but your child could probably still do work on the ankle (e.g. calf raises), and the hips (e.g. gluteals, groin, etc.).
- Green Flag: Specific CAN'Ts and plenty of CANs.
- Amber Flag: Generalised CAN'Ts and generalised CANs.
- Red Flag:Generalised CAN'Ts.
6) Repeat Bookings?
In the sports world, there are not many times your child needs to see the therapist more than once a week for rehabilitation.
And, with the exception of a few injuries (think: ACL), there are not many times your child should be seeing the therapist for more than two to four weeks.
Remember, they should have a home program.
So if the therapist tries to book your child in for multiple sessions in a week and/or multiple weeks be cautious.
- Green Flag: Emphasis on ownership of the patient.
- Amber Flag: Starts off with multiple bookings but decreases reliance.
- Red Flag: Multiple times per week; multiple weeks.
If the therapist is genuinely interested in helping your child they should volunteer to send further information to your child's coach, Physical Performance Coach and anyone else you might think important.
As an Physical Performance Coach, it is invaluable, and hugely appreciated, when the therapist communicates freely.
It gives me an opportunity to understand with crystal clarity how I can help my athlete from my side.
In fact, the three physiotherapists I refer to most regularly often call me while the patient is in the room with them. This helps prevent any 'broken down telephone'.
- Green Flag: Free communication. Volunteers information.
- Amber Flag: Happy to chat but doesn't initiate.
- Red Flag: Won't release any information.
Use this as a guide to make your decision. Not each aspect will mean the therapist is good or bad... Only you can assess if you want to continue.