Why Your Physio Asks All Those Questions – Special Questions
After the pain and the history of the presenting condition the physio will move on to ensuring that the condition that you are presenting with really is the reason for the symptoms you are reporting, and that there are no special reasons why particular treatments should not be performed. A small number of patients present with non-mechanical symptoms, i.e. their pain is not due to stresses and strains on joints or other soft tissues, but likely to be caused by an infection, osteoporosis, a tumour or trauma. It is very important to distinguish these medically serious issues from the typical soft tissue complaints.
Questions the physio will ask include: Have you a history of cancer? Is your weight steady? Is your appetite normal? Do you feel well? These queries find out about whether the person is well overall and eating normally as people who feel unwell, eat poorly and lose weight may have a serious underlying condition. Having the pain much worse at night is also a negative sign, although people with musculoskeletal problems are often uncomfortable at night. A history of diabetes may indicate a more fragile skin and a tendency to heal less well, while corticosteroid medication may indicate similar things plus a possibility of decreased bone strength.
Medications such as anti-coagulants are very important as the physio needs to know the level of force they can safely apply to the person’s joints and other tissues. Disturbances in the function of the bladder and bowel will also be enquired after as will whether the sensation is normal in the groin and around the genitals. Serious disc lesions and other problems can disturb bowel and bladder function and need urgent medical review, although bladder dysfunctions are quite common and this needs to be distinguished from potentially more serious matters.
Past history and medication being taken is also important to give the physiotherapist an overall picture of your health as in some cases another condition may be causing symptoms or the medication may be part of the problem. Disturbances in your gait may have the same relevance as bladder and bowel dysfunction in that there is a possible issue with compression of the central nervous system. Severe stiffness in the morning which does not relieve quickly can be a sign of an arthritic disease rather than a soft tissue problem. Red flags are the term for these signs of potentially serious matters and must be excluded.
Author: Jonathan Blood-Smyth