Allied Healthcare: your options outside of the medical model

Physiotherapist
photo: Beta Klinik

The medical model is one that most people are familiar with.  You get hurt or sick and you go check in with your family doctor, walk in clinic or even hospital to see what a doctor thinks about what you have done.  When it comes to illness and major trauma a physician is definitely the one you want looking after you, but when it comes to pain, injury and preventive health, both physical and cognitive, doctors are not your best choice.  The fact that you even have a choice comes as a surprise to many people; most are under the assumption that their doctors know best.  If you live in a moderate sized city, the chances are you have a choice of a variety of allied health workers that have exceedingly more specialized training in physical health and rehabilitation than any doctor you will visit.

The following post is a brief summary of some of your healthcare choices and the treatment options they can provide that don’t involve medications or surgeries (scroll down to read details about each bullet).

–    Physiotherapist
–    Massage Therapist
–    Chiropractor
–    Naturopath
–    Osteopath
–    Kinesiologist/Personal Trainer
–    Yoga/Pilates instructors
–    Counselor/psychologist
–    Occupational Therapist
–    Traditional Chinese Medicine/Acupuncturist

Full disclosure: if you were not already aware, I am a physiotherapist and am moderately biased towards my own profession, but I do work closely and share clients with almost all of the different disciplines listed above.

Physiotherapy aka Physical Therapy

Physiotherapists (in Canada) are considered primary care givers, which means you don’t require a doctor’s referral to see them.  They now have a minimum of 6 years of university education and typically extensive post graduate training in various specialties.  Physiotherapy is a profession with a broad scope of practice which allows its’ therapists to take the best techniques from many other healthcare disciplines and make them their own.  I, for example, in addition to my Kinesiology and Physiotherapy degrees, attained Diplomas in Manual and Manipulative Therapy (overlaps with Chiropractors), and Intramuscular Stimulation (IMS, overlaps with Acupuncture) as well as my extensive work in movement and muscle balancing (overlaps with Pilates, Yoga, coaching), and have started training in Visceral (organs) Manipulation, a manual technique borrowed from Osteopathy.  Some of my associates have specialized training in pelvic floor work, craniosacral therapy, or even vestibular (inner ear) rehabilitation.

No physiotherapist is the same because we have so many paths to choose from after graduation in regards to specialized training.  Our knowledge base tends to overlap with physicians, Kinesiologists, chiropractors, occupational therapists, massage therapists, Pilates instructors, osteopaths and Acupuncturists, which can make us the link of a good healthcare team for a client.  We have the capacity to develop a very specialized skill set, but our model of practice doesn’t require our scope to become so compartmentalized as the medical model does for physicians.  Generalist doctors like family physicians just don’t have very much training in musculoskeletal pain and specialists tend to become too compartmentalized in their skill set to be able to see the bigger picture when it comes to pain.  Physiotherapists tend to fill in the gaps of service that doctors aren’t able to provide; some doctor’s acknowledge this and some are blinded to it by how much they know and how entrenched they are in the medical model.

My best advice when choosing a physiotherapist is to do your homework on the person you decide to see instead of just picking the clinic closest to your house.  One physiotherapist may not be able to do anything for you and another may change your life. Good examples Envision Physiotherapy, Diane Lee, Synergy Physio

Massage Therapy  

Massage has different meanings to different people because there are many different types of massage techniques and massage practitioners.  Sometimes it is used with the goal of relaxation like in a spa setting while other times it can be more goal-oriented and therapeutic (not to say that relaxation is not therapeutic).  The act of manually using your hands to work on another person can tend to all get grouped into ‘massage’ because the discipline is more loosely regulated than a profession like physiotherapy and unfortunately this can do a disservice to a group of very highly trained and skilled manual therapists.

Many physicians and insurance companies don’t adequately recognize the value a highly trained massage therapist can provide.  Most Registered Massage Therapists (RMT) have extensive knowledge of muscular tissue, but there are many more experienced therapists that have specialized training in fascia (connective tissue), viscera (organs), craniosacral therapy, Bowen Therapy, and what is called Structural Integration (Rolphing).  Good RMTs blur the line between ‘massage’ and osteopathy.  I have worked closely with a number of them and they all have a 1-6 month waiting list to get in to see them…that has to tell you they are doing something right because believe me, most therapeutic manual therapy is not like a relaxing spa experience.

If you are looking for a good massage therapist, start by considering what you feel your needs are and then ask friends and other healthcare practitioners who they recommend.  Look for people with specialized experience and don’t be scared off by a long wait to see them….it probably means they know what they are doing.  Good examples: Mark Finch, Kor Manual Therapy  

Chiropractors

There is a general assumption out there that physios and chiros don’t like each other because they have different approaches and are somewhat competing for the same clients.  I get asked all the time what I think about chiropractors.  My short answer is: just like any profession, there are good ones and bad ones.  I have treated many people that swear by their chiropractor and I have treated others that have been hurt by them.  Click here to read my post discussing the topic in more detail, it sparked a small debate in the comments on the blog that is an interesting read.

I have worked closely with a few chiropractors and taken some courses with others.  I think a well-trained and experienced chiro can be an invaluable asset to a team.  In practice, I don’t refer my clients to them, but I am happy to work with them because our skillsets more often complement each other rather than counteract each other.  Their bread and butter is typically spinal adjustments, but many chiros will offer Active Release Technique (A.R.T., a muscle stretch/release) or Spinal Decompression (a fancy traction table) as well.

As I have suggested with Physios and RMTs, when choosing a Chiropractor, do your homework on who you choose and challenge them if they are asking you to come in 3-5x per week or prepay for anything (sometimes business can get in the way of ethical care).  Example of a good Chiro: Integrative Healing Arts

Naturopaths  

Naturopathic physicians understand the body in a way that medical physicians just don’t.  I would never try to replace one with the other, but if your interest lies more in preventative health, I would consider adding occasional visits to a naturopath as part of your healthcare team.  They better understand the role of stress and diet on the body and can use blood markers the evaluate health instead of just disease.

In my experience, their common treatments involve recommending (selling) supplements, nutritional advice, IV pushes of supplements directly into your blood stream, Prolotherapy, acupuncture and sometimes visceral manipulation.  Their scope overlaps with medical doctors, holistic nutritionists, Traditional Chinese Medicine and Osteopathy.  I think they provide a great service and can probably help you in ways you didn’t realize you needed help or may hold the answer to some issues you thought you just had to live with.  My only caution/concern is how expensive their visits can be if you don’t have good insurance coverage to see them.  The recommended supplements they will sell you can get expensive quickly, but the overall service is a valuable one.  Good example: Ron Mariotti in Seattle.

Osteopathy 

Osteopathy is effectively manual medicine.  It is a discipline that has different recognition in different parts of the world.  In my experience, it seems to be more common place in Europe and the Eastern side of North America, but is becoming more accepted and practiced by various manual therapists around the world.  Osteopaths use their hands to manually manipulate the body to treat all of the different systems including the bones, organs, nerves, muscles and blood vessels as well as the interaction between the systems.  They are the originators of visceral manipulation, cranio-sacral therapy, spinal adjustments and other manual techniques.  Osteopaths’ scope, as manual therapists goes beyond musculoskeletal pain, their foundation is that a healthy body is one that has physiologic motion and mobility in all of the systems.  They have developed precise and specific hands on techniques based on and in-depth knowledge of functional anatomy.

As a physiotherapist, I have worked with a few therapists that are also trained as osteopaths and they are always the ones I send my clients to, if my client plateaus working with me.  Their skillset to treat obscure and resistant pain issues continues to fascinate me to the point that I am starting some of the training myself.  Depending on where you are in the world will affect your ability to find a good Osteopath.  I know in Vancouver a lot of them have started as physiotherapists or massage therapists and may still be working under that title.  Many of them have such a devout following that it can take months to see them, but as I continue to suggest, do your homework and find someone good.  Examples: Deirdre Byrne, Anabelle MacKenzie

Kinesiologist & Personal Trainers

The fitness industry is the most unregulated of all of the healthcare fields in that there is a huge variety in the education level of the person you may end up working with.  In a personal training gym you may find someone with a Bachelor of Kinesiology, a Masters in Exercise Physiology and a Certified Strength & Conditioning Specialist (CSCS) designation working beside an uneducated but well intentioned person that decided to do the basic trainer certification through the local community center (and everything in between).  Don’t get me wrong, a well-intentioned person that safely gets an inactive person moving and fit is an asset, but if you have lofty goals or special needs for your body, you should do your homework on the credentials of the person you are paying to whip you into shape.

If you are concerned about hurting yourself or need help rehabilitating from an injury to get back into the gym I would look for someone with a Kinesiology degree that has some affiliation with a physiotherapist. E.g. Essential Kinetics

If you are wanting to train as an endurance athlete (runner, biker, triathlete), I would lean towards someone with a Masters degree or their CSEP certification (exercise physiology certification). E.g. Curb Ivanic

If you are looking for high performance strength training for sports and general conditioning, I would suggest finding a trainer with their CSCS certification because their knowledge level and competency on form is just that much better.  E.g. Carmen Bott

If you are trying to get back into shape after pregnancy, please don’t jump right into baby bootcamp.  I would advise starting with a screen by a physiotherapist and then a progression/combination of Pilates and Kinesiology before pushing yourself too hard.  We are currently setting up an integrated program at Envision Physiotherapy for Post-Partum women in Vancouver that includes a screen by a Pelvic Floor Physiotherapist, one-on-one clinical Pilates, and Kinesiology with progression to fitness.

Finally, if your goal is simply make me move, motivate me and get me in shape, I would recommend searching more for a good personality fit than specific credentials.  You want to make sure the person is competent, but the psychology of fitness training is hugely important and if you are going to be successful, you want to work with someone you respect and can learn from.

Yoga & Pilates Instructors

The same applies for Yoga and Pilates instructors as it does for Kinesiologists and trainers; there are multiple certifications, not much regulation and a wide variety of knowledge levels.  There are also many different types of Yoga and Pilates so do your homework before signing up for a class.  If you are considering choosing either of them, I would strongly suggest starting by doing some one-on-one sessions with an experienced instructor before you join a large group setting.  There are nuances of body awareness that instructors can teach you that you just won’t get out of group classes, but if you go into them armed with the one-on-one experience you will enjoy the classes more and be way less likely to hurt yourself.  My physiotherapy clinic has teamed up with The Movement Studio to offer one-on-one Clinical Pilates involving physios and experienced Pilates instructors (click here for more info).

Counsellors & Psychologists

As a physiotherapist dealing with people in various levels of pain and discomfort all day, I have no choice but to be part counsellor to some of my clients.  People in general will much more readily seek help for a physical problem than a cognitive one, but unfortunately the two cannot be easily separated.  Quite often recurrent and persistent pains that a person may experience have strong ties to stress, tension and anxiety, but the person is only willing to address the physical manifestation of their cognitive issues and wonder why their pains keep coming back.  I encourage people to develop self-awareness both physically and cognitively and counsellors are the best way to guide to process.  Click here for more about Mindfulness.

Occupational Therapists

I went to school with occupational therapists (OT) and have worked with them for 10 years but still have trouble defining what exactly they do because there scope is so broad.  They tend to help people find the right assistive devices, make adaptations to their home and/or learn techniques to compensate for physical and cognitive deficiencies after trauma or simply aging.  They tend to work in hospitals and the community in a way that overlaps with physios, social workers and speech language pathologists.  If you, or a loved one is having difficulty with activities of daily living due to a physical or cognitive deficit and need someone to help you problem solve the situation, your best bet is to track down an OT.

Traditional Chinese Medicine & Acupuncture

Traditional Chinese Medicine (TCM) is one that I don’t have a lot of experience or knowledge about so I will keep this short.  As a healthcare provider I have come to realize that not everything works for everybody, but some things work very well for certain people; TCM and acupuncture fall into this category for me.  I respect anything that has survived the test of time over thousands of years and acknowledge that acupuncture is the foundation that Intramuscular Stimulation (IMS) was built on, a tool that I use every day.  Click here to read about the fundamental differences between IMS and acupuncture.

Conclusions

No one person knows everything when it comes to health so be prepared to build a team of healthcare professionals around you that you are the leader of.  Be wary of practitioners that dissuade you from seeing others and be open to treatment options you didn’t know existed.  Do your homework and find professionals that are good for you instead of ones that are just close to you.  Finally, keep track of your own health.  Write down what you feel, who you see and what they have told you.  I promise it will come in handy again someday.

Hope you found this helpful, please leave comments or questions below.

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1 Comment ↓
  • Joanne

    Hi Brent, What are your thoughts on Athletic Therapists?

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