Where does physiotherapy end and Exercise physiology start?

By Physiotherapist, Vanessa Boon

Introduction

Our resident Exercise Physiologist, Rachael Kent, sits down with us to share her views on how physiotherapists (physios) and exercise physiologists (EPs) work together, which injuries she sees the most and how physios, EPs and our clients can work together to overcome them. Just as a brief background on Rachael, she has 9 years of experience under her belt, 3 of those working at Exercise Lab at BOSIC. 

What made you decide to pick a career that revolves around exercise? 

I think my general interest in sports, injuries, performance and the musculoskeletal system in general fascinates me. Learning how to train that was, and still is, something that I find really interesting. 

Are there any specific sports you enjoy training clients in? 

I love all sports, any form of sport (from golf to soccer to dance), anything that has to do with movement I enjoy learning about and training clients in/towards. 

In your words, what does an EP do? 

We use exercise as a therapy to help people move better, recover from pain and help them live a better and healthier life, whatever that means for the individual. 

Now for the question that always gets asked, in your opinion, what is the difference between an EP and a physio? 

I think that physios are more hands-on, they look after the client at the initial stages of their journey. Once they are strong enough, can tolerate load and are back to their normal activities of daily living, the EPs then take over to continue to assist them along their journey. I think within BOSIC, we have really found that synergy between the two professions where the EPs deal with the exercises that flow on from the acute care of the physios. 

Is there a particular area of the body that you prefer to treat?

I enjoy treating all sorts of injuries and I like having a good variety in my day. Something that does interest me and I feel like I have a good understanding of is the spine. I love working with the back; I think it is crucial to so many movements and so many people have issues with their back but do not have a proper understanding of how to move it. Especially for those in pain, how to get out of pain. 

Are back injuries the most common injury you see at BOSIC? 

Yes absolutely, I would say that a large proportion of my clientele have issues along their spine. Working in Barangaroo with the corporates, I think this has a lot to do with their sustained postures. But we also deal with a lot of weekend warriors who sit all week but want to twist, bend and jump all weekend, just asking their bodies for too much. This is not necessarily a bad thing but they just may not have the best training routine or a proper gym program tailored to what they want to do. 

What are the top 3 questions that your clients with lower back pain ask you?

Are deadlifts bad?

Why does a bent over row hurt me?

Is there a point that I am going to get rid of my pain? 

And what would you say to them? 

Are deadlifts bad? In a general setting I would say that deadlifts are not a bad movement. I just think that they are performed poorly and a lot of people are doing a backbend instead of a hip hinge. 

Why does a bent over row hurt me? I don’t think a bent-over row is a particularly bad exercise either, I actually think it is a great exercise if done correctly. Most people have incorrect loading patterns where they put too much load in their lower backs as opposed to loading their thoracic region, particularly their rhomboids and latissimus dorsi. 

Is there a point that I am going to get rid of my pain? In regards to pain, that is a really patient specific question but I think people are really afraid when they are in pain and rightly so. You have to be able to talk to someone and manage their expectations in regards to pain, the intensity, frequency and duration. The more you can get your client to understand their time frames and knowing that you do not have a magic wand that can get them better in the first session is really important. 

With proper loading patterns/form, if someone is not in pain but would like to learn proper form, is that something you do? 

Yes absolutely, we deal a lot with movement analysis and it is always easier to do a movement analysis if the person is not in pain. If they just want to have a better understanding of how to do movements better or more body awareness it is always easier when someone is pain free. So in that sense, we prefer to do the prehab (prevention) instead of the rehab (treatment). To get the client before the injury happens, teach them the correct movements before they get injured and they can continue on their journey, that would be in the ideal world. Unfortunately we mostly see people after their injury. 

Is that acute injury where you feel physio ties in with EP? 

Yeah, absolutely, because when people get an injury over the weekend, e.g they did a deadlift wrong or hurt their back gardening, that is when they give their physio a call, get the release, the relief, start them on that journey of reducing their pain and to the point where they feel strong enough to move and feel like they can be loaded. That is when they are transferred over to EP and I feel like this is the real synergy between the two professions: where physio is so important to give them the “ok” and EP builds onto that by getting them stronger. 

So, Rach, do you have an ideal client?

Someone who is motivated for change. They are always the easiest client to work with, they are normally the ones where you see booking in straight away after a referral. If someone comes in with a referral date from 6 months ago, in regards to their state of behavioral change  they are in that stage of contemplation and have not quite gone into the action stage just yet so we have to be more mindful with how we approach it. 

Well thank you for taking the time to sit down with me, is there anything else you would like to add? 

Yeah, I think that if you are visiting a clinic where they do not have physios and EPs working together,  you are missing a link. I think physios and EPs work really well together when they understand the boundaries of each profession and it greatly benefits the clients who visit these sorts of clinics. 

Vanessa is the Go-To Physio at Barangaroo Physio. If you have a niggle that is not going away or just want to know if we can help, give us a call at 8599 9811 or book in here and let us work with you to achieve your goals!