It’s the million dollar question isn’t it?! Will your injury, your ailment, your aches and pains get better?
The short answer is, probably, yes. But that would be a very short blog.
Let me also be clear that we will be talking about ‘typical’ things we see as physiotherapists – muscular, ligament, neural, myofacial and joint problems.
At your first appointment, there should be a lot of talking – mainly by you, the patient. Talking is good. Talking and listening, listening and talking. We, the clinician should be noting how your symptoms behave, how they started, how are they affecting you, are there other things going on? At the end of the talking bit (the subjective), we should have an idea of what potentially is causing your problem and what your prognosis is – the examination will help to develop this further.
Usually when we see someone for the first time, we will be able to give you an idea of what your prognosis is – in other words, will it get better, how long it will take and what you can do to help this process along. It is not an exact science but we’re usually pretty accurate. These are some of the most common factors which will help us answer your questions. Now you can try this yourself!
For the best will in the world, the older we get, the longer things take to heal – the slight knock we had aged 17 will resolve in a couple of days – take the same injury 30 years later, it will still settle but it will take longer.
- Mechanism of injury
In other words, how did the injury happen? Not always a true indicator but a guide. Did your symptoms come on gradually or has there been a specific injury or trauma?
Will your job help or hinder your recovery? A typical low back pain patient who spends 8 hours a day sat at a desk in front of a computer will generally not facilitate quick progress. Saying that, if you’re changing your position regularly, if your workstation is set up correctly and your workload is manageable, this then becomes more favourable.
That is, the stability of your condition. Since your injury or symptoms began, is it staying the same, improving or worsening? Depending on your response, this can impact prognosis. For example, if you have sprained your ankle and now 6 weeks down the line, we’d expect an improvement even with no intervention. If you see us with worsening symptoms then we’d be looking at contributory or ‘driving’ factors, or differentiating other structures.
- Previous treatment
If you see us, and you’ve seen 10 physios, 3 consultants, an osteopath, a chiropractor, had a steroid injection and had acupuncture, and your symptoms are no better,is it because you’ve not seen us? Unlikely ( although possible!! ) – we’d be asking more questions about the type of treatment you’d had, what was their opinion, and most importantly if there was something else going on.
- Previous history
Just because you’ve had 6 episodes of neck pain in the last 3 years, which have been taking longer to settle each time, doesn’t necessarily mean your prognosis is less favourable. But someone we see with a first episode of neck pain is more likely to respond quicker.
- Locus of control
Do you want to get better? Do you want to help yourself? Are you compliant with advice and or exercises? Or are you just ‘waiting’ for your symptoms to resolve or expecting someone or something to ‘fix’ you? This, above most things, is probably one of the biggest prognostic indicators, particularly with ‘typical’ musculoskeletal symptoms.
- Psychosocial factors
Although a lot of people don’t like this one, primarily because it shifts the focus onto them again, and it closely correlates with locus of control, the nature of you, your work life, your family life etc can all influence your prognosis. Are there other factors going on in your life putting you under pressure? Are you off work for long periods of time? Are you having problems with work, relationship or money?
- Fitness levels
Your baseline fitness and condition will either help or hinder the rate of progress your injury will make.
Smokers heal slower. FACT.
Any joint problem or lower limb injury will be aggravated by being overweight.
Probably quite an obvious one, but if you’ve injured your rotator cuff (shoulder) and your main hobby is rock climbing, this will not facilitate a speedy recovery – however, on a positive note, patients with a passion for their hobbies usually make them very compliant with advice and exercise!
- Pain mechanisms
Pain mechanisms vary from acute nociceptive pain (that acute, standing on a drawing pin type pain), neurogenic (more of a dull, longstanding, think chronic toothache type pain) to centrally sensitised pain (pain ‘has a mind of its own’, nothing helps it, it seems to flare up for no reason, and you feel even hypersensitive to touch). Pain is complex and deserves a blog all of it’s own. But if we see you at the acute nociceptive stage, your prognosis will be more favourable.
- Severity and irritability
How severe is your pain on a scale of 0-10? Do you need painkillers? Is it disturbing your sleep? Are your symptoms irritable? In other words, what flares your symptoms up/ how easily is it aggravated? And once aggravated how long until it settles down? As a general rule of thumb, symptoms of low severity and irritability will settle quicker.
All of this information gives you a whistle stop tour of how we help you, how we give you the advice we do. We take our job seriously, we take your health seriously. One of the reasons our assessment process is in depth, specific and yes, we ask you a lot of questions. We want to do the best for you, and if we don’t have all this information, we are not as informed as we could be.
Thank you for listening.
Please share and spread the word about physiotherapists. And ask questions. Ask your physio what your prognosis is, and how they came to that conclusion. Shy bairns get nowt!