Our physiotherapists are independent practitioners, who provide services in association to the Adelaide Chronic Pain Clinic.
Bret has been a physiotherapist since graduating from University of Otago (NZ) in 2006. He has always had an interest in complex or chronic pain presentations and has been working at Adelaide Chronic Pain Clinic (formerly Complex Injury Group) since 2016. Here is how he describes his approach to physiotherapy:
‘Physiotherapy for chronic pain starts with discussion, investigation and education. Persistent pain can be confusing, particularly with so much information around to sort through. We start by addressing questions and concerns and move towards increasing understanding of pain and its interaction with physical function. Pain is a complex thing but a solid understanding of pain is vital to progress so we start with this.
Attention is paid to any difficulties with physical function, often caused by a combination of injury and pain resulting in a mixture of stiffness/tightness/weakness. We methodically develop simple activity and exercise programmes which are also reviewed and progressed regularly.
Many patients experience fear of certain movements or activities, often avoiding activities they used to enjoy. It makes sense to avoid or to be apprehensive about things that have been painful in the past but pain can cause us to become overprotective. We address this as well with education and progressive experimentation.
As we move forward with exercise, it is often appropriate to introduce pool and/or gym-based exercise. Education is provided and exercises prescribed at the outset and progress is reviewed regularly. By this stage, patients have a good understanding of their pain, how their symptoms respond to activity and exercise and how safe they are to perform exercises so the pool or gym sessions are soon independent. We regularly review progress in the clinic (or at the pool/gym if appropriate) and agree on progression of existing exercises or introducing new ones.
Everything we try is informed by research and experience but some things work better for some than for others so we do what I like to call ‘Small, low-risk experiments’ to determine the best programme. We use these experiments to discover what works based on evidence from the patient’s own experience of trying the exercises and activities. We then progress or introduce new experiments. As this cycle is carried out we see improved understanding and independence and improvements in function and activity.
The overall aim is to help patients to improve their physical function and reduce the impact of pain on well-being in all areas of work and life.’