Wait and See or Seek Treatment: Knowing the Right Time to See a Physiotherapist.

Time heals everything, right? Unfortunately, not always.

Knowing the right time to seek physiotherapy treatment for an injury can be one of the most important factors in the likelihood of a full recovery.

As physiotherapists, the clients we see who require the most sessions and have worse outcomes in the long term are those who have waited months or even years to take the leap and come in for treatment.

Often during a first assessment, my clients will ask “How many sessions do you think this is going to take to improve or fully heal?” My answer often is prefaced by “Had I seen you earlier…”

So then, when IS the best time to get an injury assessed?

In this post, I’ll provide three tips on when the right time to see your physiotherapist or physician.
For simplicity sake, I will use the common ankle sprain as an example.

(This is one of the most common injuries that clients don’t seek treatment for and should, by the way!)

1. Most acute injuries will benefit from a few days to a week of rest and modified activity.

The first stage in tissue healing is the inflammatory phase. During this phase, inflammation and pain are greatest. This is why ice is most recommended during the first 48 hours following an injury. If a soft tissue is damaged, stressing it further by putting weight on it or returning to sport, can increase the damage to the tissues.

So, for the ankle sprain example: the old fashioned RICE(rest, ice, compression, elevation) formula is a good idea to follow. An exception to this is if you are not able to weight-bear (stand on your foot and walk) without pain. In this case, you should seek care immediately to determine whether you should avoid putting weight on the limb completely (like you do when you use crutches) or whether imaging (like an x-ray) is needed.

2. The pain is greater than 6/10 on the pain scale

Pain is subjective and individual. Modern pain science recognizes that not everyone experiences pain in the same way or intensity due to our nervous systems being differently wired.

However, if your pain level is over the mid-range of 5 or 6 out of 10, it may be suggestive of something more serious such as a bone fracture or infection.

In this case, seeing a doctor to determine whether investigations are warranted or to help prescribe pain medications that may help you manage the pain and sleep better, is wise.

3. It’s been over 2 weeks and you still have pain that is limiting your day to day activities and sport.

Starting as early as day 4, the subacute (or fibroblastic) phase of healing begins. During this phase, new collagen fibres are laid down in a disorganized pattern. These fibres are weaker and can’t withstand the same stress as healthy, uninjured tissue. While this new tissue is being laid down, it is important to start stressing it in a specific and protected way to prevent the formation of tight scar tissue in the muscles, ligaments and joint.
The right physiotherapy-prescribed exercises and/or manual (hands-on) therapy can help in this stage to break down any adhesions that form and align the soft tissues for a more effective healing process.
During this phase of healing, your pain starts to settle and it is also very easy to re-injure yourself if you go back to sport or activity too early as the tissues are still weak and the other systems in your body (such as your joint position sense or proprioception) are not back to their normal yet.
Returning to the ankle sprain example, once your pain starts to settle and you can walk again it may be tempting to just “try out” the ankle at your soccer or baseball game since you no longer have pain to stop you. This is where many people re-injure their ankle and often the second sprain is even worse than the initial one.
Alternatively, they return to sport and the ankle “just doesn’t feel right”, especially while running. Thinking that is will get better on its own, they continue to play, not realizing that if they came in for assessment and treatment, they may be able to get back to their prior performance level and avoid the few months of hobbling around playing poorly due to joint restrictions and altered strength.

Key take home messages:

1. Don’t go back to sport too early or underestimate the process that your body is going through to heal itself.

If your sport is important to you and additional time away if you re-injure yourself would be a real drag, get a professional such as a skilled orthopaedic physiotherapist to do an assessment and give you their opinion.

2. Getting a professional opinion on your injury never hurts.

So, if you are wondering whether to go for assessment or treatment, the safe answer is probably yes.

3. Don’t live in pain.

If it’s been over two weeks and you are still limited function-wise, get it assessed.
If you have questions regarding when the right time to come in is, call a physiotherapy clinic and ask. We are always happy to give advice on when to come in and education is a key role we play as healthcare providers.

Life is too short to not be at your best and as physiotherapists, this is what we love doing the most: helping to get our clients back to doing what they love. 

By: Katrina Sovio, Registered Physiotherapist.