UK Physio Perspective: Mehmet Gem

And, here we are, Hopeful Hippies back to the UK with a physiotherapist's perspective. Let me introduce to you, Mehmet Gem. He loves his job and that of supporting patients with all types of musculoskeletal concerns, but he also has an interest in treating hips!

1. Tell us a little bit about yourself. Why did you get into PT and how has your

practice as a PT changed over the years after working with patients?

My name is Mehmet Gem. I'm a hip specialist physio working within the private sector

within a hospital setting and within a gym. I've a huge passion for Sports Medicine of

all kinds and have worked as an MSK Physio my whole career. Having always had a

passion for all sports and playing many [sports] from a young age, I was always aware

of the role of a physio and what they do. Although when initially applying to [university]

I wasn't really sure the route I wanted to take. I initially had started off doing a Sports

Science degree as an undergrad but I soon realised that physio was what I wanted to

do, so as soon as I finished my undergrad I starts a Masters in Physio which was

another 2 years. I've been a physio for around 10 years now and have specialised in

hips for about 6 I would say.

2. It sounds like you have an area

of specialty in hip injuries and

surgeries. Tell me about some of

the benefits of that expertise

when helping people recover

from hip surgeries such as hip

arthroscopy and how it is

different from THA. How does

your knowledge help with hip

patients as compared to a general

orthopedic PT?

So rehab for patients who have

had hip scopes and THA differs

greatly as they both have quite

specific and different needs. Hip

arthroscopies have had a massive influx in

numbers (2005-2013 was about a 700% increase!!) and my interest initially came about

back in 2008 when I had my own hip surgery, that was essentially what sparked my

interest. Within the UK our orthopaedic physios tend to be ward based and will likely

only see these patients on the ward a few times and then refer on for outpatient

physiotherapy where they would see me and my colleagues. We would then gradually

guide and progress through a rehab programme that would be far more robust than

that of the exercises they would have been given whilst on the ward.

3. What is the best advice that you can give a patient leading up to an orthopedic

surgery? What about after?

Great question!! Patients need to be told everything and we must be transparent. We

need to highlight the fact that surgery may not work, it may make symptoms worse

and it is hard to 100% say it'll be successful as we don't have that luxury, though more

often than not thankfully it isn't the case. With hip scopes the pain after surgery is not

too bad if all has gone well, though with a THA it can be quite painful. Patients need to

know that. All too often they suspect that because the pain before was from bone on

bone, and that the old joint has gone the pain should have gone as well? When in theory that make sense, the process to get that the joint out and put a prosthetic one in

is a real significant process that the body goes through, and with that comes pain in

recovery. It's important to educate around that prior to surgery so that patients are not

put off post surgery due to the pain with the concern that it has not worked or that

they are doing something detrimental to the new joint. Fear avoidance of movement is

very common in all patients post op so it is important to address that pre-op and set a

positive minded approach right off the bat.

4. What are some things that a patient should make sure their PT understands if their

PT is not well versed in rehabbing patients with FAI.

It's hard to really answer this one. If a patient is having symptoms of FAI Syndrome or

if they have been diagnosed with FAI Syndrome, or even if they have had surgery for

FAI Syndrome, I do think they need to be seeing a physio who is experienced in dealing

with the pathology. Patients need a strong alliance with their physios and with that

comes the need of the physio to instill the patients with the confidence in their skill set

and management. It would be difficult for the patient to fully have trust or confidence

in if what they are doing is the right rehab, especially if they have any flares ups, when

they're aware that their PT doesn't tend to see these much. I would not think this

should be an issue. There are a multitude of areas within MSK Physio that I have

colleagues who would be better placed to help than I, so it's just about linking up with

them and working cohesively.

5. Can you explain the current research on the human pain experience? (As an aside,

I have pain, but I push through because I know there is not 1:1 correspondence to

tissue damage).

Pain is an extremely complex entity and is different for everyone. Essentially it is a

subjective experience driven by multiple factors. You're right, there are many instances

where pain does not correlate with tissue damage though in other instances it does. We

hear of people being stabbed and not saying they felt any pain, those in war who lose

limbs and aren't aware of the pain due to shock and then we have us who feel the worst

pain in the world when they stub a toe or have a paper cut. It's about perception and

experiences. Physio's must explain to patients the level of pain which is normal when

carrying out rehab and to really decipher what isn't. There is that whole no pain no gain

motto than often isn't true. A little bit of discomfort with rehab is fine but you wouldn't

want physio to always be painful otherwise people wouldn't be compliant.

Psychological factors have a very close correlation with pain. We all are aware of how

mental health can have a direct correlation with pain but the science also backs it up.

Those who are stressed or anxious have been shown to have a heightened level of

chemicals and hormones in the body which is directly linked to increasing the

sensitivity of nerve receptors. This in turn reduces the threshold of pain signals

meaning that the individuals pain experience may be worse or persistent based on the

fact that these thresholds are lowered.

6. What is your belief on the mind-body connection in healing from orthopedic

surgery? What about expectations - ie..patient expects success?

I am a firm believer that those with a positive mindset and confident will likely have a

better recovery irrespective of what procedure they are having. Patients can easily go

down two routes. Those who have personality traits that demonstrate confidence and

motivation, and those who may be more on the anxious side of the spectrum.

Unfortunately, those with anxiety may be predisposed to further catastrophizing

symptoms as part of their thought process and as discussed before, there is chemistry

and biology behind that process too. If patients are given clear expectations from the

outset I always tend to find that their approach post op is better too.

7. What do you see as a PTs greatest contribution to helping a patient recover?

Physios are key in empowering patients. We have a vital role in coaching and guiding

their recovery and enabling self-sufficiency which is key. Our sessions with patients

are short and we need to have as much of an impact as possible within these sessions

so that patients can take home key messages and feel confident. Exercises and rehab

drills are obviously vital but if a patient and physio do not have that alliance and

rapport which they have built, then the recovery journey will probably be trickier and

that patient is likely to feel less empowered. I'm really passionate about that.

If we break it down, I would say these are the key aspects that are needed for a good

recovery:

• Good relationship with physio

• Sound understanding and education around the condition and what is going to be needed from the patient

• If surgical (or even if not) patients stating what their expectations are and also the physio setting their own expectations and educating the patient about what they should be expecting.

• Empowering the patient, building their confidence and continually reassuring them.

I would say that if any of these aspects are missing it may well have an impact on their

recovery.

So, Hopeful Hippies, that's a wrap! If you are in the UK or if you want to check out any of the additional resources that Mehmet has out there, check him out on Instagram: @MGemPhysio