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