Overtreating versus undertreating

February 23, 2022

Perhaps the title should read overcomplicating and undercomplicating.

People attend the physio for lots of reasons. Some are small things, some are big things. 

Given how common injuries and pain are, it’s normal for everyone to have an idea, or an opinion as to what things are and how bad they might be.

3 other things shape this significantly

  1. Google – information is everywhere. Most of it is shit
  2. Culture – our groups, tribes, teams and families influence how we view the severity of pain and injury
  3. Health professionals!!! They are also everywhere, hopefully only some are shit.

What this leaves us with is often a predetermined idea of what needs assessment and treatment, and how much rehab it needs.

We very often get this upside down, and this comes from health professionals. If they can’t get it right then what hope does everyone else have?

I will illustrate with an example.

Back pain. Often very debilitating, very disabling, often scary and comes with many horror stories. The insane majority of back pain is very tame, will get better on its own and not require much treatment. There is good evidence that once you have it assessed, be confident it’s nothing scary and resume normal activity, you’ll get better pretty fast. Scans, 12 weeks of corrective treatment, stopping activity, all these things are mostly unnecessary.

Ankle sprain. How often have you heard “it’s just an ankle sprain”. How many people do you know that constantly sprain their ankles. There is a fairly common set of people around their 40s who either give up activity because their ankles are terrible, or have stabilisation surgery to try and and get moving again. If we rehab the first, second, third or tenth ankle sprain you have properly, you stop sliding downhill into ankle disability. Many careers have ended and lives have been affected, not by bad luck, but by bad rehab.

And most of the time you think you are doing the right thing. Many times health professionals encourage this over/under complication.

How do you know what to do – trick question. You don’t. But neither does Google, your coach or you Mum. It’s not their job. It is our job. If your health professional gives you answers that sound over/under complicated they probably are, and you should look for a new one.

The thing I do with most frequency each week is convince people with simple things that feel complicated that they’ll be ok with simple things, and convince people with bad injuries that feel ok that they need to do some rehab.

If you are unsure which one you have, that’s ok. Ask us

In summary

Things that hurt but aren’t damaged – probably get better with the right advice and not much rehab

Things that are busted, but might feel ok – need rehab, otherwise you’ll probably do it again

Dear Health Professionals – please advise accordingly