Synonymous with physiotherapy are exercises and hands-on treatments. And rightly so, because these are our basic interventions that we are expert in delivering. However, it is not just the manual therapy and massage that we use our hands for in the clinic. No, no. There is much more as I will describe below as we consider the diverse role of the physiotherapist’s hands.
The hand shake
In many cases, we shake hands with the patient at the start and end of their session. A hand shake is important and must be right — don’t crush the other person’s hand but equally there needs to be some firmness to communicate confidence and sincerity. The hand shake is accompanied by an appropriate greeting, definitely a smile and followed by an invitation to enter the room or sit down. Think about how you would invite someone into your home, wanting them to feel welcome and comfortable. Not everyone receives a hand shake though, so a different gesture is used to imply the same welcome.
The welcome gesture
Hand shake or not, we indicate that the person can enter the room or sit down by gesturing towards the door or chair. A soft, smooth movement obvious enough for the person to understand your message, and soon the person will feel more relaxed, particularly if you use some words of welcome.
When talking I use a great deal of gesticulation, both with patients and when lecturing. It is thought that we gesticulate to reduce the cognitive load on the brain — one of many ways that we think by using our body (embodied cognition). Moving one’s hands, we do this to make a point, to act, to demonstrate a movement, to point, to emphasise, to distract, to guide, to communicate, to sympathise….and much more. We can learn to use these movements with great skill as part of the art of communication. So much of our work as physiotherapists is about communication, whether this be helping someone understand their pain, move in a different way, create calm or guiding a mindful practice.
Washing our hands
This is a demonstration of cleanliness and the patient seeing this act is important. We can also use it as a natural break, feeling the pleasure of running water and a light massaging effect.
Writing and typing
There is always plenty to type and write. I have an online note taking system, which means that I type whilst the patient talks but I use a paper body chart to scribble notes about the symptoms. My hands are well occupied with these tasks, transmitting the patient’s words onto the screen or the chart without thought as I concentrate on the story that they tell me.
Guiding movement, reassuring touch and pointing
We may support a body area, or lightly apply pressure to guide the patient as he or she re-trains normal movement. Pointing to where the person needs to stand, signalling the direction of movement and gesturing encouragement are all important jobs for our hands.
Clapping, punching the air, slap on the back…
I love to celebrate someone’s success and will choose an appropriate action along with congratulatory words. It is important that the person knows that their efforts have resulted in successfully overcoming their pain problem. Praising the work that they have done, their courage and resilience will make them feel good about what they have achieved.
Goodbye for now.
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