Is Preventative Physiotherapy the Key to Growing Older with a Lot Less Pain?

‘I'm actually shocked at how much pain I’d just gradually accepted. I wish I’d gone sooner.’

Physiotherapy

It was Freddie’s 30th birthday, and as if on cue, he suddenly began to notice some aches and pains.

“I started getting problems doing normal everyday stuff, not just exercise,” says Freddie, now 31 and living in London. “Like wearing a backpack — even with it fully adjusted, not much in it, I’d get to work with a seized-up shoulder. Danced a bit too enthusiastically at a mate’s party and I had to sit down ’cause my knees went, ‘Nope.’”

A lot of 30-year-old guys — I’m one of them — would choose to ignore constant low-level pain, choosing to live with minor aching until only death provides release. But Freddie had another idea: He went to a physical therapist, even though he hadn’t suffered any major injuries.

“Felt like as good a time as any to get my body in good working order!” he tells me. Freddie was also taking his genes into consideration: His dad had “pretty bad joint problems” despite having been very healthy and active through his 40s — a fate Freddie wanted to avoid.

Freddie booked a “preventative physiotherapy” screening. What he learned about his body genuinely surprised him.

“Turns out my feet rolled inward, I had really inflexible hamstrings causing my hip to be massively rolled forward, and I walk with my head jutted like an inch more forward than is healthy,” he says.

Freddie says the two-hour appointment did wonders for his knee and shoulder problems. Today, he’s never felt better. “I’m actually shocked at how much joint pain I’d just gradually accepted and forgotten was a problem,” he says. “I wish I’d gone sooner.”

To me, preventative physiotherapy sounded too good to be true. Should everyone who turns 30 book an appointment to re-learn how to walk and sit? I talked to two physical trainers and a physician to find out.

What Is Preventative Physiotherapy?
Your body isn’t made to sit at work all daystand at work all day or even walk too much. Death is inevitable, but there’s no reason to put up with minor pain before you get there.

That’s where preventative physiotherapy comes in. The idea is that before you die, and before you fall victim to a major injury, you work with a physical therapist for what’s essentially a tune-up. Think of it as running a diagnostics check on your car — are your wheels inflated? Axles aligned? — only it’s all the decaying joints and misaligned bones in your body.

John Baio, a physical therapist at Martino Physical Therapy in Holtsville, New York, says the idea is spreading; he’s seeing more and more people come in.

Baio explains that preventative physiotherapy used to just be a thing world-class athletes would do to extend their careers. “For athletes, [the therapy is] usually done during preseason,” he says, adding that it’s “a full-body functional screen to see where the athlete’s strength and range of motion might be out of sync.”

He explains, “You can have a perfectly functioning high-level athlete playing at a top level of her sport without realizing her right shoulder is tighter than her left shoulder, and that can predispose her to injury.”

So how does it apply to normal humans?

Dr. Ilan Danan, a sports neurologist in Los Angeles, says it’s not just about preventing injury for top-tier athletes, but relieving average Joes of frequent but minor pains they might be experiencing. “I’ve absolutely seen firsthand those patients that have nonspecific issues, but may have day-to-day pain that is more consistent or is becoming a little bit more noticeable,” he says.

“It may not necessarily be limiting them in terms of their daily living routine, but things that are certainly becoming more noticeable, and it’s ultimately what brings them to a physician in the first place,” Danan continues. “Regardless of whether you’re dealing with a professional athlete, or just your routine patient who’s just trying to better themselves, in theory they shouldn’t be treated any differently, assuming they’ve got similar goals.”

Matt Huey, physical therapist at GO Sports Therapy in Texas, adds that he sees patients come in trying to rid themselves of pain that’s accrued over their otherwise “normal” lifestyles.

“People come in with tight hip flexors and thoracic spines from sitting too much, or they might suffer inefficient energy loss from things like swinging their arms too wide or hips not being in control when they run,” he says, adding that fixing these things before they potentially spill over into a full-on injury can be extremely cost-effective. The problem: Most insurances won’t cover this.

“Insurance only wants to pay for functional limitations: you’re not able to get dressed, make a meal, do your job, etc,” Huey explains. “And they see recreational activities as something you pay for on your own. … You would most likely have to pay out of pocket for it,” but it’s worth it, he says.

In other words, if you’ve got a nagging pain in your knee or shoulder after sitting too long, it’s better to spend $100 out of pocket and see what’s wrong before things go from bad to worse.

Preventative Physiotherapy: What to Expect at a Screening
First, know that not all physical therapists do preventative physiotherapy. Both Baio and Huey tell me it just depends on the therapist and the types of things they specialize in. So, it might take some research to find a physical therapist who does these exams.

Baio also suggests looking for “direct-access” physical therapists in your area. Direct access basically means you don’t need a physician’s referral to see the therapist.

Once you find the right physical therapist, Dr. Danan says, the therapists will first get a feel for your day-to-day. “If they spend 10 to 12 hours in front of a computer,” he says, “then you can start to identify where their shoulder posture lies, where their head and neck posture lies — certain things [that] immediately contribute toward specific aches and pains depending on what they’re complaining about.”

Another immediate thing that stands out, the doctor says, is lower-back posture. “How they’re standing, what type of shoes they’re wearing throughout the course of the day,” he explains. “Things like that can be physically limiting and can certainly be an underlying source of pain to identify and address.”

He adds that above all, “posture is a huge issue, along with balance and gait mechanics.” These three are so tethered to the rest of your body, that if one is causing pain, it will force patients “to compensate in another way, which can ultimately lead to developing another injury at another site.”

Routine to do every day to improve posture? from Posture

Once these are taken care of, there’s a special screening. According to Baio, there are two types of exams, the functional movement screen (FMS) and the selective functional movement assessment (SFMA), both of which “take a look at specific lack of range of motion and coordination and address them specifically from there.”

Baio, who’s trained in the SFMA, says the exam “looks at a bunch of different variables as the person’s moving to determine if there’s not only an asymmetry but something that’s an outlier beyond the norm.”

Baio explains the SFMS test “examines 10 specific movements that cover entire body — and out of those 10 movements, we include the neck, upper extremity, the torso, low back, even your ability to do single leg stand and squat, very functional movements.”

Each movement is given a rating of functional or dysfunctional, and a secondary rating of painful or non-painful.

“Functional means the movement is adequate,” Baio explains. “Dysfunctional means it’s not. So for example, the ideal would be to be functional and non-painful for all of these movements.” However, that’s rarely the case, and if one movement proves to be painful or dysfunctional (or both), Baio says “there’s a whole flow chart to follow, which breaks [each movement] down further and decides what’s causing the dysfunction.”

Let’s say Josh is in a preventative physiotherapy exam and the therapist asks him to squat. He falls forward, maybe, or gets all shaky and weird. “We’d determine their movement is dysfunctional,” Baio explains.“Sure, you might not have pain, but something is amiss.”

From there, Baio would have Josh enter a kneeling position and lunge forward. He’d test Josh’s range of motion in his ankle and hamstring.

“We kind of go through all of those things to see where the dysfunction lies within that [specific motion],” Baio adds. “If that certain motion is fine — functional, non-painful — then we just leave it at that and move on to the next motion.”

Sometimes, Baio adds, it might just purely be a strength issue, in which case you need to lift, bro.

Preventative Physiotherapy: Next Steps
Once the physical therapist has identified which areas of your body you need to focus on, they’ll set you up with an active stretching and exercise routine to get your range of motion back to normal.

According to Huey, the workout plan “may involve specific stretching and strengthening activities followed by drills and form work,” and depending on the severity, you might be asked to come back in to track progress.

After Preventative Physiotherapy, Maintenance Matters Too
“The workout plan — which ideally should be a level of physical therapy that does not require a gym but rather could be maintained at home — will ensure that muscles and joints don’t go creeping back into doing what they were accustomed to, so that six months, 12 months, 18 months down the road, they won’t be running into the same issues that brought them into physical therapy in the first place.”

Baio, meanwhile, recommends making a trip to the physical therapist similar to your yearly trip to the doctor for your physical. “People are staying very active longer,” he says, “so they need this kind of maintenance physical therapy.”

At the very least, take it from Freddie, who’s been doing his prescribed exercises every morning for a few months now. “The difference has been incredible,” he says. “One of the things that really surprised me was that there was actually a ton of everyday pain before my shoulders and knees seizing up that I’d just been ignoring, and somehow forgot about until it was gone.

“Especially sitting still for long periods of time, or anything that involved looking down, like reading a book on the couch. I hadn’t done that for genuinely years cause my neck and shoulders would hurt. My joints are a lot less noisy [now] too — my ankles and knees used to pop and click like crazy when I was just walking.

Freddie says he’s “full-on back into the martial arts now and loving it,” and is also planning a ski trip for the winter — something he didn’t think was in the cards due to his painful joints. “I can’t wait to get back on a snowboard,” he says. “Life is good!”