Physiotherapy vs Functional Patterns: Key Differences Explained

A question we often get asked is how the Functional Patterns method differs from more traditional style physiotherapy when it comes to effectively dealing with pain and injury. While the intention of this blog is not to be negative about the effectiveness of physiotherapy in general, it will highlight what we see as key differences in the practical application of both methods.

It also needs to be acknowledged that there are of course many disciplines and specialties within physiotherapy, all of which contain therapists of varying skill levels. In this sense Functional Patterns is no different. There are many practitioners all over the world with various backgrounds, and with different skill and experience levels.

For the sake of this blog we will have to speak in general terms about both in order to give any meaningful differentiation. Just incase anyone may take issue with the validity of such a comparison, it’s also worth mentioning that the person writing this particular blog happens to be both a Chartered Physiotherapist and a Functional Patterns Human Biomechanics Specialist. So anything written is based strongly on a personal experience of both.

In order to begin we will look into a number of areas such as assessment, treatment and overall follow up.

Assessment

Physiotherapy

Generally, a physiotherapy assessment will consist of a few things. To begin, a good subjective history is taken from the client in order to get more information and history before doing an objective exam. The objective exam may include things like palpation to assess trigger points, localized muscle strength tests, flexibility tests and some movement screening of exercises like squats, lunges etc…

While this of course varies from therapist to therapist, this was my experience throughout my training and the years I worked as a physiotherapist before finding Functional Patterns. Some physios may have access to a gym, have more of an emphasis on athletics, and do more advanced testing when possible.  Others may be in a simple treatment room with a message bed.

Once both the subjective and objective exams are done, a differential diagnosis will be gathered and a treatment plan then put together. Something that can be problematic here, is that people often present with multiple issues. With time limited, physios are forced to focus on the “main complaint” that the client presents with that day. It’s also worth mentioning that generally physio assessments take no longer than 1 hour, with some even being done in 30 or 45 mins.

Functional Patterns
An assessment with us typically starts in the same way, with a detailed subjective exam and history taking. From here we move onto our objective exam. Photos of a clients posture are taken from 4 angles, followed by high quality slow motion video analysis of gait (walking/running) mechanics. We then go through these images and videos together and try to give the client as much clarity around what postural and movement deficits we see, and how these are contributing to the issues they are facing.

The reason we prioritize these tests over isolated muscle testing is that it gives us a much better view of how the body is behaving as a system. This also helps both us and the clients to understand the connection between numerous issues that they might be having in what seem like unrelated parts of the body. We are looking for imbalances and asymmetries, and to give a functional diagnosis rather than purely a structural one.

This initial assessment is 90 minutes long in total with at least 45 to 60 mins dedicated to the assessment alone. This allows us to take a deep dive and go into as much detail as needed.

Treatment

Physiotherapy

During a typical physiotherapy session, hands on treatment is generally given to help alleviate symptoms and improve the bodies capacity for load. This can be in the form of message, dry needling, ultrasound, microcurrent, shockwave therapy or manual therapy.

This will be followed by prescription of a home exercise program. Again, this varies a lot depending on the clients background, the expertise of the physio, and their work environment in terms of equipment available.

From my experience, in a typical 30 minute session. 15 minutes may be allocated to hands on treatment and 15 minutes to overseeing of an exercise program. Some practices may extend and do longer sessions but most private practices in Ireland currently offer 30 minute sessions.

Functional Patterns

A follow up session with Functional Patterns looks more like a training session than a hands on physio session. While our practitioners all posses hands on skills with backgrounds such as physiotherapy, athletic therapy and neuromuscular therapy. We find it is not time best spent, at least not in the beginning. We can do hands on to help supplement what clients do alone, but the main bulk of hands on treatment is done in the form of self myofascial release (MFR).

This allows clients to essentially act as their own message therapists with our guidance. Using various tools, we teach them how to hydrate their tissues and give themselves pain relief with carefully executed MFR techniques. Some physios will also do this to supplement hands on treatment, but in my experience, not enough time is spent teaching clients how to be effective when executing the techniques.

Our sessions are always 1 hour long which gives us ample time to make sure exercises being done at home are at a high enough standard to actually be impactful. This is something we see a lot when clients have been using other methods. Their execution of basic movements is poor due to a lack of understanding, and a lack of proper care and time given to teaching them.

Other than the time allocated to overseeing exercise, the nature of the exercises and techniques we institute differs greatly. Much like the assessment, a lot of traditional physio exercises are done in an isolated way focusing purely on the muscles. We generally focus on the whole body, and the functions it has to be able to execute day to day. We use the findings of the assessment to ensure our exercises are focused on correcting imbalances.

Goals and Follow Up

Physiotherapy

Quite obviously, the main goal of any intervention is to eliminate pain and return to normal activity. The main metric being used is pain itself. This is obviously very relevant, but from my experience as a physio, pain management in one area of the body can often lead to issues elsewhere if the whole structure is not taken into account. Most times, other than feeling better, there is no evidence of any real change.

Once clients are out of pain and back to normal levels of function they are discharged. Getting someone out of pain is one thing, but keeping them out of pain is another, and truly changing someone’s structure is the most meaningful way of doing this. Lots of times, issues can return if the structure is not addressed and what follows is a merry-go-round of consultants visits, pain injections and potentially surgery.

Functional Patterns

While eliminating pain is a top priority, we are also looking for real structural change in the body as an indicator of improvement. From my experience this is the main key difference in the outcome clients can get using our training vs physiotherapy. We don’t sleep easy unless we can begin to see a change in someone’s body. Not only this, but we aim to help people become genuinely more athletic, not just returned to baseline.

When these changes happen, not only can they attack multiple issues at once, but with certainty the likelihood of future problems dramatically decreases. We can say this with confidence because we have evidence of changing people’s posture and the way they move. In our experience, these people not only get out of pain, but stay out of pain.

Our goal is also to educate them well enough so that they can continue to use exercise as a means to correct imbalances on their body long after they have finished their time with us. We don’t provide an outsourcing, but an education and guidance that allow people to self improve and really understand how to train themselves. A percentage change is all that’s needed to feel totally different.

Conclusion

I hope this blog can shed some light on what we feel are key differences between seeing a traditional physiotherapist vs a Functional Patterns practitioner. Of course there will be physios who will take issue with what has been laid out here, and again I stress that there is huge variety in terms of what is done under the label of physiotherapy. This is simply my experience having worked for years in both settings.

It should also give some understanding as to why as a trained physio I have prioritized the Functional Patterns method above all else. I believe it is a much more comprehensive way of looking at the human body, with it’s effectiveness as a practice is rooted in objective evidence of real structural change. It has given me answers to questions I had when I operated purely as a physio, and has allowed me to help people that have found it difficult to find help anywhere else.

The goal as we see it should always be correcting imbalances through training. Some in the industry refuse to acknowledge that these imbalances and asymmetries are something that need work to improve. Coincidentally, most of these people have no evidence that they can actually help people to improve them.