Question
Dear Shawn

For the last two months I have been visiting a physiotherapist for treatment of lower back pain.  The treatment consisted mostly of mobilization of my spine which has helped enormously.

The physiotherapist has been professional in his conduct throughout and we have a good rapport.

On my last visit, whilst he was performing mobilization on my spine as I was lying stretched obliquely on my side, he leant his chest onto the side of my back presumably for leverage to hold down my side.  He has performed this method on me many times before, but using only his hands, arms and elbows.  This was the first time he used his upper body.  The pressure he applied with his chest was quite hard, but it did not feel sexual to me nor did I feel harrassed.  

I would like to ask whether it is usual practice for chiropractors and physiotherapists to use their upper body on their patients during treatment?

Many thanks for your time.
Katherine

Answer
Dear Katherine,

From what you have described, the physiotherapist has not done anything inappropriate as far as body positioning and mobilization techniques.  In chiropractic school we spend hundreds of hours learning to perfect the correct line of drive in a joint space and we frequently use our bodies to apply counterpressure on the torso, hips, and thighs.  Mobilization techniques are very similar and require the same types of body positions. I would not consider this to be in any way unrespectful, sexual, or unprofessional.

I do not know what the level of education is for a physiotherapist concerning their ability to mobilize or manipulate the joint space, but as long as he is not trying to cavitate "pop" the joint space with a fast maneuver, he is also practicing within his scope of practice.

The only thing he did wrong here was not to inform you of the change he made in body position before he performed the procedure...All health care professionals are required to obtain a written or verbal consent to treat...this is called informed consent.  I have to admit, I have treated female patients in the past where I utilized different adjustment techniques on them without first informing them of the change in procedure. You get comfortable with your patients and often just assume that they trust you wouldn't do anything inappropriate in your treatment.

You have to realize that as physical medicine practitioners, chiropractic physicians, massage therapists, physiotherapists, and physical therapists are touching people all day long, every day for years, and sometimes we can make a lapse in judgement that may make the patient feel uncomfortable.  Over the years I have made a point to start describing everything that I am doing with the patient including hand placements etc...immediately before I treat them, and I always tell them with their first examination and repeat on follow-up appointment, that I want to immediately know if I am doing anything that makes them feel uncomfortable in any way.  I have found this eliminates confusion and that I get immediate feedback from my patients which helps to create a better doctor-patient relationship.

I would suggest that you bring up your concerns with the physiotherapist and let him know that you felt uncomfortable so that you can move on and he will make sure to inform you better in the future.  I am sure that he would want to know how you feel, and this can open up the lines of communication for the future.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net