Contemplating COVID-19: Will it be the end of the beginning or the beginning of the end of modern MSK care?

By Mike James | 21st May 2020 | General


What a rollercoaster the last few months have been not only for the world, but for all of us within the MSK world. We have all experienced our own unique circumstances and will have no doubt reflected on it based on these individual situations.

One thing that I have been very aware of is time. How the speed of life has allowed me to have more time in some areas of my life, and how deep I have thought about bigger picture thoughts beyond the day to day life of being a therapist.

Its taken me this long to really organise those thoughts but I hope that this blog can resonate with you and hopefully stimulate further debate or conversation within the industry.

The MSK world is certainly used to handling situations where change is both encouraged, welcomed and also resisted.

Recent years have seen us battle, challenge and reform our thinking, when it comes to some of the traditional ways we treat.

The patho-anatomical and passive model of care that potentially creates a dependency, a model that saw us as fixers of ailments and healers of injury. The concept of us being mythical beasts that could source, identify, and manipulate everything that we could possibly think of in order to restore health and well-being.

Our recent journey, although still fraught with division and animosity, has seen us evolve. We have developed a way in which many techniques and treatments are aligned within a modern, BPS thought process, that prioritises patient engagement, self management, empowerment, education and reassurance. 

This coupled with an element of "hands on" or the traditional perception of MSK care, but delivered within a narrative that fits comfortably  into modern thinking, alongside ongoing improvements in exercise prescription and self-management rehab.

Now, we certainly weren’t at the end of this journey, and we certainly weren’t perfect, but no matter how slowly the steam ship MSK was turning and changing its course, we were starting to make a change and were setting sail in the right direction.

Then the pandemic came….

What has this done for us?

For many it will have confirmed some of the thoughts and thinking they already had when challenging the traditional concepts of care. How reassuring it has been  to stand back and treat at a distance using education, reassurance, empathy, active listening, attentiveness, exercise, therapeutic alliance and be able to facilitate and guide patients towards self-care.

"Telehealth" or digital care has been adopted or expanded from its previous involvement across MSK care to varying degrees albeit with mixed feedback from therapist and patient alike.

For others, it has been a tremendously difficult time. A fundamental struggle to engage patients from a distance. A time where they may feel isolated, segregated, handcuffed and unable to perform or deliver care in the way they want or feel they can.

And of course, we must note, that each therapist and patients experiences fall somewhere along a spectrum based on their beliefs, values, training, current practises and previous experiences.

This isn’t a blog to criticise or shine a spotlight on those with particular beliefs and values that may not align with mine or those of the modern MSK narrative.

It is more a 10,000 foot view and a thought provoker of what the long term impact of COVID-19 may be on the delivery of modern MSK care.

What will happen as the clouds lift and we return to practise?

Will the therapists who have struggled with online clinics etc double down on getting people through the doors to “fix” them?

Will they seek to apply passive care and resurrect their identity and confidence?

Will they seek to build their credibility even higher that they are indeed the fixers that the patient cannot improve without?

Will the outdated narrative be exaggerated even further to scratch the itch that may have become even more irritating during lock down as people message seeking care and they have felt unable to deliver?

Will the need to pay bills and help the business survive affect the way you run your business?

Will the public react the same?

Will they seek to be fixed, to be cared for, to be reliant on a therapist?

Will the flood gates open and will we regress the recent progress?

Will there be a desperate urgency to be healed?

Will people who quite rightly benefited from government and social support for prolonged periods in so many ways now suffer from a sense of dependency on others in the long term?

Will the population identify with all the things modern MSK care is trying to promote?

Will their recognition of  the power of self-management be enhanced? will this mean they seek to be autonomous keepers of their own health and well being more than ever before?

Will we see an uptake in the understanding that we are there to help, but from an arm’s length predominantly?

Will they see us as a pastoral type carer who can be utilised as needed at different times in different ways throughout their lives?

Will it be a case that if the right person finds the right therapist then all will be ok?, and if not, we could have the perfect storm? But isn’t this what happens now anyway?

How will the public and private sector react?

Will health insurers further embrace and fund telehealth or will they want incentivise people coming through the door more than before?

How much will the NHS maintain or expand online services and which areas of MSK or healthcare at large,  be funded or prioritised for this?

It must of course be noted, that this is not an attempt to raise the hands on v hands off debate in another guise. In fact many modern MSK therapists provide first class care predominantly through the medium of hands on treatment, such as our Sports Massage and Soft Tissue colleagues. I am not advocating we stop all hands on, of course I'm not. There is an absolutely appropriate place for this in modern MSK care that we should embrace.

But we need to consider whether or not we see a backward step in the narrative and delivery of over necessary care in all facets of the industry.

Maybe most importantly, will the united approach seen by a number of professional associations during this period continue? and will this lead to a long term unification of the fractured industry? - I truly hope so.

The list of questions go on.....I guess we simply don’t know at this stage, people will need to do what they feel is right for them, their families and their business. They will need to manage their reputations in whatever way they feel appropriate, rightly or wrongly in the short term and only when the dust settles will the long term impact be revealed.

Will it make no difference at all and we have simply paused for 6-9 months or longer?

I guess it will fundamentally change some people and their practise, others will have some aspect of change and some, none. If anything it will serve as a reinforcement of previous beliefs.

For now, I urge people to simply think of the future, be mindful of a potential impact on our futures, accept all opinions and viewpoints and potentially think about gathering collective thoughts as we move forward.

These are just the thoughts of a therapist, a therapist who is fortunate enough to have a job that allows him to interact daily with many many therapists across all the MSK professions.

A philosophical old therapist that has listened to many stories of life as an MSK therapist during COVID-19.

Please do continue to treat and work as you see fit during these tough times, none of us know each other’s individual unique circumstances, and it is unfair to judge those who shoes we have not walked in.

Please do stay safe, stay well, and look out for those you hold dearly.

See you on the other side, thanks for taking the time to read.


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