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Author Topic: NHS vs. Rest of the World  (Read 2010 times)

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Offline rooshka

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NHS vs. Rest of the World
« on: October 30, 2008, 11:29:14 AM »
Hi - I am new to the boards so please be patient if this has been discussed before!  I have recently had ACL reconstruction and on a physio programme through the NHS.  I am 7 weeks post op and things seem to be going really slowly.  I really like my physio but she is always very quick and I only get to see her for about 20 mins.  Not much hands on stuff beyond a quick massage of the hammies annd then sent home with more of the same exercises.

So my question is this:  what are the benefits of going for private physio?  Is it not worth it money wise, so soon?  Is there any other type of specialist worth paying for at this stage? At 3 months?

I am desperate to get my knee back in working order so I can get back on a horse and back to yoga, back to my life, really.

Any experiences welcome!  and Thanks!
« Last Edit: October 30, 2008, 03:27:36 PM by rooshka »

Offline Silkncardcrafts

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Re: NHS vs. Rest of the World
« Reply #1 on: October 30, 2008, 11:36:32 AM »
It is definitely worth paying for a private physio. I lived in London for a couple of years and attended Pure Sports Medicine in London. They were fanastic. My sports physician had links to some great private physios. By seeing a private physio you should be able to make a quicker recovery.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline rooshka

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Re: NHS vs. Rest of the World
« Reply #2 on: October 30, 2008, 03:26:50 PM »
Thanks for that.  Is it worth waiting until the first 3 months are over?  My NHS physio has advised me to go really slow at first, no weight bearing at all...

« Last Edit: October 30, 2008, 03:28:29 PM by rooshka »

Offline lmr1

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Re: NHS vs. Rest of the World
« Reply #3 on: October 30, 2008, 04:03:31 PM »
hi rooshka

Personally i feel that the physio is the most important thing about your recovery and have always found private physios better than the NHS, it's really a question about whether you want to pay or not.

The basic difference is that a private phsyio will be willing to touch you and the nhs will be telling you what to do.

Lisa
left knee problems since 1994
2 clean outs cartlilage removed both times
Acl recon oct 2006- extensive arthritis in medial side
Mosaicpasty june 2008

Offline Silkncardcrafts

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Re: NHS vs. Rest of the World
« Reply #4 on: October 31, 2008, 06:33:02 AM »
Hi Rooshka,

I would get a private physio now. No point waiting the 3 months. You certainly shouldn't be non weight bearing for 3 months. You should get off crutches as soon as you can.

Hope this helps. Where in the UK are you based ?
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Kaputt_Knee

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Re: NHS vs. Rest of the World
« Reply #5 on: October 31, 2008, 08:09:21 AM »
Before you make any decisions get back to your surgeon and question this protocol with him/her. If they feel it is wrong they will say so then you can move on.

If you cannot contact your surgeon, then call their secretary and ask for advice. The normal rehab for an ACL reconstruction is to move the joint as much as possible as early as possible and weight bear as tolerated from day 1. However, other work done at the same time sometimes takes priority over the reconstruction. Until you know exactly what has been done in your knee from the person who did it do not make any changes, especially based on opinions given here.

We can advise you based on our experiences but we cannot tell you what to do. We are not doctors, nor are we physios in most cases and even if we were, we do not know your history nor can we see or feel what state your knee is in.

FYI 20 minutes is the usual NHS appointment span for a 1:1 with a PT. If you are unhappy with the attention/treatment you are getting, talk to the PT supervisor as well to see if there is a problem.

The NHS takes a hell of a lot of knocks as it is an easy target to shoot at, big and cumbersome, but it is always there when you need it. In other countries you are not so lucky unless you pay a whacking great contribution - ask the 45 million people without health insurance in the USA if they would like a walk in service like the NHS where they are not excluded from life-saving treatment because they cannot afford the costs.

UK trained physiotherapists are ranked as being some of the best in the world due to their standard of training, hence they are "poached" by every health care service in the world. My nieces are both PTs and regularly receive job offers from North America, South Africa, Australasia, etc. They are both still in the UK, but for how long I don't know as they are both young, well educated and sick and tired of being criticised by every Tom, Dick and Harry because they cannot devote the time they would like to to their patients.

I pay 15% of my income in contributions to an excellent healthcare system, but I still have to pay part of my treatment costs. My health insurance is a state one, not private and they have to give the OK for all treatment outside of life-saving emergency care. In the UK you pay 6% I believe in Health care contributions, I think you are getting a great deal on the whole.

Sue in Germany
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline rooshka

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Re: NHS vs. Rest of the World
« Reply #6 on: October 31, 2008, 11:00:52 AM »
Thanks for the full reply.  I am in no way knocking the NHS or my physio, I am just new to all this and new to using the health service to this extent as well.  Anyway, when I said weight bearing I meant exercises with weights, cycling etc.  I am definitely off crutches and putting the weight on my leg through walking, day to day activities etc. 

Apologies - I am not really used to all the knee related terminology yet - but I am sure it will come.

« Last Edit: October 31, 2008, 11:02:31 AM by rooshka »

Offline Kaputt_Knee

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Re: NHS vs. Rest of the World
« Reply #7 on: October 31, 2008, 11:38:56 AM »
Weight bearing is usually used to indicate how much of your weight your leg/knee can tolerate - what you are talking about is weight training and resistance work in order to build up strength. It is quite normal at your stage to not be doing any of the latter. Weeks 6 through to Week 12 the graft is at it's weakest post-op as the vasculization process is at work. You do not want to stretch it or cause it to fail in any other way at this stage by pushing too hard too soon.

In the Information Hub you will find a wealth of information about ACL reconstructions, timelines and rehab protocols. It is a good way to bone up on the terminology and also to educate yourself so that you can ask relevant questions at your PT sessions.

I was recently given the go ahead to weight train at 10 weeks after a multiple ligament reconstruction/revision. I'm now at 11 weeks and am gradually adding weights work to my programme. In the initial stages of any reconstruction the order of priority is:

1. Extension as this is essential for a normal gait, i.e. no limp and freedom from your crutches
2. Flex but not to push for too much too soon. As your gait returns to normal the flex improves as well
3. Reduction of swelling as that inhibits both of the first two
4. Patella mobilisation to prevent the knee cap sticking to any scar tissue and blocking both flex and extension.

A lot of work can be done passively either by using gravity, a Continuous Passive Motion (CPM) machine or by your therapist working your knee. Some people have very aggressive rehab protocols, others have extremely conservative ones, but they all include motion of one kind of another. Your surgeon will have instructed your physio somehow via your operation notes as to what they want to see by the next follow-up visit

You don't say what kind of graft you had, as that also plays a big role in the speed of your recovery. Allografts (donor tissue) have the fastest recover but the longest vasculization time I believe - so you are feeling great but your graft is weaker for longer. Hamstring tendons have the middle ground and patella tendon grafts take the longest to heal in my experience. The latter two are called Autografts if the tissue is taken from your own body.

The rehab is long and at times very frustrating, especially if you are someone who is extremely active - most of us are by the way, that's how we ended up here  ;) But the good news is that most people recover and return to their sports fitter and more aware of the limitations of their bodies.

go to the Cruciates Board and read some of the posts there, especially the ones "glued" to the top of the board as they offer heaps of info and advice. BUT it is better to err on the side of caution and talk to your PT about anything you want to do for yourself before you try it. One thing we repeat over and over again is do not compare yourself with anyone else as each of us is unique in every aspect.

Welcome to the ACL Rehabber's Club  - here we really do understand your frustration!

Sue  ;) in Germany
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline Silkncardcrafts

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Re: NHS vs. Rest of the World
« Reply #8 on: November 01, 2008, 09:53:46 AM »
Hi there,

If you can find a physio that is Australian they will probably be a lot more up to date with current treatments and techniques.

All the good physios I had in London were Australian. An English private physio I saw had no idea about knee problems. I think I knew more than she did which was very scary. I'm sure there are some good English ones out there but Australian and New Zealand physios are know to be very up to date with their treatments.
« Last Edit: November 01, 2008, 10:25:00 AM by kjwilkin »
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline lmr1

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Re: NHS vs. Rest of the World
« Reply #9 on: November 01, 2008, 09:55:45 AM »
My private physio is brilliant and he is english!!

And mosaicplasty in my area has only been done about six times and is therefore considered a very new technique, and at no time have i felt that he does not know how to manage my rehab..........in fact without him i really would have been snookered.

Just because you had a bad experience doesnt mean that all English physios are a waste of time and we should be seeking Australians.
« Last Edit: November 01, 2008, 09:59:35 AM by lmr1 »
left knee problems since 1994
2 clean outs cartlilage removed both times
Acl recon oct 2006- extensive arthritis in medial side
Mosaicpasty june 2008

Offline Kaputt_Knee

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Re: NHS vs. Rest of the World
« Reply #10 on: November 01, 2008, 10:01:15 AM »
Kirsty, that is the most arrogant load of twaddle I have ever read!

You condemn a whole nation of physio based on your limited experience of one physio who did not match your expectations. That is not to say that they were uneducated or not up to date.

If the Aussie system is so world-beating why are so many of the NHS PTs being actively recruited for your country? There are good and bad in every country it is stupid to judge all by the actions of one.

I find your comments extremely offensive, and completely unhelpful in the context of this user's question.

Sue
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline Silkncardcrafts

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Re: NHS vs. Rest of the World
« Reply #11 on: November 01, 2008, 10:17:54 AM »
Lisa, I'm not saying that all English physios are bad, but Aussie physio are considered to be some of the best in the world and generally more up to date. I have generally had bad experiences with English physios, but that may have just come down to luck.

Kaputt Knee, I find your comments very rude. My comment is not just based on one physio. That has been my general experience. Please refrain from being so rude. I certainly have not met many English physios in Australia. I also didn't mean to hurt anyone.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Silkncardcrafts

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Re: NHS vs. Rest of the World
« Reply #12 on: November 01, 2008, 10:22:40 AM »
Another idea is to find a good sports physician/doctor that can guide you with your rehab. I now no longer see a physio and am just guided by my sports physician on my rehab and the exercises I should be doing.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline lmr1

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Re: NHS vs. Rest of the World
« Reply #13 on: November 01, 2008, 10:32:23 AM »
We may in comparision to other nations be considered quite small but we are bigger than just London, and whilst i may have interpreted your comment wrongly, i feel you are still trying to say that the user should use an Australian physio as per your quote below.

If you can find a physio that is Australian they will probably be a lot more up to date with current treatments and techniques.

All the good physios I had in London were Australian. An English private physio I saw had no idea about knee problems. I think I knew more than she did which was very scary. I'm sure there are some good English ones out there but Australian and New Zealand physios are know to be very up to date with their treatments.
Quote

this is a very sweeping statement to come out with, although i choose to use private cover because i am in a position to afford it, the NHS although sometimes slow is such a good system that people travel from all over the world to use it, and that includes our physios!!! 
left knee problems since 1994
2 clean outs cartlilage removed both times
Acl recon oct 2006- extensive arthritis in medial side
Mosaicpasty june 2008

Offline Kaputt_Knee

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Re: NHS vs. Rest of the World
« Reply #14 on: November 01, 2008, 10:35:52 AM »
Kirsty

if you find my comments rude, then sorry but I feel that any trained physiotherapist regardless of nationality or training is only as good as their most recent updtae course. The training in the UK is acknowledged to be one of the best available, I know of several trained Aussies who came to the UK to extend their training in this field. I played hockey with a whole gang of them in Bristol - they felt that their chances back home were greatly increased by having further education in the UK.

For you to make such a Carte Blanche statement is arrogant and not at all helpful to the original poster of this topic.

You seem to have a very limited understanding of how the NHS works, possibly garnered from comments here as well as your short stay in the UK. The system is not perfect no-one claims that it is but is freely available to all and there are safety devices in place for people to question practices and attitudes. The cost of private treatment is often far beyond the pockets of many and it is a serious consideration before embarking on such a course. It also does not guarantee exactly your desired outcomes. As I said there are good and bad in all systems, but to imply incompetence is grossly over-stating the situation.

Sue
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee