And how you can optimize this for the success of your practice and your satisfaction (incl. tips and tricks)

A report by Rudolf Wölfling, physiotherapist

Working with and on patients is always a new challenge. Especially in times of hectic schedules, staff shortages and rapid changes, specialist staff often have little room for their own goals, needs and expectations. The explanations and tips from physiotherapist Rudolf Wölfling help both newcomers to everyday practice life and dealing with patients as well as experienced therapists to improve their working atmosphere, patient and staff interaction as well as their own job satisfaction.

Overwork and underwork in physiotherapy

Working as a physiotherapist and other specialists in medical professions, such as massage, occupational therapy, speech therapy, nursing and geriatric care, can be very physically and mentally demanding due to the often intensive treatments.

Occupational stress is influenced by various factors:

• The number of patients per working day
• The severity of the disorders to be treated (including the emotional stress of the patients). The expectations of patients, doctors and health insurance companies. Time pressure, for example due to the appointment structure of the working day, short or no transition times between individual patients. The support experienced in the wider operational context of one's own professional activity. For example, the working atmosphere, the quality of cooperation with colleagues and the management behavior of superiors.
• The daily work requirements in physiotherapy are not always predictable
• It can happen that a physiotherapist performs mainly routine treatments on a particular working day and is confronted with an accumulation of particularly difficult, stressful cases the following day that place very high demands on him or her. It is possible that this physiotherapist feels underchallenged on the first day with their available skills and tends to feel overwhelmed on the second day. In addition to the severity of clinical pictures, the other working conditions have an impact on the demands placed on therapists. It is extremely helpful for a practice or clinic to ensure smooth appointment scheduling so that the skills of the staff can best serve the patients. Sufficiently long treatment times benefit both patients with higher needs, information procurement for new patients and professional and human support for employees by superiors.

But even if a practice or clinic department does not implement such measures to create favorable working conditions, every therapist has opportunities for self-management to prevent and intervene in acute stress situations.

Three possible points in time for resource activation

In practice, there are three possible times for activating resources: before, during and after a working day.

Before the working day

Before the working day, a physiotherapist can prepare themselves for their work and their work with patients through brief physical and mental preparation.

During the working day

It's not just the technique that heals. It is also the trusting contact with other people, which can also promote compliance with patients and therefore easier work.

In addition to professional skills, social skills, the so-called "soft skills" (ability to work in a team, communication skills, critical and conflict management skills, analytical thinking, flexibility, creativity, empathy, organizational talent) have taken on an increasingly important role in today's society and working world.

Eye contact for the first impression

The greeting is the moment of the first impression and thus essentially determines the opinion that others develop of us. Eye contact is the first step in a greeting. An open gaze appears trusting (confidence), whereas avoiding it appears shy and insecure. The first eye contact is usually followed by a handshake, at least in Europe. The right handshake is important to make a confident and assured impression. The greeting serves to demonstrate your own strength, position and emotional attitude to the other person. In fact, even today, eye contact that is too long comes across as threatening and aggressive. The length, type and intensity of eye contact convey a clear message to the other person. Anyone who avoids eye contact appears to be hiding something. A friendly look has a positive effect, especially when combined with a genuine smile. A restless gaze that changes direction, on the other hand, leaves a restless impression.

First impression
Within just 150 milliseconds, we decide whether we find someone likeable, neutral or unappealing at first glance. This is how we protect ourselves from sensory overload. In this first phase of an encounter, we communicate over 90 percent of the time via our body. For this reason, skills such as a handshake play a key role in making a positive first impression.

Smiling works
An authentic smile starts with the eyes and ends with the mouth; the entire facial musculature is involved. A natural smile has a tension-reducing and friendly effect. Eye contact should not last longer than three seconds. If it is uncomfortable to look the other person in the eye for a long time, you can fixate on a point on the bridge of their nose. You will still look interested and attentive, but the other person will feel much more relaxed.

Smiling is healthy because the increased blood and oxygen supply stimulates the production of endorphins ("happiness hormones"). When you smile, you do something good for yourself and at the same time have a more positive effect on those around you. Even a "forced" smile leads to a reduction of stress hormones in the body.

Show openness
This includes raising your arms upwards with your palms facing upwards. During such movements, you show yourself unprotected and free of fear. This gesture can also be used to show the direction to the treatment cubicle. One hand shows the direction and the other arm goes protectively behind the patient's back. Of course, keeping an appropriate distance.

Keep your distance
If someone invades our territory by keeping too little distance, we feel uncomfortable. Everyone has their own personal distance zone and the other person's need for distance should also be respected (proxemics). Within our culture, a distance of around one arm's length is considered appropriate. The sideways position at a 45-degree angle makes it possible to stand close and comfortably together right from the greeting phase. The need for distance is considerably less when standing sideways together than in a direct confrontation and therefore creates a trusting basis for conversation.

Securing the patient in space and time
"Go into the cubicle, get undressed, I'll be right there." - As a result, the patient is still wearing clothes that he should perhaps have taken off, and the patient may already be lying down on the couch, hugging the foot support roll as a pillow. It would have been better here to give precise instructions on what is required in terms of clothing and lying down and an approximate time announcement such as "I'll be there in 3 minutes". The door should always be closed and the curtain drawn tight so that the patient feels protected. Then nothing stands in the way of carrying out the assessment, drawing up an individual treatment plan, implementing the therapeutic measures, documenting the progress and, if necessary, informing the prescribed doctor.

Digitalization can help to make everyday life easier

The use of computer-assisted aids is now widespread in the healthcare sector. Digitalization is not only taking place in the therapeutic professions, but also in nursing and medical practices. The tools are mainly used for appointment scheduling, communication and billing. Some software providers also advertise digital diagnosis and therapy documentation in the field of physiotherapy. Although the physiotherapy prescriptions issued are organized and managed digitally in most facilities, the documentation is often still in paper form. There are currently a variety of software solutions for documentation, which differ greatly in terms of content and appearance. All solutions offer a certain amount of structuring of the documentation, but do not contain any functions that contribute to saving time, such as language support or automatic generation of therapy reports, sending an SMS or e-mail. The above-mentioned options should be considered to reduce the workload. Digital training devices in physiotherapy can also reduce the therapist's daily workload. It may be worthwhile taking a certificate course in "Physio online consultation/video therapy". The right equipment, such as LED panels, LED ring lights for illumination or microphones with noise-canceling, also makes work easier. If you do become overloaded, it can be helpful to calm yourself down for a few minutes. Even under the greatest stress, you should allow yourself a moment's rest - take a deep breath - sort out your thoughts - and then start again. In this context, the studies on so-called microflows are interesting for making everyday life easier to cope with. Microflows are, for example, smaller playful activities for pleasure and small phases of creative self-determination. These are everyday activities that a person performs spontaneously for pleasure and without any recognizable external reason. These non-instrumental activities include things such as free body movements, playing with fingers and hands, arm and leg movements (fidgeting), playing with objects, puzzles, being able to move freely, contact with others, having a conversation for the sake of conversation and not to obtain information (that would be instrumental), spontaneous imaginations, fantasies, inner dialogues, listening to music, reading for pleasure, self-rewards, snacks, drinks, chewing gum.

In general, attention should be paid to a good diet, nutritional supplements and water balance. It is now known that there is a gut-brain axis. The vagus nerve also plays a role here.

ROS are formed under stress. Antioxidants such as OPC or asthaxantin can help here. To avoid sugar and thus insulin problems, collostrum or ribose can be used. Sufficient water must be drunk in any case. Large drinking bottles can motivate people to drink. Neural tremors can be applied via the iliopsoas muscle to reduce the stress you are currently experiencing. This helps immediately. However, it cannot be used to build up stress resilience.

Facilitate "hands on"
In addition to a good infrastructure, such as a good treatment table and good treatment equipment, small measures can often improve the professional work. For example, increasing the grip during myofascial techniques or lymphatic drainage with Multicare Feel gloves or Dycem foil. Various types of aids can be used to work on muscles, myogelosis and trigger points. Kinesiology tapes can also be used for this purpose. As muscle flexors are stronger than muscle extensors, working on the treatment bench inevitably leads to poor posture and, particularly in the muscles that contribute to posture, to tension and myogelosis in the shoulder/neck area, on the back and in other areas of the body such as the calf or thigh. Self myofascial release utensils, heat pads, stretching or flossing bands can provide relief. Functional clothing, socks or shoes with barefoot technology make it easier to get through the working day.

After the working day

After work, you can process your experiences with an appropriate exercise, reflecting on them if necessary with the aim of learning from them and putting them behind you. Even if it sometimes seems difficult, the regeneration of emotional and physiological states immediately after a working day can be very helpful, e.g. by means of mindset mindfulness, i.e. MBSR.

Yoga, meditation, autogenic training or ASMR can also make you fit for everyday working life again.

Nature helps. It is important that the body itself is active and moves through mechanical movement, such as walking, jogging or cycling. Simply going for a walk does not help, as the vehicle performs the mechanical movement. The eyes absorb the lateral movements of passing nature, which has a positive effect on brain activity and thus reduces stress.

Sleeping
A good night's sleep is extremely important for getting through the working day. This includes, for example, an optimal pillow, weighted blankets, sleep trackers, light alarm clocks or listening to binaural beats (there is no scientific consensus on this, but they are used in ASMR). Book tip: Conversation techniques for physiotherapists, theory - techniques - case studies by Heike Hoos-Leistner andMichael Balk.

Rudolf Wölfling is a qualified physiotherapist with many years of experience. His areas of expertise include manual therapy, lymphatic drainage, fascia therapy, basic spinal balancing therapy, medical flossing and kinesiology. His practice is located in Zurich.