From Gynecology to Sports Medicine: A Conversation with Sports Physiotherapist Dr. Nirupama Bhatt

Dr. Nirupama Bhatt (PT): I took an entrance exam for a Bachelor in Physiotherapy just to be on the safer side to have more options to choose. So, I got selected and it was a great college. When I was in my first year, I didn’t know so much about my course. But with time, I got to know about this course and what is the scope in this field, and with time I kept on loving my field more and more.

Dr. Nirupama Bhatt (PT): Okay. So, today many people don’t know about physiotherapy, and the ones who know about have misinformation about it. What we see mostly online on YouTube or Instagram is that people are performing Hijama therapy pricking the needles or doing something like that. I have done many such courses so now I know what is better for a patient and what is not to be done on a patient. Because you cannot judge just by looking at it whether it is better or not. I have done a year diploma in Osteopathic Chiropathy. What we do basically in that program is that the physiotherapy school of thought, they are not talking about Seagram and its dysfunction which is mostly present among the patients according to their literature. We work on them using manual techniques. The technique of assessment is different from physiotherapists. Basically, in other countries, it is a whole different program but we do not have a specific program in osteopathy or chiropractice here. So, we do diplomas. We have a program, that taught us basic dysfunctions and how to treat them. They have different guidelines. Chiropractice is a thing where you work on the adjustments. You might have seen people walking. Whenever they walk, their walking pattern starts becoming uneven; not because they were like that from the start, but with time, they start facing postural issues which are very common today due to sedentary lifestyle. So, when do chiropractice, we work on those adjustments. In osteopathy, the ways to assess their functions and to treat them are different. When we talk about dry needling, if a patient has pain in one particular area, so when we puncture a needle anywhere in your body, if not done by us and even if it is done by mistake, your body immediately reacts to it by releasing chemicals in that area. The nodule that was made will break. The best part of physiotherapy is that we use your body to make you the best and treat you. When we puncture a needle, your body will be activated to work more and react and be treated, there is no role of the needle, there is nothing in the needle. When we talk about cupping therapy, in cupping therapy, we create a suction through a vacuum. Your muscles are uplifted due to the suction, and your soft tissues will be released. When we combine lots of techniques, it comes into physiotherapy along with exercise intervention. That is the main goal. Because you have treated the patient and the pain is gone. But what next? If a patient does all the exercises that we have taught and along with that he adds on, then the problem will be managed there itself and it won’t increase. So, all this is mainly what is under physiotherapy.

Dr. Nirupama Bhatt (PT): For a Physical therapist, we have done Bachelors in Physiotherapy which includes electro exercise therapy along with this different kind of literature we use to assess the patient and along with that we use the whole body to treat the patient. Here there is no medical intervention, chemical intervention is not there. Physical means you try to stimulate things physically. But when you talk about physicians, physical doctors, the ones you are talking about do MBBS, and after that, they do that. They do medications and there is a whole different scenario. Here, you don’t have to do MBBS. MBBS is a whole different bachelor's degree. But a Bachelor of Physiotherapy is a different degree. So, these both are different things.

Dr. Nirupama Bhatt (PT): See, I have lots of interest in sports and orthopedic cases but I believe that neuro cases are more challenging because there you work on the brain and you never know how much time it will take. I was working on a person. She was 7 years old but due to some issues during birth her brain was fully functional but her main issue was that she couldn’t walk. The main problem we face with kids is that you need to do innovative things with them, it's not like you make them do these things and you go. These things won't give results either. So, that is most challenging as to how to make it innovative also. For me, it was like I needed to do something new so she did one and a half hours of exercise with me. I had to talk with her like a kid and then she sat with me for one, one and a half hour of exercise. So, I feel that pediatric cases are the most challenging ones. Whatever the pediatric cases I’ve dealt with, all of them are challenging with me. Children do not listen easily so you have to make them understand. 

Dr. Nirupama Bhatt (PT): See what happens now when you have a mother at your house is that she will always complain about having back pain issues, knee pain, and sometimes women do not tell these issues to men but they have urinary incontinence issues which you will not be aware of. I believe that if we stop these issues from where they started and control them, then in later life, they won’t be facing those problems. Because during our mother’s age, these problems were not there but what happens is that when you are pregnant for the first time, there are physiological changes in your body due to which all these problems are seen in future during your 40’s & 50’s. It will not be seen immediately because at that time your muscles and body will be young. At that time your abdomen becomes weak and gets stretched and it won’t heal at that time because a female on average has 2-3 babies. When the first baby is born, the injury is not recovered fully and they move on with a second baby. This is how urinary incontinence takes place because at that time normal delivery was very common and due to that your pelvic muscles get weak in the future, you face urinary incontinence, your capacity to hold urine decreases and they don’t even know that they are having this issue. So, what happens in anti-natal, post-natal science care is, I will talk about myself in recent times, with pregnant women we as medical students know that these things are going to happen and there are the things that we need to follow. But if I talk to a non-medical person, things that seem normal to us, seem too much knowledge to them. They do not know anything about it. Because the basic education level is not there unlike medical people, and seems basic to me. So, for that thing, they need someone who can guide them. A few days ago, I was talking to a woman. She was telling me that gynecologists don’t have time. They will relax and chill, everything will be alright. But being a first-time pregnant, I know how frustrating it can be because we do not know. See, this is like an exam for which you have not prepared but you want to prepare. You want to do that, yes, I want to prepare and come but no one can guide me and help me in preparations, there is no coaching center, and nothing is there. So here is anti-natal, postnatal what we do is that in starting we have exercise intervention. We tell them what is the role of it and why we are doing it. Along with it, we give childbirth education. During delivery what will happen to you and how do you have to react in that case? Because C-sections are most common nowadays and no one is giving coaching about normal delivery. If you go to a gynecologist who is working genuinely, how to do those things, where you should not give up, what will be the worst time in which you will have to react like this and this, we are with them to facilitate them to tell what options can they opt for delivery or to do the baby. So, all those things intervened there. Exercise is needed today because earlier females used to sit and mop the floors and do all household chores. Today there is no nutrition, plus women are working today. All of them are working. Our body does not have movements like it used to have in people earlier. Earlier people had more movements due to which their muscles were relaxed enough and their joints were moving nicely. Nowadays it's not like that. We have too many issues in the pelvis. Pelvis opening exercise we have to make people do it today unlike earlier when people didn’t need exercise because that was done while working only. So due to these modifications that we have seen with time, we have to come up with our interventions to treat them. Plus, if we talk about the long term, the mother’s back pain, and lower back pain, are the reason because at that time they weren’t taken care of properly which is reflected in upcoming times. So, we can even prevent them. Physiotherapists have a whole different branch in gene and OB/GYN care so you can open this setup too. It’s a part of our course only. 

Dr. Nirupama Bhatt (PT): See athletes have very fine bodies and they are very disciplined. It’s not about whether they will eat junk food or not. But, we have made a notion like that. So, when we train athletes, for example, we have 2 athletes, who both have the same condition, ACL (anterior cruciate ligament) which is very common among footballers and normal players and normal people too, I have seen it very common. So the general population and athletes need extensive training in intervention because they need to go back to sports. 

For example, I am not doing any heavy activity or anything, I have to walk normally and do my daily tasks, which is normally more than enough. So, if my muscle power is 5, that is more than enough. But the requirements of athletes are more so we have to focus more while working on them. Plus, in normal people, there is no specific time duration that you have to treat them within 2 months, but with athletes, there is a whole season so we have to work fast actually. You cannot say that you cannot do it for 6 months. It is not like that. We have to understand their mental abilities and depression and they feel very low so those things we have to keep in mind. We have to see a patient psychologically and we have to see them from a physiotherapy point of view also. So, there are a lot of differences there. 

Dr. Nirupama Bhatt (PT): You have got me now. These are my favorites. When I was in my second year I was very interested in gynecology and that’s why I did this program too because I wanted to go in gynecology. But with time, I don’t know how and why my interest in sports increased. But I would prefer that I train sports athletes who are female because they will have the same cases so this will be the smarter answer.

Dr. Nirupama Bhatt (PT): According to me, generally ethnicity or geographical locations or environmental factors play a very crucial role along with financial conditions. In India, we are not talking about some % of people who are very rich and who have every resource. Most of the Indian population, who have so many dreams to do so many things in their career, are from an average middle-class family. They don’t have enough finances to start what happens during their career, they don’t have coaching, and they don’t have enough nutrition level because it costs a lot. And all these things hamper their stamina and agility. Because the right coaching leads to a better future. If your coaching is done incorrectly then you need to go to a physiotherapist and they could not afford that too. I'm sure about that. Because sports physiotherapists charge a lot, I know that. So, all these things are there. And the one that you are saying about Europeans and these, I would say that their country supports these things a lot. If I say that Prime Minster Narendra Modi has made significant contributions to sports in India, it would be an understatement. Earlier it was not like that. Even really good athletes used to drop out of their careers because they couldn't afford bread and butter. So, these things when compared to foreign countries, they do a lot for sports. They invest a lot. And because of that their body, nutrition, and training play a great role. When these things lag, your athlete will move behind in terms of agility, stamina, anything. So, in India, these things are lagging but as time passes things are getting better. Still, I say 70% of athletes who have capability are not able to move in front and reach greater heights. So, these things are different in India.