A physiotherapist does not need a scalpel!

The Faculty of Rehabilitation at Rīga Stradiņš University (RSU) will celebrate its 25th anniversary this year. We can compare the faculty to a teenager that has grown and matured, who already knows what they want to achieve in life, and has already acquired certain knowledge and skills, but for whom much is yet to come and all paths are open. 

One of the most popular and valuable study programmes at the Faculty of Rehabilitation is Physiotherapy. In this interview we find out what Linda Skulme and Jānis Jasjukevičs think about the programme, what the field looks like today and its future development? Skulme graduated from the Faculty of Rehabilitation this year and recently started working as a physiotherapist at a sports school, while Jasjukevičs joined the faculty during its first enrolment 25 years ago and has been a respected practitioner of his field for a long time. Preparing for the faculty alumni gathering on 20 September, we invited them both for a talk.

Why did you choose to study at the Faculty of Rehabilitation?

Jasjukevičs: ‘I had just graduated from the Physician’s Assistant programme at the Riga Red Cross Nursing School. Looking at the study programmes offered by the Medical Academy of Latvia (as RSU was called at that time) I noticed the newly established Faculty of Rehabilitation. Since I had graduated from nursing school with honours, I decided to give it a try and submitted my application in 1994. I remember that this faculty had the highest number of applicants for its first enrolment period. It was interesting that applicants had to take a written essay exam. Later we joked with the other students, that we were physiotherapist-writers.’

Skulme: ‘I really like sports and play basketball. I got injured once and had to go to a physiotherapist. This had an impact on my career choice, because I realised how important and valuable the work of a physiotherapist is. I had to choose my priorities when applying for the course –physiotherapy was first, occupational therapy was second, and the health sports specialty was third. This is closely related to sports and health care.’

What do you remember about your studies? Were they difficult? 

Jasjukevičs: ‘I do not think it was really clear what the graduates’ specialty would be, at the time – whether they would be physicians-rehabilitators or physiotherapists. This was not easy for the lecturers or the students themselves. I think we learned from each other. Half of the thirty students that had enrolled dropped out already in the first year. As a result only 14 students graduated acquiring the physiotherapy specialty with a Bachelor's degree in health care. The first two years were the most difficult, of course, since we had to study anatomy, histology, chemistry, and physics. The practical lectures we had later were very interesting – getting practical training at a hospital is very important.  I do not know how the study process is being developed today, but in my time we really spent a lot of time in hospitals. During my final year, I started working at the newly established Vaivari National Rehabilitation Centre. I believe we were all rehabilitation pioneers in Latvia.’

Skulme: ‘I could break my study period down into years. The first one was difficult because you had to memorise all this theory without even really understanding why: anatomy, physiology, biology, genetics – all these subjects that shape your understanding of what a human is. Now, looking back, I see that the four years of studies were divided well. Kinesiology, the study of human movement, was added in the second year. This is when I started to understand why learning all that theory had been necessary. In the third year we started going to health institutions, rehabilitation centres, hospitals, and various outpatient treatment facilities. We met patients and experienced first-hand what the specialisation that we want to obtain actually looked like on a daily basis. So, the first two years were difficult because they were based on learning theory, and the third year was when you understood whether the chosen speciality is really what you wanted to do. The fourth year was perfect – a year-long practicum at five different health care facilities. This gave students the opportunity to meet many different kinds of patient – children, seniors, athletes and others. It is now that the student could figure out which patient group they wanted to work with in the future.’

How would you assess the progress of the field of rehabilitation to date?

Jasjukevičs: ‘There has been a lot of progress. The Faculty of Rehabilitation not only offers a qualification in physiotherapy, but also the possibility to specialise in occupational therapy, prosthetics and orthotics, audiology and nutrition. I am very enthusiastic about the material and technical educational aids that current students have access to. I think that nowadays students have more opportunities and that their study process is very interesting. It is not surprising that school-aged students have increasingly been interested in physiotherapy over the last few years. This is reflected during Job Shadow Day where it has become one of the most popular specialties to learn about in Latvia. If 25 years ago one still had to explain to people in Latvia what a physiotherapist is and what they do, nowadays people know. There are physiotherapists at every outpatient and inpatient medical facility, and a strong physiotherapist association has developed in Latvia.’

Skulme: ‘I am sure that there is progress every year. Functional specialists, such as physiotherapists and occupational therapists, are increasingly integrated into the treatment process and multiple specialists work together. New methods, technologies, foreign experience and courses are valued in physiotherapy – manual therapy, sling therapy, other types of therapy – both in Latvia and abroad. These are all applied to the treatment of various illnesses or functional disorders. 

It is not always easy to tell whether the field of rehabilitation is progressing when you are studying yourself. As a student you do not know if something is new, or innovative for Latvia, because everything is new to you. Now I am well aware of new methods that have been discovered, of scientific papers and research that is being carried out. I remember my classmates presenting a lot of interesting topics during their Bachelor’s thesis presentations. Occupational therapists and their role in patient rehabilitation and functional recovery have been increasingly recognised in recent years. An occupational therapist adjusts the environment and various aids to make a patient independent again. The occupational therapy programme is an example of progress in the field of rehabilitation. The first occupational therapy unit, which employed six therapists, was opened at Vaivari National Rehabilitation Centre and a separate study programme was set up the same year. Initially, the demand for these specialists was not high because people did not know how much it facilitates and speeds up the recovery process, but now there is no shortage of work.’

What is the role of physiotherapists in the treatment process today and how do you see the future of their role? 

Jasjukevičs: ‘Physiotherapy plays an important role in health care today. Nowadays, no one doubts the need for rehabilitation, and especially for physiotherapy. 

A physiotherapist can help anyone, whether it someone with serious health problems or someone practically healthy. 

Preventive measures also play a huge role. Modern physiotherapists use a wide range of treatment methods. Physiotherapy is still evolving, and new ideas and technologies are emerging. The work is not easy and, I believe, still not sufficiently rewarded. Unfortunately, this is wider problem within the medical field in Latvia, but I believe that everything will work out. I am a patriot and I hope that the young talented physiotherapists will not flee abroad, but rather stay here to benefit Latvia.’

Skulme: ‘Physiotherapy will play an increasingly important role in the treatment process. There are already cases where physiotherapists have helped patients avoid surgery and gets the same result through specific exercises. Doctors often make a diagnosis without even touching the patient. A physiotherapist touches and examines the patient. My colleague told me about a patient who came to the hospital complaining about constant headaches. The patient had previously had a computed tomography in Latvia and had been told that he may have a tumour, but that there was no equipment available to accurately identify it. The patient also got a CT scan abroad that revealed that there was no tumour. After examining the patient my colleague discovered that he had strained neck muscles, and a trigger point in the muscle radiated pain to his head. Using physiotherapy techniques, the muscles were stretched, relaxed, and the headache went away. This is a good example that a surgical approach is not always necessary.

In my opinion, it all starts with an active, ergonomic lifestyle and therapeutic exercises. Then what cannot be treated by conservative methods alone can be treated with more invasive methods.  Practically all major hospitals have physiotherapists. For example, in the case of hip or knee endoprosthetics, a physiotherapist will explain which movements are restricted, what exercises to perform after the surgery, and what the recovery process is likely to be. For those patients who follow this advice, the recovery process is much more effective.’

I believe that the importance and opportunities of physiotherapy and rehabilitation should be promoted on a national level.