Physiotherapy is a science-based healthcare profession that promotes recovery in illness, injury or disability. It aims to restore movement and functional ability to the person’s full potential. Physiotherapy is an independent profession where practitioners make their own treatment decisions and clinical judgements. They constantly reassess the results of their treatments and adjust their approach.
Physiotherapists in the United Kingdom are HCPC registered health care professionals. They treat people of all ages from newborns to the very old. They take a holistic approach and involve the patient closely in their own care.
Physiotherapy is sometimes abbreviated to “PT” or “Physio”. Physiotherapists may work on their own or with other colleagues in a clinic or hospital. They can also work in teams with doctors, nurses, psychologists, occupational therapists and others.
What Do Physiotherapists Treat?
Physiotherapists assess, treat and manage a broad spectrum of physical problems. These are related to the respiratory, cardiovascular, neuromuscular and musculoskeletal systems of the body.
This article concentrates on physiotherapy in musculoskeletal conditions.
Musculoskeletal Conditions
Musculoskeletal physiotherapists treat problems associated with muscles, bones, nerves, cartilage, tendons, ligaments and joints. More specifically, they can help with:
Spinal Problems – Back pain, chronic back pain. Slipped disc, herniated disc and degenerative disc disease, spinal stenosis. Sciatica. Neck pain, neck injuries and whiplash. Osteoporosis.
Soft Tissue Injuries – Sports injuries. Repetitive strain injury. Knee pain and knee injuries, meniscus tear, hamstring injury, ACL tear, patellar tendonitis. Groin pain, Shoulder pain, rotator cuff pain, bursitis, tendonitis. Wrist pain and carpal tunnel. Sprained ankle, foot pain, plantar fasciitis, shin splints.
Rheumatological Problems – Arthritis. Osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), gout, psoriatic arthritis. Fibromyalgia. Joint pain.
Rehabilitation – Discectomy, laminectomy, lumbar fusion. Shoulder operations. Knee replacement and hip replacement.
Pregnancy – Leg pain and sciatica, sacroiliac joint pain, pubic symphysis pain, lower back pain.
Physiotherapy includes movement and exercise, manual therapy, hydrotherapy and other approaches.
Movement and Exercise
Physiotherapists assess a patient’s ability to do physical activity. They look at joint range of motion, strength, sensibility, coordination, balance and doing tasks.
Physical exercises increase range of motion, strengthen muscles and improve balance and coordination. Physical activity and exercise are effective in preventing and managing many chronic conditions
Manual Therapy
Manual therapy can be important in rehabilitation. Our joints make small sliding and gliding movements when we move through a range of motion. We cannot do these movements on their own, they just occur with the main movement. After injury these small internal joint movements can become restricted and limit our ability to move our joints.
A physiotherapist can apply controlled passive movements to loosen injured joints and tissues. Passive movements are movements performed by someone else and not by ourselves. Small and repetitive movements applied to joints are called mobilisation techniques. These are always under the patient’s control because they can tense up and stop the movement. Or they can ask the physiotherapist to stop.
Fast, more forceful and single movements are known as manipulation. Manipulation is beyond the patient’s control as the joint is pushed past its limits to loosen it up. Physiotherapists do manipulate but it is more common in treatments from osteopaths and chiropractors.
Manual guidance, assisting or resisting a joint as it moves is also an important part of a physiotherapist’s treatment. Soft tissue techniques may be used to loosen up scars, swollen joints and thickened swelling after injury.
Massage has been shown in studies to relieve pain and reduce swelling but this is now more commonly done by massage therapists.
Hydrotherapy
Hydrotherapy is used to treat rheumatological, orthopaedic and neurological disorders. It is carried out in a warm shallow pool with a temperature close to body heat. Under the guidance of a physiotherapist, the patient performs exercises in water. The resistance and assistance of water without gravity allows joints and muscles to move with minimal stress. This can improve breathing and blood circulation, relieve pain, improve joint ranges, strengthen muscles and promote a sense of general wellbeing.
Hydrotherapy is particularly useful for patients with arthritis such as RA. Pain and severe weakness may be present, making it difficult to exercise in air without over-stressing joints. It allows different exercise approaches to be performed which cannot be done out of water.
Other Approaches
Physiotherapists use acupuncture, where fine needles are inserted in the skin at specific points on the body. Acupuncture has been shown to be effective at treating inflammation and pain. Ultrasound, traction, and hot and cold compresses may also be used as part of your treatment.
What is Physiotherapy used for?
Physiotherapy can help at any time in your life and in many different ways, depending on your needs and circumstances. Physiotherapy can be helpful in managing a long-term medical condition such as arthritis or an injury. Treatment can reduce pain, increase mobility and return you to your normal activities. You can also recover faster from illness and avoid hospital admissions with the help of physiotherapy.
A physiotherapist can show you how to lift objects safely and how to maintain a good posture in different situations. This can lower your risk of getting injured or developing musculoskeletal problems. They can advise you on staying fit and healthy as you grow older through lifestyle changes like regular exercise and healthy eating. If you find it hard to climb stairs or get in and out of bed, the bath or car, a physio can teach you how to get around those problems.
The main focus of a physiotherapist’s treatment is always to help you remain as independent and active as possible.
Do I need a referral from a doctor to visit a Physio?
No, you do not require a doctor’s referral to see a physiotherapist. Physios are independent professionals just like dentists or other specialists. You can book an appointment directly with them. This method is known as “self-referral” and is possible in most areas of the UK privately.
You can also see a physio through the NHS and occupational health schemes. In these cases you will be referred by another health professional. In many areas you can get a docket for the Choose and Book system and choose which physiotherapy clinic you wish to attend. The clinic you choose needs to be on the approved local list. You can then attend a private physiotherapy clinic and have your treatment paid for by the NHS.
Career Progression in Physiotherapy
In the past, there was no way of getting “up the ladder” in a career in physiotherapy unless you went into management, to which you might or might not have been suited. Once you had got to “Senior One”, the equivalent of Band 6 or 7 these days, indicating that you were a specialist in your clinical area, you had little option for advancement.
That has all changed now. The increasing pressure on GPs and secondary services have prompted a variety of innovative approaches in physiotherapy careers. The costs of doctors have prompted the question as to whether physios can do certain roles usually done by doctors, safely, effectively and more cheaply.
So if you go into physiotherapy now, there’s a path towards being a highly skilled clinical practitioner with significant responsibilities.
Advanced Practice Physiotherapist – APP
This is the preferred title for physiotherapists who often have an M.Sc. and are highly skilled in their clinical area, both academically and practically. The earlier title was extended scope practitioner (ESP) when physios began to do things “beyond the scope of physiotherapy” such as taking orthopaedic clinics in lieu of a doctor.
APPs can work in a variety of clinical settings, for example, spinal clinics or the emergency department. They may be able to diagnose a patient’s problems, investigate as required, treat, advice or inject and refer onwards if necessary.
APP roles are not set out strictly, so they often evolve to suit the requirements of the practice at the time. Some incline towards the old ESP role, diagnosing or triaging patients in hospital clinics such as spinal or orthopaedics clinics. Others have more of a treatment role, assessing and treating patients in a more traditional physiotherapy role. Other aspects of their role are teaching physiotherapy staff, monitoring clinical standards and looking at the outcomes of treatment.
First Contact Physiotherapists – FCPs
15-30% of a GP’s patients have a musculoskeletal problem and a doctor has few options apart from prescribing drugs or referring on, both of which may not be helpful. This has led to the formation of first contact physiotherapists, physios who were competent enough to see musculoskeletal patients, with back, neck or joint pain for example, as the first person to assess them.
FCPs have to have the skills to know when a patient is seriously ill with a medical problem, when they have a specific spinal or other problem of some kind and when they “just” have a pain problem that is not medically serious. So there is a lot of responsibility and these practitioners may be able to request and interpret X-rays or MRI scans, inject joints and prescribe certain medications.
Clinical Specialist Physiotherapist – CSP
This role is more aligned towards “traditional” physiotherapy, with skills in examination, testing and more typical physiotherapy treatments. Injecting and prescribing may also be part of this role.
A CSP also has a wider role in a physiotherapy department, supporting the expertise of the team and teaching and mentoring more junior physiotherapists. They also guide their teams in interpreting treatment pathways, writing and reviewing them to suit local priorities and providing patient information.
References:
- Arthritis Research UK, What is Physiotherapy,
http://www.arthritisresearchuk.org/arthritis-information/therapies/physiotherapy/what-is-physiotherapy.aspx - Chartered Society of Physiotherapy, What is Physiotherapy, 2013,
http://www.csp.org.uk/your-health/what-physiotherapy - Merck Manual Home Health Handbook, Physical Therapy, (PT), 2007,
http://www.merckmanuals.com/home/fundamentals/rehabilitation/physical_therapy_pt.html - Merck Manual Home Health Handbook, Treatment of Pain and Inflammation, (PT), 2007,
http://www.merckmanuals.com/home/fundamentals/rehabilitation/treatment_of_pain_and_inflammation.html - NHS Choices, Physiotherapy, 2012,
http://www.nhs.uk/Conditions/Physiotherapy/Pages/Introduction.aspx - US National Library of Medicine, Rehabilitation, 2014,
http://www.nlm.nih.gov/medlineplus/rehabilitation.html
Last Review Date: 21-06-2017
Next Review Date: 19-06-2019
