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What is Physiotherapy?

What is Physiotherapy?

As this is the first post on the new Optimum Physiotherapy blog, I thought it might be a good idea to look at what our profession actually is. Many patients are referred to see a physiotherapist by their doctor or an insurance company and don’t know what to expect. From a quick look on Google, it seems that it’s a common question:

physiotherapyHere are some of the ideas that some of our patients have had about what physiotherapy involves:

  • Having a nice massage
  • Being tortured (i.e. having a horrible massage)
  • Being put through their paces in an 80s-style aerobics class, complete with Spandex outfits
  • Receiving advice to take it easy and do nothing for ages
  • Being blasted with a magical ultrasound machine
  • Physios running onto a football pitch to put an ice pack on a footballer who has grazed his knee on some grass (you can tell I’m a rugby fan…)

Well, the truth is that physiotherapy might feature some of these things – but there’s also a lot more to it.

Different approaches, common themes

Physiotherapists work in an increasingly broad range of areas, and could be involved in any of the following:

  • Helping someone with chronic lower back pain
  • Assisting in the recovery from a stroke
  • Clearing the airways of patient with pneumonia
  • Rehabilitating a patient after a hip replacement
  • Planning the discharge of an elderly patient from hospital and making sure they will be all right at home
  • Proving advice on smoking cessation and healthy lifestyles

So, even though physios are to be found in all parts of the healthcare system, you might have noticed a common theme. The Chartered Society of Physiotherapy, which is our trade body and trade union, describes it as helping people “affected by injury, illness or disability” and explains that we “maintain health for people of all ages, helping patients to manage pain and prevent disease”. A key part of it is that we want to help people to be as independent as possible and ultimately not need us at all in some cases.

What sort of physiotherapy does Optimum do and what does an appointment involve?

The main type of physiotherapy we do here is classed as “musculoskeletal”. This basically means any aches and pains relating to joints, muscles and tendons. In a typical day we can see patients with some or all of the following conditions:

  • An ankle sprain from tripping at work
  • A knee injury from sport
  • Neck pain from whiplash
  • Long-term lower back pain
  • Osteoarthritis
  • Tennis elbow

The first session is always an initial assessment and often involves more discussion than hands-on stuff. We will be asking about your symptoms and how they started as well as checking your general medical history for anything relevant. We will also want to know about how your life is affected by your symptoms and what sorts of activities you’re having difficulty with so that we can come up with some goals together.

Then we’ll usually go on to do a physical examination that often looks at things like your range of movement, your strength, specific joint tests and also feeling around the problem area to check for tenderness.

The treatments for musculoskeletal conditions usually involve a combination of strengthening or mobility exercises, advice about the condition and how to modify your activities, some hands-on therapies like massage and also general discussion helping to address any of the concerns and stresses that you might be experiencing relating to your problem.

What’s the difference between physiotherapy and chiropractic? Or osteopathy, for that matter?

We get this question a lot! The professions have very different origins but, like physiotherapy, they have developed over the years to cover many of the same areas and in truth there can be a lot of cross-over.

Chiropractors originally believed that many health problems – including ones in your organs as well as muscles and joints – are caused by “subluxations” in your spine, with individual vertebrae that are “out of alignment” and which need to be cracked backed into place. Some chiropractors have now moved away from this approach because the scientific evidence doesn’t really support it as being that effective for most things.

Osteopathy originally started in the USA as a different approach to medicine, and to this day a quarter of all doctors there are DOs (with the rest being traditional MDs). In the UK and some other countries, osteopaths focus more on musculoskeletal issues which usually involves quite a lot of hands-on therapy (often more cracking!) although there are many osteos that also prescribe rehabilitative exercises.

Musculoskeletal physiotherapy differs from these professions in that we tend to focus more on exercises and advice and building up the patient to the point where they can self-manage as soon as possible. There are many physios who do a lot of hands-on treatment, including the very occasional bit of joint cracking, but for me it is the focus on self-management and getting to the root of the problem that is the essence of physiotherapy. It’s certainly true that the three musculoskeletal professions are sort of rivals, but in my clinical experience I have encountered many patients who have seen a chiropractor or osteopath regularly (sometimes as often as weekly!) to be “cracked” and put “back into alignment”. Aside from being misleading about what is actually going on in the patient’s body, it is also arguably unethical from a financial standpoint.

It is something of a generalisation but I do feel that physiotherapists tend to be better at working with the patient and considering all their needs, and this is certainly something we do here at Optimum.

What are some of the other myths about physiotherapy?

One of the myths we encounter a lot is that people expect – or even want – our treatments to be really painful. Although there are times where exercises or hands-on treatments might be a bit uncomfortable, it certainly isn’t a “no pain, no gain” approach. The idea is to reduce your pain, not create more of it!

Is this your idea of physiotherapy?

Another myth is that physio only involves massage, with the patient lying down while we do all the work! As we’ve seen, there can be an element of this in the treatment but the main work has to be done by the patient in the time outside of the appointment. I once had a stroke patient who kept asking the hospital staff for a “leg massage from a lady physio”! Suffice to say he was unsuccessful.


Physiotherapy is a broad profession with fingers in a lot of pies. Musculoskeletal physiotherapy involves assessing a patient’s joint, muscle and tendon symptoms but also considers the person as a whole to see what their needs, concerns and goals are. Together we formulate a plan to get you back on track and manage your condition yourself.

If you have any questions about physiotherapy or particular injuries, we’d love to hear them as we’ll be doing more blog posts in the future.