Physiotherapy

Also called Physio, Physiotherapist

The profession most often recommended in this library and least often explained. In most of the UK you can refer yourself, without seeing a GP first.

What it is

Physiotherapists treat movement, pain and function: after injury and surgery, during long-term conditions, and in the slow decline that makes somebody stop walking.

It is not massage and it is not mainly hands-on treatment. The core of it is assessment and then graded exercise, taught, adjusted and progressed, with the person doing most of the work between appointments. People who expect to be treated passively are often disappointed, and people who expect a quick fix usually are.

The specialisms differ more than most people realise. Musculoskeletal physiotherapists handle back pain, joints and injury. Neurological physiotherapists work with stroke, Parkinson's disease, multiple sclerosis and brain injury. Respiratory physiotherapists clear chests in COPD, bronchiectasis and cystic fibrosis. Pelvic health physiotherapists treat incontinence and pelvic organ prolapse, which is the single most under-used referral in this whole list.

In most of the UK you can refer yourself to NHS musculoskeletal physiotherapy without a GP appointment. A great many people wait weeks for a GP in order to be told that.

Signs you might notice

Signs that physiotherapy is the right ask rather than a scan or a painkiller: pain or stiffness lasting more than a few weeks, a joint or limb not working as it did, repeated falls or near-falls, breathlessness with sputum that will not clear, leaking urine, or having stopped doing something because of how the body now behaves.

Signs it is being done badly: an exercise sheet handed over with no review, no progression, no explanation of what it is for, and no plan for what happens if it hurts.

How it can affect day-to-day life

The adherence problem is the whole problem. Home exercise programmes are the active ingredient and most people do not do them, usually because nobody explained what each exercise was for, or because the plan assumed a life the person does not have.

Waiting lists are long in most places, which is a good reason to self-refer on the day the problem starts rather than after three months of hoping.

For someone with a learning disability, dementia or a communication difference, a standard appointment is often too short and too abstract. Adjustments are a right, not a favour, and asking for a longer appointment, a familiar person present, or a session in the person's own home changes what is possible.

Private physiotherapy is faster and legitimate, and the profession is regulated. Check the therapist is registered with the Health and Care Professions Council; "physiotherapist" is a protected title and "physical therapist" is not.

Supporting someone well

Self-refer where the service allows it, rather than waiting for a GP appointment to do the same thing.

Go to the first appointment with three specific things the person can no longer do. "Cannot get up from the low chair without help" gets a better plan than "my hip hurts".

Ask what each exercise is for, how often, and what an acceptable amount of pain during it looks like. Hurt and harm are not the same thing in rehabilitation, and being told so plainly is what stops people quitting.

Build the exercises into something that already happens, at a time that already exists, rather than adding a new twenty-minute slot to a day that has no gaps.

Ask specifically for the right kind of physiotherapist. "Referral to physiotherapy" for a person with Parkinson's who needs a neurological specialist can waste months.

Ask about pelvic health physiotherapy after childbirth, after prostate surgery, and for any leaking at all. Most people never learn it exists.

Where to get help

NHS self-referral where it is offered, otherwise a GP practice. Ask the practice directly whether self-referral is available before booking an appointment to request it.

The Chartered Society of Physiotherapy explain what to expect and hold a directory of private practitioners.

The Health and Care Professions Council register is where to check anybody calling themselves a physiotherapist.

For pelvic health, Pelvic Obstetric and Gynaecological Physiotherapy publish patient leaflets and a specialist directory.