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Physiotherapy


Expert reviewer, Alex Floyd, Musculoskeletal Physiotherapist at Bupa UK
Next review due June 2021

Physiotherapy is a treatment that aims to improve the way your joints and muscles work. It can help to maximise your movement, flexibility, coordination and strength, and to optimise your body’s normal functioning and physical ability. Physiotherapy is used to help people recover from illnesses and injuries, and to help treat long-term health conditions and disabilities.

Photo of a woman swimming outdoors

What does a physiotherapist do?

A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility. Your physiotherapist will discuss your care with you before carrying out any treatment. They will carry out a thorough examination to understand how best to help you. Your care may be different from what we describe here as it will be designed to meet your personal needs. This information explains what physiotherapists do, some of the techniques they use and answers to some frequently asked questions about physiotherapy.

How can physiotherapy help me?

Physiotherapy can help to treat a wide range of conditions including:

  • acute injuries or pain (pain that starts suddenly, for example, because of a fall) in your muscles, bones and joints, such as back pain, neck pain or knee injuries
  • chronic (long-term) musculoskeletal conditions such as osteoarthritis or osteoporosis
  • conditions that cause fluid to build up on your lungs, such as cystic fibrosis
  • conditions such as Parkinson’s disease, stroke or multiple sclerosis (MS), which affect your nervous system
  • women’s health conditions, such as incontinence
  • recovery after stroke, bed rest or surgery

Physiotherapy tends to be a combination of ‘hands-on’ care, exercises, advice and education. Your physiotherapist may coach you through exercises that you can then do yourself at home or with some support. Physiotherapy is also sometimes called physical therapy.

Alex Floyd, Musculoskeletal Physiotherapist at Bupa UK, says: “Sometimes, one or two sessions of physiotherapy will be enough, but sometimes you will need more. This will depend on your condition, how long you’ve had it and the cause of it, as well as your lifestyle and how well you keep up the exercises you’re given.”

How can I find a physiotherapist?

Your GP may refer you to an NHS physiotherapist or you may be able to refer yourself directly (self-referral). You can ask for information about this at your GP surgery. Alternatively, you may wish to book to see a private physiotherapist. If you have private health insurance, contact your insurer as they should be able to refer you quickly to a physiotherapist in your area. To find a registered physiotherapist in your area, contact the Chartered Society of Physiotherapy or search their website (see the Other helpful websites section, at the bottom of this page).

Make sure your physiotherapist is registered with the Health and Care Professions Council (HCPC). This means they have completed approved standards of training and follow the HCPC rules of professional conduct.

What are the different types of physiotherapy?

Your physiotherapist will ask about your symptoms and examine you. Working with you, they’ll create a treatment programme that will be most helpful for you. This may include advice and information, exercises for you to do and manual therapy. They will aim to treat and ease your symptoms, and to look at and solve any factors that may have contributed to the problem. This will also help prevent the problem from happening again.

The exercises or techniques your physiotherapist suggests will depend on why you're having physiotherapy. There are a number of different techniques they may use. The ones explained below may be used at clinic appointments (out-patient physiotherapy).

As with every procedure, there are some risks associated with physiotherapy. We have not included the chance of these happening as they are specific to you and the treatment you’re having. Ask your physiotherapist to explain the risks that apply to you.

Mobility exercises

If you have stiff joints, these exercises (also called range of motion exercises) can help to increase your flexibility. Mobility exercises may help you to get your movement back after a stroke or a long period of bed rest, for example. Your physiotherapy sessions might involve you doing exercises and stretches by yourself or with the physical support of your physiotherapist.

Muscle-strengthening exercises

Strength exercises are a relevant part of treatment for any area of the body that has lost strength because of pain, injury or lack of use. These exercises may help prevent injury from happening again by supporting and protecting the bone, joints, ligaments and tendons. For example, you might do these types of exercises after an ankle sprain or dislocating your shoulder. Or you might do core stability exercises to strengthen your abdominal (tummy) and back muscles to help protect your spine from injury. Exercises might also include resistance training (moving your muscles against some kind of force). For example, your physiotherapist may ask you to use stretchy bands, weights or your own body weight.

Massage

Massage can help to loosen muscles and tissue that have become tight (‘knots’) and improve mobility. It can also reduce pain and swelling.

Massage may also be used to complement other types of physiotherapy you’re having. It’s often carried out before doing exercises that your physiotherapist has prescribed.

Your physiotherapist may use massage to move excess fluid from your limbs into your lymph system. This is useful if you have lymphoedema, which is a condition that causes too much fluid to collect in your arm or leg.

Massage can also help if you have cystic fibrosis. A physiotherapist can help to clear mucus from your airways using a special massage technique called percussion.


Manipulation

During manipulation, your physiotherapist moves or puts pressure on a precise area of your body, such as your back, to loosen it. They may use increasing pressure or a sudden controlled push for this. Back manipulation is safe and can be effective at reducing back pain and improving mobility. It’s important that it’s carried out by an appropriately trained physiotherapist who can assess when it will be a helpful treatment to use.


Acupuncture

Acupuncture is a complementary therapy that typically involves inserting fine needles into your skin at defined points. Your physiotherapist may use it with other types of physiotherapy to help relieve pain.


Dry needling

Dry needling (often called western or medical acupuncture) is a technique involving needles but is different from acupuncture. Acupuncture and dry needling have differences in their philosophy, where the needles are placed and how the treatments are practised.

In dry needling, needles are placed into specific points of your muscles in order to treat pain and tightness and to improve movement.


Taping

Taping is a method commonly used to support injuries to shoulders and ankles. It’s also sometimes used to help improve posture and movement during sport and exercise. Different types of tape can be used, depending on the injury that needs treatment. Some tapes are rigid whereas others are more flexible, and often called kinesiology tape.


Hydrotherapy

Hydrotherapy is a set of exercises carried out in a water pool. Warm water helps to loosen and support your joints and muscles. It can also provide useful resistance, which can help you to get stronger. Hydrotherapy can help treat pain and arthritis, for example.

Alex Floyd, Musculoskeletal Physiotherapist at Bupa UK, Bupa, says: “You may have found that having a bath can ease your pain. This is because the water takes some of the weight of your body. The warmth can also relax your muscles and ease joint pain. Hydrotherapy makes use of these benefits to allow you to exercise more than you might be able to usually.”

However, hydrotherapy isn’t always an option because pools aren’t always available in clinics and hospitals.


Electrotherapy

Electrotherapy is a general term for therapies that use low-level electrical energy to reduce your pain and encourage healing. It can be used in combination with other types of physiotherapy. For example, transcutaneous electrical nerve stimulation (TENS) uses a low-level electric pulse to relieve your pain. This usually feels like a tingle.

Frequently asked questions

  • Some people find that physiotherapy helps to ease their pain straight away. Others may feel a bit sore at first, and this is common after having physiotherapy. Soreness usually lasts for about 24 hours and then eases. Many of the techniques physiotherapists use often work at or close to the area that is injured or painful. This is why it’s sometimes painful for a little while during or after your treatment.

    Your physiotherapist will discuss with you any pain you may have during or after your treatment session. Physiotherapy shouldn't cause you any long-term pain, but you may feel a bit sore after your treatment and for the first couple of days. This may be because:

    • you’re using muscles more than you have for a while
    • stiff joints have been loosened
    • tissues have been stretched

    Any pain should settle, but if it doesn't get any better, talk to your physiotherapist about changing your treatment.

    You can take over-the-counter painkillers to help manage any pain at home. Keep a note of how long your pain lasts, as this is useful for your physiotherapist to know.

  • Your physiotherapist will explain what will happen during your treatment, including whether or not you need to remove any clothing. Let your physiotherapist know if you feel uncomfortable at any time, and ask to have a chaperone if you’d like one. Your physiotherapist may also suggest a chaperone for some procedures.

    At your first appointment, your physiotherapist ideally needs to look at the area of your body that is causing your problems. He or she may also want to see the muscles or joints working. For example, if you're having problems with your lower back, your physiotherapist may want to examine your back or hips. Or, if you have problems with your knees, your physiotherapist may want to look at them while you walk.

    You won’t be asked to remove more clothes than necessary, but you may need to undress to your underwear. You may wish to wear a similar alternative such as a sports bra and shorts. Your physiotherapist will respect your wishes and beliefs and will try and keep you covered up as much as possible where they can.

    You can choose not to undress. This may influence how well your treatment works because it could be more difficult for your physiotherapist to see the problem.


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Related information

    • Physical therapy (PT). The MSD Manuals. www.msdmanuals.com, last full review/revision June 2017
    • Rehabilitation. Oxford handbook of geriatric medicine (online). Oxford Medicine Online. oxfordmedicine.com, published July 2012
    • What is physiotherapy? Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed 11 February 2013
    • Musculoskeletal problems. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Back pain – low (without radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
    • Neck pain – non-specific. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
    • Management of osteoporosis and prevention of fragility fractures. Scottish Intercollegiate Guidelines Network (SIGN), March 2015. www.sign.ac.uk
    • Osteoporosis. Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed 4 May 2017
    • Cystic fibrosis: diagnosis and management. National Institute for Health and Care Excellence (NICE), October 2017. www.nice.org.uk
    • Parkinson’s disease in adults. National Institute for Health and Care Excellence (NICE), July 2017. www.nice.org.uk
    • Multiple sclerosis in adults: management. National Institute for Health and Care Excellence (NICE), October 2014. www.nice.org.uk
    • Stroke rehabilitation in adults. National Institute for Health and Care Excellence (NICE), June 2013. www.nice.org.uk
    • Urinary incontinence in women: management. National Institute for Health and Care Excellence (NICE), September 2013. www.nice.org.uk. Last updated November 2015
    • Incontinence. Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed 4 May 2017
    • Cardiothoracic surgery. Oxford handbook of clinical surgery (online). Oxford Medicine Online. oxfordmedicine.com, published March 2013
    • What is physical therapy? World Confederation for Physical Therapy. www.wcpt.org, updated 14 October 2016
    • Find a physio. Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed 13 March 2018
    • Rehabilitative measures for treatment of pain and inflammation. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2017
    • Treatment of sports injuries. Brukner & Khan's Clinical Sports Medicine (5th ed. online). McGraw-Hill Medical. csm.mhmedical.com, published 2016
    • About manual lymphatic drainage (specialised massage) for lymphoedema. Cancer Research UK. www.cancerresearchuk.org, last reviewed 16 June 2017
    • Cystic fibrosis. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • Musculoskeletal lower back pain. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • Rubinstein SM, van Middelkoop M, Assendelft WJJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. doi:10.1002/14651858.CD008112.pub2
    • Al-Qubaeissy KY, Fatoye FA, Goodwin PC, et al. The effectiveness of hydrotherapy in the management of rheumatoid arthritis: A systematic review. Musculoskeletal Care 2013; 11(1):3–1. doi:10.1002/msc.1028
    • How does hydrotherapy help? Arthritis UK. www.arthritisresearchuk.org, accessed 4 May 2018
    • Nursing patients with pain. Oxford handbook of adult nursing (online). Oxford Medicine Online. oxfordmedicine.com, published August 2010
    • Johnson MI, Paley CA, Howe TE, et al. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database of Systematic Reviews 2015, Issue 6. doi:10.1002/14651858.CD006142.pub3
    • Chaperoning and related issues. Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed December 2017
    • Personal communication, Alex Floyd, Musculoskeletal Physiotherapist, Bupa Health Clinics, Bupa UK, 25 June 2018

  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, June 2018
    Expert reviewer, Alex Floyd, Musculoskeletal Physiotherapist, Bupa UK
    Next review due June 2021



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