Physiotherapist

What is a Physiotherapist?

Physiotherapists’ skill and experience is based upon their understanding of the structure of the human body and how it moves. They use this knowledge to treat a broad range of health conditions, including musculoskeletal (MSK) conditions. ‘MSK’ conditions – referring to our system of joints, muscles and soft tissues - are the ones most commonly managed by rheumatologists. Many of these can benefit from physiotherapy too.

MSK physiotherapists have skills in assessing people’s symptoms, in conjunction with how they are moving, in order to diagnose, treat and promote improvements in symptoms or function. A typical treatment plan may use a combination of physical techniques (such as joint or soft tissue mobilisation), joint supports and targeted exercises. Increasingly, such treatment is integrated with an approach that also empowers people with the knowledge to live well with their condition – a ‘biopsychosocial’ approach.

Physiotherapy for ‘acute’ MSK issues may be quite specific and only needed for a short time. In contrast, more complex, long-term conditions, particularly where pain is persistent, require a more holistic approach – with more emphasis on joint goal setting, movement re-education and coaching support, to develop a safe and effective self-management plan.

How are physiotherapists trained?

Physiotherapists must complete a University bachelor, masters or professional doctorate program, which includes supervised practice in a clinical setting. Physiotherapists are required by law to be registered under the National Physiotherapy Board of Australia (https://www.physiotherapyboard.gov.au/), overseen by the Australian Health Practitioner Regulation Agency (AHPRA). Continuing professional development and recency of practice must be demonstrated annually. Many physiotherapists undertake additional post-graduate training, such as Manual Therapy, Pain Science or Hand Therapy.

What services do physiotherapists offer?

In the public sector, physiotherapists specialising in rheumatology may work in multi-disciplinary teams – often within hospital settings. Others may be based in Community Health centres or hydrotherapy pools. Private physiotherapists may operate independently or as part of multi-disciplinary groups. Physiotherapy is a primary care modality, and so a referral is not necessarily needed. However, a GP referral is required for private physiotherapy under a Medicare plan.

MSK physiotherapy is most commonly provided as a one-to-one service – although groups for specific conditions (e.g. knee OA, persistent pain) or online (telehealth) services are increasingly available.

Examples of MSK conditions that may benefit from physiotherapy:

Acute or local MSK problem, e.g. Achilles tendon pain, shoulder pain, carpal tunnel syndrome
Inflammatory arthritis, e.g. Spondyloarthritis – for spinal movement assessment and monitoring, a tailored exercise plan and education
Rarer rheumatology conditions, such as Scleroderma and Myositis
Persistent pain, including fibromyalgia and ongoing pain with inflammatory arthritis
Childrens’ MSK conditions, including Juvenile Idiopathic Arthritis (JIA)
Hand arthritis

When should I see a physiotherapist?

Physiotherapy can often be complimentary to your rheumatologist’s treatment – for example, tailored exercises after a shoulder injection may help you to get the most benefit. Similarly, knowing which exercises are best may help you to get the most mobility after starting a biological medicine for ankylosing spondylitis. And for those people who experience ongoing pain, despite their inflammatory arthritis being ‘well controlled’, learning about pain and some practical tools can be an important first step in rehabilitation. Here are some ‘cues’ that might prompt you to find a physiotherapist who can work with you:

MSK pain – either new (acute) symptoms or pain that has become persistent, and is limiting your function
Joint stiffness or increased joint mobility (hypermobility) or joint deformity – from the temporomandibular (jaw) joint to the toes...
Fatigue and / or de-conditioning (generalised weakness due to reduced physical activity)
Difficulty walking (or taking part in sports or social activities)
Balance problems (including falls and near misses)
Muscle weakness (perhaps associated with a condition such as myositis)
Difficulty performing functional tasks, including hand dexterity (see below)
Soft tissue changes due to specific conditions (e.g. chest wall tightness associated with scleroderma)
Osteoporosis – especially if you also have an inflammatory MSK condition

How may I find a physiotherapist who has a specialist interest in rheumatology conditions?

MSK physiotherapists are generally experienced in assessing and managing acute MSK conditions and all the ‘common’ types of arthritis. Many have additional qualifications, and the Australian Physiotherapy Association recognise higher qualifications (e.g. Titled Physiotherapist) in relevant areas, such as Sports and Exercise, Musculoskeletal and Pain. If your condition is ‘uncommon’, it is recommended that you enquire about specific experience with that condition, and whether there is a co-ordinated team approach with other the other health professionals that you see. And if your symptoms are complex (including persistent pain), perhaps choose a physiotherapist who can offer longer appointment times.