Vivian Grisogono

About physiotherapy

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What does a physiotherapist do?
Q.You have given me inspiration to get a qualification in massage therapy and personal training. I was inspired by you when I read and practised your book THE BACK problems and prevention from since 1997 as a teenager. I am now 27 and still using your book. Vivian I would eventually like to become physiotherapist, but could you tell me what is the difference between a physiotherapist and a personal trainer. Does the physiotherapist create exercises like a fitness/gym instructor to strengthen the body? What does a physiotherapist do?
Male, UK
A.Thank you for your kind e-mail, and I am glad my book helped you.
With massage and personal training qualifications, you have a good basis for working to help people gain fitness and health, which you obviously enjoy. You ask what a physiotherapist does, and that is a good question, as the profession is very wide-ranging. When I trained to be a Chartered physiotherapist in the UK, over 30 years ago, the profession consisted of remedial massage, electrotherapy and "medical gymnastics" or remedial exercise therapy. These basic skills are still the foundation of physiotherapy training, but they have been expanded to include a lot of different types of manual therapy, including various kinds of manipulation. And of course the electrotherapy gadgets we used have to a great extent been superseded by more modern "magic machines". Now physiotherapists can also train in complementary techniques, such as craniosacral therapy and the Bowen technique. In recent times, the possibility for physiotherapists to administer injections and prescribe certain therapeutic drugs has also been opened up. Training used to be hospital-based, leading to a diploma, but is now mainly college or university based, leading to a degree. There is much more emphasis on research and scientific validation now, and efforts are constantly being made to identify the most effective patterns of treatment for problems, in order to establish rules or guidelines for evidence-based practice.

The profession has changed a lot since I qualified. We initially worked solely under the direction of doctors and surgeons, until we were granted independent practice in 1986. For a while the profession enjoyed quite a high status. For instance, major medical insurance companies accepted all state-registered physiotherapists as competent to treat private patients, and physiotherapists as well as doctors and surgeons could sign patients' claim forms. However, in the late 1990s, the major medical insurers placed limits on their cover of physiotherapy, by compiling their own lists of "recognized" physiotherapists, limiting practitioners' fees, and even intervening in matters of clinical judgement by placing limits on the type of problems which were covered and the amount of treatment which could be administered. Dramatic changes have also occurred within the National Health Service. When I qualified, physiotherapy departments were fully staffed, and physiotherapists were considered essential, because of the emergency chest work we did. In recent years, staffing levels have dropped, waiting lists have formed, and in many cases the amount of effective work that physiotherapists can do has been severely limited by under-funding.

The best way to see what physiotherapy entails now is to look up the Chartered Society of Physiotherapy website, at . What hasn't changed is that physiotherapists treat a wide variety of patients, including those suffering from strokes and head injuries, heart problems, arthritic problems, and lung diseases, as well as the sports injuries and orthopaedic problems like broken bones that most people associate with our profession. Despite the problems I have described above, the variety of patients and treatment techniques makes physiotherapy one of the most interesting, practical and rewarding of the complementary medical therapies.

Physiotherapy can offer unique contributions to people needing help with health and fitness, both remedially and preventively.  Physiotherapy is still the only profession which includes therapeutic exercise and biomechanics, as related to sickness, injury and health. This means that physiotherapists have a special understanding of how to construct fitness and conditioning programmes, and how to avoid dangerous exercises and fitness regimes.

Because physiotherapy has such a broad scope, it isn't necessarily suitable for anyone wanting to specialize in sports and trauma exclusively. There are various college-based courses in the UK which train people in sports injury treatments. For a full professional qualification in sports injuries, there is always Athletic Training, the American profession which teaches all the essentials of physiotherapy as applied to sports injuries. Athletic trainers usually look after touring tennis professionals, so if they need help on court they usually ask for "the trainer", who is in fact a sports physiotherapist by our definitions.

Without going on a full further training course, I think the best bet for a fitness professional such as a personal trainer wishing to expand knowledge of safe exercising is to work with physiotherapists and learn from them in practice and through experience. Most physiotherapists will be only to pleased to explain principles of exercise safety and efficiency, if you have specific questions relating to people you have been training, some of whom perhaps have health or injury problems. It may not give you a paper qualification, but you can always do subsidiary courses within the fitness industry if that's what you need. Adding to your practical experience by learning personally from others is the most effective way of broadening your knowledge and making you safer in the practice of your profession. don't under-estimate your work as a fitness trainer: it's very important in this age when so many people need help and motivation to get fit.