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Physiotherapists are Not All Equal – Neither are the Treatments Frequently Used

Understanding Physiotherapist Qualifications

There are so many options available these days when choosing a physiotherapist. So how do you know if your physiotherapist is appropriately qualified and the right one for you?

Sports Physiotherapist in action
Sports Physiotherapist in action

All physiotherapists graduate from University with a 4 year bachelor’s degree in physiotherapy as a minimum.  All physiotherapists will study several disciplines over the degree, covering areas such as:

  • Musculoskeletal (bones, joint, muscle, tendon and ligaments)
  • Cardiorespiratory (heart and lungs)
  • Neurology (brain and spinal cord injuries)
  • Paediatrics (children)

So as the old adage goes, a ‘new grad’ physiotherapist is a “jack of all trades but master of none”. They are really at the beginning of their journey of building skills in their chosen discipline. However, once qualified a physiotherapist may start a private practice immediately. This does not mean a young physiotherapist starting in practice will not do an excellent job in assisting you with an injury, but they will lack the experience of a physiotherapist with further qualifications.

Physiotherapist Advanced Training

The Australian Physiotherapy Association (APA) now offers Post-Graduate pathways for physiotherapists to specialise and build skills in any discipline they choose. For common injuries seen in private practice (bones, joint, muscle, tendons and ligaments) your physiotherapist is likely to be either moving along a Musculoskeletal or a Sports Physiotherapy specialisation pathway.

Australian Physiotherapist Association

This pathway entails participating in a three-tier process:

  • All tiers require membership to their disciplines national group such as the Sports Physiotherapy National group
  • 1st Tier: Participation in several courses conducted by the APA tailored to their chosen discipline such as sports physiotherapy. There are Sports Level 1, 2 & 3 courses. This can take an additional 2-5 years to complete
  • 2nd Tier: Also known as “Titling”. There are two pathways to achieving ‘titling’. The Academic pathway requires completion of a Master’s degree and a minimum 2 years of clinical experience in their chosen discipline. An alternative route is the Experiential pathway which requires a minimum of 5 years clinical experience in their chosen discipline, completion of course work as well as written and practical examinations. These pathways typically takes 5-10 years to achieve after completing undergraduate study. Upon completion of the 2nd Tier of the pathway, the physiotherapist obtains the APA title for their chosen discipline e.g.” APA Sports Physiotherapist”.
  • 3rd Tier: Completion of a 2-year specialisation program affords the title “Fellowship of the Australian college of Physiotherapists”. Alternatively, Fellowship can be obtained by providing original contributions to research.

Sports physio training

If your physiotherapist has obtained their APA Title (Tier 2) or Fellowship (Tier 3) in Sports or Musculoskeletal disciplines you can have confidence that they have developed advanced skills in managing musculoskeletal and sports injuries. You can also be assured that they will have many years of experience to draw upon.

Do Physiotherapist Qualifications Guarantee Best Treatment?

Many physiotherapy treatments are available for a wide variety of injuries with some being considerably better than others. In the past, many forms of treatment have been used based upon positive feedback from clients. However, in the last 20 years scientific rigour and assessment of physiotherapy practice has sky-rocketed and discovered that many traditional treatments used are no better than placebo (fake treatment). Undoubtedly people still report benefit from placebo treatments but if you are actively seeking professional assistance, any treatment used should provide benefit that is more effective than placebo. This can make it difficult and often very confusing for a patient to know if they are receiving the best care available as some ‘traditional’ treatments are now being cast aside.

To help with this, the APA provides guidelines as a part of the ‘Choose Wisely’ campaign. This campaign has been designed to improve the delivery of high value care (bang for your buck) and reduce the practice of low value care / placebo treatments. High value care is care that returns better health related outcomes per dollar spent. High value care is typically based on the best evidence we have available at the time. These guidelines (available on the APA website) are a good resource to help you determine whether your physiotherapist is providing you the best evidence-based treatment available.

choose wisely australia

‘Choose Wisely’ Campaign

The APA’s ‘Choose Wisely’ recommendations are quite clear in advising against the use of passive treatments for several conditions including low back pain, ankle sprains and osteoarthritis of the hip and knee. The passive treatments not recommended include:

  • Ultrasound
  • Interferential
  • Electrical stimulation (TENS)
  • Laser therapy
  • Acupuncture
  • Dry needling

Furthermore, there is minimal quality evidence that supports the use of these passive treatments for shoulder-related pain and tendinopathies. If your physiotherapist is using these approaches for your injury, in all likelihood you are receiving low value care.

Low Value Interventions

The ‘Choose Wisely’ model is based on several founding principles:

  • Improving quality of care
  • Patient focused communication
  • Regularly reviewing evidence-based treatment
  • Multidisciplinary team involvement and transparency regarding patient recommendations along with supporting evidence for this care

The good news is that on the flip side there is a growing body of evidence that supports active management approaches. These include:

  • Education around injury and recovery
  • Therapist prescribed or supervised exercise programs including progressive strengthening and mobility
  • Collaboration with a multidisciplinary team in providing other evidenced-based management such as weight control, assistive devices and medicine reviews

Questions You Can Ask of Your Physiotherapist

If you’re not sure that your treatment is consistent with these principles, then here are a few questions you can ask your therapist to gain more insight;

  • Do I really need this treatment test or procedure?
  • Will it change my treatment plan or result in a better long-term outcome?
  • What are the risks, benefits or evidence for this treatment?
  • Are there safer or better options such as lifestyle changes, eating healthier or exercising more
  • What happens if I do nothing? Will my condition get worse if I don’t proceed with this treatment?

At Newcastle Sports Medicine our Sports Physiotherapy team has a combined 50 years of experience. Our team is committed to the provision of evidenced-based physiotherapy care, consistent with the ‘Choose Wisely’ founding principles. We work in a multidisciplinary manner with Sports Dietitians and Sports and Exercise Medicine Specialists. We are completely committed to these principles and encourage you to question us as we strive to achieve the highest value care possible to all of our patients.

Please leave any comments and we will respond as soon as we can. If you would like to read more articles in the field of Sports Medicine head to our blog’s home page to see more or follow us on at @newcastlesportsmedicine.com.au

Authored by Andrew Delbridge.

Blog design, graphics and editing by Dr Ross Cairns.

Newcastle Sports Medicine

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3 comments

  1. Callie Marie says:

    Thanks for explaining that different physiotherapists may have studied different topics in school. I didn’t know that this could cover the brain or the heart. I thought it was usually muscles and joints. Since my mom expereinces symptoms related to a stroke she had, I wonder if a physiotherapist who has studied the brain would be someone who can help.

  2. I like that you mention how physiotherapy treatments can help with a variety of injuries and how it’s important to find a professional who can provide care that is effective. When choosing, you’d probably want to research local physiotherapists in order to learn about their qualifications and experience. After you’ve researched the various professionals, it could help to meet with the ones that fit your requirements in order to ask questions about the treatment they offer as well as give you the chance to discuss your situation in order to determine if they can provide the care you need for your injuries you have.

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