To think NHS Physiotherapist aren't up to scratch?

[WinterBones]

I concede it may just be my immediate Health Area.. but holy shit.

I have suffered with chronic back/hip pain since i was a teenager, i'm now in my mid 40s... i have seen the NHS physiotherapy team at least 5 times in that period.. both the hospital and my GP's own physiotherapist.

The hospital physios have only ever laid a hand on me once, which ended in a referral, but every other time they just ask me what's wrong, which i tell them, but they do ZERO investigation or assessment of my movements/mobility, throw the same 6 exercises at me, and tell me to lose weight.

This last time i went through the same thing, no hands on, despite me reporting even worse pain and losing mobility, then the GP one decided i needed the pain management clinic. (who refused the referral ftr)

Out of desperation and pain i finally coughed up £100 for a private sports physio to look me over and do a proper assessment. In the hour i was with him he moved and manipulated and tested and checked every aspect of my movement and pinpointed some quite alarming problems that were the cause of some of my other pain, things that the NHS would never have picked up on.

26 years i've been in pain, 26.. and NHS have missed multiple opportunities to help me, and failed me every damn time.

The Private Physio has put a letter in to my dr and now got me more referrals and scan requests, and is also working with me to try and help me move better/with less pain, rather than handing me a sheet and telling me to do it myself.

This isn't ok, and i am so angry with the NHS right now.

It varies a bit from area to area of course, but yes this is largely my experience too.

I've broken a couple of bones and had ok physio after those (although one the the orthopaedic consultant didn't want to refer me to, because "you can walk" - as I limped into his office with a desire to return to sports in my mid 20s!) but anything more chronic/less obvious they have been utterly useless.

My Mum had back pain and was seen by the NHS for 30 years before she was privately diagnosed with scoliosis.

I don't even bother now - I just go see one privately if I have any issues. But I am lucky I can budget to do that.

You are describing two slightly separate problems here. As far as investigations, yes, they should have done a proper examination of movement and palpations. But this would probably be largely area-dependent as NHS physios I have seen in the past did this no problem.
You comment about handing you the sheet rather than working with you... well, I am sure NHS physios could have done that if they were also paid per appointment. But they are not. The vast majority of community services are operating under "supported self-management" model. It is their goal to make the patient independent in managing their symptoms and in problem-solving. If every physio spent 10-20 sessions doing exercises with you, then they wouldn't really be able to see many patients. The waiting lists would get exponentially longer and the government would start bleating about "productivity in healthcare". Doesn't mean NHS physios are bad at their job. They are operating within a larger system.
There are many things I would like to do as part of my role in the NHS but our service is not commissioned to do them. I have very clear guidelines on what is and isn't within the scope of my practice in the particular service.

The only NHS physio I've seen was in a paediatric specialist sports clinic for ds and was excellent (and he recovered). I'd paid for a lot of private physio first and although they were very hands on they weren't as focused.

I work with NHS neuro specialist physios who are absolutely superb and very hands on.

Tbh for musculoskeketal issues myself I've always gone private as it's usually for issues I would regard as small but immediate and which are impacting my ability to keep doing my job. I've found a lot of variation in quality, usually tbh 100% to do with how much experience they have. The problem with an NHS clinic is you wait for ages and may see a band 5 with less than 6 months' experience, plus next time you go they will have rotated somewhere else. I do think think there is enough active supervision in the NHS.

Poor experiences here with NHS physios too. Last time I was sent by the GP for my numb arm/hand, and the physio didn't even examine me, just printed off a few exercise sheets from the internet.

Before that, I had a broken bone in my foot and the physio gave me a load of exercises to do, including stretching and bending the foot. After several months of no improvement, I had another x-ray and the break hadn't healed at all - then I was told it was because I should have been resting the foot to let it heal rather than religiously doing the exercises that the physio had told me to! I started resting it and it cleared up within a few weeks.!

I am fairly certain that i have an anterior labral tear, hypermobility and subluxation of the cuboid bone in my foot.

I went to my physio appointment which was rushed as the practice was closing for the afternoon.

She said it was bursitis and to do some physio exercises which I stated if this was an anterior labral tear would worsen with these exercises and I do not want to take the risk of worsening an injury until they could be sure it was not what I think it is. She said it was bursa in the hip but this pain is in my groin when my leg is flexed and nowhere near the bursa she claimed to be inflamed.

She refused to refer me for a scan and said I was refusing to engage.

My DP had a full patellar rupture that took over 2 weeks to surgically correct which significantly impacted his recovery and they just drew stick figures on a bit of paper and told him to get on with it. They're not legible, and his pain persists to impact his ability to walk. It's taken over a year to even be considered for pain management for him.

Quite simply the NHS is a shit show

My experience was quite the opposite - I had knee replacement surgery, and, keen to make the most of my new knee, booked some private physio as well as that offered on the NHS. The private physio was useless (and expensive) - just asked a few questions, checked how far I could move my leg and my knee, and at the final appointment did a couple of exercises. The NHS was really good - exercises and one-to-one, with extra sessions if you thought you needed it. So clearly, it all depends on where you live and the type of physio you get.

Ian severely disabled following an accident.

I was told I was only entitled to four sessions of NHS physio.

I had the four sessions. Obviously they didn't do much.

I've had ongoing physio for ten years now. It helped get me walking again after my accident and has helped keep me walking.

Four sessions won't fix stuff. It won't teach you enough to help you sort your own problems either.

It's just a sticking plaster. Go private.

NHS Physio’s seem to be tasked with ensuring the patient can go to work, walk around the house, cook dinner etc. private Physio’s aim to help you work to doing whatever you like physically in a pain free manner. Two different goals. If you want to live a physically active pain free life you’ll need to pay.

I am sure it must vary from individual to individual but in general my experience of physios whose role is to triage for so called Orthopaedic Choice has been of enormous incompetence.
They appear to be no more than gate keepers who have insufficient skills to diagnose serious issues. My appointments were a waste of both our time.
One made serious errors on a letter he wrote to my gp and which would have stayed on my medical records completely misleading any future medics if I had not spotted it and insisted on a correction. This was subsequently corrected but no apology or acknowledgement.
The same one sent me for a procedure (nerve block) which I had very clearly explained I highly doubted I could have because my disability would not allow me to get into the necessary position.
I duly arrived for the procedure and as I predicted it could not be done. The radiologist said this should have been identified by the referrer.
I sincerely hope I don’t have any future contact with this physio ever again.

lve Never had manipulation from any nhs physio except at the pain clinic. And they were amazing.

Private ones always do it.

I have had a terrible experience with the physiotherapist at my GP surgery:

1. For 6 months he could not diagnose my hand pain. His plan was to keep signing me off sick from work. I shelled out for a private visit to a consultant who gave me prednisolone = back to work in 3 days. Turns out I have rheumatoid arthritis.
2. Asked him about my knee pain, he told me I wasn't using my knee enough and needed to walk on it more. One visit to a different consultant = diagnosed with osteoarthritis.

I honestly don't understand how a physiotherapist can't pick up on these things. surely it's basic stuff.

i always thought pain clinic was CBT and meds adjustment. I know mine bounced back the referral the GP put through and told them they weren't prepared to see me until i've been seen by the MSK specialists.

In my very limited experience this is true.

I've had mixed experience so far.
It was a physio that picked up that my niggling lower back pain was inflammatory arthritis, not muscular.

However recently for a herniated disc causing foot drop and leg numbness/weakness, I just got told to "do calf stretches", when I'm an active 40 year old who was doing running and CrossFit a couple of weeks ago 😭

So I am considering paying for more private sessions so I can get back to moving the way I want to (assuming I avoid surgery 🙏)

I am disabled and needed help with improving mobility. My situation is complex and the NHS physio sacked me off before I'd even had all my sessions and told me she couldn't help because I didn't magically improve after 2 hours

My daughter has hand pain, probably from over practicing a musical instrument. The NHS physio took one look and told her she is weak with poor upper body strength and needs to be more active.

She saw a skinny 16 year old girl and made assumptions
. My daughter is actually heavily into sport including racket sports. Has PE as a subject as well as compulsory PE, so 16 periods a week. She trains most days after school. she coaches sport.
She deadlifts her own body weight, is a complete demon on the chin ups, planks etc. Her father works in elite sport in strength and conditioning and she has been into it with him since toddlerhood.. The last thing she is is weak! .She is freakishly strong but doesnt look it as she is slender and small boned. The physio jumped to a completely wrong conclusion but would not be shifted. It was ridiculous to the point of funny.

Sorry but hands on? You want someone else to take your pain away chronic pain doesnr go away. Its bio/psycho/social. You need to.also make changes. Sorry nhs professional working in the pain service.

Reading this responses make me incredibly grateful for my NHS Physio, she's fantastic.
I self referred for a possible L2/L3 slipped discs, after seeing the GP.
I was first seen within 5 days, really in-depth examination and manipulation. After 8 appointments over 5 months I have just been discharged having regained all the feeling I had lost, but am free to self refer again at anytime if it flares up again.
I did the exercises she gave me religiously between appointments and each time she added more and measured the progress.

It really shows it's a complete postcode lottery

I’ve seen a few threads like this bashing the NHS because the private doctor/surgeon/physio ordered loads more tests, diagnosed more issues and advised that surgery/treatment was needed when the NHS said it wasn’t.

It’s funny how the person earning money from your problems finds a lot more of them that need treating… 🤔

I have a recurring issue that every few years puts me into a&e and back into the consultant appointments etc. Every single consultant I've seen this time around has told me don't go near nhs physio, go private or don't bother was their message.

Opposite experience for me. I started to suffer from debilitating pain when I started to run and had to stop. I was referred to NHS physio but after a few weeks getting worse, I decided to go to a private physio. She indeed did a thorough assessment, tests, used very scientifically sounding words to conclude that my posture was dreadful and that's what was causing the pain. I need a number of sessions to learn to adopt a good posture. Before I knew it, she'd scheduled another appointment and an invoice if £150. I went to because she had a great reputation.

In the meantime, my NHS appt came, and I was told that it was nothing to worry about, and that just needed to build my iband muscles. She advised a course of ibuprofen and to restart running gently. I decided to try this as couldn't afford the private physio and sure enough, the ibuprofen regime helped and as I continued running gently, the pain went. That was 14 years ago, I have been running all this time and not once knee pains...bad posture...my a**...., but very convincing speech, 10/10 for that skill!

We've had terrible experiences with NHS and private physios. It's so random whether you get a good one. I'm another who was dismissed by an NHS physio who then went on to need surgery.

I find osteopaths better. I know it's different but they tend to be more hands on in my experience.

They're awful because they aren't funded to provide the service that they want to provide. No wonder so many do private work instead.

Good and bad in every profession unfortunately.
Generally poor evidence base for hands on treatment e.g soft tissue massage or manipulation for long term benefits therefore NHS physios who have a huge caseload and discharge pressures often can’t waste appts on these techniques that don’t resolve or long term improve conditions. Private physios have all the time in the world therefore can provide this service.
I do think that this means NHS physio only works well for a smaller amount of the population as you are given the tools to fix yourself e.g. exercises, whereas many attend wanting someone else to fix them with hands on therapy.

I've had the same experience, and now don't even try the NHS route but find the money to go private (which I know isn't a possibility for all). The reasoning I got for no hands on treatment is that the outcomes are no different; ie. the percentage of patients off flowing from physio caseloads is similar whether hands on treatment is performed or when they are just giving out exercises to do. No-one seems to have considered that those off flowing from the non-intervention group might have ran out of patience and stopped going to appointments because it isn't helping them, rather than their issues having resolved.