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.

Yeah "pay to play" model is very powerful. My partner does "full MOT" abroad and comes back with a whole folder of problems every year. The maddest thing was geneticist. One year he returned with a gene which prevents blood clotting even though he has history of pulmonary embolism and post-surgical clot in his leg. I threw his prescription in the trash and sent him to his GP. He's been on anti-clotting medication since.
I've also come across the Priory diagnosis a patient with multiple mental health condition with detailed treatment plan for each resulting in years of inappropriate therapy costing thousands.
Sometimes, the NHS doesn't send you for tests because, based on your symptoms, the likelihood of this test showing something is vanishingly small. It's not approach that works for every patient but it is the approach which works for the majority of patients which is how the public healthcare model is structured.
Someone up the thread is delighted because they were privately diagnosed with scoliosis but doesn't mention whether it actually resolved the pain they were living with for 20+ years.

Yes they are completely nuts; I could have cried in January 23 being told I just likely had a virus and I just needed to go swimming for the back pain, wouldn't give me an MRI so I ended up in A&E on gp advice when I failed to be able to toilet which in a way was the only saving grace to holt paralysis. So lucky I made a good recovery.

Days later I was on an operating table for a cervical spine condition.

No thanks to NHS physio or indeed the private one, who just said month before nhs physio for £50 I'd just tight muscles. I had to engage back with nhs physio after a month in hospital and they said ohhh didn't that come on quick!

I really don't know who to trust these days. Feel for anyone left years with back pain.

Mine was fantastic. He was a rugby player, looked like something out The Lord of the Rings (no not an orc, a Ranger🤣) and promptly left to go private after a few treatments 😭

That's very much our experience.
DS is 3 and has Cerebral Palsy. Hes supposed to be seen every 3-4 weeks by the NHS physio team...he was last seen in October and all of their physio sessions seem to involve zero hand on physio and instead they just ask me how he's doing.

We pay privately for weekly physio/hydrotherapy now and the progress he has made is huge.

Have you lost weight and followed through with the 6 exercises they’ve recommend?

They are like people in any job, some are great and some aren't, I've had great treatment at my local hospital and fairly rubbish treatment in the same place by a different physio.

My experience of NHS physio is that it is very much that will do attitude. They aim for basic mobility and nothing further. I am lucky enough to be able to pay for private physio but that will be out of a lot of people reach.
It really shouldn't be that way ad getting people back to fitness and good mobility will save time and money further down the line.

Tend to agree, had a painful leg for 18 months. Physio handed me a sheet of exercises, didn't go thru them with me. There was no way I coul do them given my age and physical disability. Currently working with a Pilates teacher on some exercises that may help.

My DH suffered an acute injury this year that he was advised to ultimately treat non-surgically. The NHS physio offer was one appointment 3 weeks after the injury and a telephone review 3 weeks after that.

“are you doing the exercises properly? Oh good okay then, bye”

We paid for weekly private in person sessions.

My cousin was an NHS physio and she always said if you want to get actually better and not just function, go private always

A friend of mine is an NHS consultant with her own back damage/pain issues.

She says that NHS physio training has changed over time and anyone who trained after a certain point just gives exercises.

Older physios - 50+ - who did NHS training before the changes still do assessments and manipulation. She sees a 50+ NHS trained physio privately for this.

My experience of nhs physio has been awful. I sustained a serious knee injury 2 years ago. My knee kept giving way when i tried to walk. My physio just said that i was anxious. She was abbrupt and she failed to listen. She made me doubt that there was a problem even though i kept falling when i tried to walk as my knee just gave way. I could easily walk several miles a day before my accident.

I've had exactly the same experience as you. Excruciating back pain for 10 years and repeated visits to NHS physios. My first few sessions I was told that the pain is in my head and I'm scared to move because my brain remembers the pain 🤔

I paid for a private MRI scan as the NHS refused to do one. This showed 3 herniated discs plus some other issues. Went back to the physio thinking they might now take me seriously but nope... she didn't even look at the images and claimed that my pain isn't from the herniated discs, it's because I don't bend my back enough.

Have completely given up now!

I saw one. They were good… at printing off an exercise sheet (when I could barely move)
Useless.
Went private, they were excellent

It varies. I've used physios a lot due to various injuries, both nhs and private and mostly found the NHS physios to be excellent, I've only had one who was rubbish and my gp referred me another when I explained the lack of help.

Because I effectively supplement NHS physio with private I can compare the two and have found no difference in how they examine and treat the same injury.

I'm sorry you've had such a poor experience though :(

This is not my experience.

I had to wait a long time for an NHS appointment but when it came the physio I saw was fantastic, did a full diagnostic examination, explained in detail what the problem was, treated me with manipulation on the spot, gave me follow-up exercises, and saw me several further times. I can't fault the service except for the wait, which is purely because of pressure on the NHS and staffing issues. Several times when I saw him he was the only physio on duty in a department where there was space for 4 or more practitioners to work. Whether that's a budgetary problem or a recruitment problem I don't know.

I daresay some problems are more amenable to resolving with treatment than others ofc.

yes. funnily enough the specialist i saw 10 years ago told me quite firmly that none of that would help even vaguely.

So where does she think private physios are trained? Not the 50+ but the current cohort.

I've had the experience most recently of 3 private physio sessions and exercises plus GP painkillers over 6 weeks (max paracetamol, max naproxen, codeine uf i was really struggling), all of which allowed me to just about keep going, with a tiny reduction in pain and improved range of movement.

Then I just lost it and thought I'd try an osteopath. One session and it was largely fixed - 2 sessions and I'd stopped painkillers completely, plus she'd diagnosed the original issue in a way that made infinitely more sense.

I'm aware that I saw the osteopath at 6 weeks, which I'd expect would be a time when it was calming down anyway. But the fact is it wasn't, and then I saw her and it decreased immediately.

Normally I am quite brutal about alleged complementary medicine, I do believe in the placebo effect and I usually ascribe any changes to that. But this has somewhat changed my attitude. I'm not sure how osteopathy should be included into msk clinics but I am starting to feel that it should.

What point are you trying to make?

My 5yo has suspected CP too. The physios are OK when he sees them but we basically have to do everything ourselves. I see online what kind of programmes children get in the US vs what's on offer here and it's ridiculous. I'm also really concerned that his NHS orthotics aren't actually doing anything.

I am asking a question. If she thinks all NHS trained physios in the last 50 years are only trained to prescribe exercise, I would like to know where she thinks private physios are trained. Because, it is evident in this thread that a lot of people received different input from private providers. So I'd like to hear what her theory about that is.
Well, I suppose, I would also like to know how much knowledge she has about current physio training. Personal experience of training providers? Information about course content? Perhaps, experience of working with physios outside of the MSK services? Or is she basing this knowledge on a "sample of one"?

Physios, like all the NHS, are under a lot of pressure. That is not an excuse for bad experience though. A patient should always be fully assessed and be treated as an individual.
Treatment now is usually aimed at helping the patient manage their own condition rather than having treatment “done to them”, but either way the patient should feel understood. Some people like treatment being “done to them” because it means they don’t have to take responsibility for their own health. Others feel it’s not proper treatment if they haven’t had active hands on treatment. Manipulations etc have their place, and sometimes hands on is appropriate, sometimes it’s not. As often as not the real solution is dull - it’s down to self care and following advice with no magic wand fix.

As with all I think you get good and bad.

i have two kids in national level sport.

we’ve seen bad physios, private and nhs.
we’ve seen excellent physios, both nhs and private.

much depends on what you want out of it. The “best” ones we’ve seen are ones that understand sport, diagnose, come up with a treatment plan, and offer advice on how to manage their training schedule. That’s what we want out of a physio.

others will be aimed around managing chronic issues. These are the ones that hand over exercises and give you tools to work on at home to improved your pain.

generally nhs physios are dealing with the latter, as those are the patient cohort that gets referred. The ongoing, chronic pain- usually diagnosis or resolution of acute issues have been dealt with by medics.

My experience too sadly. Five minute chat, exercise sheet, job done. Completely different from private physios.

I went private
The private physio spotted something was very wrong and refused to touch me, sent me for an MRI
I had a giant herniated disc resulted in CES and surgery. No physio post op either and I could barely walk when I was previously in the gym, horse riding etc
Did my own research, walked and walked, paid for private rehab, 4 sessions with a PT and regular sports massaged