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.

Handing over exercises isn't enough though.

I have chronic issues due to an accident.

I need to do the exercises in front of someone who knows how to do them so they can correct me if I'm not getting it right.

It's like learning yoga or Pilates from a printed sheet.

You do really need someone to demonstrate it for you and then let you try it and talk you through how to improve.

Handing out a sheet doesn't help.

I do feel sorry for NHS physios as for people with ongoing complex situations like cerebral palsy or amputations etc etc they just can't deliver a service that will meet need.

The physio i see privately used to work as a partner to the local NHS, and they have said it comes down to time. They have the time to do actual treatments, the full physical assessments. Etc, the NHS physio's don't.

I lucked out with the physio i found, they work with some of the big GB sports teams, FA, Archery UK, Cycling, British Gymnastics and they're also a rehab centre.

I understand about time, but i find it completely ridiculous that people like me are being left in the state we're in for the sake of a 30 minute physical assessment that could have found what was wrong.

Orthotics seem to be a huge postcode lottery thing in our experience. Then you get the physios disagreeing with what the orthotist has done!

I was told they don't do hands on work but I have to say the physio I was seeing was extremely thorough in getting to the bottom of my problem and tailoring exercises for it. He was older and highly experienced. Later on I saw a physio for something else - young guy out of college, couldn't have cared less.

I did see private physios for a while years ago when I had private cover. I was never sure that they weren't over treating as I was such a lucrative customer.

I wouldn't be surprised if the NHS physio protocol is to first suggest exercises and rest and only progress to manipulation if the patient returns after x weeks compaining of the same pain. You might even need to revisit serveral time to escalate treatment to manipulation. I have scoliosis which has given me back, hip and neck pain for all my adult life and I only use a private osteopath when it gets bad, rather than an NHS physio because I know what works for me.

Sorry to hear this, OP.

I've had the exact inverse. Shit care from a private physio, and absolutely world class care from NHS physios.

I expect it depends on local area - i.e. luck.

I would ask for a referral to a Podiatrist. HTH.

I agree with this completely. I think it has absolutely zero to do with training as all local physios are trained "in the NHS".. i.e. they go through the same accredited curriculum and and practice placements in the NHS.
Which is why I want to know where this consultant thinks contemporary private physios acquire this knowledge and expertise that their NHS counterparts have seemingly no access to.

It was podiatry that referred me to physio as podiatry said it might then need referring on to msk.

How overweight are you?

If you cant be bothered to help yourself and lose the weight then I'm not sure what you want a physio to do.

I've worked at a private physio, they all trained in the NHS, a couple still did NHS shifts. The vast majority of non sporting injuries problems could be helped if the patient lost weight. Oddly when paying £70 a session patients seemed more incentivised to bother doing so.

A physio can not make you better

They can tell you what to do to get better

Since you don't do it i don't know what you expect

Generally speaking my experience of NHS physios has been positive. I have complex lifelong muscular skeletal conditions so I've seen a lot of different physios over the years and my experience has often depended on how much they know about my long term conditions as a lot of what they deal with is recovery after breaks etc.

They also deal with a lot of people who aren't willing to put the work in which I imagine is extremely frustrating and it's often when a patient is proactive and has done their own research and so can engage in a better way that good results are achieved.

YANBU, let me guess. Incorrect pelvic tilt. Poor corset muscle support. Poor posture which won’t correct itself due to shortened or inactive muscles. I’m convinced half the country has these problems and no one seems to know about any of it!

But also private is sometimes no better.

You may have just stumbled on a unicorn. I found one and she is like a human x ray machine. Identified all kinds of issues and actually fixed them in a short period.

It’s an art really. Something which can only be learned through experience and working with different bodies.

I always recommend people to her. She fixes 90% of them (she’s very open to say I don’t think this is something I can fix).

It’s amazing how gifted some people are. If we could clone these people then think how many problems could be resolved but we can’t.

True. I had serious doubts about the private physio my insurers sent me to after an accident some years ago. At first I was impressed - lots of hands on stuff and I did feel better after manipulations. But things were almost back to square one after 2 weeks, so, surprise surprise I had an appointment every 2 weeks until the insurers stopped paying, upon which the physio tried to persuade me to keep going and paying myself because I "needed" those fortnightly manipulations. They also tried very hard to persuade me to have some expensive injections - not covered by the insurance and not approved by NICE. I declined and went to the NHS. It's true that I didn't get the same instant symptom relief from their approach, but long term I had more benefit I think.
Interestingly I had some fairly major orthopaedic surgery privately last year and physio at the private hospital was part of the package. Their physio was excellent and whilst she did do a bit of hands on stuff her treatment was very much more in line with what I'd experienced in the NHS, just with more time. Call me a cynic, but I couldn't help but think that the fact that she was a salaried employee might have made a difference, unlike the previous one who was self employed and would obviously benefit financially from upselling.

“just pop up on here for me”

I'm another one who is only ever gone private for musculoskeletal issues, even then it's hit & miss.
Plus you need to put in the work yourself to keep your muscles strong and your joints properly aligned- not everyone has the time or inclination for that kind of thing!

Afaik physios study for a uni degree, masters or degree apprenticeships.

But the requirements for NHS practice, unless you’re involved in high level rehab, the bogstandard NHS physios just give out exercises, they don’t do massage/manipulation any more.

NHS physios do not seem to do any hands on work nowadays so they can’t develop the knowledge and experience some of the private ones get from longer and more in depth sessions.

I'm a final year physiotherapy student and shocked by some of these comments. Firstly the training is the same, regardless of whether you intend to work for the nhs or private; three years of intense degree study after which you are expected to complete a minimum of 18 months to two years of additional training as a band 5 before you can apply for a band 6 post. Then you are expected to engage in regular training and development throughout your career. I can't speak for other universities, but at mine the entry requirements for physio are much higher than other healthcare courses.

At my university and in clinical practice we are taught to always complete a thorough subjective assessment and examination, including screening for possible red flags, however unlikely. In an MSK context this is dependent on the patients report of their symptoms, but at a minimum would include assessing their active range of movement, passive range of movement, strength, neuro integrity tests (if it's a spinal issue) muscle length (if muscle tightness is suspected, as well as special tests (testing for specific issues such as a torn ligament or tendinopathy and so on) as well as gait and postural analysis.

I have never heard from either my lecturers or practice educators of a five minute conversation then handing someone a sheet of exercises. That would be considered completely unacceptable! When it comes to MSK physio there is an enormous amount to learn, but most of our course focusses on manual therapy and mobilisations for treatment. We are taught to be cautious with manual therapy as the evidence shows that it only provides short term effects and neither NHS or private physios should be encouraging patients to become reliant on seeing us to manage their symptoms. There is also some debate about whether it is really possible for therapists to generate enough force through their hands to have much of an effect on structures like the spine via mobilisations/manipulations. They do have an effect on pain relief due to a combination of activating descending inhibition (gate control theory) and the placebo effect.

Sorry for the long rambling post, but I'm truly appalled by some of the experiences here, and they certainly don't reflect what we are taught at my university! 😟

I do the work, and i do help myself, where did i say i didnt?

I'm a bit confused about this because there are specialist MSK Podiatrists. I suppose it depends if they have one in your area.

It seems to be a bit of a "Postcode Lottery" when it comes to Allied Health Professionals.

The requirements for NHS practice is tertiary education and registration with the professional body. Otherwise, they would save money and hire personal trainers with 6 weeks experience.
Your friend commented specifically on training. Since I am in adjacent profession and we did a year of blended training with physios, I am not sure that her assessment is entirely correct because they are definitely taught manual assessments and therapy skills.
I also worked in neurological rehab, MSK, mental health, respiratory services and saw young physios with my own eyes doing assessments of movement and function.
But since we are generalising, I will also say that I find a lot of consultants to have no clue about what AHPs do and no respect for our professional skills.

I think we have one centralised msk team at our town hospital with pain management clinics based in different doctors practices and the hospital in the next city along.

Our podiatry team are quite a small unit in a multi disciplinary clinic that does everything from feet to teeth to autism.

For most things msk you're just referred to the hospital.

I’m an ‘old school’ physio - worked in the NHS for 20 years but have practiced privately for the past 10. New graduates just aren’t trained properly anymore and it’s very sad to see in my opinion. It’s all due to a lack of money and lack of time within the NHS. It means that it’s incredibly difficult to find a good hands on physio, not just someone who hands out a sheet of copy + paste exercises. DD is hoping to follow in my footsteps and study physiotherapy at university - I do genuinely worry about her as there is so little in terms of career progression and training these days without moving to Australia etc.

I dare say that a large percentage of physio applicants now are more interested in saving rugby players pitchside than doing any ‘real’ work..

You're not going to get better if the physiotherapy exercises you're given are not targeting the correct problem.

Doing all the core work in the world is not going to remedy back pain that is compensation from a shitty hip that is affecting your gait,