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.

@Lastofsummer

Multiple people on this thread are saying that they were given a sheet of exercises and nothing else. Training or not this is what seems to be regularly happening.

My daughter is hypermobile and often needs physio. The GP said to see a private one as (he was more tactful than this) the NHS would not be of help.

She recently had a knee injury and was on crutches for a month. Physio was not even suggested!

I have often thought that skilled physio through the NHS with easy access would be one of the best interventions the government could possibly do. Small problems can turn into big ones alarmingly quickly.

I have seen our local sports physio probably a dozen times for myself and DD in the last 5 years. They have never done unneeded treatment. They don't need to. They are mobbed!

Interesting thread!
My experience is similar to many. My NHS Physio was pathetic. Unfortunately, I struggled to understand what he was saying, zero hands on and he just handed out an exercise/stretches sheet without demonstrating anything 🥴
Stumped up privately for a fantastic and very hands on Osteo. It's just expensive!
Not sure what benefit if any, an NHS Physio can give a patient?
I was discharged after 3 'sessions' feeling like it was the Emperor's New Clothes 😅 He had the cheek to ask if I was better...erm, no, sorry 🙄😅

I've had 3 recent experiences with NHS physios - 2 were awful but the other physio was amazing and went above and beyond.

1st one - I went in for an initial assessment as I've been in constant and worsening pain (often developing into bouts of agony) and loss of balance and grip on my left (dominant) side. He looked completely bored as soon as I entered the room and although he'd already made his mind up - he examined me and asked me loads of questions, including making me get up on a high bed where he then moved the steps away from me and then turned his back on me and told me to get down and I almost fell badly as I tried to reach the steps (as I felt a bit intimidated by how unfriendly he was). He then told me that basically the pain was all in my head and only minor "but I'll book you in with the Pain Clinic at the hospital if you REALLY insist". I insisted!
Was examined by two senior doctors at the Pain Clinic who had assessed my gait and walking as I walked up the corridor (which I didn't realise that they were assessing me) and they noted down that my gait was leaning to the left but my strength on my entire left side was not as strong as my right and my speed was very slow and they re-referred me to a different NHS physio.

2nd one - did all of the tests and questions that the first one did, and more and she confirmed that she agreed with what the doctors had said at the Pain Clinic and I was definitely showing clear weakness and a clear bend to the left and she said that she could see clear expressions of pain in my face and could feel resistance on my left side and she referred me for a full spinal MRI - I was seen within 2 weeks and the report from the MRI indicated serious problems and possible cancer! Thankfully my cancer test came back negative but the scans also showed that not only do I have damaged verterbrae in my lower back but my entire neck has lost a lot of the cushioning between the discs and is dehydrated, I have narrowing of the spinal canal and degenerative discs in my entire neck (basically Spinal Stenosis) and on top of that I have nerves on either side of my neck, that are trapped between the dehydrated discs and they keep pinching and my neck discs crack very loudly.
She also gave me excellent advice on exercise and also which walking aids to use to prevent further twisting of my spine or at least slow it down and extend my life of not needing a wheelchair and she (and the doctors in the Pain Clinic) were horrified at how blase the initial physio had been.
I was also put on immediate, lifelong, prescription only pain medication designed to numb the nerves.

3rd one - extremely unfriendly, tried to tell me that all people in their 40s get these same issues and told me that I was dramatising when I said in passing "I prefer doing the exercises instead of just relying on pain relief and I don't want to end up in a wheelchair sooner than I need to be"
She did the minimum of exercises or questions and most of the sessions seemed to be her sneering at me whenever I asked her anything and she only ever seemed to get me to stand and sway as a form of pain relief and I told her I do that anyway - the next session she discharged me.

I'm now at the stage of my condition and pain having increased massively and I'd benefit from physio again but I'm too afraid to ask in case I end up with the two who were unpleasant.
Seriously thinking I'm going to have to pay for private physio.

I always try and see sports physios,they are fantastic ime.

Are you getting confused with chiropractors? Osteopaths do a degree and seem a lot more clued up on MSK stuff than physios. I wouldn't say it's quackery at all but everyone is entitled to their opinion. Now chiropractors are total quacks!

All departments in the NHS have been run into the ground by so many years of Tory underfunding. Be angry at them not the NHS.

It annoys me when people complain about Labour increasing taxes - we need to fund our NHS/social services/schools etc better and improve them.

There’s nothing to choose between the training of osteopaths and chiros afaik - it’s just the techniques are different (altho ime chiros are more forceful) I don’t like having my bones clicked.

Well the nhs does employ osteopaths but not chiropractors afaik so they must have more faith in osteopaths???

Sounds like an nhs physio, indeed.

Osteopaths are Regulated under Statute and have a Code of Practice.

Chiropractors are classed as Alternative Medical Practitioners so Chiropractice is not a convential medical treatment

Area dependant, I think. I'm hyper mobile and my hip likes to move out of position normally. My NHS physio showed me the x-ray where she could see it out of place by around 5mm and my exercises were based around that. The GP nor the radiologist had spotted this due to this physio, I can now self manage when things move out again.

I disagree. I did once see an excellent physio with chronic SI pain who laid me down, tugged sharply on my leg, something clicked into place and the pain was gone. I’d love to know how that physical misalignment was social or psychological.

if you really think chronic pain can’t go away then what’s the point of physios? There really is no point at all. And I do agree in their current format of handing out exercise leaflets there is no point. I’m sure when the nhs is streamlined further this will be realised and the msk nhs side of physios will go completely and people will lose their jobs. They’re costing the nhs money for no benefit now. No idea if they’re any more use in respiratory services, I hope so.

What about a physio who spots a problem like a flat foot and recommends orthotics and hopefully exercises to improve the flat foot? Won’t that cure chronic knee or ankle pain?

I didn't say I don't believe them, it's just not representative of the way we have been trained at my university.

From what I've heard both from patients and practitioners no, the funds are just not there.

Personally I've paid for private physio when I've needed it which even in central London is only £50 a session. Because of this when I've had an issue I've been seen immediately and its been corrected within two sessions with stretches at home. First was from moving furniture during a move and second from computer usage with incorrect set-up.

Also I live pain free, something most people I know even my age, and I am only late 30s, seem not too.

I appreciate if you can't afford it you can't afford it but all my friends and family in the UK reacted to me doing this as though it was an excessive extravagance, I'd lost my mind and got ahead of myself. But none would have batted an eyelid if I'd paid this for haircut or a meal out.

Many have waited months or even years for NHS physio only to find it useless when they easily could have paid for it, or even allowed me to pay for it which I offered. No one I know who lives outside the UK would do this. It's a very very British thing imo.

Chiros have to be registered with the General Chiropractic Council which is their regulatory body.

Osteopathy is not regarded as a conventional medical treatment, altho it seems to be becoming more mainstream and is used in conjunction with the NHS in some areas.

That said, I’ve had a terrible experience with a private physio -one who had supported TeamGB at one point so we fully trusted him. My DD had a knee injury and we were advised to see him by her club. We saw him every week for about 3 months and he kept saying it was getting better even though my DD kept telling him it wasn’t. In the end I phoned the GP who put us in touch with a private orthopedic surgeon who immediately sent her for an MRI. My DD had torn her ACL. No amount of physio was going to repair it and she needed surgery. I still can’t believe that physio let us spend all that time and money for months, and didn’t once think to request an MRI when my DD kept telling him it wasn’t improving. I’m still angry about it years later!

I don’t think any physio is trained to hand out a sheet of paper and wash their hands of patients. However, this is what they are expected to do in a lot of cases when they work for the NHS.

I have never had a private physio rely 100% on me rehabbing at home after demonstrating once how to do the exercises on the sheet.

I'm an AHP (not a physio, I wish). There is a lot of stuff in my profession for which there is little evidence or evidence that something very minor is equally effective/ineffective. Imo there are ways of practising within the evidence base that are still respectful and attentive to the patient. In particular, close and dynamic assessment is as essential as it ever was.

Yes the focus is absolutely on reaching a point where the patient can carry out their own ongoing therapy, as there is no funding for more than a few weeks' input in a lot of cases. But that is a process in itself, a process of assessment about their resources to do that, and requires significant input to reach that point. If they've never seen any evidence from you that X could help, why on earth would they go off and do X themselves alone?

The evidence is frequently based on younger, healthier, well supported people with fewer comorbidities and who haven't spent weeks, months or years in pain. Facing real people in the real world is different. And they've been sitting on a waiting list for God knows how long - if their problem didn't resolve by itself that tells you something anyway.

And then there's the issue that actually seeing someone has an impact. If they walk/limp away from the session feeling not listened to and with no assessment they recognised, I have caused harm. I've done this job for 13 years so I often do 'know' what's going on within a very short time of speaking to a patient. But that 'knowledge' is actually a hypothesis and I need to test that, or I'll get it wrong a good number of times.

A major issue i think now could be new practitioners observing very experienced ones and not knowing that the speed we go at is nor appropriate for them. They should be taking much much longer to assess. And they've also perhaps never seen patients improving slowly over long periods of treatment because nobody gets that any more.

This resonates with me so much! Been suffering from back pain since 2019 and they just printed an exercise sheet and said go do these but the problem is, I'm in too much pain to even do the exercises on my own! I tried for a few weeks and just gave up, felt like it just kept aggravating my pain

I wonder if it is dependent on locality, as on my last MSK outpatients placement they had 45 minutes for a new patient and 30 minutes for follow up appointments. Those timings are very tight but more than achievable to deliver good quality care. My worst experience was on my neuro inpatient placement where I was shocked at how little time the physios actually spent with the patients😔

Wow our physiios have read the referral, printed out the exercise so it's 15 minutes. There's physio equipment in a room at the back that they don't have time to use.

Someone I knew 30 years ago became a physio she had a private practice. A few years ago went NHS with this team. I notice she's gone back to practice again

15 minutes was about the length of time I had. In private practice, physios tend to spend 2-3 times that doing the initial assessment before even feeling confident to treat.

I don’t believe it’s the physios who aren’t up to scratch though. I firmly believe they are hamstrung by inadequate NHS funding.