Physiotherapy Management – when is the right time?
As a physiotherapist, we regularly see patients with injuries and one of the most common questions
is when do I start physiotherapy?
Truth be told; physiotherapy is a profession and not something we “start”. The correct question
should be, when do I start my rehabilitation. The best person to answer this is a physiotherapist.
What physiotherapists are very good at is, assessing, diagnosing and managing injuries/pain. They
identify the problem, decide if the symptom needs further investigations or if they can be managed
via physiotherapy guidance. The initial management might very well be advice and a few simple
exercises, but this will progress as your symptoms improve. Within a sports setting, a
physiotherapist will be the first person an athlete will see post injury and the management of that
injury starts immediately. This should be no different within the normal population. Deciding the
most appropriate pathway for recovery will usually start with a physiotherapist and studies have
identified an early intervention to an injury, usually yields the best outcomes.
A physiotherapist, being the most accessible specialist within the local community should be the
main person managing your symptoms. Physiotherapists have the ability to refer to GPs and
consultants and request appropriate investigations via the GP. However, we also hold the skills
necessary to issue an early intervention to help manage your symptoms.
This usually starts with advice. What we think is causing your symptoms, what to do, what not to
do, when to commence and progress exercises, when to return to sport or work and how to bridge
the gap between injury and returning to full activities or duties.
One of the main roles is to address any negative emotions, concerns or stressors that may act as
barriers to recovery and hinder return to sport or work. Without addressing these concerns, the
injury may manifest itself as chronic pain, result in a longer recovery time, affect their ability to
return to sport / work and create unnecessary anxiety and worry. This is when a physiotherapists
role is paramount for early assessment and intervention.
Some counties are highlighting the need of “first contact” physiotherapy services to allow such an
early intervention. To allow the patient the opportunity to access a specialist quickly and effectively
to get appropriate management without delay. One study highlighted this early intervention is seen
to also speed up recovery times for patients with acute whiplash and another suggested this was
beneficial for those experiencing acute low back pain in the initial acute phase. It provided the
patient with confidence, assurance, positivity and early advice which not only led to
improvement in patient symptoms, but it cut out unnecessary onward referrals and scans and
Lau et al (2008). Early physiotherapy intervention in an Accident and Emergency Department
reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial.
Australian journal of physiotherapy. 54, 243.
Sterling (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of
Physiotherapy. 60, 5-12.