Physiotherapy

Physiotherapy treats pain, stiffness and weakness by changing how a joint, a muscle or a nerve is loaded and used. It is the treatment for most back and neck pain, for a frozen shoulder, a tennis elbow, knee arthritis and a sprained ankle, and it is what restores walking, balance and daily function after a fracture, a joint replacement, a stroke or a long stay in hospital.

What separates it from exercise you could do alone is the assessment in front of it. Two people with the same knee pain need different loads, and giving the wrong one is what makes a joint flare instead of settle. Your physiotherapist measures what the joint will do, what the muscle will hold and what provokes the pain, then prescribes a dose: which movement, how heavy, how many, how often, and what to change when it gets easier.

It is arranged either at a hospital, where the equipment and the supervised gym are, or at home, where your physiotherapist works with the stairs, the chair and the bathroom you actually use. Your care coordinator arranges either, and which one suits you is part of the first assessment.

The first session is an assessment and takes the longest. Your physiotherapist takes the history of the problem, watches how you move, measures the range of each affected joint, tests muscle power, checks balance and walking, and examines the joints above and below the painful one, because a stiff hip is a common reason a knee hurts.

Goals are then set in your own terms: climbing the stairs at home, sleeping through the night, returning to a job that involves lifting, getting back to the gym. Those goals decide the programme.

A session usually combines three things. Exercise is the core of it and the part that changes the tissue — strengthening, stretching, balance work and retraining the pattern of a movement. Hands-on treatment, which includes joint mobilisation, soft tissue work and assisted stretching, is used to make the exercise possible where stiffness or guarding is blocking it. Electrotherapy, heat, ice, ultrasound, traction and taping are used alongside for symptom relief, and never on their own.

You leave with a home programme, which is where most of the progress is made. Sessions are typically two or three a week at first, dropping as you improve, and each lasts about forty-five minutes. Your physiotherapist reassesses every few weeks against the measurements taken on day one.

How long it takes is set by the tissue and by the starting point. An acute muscle strain or a simple episode of back pain often settles in two to six weeks. A frozen shoulder, a rotator cuff problem or a long-standing tendon problem runs three to six months, because tendon adapts slowly whatever is done to it. Rehabilitation after a joint replacement or a ligament reconstruction follows the surgeon's protocol and is measured in months.

Some soreness for a day after a session is normal and expected, particularly in the first fortnight. Pain that is sharper than before, or swelling in a joint that was not swollen, means the load was too much and the programme needs adjusting, so tell your physiotherapist instead of stopping.

The home programme is what decides the result. Two supervised sessions a week and nothing in between will not change a muscle; the supervised sessions exist to set and correct what you then do daily. Once you have reached your goals, keeping two or three of the exercises going is what stops the problem returning, and your physiotherapist tells you which ones those are.