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Why physiotherapy doesn't work?

woman with knee pain

Not a title you thought you might see by a physiotherapy clinic... but in order to ensure you are fully informed, I think its important to discuss both sides of the coin!

So, in all honesty physiotherapy doesn't work for some people's problems they may have. And here's why! To make it easier to understand we're going to stick with the theme of arthritic knees, but the same principle applies to any ailment.

Our bodies are not machines, we like to think they are and try to dissect every reason it does what it does...but its a living, breathing thing with a mind of its own! Think of it this way...why do most people have only one painful arthritic knee? Surely both knees have walked the same number of steps? Surely both knees have jumped the same number of jumps? So why does only one knee start to age quicker than the other?

With medicine, we are constantly learning new things, constantly researching new theories for treatments, discovering new ailments and diagnostic measures for these. We simply don't know everything yet, and I doubt we ever will as our bodies are constantly evolving. This means that we can never be 100% sure of anything, everything is down to probability, not certainty. A treatment that works on one person may not do anything at all to someone else. An example is paracetamol. I have some clients who after huge surgeries have been on paracetamol and its been all they need as pain relief. Others feel absolutely no benefit from paracetamol for the smallest of problems. Physiotherapy, like any treatment option can be similar.

Lets look at the national statistics for Knee Osteoarthritis as an example:

infographic on physiotherapy outcomes for knee OA

We can see that a whopping 95% of people improved their arthritic knee symptoms with physiotherapy! That's amazing! However 5% didn't. This could be due to their severity, their lifestyle, their weight, their body makeup, their genetics, their fitness levels, other conditions affecting them...and so on. Sometimes physiotherapy is just not appropriate. I've certainly seen patients with arthritic knees who are so far down the line the only way they will get relief is from surgery. So putting them through physiotherapy would be a waste of time for them. (they may however benefit from physio prior to surgery to get the leg as fit as possible so they are in a better position for rehab afterwards).

If you see a good clinician they should be honest with you. With ALL of my clients I am always upfront with my diagnosis and my plans going forwards. If I see someone where I am not sure if I can help I will happily refer them onto a service that can. If I have been seeing someone who has not made any improvements after 3 sessions in the way I would have anticipated, again I will have the discussion with the client to refer them onwards.

A comment I hear a lot from people in conversation is:

I went through all that physio and all those injections just to have surgery anyway. Why didn't they just refer me on in the first place instead of wasting my time?!

And whilst that is a very valid point of view... I want to raise this option to you:

Physio vs surgery for knee OA

If you had been given these statistics at the beginning of your treatment journey...would you still be asking for surgery as the first choice of treatment?

This infographic shows that for the majority of people physiotherapy helps...but not everyone... and sometimes we don't know who those 5% are.

This infographic shows that for the majority of people they have great outcomes after they've had a knee replacement...but not everyone, and sometimes we don't know who the 33% or the 20% are.

Everything within medicine is based upon probability. We can never be certain of anything! So we usually encourage the most conservative treatment option first and gradually move to a riskier or more invasive options.

So why doesn't physiotherapy work? I hope this blog has shown that physio can't help everyone. There are some people who will be left disappointed, or feel their time or money has been wasted. But I just want you to take home this: its all down to probability...not certainty.


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