Physiotherapy: What is the future – a Plea more than a rant!

When I first qualified 32 years ago as a Remedial Gymnast and then as a Physiotherapist after the two professions merged, we were still largely under the direct control of Dr’s.  Not carrying out treatments based on our own skilled assessments using clinical reasoning and the latest research. We were told do “x” for “x” number of sessions for “x” number of weeks and then discharge.

All this despite being trained to examine, reason, and diagnose -thankfully our independence and clinical standing came quite quickly and the profession made enormous steps in become lead “players” in the world of medicine in every area of healthcare.

I’d argue none more so than the area in which I work – musculoskeletal medicine and pain management.

We have become essential and key to the progression of knowledge within these areas, indeed in the area of pain management physio has been at the forefront of the revolution in this and in particular with the management of chronic pain.

Physiotherapist in recent years have gained new roles, became recognised as CONSULTANTS, EXTENDED SCOPE PRACTITIONERS, PRESCRIBER’S; This is so fantastic that we are recognised as being skilled and competent, yet there is something going on beneath our feet !!

Now I am a big advocate of talking, educating, listening, encouraging, guiding, motivating patients to self manage and take control for themselves. BUT…….there appears to a gradual and insidious sneaky almost, dissolving of many of key skills.

We touch, examine, manipulate, massage, exercise, teach, handle & facilitate

I hear of physio’s being told that in “our dept” we are not allowed to touch patients, not use ultrasound, not use massage. THIS IS ABSURD / IT IS DISTRESSING and will DESTROY our profession.

The GREAT’s who gave us the improved skills, belief, insight into examination & manual therapy – people like James Cyriax, Geoff Maitland, Greg Grieve, Freddy kalternborn, Brian Edwards, Louis Gifford to name but a few – these inspirational people who taught us how to feel & interpret joint movement and soft tissues to understand these specific details and treat our patients with improved accuracy- what would they say at the denuding  of all these skills ?

The age of the telephone therapist – MY GOD what is going on; “it’s cheaper ,just as effective”  – REALLY!! 

I hear patients all the time saying I had to wait weeks to talk to a physio on the telephone, they sent me exercises ! I eventually saw a physio – who didn’t touch me or do anything and gave me a sheet of exercises, which I haven’t done.

Now, I am not that dumb, YES some people can be listened to and a reasonable impression gained of the problem and yes exercise is a powerful tool. BUT don’t make this PHYSIOTHERAPY.

It is a short step to “crib sheets” then anyone can be the physio !!!

Be very careful people there are other professions out there, very well qualified and eager to get in our shoes. Masseurs, Exercise Physiologists, other manual therapists , Sports Therapists !! I have nothing against any of these I have worked with all of them and like and admire their drive and determination to better their professional status.


As always if you like and agree please click the like button or share; if not free to ignore this particular BLOG. Thankk you for reading   Alan

STAY POSITIVE: Despite the Pain:

STAYING POSITIVE WITH PAIN: irrespective of the cause

Become a COPER

The information below will help you to become a Coper and
prevent unnecessary suffering. Follow these guidelines –

You really can help yourself!

Live life as normally as possible. This is much better than staying in bed.

• Keep up daily activities – they will not cause damage. Just avoid really heavy things.

• Try to stay fit – walking, cycling or swimming will exercise your back and should make you feel better. And continue even after your back
feels better.

• Start gradually and do a little more each day so you can see the progress you are making.

• Either stay at work or go back to work as soon as possible. If necessary, ask if you can get lighter duties for a week or two.

• Be patient. It is normal to get aches or twinges for a time. Don’t just rely on pain killers.

Stay positive and take control of the pain yourself – try not let the pain control you

• Don’t stay at home or give up doing things you enjoy.

• Don’t worry, It does not mean you are going to become an invalid.

All this is very easy to say –  & hard to put into practise – but POSSIBLE. Do not “SWING DOOR” your activity between doing lots on good days and “paying for it” and therefore under-doing it…….

good day bad day swing door

Find a level you can do even on bad days; whether this is home chores, some physical activity such as a walk or being sociable –


Find a level to start at – you are on a staircase back to normal, so one step at a time – make them small and doable

Congratulate yourself for every time you do keep going or go up the next step …

BUT DO NOT get down on yourself for any backward steps…… This is just a “snifter” of info there will be much more on this on future BLOGs to come.

Posture: a slightly different twist !

Posture is often viewed as being in the “right position”  – to stand or sit right. The body is built to MOVE and has the ability to do incredible things you just need to marvel at Olympic gymnasts.

In 30 something years I have seen people as close to “ideal” as it seems possible to get and people far from “ideal” & It seems that many of the aches, pains, back problems and strains that afflict anyone affect the ideal and not ideal similarly. Lets be clear IDEAL I don’t mean beautiful/handsome, clever, wealthy but physically aligned, muscle balanced and posturally “spot on”.

If, as it appears to me, that this is the case. then what has been the remedy? Well across the board for everyone the answer will include MOVEMENT with almost anything – just get moving; now there may well be other treatments but without movement the results are worse.

Why would you have joints as complex as they are particularly as those of the spine if movement wasn’t the key. The move to standing office spaces rather than sitting is an improvement as movement is more likely. But sitting is ok and even sitting “badly” is ok. providing it is not all you do. Sustained standing will hurt sooner or later. You can imagine the issues if your work has paid for an expensive chair and new desk etc “you dare not move!!

Similarly SYMMETRY is not normal either. Don’t get me wrong there are times when helping people to stand or sit or move in better posture or with improvements in symmetry is very relevant.

But saying “your posture is the problem” is right up there as a fob off with you’re the wrong weight for your height ……

POSTURE – I think is an ingredient in some peoples problems. Usually a small part and some sometimes irrelevant. MOVEMENT is the key … do you move at all? ….. enough?…..  do you use all ranges and directions enough?

“YOGA” type exercises and programmes are about this – correct classes should be able to deal with all shapes and abilities  – it should not be about tying you in knots, it does not have to be spiritual unless you want that to, it should be about BREATHING.

What do you think ? as always it is just my thoughts I hope you find it interesting! …. Regards Alan

Making sense out of the language of medicine: cutting out the unneeded harm

Words can hurt !!! but words can aid healing.

This is the point of this blog … getting this right can have a very powerful effect on therapy given and in helping our bodies attempts to heal ………….

“You have crumbling bones”!!

” you have a trapped nerve”

“It is just arthritis, live with it”

These some examples of phrases I have heard said and had my patients tell me they have been told. But you know words that are spoken to us have the added benefit or problem in HOW they are delivered. The voice used, the non-verbal body language that infers things like “caring”, honesty, eye contact these sorts of things that suggest we are trying get the right message to you. Do you get listened to in a way that allows me to reply with the right terms and language that you recognise & understand but still get over the diagnosis (what is wrong) and the prognosis (treatment and expected results) correctly.

Many medical terms can be thought of as “umbrella terms”  for instance LOW BACK PAIN; what does that tell you? it tells you what you told me !!! but what is the cause? … is it ligament, muscle, bone, disc, alignment, “out of joint”, muscle imbalance, postural; ’cause you’re over weight!, is it a major problem, genetic, lifestyle based,does it come from somewhere else (referred pain) kidneys for example. What is most likely it is NOT an either or issue. There will be muscle issues, mobility/stiffness issues possibly nerve issues there will be many INGREDIENTS; the Doctors or Physio’s interpretation may vary depending on the questions we ask, the answers you give, on how you are that day. The process I often think is like dealing with a crime-scene; facts gathered and eventually some suspects or PROVISIONAL DIAGNOSIS can be made. Your condition should change (ideally improve) so the suspects or diagnosis may change to … this is how it is.

Other similar umbrella terms are:-

non-specific low back pain – which translates as ” not sure what it is but it’s not serious and should get better”

Mechanical low back pain – it’s the machinery (muscles etc)nothing serious

Tennis elbow – pain on the outer bony area of the elbow with an ache in the forearm: Probably to do with forearm tendons/muscles. But could be referred.

Sciatica –  shouldn’t be used as “umbrella” term but not infrequently is. Pain down back of leg from a “trapped nerve” (there’s another one!!!) Sciatica should only really be used if the nerve fibres that conduct the impulses up and down the nerve to and from the brain are damaged. And NOT if the outer covering or sheath is pressed or inflamed. Think of an electrical cable if the outer white cable is indented or cut this often has no effect on the connection to the electrical system – its is similar with a nerve. Continue reading

My 1st Blog; Why blog at all and a little about me !!

February 17th 2015:


CPD: Starting a domain and blog. What is the purpose?

Two main reasons I think? I’ve got knowledge, useful information and things to say (to anyone who will listen) and secondly how get people seek help for healthcare concerns and to then choose physiotherapy and ideally me!!

I have been considering ways of promoting physiotherapy to aid referrals as the ebb and flow of referrals has been ever changing. Reasons??, Well for one RTA insurance claims and those go-between companies who were set up I suppose to aid the injured whiplash suffer hastily through to treatment were for a long time keen to do just that it seemed and still make a buck themselves.

Something changed somewhere in the journey from insurer, solicitor to go-betweeners :I assume the cash was the issue someone was making less, was less interested: I am sure you know how it goes. But the calls started coming through to us “can you see our patients for less!!, can you see them sooner, can you complete the treatment faster”. There will always be some who will do just that- do it for less and jump the hoops.

The issue here is quality costs if I have spent the last 30 years honing my skills, studying & attending courses – it cost this (x) AND it will take what it takes to get the client right both in terms of how many sessions and over the right period of time. People are not widgets – they are complex physical & emotional beings – and each so different. Unfortunately a lot of the “whiplash” type work has gone out into the private sector for so many reasons. Are the insurers, solicitors and go-betweeners all cutting their profit margins? I do not stretch out treatments, give unnecessary treatments or over charge.

Other reasons for drops and rises in referral – certainly people have been watching their cash (except for essentials like nails and hair!!) other health insurers have altered their excesses and accesses and filtered which therapists are on their “lists”.

Anyway, it seems people like the try before you buy idea – the blog and website lets people make a judgement about “YOU” and “the service” you offer. An offering of advice and information can be very powerful. I have been on the buying side for years for holidays and products without realising it isn’t just the price. The aesthetics the “feel” you get from seeing & using the website before even dealing with a real person is something I have not considered or appreciated.

So, how much more so when our health is concerned!

So, I have started the process of learning how to set up a domain and then blog. Why blog (incidentally I dislike the term enormously )well, there is getting less for me to learn that actually make a difference to the day to day work – the techniques anyway, knowledge always changes and is endlessly fascinating and sometimes can be used in my daily work.

The biggy for me is the language of healthcare to aid/promote healing – the belief in healing possibility. We have all heard stories of medical words that do nothing but frighten patients or the disinterested throw away comments as the healthcare giver breezes out of the room/cubicle. I am going to BANG on and on about language in my “info-blogs” when I finally understand how to do blog properly.

Bear with me – please. My intentions are pure and heart felt: my English and language well, I aim to get better. I can see learning how to use the “net” and to “blog” will take some time but I am convinced it will be useful – I hope YOU go to dear reader.

Like the ideas you like, discard the things that make no sense or you don’t like.

I may open up some new thought or make you look further. Whether you seek me out or seek others help is all that is important. There may well be help out there – so don’t give up. It may be the therapist not the therapy.

Also, if it sounds like bunkum or too good – just maybe it is.


Alan Leigh MCSP, MSc, HCPC

Useful Links:

Here you will find links to other blogs, articles, video’s  and website that i hope will help you in your search for relief from symptoms or understanding