Physiotherapy: How to make all the right moves

We may be living longer, but when it comes to maintaining mobility and an active lifestyle, many people will need hands-on, professional help at least once in their lives for anything from a knee injury to the aftermath of a stroke.

Physiotherapy – which identifies and maximises our potential to move around, however weak, unfit or old we are – was once seen as a career best suited to white, middle-class women who might balk at more demanding, "coal-face" medical roles. Today, however, its role is far more mainstream.

Jill Higgins is director of practice and development at the Chartered Society of Physiotherapy (CSP), the professional body for the country's 47,000 chartered physiotherapists, students and assistants.

She believes the profession's expertise in health promotion, treatment and rehabilitation among people whose problems may be related to ageing, accident or illness, is a vital weapon in the battle to improve the nation's health and keep us on the move.

Far from being an undemanding occupation, she says that physiotherapy offers a wide spectrum of different career paths and attracts an increasingly diverse range of practitioners – many of them with a specialist BSc degree in the subject – throughout the public and private sectors.

"We're still not 50-50 in terms of men and women, but we have more men than ever, as well as a more diverse and representative ethnic and social mix. We hope this trend will continue."

Aside from three- or four-year degree programmes, there are a range of other options. They include part-time study, which is often tailored towards physiotherapy assistants looking for chartered status, accelerated programmes for graduates with a degree in a different, but related, subject and work-based learning leading to professional qualification.

"There is a wide range of opportunities, both here and overseas, depending on where and with whom you want to work," says Higgins. "Whether you opt for a clinical practice setting aimed at children, the elderly or orthopaedic patients perhaps, or prefer to specialise in research and education, there is great demand for your skills."

The variety of the work done by physiotherapists in a range of different settings is intriguing. While physios based in hospital outpatient clinics will treat anything from sports injuries to repetitive strain injury, a women's health practitioner will focus on ante- and post-natal care, exercise and posture, and rehabilitation in the aftermath of gynaecological operations.

Among elderly patients, treating arthritis or assisting people with Parkinson's disease will be a routine matter, as will maintaining mobility and independence. Schools may use physios in support of children with developmental movement problems, while in sports and community centres the agenda may be focused on back care and preventative work.

While many physios work independently in private practice, or are based in hospitals or GP's surgeries, others may be employed in the workplace, advising employers how to avoid staff injuries and promote safer work practices. Relaxation and body awareness classes for the mentally ill or terminally ill are another branch of the profession.

Although many NHS patients are astonished to find that their physiotherapy sessions are limited to just six, Higgins believes that for more acute musculoskeletal or cardiovascular problems, this should not be the case.

"There are, of course, budgetary constraints in terms of how often many of our patients will get to see us, but if someone has a clear need for more treatment, this will be delivered."

She adds: "Although there have, in the last few years, been problems in securing enough training places for junior physiotherapists in the NHS, this is now being addressed and we hope many more graduates will choose physiotherapy as a career, so that the growing demand can be catered for."

In terms of patient attitudes, the status of the profession has, she says, never been higher.

"Physiotherapy is very well respected among the public for what it achieves among a wide spectrum of patients who, for reasons of accident or illness, need help to achieve or improve their levels of mobility."

While the nation's appetite for complementary therapies such as acupuncture, reflexology and chiropractic is growing, Higgins believes that the various approaches are by no means mutually exclusive.

"Many physios do practise acupuncture as part of what we see as our essentially holistic approach to the treatment of illness and disease. But we believe there is a place for everyone and that the different therapies on offer are essentially complementary rather than competitive."

In terms of academic strengths, physiotherapy will require a sound science background in subjects such as biology and chemistry, as well as, if possible, a degree. Yet the personal qualities of a candidate may be just as important in the long run.

"This is a people profession and it is essential that physiotherapists can talk to their patients, relate to their conditions and, ultimately, get the best out of them," Higgins says. "We are looking for well-rounded people who are able to engage with others. If candidates have that essential gift, there are some really exciting career opportunities out there."

For more information, visit the Chartered Society of Physiotherapy (CSP) website, www.csp.org.uk

'It is possible to make a lucrative career out of physiotherapy'

Along with his partner, Matt Todman, 39, runs seven London-based Sports & Spinal Clinics, with premises in Harley Street, Fulham and the City. He has been in independent practice for 10 years and employs 40 chartered physiotherapists. His clientele, around 5,000 people a year, range from world-class tennis players, rock stars and captains of industry to ordinary members of the public. His fees are around £150 an hour.

I was four when a broken collar bone introduced me to the world of medicine and from that point on, I was hooked. After taking a post-graduate diploma in physiotherapy, I qualified in 1992 and took up a position at the Whittington Hospital in North London.

Sadly, I found the training I had received was of little relevance to the patients who came to me for treatment and I'm convinced I actually made their back pain or knee stiffness worse, rather than better.

I quit the NHS soon after, and subsequently did a degree in physiotherapy to help me break in to private practice.

That fact that 60 per cent of our new patients have already seen another physiotherapist but still have problems is testament to how ineffective some physiotherapy can be.

All of us in the profession can make people feel better in the short-term, but long-term recovery is very different, particularly for the baby boomer 60-year-old who is no longer prepared to put up with premature old age or immobility.

We offer all our patients 30 minutes of manual or manipulation physio, as well as a further 30 minutes with a rehabilitation physio who coaches you in how to move better.

If a patient is not moving better, or at least differently, after three sessions, we suggest something more invasive such as surgery, but we always try to solve the problem before that stage is reached.

Our premises are in expensive areas of London, so the overheads are high, but if you put in the hours and have real passion about your work, it is certainly possible to make a lucrative career out of physiotherapy.