Physiotherapy for chronic pain

People with pain are often referred to a physiotherapist more often in the early stages of their pain problem although sometimes later on.

Physiotherapists are specialists in human movement, who aim to help people keep active. They give advice and instruction on exercises to mobilise joints, strengthen supporting muscles, regain and maintain fitness and other techniques for managing pain (see also ‘Learning about pain management‘).

Some provide a number of different physical therapies (see also ‘Physical therapies‘) including manipulations, mobilisations, massage, electrical stimulation (TENS), acupuncture, heat and cold treatment and ultra sound. These are usually given in combination with exercise and are used to reduce pain so people can get mobile again.

Usually people attended NHS physiotherapy once a week for a set period, typically 6– 10 weeks. A few people attended longer, more intensive physiotherapy but this was unusual. People who had suffered an injury or undergone surgery were often referred to a physiotherapist as part of their rehabilitation. The main purpose of this was to get them moving and set goals for their recovery. At physiotherapy people were often given exercises and sometimes used equipment in a special gym.

People who felt that they had benefited from physiotherapy were pleased to have been referred to a knowledgeable professional who understood their pain and could advise them on exercises and practical changes that made a real difference to their daily lives.

Some said their physiotherapists were wonderful, looked forward to their appointments and felt bereft when they stopped. Many found the advice about exercise helpful although in retrospect some felt they could have done with more advice and to have learnt earlier about the benefit of pacing their exercise (see also ‘Pain management: pacing and goal setting‘).

Those who were less impressed with NHS physiotherapy said that the physiotherapist had not listened to them or seemed not to understand their pain, or that the exercises they were given were too painful. One commented that standard physiotherapy only treated the painful area and did not look at the whole body.

One person felt her physiotherapist hadn’t listened to her when she discovered that she’d referred her to a surgeon with a note saying she was keen on surgery when she definitely was not. Some were annoyed at the sporty demeanour of physiotherapists who wore tracksuits and shorts or commented that it was difficult to take advice from a fit, healthy person when your mobility was so impaired.

One person who was self-motivated to exercise did not see the point in traipsing back and forth to the hospital and stopped attending appointments.

Several people had been repeatedly referred for physiotherapy but experienced little long-term benefit, which they had found frustrating. Nowadays it is more common for people to attend physiotherapy for a limited number of sessions and if there is no improvement it may be necessary to refer them to another specialist. Some people found this upsetting as it could feel like they were being ‘given-up on’, and some continued to have private physiotherapy or went to complementary therapists instead.

Some had been referred to more specialist physiotherapy including intensive rehabilitation, back pain exercise classes and hydrotherapy (guided exercises in heated water). A woman found the back class very helpful and said she was able to continue the exercises after at a local gym.

Found back exercise classes very helpful and has been able to continue with the exercise at the gym.

Age at interview 38

Gender Female

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A man who had been to hydrotherapy found it very good but commented that it was difficult to get referred to and he only had 6 sessions. Others felt the same way and whilst some found that they could do the exercises in a normal swimming pool others found it difficult to get to a pool or felt that they were too busy (see also ‘Exercise and activity’).

Attended hydrotherapy which he found very helpful because water supports your body weight and…

Age at interview 56

Gender Male

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Others had been referred to pain management programmes, which included exercise sessions usually run by a physiotherapist (see also ‘NHS pain management programmes‘).

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