Ways Musculoskeletal Physiotherapy is changing over the years

Musculoskeletal (MSK) Physiotherapy has evolved significantly over the last 10 years. Gone are the days when patients are hooked up to machines (Interferential, TENS, Ultrasound therapy, shortwave diathermy comes to mind as examples). Unfortunately, I still see patients being treated with modalities and one wonders why they never get better.

Physiotherapy nowadays is based mainly on a manual and a functional approach. A Physiotherapist should be able to assess the action of a muscle, joint and nerve and assess how this affects the patient functionally. A tailored exercise program based on functional therapy is always recommended.

The work of Gray Cook, Kyle Kiesel, Stuart McGill, Shirley Sahrmann and Diane Lee all describe the effect of a functional approach on the human being. The joint by joint approach described by Mike Boyle has taken off in the last few years and a Physiotherapist now aims to look at the whole body rather than just “a problem at the knee”. Understanding the difference between stability and mobility is important to gain further improvements in function.

Furthermore, physiotherapists today have a wealth of knowledge at their disposal. Learning how to manipulate, the use of instrument assisted mobilization tools (IASTM), learning how to use acupuncture or dry needling are tools that will help therapists expand their knowledge and help the patient get better faster.

Manipulation is described as a specific technique to a joint that allows improvement in mobility of a joint. In the past, manipulations were only performed by Chiropractors and Osteopaths but nowadays many physiotherapists are qualified to perform these techniques. It takes time to master a manipulation, but with the right mentorship and practice, this approach can help a patient significantly. Having said all this, working with other professions has also evolved in the last 10 years. I have always worked closely with Pilates and Yoga instructors, chiropractors and osteopaths and I believe that liaising with other professions is important in today’s health industry. Dry needling, also known as intramuscular stimulation, and acupuncture are other forms of therapeutic approaches that have taken off in the last few years. I use both and these help my patients tremendously.

The other major change I have seen is Physiotherapy as a form of rehabilitation. In the past, Physiotherapists concentrated a lot on pain. Once the patient is pain free, he is discharged. Nowadays, there is a big demand for making sure the problem does not come back. Even though the patient is pain free, one must make sure the biomechanical implications of an injury have been considered. This is where functional programs come into place. Either by working closely with a personal trainer, or by including advanced strengthening and stretching program in the patient’s treatment plan can we make sure the problem will not come back.


Finally, Physiotherapy is an art that with the right tools in your repertoire can change a patient’s musculoskeletal problem. The profession is evolving, the tools are changing, but with the right hands-on approach and continuing education, one can make sure his/her career continues to flourish!


Please have a look at these websites for further information on the topics discussed above.

1. Gray Cook and Kyle Kiesel - http://www.functionalmovement.com/ 

2. Stuart McGill - http://www.backfitpro.com/

3. Diane Lee - http://www.dianelee.ca/courses-conference-presentations.php

4. Shirley Sahrmann – https://pt.wustl.edu/AboutUs/pages/facultybio.aspx?FacultyId=29

5. IASTM - http://www.grastontechnique.com/

 Written by Carl Cachia

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