The confluence of advanced technology, new research, traditional philosophies, social media, and pressure on the health system has left the physiotherapy industry batting an identify crisis, according to physiotherapist and clinical educator, Dave Renfrew. 

Traditionally, musculoskeletal physiotherapists were seen as symptom relievers, while the eventual transition into sporting fields saw the industry increase its collective skills in exercise prescriptions and rehabilitation. By the late 90s, the general perception of physiotherapy was as the ‘body mechanic’ – fix it when it breaks down, and keep servicing it to keep it running.

“The blending of skills across allied health has left physiotherapists with a huge choice in scope of practice, and a resultant, uncertainty as to what we do best, and how best to do it,” says Mr Renfrew.

Upskilling has also played a part in the evolution of the physiotherapist’s role, he says.

“More research into areas like pain, and areas of research such as psychology and pain becoming more accessible to physiotherapists has led to some analysis of what we do and how it works.

“There has been an evolution from physios being purely a technician to an advisor and coach, which has a different skill set.”

The suggested disproof of several techniques commonly used by physiotherapists has further complicated matters.

“There is plenty of research to show that many techniques used by physios have no specific effect,” says Mr Renfrew.

“For example, the intervention in isolation makes no change to the human tissue. These are things like mobilisation and manipulation, massage, taping, dry needling.

“That is not to say they have no effect, but these effects are ill-defined and poorly understood, and have much to do with the client’s own meaning behind these interventions, and non-specific effects of person-to-person interaction, the environment and the therapeutic relationship between the two people.”

Mr Renfrew believes physiotherapists, over time, took their eyes off exercise as treatment, giving way to exercise physiology as an emerging profession – but that’s not a bad thing.

“Originally physiotherapy was the only profession that could prescribe exercise as intervention,” he says.

“My opinion is that, as part of investing in the ‘physio as mechanic’ model - meaning people needed things done to them as opposed to doing things themselves with our help - has given rise to exercise physiology as a profession.
“This can only be a good thing for people, with a wider breadth of practice for medical, rehabilitation, healthy lifestyle and mental health problems.”

The impact of the exercise physiologist industry on physiotherapists depends on the type of physiotherapist and how a physiotherapist views their own role.

“I have an EP in my clinic, and we don't operate very differently. The main difference is in diagnostics, with assessing and diagnosing injury not really within an EP scope.

“A big factor in the differing roles has been with insurance companies, where their standard procedure now is to move from physio to EP, from acute to rehab, even though physios should be capable of running rehab programs.

“The fact that third parties believe we aren't, is indicative, I believe, of our own questions around identity and what we do.”

An increasing understanding of the importance of psychology across all medical fields, including physiotherapy, adds another layer to the ever-developing role of the physiotherapist.

“We all deal with humans, which means we all deal with psychology. The connection has been made by physios recently that they can access years of psychological research to help them understand how to better help their clients, whether that’s to relating to pain or just interacting with them.

“A good example is in terms of our understanding of pain, and viewing it as an experience of a person as opposed to purely an indicator of tissue damage.”

“Rehabilitation can be difficult, and often people need to make different choices than they used to. How we communicate that, develop plans, and help people implement them has a lot to do with motivation, human behaviour and change when necessary.

“This has been the domain of psychological research for 50+ years dating back to addiction.”

The final layer of complexity for the physiotherapist industry’s identity crisis, says Mr Renfrew, is a push from within the profession to have more of a primary care role to take some of the burden of musculoskeletal pain from GPs.

“Within the profession there is a multigenerational, often tribal, discussion on what we do best, letting go of outdated treatments, the influence of patient preference, our role in primary care and the direction of the profession. This often gets heated, particularly online,” he says.

Mr Renfrew believes the future of the profession is the intersection of all of the above points, and ironically, where physiotherapists have always been placed - as the best first point for assessment, diagnosis and rehabilitation of non-emergency musculoskeletal pain and injury.

“This involves understanding our own limitations, being more collaborative with each other and other health professionals, improving our skills in human interactions rather than treatment techniques and improving our understanding of research and how it helps shape our understanding of how humans work and how we are effective.

“By forgetting outdated treatments and embracing being the first point for musculoskeletal pain and non-traumatic injury, we embrace our best place in the health care system and solve our identity crisis.

“We must embrace the complexity of assessment and triaging of injuries, and the rehabilitation of pain and injury; increase our understanding of research and apply it to our practice, evolve with the times, and embrace being a coach and advisor rather than a technician.”