Qualifications of physios to treat on NHS

[cwodavids]

What are the minimum qualifications a physio would need in the UK to treat a patient unsupervised?

The reason I ask is because my physio is hopeless and has not fixed any of the problems I am having with my knees. I have now resorted to paying for a podiatrist to try and get to the root of the problem. I am in the military so I dont really have a choice about who treats me.

I have been told that there are certain physios that can't work unsupervised in the NHS because of their qualifications. A friend has a partner who is a physio and has said that the physio we are being treated by is not qualified enough to treat people unsupervised. I just want to be able to be pain free but I am getting nowhere.

I have been prescribed orthotics so hopefully this will eventually fix 2.5yrs of knee pain without having to visit a physio who seems incapable of fixing things.

Kind regards

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[Judith Mollet]

Physios who are qualified und Chartered physios can work without supervision. It doesn't mean however, that they can "fix" everything just like that in every patient they meet. Is she newly qualified or still a student? Is she new in this particular situation?
I would expect a physio or physio studentto be bright enough, if not getting any progression or success with a problem, to talk to fellow physios for advice.
And even long qualified physios can't "fix" everything. We can often improve and manage a case using a wide selection of modalities available and by teaching the patient to manage and help fix it. You don't say exactly your diagnosis is and what part the doctor played in explaining it to you before referring you to physio. Does your doctor know of your frustration for lack of progress, it's been a long time already.
Speak to your physio about your impressions of lack of progress. See what answers she come up with. Reading your "not physio bashing" I can't understand why you are going to her still or haven't talked to her about it. She must notice what your thoughts are. Maybe she is less competent than others. In all professions, some have more talent some have less, to grasp a problem and deal with all sorts of clients. But if she's qualified she can work without supervision. You say you are in military. Your profession demands alot of your body and knees. Maybe too much? I can't say as there is not enough information about your diagnosis; state of cartilage and joint surfaces; pain; behaviour of pain; treatments tried; length of treatments; what you do with your knees all the time etc. And is your knee pain due to feet-hip-other factors? There are other physios in the NHS.
Hope you get some help. Maybe be a little patient with physios, for some problems there is no quick fix. Just management.

[cwodavids]

"It doesn't mean however, that they can "fix" everything just like that in every patient they meet. Is she newly qualified or still a student? Is she new in this particular situation?"

As far as I know he has been qualified for the nearly 6yrs i have been at the base. I would assume that he has been qualified for that full time.

"And even long qualified physios can't "fix" everything. We can often improve and manage a case using a wide selection of modalities available and by teaching the patient to manage and help fix it."

I understand that the human body is a complicated thing and not everything can be fixed, however I have been given exercises to "manage it" which simply arent working.

"You don't say exactly your diagnosis is and what part the doctor played in explaining it to you before referring you to physio. Does your doctor know of your frustration for lack of progress, it's been a long time already."

I havent actually been given a diagnosis (I have told him what is wrong and what has caused it, he knows best though) The doctors answer was send me for more physio! This doesnt really help the issue and im sure you can appreciate it is VERY frustrating. I cannot get treatment from anywhere else as Im registered with my doctor on camp so cant register with any other doctor. No other doctor = no referal for other treatment.

"Speak to your physio about your impressions of lack of progress. See what answers she come up with. Reading your "not physio bashing" I can't understand why you are going to her still or haven't talked to her about it. She must notice what your thoughts are. Maybe she is less competent than others. In all professions, some have more talent some have less, to grasp a problem and deal with all sorts of clients."

I have mentioned it that I'm not getting any progress but their answer is to downgrade me (which means i cant do my job) and give me intense physio. They cant see the irony of the situation. As I explained before, I have no choice about my physio as I have to be treated by a military physio (this is much cheaper and EVERYTHING in the military comes down to money) and will not get a referral for a civilian physio.

"You say you are in military. Your profession demands alot of your body and knees. Maybe too much? I can't say as there is not enough information about your diagnosis; state of cartilage and joint surfaces; pain; behaviour of pain; treatments tried; length of treatments; what you do with your knees all the time etc. And is your knee pain due to feet-hip-other factors? There are other physios in the NHS."

My profession does require more of my body than most people however, very few professional athletes have issues like this as they get proper treatment. It is the standard of the treatment that concerns me. I am a helicopter winchman so spend a lot of time squatting. After a fall of ten feet and damaging my ankles my knees started hurting quite badly after i was able to walk again (after 3 months). I suspect my knee issues have came about from the mismanagement of my ankle injuries as i only received half a dozen physio sessions (again it comes down to money, there is one physio for a LOT of people.) After my session with the podiatrist he identified several issues from my gait. He thinks it is highly likely that my injury has caused all my problems as i never had any issues before then. Covering the issue of "state of cartilage and joint surfaces;" is half the issue i have, I have not had a single test to find out the state of my knees. All i seem to get is lines drawn on my knees and my muscles measured.

I shall be getting my orthotics shortly so hopefully this will fix things and i can completely bypass any physio.

I really dont want to belittle physios but the treatment i have had has been pretty pathetic and its got to the stage im willing to pay a LOT of my own money to go completely private. I obviously would prefer not to part with my own money but its looking like i might have too.

D

p.s. Sorry about spelling and grammar as this was done on my Blackberry and in a hurry.

[Judith Mollet]

"My profession does require more of my body than most people however, very few professional athletes have issues like this as they get proper treatment. It is the standard of the treatment that concerns me. I am a helicopter winchman so spend a lot of time squatting. After a fall of ten feet and damaging my ankles my knees started hurting quite badly after i was able to walk again (after 3 months). I suspect my knee issues have came about from the mismanagement of my ankle injuries as i only received half a dozen physio sessions (again it comes down to money, there is one physio for a LOT of people.) After my session with the podiatrist he identified several issues from my gait. He thinks it is highly likely that my injury has caused all my problems as i never had any issues before then. Covering the issue of "state of cartilage and joint surfaces;" is half the issue i have, I have not had a single test to find out the state of my knees. All i seem to get is lines drawn on my knees and my muscles measured.
I shall be getting my orthotics shortly so hopefully this will fix things and i can completely bypass any physio. "

Aha, now there's a bit more to be going on. How severe were your ankle injuries? fractures? What was doing during these 3 months befoe you walked again? in plaster? I'm not in the UK any more but I do agree that top atheletes get top medical care from the initial treatment and surgery to physio as they are in a moneyd industry. They do here. But if say a top athelete fell 10 feet and broke his ankles he might not be a top athelete any more. He'd probably have enough money for changing his career...... I do not envy your situation. I'm sure the physio also attributes your problems to the after effects of the accident. He probably wasn't involved in initial diagnosis and treament, or was he? (immediate post accident?)
Exercises can be to mobilize or strengthen or to put optimize/correct the movement dysbalance that has occurred due to accident or disease. There are sometimes limits of effectiveness due to nature of the problem (joint surfaces damaged, inflammatory conditions...) or the impossibility of the person to do adequate training or the wrong demands on the damaged joints at work. Have you had/ needed manual mobilising of ankle joints and knees to reach as much normal range of movement as possible? Is your knee and foot movement as pre-accident?
It can be that strengthening exercises and increased muscle bulk aren't the only or optimal way to go but I can't assess you online.
I would refer you back to the doctor and if necc get a second doctors opinion and not let go till I got it. Let the physio off the hook a bit. He is not a car mechanic and can't repair you as such. Try and get him as an ally to approach the doctor together. My opinion is the army owes it to you to help. X rays of knees aren't that expensive.
I've no idea how the army treats employees who are unable to do their original work, that,s your job to find out and maybe, if all else and your knees and feet fail, consider retraining. I suspect that it's not going to be easy. Downgrading doesn't sound fun.
Keep us informed!
regards Jm

[natty1905]

I feel sorry for you. It sounds like you have a pretty debilitating injury though and not the kind of one I would come across at all in my work with athletes. I don't think comparing the speed of return that athletes receive is useful as even when they have serious injuries, say, ACL ligament rupture the methods for treating this are vastly researched and tested. It sounds like your injury could be far more complex and serious.