When Jeannette Meyers developed shooting pains in her legs, her first thought was to contact her GP.
However, after explaining her symptoms, the 69-year-old from Ashford was told over the phone by a GP at her local surgery that she would need to see a physiotherapist instead.
‘I was sent to a physio in a room at the back of a local chemist, who gave me a sheet of exercises and didn’t show me how to do them,’ says Jeannette. ‘I could have got them off the internet and saved myself the journey.
‘I went back six times because the pain wasn’t getting any better – but at no point did the physio do any physical examination or try a different technique. He just kept giving me new exercises which did nothing.’
Eventually Jeannette saw a private chiropractor and found her symptoms improved. ‘I wouldn’t go back to a physiotherapist for my condition,’ she adds. ‘I’m sure there are plenty of excellent physios out there – I just haven’t met one.’
Many of our readers told The Mail on Sunday that, on contacting their GP surgery, they were referred for physiotherapy without seeing a doctor
Others complained that physiotherapists now refused to offer massages to relieve muscle tension, which many said they had benefited from in the past
Worryingly, Jeannette is not alone. Last month, The Mail on Sunday’s resident GP, Dr Ellie Cannon, mentioned in her column that there was debate among doctors on social media about the benefits of physiotherapy. In response she received a flurry of letters from readers detailing their own experiences.
Some praised physios who helped them overcome immobility. One 80-year-old described how a physio came to his aid when he ruptured ligaments in both knees after a nasty fall on a patch of ice.
But another pattern emerged. Many, on contacting their GP surgery, were referred for physiotherapy without seeing a doctor. They waited weeks for an appointment only to be given printed sheets of exercises to do at home, which made no difference to their pain.
Others complained that physiotherapists now refused to offer massages to relieve muscle tension, which many said they had benefited from in the past.
Many more complained that they were unable to see a physio in-person at all, and were simply given advice over the phone, via email or directed to a website.
One reader wrote: ‘I went to see a physio after I started to get an intense pain in my right arm.
‘The physio didn’t carry out any physical examination, but instead recommended an exercise where I hold a can of baked beans in each hand and raise and lower my arms,’ she recalls. ‘He said this would strengthen the muscles and the pain should go away.
‘A week later, the upper part of my right arm had developed a mottled, black bruise. Another physio looked at my arm and said a tendon had snapped but there was nothing I could do but wait for the arm to heal. It felt incredibly dismissive.
‘In the months after I struggled to raise my arm above my head, and even now I can’t swim like I used to because I don’t have full movement in the joint. If I’d seen a GP first, perhaps the tendon could have been saved. I’ve never bothered to go to an NHS physio since then – it seems like a waste of time.’
There are more than five million physiotherapy appointments carried out on the NHS every year. The treatment, which primarily involves being shown how to do specific exercises, is offered to patients recovering from a stroke or cancer treatment, after joint replacement and to those suffering incontinence to help strengthen their pelvic muscles. But the most common reason is for joint or back pain.
NHS figures suggest nearly nine million people in the UK live with chronic joint pain, while lower back and neck pain are the most common causes of disability.
In 2018 the NHS announced plans to allow patients to self-refer to a physiotherapist, in order to reduce the burden on GPs. But experts claim the increased workload on physiotherapists means, in some cases, the quality of care they were able to provide suffered.
Christopher Banks-Pillar, a researcher at the University of Oxford, says: ‘Patients can wait as long as 50 weeks only to then get 15 minutes with the physio who hands them a sheet of exercises. The more frequently physios see the patient the more likely it is the treatment will be effective, as they can modify advice if the exercises aren’t working, for example. But this is challenging when you’ve got such little time with the patient.’
Faced with an increasing demand for physios, and to tackle the current 17,000-strong shortage of GPs, the NHS began a recruitment drive in 2019 for a new type of health worker – called a first-contact physiotherapist. They are based within GP practices, with the aim of freeing up doctors’ time by seeing patients who request a GP appointment for joint or back pain. Unlike standard physiotherapists, these clinicians do not play an active role in the treatment of patients. They assess patients, decide if they need to see a doctor, and then offer advice and exercises to help manage their pain.
First-contact physiotherapists get five years of training – compared to the average ten years needed to qualify as a GP – meaning they can be rolled out faster to plug gaps in the NHS workforce.
They are also significantly cheaper than GPs, on average making around £45,000 a year, while GPs make between £67,000 and £100,000.
However, doctors worry that this new strategy may mean some patients with underlying health problems go untreated.
‘Just because someone has joint pain doesn’t necessarily mean they have an injury,’ says Dr Dean Eggitt, a Doncaster-based GP. ‘These kinds of pains can be symptoms of cancer or pneumonia, for example. It’s not uncommon to hear of patients who were told to see a physio when really they needed urgent medical attention.’
Other doctors also warned that patients were often not receiving good-quality physiotherapy.
‘A lot of NHS physiotherapy is done over the phone now, and that is concerning,’ says Dr Mike Smith, a Hertfordshire-based GP. ‘There’s no point in physiotherapy unless it’s in person – it’s just one step away from a Google search.’
Most experts agree that regular exercise improves mobility and reduces pain, but there is debate about the effectiveness of prescribing specific exercises for certain joint conditions. But Dr Brendon Stubbs, clinical lecturer at King’s College London, says physiotherapy does have a place: ‘It works for certain conditions. Physio isn’t a panacea, it won’t be successful for everyone.’
Studies do show that physiotherapy can be life-changing for patients with a number of serious conditions. UK research suggests that 45 minutes of physiotherapy exercises carried out five days a week is highly effective at improving mobility following a stroke. It can also improve the motor function of Parkinson’s patients as well as combat symptoms of cancer such as fatigue.
Most NHS physios no longer offer hands-on manual therapy – which involves massaging muscles to reduce stiffness, despite the fact that the treatment is popular with patients.
‘The effect of manual therapy tends to be short-lived,’ says Mr Banks-Pillar. ‘Often by the time the patient has walked to their car, the pain will have returned. So this is an approach which physios are now increasingly avoiding.
‘The problem is that many patients feel the hands-on approach means the physiotherapist is actively treating them and taking their problem seriously.
‘Many physiotherapists in the private sector still offer massages because it is so often requested by patients who believe it helps.’
Experts argue that one of the main problems with NHS physiotherapy is that patients struggle to stick with the exercises. One approach to combat this is being tested by Bournemouth University researchers, who are offering patients with hip arthritis a weekly spin class alongside physiotherapy. The eight-week course involves half an hour of education about exercises which can help with the painful condition and then half an hour on a stationary bike.
‘The classes start gently and slowly build up,’ says Professor Thomas Wainwright, a physiotherapy expert at Bournemouth University, who is heading up the trial. ‘By the end, patient should be able to do a whole spin class.’
Crucially, the patients take part in the class as a group.
‘We’re not just telling people to go off and do these exercises on their own,’ says Prof Wainwright. ‘If they see someone on the bike next to them improving, it might help them keep going because they know they will also improve eventually too.’