There are many common conditions seen in primary care where physiotherapy should be the first port of call. Physiotherapy can make a positive impact on patient’s overall physical and mental health, managing pain and getting patients back on their feet, returning to work or sport or activities of daily living as quickly as possible. In this article we list the robust scientific evidence of why you should chose a physiotherapy first approach.
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Our team of eight Chartered Physiotherapists are ISCP and CORU registered.
The public can self-refer to physiotherapy and you don’t necessarily need a referral from your doctor BOOK ONLINE
Why use physiotherapy as first port of call?
- Chronic low back pain – Physiotherapy is considered a first line of treatment. Imaging specialist review or invasive interventions should be considered only where they will change management (red flags, progressive neurological deficit, or severe unremitting symptoms). Low back pain and sciatica in over 16s: assessment and management NICE guideline NG59
- Knee meniscal tears without mechanical symptoms – No clear superiority of arthroscopic partial meniscectomy over exercise-based physical therapy for degenerative meniscal tears in middle-aged/older adults; outcomes for pain and function are comparable and surgery carries operative risks. Five-Year Follow-up of the ESCAPE Randomized Clinical Trial and multiple other RCT’s
- Osteo Arthritis– Physiotherapy first line treatment in NICE guideline, NG226. Physiotherapy is superior to injection therapy- Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee (Deyle et al, 2020)
- Shoulder Sub-acromial pain or “impingement”: structured exercise programmes and supervised physiotherapy often produce outcomes equal to or better than arthroscopic subacromial decompression in the medium–long term, and surgery provides little additional benefit for most patients. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain (Pieters et al 2020)
- Shoulder Degenerative cuff tears: Conservative care (exercise, load management, education) frequently gives good outcomes that are comparable to surgery for many patients; surgery is generally reserved for acute traumatic tears, young/active patients, or those with failed conservative care. Surgery or conservative treatment for rotator cuff tear: a meta-analysis (Ryösä et al 2016)
- Mobility, balance and frailty in older adults: Physiotherapy has been shown to improve functional capacity, including frailty status, muscle strength, gait speed and balance, reducing physical decline in older adults, maintaining independence “Effects of multicomponent exercise on frailty status and physical function in frail older adults: A meta-analysis and systematic review’ (Yang et AL 2024)
- Paediatric Developmental Delay: Physiotherapy—delivered early, goal-directed, and with parent coaching—improves motor skills and function in children with developmental delays; the strongest evidence is in infants at risk (including preterm), CP, Down syndrome, and DCD, with growing support in autism ‘International clinical practice recommendations for developmental coordination disorder (DCD)’ (Blank et al 2019)
- Foot biomechanics assessment and orthotic prescription: Whether in children, athletes or older adults, the use of biomechanics-informed assessment (foot posture, gait, load tolerance) for prefabricated orthoses or custom devices, paired with exercise and education leads to best outcomes. Evidence is strongest for plantar heel pain and as an adjunct in Patellofemoral Pain, and early Posterior Tibial Tendon Dysfunction; benefits depend on fit, comfort, and adherence.
Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values (Morrissey et al 2021).
- Physiotherapy post-surgery is evidence-based and essential for optimal recovery: Multiple systematic reviews and randomized controlled trials show that structured, early, and progressive physiotherapy leads to: Faster restoration of mobility and strength; Reduced pain and stiffness; Fewer complications (respiratory, thrombotic, or functional); Better quality of life outcomes. Faster hospital discharge means patient should continue their physiotherapy rehabilitation at home.
- Vertigo – Benign paroxysmal positional vertigo (BPPV): Cochrane systematic review 2022 demonstrated clinician guided Epley manoeuvres superior to home drills. The latest practice guidelines 2024 (AAO-HNS / Audiology update) explicitly recommend appropriate therapeutic repositioning maneuvers as standard care.
Our goal is to help patients reach their full physical potential.
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