Outpatient physiotherapy

An initial assessment appointment of 45 to 60 minutes, then treatment sessions typically two to three times a week. Each session combines hands-on treatment or supervised exercise with progression of the home programme.

The home programme is the larger part of the treatment. Two sessions a week is roughly two per cent of your waking hours; what happens in the other ninety-eight determines the result.

Musculoskeletal problems — back and neck pain, joint pain, tendon problems, post-surgical rehabilitation, sports injuries — and the continuing phase of neurological rehabilitation after an intensive block.

Also assessment appointments in their own right: a single session to establish what is wrong and what should be done, with a written programme and no obligation to book a course.

We set a review point, usually at four to six sessions, and at that point we either continue with evidence of change, alter the approach, or discharge with a home programme. Open-ended courses of treatment are not how we work.

If treatment is not producing measurable change, continuing it is not caution — it is cost without benefit, and we will say so.

A clear explanation of what we think is wrong and why, in language you can repeat to someone else. A written home programme. An honest statement of expected timeframe. And a referral onward if we think the problem is not one physiotherapy will solve.

If we do not know what is causing your problem, we will say that too, and explain what would help establish it.

Two or three visits a week amount to a small fraction of the week. The exercise programme done at home is where most of the change comes from, and the sessions exist to set it, correct it and progress it.

A course built on passive treatment with nothing to do between visits produces dependence on the clinic and very little durable change.

If four to six sessions have produced no measurable change, the plan is wrong. We change the approach or reconsider the diagnosis rather than booking another block.

Open-ended courses are the most common way physiotherapy is oversold. Every course here has a stated number of sessions, a goal and a review point.

For chronic back pain and knee osteoarthritis, the trials say yes, although the effects are moderate rather than dramatic. In chronic low back pain, a Cochrane review of 249 trials found moderate-certainty evidence that exercise reduces pain by about 15 points on a 100-point scale compared with no treatment, usual care or placebo, with a smaller effect on day-to-day function 1.

In knee osteoarthritis, a Cochrane review found high-quality evidence from 44 trials with 3,537 participants that exercise reduces pain by about 12 points on a 100-point scale, with a smaller benefit still present two to six months after treatment ends 2. Individually delivered programmes tended to do better than classes or home-only programmes, although results varied widely between studies 2. Sessions are therefore used to set and correct the exercise rather than to replace it.