Physiotherapy

Physiotherapy is generally low-risk, but mild reactions are common and you should expect them rather than be alarmed by them. In a randomised trial of people treated for neck or back pain, 51% of those who had at least three treatments reported at least one adverse event; the most frequent were muscle soreness, a short-term increase in pain, and stiffness. Most were minor, lasted less than 24 hours and were rated no more than 3 out of 10 for severity, and no serious adverse events occurred in that study. A brief flare of your usual symptoms in the day or two after a session is therefore normal — tell your physiotherapist if it does not settle, or if it is severe. Hands-on techniques can also leave temporary tenderness, localised redness or bruising at the treated area. Some circumstances call for a modified technique, or for medical assessment before hands-on treatment begins: tell your physiotherapist if you take anticoagulants or have a bleeding disorder, if you have osteoporosis or another condition that weakens bone, if you have an active infection or fever, or if you have a recent, unstable or suspected fracture — each of these is a recognised contraindication or precaution for manual and manipulative techniques, and it is your physiotherapist’s job to work around it. Physiotherapy does not replace medical care, and some symptoms need a doctor first: seek urgent medical attention rather than booking a session if you have loss of bladder or bowel control, numbness around the saddle or genital area, progressive weakness in a leg, unexplained weight loss with back pain, fever with back pain, or back pain following significant trauma. Where physiotherapy is delivered at home rather than in a clinic, the treatment itself carries the same risks, but two things change. The equipment available is limited to what the physiotherapist can carry, so a programme that depends on fixed machines cannot be reproduced at your address. And there is no on-site medical support: anyone who is medically unstable, at high risk of falling without a second person present, or being treated early after major surgery is generally safer in a clinical setting, at least at first. The home itself also has to be workable — enough clear floor space, adequate lighting, a firm surface to treat on, and a safe route to it — and your physiotherapist should tell you plainly if it is not.

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