Musculoskeletal Physiotherapy
What you must understand
Frame musculoskeletal care around tissue healing phases (inflammatory, proliferative, remodelling), load management, and progressive exercise. Know the difference between nociceptive, neuropathic, and nociplastic pain presentations and how that changes your approach. Understand capsular patterns (for example the capsular pattern of the shoulder and hip), end-feel (capsular, bony, springy, empty), and how to grade mobilisations (Maitland grades I–V). Be able to describe the rationale for eccentric loading in tendinopathy, graded exposure in persistent pain, and manual therapy as an adjunct to exercise rather than a stand-alone treatment.
Traps in questions
- Recommending passive treatment as the primary intervention for a chronic tendinopathy.
- Confusing an empty end-feel (serious pathology, no true resistance) with a capsular end-feel.
- Applying the same exercise dose regardless of irritability.
- Missing the distinction between referred pain and radicular pain.
- Overlooking load progression principles (frequency, intensity, time, type).
Rule of thumb
If the question asks 'most appropriate initial management' for a stable musculoskeletal problem, choose education plus active exercise plus load modification. Reserve imaging or referral for red flags or failure to progress.
Worked example
A runner with mid-portion Achilles pain for eight weeks, stiff in the morning, pain on loading. Best answer: progressive eccentric or heavy-slow resistance loading plus load education, not rest alone, because tendon remodelling requires controlled load.