Pathology and Clinical Medicine Relevant to Physiotherapy
Core knowledge
You must recognise the systemic and medical conditions that change how you treat a musculoskeletal or neurological presentation. Understand the pathophysiology of inflammation and healing (haemostasis, inflammation, proliferation, remodelling) and how it dictates loading progression. Know the red-flag medical conditions: fracture, infection, malignancy, cauda equina syndrome, and inflammatory arthropathy.
Cardiovascular: hypertension, ischaemic heart disease, heart failure, and the implications for exercise intensity. Respiratory: asthma, COPD, and the difference between obstructive and restrictive patterns. Endocrine: diabetes (neuropathy, wound healing, hypoglycaemia risk during exercise), thyroid disease. Neurological: stroke, Parkinson's disease, multiple sclerosis, and peripheral neuropathy. Rheumatology: rheumatoid arthritis versus osteoarthritis - the former is inflammatory, systemic, morning stiffness, and requires caution with aggressive mobilisation during flares.
Traps
Items often present a patient with a known condition and ask which finding is not expected, or which precaution applies. Know that in osteoporosis you avoid flexion and rotation loading; in suspected DVT you do not massage; in unstable angina you stop and refer. Another trap is confusing the timing of healing phases with the safe loading window.
Worked example
A 62-year-old with type 2 diabetes and peripheral neuropathy presents for balance training. The trap is to focus only on balance. The correct reasoning includes inspecting the feet before and after exercise, monitoring for hypoglycaemia, and choosing a surface that does not risk skin injury. Rule of thumb: when a systemic disease is present, ask what it does to tissue healing, sensation, and exercise tolerance.