Pathology and Medical Sciences
This domain tests whether you can connect disease processes and healing timelines to safe physiotherapy decisions. Questions often hinge on recognising a condition that must be referred, or on timing a loading programme to the phase of tissue repair.
Tissue healing timeline
- Haemostasis (minutes to hours), then inflammation (days 0–7): redness, heat, swelling, pain, loss of function.
- Proliferation (about day 3 to week 3): granulation tissue and type III collagen.
- Remodelling (week 3 to 12 months and beyond): type I collagen, cross-linking, increasing tensile strength.
- Bone: haematoma → soft callus (2–3 weeks) → hard callus (3–6 weeks) → remodelling (months to years). Smoking, poorly controlled diabetes, infection and some drugs delay union. Powerful exam principle: inflammation is a necessary phase, not a failure, so aggressive heat or deep massage in the first days after injury is usually wrong.
Chronic disease relevant to practice
- Osteoarthritis: cartilage loss, subchondral sclerosis, osteophytes, joint space narrowing; exercise is first-line treatment.
- Rheumatoid arthritis: symmetrical small-joint involvement, morning stiffness over an hour, systemic features; avoid forceful stretching of acutely inflamed joints.
- Osteoporosis: T-score at or below −2.5; avoid loaded spinal flexion and high-impact work in severe cases.
- Diabetes: peripheral neuropathy reduces protective sensation, so check the feet and screen for hypoglycaemia risk around exercise.
Red flags requiring referral
Unexplained weight loss, night pain unrelieved by rest, fever, previous cancer, progressive neurological deficit, and cauda equina features (saddle anaesthesia, bladder or bowel dysfunction).
Drug–therapy interactions
Anticoagulants (warfarin, heparin, direct oral anticoagulants) contraindicate vigorous manipulation, deep soft-tissue work and dry needling. Corticosteroids make tissue more fragile and mask pain. NSAIDs may impair bone and tendon healing.
Worked example
Ten days after total knee arthroplasty a patient has a hot, swollen, tender calf and low-grade fever. Reasoning: this is a suspected deep vein thrombosis, not a stiff knee. Homan's sign is unreliable; referral for duplex ultrasound and anticoagulation assessment is the priority. Hold all massage and vigorous mobilisation, document the observation and the referral, and continue only safe ankle pumping if cleared.
Traps that cost marks
- Massaging an undiagnosed swollen limb.
- Applying chronic-phase loading doses to acute inflammation.
- Forgetting that anticoagulant status changes what manual therapy is permitted.