Musculoskeletal Physiotherapy
Domain focus
This domain tests orthopaedic, rheumatological and manual therapy reasoning across the lifespan. Questions commonly ask you to separate mechanical from systemic presentations, select a safe load progression, and justify passive techniques only as an adjunct to active rehabilitation. Hong Kong practice also expects awareness of when to refer for medical, imaging or specialist assessment.
Core rules and concepts
- Red flags include progressive neurological deficit, saddle anaesthesia, bladder or bowel dysfunction, unexplained weight loss, fever, night pain, trauma in osteoporosis and history of cancer. These override routine treatment plans.
- Osteoarthritis is a whole-joint condition; exercise, weight management and education are core. Manual therapy may briefly reduce pain and improve movement but does not reverse structural change.
- Rheumatoid arthritis needs disease control first; respect joint protection, fatigue and flare patterns. Avoid aggressive end-range stretching during active inflammation.
- Tendinopathy management uses progressive loading and load management; complete rest often deconditions tissue.
- Manual therapy techniques require consent, positional safety, contraindication screening and reassessment of effect within the session.
- Outcome measures should be valid for the condition and region, such as pain scales, function questionnaires and range or strength measures.
Worked example
A 46-year-old reports two weeks of low back pain after lifting. Today there is bilateral leg weakness, reduced saddle sensation and difficulty starting urination. Reasoning: these are cauda equina red flags, not ordinary mechanical back pain. Stop routine manual therapy and exercise testing, document neurological status and arrange urgent medical assessment. Do not offer spinal manipulation or a home stretching programme as a substitute for referral. If the same patient had unilateral familiar pain without red flags, you could use education, activity modification and progressive exercise, reassessing irritability.
Traps that cost marks
Missing red flags because pain is improving; assuming bilateral symptoms are always harmless; overusing passive treatment without active progression; and ignoring rheumatological flare or osteoporosis risk. Another trap is choosing a special test without understanding its accuracy and purpose.
Key points
- Screen red flags before every musculoskeletal plan.
- Exercise and education are core for osteoarthritis.
- Manual therapy is adjunctive and must be reassessed.
- Respect inflammatory flares and bone health.
- Use validated, condition-specific outcome measures.