Pathology and Medical Sciences Relevant to Physiotherapy
What is tested
Disease and tissue pathology that changes physiotherapy decisions: healing timelines, inflammatory versus infective versus malignant presentations, and comorbidity that alters exercise tolerance or contraindicates a modality.
Core rules
- Soft tissue healing. Haemostasis (minutes to ~48 h), inflammation (days 1–5: neutrophils, then macrophages), proliferation (day 3–21: fibroblasts, type III collagen), remodelling (week 3 to 12 months or more: type III to type I, cross-linking). Loading must respect the phase.
- Bone healing. Haematoma → soft callus → hard callus → remodelling. Controlled early movement aids union; instability causes non-union.
- Osteoarthritis vs rheumatoid arthritis. OA: DIP nodes (Heberden), crepitus, morning stiffness under 30 minutes, mechanical pattern. RA: MCP/PIP/wrist, symmetrical, stiffness over 1 hour, systemic features, anti-CCP positive.
- Osteoporosis. T-score ≤ −2.5; avoid loaded spinal flexion and end-range rotation.
- Diabetes. Peripheral neuropathy causes loss of protective sensation, so check skin and footwear; raised risk of adhesive capsulitis; watch for hypoglycaemia after exercise.
- Red flags. Night pain unrelieved by rest, unexplained weight loss, fever, cancer history, saddle anaesthesia, bladder or bowel change, progressive neurological deficit, minor trauma in osteoporosis.
Worked example
A 58-year-old woman has 6 weeks of bilateral hand pain: MCP and PIP swelling, morning stiffness of 90 minutes, fatigue. Reasoning: symmetrical small-joint involvement with prolonged morning stiffness and systemic symptoms points to inflammatory arthritis, not OA. Physiotherapy is supportive - joint protection, gentle range, graded strengthening - but the priority is urgent rheumatology referral, not aggressive mobilisation of an inflamed joint.
Traps
Treating every painful joint as mechanical; using heat on acute infection; confusing T-score (bone density) with Z-score (age-matched); missing cauda equina because the patient only reports back pain.