Musculoskeletal Physiotherapy
Musculoskeletal physiotherapy tests clinical reasoning from history and physical examination to diagnosis, precautions, and staged rehabilitation.
Core rules and concepts
- Subjective examination screens red flags: cauda equina features, progressive neurological deficit, unexplained weight loss, fever, night pain, and history of cancer or trauma.
- Special tests are adjuncts; a test result changes probability only when interpreted with the history.
- Fracture healing proceeds through inflammation, repair, and remodelling; loading must respect the stage and stability.
- Osteoarthritis management emphasises exercise, weight management, and self-management; rheumatoid arthritis needs disease control and joint protection.
- Tendinopathy is managed with progressive loading rather than complete rest.
Worked example
A patient twists an ankle and has lateral malleolar pain. Using the Ottawa ankle rules, imaging is indicated if there is bone tenderness at the posterior edge or tip of the lateral malleolus and either inability to bear weight for four steps or bone tenderness. If none are present, fracture probability is low. Reasoning: the rules safely reduce unnecessary radiographs. Treatment then focuses on protection, early controlled movement, progressive loading, and balance training rather than prolonged immobilisation.
Traps that cost marks
- Missing red flags because the patient’s pain seems mechanical.
- Treating the imaging report rather than the patient’s function.
- Keeping a patient immobilised longer than necessary after soft-tissue injury.
- Applying strong manual therapy without screening for fracture, infection, or malignancy.