Musculoskeletal physiotherapy
Musculoskeletal physiotherapy
This domain tests safe, effective musculoskeletal management: assessment, load management, exercise prescription, manual therapy as an adjunct, and recognition of non-musculoskeletal causes. Expect questions on ankle, knee, shoulder, spine and tendinopathy presentations.
Core concepts
- Match load to tissue irritability. Reduce aggravating load, maintain pain-free movement, then progress strength, endurance and power.
- Use manual therapy for short-term symptom modulation within a broader active plan, not as a standalone cure.
- Apply clinical prediction rules cautiously. For ankle injury, the Ottawa Ankle Rules guide imaging when there is malleolar pain plus inability to weight-bear four steps or bone tenderness at specified malleolar sites.
- Address psychosocial factors: fear, catastrophising, work demands and sleep.
- Progress exercises by range, resistance, speed, complexity and functional specificity.
Worked example
A netballer has a lateral ankle sprain. Ottawa rules are negative, so imaging is not indicated. You assess swelling, weight-bearing, ligament tenderness and balance. You begin protected weight-bearing, ankle range, calf activation and balance, then progress to hopping and change of direction. You explain expected recovery and load progression. Reasoning: the diagnosis is clinical, early movement is safe, and strength and balance reduce recurrence risk.
Traps
- Relying on passive treatment and failing to prescribe progressive exercise.
- Ignoring red flags or atypical features.
- Over-restricting weight-bearing unnecessarily.
- Progressing load faster than tissue tolerance.