Musculoskeletal Physiotherapy
Musculoskeletal Physiotherapy
This domain tests whether you can convert a subjective history into a defensible clinical hypothesis, then select interventions supported by evidence rather than habit. Expect regional assessment (shoulder, hip, knee, lumbar spine), special-test interpretation, tendinopathy load management, osteoarthritis exercise prescription, and post-operative progression.
Core rules
- Screen for red flags before any manual technique: suspected fracture, infection, malignancy, cauda equina (saddle anaesthesia, bladder or bowel change, bilateral leg symptoms), and inflammatory arthropathy.
- Special tests modify probability; none diagnoses alone. Lachman is more sensitive for ACL rupture than McMurray is for meniscal tear.
- Tendinopathy is a load-tolerance problem: progressive loading (isometric for early analgesia, then heavy slow resistance or eccentric) outranks passive modalities.
- Osteoarthritis: exercise and weight management are first-line; manual therapy is adjunctive and time-limited.
- Post-operative rehabilitation follows surgeon constraints on weight-bearing, range and graft protection; therapist preference does not override them.
Worked example
A 52-year-old woman reports four months of lateral hip pain, worse lying on that side and on stairs. Resisted hip abduction reproduces pain; single-leg stance shows pelvic drop; FABER is negative. Reasoning: pain on resisted abduction plus side-lying provocation suggests gluteal tendinopathy; pelvic drop indicates abductor compromise; negative FABER lowers the likelihood of intra-articular hip pathology. Plan: load education (avoid hip-hitching and side-lying on the affected side), isometric abduction for analgesia, then progressive abductor strengthening over 12 weeks with reassessment.
Traps
- Equating pain severity with tissue damage severity.
- Skipping red-flag screening because the presentation "looks mechanical".
- Building the plan on passive modalities and electrotherapy.
- Ignoring sleep, training load and psychosocial factors that sustain symptoms.