Physiotherapy practice differs around the globe. In some countries, physiotherapists are clinical doctors; in some countries they offer respiratory therapy; in some countries physiotherapists have little clinical autonomy. However, the physiotherapy profession in general is moving in one direction and with the throughput of ever more determined practitioners, it is hoped that it will continue to prove its effectiveness and necessity in today’s modern healthcare environment.

Fig. 1.2.

The work of the physiotherapist has been around for thousands of years.

Simple techniques such as massage and even more skillful techniques such as acupuncture are seen as some of the earliest forms of treatment: acupuncture was used over 3000 years ago in China! The so-called “father of medicine,” Hippocrates, actually carried out techniques that gave rise to some of the methods we use today. Traction, heat/cryotherapy and manipulation were all practiced by Hippocrates in a crude way over 2000 years ago. The theory was dubious but who cares? It did the job! Of course, in modern-day medicine we have to totally justify everything we do by scientific rationale and be au fait with the research: this is called “evidence-based practice”. Manual techniques over the years were only carried out by physicians but mostly fell away from common usage as medicinal intervention became popular and was more convenient for such a long time. It really began getting busy for “physiotherapists” during the time of the Crimean War (mid 1800s) as rehabilitation specialists for soldiers. A need was established and solidified during the Boer Wars for the same purpose.

In 1951, countries with developed physiotherapy professions formed the World Confederation of Physical Therapy (WCPT) to enhance world continuity within the profession. More and more training colleges were established and physiotherapy quickly became an integral part of everyday healthcare provision. All around the world, physiotherapy is expanding dramatically; for example, in the early 1980s there were only 10 accredited physiotherapy courses available in India – now there are over 100! Most physiotherapy programs are offered by some of the greatest universities around the world such as Trinity College Dublin, Ireland, the College of Physicians and Surgeons, Columbia University, USA, McGill University, Canada, University of Melbourne, Australia and King’s College, London. Physiotherapy is now considered a clinically autonomous profession which assesses, diagnoses and treats a broad range of conditions.

On the whole, then, physiotherapy is a relatively young profession that has forged links and professional relationships with medical treatments, while establishing its own niche as an essential part of everyday “conventional” healthcare provision. We should all be proud of the profession’s history and flexibility through the years and look forward to more exciting advances in our working lives and beyond.

In any hospital you are likely to run into a physiotherapist. They are as settled in primary, secondary and acute care as any physician, surgeon or nurse. The role of the physiotherapist is really quite diverse: you will have the opportunity to work in an emergency department, critical care providing respiratory support, orthopedics/musculoskeletal departments, cardiac rehabilitation, neurologic rehabilitation, amputee care, survivors of torture, women’s health, pediatrics, elderly care and so on. In addition to all of this, opportunities are abundant for private clinicians in their own practice: the physiotherapist is seen as the gold standard of sports medical care, and physiotherapists may be employed as personal therapists for someone who requires intensive rehabilitation/physiotherapeutic support.

A surgeon once said of orthopedic physiotherapists that if surgeons make things possible, the physiotherapist makes things happen. This is entirely true in orthopedics – you can’t have an ACL reconstruction without the rehab; you can’t have a hip replacement without the rehab. Most, if not all, orthopedic surgeries depend upon the skill of the surgeon and the physiotherapist. Postsurgical physiotherapy isn’t restricted to orthopedics, though – thoracic and abdominal surgery patients need intensive chest physiotherapy, mobility management, scar management and so on.

Neurology is another area where physiotherapists are key to rehabilitation, with stroke patients especially. Those who have suffered any sort of neurologic incident, congenital or acquired, traumatic or atraumatic, will need physiotherapy intervention.

Rehab isn’t the only trick we have; prevention, or “prehab,” is employed by every physiotherapist in terms of pain management, biomechanic/postural education, chest clearance, mobilization of contracted joints, etc. There is little more satisfying than preventing a potentially devastating condition from occurring. An interesting concept is that of the “health coach” whereby the physiotherapist is the point of contact regarding general health maintenance. The idea that one only sees a physio in illness is becoming more outdated as patients like to get regular check-ups for fitness, weight control, diet, relaxation, etc., such as you’d expect with a dentist or optician.

You are going to have to buy some books. It is advisable to buy the most recent edition of a book for the simple reason that it will be the most up to date in terms of research, practice and economic climate. There is no true “timeless” text because of advances in research and ways of thinking so even standard anatomy books need updating. In addition to this, buying a new book gives you a real sense of ownership as you can add any notes you wish and not have to erase the previous owner’s scribbles.

Although every university has its own reading list, you will definitely be requiring good, solid anatomy, physiology and biomechanics books as well as good pocket books. There are plenty to choose from, for a good reason – everyone has different ways of thinking and learning. On this, I suggest that you head off to a library and sit for the day looking at different anatomy, physiology and biomechanics books and thinking about which author suits you best. Putting in this early work will make studying much more tolerable.