No Pills Required: How Physiotherapy Can Help

Can physiotherapy relieve aches and pains—and even prevent some surgeries?

Susan Catto Published Mar 15, 2021 15:45:05 IST
No Pills Required: How Physiotherapy Can Help ©PeopleImages /GETTY IMAGES

It was the prospect of being forced to give up cooking that made me try physiotherapy. My hands and wrists had ached ever since I’d binged on note-taking by hand and on my computer in graduate school. I could still use a computer, but I had given up opening jars, my handwriting efforts had dwindled, and even chopping a single clove of garlic left my forearms throbbing with pain.

My doctor gave me a blood test to rule out rheumatoid arthritis, but she had no idea what to do next. My husband, Andrew, had been urging me for years to try physiotherapy—he had used it to recover from tennis-related injuries—but I assumed I had the kind of permanent damage that only painkillers or surgery could address. Still, I finally made an appointment with a physiotherapist.

The results are hard to exaggerate. I left that first session with a diagnosis of tendonitis and instructions for three stretches. The exercises were easy—in one, I simply touched my fingers to a wall and then lowered my palm to the wall 10 times—but they relieved so much muscular tension that I looked forward to my thrice-daily ritual. In weekly sessions at the clinic, my physiotherapist stretched my shortened muscles and added strengthening exercises to curtail future problems. I experienced some pain relief within days and a near-total return to normal after just two months.

I realized that physiotherapy can even treat long-term problems, and that I wasn’t looking at months and months of expensive treatment. In my case and in many others, appointments taper off rapidly once the problem is identified and at-home exercises begin.

Most people are familiar with physiotherapy’s role in recovery from accidents, treatment of sports injuries and stroke rehabilitation. But in recent years, the science of evaluating and treating issues related to physical function and movement has started to play a new role in health care. And it can prevent some unnecessary surgeries.

Here are some of the ways that physiotherapy treats a variety of conditions and diseases.

Helps bad knees

In 2009, The New England Journal of Medicine published the results of a landmark study. A randomized, controlled trial by researchers at the University of Western Ontario in London, Canada, showed that physiotherapy combined with medication was just as effective as arthroscopic surgery in treating osteoarthritic knees. “Many arthritic joints are helped by work on flexibility and strength,” says study co-author Dr Robert Litchfield, an orthopaedic surgeon and the medical director of the university’s Fowler Kennedy Sport Medicine Clinic. Physiotherapists can often remove the source of the knee pain by identifying a cause such as muscle tightness around the knee and treating it with exercises or stretching.

“We’ll do a biomechanical assessment looking at everything from muscle tightness to weakness to how joints move,” explains physiotherapist Greg Alcock, clinical and research coordinator at the Fowler Kennedy clinic. “Based on that, we’ll prescribe a course of action that may include exercise to calm [an inflamed joint or muscle] or address the factors contributing to the problem.” Adds Litchfield, “Physiotherapists are very good at looking at the whole picture.”


image-66_021421063242.jpgPhysiotherapists provide hands-on help, but patients must also do excercises at home. [Credit: ©Getty Images/iStockphoto]


Lessens chronic pain

Depending on the cause, a program of physiotherapy can ease chronic pain by strengthening the muscles that surround painful joints or muscles. A Danish study of women with osteoporosis whose chronic pain was linked to spinal compression fractures found that patients used significantly less pain medication and reported improved quality of life after just 10 weeks of a physiotherapy programme designed to improve balance and stabilize the lumbar spine.

 Combats back pain

Problems such as poor posture, muscle strain or arthritis can cause back pain. Treatment will depend on the source of the problem, but some common principles apply. Paul VanWiechen, director of exercise physiology at the Cleveland Clinic Canada, advises a three-fold approach: weight management (to reduce stress on joints), muscle strengthening (to improve mobility and reduce recurrence) and “re-patterning” of muscles.

That involves changing the coordination of all the muscles in a particular area, usually through a series of dynamic exercises. “There are about two dozen muscles in and around the lower back that really matter,” he explains. “Strengthening two or three muscles doesn’t have as much of an effect as teaching all 24 how to work together.”

Relieves pelvic floor disorders

One fast-growing area of practice uses physiotherapy techniques to address pelvic floor disorders, which can occur when pelvic muscles tighten, shorten or fall into spasm after pregnancy, childbirth or abdominal surgery. Dysfunctions can manifest in conditions such as painful intercourse, urinary or bowel incontinence or general abdominal or groin pain. Physiotherapists can use a massage technique called “trigger point release” directly on the affected pelvic floor muscle to relieve the spasm. Many also run integrated practices that include core-strengthening exercises and relaxation techniques through, for example, Pilates.

image-65_021421063402.jpgVarious physiotherapy exercises and stretches can treat even long-term problems. [Credit: ©Getty Images/iStockphoto]

Provides easier breathing

That whole-picture approach doesn’t stop with our joints and muscles. Physiotherapy also addresses conditions in the autonomic nervous system—the involuntary muscles and nerves that control our organs. Patients with asthma or sleep apnoea, for example, can be treated by cardiovascular physiotherapists, who may use breathing control exercises—a simple one might be blowing up a balloon—or focus on improving the mobility of chest and neck muscles through stretching and strengthening programs. In a study published in The Lancet in 2018, researchers in the UK had 655 asthma sufferers, aged 16 to 70, participate in a randomized, controlled trial for one year. They wanted to learn if the subjects’ quality of life would improve with physiotherapy breathing retraining. The results showed that the breathing therapy, even when delivered to the patient via self-guided digital programs rather than in-person, was successful.


But you do have to do your part if physiotherapy is to be successful. Stretches and strengthening exercises done at home are crucial to treating most problems. That’s where physiotherapy can lose adherents. “A lot of my clients want to be fixed yesterday—they don’t want to put a lot of effort into it,” says Karen Orlando, a physiotherapist and the owner of ProCare Rehabilitation in Toronto. It takes time and practice to stretch or retrain muscles that have a long-established bad habit. But doing so can prevent a recurrence of the injury.

I know that in my case, whenever I was tempted to skip my exercises, I’d remember there was a good chance they could be what I needed to help prevent riskier interventions.

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