In a standard physiotherapy practice, more than 80% of patients are private patients paying private rates, with sessions lasting for between 20 and 30 minutes. Physiotherapists frequently undertake musculoskeletal assessments, offer advice, and develop a graduated loading program consisting of exercise and activity. Their real skill is in the ability to judge when people are able to return to their previous activities.

The advice provided by physiotherapists ranges from simple (do this, don’t do that) though to a cognitive behavioural approach. 

Standard treatments include manual therapy (mobilisation, massage and manipulation), electrotherapy, taping and bracing, and other miscellaneous treatments. 

Good treatment can be identified when:

• There is a clear goal of resuming full function and returning to work.
• The patient becomes increasingly responsible for their own recovery.
• Treatment moves from passive to active.
• There are clear methods of measuring the patient’s recovery.
• Treaters acknowledge that there may be non-physical factors (such as fear) which can influence recovery.

To get the best from a physiotherapist, employers in particular should visit their local providers to establish a relationship. Most physios respond well to this, and it opens a line of communication, albeit with a commercial imperative. This also enables the RTW coordinator to advise their injured workers on the local physios, and encourages the physio towards more effective work.

Employers should avoid adversarial discussions of patients with physiotherapists - remember that clinicians tend to side with their patients. You can discuss work restrictions with physiotherapists, and remember to follow these restrictions scrupulously.

For return to work treatments, consider using a physiotherapist experienced in dealing with work related conditions.  

There has been a move recently towards exercise programs in physiotherapy, however this needs to be active for the patient rather than passive, and they need to parallel improvement in function and activity.

When you suspect that someone is receiving excessive treatment, ask the treater what they are doing in terms of the treatment, and look at whether an end point for treatment has been established. You can ask how the patient is going with their recovery and whether there is a measure for the recovery. Second opinions can be valuable. 

Over-servicing can be a problem and can often be discovered through talking to the injured worker.  At the claims management level it can be more challenging, but in the clinical framework there are five principles which can be applied:

1. Measurement of recovery
2. Consideration of the bio psycho-social model
3. The treatment should be empowering the worker
4. There is a focus on return to work and function
5. Evidence-based practice is utilised

No progress is a sign there needs to be a review of treatment. Some injuries can take a long time to resolve, however there need to be checks and balances in place. 

There should be improvement every month, and if there isn’t, the practitioner needs to be able to say why. With no improvement, frequent treatments are generally unnecessary. 

Sometimes psychological factors can come into play in recovery. In these cases, it may be worthwhile referring the patient to other specialist practitioners. In limited circumstances, it may be appropriate for someone to receive very frequent treatment (such as three times weekly), but these are uncommon. 

The focus of physiotherapists should be on an early return to work, remembering that work has been shown to help injured employees to heal faster.