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Does Physio Have a Future?
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
Whilst the existence of debate in MSK physiotherapy is not new, recently the question seems to be whether we have a future at all.
If, even 10 years ago, you had suggested that MSK physiotherapy was vulnerable to developments in artificial intelligence (AI) you would have been laughed out of town. How could a profession so reliant on personalisation, hands-on assessment, treatment and rehabilitation be vulnerable? Whilst AI has huge potential as a source of information (when its reliability improves [1]), AI scrapes data into averages, so it doesn’t matter how sophisticated the system, by taking the midpoint it ignores heterogeneity and it cannot apply clinical reasoning because it doesn’t think. AI cannot reason and cannot touch, so even if your preference is only to touch to assess, guide movement and provide reassurance, how can it be a valid replacement for physio? Yet here we are, in 2025, with AI programmes shortening waiting lists and claiming they offer as good or better a service than standard care [2].
Added to this threat (and partly driving it) has been the development of new advanced and enhanced practice roles that have seen us conduct appointments only long enough to adopt algorithmic assessments and treatments traditionally conducted by doctors. We seem to embrace these medical investigations as absolute and diagnostic; administering passive, temporarily effective treatments with alacrity and no sense of irony. Have we learned nothing from the mismatch between MRI findings and differences in presentation? It appears not, for the role of the Advanced Physiotherapist seems increasingly to base their diagnoses on bloods tests and radiology, not a comprehensive and nuanced clinical examination. Advanced and enhanced practice seems to have abandoned an holistic, adaptable biopsychosocial approach and now treats the scan, not the man.
How has this come about?
The reason for the role change in the public sector was neatly articulated by the CSP’s Sara Conway and Tamsin Baird [3] who stated that these shifts were driven by NHS waiting lists and an attempt to do more with less. They also pointed out that the self-paying private sector could focus more on function and rehabilitation and wondered whether the divergence driven by the difference in priority would split our profession permanently: or is there something we can do to acknowledge the legitimacy of both these approaches and continue to work under one umbrella?
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By Physio MattersThis is a free preview of a paid episode. To hear more, visit mskmag.substack.com
Whilst the existence of debate in MSK physiotherapy is not new, recently the question seems to be whether we have a future at all.
If, even 10 years ago, you had suggested that MSK physiotherapy was vulnerable to developments in artificial intelligence (AI) you would have been laughed out of town. How could a profession so reliant on personalisation, hands-on assessment, treatment and rehabilitation be vulnerable? Whilst AI has huge potential as a source of information (when its reliability improves [1]), AI scrapes data into averages, so it doesn’t matter how sophisticated the system, by taking the midpoint it ignores heterogeneity and it cannot apply clinical reasoning because it doesn’t think. AI cannot reason and cannot touch, so even if your preference is only to touch to assess, guide movement and provide reassurance, how can it be a valid replacement for physio? Yet here we are, in 2025, with AI programmes shortening waiting lists and claiming they offer as good or better a service than standard care [2].
Added to this threat (and partly driving it) has been the development of new advanced and enhanced practice roles that have seen us conduct appointments only long enough to adopt algorithmic assessments and treatments traditionally conducted by doctors. We seem to embrace these medical investigations as absolute and diagnostic; administering passive, temporarily effective treatments with alacrity and no sense of irony. Have we learned nothing from the mismatch between MRI findings and differences in presentation? It appears not, for the role of the Advanced Physiotherapist seems increasingly to base their diagnoses on bloods tests and radiology, not a comprehensive and nuanced clinical examination. Advanced and enhanced practice seems to have abandoned an holistic, adaptable biopsychosocial approach and now treats the scan, not the man.
How has this come about?
The reason for the role change in the public sector was neatly articulated by the CSP’s Sara Conway and Tamsin Baird [3] who stated that these shifts were driven by NHS waiting lists and an attempt to do more with less. They also pointed out that the self-paying private sector could focus more on function and rehabilitation and wondered whether the divergence driven by the difference in priority would split our profession permanently: or is there something we can do to acknowledge the legitimacy of both these approaches and continue to work under one umbrella?