With the advent of Sports Rehabilitation as an Undergraduate Degree, and Sports Rehabilitators appearing in the marketplace, I’m often asked what the difference is ~ and whether someone should seek help from a Physiotherapist or Sports Rehabilitator for a musculoskeletal condition.

What is a Physiotherapist?

• The term “Physiotherapist” describes a professional who uses physical and manual methods to restore function, and rehabilitate ‘patients’ with physical conditions
• Both “Physiotherapist” and “Physio” are legally protected titles. This prevents anyone without a certified degree in Physiotherapy from
  • using the title of Physiotherapist
  • or describing their role as that of a Physiotherapist
• Physiotherapists are, alongside all other Professions Allied to Medicine (PAMs), required to have registration with the Health and Care Professions Council (HCPC), a regulatory body requiring members to demonstrate appropriate continuing professional development, to maintain their registration. Without this, a Physio is not entitled to practice

To complete the undergraduate degree, a Physiotherapist must study and demonstrate competence in the care of a range of conditions – not only musculoskeletal in nature, but also neurological conditions, respiratory disease, general surgical and orthopaedic surgical conditions and more.

The qualified Physiotherapist is then armed (as most do initially) to take up a post in the NHS or other medical institution, to continue to develop their practice. It is during the initial 2-3 years that the Physio will work across all fields of the profession, and also begin to develop a special interest in a specific area (e.g. musculoskeletal, neurology, etc.). As experience and depth of knowledge is gained, there is too much ongoing learning required to maintain expertise in more than one area.

Having said that, the early broad learning in the Physiotherapist’s career is essential, as there is a great deal of overlap in some areas. For example, some neurological knowledge is key to musculoskeletal rehabilitation, as the two systems are not mutually exclusive.

What is a Sports Rehabilitator?

• Having completed an undergraduate degree in Sports Rehabilitation, this practitioner has knowledge specifically in the assessment and rehabilitation of sporting/musculoskeletal complaints
• As the title suggests, the emphasis is often on returning a ‘patient’ to a specified level of sporting capacity. Manual/hands-on therapies are also used by a Sports Rehabilitator
• However
  • There is no training offered in a broader systems rehabilitation approach (e.g. neurological rehab)
  • This practitioner is currently not a “Professional Allied to Medicine”
  • The qualification is not currently regulated by the HCPC, and practitioners are therefore not required to meet their standards to practice
• There is also currently no avenue for the Sports Rehab practitioner to work in the NHS or medical institutions, nor to register with health insurance providers such as BUPA, AXA, etc.

Overlap
There is a great deal of overlap. Both practitioners are able to provide hands on treatments and exercise prescription, to improve symptoms. Technically and literally, a Physiotherapist practicing in the musculoskeletal specialism, rehabilitating patients back to sport, is a sports rehabilitator.

However at the time of writing this blog, the lack of HCPC registration means the Sports Rehabilitator is not found working in the field of elite sport, because of the extent of medical overlap often required in musculoskeletal roles within professional sport.

Extended Scope
It is also worth noting that, critically, a large number of medical conditions can masquerade as musculoskeletal problems. The key here, is to have a practitioner who has the correct experience to differentially diagnose whether your condition is truly musculoskeletal, or is masquerading for an underlying medical problem.

Physiotherapists with this level of expertise are highly experienced, usually having worked in a hospital/medical setting in musculoskeletal care, for at least 8, or up to 10 years, and have seen a very large volume of differing conditions over many years. They are referred to as Extended Scope Physiotherapists (ESPs).

The key skill of an ESP is knowing what is a rehabilitation problem, what isn’t a rehabilitation problem, and for the latter, who is the correct professional to refer to.

Summary

• The key thing to remember, whichever practitioner you choose, is experience
• A Sports Rehabilitator has a good depth of training, and many offer a good service in managing the recreational athlete
• However, one must bear in mind the breadth of training in Physiotherapy, and the advantage of the medical training incorporated in the Physiotherapy degree

Of course, the extent of experience of your chosen clinician is vital too. For me, the choice to open a Clinic was one I gave a lot of consideration to.  I felt this choice was realistic after I had accumulated 10 years of experience, knowing I felt confident to assess whoever walked in through our front door – but I also continue to humbly accept that I have, by no means, learnt all there is to know!

Best Wishes,
Chris

Chris Liversidge (MSc, BSc (Hons) 1998,2001, MCSP) is an Extended Scope Physiotherapist (Musculoskeletal/Orthopaedics) and Practice Prinicpal at North Light Physiotherapy Associates, UK.

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