Areas of Specialization in Physiotherapy


When it comes to talking about specialty areas in physiotherapy or what physiotherapy areas you'll like to specialize it should be based purely on your strengths and interests.
Most physiotherapists specialize in musculoskeletal or sports physiotherapy either for lack of better ideas or job prospects ( not that these are totally wrong reasons).
I think some things you should consider when deciding to specialize are -


  • What really are your interests? Would you rather work with the young or the elederly? I personally don't like seeing children in the hospital so paediatrics is definitely not my thing.
  • What skills have you gathered over the years and which of your skills are you likely to harness? Have you seen yourself coming up with successful rehabilitation programs for patients that suffered from musculoskeletal injuries, for example, over and over again? Are there particular cases or conditions that your superiors or colleagues have associated you with because of your achievements? That may be an area worth looking to.
  • What medical conditions are common in the country or city where you practise? 
  • What job openings for senior positions have you noticed? That would give you an idea of what direction your career progression should take.
  • If there's a guarantee of getting a better pay in one area of specialty than another what stops you from taking the plunge? 


Some Common Areas of Specialization in Physiotherapy

Cardiorespiratory/Cardiopulmonary
A cardiopulmonary physiotherapist works to improve functional independence and endurance of patients with disorders or diseases of the cardiopulmonary system. Disorders like cystic fibrosis, COPD (chronic obstructive pulmonary disease)...

Orthopaedic/Musculoskeletal
Musculoskeletal physiotherapists focus on Musculoskeletal injuries and conditions and handle rehabilitation after orthopaedic surgery. Common conditions treated are sprains, strains, fractures, amputation, back pain...

Paediatrics
Paediatric physiotherapists in the diagnosis and management of injuries, illnesses and diseases of younger people. They work with children with congenital birth defects and developmental delays like cerebral palsy, spins bifida and torticollis.

Geriatrics
Geriatric physiotherapy focuses on the elderly; keeping them mobile and helping them live healthy lifestyles with specialty knowledge on likely conditions or challenges they might be facing or likely to fave as a result of being advanced in age. Countries like Australia have a high demand for geriatric physiotherapists.

Sports Physiotherapy
Sports physiotherapists don't just focus on treating sport injuries or injuries sustained by athletes. They have in depth knowledge on various kinds of sports and information on likely injuries that may be sustained. They are actively involved in not just rehaibilitaing the sports person but getting him back to optimal performance.

Women's Health
Physiotherapists that specialise in women's health focus on disorders of the pelvis and pelvic floor such as incontinence, prolapse, constipation and pelvic pain.

Neurology
Neurological Physiotherapists deal with people with neurological damage, disease or disorders. Most neurological cases affect the functional dependence of these people. Cases like multiple sclerosis, Parkinson's disease, stroke and so on.


How do you get to specialize?

So now that you've made up your mind to go further in your physiotherapy career how do you become a specialist? The first move that reveals what area of specialty you are tilting towards is your Masters program. This is the first step to working towards your area of specialisation.

The next move to make is the hospital setting you choose to work. There are specialised hospitals for assessing and treating paediatric, neurological, musculoskeletal conditions...to mention a few.

If you are a registered physiotherapist in Canada this bit of information might be of interest to you thinking of specializing:

The CPA Clinical Specialty Program is a self-directed certification program to recognize physiotherapists who have demonstrated advanced clinical competence, leadership, continuing professional development and involvement in research. The specialist designation is valid for 10 years.

The CPA Clinical Specialty Program is available to all registered physiotherapists, regardless of practice setting or location.

To register as a candidate in the CPA Clinical Specialty Program, you must meet the following requirements:

A minimum of five years full time (one year full-time is 1800 hours) applied clinical experience
A minimum of 300 clinical contact hours in the clinical specialty area annually
A valid registration with their physiotherapy regulatory body in Canada
A completed application form along with payment of the application fee
See more here 



Should You Use A Health Recruitment Agency to Get a Physiotherapy Job in the US?

If you are a foreign trained physiotherapist interested in working in the US there are a couple of health recruitment agencies that may be able to help you with the whole immigration (green card) or work permit (H-1B visa) process.

There's really nothing wrong in getting an agent to help you if you have investigated the agent in question to your own satisfaction. Like I have said many times before, you may not end up with an agent you contact but you may end up with lots of useful information on how to land an international job or immigrate to the US as a physiotherapist.
Here are two health recruitment agencies you can check out, I have had contacts with one of them but you still need to do your own home work.

How to deal with a health recruitment agency:

 1.ASK Questions
Always make sure you ask all questions that are one your mind especially those are peculiar to your own situation. The agency website may have an FAQ but if you are not satisfied never feel apologetic for asking more questions.

 2.Observe Body Language
Watch the body language of the agency...do they respond to emails on time? Do they act like you are bothering them? Do they just respond to your questions with a general answer or impersonal mail? Do they sound friendly? I look out for these signs in particular because it tells me a lot about the kind of organization I'm dealing with.

3. Don't be too Quick to send your information
Don't send your CV or resume to the agency if it isn't quite clear what their requirements are. Some of these agencies just want to brag about the database of physiotherapists or allied health professionals they have....they are not actually interested in helping you.

4. The Money Factor
A reputable agency will NOT ask you to pay for anything without services rendered. Employers pay these people to head hunt so they are to get to work by locating people like you.

5. Read the Terms
Some health recruitment agencies have funny terms of agreement. Please always read their terms over and over and if you can, get a lawyer or some other intellectual to go through the agreement with you. Don't be hasty to rush into an agreement you don't thoroughly understand.

You can check these physiotherapy staffing agencies in the United States that recruit internationally trained physiotherapists:

Avant Healthcare Professionals


Avant Healthcare Professionals is the premier specialist for internationally educated nursing and allied health professionals including physical and occupational therapists. We offer visa sponsorship, free licensure and visa processing, examination preparation, and long-term assignments based in one location as well as a great package of salary and benefits.

Avant Healthcare Professionals is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to citizenship status, race, immigration status, national origin, gender, age, religion, disability, sexual orientation, veteran status, or marital status. Avant offers a range of immigrant and non-immigrant visa sponsorship for qualified applicants needing such assistance. Avant is an industry leader in international recruitment and our expert team will support you through each step of the application process.
Read more 

Interfysio


A New York-based staffing company comprised of an experienced team of healthcare professionals, lawyers, recruiters, licensing and credentialing specialists. We are the direct employer.

InterFysio is a boutique agency handling only selected disciplines within healthcare. As PTs, PTAs, OTs, COTAs, and SLPs, we know your concerns and are eager to work with you individually on your professional development.
We offer mentoring, continuing education, individually tailored development plans, customized assignments, annual performance reviews and, for those foreign trained staff, we support any licensing and credentialing that is necessary.

We offer full visa sponsorship and legal support for our foreign trained hires through our world class in-house legal team. This service is included in our compensation package. We do not make any deductions from your salary for any reason.
Read more 

20 UK Universities Masters in Physiotherapy (2)


Looking for the right postgraduate courses in their UK to take your physiotherapy course to the next level? Here are some UK universities and postgraduate physiotherapy M.Sc courses you can check out.

Physiotherapy Studies (Neurophysiotherapy) M.Sc
University College London
1 year full time
Course fees £24,400

Entry requirements
Normally a minimum of an upper second-class UK Bachelor's degree or an overseas qualification of an equivalent standard in physiotherapy; or an approved diploma in physiotherapy together with evidence of appropriate clinical work and/or teaching experience and a commitment to continuing professional development. One or two years’ post-qualification neurological clinical experience is preferred and UK state registration is desirable.
English Language Requirements
If your education has not been conducted in the English language, you will be expected to demonstrate evidence of an adequate level of English proficiency.
The English language level for this programme is: Standard
See more on this course

Physiotherapy Studies (Cardiorespiratory) M.Sc
University College London
1 year full time
Course fees £23,020

Entry requirements
Normally a minimum of an upper second-class UK Bachelor's degree or an overseas qualification of an equivalent standard in physiotherapy; or an approved Diploma in physiotherapy together with evidence of appropriate clinical and/or teaching experience and a commitment to continuing professional development.
English Language Requirements
If your education has not been conducted in the English language, you will be expected to demonstrate evidence of an adequate level of English proficiency.
The English language level for this programme is: Standard
See more on this course


Physiotherapy Professional Practice M.Sc
University of Central Lancashire
1 year full time
Course fees

Entry requirements
Applications are sought from individuals possessing an Honours degree 2:2 or above in Physiotherapy, or with a relevant professional qualification e.g. Graduate Diploma in Physiotherapy, which enables the candidate to register for licence to practice as a physiotherapist either in the UK or in their country of registration. Applicants may be asked to attend for a guidance interview.  Overseas applicants must also be able to demonstrate achievement of IELTS level 7.0, with no less than 6.5 in any individual component, before the start of the programme. Applicants wishing to apply for accreditation of prior learning (APL) for other M level modules (internal or external) may import credits according to University guidelines on APL. Credits must however be current and map to the outcomes of the programme and its existing modules. Applicants should note that some modules require Health Professions Council (HPC) registration; students who are not registered with HPC registration may be unable to take these options.  Students who are undertaking placements will require CRB clearance, for which there may be an additional fee. The awards do not provide eligibility to apply for HPC and/or professional registration.



Physiotherapy (Neurorehabilitation) M.Sc
University of Nottingham
1 year full time
Course fees

Entry requirements
A first degree in Physiotherapy or a related Health Care subject of at least a 2.2 classification or equivalent, with a minimum 2 years of clinical experience.
International students whose first language is not English are required to have the CELE pre-sessional course final assessment of ‘Pass with Merit’ before they can register on an academic programme. Please note that should you require registration to the HCPC the English Language proficiency standard required is IELTS score 7 (with at least 5 in each element) or the equivalent. International students will be required to have occupational health clearance, supply a declaration of good character and health form certified by their current employer and undertake governance training in order to undertake insight/observational visits. Please note if vaccinations are required, these will be at the student’s own expense.
See more on this course


Physiotherapy (Pre-registration) M.Sc
Manchester Metropolitan University
2 years extended full time (45weeks)
Course fees £15840 as of 2015

Entry requirements
An undergraduate honours degree (upper second class or above) in a relevant subject or the equivalent qualification. Relevant subject areas include: biological sciences, sports science, sports therapy or rehabilitation, chemistry, nursing and psychology.
Please note – If English is not your first language we also require one of the following qualifications:
IELTS – An overall mark of 7 with not less than 6.5 in any one component.
TOEFL – 600 points paper based.
Additional requirements:
Evidence of interest and work experience in the relevant field.
Evidence of studying within the last three years.
Satisfactory disclosure from the Criminal Records Bureau.
See more on this course

Advanced Physiotherapy (M.Sc)
Manchester Metropolitan University
15 Months full time
Course fees £13,300

Entry requirements
A physiotherapy UK honours degree (or international equivalent) or graduate diploma in physiotherapy – with evidence of approved and relevant post-qualification education is usual.
Applicants whose first language is not English must provide evidence of proficiency in the English language. Normally the minimum level of proficiency for acceptance on to this programme is an IELTS average score of 6.5 or TOEFL minimum score of 575 (233 on the computer based test, 90 on ICT testing).
See more


Physiotherapy (M.Sc)
Glasgow Caledonian University
1 year full time
Course fees £12,600

Entry requirements
The MSc Physiotherapy programme is open to physiotherapists who hold a UK Honours degree 2:2 (or equivalent) or an unclassified degree or professional diploma with over two years’ experience.
Applicants with a grade point average between 55 and 60% will be considered if there is evidence of suitable work experience.
Health and Care Professions Council (HCPC) registration is not required.
English Language Requirements
IELTS score of 6.5 (or equivalent) with no element below 6.0
See more

Advancing Physiotherapy Practice (M.Sc)
Coventry University
1 year full time
Course fees £11,280

Entry requirements
Applicants will normally hold a UK equivalent of 2:1 degree in Physiotherapy
Applicant with 2:2 degree equivalent and relevant work experience will be considered on a case by case basis.
Students whose first language is not English should have achieved a minimum IELTS: Overall 6.5 with no component less than 5.5
See more on this course

20 UK Universities Masters in Physiotherapy Courses (3)

Looking for the right postgraduate courses in their UK to take your physiotherapy course to the next level? Here are some UK universities and postgraduate physiotherapy M.Sc courses you can check out.

Manual Therapy (M.Sc)
Coventry University
1 year full time
Course fees £12,068

Entry requirements
Applicants should hold the equivalent of a 2:1 undergraduate degree in Physiotherapy or Sports Therapy, and additionally must have one year's experience in the musculoskeletal field of practice and evidence of continuing professional development.
Applicants with a 2:2 and relevant work experience will be considered on a case by case basis
Applicants wanting membership of the UK Musculoskeletal Association of Chartered Physiotherapists (MACP) must also be both:
a member of the UK Chartered Society of Physiotherapy (CSP); and
registered with the UK Health and Care Professions Council (HCPC).
Applicants whose first language is not English should have an IELTS 7.0 overall, with no component lower than 6.5.
See more on this course


Physiotherapy (M.Sc)
University of East London
1 year full time
Course fees £12,100

Entry requirements
Minimum BSc 2.1 Honours in Physiotherapy. IELTS


Neurorehabilitation (M.Sc)
Brunel University London
1 year full time
Course fees £17,200

Entry requirements
A UK first or second class Honours degree or equivalent internationally recognised qualification in a related degree. Applicants with five months or more relevant clinical experience is desirable.
Other subjects and qualifications with relevant work experience ie. be a registered practitioner in the field of Neurorehabilitation (or occupational therapy, physiotherapy, nursing, exercise and rehabilitation sciences) or from professions allied to medicine will be considered on an individual basis and applicants will be required to attend an interview.
The course will not further clinical skills, nor will it lead to registration from the UK professional governing bodies, but rather it focuses on developing the practitioner’s ability to conduct and evaluate neurorehabilitation research.
See more on this course


Neuromusculoskeletal Physiotherapy (M.Sc)
University of Brighton
1 year full time
Course fees

Entry requirements
The entry requirements listed here are our typical offer for this course if you wish to begin studying with us in 2016. They should be used as a general guide.
We operate a flexible admissions policy – this means that you could receive a lower conditional offer than the typical offer, informed by our assessment of your complementary non-academic achievements and experiences. For courses that require interview or portfolio review, this may also be considered in the level of any conditional offer that follows if your application is successful.
Degree and/or experience
This course is for qualified physiotherapists. Applicants should normally hold an honours degree in physiotherapy but those with suitable alternative qualifications, such as a diploma in physiotherapy, will be considered.
Professional registration as a physiotherapist is required, and students enrolling for the PGDip or MSc must be registered by the Health and Care Professions Council and be a full member of the Chartered Society of Physiotherapy or hold their own indemnity insurance. However, this is not a requirement if you are enrolling for the PGCert.
We would normally ask for a minimum of one year's post-registration experience in a neuromusculoskeletal physiotherapy setting.
For non-native speakers of English
IELTS 7 overall with no element below 6.5.
We normally require overseas applicants to hold a degree qualification in physiotherapy, which is equivalent to a UK qualification, and appropriate English language skills.
See more on this course


Movement Science and Multimodal Rehabilitation (M.Sc)
Teesside University
1 year full time
Course fees
This course provides you with postgraduate skills in application of movement science in assessment and treatment of musculoskeletal injuries and rehabilitation. You also learn how to design and implement custom-made, exercise-based rehabilitative programmes developed from applied knowledge of the pathomechanics of injury.
See more on this course


Applied Physiotherapy
University of Bradford
1 year full time
Course fees £15,600

Entry requirements
Hold a relevant professional qualification normally at Bachelor’s degree level (Ordinary or Honours) or Level 3 equivalent
Are a physiotherapist or other health professional registered with the Health Professions Council (HPC) or other relevant professional body
Normally have two years post qualification experience and normally have experience of working in a relevant speciality
Students who wish to undertake practice modules within the pathway should demonstrate that they are registered with the Health Professions Council (HPC)
English language requirements:
IELTS at 6.5 or the equivalent
See more on this course 

20 UK Universities Masters in Physiotherapy Courses (1)

Looking for the right postgraduate courses in their UK to take your physiotherapy course to the next level? Here are some UK universities and postgraduate physiotherapy M.Sc courses you can check out.

M.Sc Physiotherapy 
Robert Gordon University
Aberdeen, Scotland
Course length is 2yrs (full time)
Course fees £16,100 per academic year

Entry requirements
Applicants typically possess a Bachelors undergraduate degree in a science subject, such as biological, or sports science, and should contain human anatomy and physiology with a 2:1 or above classification, or a minimum GPA of 3.0 out of 4.0 Scale, or equivalent.
Experience of the research process is also an essential requirement for the course. Relevant work experience in the field of Physiotherapy and healthcare would be desirable.
All international students, for whom English is not their first language, are required to have an IELTS (International English Language Testing System) score of 7.0 or an appropriate equivalent, on application to the course.
Read more about the modules in this M.Sc Physiotherapy programme 

Physiotherapy (M.Sc)
Robert Gordon University
2 years full time
Course fees £16,100 per year.

Entry requirements
Applicants typically possess a Bachelors undergraduate degree in a science subject, such as biological, or sports science, and should contain human anatomy and physiology with a 2:1 or above classification, or a minimum GPA of 3.0 out of 4.0 Scale, or equivalent.
Experience of the research process is also an essential requirement for the course. Relevant work experience in the field of Physiotherapy and healthcare would be desirable.



Advanced Neuromusculoskeletal Physiotherapy (M.Sc)
King's College London
Course length 1 year (full time)
Course fees £19,000

Entry requirements
Minimum requirements are an Undergraduate Physiotherapy degree with 2nd Class honours (or international equivalent) for physiotherapists qualifying pre-1991, a Diploma in Physiotherapy.
Additional requirements:
Minimum of one years' experience working as a physiotherapist assessing and managing clients with musculoskeletal problems.
Registration with the Health and Care Professional Council (HCPC) is mandatory prior to enrolment onto the programme.
Professional indemnity cover is required for the programme. This can be obtained by membership of the Chartered Society of Physiotherapists (CSP).
You'll also be required to do your IELTS exam to prove your English Language proficiency.
Read more about this Masters programme in physiotherapy




Physiotherapy (M.Sc)
Kings College London
2 years full time
Course fee

Entry requirements
Minimum high 2:1 first degree in biomedical sciences or relevant disciplines such as psychology and sports science or the equivalent overseas qualifications. In addition applicants should have a good A-level or equivalent profile along with experience in statistics, research methods and/or a dissertation at BSc level, and the ability to critically evaluate material and study independently.
Application procedure
Applications must be made online using King's online application portal and a non-refundable application fee of £40 applies. Shortlisting for interviews will take place in early February. Selection for interview will be based on academic criteria and evidence in the personal statement of understanding of the role and scope of physiotherapy in current healthcare and any relevant work experience or shadowing (see entry requirements).



Advanced Physiotherapy (M.Sc)
University of Hertfordshire
Course length 15months (full time)
Course fees £12,500 per year

Entry requirements
Applicants will normally have completed a relevant university degree and have a recognised qualification in physiotherapy. You will normally have at least one year's post-qualification experience (post internship) and evidence of appropriate continuing professional development.
Membership of the Health and Care Professions Council (HCPC) and Chartered Society of Physiotherapy (CSP) is required.
If English is not your first language you are required to demonstrate English Language proficiency of IELTS at Level 7.0 (including 7.0 in the writing component)
Read more about this course 


Sports and Exercise Therapy (M.Sc)
Cardiff University
18 Months full time
Course fees £18,250 per year

Entry Requirements
Suitable for qualified physiotherapists with at least two years' clinical experience.
See more on this course


Physiotherapy (M.Sc)
Cardiff University
18 Months full time
Course fees £18,250 per year

Entry requirements
Either a first degree or a UK diploma in physiotherapy
Clinical experience is not a requirement of the programme. However applicants with 0-2 years clinical experience will have a limited choice of modules (see table above).
Students whose first language is not English will be required to pass an IELTS test. Please see our English Language Requirements guidance for more details. Please note that applicants with an IELTS scores overall of 5.5 or 6 may be eligible for an offer based upon attendance on Pre sessional English language Course. Please be advised that places on these courses are limited so please apply early.
See more on this course


Sports and Exercise Medicine (M.Sc)
Cardiff Metropolitan University
1 year full time
Course fees £13,500

Entry requirements
Applicants must either have chartered physiotherapy status; successful completion of an undergraduate medical studies degree or registered as an osteopath and possess membership to the HCPC, GMC or GOsC as appropriate. In addition, applicants will have to demonstrate an interest in sport and exercise medicine.
See more


Physiotherapy Studies (Paediatrics) M.Sc
University College London
1 year full time
Course fees £23,020

Entry requirements
Normally a minimum of an upper second-class UK Bachelor's degree or an overseas qualification of an equivalent standard in physiotherapy; or an approved diploma in physiotherapy together with evidence of appropriate clinical and/or teaching experience and a commitment to continuing professional development.
English Language Requirements
If your education has not been conducted in the English language, you will be expected to demonstrate evidence of an adequate level of English proficiency.
The English language level for this programme is: Standard.
See more on this course

Which Countries Pay the Best Physiotherapy Salary?


We always hear about physiotherapy being a "hot" profession and that physiotherapists are saught after all over the world and that gives us the confidence to go for international jobs. Interestingly, though, I have noticed that physiotherapists move around alot, and we're about ro find out if it's for "greener pastures" , inner fulfillment or just sheer restlessness. I know of physiotherpists that move from Australia to Canada, and others from Canada to Australia...the other day a colleague of mine told me about a physiotherapist that had just devided to leave Australia for Singapore, while he stays put in South Africa.
Many physiotherapists want to know which countries pay the best salaries to help get some motivation to move or jump ship, so let's first try to analyse places that have the best paying physiotherapy jobs or simply put, the highest salaries.

Ireland
A physiotherapist's salary in Ireland ranges from $27000 to $60000 a year andthis will of course be slightly affected by the experience factor and employer, majorly. Of course physiotherapists are paid in euros in Ireland but I put the figure in US dollars so we can get a uniform basis for comparison.

Australia
Physiotherapists in Australia are paid a salary of between $37000 to $66000 a year. This is the US dollar conversion of a salary in AUD (Australian Dollars).

Canada
Physiotherapists in Canada earn between $36000 and $72000 a year. This is the US dollar conversion as you would be paid in Canadian dollars. It also seems that experience doesn't make much difference in the physiotherapy salary.

United States of America (US)
The physiotherapy salary in the US ranges from $46000 to $91000 per year. Years of experience reflect in the size of the salary package in the United States. Physiotherapy salary may also vary slightly with the city you work.

Singapore
A physiotherapist is Singapore earns between $13000 to $57000 a year. You will be paid in Singaporean dollars but this is the US dollars conversion.

South Africa
Physiotherapists in South Africa earn between $10000 and $24000 a year. This is the US dollar conversion for the South African rand salary.

United kingdom
In the UK physiotherapists earn between $28000 and $64000 a year.

Dubai
Physiotherapy salary in Dubai ranges from $7000 to $65000. Now that is the widest range I have seen so far but I suspect that who your employer is plays a very important factor in how much you are paid. I hear the international hospitals in Dubai pay well.

Phew! So much for salary comparison... I think, however, when choosing a country you'll like to work there are several other factors that should be considered apart from salary. Here are some of my personal criteria for choosing the best country to work as a physiotherapist:

My 3 C's

1. Connection
There are some places that I don't just connect with, i really don't care if they pay the best salaries...There are some countries that spell fulfilment and joy when you think about them while there are others that are synonymous with buttetflies and knots in your belly. Don't ignore that gut feeling when it comes to getting an international job.

2. Culture
What's the country's culture like? Is the city you are looking at a metropolitan city where you can find all races and cultures? Are they friendly? Do they discriminate of do they have "preferences" for certain races when it comes to employment? Can you cope with that kind of environment? Would you like to raise your kids in that country or city?


3. Cost of living
With number one criterion in place the others may be unnecessary but sometimes you may have to get additional reasons why you should or shouldn't take a particular international job.
I will research the cost of living in the city that I am getting the job. Some cities pay more than others but the cost of living in these cities are also higher than others... Try to do a simple calculation on how much of your salary is likely to go into expenses and compare with other cities that don't seem to pay as much. Singapore is one of the most expensive countries in the world so if you are interested in working as a physiotherapist there, do your homework; find out how your physiotherapy salary will balance up with the cost of living in Singapore.

Well these are just mine you may have yours that you'll like to share. Happy job hunting!



Jobs in Physiotherapy



How to Get a Physiotherapy job in Singapore


Physiotherapy is on the skills shortage list in Singapore and is classified as an Allied Health Profession.

You as a physiotherapist should apply directly to the Ministry of Manpower  or the Human Resources department in the hospital of your choice.
Once your registration is approved you'll need a work permit and you need to have a job to get it. There are two types of work passes the EP and the S pass. You can get more information on the Ministry of Manpower website.

Part of the criteria for a foreign trained physiotherapist to to be able to practise in Singapore is to pass the MOH qualifying exam.

The qualifying exam (QE) is an assessment of the equivalence of the knowledge and skills of the foreign trained physiotherapist and the physiotherapy practise in Singapore.
The exams are conducted four times a year in January, April, July and October and you need to be in Singapore to take the exams. The results of this exam are usually released four weeks after the exam was taken.

But you need to apply for registration with the allied health professional council (AHPC) first, before you can even think of the exams. Some have even advised applying for a one year social visit visa and try to get a job as a physiotherapy assistant... Don't know how feasible that is but if you're thinking of going on vacation you may pop into Singapore and try to get more information on ground.


Qualifying ExaminationsTherapists from the regulated allied health professions (Occupational Therapy, Physiotherapy and Speech-Language Therapy) whose qualifications are not found on the List of Recognised Qualifications can take and pass the relevant Qualifying Examination (QE) to be eligible for Conditional Registration. Such therapists must first submit a registration application to the Council who will then advise on the applicant's eligibility to take the QE.
Prior to passing the QE and completing their registration with the Council, such applicants are not allowed to practise as an occupational therapist, physiotherapist, or speech-language therapist in Singapore.


Criteria for Registration 
To be eligible for registration, the applicant must:
1. Possess a basic/primary professional qualification in his profession (e.g. BSc (Physiotherapy) for a Physiotherapist);
2. Be bona fide;
3. Have an offer of employment as an allied health professional in Singapore; and
4. Be of good standing/reputation/character.

The Council will also consider other factors, where applicable, such as:
1. Post-graduate qualifications
2. Work experience and history (e.g. whether the applicant has been in active clinical practice, professional practice experience)
3. Registration with other licensing authorities
4. Evidence of proficiency in English Language (IELTS, TOEFL or OET)
5. Physical and Mental Health status
6. Evidence of passing the Qualifying Examination (QE)
IELTS TOEFL OET
Get more information here

This Singaporean process has been judged as stressful but don't despair... Here's an excerpt of someone's experience I saw on physiobob:

I am a physiotherapist with 10 years experience in a large specialty hospital in the Philippines. I also come from a very good school in the Philippines, am a member of the Singapore Physiotherapy association and hold a one year social visit pass (courtesy of the EPEC system Ministry of Manpower | About the Certificate ). So, you could say I have very good credentials.

Once I landed here I made a list of the email addresses of all the hospitals, clinics and nursing homes in Singapore and I emailed my resume to all of them, regardless of whether they have vacancies or not (you should do that because some centres don't advertise in the paper or online job databases). I got interviews after two weeks. When I went to the interviews I got job offers but my work pass was rejected because there was a problem.

All foreign-trained physios must undergo the MOH qualifying exam before practicing here. That's fair and square but here's another catch: you can't sit for the qualifying exam unless you are endorsed by a Singaporean employer. In other words you have to get a job offer first before sitting for the exam. It's all in the FAQ's Health Professionals Portal

On a side note, you could be exempted from the exam if you come from a Ministry of Health (MOH) recognized school. However, this list is quite different from the list of schools recognized by the ministry of manpower (MOM) because my school was listed there ( Ministry of Manpower | Selected Institutions List) and I was still required to take the MOH qualifying exam. There’s no public list of schools accredited by the MOH but I'm guessing that it only includes schools from the UK, Canada, and Australia. If your school is not on MOH's hallowed list, tough luck.

So to summarize, here's a list of steps on how to get a job in Singapore if you're school is NOT accredited by MOH.
1. Get an EPEC if you can.
https://epec.mom.gov.sg/
2. Make a list of the websites/email addresses of all the hospitals, centres and nursing homes in Singapore.
3. Once you land in Singapore, if you have an EPEC, get a one year social visit pass (they call it long-term social visit pass) online from the ICA https://ltpass.ica.gov.sg/eltsvp/main.do .
4. Apply as a physiotherapy aide on online application portals of hospitals and email your resume to the rest of the employers on your list. Take note that Singaporean employers will not consider you for an interview unless you are already in Singapore. Further, most employers prefer email and online applications to walk-ins.
5. Sit for interviews and before accepting any job offers or signing anything make sure your prospective employer would sponsor your for the MOH qualifying exam eventually (at least within 6 months).
6. Wait for the results of your work permit application. Your employer could apply an S pass or an E pass for you.
7. Study for the MOH qualifying exam. The reference materials are on the website Nanyang Polytechnic - SHS - Student Services.

You can also contact the Healthcare Manpower Division (HMD) of MOH Holdings. This is an excerpt of what they do:

HMD Manages the recruitment, deployment and welfare of House Officers, Medical Officers, Residents and Dental Officers across Singapore’s public healthcare institutions, and Postgraduate Medical Residency Programmes. It also supports the recruitment of Allied Health Professionals (AHPs) and nurses for the public healthcare institutions and Intermediate and Long Term Care Sector (ILTC).

How to Prepare for the Qualifying Exam for Physiotherapy in Singapore

Working Abroad: Getting a Physiotherapy Job in Dubai



Searching for information on how to work as a physiotherapist in the UAE is like looking for a needle in a hay stack, there just doesn't seem to be enough information online.
The summary of the process of working in Dubai or the UAE sounds like this:

  • Get a job
  • Get licensed
  • Get your visa

So most physiotherapists will search for a job on Jobs in Dubai, when you get a physiotherapy job you can then proceed to apply for a license with the board.

The United Arab Emirates (UAE) is made up of seven Emirates with Abu Dhabi as the capital. Interestingly, there are three main health boards that handle the licensing process:

  • MOH - Ministry of Health - passing an exam for the MOH license allows you to work in five of the Emirates except Dubai and Abu Dhabi.
  • DHA - Dubai Health Authority - passing an exam for the DHA allows you to work as a physiotherapist only in Dubai.
  • Abu Dhabi Health Authority - HAAD- and yes you got that right....passing an exam for the Abu Dhabi Health Authority enables you to work as a physiotherapist only in Abu Dhabi. 

So much for being "united" right?

You really have to make up your mind in which of the Emirates you'll like to get a job.

How to work in Dubai/Abu Dhabi/UAE as a Physiotherapist

Points to Note

  • If you have a Bachelor's degree then you need to have at least two years work experience, if you have a Masters I'm not really clear on the years of experience you need but as a Senior Physiotherapist it is seven .
  • If you need training for the licensing exam you can try this company  I have no experience with them, but you may be able to get more information from them that can help you.
  • Here is another company that says they can help you with the licensing process in Dubai/UAE, I haven't tried them but it won't hurt you to find out about how they can help you get licensed with the DHA, MOH or HAAD.
  • I hear they have a preference for Western trained physios like UK trained physiotherapists but that doesn't stop you from debunking this and giving it a try. Then let us know how it goes.
  • Be careful with jobs offered you by small clinics, always read your contracts well don't just assume you know what they mean or that they mean what you know or think. Employers have more rights than employees in Dubai.
  • You can also apply directly to the health authority that concerns you. After they have given you the permission to go ahead with writing the exams you can contact Pearson for a test date.
  • Go to HAAD for details of the test and license fees.l
  • You should register with the Emirates Physiotherapy Association 
Here's some helpful information from the Ministry of Health document on requirements and qualification (note that physiotherapy is classsified as allied health)


Allied Healthcare professionals applying for licensure must fulfill the following requirements:

  •  Must be graduates from National and/ or International recognized college/University.
  •  For graduates from the UAE universities, the program and university must be accredited by the Ministry of Higher Education and Scientific Research (MOHESR).
  •  Higher diploma certificates from The Higher Colleges of Technology in the UAE will be equivalent to Bachelor degree as per MOHESR standard 
  •  Master degree or PhD (in the area of specialty) will reduce one (1) year from the required experience for licensing provided that the Master’s/ PhD degree is not mandatory to obtain the selected title. 
  •  Qualifications acquired through honorary nature, correspondence or distance learning are not counted towards the PQR requirements. 
  •  All non-UAE national graduate allied healthcare professionals from UAE universities are required to successfully complete Six (6) months internship post- graduation. 
  •  UAE National allied healthcare professionals are exempted from the experience and internship requirements for the basic entry level.
  •  Applicants must hold a valid License/ Registration to practice in their home country and/or country of last employment (where applicable).

1.1. Educational Qualifications
 Educational programs must be nationally accredited.
 Qualifications must be issued by institutions/ colleges recognized in home country.
At the entry level, minimum qualification requirement is high school certificate as per country specific education.
 Qualifications are evaluated in accordance to the following criteria:
o The country and institution from which the qualification was awarded
o The level of national /international recognition of the qualification
o The duration and content of study, and the presence of clinical practice/ practical training.
o Qualifications acquired through honorary nature, correspondence or distance learning are not counted towards the PQR requirements.
 Qualifications not mentioned in this document may be evaluated and reviewed by the Authorities joint committee who may grant the applicant with the appropriate title.

1.2. Professional Experience
Physiotherapists should have a minimum of a B.Sc with 2 years work experience minimum and 1 year work experience for Masters degree holders.

1.3. Professional License and Good Standing Status
 The applicant must have a valid professional license to practice, or registration (where applicable) from home countr and/or country of last employment.
 The validity of the license/registration (where applicable) should cover the minimum required experiences for the applied title.
 Good Standing Certificate (GSC) must meet the following requirements:
o Valid and not older than six (6) months at the time of application for licensure
o Issued by the Health Regulatory Authority in the country(s) of last employment. In countries that lack regulatory bodies GSC may be accepted if issued officially from last employer. 
 The Authority may request more evidence or conduct investigations if deemed necessary to prove the status of good conduct of the healthcare professional.
The applicant must declare that he/she has never been convicted with any legal cases, medical malpractice during
his/her practice of the healthcare profession or he/she is currently under investigation.

1.4. Primary Source Verification
 The documents required for licensing shall be verified directly from the original or primary source
 These documents include but not limited to: educational qualification(s), experience certificate(s), professional license(s) and/or any other documents deemed necessary by the Authorities.



 Please let us know how your licensing process goes when you are done.



Jobs in Physiotherapy

What Causes Sciatica?

Simply put, sciatica describes a kind of leg pain that is felt along the path of the sciatic nerve. The sciatic nerve route is from the lower back to the buttocks, to the back of the thighs, calf and foot.

Irritation of the nerve root
The sciatic nerve has its roots or origins in the fourth and fifth lumbar vertebrae, and the first, second and  third sacral vertebrae (L4, L5, S1, S2, S3).
Symptoms of sciatic pain occur as a result of an irritated or compressed sciatic nerve and this means that sciatica is actually a symptom of an underlying condition and not necessarily a "condition" on its own.

Common causes of Sciatica or sciatic nerve pain

Herniated inter vertebral disc
A herniated lumbar disc is a common cause of sciatica. A disc hernia or slipped disc occurs when the core(nucleus) of the disc leaks out of the outer fibrous tissue. This leak can then cause an irritation of a nerve root.

Spondylosis
Spondylosis is osteoarthritis or degeneration of the vertebral discs. Degeneration of these discs occur mostly as a result of age; these kind of changes in the disc can lead to the irritation of the sciatic nerve root.

Spinal stenosis
Spinal stenosis is the narrowing of the spinal canal of the vertebrae. This is an effect of the ageing process of the spine and is common in people above the age of 60.

Piriformis syndrome
The piriformis is a small muscle in the buttock under which the sciatic nerve passes. Pain similar to sciatica may be felt if the piriformis muscle compresses the sciatic nerve.

Pregnancy
In the last trimester of pregnancy where there is increase in blood flow to the spine, there may be a resulting compression of nerves.

Other causes of sciatica are muscle strain, spinal tumours, inflammation, infection and trauma.

What are the typical sciatica symptoms?

Common symptoms of sciatica are leg pain, tingling, numbness and muscle weakness. A sufferer of sciatica may likely experience pain in one leg/buttock that gets worse while sitting. He/she may also feel a burning or tingling sensation (pins and needles) anywhere between the path of the sciatic nerve from the buttock to the foot, depending on the level of the nerve root irritation.

For example, a compression or irritation of the spinal nerve root at the L4 level ( fourth lumbar vertebrae) will present with pain, tingling and numbness in the thigh area; while a compression of the nerve root at the L5/S1 level ( fifth lumbar and first sacral vertebrae) will produce pain and tingling in the foot.

It is also likely that the leg pain is more discomforting than the back pain felt by a sufferer of sciatica.
Another common symptom of sciatica is pain that worsens with increase of the abdominal pressure, like coughing or sneezing.

How can physiotherapy help?
Since sciatica is really the evidence or a symptom of an underlying condition, therapy will focus on treating this underlying cause and therefore management or treatment methods may vary.

The aim of physiotherapy management would be to relieve pain, promote healing of the affected structures and maintain normal function. Your physiotherapist will also focus on sustaining regular movement of the affected area ad this will help to accelerate healing.

Massage Therapy
Massage increases blood circulation, helps muscle relaxation and promotes healing.

Exercise Therapy
Your physical therapist can recommend back flexion exercises, extension exercises, stretching exercises and /or strengthening exercises depending on your condition or presenting symptoms.

Working Abroad: Getting a Physiotherapy Job in Canada

When it comes to Canada...hmm. Most physiotherapists I come in contact with want to relocate to Canada, can you blame them?

My experience with the Canadian government is that they are more organised than the US when it comes to the immigration of professionals. This experience also reflects in their credentialing process as they have a page where you can see how well your alma mater has done when it comes to equivalence of qualification. So there's a good chance you'll scale that hurdle and not just throw away money because credentialing "ain't cheap".

To have an idea of how your school has performed when it comes to the Canadian assessment of your qualification go here

Here's a summary of how to get working as a physiotherapist in Canada:

The Canada Alliance of Physiotherapy Regulators is the body that establishes whether the education and qualifications of internationally educated physiotherapists are substantially equivalent to those of the Canadian educated physiotherapists.

As an internationally trained physiotherapist you must pass through the  2 stages of qualification-
1st stage : Credentialing
2nd stage: PCE (physiotherapy competency exam). This comprises a written and clinical exam.
The documents you will need to send for credentialing are :
  • A filled application form
  • A notarized copy of Identity documents (like the biodata page of your international passport)
  • Notarized copy of a proof of change of name (like your marriage certificate)
  • A notarized copy of your degree/diploma
  • Application fee. ( the last time I checked the fee was $ 1015 CAD
You are NOT to send original copies only notarized copies of your documents. So just make copies of your documents and take to a magistrate or notrary public to stamp after sighting your original documents.
Your school also will have to fill a form D and send your transcript directly to the alliance.
You also need to do an English test; Canada accepts only the IELTS, and the testing body will be requires to send your results directly to the alliance.
The Canadian credentialing processing times have seriously improved, I know a colleague that took about two years to get his qualifications assessed! But now it is an average of 11 -15 weeks.
After Credentialing:
If your qualification passes the assessment then you are eligible to write the PCE exam. You will then be able to register for the written component of the exam. In some provinces you may be qualified to get a provincial license to practise physiotherapy under supervision.
It's important to check for the requirements of the various physiotherapy regions to see their demands, some are more friendly than others. I particularly liked Manitoba and British Colombia but it's up to you to decide.
Read more about the Canadian credentialing process here
Here are the links to five of the provinces in Canada you can check out links to the rest on the alliance website:

Having your credentials assessed will definitely give you an edge when applying for the immigration process express entry and getting a provincial license means you can actually start applying for jobs in Canada. Canada isn't really fussy about work experience or having a Masters degree, but if you do have any of these, it's all good.

How to prepare for the Canadian Physiotherapy Competency Exam

Want to work in Canada as a Physiotherapist? British Columbia wants you

Working Abroad: Getting a Physiotherapy Job in US

It's okay to look out for something different after being a physiotherapist in your present location for so long. Or maybe you are a fresh graduate seeking adventure and consciously plotting an international pathway for your career...Hmmm or maybe you graduated with a degree in physiotherapy and haven't really done much with it...The question remains the same....

How can I get an international job? Are there really jobs for physiotherapists abroad or is this career just overhyped?
Overhyped?!!
Are you kidding me?
The key to plotting the right graph for your career is information, so I will do my best to point you in the right direction so you can achieve your dream of getting an international job.

Are there actually best countries for physiotherapy jobs?
Well there are quite a number of places abroad where physiotherapists are seriously sought after, but I would start with what I call the big five: United States, Canada, Australia, Dubai and Ireland... Then maybe Singapore and some of the Caribbean but that depends on where you are interested in going.

So are there actually jobs in the US for physiotherapists?
The answer is yes. However, a number of employers in the US prefer you to have a Masters in Physiotherapy, but this should not hinder you from applying.
So what do you have to do to start working in the US as a physiotherapist?
Lots of confidence in yourself is very important; believe you are unique and you have something to offer irrespective of where you could have got your first degree.

Let me walk you through the process...
Firstly you need to research the over 50 states about what their requirements are for physiotherapy registration because I have found out that all states are not the same. Some are quite liberal others are just complex or bossy.
Remember, you have to make up your mind if this is what you want before you start this process, always count the cost and make up your mind to do all that's required of you...Just do your own part well and the rest will be a walk over.
Here are direct links to some of the physiotherapy boards in some States in the US
By my own opinion I think they are one of the liberal state boards, you may have a different opinion but I recommend you check out their requirements.
You can also check out the requirements for physiotherapy licensing in the other states of the US here
Let me give you a brief summary of the working in the US process and your responsibilities:
  • One of the major requirements of getting a physiotherapy license to work in the US is to pass the NPTE exam, which is a multiple choice clinical based exam. Everyone whether US or overseas trained write this exam. The last time I checked the exam was $400. The exam is organised by the FSBT( Federation of State Boards of Physical Therapy) and you can get more information about the exam here.
  • To be eligible to write this exam, yes you have to be eligible, imagine that....you have to have your physiotherapy curriculum assessed. This form of assessment is called credentialing and this is where the bulk of the process is.

US credentialing process
  • The Comprehensive Credential Review (Type 1) is a visa screening service to get a Health Care Worker certificate required for immigration and employment in US as a physiotherapist. There a few agencies accredited to carry out this education evaluation but FCCPT ( Foreign Credentialing Commission on Physical Therapy) is the most popular in my opinion.
  • The following states require a Type 1 review: California, Louisiana, Massachusetts, Nebraska, New Mexico, North Dakota, Tennessee, Washington D.C. I however figured that if you are outside the US and need to get a work or migrant visa you should go for the Type 1 comprehensive review.
So the type 1 Review actually includes
1. Educational Credentials Review
2. License verification to verify your eligibility to practice as a physiotherapist in your own country.
3. Verification of English proficiency: you need to pass TOEFL (Test of English as a Foreign Language). There is a required pass mark for this.
You can read more about this Type 1 review process here 
I also observed that there a lots of third parties sending your information to FCCPT which is likely to slow down the overall process - your transcript and syllabus should be sent by your school to FCCPT, the form filled by your licensing body will be sent by them to FCCPT and your TOEFL results will also be sent directly to FCCPT.
The moment the FCCPT gets all the required documents from you plus payment, the process should take about 8weeks, plus or minus. The last time I checked the fee for the Type 1 review was $810.

Physiotherapy Modalities that treat Back Pain(1)


What is Electrotherapy?

Electrotherapy is the use of electricity to treat medical conditions. However, because some physiotherapy machines don't actually use electric current for their treatment process, a wider term "electro physical agents" is also used to describe these modalities of treatment.
It's not a new discovery that electricity can be used to reduce both acute and chronic pain, it has actually been a practice for over 100years!

How does electrotherapy relieve pain?

When electric signals are introduced into the body the result is a release of the body's natural pain killers called endorphins. The electrical current also interferes with the transmission of pain signals trying to notify the brain and accelerates healing of the body tissues.

TENS for back pain

Trans cutaneous Electrical nerve stimulation (TENS) stimulates the sensory nerves and in the process activates the body's natural pain relief mechanisms.
TENS is a commonly used home-based treatment, as most patients are advised by their therapists to buy or rent one. The effectiveness of using TENS is dependent on the type of pain being treated, placement of the electrodes and frequency of the electrical stimulation
.
Hi TENS (Traditional/normal TENS)
Hi TENS or what is also known the traditional TENS involves the use of high frequency electrical stimulation, usually between 80-130Hz. This high frequency electric current stimulates "non-pain" nerve fibres (ABeta sensory fibres) and in the process block the painful stimuli from reaching the brain. This form of pain relief is commonly referred to as stimulation of the pain gate mechanism.The minimum treatment time for this form of pain relief is 30 minutes and it is well tolerated; however the greater period of the pain relief is experienced during the treatment with a brief lasting effect after the machine has been turned off.

Lo TENS (Acupuncture TENS)
Lo TENS uses low frequency  electrical stimulation  usually between 2-5Hz, with a higher intensity than traditional TENS. Lo TENS stimulates the Adelta sensory fibres to cause the production of the body's natural pain relievers called endorphins.
Though the Lo TENS stimulation may be less comfortable and the pain relief process slower than  than the normal TENS,  the resulting relief of pain lasts longer after the machine has been stopped. The minimum treatment time for the Lo TENS is also 30 minutes.

How to Place TENS Electrodes

Placement of TENS electrodes is key in achieving pain relief. These placement styles work differently for different people so you may need to try out various electrode positions to get what works for you.
You can place the TENS electrodes directly on the spot you feel pain, around the area you feel pain or on the nerve that supplies the muscle where you feel the pain.

Contraindications

If you are using a pacemaker its not advisable to use TENS as there is likely to be interference in the functionality of both the pacemaker and the TENS machine. TENS is also not  usually recommended for pregnant women or people with skin conditions.
Always consult with your physiotherapist for an accurate assessment of your back pain before getting a TENS machine as not all causes of back pain are indications for Trans Cutaneous Electrical Nerve Stimulation.

Interferential Current (IFC)

Interferential current is a deeper form of TENS as it penetrates more than skin deep into the tissues.
Interferential currents may be recommended to pain sufferers who haven't had any relief from TENS. IFC is usually administered by a physiotherapist, unlike TENS that can be used by the patient at home.

Effects of IFC

  • Interferential current relieves pain
  • Stimulates the muscles and helps maintain their function.
  • Improves blood circulation
  • Helps reduce swelling.


Back Care: How to Prevent Back Pain


The complaints and occurrences of back pain have increased tremendously with most people spending more time off work to get pain relief.

As I have said many times over, pain is the body's warning signal or siren....your body just wants to let you know that something isn't right. Paying attention to these warning signs will do you a lot of good and protect you from experiencing irreversible damage.

However, most cases of back pain are not so serious so recovery may occur within a few weeks. Early physiotherapy and maintaining a helpful level of activity, rather than outright bed rest will promote healing from back pain.

Structures of the back
The back majorly comprises the vertebrae ( bones that surround the spinal cord), intervetebral discs- which are the shock absorbers between every two vertebrae, muscles, ligaments and spinal nerve roots.

Back pain prevention
These structures can be misused or traumatized even in your simple and regular daily activities so it's important you learn how to care for your back and prevent unnecessary pain and discomfort.
Knowing how to prevent back pain or care for your back actually involves you making up your mind to sign up for a lifestyle change as there are likely to be many of your personal habits and/or working or living environment that will have to undergo a somewhat radical change.

Posture

One of the  common causes of back pain is wrong or inappropriate posture- wrong sitting, standing, lying and working posture, improper lifting techniques... Basically assuming unfavorable body postures for an extended period of time
.
Here are important points to help you check your posture at all times


  • Get up and stretch regularly after sitting for long periods ( like over 2 hours). Most people at work forget that they are blessed with this free gift of just getting up and stretching.
  • Get a lumbar roll or pillow for extra support of the lower curve of your back while sitting especially when driving for long periods or distances.
  • Your work chair should promote good posture- the night of your chair at work should not be too high or too low- your hips and knees should be at the same level with your feet resting flat on the floor.
  • Your mattress should be firm enough to keep your back or spine in its natural shape and not cause excessive curving of your back.


Proper lifting method

  • Check how heavy the object you want to lift is, decide if you can carry it on your own or need help.
  • Stand close enough to the object, as lifting from a distance will compromise your balance.
  • Keep your legs apart, about the same width as your shoulder span
  • Bend your knees and not your back. Minimize bending your back to lift the object.
  • Lift the object as you simultaneously lift or straighten your legs.


Exercise
Aerobic exercises like brisk walking, jogging, swimming and cycling promote joint health. You can take part in some form of aerobic activity for about 30minutes a day for 5days in a week. This will also help to improve the condition of your muscles and generally increase your fitness level.
Being obese or having a pot belly will have a negative impact on your back by affecting the natural equilibrium of the back. Watching your weight, and preventing the accumulation of belly fat while maintain an above averge fitness level will help prevent the occurrence of low back pain.

Exercise for Back Pain Relief


It actually sounds contradictory to patients when they are referred for physiotherapy to treat their back pain and exercise comes up as part of the therapy... Who does that?

Most times when you experience any form of pain in any part of your body the last thing you want to do is move the affected part, but that's exactly what the physiotherapist wants you to do!

Do Exercises Relieve Back Pain?
The truth is carrying out the right movements will the right way are beneficial to healing, so back exercises do relieve back pain.
Research has proven that exercise is highly effective in the reduction of low back pain. The aim of the back exercise program given you by your physical therapist is for restoration of the strength and endurance of your back muscles. These back exercises also improve joint health, flexibility, blood circulation and relieve stress.

Back Exercises
Exercises that focus on the stability of the back also strengthen the core back muscles. The core back muscles also include deep abdominal muscles . These abdominal muscles can help to relieve back pain when in optimal condition.

Your core back muscles are also linked to your pelvic floor muscles, so its very likely that an exercises therapy program for back pain will include pelvic and lower limb exercises.

Endurance and strength training of the back muscles
In as much as there are numerous back exercises online recommended by many websites, you should still stick to those prescribed by your physiotherapist.
Your physiotherapist may decide to include strength and endurance exercises for the back depending on your presenting symptoms and diagnosis.

Here are some back exercises that help relieve back pain, increase muscle strength and also boost flexibility.
Exercises should be carried out gradually and are best done under the supervision of or with the approval of your physical therapist. She will ensure she regulates the frequency and intensity of the back exercises you are doing. This precaution ensures you don't "over do" it as one of the side effects of exercise is muscle pain. If your muscles get overworked you'll end up " adding pain to the existing pain".

Pelvic Tilt


  • Lie on your back (face up) on a firm surface like an exercise mat.
  • Bend your two knees ensuring your feet are flat on the mat.
  • Tighten your tummy muscles while attempting to flatten the small of your back (lower back curve or lumbar curve) as if trying to press it against the mat. You can place your hand in that lumbar curve to monitor your contractions.
  • This action moves your pelvis as your pelvic muscles get contracted.
  • Hold this contraction while counting to five (5 seconds)
  • Repeat this action about 5 times.


Single Knee to Chest Stretch


  • While still in the same position, lying on your back with both knees bent and feet flat on the mat, take your knee to your chest
  • Raise the first knee and pull gently with your arm to your chest till you feel the stretch.
  • Maintain that stretch for 5 seconds
  • Switch to the other knee and carry out the same knee to chest stretch. Maintain the contraction for 5 seconds
  • Repeat this stretch fives on each leg


Bridging

  • In the same position, lying on your back with both knees bent and feet flat on the mat, place your arms stretched out palm facing downwards on the mat.
  • Lift your pelvis off the mat higher than the shoulder level and tighten your stomach muscles.
  • Count to five then lower your pelvis gently to the mat.
  • Repeat this exercise 5 times.

Progression of these back exercises should be monitored by your physiotherapist.
If while carrying out any of these exercises you feel any discomfort or pain aside the initial pain you felt before commencing the exercises, stop immediately.
All back pain do not have the same causes or remedies, so your physical therapist is in the best position to guide you on what pain remedy is best for you.


How Can Physiotherapy Give Relief From Back Pain?


What is physiotherapy or physical therapy?

According to the WCPT (World Confederation of Physical Therapists):
"Physical Therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation."
"Physical therapy provides services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the life span. This includes providing services in circumstances where movement and function are threatened by ageing, injury, pain, diseases, disorders, conditions or environmental factors."
So a physiotherapist or physical therapist will always be concerned about you maintaining or improving your movement functionality. Anything that hinders or otherwise facilitates your movement will be of utmost concern and priority.

Interestingly, pain is one of the major hindrances to movement and that is why physiotherapy is very much in the mainstream when it comes to pain management.
All back pain don't have the same causes, so based on your physiotherapist's findings or assessment she will come up with a treatment program scheduled to meet your own needs.

There are a variety of causes of low back pain which may indicate whether the back pain is specific or non specific. Majority of people who complain of low back pain present with a non specific cause. Non specific back pain simply indicates that the cause of the back pain is not specific or linked to any pathology.

The less common specific low back pain is back pain with a specific cause or pathology like cancer, trauma, fracture, spinal stenosis and disc prolapse.

The main focus for physiotherapy management of pain is:

  • Relieving pain
  • Muscle Strengthening
  • Restoring normal range of movement (ROM)
  • Restoring normal function
  • Preventing a re-occurence

Pain Relief
There are a number of physiotherapeutic pain relieving modalities and methods, but it's up to the physiotherapist to decide on which is best for your specific situation.
Treatment options include ice, soft tissue massage, acupuncture, exercise and electrotherapy.

Strengthening and Mobilization
There are various techniques to achieve the goal of strengthening weak muscles and restoring the normal range of movement of the back. The physical therapist can prescribe back exercises and or  apply manipulative techniques depending on your presenting situation. Physiotherapy will also include balance training and teaching proper walking patterns.

Education
Your physiotherapist will educate you on how to care for your back and prevent damage or back pain re-occurence. You will be taught exercises that will protect and support your back and also prevent recurring back pain.

Postural reeducation and lifestyle changes are key points that your physiotherapist will also address.

This is a very important aspect of back pain management as research has shown that low back pain returns when preventive measures are ignored.

In some cases your physical therapist may recommend the use of a back brace, depending on your presenting condition. However, this period of immobility will be closely monitored as movement of the back is an extremely important component of the healing process.

What Causes Low Back Pain?


Why Pain?

Pain is the language your body uses to notify your brain about the presence of a threat to your body. In the actual sense of it, pain is really not a bad thing in itself. However, not responding to this "SOS" message might lead to a critical situation. Interestingly, the degree of pain isn't directly proportional to the level of damage, so just because the pain you feel is severe doesn't mean the damage is a lot and feeling mild pain doesn't mean there isn't any damage.

So what causes of low back pain?

What does this kind of pain mean? Where exactly are the signals coming from? How do you respond to them? Is there anything to be worried about? What kind of treatments can give relief from low back pain? How can physiotherapy or visiting a physiotherapist help?
Firstly, let's look at the back. What structures actually make up the back?

What makes up the back?

Bones
There are 33 small bones called vertebrae that make up what is called the vertebral column. The vertebral column starts from the neck, just below the skull (head) to the pelvic girdle. The vertebrae in the neck area are called the cervical vertebrae and they are seven in number. Next are the thoracic vertebrae, which constitute the upper back and are 12 in number. There are five lumbar vertebrae in the lower back. Finally, you have the triangular shaped sacrum (sacral vertebrae) made up of 5 bones fused together and the coccyx (tail bone) made up of 4 vertebrae at the end of the vertebral column.

Discs
The intervetebral discs are ligament-like structures that are located between every two vertebrae all the way down the vertebral column. So the vertebrae don't just sit directly on easy other but are separated by shock absorbers or cushions called inter vertebral discs. Movement in your backbone is "cushioned" by these discs.

Spinal Cord
"The cord from which all nerves in the body originate" is refered to as the spinal cord. The spinal cord is actually encased and protected by the vertebral column.

Muscles
Muscles are part of the supporting structures of the vertebral column. These muscles are responsible for all your back movements and support your back in assuming various postures such as sitting, standing, running and so on.
Other structures in the back are the spinal nerve roots, ligaments and facet joints.
So now that you have an idea of what makes up your back, having an idea of what causes back pain will be much clearer and easier to comprehend.

What is Low Back Pain?
Low back pain is one of the top five reasons why people see a doctor. According to S.Kinkade, low back pain is "pain that occurs posteriorly in the region between the lower rib margin and the proximal thighs". (Proximal - upper)

Common causes of low back pain


  • Arthritis of the vertebral facet joints also called spondylosis is a cause of low back pain. Spondylosis is more common in older people as degenerative changes take place occur with use and age.
  • Disc Prolapse or disc bulge is another cause of low back pain. This can occur as a result of increased pressure in the intervetebral discs. Actions such as lifting heavy loads increase the disc pressure. Nerve root compression resulting from a disc prolapse can produce severe discomfort.
  • Degeneration of the intervetebral disc negatively affects its shock absorbing properties. A degenerated disc is reduces the intervetebral disc space which can also lead to arthritis.
  • Increase in body fat affects the spine or back biomechanics. Obesity puts excess strain on structures of the back. It's important to note that your deep abdominal muscles also serve the function of supporting the back. So having a "pot belly" alters the lordotic curve (lordosis) or the "small of your back" by exaggerating the curve.
  • In the workplace setting, standing or sitting for more than two hours at a time, can cause a strain on your back. Driving for long hours and  lifting heavy loads are also causes of low back pain.


What is Specific Low Back Pain?
When low back pain is specific, it simply means that the cause of the pain is specific or there is an underlying pathology. Common causes of specific back pain are cancer, fracture, spinal stenosis or disc bulge.

Non Specific Low Back Pain
Most people that complain of low back pain present with the non specific type. Non specific back pain is any type of back pain in the lower back (lumbar region) that doesn't have a specific cause or serious underlying pathology (disease).