Decision guide · Physiotherapy and medicine
You've had physiotherapy and you're still in pain: what should you review now?
The short answer
It doesn't mean the physiotherapy was wrong. It means it's time to look at the map again.
When a well-done treatment doesn't give the expected result, it is rarely the treatment's fault: usually a piece of the diagnosis is missing, or a test, or a factor that wasn't in the plan. A lot of my work is exactly that: finding what is blocking the process and preparing the ground so physiotherapy can work. We don't compete — we work together.
Step 1 · Your situation
Which one sounds most like you?
Tap yours and I'll tell you what usually lies behind it and what makes sense to do.
Step 2 · Who does what
Physiotherapist and rehabilitation doctor: two jobs, one patient
They don't compete. They share the work — and in my case, literally: I see patients inside physiotherapy clinics, with the same teams who then treat my patients.
The physiotherapist assesses and treats function and movement
- Assesses your function, designs the recovery work and leads it: manual therapy, supervised therapeutic exercise
- Sees you week after week and adjusts the work
- May recommend a medical assessment when they feel it adds information or new options to the process
If you have a clear diagnosis and need to recover, starting here makes complete sense.
The rehabilitation doctor brings the medical assessment
- Puts a medical name to the problem: which structure and why
- Assesses whether a test is needed (in-consultation ultrasound, MRI, blood tests) and which one
- Assesses medical treatments: injections, hyaluronic acid, PRP, nerve blocks
- Refers you to orthopaedic surgery if the case needs it
And the coordination is not just good intentions: in my practice it is organised. After each treatment I give you an individual plan of when to resume the work, for you to fit in with your physiotherapist; when we work in coordination, we both know the plan.
In one sentence: each professional brings something different and decides within their own field. When both work with the same information, the patient gains time.
And after a medical treatment — what happens to my physio sessions?
It is not improvised, but there is no single rule either: the plan depends on the technique, the area treated and your case. After some procedures, physiotherapy can continue from very early on, when indicated; after others, it makes sense to adjust the load for a short period. I give you the plan at the consultation, for you to fit in with your physiotherapist. This is how the teamwork works →
Step 3 · What I review in each case
"Weeks in and nothing has changed"
If after several weeks you are not progressing as you both expected, it can help to review the diagnosis, the goals and the recovery plan, and consider whether a medical view should join the process.
The first things I review
- Whether the starting diagnosis was pinned down, or was just «knee pain»
- Whether what hurts is what was being treated: sometimes the knee pays for what happens at the hip or the ankle
- Whether there is something the examination and the ultrasound can see that changes the plan
What happens next
- If I find something new, we share it with your physiotherapist so the work can continue with that information
- If the diagnosis was correct, we assess whether a medical treatment can unblock the situation
- If it's not my field, I tell you whose it is
"It improves, then comes back as soon as I get going"
The most frequent pattern in tendons and overload injuries: the treatment calms things down, but the cause is still there.
What usually lies behind it
- A tendinopathy that needs progressive loading, not just rest
- A return to activity that was too fast or not adjusted
- A mechanical factor (technique, footwear, strength elsewhere) no one has looked at
What I add here
- Ultrasound of the tendon at the consultation: how it is and whether there is something else
- If indicated, a treatment that helps the tendon tolerate load
- And a return-to-activity plan agreed with your physiotherapist, not in parallel
"Something new has appeared"
Swelling that wasn't there before, loss of strength, pain that wakes you at night, tingling. These are signs it is worth reassessing — and that a medical view is probably due.
Why it deserves an assessment
- A new symptom changes the questions — and sometimes the answer
- It may be something an examination and one test can clarify in a single consultation
- Your physiotherapist may also recommend it when they feel it adds information or options to the process
What may happen
- The original diagnosis is confirmed and we adjust the plan
- Another cause appears and we change the approach
- Orthopaedic surgery or another specialist is needed: I tell you straight
"No one ever told me what I have"
«Tendinitis», «overload», «muscle tightness»: these are descriptions, not always diagnoses. And without a diagnosis it is hard to know whether the plan is the right one.
Putting a name to the problem
- A full examination, and in-consultation ultrasound if it adds information
- Which structure hurts, why, and what you can expect
- In writing — for you and for your physiotherapist
And from there
- With a specific diagnosis, the physiotherapy work can be better targeted
- If a medical treatment makes sense, we discuss it
- If everything was on the right track, I will tell you that too: sometimes all that was missing was time
If you only remember three things
- Physiotherapy not being enough doesn't mean it was wrong.
- Physiotherapist and rehabilitation doctor don't compete: each brings something different and decides within their own field.
- You don't have to choose: we usually work together, and you don't need to leave your physio.
What it does NOT necessarily mean
- …that you must «escalate» to injections or surgery: sometimes the plan just needs adjusting.
- …that your physiotherapist got it wrong.
- …that you need an MRI: examination first, and the test only if it changes the decision.
- …that you have to start from scratch.
These answer the typical fears; your specific case is assessed at the consultation.
Step 4 · What to do now
What you take home from the consultation
So you know what you're buying before booking: not «60 minutes», but leaving with a direction. English spoken throughout.
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Understanding what may be going on
I listen, review what you've done in physiotherapy, examine you, and scan with ultrasound on the spot if it adds information.
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Deciding whether a test or a treatment is needed
MRI only if it will change the decision. An injection, hyaluronic acid or PRP only if indicated in your case.
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Leaving with the next step
Continue with your physiotherapist with a more specific direction, add a medical treatment, adjust your activity, or be referred to another specialist. In writing — and if you already work with a physiotherapist, we share the direction so they can build it into your process.
Shall we review the diagnosis together?
Bring what you have — reports, scans, what your physiotherapist has told you — and in one consultation we see what's missing. And if everything was on the right track, I will tell you that too.
Frequently asked questions
I've had physiotherapy and I'm still in pain — does it mean I was treated badly?
Not necessarily. Physiotherapy treats what it is asked to treat, and does it well in the vast majority of cases. When pain doesn't improve as expected, the most frequent reason is not a treatment error but a missing piece: a diagnosis that wasn't pinned down, a test that adds new information, or a factor (load, sleep, another joint) that wasn't in the plan. Reviewing it together is normal — not a criticism.
Physiotherapist or rehabilitation doctor — who do I see first?
They are not alternatives; they complement each other, and each decides within their own field. The physiotherapist assesses and treats function and movement: manual therapy, supervised exercise, recovery. The rehabilitation doctor brings the medical assessment: tests, diagnosis and treatments such as injections. If you have a clear diagnosis and need to recover function, starting with physiotherapy makes complete sense. If you don't know what you have, you've gone weeks without improving, or you need to decide about a test or a treatment, a medical assessment helps orient the work. In practice, we often work at the same time.
Do I have to leave my physiotherapist if I come to see you?
No — quite the opposite. I see patients inside physiotherapy clinics precisely to work as a team. You leave the consultation with the plan of when to resume the work — individual to your technique, area and case — to share with your physiotherapist; and when we work in coordination at the same clinic, we both know the plan. There is no need to change professionals to consult me.
How much physiotherapy is «too much» without improvement?
There is no figure that fits everyone. As a general guide: if after several weeks of well-done work the pain hasn't changed at all, or has moved, or something new has appeared (swelling, loss of strength, night pain), it is worth reviewing the diagnosis. Your own physiotherapist may also recommend a medical assessment when they feel it could add information or new options to the process.