How does my physio know what is wrong with me?

X-ray eyes? MRI scanners in his fingers? Intuition? Black magic?

It was suggested the other day that I write a quick post on how a physio knows what is wrong with you, and how they decide on what the appropriate treatment is.

Obviously this is going to differ from physio to physio when it gets down to the nitty-gritty, but by and large there are a couple of big headings under which our assessments tend to fall.

Red flags

The first thing a physio should be doing when you walk into the treatment is to assess for things called Red Flags. These are a number of signs and symptoms which essentially mean you really don’t need to be at a physio – you need to be somewhere with much more comprehensive care, like A&E. In my career to date, I have had one of these cases, and it was a case of “you really need to be somewhere else”. It is rare, but it does happen, and physios are generally quite well switched on to it.

Once it has been confirmed that you don’t have any red flags we go onto the Subjective stage…


This is the bit where we get the general history of what is going on, from the general to the specific. It’s good to get a decent amount of information here, as more often than not the patient pretty much tells us what is wrong and why. Information is great, though occasionally there might be almost too much of it! Sometimes the story of the problem is enough – and sometimes we need to delve a little more into the past as well. However, just hearing the information is not enough. We need to be able to Interpret the information… and to do that we need to match the Subjective with the next part, the Objective information.


This is the bit where all the testing gets done. Ranges of Movement, strength testing, checking if ligaments hurt or not, checking if muscles hurt or not, and a few other funky tests. There is currently a bit of a debate as to whether all this testing actually shows anything specific up as opposed to just “something hurts”. Theoretically, through this testing, when matched with the Subjective information we can get a working hypothesis as to what is the problem, and from there, we can work out what needs to be done in terms of support, rest and loading – which essentially ends up being the interpretive stage,


Now comes the fun part. Putting all the pieces together and working out what might be the main problem. (There may be more than one). According to what is the problem – muscular, ligamentous, tendon, neural etc. what stage of healing the problem has got to – Acute, sub-acute, chronic- and the amount of pain the person is in, the treatment is decided upon and given. This, as mentioned, tends to end up with a combination of rest, protection and loading.

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