As the saying goes, if I had a dollar for every time I was asked about the difference between physiotherapists and exercise physiologists, I'd be a rich man. This question frequently arises in interviews with aspiring exercise physiologists and discussions with colleagues, yet clear answers are hard to find.
Even the Australian Physiotherapy Association (APA) and Exercise and Sports Science Australia (ESSA) struggle to provide concise explanations that I can confidently share with clients or the average person. Despite trying their guidance, I often confuse my clients more.
Lately, I've thought deeply about this simple yet complex issue, and here's my take.
When treating people injured in motor vehicle accidents or through workplace incidents, the roles of physiotherapy and exercise physiology often intersect, leading to questions about the differences between these two professions.
Physiotherapists and exercise physiologists play critical roles in the rehabilitation process. However, their approaches and timing of interventions can vary.
It’s important to highlight that, despite these differences, both professions are guided by the same clinical framework for the delivery of health services as implemented by federal and state organisations like Comcare, the Transport Accident Commission (TAC), WorkSafe, and State Insurance Regulatory Authority (SIRA).
In my 30-year career as an exercise physiologist treating compensable injuries, I have yet to receive a referral within the first six weeks of the injury date. Referrals within 6-12 weeks are slightly more common, but historically, exercise physiologists typically don't receive referrals until at least 12 weeks post-injury. As much as we advocate for earlier referral, the reality is that when a person gets injured, they initially consult with a GP who then refers to a physiotherapist for treatment of musculoskeletal pain.
I don't disagree with this approach.
Physiotherapy primarily focuses on the assessment, diagnosis, and treatment of physical impairments and disabilities resulting from injuries. Physiotherapists use a range of techniques, including but not limited to therapeutic exercises, education on activity modification and pain management and various manual therapy techniques to help reduce pain and restore function. Their interventions are crucial in the early stages of injury management, addressing acute symptoms and preventing further complications. There's no question about the importance of their role.
Exercise Physiology, on the other hand, involves the prescription of exercise to improve function, fitness and health and wellbeing and manage chronic injuries and conditions.
So, let's concentrate on the differences that emerge post-12-weeks injury, as we move into the chronic phase, where physiotherapy and exercise physiology overlap.
A Unified Clinical Framework
The clinical framework for the delivery of health services, endorsed by TAC and WorkSafe Victoria and supported by numerous compensable schemes nationally, provides a cohesive guideline for health professionals including physiotherapists and exercise physiologists. All healthcare professionals providing services to injured people as part of transport accident or workers compensation schemes are expected to adopt these principles within the standards and boundaries of their professional expertise. The principles apply to all compensable injuries regardless of their severity. This framework emphasises a biopsychosocial approach to care, recognising that recovery from injury involves not just physical healing but also psychological and social wellbeing.
The five principles of the clinical framework are:
- Measure and demonstrate the effectiveness of treatment
- Adopt a biopsychosocial approach
- Empower the injured person to manage their injury
- Implement goals focused on optimising function, participation and return-to-work
- Base treatment on the best available research evidence.
The differences, or are there any?
Despite the distinct roles and timing of interventions for physiotherapists and exercise physiologists, I believe there is minimal difference between the two professions beyond the 12-week mark of injury, where their practices often overlap. Research indicates that most soft tissue injuries reach their optimal healing within 3-6 months, suggesting that any lingering issues are less about structural damage and more about complex, multifaceted problems.
All health professionals are recommended to follow the clinical framework to ensure comprehensive care, addressing every aspect of a patient's recovery journey. By adhering to this framework, both physiotherapists and exercise physiologists contribute to a seamless continuum of care, ranging from acute injury management to long-term rehabilitation and health maintenance.
Therefore, instead of focusing on whether a physiotherapist or exercise physiologist is more appropriate in delivering the treatment, we should prioritise the effectiveness of the treatment itself and measurements of success. This typically relates to outcomes such as functional capacity, work capacity, return-to-work, and overall return to life. The discipline delivering the care should be secondary to these crucial measures of success.
Conclusion
In summary, the distinction between physiotherapists and exercise physiologists, particularly beyond the 12-week mark post-injury, becomes less pronounced as their roles begin to overlap. While physiotherapists are integral in the early stages of injury management, focusing on acute symptoms and immediate functional restoration, both physiotherapists and exercise physiologists play a crucial role in the post-12-week injury period and in the long-term rehabilitation and health maintenance phases.
The clinical framework guiding both professions ensures that patients receive continuous, comprehensive care throughout their recovery journey. This framework emphasises the importance of addressing not just the physical aspects of injury, but also the complex, multifaceted issues that often arise during the healing process of those injured in motor vehicle accidents or in workplace incidents.
Therefore, when considering the appropriate intervention for a patient's recovery, shift the emphasis from the specific discipline providing the treatment to the outcomes achieved.
Use key measures of success to guide decisions, such as:
- Functional capacity
- Work capacity
- Return-to-work
- Return to life
Furthermore, it is essential to hold health professionals accountable for adhering to the clinical framework and achieving the best possible outcomes for their patients. This accountability should be based on measurable success as mentioned, ensuring that the treatment process is focused on delivering practical, effective care that leads to real improvements in patient recovery return-to-work and empowering independence.
Ultimately, both Physiotherapists and Exercise Physiologists are essential to the continuum of care. By leveraging the strengths of each profession and adhering to a unified clinical framework, we can ensure that patients receive the most effective and holistic care possible, leading to optimal recovery and return-to-work and life outcomes.
This article was written by John Cosentino, Exercise Physiologist and General Manager of OccHealth by Altius. If you're interested in learning more about how OccHealth by Altius can assist in facilitating your return-to-work process, please contact us for a comprehensive consultation. Our team provides tailored solutions that prioritise effective recovery and sustainable work reintegration.
