(This is something I wrote when I still ran an in-person clinic. I will adapt to online physio in a future article)

Physiotherapy isn’t a treatment, it’s a profession.

Each physio will have different experiences and influences that will guide how a course of treatment will goes.

We are evidence-based practitioners, but there is so much variability between people's physiology and circumstances that there is rarely, if ever, a perfect study that says exactly what is the best course of action for an individual.

I started my career in health as a massage therapist and the treatment choice was clear. You do a massage.

However, as a physio you have so many options and that is where it can get challenging.

The north star of my business decisions is making my sessions as valuable to my patients as possible. Figuring out how to do that has been challenging (and I haven’t always got it right) but I am always trying.

When I worked in professional sport (the AFL), some players were paid >$1m a year so hitting them with every possible treatment modality to get even incremental speed of recovery increases makes a lot of sense. So, coming in for 2 massages a week, seeing the physio daily for needling or mobilisations made sense.

But for people who are not pro athletes, an incremental speed of recovery benefit will probably not be worth what it would cost them.

The treatment hierarchy of needs is the framework I developed to help guide me and my patients through the decision of how many sessions they choose to book and what we do in those sessions.

This framework is based on my interests, experience, qualifications (exercise science as well as physio), and typical client base so I recognise other physios will go about this in a different way.

I would love to hear your feedback on the treatment hierarchy and if there is anything you would add or subtract.

The bottom of the pyramid – What I think should be addressed as the priority

Goals – Short and long term
Diagnosis (what has happened)
Education about condition & prognosis (what to expect)
Pain science basics
Flare-up strategy
Acute pain management via hands-on treatment or heat (but not dragging on as the only thing we do week after week)
Recovery (short- and long-term strategies) – acute management + sleep, nutrition, stress management
Psycho-social factors – identify barriers, limitations, and facilitators of the plan
Communicating with and referring to other health professionals
Return to sport testing
Decide on treatment plan

The middle of the pyramid – Very important to make time for

Baseline testing
General exercise program
Specific exercise program
Periodisation plan for program (how to progress it towards your goals)
Exercise technique
Self-Release Guidance

Top of the pyramid – Great to have as part of the treatment strategy if everything else is also being addressed

Manual therapy/mobilisations
Massage
Heat pack
Dry needling – I do not do this in my clinic
Machine based treatments (shockwave, therapeutic ultrasound, interferential, TENS, etc.) – I have chosen not to offer these treatments as I do not believe they have enough benefit to justify the cost

The Physio Clinic Treatment Hierarchy

(This is something I wrote when I still ran an in-person clinic. I will adapt to online physio in a

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