Physiotherapy is helping to fight the problem of obesity

Set up by four nurses in 1894, the Society of Trained Masseuses started life at a time when salacious stories about massage being used as a euphemism for sexual services were becoming rife.

For the modern incarnation of that early body – the Chartered Society of Physiotherapy, or CSP – the core mission remains one of using practitioners' unique understanding of the way the human skeleton moves to help people achieve maximum mobility.

Yet while high-profile work with elite footballers and other athletes dominates the popular image of physio, the profession is moving into new and pioneering areas of pain management and exercise. A specialism in a complementary therapy such as acupuncture is also becoming a popular career choice.

Dr Sally Gosling, assistant director of practice and development at the CSP, believes physiotherapy plays a crucial role in promoting public health and combating problems such as heart disease and obesity. "The value of exercise sits firmly on the Government's health agenda and allows our members to work with all sections of society, not just professional sports people.

"Our aim is to use manipulation or electrotherapy to enhance life, not simply extend it. For our practitioners, that may mean specialising in anything from paediatrics at a special school to providing hydrotherapy for stroke patients."

Career development for today's physiotherapist reflects the new scope of the profession, with both a high graduate employment rate and a new range of advanced-level consultancy roles.

While a 30-year physiotherapy career in the NHS might once have been the norm, up to 11 per cent of the 42,000-strong community of chartered physiotherapists and physiotherapy assistants in the UK are now in private practice.

Deciding whether to specialise in, perhaps, burns work, mental health, orthopaedics, paediatrics, women's health or overall pain control isn't the only choice to be made by an undergraduate.

Joyce Hughes, head of the physiotherapy programmes at Manchester Metropolitan University, says: "While a hands-on NHS role or an absorbing research post are obvious career paths, today's physiotherapy graduate can also choose to work in the not-for-profit sector, in industry, in the Armed Forces or even in veterinary practice.

"We've already had more than 500 applications for around 90 BSc places this year, and I believe the growing appetite for the profession reflects the enormous expansion of our role in society," she adds.

At MMU, where between 25 and 50 per cent of physiotherapy students tend to be male and a mix of mature students and college-leavers is the norm, the approach is predominantly case-led and problem-solving.

It's a more autonomous way of teaching, says Hughes, and it reflects the enormous variety in potential careers.

"While clinical observation is part and parcel of the course, particularly at the early stages of learning, our problem-solving approach recognises that with today's undergraduate considering anything from complementary medicine to orthodox musculoskeletal work, it is simply not possible to teach every possible scenario they will meet in professional practice."

MMU expects some evidence of relevant work experience prior to application, or at least some knowledge of what physiotherapy involves before an applicant is accepted for a place. Tuition fees are paid by the NHS and a means-tested bursary is available. "Relevant experience isn't mandatory," says Hughes, "but we do want to feel our students understand what we do and that working with elite sports professionals is only one small part of the picture."

If a fundamental understanding of how the human body works is an important skill in a physiotherapy student, equally critical is an empathetic approach. Common sense and time-management skills are also important.

Working abroad is now very popular, says Pauline Buttling, course leader in physiotherapy at Sheffield Hallam University. "Some of our students are keen to travel after they have finished studying, particularly to Australia and New Zealand where there are similarities in the hospital set-up, and although they have to re-sit entry exams, the experience of another country and health system can be invaluable," she says.

She believes a successful practitioner is a highly diverse person who can think autonomously and work with other professionals to ensure the best outcome for the client or patient.

"Both the status and employability of physios is increasing all the time and, not surprisingly, they are highly valued members of the healthcare team wherever they choose to work," she says.

At Sheffield Hallam, where the BSc in physiotherapy has progressed from being a diploma to an ordinary and now an honours degree, students are taught alongside occupational therapists, radiographers, nurses, social workers and paramedics. Buttling says: "The multi-disciplinary agenda is gaining in importance, and, as a practising physio, it is highly likely each case you encounter will involve anyone from the ambulance team to a senior consultant. Getting used to team-working now will stand you in good stead for later on."

'It's a job that has endless variety in terms of where you work'

Matthew Chambers, 24, is a third-year BSc physiotherapy student at Sheffield Hallam University. He already has a sport and exercise degree from the university, and after six years of continuous study is looking forward to his first clinical post.

"What attracted me to physiotherapy was the hands-on, manipulation side as well as the constant communication with patients. It's a job that appears to have endless variety in terms of where you work and who with.

As part of my practical assignments, I've done some stroke rehabilitation work among people with multiple problems at a high-dependence unit and, while that area of specialism is a major challenge, it's very current in terms of public health. Because of my previous degree, sports therapy is obviously an interest, but I'm also fascinated by musculoskeletal work, particularly given that it can involve all ages and situations.

I've heard from other male students that some of the placements can be spoilt by female cliques, but, luckily, I haven't experienced that. I'm aware the profession is dominated by women, but that isn't a problem for me. Nor is the fact that so many of my fellow students are older than me.

I've got one house-mate who's 21 and another in his late thirties, and, if anything, it really improves our social life. The patients don't seem to mind what sex you are, nor how old, just as long as you can help them restore some mobility and quality of life.

Although I'm far stronger academically than I was when I arrived at Sheffield Hallam, I'd still prefer to be a physiotherapist than a doctor; particularly now that there are so many career options open to me.

I'm not ruling out any sort of specialism, nor am I certain if I'll work privately or for the Health Service. As long as I can continue to help people, I'll be happy wherever I am."

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