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Physiotherapy or Exercise Physiology?

My patients often ask me the differences between a Physiotherapist and an Exercise Physiologist (EP).

Many are unsure which type of health professional would best help them with their particular physical problem and when to seek treatment.
In some cases, a GP may help with the decision; at other times, it is down to the patient to decide where to start their therapy journey. 
Let’s take someone with low back pain and stiffness as an example.
low back pain discWhen to see a physiotherapist?
If you are struggling with low back pain, your first consultation is usually with a physiotherapist. 
Your physiotherapist will ask questions about how your back feels, what makes it feel better or worse, and how and when it got sore. You will also be asked about your general health, lifestyle, exercise habits, work environment and more so that your physiotherapist can learn more about you to better tailor treatment to your specific needs. A thorough physical assessment is then carried out, including a review of any scans you may have had. 
Your physiotherapist then puts together the various parts of your assessment using a process called clinical reasoning to make a diagnosis and develop a treatment plan. 
Physiotherapists use a wide range of treatment techniques that can be combined as part of an integrated treatment approach. These may include pain management education and advice, ‘hands-on manual therapy techniques, therapeutic exercises, acupuncture, dry needling, and electrotherapy as examples. The physiotherapist decides which techniques to use based on their skills and experience while considering your preferences as the patient. Physiotherapists must always follow a code of practice that requires them to use techniques that have been scientifically validated.
Summary: Physiotherapists are experts at assessing, diagnosing, clinically reasoning, planning and implementing treatment plans for pain and other physical problems. 
When to see an EP?
EPs are also University trained healthcare professionals who often work closely with physiotherapists and specialise in all aspects of exercise and body movement. 
Continuing with the example of low back pain, once your pain symptoms have significantly reduced, your physiotherapist may then refer you to an EP. The EP will then work with you and progress your exercises to help you further improve your spinal mobility and strength to reduce the risk of lower back pain coming back.  
Another example of when the skills of an EP are invaluable is when someone recovering from low back pain is aiming to return to high-level sport. In this case, an EP will build on the initial work done with the physiotherapist to prepare you for a successful return to sport. There may be a focus on advanced strength and conditioning, mobility and flexibility, balance and agility, and sports-specific exercises and drills.
It is not only athletes who benefit from exercise physiology. Many complex day-to-day functional tasks like climbing stairs may require an EP to ensure you can ascend and descend safely without risk of injury. Another example is the prevention of falls. EPs work with patients of all ages and different body types, breaking down daily functional tasks and developing each component to achieve the best results. 
Summary: EPs specialise in exercise and movement and work closely with physiotherapists. 
Working together 
Some physiotherapists may recommend that you consult with an EP earlier in the treatment journey, others later on, for example, once you have achieved a level of pain-free mobility and function. How and when a physiotherapist and an EP work together depends on the patient's individual needs, and communication is vital to ensure both therapies complement each other.
If you would like to find out more about how a physiotherapist or an EP will be able to help you, please get in touch by emailing me at This email address is being protected from spambots. You need JavaScript enabled to view it.
By Simon Coghlan
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