As physiotherapists, we are trained to detect RED FLAGS (i.e.: lesions to central nervous system, spinal cord lesions, cauda equina lesions, tumors, etc). Red flags are basically signs that there might be something non-mechanical that might be the root cause of pain. By ruling out systemic causes, we can ensure that we are indeed working on mechanical problems that physiotherapists can resolve most times. Those who presents with RED FLAGS or are non-responders would be referred back to MD for further investigation or to other healthcare provider.
Every once in a while, we would have a patient tell us he is not getting better or that there is “no change”. I would definitely re-assess the patient’s range of motion, strength, or any other limitations once again. These patients would almost always show improvement with one or more component. Very often, patients believe that “they are not getting better” or “there is no change” because there is no change in the pain. This is only partially true because most patients are going to see improvement with range of motion, strength, or any other physical limitations way before pain starts to diminish. What is crucial is that with the same pain, the patient is able to accomplish much more than before!
It is common for physiotherapists to refer clients for acupuncture, osteopathy, massage, pool therapy whenever appropriate. Different disciplines can target the same problem but at a different angle and sometimes tissues just need to be stimulated in another way.