In a flash poll conducted by the Australian Physiotherapy Association (APA), over 90 per cent of physiotherapists said they have treated patients suffering after unnecessary and potentially harmful surgeries. This comes following a confronting exposé of Australia’s chronic pain industry on ABC Four Corners, which highlighted potential overuse of surgical procedures, despite physiotherapy treatment being considered part of best practice.

The APA’s survey underscores a long standing bias in healthcare. Funding models, particularly Medicare, favour surgical procedures and pharmaceuticals, while non-surgical, person-centred care modalities like physiotherapy receive scant funding. This is despite evidence that physiotherapy can significantly reduce the need for these invasive and sometimes harmful interventions. When such interventions are under consideration, clinical care guidelines insist that physiotherapy must be considered as a low cost, low risk and effective treatment.

APA Pain National group Chair and Specialist Pain Physiotherapist Dr Tim Austin* says in response to the Four Corners episode, “It's time for health professionals of all disciplines to fully inform patients about the harms and benefits of different treatment options available; particularly for chronic back pain”. 

“The evidence clearly supports physiotherapy as the first line of treatment for low back pain. The Australian Commission on Safety and Quality in HealthCare's Low Back Clinical Care Standards emphasise physiotherapy not only as a stand-alone intervention, but also as a key part of truly integrated multi-disciplinary treatment.”

“Too often, patients are funnelled towards surgeries including spinal fusion and the insertion of spinal cord stimulators without being fully assessed and informed. In many situations, safer, less invasive evidence-based interventions are appropriate or should be trialled before there is any consideration of these invasive procedures," Dr Austin said.

Many patients are referred to physiotherapy only after undergoing surgical procedures, limiting the physiotherapist's role to postoperative rehabilitation instead of preventive or first-line management. 

"This not only compromises patient safety but also reflects a gross underutilisation of physiotherapy's potential in preventing unnecessary surgeries. 

“Full utilisation of physiotherapists’ scope of practice has the potential to save the healthcare system a substantial amount of money and dramatically improve the lives of many Australians," Dr Austin said.

The APA advocates for the introduction of a Medicare funded physiotherapy management plan to subsidise physiotherapy for patients with chronic pain, ensuring access to non-operative therapies before considering surgical options. 

“In cases where surgery is considered necessary, it should not be the first or only option presented to patients. Physiotherapists must be included in the overall assessment process of patients prior to these significant surgical interventions," Dr Austin said. 

The APA calls on the government to realign health service funding to support evidence-based, non-surgical treatments that prioritise patient safety, efficacy, individual choice and quality of life.

"Physiotherapy offers a holistic approach to pain management, focusing on improving function, educating patients and enabling them to live their lives to the fullest. It's time our healthcare policies reflect this," Dr Austin said. 

 *As awarded by the Australian College of Physiotherapists in 2021