Physiotherapy is ‘shackled by outdated perceptions’ and is widely perceived to be ‘a pain-relief service’, according to two leading members of the profession in the UK.

The two authors – Kate Purcell, whose correspondence address is given as the MacKenzie Medical Centre in Edinburgh, and Neil Langridge – have written a challenging editorial that is currently listed (24 March) as being ‘in press’ by the journal Physiotherapy.

Ms Purcell and Dr Langridge argue that the time has come for the physiotherapy profession to shed its long-standing association with pain relief, saying this is ‘rooted in traditional, Cartesian views of pain as a purely physical problem’.

Practitioners’ management approaches must evolve as people’s understanding of pain as a multifactorial experience grows, they suggest. ‘Moving beyond the limited goal of pain reduction, we can reclaim our identity as movement optimists, coaches, and enablers of meaningful recovery.

‘This shift is not merely semantic; it represents a fundamental transformation of physiotherapy’s role in modern healthcare, enabling it to meet society’s complex health needs.

Fostering resilience

Ms Purcell and Dr Langridge urge the profession to align itself with the biopsychosocial model of health promoted by the World Physiotherapy Confederation in its definition of a service that aims to ‘develop, maintain, and restore maximum movement and functional ability.

‘Guiding patients to prioritise meaningful activities over symptom relief empowers them to view their health through the lens of possibility rather than limitation, fostering resilience and realistic expectations for recovery.

‘Despite this progress, physiotherapy remains shackled by outdated perceptions, often seen as a pain-relief service. This perception likely persists due to lingering assumptions from a biomedical era. Healthcare systems reinforce a pain-centric framework by referring patients with pain-based labels like “back pain” and “shoulder pain”, embedding the expectation that physiotherapy exists to reduce pain rather than restore function.’

Many clinicians admit to facing professional and societal pressures to deliver structural diagnoses – despite evidence that most musculoskeletal pain is non-specific and is rarely attributable to a single cause, they note.

‘While diagnostic labels may momentarily validate patients’ experiences, they can also result in negative physical and emotional consequences, leading to unnecessary interventions and an overburdened healthcare system.’

In a call to arms, Ms Purcell and Dr Langridge urge physiotherapists to develop communication skills that ‘validate patients’ experiences’ while ‘conveying uncertainty, moving away from potentially misleading diagnoses’.

They point out that ‘recognising and normalising’ uncertainty does not mean ‘ignoring pain or specific diagnoses’: rather, it involves updating knowledge to ‘align with contemporary pain science and developing metacognitive and clinical reasoning skills to identify cases that need specialised care’.

Clinicians should aim to guide patients toward ‘realistic, function-focused goals and move beyond passive, short-term treatments’. The profession needs to ‘step up, embrace complexity, and reframe care as a collaborative journey’, the authors note.

‘By fostering resilience and staying true to our role as movement optimists and functional coaches, we can break free from the limitations that threaten to devalue our profession in modern healthcare’ [Kate Purcell and Neil Langridge]

Why is change important?

‘By taking a broader view of modifiable contributing factors and creating healthy psychobiological environments for recovery, physiotherapists can foster lasting outcomes that empower patients to manage their health beyond pain reduction.’

Physiotherapy’s strength, the authors argue, lies in its adaptability, while realising its full potential requires openness to change and collective action. ‘Employers, professional organisations, and insurers must align practices with modern standards and patient needs, note Ms Purcell and Dr Langridge.

Physiotherapists must ‘seize this moment to redefine their role’ – not just as care providers but as leaders in reshaping how society views and manages pain and health.

‘We must challenge outdated norms and reductionist care models, and drive innovation in a function-first approach that empowers patients rather than pathologising them. Doing so requires reflection, collaboration, and a commitment to shifting the narrative from reactive pain treatment to proactive health optimisation.

Change is ‘not easy’

The authors acknowledge that changing mindsets will ‘not be easy’. ‘We are not just attempting to lift individual patients out of a pain-centric mindset – we must also challenge our own ingrained beliefs, support our colleagues, and push back against harmful narratives perpetuated by media, healthcare and society.

‘By fostering resilience and staying true to our role as movement optimists and functional coaches, we can break free from the limitations that threaten to devalue our profession in modern healthcare. In doing so, physiotherapy can fully realise its mission: empowering people to achieve optimal function and a better quality of life – the true essence of our profession.’

To read the full version of the editorial – titled Redefining the Role of Physiotherapy in Modern Healthcare: A Shift from Pain Relief to Functional Empowerment – see: https://www.physiotherapyjournal.com/article/S0031-9406(25)00321-9/fulltext

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