Why your orthopaedic doctor didn't mention physiotherapy

If you have back pain, knee pain, shoulder pain, or any musculoskeletal problem in India, the journey usually looks like this. You see a general practitioner who prescribes painkillers (usually Diclofenac or Aceclofenac) and a muscle relaxant. If the pain persists, you are referred to an orthopaedic surgeon. The surgeon orders imaging (X-ray or MRI), identifies some structural finding (which may or may not be related to your pain), and recommends medication, injections, or surgery.

At no point in this pathway does someone say: "The most effective treatment for your condition, according to every international clinical guideline, is a structured exercise program supervised by a physiotherapist." This is not because physiotherapy does not work. It is because of how the Indian healthcare system is structured.

Orthopaedic surgeons in India are trained to diagnose and operate. Their medical education focuses on surgical interventions, and their practice economics are built around procedures. A surgeon who refers you to physiotherapy earns nothing from that recommendation. A surgeon who performs an arthroscopy, injection, or joint replacement earns a substantial fee. This is not to suggest surgeons are acting in bad faith. Most genuinely believe they are helping. But the system creates an incentive structure that does not favour conservative treatment.

The 5-minute consultation format in Indian healthcare also works against physiotherapy. Explaining the evidence for exercise-based treatment, managing patient expectations, and convincing someone that "doing exercises" is serious medical treatment all take time that most consultations do not allow. Prescribing a painkiller takes 30 seconds.

Finally, many doctors in India still view physiotherapy as a supplementary service ("do some physio after surgery") rather than a primary treatment. This is changing, but slowly.

The UK National Institute for Health and Care Excellence (NICE) recommends exercise as the first-line treatment for osteoarthritis, ahead of any medication. The American College of Physicians recommends non-pharmacological treatment (including exercise and physiotherapy) as the first line for chronic low back pain. The Australian Clinical Guidelines recommend against imaging and surgery for non-specific back pain and strongly recommend exercise-based treatment.

For conditions like osteoarthritis, non-specific back pain, frozen shoulder, rotator cuff problems, and most chronic musculoskeletal pain, the evidence is clear: structured exercise supervised by a physiotherapist produces outcomes equal to or better than surgery, with none of the risks.

In countries like the UK (NHS), Denmark, and Australia, patients must complete a physiotherapy program before being referred for surgery for most musculoskeletal conditions. This is not rationing. It is evidence-based practice. A significant percentage of patients improve enough that surgery becomes unnecessary.

In India, physiotherapists are independent healthcare practitioners. You do not need a doctor's prescription or referral to see a physiotherapist. You can book an appointment directly. A qualified physiotherapist (BPT or MPT) is trained to assess musculoskeletal conditions, identify what is causing your pain, and design an evidence-based treatment plan.

If your condition requires imaging or medical intervention, a good physiotherapist will tell you. Physiotherapists are trained to recognize red flags that require medical referral. The vast majority of musculoskeletal pain, however, does not fall into this category and can be effectively managed with exercise-based treatment.

This is not about choosing between doctors and physiotherapists. It is about getting the right treatment at the right time. For most pain conditions, the right first step is physiotherapy, not painkillers or surgery.

If you have been prescribed medication or surgery and want to explore physiotherapy first, you do not need your doctor's permission. But if you want to discuss it, here are practical approaches that work.

Ask: "Would it be reasonable to try physiotherapy for 6 to 8 weeks before we consider surgery?" Most honest surgeons will agree, because the evidence supports it. If a surgeon insists on immediate surgery for a non-emergency condition and discourages trying physiotherapy, consider a second opinion.

Ask: "What are the international guidelines for this condition?" This question signals that you are informed and want evidence-based care. For most musculoskeletal conditions, the guidelines support physiotherapy as a first-line treatment.

Remember: a good doctor will support your decision to try conservative treatment first. A doctor who dismisses physiotherapy without explanation may not be up to date on current evidence.

You can access physiotherapy without leaving home. Nuprana's online physiotherapy connects you with experienced physiotherapists who assess your condition via video, design a personalized exercise programme, and guide you through recovery with structured, regular sessions.

For most musculoskeletal conditions, an online assessment is as effective as an in-person one, because the primary assessment tools are observation of movement, functional tests you can perform at home, and detailed history-taking. Your physiotherapist will be upfront if your condition requires in-person evaluation or imaging.