University of Birmingham researcher champions advanced physiotherapy roles to meet global MSK health challenges
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Musculoskeletal (MSK) disorders remain one of the leading causes of disability worldwide, presenting a major challenge for healthcare systems grappling with ageing populations and rising service demands. In response, a growing cadre of highly trained professionals - Advanced Clinical Practice (ACP) physiotherapists - are redefining how MSK care is delivered, offering timely, expert, and patient-centred solutions both in the UK and beyond.
Dr Michael Mansfield, Assistant Professor in Musculoskeletal Physiotherapy at the University of Birmingham, is at the forefront of research and education in this rapidly evolving area of healthcare. His latest work highlights how advanced physiotherapy practice, particularly within the NHS and similar systems, has transformed care pathways and offers significant potential for adaptation in low- and middle-income countries (LMICs), including across South Asia.
Advanced Clinical Practice is not just about extended roles - it’s about a shift in how we view physiotherapy’s place in the health system. By expanding scope and deepening clinical expertise, we’re improving access, reducing pressure on medical staff, and ultimately achieving better outcomes for patients.
Advanced practice in physiotherapy is underpinned by four pillars: clinical practice, leadership, education, and research. ACPs are highly trained professionals - often educated to Master’s level - who operate with a high degree of autonomy. In the UK, these roles are supported by Health Education England (NHS England) frameworks that ensure ACPs meet rigorous standards across clinical and professional domains.
In primary care settings, First Contact Physiotherapists (FCPs) provide rapid assessments, streamlining access to care and reducing waiting times. They may order imaging, perform injections, and in some cases, prescribe medication, depending on their training and local regulations.
Becoming an ACP requires a blend of academic learning and practical training. Postgraduate degrees - such as the MSc in Advanced Clinical Practice or Musculoskeletal Physiotherapy - equip clinicians with the skills needed to assess complex cases, lead services, and contribute to research and teaching.
The educational journey includes structured mentorship, and competency-based assessments, ensuring that practitioners are prepared for the demands of advanced autonomous practice. These professionals often play vital roles in mentoring junior staff, leading audits, and driving service improvement initiatives.
“Advanced practice isn’t a static qualification - it’s a career-long commitment to learning and leadership,” says Dr Mansfield.
The NHS has embraced ACP roles as part of a broader strategy to address workforce shortages and rising MSK demand. National frameworks, such as the NHS Long Term Plan and the MSK Core Capabilities Framework, provide essential infrastructure for training, governance, and service integration.
But the relevance of advanced physiotherapy practice goes far beyond the UK. Dr Mansfield argues that countries in South Asia, where MSK conditions contribute heavily to disability and economic strain, could significantly benefit from adopting and adapting the ACP model.
In India, for example, physiotherapists are formally recognised as autonomous practitioners. Dr Mansfield sees this as a key opportunity to develop accredited MSc programmes and structured clinical placements to foster a new generation of ACPs. Pilot projects in primary care settings, supported by robust data collection, could demonstrate the value of ACPs in improving access and outcomes.
“There’s immense untapped potential in LMICs,” says Dr Mansfield. “We have a model that works, backed by evidence. The next step is local adaptation, policy support, and investment in training.”
Dr Mansfield also sees emerging opportunities in digital health. With the rise of remote consultations and app-based rehabilitation, ACPs can help expand the reach of MSK services, particularly in rural or underserved areas. In parallel, global education pathways - such as online MSc programmes and credentialing partnerships—are making advanced training more accessible.
“International collaboration is essential,” he adds. “By working together across borders, we can develop shared standards, enable practitioner mobility, and ultimately deliver better care for more people.”
Advanced practice in musculoskeletal physiotherapy represents more than expanded roles - it embodies a forward-thinking approach to healthcare. Grounded in evidence, education, and patient-centred practice, ACPs are already reshaping care in the UK and offer a scalable, cost-effective model for health systems around the world.
As Dr Mansfield puts it: “The future of MSK care lies in empowered practitioners, integrated pathways, and global collaboration. The University of Birmingham is proud to be part of that journey.”
This article is adapted from a feature in the July edition of Physio Times
Assistant Professor Musculoskeletal Physiotherapy
Dr Mansfield's work focuses on improving outcomes in musculoskeletal and orthopaedic care, with particular expertise in evidence synthesis and psychophysical methods.
