Physiotherapy plays a vital role in many personal injury and clinical negligence claims—both in supporting recovery and in informing the medico-legal process. But not all physiotherapists are the same. Within the profession, there are distinct areas of specialism, and understanding when to instruct a musculoskeletal (MSK) physiotherapist versus a neurological physiotherapist can make a significant difference to the relevance, accuracy, and value of expert evidence.
In the context of civil litigation, choosing the right expert is critical. A physiotherapy report that doesn’t match the injury profile—or that falls outside the expert’s true scope of practice—can weaken a claim, frustrate proceedings, or even be challenged in court. Below, we outline the key differences between MSK and neurological physiotherapists, and offer guidance on when each should be instructed.
Musculoskeletal Physiotherapists: Focus and Scope
MSK physiotherapists specialise in injuries and disorders affecting the joints, muscles, bones, ligaments, and tendons. They are commonly involved in cases where trauma has led to:
- Whiplash or soft tissue injuries
- Fractures and dislocations
- Chronic pain conditions (e.g. fibromyalgia, mechanical back pain)
- Postural issues, repetitive strain injuries (RSIs), or workplace-related injuries
- Joint dysfunction following orthopaedic surgery or accident-related damage
MSK physiotherapists focus on restoring function, managing pain, improving mobility, and preventing long-term deterioration. Their assessments typically include range of motion, strength, gait analysis, and pain response. In civil cases, their expert evidence often informs rehabilitation recommendations, timelines for recovery, and prognosis for returning to work or daily activities.
When to instruct an MSK physio:
- When the primary injury involves the spine, limbs, joints, or soft tissues
- In road traffic accidents with soft tissue injury or whiplash
- In slips, trips, and falls resulting in orthopaedic injury
- For ongoing pain or function issues post-fracture or surgery
Neurological Physiotherapists: Focus and Scope
Neurological physiotherapists work with individuals who have sustained damage to the central or peripheral nervous system. Their work is highly specialised and often longer-term, with a strong emphasis on neuroplasticity, motor relearning, and compensatory strategies.
Common conditions seen in litigation contexts include:
- Traumatic brain injury (TBI)
- Spinal cord injury (SCI)
- Stroke or hypoxic brain injury due to clinical negligence
- Neurological deterioration (e.g. MS, cerebral palsy, or neuropathies)
- Functional neurological disorder (FND), where movement may be impaired without structural damage
Neurological physiotherapists assess tone, reflexes, balance, proprioception, and movement patterns. They are trained to work with complex motor and sensory presentations and often contribute to multi-disciplinary rehabilitation alongside occupational therapists and neuropsychologists.
When to instruct a neuro physio:
- When motor or sensory issues stem from a brain, spinal, or nerve injury
- If there is evidence of neurological involvement (e.g. weakness, coordination deficits, altered tone)
- In cases where long-term disability and care needs are being assessed
- When movement issues are non-structural but functional in nature (e.g. in FND)
Why the Right Instruction Matters
Inaccurate or inappropriate instruction can lead to wasted resources, delayed proceedings, and the need to commission further expert input. It can also undermine the credibility of the evidence if an expert is drawn beyond their clinical remit.
Instructing the correct type of physiotherapist ensures:
- The assessment is tailored to the right injury mechanisms
- Recommendations for treatment and prognosis are clinically appropriate
- Expert evidence remains within the boundaries set by Part 35 of the Civil Procedure Rules
At Medico-Legal Healthcare, we match each case with the right kind of physiotherapy expert—ensuring that all reports are relevant, specialised, and legally robust. Whether the claim involves musculoskeletal trauma or complex neurological injury, our experts bring clarity, insight, and clinical integrity to every case. With access to both MSK and neuro physiotherapists, we support solicitors, case managers, and the courts in obtaining the most accurate and useful evidence—because precision in instruction leads to precision in outcomes.