Physio-aesthetics: physiotherapy or beauty therapy in disguise?

In recent months we have become increasingly aware of physiotherapy websites advertising physio-aesthetics, treatments supposedly aimed at improving the appearance of cellulite, reducing wrinkles, and improving the appearance of aging. Such sites reassure the public that by seeing a trained aesthetics physiotherapist they are engaging with a Health and Care Professions Council (HCPC) registered professional and as such are in good, safe hands. 

Let’s stop there and consider what this really means. What is physio-aesthetics? Is this physiotherapy as we know it? Can such therapists advertise themselves as HCPC registered? Are CSP members covered by the CSP professional liability insurance for aesthetic practice? 

Some websites define physio-aesthetics as therapeutic actions that can be carried out to improve the elasticity of the dermis, balance muscle tone and increase micro-circulation… to deal with cellulite, wrinkles and localised fat. 

It is not the intention of this article to describe how the CSP defines the scope of physiotherapy practice as this is already available on our website. However, it’s worth remembering that physiotherapy is one of very few healthcare professions to have its scope of practice defined by a Royal Charter. The scope of the physiotherapy profession is defined as any activity undertaken by an individual physiotherapist within the four pillars of physiotherapy practice. Central to each pillar is evidence-based practice. 

The four pillars of physiotherapy are: 

• manual therapy and therapeutic handling.
• exercise, movement and rehabilitation. 
• therapeutic and diagnostic technologies. 
• allied approaches. 

We want our profession to evolve and be able to meet population need. We are a scientific-based profession with an overarching aim of restoring movement, performance and function when someone is affected by injury, illness or disability. While our profession evolves and must meet population health needs we have to maintain the profession within the bounds of the current interpretation of the charter.

To be clear, the CSP’s position is that aesthetic/cosmetic use of any medicine, device or product is outside the scope of the physiotherapy profession and as such is not covered by the society’s professional liability insurance scheme. Physio-aesthetics is not physiotherapy.  

It is well accepted that physiotherapists have many capabilities that enable them to move into healthcare roles that contain elements of practice beyond the scope of their primary registration as a physiotherapist, and many may decide to develop their career outside of physiotherapy. 

However, where a physiotherapist chooses to offer services, such as aesthetics, outside of the scope of physiotherapy, they must do so using a separate title and must not mislead the public to believe they are acting as a physiotherapist.  

We have recently clarified the HCPC’s position on defining the scope of any of its regulated professions. They do not define the scope of any individual healthcare profession and confirm that they recognise the CSP as the arbiter of the scope of the physiotherapy profession. The HCPC also advised that they signpost registrants to Health Education England guidance, which sets out why physiotherapists have not been included in the list of groups of health professionals able to provide clinical oversight of cosmetic/aesthetic treatments.  

We do not believe there is any such thing as ‘physio-aesthetics’. The use of such a term may be misleading to the public who may assume that it infers that they are receiving physiotherapy services. Advertising and promotion of services is also a regulated activity, and websites must comply with the relevant Advertising Standards Authority rules, laid out in the Committee of Advertising Practice code of conduct. 

This does have implications for other areas of practice. For example, the huge rise in the use of laser therapy for cosmetic purposes has resulted in many physiotherapists using them in aesthetic work. While it is clear there is an evidence base for the use of laser in many areas of physiotherapy, where its use is for purely aesthetic purposes, such as improving the appearance of a scar or birthmark, the same limits apply. 

All physiotherapists who choose to offer aesthetic treatments in addition to physiotherapy services must consider how they separate out their physiotherapy role, how they advertise both roles, their insurance needs and ensure that they are not misleading the public.