History and context of scope of practice

Contemporary practice has developed a great deal since its early days. The four broad 'pillars' granted to the profession by Royal Charter in 1920 were updated in December 2020. The context of practice is very important to understand in relation to scope of practice. 


The four pillars granted to the profession by Royal Charter in 1920 were:

  • massage
  • medical gymnastics
  • electrotherapy
  • kindred methods of treatment

The fourth pillar, kindred treatment, facilitated the inclusion of related areas of practice into scope. This enabled members and the profession to move into new areas of practice and respond to changing population needs, healthcare environments and the evolving evidence base, within the parameters of patient safety, patient centeredness and effectiveness.

Updates to the wording in December 2020

The original wording of the four pillars of physiotherapy practice reflected the language and practice of that time. In December 2020, the CSP Council approved changes to the wording of the four pillars, so that they reflect the profession’s contemporary practice.

CSP members were involved in determining the new wording. More than 300 members, from all parts of the UK and representing different specialisms and membership categories, took part in 31 focus groups. More than 2,000 people voted on different wording options. Since 2 December 2020, the four pillars, which describe the fundamentals of the scope of practice of the physiotherapy profession, are: 

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

The charter does not prescribe a list of techniques that are ‘in’ or ‘out’ of scope, but sets a boundary on physiotherapy practice that maintains the profession’s continuity over time while accommodating developments that occur in practice.

Find out more about the updated wording of the four pillars.


It is important for you to clearly describe the context of how you are doing an activity, including how you exercise professional judgment, autonomy and decision making in physiotherapy practice.

This protects the public by assuring them that they can expect to receive the reasonable standard of care that physiotherapists are required to deliver.

The CSP offers an insurance scheme to eligible members. This covers you for all activities within the scope of physiotherapy practice in the UK, but doesn’t cover other activities outside of this.

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