EVENT 2 AT FOLKEMØDET 2026
Physiotherapists with the Needle
– Dangerous or Forward-Thinking?
Danish Dystonia Association
About Folkemødet
Folkemødet, also known in English as the Danish Democracy Festival or the People’s Meeting, is Denmark’s largest annual festival of democracy. Held on the island of Bornholm, it brings together politicians, organisations, professionals, businesses, journalists and members of the public for open debates about society, health, welfare and politics.
At Folkemødet 2026, the Danish Dystonia Association organised three events to raise awareness of dystonia and bring patients’ experiences into the public and political debate.
Physiotherapists with the Needle – Dangerous or Forward-Thinking?
This was the title of one of the Danish Dystonia Association’s events at Folkemødet 2026.
Could physiotherapists be part of the solution to the long waiting times for botulinum toxin treatment? This question was at the heart of an engaging panel discussion in which patients, neurologists, physiotherapists and politicians shared their perspectives on the future of treatment.
The discussion was not only about who should hold the needle. More importantly, it was about how the healthcare system’s limited resources can be used as effectively as possible without compromising quality, professional responsibility or patient safety.
The panel consisted of Pia Vejle, Chair of the Danish Dystonia Association; Bo Biering-Sørensen, consultant neurologist at Rigshospitalet Glostrup; Jens Henrik Thulesen Dahl, health spokesperson for the Denmark Democrats; Søren Bruno Elmgreen, consultant neurologist; and physiotherapist Mads Nygaard Madsen, both from Aalborg University Hospital. Martin Vith Ankerstjerne moderated the discussion.
A Shortage of Neurologists Creates Long Waiting Times
The background to the discussion is the considerable shortage of neurologists in Denmark. During the event, it was highlighted that the country is short of around 100 neurologists, corresponding to an understaffing level of approximately 25 per cent. The challenge is particularly severe west of the Great Belt, although other parts of the country also experience insufficient capacity, vacant positions and recruitment freezes.
The result is long waiting times for assessment, treatment and follow-up.
For people with dystonia, these delays can have a major impact. Botulinum toxin is not a one-off treatment but must be repeated at regular intervals, often approximately every three months. When treatment is delayed, its effect may wear off, causing pain, involuntary movements and loss of function to return or become worse.
Pia Vejle explained that delayed treatment can affect a person’s ability to work, sleep, take part in family life and manage ordinary tasks at home. For some patients, inadequate or delayed treatment may ultimately result in sick leave or withdrawal from the labour market.
Waiting time is therefore not simply a question of calendars and administration. It is about quality of life and the opportunity to live as active and independent a life as possible.
Experience from Aalborg
At Aalborg University Hospital, a model has been introduced in which specially trained physiotherapists administer botulinum toxin injections to patients with spasticity.
The arrangement was established because the department lacked capacity and had long waiting times. Two physiotherapists with relevant experience were trained through supervised clinical teaching, theoretical instruction, ongoing supervision and a specialised international training programme.
The neurologist continues to carry out the initial medical assessment, establish the diagnosis and determine the treatment plan, the relevant muscles and the dose. Once a patient’s treatment is stable and clearly defined, the physiotherapist can take over subsequent injections.
If uncertainty arises, symptoms change or the treatment needs to be adjusted, the neurologist is involved again. In Aalborg, a neurologist is available so that the physiotherapist can quickly obtain a medical assessment.
The results have been positive. Together, the two physiotherapists treat around 30 patients each week. Waiting times, which were previously approximately 18 months, have been reduced to around two to three months, and the department can now treat considerably more patients than before.
At the same time, several patients who had previously been referred for treatment outside the region have returned to Aalborg. This has improved continuity in their treatment pathways and provided an economic benefit for the region.
The panel also emphasised that physiotherapists contribute specialised knowledge of movement, physical function and the body’s compensatory patterns. Interdisciplinary cooperation may therefore strengthen the quality of treatment rather than merely relieve pressure on neurologists.
Could the Model Be Used for Dystonia?
The Aalborg model currently applies primarily to patients with spasticity. The discussion therefore also explored whether a similar model could eventually be used for people with dystonia.
The panel agreed that some responsibilities must remain with neurologists.
Dystonia can be difficult to diagnose and may be confused with other diseases and conditions. Assessment, diagnosis and complex medical decisions should therefore continue to be carried out by doctors.
However, specially trained physiotherapists may be able to take over clearly defined treatments for patients whose diagnosis has been established and whose treatment has already been tested and is stable.
This would require physiotherapists to learn much more than the injection technique itself. They would need in-depth knowledge of anatomy, muscle function, indications, contraindications, ultrasound guidance and the patient’s overall neurological condition.
International Experience
The discussion also referred to experience from countries including England, where physiotherapists have carried out similar tasks for several years.
An English study involving 262 patients with spasticity compared treatment delivered by physiotherapists with treatment delivered by doctors. The study found no significant differences in patient outcomes, and no serious reportable adverse events were recorded.
However, the panel emphasised that the education and legal status of physiotherapists in England differ from the Danish system. The experience cannot therefore be transferred directly. It does, however, demonstrate that the model can work when treatment takes place in a specialised unit with thorough education, supervision and clearly defined frameworks.
Legislation Is a Barrier
One of the greatest challenges is the current Danish legislation.
Physiotherapists may currently administer injections when the task has been delegated by a doctor, provided that the procedure has been clearly described and the physiotherapist has received sufficient training and supervision. They cannot, however, prescribe the medicine themselves or independently make medical decisions concerning matters such as dosage and treatment plans.
If changes become necessary during treatment, a neurologist must therefore be involved. At Aalborg University Hospital, this is managed in practice by ensuring that a neurologist is available and can be contacted quickly.
During the discussion, it was pointed out that the current rules can be unclear and difficult to work within. Physiotherapists also do not have the same status under pharmaceutical legislation as certain other healthcare professionals. Among other things, this limits their opportunities to participate in relevant pharmacological courses and training programmes.
If physiotherapists are to have a greater and more independent role in botulinum toxin treatment in the future, legislative changes will therefore be required, together with a specialised training programme and clearly defined competency requirements.
It Must Not Become a Cost-Cutting Exercise
There was broad agreement that a new division of responsibilities must not become a cost-cutting exercise in which physiotherapists simply replace neurologists because they are less expensive.
The purpose must be to improve treatment, reduce waiting times and free neurologists to focus on the patients and tasks for which their specialist medical expertise is most essential.
National requirements would therefore be needed for education, supervision, professional responsibility, quality assurance and ongoing evaluation. It must also be clear when a physiotherapist may act independently and when a neurologist must be involved.
Patient safety must always come first.
Agreement on the Need for Action
Although the panel had different views on exactly how the model should be designed, everyone agreed on one point: action is needed.
The current waiting times are not acceptable, and patients need faster access to both assessment and treatment.
During the discussion, Jens Henrik Thulesen Dahl said that he was willing to help move the political discussion forward. First, however, healthcare professionals must describe the necessary competencies, educational requirements and safety measures. Politicians can then consider the legislative changes and frameworks required.
The discussion was constructive and measured throughout. The focus remained on how patients can be guaranteed the best possible treatment, both now and in the future.
Experience from Aalborg shows that specially trained physiotherapists can be part of the solution when their responsibilities are clearly defined and cooperation with neurologists is close.
The answer to whether physiotherapists with the needle are dangerous or forward-thinking therefore depends on the framework. With the right education, clear rules and a strong focus on patient safety, the model may prove to be both forward-thinking and necessary.
The Danish Dystonia Association is pleased that the discussion highlighted the challenges experienced by many patients and explored opportunities to create a more accessible and coordinated treatment service.
| Watch the full discussion on the Danish Dystonia Association’s YouTube channel: |
