Answers to the questions I hear every day

In Germany, physiotherapy requires a prescription from a doctor. In principle any doctor working within the statutory system can issue one — in practice it is usually your GP or an orthopaedic specialist.

To get started, the GP is almost always the faster route: they know your history, and waiting times are shorter than in orthopaedics. For more complex cases — after surgery, with unclear findings, or when imaging is needed — an orthopaedic or surgical practice, or one for physical and rehabilitative medicine, is the right address.

Jaw complaints are a special case: for CMD your dentist issues the prescription, using a separate dental remedies form.

After an operation you will normally receive the first prescription directly from the hospital. After an accident at work or on the way to work the process differs — see treatment via the employers' liability insurance.

You do not need to know which treatment is required. That follows from the diagnosis. Simply describe what is limiting you and since when.

A few details must be complete before I can treat you. The most important ones:

• Diagnosis and diagnosis group — the group determines which treatments and how many sessions are possible.
• The remedy — the type of treatment, for example therapeutic exercise, manual therapy or lymphatic drainage.
• Number of sessions
• Frequency — usually a range such as "1–2× per week".
• Date of issue, practice stamp and signature

If something is missing or illegible, billing can be blocked. Minor formal errors are usually easy for the issuing practice to correct.

You do not have to wait until your appointment. Upload the prescription when booking via Doctolib, or send me a photo via WhatsApp. I will check it in advance, so anything missing can be sorted out before you come.

You hear this often, and it usually rests on a misunderstanding. There is no fixed budget that simply runs empty. Doctors are subject to an economic efficiency review — they must be able to justify what they prescribe. That is something different from a quota.

What matters are the categories of special prescription need and long-term remedy need. For certain conditions listed nationally, prescriptions do not count towards the practice's efficiency review. The list covers, among others, severe neurological conditions, states after major surgery and certain permanent functional impairments.

If your diagnosis is on that list, that is a factual argument — raise it politely with the practice. For long-term needs an application can also be made to your health insurer, who then approves the need for a longer period.

And the most important point: in Germany you have free choice of doctor. You may consult a different practice at any time — even just for the prescription. Prescribing volumes are calculated per specialty group and differ widely. Roughly from most to least headroom:

• Physical and rehabilitative medicine — by far the most room; remedies are their core business
• Orthopaedics and trauma surgery
• Surgery
• General practices
• Dental practices — for CMD. They bill via a separate dental remedies form, entirely apart from the medical budget

People aged 18 and over with statutory insurance pay a legally set co-payment for remedies. It has two parts: 10 per cent of the treatment costs plus 10 euros per prescription.

A common misunderstanding: the co-payment is not additional income. I collect it on behalf of your insurer — it stays with me, but the insurer deducts the same amount from what it pays me. So it makes no difference to me whether you are liable for it or not.

Exempt are:

• children and young people under 18
• anyone who has received an exemption certificate from their insurer
• treatment charged to the employers' liability insurance after an accident at work or on the way to work

An exemption certificate is worth applying for once your own co-payments in a calendar year exceed a personal limit — a small percentage of annual gross income, and lower for people with chronic conditions.

If you are already exempt, please bring the certificate to your first appointment.

A private prescription is a doctor's prescription not charged to the statutory insurer. You receive one if you have private insurance — or if you have statutory insurance but want treatment beyond what the insurer covers. The invoice goes to you; privately insured patients submit it to their insurer and, where applicable, to their public allowance scheme.

Treatment entirely without a prescription is also possible, as a self-payer. That makes sense if you cannot get a prescription or do not want to wait for one, if you want to continue beyond the prescribed sessions, or when it comes to training, prevention and advice — areas the insurer does not cover anyway.

Current prices for private patients and self-payers are listed in the price overview. You know what to expect before we start — there are no surprises on the invoice.

After an accident at work or on the way to work, your health insurer is not responsible — the employers' liability insurance association (Berufsgenossenschaft) is. The process therefore differs.

The first stop is a specially accredited trauma or orthopaedic practice (Durchgangsarzt). They document the accident, make the diagnosis and steer further treatment. The physiotherapy prescription comes from there and is billed to the association.

For you this mainly means two things: there is no co-payment, and treatment is usually more frequent, because the association has an interest in restoring your ability to work quickly.

Do report the accident to your employer — without the accident report there is no basis for covering the costs. I bill the associations directly.

• the original prescription
• your insurance card
• your exemption certificate, if you have one
• any existing findings — doctors' letters, surgical reports, MRI or X-ray reports. I do not need the images themselves, the written report is enough.
• comfortable clothing you can move in, plus sports shoes if we will be working on equipment
• a towel to lie on

If something is missing, that is no reason to cancel — we will start anyway and sort out the rest along the way.

And ideally the completed intake form — see the next question.

Yes, and it is worth it. At the first appointment I ask about your history: past injuries, pre-existing conditions, what you hope the treatment will do. That takes time. If you fill in the form beforehand, more of the appointment is left for the treatment itself — and you can think it over instead of answering off the cuff on the couch.

Download the intake form

Print it and bring it along, or send it in filled out beforehand — via Doctolib, by email or on WhatsApp. The form is in German. If that is a problem, just write to me and we will go through it together.

Not compulsory. No printer, or simply forgot? We fill the form in together at the appointment. This is about your time, not an obligation.

That depends on how busy the practice is. For acute complaints I try to find something in the current or following week. The quickest way to see free slots is Doctolib — all available appointments are listed there, around the clock and without a phone call.

One note on booking: I treat at two locations. You choose which one applies to your appointment during booking. Please check carefully so you do not end up in the wrong place.

Cancellations are no problem if they come in time — please at least 24 hours ahead. Then I can offer the slot to someone who is waiting. Appointments cancelled at short notice or not at all have to be invoiced; insurers do not cover missed appointments. If you fall ill or something comes up, just get in touch — we will find a solution.

There is no single number, because it depends on which stimulus you want to set. Endurance, strength and tendon capacity each need different repetition counts, rest periods and recovery times. I therefore work with defined stimulus types — from endurance (16–40 repetitions, 24 h recovery) through strength (8–12 repetitions, 72 h) to tendon training (3–7 repetitions in a very slow tempo, 96–120 h).

The recovery time determines how often you train: usually two to three sessions per week. The stimulus type itself we change every two to six weeks — if it stays the same for too long, the effect flattens out.

Which type suits you right now we decide together. You will get the full plan with documentation sheets at the practice.

More than most people think. Pain does not equal damage. With tendon complaints and long-standing problems in particular, loading with some pain is not merely allowed — it is part of the treatment.

As a practical guide I use a simple rule: pain during the exercise is fine as long as it stays tolerable — roughly up to 4 or 5 on a scale of 0 to 10. What matters is what happens afterwards: the pain should settle back to its baseline within a few hours and should not be worse the next morning.

Warning signs are different: sharp, stabbing pain, a clear increase over several days, new swelling, pain at night, or a loss of range of motion. Then the dose is too high — or the exercise is not the right one.

In that case get in touch rather than pushing on alone or stopping altogether. Usually a small adjustment is all it takes.

There is a dedicated stimulus type for exactly this phase: acute pain — 13 to 15 repetitions at a very slow, even tempo (3:1:3). The movement is preserved, the peak load disappears. That almost always lets us carry on without pausing altogether.

The obvious reflex when something hurts is to rest it. Short term that is often right — after a fresh injury a few days of relief make sense. Over time, though, the effect reverses: tissue that is not loaded becomes weaker and less tolerant. Muscles lose cross-section, tendons and cartilage are supplied less well, and the threshold at which something hurts drops.

Strength training turns this around. Load is the stimulus tissue adapts to — muscles get stronger, tendons stiffer and more tensile, bone denser. At the same time something happens in the nervous system: experiencing that a movement works again, and that nothing bad follows, removes the fear of it. Decoupling movement from threat is often the real mechanism.

That is why training is not an afterthought at the end of a session with me, but the core of it. Manual techniques create the room — training fills it and makes the result last.

That depends on which tissue is involved. A few rough timeframes help keep expectations realistic:

• Muscle heals comparatively quickly — days to a few weeks depending on the extent.
• Tendons and ligaments take considerably longer, often several months, because their blood supply is poorer.
• Bone has consolidated after roughly six to eight weeks; the full remodelling phase takes longer.
• Cartilage has the least capacity for self-repair; here it is usually about stabilising the surroundings.

Separate from this is adaptation through training. In the first four to six weeks, gains in strength come mainly from the nervous system — you get stronger without the muscle visibly growing. Structural change takes twelve weeks and more.

Noticeable relief often arrives much earlier than structural healing. That is a good sign — but not a reason to stop the programme.

Every stimulus type gives a range of repetitions, not a fixed number. For strength endurance the table says 13–15: 13 is the lower limit, 15 the upper. For strength (8–12) it is 8 and 12, for tendon training (3–7) three and seven.

These two numbers control the weight, always judged by the first set:

• More repetitions than the upper limit means the weight is too light — 17 repetitions where the limit is 15: add weight.
• Fewer than the lower limit means it is too heavy — only 11 where the limit is 13: take weight off.
• Within the range: the weight is right. Keep it until you grow past the top.

Repetitions dropping from set to set within a session is normal and even intended: first set at the upper limit, last set slightly below the lower one through fatigue.

Between sessions the recovery time of the stimulus type decides. If you still feel clearly fatigued and manage fewer repetitions than last time, add another day.

Step back if symptoms clearly increase over several days, with new swelling, pain at night, or if your technique breaks down. That almost never means stopping entirely.

Home training goes further than most people assume. With your own body weight, a few resistance bands and some imagination you can cover almost everything — especially at the start, when loads are low anyway.

You reach limits with two things: heavy strength training for large muscle groups, where at some point there simply is not enough weight, and fine dosing. On equipment, resistance can be adjusted in small steps — in rehabilitation that is often exactly what matters.

That is what equipment-based exercise therapy is for: it is a remedy in its own right and can be prescribed by a doctor. We then work on the equipment together, and you take the matching home programme with you.

My recommendation: start at home. If we reach a point where more resistance is needed, we will notice in good time — and then we can talk about it.

The first appointment starts with a conversation. I want to know what is limiting you, since when, what makes it better and what makes it worse — and above all what you want to be able to do again. That goal is the yardstick for everything else.

Then comes the examination: range of motion, strength, load tolerance, specific tests. From the conversation and the findings a picture emerges, which I explain to you — what I suspect, what I base it on and what I suggest. We then already treat in that first session, and you will usually take one or two exercises home.

Allow a little more time for the first appointment than for the sessions that follow — history-taking and examination are added.

No. "It has to hurt to help" is a stubborn myth. There is no link between how painful a treatment is and how much it helps.

Some things are uncomfortable nonetheless. When I work on a sensitive structure or take a movement to its limit, that can briefly pull or press. That is normal and passes quickly. What is not normal: pain that makes you hold your breath or tense up. Then I am working against your body instead of with it, and the effect reverses.

Please tell me during the session if it becomes too much. That is not an interruption but the most useful feedback I can get — I can adjust the intensity of almost any technique.

Treatment is available in German, English and Turkish. Just let me know when booking which language you prefer.

In physiotherapy this is more than a courtesy. A large part of the work consists of explaining: what is going on, why an exercise looks the way it does, how much load is acceptable. When those explanations land in a language you are at home in, treatment simply works better.

Tedavi Türkçe olarak da mümkündür. Randevu alırken belirtmeniz yeterlidir.

I treat at two locations:

• Gasstraße 2, Haus C in Hamburg, on the border between Ottensen and Bahrenfeld — Mondays, Tuesdays and Thursdays.
• Martinistraße 64 on the UKE campus in Eppendorf — Wednesdays and Fridays.

Both are rooms of Hansetherapie; I work there as a freelance subtenant.

You choose which location applies to your appointment directly when booking via Doctolib. Please check carefully — the two sites are about seven kilometres apart.

Exact treatment hours and directions to both locations are on the contact page. For Hansetherapie it is worth looking these up in advance: the UKE campus is large and hard to navigate.