When 24-year-old Lily James began treatment for anorexia nervosa, she didn’t expect to see a physiotherapist. Her care team included a psychologist, dietitian and GP, but movement hadn’t been part of her life for months.

“I assumed they would just tell me to avoid exercise altogether,” she says. “But instead, I was encouraged to work with a physio to rebuild strength safely and relearn what healthy movement looks like.”

Physiotherapy is not always the first thing that comes to mind when people think about eating disorder treatment. But across Australia, more clinics and care teams are recognising the value physiotherapists bring to recovery. Whether someone is dealing with anorexia, bulimia, binge eating disorder or another related condition, physiotherapists can help with body awareness, safe reconditioning and managing physical symptoms linked to long periods of illness or inactivity.

People experiencing eating disorders may go through phases of extreme inactivity or, in some cases, compulsive over-exercising. Both can lead to health problems. These might include reduced bone density, muscle loss, joint pain or fatigue. Physiotherapists are trained to assess these physical impacts and provide support based on the person’s current health, goals and stage of recovery.

“I wasn’t doing anything intense. Mostly stretches, breathing exercises and some light movement,” she says. “The focus wasn’t on burning energy. It was about reconnecting with my body in a way that didn’t feel punishing.”

That shift in thinking is central to the physiotherapy approach in eating disorder care. Sessions are designed to take the pressure off performance or appearance. Instead, they help people feel stronger, more stable and more in tune with how their body moves. Exercises are adjusted over time, and people are encouraged to notice how they feel rather than pushing through discomfort.

In addition to individual sessions, some treatment centres offer small group classes led by physiotherapists. These might focus on posture, breathing, flexibility or coordination. The aim is to introduce movement in a calm and supportive environment, free from competition or fitness goals. For people who have had difficult relationships with exercise, this kind of structure can help rebuild confidence.

Safety remains a priority. Physiotherapists assess each person’s physical condition before recommending any activity. In the early stages of treatment, particularly when someone is medically unstable, exercise may be paused. But as recovery progresses, gradual reintroduction of movement can support both physical and mental health.

Fatigue, dizziness and joint pain are common concerns during recovery. Physiotherapists can provide strategies to manage these symptoms, including pacing, posture adjustments and strengthening exercises. They also help people return to daily tasks such as walking longer distances, climbing stairs or carrying groceries without overexerting themselves.

Education plays a large role in the process. Many people with eating disorders hold beliefs about exercise that are influenced by past habits or misinformation. Physiotherapists provide evidence-based information about the body’s needs during recovery, and how to balance rest and movement. This helps people make informed decisions rather than relying on rigid rules or fear.

Lily says learning about the impact of long-term inactivity was eye-opening.

“I thought I was protecting myself by not moving much, but I didn’t realise how weak I had become. My physio explained how muscle loss and poor circulation were affecting how I felt, and that some gentle movement could actually help.”

In some cases, physiotherapists also support the broader care team. They might work with dietitians to monitor energy levels or advise psychologists on physical changes that may affect mood or behaviour. Carers and family members can also benefit from physiotherapy input, especially when helping someone with everyday tasks like getting up from bed or navigating stairs safely.

Not every treatment centre includes physiotherapy, and access varies between public and private services. Some people may be referred through specialist clinics, while others might find a physiotherapist with experience in this area through community health services or private practice. Telehealth has also made this support more accessible, particularly for people in rural areas.

As awareness grows, more physiotherapists are receiving training to work in eating disorder care. Professional organisations and treatment networks are offering resources and guidance to support this expansion. The focus remains on integrating physiotherapy in a way that complements psychological and nutritional care, rather than replacing it.

Lily has now been working with her physiotherapist for just over three months. She says the experience has helped her feel more prepared to take part in life again.

“It’s not about looking a certain way or hitting a fitness goal. It’s about being able to walk around the block, lift my shopping bags and feel steady on my feet again.”