What Really Happens In Physical Therapy: A Review

About a year ago, the editors of Consumer Reports wrote an article titled, “What Really Happens in Physical Therapy.

My first reaction was, “Well, it’s about time…this conversation is long overdue.”

As physical therapy becomes increasingly more mainstream, we, as an industry, owe our customers value and daily demonstrations of our worth.  As reported in the article, millions of people are referred to physical therapy every year.  The number of self-referred patients grows every year as well, as the public takes advantage of their right to direct access. Our customers are savvy and straightforward answers are critical for excellent outcomes.

In the article, Consumer Reports talked with experienced therapists at the American Physical Therapy Association who then recommended five items in order to maximize excellent results while participating in physical therapy.  These recommendations, naturally, brought up other issues and thoughts.

1. “Don’t waste too much time with ice and heat.”

That’s true…mostly.  I believe that the value of a physical therapist lies in their hands and brains.  Time and effort placed on modalities (medical/treatment devices) to deliver passive results is misdirected.  These items serve a good purpose but do not take the place of action.  Personally, it is a rare patient that doesn’t receive ice/cold pack after an appointment with me.  I want to minimize discomfort/inflammation post-treatment and this is one of the easiest ways to achieve that.  Heat, in all its variations, feels good and serves as a way to “warm up” to activity but it really is not necessary.  A physical therapist is quoted in the article – “It (heat) makes patients feel good, but it’s not very helpful.”

Well…since when is making a patient feel good not helpful?  Ask patients what they look forward to in physical therapy.  During an appointment that is very hard work and is often challenging and unpleasant, is an activity that “feels good” a bad thing?  My point is – get as much information from your therapist that you can and then make an educated choice but keep both eyes on a bias for action.

Other, more technical modalities (ultrasound, electrical stimulation, infrared/cold laser, etc..) also have their place and can, indeed, be helpful relative to the pathology and status of your recovery.  Talk with your physical therapist about them, make an informed decision about their use, but remember…nothing takes the place of active rehabilitation.

2. “Do push yourself when exercising.”

That’s true…mostly.  The cornerstone of any effective rehabilitation is based on the SAID Principle – Specific Adaptation to Imposed Demands.  This means that the human body adapts and improves relative to the demands placed upon it.  Training, in all of its variety, boils down to controlled abuse.  The body (and the mind for that matter) is being stressed.  Your body then responds and adapts by becoming stronger, faster, and more resilient as it prepares for more abuse.  Thereby, we get stronger and adapt to the forces placed upon us.  But the “More is Better” and “No Pain/No Gain” approach is pitifully basic.  It’s just not that simple.  I’ve seen countless examples of people who pushed themselves beyond a rational limit that then turned into pathology.  Constructive rehabilitation requires hard work and it won’t be pleasant.  But, ultimately, it has to be tolerable.

3. “Don’t rely on passive motion machines after knee replacement.”

That’s true but this really is not in the realm of physical therapy.  Your physician is typically the source of this order.  Personally, I’ve treated patients that have used these devices and those that have not.  It never really seemed to make that much of a difference.  But several exceptional doctors, that refer to us, routinely order these for their patients.  They must have solid reasons for doing so.  If you have questions about these devices, ask your physician.  But I do go back to one core point – the one word that I do not support, in even the title of these devices, is PASSIVE.  Given a choice, it is always better to do rather then having something done to you.  Bias ACTIVE vs PASSIVE.

4. “Do get pushed around.”

Back to # 1…a physical therapist’s value is in his or her hands and brains.  Your therapist will spend a significant amount of time working individually with you with hands-on stretching and strengthening techniques.  Cooperate to the best of your ability.  These are often the most helpful activities that you will engage in during your time in physical therapy.  They will produce the best results.  Just like vigorous exercise, this will not always be pleasant but should always remain tolerable.

5. “Don’t expect much from whirlpools.”

Back to #1, again.  But it does depend.  A whirlpool to initiate and warm up to your activity is great but not necessary.  Ten to fifteen minutes on the stationary bike is better and, once more, it is active rather then passive.  On the other hand, an iced whirlpool after physical therapy (for an acute ankle sprain, for instance) is an outstanding choice.  Talk with your physical therapist and have an open and honest exchange of information.

It’s encouraging that our industry has matured enough to be the topic of review in Consumer Reports.

Exchanges of information on a domestic level will only bring out the best in us.

 

 

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