There was a recent article written in the NY Times about Physical Therapy which I thought brought up some very interesting issues and I thought I would share my view on it with everyone.  The article spoke of the worthiness of therapy, how much of it is evidence-based and how some parts of it are “Voo Doo”.  The title of the article is “Treat Me, But No Tricks Please” and was written by Gina Kolata.  The link is: http://www.nytimes.com/2010/01/07/health/nutrition/07best.html.

One of the most significant points that it speaks about is how classic (what I would call low-level and old fashioned Physical Therapy)  is not very beneficial.  Therapy such as this is primarily focused on modalities such as Ultrasound, Heat, Electrical Stimulation and Ice and is considered “Voo Doo” by many physicians.  It does not focus on what is causing the symptoms and  how to decrease these symptoms.  Most pain, muscle spasms (“knots” in a muscle) and limitations of motion are due to limitations in the mobility of a joint or overworking of specific muscles.  If you fix the underlying “drivers” of a person’s pain, the inflammation, pain, muscle spasms, etc all go away.

The author of the article makes some interesting comments on the use of modalities.  A quote from the article:

When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.

My doctor at the Hospital for Special Surgery in New York, Joseph Feinberg, seems to share my opinion. “Very often, I think the hot packs, cold packs, ultrasound and electrostimulation are unnecessary,” he said, adding, “For sure, in many cases these modalities are a waste of time.”

I agree thoroughly with most parts of this article, including where we need to have more evidence to back up what we do in therapy.  Unfortunately, there is a definite side of therapy that is difficult to measure and “prove” in a research study.  This side  is significant, however, in why patients get long-term improvement with treatment.  The American Physical Therapy Association wrote a response to the article listed above (link is:  http://www.apta.org/AM/Template.cfm?Section=Letters1&CONTENTID=67938&TEMPLATE=/CM/ContentDisplay.cfm) and they make a fantastic statement in the response that I’d like to share:

But evidence alone cannot heal a patient. With the best available evidence at hand, a health care provider must use their evaluative skills, clinical judgment and assessment of a patient’s needs to develop a plan of care.

Evidence is essential, but it must be combined with a health care provider’s unique knowledge and understanding of an individual patient.

Physical Therapy, just like much of medicine including Orthopedic Surgery, is a combination of science and art.  A good therapist will treat their patient keeping these two things in mind.  Therapists who simply focus all of their treatment on exercise are basically glorified Personal Trainers and clinics that recommend every patient be treated with heat, cold, electrical stimulation and ultrasound are places that give Therapy a bad name.  A great PT clinic finds the source of a person’s pain and treats the source. Taking it one step further, a great PT will teach the patient how to treat themselves with specific exercises for strength and flexibility which will address postural issues that a person may have.  And, only if needed, the use of modalities to settle inflammation down along with everything else.