This post is intended to motivate the therapist and get them to really think about what they are doing day to day.

The placebo effect can have very positive results in physical therapy, no doubt.  We do not use it as specifically as in the other medical fields as our treatments can’t be through saline injections or sugar pills, or can it?

The placebo effect is the result of a positive expectation, belief, or hope in patients derived from a clinical encounter.  We do not think about it, but we stumble across it day to day.  Patients are referred to us because of positive word of mouth.  Others have received great results.  This or that therapist is the best and he/she can fix you.  The physician said physical therapy should help this problem.

The expectation is high and physical therapists are typically ‘nice’ people.  The positive engagement in a comforting environment, usually taken without a long wait, another individual putting their hands on you and a clinician listening for more than 14 seconds without interrupting because we have 30-45 minutes for an evaluation.  Are these all placebos?

Rise above the placebo effect.  Get the best results and outcomes.  In most instances, we know what we are going to do will work.  The patient should get better, eventually.  A good example of this is looking at treating PFPS.

I recently read an editorial entitled, “The Evolution of Rehabilitation for Patellofemoral Joint Dysfunction” written by Dr. Guy Simonaeu in November 2003 JOSPT.  You can access the article here (members only).  Or just simply google the title and you can find the pdf 🙂

In short, Dr. Simonaeu described the evolution of rehabilitation for PFPS from quad sets and avoiding knee flexion; to isolating the VMO; then to provide foot orthotics; and then to address more proximal regions by addressing the pelvis and lumbar spine.  Patients got better back in the day through the old approach.  But, we know now that wow, more patients could have received better outcomes if these newer concepts were incorporated.  Was the prior approach placebo?  Yes, patients can get better with strengthening the quadriceps and stretching the hamstrings.  However, is this coating the patient with sugar?

Stay on top of the literature.  Keep expanding your repertoire and use novel ideas.  You don’t have to go out and spend thousands of dollars on continuing education; just think about how you are thinking.  Don’t just assume since you get good outcomes is that you are not performing placebo therapy, but be the highest in treatment effects.

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2 comments

  1. Given that EVERY intervention a PT performs from the introduction, to the assessment, to the words used, to the environment, to patient expectations will likely act as a placebo or nocebo OR increase/decrease patient expectation, it could be argued that MAXIMIZING the placebo effect and patient expectations of our interactions is of the utmost importance. Am I talking about building up ultrasound as a cure all. No.

    The size of the “placebo” or non-specific effects of our interventions are variable.

    This article applies:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/

    1. Kyle,
      Thanks for sharing that! . I have read the original article but not this follow up. My only concern with maximizing placebo effect is that this seems to be a minimalist approach. I want to be able to tell my kids, students, friends, and colleagues that what I do means something…just not placebo. A good rule of thumb I like to teach my students is to minimize placebo effect, if possible..

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