Several weeks ago, I posted an article entitled, “Don’t be a sugar pill” that received a great deal of feedback. Check back with that article before reading this one if you can to get you updated. I had a case arrive the other day to make me think of this topic even more and made me ponder, am I treating with a standardized treatment approach; or in other words, is what I am prescribing the patient referenced in the literature as the control group?
You do not want to be the therapist prescribing control group exercises. Now don’t get me wrong, it works (and studies show from time to time significant improvements in disability, pain, and function with the control group); but is this what we are here for? Shouldn’t we be better and don’t we all want to be considered musculoskeletal specialists and the Go-To clinicians for MSK injuries? We can’t expect to be elite status with standardized treatments.
The first question that may come to mind is, what is the control group? For most studies, it could be no treatment at all, sham treatment (such as putting a patient into a position for MET but not performing it, just getting them to sit in the room for a period of time), or to go with usual care (avoid bed rest, maintain as much activity as possible, use NSAIDs and muscle relaxers). Now I know we do not do these type of control groups but you get what I am trying to come across here. Here are some examples from the literature:
1. Puentedura et al. Development of a Clinical Prediction Rule to Identify Patients with Neck Pain Likely to Benefit from Joint Thrust Manipulation to the Cervical Spine. JOSPT. July 2012. This is a CPR, not a RCT but patients received the below exercise in addition to CSM. So if you are just prescribing this exercise and not performing a manual treatment or a more specific program; you are a control therapist.
2. Kachingwe et al. Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement : A Randomized Control Pilot Clinical Trial. JMMT. 2008. In short, a greater improvement in pain and function was found in the MWM group than exercise group of strengthening parascapular muscles and RTC.
It was actually much harder to find what I wanted to here while researching the literature (for giving you more examples). There are so many variables out there but I hope you get the point. Be as specific as you can and just don’t go with standardization treatment. Don’t follow your clinic’s “excel sheet of exercises for body parts” or generally flow sheets. This is for extender staff, not clinical doctorate professionals.
If you find yourself giving patients the same treatment (and becoming exhausted with this), then take a step back and ask yourself if you are a control therapist. You are relying on chance association and not causation. If so, just reach in your wallet, take out $25 in cash and give it back to the patient to reimburse them for their co-pay. Then, refer them to google image for exercises so they can find WebMD and do this all from home. You will save yourself, patients and insurance a lot of time and money. 🙂