I was recently evaluating a patient for low back pain who within the last 6 months had PT at another location for same condition. I asked him what type of procedures were performed to assist in his recovery.  I tend to do this in general to get an idea of what works and what doesn’t work so I am not performing same treatment hoping for a different result (as it didn’t work for pain relief or function at previous clinic).

I noted what he said in bullet form verbatim:

  • “Get on bike and pedal”
  • “pull rubber bands”
  • “band pull machine”
  • “leg presses with total gym”
  • “knees to chest lying on back”
  • “rolling ball on one side of table to the other”
  • “massages”
  • “put heat and electrical on back”

If this patient was telling a friend, family member or even healthcare professional…what would they THINK we do as a physical therapy profession?

I can tell you: A bunch of rolling around exercises with a ball and massages to the low back with heat.

Get real guys.  Patients need and want more than this.

As much as some people will bash mobilizations/manipulations/dry needling or that we do not need specific directional exercise training, these procedures carry weight in what patients remember and pass on to others about what we DO as a profession.  Specialization is in our future as patients will need to seek it out.

Results carry weight too.  My experience and anyone else who treats back pain in the clinic everyday will tell you that the rubber bandy pulls do not get results.  Lack of results do not progress our profession.  Patients continue to seek services elsewhere.

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5 comments

  1. Choudhry et al showed physicians’ knowledge and performance decline over time. There are way too many PT’s that are old new grad using the same PT interventions, they had learned from their out dated days of PT school. When it comes to education, I like to refer people to Thomas Jefferson’s quote of, ‘To penetrate and dissipate these clouds of darkness, the general mind must be strengthened by education.’ I often define a physical therapist is as a neuro-musculo-skeleto-cardio-pulmonary specialist that specializes in the diagnosis, treatment, and prevention of movement dysfunction through the use of medical exercise therapy. In order to live up to that definition, we have to continue showing our value to the public by educating them on our knowledge and by providing our patients with the most effective and efficient treatments available that is supported in the literature. This comes through our due diligence of critical thinking and clinical reasoning that directs our clinical judgment.

    Choudhry et al. Systematic Review: The Relationship of between Clinical Experience and Quality of Health Care. Ann Intern Med. 2005;142:260-273.

    Ron Masri, PT

  2. I would be careful though, not to defend the particular treatment you mentioned,sometimes manual therapy is interpreted as massage by patients…sometimes i have done my best to explain the rationale behind directional preference, or pain theory, or graded exercise/activity or other treatments and I am sure some patients interpret that as he just talked to me and did a few random exercises.

    Some clients get it and understand some don’t, some buy in to what we are doing some don’t, which can be up to us to explain better, but I know i have treated patients from therapists that i know are up to date and doing good things and when i ask them what has been tried the client’s answer in pretty uninspiring, but if i get on the phone and get the notes or talk to the therapist, the picture can be quite different.

  3. Keith,
    Great point and I agree. I have had multiple incidences where interpretation from patient to physician and even patient to fellow colleagues in my office is WAY off from what was said.

    This guy’s demeanor, which cannot be displayed through words, was quite unimpressive. It was just disappointing…and painful…listening to him explain his experience.

    It may have been that he was seen by a tech who did not explain things, who knows.

    Hv

  4. I have no doubt some people are getting random exercises and lazy therapy…just wanted to make sure we arent always slagging each other…This got posted on a facebook post and it turned into a comment section slagging older therapists for not keeping up to date..which of course does happen…but i think sometimes we get wrapped up in “our way” of doing things and when we dont investigate we miss that maybe someone else was doing things within current clinical guidelines but it got warped in the game of telephone between us the patient and previous caregivers.

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