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Gina Kolata has another debunking-conventional-wisdom Personal Best column in the New York Times, this time taking on physical therapy (or physiotherapy, as it’s known here in Canada). I’ve really appreciated some of her previous articles on stretching, cool-downs, massage, lactic acid, and so on. This one, I was less impressed by. She writes:
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.
To me, this is sort of like saying “Yeah, I’ve tried antibiotics several times, but it never seems to work for me, so I always just take the pills for a day or two and then throw the rest away.” Any successes I’ve had with physical therapy tend not to be the “fix pain in two weeks” category, but more like “spend six months correcting some subtle weaknesses and imbalances in order to avoid repeating the injury you just had.” It’s a long-term investment.
That being said, the article has some interesting information about which treatment and recovery modalities actually have solid evidence behind them (not many). I’ve written about heat and ice and massage before — the fact is, if we limited ourselves to the modalities that have solid peer-reviewed evidence, we’d all just be lying in bed for a few weeks every time we got injured. So much as I like evidence-based medicine, I think we have to be realistic about the current state of knowledge.
I’ve also read Gina’s article and found some good points and, as usual, some generalizations. Physical therapists can be very effective at fixing pain and they can be very ineffective. As a physical therapist, I find most modalities to be ineffective.
Interesting perspective, Rick. So would you say that the key to successful physical therapy is the individual therapist’s understanding of the human body, rather than which machines and modalities they use? Certainly in the running community, there’s a lot of emphasis on going to see therapist X or therapist Y, rather than just getting a referral and going to see any old therapist. That suggests that, at this point, there’s a lot more art than science to the process.
Of all the blog’s or articles I’ve read, the few of your’s I’ve seen, are the most informed, and level headed that I’ve come across.
Thank you. Thank you for not “debunking” stuff with personal opinion, but with facts. Thank you, for using research and understanding what you are writing about. Thank you.
Thanks, Josanne — that’s a very kind comment.
Many people do find Physiotherapy works for them and find that they begin to feel much better after a few sessions. However, not everyone may benefit from Physiotherapy. Home exercises are often given to help with pain management on a daily basis which the patient needs to follow.
Hi,
I’m an Australian Physiotherapist with 20 years experience. The modalities, exercises and advice are all totally useless. What does work is if the therapist has confidence and a positive energy. In other words, it’s all placebo, which is why you don’t just go to see any old physio but you go to someone who actually believes he is good.
Unfortunately for me, I realised long ago that the treatments themselves are useless, and so it’s very hard to have the requisite confidence and energy. It’s like sweeping up a pile of leaves in a strong wind. Still, there are a few who actually believe in the treatments, and they can make their patients believe, so it works (via placebo).
Very interesting — and honest! — thoughts, Cam. I have to admit that I feel sort of the same way about some of the training technologies and techniques that I write about on this blog. I wish I could believe in them, because then they really would work for me. But because I’m skeptical and looking for “objective” evidence, I puncture whatever placebo effect I might have gained.
I don’t think it’s useless, but I do think there are good and bad physiotherapists out there. The bad ones damage the name for the good ones which really isn’t good for the whole practice.