Reflections On Voodoo And Physical Therapy

Back in January 2010, the NY Times published an article entitled “Treat Me, But No Tricks Please”. It got a lot of physical therapists fired up, and it even prompted a response from the American Physical Therapy Association. And it made me chuckle about many things I have known for a very long time.

The firestorm of debate started when Dr. James J. Irrgang, a researcher in the Department of Orthopedic Surgery at the University of Pittsburgh and President of the Orthopedic section of the American Physical Therapy Association at the time, noted that “there is a growing body of evidence that supports what physical therapists do, but there is a lot of voodoo out there, too”. He also noted that “You can waste a lot of time and money on things that aren’t very helpful”.

Fast forward to 2011. I am now in the midst of preparing a 3 hour presentation entitled “Mechanisms Of Therapeutic Exercise Progression” for the Texas Physical Therapy Association’s Annual Conference in October. This will be my third consecutive appearance at their Annual Conference. What I have been reminded of – as I have reviewed a topic high on evidence-based cellular physiology research and low on practical application by clinicians – is that Irrgang was indeed correct. Sadly, not much has changed in our profession since this article was published, even with the responses and outrage it generated.

Gina Kolata, the author of the NY Times article, made note of a patient that had received eight weeks (20 total hours) of physical therapy treatment – at $150 per session – and still had not returned from their running injury … though it was “clearly beneficial and cost-effective”.

Stop right there for a moment. In my world, eight weeks without returning to running – at a cost of $3,000 – is not “clearly beneficial and cost effective”. Frankly, nature does a better job than that on its own. I would suspect that somewhere in the midst of this scenario, the “voodoo” made an appearance. Somewhere in the midst of this, the mechanisms of therapeutic exercise progression were lost, forgotten, or simply ignored.

Dr. Irrgang noted that the “voodoo” treatments are none other than ice and heat and ultrasound, and he noted that

“there is no evidence showing laser and release — a massage technique — to be effective in helping injuries heal”.

Try making a few phone calls to your local physical therapy clinics, and I would bet that they are emphasizing these same “voodoo” treatments – or worse.

If that is how we are going to define voodoo, then it has apparently become the acceptable standard of care for running injuries, among others. Sad state of affairs, isn’t it?

He also noted that

“if you have access to a gym, you might go to physical therapy for one or two sessions, learn what to do and then return to physical therapy in a few weeks to check on your progress … often, you don’t need to go to physical therapy three times a week or five times a week.”

I would fully agree with this statement, although it would be considered heresy by many traditional clinic owners these days. 

Can physical therapists add value to the consumer experience? Without a doubt. But not all physical therapists are created equal. The use of hot packs, ultrasound, and massage as the “treatment of choice” has little to no support in the scientific literature. Nonetheless, physical therapists and chiropractors alike continue to apply these treatments regardless of the lack of scientific support. And they earn a living providing these treatments, regardless of the patient outcome. It has become, quite frankly, the gift that keeps on giving for physical therapy and chiropractic clinics around the nation.

Physical therapists that utilize the current scientific evidence in their clinical reasoning skills are the future of the profession. But until we choose the higher common denominator for the profession – instead of continuing to accept the utilization of “voodoo” – we will continue to be the fodder for articles like that in the NY Times.

Fortunately, Ms Kolata provided the consumer with some valuable information, some hard truths for physical therapists in general, and a good reminder of why I am preparing this presentation in the first place. The “Mechanisms Of Therapeutic Exercise Progression” program has been developed to provide physical therapists with the principles and mechanisms underlying effective therapeutic exercise prescription and progression. No voodoo – just science and a patient-centered focus.

Further information on the TPTA Annual Conference can be found here. I hope you can join me for this 3 hour voodoo-free learning adventure.

Photo credits: billtacular