Manual therapy for mechanical neck disorders: The effectiveness of sub-group specific manual therapy for low back pain: French HP, Brennan A, et al. Manual therapy for osteoarthritis of the hip or knee- a systematic review. There have been a couple of randomized controlled trials demonstrating the efficacy of manual therapy for the treatment of knee OA.
These trials resulted in large effect sizes, decreased use of meds, and decreased surgical rates. Physical therapy treatment effectiveness for osteoarthritis of the knee: Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med ; You have made some good points in my opinion. However you have made very broad statements which require further investigation.
The use of core stabilization may not be as important in the prevention of back pain, but does that hold true for individuals with back pain? I think that as a profession we must bring along the things we have found to be beneficial to our patients and leave behind the tools that we have found to be ineffective.
However, there are a plethora of things that we still need to figure out through rigorous scientific study. Generalizations do not help us in this cause as they only swing the pendulum to extreme ends.
We must not forget that not all research is of the highest quality. Physical therapists as a profession must learn how to digest the evidence properly and learn the difference between a well constructed study and a poorly constructed one.
Once that hurdle is cleared I believe the real discussion can begin. Thanks for the comment Alden.! Even though a couple of RCTs may have demonstrated some benefit of manual therapy for knee OA, the systematic review that I cited, published in Manual Therapy last year, took these into account, along with other studies on the subject.
Maybe we can attribute this to regression towards the mean? Core stabilization is most definitely a hot topic which I expected would raise some criticism. My issue with core stabilization is this: How do we reliably identify an unstable spine or individuals who would benefit from this treatment approach? Do these muscle fibers fire correctly after one has injured their back read: Macdonald D, Moseley GL, et al. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain.
How can we justify that core stabilization is more beneficial vs. The articles that I cited, are all well-done, quality systematic reviews excluding the 2 RCTs in the exercise sections , and I think we at least know enough about modalities that we can leave them somewhat behind.
Have a good one! Good discussion and points! But, I think researchers and the academic PT community are just as much to blame. Researchers continue to perform trials investigating interventions with little to no regard of a deeper theory of mechanisms, pain, or treatment effect.
Researchers continue to perform trials guided mis-founded theories, or with a potentially short sighted view of other data on impairments certain populations exhibit i. And yes, we need clinicians to be more scientifically and research minded. Excellent piece Joe, I hope this creates further discussion. First off let me tell you this article was very refreshing.
I most certainly agree with you. What am I going to do — I will think on that and save it for another post. Thanks for the comments Tim! We need to drop modalities—at least for the majority of our patients. I agree that there are financial incentives to using junk, but morally and ethically speaking, that puts us in the same classification as physicians who prescribe medications for kick-backs.
There are other ways to generate revenue. Providing unnecessary treatments is not one of them. In terms of PT schools teaching ultrasound…there is alot of catching up to be done in PT educational institutions. The change needs to come within the practice of PT.
Educational systems will then follow…. Thank you for putting forth a thought provoking blog post. I would like to comment on a few points. There seems to be a trend in that more successful outcomes are found in studies that target a specific intervention to a specific patient population.
With directional preference exercises positive outcomes have been found by identifying those with a directional preference and placing them into the appropriate treatment category Long. Studies that tend to lump people with LBP into one treatment program without making an effort to predict who will respond best to which treatment appear less successful…if not doomed to fail. In my experience, very few people are using this sort of examination in the clinic, and there have yet to be sufficient studies done to determine which PT treatments these groups of patients would respond best to.
I do agree with you in that physical therapists need to have a better understanding of the pain neuromatrix. IMHO, it is best used for cases that do not fall into a treatment category that can reasonably be expected to bring about a positive outcome.
Again, thank you for posting, and thank you for offering the opportunity to respond. Just need some time and your permission, Joseph. This reflects the state of PT around the world, at so many levels, that seemed you were talking about Europe. You can translate this post to any language you want! Just keep my name attached. Outstanding post and website. Espero que pronto esta informacion se masifique y todos podamos disfrutar del conocimiento adecuado para tratar a nuestros pacientes.
Un abrazo desde Colombia. Or, maybe, over time, it would no longer be associated with PT at all. And, I have no problem with that. This has the potentially to profoundly change how we practice.
I can definitely attest to barrier 3 board examination since I recently went through it and it was really frustrating the amount of information I had to learn in order to pass it, even knowing that I would never use them in my career ie. And as far as modalities, PT programs will continue to teach them while they are on the board exam because in the end that is their main goal, get the students to pass it preferably on their first attempt.
Just my 2 cents, since that would be a win-win. Finally, do you know what is the research behind H-waves? I already covered a couple of different clinics that use it with most of their patients. Hey Francisco, It is my professional opinion that e-stim is e-stim. In terms of it reducing pain—no e-stim device will be therapeutically effective in reducing all pain.
The reason is that pain is much more than nociception. A multitude of variables are contributory and you must effect the central output, not simply the peripheral input.
The H-wave clinical unit is quite large and hollow. So one mechanism of short-term effectiveness is that if the size of the unit is correlated with the expectation that it will work ie. It likely can elicit short-term placebo but I would be very, very, very surprised if it demonstrated any long-term statistically significant effectivenss as an isolated intervetion or in conjunction with other interventions.
Interesting that you mention the size of the unit, because I also wondered why is it so big considering their home unit is a lot smaller and does the same thing. When dealing with someone who has chronic pain that does not respond rapidly to a PT intervention I spend a good deal of time going over the material in Explain Pain.
These are people who are in different places in the pain neuromatrix. One is likely dealing with somatic, referred, or radicular pain whilst the other is experiencing a chronic pain state. One of the largest barriers IMHO to science is this notion of experience. When talking with clinicians who continue to perform treatments which have been disproven or have very questionable plausibility the most common defense is anecdotally driven.
Based on my limited knowledge of how our brains work, it seems that our experience is often flawed, biased and self serving. We are much more likely to observe and remember events and relationships which support our beliefs and understanding of the world.
We also commonly make assumptions about causation without critically appraising our judgments for errors. Unfortunately our own brains are masterful at deceiving us.
We are often blind to this deception and have a strong sense of confidence even when we are wrong. I think understanding the limitations of experience is the key to moving past anecdotes and into the realm of science. How does experience help us as clinicians? How does experience hinder us as clinicians?
What can we learn from experience? Thanks for the great blog post! Adam, That is a great comment. I believe we have overemphasized the role that experience should play in clinical decision making and woefully underemphasized the value of experience in creating positive patient encounters. In a large number of patients the novice and expert should make the same clinical decision however, the type of interaction in terms of caring, empathy, motivating, etc.
It is inevitable that the longer we live life the more likely we will suffer loss, heartache, etc. Patients beliefs and expectations as well as your confidence, beliefs and clinical interaction are all influential over outcomes. As stated below, outcomes from acupuncture are likely not directly due to the acupuncture… a b s t r a c t The nonspecific effects of acupuncture are well documented; we wished to quantify these factors in osteoarthritic OA pain, examining needling, the consultation, and the practitioner.
Orthopedic therapists are trained in the treatment of post-operative joints, sports injuries, arthritis and amputations, among other injuries and conditions. Joint mobilizations, strength training, hot packs and cold packs, and electrical stimulation are often used to speed recovery in the orthopedic setting.
Those who have suffered injury or disease affecting the muscles, bones, ligaments or tendons of the body may benefit from help from a physical therapist specialized in orthopedics. Geriatric physical therapy covers many issues concerning people as they go through normal adult aging. These include arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders and incontinence.
Geriatric physical therapists make special programs for the injured to help restore mobility, reduce pain and increase fitness. Neurological physical therapists work with individuals who have a neurological disorder or disease.
These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury and stroke. The majority of problems of patients with neurological disorders include paralysis, vision impairment, poor balance, difficulty walking and loss of independence. Therapists work with patients to improve these damaged areas.
Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of people with cardiopulmonary disorders and people who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing patient endurance and independence. Pediatric physical therapy helps in early findings of health problems as well as the diagnosis, treatment, and management of infants, children, and adolescents with a variety of injuries, disorders and diseases that affect the muscles, bones, and joints.
Treatments emphasize on improving fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing and integration. Children with developmental delays, cerebral palsy, spina bifida and torticollis are a few of the patients treated by pediatric physical therapists. There are many different kinds of treatment in physical therapy.
There are quite a few kinds of electrotherapy which are used in the current age. TENS Trans-Cutaneous Electrical Nerve Stimulation , IFC or interferential current, which is a Russian stimulator for strengthening of damaged muscles and usage of micro currents to use small intensity currents to return damaged tissues, are some of the methods.
Galvanic Stimulation or Iontophoresis is another form of electrotherapy. TENS is one of the more dominant methods, which blocks slow spread nerve fibers that carry pain signals from the brain.
It is perfect for physical therapy to relieve chronic and severe pain. Each of these methods uses changing combinations of voltage and current to vary the physical therapy for relieving different forms of pain being made from various sources. Virtual rehabilitation is one of the latest kinds of physical therapy, which can be seen as a way of stimulating the brain through virtual reality.
In this form of therapy, the patient is made to interact with characters on-screen as well as objects in a wide selection of sporting and adventure activities. These are designed as part of an exercise treatment that is designed by the clinician keeping the patient's handicaps in mind. Immersive Therapy Solutions keep track of the hand-eye coordination, movement and repair of the patient. There are various stages for this form of physical therapy as the patient continues to be rehabilitated.
This form of therapy is pretty popular for those with mental impairment, traumatic brain injuries, autism, cerebral palsy or strokes in the past. Mobility and motor movement are greatly improved with this technology. Physical therapists wrap moist hot packs in several layers of towels and place them on the area that needs treatment. The heat provided by the hot packs has several important benefits.
It relaxes tight muscles causing tissues to relax. This decreases pain caused by muscle tension or spasms. It also causes vasodilatation of the blood vessels which increases circulation to the area.
Patients with muscle strains, spasms, or arthritis often get better from treatment with moist hot packs. Cold packs are a frozen gel substance used by physical therapists to treat areas of pain and inflammation. The cold packs are wrapped in wet towel and applied directly to the area in need of treatment. The cold transferred to the patient's skin, muscle, and tissue has several beneficial effects. The cold temperature causes constriction of the blood vessels in the area.
This decreases the inflammation in the area. By decreasing inflammation, pain and swelling are decreased. A long time ago, one would find that the interventions used by physical therapists today have been used throughout the ages. The first real evidence of physical therapy dates back all the way to BC. Ancient peoples like the Greeks, Romans and Chinese used massage, sunlight and water for healing the wounded. Exercise was used in almost all cultures and across time as a way to improve health.
She contributed a lot to the rebuilding advisor services and came to be known as "The Mother of Physical Therapy". It was in the same year, that the first research paper on physical therapy was published in the US.
The year , was regarded as a milestone, in the field of physical therapy, as physiotherapy programs were introduced. Physical therapy was mainly provided at critical care hospitals or special rehabilitation centers until the s when patient clinics, schools and skilled nursing facilities all began to hire their own therapy staff. Rehabilitation was now becoming common and accessible to the whole population.
The passing of the Civil Rights Act of did more than to reduce racism, it also allowed for those with disabilities to access the world in a way they had not been able to before.
This was now an opportunity for physical therapists to help patients in a different way no longer just helping with rehabilitation from an injury or illness but in helping them fit back into society, something therapists continue to do today.
Treatment up through the 's mostly consisted of exercise, massage, and traction of muscles. Manipulative techniques to the spine and joints began to be practiced, especially in the British countries, in the early 's.
Up until this point, there was no known practice of a combination of exercise and manipulative therapy in existence. In the 's, Physical Therapists started to move beyond hospital based practice.
When a person thinks of physical therapy they think injury or injury repair. Physical therapy is a health care profession that treats and repairs injury. /5(3).
Physical therapy essays"Goals for Becoming a Physical Therapist" I always new I wanted to do something in the medical field, but I had no idea what, so I attended a healthcare career day in junior high school. After that opportunity I still was undecided but I knew for sure I wanted to d.
Free physical therapy papers, essays, and research papers. The benefits of physical therapy on physical activity are immense and essential to people’s health. Overall, physical therapy impacts the general health of people in countless ways. Without physical therapy and rehabilitative care, injuries, illnesses and diseases could be catastrophic to a person’s physical activity level.
PHYSICAL THERAPIST Physical therapists, also called PTs, help injured or ill people improve their movement and manage their pain. They’re an important part of rehabilitation and treatment of patients with chronic conditions or injuries. Free Essay: Introduction The medical field is expanding ever so rapidly in today’s society. In the field of Physical Therapy one needs to have the.