What Two Things Killed Physical Therapy?

By Steven Hefferon, CMT PTA

When I first started in physical therapy in the early 1990s, I knew I had found something I loved to do, and it was a profession I was good at. I soon realized I was spending more time doing paperwork than I was doing treatments. I began to hate my job, insurance companies, the entire health care system. So I quit and became a bit of a maverick health care advocate.

Look, physical therapy should be the Holy Grail for anyone who suffers from back pain. The average PT has a master’s degree; some even have a doctorate level degree. So why can’t they give you relief?

Lets look at some of the treatments PTs have at their disposal, what their intended outcomes are, and why they fail to provide long-term relief:

1. Hot Packs: They relax tight muscles and increase blood flow to the affected area in an attempt to reduce pain and promote healing.

   Yes, and so can a hot shower, bath, or dip in a hot tub. Of course, heat can play a critical roll in your recovery, but I don’t think you need to pay $120 an hour to get a 10-minute heat treatment. PTs can and should be using their time better. Besides, hot packs fail to address any physical problems such as strength or flexibility.

2. Cold Packs: These are good analgesics that can help control inflammation in the early stages of an injury; cold packs are also a good post-treatment idea if the treatment caused a little irritation.

   As is the case with hot packs, cold packs do nothing for any underlying physical issues you might have. And the more time PTs spend on a temperature modality, the less time they will spend investigating the cause of your condition.

3. Ultrasound: The theory here is that sound waves warm the affected area, with the goal of increasing blood flow and promoting tissue healing. Ultrasound can also be used to reduce inflammation and break up scar tissue.

   The downside is that ultrasound can only be used a limited number of times on the same spot. I have administered thousands of ultrasound treatments to thousands of clients, and I can say that the effect is minimal at best. This type of treatment is a time burner and does not address any physical aspects of your problem.

4. Electrical Stimulation: Electrical current will cause a muscle to contract. If you are very weak – and I mean very weak – electrical stimulation can affect the strength of that muscle. The procedure can also be used to control pain for a short time. And I do mean a short time.

Do I really need to say this again? Maybe not, but I will: All of these modalities can help to some degree, but they do nothing to address the physical aspect of your condition. Do you really want to spend 10 minutes on a hot pack, then undergo a 6-minute ultrasound treatment, and just before you leave get 10 minutes getting of electrical stimulation and cold packs. That adds up to 26 minutes, not including set-up time.

I realize that physical therapy consists of more than the four modalities listed above, but it’s my contention that these four account for more than half of your treatment time. The other half is most likely “therapeutic exercises,” which includes a 10-minute warm-up – better known as a time burner – on the treadmill or stationary bike. I’ve taken you 36 minutes into your one-hour treatment, and most of what you’ve done so far you could have done on your own. Remember, you’re paying $2 a minute. At this point, you may be asking yourself: What’s the PT going to do in the remaining 24 minutes that will fix my problem?

A little more about “therapeutic exercises.” I guess it’s just my nature to be nice, so I have a hard time bashing my beloved profession. But the truth is that the term “therapeutic exercises” means nothing more than routine stretching and exercise. The problem here is that all stretching and exercise programs are not created equal.

My biggest beef with modern physical therapy is that most of its practitioners don’t do enough one-on-one, down-and-dirty, hands-on WORK! It starts with the evaluation. Let me reveal an insider’s secret: A PT will never question or change the prescription that the referring MD gave you. Why? Two reasons: one is liability and two is that the PT relies on the MD to refer clients to him. If the PT embarrasses the MD, he will never get another referral from that doctor. So what happens is that the PT gets the prescription stating the diagnosis as “Back Pain,” and he proceeds to treat the symptoms of a condition the MD diagnosed, never addressing the root cause of your problem. Months or years later, you’re still in pain.

When a back pain sufferer goes to a PT, the evaluation certainly should take into account the referring doctor’s diagnosis. Next, the PT should make an effort to find the underlying cause of the condition (the missing link). Once this is done, a very specific and very targeted program should be developed for you and your condition. Rarely, if ever, are muscle imbalances and postural dysfunctions considered when a PT puts together a routine. There, I said it.

If your PT did not discuss the underlying cause of your condition with you and did not set up your program based on the underlying cause, here are some questions to ask:

• What caused my condition in the first place?
• Are you working on the root cause of my condition?
• Did you identify any muscle imbalances? If so, would you write them down for me?
• Which postural dysfunctions, if any, did you identify?
• Are the stretching and exercises I’m doing going to bring my body back into balance, or are you just having me strengthen my core? (You want both.)

If you don’t get the answers or results you want, it’s time to find a new PT. Don’t be afraid to offend anyone. After all, it’s your life and your health, and you need to take control. The better educated you are about your condition, the better chance you’ll have of receiving proper care. Above all, demand more one-on-one treatment time – in my opinion, 70 percent of the treatment session should be one-on-one.

Another alternative is to find a “Manual Physical Therapist.” These professionals are more likely to take a holistic approach, and the treatments are 90 percent one-on-one, using manual techniques that are far more effective than the four modalities I outlined above.

Let me assure you that the answer is out there for you and your condition, even though you may feel you’ve tried it all. The best thing you can do is to keep looking and educating yourself as best you can. That is one of our missions here at The Healthy Back Institute. Everything you read or see on this site is designed to provide you with options you may want to explore if traditional treatments have failed you.

You now know the two things that killed physical therapy – lack of time and lack of proper treatment! Remember how we broke down an hour with a typical PT: 36 minutes of ineffective treatment and 24 minutes of “therapeutic exercises?” If you go to a PT three times a week, that’s just 72 minutes where you’re doing anything that might actually help you. And, really, 72 minutes a week is not enough time to get anything done – and that’s assuming you’re doing the correct program in the first place.