I am a physical therapist. I am a physical therapist who uses manual therapy. One who uses exercise in many forms. I use pain neuroscience and specific treatments to address persistent pain (PNE, graded motor imagery, graded activity and exposure). I dry needle. I use heat, ice and, hell, sometimes I might use ultrasound. However, the most important clinical “technique” of all: the reasoning on how, when and why I use them.
There seems to be much discussion at times about one technique being better than another. How one PT is the expert in “dry needling” or “thrust manipulation” or “corrective exercise” or “[insert treatment here].”
Our profession naturally has many different treatment techniques, some supported by the literature and some not. Some that PTs are biased towards and some that patient’s expect to have integrated into their treatment approach. At the end of the day, it is our reasoning approach that we should value over the technique itself.
After going through a manual therapy fellowship, I can say that my bias is to use manual therapy. But the one thing that fellowship taught me was how to think through when to use it and when to not use it. As a result, I learned a reasoning model that allows me to use any treatment out there and know if it is providing meaningful change for the patient sitting in front of me.
Where I sometimes get concerned professionally is when I see or hear PTs touting certain techniques as if they solve all of our patient’s problems. We need to look beyond the technique and focus on the reasoning behind the use of that technique. Therefore, I hope those reading this post can appreciate this sentiment and understand this concept and the importance of refining our clinical decision making process–challenging our biases and questioning our outcomes that makes us grow and develop as a professional. We shouldn’t have to feel that we are defined by the techniques that we use in clinic. We should lean on sound clinical reasoning that ultimately trumps any one technique.