Physical Therapy Myths De-bunked – Part 2

As a follow-up to our recent post requesting readers to submit potential myths in PT that have been accepted as fact over time, I have included a comprehensive list of the submissions below. True to my word, I have done very little editing other some basic consolidation where there were duplicate submissions and some minor edits to put everything in active voice, similar tense, etc. To help organize the myths, I also categorized them according to general, examination, and treatment-related myths. Here they are:

General Myths
-No pain, no gain.
-More years of experience is useful in identifying expert PTs.
-Older adults are fragile.
-Requirements to report pain levels for each session of PT is a meaningful outcome.
-Evidence-based medicine soley relies on the evidence without consideration of clinical expertise and patient values/expectations.
-The Physician Quality Reporting System is worthwhile and will improve quality of care without increasing costs.

Examination Myths
-We can reliably determine vertebral rotations or an abnormally positioned SIJ through palpation and movement testing
-Biomechanical assessments are reliable.
-We can reliably determine end-feels and identify hyper and hypo-mobility.
-We can reliably perform manual strength testing.
-We can feel “adhesions”.
-Measurement of leg length discrepancy is useful.
-You need an MRI to treat patients with neck or back pain.
-Your patient’s MRI shows a herniated disc, therefore, you should not manipulate them.
-The VBI test tells us useful information about the vertebral artery.
-Physical therapists can reliably intuit low frequency events (such as deep vein thrombosis) without prompts (paper or electronic).
-A physical therapist’s visual assessment is a sensitive tool to reliably gauge the risk of a DVT.

Why is my patient in pain? What is the cause?
-Pain has a cause and can be identified.
-Abnormal biomechanics causes pain.
-Bad weather causes pain.
-Bad postural alignment causes pain.
-We can reliably differentiate which type of tissue is causing our patients’ pain.
-Pain is in the joint, muscle, disc, or fascia.
-Patients have pain, because they are weak. If we give them exercises to make them stronger, their pain will go away.
-When our patient’s condition worsens, it’s rarely because we selected an inappropriate treatment. It’s almost always because they are not doing their HEP.

Treatment – Manual Therapy/Soft Tissue
-We can isolate segments with grade 5 thrust manipulations.
-You need an ‘orthopedic blackbelt’ (i.e. spent a lot of money in biomechanical con ed courses) to apply manual therapy to patients and improve outcomes.
-We can manipulate fascia.
-We can “release” things.
-S.T.S.I. (Scraping The Skin with Instruments) works.

Treatment – Exercise
-Exercise is innocuous. Everyone can benefit from any kind. It is impossible that my patient with back pain is being made worse by the exercises I have given them.
-Substantial strength gains happen in 4-8 weeks.
-Orders to improve VMO strength to decrease patellofemoral pain.
-Pre-participation static stretching is useful to prevent injury.

Treatment – Orthotics
-Custom orthotics are worth the money.
-Abnormal biomechanics can be corrected by orthoses.
-Orthotics are absolutely needed.
-No one ever needs orthotics.

Treatment – Modalities
-Everyone with neck or back pain will benefit from traction.
-Ultrasound does something beyond a placebo effect.
-Cold laser does something beyond a placebo effect.

I’d like to especially thank one of our readers, Jon Newman, who referenced in one of the comments an interesting handbook called The Debunking Handbook, which can be downloaded for free here. He pointed it out because the one of the premises of the author is that listing myths might actually have the unintended consequence of reinforcing the myths further in peoples’ psyches! The handbook refers to this as the “The Familiarity Backfire Effect.” However, I guess we can only hope that our being familiar with this effect might neutralize any potential for these myths to be further solidified as fact subconsciously in our psyche.

In conclusion, I liked this quote that Matt Rupiper posted from Lorimer Moseley, who is addressing the myth that pain can be inextricably linked to an anatomical source. He is quoted as saying, “I would go so far as to suggest that even the use of these erroneous terms – pain receptors, pain fibers and pain pathways – leaves the patient with chronic pain feeling illegitimate and betrayed, and leaves the rehabilitation team lacking credibility when they look beyond the tissues for a way to change pain”.

The way forward is obviously being able to differentiate between fact and myth and elucidate this distinction for the benefit of the patient’s ultimate outcome. What say you?

John