Gina Kolata has another debunking-conventional-wisdom Personal Best column in the New York Times, this time taking on physical therapy (or physiotherapy, as it’s known here in Canada). I’ve really appreciated some of her previous articles on stretching, cool-downs, massage, lactic acid, and so on. This one, I was less impressed by. She writes:

When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.

To me, this is sort of like saying “Yeah, I’ve tried antibiotics several times, but it never seems to work for me, so I always just take the pills for a day or two and then throw the rest away.” Any successes I’ve had with physical therapy tend not to be the “fix pain in two weeks” category, but more like “spend six months correcting some subtle weaknesses and imbalances in order to avoid repeating the injury you just had.” It’s a long-term investment.

That being said, the article has some interesting information about which treatment and recovery modalities actually have solid evidence behind them (not many). I’ve written about heat and ice and massage before — the fact is, if we limited ourselves to the modalities that have solid peer-reviewed evidence, we’d all just be lying in bed for a few weeks every time we got injured. So much as I like evidence-based medicine, I think we have to be realistic about the current state of knowledge.

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  • Mary Brannagan says:

    I understand that those are her (Gina Kolata) sentiments from experiences that she’s had however, when I hear people make statements like that I have to wonder:

    1)if they (the patient) are being too impatient and not complying with the prescribed treatment regime and the necessary time it takes to heal the injured tissues. (usually 6-8 wks for a substantial soft tissue strain / sprain) (Every impetuous run (when you’ve been instructed otherwise) because “I just HAVE to run!” can set the healing back farther. There isn’t a great deal you can do to speed soft tissue healing. Rather you can provide optimal conditions for healing (or mess it up by doing the wrong thing!)

    2) if her treating health care professional found and addressed the CAUSE of her current injury. (Sometimes we are satisfied with “over-use” as a cause, when clearly there are underlying mechanical issues that initiate or perpetuate pain and dysfunction elsewhere. Very often it’s more complicated than the over-simplified articles one reads in running magazines / newspaper columns.

    Any good physiotherapist is concerned not only about addressing the symptoms (swelling, pain etc.) perhaps with modalities such as those you’ve described; but also, and perhaps more importantly, addressing the causes of those symptoms.

    To explain further, the area that is painful or swollen is often the “victim” and not the “culprit”. For example a subtle imbalance of the muscles in the pelvis and hip can cause aberrant motion of the thigh bone (femur) causing mechanical problems in the knee. Because our bodies are great at adapting to altered stresses, we don’t notice an immediate problem, but eventually the soft tissues at the knee can no longer cope with the abnormal strain, and they break down …and we feel pain / notice swelling.

    If in this situation the treating health care professional only treats the “victim” (I.e. the sore knee tendons) and not the culprit (the poor motor control at the pelvis / hip) then the problem is likely to come back, if it goes away at all.

    A more experienced therapist will tackle both the symptoms (knee pain) and the cause (muscle imbalances in the remote region) in order to avoid further trouble. ( Most experienced physiotherapists use far more than just electrical modalities to treat patients. Many also have achieved a high level of expertise in manual therapy, acupuncture, corrective exercises for mobility and motor control to name a few.)

    A good clinician will also do an adequate job at explaining these concepts to the patient so that they can understand why they need to comply with the therapy, and the expected time frame for gradual return to running.

    That’s mt 2 cents, but clearly I’m biased.

    Mary Brannagan BSc(PT) FCAMPT (and middle of the pack hack marathon runner)

  • Alex Hutchinson says:

    Thanks for the comments, Mary. I couldn’t agree more that (a) you can’t expect an “instant” fix, and (b) the real value of a great therapist is addressing the underlying causes of an injury, not just shortening the healing time of a soft-tissue injury by a few days.

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