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Is physiotherapy useless?

If you plan to go for one or two treatments and be cured, your expectations may not be realistic.

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.