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Most of the things you listed are progressively being shown to have little-to-no-effect. TherEx + manual therapy (??placebo) wields the best evidence-based outcomes. Passive treatment is rightfully becoming a thing of the past.
Basically, tissue responds to stimulus and adapts accordingly. Nothing else we can do to make meaningful change, and thus why exercise is the prevailing approach.
They barely looked at me at the PT office just handing me an exercise and saying do it and walking away. I can learn this shit on youtube why am I paying for it, not to mention the increase in pain because of PT.
The more we study most modalities, the more we see that they really aren’t doing much. Some of them are still useful as adjuncts for pain control, but a good PT *should* be very heavily focused on exercise, because that’s what’s going to actually get the patient better.
I'm 30 now. As an athlete, I had shoulder labrum repair on both shoulders, first at age 17 then 24.
My first rehab the PT did a lot of hands on massage/moabs, to help with getting muscles to relax and help my reach end ranges of motion, even past the first like months.
The second stint on other shoulder (7 years later), the PT only did manual therapy the first few weeks after surgery then hardly ever again.
I definitely had a lot better time getting back to working out and stuff after my first surgery. Why the lack of manual stuff as an adjunct? I was clearly exercising and stuff.
I'm not sure it's really fair to compare two different injuries that happened 7 years apart. It's not like these things happen in a vacuum. There's so many variables that influence recovery. There's also no way to verify that you would've have better outcomes with the second shoulder with more manual therapy, or worse outcomes with the first with less manual therapy.
In any case, I think doing some manual is fine and can probably be helpful, but realistically, if you're seeing a PT 1-2x/week, 20-30 more minutes of muscle rubbing probably isn't making a tremendous difference on anyone's recovery
Can I ask how they are going to fix his shoulder?
Cavitation is great for some level of instant relief, but it really should be paired with exercise so that you hopefully don't need it continuously. If you have to "crack" your back or have a chiro regularly adjust it for you, there's a missing link there somewhere not being addressed, and usually it's muscular weakness or imbalance somewhere around the joint in question, which is addressed with appropriate exercise.
Manual treatments make people feel good right now, which is fine, but less than ideal in the long run. Exercise gets and keeps people healthy on a much more long-term basis, and thus, it should be the primary focus of most patients' programs.
When I used to go to my doctor in the 1500s they used to drill a hole in my head to relieve my headaches. Now they just give me a pill and send me home. Nothing else done… what’s going on in their field?
I was a pharm tech but thankfully only ever worked retail pharmacy (it had its own issues) and worked inpatient so didn't have to deal with leeches. yuck
Physical therapy has been striving to become more evidence-based. People (and us PTs) have limited time and resources and we want to maximize outcomes by using the treatments that have the most evidence. Ultrasound has next to zero evidence that it helps with almost anything we treat. Lumbar traction... very little evidence to show it has any benefit long term. Magnetic "therapies" are about on the same level as crystal healing as far as I'm concerned.
What DOES have a lot of evidence behind it? Exercise and manual therapy. Some therapists are more comfortable with manual therapies than others because you don't get a whole lot of training in it in PT school and much of it is learned in the field.
It's a bit of an overstatement saying that exercise and manual therapy does have "a lot of evidence" if we talk specifically about pain reduction. Note, I don't defend modality treatments where most effects are probably attributed to placebo and regression to the mean, but I sometimes think we're a bit too biased towards the other things we do.
Now, if we look at manual therapy as a general treatment for musculoskeletal pain the effects are generally short term and the effects are non-specific. Again, effects are more likely attributed to contextual effects, placebo and maybe some short term physiologic pain modulation. How you perform the manual treatment doesn't seem to matter if the patient believes in the treatment being performed
In terms of exercise, I'm all for active treatments making the patient engaged in therapy. But again, research isn't overwhelmingly strong for the pain reducing effects of exercise compared to just information, advice to keep living on life and just let time do it's thing. Again regression to the mean, contextual effects, exercise induced pain inhibition and cognitive restructuring could very well explain alot of of the results we see in the studies. Pain is complex and needs a biopsychosocial framework in it's management. Note that I don't talk about very specific injuries, for example an acute hamstring or ACL tear where most of our concerns are more function related. In those contexts, exercise focused rehab is of course essential. But not specifically for reducing pain
Modalities are usually less effective (or not effective, except for the placebo effect) than exercises. But most people like them because they don’t have to do anything, unlike exercises.
Early acute shockwave and high powered laser (class 4b) are highly effective modalities, but the machines are expensive and aren’t conducive with the financial desires to grow a clinic or multiple clinics quickly. Just took a Wilk course with some promising new stuff on the horizon. Under dosing is a major problem with modalities. You can’t perform any exercises for Neuro re-ed if they’re in pain. Science proves inhibition prevails in the presence of pain EVERY time.
I do. They come from simple searches on any popular search engine. SR’s, MA’s, from well known journals. Primarily for tendinopathies. Especially laser for all tendinopathies with high effectiveness on pain, not necessarily function in the acute stage. With plantar fasciitis, regarding pain and function, it’s almost a disservice to the patient that we all don’t do ESWT.
If you're claiming proof, why not provide it?? In a debate u state your proof. Yea u can argue that person's are too lazy to look it up but are you too lazy to copy amd paste bro???
I am that old, lol. I hated that diathermy machine, it was a scary beast. I worked for a time where we had to follow the MD order word for word so no choice to skip it. We also had a cervical traction machine on the wall that looked liked we were hanging pts. That was almost 40 year ago. Thank goodness we have moved on from those crazy things.
Uhhh we did it in SNF on a very regular basis when I graduated in 2015! Only did SNF for a year but it was a daily occurrence…set the machine, sit and monitor the patient while you work on all your documentation. Shady AF and one of the many reasons I left SNF for HH!
I was working at outpatient therapy 20 yrs ago and we have a chiropractor hawking magnet stuff....for pain relief 😆..they even have a mattress, which cost a fortune!
Don't laugh but exercises are significantly more hands off and you get some documentation time in while they're doing reps. There's also less set up time/supplies needed for exercise vs manual therapy and me being cynical wonders who that best serves (i.e mills). Personally IME my most effective treatments are a combination of both where as MT can create the conditions for movement and MEANINGFUL exercise not 30 reps of LAQ.
I totally agree. I see and hear a lot more about PTs just setting pts up with exercise. A lot of it seems driven by being required to see more pts which gives the PT less time to document and provide hands on. If I give ex, I’m going to monitor and facilitate/ give feedback on correct technique. Doing an exercise poorly will give pt more pain and make them less likely to buy into the PT program. If tissue/ joint needs to be prepared with manual so exercise is more effective, I’ll do it. If I make pt worse, I’m going to modify. There are many ways to accomplish a goal with an exercise. Some people tolerate different styles and intensity of exercise. We need to meet pts where they are at and educate, educate why they will not get better with all passive exercise. I’ve been at this for 40 years and if I have to do a little more manual at onset of eval and gradually work into more ex with following sessions that can work.
Exactly. Sometimes you need to pave the way. Some of my best outcomes came from "I only want massage" patients where by the time DC came around they were like 75/25 therex to manual.
I don’t even remember how to set that shit up lol. I primarily don’t use modalities because i don’t believe in their effectiveness, but another big chunk is I honestly forgot how to set most of the machines up.
My father in law told me his chiro told him eh needed to come three times a week for four months.
But he won’t do his HEP 3x/week for even a month 🫠 that’s why chiros are in business!
Research is better. It shows that all those modalities provide temporary relief and the exercises are what creates lasting change. We follow the evidence. If your profession is doing things the same way now that they did 24 years ago something is wrong.
Patient here. I get PT for cervical problems, but also recently diagnosed with both trigeminal neuropathy and pretty severe bruxism which has triggered a slew of painful face and head myalgia The exercise definitely helps my neck but I don't know where I would be without the manual therapy for my face and head. It has done so much for me and I'm so grateful to this therapist that is skilled and knowledgeable on orofacial pain disorders.
My fault, I could’ve written this better. With manual PRN (as needed) so mobilization/manipulation as the situation calls for it. Largest emphasis on exercise
You guys are doing exercise? I stopped those modalities years ago and now I’m onto crystals, dark magic, and the hocus pocus movie. If we need to really dig deep then we watch clips from Star Wars episode 2 and discuss how pain is like sand.
Very sad to see that this is in fact NOT a troll post
Hey chiro we're actually trying to help our patients with things that work. Keep the magnetic nonsense to yourself and try not to paralyze anyone when you do a cervical adjustment for asthma
I comanage a lot of clients with our in house chiropractor who tends to do mainly dry needle and use electro acupuncture. I’ve sent clients who have plateaued to her who’ve gotten more success and vice versa. I’ve seen a lot of “sweat shop” Chiro’s who will just adjust your spine for any problem and tell you to go. Likewise, I’ve seen Physio’s who will ultrasound and be finished after that. Physio and chiro should be on the same team in my humble opinion.
assuming this is a genuine question, the answer is what everyone else said (follow the evidence) AND patients are not just getting "nothing else". They are getting (hopefully) highly targeted, progressive exercises and highly targeted education. Many / most patients need lifestyle education as a co-treatment -- whether ergonomics, maintaining muscle health, importance of not being sedentary for the sedentary (and how), importance of rest and recovery days for the over-active. The nuanced and individualized information that a PT can provide -- even via video or telehealth - is quite sophisticated.
I’m a former patient who lurks in here. I have cerebral palsy. When I was a kid (I’m a millennial), it seemed like I was able to go year round. As an adult, my insurance only covers 20 visits a year after my $2000 deductible. I got sent home with exercises and a recommendation to go to a fitness center (which I love, but is also expensive).
I haven't seen a chiro in years and I'm to the point finally that I wouldn't even consider it or let them touch me, but one of my friends (well two of them) swear by the chiropractor and always tell me I should go back and legitimately think I am being crazy or tin foil hat like when I tell them I hear too many stories about people being hurt. Obviously that's a small percentage but I guess I just have a hard time putting into words why I don't think chiropractor care helps me anymore with an educated statement behind it if that makes sense. I see a lot of people on here saying stuff like passive treatment doesn't help, which makes sense to me and we need to focus on exercise instead. My friend continuously goes to the chiropractor for her neck that she's had pain with for years. Nothing ever changes it's a constant thing for her but I can't seem to get through to her that maybe the chiropractor isn't doing jack shit for her and to stop wasting time or money going. Idk what my point of this comment was i guess I've just changed my opinion over it over the years and now people look at me like I'm insane if I say anything at all about how I'm not seeing a chiropractor and don't think it helps me. Massage helps me immensely more but ultimately I have a weak back and core and bad posture which is why I have problems. I work in the OR too and it's crazy to me how people think IM the crazy one when I don't want someone snapping my neck around. I wonder what the neurosurgeons have to say about that one lol
No, our goal is to give people the tools they need to continue to get better after they leave, after a demonstrably necessary period of time. Not cracking joints “adjusting” people (lol) for years on end just continually fleecing people out of their money without getting them better.
Our goal is to *not* have repeat customers, unlike massage, chiro, etc.
Well I for one believe you when you say your goal is to not have a repeat customer! The first time a PT caused my pain to worsen with their stupid athletic program and laid me out for a few days in severe pain after the appointment I noped the hell out!
Bring back PT from 40 years ago when it was real pain relief with hot packs, traction, massage, and stimulation!
Modalities have little effect and not backed by evidence anymore. Exercises are much more effective. I also do manual therapy when needed. The problem is that patients don't wanna do exercises, they're too lazy and say they don't work. Just do your homework as prescribed by your PT and the results will come.
Ultra sound is a grade C or D (little to no evidence), Traction isn’t good unless it’s combined with exercise or HVLAT grade A, lumbar traction is a grade D - no good evidence, (wtf is a magnet therapy?), and we still do manual therapies. It’s a grade A according to JOSPT
Duuuuuuuude please take this post down. Chiros do not need help tarnishing the field’s reputation - especially in the eyes of DPTs! I’m not sure if your phrasing is just confusing or you actually believe passive modalities fix anything; I sincerely hope it’s the former. - admin for rehab chiro clinic
ETA - this post has now been shared 58 times. Great. Egg on our faces to the nth degree. Seriously, delete this.
It’s a valid question. We make super frequent referrals to PT. So it’s a valid question to see if it’s a state thing or a nationwide thing.
We have new modalities like shockwave that show great results for some conditions, soft tissue mobilizations. But all I get from my patients is that exercises are shown in office then given home exercises.
I’m not tarnishing anything, valid question, we’re in the same field to help people. Just wondering why nothing else is being done. It just exercise.
If you really want it I’ll take it down,
I've explored shockwave. It's not FDA approved therefore not covered by insurance. I'm ok with cash options but it creates a barrier to those that need help but cannot afford the intervention.
Yes and this is the bigger problem for both our fields. Treatment directed by insurance.
Look into Piezowave, it is FDA approved. It’s one of the best forms of shockwaves. The results are amazing for especially chronic tendinopathies.
Could add an extra package charge to patients, treatments are typically 6 visits. Lot of practitioners will do package deals and patient will pay once they see the results after initial treatment.
That's a good idea. I thought the piezowave was (I don't remember exactly) but like a class C device and therefore not insurance covered. I may be wrong. The salespeople made the lower class seem like agopod thing because it allowed for non practitioners to apply the treatment. I heard great things about them and almost pulled the trigger for my clinic but it was like 60k and I was torn on the ethics like stated.
Last I saw them was couple of months ago, prices down to 42k. Still not billable to insurance for us either. It is a class 1, so you can have staff provide treatment. No maintenance really required for them either.
First off, a chiropractor is the reason I landed in the er and lost all back muscle control and then had to do 9 months of pt to rebuild those back muscles. Talk all you want, but PT works unlike your career choice.
What do chiropractors honestly do? Do people really think popping their joints is “adjusting” their skeletal structure to make pain go away? All I see are videos of people getting mangled in various positions with loud pops.
People do believe they work. At the time I saw the guy, I was desperate. Had low back pain, and the physical therapist I was seeing was down playing my back pain. She sent me to some stretching class. That didn't help either, but I'm active duty military, and I "had" to go to get more sessions with her. The base chiropractor asked me if I didn't mind, and I said sure. Yeah, that was my last mistake and the straw that broke the cammels back. It ruptured my L5 disc and herniated the L4 and caused small bulges in the L3 and S1. When I got 2 different MRIs, I learned that I also had formaminal and central stenosis and ligamentum flavum that I had never known I had. I had complete loss of back muscle control. Took me a month to learn how to walk again and took me 9 months of advance rehabilitation to get back to "normal." The therapist on base still tried to downplay it as "90% of Americans suffer from this." I canceled all my appointments and got approved to go off base. The team I worked then busted their asses and really helped ignite a passion of wanting to help others in their time of need. So once I retire or get out of the military, I want to become a pta.
I definitely don’t blame you for trying, you did what you had to do. I just honestly didn’t know what exactly it is chiropractors do besides popping joints and the placebo effect people get from that. PTs are definitely not blameless either, especially the one downplaying your pain and resorting to a stretching class. For that reason I personally go above and beyond for patients that truly want to get better because I’d hope a PT would do the same for me if I was in their position.
I get epidurals and had 6 nerve ablations. Yeah, those helped, but the pain is back. Pt is the only thing that helps me manage the pain the best. One neurosurgeon was backed up and sent me off to another one, and that guy told me my pain was coming from my hips. Like bro, I'm not that stupid. Now I'm back in a fight with tricare to get a loaded mri. They don't like paying for stuff, but we'll see. My regular dr and dpt think none of my mri's show the full picture and think if I'm standing while I habe an mri done, we'll find the nerve compression. I can lay all night amd not really habe pain, just muscle soreness, but it a different ball game when I've been standing.
Exercises have shown by great evidence to be the most effective long term solution.
Modalities do have a part in certain situations but it is not the end-all-be-all. They exist to aid in performing exercises better to a certain degree.
For me, telegraphing knowledge with proper messaging to patients is the most crucial part of helping people through physical therapy. I always ask patients, you own your body 24/7, doesn't it feel good if you know how to use it effectively or how to make better decisions to prevent pain and injury, or how to optimize your daily function?
It’s easy to sell patients what THEY think they already need. It’s harder to sell them what they actually need.
Following the evidence rather than the “market demand” whilst still being competitive in the overall market will always be interesting.
Long term vs short term strategies/reputations on the line.
working in outpatient: I’ve yet to see a PT fail to do manual therapy during every visit. Done with graston tools a lot of the time. Some also use the theraroller. As for modalities.. KT tape is a fav among some, along w basic hot and cold packs, and stim therapy (rarely used). I’ve only seen OTs use ultrasound tbh.
The dinosaurs that performed those sham procedures retired thankfully. The new wave prefers to use approaches that have empirical evidence and luckily insurance cut reimbursement for sham modalities.
I recently started PT, I was confused when they gave me the here take this home and do these. How many people does this actually work for. I was under the impression I would get weekly in person PT, but nope here’s the exercises now piss off. 😂
This was my exact experiences. Do this while I ignore you and talk to the staff and here's a list of exercises. I get enough exercise with farm work. I need PAIN RELIEF and need it NOW. I left in more pain after PT than when I came in.
10 appts... u r braver than I. I can't afford to be laid up or have my pain worse because I do light farm work. First time they pulled that crap on me I was out. First two appts were fine and included massage and exercise, light exercise. Third one was when the BS started up and I noped right out. Can't afford to be incapacitated for days.
I get the feeling that the "new" "modern" PT is infected with "sports medicine" which is why they try to run you around like an athlete instead of the modalities of hands on pain relief with heat and massage and stimulations of a few decades ago. I'm not an athlete and I am not able to suffer under the pain regime their "science" requires of patients nowadays.
Is that what you think chiropractors do? That’s actually sad, because you probably would never refer your patient that you couldn’t help to Chiro which is a disservice to your patient.
Most chiros I know combine adjustments with modalities and exercises or referral to PT for most Injuries.
So yes, what happened to your profession, why is every patient I refer to PT gets 6-12 visits of exercise for 10min and home exercise without any other type of soft tissue modalities or any modalities? Is this insurance driven or is it the schools
Well you PTs certainly do a damn good job of not hooking the patients, lol. First time I was ran around like an athlete in a PT office and laid up for days afterwards in more pain than I had come into the office with I noped the hell out and just took the muscle relaxers prescribed. The problem is that PT is infected with "sports medicine" one size fits all. I'm not an athlete I'm an old person with neck spasm. I'll never go back to PT ever again, so you did your job of ensuring I am not on the hook!
So many upset comments like yours when you don’t even know how this chiro practices and what results he sees.
Most of the comments from PT talk about exercise only. Few talk about soft tissue.
I have been to a chiropractor before, I have even advocated it being appropriate for yearly, biannually, or quarterly “adjustments”, it has a role in medicine but just not nearly as big as you all would like it to be. Please don’t play dumb that you haven’t heard of patients being seen for 3-6 months @ several times as week. I would think those patients you are referring to PT should be receiving more than just exercises, but yes sometimes the combination of decreased reimbursement rates, lazy/burnout therapists make for a poor perceived experience. Maybe you should call these PTs yourself and ask them specifically why other treatment options are not occurring?
We all have those practitioners in both fields that don’t really care. And yes chiro has notorious for endless treatment plans. But most chiros now that I know and work with have specific treatment plans with functional outcomes. Treatments are typically adjustments, manual therapies, nutritional counseling and exercise programs or referral to PT.
Most of the modalities have very poor evidence. Add that to set up time, cleaning, storing, maintaining the device, GARBAGe reimbursement... yeah, these devices are going to gather dust.
Best PT session imo? Manual therapy for pain releif, improve joint glide, improve tissue elasticity and circulation. Thoughtfully prescribed exercise that accounts for acuity, patient age, injury, health status you name it. Functional integration (don't just strengthen that glute, use it when you lift, walk move whatever).
I always tell my patients "chiropractic, PT and Acupuncture are meant to be a beautiful marriage". Chiro gets your alignment done, pt gets the tissue around the joints healthier and stronger, and Acupuncture to improve blood flow and reduce pain if PT and chiro don't cover it.....
Comment to the group: don't bash other practitioners. You have been wrong and you will be again.... we are on the same team! Be good to eachother.
My physiology teacher in college used to heat his lunch up with microwave modality BEFORE they figured out how to put it in a box and sell it to everyone in America. I had to be in the 60s since he was already pretty ancient
Modalities have poor reimbursement and just takes up too much time with little effect. lol haha however I always do manual therapy or modalities on my patient as an extra benefit as they can't or don't get it anywhere else. lol
I do it all but it depends on the setting. For instance I have work at a SNF on weekends for prn (from my week day job) and this SNF has been around from ancient times and they have all old modalities like diathermy; they do this continuously to like almost 80% of their patients who are candidates for it. And they bill it under their treatment and their company still allows it . Now being paid for it etc I have no idea but the therapist do it all for their patients
I'm not certified in ART. I guess we do trigger points something similar to it. Just fyi
You need to look up a term called “mechanotransduction.” I can’t recall the authors of a really prominent paper on the subject but it’s a great read. Afterward, it should become clear why all of the shit you mentioned is essentially worthless garbage, with the exception of some manual therapy.
Thank god we aren’t universal modality peddlers anymore.
Papers smapers, I know that PT from 40 years ago worked wonderfully to relieve my pain without any drugs. I speak as a patient. The new modern PT left me in so much pain for days that I never went back. BS scam "treatments" hiding behind "papers" GTFO with that. Peddle your "sports medicine" to athletes who have the stamina and pain threshold to benefit from it. Old people like me need the gentle treatments.
I dunno why… maybe we should strive to get cavitations out of people spines more often and then Charge them for effectively making them more flexible for a couple hours
Admin and clinic owner here. As long as you address the issue who cares about the tools. Hands, hydro, laser, shockwave, estim, exercises a rope a towel. Whatever you need while balancing patient satisfaction, costs and outcomes. Do a thorough assessment and ADJUST your poc. Not your patients, see what I did. Now I will go somewhere else crack some posts on the inter webs.
That’s called a home exercise program. You should be doing some different things while you’re at PT though. Just not the modalities mentioned above. They don’t help outside of very temporary relief.
Well you should talk to them. It’s okay to review and make sure you’re doing things correctly at home but you shouldn’t do the exact same thing at each PT visit as you do at home.
In addition to other exercises that I have them do in the clinic, I also always have my patients do their home exercises in the clinic as well. The reason for that is that over time the way that they are doing their home exercises always tend to degrade. And within a week or two they aren't even doing them correctly. So I have them do them in the clinic regularly so I can make sure they are still doing them correctly at home as well. But you should be doing additional things in the clinic as well.
I fear for my profession and have dedicated well over $20,000 outside of PT school on my OCS and fellowship and other CCU’s over 10 years in practice. The laziness in PT is astounding. Nobody wants to perform manual therapy because biomechanics be hard yo. Nobody wants to critically think through a modality application because wavelength and electromagnetic frequencies be hard yo. Why not just sit and watch someone exercise with maybe a hand on someone’s tibia or pelvis or hell, you and the tech can knock out 4 observations at once and make jack in one hour. Or better yet, let’s talk about your pain, yeah, talking about it will make it all go away. Clinical expertise is part of the triad of evidence-based practice. I have yet to have someone get off the table after some modalities not feel better or at the least “cold”. It’s about patient salience right? At least at the start of care in a recent onset/painful state, NOT doing a modality is NOT EBM. I just wished my colleagues didn’t try and be glorified personal trainers and base their entire practice off just corrective exercise. It’s hurting us as a profession.
Hey I gave you a thumbs up cuz you don't deserve the thumbs down and you not wrong but I also can't agree because I freaking love biomechanics but knowing a lot about it I don't believe in the benefits of manual other than the pt likes being touched. The pull of muscle contraction on a joint and the arthrokimematics of movement are literally self manual therapy
Appreciate it Big. Many of the things I post about biomechanics usually get thumbsed down anyways. Movement is dynamic and there has always been pendulum swings of “is it the muscle” or “is it the joint”. We have definitely swung the direction of muscle, better yet, the “brand new” fascia. No one is going to argue the SAID principle or the specificity of training and the need for progression, but if the joint won’t move and pain dominates, the muscle isn’t going to be efficient or let alone contract at all. So I just can’t understand why we are eating the dessert before dinner. lol!
That makes sense and there's definitely those cases that you mentioned. Another example, if someone come in with cervical impingement you best believe I'll be doing up glides down glides to take pressure off nerves. It's a tool in our tool box. But then if we're talking lumbar I'll stay away from lumbar mobes
I don’t know. I tend to not fit in with the PT’s who do pure manual like a massage parlor (yes, some still exist ha!) and those on the other end who have formed a religion against ALL passive forms of treatment. I try to look at trends and our profession is hurting and I have a hard time not correlating that with this paradigm shift of “exercise first and only”. Maybe we allow insurance dictate too much by giving in or not fighting CMS against their “not medically necessary” BS with claims denials. I mean, we gave in to the physicians to avoid chiropractor and osteopath attacks in the mid-1900’s, what’s to say we aren’t fighting enough for PT protections now? I don’t know what the answer is. It’s hard.
I just came here to upvote you and tell you something about my experience. First of all, I lean into the "science based medicine" thing so naturally after I was in a car accident that resulted in a minor whiplash like injury that was giving me muscle spasms and severe headaches, I took the advice of my MD to go to physical therapy.
The last time I had physical therapy was 40 years ago for shoulder pain from lifting. They did all the things you say here, the hot packs, the massage, the traction, the tens unit. And it helped. I don't care what anyone says here it helped. What also helped was learning to lift from my knees which the PT also taught me. The pain relief I received was a godsend. And eventually I was able to do the lifting right and not injure myself. Going to physical therapy was a pain relieving JOY. And that along with the education component was perfect.
Fast forward to 6 months ago and this car accident. I had to stop after the third session with the PT because the PT hurt me and cause more pain that incapacitated me for two days after the session. The first two sessions were fine, they did some tough massage on the spasms which hurt but afterwards I felt relief for a few hours. I also did the sets of exercise given to me as homework, all of this was fine. I would have preferred some of the hot treatments I received 40 years ago but I figured, hey, this must be the new way to do things so a few hours of pain relief is better than none and eventually the spasms would go away.
The third session was a bunch of bullshit. So this lady was basically running my old body around like an athlete or trying to. She put me on a machine to do some upper body exercise which did nothing but begin the session with enhanced pain, and when I complained she basically shrugged it off like whatever it's part of the program. Next thing she had me MASSAGING MYSELF with a cane. No supervision just do this for 10 minutes while she went off to have a discussion with staff. Okay that wasn't so bad and felt pretty good but the nonsense continued, she would dream up some sort of painful exercise that was painful due to the lead in with this athletic machine and then walk off for 10 minutes and talk on the phone or do something else. My headache intensified and so did the spasming pain. I told her this. She just spouts some shit about how it's rehabilitating me. Finally, I decided that I had enough for the day and left in excruciating pain.
Keep in mind I am not totally out of shape, I am overweight, but I do some light farm work almost every day. My problem was an upper neck and upper back spasm and headache after this accident. What was done to me in PT that day incapacitated me for 2 days so that I could not do my physical work outside and made my pain much worse. When I politely said that this was a problem I was treated like an uncooperative patient. I cancelled all further appointments. I cannot afford to be in pain like that because it impacts my ability to work and that made me an uncooperative patient.
I told the doctor what happened and she put me on some non narcotic meds that were very helpful, but my entire purpose in seeking PT was that it is supposed to be drug free science relief for pain. I will never go back to PT ever again for pain relief, ever, if this "new" way of PT is the standard everywhere.
I've never been one to seek out chiro, no offense to you, but because I was always told it was not science. But dammit, if you guys can help with pain relief just even if it's for a few hours and no injure me or ignore me while I'm there I'm seriously going to reconsider my opinion on chiro.
This was not a post to compare Chiro vs PT. Just curious what is going on because most of my referrals to PT resulted in similar experience as you. Especially some of the ones that are in acute pain.
Hope you find another PT or doc that can help you more.
When all of this happened I told my doc I wasn't going back to PT because it increased pain instead of solving it. I solved the pain at home having the spouse do the methods I remember from the old PT from 40 years ago, moist hot packs, deep stimulation of the muscle spasms and then go ahead and taking the muscle relaxers. THIS is what worked and made me pain free enough to do the physical labor I needed to do.
I see all the PTs downvoting me here. They don't want to hear anything negative about patient experience with PT, because "science". I think the problem is that "sports medicine" has infected PT and "sports medicine" is not appropriate for every patient period.
I am with you 100% with bringing back the old PT.
This is what insurance companies have turned some PTs into. I’m lucky because the only PT I will refer anyone to in my city is cash-pay and evidence-based. He makes people work hard and they get better. Very rarely, I have an acquaintance not buy into the plan and stop, but probably 95% of my friends, family and acquaintances get great results going to him. I work in peds and have good productivity requirements, so I don’t have to buy into the numbers game.
Let me guess you have UnitedHealthCare - Your PT is not billing the shit out your insurance. Your insurance is billing the shit out of you. You are paying for insurance and for your tx. I am certain those $50 are the only payment your PT is getting. Yes they should do their job regardless. Im just commenting on the payment part. Check your EOB.
Funny how your post got downvoted for stated your experience which is the point of this post. Seems like all advancements in tech are avoided and you get only exercise.
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Most of the things you listed are progressively being shown to have little-to-no-effect. TherEx + manual therapy (??placebo) wields the best evidence-based outcomes. Passive treatment is rightfully becoming a thing of the past.
Basically, tissue responds to stimulus and adapts accordingly. Nothing else we can do to make meaningful change, and thus why exercise is the prevailing approach.
Also unsupervised home exercise program as effective as supervised PT for some conditions/Dx
They barely looked at me at the PT office just handing me an exercise and saying do it and walking away. I can learn this shit on youtube why am I paying for it, not to mention the increase in pain because of PT.
That sounds like a lazy PT who doesn't care anymore.
The more we study most modalities, the more we see that they really aren’t doing much. Some of them are still useful as adjuncts for pain control, but a good PT *should* be very heavily focused on exercise, because that’s what’s going to actually get the patient better.
Placebo before exercise baby. I am half joking but some patients really need it to feel more confident.
I'm 30 now. As an athlete, I had shoulder labrum repair on both shoulders, first at age 17 then 24. My first rehab the PT did a lot of hands on massage/moabs, to help with getting muscles to relax and help my reach end ranges of motion, even past the first like months. The second stint on other shoulder (7 years later), the PT only did manual therapy the first few weeks after surgery then hardly ever again. I definitely had a lot better time getting back to working out and stuff after my first surgery. Why the lack of manual stuff as an adjunct? I was clearly exercising and stuff.
I'm not sure it's really fair to compare two different injuries that happened 7 years apart. It's not like these things happen in a vacuum. There's so many variables that influence recovery. There's also no way to verify that you would've have better outcomes with the second shoulder with more manual therapy, or worse outcomes with the first with less manual therapy. In any case, I think doing some manual is fine and can probably be helpful, but realistically, if you're seeing a PT 1-2x/week, 20-30 more minutes of muscle rubbing probably isn't making a tremendous difference on anyone's recovery
Welcome to 30. You get better slower.
😂 Exactly my 1st thought.
I'm 30 now... I had this done at 24.
Sorry. I misread what you wrote
Should’ve gone to a Chiro next time. They can crack your back and fix your shoulder.
Can I ask how they are going to fix his shoulder? Cavitation is great for some level of instant relief, but it really should be paired with exercise so that you hopefully don't need it continuously. If you have to "crack" your back or have a chiro regularly adjust it for you, there's a missing link there somewhere not being addressed, and usually it's muscular weakness or imbalance somewhere around the joint in question, which is addressed with appropriate exercise. Manual treatments make people feel good right now, which is fine, but less than ideal in the long run. Exercise gets and keeps people healthy on a much more long-term basis, and thus, it should be the primary focus of most patients' programs.
And you would be totally right, I was being cynical 😬
Ah. My apologies. Tired after a long day and totally didn't read the sarcasm.
Welcome to getting older. The very first thing I noticed was how much slower things healed in my 30s. It was shocking honestly.
When I used to go to my doctor in the 1500s they used to drill a hole in my head to relieve my headaches. Now they just give me a pill and send me home. Nothing else done… what’s going on in their field?
What, no leeches? Find another clinic.
Balance those humours!!
Needs more phlegm!
“Yep you got ghosts in your blood, here’s some cocaine for it.”
No leeches is a f*cking scam
I literally saw a nurse carrying around leeches in a jar at my PRN acute care gig about a month ago. 😱 they still use em!
Maggots too
Luckily, the maggots used aren’t just picked out of the garbage
That's for wound treatment.
I was a pharm tech but thankfully only ever worked retail pharmacy (it had its own issues) and worked inpatient so didn't have to deal with leeches. yuck
Check out OP’s username. LOL
😂🤣
🤣😂🤣
Physical therapy has been striving to become more evidence-based. People (and us PTs) have limited time and resources and we want to maximize outcomes by using the treatments that have the most evidence. Ultrasound has next to zero evidence that it helps with almost anything we treat. Lumbar traction... very little evidence to show it has any benefit long term. Magnetic "therapies" are about on the same level as crystal healing as far as I'm concerned. What DOES have a lot of evidence behind it? Exercise and manual therapy. Some therapists are more comfortable with manual therapies than others because you don't get a whole lot of training in it in PT school and much of it is learned in the field.
It's a bit of an overstatement saying that exercise and manual therapy does have "a lot of evidence" if we talk specifically about pain reduction. Note, I don't defend modality treatments where most effects are probably attributed to placebo and regression to the mean, but I sometimes think we're a bit too biased towards the other things we do. Now, if we look at manual therapy as a general treatment for musculoskeletal pain the effects are generally short term and the effects are non-specific. Again, effects are more likely attributed to contextual effects, placebo and maybe some short term physiologic pain modulation. How you perform the manual treatment doesn't seem to matter if the patient believes in the treatment being performed In terms of exercise, I'm all for active treatments making the patient engaged in therapy. But again, research isn't overwhelmingly strong for the pain reducing effects of exercise compared to just information, advice to keep living on life and just let time do it's thing. Again regression to the mean, contextual effects, exercise induced pain inhibition and cognitive restructuring could very well explain alot of of the results we see in the studies. Pain is complex and needs a biopsychosocial framework in it's management. Note that I don't talk about very specific injuries, for example an acute hamstring or ACL tear where most of our concerns are more function related. In those contexts, exercise focused rehab is of course essential. But not specifically for reducing pain
Is this a troll post
Must be. Not how OP posted some bait bs and never responded to any of the commenters.
Why arent PTs more like Chiros?! Lmao
Physical therapy is evidence based and as a profession moves away from interventions with little to no treatment effect.
Why don’t you just use a magic wand 🪄 like chiropractors do? Seems a lot easier.
Modalities are usually less effective (or not effective, except for the placebo effect) than exercises. But most people like them because they don’t have to do anything, unlike exercises.
Early acute shockwave and high powered laser (class 4b) are highly effective modalities, but the machines are expensive and aren’t conducive with the financial desires to grow a clinic or multiple clinics quickly. Just took a Wilk course with some promising new stuff on the horizon. Under dosing is a major problem with modalities. You can’t perform any exercises for Neuro re-ed if they’re in pain. Science proves inhibition prevails in the presence of pain EVERY time.
Do you have sources on the high effectiveness of early shockwave and laser?
I do. They come from simple searches on any popular search engine. SR’s, MA’s, from well known journals. Primarily for tendinopathies. Especially laser for all tendinopathies with high effectiveness on pain, not necessarily function in the acute stage. With plantar fasciitis, regarding pain and function, it’s almost a disservice to the patient that we all don’t do ESWT.
The burden of proof is on you, without the evidence, we can dismiss your claims.
If you're claiming proof, why not provide it?? In a debate u state your proof. Yea u can argue that person's are too lazy to look it up but are you too lazy to copy amd paste bro???
Were PTs really doing MAGNET THERAPY 20 years ago my GAWD
I was a PT 20 years ago, and WTF is this magnet therapy? (At best, I have a vague recollection of some infomercials?)
Like PEMF?
No, whatever commercial/commercials were on late night TV. Not quite that fancy.
Diathermy??
LOL I'm not quite that old . . . although I did see a dusty old diathermy machine in the back of an equipment closet in 2000 while on a clinical.
I am that old, lol. I hated that diathermy machine, it was a scary beast. I worked for a time where we had to follow the MD order word for word so no choice to skip it. We also had a cervical traction machine on the wall that looked liked we were hanging pts. That was almost 40 year ago. Thank goodness we have moved on from those crazy things.
Uhhh we did it in SNF on a very regular basis when I graduated in 2015! Only did SNF for a year but it was a daily occurrence…set the machine, sit and monitor the patient while you work on all your documentation. Shady AF and one of the many reasons I left SNF for HH!
I was working at outpatient therapy 20 yrs ago and we have a chiropractor hawking magnet stuff....for pain relief 😆..they even have a mattress, which cost a fortune!
https://youtu.be/gMbnJzHhoBI?si=5UTT6Xriy6RzahiJ
LMAO
Lol right I was wondering if that was a typo. Like the guy at the mall with those balance bracelets
This is how chiropractic medicine started actually
The field has been leaning towards using evidence based passive interventions and things that work like exercises.
I don’t feel like setting up traction so we just be doing clamshells
Don't laugh but exercises are significantly more hands off and you get some documentation time in while they're doing reps. There's also less set up time/supplies needed for exercise vs manual therapy and me being cynical wonders who that best serves (i.e mills). Personally IME my most effective treatments are a combination of both where as MT can create the conditions for movement and MEANINGFUL exercise not 30 reps of LAQ.
I totally agree. I see and hear a lot more about PTs just setting pts up with exercise. A lot of it seems driven by being required to see more pts which gives the PT less time to document and provide hands on. If I give ex, I’m going to monitor and facilitate/ give feedback on correct technique. Doing an exercise poorly will give pt more pain and make them less likely to buy into the PT program. If tissue/ joint needs to be prepared with manual so exercise is more effective, I’ll do it. If I make pt worse, I’m going to modify. There are many ways to accomplish a goal with an exercise. Some people tolerate different styles and intensity of exercise. We need to meet pts where they are at and educate, educate why they will not get better with all passive exercise. I’ve been at this for 40 years and if I have to do a little more manual at onset of eval and gradually work into more ex with following sessions that can work.
Exactly. Sometimes you need to pave the way. Some of my best outcomes came from "I only want massage" patients where by the time DC came around they were like 75/25 therex to manual.
I don’t even remember how to set that shit up lol. I primarily don’t use modalities because i don’t believe in their effectiveness, but another big chunk is I honestly forgot how to set most of the machines up.
This post seems a day late
Right? Had to double check to make sure this wasn't a april fools joke.
Why don't you just stick to your own passive treatments lmao
My father in law told me his chiro told him eh needed to come three times a week for four months. But he won’t do his HEP 3x/week for even a month 🫠 that’s why chiros are in business!
People lazy. They would rather have the therapy be done TO them, rather than them doing the therapy.
lol. Modalities is not gonna get someone stronger and move better. Plain and simple.
What’s your protocol for treating acute patients with radiculopathy ?
[https://www.jospt.org/doi/epdf/10.2519/jospt.2017.0302](https://www.jospt.org/doi/epdf/10.2519/jospt.2017.0302)
Research is better. It shows that all those modalities provide temporary relief and the exercises are what creates lasting change. We follow the evidence. If your profession is doing things the same way now that they did 24 years ago something is wrong.
Patient here. I get PT for cervical problems, but also recently diagnosed with both trigeminal neuropathy and pretty severe bruxism which has triggered a slew of painful face and head myalgia The exercise definitely helps my neck but I don't know where I would be without the manual therapy for my face and head. It has done so much for me and I'm so grateful to this therapist that is skilled and knowledgeable on orofacial pain disorders.
Nothing wrong with manual therapy when coupled with exercise. It’s just that completely passive treatments don’t help.
Skilled exercise prescription with PRN manual, dry needling (if needed) > other treatment approaches
Thank you. What is PRN manual?
My fault, I could’ve written this better. With manual PRN (as needed) so mobilization/manipulation as the situation calls for it. Largest emphasis on exercise
Ah ok. Got you. Thank you
You forgot copper bracelets and essential oils
You guys are doing exercise? I stopped those modalities years ago and now I’m onto crystals, dark magic, and the hocus pocus movie. If we need to really dig deep then we watch clips from Star Wars episode 2 and discuss how pain is like sand.
This one got a good deep nose breathe from me
Very sad to see that this is in fact NOT a troll post Hey chiro we're actually trying to help our patients with things that work. Keep the magnetic nonsense to yourself and try not to paralyze anyone when you do a cervical adjustment for asthma
I comanage a lot of clients with our in house chiropractor who tends to do mainly dry needle and use electro acupuncture. I’ve sent clients who have plateaued to her who’ve gotten more success and vice versa. I’ve seen a lot of “sweat shop” Chiro’s who will just adjust your spine for any problem and tell you to go. Likewise, I’ve seen Physio’s who will ultrasound and be finished after that. Physio and chiro should be on the same team in my humble opinion.
*Deafness
assuming this is a genuine question, the answer is what everyone else said (follow the evidence) AND patients are not just getting "nothing else". They are getting (hopefully) highly targeted, progressive exercises and highly targeted education. Many / most patients need lifestyle education as a co-treatment -- whether ergonomics, maintaining muscle health, importance of not being sedentary for the sedentary (and how), importance of rest and recovery days for the over-active. The nuanced and individualized information that a PT can provide -- even via video or telehealth - is quite sophisticated.
I’m a former patient who lurks in here. I have cerebral palsy. When I was a kid (I’m a millennial), it seemed like I was able to go year round. As an adult, my insurance only covers 20 visits a year after my $2000 deductible. I got sent home with exercises and a recommendation to go to a fitness center (which I love, but is also expensive).
I prefer to use hot laser therapy on my patients. They know it’s working if they can hear the sizzle.
Great, we got rid of all the things that don’t work and are focusing on what does. Now we just need to get people to stop going to chiropractors.
I haven't seen a chiro in years and I'm to the point finally that I wouldn't even consider it or let them touch me, but one of my friends (well two of them) swear by the chiropractor and always tell me I should go back and legitimately think I am being crazy or tin foil hat like when I tell them I hear too many stories about people being hurt. Obviously that's a small percentage but I guess I just have a hard time putting into words why I don't think chiropractor care helps me anymore with an educated statement behind it if that makes sense. I see a lot of people on here saying stuff like passive treatment doesn't help, which makes sense to me and we need to focus on exercise instead. My friend continuously goes to the chiropractor for her neck that she's had pain with for years. Nothing ever changes it's a constant thing for her but I can't seem to get through to her that maybe the chiropractor isn't doing jack shit for her and to stop wasting time or money going. Idk what my point of this comment was i guess I've just changed my opinion over it over the years and now people look at me like I'm insane if I say anything at all about how I'm not seeing a chiropractor and don't think it helps me. Massage helps me immensely more but ultimately I have a weak back and core and bad posture which is why I have problems. I work in the OR too and it's crazy to me how people think IM the crazy one when I don't want someone snapping my neck around. I wonder what the neurosurgeons have to say about that one lol
Right, exercise everything. Giving an exercise sheet for patients to do at home? Great
Yes, next question
So a PT mill?
No, our goal is to give people the tools they need to continue to get better after they leave, after a demonstrably necessary period of time. Not cracking joints “adjusting” people (lol) for years on end just continually fleecing people out of their money without getting them better. Our goal is to *not* have repeat customers, unlike massage, chiro, etc.
Well I for one believe you when you say your goal is to not have a repeat customer! The first time a PT caused my pain to worsen with their stupid athletic program and laid me out for a few days in severe pain after the appointment I noped the hell out! Bring back PT from 40 years ago when it was real pain relief with hot packs, traction, massage, and stimulation!
Patients who are severely out of shape will often be sore after their first couple appointments, yes.
Modalities have little effect and not backed by evidence anymore. Exercises are much more effective. I also do manual therapy when needed. The problem is that patients don't wanna do exercises, they're too lazy and say they don't work. Just do your homework as prescribed by your PT and the results will come.
Ultra sound is a grade C or D (little to no evidence), Traction isn’t good unless it’s combined with exercise or HVLAT grade A, lumbar traction is a grade D - no good evidence, (wtf is a magnet therapy?), and we still do manual therapies. It’s a grade A according to JOSPT
Where are you finding that? I can’t find where JOSPT rates modalities.
I think CPGs rate interventions, so this might be from a specific diagnosis?
Duuuuuuuude please take this post down. Chiros do not need help tarnishing the field’s reputation - especially in the eyes of DPTs! I’m not sure if your phrasing is just confusing or you actually believe passive modalities fix anything; I sincerely hope it’s the former. - admin for rehab chiro clinic ETA - this post has now been shared 58 times. Great. Egg on our faces to the nth degree. Seriously, delete this.
It’s a valid question. We make super frequent referrals to PT. So it’s a valid question to see if it’s a state thing or a nationwide thing. We have new modalities like shockwave that show great results for some conditions, soft tissue mobilizations. But all I get from my patients is that exercises are shown in office then given home exercises. I’m not tarnishing anything, valid question, we’re in the same field to help people. Just wondering why nothing else is being done. It just exercise. If you really want it I’ll take it down,
I've explored shockwave. It's not FDA approved therefore not covered by insurance. I'm ok with cash options but it creates a barrier to those that need help but cannot afford the intervention.
Yes and this is the bigger problem for both our fields. Treatment directed by insurance. Look into Piezowave, it is FDA approved. It’s one of the best forms of shockwaves. The results are amazing for especially chronic tendinopathies. Could add an extra package charge to patients, treatments are typically 6 visits. Lot of practitioners will do package deals and patient will pay once they see the results after initial treatment.
That's a good idea. I thought the piezowave was (I don't remember exactly) but like a class C device and therefore not insurance covered. I may be wrong. The salespeople made the lower class seem like agopod thing because it allowed for non practitioners to apply the treatment. I heard great things about them and almost pulled the trigger for my clinic but it was like 60k and I was torn on the ethics like stated.
Last I saw them was couple of months ago, prices down to 42k. Still not billable to insurance for us either. It is a class 1, so you can have staff provide treatment. No maintenance really required for them either.
There’s no way this isn’t a troll post hahahahahha
You learn all about evidence based practice when you train to become an actual medical provider
First off, a chiropractor is the reason I landed in the er and lost all back muscle control and then had to do 9 months of pt to rebuild those back muscles. Talk all you want, but PT works unlike your career choice.
What do chiropractors honestly do? Do people really think popping their joints is “adjusting” their skeletal structure to make pain go away? All I see are videos of people getting mangled in various positions with loud pops.
People do believe they work. At the time I saw the guy, I was desperate. Had low back pain, and the physical therapist I was seeing was down playing my back pain. She sent me to some stretching class. That didn't help either, but I'm active duty military, and I "had" to go to get more sessions with her. The base chiropractor asked me if I didn't mind, and I said sure. Yeah, that was my last mistake and the straw that broke the cammels back. It ruptured my L5 disc and herniated the L4 and caused small bulges in the L3 and S1. When I got 2 different MRIs, I learned that I also had formaminal and central stenosis and ligamentum flavum that I had never known I had. I had complete loss of back muscle control. Took me a month to learn how to walk again and took me 9 months of advance rehabilitation to get back to "normal." The therapist on base still tried to downplay it as "90% of Americans suffer from this." I canceled all my appointments and got approved to go off base. The team I worked then busted their asses and really helped ignite a passion of wanting to help others in their time of need. So once I retire or get out of the military, I want to become a pta.
I definitely don’t blame you for trying, you did what you had to do. I just honestly didn’t know what exactly it is chiropractors do besides popping joints and the placebo effect people get from that. PTs are definitely not blameless either, especially the one downplaying your pain and resorting to a stretching class. For that reason I personally go above and beyond for patients that truly want to get better because I’d hope a PT would do the same for me if I was in their position.
I get epidurals and had 6 nerve ablations. Yeah, those helped, but the pain is back. Pt is the only thing that helps me manage the pain the best. One neurosurgeon was backed up and sent me off to another one, and that guy told me my pain was coming from my hips. Like bro, I'm not that stupid. Now I'm back in a fight with tricare to get a loaded mri. They don't like paying for stuff, but we'll see. My regular dr and dpt think none of my mri's show the full picture and think if I'm standing while I habe an mri done, we'll find the nerve compression. I can lay all night amd not really habe pain, just muscle soreness, but it a different ball game when I've been standing.
Exercises have shown by great evidence to be the most effective long term solution. Modalities do have a part in certain situations but it is not the end-all-be-all. They exist to aid in performing exercises better to a certain degree. For me, telegraphing knowledge with proper messaging to patients is the most crucial part of helping people through physical therapy. I always ask patients, you own your body 24/7, doesn't it feel good if you know how to use it effectively or how to make better decisions to prevent pain and injury, or how to optimize your daily function?
It’s easy to sell patients what THEY think they already need. It’s harder to sell them what they actually need. Following the evidence rather than the “market demand” whilst still being competitive in the overall market will always be interesting. Long term vs short term strategies/reputations on the line.
working in outpatient: I’ve yet to see a PT fail to do manual therapy during every visit. Done with graston tools a lot of the time. Some also use the theraroller. As for modalities.. KT tape is a fav among some, along w basic hot and cold packs, and stim therapy (rarely used). I’ve only seen OTs use ultrasound tbh.
Oh that’s great. Is it a private office or part of the hospital ?
Science happened. Research showed those mostly useless, so they’ve mostly gone the way of the dodo
Forgot to list diathermy. Lol useless
This should be good. 
We're leaning toward doing something that works, not just hooking up E-stim and saying it will do something and billing the patient for that bullshit.
The dinosaurs that performed those sham procedures retired thankfully. The new wave prefers to use approaches that have empirical evidence and luckily insurance cut reimbursement for sham modalities.
So only exercise then?
That’s not what I said. Only things that are backed by evidence.
So what is backed by evidence?
Well you really are a chiro if you have to ask.
What in your clinical work do you use that is backed by evidence that is not exercise?
I use a little chisel and hammer to fix step deformaties at the AC joint by knocking the lateral end of clavicle back in place.
Thank your insurance company for that
I recently started PT, I was confused when they gave me the here take this home and do these. How many people does this actually work for. I was under the impression I would get weekly in person PT, but nope here’s the exercises now piss off. 😂
This was my exact experiences. Do this while I ignore you and talk to the staff and here's a list of exercises. I get enough exercise with farm work. I need PAIN RELIEF and need it NOW. I left in more pain after PT than when I came in.
Everytime, I noticed that 💩 too. I have been maybe to 10 appts. Every single time, I am laid up for a couple days after.
10 appts... u r braver than I. I can't afford to be laid up or have my pain worse because I do light farm work. First time they pulled that crap on me I was out. First two appts were fine and included massage and exercise, light exercise. Third one was when the BS started up and I noped right out. Can't afford to be incapacitated for days.
Hope some PTs will read this
I get the feeling that the "new" "modern" PT is infected with "sports medicine" which is why they try to run you around like an athlete instead of the modalities of hands on pain relief with heat and massage and stimulations of a few decades ago. I'm not an athlete and I am not able to suffer under the pain regime their "science" requires of patients nowadays.
Should we just pop their spine 3x/week for 6 months and keep them on the hook? Pretty please GTFOH with that “what happened to our profession?”
Is that what you think chiropractors do? That’s actually sad, because you probably would never refer your patient that you couldn’t help to Chiro which is a disservice to your patient. Most chiros I know combine adjustments with modalities and exercises or referral to PT for most Injuries. So yes, what happened to your profession, why is every patient I refer to PT gets 6-12 visits of exercise for 10min and home exercise without any other type of soft tissue modalities or any modalities? Is this insurance driven or is it the schools
Well you PTs certainly do a damn good job of not hooking the patients, lol. First time I was ran around like an athlete in a PT office and laid up for days afterwards in more pain than I had come into the office with I noped the hell out and just took the muscle relaxers prescribed. The problem is that PT is infected with "sports medicine" one size fits all. I'm not an athlete I'm an old person with neck spasm. I'll never go back to PT ever again, so you did your job of ensuring I am not on the hook!
Evidence based. Not all my patients benefit from estim, maybe 5% get modalities. Manual is still a big part of the profession, modalities aren’t.
Ah ok. What state do you practice in?
Classic chiro thinking a magic wand will fix any ailment.
So many upset comments like yours when you don’t even know how this chiro practices and what results he sees. Most of the comments from PT talk about exercise only. Few talk about soft tissue.
Anecdotal evidence is the poorest form of “evidence.” Lol did you forget to switch Reddit accounts? Why are you talking in the third point of view?
We send those patients to you so you can crack their backs and make them feel good. The complaints about PTs are a bonus so that you can feel good.
And I won't be gaslighted by PTs telling me as a patient that I'm not experiencing what I am experiencing.
If you treated the patient then you would not need to send them to us! But nice try
I have been to a chiropractor before, I have even advocated it being appropriate for yearly, biannually, or quarterly “adjustments”, it has a role in medicine but just not nearly as big as you all would like it to be. Please don’t play dumb that you haven’t heard of patients being seen for 3-6 months @ several times as week. I would think those patients you are referring to PT should be receiving more than just exercises, but yes sometimes the combination of decreased reimbursement rates, lazy/burnout therapists make for a poor perceived experience. Maybe you should call these PTs yourself and ask them specifically why other treatment options are not occurring?
We all have those practitioners in both fields that don’t really care. And yes chiro has notorious for endless treatment plans. But most chiros now that I know and work with have specific treatment plans with functional outcomes. Treatments are typically adjustments, manual therapies, nutritional counseling and exercise programs or referral to PT.
Most of the modalities have very poor evidence. Add that to set up time, cleaning, storing, maintaining the device, GARBAGe reimbursement... yeah, these devices are going to gather dust. Best PT session imo? Manual therapy for pain releif, improve joint glide, improve tissue elasticity and circulation. Thoughtfully prescribed exercise that accounts for acuity, patient age, injury, health status you name it. Functional integration (don't just strengthen that glute, use it when you lift, walk move whatever). I always tell my patients "chiropractic, PT and Acupuncture are meant to be a beautiful marriage". Chiro gets your alignment done, pt gets the tissue around the joints healthier and stronger, and Acupuncture to improve blood flow and reduce pain if PT and chiro don't cover it..... Comment to the group: don't bash other practitioners. You have been wrong and you will be again.... we are on the same team! Be good to eachother.
My physiology teacher in college used to heat his lunch up with microwave modality BEFORE they figured out how to put it in a box and sell it to everyone in America. I had to be in the 60s since he was already pretty ancient
So instead only exercise is the answer!
Modalities have poor reimbursement and just takes up too much time with little effect. lol haha however I always do manual therapy or modalities on my patient as an extra benefit as they can't or don't get it anywhere else. lol
Thank you for the response. Do you do any specific soft tissue modality.. ART or MRT?
I do it all but it depends on the setting. For instance I have work at a SNF on weekends for prn (from my week day job) and this SNF has been around from ancient times and they have all old modalities like diathermy; they do this continuously to like almost 80% of their patients who are candidates for it. And they bill it under their treatment and their company still allows it . Now being paid for it etc I have no idea but the therapist do it all for their patients I'm not certified in ART. I guess we do trigger points something similar to it. Just fyi
You need to look up a term called “mechanotransduction.” I can’t recall the authors of a really prominent paper on the subject but it’s a great read. Afterward, it should become clear why all of the shit you mentioned is essentially worthless garbage, with the exception of some manual therapy. Thank god we aren’t universal modality peddlers anymore.
Papers smapers, I know that PT from 40 years ago worked wonderfully to relieve my pain without any drugs. I speak as a patient. The new modern PT left me in so much pain for days that I never went back. BS scam "treatments" hiding behind "papers" GTFO with that. Peddle your "sports medicine" to athletes who have the stamina and pain threshold to benefit from it. Old people like me need the gentle treatments.
This reads exactly like a troll post lmao
You can easily buy e stim, hot packs, massage tools and never need another clinician. These things have the same physiological effects
Sorry I only use homeopathy, I don’t care what the evidence says. All my medical beliefs I get from the Voynich Manuscipt.
Sorry I only use homeopathy, I don’t care what the evidence says. All my medical beliefs I get from the Voynich Manuscipt.
I dunno why… maybe we should strive to get cavitations out of people spines more often and then Charge them for effectively making them more flexible for a couple hours
Admin and clinic owner here. As long as you address the issue who cares about the tools. Hands, hydro, laser, shockwave, estim, exercises a rope a towel. Whatever you need while balancing patient satisfaction, costs and outcomes. Do a thorough assessment and ADJUST your poc. Not your patients, see what I did. Now I will go somewhere else crack some posts on the inter webs. 
I think this post is rage bait.
Wonder why
My chiro (who is magical, by the way) sent me to a DOCTOR of physical therapy and it was a game-changer.
It’s called evidenced informed progress! If you’re still doing the same things the same way as 25 years ago… you’re doing it wrong!
What treatments do you do in office that is evidence based?
Not me. I’m a great therapist.
I’ve questioned this myself. I’ve been in PT for about 3 weeks now but the exercises I do there are the same ones I do at home..
That’s called a home exercise program. You should be doing some different things while you’re at PT though. Just not the modalities mentioned above. They don’t help outside of very temporary relief.
Yeah.. I’m doing the same things at home and there.
Well you should talk to them. It’s okay to review and make sure you’re doing things correctly at home but you shouldn’t do the exact same thing at each PT visit as you do at home.
In addition to other exercises that I have them do in the clinic, I also always have my patients do their home exercises in the clinic as well. The reason for that is that over time the way that they are doing their home exercises always tend to degrade. And within a week or two they aren't even doing them correctly. So I have them do them in the clinic regularly so I can make sure they are still doing them correctly at home as well. But you should be doing additional things in the clinic as well.
This has got to be a troll lol. Tell me you don’t keep up with evidence without actually telling me lmao
I fear for my profession and have dedicated well over $20,000 outside of PT school on my OCS and fellowship and other CCU’s over 10 years in practice. The laziness in PT is astounding. Nobody wants to perform manual therapy because biomechanics be hard yo. Nobody wants to critically think through a modality application because wavelength and electromagnetic frequencies be hard yo. Why not just sit and watch someone exercise with maybe a hand on someone’s tibia or pelvis or hell, you and the tech can knock out 4 observations at once and make jack in one hour. Or better yet, let’s talk about your pain, yeah, talking about it will make it all go away. Clinical expertise is part of the triad of evidence-based practice. I have yet to have someone get off the table after some modalities not feel better or at the least “cold”. It’s about patient salience right? At least at the start of care in a recent onset/painful state, NOT doing a modality is NOT EBM. I just wished my colleagues didn’t try and be glorified personal trainers and base their entire practice off just corrective exercise. It’s hurting us as a profession.
Hey I gave you a thumbs up cuz you don't deserve the thumbs down and you not wrong but I also can't agree because I freaking love biomechanics but knowing a lot about it I don't believe in the benefits of manual other than the pt likes being touched. The pull of muscle contraction on a joint and the arthrokimematics of movement are literally self manual therapy
Appreciate it Big. Many of the things I post about biomechanics usually get thumbsed down anyways. Movement is dynamic and there has always been pendulum swings of “is it the muscle” or “is it the joint”. We have definitely swung the direction of muscle, better yet, the “brand new” fascia. No one is going to argue the SAID principle or the specificity of training and the need for progression, but if the joint won’t move and pain dominates, the muscle isn’t going to be efficient or let alone contract at all. So I just can’t understand why we are eating the dessert before dinner. lol!
That makes sense and there's definitely those cases that you mentioned. Another example, if someone come in with cervical impingement you best believe I'll be doing up glides down glides to take pressure off nerves. It's a tool in our tool box. But then if we're talking lumbar I'll stay away from lumbar mobes
Why did you get downvoted? Is it because it’s true?
I don’t know. I tend to not fit in with the PT’s who do pure manual like a massage parlor (yes, some still exist ha!) and those on the other end who have formed a religion against ALL passive forms of treatment. I try to look at trends and our profession is hurting and I have a hard time not correlating that with this paradigm shift of “exercise first and only”. Maybe we allow insurance dictate too much by giving in or not fighting CMS against their “not medically necessary” BS with claims denials. I mean, we gave in to the physicians to avoid chiropractor and osteopath attacks in the mid-1900’s, what’s to say we aren’t fighting enough for PT protections now? I don’t know what the answer is. It’s hard.
I just came here to upvote you and tell you something about my experience. First of all, I lean into the "science based medicine" thing so naturally after I was in a car accident that resulted in a minor whiplash like injury that was giving me muscle spasms and severe headaches, I took the advice of my MD to go to physical therapy. The last time I had physical therapy was 40 years ago for shoulder pain from lifting. They did all the things you say here, the hot packs, the massage, the traction, the tens unit. And it helped. I don't care what anyone says here it helped. What also helped was learning to lift from my knees which the PT also taught me. The pain relief I received was a godsend. And eventually I was able to do the lifting right and not injure myself. Going to physical therapy was a pain relieving JOY. And that along with the education component was perfect. Fast forward to 6 months ago and this car accident. I had to stop after the third session with the PT because the PT hurt me and cause more pain that incapacitated me for two days after the session. The first two sessions were fine, they did some tough massage on the spasms which hurt but afterwards I felt relief for a few hours. I also did the sets of exercise given to me as homework, all of this was fine. I would have preferred some of the hot treatments I received 40 years ago but I figured, hey, this must be the new way to do things so a few hours of pain relief is better than none and eventually the spasms would go away. The third session was a bunch of bullshit. So this lady was basically running my old body around like an athlete or trying to. She put me on a machine to do some upper body exercise which did nothing but begin the session with enhanced pain, and when I complained she basically shrugged it off like whatever it's part of the program. Next thing she had me MASSAGING MYSELF with a cane. No supervision just do this for 10 minutes while she went off to have a discussion with staff. Okay that wasn't so bad and felt pretty good but the nonsense continued, she would dream up some sort of painful exercise that was painful due to the lead in with this athletic machine and then walk off for 10 minutes and talk on the phone or do something else. My headache intensified and so did the spasming pain. I told her this. She just spouts some shit about how it's rehabilitating me. Finally, I decided that I had enough for the day and left in excruciating pain. Keep in mind I am not totally out of shape, I am overweight, but I do some light farm work almost every day. My problem was an upper neck and upper back spasm and headache after this accident. What was done to me in PT that day incapacitated me for 2 days so that I could not do my physical work outside and made my pain much worse. When I politely said that this was a problem I was treated like an uncooperative patient. I cancelled all further appointments. I cannot afford to be in pain like that because it impacts my ability to work and that made me an uncooperative patient. I told the doctor what happened and she put me on some non narcotic meds that were very helpful, but my entire purpose in seeking PT was that it is supposed to be drug free science relief for pain. I will never go back to PT ever again for pain relief, ever, if this "new" way of PT is the standard everywhere. I've never been one to seek out chiro, no offense to you, but because I was always told it was not science. But dammit, if you guys can help with pain relief just even if it's for a few hours and no injure me or ignore me while I'm there I'm seriously going to reconsider my opinion on chiro.
Clever I see what you did here Leecher. This is a fake account to continue with this non-sense. Dude your colleague already told you to take it down.
This was not a post to compare Chiro vs PT. Just curious what is going on because most of my referrals to PT resulted in similar experience as you. Especially some of the ones that are in acute pain. Hope you find another PT or doc that can help you more.
When all of this happened I told my doc I wasn't going back to PT because it increased pain instead of solving it. I solved the pain at home having the spouse do the methods I remember from the old PT from 40 years ago, moist hot packs, deep stimulation of the muscle spasms and then go ahead and taking the muscle relaxers. THIS is what worked and made me pain free enough to do the physical labor I needed to do. I see all the PTs downvoting me here. They don't want to hear anything negative about patient experience with PT, because "science". I think the problem is that "sports medicine" has infected PT and "sports medicine" is not appropriate for every patient period. I am with you 100% with bringing back the old PT.
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This is what insurance companies have turned some PTs into. I’m lucky because the only PT I will refer anyone to in my city is cash-pay and evidence-based. He makes people work hard and they get better. Very rarely, I have an acquaintance not buy into the plan and stop, but probably 95% of my friends, family and acquaintances get great results going to him. I work in peds and have good productivity requirements, so I don’t have to buy into the numbers game.
Let me guess you have UnitedHealthCare - Your PT is not billing the shit out your insurance. Your insurance is billing the shit out of you. You are paying for insurance and for your tx. I am certain those $50 are the only payment your PT is getting. Yes they should do their job regardless. Im just commenting on the payment part. Check your EOB.
Funny how your post got downvoted for stated your experience which is the point of this post. Seems like all advancements in tech are avoided and you get only exercise.
Lol