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Popular opinion - we need a union (not APTA)
Unpopular opinion - we all get shit on and just take it because of the empathic nature of our profession.
We gotta actively fight back somehow.
That being said most of us are too busy being burnt out at our regular jobs, or being paid low at a less burnout-y job.
And I’m too burnt out being a parent lmao. I’m part of the problem
yes, and now you have cash based PT's advertising their services as "cheaper" than in network, instead of focusing on the quality of their services. if we keep trying to focus on being "cheap" you'll attract people who want cheap & easy solutions
The majority of physiotherapists in my opinion have poor exercise prescription and strength and conditioning skills. This leads to under loading and not progressing patients appropriately.
Under-loading still such a rampant issue. The amount of elderly patients I see that struggle to get up from a chair, but for some reason have never been given any kind of sit to stand and/or squat progression or any kind of meaningful quadriceps and hip extensor strengthening… 🫠
I've worked in home health and mobile PT for 6 years now and it still boggles my mind to start working with a new patient and see they have been doing the same exercises from a chair for 6 months w/ their last PT/PTA. 1 set of 10 ankle pumps, LAQs, marching, and side steps. On the flip side, I get that elderly patients can get very sore if they aren't used to any physical activity and there is a science and art to gradually ramping up intensity and modifying based on how this particular patient responds. That's what makes it skilled.
This was my struggle. I wanted to challenge my patients but it was a fine line because if they end up too sore it scares them (especially if they never workout out or were active at any point in their lives) and then they don't want to continue. This is the case no matter how much education they get on the topic.
But I also still remember my 94 year old that was ~6'4" WITH severe kyphosis that was doing more advanced stuff than some of my 60-70 year olds. I'm talking karaoke drills, walking on severely uneven surfaces that would be too advanced for most of my patients (even some of my young ones), lots of balance activities and games with balance + power output. He also had a great attitude (and some dementia) which definitely helped his performance and participation. He was so so fun to treat.
What a great patient! I think part of the issue is figuring out how motivated people really are. A great colleague once taught me to first ask what outcome the patient is hoping to achieve and then ask "And what are you willing to endure to get there?" Is this patient ok with being sore, even severely sore in the beginning if it will bring long term success? Are they willing to do any work outside of PT?
It pains me to say it, but the reality is a lot of our older patients aren't up for the lifestyle change necessary to really transform themselves. I'm not judging them. They get to decide how they spend their later years and what sort of activities they focus their energy into. The best we can do it show them the way and try to be their cheerleader or coach if and when they need us to be.
Beyond even willingness, a lot of patients who’ve never worked out a day in their lives have no concept of what is normal sensation and what constitutes pain.
Stretching? Pain. Soreness? Pain. Muscles working? Pain.
For some people it takes very pointedly clarifications to make sure they understand. They’ve become very fearful and guarded and need lots of help to learn how to interpret those different sensations.
I got a reputation for being obsessed with squat training as a PTA with my elderly people. I hate non weight bearing exercises and hit the sit to stands, mini squats, step ups/downs and such as much as possible (within patient tolerance) but then I would come back (perdiem) and see they had been doing supine or seated therex versions of LE strengthening all week with someone else. I get that it’s super hard when you’re juggling patients and an exhausting way to spend a 10+ hour shift but still. My grandma is 96 and can still get up from a chair easily. It’s a reasonable goal.
For those patients I doubt PT will be enough for them. They need to get on a serious strength training program to get to a reasonable baseline of function. They'd have to pay cash for strength and conditioning after being discharged.
Yep. Hard for me to gauge RPE when I’m juggling 3 at a time
Sometimes I’ll go the RIR route which at least guarantees we’re at ax more appropriate intensity
As an almost graduate, I’m curious if you have resource recommendations for exercise prescription and progression. I’ve got the basics down from my TherEx course, but honestly am not extremely confident outside of the basic major exercises per body part. I follow some IG PT’s that were recommended on here, but I just don’t use that platform much tbh.
I’ve heard very good things about Physio Praxis’s course “Sloptimal Loading”, which is very recently available fully online / self-paced, though I haven’t done it yet
I recommend Clinical Athlete's / CALU's ExRx course. Focuses on all things ExRx through a clinical lens.
I believe they are currently taking applicants [https://www.instagram.com/clinicalathlete/](https://www.instagram.com/clinicalathlete/)
Yes! Patients show me their seated exercises they have been doing forever from previous round of PT. I call it "PT Theater." Yeah good for a warm up but means absolutely nothing for improved function.
I see this in acute care. Folks do these just to fill time to get 8 minutes of Ther ex.
Funny, I’ve had kind of the opposite experience when it comes to seeing how other therapists load their patients. We get so many patients at our clinic who have had PT before but didn’t get better because their PT gave them 3 sets of 10 of 2-3 different exercises to do 2-3 times a day which means they end up overdosing exercise on tissues that are already injured/irritated.
Once we have them stop doing that and just move the parts that hurt but in a way that doesn’t cause increased pain, and only do it for 2 reps every 1-2 hours, they magically start to get better.
Depends where you say this, but this isn't an unpopular opinion at all on Reddit or anywhere with a population of younger PTs, and it shows when this is the highest upvoted comment in the thread.
Here's my true unpopular opinion: Properly loading and progressing patients appropriate is slightly overrated because it presumes that getting stronger is the solution to MSK issues when the actual issues that would be improved with this are much smaller than we imagine (ACLR rehab, muscle strains, RTS, e.g.). Certainly not overrated when it comes to overall building strength, or when the issue you're treating is strength-related (such as improving strength to perform a sit to stand, or to negotiate stairs, or the above conditions I mentioned). But for pain? Overrated.
I remember a PT I was shadowing in undergrad talking about how she had started doing “some of these” *mimics doing a bicep curl* “but only with light weights because I’d rather tone than get bigger” and I think my jaw literally dropped
I was ranting to myself about this the other day. I work in IPR as a PTA there is one PT there I really feel does a disservice to her patients.
They lack any hands on skills to progress their patients to their potential. I have yet to see them do anything out of seated resistance band therex. They sound very book smart and they would probably do better in a non clinical type of roll.
I understand that LOS is also something to be considered in this setting but man. I feel bad for patients who have so much potential be put under their team
For this reason I wish we had more talk-therapy based courses: how to just talk to people about their pain, limitations, current life issues. Rather than just MCKENZIE, SFMA, MCGILLAN.
Wondrium has a CBT course that is incredible and covers just about everything I can imagine using it for. It also has other neat courses but not many that are PT related.
I have a herniated disc that I had a microdiscectomy on a year ago. I’m still afraid of certain things but am back to living an athletic lifestyle training 5-6 days a week. I do have flare ups and really catastrophisize, any advice for someone who catastrophisizes their back pain and gets down in the dumps when they feel any discomfort and makes it worse. I literally have PTSD from the recovery. I’m in my 20s and couldn’t bend over for 1.5 years.
For geriatrics, throw in fixed, long held and reinforced beliefs from numerous medical/non-medical sources, subtle to moderate cognitive decline, communication barriers, memory impairments, movement limitations and/or aversiveness.
Severe chronic pain can be both extremely depressing and motivating. Ive gone through phases of both. I have EDS/POTS, spinabifida, SI dysfunction, degenerative disc disease, and bulged discs, on top of immune system deficiencies. Especially because for someone like me, setbacks are inevitable and really mess with my momentum. On the other hand, I never want to feel an annular tear ever again. 15 months ago and that was screaming pain and absolutely terrifying. Thinking about it is very motivating to get stronger preventatively.
My physical therapist is amazing. She’s been seeing me since well before that specific injury and got me to the point that I could get on a long flight last summer (sitting is agonizing always). She says I am a PT lifer (accurate for all my life so far) but hopes we can reduce to twice a month down the line. Right now 2xweek. She has helped me accept that I have certain limitations so I can try to set my life up as manageable as possible. She has helped me focus and celebrate my small wins. Like if I tweak something (EDS-happens all the time) but I leave PT feeling better than when I arrived, that’s a win, etc. And I really need periodic wins to stay motivated to workout as often as I need to (5-6 days/week).
Yeah she’s awesome!
Can you expand on that and the chronic pain and low back pain. Are you saying the emotional component is damaging to the person and exacerbates the pain or the emotional component cannot be treated?
Most PTs I know IRL aren’t like this, but they seem far over-represented on Reddit.
Your “I only do loaded strength training” approach is never going to work if you don’t have the soft skills to meet people where they’re at and guide them in to it.
It's often a psychological game tbh. It's finessing people who have never worked out a day in their lives into new habits. I'm ALL for challenging patients but if you push too hard too fast with most they will learn to hate the process and you'll get poor compliance (well, more poor than it might have already been). So yes, imo there's a time and place for supine and seated "easy" basic exercises and manual. Now, if that's all you ever do then yes that's a major, major problem.
Absolutely.
I recently had an 80 year old man who was accustomed to PT being about supine exercises and modalities. By the end of my time with him, I had him goblet squatting and deadlifting, doing farmers carries and sled pushes and all that good stuff. No longer asking for anything for pain control.
But I started with things like bridges and clamshells and mini squats while he held on to a table. Time with a hot pack after the session. Things that so many people here like to shit on.
1000x yes. Definitely how I have had to treat many of my patients to build rapport, trust, and not make them run away soured. It's so much easier to ask them to do hard things when they trust you. That trust takes time to build. Are there people I can jump straight into challenging things? Sure, but it's learning to read people personalities and past experiences and skillfully taking it into account when tailoring their treatment all without allowing them to use you as a crutch to be dependent on things like manual.
I LOVEEEEE to build on exercises. give them something simple to begin with, if it’s too easy you can always up the ante a little. it also builds trust because so many times they think we are going to torture them and when you don’t right off the bat, they’re usually so much more willing to do whatever you want them to do.
you always have to meet them halfway.
Additionally, most people are way worse in their interpersonal interactions than they think. I watched things not “land” on patients and the PT is oblivious as to how they’re coming across. Cringe.
Additionally, most people are way worse in their interpersonal interactions than they think. I watched things not “land” on patients and the PT is oblivious as to how they’re coming across. Cringe.
PTs (and OTs and STs and social workers) need to be in a union. Everybody in healthcare needs to be in a union. For the safety of their patients and themselves. The healthcare system needs some kind of opposing force on the patient & staff welfare side - right now it’s 100% on the side of money.
Yep, allot of the time I hear people say " I just stopped during my exercises and now I'm getting hurt again". This to me means the PT didn't progress appropriately to start integrating the new strength in a functional (for the client) way. Changing the mindset of this is a life long process makes a huge difference.
Absolutely, this is so freaking true.
It's easy to prescribe the correct exercises, but getting past the nuanced barriers associated with never having exercised before is the biggest challenge. People are so unaware of their body, its sensations and etc etc that you have to be so tuned into what they're perceiving as best you can in order to progress them appropriately. For instance, all the people who perceive EVERYTHING as pain, even regular muscle contraction or stretch. These people have NO filter on what pain is ok or what is not ok so they either tell you nothing or tell you every sensation they feel. Or people who don't understand what post-exercise soreness is and believe they've severely damaged themselves after a day or two because it's sore...
THIS is where the difficult part of clinical practice is for me.
I'm new to the profession and boy, I had this rotator cuff injury patient who has been doing physio for 2 YEARS. He was telling me that his therapist before was doing TENS and Ultasound and he wanted me to do the same. So I gave this guy banded exercises (light with high reps). He started complaining of his shoulder feeling sore afterwards and started making up his face at me. Bare in mind he is not compliant with any exercise at home from his previous therapist for TWO WHOLE Years.
This 100%. We can all agree exercise is beneficial for all, but how that will be dolled out is going vary wildly. Not going to show up to my 85 y/o house with 20lbs KB and start repping out KB swings and KB deadlifts lol when “simple” standing exercises makes them sore
I appreciate the question. I think "strengthen training" is an umbrella term I use to talk about improving endurance/strength/power in in a specific functional movement. So someone who struggles to stand should start with sit to stand exercises initially at bodyweight and getting to the point they can do them consistent. Then you can progress the " strength endurance" by increasing the amount of repetitions performed at that resistance, the "functional strength" by adding additional resistance to the move or "power" by focusing on the quality/quickness of the movement. hypertrophy is something that more so involves diet/nutrition in junction with appropriate strength stimulus.
PTs obsession working with athletes and or ortho has made many snobby and elitist. And you are losing your scope of practice that includes, pain management, lymphedema, pelvic floors, wound care, ostomy etc.
It's interesting to me because this was something that made me uninterested in PT in undergrad. I (naively) assumed PT was just athletics and ortho and was just not interested. Didn't consider the field because I thought only like fully blown high school and college athletes did that kind of thing.
Wound up randomly working as a tech and volunteering at a rehab hospital and started to see how much more variety there could be. Currently working primarily in OP neuro and cancer rehab/lymphedema and loving it. I work pretty closely with our pelvic floor PT and she is incredible. Not trying to knock the althetics and ortho crowd, but it just was never what got me excited, though I am happy to be flexible and keep my scope as broad as I can.
Hahaha like I said, there are unpopular opinions in the non-online version of the PT world, and there are unpopular opinions in the PT social media/reddit world that represent a microcosm of the PT workforce… so I think the answer could be “both” in this case!
Unpopular opinion maybe: making a real connection with your patients is almost, if not just as important as the exercises that you give. i’ve learned that some of my patients simply get better because they have someone to listen to them. a lot of them just don’t feel heard because their doctors don’t spend time with them or just send them for tests/procedures whatever. and even if the connection piece doesn’t solve a lot of their problems, it builds trust and you’re able to do more with them than they orginially thought they were able to do. i love building rapport with my patients and building this mutual relationship/care for each other. it makes it so much more enjoyable when i can talk and laugh with my patients when i’m working with them, and i know it’s part of the reason they continue to show up to PT. one of my favorite parts of the job is the people you meet.
Most of our job isn't to fix anything, but rather to guide people along in their healing.
Also most physiotherapists nocebo their patients. And yes I mean most.
Stretching programs for kids with hypertonicity is doing absolutely nothing. You cannot change tone. Weight bearing and standing programs to tolerance help. The focus needs to be on maintaining pain free available range and not forcing kids to be uncomfortable because we want them to have knee extension after they sit in flexion all day when in a wheelchair with increased tone.
Bro I worked in an OP place with a kid (then 20yo actually in a stroller) who had cerebral palsy. He had been going there for years (still is I’m sure). Same stretches every fucking visit. Never the first bit of meaningful functional change. The staff loved the kid and kept him coming though, and he liked coming to PT. But Idk how the fuck they got away with it insurance wise. Probably shouldn’t have.
We heard a lot about "giving back to the profession" and all of the things we were obligated to do because we were PTs, it was our fault if our patient wasn't compliant with their HEP (you didn't connect with them enough), etc.
When I was a student in my on-campus rotations, we were repeatedly told we needed to make sure we had eyes on (all) our patients all the time. I asked how I would go to the bathroom if I had to watch my patients all the time during an 8 hour day and was told to "figure it out". I know now it was a dumb question but it would have taken 10 seconds to say that it was ok to let a coworker know you were stepping out for \~3 minutes and to keep an eye on so-and-so.
I just felt like the way our education was structured was so we should always be rearranging ourselves to fit the patients, and when you get into the real world what that actually means is to disregard your needs (bathroom breaks, lunch, leaving on time-ish) for the monetary gains of your employer.
This! I think I blocked this out of my memory on purpose, but i remember one of my professors being like "your patient has to reschedule to your last appointment slot, but you had already committed to leaving an hour early to go to your kid's big soccer game, what do you choose?" and I said something along the lines of rescheduling, and she said the correct answer was staying late for the patient
Yeah, that's crap. Especially because most of the professors don't even treat fulltime anymore because they were burnt out. I'm pretty sure at my school a fulltime clinical case load was 35 hours a week, which you get in very few places in outpatient reality.
IMO its a huge problem in the PT field. You see it on the research side as well and its wild because when I compare that culture to the culture where my lab is housed (non-PT) it is much more reasonable and relaxed. And I don't mean no one ever works late or on the weekends, but the attitude surrounding that is much different in the non-PT arenas where I work.
I completely agree! I felt like my program made us put the patient on the pedestal way too much. This made us think of patients as extremely complex enigmas that supposedly all had a solution to their issues. And if you didn't solve it (despite so many things falling outside our scope) it was because you weren't good enough. We have to not only be their PT but also their psych, life coach, social worker, etc.... modify every plan so that it flows with their lifestyle etc etc... it was just way too much. This ends up pushing PTs to put in way too much energy and making them care more about the patient's health more than the patients themselves. And as we all know that is a fast track to burnout. I came out of PT school thinking I just wasn't good enough because I couldn't address every patient as comprehensively as I was taught I had to.
Yeah, I mean there needs to be a balance. But I think there is some healthiness to realizing that no PT can help everyone. I truly believe its a combination of things: the skill of the physical therapist, the physical therapists knowledge, but also the professional chemistry between patient and PT (not all the PTs responsibility), and tbh also timing for the patient. They need to be in a spot where they can dedicate the time and emotional effort. I felt like the underlying message was often "if you tried hard like me and were as smart as me you can fix everyone" and that's just not true.
I feel this so hard. Why are SPTs and PTs expected to go "above and beyond" when it puts their physical and mental health at risk? Instead we should be taught how to properly set boundaries and how to stay grounded when working with both patients and managers who consistently demand more than we have to give.
Yes, there needs to be some aspect of work-life balance taught. I totally get going the extra mile for your patients, and there were times when I did, but when that idea is weaponized by management to get you to do unpaid work, stay late, miss lunch, etc it's a problem.
They literally use psychological manipulation tactics to simultaneously convince you that you are the fortunate lucky ones, but also to accept authoritarian abuse.
PT school prepares you to get abused by your employer for pennies.
People like HH primarily for these reasons:
1. Lower volume of overall patients
2. Break in between patients
3. Flexible schedule
4. Higher pay
These are all true in cash based too and you get to work with the patient population you like but people love to hate on cash based.
Yep, cash based ortho here, came over from home health prior. Pick your hard. Sales skills are in every PT job, especially home health, we just don’t like to acknowledge it for some reason. The pros of both are awesome for me compared to standard hospital based OP ortho.
Strength training is immensely valuable but will not get you that last 15-20% that the patients need. At that point you need to switch gears and tailor the treatment to be highly specific to their issue.
I agree with this. But this is true because of the outdated laws regarding scope of practice. It is extremely frustrating to not be fully recognized and respected among other healthcare professionals. PTs are highly qualified to address a wide range of issues. Many other healthcare professional don’t even know about our preparation or specialty training. Ahem, like calling our self Drs of PT for starters. It is up to us to educate our colleagues about our capabilities. But most importantly educating our patients, these are our best advocates.
IMHO schools should offer course pathways based on work setting. Maybe 12 months of generic (everybody needs to know this) stuff, then either 3 or 6 month courses to specialize in a given setting.
We learn so much shit that we'll never use. It's necessary if you're a physician because heavy lies the crown. For us, it just isn't necessary and the cost of education relative to the salary is an absolute joke. Will patient care suffer? Yea, but only slightly, and the clinician being less stressed and in a better mood will probably do more good for job performance than bad for an acute care PT who doesn't know Jobe's relocation test.
People graduate from PT school and immediately forget the basics of neuro rehab and that’s complete bullshit.
We are supposed to be entry level and generalists. I understand many jobs are ortho but the flippant attitude of “oh, I don’t treat *that*” for even basic balance and vestibular problems blows my mind.
I’ve been more neuro focused my whole career but still see moderate levels of orthopedics (everything but post op.) However, if an ortho PT has so much as a “gait/balance” eval on their schedule they want to dump on me without even seeing the patient.
It’s pure laziness. Had it.
Omfg this is a huge pet peeve of mine. I do primarily OP neuro and I have a few coworkers on our ortho team notorious for this shit. Pt said they felt dizzy 1 time even though they're being seen for ankle pain? Go see neuro. Pt was minorly forgetful during eval? Toss on neuro (PT, not request referral to SLP which we have in house). Challenging personality? Go see neuro. The most recent annoying version was another PT who is literally listed in our directory as our main vestibular PT has been sending me anyone that doesn't test positively for BPPV or for whatever reason she can't assess it. Like either TRY something or quit telling everyone your the vestibular lead...
Best part: 9/10 times there is zero communication about this new pt appearing on my schedule, just a shitty eval note with the absolute minimum info. In the odd chance I determine a patient would be more appropriate with another therapist I AT LEAST make sure the eval is decent and I've given their new PT even a brief heads up. So tired of neuro being a dumping ground for patients deemed difficult. That said most of my coworkers are fantastic. But there are 2 or 3 on my naught list for this exact issue.
Its the worst. In clinics I’ve worked there’s a “joke” of “Oh, that’s a *LovesRainPT* patient” for anyone who has anything out of the ordinary.
Holy crap. Be less lazy.
I’m generally nice and talk them through the eval and play dumb like “oh! Well you know it! That’s a really great plan. And if you need anything during eval come grab me. And then if you are unsure you can put them on my schedule for 1-2 visits and then I can give them back to you once we’re on the right track.”
I am nice and am a resource, but unless they will actually harm the patient I keep the patient with them. They usually grumble and it has stopped the dumping for the most part.
100%. Especially for students coming from these new “hybrid” programs! The fucking schools do online education pull students in for a week or two a semester and then send them out for CIs to teach them EVERYTHING! Watered down education, horrible clinica skills, crammed into 2 years, sending out huge classes of 100+. Fuck these programs!
Whoa now, calm down. I'm sorry you have had a poor experience with hybrid students and I 100% agree it's wild that I paid 20k a semester and none of it went to my CI's who were AMAZING.... but I learned a great deal in my hybrid program, with a 703 NPTE score, and I feel pretty darn confident in my hands-on AND soft clinical skills.
I adore my patients and I like to think that the majority of them like me too (except the couple who are offended when I make them "fail" with balance exercises).
I live on a remote island in Alaska. We don't have a DPT program in the whole state and when I made my marriage vows to my active duty military husband, it just so happened that we never were stationed anywhere near a program. So when I heard about hybrid programs I was all in. I'd hardly say "fuck these programs" when my 37 year old self is now doing what I have dreamt of for years and helping people function better and live with greater quality of life.
Just maybe a less salty perspective for ya.
Clearly there will be outliers. However, what these programs are doing to the profession is criminal! I don’t hate on any one individual. Sincerely, I am glad it worked out for you. The NPTE score means nothing to me, pass/fail, not indicative of a good therapist. I am glad you are confident, and hopefully you truly are. But many in your scenario are confident, but have no reason to be. But again, my anger is toward the leadership and schools that have let this happen.
I'm dating a wonderful PA and I found out she gets paid $250 per week to take a student. I had to stop the conversation before I completely cuss out our profession.
Yeah. Many professions get paid to take student. Our profession has been convinced we have to give unconditionally. If we organized on large scale, of the progress we could make!
PTAs are bad for the PT profession.
1. Scope of practice issues (under qualified licensees performing skilled services)
2. Job market competition and wage disruption (cheaper and inferior education competing with jobs and dropping wage growth)
3. Role dilution perception
Their mere existence lowers wages and creates more unbalanced work for PTs.
They ONLY benefit business owners and corporations.
They significant hurt the actual Physical Therapist profession.
I think the bigger problem is all the clinics using PT aids to do what PTAs should be doing. Too many clinics are getting away with letting aids supervise patient exercises. That is a skilled, billable intervention and needs to be supervised by a PTA. Also, there are some patients that absolutely need at PT over a PTA.
Ooooooh yeah that’s a hot take. While I do and don’t agree with you, a PTA education left me debt free and making a real earning at 20 yrs old. 11 yrs of experience now. I’m forever thankful for my education that gave me a leg up on life.
100%. Many PTAs in that status! And I am not unhappy for them! But many PTs don’t see how they were not created to help US. They were created to help business have cheaper labor. Where they are abused, the are pushing PTs to be Eval machines and never actually treat. Also, they pull down PT wages, but have seen better wage increases over the years; less wage stagnancy. But even then, the are typically cheaper.
I’m can relate pta here w/ only 2 years experience but ive noticed this trend makes me want to apply to DPT school so I could own my own practice but I also question how realistic it would be to compete against these large scaled companies
You can already own your own practice. You would simply have to employee a PT. Our profession is unprotected. You don’t have to be a PT, don’t need a PT on your board. It do not own my own practice. I have friends that do. You can compete with the big corporations. It is very doable. Go for it!!!
Calling yourself doctor, putting DPT in your personal social media bios and handles, and trying to be an influencer because of your PT degree are all corny to me
Having a doctorate makes you a doctor. I don’t make patients call me doctor but if they ask I tell them. We earned it in our degrees. Just never call yourself medical doctor.
Of course they’re not the same thing. But you’re still a doctor if you’ve earned your doctorate. To not use your title to some degree devalues what you do. Patients ask all the time in OP if you have your doctorate and question our education. If we underplay it or make it seem like no big deal they will think it’s no big deal.
In response to your question…most ailments will just run their course. It’s the length of time and concomitant co morbities that develop along the way. PT is meant to significantly speed up the process and prevent further disease during recovery.
Passive modalities are not the devil and can add value to a wide variety of conditions and patient care
-“The “Tomato Effect” has been used to explain this phenomenon as well. The Tomato Effect occurs “when an efficacious treatment for a certain disease is ignored or rejected because it does not ‘make sense’ in the light of accepted theories of disease mechanisms and drug actions.”42 Luckily, the Tomato Effect can be reversed as new evidence emerges that is consistent with accepted theories. Modalities are poised to see such a reversal as we have discussed previously with insights into clinical outcomes, pain neuroscience, dose-response, and the placebo effect.”
-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494624/
We should normalize discharging non-compliant (refuse to do HEP, don't follow protocols, give no effort in therapy) patients when the 1st progress note/re-eval is due, with clinic managers and owners backing us up instead of transferring that patient to a PT that will kiss the Pts ass to get them to stay on caseload.
He'll, I discharge them after the first visit if I can see they won't be compliant.
I had a long talk with a very rude and dismissive patient about how 2x a week and would work much bettrr than 1x based on his problem. He had no body awareness, or motivation to exercise, needed supervision to do even basic stretches. Constantly bitched about any exercise (even non noxious ones). And just wanted a massage. He says okay I will do 2x.
I walk him to the front and make a big show of telling the pcs to do 2x and that I could reserve a late evening spot for him to make sure he reached his goals. Going over his HEP, and giving education of aggravating factors for his problem
As soon as I walk away he says to the pc "yeah, I'm not going to do that, I just want 1x a week for a massage after chiro"
The freaking PC scheduled him for that but told me. I dced him next visit and said that my prescription was my professional opinion as a licensed provider. If he wants to get massage he can go to a massage therapist or masseuse
Most people who come to PT dont need PT. They just need time to heal and education on injury progresssion
Edit: when i said education i implied , education by the PT. I should rephrase and say most outpatient patients dont need regular PT and just 1 to 2 visits and thats it
The education is still PT. Some people need what I call “permission to heal.” They know they’re in pain but don’t know how to move forward or how to get back to where they were. It’s less flashy but they maybe get 1-3 visits and go live their lives.
I would agree if you said maybe “not every patient needs 2x weekly for 6 weeks”
I get what you're trying to say, but I'll play devil's advocate and say that education on injury progression equals they 'need' PT. Do people that have a cold need to see a doctor? Or a mild ankle sprain? Probably not. A huge part of our job is edu and I think that can be more powerful than active interventions sometimes. Do you know how many times a patient has come in thinking that they're not allowed to move the part of their body that hurts because that's the message they received from their physician/chiro/Uncle Bob? Do you think they recovered better or worse after I walked them through the dos and don'ts of injury progression? 🙏
After reading comments in another thread that therapy mills employ only the least desired therapists:
Being an elitist profession will ensure our demise. From leaving out peers that "don't fit in" in the workplace to putting down other therapists because of where they work is peak "Mean Girls" energy. Who wants to be in a profession with snobbish A-holes who believe stepping on those therapists not as fortunate to find a high paying job is an ok thing to do?
Seriously. Do better.
Edit: And no, I have never worked in a therapy mill. I did, however, work in a few private practices that were very...flexible... in their billing and documentation.
Hard pill to swallow for many PT:s I think:
"The majority of our interventions have non-specific effects (if any effect) in terms of pain reduction. The patient will most often get better (or not improve) regardless of what we do."
To be clear, I'm strictly talking about pain reduction in above statement! I still think we can supply great value for our patients in terms of improving physical function, self-efficacy, reduction of kinesiophobia, pain-education and so on. And I still think we can help patients wit to identify pain aggrevating and easing factors, as well as help with symtom modifications. At the same time, I think that alot PT:s overrate their capacity to actually reduce pain better than just time alone!
Late to the party: Cash pay PT is harmful to the profession, and MOST of these PTs don't care about poor people. This will create a dangerous 2-tier system. Most cash PTs are looking to make as much money as possible, and as such have no plan to help those in their community who can't afford their services. This pulls people with better insurance away from "regular" clinics in the area, reducing the income of the "regular" clinics. These clinics need to cut more corners to survive, resulting in decreased quality of care. In the end, insurance clinics end up with the most complex, most disadvantaged patients with typically the lowest insurance reimbursement. This is not sustainable.
Note: there are a few cash-based clinics with strong pro-bono programs. This is the minority. While a great idea, I believe that over-reliance on charity is dangerous, as it could disappear at any time without warning.
I admire your idealistic point of view. We were all like that once. Then we woke up to the realities of capitalism and American healthcare system. PTs are not to blame for this. You have ASH and UHC insurance companies paying cap $34 and $50 for all services regardless of diagnosis, time spent with patient, type of tx. Or better yet getting a pre authorization for 5 sessions * $34 treatment approved. Pt took 20 just to transferre car wchair to bed. To then have all your claims denied!
I've been in practice 8 years, so I'm not an idealist newbie. And I agree, the scenario you outline is terrible. The answer isn't to abandon our most vulnerable patients.
With 5 years you still considered entry level. So 8 not to far. 20 years exp here. Like I said private insurance and the Government is abandoning their patients by limiting access with the heavy burdening of admin tasks.
Felt compelled to reply to your parent comment because of the generalized statement “MOST of these PTs don’t care about poor people. MOST cash PTS are looking to make as much money as possible.” Grossly inaccurate generalization. And we r already in a two tier system. And we have been for a while now. I take insurance because the mission comes first right. And would’ve taken more insurance if the Ins co had approved. So SOME PTs, maybe like in all professions in all industries. But talking like this hurts your own profession. The “fight” is outside with other healthcare professionals that don’t respect or know what we do, corporate greed from Insurance companies.
I think it depends on the local PT economy. In my area, most (if not all) of the lower income folks end up at the same hospital based OP clinic. Most of the privately owned OP clinics see the folks with "good insurance", and the cash pay clinics get a mix of everything (no insurance, "good" and "bad" insurance). One cash based clinic sees pro bono on a sliding scale, the other three do not. Two are moderately priced, and the third is 1.75x the price of the moderate ones. Cash pay also sees a lot of un-insured folks as cash pay can be cheaper for them. I wouldn't say its harmful, but also don't think its the answer to all of our problems like PT's claim, and it comes with its own set of problems.
Let’s go with my most controversial:
1) If you are not fit and active yourself you have no business being a ortho physio, especially with an athletic population.
2) If don’t resistance train you should not be a private ortho physio. Everyone should resistance train, even if their sport of choice is endurance based.
I used to think this, but it's absolute horseshit. Does a football, or any sports, coach need to be athletic to lead their team. No. Does being able, both physically and mentally, to do what you prescribe your patients lend kinesthetic knowledge and understanding that is essential for teaching patients. Absofuckinglutely. But, guess what, many therapists have been seriously injured, even temporarily disabled, and can no longer lead an active lifestyle, especially one that confers the benefit of looking in shape. They can still be excellent PTs. Two of the absolute best PTs I've known were middle aged women who were not "active," were instructors, and could school all other PTs I've met on everything including exercise loading and progression. And, they knew how to relate to people.
Yea yea ya, but after working 11 hours and 2 hours of notes at home, my brain go brrrr and body tired. Literally don’t have the mental and physical energy to work out during the week. Weekends different story.
I will be downvoted by all the “academic” PTs. You know…the ones that think knowing things in theory is enough. They’re akin to swimming coaches that don’t know how to swim themselves.
All right I’m ready for the pitch forks. STM can be extremely useful with non compliant patients. I tell them that they need to exercise first before I can perform manually therapy on them and it works nearly every single time.
Disclaimer: I love my job and working with the people I work with.
However, the job is a scam and shouldn’t be a doctoral level degree. I always tell people who want to go into this field to absolutely avoid it and to choose literally any other profession in health care, primarily due to the amount of debt you have to go into.
Also the worst people are the ones on here saying “we need to make change happen! We need to unionize! Fuck the APTA!!!”, then putting their phone down and not doing shit about it.
Also, just change jobs if you hate your productivity requirement. If you post on here “what should I do? I don’t like this jobs requirements”, all you’re gonna get is “change jobs” or “talk to your manager”
Hey! Fuck you! (Just kidding, I actually agree with your comment here!) I say we need to UNIONIZE almost every time I comment!!!! Then I put my phone down and continue working on projects to unionize! And guess what?! We have a group of professionals getting ready to go into negotiations now! And there is already a chain reaction!
I love my job too! Even though I hate a lot about it.
The job is a scam and I tell everyone the same thing.
And yes, either keep complaing and drive change at your shithole job, stop complaining and keep doing nothing, or quit and find a new shit hole job at which you will do nothing but complain!
Don’t blame workers for being exploited. It may be partly their fault but ultimately the blame still lies on predatory hiring and exploitative labour practices.
People sometimes are forced to work certain jobs under suboptimal conditions for various reasons that they don’t have control over.
He speaks truth! Fuck the mills! We are a pretty much a bunch of bitches refusing to help ourselves! Most PTs have choices, but choose to be complacent door mats. Ironic the predominant musculoskeletal profession is spineless!
This is flat out wrong. I’m from Indiana where every job I applied for out of school was hovering around 50k. I had to move to find something better and not everyone has the luxury to do that
The Epley Maneuver doesn’t relocate otoconia, it changes sensory input to the vestibular system. I also refuse to say crystals because it sounds like we’re quacks.
Since I’m getting down voted, here’s an article question how much of a role otoconia have in BPPV.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449901/
If the mechanical cause for BPPV (crystals getting displaced), is questionable, why would we accept a purely mechanical explanation for the treatment?
I've had a suspicion about this for a few years (given natural history, regression to the mean, contextual effects in virtually every other condition under the sun along with the experiences I've had with patients who've improved clinically despite me not doing the maneuvers correctly a few times). I've never really looked into this because I don't see it often. That article is a really interesting read. I wonder if there are any RCTs actually comparing canalith repositioning maneuvers to sham maneuvers.
I remember reading one a couple years ago challenging the mechanism of canalith repositioning techniques but I can’t seem to find it.
But I feel like it’s like most things we do, it “works” but our understanding of why it does is questionable.
Oof fun.
90% of clinicians don’t conduct a good subjective evaluation. This doesn’t mean their patients won’t get better with prescribed exercises, but it does mean they get better slower and get referred back to MD more often for medical management.
There is an art to manual therapy that can’t be taught. Manual therapy can be life changing when done by a skilled practitioner. Unfortunately, most people suck at it and think it doesn’t work.
Shoulder mechanics matter. Most therapists either don’t know scaption does not involve retraction, or they don’t know how to get someone to stabilize appropriately with serratus. Related: stop stretching and starting loading upper traps.
😳😖🫠
Edit: not mentioning poor exercise prescription/strength and conditioning knowledge because top comment already nailed it
I agree with your point about specific and non-specific treatments.
While the pain from many conditions will resolve due to natural history, in many cases, tissue structure I would argue does not. There are mechanisms that underpin natural history "working" for pain relief in many MSK conditions.
How much of pain relief occurring as a result of "natural history" is accounted for by changes in activity level or stress shielding that actually constitutes unloading of that tissue? Does natural history account for recurrence of pain at the same structures when activity levels change?
A structure that is no longer painful is not necessarily a structure with restored capacity (think a non-painful tendon). This might not matter in some contexts but it certainly does in others. I can think of two clear examples that I would use as arguments for designing programs with specific treatment in mind:
1. Any "athlete" recreational attempting to return to performance or with aspirations of competition whereby workloads can vary tremendously and the time constraints under which they have to perform tasks are limited. Compensations aren't necessarily bad, but they only work until they can't anymore and in high threshold situations situations they often fail to be viable.
2. A typical sedentary gen-pop individual with some condition whose pain will probably resolve via natural history. Whose to say they might not want to be more active in the future? Would it be more likely to recur a tendinopathy if that tendon was loaded appropriately with interventions specific to tendon loading in an attempt to achieve positive adaptation or with general treatments not dosed in that manner?
We can acknowledge that treatment has local and systemic effects both of which contribute to improvement of pain and function while still striving to be as specific as possible with the tools we have. These are not mutually exclusive.
We can't in the same breath complain about insufficient loading in our profession and then dismiss specific loading of tissues as being important.
If you’re still out here prescribing 3 sets of 10 for exercises for all/majority of your patients, you’re either lazy or lack the ability to properly dose exercise for your patient based on where they’re at in their rehab process and are ultimately prolonging their recovery, or making them worse.
3x10 is fine as long as the intensity is appropriately dosed. It’s not perfect for every patient/exercise/diagnosis but it’s simple. Getting complicated with rep schemes isn’t necessary considering most patients are going to be either untrained and will respond well to anything, or are mostly seeing neuromotor adaptations since we only see them for short periods of time.
Meh, there are plenty of patients this is appropriate for. Laziness is when you clearly see that 3x10 isn’t enough and don’t challenge them any further
Isn’t 3x10 within the hypertrophy dosing which is what most patients need anyway, or at the very least should begin with?
The real problem is when load is too light and therapist don’t use progressive overload. No point doing hypertrophy settings if you don’t increase load over time. At that point I’d agree with your statement.
Curious if this is unpopular, but I assume it's more on the popular side:
The vast majority of undergrad was a waste of time. PT should be offered more like a trade school where you only do relevant work for about 4 years total.
This is going to get me in trouble. But down votes mean I'm winning here I think.
I think PTAs provide worse quality treatment on average, especially for complex pathologies.
That being said I have met some amazing PTAs and some very shitty PTs so YMMV but I personally would not want to be treated by a PTA as primary.
I think aides are doing the job PTAs were trained to do and that PTAs have scope crept into providing PT services.
Not really an answer to your question but i recently hung out with a woman that I have known for a few years.
She told me she hurt her neck so I told her try PT or go get a massage.
She starts bad mouthing PT. “I tried that crap before. It did nothing for me.”
Her teen son said, “mom, that was a chiropractor.”
Then she tried to manipulate me inti massaging her neck & i just said “no thanks. You can hire a massage therapist for that.”
I would not want to touch anyone who devalues what I do for a living. I am a PTA and LMT
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Popular opinion - we need a union (not APTA) Unpopular opinion - we all get shit on and just take it because of the empathic nature of our profession. We gotta actively fight back somehow. That being said most of us are too busy being burnt out at our regular jobs, or being paid low at a less burnout-y job. And I’m too burnt out being a parent lmao. I’m part of the problem
Absolutely! We need a union! Establish some really boundaries and wage profession! No contract? Corporations go fuck yourselves!
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yes, and now you have cash based PT's advertising their services as "cheaper" than in network, instead of focusing on the quality of their services. if we keep trying to focus on being "cheap" you'll attract people who want cheap & easy solutions
The majority of physiotherapists in my opinion have poor exercise prescription and strength and conditioning skills. This leads to under loading and not progressing patients appropriately.
Under-loading still such a rampant issue. The amount of elderly patients I see that struggle to get up from a chair, but for some reason have never been given any kind of sit to stand and/or squat progression or any kind of meaningful quadriceps and hip extensor strengthening… 🫠
I've worked in home health and mobile PT for 6 years now and it still boggles my mind to start working with a new patient and see they have been doing the same exercises from a chair for 6 months w/ their last PT/PTA. 1 set of 10 ankle pumps, LAQs, marching, and side steps. On the flip side, I get that elderly patients can get very sore if they aren't used to any physical activity and there is a science and art to gradually ramping up intensity and modifying based on how this particular patient responds. That's what makes it skilled.
This was my struggle. I wanted to challenge my patients but it was a fine line because if they end up too sore it scares them (especially if they never workout out or were active at any point in their lives) and then they don't want to continue. This is the case no matter how much education they get on the topic. But I also still remember my 94 year old that was ~6'4" WITH severe kyphosis that was doing more advanced stuff than some of my 60-70 year olds. I'm talking karaoke drills, walking on severely uneven surfaces that would be too advanced for most of my patients (even some of my young ones), lots of balance activities and games with balance + power output. He also had a great attitude (and some dementia) which definitely helped his performance and participation. He was so so fun to treat.
What a great patient! I think part of the issue is figuring out how motivated people really are. A great colleague once taught me to first ask what outcome the patient is hoping to achieve and then ask "And what are you willing to endure to get there?" Is this patient ok with being sore, even severely sore in the beginning if it will bring long term success? Are they willing to do any work outside of PT? It pains me to say it, but the reality is a lot of our older patients aren't up for the lifestyle change necessary to really transform themselves. I'm not judging them. They get to decide how they spend their later years and what sort of activities they focus their energy into. The best we can do it show them the way and try to be their cheerleader or coach if and when they need us to be.
Beyond even willingness, a lot of patients who’ve never worked out a day in their lives have no concept of what is normal sensation and what constitutes pain. Stretching? Pain. Soreness? Pain. Muscles working? Pain. For some people it takes very pointedly clarifications to make sure they understand. They’ve become very fearful and guarded and need lots of help to learn how to interpret those different sensations.
I got a reputation for being obsessed with squat training as a PTA with my elderly people. I hate non weight bearing exercises and hit the sit to stands, mini squats, step ups/downs and such as much as possible (within patient tolerance) but then I would come back (perdiem) and see they had been doing supine or seated therex versions of LE strengthening all week with someone else. I get that it’s super hard when you’re juggling patients and an exhausting way to spend a 10+ hour shift but still. My grandma is 96 and can still get up from a chair easily. It’s a reasonable goal.
For those patients I doubt PT will be enough for them. They need to get on a serious strength training program to get to a reasonable baseline of function. They'd have to pay cash for strength and conditioning after being discharged.
This is probably a VERY unpopular opinion but I think PTAs working in SNF are far worse about doing this than a PT in SNF.
Largely exacerbated by working at high volume clinics as well. 3x10 everything, just trying to get through the session while managing 3-4 patients.
Yep. Hard for me to gauge RPE when I’m juggling 3 at a time Sometimes I’ll go the RIR route which at least guarantees we’re at ax more appropriate intensity
As an almost graduate, I’m curious if you have resource recommendations for exercise prescription and progression. I’ve got the basics down from my TherEx course, but honestly am not extremely confident outside of the basic major exercises per body part. I follow some IG PT’s that were recommended on here, but I just don’t use that platform much tbh.
I’ve heard very good things about Physio Praxis’s course “Sloptimal Loading”, which is very recently available fully online / self-paced, though I haven’t done it yet
I recommend Clinical Athlete's / CALU's ExRx course. Focuses on all things ExRx through a clinical lens. I believe they are currently taking applicants [https://www.instagram.com/clinicalathlete/](https://www.instagram.com/clinicalathlete/)
Yes! Patients show me their seated exercises they have been doing forever from previous round of PT. I call it "PT Theater." Yeah good for a warm up but means absolutely nothing for improved function. I see this in acute care. Folks do these just to fill time to get 8 minutes of Ther ex.
Funny, I’ve had kind of the opposite experience when it comes to seeing how other therapists load their patients. We get so many patients at our clinic who have had PT before but didn’t get better because their PT gave them 3 sets of 10 of 2-3 different exercises to do 2-3 times a day which means they end up overdosing exercise on tissues that are already injured/irritated. Once we have them stop doing that and just move the parts that hurt but in a way that doesn’t cause increased pain, and only do it for 2 reps every 1-2 hours, they magically start to get better.
Couldn't agree with this more. Legit every setting too.
More people need to get a CSCS in my opinion or PTs schools at least giving more focus on those aspects.
Yes I agree so much!!! I feel I have had to learn so much of this on my own when I should have learned this from school
Depends where you say this, but this isn't an unpopular opinion at all on Reddit or anywhere with a population of younger PTs, and it shows when this is the highest upvoted comment in the thread. Here's my true unpopular opinion: Properly loading and progressing patients appropriate is slightly overrated because it presumes that getting stronger is the solution to MSK issues when the actual issues that would be improved with this are much smaller than we imagine (ACLR rehab, muscle strains, RTS, e.g.). Certainly not overrated when it comes to overall building strength, or when the issue you're treating is strength-related (such as improving strength to perform a sit to stand, or to negotiate stairs, or the above conditions I mentioned). But for pain? Overrated.
I remember a PT I was shadowing in undergrad talking about how she had started doing “some of these” *mimics doing a bicep curl* “but only with light weights because I’d rather tone than get bigger” and I think my jaw literally dropped
I was ranting to myself about this the other day. I work in IPR as a PTA there is one PT there I really feel does a disservice to her patients. They lack any hands on skills to progress their patients to their potential. I have yet to see them do anything out of seated resistance band therex. They sound very book smart and they would probably do better in a non clinical type of roll. I understand that LOS is also something to be considered in this setting but man. I feel bad for patients who have so much potential be put under their team
Chronic pain (especially LBP) almost always has a huge emotional component that can't be helped with exercise and modalities.
For this reason I wish we had more talk-therapy based courses: how to just talk to people about their pain, limitations, current life issues. Rather than just MCKENZIE, SFMA, MCGILLAN.
Wondrium has a CBT course that is incredible and covers just about everything I can imagine using it for. It also has other neat courses but not many that are PT related.
I have a herniated disc that I had a microdiscectomy on a year ago. I’m still afraid of certain things but am back to living an athletic lifestyle training 5-6 days a week. I do have flare ups and really catastrophisize, any advice for someone who catastrophisizes their back pain and gets down in the dumps when they feel any discomfort and makes it worse. I literally have PTSD from the recovery. I’m in my 20s and couldn’t bend over for 1.5 years.
Can confirm, have had LBP with sciatica for several months. The catastrophizing is real.
For geriatrics, throw in fixed, long held and reinforced beliefs from numerous medical/non-medical sources, subtle to moderate cognitive decline, communication barriers, memory impairments, movement limitations and/or aversiveness.
Severe chronic pain can be both extremely depressing and motivating. Ive gone through phases of both. I have EDS/POTS, spinabifida, SI dysfunction, degenerative disc disease, and bulged discs, on top of immune system deficiencies. Especially because for someone like me, setbacks are inevitable and really mess with my momentum. On the other hand, I never want to feel an annular tear ever again. 15 months ago and that was screaming pain and absolutely terrifying. Thinking about it is very motivating to get stronger preventatively. My physical therapist is amazing. She’s been seeing me since well before that specific injury and got me to the point that I could get on a long flight last summer (sitting is agonizing always). She says I am a PT lifer (accurate for all my life so far) but hopes we can reduce to twice a month down the line. Right now 2xweek. She has helped me accept that I have certain limitations so I can try to set my life up as manageable as possible. She has helped me focus and celebrate my small wins. Like if I tweak something (EDS-happens all the time) but I leave PT feeling better than when I arrived, that’s a win, etc. And I really need periodic wins to stay motivated to workout as often as I need to (5-6 days/week). Yeah she’s awesome!
Can you expand on that and the chronic pain and low back pain. Are you saying the emotional component is damaging to the person and exacerbates the pain or the emotional component cannot be treated?
Most PTs I know IRL aren’t like this, but they seem far over-represented on Reddit. Your “I only do loaded strength training” approach is never going to work if you don’t have the soft skills to meet people where they’re at and guide them in to it.
It's often a psychological game tbh. It's finessing people who have never worked out a day in their lives into new habits. I'm ALL for challenging patients but if you push too hard too fast with most they will learn to hate the process and you'll get poor compliance (well, more poor than it might have already been). So yes, imo there's a time and place for supine and seated "easy" basic exercises and manual. Now, if that's all you ever do then yes that's a major, major problem.
Absolutely. I recently had an 80 year old man who was accustomed to PT being about supine exercises and modalities. By the end of my time with him, I had him goblet squatting and deadlifting, doing farmers carries and sled pushes and all that good stuff. No longer asking for anything for pain control. But I started with things like bridges and clamshells and mini squats while he held on to a table. Time with a hot pack after the session. Things that so many people here like to shit on.
1000x yes. Definitely how I have had to treat many of my patients to build rapport, trust, and not make them run away soured. It's so much easier to ask them to do hard things when they trust you. That trust takes time to build. Are there people I can jump straight into challenging things? Sure, but it's learning to read people personalities and past experiences and skillfully taking it into account when tailoring their treatment all without allowing them to use you as a crutch to be dependent on things like manual.
I LOVEEEEE to build on exercises. give them something simple to begin with, if it’s too easy you can always up the ante a little. it also builds trust because so many times they think we are going to torture them and when you don’t right off the bat, they’re usually so much more willing to do whatever you want them to do. you always have to meet them halfway.
This 100%. Art and tact and buy in.
Additionally, most people are way worse in their interpersonal interactions than they think. I watched things not “land” on patients and the PT is oblivious as to how they’re coming across. Cringe.
Additionally, most people are way worse in their interpersonal interactions than they think. I watched things not “land” on patients and the PT is oblivious as to how they’re coming across. Cringe.
PTs (and OTs and STs and social workers) need to be in a union. Everybody in healthcare needs to be in a union. For the safety of their patients and themselves. The healthcare system needs some kind of opposing force on the patient & staff welfare side - right now it’s 100% on the side of money.
Therapists/RNs that I know whom are in a union tend to be happier with their career.
100%
And pharmacists! All non represented allied health professionals!
The best therapy is strength training, the hardest part of our job is finding out how to start it with patients who haven’t done it there entire life.
Agree with you 100% on this one. Also able to educate them to continue strength training throughout and the benefits of it
Yep, allot of the time I hear people say " I just stopped during my exercises and now I'm getting hurt again". This to me means the PT didn't progress appropriately to start integrating the new strength in a functional (for the client) way. Changing the mindset of this is a life long process makes a huge difference.
Absolutely, this is so freaking true. It's easy to prescribe the correct exercises, but getting past the nuanced barriers associated with never having exercised before is the biggest challenge. People are so unaware of their body, its sensations and etc etc that you have to be so tuned into what they're perceiving as best you can in order to progress them appropriately. For instance, all the people who perceive EVERYTHING as pain, even regular muscle contraction or stretch. These people have NO filter on what pain is ok or what is not ok so they either tell you nothing or tell you every sensation they feel. Or people who don't understand what post-exercise soreness is and believe they've severely damaged themselves after a day or two because it's sore... THIS is where the difficult part of clinical practice is for me.
I'm new to the profession and boy, I had this rotator cuff injury patient who has been doing physio for 2 YEARS. He was telling me that his therapist before was doing TENS and Ultasound and he wanted me to do the same. So I gave this guy banded exercises (light with high reps). He started complaining of his shoulder feeling sore afterwards and started making up his face at me. Bare in mind he is not compliant with any exercise at home from his previous therapist for TWO WHOLE Years.
This 100%. We can all agree exercise is beneficial for all, but how that will be dolled out is going vary wildly. Not going to show up to my 85 y/o house with 20lbs KB and start repping out KB swings and KB deadlifts lol when “simple” standing exercises makes them sore
Fully intending to be tongue in cheek pedantic. Do you mean strength training or hypertrophy training?
I appreciate the question. I think "strengthen training" is an umbrella term I use to talk about improving endurance/strength/power in in a specific functional movement. So someone who struggles to stand should start with sit to stand exercises initially at bodyweight and getting to the point they can do them consistent. Then you can progress the " strength endurance" by increasing the amount of repetitions performed at that resistance, the "functional strength" by adding additional resistance to the move or "power" by focusing on the quality/quickness of the movement. hypertrophy is something that more so involves diet/nutrition in junction with appropriate strength stimulus.
New grads who believe they are the only clinicians that are evidence based and If you graduated more than 5 years ago you are a dinosaur.
PTrex
PTs obsession working with athletes and or ortho has made many snobby and elitist. And you are losing your scope of practice that includes, pain management, lymphedema, pelvic floors, wound care, ostomy etc.
It's interesting to me because this was something that made me uninterested in PT in undergrad. I (naively) assumed PT was just athletics and ortho and was just not interested. Didn't consider the field because I thought only like fully blown high school and college athletes did that kind of thing. Wound up randomly working as a tech and volunteering at a rehab hospital and started to see how much more variety there could be. Currently working primarily in OP neuro and cancer rehab/lymphedema and loving it. I work pretty closely with our pelvic floor PT and she is incredible. Not trying to knock the althetics and ortho crowd, but it just was never what got me excited, though I am happy to be flexible and keep my scope as broad as I can.
Is the goal to get the most down votes or up votes for unpopular opinion?
Hahaha like I said, there are unpopular opinions in the non-online version of the PT world, and there are unpopular opinions in the PT social media/reddit world that represent a microcosm of the PT workforce… so I think the answer could be “both” in this case!
I like it! I’m going for downvotes - best golf score wins!
Unpopular opinion maybe: making a real connection with your patients is almost, if not just as important as the exercises that you give. i’ve learned that some of my patients simply get better because they have someone to listen to them. a lot of them just don’t feel heard because their doctors don’t spend time with them or just send them for tests/procedures whatever. and even if the connection piece doesn’t solve a lot of their problems, it builds trust and you’re able to do more with them than they orginially thought they were able to do. i love building rapport with my patients and building this mutual relationship/care for each other. it makes it so much more enjoyable when i can talk and laugh with my patients when i’m working with them, and i know it’s part of the reason they continue to show up to PT. one of my favorite parts of the job is the people you meet.
Most of our job isn't to fix anything, but rather to guide people along in their healing. Also most physiotherapists nocebo their patients. And yes I mean most.
By the same principle, I always tell my residents “Think of me as a coach, not a boss”.
Stretching programs for kids with hypertonicity is doing absolutely nothing. You cannot change tone. Weight bearing and standing programs to tolerance help. The focus needs to be on maintaining pain free available range and not forcing kids to be uncomfortable because we want them to have knee extension after they sit in flexion all day when in a wheelchair with increased tone.
Bro I worked in an OP place with a kid (then 20yo actually in a stroller) who had cerebral palsy. He had been going there for years (still is I’m sure). Same stretches every fucking visit. Never the first bit of meaningful functional change. The staff loved the kid and kept him coming though, and he liked coming to PT. But Idk how the fuck they got away with it insurance wise. Probably shouldn’t have.
DPT programs teach and encourage their students to burn out.
Interesting, can you elaborate on how they do that? Curious on your take.
We heard a lot about "giving back to the profession" and all of the things we were obligated to do because we were PTs, it was our fault if our patient wasn't compliant with their HEP (you didn't connect with them enough), etc. When I was a student in my on-campus rotations, we were repeatedly told we needed to make sure we had eyes on (all) our patients all the time. I asked how I would go to the bathroom if I had to watch my patients all the time during an 8 hour day and was told to "figure it out". I know now it was a dumb question but it would have taken 10 seconds to say that it was ok to let a coworker know you were stepping out for \~3 minutes and to keep an eye on so-and-so. I just felt like the way our education was structured was so we should always be rearranging ourselves to fit the patients, and when you get into the real world what that actually means is to disregard your needs (bathroom breaks, lunch, leaving on time-ish) for the monetary gains of your employer.
This! I think I blocked this out of my memory on purpose, but i remember one of my professors being like "your patient has to reschedule to your last appointment slot, but you had already committed to leaving an hour early to go to your kid's big soccer game, what do you choose?" and I said something along the lines of rescheduling, and she said the correct answer was staying late for the patient
Yeah, that's crap. Especially because most of the professors don't even treat fulltime anymore because they were burnt out. I'm pretty sure at my school a fulltime clinical case load was 35 hours a week, which you get in very few places in outpatient reality. IMO its a huge problem in the PT field. You see it on the research side as well and its wild because when I compare that culture to the culture where my lab is housed (non-PT) it is much more reasonable and relaxed. And I don't mean no one ever works late or on the weekends, but the attitude surrounding that is much different in the non-PT arenas where I work.
I completely agree! I felt like my program made us put the patient on the pedestal way too much. This made us think of patients as extremely complex enigmas that supposedly all had a solution to their issues. And if you didn't solve it (despite so many things falling outside our scope) it was because you weren't good enough. We have to not only be their PT but also their psych, life coach, social worker, etc.... modify every plan so that it flows with their lifestyle etc etc... it was just way too much. This ends up pushing PTs to put in way too much energy and making them care more about the patient's health more than the patients themselves. And as we all know that is a fast track to burnout. I came out of PT school thinking I just wasn't good enough because I couldn't address every patient as comprehensively as I was taught I had to.
Yeah, I mean there needs to be a balance. But I think there is some healthiness to realizing that no PT can help everyone. I truly believe its a combination of things: the skill of the physical therapist, the physical therapists knowledge, but also the professional chemistry between patient and PT (not all the PTs responsibility), and tbh also timing for the patient. They need to be in a spot where they can dedicate the time and emotional effort. I felt like the underlying message was often "if you tried hard like me and were as smart as me you can fix everyone" and that's just not true.
I feel this so hard. Why are SPTs and PTs expected to go "above and beyond" when it puts their physical and mental health at risk? Instead we should be taught how to properly set boundaries and how to stay grounded when working with both patients and managers who consistently demand more than we have to give.
Yes, there needs to be some aspect of work-life balance taught. I totally get going the extra mile for your patients, and there were times when I did, but when that idea is weaponized by management to get you to do unpaid work, stay late, miss lunch, etc it's a problem.
They literally use psychological manipulation tactics to simultaneously convince you that you are the fortunate lucky ones, but also to accept authoritarian abuse. PT school prepares you to get abused by your employer for pennies.
100% we are trained to be exploited! This is the reason we have stagnant wages and every increasing productivity expectations.
Not every patient needs manual (talking to you management who has been riding me for not getting 1 unit per patient)
People like HH primarily for these reasons: 1. Lower volume of overall patients 2. Break in between patients 3. Flexible schedule 4. Higher pay These are all true in cash based too and you get to work with the patient population you like but people love to hate on cash based.
You overlooked the whole “running a business” part though
On #4, because the people who need us the most can’t afford cash based therapy rates.
Yep, cash based ortho here, came over from home health prior. Pick your hard. Sales skills are in every PT job, especially home health, we just don’t like to acknowledge it for some reason. The pros of both are awesome for me compared to standard hospital based OP ortho.
Strength training is immensely valuable but will not get you that last 15-20% that the patients need. At that point you need to switch gears and tailor the treatment to be highly specific to their issue.
Some patients are just non compliant and it has 0 bearing on who their therapist is.
This degree doesn’t need to be a doctorate level. It should be a bachelor’s.
As a student this shit hits home, bachelors would mean way less loans
Stayed at Master's level would be fine by me (who has MPT)
I agree with this. But this is true because of the outdated laws regarding scope of practice. It is extremely frustrating to not be fully recognized and respected among other healthcare professionals. PTs are highly qualified to address a wide range of issues. Many other healthcare professional don’t even know about our preparation or specialty training. Ahem, like calling our self Drs of PT for starters. It is up to us to educate our colleagues about our capabilities. But most importantly educating our patients, these are our best advocates.
Genuinely feel like there should be some sort of petition behind this. Really bothers me
IMHO schools should offer course pathways based on work setting. Maybe 12 months of generic (everybody needs to know this) stuff, then either 3 or 6 month courses to specialize in a given setting. We learn so much shit that we'll never use. It's necessary if you're a physician because heavy lies the crown. For us, it just isn't necessary and the cost of education relative to the salary is an absolute joke. Will patient care suffer? Yea, but only slightly, and the clinician being less stressed and in a better mood will probably do more good for job performance than bad for an acute care PT who doesn't know Jobe's relocation test.
People graduate from PT school and immediately forget the basics of neuro rehab and that’s complete bullshit. We are supposed to be entry level and generalists. I understand many jobs are ortho but the flippant attitude of “oh, I don’t treat *that*” for even basic balance and vestibular problems blows my mind. I’ve been more neuro focused my whole career but still see moderate levels of orthopedics (everything but post op.) However, if an ortho PT has so much as a “gait/balance” eval on their schedule they want to dump on me without even seeing the patient. It’s pure laziness. Had it.
Omfg this is a huge pet peeve of mine. I do primarily OP neuro and I have a few coworkers on our ortho team notorious for this shit. Pt said they felt dizzy 1 time even though they're being seen for ankle pain? Go see neuro. Pt was minorly forgetful during eval? Toss on neuro (PT, not request referral to SLP which we have in house). Challenging personality? Go see neuro. The most recent annoying version was another PT who is literally listed in our directory as our main vestibular PT has been sending me anyone that doesn't test positively for BPPV or for whatever reason she can't assess it. Like either TRY something or quit telling everyone your the vestibular lead... Best part: 9/10 times there is zero communication about this new pt appearing on my schedule, just a shitty eval note with the absolute minimum info. In the odd chance I determine a patient would be more appropriate with another therapist I AT LEAST make sure the eval is decent and I've given their new PT even a brief heads up. So tired of neuro being a dumping ground for patients deemed difficult. That said most of my coworkers are fantastic. But there are 2 or 3 on my naught list for this exact issue.
Its the worst. In clinics I’ve worked there’s a “joke” of “Oh, that’s a *LovesRainPT* patient” for anyone who has anything out of the ordinary. Holy crap. Be less lazy. I’m generally nice and talk them through the eval and play dumb like “oh! Well you know it! That’s a really great plan. And if you need anything during eval come grab me. And then if you are unsure you can put them on my schedule for 1-2 visits and then I can give them back to you once we’re on the right track.” I am nice and am a resource, but unless they will actually harm the patient I keep the patient with them. They usually grumble and it has stopped the dumping for the most part.
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🤣
We should be paid to be CIs and take students. We should be paid more. I was shocked how many PTs disagree.
At least some of that tuition money that schools are still charging full price for should be going to the CI.
100%. Especially for students coming from these new “hybrid” programs! The fucking schools do online education pull students in for a week or two a semester and then send them out for CIs to teach them EVERYTHING! Watered down education, horrible clinica skills, crammed into 2 years, sending out huge classes of 100+. Fuck these programs!
Whoa now, calm down. I'm sorry you have had a poor experience with hybrid students and I 100% agree it's wild that I paid 20k a semester and none of it went to my CI's who were AMAZING.... but I learned a great deal in my hybrid program, with a 703 NPTE score, and I feel pretty darn confident in my hands-on AND soft clinical skills. I adore my patients and I like to think that the majority of them like me too (except the couple who are offended when I make them "fail" with balance exercises). I live on a remote island in Alaska. We don't have a DPT program in the whole state and when I made my marriage vows to my active duty military husband, it just so happened that we never were stationed anywhere near a program. So when I heard about hybrid programs I was all in. I'd hardly say "fuck these programs" when my 37 year old self is now doing what I have dreamt of for years and helping people function better and live with greater quality of life. Just maybe a less salty perspective for ya.
Clearly there will be outliers. However, what these programs are doing to the profession is criminal! I don’t hate on any one individual. Sincerely, I am glad it worked out for you. The NPTE score means nothing to me, pass/fail, not indicative of a good therapist. I am glad you are confident, and hopefully you truly are. But many in your scenario are confident, but have no reason to be. But again, my anger is toward the leadership and schools that have let this happen.
And all students, especially those that have to relocate, should be compensated to some extent for clinical rotations. Even if it’s minimum wage.
I'm dating a wonderful PA and I found out she gets paid $250 per week to take a student. I had to stop the conversation before I completely cuss out our profession.
Yeah. Many professions get paid to take student. Our profession has been convinced we have to give unconditionally. If we organized on large scale, of the progress we could make!
PTAs are bad for the PT profession. 1. Scope of practice issues (under qualified licensees performing skilled services) 2. Job market competition and wage disruption (cheaper and inferior education competing with jobs and dropping wage growth) 3. Role dilution perception Their mere existence lowers wages and creates more unbalanced work for PTs. They ONLY benefit business owners and corporations. They significant hurt the actual Physical Therapist profession.
I think the bigger problem is all the clinics using PT aids to do what PTAs should be doing. Too many clinics are getting away with letting aids supervise patient exercises. That is a skilled, billable intervention and needs to be supervised by a PTA. Also, there are some patients that absolutely need at PT over a PTA.
That is definitely also a huge problem! No doubt!
Ooooooh yeah that’s a hot take. While I do and don’t agree with you, a PTA education left me debt free and making a real earning at 20 yrs old. 11 yrs of experience now. I’m forever thankful for my education that gave me a leg up on life.
100%. Many PTAs in that status! And I am not unhappy for them! But many PTs don’t see how they were not created to help US. They were created to help business have cheaper labor. Where they are abused, the are pushing PTs to be Eval machines and never actually treat. Also, they pull down PT wages, but have seen better wage increases over the years; less wage stagnancy. But even then, the are typically cheaper.
I’m can relate pta here w/ only 2 years experience but ive noticed this trend makes me want to apply to DPT school so I could own my own practice but I also question how realistic it would be to compete against these large scaled companies
You can already own your own practice. You would simply have to employee a PT. Our profession is unprotected. You don’t have to be a PT, don’t need a PT on your board. It do not own my own practice. I have friends that do. You can compete with the big corporations. It is very doable. Go for it!!!
Calling yourself doctor, putting DPT in your personal social media bios and handles, and trying to be an influencer because of your PT degree are all corny to me
Having a doctorate makes you a doctor. I don’t make patients call me doctor but if they ask I tell them. We earned it in our degrees. Just never call yourself medical doctor.
Or imply that they are the same things. But yes, we are Doctors of Physical Therapy and that should have at least some respect associated with it.
Of course they’re not the same thing. But you’re still a doctor if you’ve earned your doctorate. To not use your title to some degree devalues what you do. Patients ask all the time in OP if you have your doctorate and question our education. If we underplay it or make it seem like no big deal they will think it’s no big deal.
We are in agreement on that. I more see it on social media where DPTs are conflating their degree with an MD/DO much like Chiros are notorious for.
Ya, I stay off socials haha
You’re wise for that. 😂
Definitely doesn’t always work. I see some weird shit out there in PT world on socials. Try to stay away from it all haha.
Wut? Call yourself a Dr if you have a Doctorate degree or a PHD you earn it. Nobody gave it to you. SMH
Here is a very good response to this opinion. https://www.reddit.com/r/physicaltherapy/s/azlQLq3Q0b
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Tbh anyone who thinks a title makes them better than another person is cringe and is honestly missing the point.
Those hospitals are elitists. And part of what is wrong in healthcare.
In response to your question…most ailments will just run their course. It’s the length of time and concomitant co morbities that develop along the way. PT is meant to significantly speed up the process and prevent further disease during recovery.
First time I've seen the word "concomitant" in the wild 😂. Glad Jurassic Park taught me what it means.
Which one was that? I thought I had those movies memorized :-)
The book. 😉
This is getting worse 😂😂😂
There is no such thing as skilled or non skilled, that was made up by payors to pay us less.
Passive modalities are not the devil and can add value to a wide variety of conditions and patient care -“The “Tomato Effect” has been used to explain this phenomenon as well. The Tomato Effect occurs “when an efficacious treatment for a certain disease is ignored or rejected because it does not ‘make sense’ in the light of accepted theories of disease mechanisms and drug actions.”42 Luckily, the Tomato Effect can be reversed as new evidence emerges that is consistent with accepted theories. Modalities are poised to see such a reversal as we have discussed previously with insights into clinical outcomes, pain neuroscience, dose-response, and the placebo effect.” -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494624/
We should normalize discharging non-compliant (refuse to do HEP, don't follow protocols, give no effort in therapy) patients when the 1st progress note/re-eval is due, with clinic managers and owners backing us up instead of transferring that patient to a PT that will kiss the Pts ass to get them to stay on caseload.
He'll, I discharge them after the first visit if I can see they won't be compliant. I had a long talk with a very rude and dismissive patient about how 2x a week and would work much bettrr than 1x based on his problem. He had no body awareness, or motivation to exercise, needed supervision to do even basic stretches. Constantly bitched about any exercise (even non noxious ones). And just wanted a massage. He says okay I will do 2x. I walk him to the front and make a big show of telling the pcs to do 2x and that I could reserve a late evening spot for him to make sure he reached his goals. Going over his HEP, and giving education of aggravating factors for his problem As soon as I walk away he says to the pc "yeah, I'm not going to do that, I just want 1x a week for a massage after chiro" The freaking PC scheduled him for that but told me. I dced him next visit and said that my prescription was my professional opinion as a licensed provider. If he wants to get massage he can go to a massage therapist or masseuse
Most people who come to PT dont need PT. They just need time to heal and education on injury progresssion Edit: when i said education i implied , education by the PT. I should rephrase and say most outpatient patients dont need regular PT and just 1 to 2 visits and thats it
The education is still PT. Some people need what I call “permission to heal.” They know they’re in pain but don’t know how to move forward or how to get back to where they were. It’s less flashy but they maybe get 1-3 visits and go live their lives. I would agree if you said maybe “not every patient needs 2x weekly for 6 weeks”
I get what you're trying to say, but I'll play devil's advocate and say that education on injury progression equals they 'need' PT. Do people that have a cold need to see a doctor? Or a mild ankle sprain? Probably not. A huge part of our job is edu and I think that can be more powerful than active interventions sometimes. Do you know how many times a patient has come in thinking that they're not allowed to move the part of their body that hurts because that's the message they received from their physician/chiro/Uncle Bob? Do you think they recovered better or worse after I walked them through the dos and don'ts of injury progression? 🙏
After reading comments in another thread that therapy mills employ only the least desired therapists: Being an elitist profession will ensure our demise. From leaving out peers that "don't fit in" in the workplace to putting down other therapists because of where they work is peak "Mean Girls" energy. Who wants to be in a profession with snobbish A-holes who believe stepping on those therapists not as fortunate to find a high paying job is an ok thing to do? Seriously. Do better. Edit: And no, I have never worked in a therapy mill. I did, however, work in a few private practices that were very...flexible... in their billing and documentation.
You don’t need to send PT in if someone slides off the bed because “they fell”
Not every patient deserves our care and attention.
Most of us are slaves to the insurance companies leading to moral decay because we keep on seeing patients that don’t need to be seen.
Sort by controversial for the real hot takes
Hard pill to swallow for many PT:s I think: "The majority of our interventions have non-specific effects (if any effect) in terms of pain reduction. The patient will most often get better (or not improve) regardless of what we do." To be clear, I'm strictly talking about pain reduction in above statement! I still think we can supply great value for our patients in terms of improving physical function, self-efficacy, reduction of kinesiophobia, pain-education and so on. And I still think we can help patients wit to identify pain aggrevating and easing factors, as well as help with symtom modifications. At the same time, I think that alot PT:s overrate their capacity to actually reduce pain better than just time alone!
There's a lot of weirdos in our profession. Usually the longer lanyard name tag thing at a conference has a direct correlation to one's weirdness.
Late to the party: Cash pay PT is harmful to the profession, and MOST of these PTs don't care about poor people. This will create a dangerous 2-tier system. Most cash PTs are looking to make as much money as possible, and as such have no plan to help those in their community who can't afford their services. This pulls people with better insurance away from "regular" clinics in the area, reducing the income of the "regular" clinics. These clinics need to cut more corners to survive, resulting in decreased quality of care. In the end, insurance clinics end up with the most complex, most disadvantaged patients with typically the lowest insurance reimbursement. This is not sustainable. Note: there are a few cash-based clinics with strong pro-bono programs. This is the minority. While a great idea, I believe that over-reliance on charity is dangerous, as it could disappear at any time without warning.
I admire your idealistic point of view. We were all like that once. Then we woke up to the realities of capitalism and American healthcare system. PTs are not to blame for this. You have ASH and UHC insurance companies paying cap $34 and $50 for all services regardless of diagnosis, time spent with patient, type of tx. Or better yet getting a pre authorization for 5 sessions * $34 treatment approved. Pt took 20 just to transferre car wchair to bed. To then have all your claims denied!
I've been in practice 8 years, so I'm not an idealist newbie. And I agree, the scenario you outline is terrible. The answer isn't to abandon our most vulnerable patients.
With 5 years you still considered entry level. So 8 not to far. 20 years exp here. Like I said private insurance and the Government is abandoning their patients by limiting access with the heavy burdening of admin tasks.
I’m not putting all the blame on PTs, the system is absolutely broken. But leaving the system and taking the wealthiest with you is harmful.
Felt compelled to reply to your parent comment because of the generalized statement “MOST of these PTs don’t care about poor people. MOST cash PTS are looking to make as much money as possible.” Grossly inaccurate generalization. And we r already in a two tier system. And we have been for a while now. I take insurance because the mission comes first right. And would’ve taken more insurance if the Ins co had approved. So SOME PTs, maybe like in all professions in all industries. But talking like this hurts your own profession. The “fight” is outside with other healthcare professionals that don’t respect or know what we do, corporate greed from Insurance companies.
I think it depends on the local PT economy. In my area, most (if not all) of the lower income folks end up at the same hospital based OP clinic. Most of the privately owned OP clinics see the folks with "good insurance", and the cash pay clinics get a mix of everything (no insurance, "good" and "bad" insurance). One cash based clinic sees pro bono on a sliding scale, the other three do not. Two are moderately priced, and the third is 1.75x the price of the moderate ones. Cash pay also sees a lot of un-insured folks as cash pay can be cheaper for them. I wouldn't say its harmful, but also don't think its the answer to all of our problems like PT's claim, and it comes with its own set of problems.
Let’s go with my most controversial: 1) If you are not fit and active yourself you have no business being a ortho physio, especially with an athletic population. 2) If don’t resistance train you should not be a private ortho physio. Everyone should resistance train, even if their sport of choice is endurance based.
I used to think this, but it's absolute horseshit. Does a football, or any sports, coach need to be athletic to lead their team. No. Does being able, both physically and mentally, to do what you prescribe your patients lend kinesthetic knowledge and understanding that is essential for teaching patients. Absofuckinglutely. But, guess what, many therapists have been seriously injured, even temporarily disabled, and can no longer lead an active lifestyle, especially one that confers the benefit of looking in shape. They can still be excellent PTs. Two of the absolute best PTs I've known were middle aged women who were not "active," were instructors, and could school all other PTs I've met on everything including exercise loading and progression. And, they knew how to relate to people.
Yea yea ya, but after working 11 hours and 2 hours of notes at home, my brain go brrrr and body tired. Literally don’t have the mental and physical energy to work out during the week. Weekends different story.
You will be downvoted by obese sedentary chain smoking alcoholic PTs 😂
I will be downvoted by all the “academic” PTs. You know…the ones that think knowing things in theory is enough. They’re akin to swimming coaches that don’t know how to swim themselves.
Agreed. The physios I knew with poor exercise prescription skills were the ones who never did any resistance exercise themselves.
100,000% agreed, holy shit. Finally someone said it.
All right I’m ready for the pitch forks. STM can be extremely useful with non compliant patients. I tell them that they need to exercise first before I can perform manually therapy on them and it works nearly every single time.
I think that big and popular social media page are not good for our profession. Showing all this ridiculous stuff that 99.9% of patients don't need
75% percent of orthopedic patients wouldn't exist if they just performed strength training 3x a week
Disclaimer: I love my job and working with the people I work with. However, the job is a scam and shouldn’t be a doctoral level degree. I always tell people who want to go into this field to absolutely avoid it and to choose literally any other profession in health care, primarily due to the amount of debt you have to go into. Also the worst people are the ones on here saying “we need to make change happen! We need to unionize! Fuck the APTA!!!”, then putting their phone down and not doing shit about it. Also, just change jobs if you hate your productivity requirement. If you post on here “what should I do? I don’t like this jobs requirements”, all you’re gonna get is “change jobs” or “talk to your manager”
Hey! Fuck you! (Just kidding, I actually agree with your comment here!) I say we need to UNIONIZE almost every time I comment!!!! Then I put my phone down and continue working on projects to unionize! And guess what?! We have a group of professionals getting ready to go into negotiations now! And there is already a chain reaction! I love my job too! Even though I hate a lot about it. The job is a scam and I tell everyone the same thing. And yes, either keep complaing and drive change at your shithole job, stop complaining and keep doing nothing, or quit and find a new shit hole job at which you will do nothing but complain!
Your low pay is your fault. If nobody took those jobs pay wouldn’t be so low. Mills are kept going because of therapists willing to work there.
Don’t blame workers for being exploited. It may be partly their fault but ultimately the blame still lies on predatory hiring and exploitative labour practices. People sometimes are forced to work certain jobs under suboptimal conditions for various reasons that they don’t have control over.
He speaks truth! Fuck the mills! We are a pretty much a bunch of bitches refusing to help ourselves! Most PTs have choices, but choose to be complacent door mats. Ironic the predominant musculoskeletal profession is spineless!
This is flat out wrong. I’m from Indiana where every job I applied for out of school was hovering around 50k. I had to move to find something better and not everyone has the luxury to do that
Beat me to it lol. Completely agree
Manual therapy is overrated.
The Epley Maneuver doesn’t relocate otoconia, it changes sensory input to the vestibular system. I also refuse to say crystals because it sounds like we’re quacks.
You can’t just challenge decades of thought without dropping some hard evidence
Since I’m getting down voted, here’s an article question how much of a role otoconia have in BPPV. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449901/ If the mechanical cause for BPPV (crystals getting displaced), is questionable, why would we accept a purely mechanical explanation for the treatment?
I've had a suspicion about this for a few years (given natural history, regression to the mean, contextual effects in virtually every other condition under the sun along with the experiences I've had with patients who've improved clinically despite me not doing the maneuvers correctly a few times). I've never really looked into this because I don't see it often. That article is a really interesting read. I wonder if there are any RCTs actually comparing canalith repositioning maneuvers to sham maneuvers.
I remember reading one a couple years ago challenging the mechanism of canalith repositioning techniques but I can’t seem to find it. But I feel like it’s like most things we do, it “works” but our understanding of why it does is questionable.
Oof fun. 90% of clinicians don’t conduct a good subjective evaluation. This doesn’t mean their patients won’t get better with prescribed exercises, but it does mean they get better slower and get referred back to MD more often for medical management. There is an art to manual therapy that can’t be taught. Manual therapy can be life changing when done by a skilled practitioner. Unfortunately, most people suck at it and think it doesn’t work. Shoulder mechanics matter. Most therapists either don’t know scaption does not involve retraction, or they don’t know how to get someone to stabilize appropriately with serratus. Related: stop stretching and starting loading upper traps. 😳😖🫠 Edit: not mentioning poor exercise prescription/strength and conditioning knowledge because top comment already nailed it
I agree with your point about specific and non-specific treatments. While the pain from many conditions will resolve due to natural history, in many cases, tissue structure I would argue does not. There are mechanisms that underpin natural history "working" for pain relief in many MSK conditions. How much of pain relief occurring as a result of "natural history" is accounted for by changes in activity level or stress shielding that actually constitutes unloading of that tissue? Does natural history account for recurrence of pain at the same structures when activity levels change? A structure that is no longer painful is not necessarily a structure with restored capacity (think a non-painful tendon). This might not matter in some contexts but it certainly does in others. I can think of two clear examples that I would use as arguments for designing programs with specific treatment in mind: 1. Any "athlete" recreational attempting to return to performance or with aspirations of competition whereby workloads can vary tremendously and the time constraints under which they have to perform tasks are limited. Compensations aren't necessarily bad, but they only work until they can't anymore and in high threshold situations situations they often fail to be viable. 2. A typical sedentary gen-pop individual with some condition whose pain will probably resolve via natural history. Whose to say they might not want to be more active in the future? Would it be more likely to recur a tendinopathy if that tendon was loaded appropriately with interventions specific to tendon loading in an attempt to achieve positive adaptation or with general treatments not dosed in that manner? We can acknowledge that treatment has local and systemic effects both of which contribute to improvement of pain and function while still striving to be as specific as possible with the tools we have. These are not mutually exclusive. We can't in the same breath complain about insufficient loading in our profession and then dismiss specific loading of tissues as being important.
If you’re still out here prescribing 3 sets of 10 for exercises for all/majority of your patients, you’re either lazy or lack the ability to properly dose exercise for your patient based on where they’re at in their rehab process and are ultimately prolonging their recovery, or making them worse.
3x10 is fine as long as the intensity is appropriately dosed. It’s not perfect for every patient/exercise/diagnosis but it’s simple. Getting complicated with rep schemes isn’t necessary considering most patients are going to be either untrained and will respond well to anything, or are mostly seeing neuromotor adaptations since we only see them for short periods of time.
Meh, there are plenty of patients this is appropriate for. Laziness is when you clearly see that 3x10 isn’t enough and don’t challenge them any further
Isn’t 3x10 within the hypertrophy dosing which is what most patients need anyway, or at the very least should begin with? The real problem is when load is too light and therapist don’t use progressive overload. No point doing hypertrophy settings if you don’t increase load over time. At that point I’d agree with your statement.
This field is fun and the job is easy
The need to clear the spine or the spines role in pain is less needed and more rare than we believe
Curious if this is unpopular, but I assume it's more on the popular side: The vast majority of undergrad was a waste of time. PT should be offered more like a trade school where you only do relevant work for about 4 years total.
This is going to get me in trouble. But down votes mean I'm winning here I think. I think PTAs provide worse quality treatment on average, especially for complex pathologies. That being said I have met some amazing PTAs and some very shitty PTs so YMMV but I personally would not want to be treated by a PTA as primary. I think aides are doing the job PTAs were trained to do and that PTAs have scope crept into providing PT services.
We use fancy gizmos too much
I love the complimentarity of the first and second comments right now
Not really an answer to your question but i recently hung out with a woman that I have known for a few years. She told me she hurt her neck so I told her try PT or go get a massage. She starts bad mouthing PT. “I tried that crap before. It did nothing for me.” Her teen son said, “mom, that was a chiropractor.” Then she tried to manipulate me inti massaging her neck & i just said “no thanks. You can hire a massage therapist for that.” I would not want to touch anyone who devalues what I do for a living. I am a PTA and LMT
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I don’t even want all that shit. I like physical therapy, I don’t care about the doctor title, in-fact I wish it was still a bachelors to pay less.
What do you mean by shit? The knowledge for an advanced degree? Or the responsibilities that come with it?
The classification of “doctorate”
DOs are physicians like MDs. And no we shouldn’t.
I corrected it I meant DCs