Opinion: Why Physical Therapy Doesn’t Work

Having been a physical therapist since 2005, I have seen plenty of sub-optimal rehab strategies and less-than-stellar patient care. There are definitely excellent clinicians in the field and most have good intentions, but there are just as many average or worse therapists out there as well.

Furthermore, the insurance model is restrictive and has very specific systems in place. Passive modalities like ultrasound, electrical stimulation, and heat/ice–all of which have dubious scientific evidence backing their efficacy–are often covered, whereas more scientifically-supported treatments like spinal manipulation or even strength-training aren’t. Unfortunately, the majority of PT takes place through this model.

This is just one reason why most physical therapy doesn’t work; PT’s aren’t being rewarded for advancing the field with newer and better treatment strategies, insurances won’t cover them, and patients are reluctant to pay for it. It’s also hard when patients expect to be completely rehabbed in just a few visits–only to go back to what got them injured in the first place, as if they didn’t learn from their prior mistakes.

Perhaps this is why most physical therapy just focuses on managing your short-term symptoms. Some studies have even shown that 6 weeks of PT for common conditions like “low back pain” have similar outcomes as no therapy at all! The underlying cause of these conditions are rarely explored and treated. I would not be surprised if these patients were treated with the passive modalities noted above, that don’t actually work.

We need to empower the patient through a holistic approach that emphasizes improving movement patterns and appreciating strength. If all you offer is short-term pain relief, you won’t get people out of pain for life. It’s great to get your back cracked at the PT’s office, but does that relief last all day and beyond? We should be reinforcing lifelong improvements rather than just symptom management.

Your tissues–muscles, bone, cartilage, etc–are meant to be loaded, and NEED this in order to heal. Most PT’s are far too conservative with weight-training in the clinic. 3 sets of 10 reps with a thin rubber band won’t get you very far. There is plenty of research to support weight-training and using more load in PT treatments. Yet even though they can lead to advanced healing times, they are often overlooked.

As PT’s we need to assess our patients down to their underlying cause of dysfunction. We can’t just keep sticking someone on a table with a machine for an hour every session.

I don’t know about you, but I never want to be injured or re-injured. I want to take as many steps as I can now to minimize my risk. With proper education on your orthopedic conditions and a head to toe approach, a therapist can find and treat the real cause of your symptoms. just like we do here at Halevy Life. Invest in yourself and avoid wasting time by chasing the root of your problems rather than the symptoms.

by Dr. Bo Babenko, DPT

New York, NY

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