Misconceptions of PT – What are we going to overcome during this year’s PT month?

Misconception 1: You need a doctors referral to see a physical therapist

Misconception 2: Physical therapy is just modalities, heat/stim/ultrasound and is temporary

Misconception 3: Physical therapy hurts

Misconception 4: All physical therapy is the same

Miconception 5: “I can do my own physical therpay if I do the exercises to strengthen the area”

Great topic and piece Luke. These misconceptions are not only ones that potential patients have but also referral sources. Many docs still view us as curing a sprain with ultrasound and stretching vs. gait analysis, neuromuscular reeducation of the muscle spindles and manual mobilization of specific joints. Because of the autonomy we are gaining as practitioners, we have to do a better job in changing the perception by educating every patient on what is going on, what research shows will make them better and how to convey what they experienced in PT to the MD/DO.

Myth 6 we do not treat body parts. We treat people.

Myth #1: Physical Therapy is an intervention, rather than a discipline. I often hear patients say, “I tried physical therapy for (x diagnosis) it didn’t work.” They may have had treatment for condition x, but what did it consist of? Did the physical therapist use joint mobilization/manipulation, neuromuscular re-education, ultrasound, massage, exercise? There are many conditions that we successfully treat, but someone has experienced a failure because the appropriate intervention was not selected.

Absoultely Bruce. I often hear, “today I’m here for my shoulder, but my back hurts, can you treat it?” Patient’s and PT’s alike often worry about insurance coverage, and forget we’re dealing with a human being. With good clinical reasoning you can “put the patient together” get them better, while appeasing insurance companies.

PT begins with electrical stimulation.

Physical therapists are not trained to perform joint manipulation.

While some states have outlawed manipulation by physical therapists, we are trained to perform joint manipulation.

PT sessions end with an ice pack.

Joseph Pilates was a PT. Pilates is an evidence based PT intervention.

Bruce what are you talking about here??? I feel like you are making personal attacks which have no validity. There has been significant recent literature on Pilates-based physical therapy in the treatment of low back pain. While you are correct that Joseph Pilates was not a PT(not sure how many people have this misconception though…), he did contribute a method of core stabilization which has shown in the literature to be effective. Below are three articles for you to read (again I can send you .pdfs if you don’t have access to a journal database) and then challenge you to make this allegation.

Herrington L, Davies R. The influence of Pilates training on the ability to contract the Transversus Abdominus muscle in asymptomatic individuals. Journal of Bodywork and Movement Therapies; 9:52-57.

Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect of subjects with nonspecific chronic low back pain and functional disability. Journal of Orthopedic and Sports Physical Therapy;36:472-484.

LaTouche R, Escalante K, Linares MT. Treating non-specific chronic low back pain through the Pilates method. Journal of Bodywork and Movement Therapies;12:364-370.

Joesph I am going to review these some for a second time. I have read little that is base on Joesph Pilates documented work. I see a lot in PT in the “name of Pilate”. This is sad because we have many master PTs from the much earlier and later that have great documtations of trunck stability. I will back to you on this.

I have been increasingly frustrated by the profusion of exercise programs claiming that they are based on Pilates’ work. Pilates was not himself a physical therapist an yet the “Pilates” name currently has brand appeal while “physical therapy” is less well recognized. I do not think we are helping ourselves as a profession when we allow ourselves to be identified with the latest fitness trend rather than grounding what we do and recommend to our patients in more evidence-based exercise applications. The JOSPT article to which you referred is an evidence-based source to be sure, but many of the exercises included in the article could just as easily be labelled “therapeutic exercises for stabilization of the spine”, instead of “Pilates-based”. Pilates’ original 30+ exercises certainly made us more aware of the need to control the musculature of the trunk, but we cannot call every stabilization exercise something that has been derived from Pilates’ work. There is not one real article referenced in the JOSPT article that is by Pilates or one of his devotees. Pilates did not actually write down much of what he did–although he certainly did offer us a great springboard for discussion. It is time that we base more of our future discussion about constitutes stabilization exercises on sound scientific based work and less on a well known exercise personality. We owe it to ourselves as physical therapists.

PTs tell you to stop doing anything that hurts.

Myth: That physical therapy is for injured athletes and old people.

Currently there are eight specialty areas: Cardiovascular and Pulmonary, Clinical Electrophysiologic, Geriatric, Neurologic, Orthopaedic, Pediatric, Sports, and Women’s Health physical therapy.

Within these either specialties there are a multitude of special interests/sections. Physical therapists can help you with a multitude of anatomical problems/injuries including wound care management, respiratory problems, incontinence, emergency care, etc. . .

PTs are trained in running injury management.
Truth running is not an ADL as determined by CMS and is fitness and not covered by third party insurance. Running is not taught by many PT programs. There is little good evidence in running injury management in PT.

Bruce. I am unsure of the validity again in your comment here. I am unsure of the curriculum that was taught in bachlor level pt courses but am sure that dpt accredited programs cover the orthopedic care of running and sport related injuries. The nagi and icf models of disability do emphasize the return of an individual to their normal social needs, such running, not simply adl’s, and this return to normal social function is the emphasis of current pt programs.

Joe I been having new grads for 25 years from many different programs and none got runing injury management beyond modalities and avoidence. At OCS level I was glad a few questions were basic running facts on the boards.I see very litle about running in our journals. That said much more in recent years.