Performance Therapy vs. Physical Therapy
Performance Therapy Vs. Physical Therapy
Let me start this blog post by saying that this will not be an argument for or against cash based versus insurance based physical therapy. I wrote a whole blog post devoted towards cash based physical therapy. You can access that article here. (Insert link). Rather, this article will give you insights into how I believe the physical therapy profession should be evolving and the action steps needed to make it a reality.
The standard physical therapy system is hopeless. Most, if not all, physical therapists join the profession due to a profound need to help people. We have our hearts in the right place. We want to get people out of pain and improve their quality of life. Our focus may be specialized, but when it comes down to it, we want to help people in a way that is different from the usual “dis-ease” based system prominent is today’s society. PT’s want to believe that helping reduce pain, reduce the use of medications, and prevent unnecessary surgeries. However, some PT’s may not be as different from physicians as they might think.
Are We Really Different from the MD?
Throughout my years as a PT, I have worked in a variety of clinics and settings. The common denominator I’ve found is that most practitioners are fighting the battle of who has the best manual techniques. Who can manipulate, dry needle, or massage someone out of pain the best? That being said, I am a manual therapist myself, but I don’t believe this should be the mainstay of our treatments. By performing passive modalities, are we not simply giving a pill just like the MD? Everyone wants the quick fix. Can I help you today? YES! But, this is not enough.
We are capable of more than this. Our training, especially in movement analysis dictates this fact.
A patient comes into my clinic with complaints of low back pain for the past few years. MRIs and X-Rays were performed, but his back wasn’t “bad enough” to warrant surgery. He was then sent to standard physical therapy clinic “X” where he was discharged because his insurance wouldn’t pay for the sessions anymore. He wasn’t progressing according to his outcome measures, both quantitatively and qualitatively.
Throughout this entire vicious cycle, bouncing back and forth between providers, not one of them actually took the time to watch him move and perform the patterns of sport and recreation he enjoys; in this case weight lifting. Sure, the doctor prescribed medications that somewhat worked, yet made him feel odd. The PTs performed the same massage, dry needling, and mobilizations targeting his low back that had the same short-term success.
In the end, this person wasted 2 years and a lot of medical dollars because he did not find the right provider who would actually take the time to figure out the cause of his pain. No one watched him move. No one taught him how to move to prevent his back pain in the first place. There were plenty of inputs placed into the nervous system (massage, medications, manipulations), yet when that window opened to improve his movement, nobody seized the opportunity.
Is The Physical Therapy Profession Too Weak?
There also seems to be this false idea that the aches and pains you come to see a PT for in the first place shouldn’t be any worse than when you came in. This mentality is flawed. You go to the gym, train hard, and expect to be in some discomfort the next day. If we are truly stressing the body and brain towards positive adaptation to create better movement, shouldn’t we expect the same response the next day after our treatment or training sessions? Improving mobility and decreasing pain is not a cakewalk. There is no quick and painless fix. Rehabilitation is hard work. To get the best results, you need to be willing to put in the effort.
The patient mentioned in the previous example put in that effort. After two short weeks of carrying heavy sandbags and reprogramming his hip hinge strategy, he was completely pain free. Yes, he was uncomfortable. Yes, he sometimes aggravated his symptoms. However, his movement strategies were sound and he trusted my reassurances that he was making progress.
A lot of this responsibility falls on us as movement experts and rehabilitation specialists in the way we interact with out patients. We need to give patients knowledge, not just information. We need to explain the why and the how to solve their problem and give them a solution that empowers them to take control of their own rehabilitation. They will listen to this form of communication, which will give us the buy in we need to establish rapport. They will then trust us when we give them the “what to do.” In reality, we need to appeal to the limbic part of the brain that controls emotion. They will then understand the problem and integrate the knowledge to achieve long-term success. I always hear “I want you to fix me.” No, I will help you fix yourself.
Today, standard physical therapy puts out the fires, but never addresses what started the fire in the first place. This is a great business model to get return visits. Dowse the client with water and wait for the re-kindling to start. I am in the business of long-term success for my patients. I do this by making my clients efficient human movers, period. I want to give them the tools to troubleshoot any problem that may come up for years to come. We all have the potential to be great athletes. It is time to unlock that potential and improve your performance in life and sport.