I’m a diligent Sports Therapist. I’ve read all the Physiotherapy text books. Well not all, but a lot. I’ve been using a variety of physiotherapy techniques now for over 12 years. And I’ll do pretty much anything to help get people feeling better. But, there are some pretty outdated ideas still being used by many Physios and Sports Therapists alike.
I can’t blame them. It’s what we’re taught at Physio and Sports Therapy school. It’s what is still written in many of the well respected text books. It takes a brave therapist to stand up and shout about so many things that are wrong in the Physiotherapy world. Why would I dare to be in a position to question these concepts and techniques? Because I’ve used them, unsuccessfully, and had to find better and more sensible approaches that actually get people better.
So here’s the list of 5 Physiotherapy concepts that should have gone out with the arc. Some of them I try to debunk with a blaze of science and fact. Some I question from personal experience. Some I just get carried away in the emotion of the moment!
1. Leg Length Affects Your Symptoms
I get steam coming out of my ears when I hear this one. And it’s still used frequently in all the text books as a pre-disposing factor in all kinds of injuries. Whilst statistically I’m sure it is true. I’m not arrogant enough to suggest that all that good research is nonsense. But let’s take a step back and with common sense consider the following question:
“Was your leg the same length before you got the injury?”
Now, barring the most severe of accidents, chances are your legs are the same length as they were before the injury. Which suggests that other factors, once addressed, will resolve the issue. Rather than putting a wedge in your shoe – of which you have no idea of the consequences of what will happen. Or hacking a lump out of your leg!
I go further. A genuine leg length discrepancy is very rare and can only be confirmed on x-ray. If some well meaning Physiotherapist or Sports Therapist or any other kind of therapist has concluded you have one leg longer than the other without using an x-ray and a ruler shame on them! It’s also put a negative idea in your head, which in turn can actually exacerbate your condition.
That’s been brewing for a while – I’m starting to feel better already.
2. Core Strengthening Sorts All Problems
Now this one I’ve mentioned just a few times previously as in my in depth piece asking: Is There Any Point To Core Exercise? Since writing the piece I have mellowed somewhat and have actually brought one core exercise out of retirement. I now returned to mentioning core strength when talking about posture.
Briefly my anti core stance is this. Everyone is different. Every condition has a different driver of the pain. It could be where the pain actually is. More likely in acute (when you do something to a specific area) conditions. But more commonly the driver is likely to be elsewhere.
If your pelvis is the main driver of your pain then core exercises should help with your condition. Whether that’s in your neck, shoulder, knee, low back, wherever. But, you need to scientifically show that this is the right approach for this person. So many times we see people at the clinic who have commenced a core strengthening programme only for it make the condition worse not better.
3. Ultrasound Helps Tissue Healing
Now I have to say I have no clinical experience of ultrasound. I remember studying and applying this at Sports Therapy college and listening to the ‘theories’ as to how it works. I remember thinking at the time “That sounds like absolute nonsense!” Now I was biased even back then having had ultrasound treatment on a previous sprained ankle. With, you’ve guessed it, no affect whatsoever!
The truth is that originally the effects of therapeutic ultrasound where hypothesised and not fact. Often hypothesised and researched by the people selling the machines! It’s just been around for so long that it is deeply ingrained into Physiotherapy culture.
If you go to see any therapist who uses ultrasound as a treatment modality they are either lazy, out of date or both. I don’t think I can say it any harsher than that. I love this piece of research which compares 35 studies between 1975 and 1999 into the efficacy of ultrasound for treatment. Of the 35, only 10 were deemed to have suitable research methods. Of the remaining 10, 2 suggested it might help some conditions and the other 8 said it had no effect.
It goes onto to conclude that it is no more effective than placebo in treating musculoskeletal problems or for promoting soft tissue healing. Fairly sweeping. Just to twist the knife on the quality of the science it adds: “The dosages used in these studies varied considerably, often for no discernible reason.”
4. The Pain Is Where The Problem Is
So much Physiotherapy looks at where the pain is. I know I’ve been there and got the t-shirt. It’s pandering to human emotion. “I have a pain here, there must be something wrong with that bit.” Putting my human hat on and having been injured myself this is completely understandable. But it takes years of experience and confidence to look away from the symptom. I still have to give myself a good talking to every now and then as I get drawn into treating the symptom.
Don’t get me wrong. Sometimes it is absolutely the right thing to do. Especially after a recent injury. We need to assess what tissues we think have been damaged. But even then using our knowledge of the connection of the tissues we think are damaged to other parts of the body we often see surprising changes to the symptoms after treating those connected parts.
5. Prolapsed Discs Are The End Of The World
This is a tough one for anyone who has suffered from such a thing to even begin to think about. These things can be absolute agony. Equally they can be completely painless! They are an enigma in modern Physiotherapy. Research using MRI has shown people with large bulges pressing directly on nerve roots who don’t even know they have a prolapse and people with minor bulges who are in complete agony.
But fear not help is at hand. This wonderfully positive piece suggests most people will get better anyway without any surgical intervention. This piece agrees with our approach in that anything not responding to conservative approach after 6 weeks should be considered for surgical treatment. However, it also suggests that even if surgery is not carried out most people will get better anyway.
As to why there is so much discrepancy in the amount of pain people feel I do have a theory. Reading the physiotherapy text books it is hypothesised that the pain from a disc comes from a combination of mechanical irritation of the nerve root (the bulge pressing on the nerve) and chemical irritation of the nerve (the way our body responds to pain stimuli).
We explore this concept in greater depth in our article investigating the affect of Psychology on our pain experience. One of the mechanisms in the way that pain is felt is that pain receptors (nociceptors) respond to chemicals from structures that are not happy (any pain scientists please excuse my gross simplification) and contribute to our experience of pain.
However, when we are stressed, not only do we produce more of the “pain” chemicals our pain receptors are also more porous to these pain chemicals. In other words they are also more sensitive to the pain chemicals in our tissues.
This was a bit technical I know. But this is backed up by what we see in the clinic. Most people coming to the clinic with disc prolapse type symptoms almost invariably have an increased level of stress in their lives. Either at the time when symptoms started, at the end of stressful period or just stress ongoing! It doesn’t mean stress is the only factor, just an important one that needs to addressed as part of any successful treatment for disc prolapses.
Conclusion On Physiotherapy Myths
So there you have it. That’s my findings from 12 years in the game. I hope you found it as interesting as I do. Maybe not as you guys probably get out a bit more than me and aren’t quite so geeky! But each to their own. I will warn you I have another 5 Physiotherapy Myth busters in the pipeline.
Hopefully you found this useful. If you’d like to discuss any of the topics covered here than please let me know. Equally if you’re interested to know how our ‘up to date’ approach to the physiotherapy world can help you with your condition then please give us a call on or mail at info@BrightonSportsTherapy.co.uk.
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