This is a very interesting article, and I think that any patient that is planning to undergo physical therapy should read through it. After you’ve read it, I have a few (ok, more than a few) comments:View Post
Can You Prove It?
Attempting to prove or disprove the effectiveness of “therapy” can be problematic. Imagine a study of the effectiveness of therapy on knee pain and disability. Pain and disability may due to a ligament tear, cartilage tear, or degenerative arthritis. Therapy might consist of ultrasound treatments, hot packs, ice packs, electrical stimulation, exercises, or a combination of all or some of these treatments. Measures of effectiveness might be a decrease in pain level, the ability to walk normally, the ability to return to sports, or a combination of any of those. Due to the array of differing treatments, diagnoses, treatments and measures of effectiveness, determining effectiveness can be difficult, if not impossible.
Is Everything Under Control?
Ideally studies would always “control” for a specific diagnosis (or even a subset of that diagnosis), specific treatment (or a particular variation of a treatment), and establish a specific criterion for judging effectiveness. Such a study would include a large group of a subjects, and the study would either demonstrate or fail to demonstrate effectiveness when judged against a “control” group, that received no treatment, or that received a “sham” treatment.
My undergraduate field of study was physics, and it was very easy to control for all kinds of things experimentally. However, when dealing with people it becomes more difficult.
It boils down to this: there are specific interventions in specific situations that we have been able to identify as effective. There are types of interventions in specific situations that we can identify as effectiveThere are also treatments that are commonly utilized that do not have demonstrated effectiveness. In some cases, there are studies that suggest certain treatments have no benficial effect. These treatments may still be utilized, as they may demonstrate effectiveness in situations that have not been studied, or that may be very difficult to study.
A skilled therapist can utilize classification schemes to find patients that may achieve short term benefit from a treatment with little or no beneficial evidence. For example, spinal traction has not been demonstrated generally to be effective in treatment of low back pain, however, when a patient has limited movement, a skilled therapist may be able to employ traction for 1-4 sessions and realize faster restoration of motion than without employing traction.
Compare These Approaches
Compare and contrast a chiropractor who utilizes spinal decompression – signing the patient up for a contract typically including 24 treatments at a cost of $3500 – to the physical therapist who, during an 8-visit course of therapy, employs spinal traction to quickly (in 1-3 sessions) restore a patient’s ability to move, achieving treatment goals and allowing the patient to make faster progress toward total resolution of their problem.
What Does Insurance Cover?
Insurers generally only cover “skilled” physical therapy. Skilled therapy means that it requires the specific training and expertise of a physical therapist to facilitate your recovery. For example, you may be given specific exercises to perform to help resolve a problem, but those exercises should be altered, adapted, and changed to some extent each appointment, based on your status as of that day. You may also require hands on treatment such as manual therapy and intensive stretching to assist you in recovery, and these should be things that you cannot do on your own, and are designed by a therapist for your specific situation. Simply performing a set of exercises, or receiving the same series of treatments each time you come to the clinic is not skilled therapy.
By its nature, skilled therapy should result in a predictable pattern of improvement that is faster than what you might experience if you chose not to perform therapy, depending on your situation. I generally have a “two week rule.” That means that any patient we see should experience significant improvement in two weeks or less, or therapy is not the treatment of choice.
What About That Hamstring Strain?
Well, we see hamstring injuries too. Ordinarily they require light exercises, performed several times a day (at home or work) and progressive weight bearing and walking. This is followed by gradually more aggressive flexibility training (increasing flexibility to attempt to reduce the chance of recurrence) and return to sports. All in all, we expect to see this type of patient 4-8 visits before full return to sports, depending on the severity of the injury.
At Terry Rehabilitation, each patient is expertly evaluated, each treatment plan is customized for that patient, and all treatment occurs with a highly trained professional.
Our rehabilitation programs include:
- Hands-on manual therapy techniques – to quickly correct loss of motion
- Supervised therapeutic exercises targeted to specific deficiencies
- Modalities such as cold packs, heat, and electrical stimulation to reduce pain, inflammation, and to increase flexibility
- Targeted home exercise programs that do not require special equipment
- Restoration of functional strength and stability for daily activities
- Work-specific or sport-specific rehabilitation
Contact us to schedule an initial evaluation. If physical therapy is recommended, we will contact your physician in writing regarding the recommended plan of care, allowing him or her to make the most informed decision possible for the care.