Terry Rehabilitation & Testing | Physical Rehabilitation and Functional Testing

It Must Be More Complicated Than THAT

This is something that goes unsaid in my office, but I can read it on the faces of patients. Today’s patient had suffered 6 months of nagging headaches and neck pain. After a few visits to the doctor for NSAIDs and muscle relaxants, he was referred to a neurosurgeon and pain management physician, an MRI was ordered, and his neurosurgeon referred him to see me.

3 visits into his therapy he has no pain. In fact, he had only minimal pain after the second visit and seemed a little paranoid that it was all just too quick and easy. After today’s visit, it makes sense to him, but he still seemed to want a more complex explanation. A few exercises and that was it. How could this be?

The master mechanics turn the same wrenches on the same bolts the same way. All the automated diagnostic help in the world (for cars or people) still can’t beat a mechanic’s fundamental knowledge of how something works, when it comes to getting something fixed quickly and easily.

I have no explanation for why neck pain and mechanical headache required waiting for neurosurgical and pain management referrals and an MRI. That’s a complex answer I don’t have. On the other hand, his pain was localized, symmetrical, and mechanical. That’s easy for most therapists.

I should have made something up about scoliosis, his “hip bones being out,” trigger points, or “compensation” for something like his wallet, and he might have found that more satisfying, lol.

Chasing “The Latest Thing”

I recently received a voicemail message from a former patient (whose son I had also treated) asking if I practice a specific proprietary, trademarked, and well-publicized technique. I responded via email, and then realized that this response could have been written a dozen or so times over my previous 17 years as a therapist, so I ought to just make a generic letter regarding all such techniques:

Dear _______,

I hope you and your family are doing well. ____ is a proprietary treatment approach that incorporates very good marketing resources, with very expensive tools and educational materials, and is a treatment technique very similar to many other techniques that have been used for tens, if not hundreds of years.

Despite the hype, _____ has yet to demonstrate it’s effectiveness as a technique above and beyond other techniques. I just checked their website (figuring that I would find the most favorable literature there) and found a list of published case studies, most of which were single case studies. That means that as a “new” treatment, it was published in a peer-reviewed journal or magazine, with the data from only one patient that was treated using the technique.

Although they tout a presentation they put on at a_________ meeting, that research has yet to be published in a peer-reviewed journal. I’m not sure it ever will. There is no date regarding what year the presentation was made.

They have an effectiveness chart for ______ that looks very impressive, but again, it does not compare the effectiveness of their technique to any other treatment, and in the fine print states that their outcomes include treatment that is comprised of other techniques with _______ being only a portion of the total treatment.

Other research on their site is included if it mentions _______ in passing, as a “new” or “alternative” technique for a particular problem.

Without any randomized control studies, nor any other comparative data to demonstrate effectiveness, I will not be taking their courses or touting their trademarked name or logo, unless someone offers it to me free of charge. The same treatment techniques have been taught to physical therapists (including me) for decades, but without the same expert marketing panache.

The generic term for this kind of treatment is _________ and does has proven effectiveness in very limited circumstances. I practice __________ on selected patients, based on evidence of effectiveness. I select a technique if can I get a better result with it, or can I get the same result as other techniques, but with fewer visits or expense for the patient.

Hope this clears some things up. Some physicians – especially sports medicine physicians – are perennially sold on the latest and greatest technique, only to move on to the next new thing a few years later. I wish that more would read the scientific literature, or simply find a therapist whose judgement they trust, rather than chasing after the latest fad. Unfortunately, many therapists have simply given in, and pay exorbitant fees for these classes, so that they can claim they provide a proprietary technique, even if they know it to be ineffective. It’s simply a marketing decision.

So….call me to ask if I can treat a particular problem, and ask me my opinions of the technique. Allow me to use my best judgement and the most current information, and I can give you the best outcomes possible. If things are not working out as planned, I have several “alternative” tricks up my sleeve as well that may be helpful, and I can route you to the person who can ultimately solve your problem if I cannot.

Fear, Avoidance, and Beliefs

Fear, Avoidance, and Beliefs negatively impact patient care on a daily basis, however, they can be helpful in recovery when properly oriented an placed in perspective.

Read more

Spinal Decompression Update

So What’s New?

I was working long through a Saturday, and low and behold there was an informercial for a local group of chiropractors advertising their spinal decompression treatments.  They featured an orthopedic surgeon from Georgia.  I looked him up, and found that he had been stripped of his board certification because of a felony fraud conviction related to a spinal decompression device. Read more

Evaluation and Management of Back and Neck Pain – Divide and Conquer, Part 3

Treatment of Spinal Pain Based on Syndrome Classification

The last post (#2 in this series) explained how classification of spinal pain by position or anatomic abnormality has generally failed to yield tangible results when linked to conservative (non-surgical) treatment. Through classifications based on cyclical loading (as well as some other factors) better rates of success have been achieved (both anecdotally and through research trials) in treating spinal pain.

Read more

Evaluation and Management of Back and Neck Pain – Divide and Conquer, Part 2

Methods and Classification Systems for Spinal Pain

Early classifications for low back pain were based on either anatomical findings, restrictions of movement, or assessing alignment of body landmarks. Many of these classifications still are in use today. Read more

Evaluation and Management of Back and Neck Pain – Divide and Conquer, Part 1

How Do You Treat Back Pain?

That question, as simple as it sounds, can be one of the most controversial and divisive questions that anyone could ask a physical therapist. There are millions of people out there with low back pain (about 80% of adults have an episode of significant low back pain during their lifetime) and, it seems, a million different ways to treat it. Published research over the past 15 years or so (I’m speaking of serious research, peer-reviewed by experts in content and statistical analysis) has trended in a few general directions: Read more

Spinal Decompression – What Is It?

This is a big question these days! Everywhere me and my patients look (or listen) we hear about “Spinal Decompression” and it’s 85% to 95% (the number varies from commercial to commercial) success rate. I thought I knew what it was all about, but decided to do some research over the past couple of days.Spinal Decompression mostly refers to a type of spinal traction device called the DRX 9000, but can refer to other devices such as the Vax-D, DRS, and even the Chattanooga Triton Spinal Traction machine.

What I Found

Read more

Terry Rehabilitation & Testing | Physical Rehabilitation and Functional Testing