Unfortunately, very few truly understand what orthopedic physical therapy is, and those that think they do, rarely agree. I hear it all the time: “What stretches should I do?” “Do you do trigger point release?” “Will dry needling fix my problem?” “My other clinic used ultrasound and E-stem, do you even have a theragun?” I want people to understand that these are passive modalities, not a solution. As Shirley Sahrmann proposes, orthopedic physical therapy should consist of a comprehensive evaluation of the musculoskeletal system as a movement system, identify tissues creating symptoms, and expose and correct the movement dysfunction to permanently resolve the recurrent pain.
Don’t get me wrong, massages, electrical stimulation, hot packs and stretching (some argue) feel great, but don’t expect them to address a movement dysfunction. Musculoskeletal movement dysfunctions can present in assortments of pain ranging from sharp, dull, tightness, burning, tingling or numbness, much like an infection presents with fevers, rashes, sore throats and coughing. However, in the latter, people realize that no matter how much ice, topicals, throat lozenges or cough suppressants are consumed, without antibiotics, the infection will not resolve. The musculoskeletal system is the same, and the movement dysfunction is the cause of the symptoms. Modalities are tools to manage symptoms. They may diminish symptoms for a duration of time, but they will never resolve the underlying issue. Marketing has allowed society to believe the latest “feel good” or in some cases “hurt so good” is the “quick fix” based on its ability to temporarily mask symptoms. It is 2019, technology is great, going to the moon is routine, cars are electric, artificial intelligence solves problems, and communication is easier than ever. Movement dysfunctions and pain have existed forever, if there was a “quick fix,” it would be well known.
Orthopedic physical therapy should be focused on identifying where the movement system is breaking down. In a movement dysfunction, the associated tissues will experience an abnormal load, creating the symptoms. Rather than chasing or masking the symptoms, treatment should be geared towards correcting the movement dysfunction to end the re-irritation of associated tissues and inflammation. Because tissues heal though oxygenation, exercises must be tissue specific and dosed accordingly. This process is fatiguing, but should not be painful. However, if dosed or executed incorrectly, patients fall victim to poor physical therapy and continue to believe, “PT stands for pain and torture.” Ending the cycle of perpetual, recurrent symptoms requires neuromuscular retraining to correct the movement dysfunction and implementation of these behavior changes in daily activities. This does not occur through a laundry list of strengthening exercises and is why physical therapy is so hard and the “quick fix” sounds so enticing.
There needs to be this paradigm shift in the perspective of orthopedic physical therapy. Physical therapists need to be trained and competent as movement specialist, not a sales person for the latest marketing trend or “quick fix.” There is nothing glamorous or easy about physical therapy, but is a rewarding experience where hard work pays off. Here at Austin Manual Therapy Associates, our highly trained physical therapists take pride in treating the cause of musculoskeletal movement dysfunctions rather than chasing pain with modalities. Are you or a loved one tired of those pesky symptoms that keep returning despite endless stretching, massages or chiropractic visits? If so, schedule an appointment at Austin Manual Therapy Associates to learn how to end your suffering, enjoy the process, and see how orthopedic physical therapy is supposed to be practiced.
Justin Guillot, PT, DPT