Is Physiotherapy a Science?

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GCoe (July 03, 2010, 04:25:19 AM):
Physiotherapy is and should be essentially an applied science. Of course the patient must be treated individually and there will always be and art aspect to practice. However utilising science-based data provides so many benefits to patients over therapists who base their practice solely on clinical experience (basically anecdote), their pet theories, and what they were taught on continuing education courses or in their undergraduate education of many years gone by. The scientific literature provides evidence for most aspects of physiotherapy whether it is diagnosis, prognosis, effects of specific interventions, risk of harm, systematic evaluation of patient experiences etc.

Physiotherapists who fail to utilise evidence in their practice in a meaningful way are letting both the public and their profession down.
benguela (July 05, 2010, 13:09:26 PM):

I have been to a physio for the following 3 sports injuries

1: ACL replacement surgery from bad skydiving landing.
2: Pinched nerve in lower back from impacting with a rock in a rapid while kayaking (or falling out of kayak in this case)
3: Stretched ankle ligaments from trail running.

The physio used the following treatment protocol for all 3 injuries

1: Apply heat to warm up the injured area prior to treatments.
2: Laser Therapy
3: Ultrasound
4: Electro Therapy
5: Manual Manipulation / Massage
6: Attempted acupuncture which I politely declined. I should have challenged the physio right there!

I was also given mobility/stretching/core stability exercises and later weights to do at home.

For all injuries the same treatments were used which appeared to be a shotgun approach. I'm guessing that if a sales rep sold the physio another gadget, it would be included in the standard treatment lineup that could be charged for.

After the acupuncture incidents and the opinion of a skeptical orthopedic surgeon, I started investigating these therapies on Pedro and discovered that the treatments are mostly bogus, including what i recently found out on this forum, the massage! What is in vogue lately is some patch that they stick on your body somewhere that apparently promotes healing or some such. I forget what it's called.

Would you say this lineup of treatments is typical of what one could expect from physio's in this country?

My conclusion is that physiotherapy needs to get it's house in order and expose these treatments as sham. The main problem I have is that they are perceived to be legit unlike homeopaths and chiropractors.

GCoe (February 04, 2012, 02:52:30 AM):
It is a bit hard to generalise across your three conditions but my guess is you bought a dud. Looking through your list there - core stability exercises is a popularised term for an evidence-based treatment for certain types of low back pain. So in the context of low back pain this may be relevant to you - but it depends on your presentation - if you have functional instability between intervertebral segments in the low back that may be contributing to the "pinched nerve"

1: Apply heat to warm up the injured area prior to treatments.
2: Laser Therapy
3: Ultrasound
4: Electro Therapy

these are genially found to be useless treatments. although heat and certain forms of electrotherapy do have temporary pain relieving effects.

Manipulation may have a place in the treatment of acute low back pain but there again the effect is short lived and doesn't appear to alter long term recovery. Accupuncture MAY have some some benefits in reducing pain at certain sites but the result is most definitely due to the physiological sticking needles into people and not due to some pseudoscientific of energy meridians. However the effect size is small so if it really makes for clinical significance in the treatment is open too debate.

Physiotherapy has a definite role in rehabilitation of ACL surgery, and sprain ankles - without going into the specific treatments in detail, the therapy should focus exercise that improves the appropriate healing of ligaments such as graduated increases in normal stressing of the healing tissues (e.g. graded increase in stretching and load bearing of the affected tissues, to promote a stronger and more resilient ligament) , exercise to strengthen the appropriate muscles, restoration of proprioception usually using some progressive balancing exercises, and the therapist should address other issues such as keeping you fit (aerobic exercise such as cycle ergometry, or arm ergometry, treadmill as tolerated etc.). If you are involved in a manual occupation or specific sport the programme should design include task-specific exercise that will get you back to such activities safely and as quickly as possible.

Physiotherapy in South Africa is quite advanced relation to academic activity with a good research profile. However I couldn't comment on the practice in private practice. Unfortunately just having good university training and research profiles doesn't amount to best practice in the field.

I agree that physiotherapy needs to get its act in order and there is much to do. However I would maintain that physiotherapy continues to have a legitimacy over such things as homeopathy and chiropractic - physiotherapy is very much a branch of allied health science and is part of medical science where as homeopathy and chiropractic are not. In the case of physiotherapy it is a matter of quality of practice that needs improving and that improvement needs to come from translating high quality clinical research into practice
BlueRecurve (October 24, 2012, 17:59:24 PM):
Having been treated for various injuriesand strains by both physiotherapists and chiropractors (and seeing the effects of such treatments on numerous family members and friends) I do think there is a science to the disciplines. Saying it's not a science would be like saying medicine is not a science. A lot of studies go into these disciplenes, sciences revolving around the fuctioning of the body.

Admitedly, chiropracty curing infant cholic is bull (and it's claims like these that make people think chiropracty is airy fairy nonsense). But chiropracty helping realign the skeleton, does actually work.

@Benguela. The actupuncture needles are not used in the way Chinese medicine does. The needles are inserted into deep areas where the physio cannot reach to help blood flow reach that particular area. It has worked on me and my family. Was there placebo involved? Maybe? But then I think placebo has a huge effect in any field of medicine.


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