Is Physiotherapy a Science?

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GCoe (April 27, 2010, 11:23:08 AM):

I am a physiotherapist. In response to benguela in a post a good while back it is a constant source of professional embarrassment that so many physiotherapists deny good science in their practice. The uncritical adoption woo and pseudoscience within the profession is rife although I don't think you would find that physios are worse at this then Nurses, GPS or many other mainstream health practitioners.

However the basis for all branches physiotherapy is applied science where we rely on evidence. Our background science is the biomedical sciences, particularly anatomy, physiology, pathology and biomechanics. We draw heavily on the applied exercise sciences and movement science. Physiotherapists in most western countries are instilled in evidence-based practice. We now can rely heavily on clinical guidelines and systematic reviews that are in turn based an excess of 3,000 randomised controlled trials to base our practice on. We have one of the most comprehensive databases for evidence-based practice that is devoted solely to physiotherapy (PEDro)

One reason why a number of physiotherapists adopt kooky ideas in their practice is that physical medicine is by its nature dramatic and very prone to placebo effects. When you are working within the realm of touching people which is a big part of physiotherapy practice the non-specific and placebo effects are often ramped up - much more so than prescribing a pill for instance. It isn't just the patient that gets fooled - therapists that fail to keep a skeptical viewpoint of their practice, get sucked into thinking they are being more effective then they really are and draw wrong conclusions about cause-effect relationships. We and are often influenced by charismatic practitioners who run short continuing education courses who provide "certainty of effectiveness" if you just follow their methods (this is where a lot of dubious practices such as acupuncture are adopted).

Some countries do better at producing and maintaining science-based physiotherapy through high quality faculties and high professional standards. Countries such as Australia, Canada and the better courses in the US are good examples. So there is a marked difference between nations.

Physiotherapy is a valuable part of health science but we have our problems. We could do better.

I'd be interested to know what members have found in their dealings with physios
GCG (April 28, 2010, 10:29:45 AM):
i had to attend physio three odd years ago when a 500kg piece of concrete fell on my back.
a tiny woman, highly pregnant, but by god, did she have a squirming in agony.
but she fixed me up real good.

in my mind, physiotherpy as definately a science. you have an injured muscle, or muscles in spasm, you apply pressure or heat or friction, and it affects the muscle fibres to relax, release, whatever. no hocus pocus to that.
i dabble in massage therapy as well, and i have felt, with my own hands, a knotted muscle release after work being done on it.
benguela (April 28, 2010, 14:40:02 PM):
Hi GCoe,

I would like something to the equivalent of FishMS. We'll call it QuackMS ;)

Whenever a physio,gp,etc is about to perform or prescribes a treatment, I can send an sms to QuackMS of the treatment's name and it replies with one of the following

"proven to work for x,y,z",
"possibly works for a,b,c the jury is still out",
"does not work, name and shame the quack"

In my case I injured my spine while canoeing, a nerve was pinched in my spine causing severe pain in my ass. I forget the exact name of the nerve, not the one that runs down the leg, everybody mentions that one, just in the ass. Everytime I moved it was like an electric shock from my spine to my ass. I am a sportsman and have always used physiotherapy. For this the physio gave me the works, laser, electro, thermo, acupunture, dry-needling, massage etc. Not coincidently they were the same treatments when I was recovering from acl surgery, when I stretched the ligaments in my ankle and when I cracked my hand. It's like a shotgun approach, use all the tools and hopefully one works, doesn't matter what the injury is, it's all just muscles, ligaments and bones.

Yes, eventually the pain went away. The orthopedic surgeon said I wasted my money, it would have healed itself anyway. That pissed me off and left me wondering if anything he had used had actually shortened the recovery period, or was I ripped off? I speculate that somethings work and some don't, but which one. Please just use the ones the work so that it doesn't cost an arm and a leg.

For example, what I have found so far in PEDro is that studies show dry-needling to not be more effective than placebo and "possibly works" while others studies come out and say it does not work period. To me "possibly works" equates to "does not work", I don't understand why they cop out like that on PEDro but I'll allow that option in the QuackMS responses.

and @gothcatgirl, your evidence is anecdotal, which proves nothing.

GCG (April 28, 2010, 14:54:47 PM):
an·ec·dot·al (nk-dtl)
1. also an·ec·dot·ic (-dtk) or an·ec·dot·i·cal (--kl) Of, characterized by, or full of anecdotes.
2. Based on casual observations or indications rather than rigorous or scientific analysis: "

indeed not.
you say youre a sportsperson.
my ex is an extreme athlete. runs, bikes, paddles, climbs. has torn ligaments, cracked bones, collided with cars, drowned, you name it.

he was born with a misaligned spine. so when he does adventure racing, he often returns with his back in agony. with a nerve pinched somewhere. cant sit, cant lie down, cant stand.
i have no training in any form of medicine, real or woo-woo. i use what is commonly called common sense.
a muscle is made out of fibrous collections of cells.
the reason the nerve is pinched, is cause a musle is in spams, causing the nerve to be deprived of oxygen, contorted, overexposed to stimulus, and a whole bunch of other stuff.

why does the muscle do this. the cells are oversaturated with waste by-products of being overworked, either by repetition or unusual strain. or simply damaged.
thus, eliminate the lactic acids and what the hell ever is else is present, and your cells with chill out.
how do you do this?
you encourage bloodcirculation to said area. by applying pressure, heat, any and all stimulation. i use massage, with alternating hot and cold packs. and some deep heat. if that actually does anything apart from smelling shitty, i dont know.

so the blood brings more oxygen to the area, helping the healing of torn and overworked muscle, clearing out waste.
basic biology.
rigorous or scientific analysis, proven plenty times over. by scientists, not woo-woos.

for needling, acupuncture, meridians and whatnot. i havent had experience to any of it, so i cant comment.

so anecdotal fail.
benguela (April 28, 2010, 15:42:49 PM):

Your theory on how massage therapy works does not prove it's correct, I'm not saying it's incorrect, what I'm saying is that it's just speculation. Your comment

i dabble in massage therapy as well, and i have felt, with my own hands, a knotted muscle release after work being done on it.

is anecdotal, or at least my understanding of anecdotal, I may be wrong here.

This is the kind of evidence that is not anecdotal or speculative

I must thank you for leading me to this information on sports massage, from now on I will only pay for a massage at my next race if I'm suffering from cramps and I need to finish before the cutoff. Definitely not because I need to recover in the evening for the next day's stage. I'm embarrassed of all the money I spent on those masseurs up to now!

And let's talk about common sense, common sense told me that quantum theory is bs, and yet, it's true, it's both a particle and a wave!


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