When the younger PTs are correct
Sorry, I really am trying to give them a compliment. I’m constantly griping about them on here, but they are correct about our past. And, I’m a hypocrite. I was obnoxiously eager and opinionated as a younger rehab guy, working around quieter, and far more experienced veterans.
If you are a new grad, feel free to go off on the grumpy veteran jerks like me, in the comments.
The case against modalities
The younger ones are always spouting off about all this sciency stuff, and this study says this, etc.
They do have the goods on us about modalities. And what we did in the past, and it’s embarrassing.
Modalities are all the cool gadgets and tricks that we said would help get rid of your pain. Ultrasound, electrical stimulation, diathermy (don’t ask), pool, ice/hot, lasers (pew, pew, “It’s a “laser beam”’ - Dr Evil), traction (medieval?), etc.
Modalities were much more prevalent in the 80’s and 90’s, under the Golden Age of Medicare billing. Most patients were taken to a table and received 2-3 of these modalities before some other exercises or manual work.
So there is a high percentage of people who have to come to therapy because they are out of shape in the first place. So what did we do? We have them lay down (some more) and gave them a nice comfy pillow. “Dont’s strain yourself! Just lay back and relax your mind (and wallet).”
Did this shit work at decreasing your pain? No. In the first 9 years of my career, not one person ever came in and said their pain was gone because of XYZ modalities. Did it help? Maybe.
Time
The problem with many of these interventions, and our own biases, is we don’t know if the ultrasound helped, or if it was just healing time.
Billing
As I mentioned in the last article, part of the problem is the employers insisted that we bill people for a whole hour. So these “modalities” took up 30 minutes of billable time. And we could employ unlicensed people to deliver some of these services.
What does work…
You guessed it. Finding weakness and a lack of motion, then strengthening and improving motion. Many of those patients can become pain free after a few months, or at least have long lasting changes.
Still want me to make fun of our profession?
So with you Mike. I dropped a chunk of money last year to fix my tendinopathy, hip bursitis and labral tears. In the end I said to myself I have to work it out myself so I ramped up my strength work and diaried every day. Lo and behold it has worked. I am pain free, feel great and slowly working up from there. You have to take responsibility for your own health.