Is Physical Therapy Overrated?

This piece in Pajamas Media addresses an important medical question, but I can’t resist dedicating the obligatory quote to the personal anecdote in the intro:

Twenty-seven years ago I found what seemed to be the only functioning storm-drain in Tanzania, in East Africa, and fell down it, severely injuring a knee in the process. The journey to the mission hospital in the back of a pick-up truck over sixty miles of rutted laterite road was one of the more agonising experiences of my life.

I had an arthroscopy when I returned home several weeks later – I could not even hobble until then – and the orthopaedic surgeon told me that unless I did physical therapy every day for a very long time it was inevitable that I should be crippled by arthritis within twenty years.

It was equally inevitable that I would not do physical therapy every day for a long time; and here I am, twenty-seven years later, without so much as a twinge from my knee. My faith in the predictive powers of orthopaedic surgeons has been somewhat dented.

11 thoughts on “Is Physical Therapy Overrated?

  1. Bill

    I’ve been working in the Physical Therapy profession for over 18 years and I have to agree with you. Physical Therapy is very over rated and mostly unnecessary. If Physical Therapist were to stick their actual scope of practice, which is in hospitals where they walk patients and see if they are able to go home without any problems, then there wouldn’t be very many Physical Therapists opportunities available. You know there’s a problem, if you have a profession that tries to step into other scopes of practice, uses them, then takes credit for it. Most physical therapists talk a lot of bad things behind everybody’s back, including most doctors too. It’s a really questionable field to be in, I’ve heard physical therapists who have been in the field for over 25 years admit, that their not even sure if what they’ve been doing has even been effective to patients or not.

    From what I have seen, “Physical Therapy” mostly in orthopedic outpatient clinics is completely useless and a waste of peoples time and money. I can say, that “Fitness Trainers” definitely have what it takes to make a difference, especially in preventive medicine.

    My observations are based on actual experience over an 18 year period within physical therapy clinics. Patients will heal from surgery and injury no matter what happens.

    Reply
    1. Chip Hurst PT

      Physical therapist here–15 years. You hit it right on the head Bill.

      I was 33 when I started practicing so I didn’t drink the kool aid led by the APTA.

      We have our place–an important place. Especially in ortho hospital and initial ortho recovery. Also neuro recovery we are essential. And pediatrics we are huge. The problem is just what you said–thanks to our APTA we moved our profession to a doctorate which isn’t even legitimate. They don’t do a real thesis that they defend, don’t do orals and don’t teach lower level classes while they go to some sort of “advanced PT school.” They go to PT school just like my Bachelor’s. They take a few courses and suddenly think they are chiropractors. Recently dry needling is the rage. No matter what the scope is the PT wants inclusion.

      Simple fact is we are ancillary. And on top of that we have become a charlatan profession. We are fascinated by the new fibromyalgia and chronic pain syndromes–we create philosophies on the matter, get certed and accomplish exactly nothing. Because in all of my years I have never seen one therapist, brilliant or not, solve a chronic pain patient. Because the new chronic pain syndromes are due to obesity and poor lifestyle. Oh and the chronic neck pain patient? It’s usually stress due to again our hyper lifestyle of unhappiness in this country. Huge divorce, huge debt and overkill on the job line all while living like Modern Family. Sure we can mobilize stiff cervical segments–and the stress re stiffens them unless the person changes their lifestyle–like exercise daily. Yoga four times a week would do more for these patients than PT. And we aren’t even bright enough to see that much. This patient whose problems are a reflection of lifestyle has become the PT’s main course for financial reimbursement.

      And for the person who sprains his back? Guess what, they don’t need to rush off to PT. Time does usually take care of it. And if they are 100 pounds overweight then time won’t solve it quickly. And neither will PT.

      Last year I quit a fellowship due to this nonsensical attitude. This “profession” has become utterly and completely ridiculous. First of all, most OP PTs are treating two patients at a time which is a waste of time. Do that and there will be no skill level 10 years later. And that IS how most OP clinics operate. I don’t and I’m usually the only one in the room who doesn’t. I also discharge the 100 pound overweight patient who won’t change his lifestyle. Now there are many many patients who have pain developed where ever in the 6 month to year zone that I can help–usually if they are active as a person. Mobilizations and soft tissue and a few key reprogramming exercises will do it. Usually in 6 visits max. But most PTs just bring them in and watch them do exercises with someone else in the room. Second, we keep taking the same patients back over and over as if what we do THIS time will somehow result in something new from the same thing we did LAST time. All while we shove research out screaming “evidence based, evidence based,” as these idiots shove multiple patients through the assembly line all day. While at the same time claiming they are “doctors” too.

      PT is the most pretentious profession I have ever encountered in the medical field which is ironic as they have the least amount of actual substance in their long term outcomes due to our sedentary lifestyle and obesity which has become epidemic. PT is also a profession largely made of do goodies who are myopic for what the rest of us call reality. The insurance companies should crush us and force us to go back to what we were primarily created for—neuro and ortho recovery in the short to mid term. And peds. Because the simple fact is that most of what we do now is a waste of time and resources.

      Reply
      1. Bill

        Hi Chip! I just read your post and re-read my old post. I left a lot out of my original post, but you basically said exactly what I was referring too. Physical Therapy has it’s place in healthcare IF, future PT’s remain within our scope of practice. As for now, I see way too many new DPT’s coming out of school thinking they’re better than actual Physicians and there will be a day, when our profession gets put in it’s place by the gate keepers/Physicians. I feel we have more strength as a profession if we stay within our scope of practice.

        Reply
        1. chip hurst

          Unfortunately, Bill, our opinion is in the minority. You should see the hate mail replies I get when I post the above on the forums. “You should get out, you’re five steps behind the modern PT, why are you bashing us, bitter much?, I would be terrified to let my patients near you?”

          I think a lot of it is a chronic anger when they realized they just got a huge debt that they are never going to pay off.
          I warned of this twelve years ago. If you type “Chip Hurst, Are you a Healer or a Sellout” you will find a now archived letter to the editor of Advanced PT. Way back in 2004 when I had less than 4 years in the field. Stating much of what I stated above. And now it is here. Old PTs are very vocal about the “new patient population”—-which is largely one of Generation X and Y irresponsibility and apathy. I’ve got less than five years left in the field and I’m done as the problem used to be the system—now it is the system and the patients themselves.

          Good luck out there in continuing on, Bill in whatever you do in PT land. ,

          Reply
          1. Clinton Post author

            As Texans say, I have no dog in this fight, but I found this thread interesting and entertaining. Also, impressive that you all are reflective enough to accept the limitations of your profession. My own profession often pretends to be more effective and helpful than it is as well. Best wishes.

  2. drew

    A few years ago I experienced considerable pain in my left hip. After visiting the Doctor I was sent for an xray . The xray technician would not reveal any information until I badgered her mildly,pointing out that she was probably more experienced in interpreting the results than many young physicians.She told me there was nothing organically wrong with me……so I was sent to PT.

    I went once to PT. When the cost was relayed to me I knew that I simply could not afford it.However I do have a physical therapist of my own; a fifteen pound schnauzer that demands to be walked extensively every day…….my pain went away.

    Reply
    1. Chip Hurst

      Gee, activity and natural time healing solves acute pain. Like it has for thousands of years. Go figure. And wow–didn’t even need the help of a PT.

      My point about what our profession is getting reimbursed for on a global scale.

      Reply
  3. Tim

    Every time I have been to Physio its a not so intelligent person with silly half baked exercises that I could do at any gym for 1/10th the price.

    Just went after Spinal fusion and after a few visits its the typical Physio nonsense. No one on one individual teaching me how to move properly. Just silly exercises I knew already.

    Seriously .. I feel like phony my insurance and telling them to take Physio coverage away. In my opinion thats all the industry does is milk insurance/benefit companies.

    Reply
  4. Mr Brian

    I been to PT more than anyone you know. I had and still have plantar fasciitis, had and still have shin splints, 4 knee meniscus surgeries and rotator cuff surgery. It cost the insurance company in the $30k-$40k range! In my opinion, not yours, it was a huge waste of time and money. The first time I feel it was useful to show you how to do all the exercises, but no need to come back for the next 11 times to just do the same simple exercises I can do at home for free! Typical session, I walk in and they ask you how you are feeling and write something down on a clipboard. Then, put a heating pad on me for 10 minutes and I ride a stationary bike for 10 minutes. Then, they tell me, “Just do the exercises I showed you yesterday.” Afterwards, they put an ice pack on me for 10 minutes and I leave! I have gone to 4 different PT places in different cities in the last 15 years and that’s the norm. On the last session, they always say the same thing, “Call your doctor and see if you can add some more PT because I feel you could benefit from more sessions.” Apparently, I’m too stupid to do simple exercises at home and need supervision. Let me also tell you, in most of the places, they booked 2-5 patients in the time slot and the PT is running around! One place, I did one exercise, then waited 5-10 minute for the PT to come back because she had 4 other new patients she was instructed. Those 1 hour sessions turned in 2 hour session because of all the wait time. One time, I left 30 minutes early because she never came back and when I returned two days later, she asked me why I left 5 minutes early?

    Reply
    1. chip

      First off your physical therapists were charlatans. I would have had you one on one. You would have been given a few key self mobilizations that would correspond directly to the MANUAL therapy I was doing. This will shock you but once you demonstrate whatever I tell you to do at home I never look at that again–because I’m working with my hands. I would have looked at foot mobilizations for the plantar problems then would have looked at the pelvis where I bet one side is higher than the other. Then would have looked at not only shoulder restrictions in the capsules as well as the thoracic and cervical ribs which can be huge contributors. And we would have worked on those for 45 minutes straight one on one. And maybe I couldn’t 100% resolve you—and if not I’d have let you go no hard feelings.

      What you got were charlatans who think they are doctors for going to PT school after a degree which was unrelated and don’t have the brains to realize they are being nothing more than glorified athletic trainers

      Reply
  5. Debbie Kerchenski

    This is all very interesting and in agreement with what I have been feeling. I hurt my arm and shoulder and went for an x-ray with an orthopedic doctor. He is unable to tell me exactly what is wrong because without an MRI there is no telling for sure if I have a tear somewhere or it is another type of problem. But, unless I go to physical therapy, the insurance company will not pay for an MRI. So I am bound to go to physical therapy where they will probably make the matter worse because how can you treat something that you don’t even know what you are treating? I don’t want them to make a rotator cuff tear worse or if it is another tear in the arm somewhere. I have been to physical therapy after a car accident and it helped none whatsoever. Rest, cold packs, heat and massage worked better. Granted, it was only a soft tissue injury but in any event the physical therapy did not help at all. My neighbor was sent to physical therapy after she fell, and again, without an MRI, they had no idea what they were treating. She was in excruciating pain and had cortisone shots and the whole nine yards. In the end, she demanded an MRI and came to find out she had a severe herniated disc that was not going to get better at all with any amount of physical therapy or cortisone shots unless she had surgery. After the surgery, which was done by a fantastic doctor, she is able to move freely. I too believe that a lot of people are milking the system. I will go to physical therapy as directed only for the amount necessary to get an MRI.

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *