31 Jul Physical Therapy Myths – Busted

I have always enjoyed the Discovery Channel program Mythbusters, where special effects experts Jamie Hyneman and Adam Savage consult with specialists in a variety of topics to dispel common myths and urban legends.  Will your airbag explode at the expense of your thumbs? Unlikely. How safe is your food if you drop it and invoke the 5 second rule? Not very.  And does talking on a cell phone mentally impair drivers as much as drinking alcohol? Well, as it turns out, up to a point it certainly does.
So that leads me to think a bit about myths and misconceptions regarding what I spend most of my time doing: consulting with patients regarding injury prevention and treatment, physical therapy care, fitness, and wellness.  I thought I would talk about 6 myths that have been recurring in conversations with patients, physicians, and others. I came up with closer to twenty, but here are my top 6 myths and misconceptions:

Myth #1: You need a referral or prescription to receive physical therapy care

Busted: You are free to consult with and receive treatment from a licensed physical therapist in Indiana without a physician’s order.  We value our professional relationships with physicians in the community, and frequently work with patients on a referral basis.  If you tweak your back, wrench your knee, or strain your shoulder, we can be your first stop for evaluation and treatment. We’re here for you, give us a call.

Myth #2: Physical Therapy is a passive process

Busted: Could not be further from the truth. Pain-free, independent mobility and return to routine activities is our goal for physical therapy intervention.  While physical therapy care often includes measures to reduce pain and restore movement, ultimately we need full participation by you, the patient, to maximize our effectiveness.  The active part of physical therapy begins with your commitment to a therapeutic partnership, and continues in the form of exercise in the clinic during a visit and ultimately home activities that include exercises and specific therapeutic movements. Your active participation empowers you to control much of the recovery process, with our guidance.

Myth #3: Physical Therapy can be delivered by anyone who knows about exercise.

Busted: Physical therapists have specific education and training that includes an undergraduate degree in biology, athletic training, movement science, kinesiology, psychology, or related fields that qualify them for graduate education.  Professional graduate programs in Physical Therapy education prepare students in anatomy, neuroscience, physiology, movement science, therapeutic exercise, manual therapy techniques, developmental disorders, pharmacology, human development, discharge and care planning.  All of these lead new graduates to a Doctoral Degree in Physical Therapy, after which graduates sit for a National Physical Therapy Board Exam.  Ask your therapist about their education and training. Accept no substitute.

Myth #4: Static stretching is bad for your body.

Busted: I frequently hear from concerned patients, coaches, some in the fitness industry and the media that static stretching is bad for or hard on your joints.  As a result, there has been a significant shift in stretching and warm-up routines in the youth sports and fitness industries. In my professional opinion, there is no need to throw the baby out with the bathwater, as my Grandmother used to say.  I believe more than anything it is a matter of context.  According to the American College of Sports Medicine guidelines, a combination of static (think slow hold stretch) and dynamic (think leg kicks, arm swings, long strides) stretching is recommended for a comprehensive fitness program.Static stretching, holding tissue at the end of the range of motion, is frequently used to lengthen tissue shortened by injury, disease, disuse, or habitual posturing, and has been shown to be most effective after a gentle warm-up of the tissue.  The process of moving a joint or limb to the end point of motion and holding for 30 to 60 seconds and has been shown to be effective in lengthening tight or shortened tissue, particularly when repeated three to five times.

Of course, for individuals who are active in explosive sports such as sprinting, soccer, football, P90X, tennis, etc., adding dynamic stretching is necessary and appropriate.  In my opinion, a certain amount of static stretching will always be beneficial for those with tightness or shortness of tissue, and can be performed without risk of injury. Static stretching creates movement, while dynamic stretching makes it more immediately accessible.  It takes more time and precision than dynamic stretching, but is necessary, just like cleaning cobwebs out of the corner spaces in a room.

Myth #5: Any exercise will do…

Busted: In my opinion, that is like telling someone with high blood pressure that any medicine will do.  Rarely is this true in the context of rehabilitation or fitness, with the exception of very general strength and endurance efforts. In a general sense, our bodies tend to take the path of least resistance, whereby areas of weakness become weaker over time, as do areas of tightness. Exercise is a powerful intervention, and therefore is best and most effectively applied with specificity for those with specific weakness, tightness, pain or disability.

Myth #6: I need an MRI to before I begin therapy…

Busted: It is common for patients and physicians alike to want to perform advanced imaging to screen for the presence of tissue damage or disease.  However, several recent studies have concluded that in the vast majority of cases obtaining an MRI prior to beginning therapy is unnecessary, and doing so frequently delays the beginning of appropriate therapy.  A more prudent use of advanced imaging occurs after 4 weeks of therapy if your therapist and physician feel that your condition is not making sufficient progress.

Bonus Myth #7: No pain, no gain

Busted: Our objective is always to maximize your progress while minimizing the discomfort involved.  Occasionally restoring mobility will be painful, but we are never cavalier about your pain.  If physical therapy is done correctly, you should feel better for the experience, understand your pain, and learn how to work around rather than through the discomfort. I prefer the mantra ‘no strain, no gain’, as I believe it more accurately reflects our philosophy of care.