So I gave in and have started a course of physical therapy for a couple of musculoskeletal problems.
Part of it makes a lot of sense – range of motion exercises, stability/strength training, stretching, heat/cold treatment, massage-type manipulation to relax spasming muscles, etc.
But then they come in with some dubious stuff – electro stimulation, ultrasound, and “cool laser to reduce inflammation.”
I’ve done some Googling and my skepticism regarding these “technologies” seems not to be an isolated phenomenon.
So – I’m not asking for medical advice, you’re not my doctor, etc., and there may be no definitive answer – but does anyone have either any sciencey support for these type of things, OR personal/anecdotal experience that they actually make a positive difference, speed healing, etc.? And to the cynic in me – are they able to jack up the bill they send to the insurance company by including multiple “treatment modalities,” some of which are questionable?
I think you’d have to do your own comprehensive research pretty much on each specific thing your physical therapist has you do and what devices they use and for what specific ailments they are having you perform certain tasks or use certain devices.
That being said, around here a lot of the vocational schools where physical therapists get certified are 2 year schools that also specialize in massage therapy and such; often times with a bent towards dubious practices like manual manipulation and etc. Some of these schools feed into chiropractic schools as well, which is also a dubious field in and of itself.
So I wouldn’t be totally shocked if yes, a decent portion of PT you’re doing is not rigorously backed by science. A lot of physical therapists will take machines and techniques designed for one thing and then use them “off label” in ways that may be standard industry practice but are different than what the real science people had in mind when they did the due diligence and studies on creating the activity/machine.
I think if your physical therapist has a BS or Master’s from a decent school then their focus will probably be more on techniques supported by most of the medical community. I just know around here most physical therapists have associates degrees from sketchy schools and themselves have sketchy concepts and ideas.
Becareful with the terminology. Actual physical therapists need at least a Master’s degree or Doctorate in PT (and if I recall properly, the national accreditation board is moving for all PTs to have a PhD or Doctorate in PT).
Practitioners with 2-year degrees can be PT assistants, massage therapists etc, but are not physical therapists. Some chiropractors are also PTs, but that requires credentialing in both areas.
My anecdotal evidence is that the electro-stimulation does work. I once had it as part of PT and I liked it so much I got my own TENS unit. It works wonders on my lower back when nothing else will.
I can’t speak to electro-stimulation or cool laser treatments, but I was under the impression that ultra-sound was established mainstream medical therapy.
I had to have surgery on my left hand approx. 15 years ago which left one finger pretty much useless. Part of my physical therapy, along with stretching and strength exercises, was ultra-sound. It was explained to me that this helped scar tissue transform to fibrous(?) tissue. Unfortunately, my memory’s hazy. Anyway, the ultra-sound was performed by an actual medial doctor working out of the hospital, itself.
Coincidentally, I just had my first theraputic massage this morning to treat a muscle strain in my upper back. It’s way too early to tell how much it will help me but my doctor strongly recommended that I do it.
I can’t speak to it’s efficacy, but if it’s any help electrostimulation (TENS) has been around at least a couple of decades, so it’s not a new therapy. I can’t remember exactly when I had it, but it was definitely at least 20 years ago and I am thinking more like 25-30 years ago.
I was in PT for about 3 months for a frozen shoulder (result - 95% recovery of range of motion, and continuing to improve). My therapist had a PhD, and he prescribed ultra-sound for every visit. I know he told me what it was for specifically, but I don’t remember what he said. I got the impression over time, though, that the main effect was to warm up and relax the tissues involved.
The actual ultra-sound was administered not by the therapist but by any one of the several student/intern types they had helping. These are the same ones that took me through the exercises at the end of the session. So actual manipulation was done by the therapist, and he would also prescribe the exercises, but he wouldn’t actually take me through them.
And the answer to the OP’s second question is yes, more procedures does increase the billings; that doesn’t speak to whether they are legitimate or not.
Roddy
I’ve had ultrasound for multiple injuries. It’s been ordered by doctors as well as physical therapists. I agree that it doesn’t seem to do much, but it is certainly established practice by people who know considerably more about it than I. I think that it must be based on evidence or it wouldn’t be so well established.