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Thread: Improve physical therapy

  1. #1
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    Default Improve physical therapy

    I am a current doctorate of physical therapy student. Over the last year, I have become interested in barbell training for both myself and patients. To learn more, I have investigated Starting Strength and these forums. I was surprised to see how displeased the strength community was with physical therapy. As far as I can tell, it seems that people have experienced physical therapy that fails to sufficiently challenge them and/or improve their physical problems.

    My school's program has always emphasized the need for functional training to create change on a neurological level. That is, repeated functional exercises like squats and lunges help people learn how to perform a movement efficiently and thus allows them to perform the same movements well at work and in their home life. From what I can tell, this is something Starting Strength also emphasizes. Modalities like ultrasound are considered laughable by my professors, as are light resistance band exercises for all but the profoundly immobile and disabled.

    As someone who wants to be good at their job and help affect their profession in a positive way, I am curious as to what you perceive as the main issues in physical therapy and what changes you wish PT would make. What suggestions do you have for a new grad hoping to avoid those issues?

  2. #2
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    Physical Therapy is insufficiently stressful to provoke an adaptive response. The stress/recovery/adaptation cycle is not taught as the foundational concept in PT, and our approach to rehab actually works while PT -- as practiced in the US by <99% of clinics -- is so bad that I consider it to be a form of medical fraud. IOW, if you get better while in PT, you just healed up. So, my suggestion is that Physical Therapy be approached from the same perspective as training, i.e. a program of progressively increasing resistance be actually applied to PT patients, as opposed to mere lip-service in this direction. Further, PT needs to revisit the concept of Specificity, and evaluate its role in the design of rehab protocols.

  3. #3
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    Gophole - One suggestion for you would be to diligently follow Starting Strength yourself (and ideally with a group of your fellow students/doctoral candidates) and see the results for yourselves. And then once you have lived it, develop a study comparing the results of individuals with similar injuries with 1 group doing traditional PT and an another group doing Starting Strength. Maybe measure the results over a 3 month period. However, if you do that, it would probably best serve if you got a Starting Strength Coach to provide a seminar (or at least online coaching/video reviews of form) to make sure the lifts are being done correctly. Without ensuring correct form, the results won't really tell you much, as quarter squatting through your LP doesn't really drive the same adaption as full squatting does.

  4. #4
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    I think part of the problem is that many PT's, especially outside of the sports area of practice, lack the confidence or training to instruct patients in the basic lifts that are so functionally relevant. This is part of the reason I'm trying to get a good foundation now so I can progress patients to a meaningful level of strength. Thanks for your insight.

  5. #5
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    Physical Therapy is insufficiently stressful to provoke an adaptive response. The stress/recovery/adaptation cycle is not taught as the foundational concept in PT, and our approach to rehab actually works while PT -- as practiced in the US by <99% of clinics -- is so bad that I consider it to be a form of medical fraud. IOW, if you get better while in PT, you just healed up. So, my suggestion is that Physical Therapy be approached from the same perspective as training, i.e. a program of progressively increasing resistance be actually applied to PT patients, as opposed to mere lip-service in this direction. Further, PT needs to revisit the concept of Specificity, and evaluate its role in the design of rehab protocols.
    I think part of the problem is that many PT's, especially outside of the sports area of practice, lack the confidence or training to instruct patients in the basic lifts that are so functionally relevant. This is part of the reason I'm trying to get a good foundation now so I can progress patients to a meaningful level of strength. Thanks for your insight.
    Rip is right on in terms of the current preparation of PTs at the graduate level in the U.S. Gophole, your observation is also correct. As has been discussed here many times before, the basic problem is that PTs are not trained to apply the Stress, Recovery, Adaptation model in any meaningful way with any progressively loadable, multi-joint movements. As such, they do not know how to go about programming or even teaching these basic movements to people. The standard PT curriculum prepares students to pass their state's licensing exam and not much else. The very few PTs who know how to teach people to squat, press, and pull learned how to do it on their own through practical experience gained by being under the bar themselves.

  6. #6
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    Oct 2013
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    Quote Originally Posted by gophole View Post
    I am a current doctorate of physical therapy student. Over the last year, I have become interested in barbell training for both myself and patients. To learn more, I have investigated Starting Strength and these forums. I was surprised to see how displeased the strength community was with physical therapy. As far as I can tell, it seems that people have experienced physical therapy that fails to sufficiently challenge them and/or improve their physical problems.

    My school's program has always emphasized the need for functional training to create change on a neurological level. That is, repeated functional exercises like squats and lunges help people learn how to perform a movement efficiently and thus allows them to perform the same movements well at work and in their home life. From what I can tell, this is something Starting Strength also emphasizes. Modalities like ultrasound are considered laughable by my professors, as are light resistance band exercises for all but the profoundly immobile and disabled.

    As someone who wants to be good at their job and help affect their profession in a positive way, I am curious as to what you perceive as the main issues in physical therapy and what changes you wish PT would make. What suggestions do you have for a new grad hoping to avoid those issues?
    OP, I wrote an article that's very relevant to your questions, here (hope Rip excuses the plug): The Fatal Flaw of (most) Physical Therapy | Barbell Medicine

    Also, I've posted this article on "Therapy Babble" here before, but it's worth I think it's familiarizing yourself with before you fall into this trap too: https://www.painscience.com/articles/therapy-babble.php

  7. #7
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    What's the Starting Strength Model for rehabilitating an ankle?

  8. #8
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    The first step would be determining what's wrong with the ankle.

  9. #9
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    My deltoid ligament was repaired and my posterior tibial tendon had a small longitudinal split tear that was stitched up. This was 2 months ago and my first PT appt is next week for it.

  10. #10
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    You are 2 months post-op on a soft-tissue repair, and you haven't started rehab yet??? Fine. The question was about the practice of Physical Therapy, and your question is a derail.

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