Physical Therapy

[RickBarker]

Mark-

This board has often documented your disdain for physical therapists. Although I am currently studying to be a PT, I often find myself agreeing with your complaints. I believe PTs could learn a lot from you and others who do what you do. I have two questions.
1) What are your main issues with the way physical therapy is practiced and what could be done to rectify them?
2) What are the areas, if any, you think physical therapy makes a legimate and unique contribution to medical services (i.e. post-surgical, CVA recovery, etc...)?

Just interested to hear your thoughts. Any other MDs, PTs, or other medical personnel can feel free to chime in too.

Thanks,

Rick

[Mark Rippetoe]

In a nutshell, I think the basis of the problem is that PTs are trained to apply a version of the medical model to rehab: what structure is damaged? and how do we fix that structure? In most cases, this analysis is flawed, and it is almost always flawed when applied to athletes, because it fails to consider the System of which the structure is a component.

I've bitched enough about this. But we have two guys here, Will Morris and John Petrizzo, both SSCs and both PTs, who can address the issue productively. In fact, John has written an article about this, which will run very soon.

[RickBarker]

Awesome. I really look forward to reading it.

[Tamara Reynolds]

Most of the lifters at my gym would be shit out of luck if we didn't have at least two great PTs in town who understand both the mental and physical components of competitive lifting. I cannot complain about what we have available from the numerous orthopedic surgeons and the resulting referrals to PTs in this area.

[FatButWeak]

Isnt physical therapy just piss-poor, ineffective training for people who are too weak/deconditioned or stupid to figure out how to exercise their damaged body parts on their own? Or is there some other voodoo?

[John Petrizzo]

In a nutshell, I think the basis of the problem is that PTs are trained to apply a version of the medical model to rehab: what structure is damaged? and how do we fix that structure? In most cases, this analysis is flawed, and it is almost always flawed when applied to athletes, because it fails to consider the System of which the structure is a component.

In my experience, I think the biggest problem with most outpatient, orthopedic PTs is that they really do not understand the usefulness of physical strength and how vital it is to everything we do. The reason for this is that the concepts of strength training and how humans adapt to it, are not required to be part of the typical graduate level PT curriculum. This results in many PT grads working in clinics where they are charged with rehabilitating athletes without ever having been exposed to barbell exercise. If a PT does not have previous experience with barbell training and all of its potential benefits, then they are out of luck because they will never get exposed to it during their coursework. In my opinion, this is why many PTs rely on machine based and body weight exercises, even for athletes.

Even the PTs who do realize that strength is important often times will focus treatment around very low level, isolationist-type exercise for high repetitions. In other words, even the PTs who do realize the importance of strength, do not know how to go about implementing a treatment plan that will actually cause a strength adaptation. The stress of barbell exercise causes a system wide adaptation. Straight leg raises, and shoulder external rotations do not.

That is not to say that PTs do not have anything to offer the population as a whole. I have worked in acute care hospitals and neurologic rehabilitation centers and have seen the positive impact the physical therapists can have on the seriously ill and de-conditioned. The problem for most people who read this board will be when they seek treatment at an outpatient clinic for a minor injury, the PT will 1) not be familiar with how to properly execute the basic barbell exercises and therefore will not be able to fix any technique issues that may be causing injury and 2) they will most likely just tell you to not lift so heavy or just not lift all together. This is the problem for people like us.

As Tamara pointed out, this is obviously not the case everywhere and there are many good PTs out there who can help lifters and athletes but until there is a paradigm shift in the way PTs are educated, the problems that Rip wrote about in his post will continue to be pervasive.

[SMC]

Isnt physical therapy just piss-poor, ineffective training for people who are too weak/deconditioned or stupid to figure out how to exercise their damaged body parts on their own? Or is there some other voodoo?

Pretty much. Throw in a bit of foam rolling and ultrasound (to break up scar tissue supposedly) and you've pretty much got my first experience with PT.

Then there guys like Kelly Starrett, but I imagine they're pretty few and far between

[Gerald Boggs]

In my experience, I think the biggest problem with most outpatient, orthopedic PTs is that they really do not understand the usefulness of physical strength and how vital it is to everything we do.

My neighbors are chiropractors and are completely disdainful of strength training.