by Adam Brown BScPT, MClScPT
Advanced Practice Physiotherapist
updated Oct 18, 2023
Physiotherapy is one of the most commonly recommended management strategies for a wide variety of musculoskeletal disorders and injuries. When faced with the prospect of undertaking a course of physiotherapy, it is perfectly natural to want to ask “Is this going to work?” The question itself is a bit flawed since “physiotherapy” is not one specific thing. The outcome of any physical therapy treatment requires a well put together plan with an accurate diagnosis, and interventions designed to create an environment and physiological adaptation that will lead to an optimal outcome.
This is precisely why not all physiotherapy is equally likely to result in success. A skilled physiotherapist has deep knowledge of how to apply different treatment methods and to coach specific behaviors to bring out the precise adaptation required for success.
It may actually be more useful to look at why physiotherapy sometimes fails and what can be done to prevent the likelihood that your treatment plan will go awry. At Cornerstone Physiotherapy, we make it a point to be as precise with the development of our treatment plans as possible. We carefully study why some patients do not get the outcomes they should, and we reduce those risks to ensure we are being as effective as possible.
Here are some of the reasons that patients may not get the results that they are looking for.
Poorly Understood Diagnosis
When patients have tried therapy before and have not gotten the result they were looking for, our first question is “what was the diagnosis you were given?”. Often the patient has trouble describing a specific diagnosis or was given a non-specific biomechanical explanation of their problem. It is very important that a clear understanding of the problem is established early on in the treatment process. Not every painful condition can be given a exact medical diagnosis, but the vast majority can be well understood. This is important because it helps to establish prognosis (long term outcome), and informs the ideal plan. Without a thorough understanding of the problem and the factors that are contributing to it, it is unlikely that an effective treatment plan can be created.
Cookie Cutter Treatment Plan Design
Each injury is different. Patients present to us at different stages of their healing and with different factors that have contributed to the development of their symptoms. Physical therapy treatment should be precise and targeted to elicit the change or adaptation required for progression toward healing. When your treatment plan is presented to you, you should be able to see that it was well thought out. It should have specific and meaningful milestones you are working toward and your physiotherapist should be able to explain why they are selecting the treatment methods involved using clear language with physiological rationale. If you feel like you are going through the same process as all of the other patients in the clinic, you may want to start asking questions.
Sometimes patients don’t get results even when the right treatments are being chosen. A frequent reason for this is an inadequate stimulus. Let’s look at a common example that highlights this, with exercise prescriptions that try to improve strength.
Well established principles of exercise physiology clearly show that for strength of a muscle to increase, we must stress it near the limit of its capability, then we must slowly increase the demand through a process called “progressive overload”. This can be accomplished by adding reps, increasing load, or changing how the exercise is performed to make it more difficult. When strength is not changing, it is often because patients are doing exercises well within their capability and they are not progressively increasing in difficulty. This concept can be applied to other types of treatments as well. If the aim is to lengthen a tissue, is the force high enough? Is the duration of force applied long enough to expect results? An experienced therapist can not only tell you what techniques to use, but how they must be applied to get great results!
So you have the right treatment methods, applied the right way, … how can you go wrong?
Well if you don’t do it often enough, or too often, it can impair progress. For some types of treatments, more is better. For others (like strength training) rest and recovery is required between sessions. The frequency that a treatment is applied is key to its success.
The best laid plans do not stand a chance when they are kept on the shelf. As a patient you are often asked to do some homework between appointments. Be up front about the time commitment you can make so that your physiotherapist can prioritize the most critical aspects of your plan. We find that if all of the factors above are explained clearly and patients understand that their participation is a crucial requirement for success, most people will do what needs to be done. If you find yourself behind, discuss it with your physical therapist so they can provide strategies to ensure the most important aspects of your care are getting done right.
Not Thinking Outside the Physio Clinic | Poor Recovery Hygiene
For human beings to recover from injury they need to be in a physiological state that is open to recovery. This means adequate quality nutrition, hydration, sleep and stress management. Talk to your physiotherapist if you need strategies to develop good recovery habits. Meet with other professionals like dieticians and physicians if you struggle in these areas.
A Need for Medical/Surgical Intervention
Sometimes it’s not possible to know at the start of physiotherapy if the problem can be successfully managed with rehab alone, or if it will need to move on to medical/surgical management.
Let’s look at the example of a large rotator cuff tear. Most of these (> 90%) will respond well to physiotherapy, while a small percentage will require surgical intervention to resolve. Unfortunately it is not possible to predict who will be in the small percentage that require surgery. So the recommended process is to try physical therapy for 12 weeks and only if that fails to move on to surgery. This approach is used for many musculoskeletal problems including spinal disorders and meniscus injuries of the knee.
Ask your therapist what the approximate likelihood of success is, and what options are available if rehab does not produce the outcome desired. While physiotherapy is a powerful tool for most problems, it is not a panacea and we sometimes need the help of our medical colleagues to get you across the finish line!
Use of Methods/Techniques that are Not Effective
Unfortunately there are still some patients being offered treatment methods that have long been understood to be ineffective. There was a time where a walk through a physiotherapy clinic would reveal patient after patient hooked up to machines hoping that the treatment provided would help them heal. Many of these methods have since been shown to be ineffective. There are exceptions of course, but note that they are the exception, not the rule. If your treatment consists of a series of machine applied treatments with claims that seem too good to be true, they probably are.
So the answer to the question “Does Physiotherapy Work?” is simply … YES!
Physiotherapy is very effective provided that the condition is well understood, the desired adaptations are clear, the treatment plan is well designed and the patient and therapist are diligent in completing the plan.
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