Located in Sterling, VA (703) 421-1200

Problems With Traditional Physical Therapy?

As we age, especially if we live an active lifestyle, we find ourselves a bit more susceptible to aches, pains, and even injuries, than we were in our twenties and thirties. Play a few rounds of golf in the course of a week, and you may feel a twinge in your lower back. Play pickup basketball regularly and you're likely to feel some pain or discomfort in your knees, hips, ankles, or feet. If these conditions persist, you may decide to schedule an appointment to be examined by your family doctor. If the injury is serious, you may get a referral for an orthopedist. If the condition is less severe, there is a good chance that you'll be given a prescription for physical therapy.

The physical therapists that I have encountered are educated, knowledgeable about many aspects of the human body, and well-intentioned. Prior to coming to work at Total Results, I worked in an exercise studio that was across the hall from a physical therapy clinic. The owner of the business was affiliated with the Washington Redskins, and he had a good professional reputation. Unfortunately, from what I observed the therapists relied upon a variety of modalities and practices that are, at best, outdated and largely ineffective, and at worst, dangerous. It resembled an assembly line; therapists were often juggling up to three patients at a time, which meant the patients were receiving very little individual attention. One patient might be administered ice, while another received electrical stimulation, and a third used resistance bands. When actual strength training exercises were performed, there was little to no consideration for force or speed of movement, and the number of repetitions and sets performed was completely arbitrary. This is where the problem lies. You don't need to see a physical therapist to administer RICE protocol (rest, ice, compression, elevation) for an injury; that can be done in the comfort of your own home. Electrical stimulation provides very little benefit. Physical therapy clinics often use electrical stimulation as an additional modality to impress patients and charge insurance companies. In my experience, most people that participate in physical therapy make improvements in spite of what they're doing, not because of it. It's a testament to how resilient the human body is and what it can withstand. I have even seen clients' injuries worsened by participating in traditional therapy. There has to be a better way.

Proper strength training, like the exercise philosophy we instruct at Total Results, should be the majority of one's physical therapy. In order to successfully rehabilitate an injury, we need to improve a muscle/joint's functionality. The only way to effectively do that is to perform exercises that track muscle and joint function properly, and to perform them in a low-force manner that will not exacerbate the problem. Excessive force is the root cause of injury. A muscle that is measurably stronger will function better. Charting and record-keeping are very important, so that progress can be objectively measured. Resistance bands do not progressively overload the muscle; we must be able to increase the amount of resistance over time. We also must take into consideration a safe and pain-free range of motion, and also to make sure that the client is able to differentiate between muscular discomfort (the burning that one experiences with muscular fatigue) and injurious pain (something sharp and sudden). It's also critical that we have consideration for proper head/neck position, spinal and pelvis positioning/restraint, avoidance of unilateral loading (which can unevenly load the spine and pelvis), and proper breathing. These requirements and standards of care are often not performed in traditional physical therapy. Finally, it's important to avoid strengthening exercises that try to mimic a certain skill, as is often seen in occupational therapy or so-called functional training. Trying to combine a specific skill with weight training is a recipe for injury.

At Total Results, we have a variety of "tools in our toolbox" to work around nearly any injury or issue. We use traditional dynamic exercise (10/10 speed of movement), manual resistance, Timed Static Contraction protocol, negative-only exercise, and even static holds to allow us to target the muscles without exacerbating the injury. We also make sure to carefully supervise proper entry and exit of each machine to avoid unilateral loading. Traditional physical therapy often doesn't do those things. The next time you get an ache, pain, or injury, be cautious of your choice of physical therapist and make Total Results an important part of your healing and strengthening process.

Posted November 19, 2018 by Matthew Romans