5 physical therapy treatments you probably don't need

5 physical therapy treatments you probably don't need

Here's what you should try instead

Published: September 15, 2014 12:15 PM

At some point in your life—maybe after an injury or surgery, or just after you reach a certain age—there’s a good chance you’ll find yourself in a physical therapist’s office. And as you look around at the balance balls, ultrasound machines, and other contraptions, and as your body is pushed and pulled in a variety of odd and sometimes even painful ways, you may ask yourself: Does any of this stuff really help?

Well, yes—and no. And now, thanks to the American Physical Therapy Association, it’s easier to distinguish what works from what doesn’t. The organization recently identified five treatments physical therapists sometimes offer that usually don’t help, are often a waste of time and money, and in some cases can even delay your recovery or pose risks.

The APTA identified the therapies as part of a campaign called Choosing Wisely, in which health care professionals identify treatments they do that aren't backed by solid scientific evidence. More than 50 medical groups have identified such lists to date, but APTA is the first nonphysician group to do so.

“A well-informed patient is a well-treated patient,” says Paul A. Rockar Jr., the president of the APTA. “The Choosing Wisely campaign addresses the patient’s role in good health care. We are happy to join this effort to help patients make better-informed choices.”

The campaign is led by the ABIM Foundation and Consumer Reports. “We welcome APTA as the first nonphysician organization to join the Choosing Wisely campaign”, says Tara Montgomery, senior director for health impact at Consumer Reports. “We applaud APTA’s courage in addressing overuse and salute the association’s encouragement of informed patient-doctor dialogue. By understanding what works and what to question, patients can get the most from their physical therapists.”  

Here are the five therapies you should question, along with advice on what you should do instead.

1. Heat and cold

A hot pack sure feels good on an aching back or knee. Same for the heat from an ultrasound machine, which can warm tissue deep in your body. And a cold pack on a swollen joint can also feel nice. But none of it will help you recover faster. “It’s a lot like the free coffee in the waiting room,” Anthony Delitto, Ph.D., chairman of the APTA group that identified the questionable practices, said. “It makes patients feel good, but it’s not very helpful.” In one study, for example, some patients were treated with exercise and either ultrasound or sham ultrasound. There were no differences in the recovery time between the groups.

What to do instead: Reserve the ice and heat for home. Ice can ease pain and reduce swelling in an injured joint, and heat can ease sore muscles. But neither will speed your recovery, so don’t waste precious time in the physical therapist’s office on them.

2. Exercise machines after knee replacement

If you've had your knee replaced, you may be strapped into a “continuous passive motion machine” before you leave the hospital and then discharged with the device so you can continue using it at home. The idea is that the machine, which extends and then bends your leg for you, will help control pain and speed recovery. Sounds good—but there’s no evidence that the device achieves those goals, according to the APTA. In fact, some people may use the devices as excuses to avoid the exercises that really can help.

What to do instead: By all means, start exercising your artificial joint as soon as possible. Research shows that starting exercise-based physical therapy within 24 hours of the operation restores motion, prevents blood clots, and shortens hospital stays. But if you’re offered a continuous motion machine for an artificial knee, just say no-thanks. Read more about how to recover from surgery.

3. Wimpy exercise programs

The exercises prescribed by physical therapists, especially for older people are sometimes too easy, using much lighter weights or fewer repetitions than you can handle. That’s a mistake, since to make gains you have to tax yourself, and the best way to do that is under the supervision of the a trained physical therapist.

What to do instead: The therapist should match the program to your abilities, and add weight, repetitions, or new exercises whenever the task gets too easy. If you think you can handle more, say so.

4. Bed rest for blood clots

Blood clots in the veins of your leg can break free and travel to your lungs. To avoid that potentially deadly complication, physical therapists have long put patients with one of the clots, called a deep vein thrombosis, or a DVT, on bed rest. But research now shows that walking with a DVT doesn’t pose risks. In fact, bed rest can cause new clots to form and make existing ones bigger.

What to do instead: If you are taking an anticoagulant drug to treat the clot and there is no evidence that a clot has traveled to your lungs, you can start walking as soon as your physical therapist gives you the OK. That can actually ease the pain of the DVT. You could also consider wearing compression stockings, which can prevent blood from pooling in your legs. But refrain from vigorous exercise until you get clearance from your physical therapist. Read more about how to prevent blood clots.

5. Whirlpools for wounds

Physical therapists first started using whirlpool baths to clean wounds more than 100 years ago, and many still use the baths, sometimes designed especially for legs, arms, or hands. But there’s little evidence that the baths help wounds heal. In fact, some research suggests the jet can actually damage tissue. And they increase the risk of infection from bacteria spread from a previous user or elsewhere on your body.

What to do instead: Therapists should rinse the wound with a saltwater wash, or deliver the liquid from a sterile, gunlike device that’s used on a single patient and thrown away.

—Sue Mittenthal

What about hands-on therapy?

Your physical therapist will probably spend considerable time poking, prodding, and pushing you, sometimes in ways you wish she wouldn’t. But you should let her. The techniques, including mobilization and manipulation, can help.

Mobilization. This is used to ease restricted motion caused by a surgical scar or surgery, such as rotator cuff surgery, that requires periods of immobilization. The therapist may stretch a joint and hold it in a way that is hard for you to do on your own, or push on the joint in a rhythmic motion, allowing muscles to relax.

Manipulation. This is used more often for back or neck pain, and involves small, quick thrusts, similar to what chiropractors do. Research shows that the technique, whether performed by a chiropractor or physical therapy, can bring relief. 

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