My opinion on PT “Science”

I came across this article from the New York Times “What to Look for in a Physical Therapist,” and love this line:

When compared head-to-head, active exercise-based therapies are both less expensive and more effective than passive ones. In some instances, exercise is even as effective as surgery.

I encourage you to take a look at this article though I disagree with it in important ways!  The science that has been done historically was very flawed and to some degree I disagree with the premise of all research involving bodies. 

It is presumed that all people move in the same way and all people respond to treatment interventions in the same way and this is simply not the case.  What works for one person often does not work for the next.  Or even different areas of one body will respond to specific interventions differently. 

Take ultrasound, for example.  I have used it throughout my 30 years of practice.  If ultrasound is used when there are very dense areas of myofascial restrictions it CAN work extremely effectively.  I know from personal experience as well as professional experience since I always test the tissue feel before and after.  Some of my patients have been helped A LOT by it!  Ultrasound, or any other intervention for that matter, will not be effective 100% of the time.  That is why PTs need a host of interventions to be truly effective.  If ultrasound is used without first evaluating that there is need for it, as was often done in research studies, and continues to be performed as a matter of course, rather than need, in many PT clinics (the ones using "anecdote" as the article suggests). 

Take studies done on the "effectiveness" of specific exercises for strengthening specific muscle groups.  Here to, there is so much variation in movement patterns between people and there is so much affecting movement patterns such as habit/muscle memory, posture,  muscle inhibition and weakness, short muscles, joint mechanics, environmental constraints, etc, to have one specific exercise be effectively strengthening a specific muscle in all cases. 

If you are not looking at the bigger picture of what a body is subjected to over and over again, day after day, and evaluating how that particular person is moving in their unique way, then PT will be limited in effectiveness even if you are using evidenced-based practices.