Five things your physiotherapist shouldn’t be doing

Paul Kochoa, PT, DPT, OCS, CKTP, CGFI

I’m sure you’ve seen this, thanks to the American Physical Therapy Association, it’s been covered in the media before.  It’s the five things that your physiotherapist should not be doing.  These treatments are basically not as effective as other options.  Here’s the list:

1. Applying heat or cold to an injury.  You can do that at home.  No need to perform it in the clinic.
2. Using a passive motion machine after knee surgery.  Passive range of motion is not as effective as active motion.
3. Exercise programs that are too easy.  Developing strength needs to be of sufficient intensity to create change in the muscles.
4. Bed rest for blood clots.  Bed rest can create more bad side effects and complications. Medications, compressive stockings, and active movement are better.
5. Whirlpool for wound care.  More for hospital use, but if you have a wound and are getting whirlpool treatment, you might get an infection or just prolong the healing process.

Some of these points, we’ve already been doing here at Professional Physical Therapy and Training.  We never use heat for warming up a joint or body part.  We prefer active warm up exercises or dynamic stretching.  We typically spend more time doing manual work and addressing issues personally than using any passive modality.

And as for intensity of the exercises.  We always strive for progress.  If you don’t feel a change, probably no change happened.  Same goes for resistive exercises.  So many times, I’ve been asked if we’re “doing too much”, or a patient will say that they “couldn’t move after last session” or that I really “killed them last time they came in”.  That’s fine.

Strength training will make you a little sore.  The subjective intensity of which depends on the tolerance of that particular patient.  Someone who hasn’t exercised at all in their life, and then comes to start a program, that person will definitely be sore afterwards. They usually will say that they couldn’t walk the next day.  For other people who are active, that soreness level will be acceptable and tolerable.

As someone gets stronger and stronger, the same exercises that made it difficult to walk the next day won’t be so bad.  They begin to tolerate the program. Their brain and muscles become stronger and can do more with less soreness and pain.  That’s progress.

If you’re seeing a physiotherapist and they’re still doing a hot pack and exercises that are too easy, you might not be seeing the results that you want or you may not be getting better.  Maybe it’s time to rethink your program.

If you would like more information, please call Professional Physical Therapy and Training at 973-270-7417.  Our offices are located within the YMCA locations in Madison and Summit, NJ.  You do not need to be a member of the YMCA to visit us.