As I have mentioned in prior blogs, an overemphasis by the PT profession on self-help or active interventions is not evidence-based. Manual therapy with exercise demonstrates the best improvements empirically for a wide variety of musculoskeletal issues. But no less important is that the emphasis on so-called active interventions is neither marketable nor sustainable for the profession.
First, it is unfortunately a well-researched fact that U.S. citizens do not follow health advice well. People have known for decades that they should eat nutrient-dense foods in appropriate portions to maintain a healthy body weight, but the proportion of Americans that are overweight remains high. Similarly, the deleterious effects of smoking are well-documented but the tobacco business is still enormously lucrative. In the same vein, all therapists should provide exercise and other self-help strategies as a component of conservative interventions for musculoskeletal issues, but we already know that patient adherence to these remedies is poor. If all we provide to patients are self-help strategies, I cannot imagine patients jumping in line to show up at therapy, even if a perfect application would cure their issues (not surprisingly, evidence indicates it will not).
Second, and interconnected with the first point, is that an obsession on active interventions should not compromise our profession’s ability to draw customers to our clinics. I’ve seen many social media posts lauding the ability to get the patient to fix their own problems. Although I may agree with this in principle, I don’t believe this is actually occurring in many circumstances. I believe some patients tell their therapists that they are improving to not hurt their feelings. I believe others honestly do get benefits for a time with self-help strategies, but when the pain returns, they seek other providers that can give them something they can’t do on their own. Either way, physical therapy without specialized services won’t be the patient’s go-to option.
Lastly, and again interconnected to the last point, is that patients do not give a plug-nickel for what shows up on research reports, they care only about what happens to them in the immediate, short, and long-term. And if they are not getting anything consistently in the immediate-term, they may not stick around to get anything longer. People will pay consistent amounts of money for attractive services they could either do on their own or from which they get only immediate results. This is why people pay $100 for a meal, $80 for their nails, or $200 at the massage therapist’s office.
In summary, the physical therapy profession must tap into these practical aspects of treatment to not only help people as best as we can, but to help our profession be sustainable in a competitive and fast-paced world.
References:
1. Burton, T. and MacGregor-Scott, P. (Producers) & Schumacher, J. (Director). 1995. Batman Forever. United States: Warner Bros.