Recently I was listening to Widespread Panic (the music band, not the collective state of mind of injured patients). They were performing their song “You Got Yours”. The lyric “I got my way, you got yours” got me thinking about physical therapy. What doesn’t?! Patients often ask which therapy is right for them. Here’s the truth: We don’t know 100%. But, moreover, different therapists do different things – even when they represent the same profession. Behind closed doors, physical therapists can often be heard saying this to one another: “I got my way, you got yours”. Who’s right? Can’t we both be right? Of course we can. If it were possible to have the same patient (identical copy) with the same injury try two different forms of therapy, is it possible they would both recover? Of course; but maybe for different reasons. And, it isn’t to say that ‘any’ treatment would work. It’s just that physical therapy intervention is very powerful. I, an evidence-informed chiropractor, make use of Functional Release & Graston Technique soft tissue approaches, Cold Laser Therapy, Joint mobilization, spinal manipulation, Functional Range Conditioning, etc. I work alongside Osteopathic Manual Practitioners that use osteopathic hands-on techniques. We all work alongside massage therapists that use deep tissue massage. We all work with an acupuncturist who uses both Eastern Chinese acupuncture techniques and more modern Western acupuncture techniques. “I got my way, you got yours”. Some of what I’m doing is right. Some of what they’re doing is right. And, something none of us are doing is probably right. It is likely impossible for anyone of us to do it all, and for it all to be right. If you select one practitioner only, you may recover. If you select more than one, you may get a synergistic approach. And, if you select more than two, well, you get the idea. Money, time, convenience, and knowledge are often the stumbling blocks to doing everything you should to recover from your injury as effectively and efficiently as possible. [This is why professional athletes often recovery exceptionally fast from their injuries: (a) they are excellent physical specimens to begin with, and (b) they have all of the therapies readily available to them without the stumbling blocks]
With that said, physical therapy is not just my job, it is my passion. I am always learning. My pledge to my patients (you!) is that I will always try to provide the most effective and efficient strategies to recover and optimize your body.
While attending this past weekend’s Functional Release technique course (3 days), I found myself chatting with a massage therapist, a physiotherapist, and another chiropractor about technique efficiency. The Therapeutic Efficiency Coefficient (TEF) is a term I made up (don’t go looking it up; I made it up to express a point). I do not know how to calculate it, but I do know that it exists. Take for example a patient with low back pain that decides massage therapy is the treatment that will help them recover. Each visit is one hour in length; the patient ends up needing 6 massage sessions in a two month span of time to feel better. Is this efficient? Maybe. Depends on the diagnosis, the patient, and the skill of the therapist, along with more variables, I’m sure. But, an important variable, of course, is the efficiency of both the treatment and the therapist’s delivery of that treatment. Do not assume the back pain itself is rooted in muscular tension. It may be rooted in poor spinal joint mobility mechanics; the back pain may mostly be rooted in “upregulated central nervous system tension and pain pathways” (more on this later). So, the diagnosis is key if we’re going to be efficient. Secondly, the treatment needs to target the diagnosis. So, if the patient has poor control over moving their individual joints of their spine (this is lots of people, by the way), then that patient really needs to learn how to move those joints. Otherwise, the poor mobility of those joints will not provide your brain the necessary movement feedback it requires to regulate that part of your body. Without that ‘normal’ regulation, the central nervous system (CNS) upregulates tension and pain pathways. This incredibly common, scientifically understood, relatively new understanding of many back pain problems CANNOT be massaged into submission. This is referred to as neurological tension. And thus, the Therapeutic Efficiency Coefficient when massaging that back problem will be incredibly low, regardless of how skilled the massage therapist might be. Massage may be part of the treatment plan, but not for the reason the patient/therapist might think. In a scenario that involves neurological tension (very common), massage may play a role in relaxing the patient and reducing muscle tension in surrounding areas that are not affected by the neurological tension. Other forms of treatment, including isometric strength and mobility work at the affected area become a much more important therapy for this patient. Without it, the TEF is very low. Add in other forms of therapy that can synergistically help, such as Cold Laser to reduce inflammation and promote healing, spinal manipulation to restore motion to the spine, Functional Release (muscle tension release technique) to increase efficiency of reducing tension of the musculature are all techniques that can significantly increase the efficiency of the treatment.
So how does one ensure that they’re receiving the right treatment for the right diagnosis with a high degree of efficiency? Come speak to me to better understand your injury, condition, or pain. I promise to guide you in the right directions, whether that leads you back into my office or into one of my colleagues’ office.
With increased efficiency comes quicker recovery, less money spent on treatment, less productivity lost at work, more time playing with your kids, exercising, and enjoying life. And, isn’t that what it’s all about?!