Don’t waste your time and health care dollars.
Whether you’re coming off a sports injury or rehabbing from joint surgery, your physical therapy goal is to return to full function as quickly as possible. So you’re not interested in a PT procedure that doesn’t work well and isn’t proven effective — even if that’s how it’s always been done.
As part of the Choosing Wisely campaign, in which 60-plus medical specialties have targeted overused practices that practitioners — and patients — should question, the American Physical Therapy Association made its own list. Here are the top five PT treatments you probably don’t need, and some better options for recovery.
1. Hot packs, ultrasounds and other “passive physical agents.”
When you’re suffering from back or neck pain, or a quadriceps or shoulder strain, passive physical therapy — with ultrasound deep-heating, or a hot or cold pack wrapped in a towel — sounds soothing and effortless. But treatment with “passive physical agents” is not ideal or backed by evidence, says Anthony Delitto, a professor and chair of physical therapy at the University of Pittsburgh.
Exercise training makes smarter use of your appointment minutes, insurance dollars and the therapist’s expertise. “The time spent with a skilled therapist is better spent in those areas than just lying there in a hot pack,” Delitto says. If you’re offered passive therapy, he suggests asking: “Rather than do this hot pack treatment here, can’t I do it at home — and is there something else I can do that’s more beneficial while I’m here?”
2. Strength-training programs that don’t challenge older people.
When physical therapists create too-easy exercise regiments for older patients, that only holds back recovery. “We need to challenge patients,” Delitto says, whether it’s with strength, agility or endurance training. That can be done safely as physical therapists are trained to prescribe activities according to a patient’s unique goals and ability.
In 2013, Steve Fine, a 61-year- old public relations writer and instructor, struggled with lower back disc pain despite two surgeries. He wasn’t thrilled with his hospital physical therapy experience, where, he recalls, “somebody came in with a checklist of exercises.” Fast-forward to January, when he had major surgery for “insane back pain, three blown discs and a hairline vertebral fracture.” Fine says that afterward Delitto, now his therapist, “sat down with me and literally asked me what my goal was.” The answer: to drive a long distance and dance at his son’s August wedding. With a regimen including biking, treadmill, leg lifts with weights and yoga planks, he went from “shuffling around like a 90- year-old on a walker” to joining his wife on the dance floor.
3. Bed rest for a deep vein thrombosis (blood clot).
When a patient who has been diagnosed with a DVT — a blood clot in the deep veins of the legs — is being treated with anti-clotting medicine, bed rest isn’t required, unless there are “significant medical concerns,” the APTA recommends. Instead, Delitto says, “The person ought to be activated.” The conventional wisdom had been that the clot might move around if the patient did, but that’s not borne out by evidence, he says. Once the DVT is being managed medically, it’s the physical therapist’s role to get the patient up and moving.
4. Continuous-motion machines after total knee replacement.
“I can move my own knee, thanks,” is a fair way to turn down therapy with a continuous passive motion machine. A February evidence review found no “clinically important effects,” from using the devices after total knee replacement. While a major goal is to prevent knee stiffening after the procedure, rates with CPM aren’t lower. Carefully moving your knee — slowly bending and straightening, flexing and extending — on a routine basis should help prevent it from becoming stiff, Delitto says. You’ll do this first with assistance from physical therapists and nurses, and then on your own. The APTA outlines your steps to knee recovery.
5. Whirlpools for wound care.
Soaking a patient’s wound in a whirlpool containing iodine-based solution may clean the wound but doesn’t heal it — just the opposite, Delitto says. The once-standard treatment “was actually causing a negative effect,” he says, with the water jets and Betadine fighting the body’s ability to close the wound and repair itself.
Whirlpool for wounds could even be unsanitary. In years past, Delitto says, “we probably weren’t as challenged with resistant bacteria as we are nowadays, so we got away with it.” But for a patient with multiple wounds, an infected wound could potentially cross-contaminate the others. “Obviously that’s a classic case where the juice isn’t worth that squeeze,” he says. Instead of whirlpool, Delitto says, top-notch wound care centers use pulse lavage — hand-held devices that direct pulsating streams of saline-water solution into wounds — with much better results.
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5 Physical Therapy Procedures You Should Question originally appeared on usnews.com
