Eric:

This is a good video clip - thanks for posting. However, I will throw a couple of ideas out there to consider.

The video reports "eight treatment visits is standard". I would challenge the assertion that neck pain requires that many visits as "standard" (for most cases).

Another thought: if a patient has the tools to perform the same movements that decrease or abolish symptoms and improve/restore function (under their own volition), then should we continue to provide "manual physical therapy"?

Much of this speaks to the self-perceived role of the physical therapist in the care of the patient. Many want to be "fixers", others want to be "facilitators" or "educators". There is a subtle (but important) difference when it comes down to the patient's understanding of cause and effect and their "learning experience" with PT. As but one example, there are tremendous similarities between manual therapy and the McKenzie method ... yet the former opts for "therapist-generated forces" first, whereas the latter opts for "patient-generated forces" first. I would suggest there may be an elemental difference in how the patient perceives these roles.

I think this is not only an issue of cost/efficacy. It's also an issue of "prevention". Based on the statistics, people who have neck and back pain typically have recurrent episodes. The patient must have the capacity to apply self-treatment procedures without a PTs intervention should there be a recurrence. Then I think we'll be looking at real changes in both long-term outcome and cost of care.

Interesting views on the quality of the study etc ... but I think that misses a rather significant point.

Ultrasound is a PASSIVE modality. Passive approaches to care foster patient dependence upon the provider. The "mechanical properties"/responses that Mark mentions can be elicited at the cellular level via exercise and mechanical loading strategies. The mechanical principles underlying tissue repair and remodeling have been thoroughly researched.

Perhaps understanding the critical parameters of mechanical loading required at the cellular level to foster collagen synthesis, etc would be far more valuable than utilizing the parameters necessary to apply ultrasound - not only for optimal repair and healing, but for active patient involvement as well.

Allan Besselink, PT, Dip.MDT

"How long are we going to be treated like technician from physicians who never pick up a rehabilitation piece of literature?"

Some simple answers:
- we will be treated like this until we have direct access. In all states.
- we will be treated like this until physical therapists come together as a group and stop considering this as "acceptable clinical behavior" (regardless of the evidence against it).
- we will be treated like this as long as we keep spending an inordinate amount of time teaching it in our PT/PTA programs (regardless of the evidence against it).

Allan Besselink, PT, Dip.MDT

Icing is definitely an over-used treatment approach. If there is an active inflammatory process, then ice would be indicated for the first 24 to 72 hours (max). Differentiating between "hurt" and "harm" is the primary issue to establish this. "Hurt" is an awareness of symptoms etc that is produced with the activity, does not increase significantly during the activity, and does not remain (at rest) any longer than 30 minutes post-activity. "Harm", on the other hand, would be symptoms that are increasing AND remain worse afterwards. "Hurt" typically means you are stressing the tissues - "harm" may indicate the initiation of an inflammatory response (and thus ice would be appropriate).

Of course, this does not include the "oh-I-just-twisted-my-ankle-on-the-trail-and-it-is-swelling-up" pain ... ice time!

Hope that helps!

Allan Besselink, PT, Dip. MDT