The Greatest Myth in Physical Therapy

Communication, language and terminology.

A recent patient went to her physician with a sore throat. When she got to the office, he prescribed to her an anti-biotic after a (+) throat culture for strep. The strep resolved and she felt much better.

Let’s look at this a different way. The patient goes in and the physician instead prescribes a corticosteroid and no anti-biotic. The patient’s throat does not improve and she continues to feel ill.

The final version of this is that the patient feels ill and opts to take Tylenol and a home remedy she finds on the internet. She still does not get better.

In which of these 3 situations would we say, “The patient did her doctoring.” Or maybe instead, “The doctoring was not effective in resolving her symptoms.”

This sounds ridiculous, right? Only one of these situations was the patient getting the treatment which has been shown to be effective at resolving her ailment. Why would anyone think this would be effective if the patient does not follow the leading treatment algorithmr?

Now let’s look at Physical Therapy and similar situations:

  1. Knee OA: Orthopedist says, “You can do your physical therapy at home.”
  2. Knee OA: Patient finds exercises on the internet and states, “I already tried physical therapy and it did not work.”

Which of these statements/situations is the best? Which of them makes sense to you?

I vote NONE! When someone says they are doing Physical Therapy at home, it just isn’t true. This is hurtful terminology that belittles a physical therapist’s skills and the entire profession as a whole. Physical therapy is a career, focusing on a multi-skilled pathway. It is not a synonym for exercise.  In the 2 statements, the proper terminology is not, “I did my physical therapy”.  It is instead, “I did my exercises.”

Think about this and listen to how rampant this language is while you are in the clinic this week. Think and discuss how detrimental this can be to further growth and respect of our profession. The rehab community is pushing the use of improved language with our patients. A recent article was published in JOSPT which discussed the impact of our language in rehab.¹ What we say and the way we say it has a huge impact on our patients’ mindsets and ultimate outcomes. Our language influences patients’ beliefs. Even Louie Puentudura found that patients’ beliefs on cervical manipulation influenced whether a manipulation would lead towards success.²  If our patient’s and physicians believe Physical Therapy is synonymous with exercise, then this highly influential belief-system is broken before the patient arrives at our door. Medications, surgery, and many other treatments are likely to outweigh the influence of the physical therapist, creating an uphill battle.

I am a Physical Therapist in the United States and for many of you reading this, you may be Physiotherapists in other countries. Do you struggle with the same issues? Please share with us your struggles and successes in language. What steps do you believe must be taken to move us past this barrier?

1. Stewart M, Loftus S. Sticks and stones: The impact of language in musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018;48(7):519-522.
2. Puentedura, Emilio J., et al. Development of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thrust Joint Manipulation to the Cervical Spine. J Orthop Sports Phys Ther 2012; 42(7): 577-592.

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