A Patient’s Advice to Her Physical Therapist

A Patient's AdvicePhysical therapy is a mother’s friend. I believe ALL new moms should be offered physical therapy. Unfortunately, that’s a pipe dream in the United States. However, if you suffer from diastasis recti or pelvic floor dysfunction, ask your doctor for a referral.

That said, physical therapy isn’t a panacea, and physical therapists don’t always agree with each other, leading to less than standardized care.

How Much Should We Trust Physical Therapy Advice?

Like the rest of the health world, physical therapy fads come and go. Some physical therapists also dabble in woo (non-evidence based practices that lack plausibility), and others toss around nutrition advice outside their scope of practice. Even very good therapists can develop a vested interest in a particular modality, so, as Maslow said, if all they have is a hammer, everything starts to look like a nail.

This can lead to vastly different physical therapy experiences among women.

Comparing notes can go something like this:

“Your physical therapist told you to wear a splint and pull belly to spine? Mine said the splint would push my organs down, as would always pulling belly to spine.”

“Yours said to do that type of Kegel? Mine said never to do a stand-alone Kegel because it isn’t ‘functional’.”

“Yours said your lumbar lordosis was too flat? Mine said postnatal women are mostly hyper-lordotic.”

“Yours performed Reiki? Wait, what?”

This can be confusing for patients. I know it was for me. Whose therapist is “right”?

A Patient’s Advice to Her Physical Therapist

I’ve thought a lot about the physical therapy world, eavesdropped on your forums and podcasts and newsletters and textbooks. I have immense respect for your knowledge base. I love listening to your messy and complicated and fun intra-therapy debates.

For a nanosecond I even looked into physical therapy school, but quickly remembered I’m a thirty-something mom of three with an academic background in the humanities. I’ve learned to satisfy that itch with the wiretapping.

I’ve also realized my status as patient, rather than as practitioner, lets me look at the benefits and drawbacks of physical therapy through the eyes of someone who doesn’t care HOW her body gets better, just cares that it DOES. This means I don’t have a modality horse in the physical therapy race.

Admittedly, my layperson advice lacks teeth because I mostly don’t know what I’m talking about, but at least I know I don’t know, and that’s a leg up over many fitness professionals (and sadly some physical therapists).

This is What I’ve noticed.

Anecdote

In the absence of conclusive evidence, many clinicians rely on their anecdotal experiences.

Sure. This makes sense.

I’m doing the same thing by using my anecdotal experience as a way into the larger discussion. It can’t be avoided.

Clinicians want to help women and sometimes the evidence doesn’t exist yet, so they make an educated guess. This is especially true for ailments like diastasis recti.

Warning

But as a patient, I would like to issue a word of warning. Only marginally trust the feedback from your patients. As individuals, we aren’t great evidence of efficacy. The patients who get better will tell you. The patients who don’t will find someone else. You are getting a skewed self-selected sample size.

Plus, often you are dealing with subjective and fluid symptoms, even when addressing what should be concrete. For example, a diastasis can be measured, but as I have pointed out, the size will fluctuate on its own, so measurements need to be incredibly standardized to draw conclusions about different interventions by different therapists.

A patient wants to please you as much as you want to please her. A patient wants to get better. And might think she is, even if nothing all that much has changed. This leads you—the practitioner— to put even more faith in your technique until it becomes a self-evident fact, when it should be treated as another nifty testable idea.

And not tested by you. As a science academic outsider, I’m astounded by some studies in which the person measuring and advising the subjects is the same as the one interpreting study outcomes. Isn’t this blatant outcome bias?

Also, the sample sizes are often miniscule. How does the law of small numbers not invalidate everything? I don’t know. I’ll let a scientist figure that one out. Oh, and a case study is just that — a case study, not groundbreaking evidence.

I get that money plays a big role. I get that not everyone can go out and design studies. You have patients to treat after all. Most of you are real world clinicians, not researchers.

Just don’t trust your clinical experience too much. Recognize when you are playing a guessing game. Tell us WHY you want to try something. If the literature doesn’t support a modality, tell us it is experimental.

You are keeping up with the literature, right? I get the sense that most therapists diligently read, but some veterans have attached to particular techniques so strongly they can’t let them go, even when the evidence flits away.

Conversely, some “ground breakers” advertise a better way, but aren’t they simply disregarding the evidence base under the guise of offering women a new approach? If you are going to abandon a grade A, conservative first line treatment, you better have some damn good evidence to justify this. Yes, I’m looking at you Kegel apostates.

I know part of a treatment’s effectiveness stems from the practitioner’s confidence. To some extent, our ability to get better depends on believing in what you teach us. But the converse can be true too. If we believe your advice is infallible, and we still don’t get better, we might blame ourselves. Let’s be honest, you might blame us as well.

We — patient and practitioner — should recognize the line between confidence and overselling.

From a Fan

Let me say again, I love what you do. I believe EVERY SINGLE NEW MOM should have at least one appointment with a women’s health physical therapist. Keep up the research. The experimentation. The debates among yourselves.

Only, please, stop mixing in nonsense. It degrades your truly awesome vocation. Just say no to Reiki.

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