The problem with Evidence in Physiotherapy

It would seem that the problem with evidence in physiotherapy is quite often that: a) there isn’t enough of it b) what there is is of bad quality c) you can’t really blind people to a lot of the treatments d) a number of the outcome measures are subjective as opposed to objective which gives an inherent risk of bias. e) the outcome is nearly always “we need to do more research”. And these are only the problems that I can pull off the top of my head on a Saturday evening. Traditionally we see clinical trials- randomised double blind … Continue reading

What they want vs what the evidence says: the MaccyD problem

You walk into McDonalds and order your big mac and fries and a milkshake the size of a walrus, all good and well. The guy takes your order, goes and gets it- but comes back with a Lean Chicken Salad with a veg juice. What the heck is this? You think…. I came in here with a certain expectation of what I want and what, at this point, I *need*, and yet *this* is what I get. What the hell? So you question the guy behind the counter… what happened to the Big mac, the fries and the milkshake? Ah, … Continue reading

Load and Capacity in sports and life

This was going to be a post specifically about runners, but to be honest it is very much about the majority of people that I see as a physio- it just happens to be a lot more obvious in the runners. Most people understand that their body has a finite capacity. It has an ability (to a point) to absorb force and carry on with life with barely any alteration to their daily goings- on. This capacity is different for every single person and is quite often thought about in a physical context. As an example: I, for one, will … Continue reading

The problem with nocebic language

Nocebic language? What? Is Tim making words up now? No. Ok- let’s back up a little bit and start with an old saying. Sticks and Stones may break my bones but words shall never hurt me. This is perhaps not the most truthful of statements, as pretty much anyone can attest. Ok, so words can hurt you emotionally- but they can’t hurt you physically… can they? Nocebo is the opposite of placebo. A harm inducing practice. Nocebic language is pretty much an encouragement to harm. Why would any health professional say something that might harm you? It might seem strange … Continue reading

Manual Therapy Sucks?

Manual Therapy Sucks. Manual Therapy does nothing for the patient. Manual Therapy is absolutely useless and shouldnt be used in a therapeutic context. How often have we as physiotherapists heard this kind of thing trotted out in the past few years? Yes, it makes a great twitter line, a good slogan on a t-shirt and a superb way of making people jump up and down and get riled up. I suppose I’m here to say: Manual therapy is not without benefit. Someone wants comforting- what do we do? Immediately we are drawn to comfort them with spoken word, but also … Continue reading

Knee Pain and doing your exercises

A couple of athletes have come to me recently with knee pain. One, a very good runner, the other, an alpinist with a history including an ACL rebuild. The thing they had in common was that in the last year they had done some excellent gym work, building up their leg strength and proprioception. However, for whatever reason, in the last 6 to 8 months this level of rehabilitation, or in fact any level of work in the gym, had completely tailed off. Despite this, their levels of activity in sport had stayed the same or became greater. Everything has … Continue reading