I heard this expression on a podcast recently. It really struck a chord so here are some thoughts.
This is a topic that ruffles feathers because the popular understanding of manual/physical therapy is that it is there to fix problems. A patient comes with something misaligned, twisted or ‘out of whack’ and our job is to correct and realign; put back?? Like a car. And why wouldn’t you think that? Many therapists believe this themselves; it is heavily supported by media messages and heck, many patients do improve with this approach (for a short time at least).
Here is the problem I have with the ‘fixing’ concept:
- It’s not supported by evidence at all. Unlike the perfect structures you see in anatomy textbooks we are not like this in anyway, nor should we try to be. We come in all shapes and sizes. Happily, there is no evidence that unbalanced body shapes and poor posture causes pain. Often, even the most deformed of spines do not cause any pain at all.
- In fact, what we know from MRIs is that (for muscle and joint pain) most findings on a scan do not correlate at all well with the pain you feel. At least 70% of us adults with NO PAIN AT ALL are walking around with disc bulges, degeneration and all sorts of so-called abnormalities. Why don’t more people know this? Please tell your friends!
- Think about it. What could even the beefiest of manual therapists really realign or put back in a half hour session that wouldn’t immediately be undone the moment you stepped off a kerb? Yes, I know that click sounds reassuring but I promise you it doesn’t put anything back.
- Because pain is commonly viewed as a structural thing to fix, enter numerous companies eager to sell you the latest expensive orthopaedic chair, specialist shoe or muscle-strengthening gadget. Watch out for this, we’ve all been there. Think of those three-letter named rocker trainers languishing in the bottom of your wardrobe!
- Lastly, and perhaps worst of all, when you are led to believe you are broken and need to be fixed this supports the myth that you need to have something done to you to recover. That you must rely on someone or something in order to get better. This is both sad and untrue. I believe I can help people in pain a great deal. Not by fostering dependency but by giving them the knowledge and skills to understand pain, work with and overcome it – by themselves. This is so much more powerful, in my view.
Don’t get me wrong, I’m not out to bash manual therapists. I am one and proud to be so. I just feel strongly that we should really understand what we are trying to achieve and communicate this better. I’ll tackle the ‘what bit’ on another day.