5 Outdated Physiotherapy Treatments Which Are Still Widely Used
Updated: Aug 24
On average, it takes 17 years for new knowledge generated by research to be applied into practice. Therefore, it comes as no surprise that many therapists still perform outdated treatments and provide inaccurate explanations to their clients. Read on to find out about the top 5 widely used treatments lacking of scientific evidence.
1) Spinal manipulation to correct scoliosis
Spinal manipulation involves a high velocity thrust movement of the patient's body that leads to a pop sound of the underlying joints. The popping sound you hear when having your spine manipulated is nothing more than a pressure change in the joints, just like popping the joints in your hands. It has nothing to do with correcting the alignment of your spine. That said, spinal manipulation can be effective for short term pain relief for patients with back and neck pain and can be part of a treatment plan. However, be wary of therapists that tell you need endless number of sessions of manual therapy to straighten your spine.
2) Patellar maltracking treatment
A common narrative that therapists use to explain patellofemoral pain to their patients is that the kneecap is pulled laterally by their tight Iliotibial band, preventing the patella to glide correctly on the femur. Therefore, treatment offered often consists of massage and stretching of the IT band and exercises to strengthen the Vastus Medialis Oblique (VMO), which is one of the quadriceps muscles that attaches to the inner side of the patella. This explanation has been proven to be flawed. First of all, the IT band is a very thick and non elastic structure that is almost impossible to stretch. Studies both in-vitro and in-vito show that regular stretching does not change the length of this tissue. Secondly, it is not realistic to train only the VMO without activating the other 3 muscles that form the quadriceps. Even if that was possible, strength training does not make muscles shorter. Therefore, VMO isolation exercises would not affect patellar alignment.
3) Therapeutic ultrasound
Therapeutic ultrasound has been one of the treatments offered by physiotherapists for many decades. The rationale behind ultrasound treatment is that it helps to improve tissue healing by increasing blood circulation. However, there is very little evidence that therapeutic ultrasound provides significant benefits. For this reason, it can be argued that clinical time should be spent by providing more valuable treatment options, like education, therapeutic exercises and manual therapy.
4) Core exercises to treat back pain
Core exercises to treat back pain became popular in the 1990s after a study by Hodges et al. that showed the transverse abdominis muscle was slower to activate in people with back pain compared to people without back pain. Despite the fact that their research was cross sectional, as such we can’t tell if core muscle delays are a cause or consequence of pain, core exercises became very popular among physiotherapists to treat back pain. However, recent studies show that general exercise such as walking is equally effective in treating back pain. Moreover, we now know that back pain is multifaceted. Many factors like stress level, sleep quality, obesity and smoking can influence pain sensitivity. For this reason, focusing only on core exercises to treat back pain appears to be simplistic.
5) Leg length discrepancy treatment
Many therapists attribute back, knee and ankle pain to a leg length discrepancy (LLD), and they use manipulation and massage to try to correct this imbalance. However, LLD is very common and in the majority of cases it does not cause pain. About 90% of people have a leg length discrepancy, with the average being 1/2cm. Studies indicate that a LLD above 2cm is clinically significant to cause pain. However, only 1/1000 individuals have such disparity. Therefore, if you have LLD, odds are it is not clinically significant to cause pain. Moreover, there is no study to date to support the use of manual therapy for this condition. A LLD above 2cm can be corrected with custom-made insoles by a podiatrist.
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Bialosky JE, et al. Unraveling the mechanism of manual therapy: modeling an approach. J Orthop Sports Phys Ther. 2018.
Falvey EC, Clark RA, Franklyn-Miller A, et al. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2010 Aug
Wilhelm M, Matthijs O, Browne K, et al. Deformation Response of the Iliotibial Band-Tensor Fascia Lata Complex to Clinical-Grade Longitudinal Tension Loading in-Vitro. Int J Sports Phys Ther. 2017 Feb
P W Hodges1, C A Richardson et al. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976) 1996 Nov