The Art and Science of Physical Therapy

Mike Darnell, PT

April 2009

I have always found it interesting and revealing that many times when I provide fill-in physical therapy for another therapist, the patient will frequently remark that I provide them with treatment that is different from the other therapist.  Mind you, the patient is not saying that one treatment is better than the other but simply different.  The difference usually involves the specific exercises I choose as well as how I may utilize my hands during treatment.  This then gives me the opportunity to comment on what I consider to be the art of physical therapy. The analogy that I give is that the style of a physical therapist is comparable to that of the drawing artist.  Give ten drawing artists a description of a scene and then have them go their separate ways to apply their artistic style.  In the end, you will have ten completely different pictures but of the same basic scene.  This is much how the art of physical therapy is applied.  Give ten physical therapists the same patient and have them separately apply their artistic style to the patient and you may well get ten different approaches.  In the end however the patient’s problems are being addressed.

 Physical therapy, and all that it encompasses, allows the therapist an opportunity to apply their mind through science as well as their hands through art.  Being somewhat “old school”, I learned early on the art of hands-on treatment.  Like drawing artists who attend workshops to learn the techniques and nuances of their trade, physical therapists take advantage of workshops that demonstrate a particular hands-on approach that is another therapist’s style.  The therapist then assimilates and refines these manual skills and exercise strategies into an approach that is eclectic and individual to them.

 What is now becoming so exciting to the physical therapist who is very hands-on is the mounting scientific evidence indicating that patient outcomes are enhanced through hands-on skills.  As an example, through evidence based research, we now know that if a patient has a complaint of non-specific low back pain then a generalized thrust manipulation by the therapist to the patient’s lumbopelvic girdle will significantly reduce their complaint 45% of the time.  However, again through evidenced based research, when this same patient with low back pain also demonstrates a certain cluster of signs and symptoms that can be identified and measured then the manipulation’s effectiveness will increase to as much as 95%.  Again, taking this even further through evidenced based research, if the manipulation treatment also includes targeted strengthening and flexibility exercises performed in the clinic and/or through a self-care program then long term reductions in complaints and recurrence are enhanced.

 Evidence based physical therapy treatment is being published more and more in peer reviewed journals available to the therapist.  This information demonstrates how patients with similar complaints can be classified into subgroups which then allows for more specific care plans that are statistically more likely to be of significant benefit.  Of course, coupled with this science is the art style unique to the therapist.

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