Does Evidence Have a Place in Practice?
I have been working as a PT for about 2 years. I used to be a pro EBP clinician when I was in Uni as we were all taught to carry out our treatments with the best available evidence. Needless to say, the best available evidence for most MSK conditions would be exercise therapy. I know that exercise therapy is the best treatment for my client but does my client know about that? Will my client believe me if I told them that all you need to do is do these few movements and your condition will improve. So, how do I help?
There are many researches that suggest that manual therapy, electrotherapy or taping have insignificant effect on pain or recovery but why do I still practise them when I am well aware of its research? My answer is simple: my goal is to get my clients pain free and I often resort to using electrotherapy or taping as my last resort. I still use manual therapy despite the evidence because I need to desensitise the painful region and then promote mobility through graded exposure and progressive loading.
It is no secret that people like to be treated or touched. Maybe it makes them feel good or maybe it’s the belief that they will get well because you have done something to them. However, I am not in a position to argue with you about what science suggests about manual therapy, electrotherapy or taping because my goal is to get my client pain free and up and moving. If manual therapy doesn’t yield the results I am looking for then I’ll keep manipulating my treatments till I get a positive effect.
Essentially, I am treating the person more than pain or the condition so my techniques will change as I treat my client. My end goal would be for my clients to self manage through some sort of HEP because I believe that HEP would reinforce the effects of my interventions. For example, I will use TENS for my LBP client and then I would prescribe McKenzie’s extension exercise in prone as the HEP. In a way, I am trying to associate a pain free state with McKenzie’s extension exercise in prone.
My final thoughts:
I value the findings of research but I am unable to treat my clients by basing my treatments solely on empirical evidence.