We live in a world of quick fixes. In the physical rehab world, this means dry needling, neck cracking, shockwave, active release, scraping, taping, and so on. If you have looked at booking into physiotherapy in the past, there are always lots of treatment options to choose from. Each promises to deliver the long-sought-after fix to our pains and physical limitations. Many people show up in physiotherapy excited and hopeful for a magical solution to their long term problems-- it might be a case of whiplash from a few years ago, an old knee injury, or recurrent tightness in their neck and shoulders. Others often show up adamant that 'X' technique is the only thing that is going to help them, and they aren't immediately open to exploring other options.
Physiotherapists, chiropractors, and the like are excited to use these new treatments as well. We are constantly being marketed to by companies running courses on the next big treatment technique, as if it will be the missing solution for all of the patients that we have failed to get better in the past. We buy in, because we obviously want to help all of our patients, and we are excited to have a new means to do so.
A lot of the time, when done correctly, these passive treatments really can help reduce your pain and help you to move better. It can be really gratifying for a patient and a therapist to try a technique like needling and immediately have a reduction in pain, or for them to suddenly be able to turn their head a little further over their shoulder. It requires minimal effort too—lie back, get that sore sport worked on, and leave without having to put much effort in beyond dealing with the pain of a needle, the suspense of an incoming crack to the back, or the loud noise of a shockwave machine.
I employ lots of these techniques myself. They often serve as a great way of loosening up a tense muscle, getting more range of motion through a joint, resetting the nervous system, reducing inflammation (or sometimes increasing it), depending on the approach and what research studies you’ve read. I’m happy to be able to do something that can immediately help my patients feel better and make their day a little easier, or take the edge off before getting to the exercises that I need to take them through.
The problem is that in isolation, the improvements from the vast majority of these interventions are short-lived, and in some situations may offer nothing more than a placebo effect. They help for a few days, weeks, or months, but since we haven't gotten down to the root causes of the problem, the same issue eventually comes back. The quick fix is just enough to keep you coming back again and again. For some people, this is all they are looking for, and that’s fine. That said, for many, it creates a cycle of dependence, where the patient must go back again and again, continuing to ration away their personal funds and benefits, trying to keep the problem under control.
Many of these treatments are fast and easy to administer as well, so practitioners can go from patient to patient, in a very busy setting, ‘helping’ away, while slowly becoming detached from opportunities to connect with and really help our patients. It's easy to needle or shockwave upwards of 15-20 people a day, bouncing from bed to bed, and bring in a big chunk of revenue. Taking time to really invest in your patient and be present for them is a different story. This quantity over quality approach to patient care has become a major problem in our profession.
The reality is most of us, patients and practitioners alike, often don’t like getting down to the hard work. When it comes to doing work and facing challenges, we become focused on the short term path of least resistance. We want to stay in our comfort zone.
The hard work takes more than a 15-20 minute visit. It requires that both parties are present and willing to work through challenges. The practitioner must be present. They have to continually assess, clinically reason, execute, evaluate, and modify what they're doing, and problem solve through factors unique to each patient-- and they cannot see as many people in a day.
The patient may have to change their behavior, adopt a new habit, or find time to do their exercises during the week. They have to own up and take responsibility for their own recovery. It can be challenging and uncomfortable, and the last thing we want in a world that is already challenging enough is more discomfort.
What we don’t realize is that when you look at the big picture, this 'quick fix' approach actually takes away from your time and quality of life much more than just getting down to doing the hard work right now. In the short term, a couple of sessions of needling, or a trip to a chiropractor for an adjustment might seem like the best option-- but those quick fix visits, given that they usually only offer temporary relief and require you to go back again and again, add up. Consider how long the problem persists, on-and-off over weeks and years, getting in the way of your work and the things you enjoy. Think about how many visits you will have to make to the clinic, again and again, taking time out of your day to keep the problem under control. Think about how much money is coming out of your pocket which each subsequent session. In the past, I've been in clinics where I've witnessed patients coming back again and again with the same problem 10, 20, 30, even over 50 times. This fixation on the quick fix misses the entire point of physiotherapy.
Its actually a lot faster and more beneficial to just do the hard work now-- to attend 5-10 visits involving active participation in rehab, focus, hard work, and collaboration; to leave after and follow through on your homework; to face some real discomfort; to stop having to rely on going to visit and pay someone else for temporary relief; to get better and stay better. A year from now, you will be better off, and proud of yourself for doing the real work that was required of you to grow and recover.
Passive treatments like manipulation, shockwave, needling, and so on can work for you, but in isolation, their benefits are mostly short-lived. They are meant to be just the first step in a process that gets you from pain and disability to independence and freedom. This means getting better and staying better.
It is, after all, becoming obvious, if we look around at the world at large, that our ‘quick fix’ culture is catching up to us. Sooner or later we will all have to own up to this. This applies to the rehab world as well, and we rehab professionals must hold ourselves to higher standards to continue to allow our lines of work to grow and thrive with integrity and respect from the public. Patients deserve to consistently receive better care than a 'quick fix'. For patients, doing the real work first is much more fulfilling, and sets your future self up for greater independence, better health, less pain, and more happiness. In my next post, I will be outlining when the ‘quick fix’ is appropriate, and what you should expect from there onwards to ensure you are getting the most for your time and money, and that you are actually healing and recovering, and living your life to its fullest potential.