Written by Teo Buzas, PT, DPT
When seeking professional healthcare, do your best to find out what they believe and how they treat. Do your due diligence with research. You can find out a lot on the website. You can search the ‘about’ page to find out more. Also, find out from friends and family who have experience with a good physical therapist. Find out from other trusted health care professionals if they have a strong recommendation.
From your first session, consider what your provider believes because this can strongly influence their advice to clients, potentially fueling the goal to health or fueling unhelpful coping responses. There is strong evidence that clinicians commonly hold erroneous and unhelpful beliefs about musculoskeletal pain (1, 2).
How the health professional communicates their clinical diagnosis seems to shape patient beliefs. Incorrect information provided by health professionals influences people’s views of the diagnosis. If a diagnosis sounds threatening people will change their movement and activities.
Do you care if your treatment is evidence-based? Can/does your provider show how their treatment is evidence-based? Is there evidence or are there just stories?
Stories and examples are crucial. Stories bring experiences to life. It gives us something to connect with and relate to. It helps provide hope. However, when it comes to health care and science, stories without data are just that, stories. That which can be asserted without evidence can be dismissed without evidence.
So, what is evidence-based practice?
Evidence-based practice is the integration of current best evidence, clinical expertise, and patient values.
It is important to acknowledge the research. Research is not perfect, but it points us in the right direction based on current evidence and helps to reduce the huge variances in treatment. It is also important to integrate clinical expertise and patient values. Each person is different and has different influences affecting their experience, pain, health, and symptoms. Clinically it is important to reconcile the research information with each person’s individual presentation and their experiences/beliefs etc. Rehabilitation and recovery are a process.
Find a physical therapist who understands pain and recovery.
Consider this article from the NY Times. Not every PT is equal. What to look for in a physical therapist: https://www.nytimes.com/article/physical-therapist-search.html
What about personal characteristics?
Consider the personal characteristics when you first meet with a healthcare professional. Do you feel like you were listened to? Do you connect logically and emotionally? Do you like the overall experience? These personal characteristics matter.
A systematic review (3) found that the interpersonal attributes (e.g., effective communication and empathy, etc.) of the therapist and the process of care are key determinants of patient satisfaction. Medical professionals do not have a magic cure, pill, or intervention that makes chronic pain go away. Be wary of the ones who claim they do. There is successful recovery with chronic pain, but not because of one single magic treatment.
What about language?
The language we use ourselves and the language health professionals use when communicating are very important. Good communication between health professionals and clients is vital and has been found to affect opportunities for optimal care. Conversely, poor communication can have negative impacts on outcomes (4). The way people speak about their health is important in shaping and reflecting their experience and their attitude towards health.
So, what does the research say about musculoskeletal pain?
Let’s look at a systematic review from 2020 (5), which looked at multiple high-quality clinical practice guidelines. They identified 11 consistent recommendations for health care professionals in treating musculoskeletal pain:
- Screen for red flags/serious pathology
- Assess psychosocial/lifestyle factors
- Imaging is discouraged and should be limited
- Physical examination
- Assess progress with outcome measures
- Provide education
- Address physical activity/exercise
- Apply manual therapy as an adjunct
- Offer evidence-informed non-surgical care before surgery
- Facilitate participation/resumption of work
A systematic overview of current evidence from 2017 reported on effective treatment options for musculoskeletal pain in primary care. The aim was to summarize current best evidence for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee, and multi-site pain (6).
The evidence synthesis of interventions showed moderate-strong evidence for exercise therapy, education, and psychosocial interventions, with short-term benefits only from pharmacological treatments. Other non-pharmacological therapies are considered and used as second-line or adjunctive treatment options (7).
Education, exercise, and lifestyle factors continue to be found in multiple clinical practice guidelines as primary keys to treatment. These must be client-centered and specific.
At Bridging the Gap Physical Therapy, we are here for you. We offer full body evaluations and discuss your treatment plan. This includes your diagnosis, your goals, and the plan for getting you there. Find out more by speaking to our team today at 239-676-0546.
- Darlow B, Dowell A, Baxter G, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013;11(6):527-534.
- Bishop A, Foster N, Thomas E, Hay E. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008;135(1-2):187-195.
- Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011; 91:25–36.
- Lloyd CE, Wilson A, Holt RIG, Whicher C, Kar P. Language matters: a UK perspective. Diabetic medicine. 2018;35(12):1635-1641.
- Lin I, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2020;54:79-86.
- Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017 Jun 22;12.
- Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG. Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383.