Physician Update

July 24, 2008

Re: Gentle is Best   

Dear Doctors:

I’m tired of the long running joke about physical therapists being physical terrorists.  I understand where this comes from, but I take offense because it is usually unnecessary to inflict pain in order to help a patient improve. 

Our treatment philosophy at Urbana Physical Therapy is simple: perform the gentlest technique to achieve the desired result.  We always start gently.  If the patient improves, nothing else is needed.  And most patients do respond to gentle techniques.  If the patient does not improve, we gradually intensify the treatment until there is improvement.  

Some time ago we discharged a patient whose surgeon told her that I “was going to kill her.”   She was recovering from her second surgery for hallux valgus and osteoarthritis of the R MTP joint. The ROM of the toe was limited in all directions, causing pain and an abnormal gait. 

At no time was it necessary to “crank” on her toe.  Her treatment may seem unorthodox, but it was extremely effective:

1. Total Motion Release exercise to the thoracic spine and the left lower extremity resulting in immediate reduction in pain and a better gait.
2. Myofascial scar releases, not the painful cross fiber techniques that are done elsewhere.
3. Myofascial release in which we gently distracted the toe longitudinally and then took it into rotations as the tissues released.
4. Gentle active and passive ROM activities.
5. Home program for active and passive ROM to all the toes and foot.

At her discharge she was painfree and her ROM and gait were much improved.  She said, “I can’t wait to tell my surgeon that you didn’t have to hurt me.”

Sincerely,

Chris Cotter, P.T.