Have you ever suffered from muscular pain? And did you underwent rehabilitation that did not benefit you? Then you may find out why in this article. Unfortunately, some methods of physiotherapy approach quackery rather than evidence-based medicine. It uses a wide range of devices, procedures or aids that have no proven or substantiated effect, to the detriment of what is really beneficial for patients.
The purpose of this article is to point out one big mess. It is found that instead of comprehensive rehabilitation, which consists mainly of targeted exercise and active approach of the patient (say at least 80% of the time spent in the surgery), patients are often prescribed only a series of passive procedures (eg a popular combination of electrotherapy, warm up and taping). ). The result is not the long-term success of the treatment, but a lot of regular "customers" or skeptics, who then turn to charlatans, yoga instructors or fitness trainers with issues whose solution does not fall under their competence.
So let's have a look specifically at a few examples of what (doesn't) work.
Apparatus and physical therapy
Perhaps every rehabilitation facility offers a whole range of different devices that are supposed to treat with different types of physical energies. This includes physical energy from the simple action of heat or cold (thermotherapy) to the use of the magnetic field (magnetotherapy). The described effects differ depending on the selected method, but most of the time it is still the same all the time - an effort to achieve better blood flow to the tissue in the area. However, there is power in simplicity, and if these devices for the application of electrotherapy, ultrasound, magnetotherapy, vacuum therapy and the like did not exist, patients and physicians would be able to do without them. Our body is smart enough with what it has. The tissue can (much better than with the help of devices) well perfuse itself and a targeted and well-dosed movement will suffice, or diversification with a hot or cold shower (normal and natural alternation of the effect of heat and cold).
Most of the devices used in rehabilitation are completely useless for humans, and if they work, especially as a placebo. This is because patients sometimes experience significant improvement after application. However, this was despite the fact that the device was switched off throughout the alleged application (Saltychev, Mikhail, Merja Eskola a Katri Laimi. Lumbar fusion compared with conservative treatment in patients with chronic low back pain. International Journal of Rehabilitation Research 2014, Ketola, S., J. Lehtinen, T. Rousi, M. Nissinen, H. Huhtala, Y. T. Konttinen a I. Arnala. No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome. Bone & Joint Research 2015)
Unfortunately, I often come across the fact that patients are meaninglessly prescribed ONLY this application of physical energy, which has no chance to solve the problem in the musculoskeletal system.
What does it lead to? Because the patient is not led to an active approach, the huge self-healing potential of his body is not used. The patient then becomes skeptical and gradually becomes afraid that conservative treatment is not helping him. All you have to do is resort to advice on the Internet, miraculous ointments and painkillers.
ULTRASOUND
Let's start with the ultrasound, which is part of almost every prescription for rehabilitation. Have you ever tried it? The head on which the therapist applies a slimy gel and rides it in a circular motion around a painful place? Did you feel the deep, penetrating and warming effect of… placebo? Not only has its biophysical effects not been shown to be of therapeutic and clinical significance in the past, but there is still no convincing evidence of its effectiveness (https://academic.oup.com/ptj/article/81/7/1351/2857699/A-Review-of-Therapeutic-Ultrasound-Biophysical). There is also experience that patients report improvement even after the ultrasound has been switched off on the skin with the device switched off), which clearly confirms the fact that the ultrasound acts mainly as a placebo, or even affects the perception of the area (https://www.dovepress.com/effectiveness-of-ultrasound-therapy-for-myofascial-pain-syndrome-a-sys-peer-reviewed-article-JPR). However, this is nothing that cannot be influenced by a pair of warm hands. So for me - feel free to have an ultrasound as a five-minute supplement to a half-hour workout, but not as a whole therapy!
ELECTROTHERAPY
Electrotherapy generally has many options and different settings with different targeted effects, the potential of which can be used by well-trained therapists (preset programs are not very reliable). However, in addition to the expected placebo effect (again, simply applying the electrodes of the switched-off device can help), it also brings various sensations that move it a little further than the above-mentioned procedures. However, it is again a supplement to therapy, which is far from replacing an active approach.
TAPING
Taping is perfect for the earnings of fitness trainers, physiotherapists or rehabilitation centers. Apart from skin defects or rare allergies, it has essentially no contraindications. Tapes can be glued anywhere and on any problem in the musculoskeletal system. The application is fast, easy and sometimes brings immediate results. Unfortunately, it works much like sticking a car light.
I used to glue one tape after another during my studies like on a treadmill. A colorful fashion accessory that has a whole range of great effects and most importantly - it really helps patients subjectively from pain. As I tried to educate myself, I gradually came to the conclusion that there are more methods and some of them contradict each other, but at the same time both help! So one day it occurred to me to do my own research, and I thoughtlessly glued a few tapes to a painful spot. And wonder of the world, it helped too.
First of all, it is necessary to realize that although there are many ways to tape, and each problem of the musculoskeletal system has its specific method of application, so it is still just a patch. Colored elastic patch, glued to the skin. What can such a patch do for what? Unfortunately, not on the claimed biomechanical or biological effects on tissues, as described by the authorities. However, what information is passed from the surface of the skin at the site of application to the brain, yes, which of course can have some benefits. By gluing the tape, it is practically possible to influence the perception of pain, but we can also reduce mobility by pulling on the skin. Unfortunately, when it comes to improving performance, taping won't help you objectively (Vercelli, Stefano, Francesco Sartorio, Calogero Foti, Lorenzo Colletto, Domenico Virton, Gianpaolo Ronconi a Giorgio Ferriero. Immediate Effects of Kinesiotaping on Quadriceps Muscle Strength. Clinical Journal of Sport Medicine 2012).
Conclusion
I would like you to take away the fact that the mentioned devices and taping are really beneficial, but only as a small part of complex active physiotherapy. Otherwise, when these passive procedures predominate (or worse, when they are prescribed instead of active exercise), the role of physician or physiotherapist fails.
