At least once a year I make an attempt to argue for the benefit of reaching beyond the current clinical standards. There are many who live and die by a single pillar of evidence-based practice: research. While it is an essential component to improve our practice patterns, it has limitations. Some of the crazier techniques out there are currently impossible to standardize and accurately assess. Should this alone make them useless? The other pillars include patient beliefs and clinical experience. With the power the mind plays in pain and dysfunction, it is essential we do whatever it takes to help our patient, even if the higher level research doesn't support it.
Am I saying we should abandon what decades of research have taught us? Absolutely not. This evidence should absolutely guide our decision-making, just not rule it. For example, should a patient come in with patellafemoral pain syndrome, the evidence says we should incorporate quadriceps and gluteus strengthening. However, if tibial IR mobility is limited, we may possibly significantly improve the patient's function and pain through simply addressing that. There is no research to support this concept but has been seen clinically by many clinicians who implement repeated motions.
Even repeated motions has some sort of foundation of research. There are other techniques and schools of practice out there that are laughed at and have shown significant clinical success, such as visceral treatment, craniosacral, dry needling and more. I'm not sure these techniques can be categorized the same way much of the EBP followers are used to, but success can be shown with implementation of asterisk signs (even if we don't know the mechanism). Without some individuals attempting to go outside the current boundaries of evidence-based practice, we would fail to learn not only what techniques or treatment styles work, but also what doesn't work.
-Dr. Chris Fox, PT, DPT, OCS
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
|The Student Physical Therapist||
Always evolving, Always learning