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
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