Come. Let us reason together

Of late,Twitter has been engulfed in a rather ferocious to and fro on dry needling. The current darling of the PT world has been challenged. As any chivalrous gentleman would do, swords were drawn from their scabbards in defense of ‘her’ honor. The two sides parried back and forth until, so far as I can tell, each became weary of the other and returned to their abodes with nothing in particular resolved. (See just a few points of view here, here, and here).

This is perhaps the most interesting point of the whole episode. Dry needling today reminds me of manipulation a decade ago, which in turn reminds me of manual therapy in general a decade before that. Every so often, a ‘new’ technique arises, and everyone becomes quite besotted with it. Courses spring up, certifications abound, new kings of the hill are crowned. Then we study it, and realize that although there are benefits, they are really quite small. We shrug our shoulders and move onto the next ‘new’ thing. The cycle begins again (usually after a lot of money has been spent, and made).

You see, it’s all about movement. Humans were designed to move. When we stop moving, things literally begin to fall apart. Sometimes we stop moving because of a job, or because we’re not sleeping well. Maybe we’re eating poorly, or we’ve been injured, or overcome by stress. PT’s exist largely to optimize movement. Usually, we have to increase it. Sometimes we have to decrease it. Often, we just need to change it; improve the quality of the movement. When people move, they can participate; they’re more confident, they can strive, they can be whole again. There are as many ways to increase movement as there are reasons that Australia can’t seem to play cricket properly anymore. Whether it be with our hands, or with a tool, or a sharp stick, or with just plain old exercise, it all seems to work at one time or another. The key is knowing what to use and when to use to it, or, perhaps more importantly, when not use it. Sometimes the best intervention is to do nothing, Ah, reasoning!

Physical therapy has become too technical, too robotic, too focused on finding the best technique. We compare techniques in studies as we would two bottles of Brunello di Montalcino. The hunt is on for the panacea; the can’t miss. I don’t think it’s there. What is there is a person who can’t move properly. A person who is hurting, and needs our help. Our patients need us to think, to screen for a serious medical problem that needs attention. They need us to build risk profiles to ensure that when they do move, they are protected from further harm. Our patients need us to understand their whole story, so we can recognize their hopes, and their fears, and deliver a positive message that the body is strong, the body is robust and that the body wants to move, if only we’d just let it. Finally, our patients need us to understand what to move, when to move it, how to move and when to stop. That takes great thought, and even greater skill. The best PTs I know do this almost perfectly. We must think.

The rest is movement, however you like to do it. It really doesn’t matter. Choose what works for you.

Time to forget the obsession with ‘techniques’. Time to go back to listening. Whether verbal or not, patients usually tell us all we need to know and more about how to help them get well. We not only have to listen, we have to hear. We have to reason.

Brett Windsor, PT

3 thoughts on “Come. Let us reason together

  1. Brett, this is a fantastic write up with many excellent insights. I appreciate your effort in expressing these thoughts. I do, however, take issue with the following assertion “The rest is movement, however you like to do it. It really doesn’t matter. Choose what works for you.” if you are broadly referring to which interventions or techniques we use to facilitate, or even decrease, movement. I’d agree that when it comes to movement itself choose what works for you. But, when it comes to choosing actual interventions, thought processes, and reasoning models we must not fail trap to “do whatever works or appears to work.” And, that’s one of my main contentions with needling is that in the face of A LOT of accupuncture trials and data that suggest no robust effect, weak DN research, and an expensive to learn INVASIVE procedure, we (PT’s) shrug our shoulders and state “whatever works, it’s just tool, it’s not all I do.” I’m fairly certain you are NOT stating this, but just wanted to mention. Your ending quote is quite strong, and accurate. Everyone in our profession should read it:

    “Time to forget the obsession with ‘techniques’. Time to go back to listening. Whether verbal or not, patients usually tell us all we need to know and more about how to help them get well. We not only have to listen, we have to hear. We have to reason.”

    I agree. It’s time to move and re conceptualize a foundation to our a profession based on reason not interventions.

    Thanks again for this most excellent post.


    1. Hi Kyle, Thanks for your comments. I completely agree with what you’ve said here; what you’re referring to with the acupuncture research is pretty much what we find across the board when we study any intervention – ‘no robust effect’. Two points, 1) We must stop over-interpreting study findings to conclude that a particular intervention ‘works’ when there really is no strong effect, but 2) realizing that we must interpret study findings to look for context that allows us to ‘experiment’ clinically and look for the types of patients where a particular intervention may well be consistently effective. There is the ‘art’ side to what we do that will never truly be quantifiable. I believe that there is an experiential component to that. Unfortunately, both pieces require a deep level of thought. Are we still willing to do that? Thanks again for your comments. Brett


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