Top 5 Fridays: 5 More PT Myths | Modern Manual Therapy Blog

Top 5 Fridays: 5 More PT Myths

Let's review some common topics I go over repeatedly, but are still believed by a majority of clinicians today.

1) Any One Commercial Model will net you success in 80% of more of your caseload
  • nothing irks me more than grandiose claims of many commercial models stating you have to buy into what they do 100% to have success with your patients
  • always be wary of those who say "always" and never trust those who say "never"
  • if that were true, why do those who don't correct muscle balance, L AICs, unstable areas, correct cerebrospinal fluid rhythms or more still get people better?
  • I have no doubt their faculty have success, but a lot goes into that including
  • patient expectation of seeing an expert
  • the faculty member really knowing how to sell their approach
2) Painful or uncomfortable treatments are ok as long as the patient gets better
  • I think this starts in PT school on acute care rotations when your CI makes you crank on some unfortunate little old ladies fresh TKA to "get them to 90"
  • it is perpetuated by having actually having patients improve after painful techniques like cross friction massage, trigger point release, etc
  • I challenge anyone who is reading this, that if your patients are sore after your treatment, you are being too agressive (not counting DOMS)
  • you will have better outcomes, and your patients will like you better if ALL of your treatments are pain free
3) Exercise/Strengthening is also ok when the patient is in pain

  • manual therapy, pain science education and other methods should be used to modulate as much pain as possible
  • if pain alters motor control, and you are trying to facilitate certain movement patterns, it's not a great idea to exercise while the patient is under threat
  • this does not include those chronic pain/centrally sensitized patients who have to learn to exercise and move while in pain, but even then, it should not dramatically increase with their prescribed exercises
4) Any one treatment or exercise is better than another

  • going back to #1, if every treatment/exercise is really just an input designed to change an output, this again depends on patient expectation, preference, and how the interaction goes betwen patient and clinician
  • some treatments may be more effective in your experience, but you are probably better skilled psychomotor wise, can explain it better, can make it more comfortable, and can recognize clinical practice patterns that tells you when to apply them
  • like my pal Charlie Weingroff says, "Anything can work for anyone"
5) Palpation for motion/position is reproducible between clinicians (or even needed)
  • let's face it, you may spend 5-10 minutes doing various palpation testing, only to really do the same needling, IASTM, functional release, joint mobs or manips based on their gross active/passive movement anyway, right?
  • why not cut that out and stop poking and prodding and just do the treatments which are not really that specific anyway?
  • giving up palpation during evaluation is very liberating and gives you more time to educate and treat, instead of perpetuating sensitization to a threatened nervous system
  • even if a patient tells you the most painful spot, or most tight spot is very focal, you can have them palpate it, then you modulate it with your resets, their input is often less threatening than yours
What are the take homes? Stop hurting your patients, soreness post treatment is not normal unless it's from strengthening and conditioning, palpation is not necessary.

If I can give up these things after doing many of them for well over a decade, so can you.

Keeping it Eclectic...


  1. I follow a few PT blogs/instagram's and also have a few mentors that I work with in person and it there is such a wide spectrum on level of pain someone should feel with manual work/physical therapy. I had read one quote from Tom Myers that "When there is pain stored in the body, it has to be felt on the way out." Also some of the techniques my mentors practice such as active release are pretty painful but appear to be effective and I have seen success with it. This makes it tough as a newer PT developing my skillset and practice philosophies to determine which way I should take my practice.

    Link to quote and Tom Myers interview

  2. That's just perpetuating the palpation myth, you can't feel pain or break up areas that 'store' it. We all make improvements on people. You can do the same or better with no pain. Why wouldn't you? Do you like hurting people?

  3. Thanks for posting Dr E! I've been following your blog for about a year and some change and I've been able to utilize much of your treatment philosophies and approaches with success.

    Working in hospital-based clinic with focus commercial insurance and their ever-changing rules for reimbursement and whatnot (who doesn't like to get paid?) so I have to spend much of my time documenting very specifically. I like the idea of limiting palpation and getting to the heart of the matter, but I'm not following how best to document in the treatment note. Any suggestions?

  4. Absolutely not, which is why I continue to follow your blog and wisdom and have unfollowed many more that preach more painful treatment options. As I continue to practice I am leaning much more towards pain free vs painful. It keeps patient report and compliance up which in the end is very important since their time with us is limited to a few hours a week if that. Thanks for the reply

  5. No problem, just trying to make patients more comfortable with us, one clinician at a time. I wanted my reply to come off as a logical argument, not sounding like a jerk. Have a great weekend!

  6. Erson, I have to say that your points are conflicting. You say "be suspicious of people who say 'never' or 'always'", then you go on to say "never cause pain". Which is it? Two exceptions to your rule right off the top of my head - treatment of tendinopathy (it appears that training into some comparable pain is effective in triggering a remodeling response, dosage is important - this pertains to patients you term slow responders), and some soft tissue techniques in some patients depending on their belief system. It's just in the latter case, the pain probably shouldn't be exactly their comparable pain. I like how Paul Ingraham describes the likely CNS perception of that event: "Wow, that's such a strange, potent feeling that it must meant that the therapist has found something important and is fixing me! Yay" And lo, the actually feel the heck better. Because that's how pain works. (Remember: pain is impressively modulated by Mr. Brain's pre-conscious threat assessments.)" Thoughts?

  7. Jay, I never said that! Just kdding, I mean you should not cause pain when you do not have to. There are always exceptions, hence the never or always initial statement. Tendinopathy would be one, I do say for those slow responders that much can be done in the way of modulation of discomfort, but it will likely not be pain free. I have lost a few patients here and there as I transitioned to not beating on them. They went elsewhere because I refused to go to town on their ITBs. Yes patient perception of positive benefit is huge when it comes to treatment choice and expected outcomes, however, if I cannot convince them that it is not needed, I just refuse to do it so I don't compromise my principles.

  8. I'd be interested in some of your less painful treatment approaches for gaining ROM for patients s/p TKA. If you have any pearl to share, please do!

  9. I'll write about this next week! Have a great rest of weekend!

  10. Great post, Dr. E! I will live and die by this quote..
    always be wary of those who say "always" and never trust those who say "never"

  11. Lol, I thought no one caught that. Thanks for reading!

  12. Ha! I saw someone else bring it up already :) but I really do live by this saying..

  13. Yeah I figured I didn't make it up. I just like to think I did. Have a good night and holiday