I currently have a few patients on my schedule that have failed care at other physical therapy offices, and have responded very well to my treatment plans. This got me thinking. There are some common reasons why patients fail physical therapy. I’ve been too lazy to write them all down until now. So, here is my list.
Top 12 Reasons Why Patients Fail Physical Therapy for Cervical Spine Problems:
1. Too much stretching.
2. No deep neck flexor/serratus anterior strengthening/overemphasis on middle and lower traps.
3. Does not examine or address vestibular/coordination problems.
4. Does not address self-care, including sleeping and prolonged sitting.
5. Too much manual therapy/dry needling for cervical instabilities/hypermobility.
6. No manual therapy for limited joint mobility
7. Missed nerve root irritation at the level of the spine or at common entrapment sites in the neck, shoulder, and elbow.
8. Missed Shoulder pathology and/or dysfunction
9. Use of passive modalities
10. Does not consult or refer to additional providers when appropriate.
11. Missed dysfunction of anterior cervical muscles (SCM and anterior scalene)
12. Treating chronic neck pain like acute neck pain.
All of the above can best be described as incomplete assessment and treatment of the cervical spine. A complete examination should be able to find these problems in the < a href="https://www.metropolitanphysicaltherapy.com/" title="Well-Trained And Experienced Physical Therapist">well-trained and experienced physical therapist..
Part of the problem is provider bias, whereas client tends to push in a direction that the treating clinician feels comfortable, rather than clinician being pushed in the direction of providing the care the client actually needs. Great examples of this is the novice clinician who is really into dry needling and dry needling becomes the only modality they provide, or the myofascial release guru who only performs soft tissue mobilization and stretching, or the Pilates/yoga PT who only performed those exercise paradigms and no other approach. You get the idea. Incomplete care is ineffective care.
80% of the US population will experience some kind of debilitating spine pain in the course of their lifetime. Spine problems are typically the most common problem that presents to outpatient physical therapy clinics. This is why we specialize in spine care, because the most common problem is one that many PTs don’t specialize.
Our approach for spine care is comprehensive and systemic. We believe that excellent care is complete care. Excellent care is being able to apply what has been shown to work and not perform treatments that are either redundant at best or ineffective at worst. “Innovative solutions for pain” means being able to work through all the competing narratives of physical therapy to find the best approach to have you hurt less and live more.