Thank you for your response.

You seem quite scornful of scientific theory. In my opinion physiotherapy is a health science. Sound theories don’t arise out of a vacuum but out of a need to better explain the results of experimental research. Theories don’t change with the wind. Occasionally they may start with a sudden insight, sweeping away what went before but more often theories evolve slowly. Changes don’t happen overnight. And theories do need to be updated as new research comes to light. I think this is a good thing. Far from making such theories unreliable keeping up to date with such theory can provide you with a much firmer foundation on which to base your clinical reasoning.

quote: "Wouldn't it be better to see if a system works and if it works to proclaim (in case PNF does work) that the theory behind it is outdated but that PNF does work."

In these days of evidence-based practice an intervention to be considered effective must meet two criteria:

1. To start with it must have a sound biomedical basis. If there isn’t a sound basis that is rooted in such things as movement science then we are not even off to square one. It is quite possible for techniques that have no understood basis or a poor basis to be effective. But the likelihood that it will turn out to be effective is greatly decreased. Rather then shooting in the wind and hoping we might hit the target by some random chance, why not choose interventions that are more likely to hit the target based on good science. Having a sound basis for an intervention improves our ability to reason through the use of the intervention and how better apply the technique.

2. It must be backed by sound research that provides evidence for its effectiveness. Now days we expect that interventions have a good track record with replicated randomised clinical trials, and hopefully we can someone has pooled these trials into a systematic review of the intervention. Anecdotal evidence provided by a physio is not an adequate standard for evidence that a technique works.

My point here is that PNF fails on both these counts. Relying on a biomedical concept that dates back to the beginning of the 20th century and that has been hugely surpassed by an enormous amount of science is not a sound justification for evaluating a technique. PNF has some evidence for stretching in sports and orthopaedic settings but that is not why we are using it in neuro. We are interested in strengthening for improved function. There is also little evidence for employing the technique. I found two trials that examined PNF, both of poor quality (3-4/10 PEDro scale) One study supported its use and one study showed it was no better than other methods. This is not good evidence for PNF. 60 years after its appearance; I think we could have a bit more evidence than two weakly designed studies:

PEDro - Selected Search Results

Quote: “I am not sure but I feel this sort of assault could be on every principle within physiotherapy treatment. e.g. Wikipedia reference-linkBobath, spinal manipulation and so on”

This is exactly right! I am not singling out PNF. For example Bobath comes in for exactly the same limitations as PNF. – except in the case of Bobath there is more evidence but the evidence discourages adopting it. As health science professionals we should be questioning what we do and we should be coming up with better interventions as our knowledge of what works gets better.

A few years ago there was not that much evidence for neurological physiotherapy. That has now changed and it is getting better.

Strengthening techniques such as FES, biofeedback, progressive resistance training, component practice in walking, to a limited extent body weight support treadmill training, distributed practice and summated feedback on gait are just to name some techniques for improving gait.

Likewise our scientific understanding of what we are doing has greatly improved. So rather than getting stuck on techniques with little scientific merit why not make use of what is out there.