why SWD and IFT in sciatica?

[outbackphysio]

Evidence Based Physiotherapy.... required so that we can substantiate what we do to the rest of the medical/scientific fraternity but aren't we all smart people with our own ideas? We enter physiotherapy so that we can help people and different people respond to differenct forms of treatment... i.e. some prefer hands-on therapy others prefer electrotherapy. I am definately a hands on therapist who prefers to introduce the patient to self-management techniques (mainly due to my remoteness and the fact that in most cases I may only be able to see that patient once a month). It is all well and good for us to have the studies to support our treatments but in the long run it comes down to that individual patient and the individual clinician. Physiotherapy is never going to be a black and white science.

[alophysio]

Is it a science at all?

I have re-read the posts above.

I accept that others like electrotherapy and others (like me) don't.

In context, I think a thorough assessment, examination, diagnosis and classification will lead you towards the most appropriate treatments.

Next, how many of us have actually done post-graduate training (e.g. Masters in Sports pHysiotherapy or Manipulative Therapy)? Perhaps we all should consider improving our skills in this way - i started my masters last year after 10 years of clinical practice. I should have started a little sooner!

Lastly, it is hard to provide research in a double blind RCT for manual therapy because a good manual therapist doesn't apply the one treatment in isolation, nor do they apply only one treatment technique to ALL subjects. Also, you cannot "blind" the therapist to what treatment technique the patient is having. Nor can you have a manual therapist provide a placebo without being blinded.

Obviously for electrotherapy, it is not used in isolation (although you do hear lots of stories about electro without much else...), it forms part of the overall management of the patient. But with these studies, you can have both the patient and therapist blinded because you can just make the machine LOOK like it is working when it is not, especially U/S. So theoretically, the studies on electro should be of a higher standard because the therapist never knows if the machine they are using is actually working or not.

Anyway, more food for thought!

[asha]

After reading through all the posts, I totaly agree that it not science at all to depend on swd/ift in sciatica. If we were to concentrate on finding the cause of sciatica and release the patient of it, pain relief automatically follows.
As someone has written in one of the posts,

I am often frustrated by physios who look down on certain modalities, while maintaining that their particular approach minus modalities is the only one that promotes "professional status". These people, in my opinion, are focused on the diagnosis and not on the holistic treatment of the human being in their care.

it is not looking down on certain modalities, nor is it that our particular approach minus modalities is the only one that promotes "professional status". It is not that we are focused on the diagnosis and not on the holistic treatment of the human being in our care. If my treatment is backed by a good assessment, I do not need any modality to bring relief of pain to any patient. In fact since most of my patients are direct contact patients,I make it a point to tell them to come for their assessment & their sessions without taking any NSAIDS. This lets me know exactly what effect my treatment has had on the patients symptoms. I emphasise on modality on those patients who are a little sensitive and equate the time spend at the clinic to the price they are paying , and do not concentrate on the relief obtained. In these patients again I give the modality according to what is most convenient to me at that point of time.
Regarding alophysio's comment that the therapist never knows if the machine they are using is actually working or not, I think that would be unforgiving. If I do not use my U/S for a period of time, I always make it a point to test it before administering it on a patient. Even if we use the modality for a placebo effect, one must see that they in working condition.

[alophysio]

Hi,

Thanks for your comments asha.

My point about the electro machines not working is that when you design a study, it is more likely to be of a higher quality for electrotherapy because you can blind the therapist.

That is, the therapist doesn't actually know whether the machine is working or not and so that level of bias is taken out of the equation.

Therefore, if there is equivocal research on the use of electrotherapy, then it is stronger evidence that it may not work that for manual therapy simply because the research design is different. Because Electro studies can be DOUBLE BLINDED (MT cannot be for reasons discussed earlier), it is more rigorous evidence that is works or not works.

Obviously in the clinic, you would test your equipment and make sure it is working before using it!

I hope that helps!