Hands-off treatmets..Better than hand-on???

[quorthon]

Hi fellas....Recently i start wondering about the comparison between hands-on treatments (like manual therapy,massage...) and hands-off (as Mckenzie,exercise therapies and so on)...
I am really keen on the second of those both for reasons i ve seen in practice like better outcomes, long-term relief for my patients but since some weeks or a couple of months to be precise i witnessed a drop in new patients-flow in my private practice...The fact that i ve heard many of my clients from time to time moaning that i never "touch" them, even if they are really getting better with the methods i am implementing...
Sometimes i perceive a widespread belief among new patients coming to my clinic that they just need your hand on them, even for a temporary relief, without caring about the long-term!
Do you really think that the complete reliance on hands-off methods can be have a negative impact on marketing of a private physio clinic, and of course generate income loss???

Thanks for any reply!!

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[ophqui]

Definitely. If you can be accused of 'not doing anything' then your business will suffer from bad word of mouth, no question, even if its just from the few ignorant patients. Its about their perception of physio. You can go on about evidence till you're blue in the face but its pretty meaningless when your patients are disappointed that their not getting the hands on treatment they were expecting. They can always go get it somewhere else

[quorthon]

maybe you are true...in fact even the "pleased" patients which had been treated by "hands-off" methods will not have the same influence to their friends or family members saying that the therapist didnt apply so much his hands on him..Despite that they got better....From a personal standpoint, physical therapy is not just "hands-on"-oriented, there are many more features incorporated, such as proper use of assessment, history-taking, patient-education which we all need to consider seriously during treatment sessions...Sometimes though, patients dont seem to like this, to tell the truth....It is common when a patient presents for a follow-up session and when he is asked if he done his exercise-programm, he said "am i really supposed to do that, since u the therapist will "fix" me???

[ophqui]

Hmm i think its just about communicating effectively. If you can make it clear to the patient that whilst soft tissue techniques etc will provide symptomatic relief but its the home exercise programme, ergonomic changes etc that will ultimately fix the underlying problem. . .then you win! Its about giving the patient the best of both worlds

I think a good physio will manage to toe the line between not laying a hand on patients and making the patient reliant on you to 'fix' them

[gcoe]

I think we all intuitively know something about the power of laying on hands on a day-to-day basis. but at the evicdence level almost all guns point to the benefits of active exercise and physical activity. Knowing more about the beliefs about our patients have about constitutes effective therapy is a key area that needs to be properly investigated. Yet it is a key area in health psychologybwhen it comes to medications, surgery, and lifestyle interventions as it is a principle factor in whether patients adhere to treatment and attend followups. And simply providing education that it is "better to keep hands off" has a poor track record for persuading our patients. I think we have a lot to learn about 1) the psychological and physiological benefits of touch - did we make a mistake when we chucked out the massage as a core modality? 2) patients perceptions about what makes a an effective therapeutic experience. Finding this out doesn't negate or stop us from using the most effective hands off approaches we have available. But it does mean that we could use our hands more discerningly rather than in the service of false claims.

[Sole Man]

Definitely. If you can be accused of 'not doing anything' then your business will suffer from bad word of mouth, no question, even if its just from the few ignorant patients. Its about their perception of physio.

Patient communication is an important element here I think, once they are aware from the get-go that physiotherapy is somewhat different to what they might be expecting, their expectations change.

[olaoluwa]

Re;Hands-Off treatment better than hands on
Hi,
there has to be a balance with the to modalities,but i think hands-on boosts patients Morale and increases their psyche,and this helps in patients response to treatment

[hijump]

HANDS on treatment is preferable by me .........modalities are assistive devices with help with it...like for breaking spasm.

[Braedan@ Physio Surrey]

Quorthon,

What I like about your practice is that you seem sincere in wanting optimal patient Outcomes. This is, in the end, all that matters. I tell my patients that if juggling chainsaws would make them better then that is what we should do. I really like that you have the courage to change your practice, since so many just plod along year after year, doing same old- same old ...

I would caution you about how you exercise that boldness. I personally, am very good at exercise, and communicating the need for that exercise. I have built and run regional athletic performance centers that serve the needs of major cities elite and developing athletes. I say this to say that I am " an exercise guy."

Even though I am an exercise guy, there are many things that I can change better with my hands. If we use exercise to adapt a body tissue, can't we also use our hands to adapt other body tissues? If exercise "fixes" everything, why has manual therapy existed for centuries? Why do people pay good money for it?

Until ALL of your patients get Fast, Complete, and Total outcomes, why would you limit yourself in the tools that you would use to advance the patients case. hopefully not because of sparse research evidence on a subject matter that is light years away from being Fully explored by science. The jury is not in when it comes to clinical orthopedics. We musn't look at what we have and assume that its the whole picture.

Not using our hands in our PT practices, to me would be like choosing to not use my mouth (like when there is a language barrier), or my eyes ( a physio in my home town is completely blind), or exercise equipment (you can get a great strength workout with an eight inch step and a stopwatch) ... We all know that none of these clinical situations is 'optimal', but they are all 'doable'. We owe it to our clients to become experts in All areas, and use whatever we can to help optimize outcomes. Lets keep our boots firmly on the ground and our hearts attentive to the struggles of the injured folks in the trenches.

The danger in reading another handful of research papers is if we let those papers blind us. Science should open our eyes so we need to be cautious in throwing out what any grey haired clinician can tell you can help. There is a qoute from an old doc named Osler, asking physicians to listen to their patients. Many of the best of us would agree, from Mckenzie, to Maitland, to Mulligan, to Cyriax.

Good luck with your practice. If you stay dedicated to your clients needs, they will notice, and your practice will thrive ... And most importantly, you will help your community.

Canuck clinician
From Total Outcomes Physio Surrey