Discussion: Put away the ice and tape

Not much support for physical therapy in this article:
http://www.nytimes.com/2010/01/07/health/nutrition...

Of course not. Because we all know this is the way to go!

;)

people can write anything they want. A lot of PT is probably useless, but some stuff is undoubtedly beneficial. I did not find this article helpful. The same regimen doesn't work in all cases, but some combination of ice, rest, stretching and strengthening eventually seems to fix most things. Just hard to know which to emphasize in an individual circumstance, and professional help may not be any better than asking your friends and experimenting.

I can't believe you have the audacity to call yourself "coach"...

This is the second time I have seen you post a link to a NY Times article which is utter utter tripe

For once I agree with Nixon. I find that article quite insulting. I don't treat my patients with voodoo but I'm well aware that there are also those physios out there who do. Just like there are doctors who don't even know what physiotherapy is...

From the article... When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.

-------------------------
When I've experienced PT it's always incorporated exercises as well which is where I find I get the greatest benefit. I've been very very impressed with how simple exercises (combined with the other pieces) that I've learned from my PT can resolve injuries that have otherwise been very persistent.

Then again, when I ignore my PTs recommendation and don't do the exercises it doesn't do too much :)

ice and heat don't cure tendinosis - what a surprise - long term tendinosis isn't an inflammation problem, and ice and heat are generally used in the acute phase of injury management in the first 48-72 hrs post-injury to minimise swelling and further related damage...

Nixon, I have no problem with ripping the NYT, but how about lightening up on "coach", unless you forgot to add some smiley faces.
There is a serious difference between posting and endorsing.

If he posts something with no analysis or comment of his own, it's reasonable to assume he's endorsing it. If coach thinks it's a load of tripe....why post it?

"If he posts something with no analysis or comment of his own, it's reasonable to assume he's endorsing it."

Wow.
Does this really need an answer?
Are you familiar with the concept of "food for thought"
At the very least we now have a worthwhile discussion thread, well until it got personal.

Doesn't seem like all that worthwhile a discussion from here - the qualified people have said "err...no", and everyone else has said "sounds like twaddle, but whatever." It's 'food for thought' in the same way that McDonalds is 'food'.

Coach's other effort (that Nixon was referring to) is here and seems to follow the same vein - blunt statement of 'fact' as the topic, link to NY Times article with no opinion or analysis of his own. General consensus (including from you): article is a load of either incomplete, misleading or just plain wrong.

I've had some doctor-prescribed PT that was overpriced and ineffective. I've also had some that was amazing and priceless.

This article seems like a well-written and well-researched **newspaper article** that is reporting a surprising finding from real researchers. I'm not at all surprised that it is difficult to figure out whether PT in the general sense is effective.

---The placebo effect---is real.

---Knowing that people are praying for you---makes you feel better.

---Going to a Physical Therapy office (that may or may not be owned in part by your physician) and having to pay a $15 copay (while your insurance company pays over $400) for 30 minutes of having a therapist measure range of motion and demonstrate some exercises, and then leaving with some fancy rubber bands---you tell me.

Maybe it's a difference in expectation in what a physio does? The article reads along the lines of "I've got an injury, I expect the physio to treat me until it's healed." My experiences are nearer Suzanne's - I go to the physio to:

- understand what the injury is
- find out what has caused it if not obvious already, e.g. a muscle weakness
- establish what *I* need to do to fix it, and prevent the injury from reoccurring - stretching, range of movement, strengthening exercises etc
- get an idea of how to return to exercise, and how long it will be before I can...

It might be necessary to go back if things aren't working/to assess progress, but I'm not going to go two/three times a week for the sake of it.

Physio is a very individual thing - there are likely causes for injuries but exact circumstances vary from person to person. The same treatment for a certain injury won't work for everyone. A 'clinical trial' type study would have to select participants very carefully to actually have any meaning - you can't say a certain therapy doesn't work if it never was going to in the first place...

@NIXON & ruhis

I often post items to AP that I think people will be interested to discuss regardless of any opinion I have about the item. Sometimes I have not even read the item. The point is, people may enjoy discussing it here, so I post. Opinionated discussions may be YOUR gig, but please go easy on those who take a different tack.

The article seeks to answer the following:

Is there rigorous evidence showing it (physical therapy) works?

Consider that what is conventional - remedies, etc - may not necessarily be constructive. The article does seem to oversimplify, given the numerous physical therapy techniques that exist - as Charlie points out.

Based on my own observations, I happen to think that both rudimentary things like RICE and heating and techniques from professionals are useful, but I can't point to peer reviewed studies exploring that topic. A simple google search would probably turn up some material, but I don't have the inclination at present. Of course, the absence of studies demonstrating the effectiveness of certain techniques does not imply that physical therapy lacks merit.

I have noted many personal criticisms on attackpoint that I do not think are constructive to the discussion and broader community goals. In the future, rather than criticizing or attacking individuals, rebut the information presented. Also, proof by assertion (e.g. "This information is obviously worthless") is useless in a forum. At least cite your own experience, if not something more robust like articles or studies.

@Nixon and Juffy

The NYTimes is one of N.Am's leading newspapers. Not everyone likes everything that they print, but people pay attention to what they print and its themes often get picked up by other media. This, to me, makes the article of general interest and worthy of discussion, and I appreciate it when coach or others bring these things to our attention.

But regardless, I do not recall anyone ever appointing you guys the AP police. We've all got along just fine for quite a long time without you telling us what is a good or bad topic for discussion. And the personal attacks are juvenile. Please stop it.

From the article, "“Very often, I think the hot packs, cold packs, ultrasound and electrostimulation are unnecessary,” he said, adding, “For sure, in many cases these modalities are a waste of time.”"

IIRC, the one time I resorted to physical therapy, it was a combination of ultrasound and electrical stimulaton that had a seemingly magical effect on an injury that hadn't got better on its own in more than a month. YMMV but I'm not willing to dismiss either technique as nothing more than a placebo in all cases. Nor, for that matter, was the doctor quoted above, though the other one using the word "voodoo" apparently feels differently, at least about ultrasound.

BTW, not to put too fine a point on it, a number of things MDs do aren't supported by rigorous science, at least so the media tell me.

OK, how about this one?

Requisite disclaimers: a) I only skimmed the article, b) it is from the NYT and therefore bogus?, c) and it is not on this subject.

But, I will add one personal observation, as people seem to require those now. I think the poor, benighted Mr. Feintuch simply did not work out hard enough. Or else the photographer(s) really had it out for him.

I would like to thank Coach for bringing these articles to our attention. I do not read the NYT too often and these references bring information related to our endeavors out for discussion, positive and negative.

My experience with PT has been mixed. The first applied much of the mentioned techniques with little result. The malady worsened over several years and another PT round with a different office identified a problem and provided stretches that provided relief.

As to the articles mentioned, I have found that the NYT provided links to additional articles of interest and worth perusing. Keep up the info flows.

I hope the comments from some crabby souls don't inhibit these types of postings. PT is something that most athletes experience. It is subject ripe for discussion on AP.

coach: Please don't let the nasties get to you. They don't know you.

Those of us who do recognize that your contributions to US orienteering in general -- and US junior orienteering in particular -- have been invaluable.

How many coaches have protege or progeny in the world championships of two quite different sports?

I think it is the Discussion heading "Put away the ice and tape", more than the article itself which is the issue. The article is superficial and what you might expect a newspaper journalist to write.

Injury rehab is a very individual thing. Personally I've only been able to be competitive at Orienteering over the last few years with the help of a physio. A runner I know visited 92 different physios/doctors/surgeons/osteopaths/medical practitioners/alternative practitioners before finding the person that could and did fix his problem. Paula Radcliffe will fly across the globe to visit a particular physio

FYI here are a few of the many NY Times and Globe and Mail articles featuring peer-reviewed exercise and nutrition research by Dr. Mark Tarnopolsky (adventure runner, orienteer and adventure racer in GHO) and other McMaster University researchers (Phillips, Gibala) over the last few years. It is important for athletes (especially young athletes) to learn the state-of-the-science knowledge as it is easy to be misled from TV and internet ads (and the odd newspaper article). So as GHO develops our new AdventureRunningKids.ca program, Patrick Goeres has arranged to bring in Mark to talk to our young kids once every few months. Given that McMaster also is one of Canada's leading PT institutions as well (with several graduates of that program here on AP), I've added a link below that is a response to the NY Times article featured on this thread by the Canadian Physiotherapy Association.

Tarnopolsky articles:

caffeine:
http://www.nytimes.com/2009/03/26/health/nutrition...

nutrition:
http://www.nytimes.com/2008/06/05/health/nutrition...

protein:
http://www.theglobeandmail.com/life/article1139578...

creatin:
http://www.theglobeandmail.com/life/article975991....

Canadian Physiotherapy Association response:

http://www.physiotherapy.ca/public.asp?WCE=C=47|K=...

I must have made a mistake and mistakenly put this under the "Opinion and Rant" tab. I'll be more careful next time.

Well, the article matches up fairly closely with my experiences.

And I agree with O-ing on the individuality of injury rehab.

Picking up ultra-endurance sports as a hobby rather late in life, I've suffered my share of tendon, ligament and muscle injuries over the past seven years; seen my share of doctors; received many similar diagnosis of tendonitis. Including a diagnosis in 2005 of permanent patellar tendonitis immediately followed by the advice that I should quit running. Since then I've received every form of treatment specifically listed in the (orginally posted) article and with many, I've had both good and bad experiences.

My observations and editorial opinions:

For the routine stuff, an average doctor is probably just fine. But what I've found in my sampling of 'average' doctors is that their depth of knowledge on sports injuries (and treatments) is fairly shallow. Everyhing is a sprain or tendonitis treated with rest, ice, heat, and anti-inflam. For orthopedists, it's much the same, but they'll also send you to PT and perhaps administer the dreaded steroid injection.

My point is that sports injuries are a specialized sort of injury, so go to a doctor who specializes in that area of medicine.

The chronic injuries I was suffering from didn't start healing until I found a Dr who really practices sports medicine and knows how to recognize and treat overuse injuries.

Not to be forgotten, I have also benefitted from three great PT's who taught me how to prevent injuries with strengthening exercises and stretching.

One last thought: Sometimes, every once in a while, a treatment that seems like 'voodoo' turns out to be a really great thing.