Myths abound in musculoskeletal medicine. Most are offered up by primary care providers that have very little, if any training in this area, and this has been proven. They then refer their patients to physical therapists (usually employed in the same system) who follow their recommendations for care, because these therapists want to “keep the business”. Sadly, in my 40 years experience few primary care providers or therapists keep abreast of what current evidence shows to be true, and keep on doing the same stuff they were trained to do – sometimes these interventions have been shown to be harmful!
Below is a list of “Scottisms” that I compiled because a physician friend of mine asked me to.
- Trochanteric bursitis does not exist for the most part; it is almost always something else causing the lateral hip pain.
- Scapular dyskinesis is a popular diagnosis that is looking for a definition (like fibromyalgia).
- Sciatica or compression of a component of the sciatic nerve is rare (but not in the Lafayette, Indiana area) and has not been shown to be caused by repetitive lifting, bending, or twisting.
- Research has not shown that stretching can prevent injuries.
- Almost all traditional mechanical factors, such as lifting, deemed culpable in NSLBP (Non-Specific Low Back Pain – NSLBP is low back pain not caused by more obvious factors such as cancers) have been debunked in recent years.
- In order to help folks with NSLBP and other musculoskeletal problems one must first de-program them; thus education is paramount to success.
- For a program to be successful, patients must receive the same message based on available evidence from all involved in their care.
- Ruptured or herniated discs, and degenerative changes are common findings even in young asymptomatic people, or as Josh Levin MD says it, “a normal MRI is abnormal”; most imaging is not helpful and may lead to harms for people with NSLBP.
- A specialist referral for NSLBP often places the patient at unnecessary risk for unproven, risky and costly interventions, i.e. injections, medications, imaging, surgery.
- Most times a referral for NSLBP should be made only when it is known that therapy has not been helpful and there are no “yellow flags (psychosocial issues)”.
- There is only one proven intervention for NSLBP that is effective, safe, and low cost and that is Physical Therapy with manual therapy and/or manipulation, exercises, and education.
- A Physical Therapy evaluation can help delineate the problem. The orthopedic PT has been shown to be equal in outcomes to the fellowship trained orthopedic surgeon but generates lower costs.
- The overall effect on the quality of life of NSLBP is low in the very young and adults that do not seek healthcare for it. Medical management usually exacerbates the problem, not relieve it.
- Most rotator cuff tears – even full thickness – do not need surgical correction; many times care plans are based on imaging findings versus clinical findings, contrary to most expert and evidenced based guidelines.
- Psychosocial issues and depression are infrequently addressed or poorly managed in folks and often leads to medicalizing and medical overtreatment or treatment that is risky, and not likely to produce a good outcome.