March 4, 2020

In January of this year, The Journal of Orthopedic and Sports Physical Therapy (JOSPT) published an article that caught our attention. JOSPT, one the most distinguished and respected journals for physical therapy in the field of orthopedics, generally publishes literature reviews and research studies with the aim of identifying and improving quality practices for physical therapists. In January they published a different kind of article titled “The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice,” a piece that expressed the view that we in orthopedics are seeing too much over-diagnoses, over-medicalization, and over-detection (or over-imaging) that has led to over-treatment and mishandling (not to mention confusion) for many of our patients. As orthopedic physical therapists, the article spoke to a reality that we’ve experienced and witnessed too often.

In our clinic we commonly have patients who are not only seeing us for their musculoskeletal pain, but are also seeing massage therapists, acupuncturists, and chiropractors among other clinicians, all while taking a steady diet of non-steroidal anti-inflammatory medications. While each of these practitioners and modalities may have some benefit, it is the variety of (potential) mixed messages and constant search for a “fix” to one’s limitations and pain that can lead us down the path of “Too Much Medicine.” It is our role as healthcare providers to identify when a patient may be experiencing “Too Much Medicine” and to intervene in the most appropriate and effective way.

When we encounter patients whose experience mirrors that of what was just described, we commonly address several key take-aways:

  1. Rehabilitation is a process, not a fix. Additionally, the process is commonly not a linear one but rather one that ebbs and flows and with peaks and valleys.
  2. “Abnormalities” found on imaging may actually be normal. We have a wealth of scientific research that shows that “abnormal” findings on imaging such as spinal disc bulging, joint arthritis, and bony changes are commonly found in people experiencing no pain. More importantly, many of these imaging findings are what we would consider normal age-related changes and are not a cause for concern but instead may inform us when developing a targeted home exercise plan and an individualized physical therapy treatment strategy.
  3. More health care is not always better (Too Much Medicine!). Having multiple providers, hearing a variety of diagnoses, and being treated in a multitude of ways can lead to developing more questions than answers. When this happens, health concerns are amplified rather than soothed.

What can you as a patient do to not fall victim to “Too Much Medicine?” Luckily, physical therapists get to spend a good amount of time with their patients. Take the time during your treatment sessions to ask questions about your condition. Having a better understanding of what will help in your recovery, what things to avoid, and defining expectations are a crucial part of physical rehabilitation.

Have any questions? Feel free to contact us at [email protected]