New to Physiotherapy? 8 Myths to Ease Your Mind

General Physio Myth:

Myth: I must get a doctor’s referral to see a physiotherapist.

Fact: In Ontario, physiotherapists are considered primary health care practitioners. This means that they are equipped to be your PRIMARY contact in the healthcare system.

So, in short, you definitely do NOT need a referral to see a physiotherapist.

That being said, some insurance companies may still require that you accompany your physiotherapy claim with a doctor’s referral.

This is something that will hopefully change in the future.

Human Body/Position Myths:

Myth: My bad posture is causing my back pain.

Fact: Most of the scientific evidence does NOT support the claim that back pain is caused by posture.

This alone could be a blog post. In fact, here’s an excellent one from Todd Hargrove on ‘Better Movement’.

That blog post provides multiple references to show that:

Most studies show no correlation between posture and pain Some studies do show a correlation between posture and pain,

However, correlation does not mean causation (this means that people who sit with ‘poor’ posture may also report back pain, but no study has shown that the actual CAUSE of their pain is their posture (pain is very multifactorial)).

That blog post also provides possible reasons as to why the research says this and what we can do about it! Go read it!

Tyler’s additional notes: Research says there’s no such thing as a “bad” posture.

However, if you think your posture is causing you pain, MOVE! Although 1 particular posture isn’t “bad”, remaining completely static in any single posture is likely to cause some discomfort. 

“The only GOOD posture is one that is often changing!”

Myth: The result on my MRI/x-ray/scan (i.e. a disc herniation), is the source of my pain.

Fact: I’ve written a full blog post on this (see here: Try Not To Become A V.O.M.I.T), and I’m pretty passionate about this topic.

In short, multiple studies, on most body parts, have shown that many scan findings are also present in healthy people with NO PAIN.

This means that in most cases, imaging results DO NOT CORRELATE with pain and function (for example, ‘severe arthritis’ shown on an x-ray does not mean you will have ‘severe pain’ or a ‘severe loss of function’).

Tyler’s additional notes: Pain science education is a crucial part of understanding the source of your pain. Melissa (a local counsellor), and Mike wrote an excellent blog post about pain, here: Why is My Pain So Stubborn

Myth: Our joints go out of alignment, or out of place (i.e. My back/hip is out of place, so I need to get it adjusted back into place). 

Fact: Sure, our joints can go out of place. It’s called a dislocation, and it’s a serious injury. It did not happen just by walking around.

If you had a significant trauma or accident, go to the hospital for proper evaluation. If you hurt something as part of an everyday movement, it’s highly unlikely that something is out of place.

Our joints, especially our vertebrae (back joints), and hip joints are very strong and robust. They don’t go out of place.

This started (hopefully) as a poor miswording, and things have gotten a little carried away! 

Treatment Myths:

Myth: The crack I hear/feel during a manipulation is my joint going back into place.

Fact: Since nothing was out of place to start with, nothing was put back into place with the manipulation.

The noise you heard was most likely air being released from the joint, and the reasons you feel better afterwards can be related to other factors (i.e. supraspinal effects (like endorphin release), and decreasing muscle tone).

Myth: Sitting on an exercise ball at work is giving me a good core workout.

Fact: Here’s the conclusion from a study comparing sitting on a ball vs. sitting on a stool: “prolonged sitting on a dynamic, unstable seat surface does not significantly affect the magnitudes of muscle activation, spine posture, spine loads or overall spine stability.” (McGill et al., 2006).

Therefore, no, unfortunately sitting on an exercise ball while you work does not give you a six pack. 

Reference: McGill, S. M., Kavcic, N. S., & Harvey, E. (2006). Sitting on a chair or an exercise ball: various perspectives to guide decision making. Clinical Biomechanics, 21(4), 353-360

Tyler’s additional notes: Thank you, Krista (my beautiful wife), for trying to help spread the word on this one!

Myth: Therapeutic ultrasound is an effective modality for treating my pain/injuries.

Fact: In 2001, a review on the effectiveness of therapeutic ultrasound was conducted and published in “Physical Therapy” (a scientific journal).

Here is the conclusion: “There [is] little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing”. 

Source: Robertson, V. J., & Baker, K. G. (2001). A review of therapeutic ultrasound: effectiveness studies. Physical Therapy, 81(7), 1339-1350.

Tyler’s additional notes: This was 16 years ago, and yet therapeutic ultrasound is still widely used.

In my opinion, we should switch our focus to more movement, exercise, and pain science.

Myth: No pain, no gain.

Fact: Modern pain science research has taught us that the “no pain, no gain” mentality is often not effective.

When healing from most injuries, I prefer the saying: “Know pain, know gain”. Use your physiotherapist to help you understand what levels/locations/occurrences of pain are safe, and which are not. 

Tyler’s additional notes: Admittedly, there are cases where pain may be necessary to make appropriate changes with rehab (i.e. after a knee replacement, or in cases of longstanding (chronic) pain), but that doesn’t mean that pain science doesn’t play a role. Also, we treat individual people, not injuries. Nothing is one size fits all.

Thank you for reading! If you have any other potential ‘myths’ you are curious about, feel free to ask us on social media!

Our Facebook page is ‘Strive Physiotherapy & Performance’, or you can find us on Instagram @striveptandperf.

Be informed, and keep moving!

Cheers,  Tyler Allen Registered Physiotherapist

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MIKE MAJOR, PT

BSc Kinesiology, University of Waterloo MSc PT, McMaster University

Physiotherapist

Born in Lahr, Germany

Mike treats people of all activity levels and ages from weekend warriors to elite athletes. He has mentored physiotherapists across Ontario as well as worked on the Board of Directors of the Ontario Physiotherapy Association. Recently, Mike represented physiotherapists within the Pan Am/Para Pan Am Games Medical Services Expert Provider Group. Mike has also had the opportunity to work side by side with orthopaedic surgeons, allowing him to work with many people following complex and traumatic injuries. Mike also consults over 1,000 physiotherapy cases nationally. This has given him a lot of insight into what Physiotherapy looks like across Canada.    

Prior to becoming a physiotherapist, Mike served in the reserves for 9 years as a member of the Artillery in the Canadian Armed Forces. He also enjoys coaching local athletes to help improve their performance through MeFit, a local not-for-profit organization.

What Really Matters...

Cats or dogs?

Dogs.

Worst idea you've ever had?

Skiing behind a car.

Worst fad you've ever participated in?

Rat Tail

Do you have any kids?

A baby named Maverick.

Last book you read?

Together is Better: A little Book of Inspiration

Most useless talent you have?

Sewing

 

What 3 things are you bringing with you, stranded on a desert island?

A multitool, My Wife, and our baby

Biggest Pet Peeve?

A multitool, My Wife, and our baby

In your high school yearbook, you won/would have won...?

Most likely to get stuff done

What song would play every time you enter a room?

Eye of the Tiger – Survivor

 

“It’s not the size of dog in the fight, it’s the size of the fight in the dog”