Welcome to our series on “Crazy Things In PT.” You can find other posts in the series via these links – Outdated Interventions, Postural Restoration, Crazy Manual Therapy. Before we begin, here’s a little note from the management:
These articles are intended to show some of the things currently done by physical therapists around the US and around the globe. There are many very well meaning PTs out there and we are not in this to shame or accuse specific people of evil motives, only to expose specific theories and/or interventions in physical therapy. We acknowledge that patients do get improvement with some of these techniques, but strong claims call for strong evidence to back it up. Remember, some people do get better after taking a sugar pill.
Individuals will be used as examples from their own videos or published articles, but in every case we will use as much of their own material as possible so they can speak for themselves. Oh, and this is not an educational/research site, so if you have a problem with satire you should just move on.
Oh boy. The sacred cow of physical therapy…exercise. Truth is, some exercises are just stupid. And for this post we’ll be focusing on stupid exercises, corrective exercises, and things that loosely fall under the term “exercise.”
Let’s get something out of the way right now, is there anything more stupid than the “empty can” exercise? First off, it’s unnatural. Second, for many people it’s painful. Third, it’s stupid.
If someone has pain with a combination of shoulder internal rotation and elevation, maybe you shouldn’t have them do it as a strengthening exercise! Think, just a little.
While we’re talking about the shoulder, let’s talk about a really popular stretch given to many people having trouble with internal rotation. I’m talking about the “sleeper stretch.” The crazy thing is, if you do this “stretch” to a person while they’re sitting up, it’s called a Hawkins-Kennedy impingement test. How many tests for shoulder pain do you make into exercises? Think about that for minute. Plus, look at how dumb this is, even this cartoon guy is pissed off about it.
My last shoulder exercise is the shrug. I know soooo many PTs that give their post-op shoulder patients shrugs as an exercise for their home exercise program. WHY?!?! Seriously, have you ever seen a post-op shoulder patient try to lift their arm? All they do is fire that trapezius muscle. In many people, it’s so excessive that you have to really work to get rid of this “shrug sign” so they can lift their arm over their head! Is it really a good idea for them to work this muscle MORE?!
Can we talk about stupid “core” exercises? If you patient requires maximum verbal and manual cues to perform the exercise correctly, do you think they’re EVER doing it correctly at home? If they can’t perform an abdominal brace in hooklying, with your constant cues, with the soothing sounds of Kenny G in the background, do you think it’s something they’ll be able to do while doing anything remotely functional? Here’s an inside tip: the only time Winfred is doing them is when he is on the crapper…and he’s holding his breath…let’s say a prayer right now that he doesn’t have a stroke. Don’t die on the toilet Winfred.
Are you having your patient do extension exercises? Do they know that the only way to have a strong back is to also have a really dumb looking spray tan? Seriously, take a second and do a Google search. This is what you get.
Are you one of those PTs that tells your patient that their knees should never go ahead of their toes? If so, I’d love for you to show me how to get up out of a chair or go down stairs. There’s a different between trying to use your glutes more and being realistic and functional.
Stool scoots. For making your patient be the best damn office chair racer in the company. Really, this exercise may engage the hamstrings, but it’s in a limited range of motion and there’s no chance of your patient doing this at home. This might sound crazy, but squats and lunges work the hamstrings pretty damn good.
Quad sets. If your patient isn’t immediately post-op and you have them doing quad sets every visit, you need to retire. Just stop being so stupid.
Does rotating your hip when you squat/lunge/perform a quad set really change which part of your quads are engaged? Is that what you think happens?
This Is The Most Important Part Of The Post!
Gotta end this somewhere, so this is the best place. If you have your patient do the same amount of reps, with the same weight, for different exercises targeting different muscles, you are a stupid therapist. 10 reps of shoulder external rotation is very different than 10 reps of shoulder abduction, so why would they do the exact same amount of reps at the same resistance?! What are you trying to accomplish? Do you know how strengthening happens? Are you doing anything of significance? Or are you just trying to fill up the time slot so you can bill that extra therapeutic exercise code? Use your damn brain. Take a refresher class on exercise science if you need to. The profession needs you to not be a shitty PT, otherwise you drag the rest of us down with you.