05/03/2026
Following my post yesterday, many physiotherapists commented. I won’t be able to reply to everyone individually, so I’m addressing it here. Some colleagues agreed with me, but I would like to respond to those who disagreed.
First common excuse:
Patients don’t like exercises, they want electrotherapy.
Blaming patients instead of improving our communication and clinical reasoning is not acceptable. When a patient demands a specific treatment, it often reflects a lack of understanding or trust. That means we may not have adequately explained their condition, prognosis, and the importance of their active participation in recovery.
Have you ever seen a patient dictate antibiotic choice to a physician during a consultation? No. because doctors educate, guide, and lead the plan of care. Evidence consistently supports exercise therapy and patient education as first line management for most MSK conditions. Passive modalities may be used as adjuncts, but they should not replace active rehabilitation.
Let’s not blame patients. Let’s improve how we educate and empower them.
Second common comment
My patients improve with this approach.
This is not strong scientific reasoning. Many MSK conditions are self limiting. DOMS, minor spasms, and several acute injuries improve naturally over time, even without intervention. Natural recovery should not be confused with treatment effectiveness.
We see Quacks (Athai) in rural and urban areas whose patients sometimes report improvement. Does that mean they practice evidence based care? Of course not. Improvement alone does not validate the method.
Physiotherapy should make patients independent, not dependent on repeated passive sessions.
Third point raised
A few said TENS, US, IFC etc work effectively, and questioned who is using them incorrectly.
This argument is misleading.
Modalities such as TENS, US etc can provide short term analgesic effects in selected cases. However, high quality clinical guidelines consistently show that their effects are generally small, short term, and inferior to structured exercise based rehab for long term outcomes in most musculoskeletal conditions.
If a modality reduces pain temporarily but does not address strength, mobility, motor control, or functional deficits, it is not solving the core problem. It may reduce symptoms but it does not necessarily improve function or prevent recurrence.
Using electrotherapy as an adjunct is reasonable. Using it as the main treatment plan is not evidence based care
The goal is not to eliminate modalities completely, but to use them appropriately and not overestimate their value.
Fourth common phrase
According to my experience...
Clinical experience is important, but it does not override research evidence. Evidence based practice integrates:
1 Best available research
2 Clinical expertise
3 Patient values
Relying only on personal experience is outdated. Healthcare evolves. A physician does not treat malaria today the same way it was treated in 1990 because research advances practice.
Similarly, a positive Neer test from 1978 does not automatically confirm subacromial impingement syndrome. Many special tests have limited diagnostic accuracy when used in isolation.
We must move from tradition based practice to evidence informed practice.
Physiotherapy is a science. If we want professional respect, we must practice like a science driven profession.
