Simon, you will always be able to go to the literature and find a couple of articles contradicting the status quo or another profession. That's the nature of scientific research. However, the truth is found in many articles, not a couple. And consensus amongst informed peers is usually required to interpret the significance of a couple of novel findings.
The problem with what you are inferring is thus:
- the musculoskeletal and manual therapy literature is polluted with many poor methodologically designed papers. Before 1995, the physio profession was just as guilty of this as others. The chiros and osteos have been slower in improving their study design, though are beginning to produce some good stuff.
And I should add that there is very little evidence base for much of what the medical profession currently do. One example is that orthopedic surgeons heavily prescribe arthroscopies for arthritic knees. There are several papers saying the outcome of these operations are far too ineffective to be used so generally. Unfortunately, the operations are quick and relatively complication free, and are great profit spinners for the surgeons. Another example is that of long term outcome for cortisone shots into plantar fascitis and rotator cuff tendonosis.
Nevertheless, I am one of the biggest critics of the use of electrotherapy and ultrasound in physiotherapy. Early studies in support of it were designed poorly. Recent evidence suggests their efficacy is no better then placebo in most instances. And I would congratulate many of the Aussie physio schools for having adapted to that research comparatively quickly, as they have cut down heavily on its significance. The chiros and osteos are generally slower to evolve their therapies in the light of hard research.
- the definition of what constitutes physio prescribed low back pain exercise and general exercise is highly variable, especially between different countries. Indeed, what constitutes physiotherapy in different countries is highly variable. For instance, much of what is taught as physiotherapy in Australia, is taught as manual therapy in Holland, Scandinavia, the USA and Canada.
I would add that low back exercise as prescribed by physios is evolving rapidly, as the research continues to gain more funding. What was taught 2 years ago has evolved tremendously. Meanwhile, many people have jumped on the bandwagon trying to exploit the latest science about low back pain and core stability exercise. The worst lot is the Pilates movement. Much of what they are pushing was not taught by Joseph Pilate. The Pilates industry have just picked up on what has come out of the pure research being done by the physiotherapy and sports medicine disciplines, and have been more effective at marketing via Hollywood bodies and infomercials.
- I would agree that many inexperienced physios, who are not clinically experienced, do not prescribe a balanced exercise program. They focus on core stability, and thus ignore the importance of a more wholistic program. However, a good physio with a view to getting a long term self managed outcome for their clients, will get the balance right. That is how I work and more and more physios are.
I don't know of any chiropractors or osteopaths who leave their clinic to attend a gym to instruct people on a complete exercise routine. Here's a link to a sample generic wholistic exercise program I start with.
http://www.tekserv.com.au/bruce/AntiAgeing%20RxEx.xls
the company car i drive is not the latest model.... mid 90s hilux and the seat is just losing its support... i'm thinking of getting a back support when i drive... anyone know where to get one?
