This is the crux of it, but there is more to it. Look, we all have to start somewhere and the truth is experience matters. Not all PT’s get the same education in school, and after that forget about it, it gets wild. Post graduate training is all over the map. I can take a geriatric course (even though I do Orthopedics and that still counts as my con-ed for the year). I can’t recall the exact study but it showed less than 40% of PT’s actually go on the take continuing education they are responsible for (ie. not just sit in some class for 3 days and collect a certificate but actually test out and get some post graduate certification for showing you know the material). The other thing is imaging. Did they do flexion and extension films (ie. actually test the stability), or was this recommendation being made solely on a static MRI or plain X-Ray? I can think of one patient I saw with a Spondy and the Surgical PA told her they could guarantee a 100% successful outcome with surgery. Ended up that she had kidney stones (and that was the main cause of the LBP she was having) and when they compared her current MRI (after the onset of pain) to an old one (when she didn’t have that specific pain) the Spondy had not changed at all!
Get educated on the matter, and varied opinions. I’ll be honest and say at times I want to not be associated with the healthcare industry because of the nonesense I hear about every day in the clinic. Patients seen for no time at all, a wave of patients in and out on the hour like some sort of cattle drive, clinicians not actually listening to what the patient is saying and just running on their clinical bias’, patients barely supervised (if at all) by techs and not even licensed providers.
My opinion is you should see results, if not day one, within 3-4 weeks tops. Please don’t be one of those patients that works with someone for months on end but is not getting better (or worse yet, is getting worse). I used to spend a lot of time trying to educate the Docs about this stuff. Sadly, many have financial relationships as either owners in a PT clinic or have relationships with the providers. I have come to realize the people that need to be educated are the patients. So, here I am trying to educate the public one patient at a time :).
At the very worst this is something you can work around (and still be lifting). At the best, it’s a radigraphic finding with little if any clinical relevance. You have seen providers so we can (hopefully) surmise the nasty things have been ruled out (like progressive neurological deficits, etc).
McGill has some excellent work and insights. I have read most of his books and attended his seminars. Personally I think he overlooks some simple mechanical stuff we see using MDT, but in the grand scheme of things he’s at the top of the heap with regards to providers that “get it” when looking at back pain.
As an aside, there is a very eye opening book that came out called “crooked, examining the back pain industry”. There is a lot of money to be made treating LBP (low back pain) and sadly that entices some practitioners to paint a dark clinical picture to justify an expensive or prolonged treatment (however, at times that is the only option)…the challenge is knowing which is which.
I apologize for the rant, but it just really ticks me off when I feel that patients are not getting solid and patient specific information. No one gets it right 100% of the time, but blanket statements like that (after what seems like only one visit with you “I went to physiotherapist and he said”) seems premature.