Movement is Medicine: One Size Fits all Physical Therapy

My physical therapy practice has evolved over my 29 years of practice. From hot packs, ultrasound and massage, to hands on practice and skilled exercise. I have even transformed my practice on 2 significant occasions. The first was when I completed a year long training course in manual therapy and the second time when I returned to a 2 year doctoral program. Each time I immersed myself in improving my physical therapy skills and I have been rewarded in more ways than I could have imagined. My ability to problem solve, to see symptom patterns, and develop treatment plans continues to grow and evolve.

Over the last 15-20 years there has been a push for evidenced based practice in all aspects of medicine including physical therapy. Evidence based medicine is defined as “the judicious use of the best current scientific research in the decision making process about the care of patients.” In physical therapy practice this means we as PT’s should be using high quality research to help make decisions about the best and most efficient treatments for our patients. This model has been further defined for the clinician and it includes a 3 pronged approach: 1) Clinical research 2) Patient’s needs and goals and (3) the Clinicians experience.

Standardized treatments and protocols make up a large part of physical therapy practice. Protocols are researched based and are updated evolving over time to keep pace with new information and understanding. When patients don’t progress per protocols it is important for any health care provider to stop doing the same thing over and over, expecting a different result. We must not rely on written progression without using our problem solving skills and knowledge when something is just not quite right.

Here is an article that appeared in the Washington Post Dec 2016 written by a physician who underwent a total knee replacement. In this article the physician finds out that “one size fits all medicine” doesn’t always work for everyone.

This article was upsetting to me. As clinicians we must apply the principles of rehabilitation and be willing to back off and/or stop when things are not progressing as expected versus “pushing” a patient through a protocol.

As individuals we all bring our unique genetics and personal experiences to the treatment. While we can and should expect standards of treatment, we need to understand that not everyone is going to respond to treatments in the same way based on their unique body and mind.

Here are two excerpts from the Washington Post article referenced above:

“In a 1969 lecture, British psychoanalyst Enid Balint introduced the term “patient-centered medicine,” the idea that “the patient, in fact, has to be understood as a unique human-being.” Almost 50 years later, we are still far from fulfilling that objective, but every aspect of health care needs to strive for it — needs to strive for individualized care.”

“Francis Peabody’s 1927 “the secret of the care of the patient is caring for the patient.”

As we move forward and evolve with changes in healthcare and better treatments I believe we must always prioritize the individual response to the treatment and make appropriate adjustments.

What do you think?

Dr. Maria Fermoile is a Doctor of Physical Therapy at Alliance Health in Fresno. She will be happy to answer questions submitted to Learn more about movement, fitness and health in this space each week, on our Facebook page, by going to, or calling 478-5833.



This article first appeared in the Hanford Sentinel, Movement is Medicine column, written by Alliance Health.

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