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Physiotherapists and complementary therapies

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Since the following article was published, the Chartered Society of Physiotherapy (CSP) has contacted Pulse to inform us that it no longer identifies itself with the views attributed to it, and that the information quoted was removed from the current version of its website by the end of 2008. This information is, however, still available online via an out-of-date version of the CSP’s website, and the link referred to in Professor Edzard Ernst’s blog does still work. We would like to draw readers’ attention to the response posted by the CSP in the comments section at the end of the article, and to its new website.

I sometimes receive correspondence from people who think that I unfairly target certain groups of alternative practitioners who practice unproven treatments. In view of the fact, that established healthcare professionals seem to be doing similar things, this may seem unfair.

In this blog, I therefore focus what UK physiotherapists are up to. The Chartered Society of Physiotherapy (CSP) has a website where we find the following statement:

'Chartered physiotherapists are increasingly using alternative health interventions to work with the traditional physiotherapy treatments that link with the above. Physiotherapists are now developing their skills further and practice in:

·         Acupuncture

·         Alexander technique

·         Aromatherapy

·         Craniosacral therapy

·         Pilates

·         Reflextherapy

·         Shiatsu massage.'

I find the mention of craniosacral therapy (CST) particularly amazing. CTS is one of those alternative treatments which is neither plausible nor supported by clinical evidence. The CSP informs us about CST as follows:

'CST is suitable for acute or chronic conditions and can be used effectively on people of all ages, babies and children. The number of treatments required will depend on the "inner health" of the patient and their body's ability to change.'

'The present pain may result from a lifetime's distortion and compensations, which cannot be unravelled instantly. A baby (who can be treated from very young) may only require a few sessions whereas a child with cerebral palsy may benefit from ongoing treatment. An adult may respond in about four to eight sessions, but longer in deep seated conditions. Some conditions where craniosacral therapy is a suitable treatment approach

·      All back dysfunction

·      Asthma

·      Blood pressure

·      Digestive disorder

·      Incontinence

·      Infant disorder including colic, sleeping, feeding, speech, ear and behavioural problems

·      Migraine and headache

·      Neurological conditions including Parkinson's disease, Bells Palsy and Cerebral Palsy

·      Pain

·      Pregnancy care

·      Rehabilitation after trauma and accident

·      Soft tissue injury

·      Stress and panic disorders.'

These are big claims and assumptions and none of them is supported by what I might call good evidence1. This begs the question whether promoting such nonsense is responsible.

The conclusion from this little excursion into the world of physiotherapy is simple, I think: Even decent education and training does not completely protect us from falling victim to irrationality. The lesson for GPs is clear: if I had the choice, I would refer my patients to a physiotherapist who does not promote nonsense.

Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter

References

 1.   Ernst E, Pittler MH, Wider B, Boddy K. The Desktop Guide to Complementary and Alternative Medicine. 2nd edition. Edinburgh: Elsevier Mosby. 2006.

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