Choosing Wisely

Physical therapy

Five treatments you probably don’t need

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Physical therapists can help people who are having trouble moving after an injury or surgery. They also help people with conditions such as:

  • Arthritis
  • Back or shoulder pain
  • Cerebral palsy
  • Osteoporosis (weak bones)
  • Spinal cord injury
  • Stroke

Physical therapists can help people gain strength and get moving again. They can help reduce or prevent pain and disability.

Physical therapists provide care in hospitals, private practices, nursing homes, schools, rehabilitation centers, or in your home.

They use a variety of treatments, with a focus on physical activity and exercise. Goals include:

  • Strengthening muscles that are weak from lack of use.
  • Helping stiff joints move again.
  • Helping you use your muscles correctly, so you can move with less pain and avoid injury.

But some physical therapy treatments are not useful. They can make your symptoms last longer, and even cause new problems.

Avoid treatments that don’t help. 

Most insurance plans pay for a limited number of physical therapy visits. If your treatment doesn’t help, then you have wasted those visits.

Also, if treatment doesn’t help, people are more likely to seek unnecessary tests, injections, and surgery. These can be costly and risky.

As part of the Choosing Wisely series, the American Physical Therapy Association has listed five common treatments that are usually not helpful. They can lead to harm and to more tests and treatments. And your costs go up. Here’s why:

Heat treatments

The problem: Treatments include hot packs and deep heat machines, such as ultrasound. They can feel good on a painful back, shoulder, or knee. They may help relax you before exercise, but there is no proof that they have any lasting effect.

For example: Studies have found that deep-heat ultrasound, added to an exercise program, does not improve arthritis of the knee. It’s better to learn specific exercises and new ways to do things.

The harms: Many people are afraid to be physically active when they’re in pain. Physical therapists may support these fears by using heat treatments. But avoiding movement only makes the problem worse. This can lead to unnecessary medical procedures, such as knee surgery or steroid injections for back pain.

When to consider heat:

  • Home heat treatments, such as a hot bath or shower or a heating pad, can help give temporary relief of aches and pains.
  • Calcific tendonitis is a painful shoulder condition. Deep heat using ultrasound can help.

The wrong kind of strength training for older adults

The problem: Many older adults have weak muscles—due to lack of activity, hospitalization, or surgery. This can cause problems with walking, balance, rising from a chair, and other everyday activities. The risk of falls increases.

The right strength training program can make you stronger and help prevent falls. A physical therapist can teach you how to use exercise machines, free weights, elastic bands, or your own body to build strength.

But the exercises may be too easy. The therapist may be afraid that you’ll be hurt.

Studies show that a challenging program offers the most benefits, even for seniors in nursing homes. The therapist should match the program to your abilities. When you can do a task easily, the therapist should add weight, repetitions, or new exercises.

The harms: If strength training isn’t challenging, it is a waste of time and money. You will still have problems from weak muscles. And you will still be at risk of falls.

When to go easy on muscles:

  • Start out with lighter weights so you can learn the correct form.
  • Don’t do strength training if you have a painful, inflamed joint, such as a swollen elbow or knee.

Bed rest for blood clots

The problem: Older adults and people who have had surgery have a risk of deep vein thrombosis (DVT). This is a blood clot in a deep vein—usually in the leg.

The main treatment for DVT is medicine that dissolves blood clots. In addition, patients are often put on bed rest.

The purpose of bed rest is to keep the clot from breaking loose. A loose clot may travel to the lungs and block blood flow in the lungs. This is called a pulmonary embolism (PE), and it can be fatal.

But studies show that bed rest doesn’t help. People who walk around with a clot are no more likely to develop a PE than people who lie in bed.

Also, getting up and walking has many benefits. It makes people feel better. It relieves pain and swelling in the leg. And it reduces the risk of more leg problems.

A physical therapist can help you start walking as soon as the clot-preventing medicine starts working. Or the therapist or your doctor can tell you how active to be on your own.

The harms: Bed rest can make a clot larger and lead to new clots. And you will have a higher risk of complications, such as pneumonia. Your entire body will become weaker.

When to consider bed rest for DVT:

You may need bed rest if:

  • You can’t take clot-preventing drugs
  • You have another medical reason for bed rest, such as bleeding in the brain from a stroke, or severe breathing problems.

Exercise machines (CPM) after total knee replacement

The problem: Most people start physical therapy within 24 hours after knee replacement surgery. The therapist should show you how to exercise your knee, walk, and get in and out of a bed or chair. This helps you move your knee again. It reduces the risk of a blood clot in the leg and shortens hospital stays.

But some surgeons recommend that you also use a continuous passive motion (CPM) machine. A CPM machine keeps moving the knee for several hours a day while you’re in bed. A physical therapist teaches you how to use the machine.

But studies show that adding a CPM machine to physical therapy doesn’t improve pain. It doesn’t help you bend or straighten your knee better. And it doesn’t help you return to normal activities or improve your quality of life.

In fact, people do just as well with physical therapy whether they add a CPM machine or not.

The harms: CPM is a large, heavy machine. It is hard to put on. You have to pay to rent it. And you may stay in bed longer, instead of getting up and being active.

When to consider CPM:

CPM may be helpful if:

  • You had a serious complication from the surgery, such as a stroke or respiratory failure. In this case you may need more bed rest.
  • You are recovering from a second knee replacement operation because the first one failed.

Whirlpools for wound care

The problem: Physical therapists are often asked to treat wounds that are slow to heal, chronic, or infected. One treatment uses a whirlpool bath to soak and clean the wound. But there is little evidence that whirlpools help. And they can cause infections.

There are safer, gentler, more effective ways to clean wounds. The therapist can:

  • Rinse the wound with a saltwater wash.
  • Spray liquid on areas of the wound with a single-use sterile device.

The harms:

  • If the tub is not clean, bacteria can spread from person to person.
  • Bacteria can spread from other parts of your own body to the wound.
  • An infected wound heals more slowly and you may need antibiotics.
  • If your immune system is weak, the infection can spread to the blood and cause a serious
  • condition called sepsis.
  • Chemicals used to clean the tub and disinfect the water can damage the new skin cells on the wound.
  • Whirlpool jets can harm fragile new tissue growing in the wound.
  • Long soaking can break down skin around the wound.
  • The placement of the leg can cause swelling. People who have vein problems may have serious complications.

When to consider whirlpool therapy:

Never use whirlpool therapy to treat open wounds. It may help sports injuries such as strained muscles, but the benefit has not been proven.


Advice from Consumer Reports

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2014 Consumer Reports. Developed in cooperation with the American Physical Therapy Association. To learn more, please visit