Sunday, December 18, 2022

Bluetooth Physiotherapists?

I definitely agree with the article (Davidson et al, 2019) that suggests that palpation should be used with caution when diagnosing and defining patient care. As defined by Wikipedia, palpation is the process of using one's hands to check the body, especially while perceiving or diagnosing a disease or illness.

The aim of the published article was to assess how 125 physiotherapists assess muscle stiffness on a 7-point palpation scale generated by a novel device. Measurements of displacement, force and stiffness were recorded.

Physiotherapists always use their hands to palpate muscle tension (or muscle tone), which is commonly known as muscle stiffness, among other assessments. It is then standard practice to base some subsequent treatment on these palpation findings. Of course these assessments can be considered subjective and may vary from one physiotherapist to another. It's accuracy and repeatability will depend on each physiotherapist's skill and experience.

At the same time, there are heated calls within the Physiotherapy profession to stop hands-on manual therapy (or passive physiotherapy treatment) since it creates dependence, low value in care and is not totally evidenced based. Physiotherapists who work in hospitals here in Singapore and elsewhere have practically eliminated this form of 'passive' treatment when treating patients. Physiotherapists who support these views are affectionately called 'bluetooth' (or hands free) physios.

Would a 'bluetooth' physio be able to palpate accurately and consistently compared to another physiotherapist who only uses their hands for assessing and treating? That is probably why the above mentioned research paper concluded that palpation is 'not reliable' to diagnose pathology and develop treatment protocols.

While the physiotherapy community argues whether we should or should not be using hands on manual therapy, the massage therapy, chiropractic, osteopathy, personal training and strength and conditioning professions will be watching us fight online, waiting to take over our patients while we complain that they are practising certain treatments 'beyond' their scope.

Do not complain if you don't want to do it, but just be aware others will. Remember when physiotherapists used to complain about doctors who don't even bother to examine their patients?

If you are a 'bluetooth' physiotherapist and do not want to use your hands to treat your patients, do not criticize another physiotherapist who does it appropriately. Perhaps consider asking yourself what your patients want and need. Patients will vote with their dollars and seek alternative treatment, if their physiotherapist isn't able to solve their problem.

Of course, even perfect palpation skills on it's own may not be enough, since muscle stiffness is just one aspect of the assessment. You have to put together history, mechanism of injury, interpret movement direction, symptom provocation etc to decide treatment selection for your patient. The muscles you are palpating may not even be the cause of the problem even though it is 'stiff'.


Davidson MJ, Nielsen PMF, Taberner AJ et al (2019). Is It Time To Rethink Using Digital Palpation For Assessment Of Muscle Stiffness? Neurourology and Urodynamics. 39(1): 279-285. DOI: 10.1002/nau.24192

From Tiktok
I almost never ever watch Tiktok, but someone sent me a link mocking the exercise a 'bluetooth' physiotherapist teaches. Have a look here. The comments section -- not good for physiotherapists! Still wanna just teach exercises for treatment?

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