June 17, 2024
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MythBusters: Physical Therapy Edition

Numerous myths and misconceptions surround the field of orthopedics. Physical therapy is a crucial component of healthcare, designed to help individuals recover from injuries, surgeries and various medical conditions. Here, using evidence-based research, I want to debunk some of the more prevalent myths that I’ve encountered as an orthopedic physical therapist for over 20 years.

Cracking Your Back or Knuckles Can Lead to Early Arthritis

I hate to say it, but your mom was wrong about this one. This myth is absolutely bogus. According to a major study conducted in 2016 involving over 45,000 participants, there was no association found between knuckle cracking and osteoarthritis.

Here’s what happens when you “crack” a joint. When you stretch your fingers or back, you create negative pressure within the joint capsule, which is the sac surrounding the joint filled with synovial fluid. This negative pressure causes gases (mainly carbon dioxide, nitrogen and oxygen) dissolved in the synovial fluid to form bubbles. The stretching increases the volume within the joint and when it reaches a certain point, the bubbles rapidly collapse or burst, producing the popping sound, called a cavitation. After the joint has been cracked, it cannot be cracked again immediately. This is because the gases need time to re-dissolve into the synovial fluid, which typically takes about 15-30 minutes. While cracking your back may not cause arthritis, there is probably an underlying orthopedic issue that is creating the desire to relieve the pressure and can be addressed by a healthcare professional.

Joint Replacements Are Only For Older People

It’s true that the average patient age for a joint replacement is in the late 60s, but there are definitely people in their 50s who decide to get joint replacement surgery. If it looks inevitable that you will need a joint replacement, my suggestion is to do it sooner rather than later. Pushing it off will likely result in more muscle atrophy and weaker cardiovascular health since it’s painful to move around, and the physical rehab will be easier at a younger age. Joint replacements can last over 20 years and revision surgery is easier and has better outcomes today than it used to, so adults at any age should consider a joint replacement if they failed more conservative interventions and the pain is significantly affecting their quality of life.

Running Causes Arthritis

Nope. There is no direct link between running and arthritis in the knee and hip joints. In fact, some studies have shown that running may actually protect against knee arthritis. Muscle and bone get stronger based on the stress that is placed on them. Weight-bearing exercises like walking, running, jumping and climbing work against gravity and put pressure on your bones, which stimulates bone formation. A Northwestern Medicine study of 3,800 Chicago Marathon runners and a Stanford University study that followed 1,000 runners and non-runners found that “runners’ knees were no worse off than non-runners.”

Ultrasound Is the Answer to My Orthopedic Issues

The effectiveness of therapeutic ultrasound has been the subject of numerous studies, with mixed results. There are many studies that compare ultrasound use to sham (fake) ultrasound. These studies indicate that people who receive ultrasound for an injury do not have a speedier, healthier recovery or a better outcome. Some studies have shown that ultrasound can help with pain, including a 2020 clinical trial that found low-intensity ultrasound reduced pain in people with shoulder and neck pain. However, a 2014 study found that ultrasound didn’t help with pain or function in people with osteoarthritis. The bottom line is that there may be some limited conditions that might benefit from its use, but there is a lack of empirical evidence to support the use of ultrasound for most orthopedic conditions.

You Should Always Rest a Musculoskeletal Injury

The idea of resting an injury until it is fully healed is outdated. While rest is crucial in the initial stages of recovery, the right balance of rest and movement is key for optimal healing and rehabilitation. For many orthopedic injuries, early mobilization under the guidance of a physical therapist helps prevent joint stiffness and muscle weakening. Just a few decades ago, patients recovering from knee replacement or ACL repair would have the knee immobilized for the first several weeks. Today, they start bending the knee on day one after surgery.

Physical therapy is a dynamic and evidence-based field that provides essential health to a diverse population. By debunking these common myths, I hope to encourage a broader understanding and appreciation of the benefits PT offers. Whether you are recovering from an injury, managing a chronic condition or seeking to improve your overall physical health, consulting with a physical therapist could be a crucial step toward achieving your health and wellness goals.


Noah Wasserman, DPT, CSCS, is the owner of Wasserman Orthopedic and Sports Rehab in Englewood, New Jersey. wassermanorthorehab.com or (201)371-3271.

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