"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Thursday, December 27, 2007

SIMPLE Describes Low Back Pain

The SIMPLE movements reflect a common problem.

The SIMPLE movements were derived from my observation that many patients in my practice suffered from disordered movement patterns that result from and contribute to lumbar spinal stenosis.

The interesting thing that I noticed after I had started to gather the data was that many patients who had not (yet) developed radiographic evidence of stenosis, nevertheless, displayed many of the same impairments in strength and range of motion as those patients who had a medical diagnosis of spinal stenosis from their physician.

Low back pain is an endpoint and lumbar spinal stenosis is the last step in the degenerative cascade that originates with disordered movements in our earliest years.

Patients present to many practitioners at points along the way to their penultimate point and it is my hope that SIMPLE can be used to describe the physical dimension of those points.

In my naiveté I persist in believing that if we can describe a physical process then we can change it.


At this point I should acknowledge an obvious bias in the SIMPLE system: an exercise bias.

SIMPLE is designed to provide the physical therapist with goals and interventions that are amenable to therapeutic exercise and (to a lesser extent) manual therapy.

This bias is not accidental.

The physical therapy profession is well positioned to lead the public in modern exercise attitudes and in movement awareness. Exercise is very nearly synonymous with the phrase ‘physical therapy’.

The connection between exercise and physical therapy exists, not because of advertising and marketing, but because of a real need and a demand for skilled exercise services.

The connection between exercise and physical therapy is not complete since the association with exercise is ‘flavored’ by athletic trainers, personal trainers, exercise physiologists, aerobics instructors, coaches and fitness gurus.

To control the domain of exercise then physical therapists need to measure movement.
If a physical therapist can tell their patient the exact amount and quality of their existing movement impairment then the physical therapist can prescribe exercise precisely to correct the impairment.

To measure movement physical therapists need simple and precise tools that determine the extent of their patient’s involvement and that can help decide the proper intervention.

In Outpatient Physical Therapy for Musculoskeletal Conditions, Stephanie Carter, PT, PhD says the following:

“It is not known how many people with musculoskeletal conditions actually need physical therapy services, and no criteria exist for making this determination”8

SIMPLE is predicated upon the following assumption:

The presence of impairments (with or without pain) should be the criteria for determining those people who need skilled exercise intervention.

The role of SIMPLE is to help physical therapists measure the presence or the absence of impairments that affect physical function and thereby become better decision-makers and better diagnosticians.

To physical therapists, physical therapy is much more than just exercise.

To physical therapists’ patients, however, physical therapy is just what physical therapists do.

The patient doesn’t know the difference and the patient doesn’t care.

The patient just wants to get better.


Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.