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08
02
2018

Internet Rx: Common pitfalls of internet advice

Every day I witness the challenges that my physical therapy clients face when they turn to Dr. Youtube or Nurse Google for help with typical muscle, joint, and movement pains. Navigating the vast sea of recommended exercises and procedures requires some context in the basic sciences and insight in the realm of health and fitness.

Of course, the challenges of finding, understanding, and appropriately implementing credible on-line advice is not unique to my profession. Due to lack of insight and context in the realm of plumbing, I recently made a simple issue with the kitchen sink turn into a drywall issue on the basement ceiling. Thanks a lot, YouTube!

Here are three common ways that we fail ourselves by leaning too heavily on the internet. These examples do not mention all the plainly bad information out there. Instead, I’m going to address three less obvious errors that we make even when the information involved is credible and technically correct.

  1. Incorrect Diagnosislucy advice

A patient recently reported that weeks of stretches for the intense pain on the side of her thigh were not helpful. Upon further inquiry I learned that she had searched the internet for iliotibial band (ITB) tendonitis because her sister experienced a similar problem in the past. After evaluating her, we discovered that she was dealing with a pinched nerve in her lower back referring pain to that area of the leg.

Make sure your diagnosis is correct. Otherwise you’re barking up the wrong tree.

  1. Correct Diagnosis, Incorrect Treatment

I’ve had plenty of patients correctly identify their problem but apply the wrong treatment. In the example above, a Google or Youtube search of “ITB tendonitis” will provide thousands of recommendations for stretches, foam rolling, and massage techniques to treat this condition. But many times, the condition improves far more from exercises focused on building trunk and core strength and addressing subtle asymmetry in walking and running. The appropriate exercises are not elusive or hidden. But they do not turn up under a typical on-line search.

Do not assume that having the correct diagnosis is an automatic pass to the right treatment advice for your specific circumstances.

  1. Correct Diagnosis, Correct Treatment, Wrong Timing

Continuing with our example above, the person correctly identifies their problem with an on-line search, and comes across good advice. They proceed to implement exercises like various squats, lunges, and running drills, only to find that these activities worsen the pain. The error here is applying the right exercises at the wrong time. The person in this example will benefit from those exercises only after a period of performing lower level corrective exercises before jumping into full weight bearing movements like squats and lunges. They may need to temporarily rest from running altogether, then slowly build back with altered form.

In contrast, other clients with persistent pain do only the easier non weight exercises like leg raises and thera-band hip rotation, only to have the problem return when they return to higher level activities like running or hiking. These clients need to be challenged with higher level weight bearing exercises to fully build resiliency and strength to bridge the gap toward repetitive higher impact activities.

Give attention to the phase of recovery. Exercises and treatments in one phase of recovery are not optimal in other phases.

The moral of the story is to recognize the limits of internet searches because even good information can easily be applied incorrectly. The above errors are common pitfalls that I witness in orthopedic physical therapy, one realm of life familiar to me. I’m sure this happens in every discipline, and none of us are immune. Don’t not be afraid to seek the help of a specialist where you need it!

author: Bob Gorinski