Effective healthcare can be thought of as delivering the most beneficial treatment(s) at the minimum dosage required to produce a positive outcome that outweighs associated side effects and cost. Unfortunately, healthcare is too often wrought with overdiagnosis, overtreatment and exorbitant costs while producing a less than desirable outcome. Pain, in particular, is an overwhelming burden on both individuals and society at large with an estimated economic cost of 560-635 billion dollars a year. This is in part due to an abundance of diagnostic approaches that fail to identify meaningful pathology, leading to numerous treatments that fall short of delivering a meaningful outcome. Unfortunately, many of the treatments designed to address people’s pain have been well studied and found to lack a meaningful benefit, but nevertheless, these interventions continue to be delivered, often by passionate purveyors eager to fill a desperate need.

In the face of evidence demonstrating that many of the treatments offered to patients fail to justify their continued use when adequately controlled and studied, why do ineffective treatments persist in clinical practice? Many of the contributing issues are by no means unique to physical therapy and more broadly are inherent to human nature and reasoning. Nevertheless, I am a physical therapist and as such these issues will be viewed through a physical therapy lens.