Physical Therapy Shouldn’t Be Rooting For More Steve Kerrs

Steve Kerr has recently been anointed as the de facto ambassador for physical therapy after speaking publicly about his debilitating back pain and his frustration with surgery.  Predictably, many PTs have shared Kerr’s testimony in an effort to promote their profession as a safe and effective alternative to surgery.  Indeed, there is plenty of research to support the efficacy of conservative care for certain types of back pain.

In physical therapy social media threads, some people are simultaneously chastising back surgery and questioning the clinical aptitude of Kerr’s rehabilitation team.  These commentators are effectively suggesting that Kerr's physical therapists or athletic trainers must have been inept; that had Kerr been treated by one of them he never would have ended up in a back surgeon’s office to begin with.  Again, just as with Tiger Woods, most of us lack sufficient context to make an informed judgment. Context is contingent upon details and without details, it's difficult to have a meaningful conversation about something as complex as the role different health care professionals should play in relieving back pain. Perhaps I'm not as adroit a clinician as some of the people who pontificate on these threads.  I've evaluated, and subsequently referred to spine surgeons, people for whom surgery was the only thing that relieved their debilitating symptoms like sensory loss and motor weakness. For these patients, surgery provided immediate relief and substantially improved the quality of their lives when nothing else worked.  I’ve also encountered patients who sought non-operative treatment after a failed surgical procedure or series of procedures.

It can be irresponsible for non-operative providers with skin in the game to share Kerr’s “stay away from back surgery” comment without any additional qualification.  Moreover, Kerr is not a medical professional.  He is a chronic pain sufferer who is missing the most crucial part of his team’s season because of something over which he seemingly has no control.  The reality is he probably tried physical therapy. He has access to non-surgical providers every day, many of whom are likely exceptional at what they do, which makes the additional suggestion that his surgery would have been averted if not for "bad" physical therapy even more ignorant. Kerr's perspective may be illuminating but his story needs to be shared with tact and respect for his anguish.

Most of the physical therapists spreading Kerr’s message are well intentioned.  It’s difficult to definitively determine if what they’re doing is good or bad for their profession.  Their tweets and Facebook shares are likely causing neither any damage nor any benefit. A potential downside that should preemptively be squashed is the professional cannibalism that can ensue when people drink too much of their own Kool Aid (e.g. physical therapy is superior to surgery but only if you don't get treated by one of the crappy PTs Kerr presumably had). Whatever benefit physical therapy derives from Kerr’s situation is likely attributable to his platform as a championship level coach, not to retweets from PTs who have very little outreach beyond their own field.  In health care, consumers/patients are the real advocates for a service.  The focus among professionals should be on improving their product.

To be clear, PTs that share Steve Kerr’s story are not necessarily undermining their profession or pandering to identity politics.  Without context, however, Kerr’s message is potentially irresponsible and not one that speaks to why physical therapy is a unique and important health care service.  There probably are too many unnecessary back surgeries.  Overutilization doesn't equate to never beneficial. One can advocate for conservative care without embracing the extreme position that can be extrapolated from Kerr's remarks.  Kerr’s procedure may have been unnecessary but nobody in the court of public opinion possesses sufficient evidence to make that determination.  We just don’t know.

Professions that attempt to keep score after singular, albeit high profile incidents like this one should solidify their professional identities in more constructive ways.  To the extent possible, physical therapists should avoid bottom feeding and exploiting somebody's misfortune for political gain. Leave that to other professions. Remember the one patient whose cancerous back pain was misdiagnosed by a direct access PT? That's never happened to a primary care physician. Therefore no PT should granted direct access. Back surgery didn't work for Steve Kerr or Tiger Woods. “Stay away from back surgery”, however, isn’t much different than stay away from direct access physical therapists.  There’s a fine line between professional advocacy and fear mongering.  The latter creates an unnecessary divide between professions that must inevitably work together.  When professions keep score, the patient generally loses.

Opportunism shouldn’t come at the expense of the truth.  Some people are more miserable after having back surgery.  Do physical therapists help patients avoid misery by professional default or do they offer something more concrete and salient?  It’s not enough for physical therapy as a profession to say “we’re not as bad as surgery”.  Physical therapy will have realized its potential when its mission is sufficiently clear that it doesn’t need to capitalize off the unfortunate circumstances of a single celebrity.

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