Sweet Magnolias on Netflix is in its second season and make no mistake, I binge-watched the entire season in one weekend.
In fact, I stayed up way too late because I thought it would only have eight episodes (spoiler: there’s 10), which left me going to sleep at 1:30 am instead of my usual weekend bedtime of 10 -ish pm.
There’s one episode, though, where Sweet Magnolias missed the mark, hard. So hard, in fact, that they are unknowingly contributing to the opioid crisis.
That might seem like a big stretch, but I’ll explain, in a moment.
First, let’s talk about all the really great things about Sweet Magnolias on Netflix.
Sweet Magnolias does tv like every network should do tv — filled with a diverse cast that fits seamlessly together in a heartfelt way. You don’t feel like you’re watching a cast of different cultures, races, or sexual orientations.
You feel like you’re watching humans, the way humans should be — with their messy lives and all. I love this about the show and I think a lot of other shows could learn from the seamless way they make it happen, heck a lot of us actual real-life humans can learn a lot from how these fake humans interact.
This show is perfect for people who want a little bit of drama but generally would rather watch the hallmark channel Christmas movie re-runs than read the news (because the news gives them anxiety - Lauren raises hand here in case you feel like you’re alone).
In fact, I find Sweet Magnolias kind of nostalgic since I grew up watching 7th Heaven and there are pieces of Sweet Magnolias that remind me of the 7th Heaven years.
Alas, not every show on every series can be perfect though, and here’s where episode 6 of Sweet Magnolias misses the mark and does a lot of unintentional (I’m hoping) damage to the general public.
For full disclosure, I am a Physical Therapist, so a lot of this article is based on the fact that this episode did not paint Physical Therapy in the best light.
Besides the hurt and general concern I have for the misinformation in this episode regarding Physical Therapy and the potential impact it can have on people reaching out to Physical Therapists after watching this episode, I think there’s a bigger concern here and that’s how this episode is unintentionally contributing to the opioid epidemic.
Some background:
(spoiler alert if you haven’t watched Sweet Magnolias season 1 yet).
Kyle, the second oldest son of Maddie Townsend, was involved in a car accident at the end of season 1. He survives (thankfully) but is significantly injured. In Season 2, Sweet Magnolias shows Kyle moved into the living room with a hospital bed while he’s in a cast, struggling with crutches, and navigating with a wheelchair.
This is all fairly accurate, since he has a family that is able to care for him, he likely wouldn’t have needed home health physical therapy and the hospital PT would’ve discharged him home with a script from the doctor for outpatient PT.
If this was an individual who was home with less care, then home health PT would’ve been more accurate.
So far, so good with the recovery in this episode and accuracy from a medical standpoint. Once Kyle starts going to outpatient Physical Therapy (where someone drives him to his appointments) this is where Sweet Magnolias starts to contribute to the opioid crisis.
The opioid crisis is significant and terrifying for adults but also children.
According to the US Department of Human and Health Services, in 2019, “an estimated 10.1 million people aged 12 or older misused opioids.” This crisis could affect Kyle as he is within that population of 12 or older (he’s a freshman in high school in the show).
If a teenager is prescribed an opioid, they are 33% more likely to abuse it than teenagers who weren’t prescribed an opioid.
Opioids are commonly utilized for pain control post-surgery or trauma, like a car accident, which is how Kyle sustained his injuries.
There are other ways in which to control pain that are more conservative including Physical Therapy, mindfulness techniques, and meditation.
Episode 6 of Sweet Magnolias talks extensively about Physical Therapy, but they drop the ball. They drop the ball like a YouTuber would throw eggs at a moving car — messy with all kinds of consequences.
In the episode, Cal asks “How did Kyle’s Physical Therapy go this morning?” to which Maddie responds, “Oh, it was horrible. 100 percent pure unadulterated horrible. I know it makes him stronger, but every time she just [does not finish sentence]. I honestly didn’t think Kyle would make it. He almost ripped the pad in half because he hurt so much… It broke my heart.”
She continues, “And I hate to push him at his at-home exercises because he hurts so much, but I know I have to.”
This is terrifying to watch/hear as a Physical Therapist, who knows better.
Imagine what someone else who is in pain and watching Netflix to escape now thinks about Physical Therapy. That it is “100 percent pure unadulterated horrible,” and that if they seek out the services of a Physical Therapist it might hurt so much that they might die (aka “make it”).
If I wasn’t so appalled, I’d be pissed.
Not for my profession, for the person watching Sweet Magnolias that is in pain and has now decided that they will not try conservative measures because it will be the equivalent of torture.
So instead, they turn to opioids that their doctor prescribed them, thinking “this must be the only way to stop the pain.”
This is where we should STOP. FULL STOP.
This is where we need to take responsibility as creators to realize that our words have power.
Think of how ridiculous it was when Peloton stock tanked after Sex and The City had Mr. Big die on his spin bike — villainizing another totally valid and healthy way to avoid heart attacks, not have them.
Sweet Magnolias whether they realize it or not are contributing to the opioid epidemic.
There is a teenager or adult out there right this second, who is no longer open to the idea of conservative therapy and is going to make choices based on the picture that Sweet Magnolias painted.
They’re choosing opioids over conservative therapy and Sweet Magnolias gave them ZERO hope for pain relief and that PT was only going to make their experience more miserable.
In an era, where people are literally dying by the tens of thousands (48,006 in 2020 to be exact), we owe it to the country to provide at the minimum accurate representations of conservative management options.
Cal tries to make it better by saying he’s had a lot of Physical Therapy in the past but doesn’t speak one piece of hope about it — except for the fact that he obviously isn’t dead from it, because he’s lived to tell his tale.
There are many, many things that could have been done better in this episode as it relates to Physical Therapy, but we’re not quite there yet.
Because it continues to get worse.
When Cal and Kyle are at the hospital after his Physical Therapy appointment, there is a significant missed opportunity to show what his Physical Therapy appointment looked like (we’ll talk more about this later, in what tv shows can do better).
Instead, they fast forward to after his PT appointment, where Cal says, “I’m sorry it didn’t go any better today.” Kyle responds with, “no it still hurt, a lot.”
Here’s where Sweet Magnolias chooses to turn the Physical Therapy storyline into a “life is painful,” life lesson moment. Cal asks whether it’s a “good kind of hurt,” when Kyle asks what that is, he describes “good hurt,” as “pain that eventually pays off, in this case building muscle.”
Kyle is still frustrated, saying that “this is worse than going around on crutches,” and “I don’t know why I have to keep doing this.”
Cal explains that life is full of pain and that we have to pick which pain we want. Not bad advice by a long shot and I understand the general storyline leading up to this point.
Kyle had to have the pain to learn that life is full of pain, but you have to pick which pain you’re willing to live through — the pain of regret and missing out (if he quit PT) or the pain of going through healing and then coming out on the other side (stays in PT).
However, this conversation is too little too late for all the people who only heard the misconstrued information that PT will be horrible, painful, and almost kill them.
How Sweet Magnolia’s could have avoided perpetuating the opioid crisis with their choice of language and storyline:
There were ample opportunities for Sweet Magnolias to be honest about the pain Kyle was experiencing without vilifying Physical Therapy, the healing process, or unknowingly encouraging viewers to avoid conservative management of pain and opt for opioid use as their pain management strategy.
As a Physical Therapist, I have made individuals cry.
It can happen and often for different reasons. I have had patients cry because their life is tough and Physical Therapy is the only sixty minutes in the day they have to themselves.
I’ve had patients cry out of relief because they feel as though no other healthcare professionals have given them the explanation of what is going on in their body or take the time to listen to their symptoms.
I have had patients cry because they’re infants and moving their body against gravity is much harder and takes much more effort and energy than anyone can imagine.
I have also had patients cry because of pain.
Here is what we, as Physical Therapists do not do when our patients cry:
Continue pushing.
We do not force their limbs into positions while a patient thinks they’re going to die on our tables.
This is torture and we do not torture people.
We help people, through movement, exercise, mobilizations, and understanding.
We do not force them to do things that are more than they can handle.
A lot of Physical Therapists, including myself, are doctors of physical therapy. We understand how to grade movements and exercises to a patient’s tolerance level.
Yes, an exercise might still be hard and might still evoke some pain, but there are also conservative ways to treat that pain, like electrical stimulation, ice/compression, or kinesiotape.
If a patient is having so much pain in their home exercise program that they can barely complete it, that patient should speak to their physical therapist and at best have their program changed or at worst — FIND ANOTHER PHYSICAL THERAPIST.
Yes, that is your right as a patient, to find another physical therapist that understands your tolerance level and can meet you where you AND your pain are.
Sweet Magnolias could have shown what most individuals who receive physical therapy know: that the Physical Therapist is a compassionate healthcare provider that is on their team, not a villainous pain-producing Drill Sargent forcing their limbs into positions they do not want to go.
Sweet Magnolias could have shown Kyle in Physical Therapy, grading the motion and exercises to his tolerance in a manageable way — there might still be pain, but with a storyline that took it down a few notches.
Here are 5 ways that Sweet Magnolia’s contributed to the opioid crisis:
Portraying conservative pain options as “horrible,” and on a level that might kill someone with the phrase “I didn’t think he’d make it.”
Influencing viewers to steer away from and vilifying conservative PT without any education on the consequences of opioid use despite being in an opioid epidemic.
No education on how physical therapists can be compassionate healthcare providers that understand their pain and instead portrayed as a rigid Drill Sargent that doesn’t care about their patients’ pain or experience.
Encouraging people to “push through their pain,” because it is is a necessary part of life instead of trying to understand it, moderate it, and have healthcare professionals that care about the level of it.
No advocacy from the part of the family (Maddie, Cal, or Kyle) on how to improve Physical Therapy to decrease the level of intensity. Instead, they take a “do not question the provider,” approach instead of a self-advocacy patient-first approach that is healthier overall.
Here are 5 ways that future television shows can avoid the mistakes of Sweet Magnolias in episode 6 season 2.
Portray Physical Therapy honestly but compassionately and as an evidence-based alternative to surgery and opioids in regards to musculoskeletal injuries and conditions.
Show a Physical Therapist working with a patient grading the intensity to their tolerance, showing patience and understanding; altering the treatment to the phase of injury they are in.
Educating on the consequences and life-altering chemical dependency effects of opioid use when discussing pain management options.
Avoid vilifying legitimate options for a healthy lifestyle including Physical Therapy and Exercise, because as a nation we are the most unhealthy and addicted we’ve ever been.
Consult with actual Physical Therapists on their profession and be mindful of how your portrayal of a specific profession may influence your views opinions of receiving care from those professionals.
This article might sound like I am making extravagant claims, but with the outstanding underutilization of conservative measures that are evidence-based, I happen to disagree.
Physical Therapists do an outstanding job at managing musculoskeletal injuries, but they (we) do a very poor job at educating the public, taking on the media, and raising a ruckus when others portray our profession in a misconstrued light.
We (Physical Therapists) often keep our heads down and our mouths shut, which is harming everyone (including our bottom line).
I’m personally done sitting quietly in the corner with my hands folded in my lap.
And I think our profession should be too.
We help people in some of the worst seasons of their life find hope. We help them believe that they can move again and often better than before.
We deserve the opportunity to help people find us. We are ready to raise our voices and educate the general population — but with that, comes the responsibility to stand up to those who mislead the general population, educating them as well on how to best represent our profession.
If we don’t stand up for the field of Physical Therapy, who will?
Not Doctors or Pediatricians (ahem new CDC development guidelines that had zero PTs, OTs, or SLPs on the team).
Not television producers or reports.
Who then?
Us and our patients — who know better than how we’re portrayed.
People like professional athletes who need us to perform at their best.
First Lady’s like Jill Biden who spoke at the 100 year anniversary of the American Physical Therapy Association (APTA) who stated that Physical Therapy “pioneered the treatment of chronic pain to create safe alternatives to opioids.”
She goes on to say, “you remind us that there is a name behind every number. A person who is unique and vulnerable…and loved.”
Babies and their parents who need help to move independently, who aren’t educated in movement strategies or functional play by their pediatricians. Who want to learn things they can do to help their child if only given the chance and information.
Physical Therapy is a valid and necessary option for people in pain.
Here are five reasons Physical Therapy should be shouted about from the rooftops instead of vilified:
In a study of 88,000+ individuals with shoulder, knee, back or neck pain PT was associated with a 10% statistically significant reduction in subsequent opioid use.
Opioids do not change the function of the tissues but Physical Therapy can. Opioids are a bandaid, Physical Therapy can get to the root of the problem by looking at how your body is moving and treating the joints and tissues responsible for that movement.
A review of 35 randomized controlled studies with a total of nearly 3,000 patients post-surgery found that Physical Therapy led to significant reductions in pain, shorter lengths of stay postoperatively, and improvements in function.
Physical therapy decreases the need for prescription pain management, which is often misused with health care and substance abuse treatment costs of $29 billion every year. [3]
The American Heart Association encourages patients with heart disease to see a physical therapist for the initial treatment of pain as an alternative to prescription medications.
If that isn’t enough, the Surgeon General is also a big fan stating, that physical therapy has a critical role in solving the opioid crisis by saying,"It's an indisputable fact that physical therapists are well-positioned to change the culture around pain management," said U.S. Surgeon General Jerome Adams, MD, MPH. "We know that physical therapy is going to be a part of the evolution toward value-based care."
Here’s your choice:
you can either perpetuate the opioid crisis or you can help solve it.
But you don’t get to vilify the solution and not be part of the problem.