I’m just a physio…

I often get accused of not being a ‘proper’ physio with many calling me a glorified personal trainer in some misguided, misinformed, and laughable belief that this is an insult to me. Many think that because I don’t use any manual therapy, electrotherapy, dry needling, taping, or other adjuncts to help people with pain or disability, preferring to only use advice, education, movement, and exercise that I am not fit to call myself a physio.

It does make me laugh that a lot of physios have an arrogant belief that personal trainers are beneath them, and to call a physio one is an insult. Even though personal training is an unregulated profession and anyone can claim to be one many physios could learn a thing or two from some personal trainers.

pt-stupid

A lot of physios love to belittle or ridicule personal trainers for their lack of knowledge on anatomy, biomechanics, or because they don’t have formal qualifications or protected titles. However, when it comes to exercise selection, prescription, planning, and programming most personal trainers put most physios to shame.

Physios are allegedly supposed to be the ‘experts’ of exercise but personally, I know most physios training does a really shitty job at educating and equipping physios to prescribe and program exercise effectively. Most physios training does not teach them how to prescribe, dose, progress, regress, or execute exercise well. Most physio training on exercise tends to reach the dizzying heights of how to use a Thera-band safely and how to walk up and down a flight of stairs, which of course is important, but let’s not forget that without sufficient leg strength no one is walking up or down any stairs, anytime soon.

So you would think it would also be a good idea to teach physios how to develop sufficient leg strength in their patients. You would think it would be a good idea for the universities to teach physios how to perform and teach exercises such as the squat, the dead lift, the overhead press, and many of the other basic strengthening exercises. Yet most physios couldn’t tell you the difference between a front squat, back squat, sumo squat, goblet squat, hack squat, pistol squat, split squat, or just a squat squat, let alone demonstrate them well.

Unfortunately, most physios attention is not on exercise but on the crappy adjunct interventions like manual therapy, dry needling, and taping etc. Many physios are taught to believe that these shitty techniques justify their roles and their place in the healthcare system. This makes me want to scream. Our interventions are NOT our identities, physiotherapy is so much more than manual therapy, electrotherapy as explained beautifully by the bright young physio Kenny Venere in his blog here go read it.

got-small

Many physios suffer from inadequacy issues, and inferiority complexes, feeling the need to exaggerate and inflate what they do to make themselves feels more important and more worthwhile in the eyes of their patients, their peers, and other healthcare colleagues. Many physios still seem to think if they are not doing something to someone then they are not a true physio. Many physios do not see the value in good, simple, honest, education and exercise.

Why many physios don’t feel confident to do the simple things well and say that their job involves motivating, encouraging, and cajoling people in pain to move more is beyond me. Why many physios feel the need to justify their existence by saying they correct imbalances, fix faulty biomechanics, break up scar tissue, or release stiff joints, muscle knots, and fascial adhesions is beyond me.

So I will start by saying quite confidently, quite loudly, quite often that as a physio I help people in pain or with a disability, after an injury or surgery to move and function better. I try to do this by giving simple, honest, clear advice and education, by getting them stronger, fitter, and more robust both physically and psychologically. I do this with all types of activity and exercise-based interventions NOT with rubbing, poking, pricking, prodding, or taping. I don’t correct faulty biomechanics. I don’t change joint stiffness or position. I don’t alter soft tissue tightness, spasm, tone, or flexibility, and I don’t miraculously cure or remove pain.

So my plea to all physios is this… please be more comfortable and more confident in providing simple, honest, clear advice, education and exercise. Be more confident in just doing the simple things really really well. Be confident that you don’t have to use adjuncts, or exaggerate, or conflate what you do. Be proud in what you do and how you do it.

I am, because I am ‘just’ a physio!

As always thanks for reading

Adam

51 thoughts on “I’m just a physio…

  1. Dear Adam,

    Great article- I agree on 100% of what you have wrote.

    Keep the good work on.

    Kind regards, Jawad

  2. As always Adam, you are a straight shooter.

    Let me ask you this so that I can define what I see the problem as: If you get a toothache…who do you see? If you start to notice a decline in vision…who do you see? etc etc.

    Most medical situations have a defined (often exclusive) healthcare profession for which government or third party insurance will pay for.

    Not so when it pertains to “pain”. Chiropractors, acupuncturists, osteopaths, Massage therapy, Physiotherapy….all supposedly are qualified to treat pain.

    It creates an environment where too many providers are competing amongst each other to prove who has the most (perceived) skill.

    I honestly feel this is the origin of the emergence of this crap treatment called TDN. It’s a game of ‘one upmanship” where the main goal does not seem focused on the patient.

    The only way this resolves itself is for one healthcare professional to emerge as the defined expert. Otherwise, we can expect this battle for a piece of the pseudoscience pie to continue.

    Shame really because the Physiotherapy profession was perfectly poised to be that expert. Yet here we are….often 100K in student debt to obtain “doctor” status competing with high school graduates who went to certification course in massage….and so on and so forth

      • I feel your pain ! MACP..pedantic and narrow in their thinking. Re Strength and Conditioning…I have bags of humility and always keen to improve our software (exerciseprescriber.com)…would you have any good contacts who could help us develop our database still further. Ideally they’d be reasonably close to me (I’m in Flitwick)…Cheers, Gary.

  3. CBT outcomes are getter for clbp than manual therapy.Doesn’t that say it all?.Exercise helps and is the one thing we have in our arsenal that has a good evidence base.
    But we must invest in the therapeutic alliance, learn how to listen instead of delivering a sermon.
    I personally don’t think what type of exercise matters that much, it’s more behavioural,just encourage seeking behaviour get people activated and that’s what snotty nosed personal trainers do well, in the outdoors (as John Ratley calls it exercise squared).

  4. Refreshing article.
    Most of my clients are disappointed with the out of date post injury prescription exercise sheets they receive from NHS physios. Once the basics have been established it can’t be a one size fits all approach to strengthening and restorative function.
    In my opinion Physio’s / sport therapists with experience in training , fitness and PT background get better results via education and role modelling.
    Ps I’m sure robuster is a word you’ve invented 🤔
    Enjoyable read thank you

    • Hi Marie,

      Your generalisation of NHS practice is short sighted, inaccurate and a bit boring. I primarily work in the NHS, and have also worked in private practice and elite sport. To say that patients are disappointed with the exercise sheets given by NHS physios, is like me saying I see patients every day who are disappointed with the ultrasound, acupuncture and massage they receive from private practice, or disappointed in the chiropractic treatment they’ve received that has “put my back in alignment” but, shock, horror, they are still in pain, which I do, but I don’t tar all other practitioners from a different setting with the same brush.

      Most NHS physios work to a high degree of EBP, more so than other work settings IMHO, along the lines that Adam is advocating.

  5. I like most of what you have said but I have a couple of problems. First, physiotherapy is a profession based on combination of methods, exercise being a very important one of them. You seem to have changed the definition of physiotherapy. Now that’s ok for your practice but it implies that the Chartered Society somehow have it wrong in their promotion of physiotherapy as manual therapy, modalities and exercise as well as how these are combined by the therapist in particular circumstances. Exercise is great but other treatments might be needed in other areas. In the context of ortho or sports you might get away with it but then again I can’t even be sure that is true.

    Now I have treated and watched personal trainers develop over the last 40+ years and noticed that they have as many of the same problems with gurus, schools of thought and proprietary methods as do those in physiotherapy. You can see those from Cross Fit fighting with the National Strength and Conditioning Association in the USA. Each has their own research to support their methods even if their opponents have their own version that is contradictory. Physios are still needing, as you rightly point out, to evaluate and learn from the methods used by these different groups. Unfortunately I think bro science or the ”flavour of the month” can occur in exercise circles much the way that Maitland, McKenzie and others have been popular in manual therapy circles. Some like Oly lifts, some ”functional” training and others old school power lifting methods. It’s just not that simple or clearcut.

    We are all learning and until the jury is out I wouldn’t want to throw out any aspect of physiotherapy until a lot more better research is carried out. So keep up the good work. Just maybe cut your profession a little slack.

    :’ )

    • I’ll cut the profession some slack we it pulls itself together sooner, faster etc… and yes Rome wasn’t built in a day… blah blah blah… but there’s no harm in giving the builders a shake up now and then to get a bleedin move on!

  6. Hi Adam,
    Great blog and having worked with some excellent rugby union S&Cs I can see that my own knowledge of strength and conditioning needs to improve. Any good resources you could recommend?

    Cheers,
    Paul

  7. I agree with you, i worked in a refugee camp so the settings were at minimum and high caseload so all i had is education and exercise. I had great results. But I also believe that you shouldn’t call one intervention the best , you should use all you have. Btw no one is beneath us or above us. We all contribute for the seak of our patients.

    Thank you,

  8. Physiotherapists is only professional who are worried about other physios that they are not doing justification with physiotherapy.
    No other professionals will think like that.

  9. Hi Adam, i am seeing this as just your opinion, it will differ person to person. All physical forces can be used to treat the pain. Prevent, correct, and cure done by Physiotherapy by using all the physical Agents and forces like manual therapy, dry needling, tapping…. I don’t feel any wrong in this. Balaji Gandhi

  10. Hi Adam!

    Really love the article – especially pointing out that the universities do an awful job at teaching exercise prescription. I’m a recent physio grad and really want to advance my exercise prescription/ knowledge. Do you have any recommendations on how to do so? (Courses, books etc.)

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