I am just a physio…

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

This makes me both laugh and cry at the same time. First it makes me laugh that many physios have the arrongant belief that personal trainers are beneath them. Even though personal training is an unregulated profession and anyone can claim to be one, from the snot nosed teenager with a shitty weekend course to their name to the highly experienced and extremely qualified ex-pro-athlete, most physios could learn a thing or two from most personal trainers, with the exception of that snot nosed teenager.

pt-stupid

The uncomfortable truth for most physios is although they love to ridicule personal trainers for their lack of knowledge on anatomy, biomechanics, professional qualifications, or protected titles, when it comes to exercise selection, prescription, and planning many personal trainers put many physios to shame. 

Physios are supposed to be the experts of exercise but I personally know most physio training does a really shitty job at educating physio’s on exercise prescription. Many physios simply do not know how to prescribe, dose, progress, regress, and execute exercise well at all. Most physio training on exercise reaches the dizzying heights of how to use a theraband safely and teaching someone how to walk up and down the stairs, which of course is important, but lets 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 and physio schools to educate physios how to perform exercises such as the squat, the dead lift and many of the other simple and effective strengthening exercises. Yet most physios could not tell you the difference between a front squat, back squat, hack squat, pistol squat, or split squat let alone demonstrate them. This makes me want to cry.

What also makes me want to cry is that for most physios it seems that their focus is not on exercise but rather the crappy side interventions of our profession like manual therapy, dry needling, taping etc. Many physios believe these techniques justify their existence, and their place in the healthcare system. This makes me want to cry. Interventions are NOT identities as well explained by the excellent young US physio Kenny Venere in his blog here go read it.

got-small

Unfortunately most physios seem to think if they are not doing something to someone then they are not true physios. It appears that most physios suffer with inadequacy issues, inferiority complexes, or small man (or woman) syndrome. Many physio’s feel the need to exaggerate and inflate what they do to make themselves feels more important and more worthwhile in the eyes of their patients, peers, and other healthcare colleagues. Most physios do not see the value in education and exercise nor what they do or how they do.

This again makes me want to both laugh and cry. Why most physios feel inadequate to simply say that their job involves motivating, encouraging, and cajoling people in pain to move more and return to function is beyond me. Why many physios feel the need to justify their existence by saying they can correct faulty biomechanics, fix movement abnormalities, release stiff joints and tissues such as fascia, knots, scar tissue,  etc again is beyond me.

I try to help people in pain, disability or injury move and function better. I try to do this by getting people fitter, stronger, robuster, both physically and psychologically. I try to do this with advice, education, activity and exercise, NOT rubbing, poking, prodding, or taping. I can’t and don’t correct faulty biomechanics. I can’t and don’t change joint or tissue stiffness. I can’t and don’t miraculously cure or remove pain.

I am just a physio.

So my plea to all other physios is this, be proud and confident in providing GOOD effective education and exercise. You don’t have to do or throw everything an anything at someone in pain to help them, and you don’t need to exaggerate and inflate what you do. Finally please for the love of Jehovah and my sanity please go and learn how to teach squats and deadlifts better. 

As always thanks for reading

Adam

 

44 thoughts on “I am 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

  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 πŸ€”
    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

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