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 now 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.

First it does make me laugh that a lot of physios have the arrogance to think that calling a physio a personal trainer is an insult in some belief that personal trainers are beneath them. Even though personal training is an unregulated profession and anyone can claim to be one, in my opinion many physios could learn a thing or two from some personal trainers.

pt-stupid

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

Physios are allegedly supposed to be the ‘experts’ of exercise but 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 for physios to know 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, half or quarter squat, let alone demonstrate them well.

Unfortunately, these days most physios attention is not on exercise but on adjunct interventions like manual therapy, dry needling, and taping etc. Many physios are taught to believe that these shitty treatments justifies their role 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, needling, even my beloved exercise as explained by the bright young physio Kenny Venere in his blog here go read it.

got-small

Why so many physios feel the need to justify their existence by saying things like they correct faulty biomechanics, or break up scar tissue, release stiff joints, free fascial adhesions is beyond me. Why many physios don’t feel confident to just explain things clearly and simply and do the basics really well is due to many reasons.

Many physios seem to think that if they are not doing something to someone then they are not a true physio. Many physios do not see the value in simple, honest, education and exercise. Many physios suffer inadequacy issues and inferiority complexes, feeling the need to exaggerate and conflate what they do to make themselves feel more important and worthwhile in the eyes of their patients, their peers, and other healthcare colleagues. This is both sad and disheartening.

So I will start by saying here that as a physio I help people in pain or with a disability to move and function better. I try to do this by reassuring, motivating, encouraging, and cajoling them. I also try to do this by giving simple, clear, honest, evidenced based advice and education, and by getting them moving more and different ways, making 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 joints positions. I don’t alter soft tissue tightness, spasm, tone, or flexibility, and I don’t miraculously cure or remove pain.

My plea to all physios is simple… please be more comfortable in providing simple, clear, honest advice, education and exercise. Do the simple things really really well. Be confident that you don’t have to use any adjuncts to be a good physio. Finally 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

53 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.)

  11. Adam…

    What a load of tosh you speak…..

    I pity your patients and feel saddened that you have chosen the Physiotherapy profession… total discredit.

    I presume you are quite small in stature and need to be big in other ways. Did you ever meet Louis Gifford or Kevin Banks….I suspect not and you would have been a fly flapping around them!

    • Hey Dan Thomas, thanks for your comments…

      Yes I did have the honour of meeting Louis a few times before he sadly passed away, I even shared a few pints with him, I’m not sure I flapped around but who knows after a few beers I can do some strange things, but he was a big influence on my thinking and approach as a physio, and very much made me question and challenge all we do.

      As for you feeling saddened that I choose the physio profession and feeling sorry for my patients well that’s nice of you, perhaps you would like to come and visit me and watch how terrible I am and how unlucky my patients are… or are you just the usual wassock keyboard warrior who has nothing better to do than write pathetic comments on blogs! Either way the invitation is open, just let me know!

      All the best now

      Adam

      Oh and I’m 6 foot in stature, and everything else seems to be in fairly good proportion by the way!

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