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. Nearly every in service I do is based on exercise prescriptions and progression,
    Updating guidelines on strength progression, signposting guys towards NSCA, ACSM etc literature. When newly qualified guys ask what courses they should do my advice is always to go and first do a S and C course……..

  2. Personally I agree with most of ur comments. As a physio for 26 years and Maitland trained I am now more aware than ever in the black hole of exercise effects and prescriptive info I was ever made aware of . I really hope ur stirring helps develop our profession to realise the power of the body and how with correct exercises and advice we can make a huge difference. I now use less and less manual therapy the odd bit to help facilitate movement or an exercise but empowering people to help themselves is my most important role. I continue to learn more and often liaise with personal trainers and sports therapists. We need to progress. Thank u

  3. Spot on mate, as an Osteo I regularly experience the hierarchical nature of the medical system and the nonchalant arrogance of docs with Msc’s in sports Med injecting and zapping everything that moves whilst ignorantly slating lowly personal trainers for helping make patients more robust!! As an experienced PT and sports therapist I’m also stereotyped by the mysterious title of osteopath which confuses patients when I don’t poke, prod, pull and click them! As musculoskeletal therapists we are all aiming at the same target with different arrows but when will we as a collective accept that the active participant is so much more effective than the passive recipient? Physio’, osteo’s, Chiro’s are all unfortunately victims of poor education when it comes to effective treatment and some if not most are hanging onto archaic modus operandi for dear life! In the words of Sam Cooke- a change is gonna come! Keep preaching brother!

    • Cheers Ricky… as Stark said as well brace yourselves… winter is coming!

      And keep on making those patients of yours robust and yoked out beasts!

  4. Good article. When I fractured my upper left humerus just below the lesser tuberosity I could not even move it an inch. My physio like yourself Adam left out manual therapies only giving me a cortisone injection into my infraspinatus in the earlier stages of my recovery once. From then on it was graded strength training. Now happily repping out 24kg overhead kettlebell shoulder presses with full range of movement and no pain can vouch that strength training worked for me and I am guessing would work for others.

    That’s proof for you

    • I have always said……. “let the people (or patients) speak” as they know their bodies better than anyone. Most of us want to be fixed for good not prodded around with needles. It is a cash cow I am afraid. Where would all the physio’s be if fitness trainers took over healing patients for good with repeating conditions such as a jammed up sacro iliac joint on one particular side prescribing unilateral exercises to strengthen unbalanced muscles???

      This is why the training colleges of physiotherapy and the like WILL ALWAYS want to teach “other methods” away from basic strength training.

      Let the patients have THEIR say……..it might if we all united change the way of current treatment.

      Many are too afraid but go for one therapist to another private or NHS wasting hundreds of pounds….such a shame

  5. I think you are right but this is a bit how most things are in life. For people it seems easier to believe than to do a bit of research about what Could be the best in that situation. i think if you were a surgeon you probably wouldn’t operate that much and being An electrician you maybe would educate people what they don’t need in their house. I think this should also be done but this is everywhere… returning to pt , i wonder if exercise eventualy should be promoted as for training and the physiology regarding trainingseffects are myths in a lot of cases. I hope evidence Will be more around in everydaylife but i think it Will not be for tomorrow. I think we are selected by evolution to have false beliefs. If our forefathers didn’t imagine Some kind of dangerous animal and run when hearning something in the bush , we wouldnt be here. I think the possibility to imagine this is also the reason people are probe to believe in a God and also in quackery… so maybe we are evolved for this..

  6. Excellent post! The point about lack of proper education about exercises in physio colleges is spot on. I am physiotherapy student and most of my knowledge on exercises and how to actually do them has come from self learning.

    • Thanks Fatema… it is still a shame that physio training is still lacking in exercise education as it was back when I trained and many others tell me the same as you have that it is still poor!

  7. Another great post, Adam. I have been telling PTs for years now that “soft skills”, the ability to analyze, problem solve, counsel, communicate, educate, and motivate our patients to take an active role in their own recovery are far more important than the technical “hard skills” like manual techniques. Worse yet, as you point out, the evidence behind many of these techniques ranges from poor to non-existent to not even plausible. I feel like this largely falls on deaf ears. I have had PTs walk out on a talk because I dared question the validity of cranio-sacral therapy.

    I also believe that this over emphasis on techniques that are done to patients is a symptom of a professional inferiority complex, and a history of being viewed as technicians by the rest of healthcare, but that is a subject for another time.

  8. I have found this quite heart felt. 1) I am a PT. 36, but not an elite athlete 2) I am also doing a soft tissue therapy course. Yep!!!! But I’m also a Cardiac Tech. No, not in a darkened room doing echo, but in the cath lab watching pen springs being inserted.
    So, I completely agree with you. I too suffer the same down trodden regard for my own profession.
    For me you have hit on something close to heart. The NHS is a hierarchical system. But , for it too survive it needs to change.
    Good article!!!

  9. Awesome article! As a trainer trying to learn from physios, its really helped broaden my understanding and put greater care into helping others train better. My internship at a local clinic is experience that I’ll never take for granted.

  10. I realize that I am banned from your site for being critical of some of your past comments. Inquestions how every physio should be proud of what they do when the typical physio experience for many of the patients is an utter waste of time. I encourage people to see a few absolutely outstanding therapists in my community but people have the right to see whoever they want and typically it is a friend or a friend of a friend. UnfortunstelynI will continue to say youneritevs lot of words with little to say and I will happily retain my banned status because of your holier than thou attitude.

  11. Great post Adam. I’m currently doing my masters and recently completed a module called ‘Exercise prescription, progression and periodization following injury’ precisely because of the points you have made re physios not knowing enough about exercise prescription and progression. It included a session with an S&C coach who taught us correct technique for squat, back squat and deadlift – great to learn that stuff. One of my colleagues was a personal trainer until he recently qualified through the 2 years masters route and he’s a great source of knowledge.

  12. Thanks Adam! I am a personal trainer and appreciate your post. I also agree with you. Although I received my cert. from one of the most reputable companies, I was completely overwhelmed with how much I didn’t know and needed to learn. An exercise physiologist gets 4 years to learn what I studied for 4 months. I was constantly afraid I would hurt someone because of my limited knowledge.
    I am grateful now for that fear. It inspired me to view my continuing education as though I was going through a degree program. I began choosing to study areas that excited me but also would increase my knowledge of the workings of the human body. 6 years later I am growing in confidence but because the human body is so amazing, I know I have a life time of learning ahead of me.

  13. Great post Adam and thanks for your blog. I’m a physio student and I have many times felt the frustration and questioning feeling of “just” being teached to do massage, mobilization of joint, myo-fascia release therapy etc. i stead of having a proper lesson in training. I think we had 1 x 2 lessons with strengh training 6 months ago, where our teacher “learned us” how to do the big three: benchpress, squat and deadlift. And the rest of if was how to use a leg press machine, leg extension machine ect.
    I’m glad that I have experience from my own training and interest in learning more about it, because we are NOT teached how to train people. And it’s very sad.
    Thanks again for your blog and keep them posts coming.

  14. A Physio recently attempted to pick me apart for my posture, over developed para spinals, reduced hip extension and lordotic spine (useful to add that said clinician has countless injuries and I have none)………. My comeback of “So What”? “Strength trumps everything else” (followed by a flawless demonstration of a FROM SL Squat) and “motion is lotion” took the wind out of the sails. Love this blog Adam, thanks for making my Sunday 🙂

    • Love it… many physio’s still cling to the idea of perfect ideal alignment and posture, stance really as you would think if that were the case then as a population physio’s would be perfectly aligned… most are not!

  15. I agree in some points but also disagree. Like we shoudn’t generalize things about exercises its also important do the same about other treatments (manual therapy,…). Its not important if we are hands on or hands of therapist but we should do things which helps patient and of course use these technique which are proven. Im attending a post graduated course in manual concepts (IOMT) and its perfect example for me how should we use different type of physiotherapy techniques for treating different conditions based on evidence based medicine. Its combination of everything what evidence suggested its effective from manual therapy, exercises to education of patient,…Like everywhere else, there is also in physiotherapy differncies, certain lobbies, war of egos, trends. Especially trends are very popular. Last year there was lot of talking about Lecester miracle in premier league and they already made connections between success of team and physical conditions of team (rehab, physical preparation,..), after this season they will.not be probably interesting anymore:).

  16. I agree Adam, working as a PTI in the army has definitely given me the edge when prescribing exercises to my patients. Despite their diagnosis I find starting patients with ‘kneeling gun drills,’ burpees followed by carrying logs over the assault course fantastic rehab for any condition.

    • Knowing you a little Stubbs I can sense the sarcasm a mile off mate…

      I’m not implying exercise such as squats cure everything pain related (everyone knows that dead lifts do that 😁)

      Anyway if the blog post has come across as you think I am saying a simplified approach is easy then that’s my mistake, it’s not easy but it doesn’t mean we have to keep adding and adding intervention after intervention in the blind hope something works! And the point was more to try and get more physio’s to feel comfortable and confident that they don’t have to 6 different interventions per patient no matter how complicated their issues are!

      Advice, education, promoting movement in all its wonderful diversity, and loading as much as possible/tolerable both physically and psychologically will do for me!

      At ease solider!

      Cheers pal

      Adam

Comments are closed.