This post if for young therapists that freshly graduated and other interested therapists.
First of all, congratulations, you just graduated. Enjoy this moment, you have worked hard and probably deserve it.
Now there is a few things I want to tell you…
First of all, physiotherapy is the most amazing profession! You get to learn and help people on a daily basis. People trust you and love you for what you do and you can’t help but feel rewarded… This reward, however, comes with a price. It comes with responsibility.
You have the responsibility to go out there, spend time to read, learn and especially UNLEARN. If I have one thing to tell you, it’s to stay humble and skeptical. We are still in the dark ages of physiotherapy… very little is known. Don’t take what you have learned so far for granted…
For example, allow me to expose a few lies you might have learned from physio school (with awesome blogs that you should follow. The real reference are via those blogs. Don’t take it for granted and go read the actual research until you trust the authors..)
- You can’t stretch a fascia. Here are 2 great blog posts that completely changed the way I treat patients.
- Palpation is rarely reliable… and often, when you use it, it can lead to a misdiagnose and a wrong treatment. When I learned that, I felt relieved. I didn’t need 20 years of experience to be able to accurately palpate… no one can (although some still think they can).
- Most of your treatments don’t change the mechanics, the anatomy nor replace anything… You can’t break down scar tissues… Manual therapy probably only has a neurophysiological effect
There are many more weird things in physiotherapy like: ultrasound, muscle energy techniques, dry needling, etc… which might be clinically useful but which all have outdated/ wrong theories on why they work.
There are a lot of approaches out there and I encourage you to understand a bit of all of them and to keep an open but critical mind… However, whichever approach you use, stick to the basics, and keep it simple stupid.
Know the basics. Start with that. Many systems share the same principles. Whether they call it “Quantification of mechanical stress” from Blaise Dubois courses on running injuries, “gradual exposure”, “Reset, reinforce, reload” from Gray Cook’s SFMA and FMS courses, or “postural correction + avoidance” from the McKenzie approach, it’s all the same thing.
My favorite way of describing it goes to Greg Lehman (http://www.greglehman.ca/):
Calm Shit Down, Build Shit Back Up.
Calm shit down by:
- Use symptoms modifications whether it’s:
- McKenzie’s directional preference
- Mulligan technique
- Jeremy Lewis algorithm for shoulder
- Relaxation for patients with sensitized nervous system
- Calm shit down often
Build shit back up with:
- Creativity, variety, exercise
- Functional meaningful exercise for your patient
I hope that this post helps some of you freshly graduated physiotherapists. Future posts will focus on what continuing education I think is worth taking and why I believe classification systems are the futur of physiotherapy.