A letter to a freshly graduated therapist (part 1) – The Basics

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…Quotefancy-3331-3840x2160.jpg

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.

http://www.greglehman.ca/2012/10/26/fascia-science-stretching-the-relevance-of-the-gluteus-maximus-and-latissimus-dorsi-sling/

https://www.painscience.com/articles/does-fascia-matter.php

  • 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).

https://thesportsphysio.wordpress.com/2014/05/05/diagnostic-palpation-is-it-a-skill-an-art-or-an-illusion/

  • 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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/

 

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like: ultrasound, muscle energy techniques, dry needling, etc… which might be clinically useful but which all have outdated/ wrong theories on why they work.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. 

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Calm shit down by:

  • Reassurance
  • 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.

Olivier Lam

 

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7 Replies to “A letter to a freshly graduated therapist (part 1) – The Basics”

  1. Good stuff

    Basic points indeed…yet 95% of the physios I know, have zero beliefs in these points (which is beyond ridiculous, and sad, and disappointing, etc etc).

    And I think it puts the new grad in a tough spot, in terms of having to conform to the ”experienced” owner/therapist, who will be quick to point out that he’s been running his clinic since 1872, with his/her magical hands/techniques, and that you are in no position to question stuff… Especially as a rookie!

    Liked by 1 person

    1. I agree with you that it can be very challenging sometimes…

      I hope that blogs like mine will reach those new grads and have an impact on how they treat patients. I hope that it helps them feel more confident by knowing that something else exists out there ! 🙂

      Like

  2. I gotta say, this is very interesting even for a non-physio like myself. It’s insightful to read a skeptical point of view like yours, which you give without any hint of pessimism (quite the contrary, rather!). I like it. Keep ’em coming! 😀

    Liked by 1 person

  3. This speaks to me pretty well, not a new grad but I’ve been aware of these concepts since before entering PT school…now that I’m on my first clinical placement I’m being shoehorned into all these traps. Serious brain drain and I’m not really enjoying my time when I’m skeptical of 90% of the things I’m doing…advice?

    Like

    1. Keep an open mind on what could be working and ask yourself: why is it working?

      Is it working because we replaced something? Or is it working because of a change in the neurotag? or is it working because of a neurophysiological effect?
      Understanding the underlying mechanism of a treatment can potentially improve that treatment!

      Also, try to look at some classification models that use more “manual therapy” clinical characteristics (e.g.: treatment based classification)

      I hope this helps 🙂

      Like

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