Monday 11 September 2017

What I'm doing differently in my 2nd year out of PT school - Part 2

In Part 1 of this series I talked about 3 changes I’ve made in my second year out of PT school. In this article I will discuss 3 more changes I’ve made in my work.

4) Being more selective with whom I use Pain Neuroscience Education (PNE) with and also how I deliver it

                Since the popularity of pain science PNE has been implemented a lot more in orthopedic physical therapy. I think it’s great and I think it’s important that patients understand that pain is not a sole reflection of tissue damage and that many factors can contribute to pain.
                That said I do see people make a lot of mistakes with PNE including
-          Overwhelming people with too much information at once and/or
-          Forcing it on people who are just not interested and don’t believe it

While pain science education can be beneficial the research shows that people can respond quite
differently to it – some positively and some negatively1. When I decide if and how I’m going to implement PNE I go through a two-step process
                First – some research shows that pain science education has to be relevant to the individual to be effective1. For instance – someone who broke their arm and has no psychosocial factors or maladaptive beliefs probably wouldn’t benefit from PNE (and may even have a negative effect) compared to someone with a non-specific back pain and many negative psychosocial factors and beliefs.
                Second – when I am explaining the reasons for their pain I simply state that the reason the individual’s <insert body part here> hurts is due to changes to the nervous system that make it more sensitive. If applicable I point out how certain health & lifestyle factors can contribute and that their pain is more of an issue of sensitivity than of injury. This gives me a chance to explain what is going on and to put a feeler out there to determine if the individual I’m talking to is interested about learning more about pain. If they aren’t – no harm no foul. If they are than it can and should be broken up into small nuggets each session.
                I’m also of the belief that biopsychosocial rehabilitation doesn’t always need to include PNE. Giving people a lot of positive encouragement, teaching them about the body’s healing and adaptive capabilities, and building their tolerance towards the activities they enjoy are other examples of ways to help their confidence and beliefs.

5) Not over-coaching exercises

                Earlier this summer I listened to a podcast with Chris Duffin and Craig Liebenson. Liebenson discussed how there are some therapists/trainers that say “just move” and don’t worry about technique  while on the other hand there are people who are so sticky about form they feel there is only one right way to move and that any deviation will lead to harm.
                It’s a delicate balance – on one hand you don’t want people moving in a way that will drastically increase their risk of injury during a high load situation (ie jumping, sprinting, lifting heavy weights) but at the same time you won’t want to be so nit-picky with coaching that you detract from the initial value of the exercises.
                I agree and subscribe with Liebenson’s statement of “correcting as little as possible” in order to give clients the benefit of the exercises in a way that’s safe & effective but isn’t overwhelming2.

6) Cutting back on my non-clinical hours

                From the time I started undergraduate to the time I finished my board exams I regularly put in 60-100 hour weeks of classes, studying, and outside “side-bar” projects for the better part of 7 years. Needless to say this wears on the body and mind after a while.
                Earlier this year I got to the stage where I found myself so ran down that I couldn’t even train effectively and took an impromptu week off. Between starting a new job at Impact Physiotherapy & Performance, helping 2 university curriculums, running a website, working on another big project (details coming soon) and training for powerlifting at the highest level I got burned out.
                All this changed when I met former pro-bodybuilder and world-record holding powerlifter Stan “the Rhino” Efferding at a seminar in Woodstock, Ontario, Canada (not the same Woodstock where Jimi Hendrix performed 5 decades ago). At his advice I increased my calories and cut down on the amount of time I was putting into continuing education, curriculum work and writing. Afterwards my energy levels increased and my training got so much better. 

                In today’s society, especially among us ambitious health & fitness professionals, there’s an attitude of “rise and grind” and “more is better.” While I appreciate the value of hard work, you can only do and recover from so much. If you’re not taking care of yourself – how can you take care of your patients & clients.

So that’s what I’ve done differently in my second year out of physiotherapy school. What have you done differently in the last year? Feel free to comment below.


1.          Robinson V, King R, Ryan CG, Martin DJ. A qualitative exploration of people’s experiences of pain neurophysiological education for chronic pain: The importance of relevance for the individual. Man Ther. 2016;22:56-61. doi:10.1016/j.math.2015.10.001.
2.          Strength Chat #34: Dr. Craig Liebenson from LA Sport and Spine - Kabuki Strength. Accessed September 8, 2017.

No comments:

Post a Comment

How I've Adapted The McKenzie Method Over The Years

If someone were to ask me “what are the biggest influences on your therapy philosophy” they would be (in no particular order) ·  ...