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courtesy of Ambro at FreeDigitalPhotos.net
When I was a kid the Star Wars
prequel films were coming out. While I’m not as critical of them as many are –
they certainly fell short when compared to the originals. I’m glad that the
last few Star Wars movies (The Last Jedi, Rogue One, and The Force Awakens)
have helped the franchise regain its former pride.
One
of the highlights of the prequels was Ian McDiarmid’s performance as Chancellor
and later Emperor Palpatine. Palpatine’s brilliant, cunning and deceptive
character stood out to me as the most interesting characters of movies I-VI.
As
someone who’s battled frustrations with the education system of rehab &
fitness professionals I’ve asked myself – what would I do if I was made
absolute ruler of the education system and could do what I wanted? I’m involved
off & on with the University of Waterloo Kinesiology program and the
Western University Physiotherapy program and have seen a lot of great change in
the education systems (especially the former) but we still have ways to go in
improving the education system as a whole.
After reading my colleague
Nick Ferrara’s brilliant article
earlier this year I’m eager to post some ways we can improve the education
system. While it is directed towards PT school the principles can apply to all
rehab professions (Kins, PTs, OTs, Chiros, ATCs) and even fitness professionals
to some degree.
Side note: I’ve written about many of these topics in
detail before (and have links where applicable) or will continue to write about
them in more detail in future articles.
A large body of research in the last three decades has
shown that pain is not
solely linked to injury and can be influenced by various biological, psychological and
sociological factors. This is important to understand as many patients can
be very fearful of their body & activity as they may think that their pain
is due to damage. Health professionals, often well meaning, who think the same
can sometimes feed into this cycle with negative language
(please read this linked article
if you haven’t already) as well as overrestrictive activity modifications which
can feed into this negative cycle & promote disability.
Understanding that pain does not always mean damage &
can be influenced by various factors can and should help with health
professionals making better decisions for people with pain.
2) Educate professionals about real
biomechanics – not pseudobiomechanical nonsense
This is a bias for me being friends (either in person or
online) with many great biomechanics researchers such as Stuart McGill, Jack
Callaghan and Tim Hewett.
Some may disagree – but I still think biomechanical
research has huge merit in terms of understanding the loads and muscle
activation levels associated with various exercises & movements as well as
mechanisms of specific tissue injuries. This can go a long way in preventing injury as
well as making smart exercise & movement decisions when rehabilitating from
an acute injury.
That said – so much of what’s biomechanically taught in
school revolves around many pseudobiomechanical variables such as upper/lower
crossed syndrome, upslips/downslips/rotated pelvic bones, and
hypermobile/hypomobile spinal segments (to name a few) that either can’t be
reliably assessed or don’t correlate well with pain. Towards that end its
critical to know when biomechanics is and isn’t important.
3) Teach manual therapy in a way that is simplified
& in line with the evidence
I’ve talked to many new therapists who feel their manual
therapy skills aren’t up to par with their colleagues as they can’t “detect”
certain positioning
or mobility defects and they can’t seem to “feel the joint.” As I’ve written
about before – many manual therapy variables such as motion
and positional
palpation aren’t reliable, you can’t isolate a technique to one segment,
and different techniques have shown equivalent
results in RCTs for the same condition in some studies.
As such – understanding the true neural mechanisms of
manual therapy & teaching it in line with the evidence, while robbing a
few of the illusion of magic hands, will in my opinion create many more
confident therapists moving forward.
4) Push more exercise & less passive treatment
One of the biggest gripes in my PT school experience, as
with many I’ve talked to, is the lack of time spent teaching therapists to push
forward what is often the most effective
intervention for many (not all) musculoskeletal pain conditions – exercise.
We cover the same manual therapy technique six times and learn all the ins
& outs of an ultrasound machine but we don’t know how to coach, correct,
progress, regress, and modify basic movements such as squatting, hip hinging,
lunging, pushing, pulling, as well as more “traditional” PT exercises.
Most of my exercise knowledge has came from S&C
coaches. While I’m not as knowledgeable as some when it comes to exercise – I
realized the level of knowledge most PTs have with exercise when I attended a
course in October and ended up being asked to teach a lot of cues and
modifications I use with my patients on a day to day basis. What I thought was
rudimentary, first line knowledge was something that most therapists apparently
don’t know. This needs to change. I’m not saying you need to be a Brian Carroll, Eric Cressey or Chris Duffin of exercise knowledge – but
having better knowledge, skills and confidence to recommend more exercise &
less passive treatments can’t hurt.
So there’s my list of four ways we can improve the PT
(and rehab) education system.
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