Monday 26 February 2018

4 Ways We Can Make The Rehab Education System Better

Image courtesy of Ambro at

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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