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Anyone who spends more than 10 minutes with me, learns I am a big fan of movies. Of course, I’m most familiar with the movies I grew up with during 80’s, 90’s, and early 2000’s, watching them multiple times.
As a huge fan of the Indiana Jones movies, I have seen all of them including the latest rendition, Kingdom of the Crystal skull. There is a memorable scene where Indiana and Mutt were getting chased by Soviet spies, while riding on Mutt’s motorcycle. They were going through Indiana’s college campus where he teaches. They end up driving right through the main library where they encounter one of Indiana’s students. The student has the audacity to ask him a question regarding one of his upcoming assignments. Hilarious! After Dr. Jones gives him the answer and is speeding away, he reminds his student; "If you want to be a good archaeologist, you gotta get out of the library!”
I love this scene because it says so much regarding Dr. Jones’ character and how he feels about his profession. In all of his movies, he is the most sought-out Archeologist for finding ancient artifacts, solving complex problems, and of course, demonstrating skills that are WAY beyond being a good archeologist (fighting, running, general survival in remote locations).
Physical therapy can be viewed in a similar way; if you want to be a good physical therapist (PT), you gotta get out there and experience movement! move, learn about ones own body, get uncomfortable, learn new movement skills, fail and learn again! Most importantly, get out from behind the computer (researching), apply as much as possible and be bold! Try a new movement system. Our profession essentially represents experts/teachers in movement, using current evidence, our own movement experiences, and clinical outcomes from treating patients. We should act like it. With this formula, "movement expertise" would enhance with years of clinical experience, well-read/up to date on current evidence, and the PT’s own movement skills repertoire.
These days, there are mountains of information being shared on social media regarding treatment evidence and PT’s beliefs/opinions. Occasionally, I come across PT's who’ve been practicing for decades, using their age and previous injuries as a diagnosis and for a reason not participate in movement programs. They are unwilling to challenge themselves with lifting or new movement skills they have never experienced for the FEAR of injury. This is hard for me to read...its unfortunate because their inability to navigate their own well-being, within their profession, is ultimately passed on to their patients. Patients will seek PT’s expertise, with the hope they can assist and navigate THEIR injury. How can a PT help patients if their unable to navigate their own health and movement weaknesses? It would be the same if one were to get treated by a dentist who has an inability to take care of his/her teeth. Who would want to get their teeth treated by a dentist with yellow, crooked teeth? I definitely would not...
Kinesiophobia is a well-documented term meaning “an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability due to painful injury or reinjury” (1). Recent investigations have proven that PT’s who have their own kinesiophobia, will essentially pass it on to their healthy patients (2), creating movement avoidance behavior, thus decreasing well-being. Kinesiophobia can also be a main contributing factor in heel pain, along with pain catastrophising (3). In addition, If one is injured, no matter the injury location, patients will exhibit elevated levels of kinesiophobia (4). If this is not addressed, further injuries can occur due to the fear of movement (5).
In rehab, it is imperative to reduce patient’s levels of kinesiophobia while addressing their injury/condition. Patient’s progress could spiral into an "alternate outcome", if kinesiophobia is not considered. Just like in Back to the Future II, when older Biff (from 2015) gave the sports almanac to younger Biff (from 1955), it created an "alternate reality”, skewing into a different 1985. Not good! PT’s should be able to help the patient navigate their fear of movement, and guide them in the most efficient direction for recovery.
Many PT’s would argue that solely diving into the research, keeping it conservative with movement, using their past injuries/poor movement experiences/age for lack of novel movement practice, or increasing weekly patient volume would suffice for their current state of practice. Those who continue to fear-monger/body shame patients, fail to involved themselves in up-to-date organized movement practices, and not continually improving ones own body functioning, is fairly irresponsible as a PT. The latter gives credence to the mass negative perception of PTs; that we are ill-equipped to help patients navigate their injuries/dysfunctions compared to MD’s/DC’s/Trainers/LMT’s, use passive therapies (ultrasound, electrical stimulation, passive manual therapies) to “treat” patients. The reality is, patients seek out our assistance, as experts in movement (including evidence), to guide their recovery/pre-hab in the most-efficient direction. This does not seem possible if we do not lead by example and maximize our movement skills repertoire.
When seeking out a PT, ask yourself (and them) these questions;
1. How long have they been in practice? (under 5 years would yield a higher chance PT’s continuing through their “learning curve” for efficiency of treatment).
2. Do they mainly treat conditions/injuries similar to mine? (A neuro-PT, might not be as efficient in treating an orthopedic injury).
3. What activities do they participate in regularly? (conservative activities like biking/swimming could be considered adequate as long as they participate in races. Ideal activities would be powerlifting, olympic weight-lifting, olympic triathlons or longer, kettlebell training, martial arts).
4. Have they started a new movement skill in the last year? (this will demonstrate their willingness to learn new skills and levels of kinesiophobia).
5. Is resistance/strength training for health bad for me? (its well established that resistance training at any age/level is important for health and well-being for movement longevity).
6. How many patients do they see in a week? (a higher volume PT would less likely be able to perform reviews of research than a low-volume PT. Of course there are rare exceptions...similarly, someone will always win the mega millions…but the chances it’ll be you, is very slim).
7. Do they have specialized certifications in the fields of movement? (Key ones include; CSCS, FMS, FRCms, SFG, FR, OS, CCWC, SFMA, RKC, Ido Portal courses, MoveNAT courses).
8. Have they ever taught a movement system to novices and/or experts? (specific instruction in any the following; powerlifting, olympic weight-lifting, olympic triathlons or longer, kettlebell training, martial arts).
9. Are they able to perform the movement skills they are prescribing, with proficiency and deep understanding of their purpose.
10. Do they offer more problems than solutions to help with your condition? For instance, do you see them for knee pain, come out learning that your spine/pelvis is “completely misaligned” and they are the ONLY clinicians that can help you “align” them? A seasoned clinician should offer realistic solutions for each individual, with a progressive program that one could follow.
In closing, your interactions with a clinician should be positive, and they should help LEAD you in the right direction. I do not see many movement LEADERs who look like they have been stuck underground performing experiments, reading research, and arguing on social media!
Great movement leaders embody happiness, strength, and possesses an overall positive outlook on all things physical. Find those clinicians!