Are we getting too fancy?

Posted: April 14, 2014 in Uncategorized


Earlier tonight I was watching an Inner Circle webinar from Mike Reinold. The webinar was discussing 5 common stretches we probably shouldn’t be doing and like anything else I’ve watched from Mike, it was a nice review with great content. During the Q & A part at the end, a physio asked if we are getting too fancy as new clinicians and favouring movement and neurodevelopmental approaches to assessment in favour of the basics? Are we jumping into Kolar and Yanda before understanding the basic work of Kendal, Magee, and Colby etc? In answering this young physios question, Mike stated:

“We’re seeing a lot of new grads coming out of PT school and they’re FMS certified, maybe SFMA etc. They’re doing PRI and DNS classes. They get all these funky things that they’re doing but they don’t know how to treat a joint. They can’t get people strong and mobile or much of anything else, yet they are trying to stimulate peoples diaphragms. It’s great to have the training in these things, but you must have the basics down first.”

– Mike Reinold, Inner Circle Webinar

I think this was an excellent reply from Mike as I also think social media has “pressured” us to take every con-ed course under the sun in the name of becoming “better”. But is taking seminar after seminar in the hopes of finding answers really making us better? Or is just making us more confused? I think taking con-ed is very important and have done my fare share, but I also think keeping the basics in mind is just as important. We have to understand stages of healing, true pathology, arthro and osetokinematics, normal ranges of motion and biopsychosocial care paradigms before we can start assessing crawling and rolling. These assessments are warranted and should be done, but not because we think we should to be “trendy”. They should be done only when you know exactly why you are doing it and how having that information will alter your subsequent treatment and exercise prescription. In talking to many therapists as of late, I have come to the sad conclusion that many do all kinds of movement’s screens and other fancy assessment techniques, but ultimately utilize the same interventions regardless of what their assessment tells them. Why? Because they don’t yet know what they should do with the information they have obtained. This could be because instead of truly mastering the basics, they have taken course after course but really don’t know what to do with the information they have been given. This may lead to confusion and frustration on the part of the therapist…sort of like paralysis by analysis. Personally I have chosen to slow down my course registrations per year because I believe it’s about quality, not quantity. I rather take a course and master it’s concepts to the best of my abilities before jumping into something else. I used to feel like I had to know it all now. I have a long career ahead of me and will take my time in getting these tools under my belt. I have actually found that I get better results when I stick with one form of care instead of jumping around from technique to technique in the hopes of finding that magic bullet.

I think having the desire to learn more is admirable and is something I can relate to. But I have come to learn that you can’t absorb it all right away. Learning through experiences via treating complex patients and even failing is what makes us better. As long as we are constantly being introspective about our practice and figuring ways to try and be better the next time I see nothing but a bright future for our profession!

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  2. Harrison Vaughan says:

    Good post Jesse! I have to agree with Mike and yourself. Sometimes getting back to basics works just fine. I don’t think it is a bad idea whatsoever to aim higher, but you can climb the tree without first stepping on the lower branches and these are sometimes the most important!

    I have found myself too that applying systems, such as SFMA…leads me right to where I would have gone anyway…however, from an outsider looking in (such as a student)…they don’t know HOW you got to your answer (say, it is my head or through experience), so these systems do a good job at dispensing this information to them.

    I am just a few yrs ahead of you and have the same mindset to learn all I can! What I am doing now is not the what and how…it is the why. The why is clinical reasoning and I think this is what experience is all about. However…clinical reasoning isn’t “sexy” like all of these other approaches…just like defense may win games, but not more exciting than putting points on the board in offense.


  3. jessephysio says:

    Harrison, I’d be curious to know how you have decided to further your education over the past year or two? What have you done to enhance your understanding of this crazy world of orthopaedic physiotherapy?
    Thanks for reading!

  4. Harrison Vaughan says:

    Well, in the last year I’ve taken courses on SFMA and a lower level Maitland course. The Maitland course was great as it brought together in a formal design what I already do…such as assess/re-assess and finding the concordant (they call it comparable) sign. This has allowed me to teach it to my interns with more substance…vs just teaching them how I practice…know what I mean?

    I continue to take course work on MedBridge, but as with online courses, there are limitations. You can’t become an expert by any means on one of these topics but it does seem to open up your eyes and ears to other approaches that you wouldn’t normally spend the money to go to a con ed course.

    Also, I’m starting an orthopedic manual therapy fellowship this June for a year. This should be the icing on the cake I hope. Really looking forward to fine tuning my skills, thoughts, and of course learning new adventures.


  5. Josh French says:

    Seems to me that physios live in this magical world where everyone is normal and shows up with a nociceptive like injury and “the basics” works well to help them. Sad thing is, strong evidence has shown over and over again that “the basics” does very little to help chronic problems beyond temporary relief (if that) in most people. Show me a patient with neurocognitive problems, learning difficulties, sensory motor problems which inevitably lead to gross motor control deficits (whether the pain is mechanical or central) and explain to me how “the basics” will help change these deficits and help this group of people? Well this is a high proportion of the people who are disabled from chronic pain. “The basics” are needed and required in physiotherapy but you need to move on in your continuing education. Basic skills help basic problems. I wonder what the rate of disability would be if our foundation of learning and clinical reasoning was to address central sensitization, neurocognitive deficits, behavioral issues, sensory motor issues and gross motor changes? Instead we learned and continue to teach a system where labeling (in which reliability is ridiculous) and mobilizing a joint are a large part of the foundation of clinical reasoning. Just playing the devil’s advocate here…

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  9. I should have read this first shouldn’t I ?

  10. […] We became too fancy without solid foundations. […]

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