Beyond The Sponge: A Young Physiotherapist's Evolution
As a relatively young physiotherapist, my perspective has changed dramatically during my time in university, as a newly graduated therapist, as a more senior therapist, and now after having worked overseas in a different health system and setting. I think a lot of these perspective changes come down to natural shifts of perspective from age and experience. Which I would imagine is something that has occurred to generations before me, and will continue with generations ahead of me.
Though as a “millennial” who can’t remember when it changed away from Gen Y, now that I think about it, I think we have a very unique perspective and I’d like to contribute to that conversation. Being trapped, much like the late Gen X’ers in the period where technology has gone from enjoying TV during scheduled times, early video game consoles like the SNES, and hoping your friends turn up to plans, to having a powerful supercomputer in our hands where people look at memes for hours. We have pivotal periods of our development as children and young adults being shaped by very different worlds, which I think as a physiotherapist has given me a unique perspective and it’s changing the type of physiotherapists now coming into the profession.
Scepticism is the skill (I think) that has been instilled in us, and I would like to know if it is/was something older physiotherapists have to the extent we do. The reason I believe a lot of my younger colleagues and I are more sceptical is because we have gone through, not only the technological changes over the past few decades, but also the change of information availability. I have gone through only being able to research a topic via libraries, to limited information online on a PC, to unlimited access to anything I want to know on my phone. And as this developed, I was also able to see how the spreading of misinformation also changed and developed. Finding videos online of bigfoot, aliens, and other less savoury content helped develop my skills of source searching and finding out the BS online. Which I know for my parents at least, took a lot longer to develop.
Even more so, with this next generation it will be an interesting time to see how they absorb information, and how trustworthy they are of this information.
With the popularity of social media platforms like TikTok and the like, we are seeing countless viral content spreading straight-up lies (similarly touched on in our previous blog post). I know most people are not bothered to fact-check most of these videos, and why would you for the amount of videos you watch each day? I do wonder how this will translate as the younger generation gets older. What internal bias’ or misinformation have they held from the thousands on thousands of hours they have digested during their life? Will this affect how they ingest research, their ability to appraise research, and what/who they value when it comes to what they believe to be a reliable source?
This scepticism has carried over to my career as a physiotherapist and is seen throughout current discourse in the “rehab” social media space. There is a division that, from what I’ve hear is not new in this space, but now has a greater ability to be discussed and challenged. That is the division with using manual therapy. If you are a physio reading this, you know exactly what I am talking about. For you non-physios, what I am talking about is the use of what we call “passive” or adjunctive therapies like massage, dry needling, joint manipulations etc. Basically, something that requires someone else to provide the treatment on you, rather than treatments like prescribing someone exercise or even just education - which is more collaborative and places the work on the patient.
To spoil the end of my story in this battle, I like both, I lean slightly towards the camp that manual therapy is overhyped/overused, but I believe it does have its place. Which I’d imagine will be different when you ask me again in 6 months, I believe it’s important as a therapist to be open to, and actively looking for truth, and to not be afraid to change your perspectives based on new information.
How I started coming out of university, was like a partially soaked sponge. I had some information I had learnt from university, my own research and previous exercises that were ready to be used. But like a sponge without a hand to use it, I didn’t have any direction on how to apply this information and the information I had was probably only enough for half a job if I am being honest. I had lots of gaps in my knowledge, minimal to no clinical experience for some conditions, and I knew some of what I had just learnt in university was already outdated.
I was lucky to work early on in a practice with various physiotherapists who had differing backgrounds, which helped shape my approach. Although early on, having a structured approach helped me guide my appointments, this structure was again subjective information (information the patient can tell me), complete and objective assessment (assessing the body more physically) then going into a passive treatment like massage or a joint mobilisation generally, and finishing off with some exercises. For both physiotherapists and a lot of patients of physiotherapists, this may ring very familiar. This is a common approach, which has led to what I would call a downside of this method – expectations. By doing this, both myself, and the profession as a whole, have created an expectation for many that having this passive treatment is a necessary portion of the consult, and without it, you are losing/missing out on an important part of the treatment to get you better. Which, is just not true.
I remember one particular patient I had, as a 1st year newly graduated physiotherapist, who had worked now for a few months and had become a lot more confident in their skills. It was a Friday afternoon, and on Friday afternoons two things happened. The first is I would work alone, no other physios were working in the clinic other than me, and our receptionist would not work in the afternoon. The second was we had weekly in-clinic CPD (professional development) where our most senior therapists would provide a teaching on a certain topic. This particular week was about patient information and chronic pain, and a way to explain this pain so that your patient could understand it, to then change their behaviour to help their pain. It was great, I came out feeling motivated, and empowered to help my patients, and felt like I had another tool in my toolbox as a therapist to help patients who have had pain for years. Now this afternoon, I had a new patient, who by chance was presenting with chronic low back pain – the perfect person for this type of education. Now they arrived late to the appointment, and I was booked out for the afternoon. Due to this, I decided to scrap the manual therapy portion of the session and get a great subjective and objective assessment and educate the person on their pain, why it was still around and how we can get it better. This patient was referred under a program by the Australian government which provided them 5 sessions, which my clinic did not charge any gap for, so I knew we had time in future sessions to get into more passive treatment if needed.
The learning moment was when I had a call from my boss, as the patient's child called up and asked to see a different physiotherapist (or potentially decided not to book back in entirely, my memory is a little fuzzy). The reason for this is because they did not get a massage! I was confused more than anything at first, during the consult I explained that massages were not going to change anything long-term in her back, and I did not get any pushback. But what I realised after is that there were a few things I didn’t factor in or realise.
First, this patient came in with expectations – she was told that she needed a massage from family, friends and likely other health professionals and she probably has had a massage before and it helped temporarily with her pain. Secondly, she was a very nice person, and due to this, she was not the type of person to push back during the session because she wasn’t getting a massage. It did not matter that she was late, or that I as a health professional had explained the answer for her back pain was not a massage but modifying her daily habits and behaviours. Her expectations weren’t met and she left without any improvement in her pain, and likely annoyed this young man just talked to her for the whole consult – physios are meant to massage!
This is not any one individual's fault, I as a therapist should have understood her expectations and tried to meet them for her to buy into the real solutions. I was not going to change her whole outlook in one session, and now she wasn’t coming back again so providing some manual therapy, and explaining the same things may have been a way to have her return to get her on the right path. Looking back, the information I provided was not wrong, but the delivery was wrong. On the other side, as a health professional, I must assess patients before providing treatment, for their safety and so that they can receive the best treatment for them specifically. I may have not just explained my expectations to her well enough so that she knew what she was getting out of the session.
Years on from this point, with many patients seen from various backgrounds with various conditions, I have more of a nuanced approach. I tend to use manual therapy sparingly and use it as a way to improve pain short term, change movement short term to show someone why a specific exercise treatment approach is chosen and to allow me to educate someone in a more relaxed situation. Rather than talking face to face, it can be easier to listen for some when they are looking at the blank floor having a back rub. This though is only when time permits and it makes sense. What I avoid doing, is creating expectations that the massage is mandatory for them to get better.
This is why I also have opened up NEOstream, as I know most people's solution is not dependent on whether or not they can see someone for a massage, joint manipulation, or receiving dry needling. It allows me as a hopefully more soaked sponge, to utilise my greatest skill set, which is assessment and treatment in the form of exercise and education to help people. Thankfully, there are plenty of ways for people to self-massage, which I think for some can be helpful as a part of their therapy treatment plan.
As the world of physiotherapy evolves, so too does the need for openness and adaptability. The future holds exciting possibilities, especially in how we approach patient care and debunk preconceived notions. It's an ongoing journey of discovery and growth for both therapists and those seeking physiotherapy/rehab.
NEOstream brings the buzz of telehealth to your fingertips 👨💻. Ready to redefine your physiotherapy experience? Here’s your chance – book your initial appointment and feel the NEOstream difference firsthand! 🙌
