Physiotherapy - My Thoughts So Far
What is Physiotherapy?
Physiotherapy is a type of healthcare where Physiotherapists:
help people stay healthy by encouraging exercise and physical activity.
work to prevent problems that might stop people from moving well, like health issues or stress.
provide treatments to help people move better and feel stronger. This helps them live independently, work, and enjoy life more.
modify environments, homes and workplaces so people can fully take part in daily activities.
In Australia, to become a physiotherapist, you need to complete a 4-year university program or a 2-year Master's program that is approved by the Physiotherapy Board of Australia.
Prologue
When I was in high school the careers counsellor advised me that I would make a good Physiotherapist.
I didn’t believe him, and didn’t fancy myself at 17 years old as wanting to tend to people’s injuries, let alone managing the health of people in their 40s/50s and beyond, who I could relate to very little.
I opted instead to pursue a general entry into the world of sport, fitness and health with a Bachelor of Exercise Science.
It was and introduction to foundational principles in psychology, exercise, nutrition, and public health, and led to my first jobs in sport and fitness.
Despite my enjoyment in these fields, there was always clients and athletes becoming injured, and some of them had conditions or other relevant factors that I just couldn’t address no matter how good my exercise programs were.
Luckily, I worked my way into a rehabilitation role in sport for the Casey Demons (VFL) where I was first exposed to injury management and spent time with the medical staff, especially the Physiotherapist.
About half way through my time in this role I realised that Physiotherapy was, actually, exactly something I wanted to do. It provided solutions to many of the conditions I was seeing in the clients and athletes that I worked with.
In 2022 I began my career as a Physiotherapist, and am now in my third year of practice.
It’s an incredible profession, not without its controversies and areas for improvement, but one which I’m glad I chose deliberately, and one which has so much potential for what it could become.
I don’t know where it will take me, but there are many therapists I aspire to follow. David Butler, Louis Gifford, Peter O’Sullivan, Robin Kerr, among others.
Not just because of their technical contributions to the profession or their individual skills as practitioners, although esteemed, but the way in which they’ve pursued the development of the profession, and the ways they deliver healthcare to patients.
In following these great people, I came David Butler’s blog post “The Rollercoaster of Professional Life – still evolving”, which has inspired me to consider how my career will develop and what I will look back on in 10 (/20/30/40) years time as key shifts in my practice.
In aid of this reflection, and to accurately document my thoughts in real time, here is stage one.
One - The Biopsychosocial Model, (Psycho) Social Media, and Beyond
BPS has overtaken Biomedical as the preferred treatment framework, although still presenting integration difficulties between the three elements Bio, Psycho and Social, and a slew of therapist who have not yet.
Concepts such as the enactive approach are emerging as logical next steps from BPS (with difficulty as outlined by Cormack, Stillwell et al.). However, in healthcare we are a long way from fully understanding (let alone practicing with consideration for) the complex dynamic system that is human existence and how it relates to health, illness and injury.
Imaging and biomedical models as causal explanation for people’s conditions are somewhat frowned upon, as are manual therapy techniques, but only depending on who you speak to. Nevertheless, anatomical variations do not seem necessary for pathology or pain.
Physiotherapists who do neglect the provision of manual therapy are likely missing out on a crucial element in the treatment process, and because of this are losing favor with some of their consumers who wonder what else it could be that a Physiotherapist does to help.
Social (and other) media’s influence is running rampant in its effects on healthcare, and is overtaking formal study and scientific resources as a #1 source of information for time poor and often uninspired clinicians. A win for information distribution with an unfortunate side effect -some senior practitioners are dispersing unfounded anecdotal claims, or taking to social media to argue with eachother. This is creating a turbulent social climate within the profession, and confusion at best for new healthcare practitioners and the health-conscious public.
Exercise is still in vogue, and so is patient education. Packaged together with other methods as “facilitating Self Management” - these treatments should probably be more prevalent, but we are having difficult shaking the tradition of the reputation of “therapist as the fixer”. A move to “therapist as guide” would likely suit well.
Physiotherapists are now many things to many people (counsellors, manual therapists, diagnosticians, exercise prescribers, referral sources, social media personalities), due to the changes that have come with theoretical, practical and social shifts.
Many high level thinkers in the profession are looking to adjacent or disparate fields: including philosophy, psychology, phenomenology, mathematics and technological advance, to determine where the profession will develop. This leads some to believe that we will separate into ever smaller hyper-specialised areas of practice, and others to believe that we will become a fully integrated practitioner capable of managing all of the duties outlined in the previous point. Neither side has yet made a clear enough affirmation that one is more likely than the other. Although, in Australia, the Australian Physiotherapy Association and Physiotherapy Board are making enquiries for Physiotherapy to expand its scope to activities such as to prescribe scheduled medicines and other changes such as increased referral capabilities and Medicare Benefits Scheme access may result as the Australian Government is reviewing scope of practice in primary care settings
Overall I am hopeful of where the profession may lead to, and comfortable with my place in it, albeit often overwhelming.
I ride the Dunning-Kruger rollercoaster daily, sometimes even hourly, but I always find myself more inspired by the end of the ride than I was at the start.
Clinical practice is a constant cycle of implement - reflect - adapt.
Mistakes may be made along the way, but extraordinary care is to be taken to ensure none of them are catastrophic.
Let’s see what happens next.