Work Outside of Your Box
Updated: Aug 16, 2020
Most of us in health and wellness are lifelong learners-- and man, did I do a lot of continuing education courses as soon as I was a registered physio out in the workforce. It felt like a necessary step if I wanted a chance to get ahead. Within a few years, and thousands of dollars later, I had covered several manual therapy and spinal manipulation courses, acupuncture and dry needling, biomechanical assessments, and so on. As soon as one was done, there was another that I felt like I had to do next. Continuing education courses are an industry in of themselves; there is always a new technique, a deeper understanding of mechanics, a new approach to movement-- being marketed to us as the next big thing by the those selling the courses, or sought after as prerequisites by prospective employers. It’s obviously important to continue to specialize in your profession and gain more in-depth knowledge of what you are doing with your patients or clients. That said, with endless courses coming out, there is an endless race to demonstrate the highest level of knowledge, experience, or expertise in a field. While the pursuit of more knowledge is definitely a desirable goal, and we all want to become the most effective at what we do, the problem is we often get tunnel vision in this pursuit. I began to ask myself, how much more do I really need to know about a specific joint, sliding in a particular direction, during an isolated movement, to really make more of an impact with my patients? How many ways can we assess a back or neck, or give stability exercises for a knee or shoulder? Is this really why people aren’t making better progress in physio? After branching out and completing yoga teacher training, I went about trying to become a more ‘well rounded’ physiotherapist to offer better quality care to my patients, and no, being well-rounded didn’t mean learning a new way to activate the glutes or a new place to insert a needle. Yoga led to learning more about mindfulness and its impact on lifestyle and recovery. From there I became more interested in the science behind nutrition on pain and recovery, as well as the science behind sleep, human behavior, stress and mental health. I just completed a course in coaching behavior change. Next up is the NCSA Strength and Conditioning Specialist certification, and then a university course in plant-based nutrition. Aside from the NCSA certification, my resume is beginning to look a little different from that of a traditional physio. Given what I know now, how can I stay in that box anyway? How do I holistically treat a patient, especially one with chronic pain, if I only give them a few rehab exercises and a brief explanation of pain physiology? How do I not talk to them about nutrition, given what I know about the relationship between our gut microbiome and pain, mood, and inflammation? What’s the point of knowing the best exercises for shoulder pain if my patient isn’t motivated to do them on a regular basis anyway? Will those upper traps really relax for long if the person is still stressed out of their mind and short on sleep? A rehabbed concussion or ACL doesn’t mean much if the player is afraid to return to their sport. On a bigger scale, why do we stop once the tennis elbow is better if the patient is walking out of the office still pre-diabetic and sedentary, when there might be an opportunity to offer more to them, like better all-around health and well-being? Of course, I know when to stay in my court and refer somebody on when something is truly out of my scope. It is very important that we work within the bounds of our education. However, that doesn’t mean I can’t provide some science-backed knowledge on nutrition, behavioral science, or mental health during a physiotherapy session, provided I have taken the time to learn the science from trusted sources. There is just too much more to recovery than manual therapy and exercise, or even education on pain management. Although interdisciplinary teams have their place, are becoming more common, do I really expect every patient, often with limited funds, time and/or energy, to see half a dozen other professionals on a regular basis in order to become their healthiest and happiest self?
Better care in health and fitness comes from being well-rounded, flexible, and open-minded. It does not necessarily come from adopting a narrow tunnel vision approach to becoming an ‘expert’ in one’s field. Just like we shouldn’t place our patients inside a preconceived box, we shouldn’t put ourselves in them as professionals either. We should all of course be experts in our fields, and continue to deepen our knowledge—but we should also know enough about everything else to be able to provide accessible, holistic care to our patients and clients. The best care happens when we treat the whole person, not just the painful area circled on a body chart. Quote: Dr. John Berardi