Resilient's Greg Spatz was recently interviewed for an article published by Outside Magazine.
The article is titled "What We Learned From A 145-Year-Old Strongman"
Here's a quote:
“Most people overlook the power of deep breathing. But full deep-breathing cycles in the squat position is something I recommend for a lot of my patients.”
By Doug Kechijian
The following scenario is fictitious but not unlike what I encounter in the clinic on a routine basis…
Clinician: Have you seen any other providers for your knee/hip/back/shoulder pain?
Patient: Yes. I see an acupuncturist once a week. He/she sticks needles along the length of my leg and it seems to help. The chiropractor I see two times a week adjusts my back because it gets out of alignment every few days. My physician prescribed anti-inflammatory medication and provided a series of injections. I saw a physical therapist for a few months and we worked on core strengthening. My personal trainer says I’ll feel better when my fitness improves. My yoga teacher says I need to be more flexible.
This encounter speaks to the futility of viewing certain phenomena through a very specialized lens (e.g. pharmacology, exercise, spinal manipulation, energy meridians). Even if each of the aforementioned professions adhered to theoretically and empirically robust practice standards, indeed a generous assumption, their respective political, legal, and educational parameters limit clinical utility.
Does puncturing the skin with a needle containing no medication or eliciting a joint cavitation really warrant a distinct profession? Is therapeutic exercise so complex that it should be studied at the exclusion of other constructs? How generalizable and relevant are professions that define themselves by particular tools or interventions?
Paradoxically, professions that politic to monopolize particular interventions (like acupuncture, spinal manipulation, prescription medication, and injections) render themselves less capable of adequately servicing their customers. Medical myopia is wasting people’s time and money.
Some diseases and procedures, mainly surgical ones, do warrant highly specialized providers. The orthopedist who limits his/her practice mainly to ACL reconstructions is undoubtedly more adroit at that procedure than a general surgeon. An ACL tear, however, is a much more concrete diagnosis than can typically be identified in physical medicine and sport. Moreover, pinpoint structural diagnoses don’t satisfactorily characterize the practice patterns performance-minded clinicians and coaches encounter in non-contact or atraumatic instances. How much different is “rotator cuff syndrome” from “biceps tendinopathy” or “scapular dyskinesis” really?
Specialization often promotes a kick-the-can mentality among different providers, typically to the detriment of the patient or athlete. Medicine and coaching need fewer specialists, not more. That the patient in the above scenario felt compelled to see so many different practitioners speaks to each individual profession’s shortcomings and to the systemic flaws of medicine as a whole. Complimentary providers should spend more time collaborating to minimize redundancy and diminish the intellectual void created by specialized thinking and identity politics. Instead, it is more likely that various professions will continue to champion their perceived uniqueness in an attempt to validate their existence. The pursuit of uniqueness is interfering with the acquisition of knowledge and the application of scientific truth.
Resilient's Trevor Rappa was recently interviewed for an article published on the Map My Run Blog.
The article is titled "From Couch to… What You Need to Know Before Diving Into an Intense Workout."
Here's a quote:
“Trying to radically change your exercise behavior is stressful and hard to maintain. Try making small changes over the course of a few months that will add up.”
By Doug Kechijian
Physical therapy students in the United States are unable to practice unconditionally until they graduate from an accredited program and pass the National Physical Therapy Exam (NPTE). Many states permit students to sit for the NPTE within 90 days of graduation. Even in these states, however, program directors at the university level must authorize these students to take the exam. In Ohio, for example, program directors must certify that pre-graduation NPTE applicants are “bono fide candidates”. In other words, program directors, not state and federal adjudicators, ultimately control when a physical therapy student is eligible to take the NPTE. Any physical therapy student within 90 days of graduation, however, is effectively a “bono fide candidate”. A program director’s written endorsement of a candidate should therefore be more of an administrative formality than a permission slip.
Completing and ultimately passing the NPTE prior to graduation expedites loan repayment and maximizes potential job opportunities. Tuition costs alone often leave novice physical therapists a few hundred thousand dollars in debt. Moreover, they await some of the lowest entry-level salaries among clinical doctors despite similar educational costs. Time is financial independence. Nevertheless, some program directors refuse to permit students to take the NPTE within 90 days of graduation despite state policies to the contrary, allegedly because initial pass rates might improve when less employable candidates are held hostage over the summer with no professional or academic responsibilities besides exam preparation. Would this line of reasoning hold up if a student took his/her program to court? Luckily for these universities, physical therapy students are in too much debt to afford an attorney. Program directors should not be granted veto power over matriculating students seeking to maximize their earning potential and begin their careers when state provisions are otherwise respected.
That the discretion of individual program directors should supersede state and federal doctrine is rationalized by the following explanations:
Every argument against taking the NPTE prior to graduation essentially amounts to gatekeeping and can easily be rectified if adequate countermeasures are implemented (e.g. CIs not permitting test review during clinical hours). The NPTE isn’t this enormous rite of passage. Entry-level DPT programs can prepare students for the exam without forbidding all other pursuits. The NPTE is a test of minimal competency, basic concepts, and safety, not something that requires candidates to learn new information. Moreover, program directors shouldn't be able to override the intent of state and federal policies despite the technical demand to validate that a candidate is in “good standing”. State boards permit students to take the NPTE before graduation regardless of the potential outcome. Favorable status with CAPTE shouldn't be valued more than a new graduate’s earning potential and freedom to choose. Neither are these aims dichotomous.
The burden is on entry-level programs to prepare students for the NPTE in conjunction with other coursework and clinical experiences. Program directors and preceptors don’t coddle medical students during the physician credentialing process. Physical therapy will never achieve the level of autonomy it wishes for if it refuses to empower its own people. True direct access providers are health care leaders. The rebuttals to the original question posed here do little to promote professional leadership. They paralyze the profession with fear of failure. Empowering students advances the profession's political interests more than delaying NPTE preparation. Physical therapy hashtag movements are futile without emboldening professionals early on in their careers. Other medical professionals and the public will continue to regard physical therapy as subservient as long as #GetPT1st treats its own people as such.
Should be #cultivateleadershipandconfidencewhiletakingcareofyourpeople1st