Highs, Lows, and Plateaus

For my last blog of 2017, I thought I’d take a quick look at some of the highs and lows of the year that I have been involved in or around this profession of ours. So if you’re ready to hear some back-slapping and some back-stabbing then come with me as I take a look back at 2017.

In general, it has been a fairly torrid and tumultuous 12 months for me both personally and professionally, but it also has been a big 12 months for the UK physio profession with some big changes to its structure and way its governed. However, physiotherapy is no stranger to ups and downs, and others have discussed the rollercoasters this profession tends to go through.

Over the years there have been some big claims and high expectations about how effective various different treatment techniques and modalities within physiotherapy could be for some conditions and pathologies. Unfortunately, this year the research and the critics (myself included) have shown and highlighted that a lot of these are not as effective or useful as some would like to believe or claim.

This has caused a lot of debate, disagreement, and disillusionment for many physios who often feel their efforts and hard work are nothing more than placebo and that the profession has no real future. However, some are beginning to realise that physiotherapy can have a key role in modern healthcare if it follows the evidence better, ditches the low value, ineffective treatments quicker and recognises its role lies more in providing simple, honest, advice and education, and promoting and advocating the benefits of physical activity and exercise.


Like most others, I have been riding this physio rollercoaster right from the beginning of my career when I was full of high expectation and anticipation thinking I could help people with pain and disability. I was taught and led to believe that the many different manual therapy techniques and corrective exercises I had learnt would be reliable and effective.

Unfortunately, it wasn’t long into my career that I became hugely disillusioned and despondent as I realised my training and education had left me woefully unprepared and ill-equipped to help those I was seeing.

The more I read the research critically the more despondent I became, and I will be honest and say there have been many times I have thought about leaving the profession.

However, I can now say that I have reached the ‘plateau of productivity’ and although I still find my job frustrating and far from perfect, it is far more rewarding and satisfying now that I have ditched the crap and clutter and am realistic in what I can, and more importantly what I can’t or don’t need to help people with.

It is this plateau of productivity, or expanse of effectiveness, or plain of common sense where I want more physios to reach, and hence my efforts and attempts on here and other social media platforms to promote a more simple, honest, and evidence-based message and way forward, which leads nicely into my first high of 2017…!


Without a doubt, one of the highs of 2017 for me has been the success of my course. I have been extremely fortunate that in the last 12 months I have been invited to 11 different countries, done 25 courses, and spoken to well over 600 therapists. I would like to personally thank everyone who has kindly invited me, helped organise and attended one of my courses.

Not only have you put up with me for two days ranting and raving about shoulders and various other issues in and around physiotherapy management, but you have also helped me realise that many of you have the same issues, frustrations, and concerns that I have, giving me hope that our profession is in good hands and will endure despite the many dinosaurs and idiots determined to hold it back.

I am also grateful for the feedback and suggestions I get on how my course can be improved, and although my course is mainly focused on the management of the shoulder, the principles I think can be applied to many other areas. So thanks to your feedback I hope to launch my new course soon simply called “Physiotherapy; Complex doesn’t have to be Complicated”.

This new course will aim to give those attending the confidence to overcome the barriers and common myths around simplification in this profession of ours that just loves the opposite, but more importantly, it aims to give the evidence that simple advice, education, and active interventions are effective for many conditions.

Another high for me this year has been the continued growth of this site with more and more of you reading these bloody things. What first started as just somewhere for me to rant about my issues and frustrations with the profession back in 2012 with a grand total of 9,342 views for the year, has grown into a site that now has over 150 evidence-based blogs and has had over 1.2 million views this year alone.

This simply blows my fucking mind that these posts and rants of mine are read by so many, and I will admit it does make me a little more nervous when I write them and occasionally makes me check my spelling and language a little more… but only a little bit! Anyway, thanks to you all for reading and sharing these posts and for all your comments and feedback… well mostly… as with the increased number of visitors so comes the increased number of stupid, daft, and sometimes downright nasty comments I get, and this leads into my lows of 2017…!


Now I am no stranger to receiving nasty comments and personal attacks due to my strong and unpopular views on many things in this profession that often challenge and confront others own views and opinions, usually around the effectiveness and usefulness of manual therapy and other passive interventions and treatments.

And I’m not going to act like I am whiter than white and without blame here, as I am well aware that I do rub people up the wrong way, sometimes purposefully, but often unintentionally with my mannerisms and language. I also know how I express my views and opinions can be a bit ‘rough around the edges’ but as I have said many times before… tough shit 

However, this year has been without a doubt one of the worst I can remember with regards to personal attacks, not just because of the number of them, but more for the nasty, vindictive, malicious nature of them, and who they have come from. This year I have had two serious attempts to smear and discredit my personal and professional reputation by some of our most senior members from some of the most popular orthopaedic, sports, and manual therapy interest groups in the UK, USA, and Australia such as the MACP, IFOMPT, WCPT, IFSPT, and AAOMPT.

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These unfounded and ultimately failed attempts have tried to remove my licence and ability to practice as a chartered physiotherapist, as well as attempt to censor or at least discredit my views and opinions on manual therapy and other passive interventions. However, these complaints are a thin and pathetic disguise for these individuals own fear, frustration, and jealousy of the platform I have via my social media profile, and because I threaten their own vested interests.

Many of the individuals who have attacked me this year are closely linked with the promotion and selling of their interest groups memberships, training programs, and accredited qualifications, not to mention their own personal courses, and to put it simply I threaten this hugely profitable business for them.

I have and I will continue to challenge physios that they don’t need to spend thousands of pounds, euros, or dollars as I have done on extensive courses or group memberships that promise you much but deliver little. These often only try to teach you overly complex and technical ways to rub, poke, prod, prick, stick, or click patients yet they all ultimately have little to no specificity and add very little to your ability to be an effective physiotherapist.

Personally, I hope that most of these interest groups are soon a thing of the past. Why the musculoskeletal profession needs so many different groups is beyond me and some others. Personally, I see them as a huge barrier to our progress with their mixed messages, elitist closed group mentalities, and hidden agendas of selling courses and subscriptions thinly disguised behind promoting best practice and career progression.

Now you may think this is a bit rich and hypocritical coming from me who also sells a course to be calling out others who run courses, and yes it is a bit. However, although I do earn an income from my courses I don’t rely on it as others do. I am and always will be a full-time clinician and my courses are ever only extra-curricular activity whilst people are interested in what I have to say and do.

And before you accuse me of discrediting all post-graduate learning, I know that there are many, many excellent courses out there run by some ethical and sensible clinicians, and there is no doubt that continued post-graduate learning and education is essential for all of us. However, I would ask you all to consider your post-graduate training and courses a little more carefully in the future and perhaps consider potential conflicts of interests and financial biases that some of these groups and individuals have, including mine!

Finally, to finish on a positive note, one good thing that has occurred from this whole nasty fiasco is that the profits from the sales of my slogan t-shirts that first triggered many of these complaints this year have raised just over £250 for the charity Save the Children so thank you all for that. If you would like to help support this charity my t-shirts can be bought online here.


To finish off my review of 2017 I want to talk about a couple of events that have happened this year that I am hopeful will bring some much-needed level ground to our profession in the UK.

The first is the landmark changes to the CSPs council and its committees with a radical streamlining from 27 members to just 12. This is an effort to remove the unnecessary delays and organisational difficulties that such a large group of council members create. The smaller council will hopefully make our professional body more fit for purpose and able to keep up with changes in policy and practice that are constantly needed. I also hope it will reduce the number of members who have biases and vested interests for some of the special interest groups I have already mentioned.

The other event that I have big hopes for is the call for Reasoning, Responsibility, and Reform or the Big R’s. This project I hope will help drive forward more responsible clinical reasoning and much-needed change for the profession. However, if my call for the removal of therapeutic ultrasound machines is anything to go by, it’s in for a rough and challenging ride.

In summary 2017 has been like most other years, full of ups and downs, highs and lows. However, I am hoping that this new year of 2018 is the start of more physios reaching the ‘plateau of productivity’. I hope that more physios recognise and tolerate the uncertainty in our ability to diagnose why things hurt and that pain is a multifactorial presentation which often we will not fully understand.

I am also hoping that more start to recognise that many of the treatments we use are surrounded by uncertainty about how they work and have some serious limitations in what they can do. However, this doesn’t mean physiotherapy is useless, in fact, if used responsibly and rationally physiotherapy has a strong and bright future.

So finally I wish you all a happy, healthy, and successful New Year and look forward to writing more in 2018.

As always thanks for reading!




  1. Adam, yours is a needed, naysaying perspective. Tough year, but keep going! Many wish for a bit more decorum re: language, etc., thinking your message might have even more power and be harder to dismiss (just an angry man with an f’ing chip on your shoulder); but as you say, your shear # of views continue to explode, and it’s your blog so t.s. I appreciate the discussion, debate, and tempest you … are. 🙂

  2. Another exciting year following your ups and downs,
    Thanks for all your continued hard graft and entertainment.
    Have a great new year and see you on the other side!

  3. Hey Adam,
    Thanks for your work. I’ve been following your material since I was a student and I admire your tenacity to withstand both professional and personal attacks thrown your way.
    In my opinion, challenging current beliefs and the ability to look at all information (both positive and negative) is integral to the growth of the profession. Yours can be a breath of fresh air in an environment that feels much like an echo-chamber at times.
    For what it’s worth there are many many clinicians out there who support your work!

  4. Hey Adam
    A friend recently recommended that I take a look at your blog and I’m glad that I did. I agree with most of your philosophies and there a lot of other people out there who do too. Sorry to hear that you have come under so much criticism this year. For your own benefit, it might be good to tone down the locker room banter just a bit, swop the F’s for S’s, soften your approach just slightly. Keep hold of what makes you who you are, without upsetting people and ending up under fire. I have learnt this the hard way and thought I would share.

    • Hey Julia
      Thanks for your comments and suggestions, its very well received. I will endeavour to ‘dial’ it down a notch or three and see how it goes… however I think, and others have told me that I have ‘mellowed’ over the years and it doesn’t seem to have made that much difference to the complaints and angst I seem to create.

  5. Hey Adam,
    I can’t tell if finding your blog has been the best or worst thing to happen to me this past week…. I’m currently a student on my MSK placement in a private clinic and the first month was great, but we see lots of whiplash and it seems like 80% of the patients have been coming there for months or years and have seen fuck all gains. I get exposure to a bunch of cool cases and my CI gives me tons of freedom but I can’t help cringe when I’m asked to explain what ultrasound is “supposed to do”.
    I got pissed off with being told we can’t do anything for most people, so I looked around for extra info and stumbled here, which was a real kick in the nuts to read all the sources on how so much of what I’ve learned in Uni has been buttered up.
    Honestly I went into physio to be a mechanic, I struggle with being engaged in almost any class and although I work out myself, never wanted that to be my go-to intervention, but I can’t help that I’ve become a radical skeptic of manual and modalities now. I’m really struggling being so disillusioned with physio, and wondering if I should continue with school since I’ve already been having issues with my professors and people I work with by being “unprofessional” from cracking jokes.
    I know you’ve had similar issues during school but I can feel myself being molded by how we “should” act and frankly I feel stupid giving people exercises without explicit diagnosis so I’m almost burnt out, without even seeing someone all stoked out!
    Perhaps is all from inexperience but how do you suggest I re-motivate myself and go about challenging some of the things I’m learning, considering grades during practical exams are subjective and I don’t wanna fuck that up? Thanks for writing the blog man, I still have hope now that I don’t have to be soft to succeed. – J

  6. Always enjoy your common sense viewpoint. The graph really sums up the journey of high expectation as a new grad to creeping reality with experience and reflection.

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