Just A Physio

I often get asked by other physios ”what kind of physio are you?”. Often I reply ‘just an average one’ to wind them up because I know what they are really asking me is what are your qualifications and allegiance to a specific physio method or treatment?

Now there are many kinds of ‘method physio’ such as McKenzie physio, Maitland physio, Mulligan physio, a Cyriax physio, even a Cognitive Functional Therapy physio. And there are many kinds of ‘treatment physio’ such as a manual therapy physio, a pilates physio, a dry needling physio, a cold laser physio, a myofascial release physio, even intergrated functional systems physios.

Well, I am now proud and happy to say I am none of those, I’m just a plane boring bog standard physio. I’m not accredited, affiliated, or aligned with ANY specific methods, treatments, groups or gurus, and personally I don’t think any physio should be.

Now don’t get me wrong I think we can all learn some stuff from many of these methods and treatments, and I have! I’ve personally done many of these courses, jumped through their hoops of assessment and passed their pseudoscientific exams to earn post graduate ’qualifications’. But I don’t align myself with any of these methods or treatments when it comes to doing my day to day job seeing people in pain or with disability!

Personally I think most if not all of these groups, clans, and tribes within our profession cause more problems than benefits producing more bickering, backstabbing, infighting and endless pathetic claims of superiority over each other.

For example, when I was a young naive and impressionable physio I did my first MSK orthopaedic post graduate course with the Cyriax affiliated ‘Society of Orthopaedic Medicine’ or SoOM as its called, I was consistently belittled and looked down upon by those in another MSK orthopaedic special interest group called ‘The MACP’ which used to stand for ‘The Manipulation Association of Chartered Physiotherapists’ but changed its name to the ’Musculoskeletal Association of Chartered Physios’.

Because of this I then started to do my MACP post graduate training but kept coming across so much ego and elitism in their members and tutors that I left half way through my training unable to stomach it or them anymore. Still to this day because of these experiences I hold the MACP and most of its members in low regard. I have also had some personal and professional disagreements with some of their senior members and have found the MACP to be a seething nest of spiteful, vindictive, and narcissistic attitudes and actions.

The MACP often try to promote they are working hard to improve the standards and advance MSK physio, but in my opinion this is just a thin disguise for their real motive which is to get as many physios as they can to join their clan, pay their subscription fees, do their training, jump through their hoops of assessment and accreditation, and ultimately think and act exactly like they do.

I’ve lost count of the number of times I’ve seen or heard MACP physios thinking and acting the same, often claiming that they are better trained, better skilled than other physios because of their membership. Many think and have told me that because I haven’t completed the MACP training brainwashing or jumped through their hoops of accreditation that I am somehow less skilled, less capable, less of physio

I often get called by many MACP members in senior ESP, APP, FCP roles a ‘glorified personal trainer’ in some misguided and laughable belief that this is somehow an insult to me. Many think that because I dont use manual therapy, electrotherapy, dry needling, taping, or any other adjuncts to help people with pain or disability, preferring to use advice, education, movement, and exercise that I am not fit to call myself a physio.

Many think that because I dont use any passive treatments, tricks, gadgets or gizmos then that makes me less of a physio! This makes laugh and cry at the same time

For example, when some physios call me a glorified personal trainer it clearly shows their arrogance and ignorance in thinking that personal trainers are somehow beneath them. Even though personal training is largely an unregulated profession I think many, many physios could learn a thing or two from some personal trainers.


A lot of physios like to belittle or ridicule personal trainers for their lack of knowledge on anatomy, biomechanics, or because they don’t have formal qualifications or protected titles. However, when it comes to exercise prescription, planning, and programming most personal trainers put most physios to shame.

Physios are thought to be the ‘experts’ of exercise but I know first hand that most physio training does a really shitty job at educating and equipping them to understand, prescribe and program exercise effectively. Most physios training on exercise and rehab tends to reach the dizzying heights of how to prescribe safety googles before using Thera-band and how to walk up and down a flight of stairs, which can be important, but let’s not forget that without sufficient leg strength no one is walking up or down any stairs anytime soon.

So you would think it would be a good idea for physios to also learn how to develop sufficient leg strength in their patients. You would think it would be a good idea for the universities or special interest groups like the MACP to teach physios how to perform and teach exercises such as the squat, the deadlift, the overhead press, and many of the other basic strengthening exercises. Yet they don’t!

Most MACP or other accredited method/treatment courses couldn’t teach you the difference between a front squat, back squat, sumo squat, goblet squat, hack squat, pistol squat, split squat, half or quarter squat, let alone demonstrate them well. Most physios training does not teach them how to prescribe, dose, progress, regress, or execute exercise well.

Most physios training is just not focused on exercise or rehab, but rather on modalities and adjuncts like manual therapy, dry needling, and taping etc. Many physios are lead to believe that these treatments justify their role and their place in the healthcare system, and exercise is the simple easy bit that can be done at the end, or worst not at all!

This makes me both mad and sad. Physiotherapy is so much more than its treatments of manual therapy, electrotherapy, needling, even exercise.

Many physios feel the need to justify their existence by saying things like they break up scar tissue, release stiff joints, free fascial adhesions, or correct muscle imbalances or faulty biomechanics. Many physios just don’t feel confident to explain that what they do is assess, reassure, advise and try to get people moving more.

Many physios feel the need to exaggerate and conflate what they do to make themselves feel more important and more essential in the eyes of their patients, their peers, and other healthcare colleagues. Many physios just do not get taught or encouraged to see the value in simple, honest, things they do.

This is again both sad and maddening.

So I will try to change this by saying that as a physio I try help people in pain or with a disability to move and function better. I do this by assessing for any serious or sinister stuff, then advising and reassuring patients that its safe. I then try to look at ways to get them to move differently, get them a little stronger, fitter, and more robust both physically and psychologically.

I do this without any gadgets, gimmicks, magic tricks, or bull shit. I don’t correct faulty biomechanics, I don’t release fascia, I dont alter soft tissue tightness, spasm, tone, or flexibility, and I don’t miraculously cure or remove pain.

In summary, I’m just a physio!

As always thanks for reading
Adam

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  1. Nearly every in service I do is based on exercise prescriptions and progression,
    Updating guidelines on strength progression, signposting guys towards NSCA, ACSM etc literature. When newly qualified guys ask what courses they should do my advice is always to go and first do a S and C course……..

  2. Personally I agree with most of ur comments. As a physio for 26 years and Maitland trained I am now more aware than ever in the black hole of exercise effects and prescriptive info I was ever made aware of . I really hope ur stirring helps develop our profession to realise the power of the body and how with correct exercises and advice we can make a huge difference. I now use less and less manual therapy the odd bit to help facilitate movement or an exercise but empowering people to help themselves is my most important role. I continue to learn more and often liaise with personal trainers and sports therapists. We need to progress. Thank u

  3. Spot on mate, as an Osteo I regularly experience the hierarchical nature of the medical system and the nonchalant arrogance of docs with Msc’s in sports Med injecting and zapping everything that moves whilst ignorantly slating lowly personal trainers for helping make patients more robust!! As an experienced PT and sports therapist I’m also stereotyped by the mysterious title of osteopath which confuses patients when I don’t poke, prod, pull and click them! As musculoskeletal therapists we are all aiming at the same target with different arrows but when will we as a collective accept that the active participant is so much more effective than the passive recipient? Physio’, osteo’s, Chiro’s are all unfortunately victims of poor education when it comes to effective treatment and some if not most are hanging onto archaic modus operandi for dear life! In the words of Sam Cooke- a change is gonna come! Keep preaching brother!

    • Cheers Ricky… as Stark said as well brace yourselves… winter is coming!
      And keep on making those patients of yours robust and yoked out beasts!

  4. Good article. When I fractured my upper left humerus just below the lesser tuberosity I could not even move it an inch. My physio like yourself Adam left out manual therapies only giving me a cortisone injection into my infraspinatus in the earlier stages of my recovery once. From then on it was graded strength training. Now happily repping out 24kg overhead kettlebell shoulder presses with full range of movement and no pain can vouch that strength training worked for me and I am guessing would work for others.
    That’s proof for you

    • I have always said……. “let the people (or patients) speak” as they know their bodies better than anyone. Most of us want to be fixed for good not prodded around with needles. It is a cash cow I am afraid. Where would all the physio’s be if fitness trainers took over healing patients for good with repeating conditions such as a jammed up sacro iliac joint on one particular side prescribing unilateral exercises to strengthen unbalanced muscles???
      This is why the training colleges of physiotherapy and the like WILL ALWAYS want to teach “other methods” away from basic strength training.
      Let the patients have THEIR say……..it might if we all united change the way of current treatment.
      Many are too afraid but go for one therapist to another private or NHS wasting hundreds of pounds….such a shame

  5. I think you are right but this is a bit how most things are in life. For people it seems easier to believe than to do a bit of research about what Could be the best in that situation. i think if you were a surgeon you probably wouldn’t operate that much and being An electrician you maybe would educate people what they don’t need in their house. I think this should also be done but this is everywhere… returning to pt , i wonder if exercise eventualy should be promoted as for training and the physiology regarding trainingseffects are myths in a lot of cases. I hope evidence Will be more around in everydaylife but i think it Will not be for tomorrow. I think we are selected by evolution to have false beliefs. If our forefathers didn’t imagine Some kind of dangerous animal and run when hearning something in the bush , we wouldnt be here. I think the possibility to imagine this is also the reason people are probe to believe in a God and also in quackery… so maybe we are evolved for this..

  6. Excellent post! The point about lack of proper education about exercises in physio colleges is spot on. I am physiotherapy student and most of my knowledge on exercises and how to actually do them has come from self learning.

    • Thanks Fatema… it is still a shame that physio training is still lacking in exercise education as it was back when I trained and many others tell me the same as you have that it is still poor!

  7. Another great post, Adam. I have been telling PTs for years now that “soft skills”, the ability to analyze, problem solve, counsel, communicate, educate, and motivate our patients to take an active role in their own recovery are far more important than the technical “hard skills” like manual techniques. Worse yet, as you point out, the evidence behind many of these techniques ranges from poor to non-existent to not even plausible. I feel like this largely falls on deaf ears. I have had PTs walk out on a talk because I dared question the validity of cranio-sacral therapy.
    I also believe that this over emphasis on techniques that are done to patients is a symptom of a professional inferiority complex, and a history of being viewed as technicians by the rest of healthcare, but that is a subject for another time.

  8. I have found this quite heart felt. 1) I am a PT. 36, but not an elite athlete 2) I am also doing a soft tissue therapy course. Yep!!!! But I’m also a Cardiac Tech. No, not in a darkened room doing echo, but in the cath lab watching pen springs being inserted.
    So, I completely agree with you. I too suffer the same down trodden regard for my own profession.
    For me you have hit on something close to heart. The NHS is a hierarchical system. But , for it too survive it needs to change.
    Good article!!!

  9. Awesome article! As a trainer trying to learn from physios, its really helped broaden my understanding and put greater care into helping others train better. My internship at a local clinic is experience that I’ll never take for granted.

  10. I realize that I am banned from your site for being critical of some of your past comments. Inquestions how every physio should be proud of what they do when the typical physio experience for many of the patients is an utter waste of time. I encourage people to see a few absolutely outstanding therapists in my community but people have the right to see whoever they want and typically it is a friend or a friend of a friend. UnfortunstelynI will continue to say youneritevs lot of words with little to say and I will happily retain my banned status because of your holier than thou attitude.

  11. Great post Adam. I’m currently doing my masters and recently completed a module called ‘Exercise prescription, progression and periodization following injury’ precisely because of the points you have made re physios not knowing enough about exercise prescription and progression. It included a session with an S&C coach who taught us correct technique for squat, back squat and deadlift – great to learn that stuff. One of my colleagues was a personal trainer until he recently qualified through the 2 years masters route and he’s a great source of knowledge.

  12. Thanks Adam! I am a personal trainer and appreciate your post. I also agree with you. Although I received my cert. from one of the most reputable companies, I was completely overwhelmed with how much I didn’t know and needed to learn. An exercise physiologist gets 4 years to learn what I studied for 4 months. I was constantly afraid I would hurt someone because of my limited knowledge.
    I am grateful now for that fear. It inspired me to view my continuing education as though I was going through a degree program. I began choosing to study areas that excited me but also would increase my knowledge of the workings of the human body. 6 years later I am growing in confidence but because the human body is so amazing, I know I have a life time of learning ahead of me.

  13. Great post Adam and thanks for your blog. I’m a physio student and I have many times felt the frustration and questioning feeling of “just” being teached to do massage, mobilization of joint, myo-fascia release therapy etc. i stead of having a proper lesson in training. I think we had 1 x 2 lessons with strengh training 6 months ago, where our teacher “learned us” how to do the big three: benchpress, squat and deadlift. And the rest of if was how to use a leg press machine, leg extension machine ect.
    I’m glad that I have experience from my own training and interest in learning more about it, because we are NOT teached how to train people. And it’s very sad.
    Thanks again for your blog and keep them posts coming.

  14. A Physio recently attempted to pick me apart for my posture, over developed para spinals, reduced hip extension and lordotic spine (useful to add that said clinician has countless injuries and I have none)………. My comeback of “So What”? “Strength trumps everything else” (followed by a flawless demonstration of a FROM SL Squat) and “motion is lotion” took the wind out of the sails. Love this blog Adam, thanks for making my Sunday 🙂

    • Love it… many physio’s still cling to the idea of perfect ideal alignment and posture, stance really as you would think if that were the case then as a population physio’s would be perfectly aligned… most are not!

  15. I agree in some points but also disagree. Like we shoudn’t generalize things about exercises its also important do the same about other treatments (manual therapy,…). Its not important if we are hands on or hands of therapist but we should do things which helps patient and of course use these technique which are proven. Im attending a post graduated course in manual concepts (IOMT) and its perfect example for me how should we use different type of physiotherapy techniques for treating different conditions based on evidence based medicine. Its combination of everything what evidence suggested its effective from manual therapy, exercises to education of patient,…Like everywhere else, there is also in physiotherapy differncies, certain lobbies, war of egos, trends. Especially trends are very popular. Last year there was lot of talking about Lecester miracle in premier league and they already made connections between success of team and physical conditions of team (rehab, physical preparation,..), after this season they will.not be probably interesting anymore:).

  16. I agree Adam, working as a PTI in the army has definitely given me the edge when prescribing exercises to my patients. Despite their diagnosis I find starting patients with ‘kneeling gun drills,’ burpees followed by carrying logs over the assault course fantastic rehab for any condition.

    • Knowing you a little Stubbs I can sense the sarcasm a mile off mate…
      I’m not implying exercise such as squats cure everything pain related (everyone knows that dead lifts do that ?)
      Anyway if the blog post has come across as you think I am saying a simplified approach is easy then that’s my mistake, it’s not easy but it doesn’t mean we have to keep adding and adding intervention after intervention in the blind hope something works! And the point was more to try and get more physio’s to feel comfortable and confident that they don’t have to 6 different interventions per patient no matter how complicated their issues are!
      Advice, education, promoting movement in all its wonderful diversity, and loading as much as possible/tolerable both physically and psychologically will do for me!
      At ease solider!
      Cheers pal
      Adam

  17. Dear Adam,
    Great article- I agree on 100% of what you have wrote.
    Keep the good work on.
    Kind regards, Jawad

  18. As always Adam, you are a straight shooter.
    Let me ask you this so that I can define what I see the problem as: If you get a toothache…who do you see? If you start to notice a decline in vision…who do you see? etc etc.
    Most medical situations have a defined (often exclusive) healthcare profession for which government or third party insurance will pay for.
    Not so when it pertains to “pain”. Chiropractors, acupuncturists, osteopaths, Massage therapy, Physiotherapy….all supposedly are qualified to treat pain.
    It creates an environment where too many providers are competing amongst each other to prove who has the most (perceived) skill.
    I honestly feel this is the origin of the emergence of this crap treatment called TDN. It’s a game of ‘one upmanship” where the main goal does not seem focused on the patient.
    The only way this resolves itself is for one healthcare professional to emerge as the defined expert. Otherwise, we can expect this battle for a piece of the pseudoscience pie to continue.
    Shame really because the Physiotherapy profession was perfectly poised to be that expert. Yet here we are….often 100K in student debt to obtain “doctor” status competing with high school graduates who went to certification course in massage….and so on and so forth

    • The MACP are evolving as we all are, however many MACP members (not all) are elitist, delusional, and wind me the fuck up… but that’s for another blog ?

      • I feel your pain ! MACP..pedantic and narrow in their thinking. Re Strength and Conditioning…I have bags of humility and always keen to improve our software (exerciseprescriber.com)…would you have any good contacts who could help us develop our database still further. Ideally they’d be reasonably close to me (I’m in Flitwick)…Cheers, Gary.

  19. CBT outcomes are getter for clbp than manual therapy.Doesn’t that say it all?.Exercise helps and is the one thing we have in our arsenal that has a good evidence base.
    But we must invest in the therapeutic alliance, learn how to listen instead of delivering a sermon.
    I personally don’t think what type of exercise matters that much, it’s more behavioural,just encourage seeking behaviour get people activated and that’s what snotty nosed personal trainers do well, in the outdoors (as John Ratley calls it exercise squared).

  20. Refreshing article.
    Most of my clients are disappointed with the out of date post injury prescription exercise sheets they receive from NHS physios. Once the basics have been established it can’t be a one size fits all approach to strengthening and restorative function.
    In my opinion Physio’s / sport therapists with experience in training , fitness and PT background get better results via education and role modelling.
    Ps I’m sure robuster is a word you’ve invented ?
    Enjoyable read thank you

    • Hi Marie,
      Your generalisation of NHS practice is short sighted, inaccurate and a bit boring. I primarily work in the NHS, and have also worked in private practice and elite sport. To say that patients are disappointed with the exercise sheets given by NHS physios, is like me saying I see patients every day who are disappointed with the ultrasound, acupuncture and massage they receive from private practice, or disappointed in the chiropractic treatment they’ve received that has “put my back in alignment” but, shock, horror, they are still in pain, which I do, but I don’t tar all other practitioners from a different setting with the same brush.
      Most NHS physios work to a high degree of EBP, more so than other work settings IMHO, along the lines that Adam is advocating.

  21. I like most of what you have said but I have a couple of problems. First, physiotherapy is a profession based on combination of methods, exercise being a very important one of them. You seem to have changed the definition of physiotherapy. Now that’s ok for your practice but it implies that the Chartered Society somehow have it wrong in their promotion of physiotherapy as manual therapy, modalities and exercise as well as how these are combined by the therapist in particular circumstances. Exercise is great but other treatments might be needed in other areas. In the context of ortho or sports you might get away with it but then again I can’t even be sure that is true.
    Now I have treated and watched personal trainers develop over the last 40+ years and noticed that they have as many of the same problems with gurus, schools of thought and proprietary methods as do those in physiotherapy. You can see those from Cross Fit fighting with the National Strength and Conditioning Association in the USA. Each has their own research to support their methods even if their opponents have their own version that is contradictory. Physios are still needing, as you rightly point out, to evaluate and learn from the methods used by these different groups. Unfortunately I think bro science or the ”flavour of the month” can occur in exercise circles much the way that Maitland, McKenzie and others have been popular in manual therapy circles. Some like Oly lifts, some ”functional” training and others old school power lifting methods. It’s just not that simple or clearcut.
    We are all learning and until the jury is out I wouldn’t want to throw out any aspect of physiotherapy until a lot more better research is carried out. So keep up the good work. Just maybe cut your profession a little slack.
    :’ )

    • I’ll cut the profession some slack we it pulls itself together sooner, faster etc… and yes Rome wasn’t built in a day… blah blah blah… but there’s no harm in giving the builders a shake up now and then to get a bleedin move on!

  22. Hi Adam,
    Great blog and having worked with some excellent rugby union S&Cs I can see that my own knowledge of strength and conditioning needs to improve. Any good resources you could recommend?
    Cheers,
    Paul

  23. I agree with you, i worked in a refugee camp so the settings were at minimum and high caseload so all i had is education and exercise. I had great results. But I also believe that you shouldn’t call one intervention the best , you should use all you have. Btw no one is beneath us or above us. We all contribute for the seak of our patients.
    Thank you,

  24. Physiotherapists is only professional who are worried about other physios that they are not doing justification with physiotherapy.
    No other professionals will think like that.

  25. Hi Adam, i am seeing this as just your opinion, it will differ person to person. All physical forces can be used to treat the pain. Prevent, correct, and cure done by Physiotherapy by using all the physical Agents and forces like manual therapy, dry needling, tapping…. I don’t feel any wrong in this. Balaji Gandhi

  26. Hi Adam!
    Really love the article – especially pointing out that the universities do an awful job at teaching exercise prescription. I’m a recent physio grad and really want to advance my exercise prescription/ knowledge. Do you have any recommendations on how to do so? (Courses, books etc.)

  27. Adam…
    What a load of tosh you speak…..
    I pity your patients and feel saddened that you have chosen the Physiotherapy profession… total discredit.
    I presume you are quite small in stature and need to be big in other ways. Did you ever meet Louis Gifford or Kevin Banks….I suspect not and you would have been a fly flapping around them!

    • Hey Dan Thomas, thanks for your comments…
      Yes I did have the honour of meeting Louis a few times before he sadly passed away, I even shared a few pints with him, I’m not sure I flapped around but who knows after a few beers I can do some strange things, but he was a big influence on my thinking and approach as a physio, and very much made me question and challenge all we do.
      As for you feeling saddened that I choose the physio profession and feeling sorry for my patients well that’s nice of you, perhaps you would like to come and visit me and watch how terrible I am and how unlucky my patients are… or are you just the usual wassock keyboard warrior who has nothing better to do than write pathetic comments on blogs! Either way the invitation is open, just let me know!
      All the best now
      Adam
      Oh and I’m 6 foot in stature, and everything else seems to be in fairly good proportion by the way!