What's in a name…

Shakespeare’s‘Romeo and Juliet’ famously tells the tragic story of two ill-fated, star-crossed lovers who meet their untimely demise due to their families long-standing bitter feud. However, out of this tragedy comes hope as it eventually leads to their families reconciliation, and like Romeo and Juliet, I am hoping that some of the feuds I have had with other therapists with different names will eventually lead to some reconciliation.
There are many well-known scenes in Romeo and Juliet, such as when Romeo is wooing Juliet on her balcony, and Juliet says down to Romeo below…

Oh Romeo, Romeo, where art thou Romeo…

After some romantic discussions, Juliet goes on to say to Romeo…

What’s in a name? That which we call a rose, by any other name would still smell as sweet.

Juliet is referring to Romeo’s surname belonging to her families arch enemies the and how this does not matter to her. Nowadays this saying is often used to imply that the names of things or people do not truly reflect who, or what they are, or even what they do!

So what is in a name for physios?

As you may be aware I was involved in a VERY long, and VERY frustrating debate on the topic of names and titles we use within our profession with a physical therapist in the US called Dr James Dunning. It began when I saw a retweet from one of his followers about some training he runs in something called ‘Osteopractic manipulation’ that leads to a qualification to become an ‘Osteopractor’.
Now not being aware of the title of ‘Osteopractor‘ or what they are, or what they do, or how their treatment differs from physio, I asked this simple question…

What followed was a confusing, frustrating, and difficult ‘discussion’ with the James, the originator and founder of a private teaching institution that trains physios to receive the acclaimed title ‘Osteopractor‘ which lasted for THREE days! Yes that’s right THREE days. Now to be fair this was because we are on different sides of the planet, so time differences did delay our ‘discussion’ and of course talking in 140 characters takes its time.
However, I use the term ‘discussion’ very loosely here, as from the start this head ‘Osteopractor‘ evaded, misdirected, and deliberately misrepresented my questions and replies. He also used so many logical fallacies that my head is still spinning, in fact, at times, I actually forgot my original question, and ultimately I never did get an answer, or find out what differentiates an Osteopractor from a physio.
What I did find out is that the title ‘osteopractor‘ seems to be only used by physios in the USA, and they seem to do nothing different from any other therapist except bastardised the names of osteopaths and chiropractors to generate a new title.
Why they have done this is beyond me! Why a physiotherapist or physical therapist as they are called in the USA, who has invested years of dedication, study, hard work, energy and finances, to earn the right to use the professional and protected title of physiotherapist feels the need to replace this with a ridiculous made up title just seems crazy to me.
My ‘discussion’ with James was constantly redirected to us talking about the right to use other titles and names in our profession. James was quick to defend his right to use the title of ‘osteopractor‘ by comparing it to the fact that many therapists also use titles other to define our roles. For example, he stated that many physios, including myself, use prefixes before our titles such as sports, neuro, paediatric, or cardio-respiratory, and this James felt justified his use of his ‘unique‘ title of Osteopractor.
This is a false comparison and a bit like comparing apples to oranges. For starters, prefixes are used to help describe what specialism or area a physio has and often helps a patient find the best therapist for them. As a sports physio I would be of NO help to a cardiorespiratory or neurological patient. Also prefixes are real words that can be found in the dictionary, not made up, confusing, gobbledegook, bastardisations words that no understands.
This is my biggest concern with the ‘Osteopractor‘ title, confusion, both for other healthcare professionals, but mainly for the public. Titles should clearly and simply describe what the person is and does, not confuse and confound.

Does it really matter?

Many people today still can not tell you what the difference is between a physiotherapist, osteopath, or a chiropractor, and often I can’t either. With the boundaries between our professions becoming more and more blurred I personally think that most therapist titles are confusing to the public. I see osteopaths practice more like physios, and physios practice more like chiropractors, and I’ve seen the good, the bad, and the ugly in all the professions fairly equally. 
Adding more titles to this already confusing situation, will not help and only confuse things further, and where will it stop, will we have physiopaths™ or chirotherapists™ next?
When I tried to voice my concern about this confusion I was quickly called a hypocrite by James for questioning his Osteopractors and not other titles such a Mckenzie, Maitland, Mulligan, McTimmony, Alexander, Feldenkrais therapists, and he has a fair point. I don’t like any of these titles, they mean nothing to most healthcare professionals and even less to the public. Why are there so many titles in our professions named after gurus?
To be honest I even dislike the title ‘manual therapist’ that I know many physios like to call themselves. Why some therapists need to do this, is again beyond me, why call yourself after a technique? Not many physios only use manual therapy, just as not many only use exercise, electotherapy, taping etc, yet you don’t get some physios calling themselves, ‘electro therapists’ or ‘tape therapists’ do you. So I do agree with James here, if we are going to be critical of one ridiculous title, then we must be critical of them all.
In my opinion therapists who use confusing titles, or who list alphabet soup behind their names, do it more for their own benefit to inflate their delicate egos rather than for any patient benefit. I see no rationale or reason why ANY therapist has to define themselves by the names of methods of one particular treatment!
What is so wrong with simply calling yourself a physio and perhaps highlighting your area of specialism or interest with a prefix, such as cardio-respiratory, neurological, paediatric, sports etc…

Straw men

The next argument that James used is what qualifies someone to be able to use these prefixes, with certain titles not requiring any formal accreditation or post graduate qualifications. For example the title I use as a Sports Physiotherapist is not actually an ‘official’ accredited title in the UK!
This again is a fair point, and is something that does need to be addressed by our professional and governing organisations in the UK. However, I have recently found out that even the title of physiotherapist and other HCPC protected titles are NOT actually protected per se (read more here). I have also found out that ANY one can call themselves a physio as long as they use a disclaimer that no physio services are offered (read more here)…. This is a huge shock to me as I thought I paid into the CSP and HCPC to protect my title from misuse to protect the public from charlatans.

I’m an ESP me!

Finally whilst we are on the subject of confusing and nonsensical titles, I also want to talk about another confusing title I am the shamful owner of. That is an ‘ESP’ which sounds more like I have some supernatural power, but actually stands for an Extended Scope Practitioner.
An ESP is a physiotherapist who works outside their usual scope of practice, and usually means they work along side consultants and doctors in orthopaedic, rheumatology, neurology and cardiorespiratory clinics triaging patients as a first point of contact.
ESP’s are tasked with the same remit as consultants and doctors, that is to assess, diagnose patients appropriately. ESP’s are able to request investigations and tests, such as X-rays, MRI’s, CT’s, blood tests etc, some are also able to list patients for surgery, and trained in other skills such as sonography and injection therapy.
Now as exciting as these posts are for the future of physiotherapy, the title is, in my opinion, not the best. First because again patients have no idea what the title means, I know this first hand as I am more often than not having to explain it to patients when I introduce myself.
The next issue and far more important one is that, in my opinion, many ESP’s lose sight of the fact that they are physiotherapists. I have also seen first hand many ESP’s acting and masquerading as doctors, forgetting their foundation as physios. This is not only sad but also pathetic. An ESP is a post that is supposed to offer a different dynamic to any medical or surgical team. An ESP is supposed to bring a different skill set, thoughts and opinions into the clinical decision making process, not to just act like a medical doctor or surgeon.
There has been a call to change the ESP title to Advanced Practitioner recently, which although I think is a slightly better, it still is not that clear that the individual is a physiotherapist. I am proud to have achieved an ESP post and proud to be given the responsibility that this comes with, however, I am also proud that I am a physiotherapist and so I think the title needs to reflect this.

I have a dream!

Clear, concise, and most importantly simple professional titles are important. They allow patients to understand and be able to choose and decide which therapist is best matched for their needs and issues. Confusing, lengthy, or made up titles like ‘Osteopractor‘ add nothing and they need to be questioned and abandoned
I have a dream that one day all the current titles of therapist such as physio, osteopath, and chiropractor will become obsolete, as they become more aligned in their philosophy, training, and practice, and eventually we will see the emergence of a newly unified therapist.
What they will be called, who knows, as long as its clear and simple I don’t care. I am hoping that just as in Shakespeare’s ‘Romeo and Juliet‘, the death of some loved ones, will lead to the end of the feuds and fractions within our professions.
Finally, it is also good to remember that the most important title you have, and one that ALL your patients NEED to be aware of, is simply the one your parents gave you… your name, ALWAYS USE IT FIRST!
As always thanks for reading
Adam, the physio!



  1. Nice post. To offer some insight to your original question, having taken Dunning’s courses, his so-called ‘osteopractic’ manipulations are a carbon copy of Laurie Hartman, DO’s right down to the mannerisms. Draw your own conclusions there.

  2. Morning Adam,
    Basically, if you are not regulated by a proper official body you can do what you like and call yourself what you like. I heard the words medical reflexologist just the other day.
    As far as physiotherapy is concerned, I think we have a lot of over inflated egos in our profession at every level form clinicians and lecturers to researchers.
    The introducing yourself on a course scenario is one I very much look forward to at the beginning of a course.
    My line is ‘I am Adrian and I am a physiotherapist.’
    Then you get the ones where it takes them ten minutes to reel off their title and another hour to tell everyone how brilliant and important they are. Everyone at this stage is thinking get on with it, you are getting us confused with someone who is interested. Of course I have wildly over exaggerated this but why let the truth get in the way of a good story. If rubbish research can do it so can I.
    Your twitter debate was comedy gold. But it is time you can never get back.

  3. Love all your ideas and comments, but your best yet is “should I launch the ‘Meakins Method’. How about it?
    It would be the best ever no frills, honest and well researched treatment ever.
    (I’m an older adult fitness instructor, who hates to see clients paying for snake oil)

  4. The “otseopractor” tile is utter nonsense for any professional to utilize. It marginalizes the Physiotherapy profession and might I suggest that the regulatory bodies in the great US of A should intervene and forbid this type of crap.
    The Physiotherapy profession, once highly regarded as healthcare multipliers, are quickly become nothing more than purveyors of bouquet marketing tactics. Like salons or curbside snake-oil salespeople .Are we hairdressers or valuable healthcare providers bound by defendable, scientifically generated treatments…and a succinct recognizable title?
    Cripes that stuff bothers the hell out of this 20 year veteran of Physiotherapy. Bloody shameful in my opinion.

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