Dinosaurs in Physical Therapy- Will a Comet Ever Wipe Them Out?

This post will address a topic I have had on my mind for a while now. It was sparked by a recent talk my co-worker and good friend Michael Connors just gave at the annual Graham Session in Phoenix, AZ about the worst personalities in PT. I want to choose a specific sub-group of physical therapists to unleash the fury of my keyboard on. This sub-group, as you could guess from the title, are the dinosaurs of our profession; the relics, the outdated, the burnt out, the non-evidence informed, the pain in my butt.

I want to start by explaining to the unfamiliar what a dinosaur is and looks like. A few of you may have a preconceived idea, but hopefully I will challenge that a little. Most of you reading are likely picturing someone like this:

 

 

You are partially right. The gentleman in the above meme definitely falls into the dinosaur category. He went through PT school when rehab principles were in their infancy, EBP had never been heard of, and there wasn’t an information super highway to easily gain access to hundreds of thousands of journal articles, evidence based blogging, and discussion. The gentleman above has a little bit of an excuse to justify why he practices the way he does. A practice that includes the following

·         He likely uses ultrasound on a daily basis

·         He gives every single patient a hot pack to start treatment with

·         He still thinks he is breaking down fascia with his hands

·         He cross friction massages the crap out of people

·         He thinks the VMO is the cause of all knee pain

·         He thinks he can specifically train the VMO

·         He thinks the psoas is the center of countless dysfunctions in the body and “releasing” it will be the key

·         His techs treat more patients than he does

 

 

·         He prescribes 2x10 on every single exercise

·         He does the same exercises on every single person that comes through the door

·         His favorite exercise tool is yellow theraband

·         He tells everyone that squatting past 90 degrees is a sure fire way to ruin your knees for the rest of their lives

·         He tells people that they should never bend forward or rotate because they will “slip” their discs

·         They sleeper stretch every person with shoulder pain

·         He stabilizes everyone’s core because they are unstable

·         He thinks “pronated feet” lead to TMJ and left shoulder pain

·         He hollows everyone’s transverse abdominus because motor control

·         He PA mobs every person to death by only bending the legs of a fly because Maitland is God

·         He treats every patient with lumbar extension because the picture of Robin McKenzie over his desk told him to

·         He corrects the innominate torsions he finds in EVERYONE that are causing them to have leg length discrepancies and back pain. Its ok though, because he puts Tiger Woods sacrum back in all the time.

·         He rubs bumpy balls on people’s muscles to “release them”

·         He still thinks there are pain receptors and pain is carried from the body to the brain

·         He has never heard of a neuromatrix concept

·         The last journal article He read was when he was in school

·         He makes people exercise on upside down bosu balls because its “functional”

·         He hasn’t taken a vital sign measurement since school

 

Forty years of the same type of practice creates a strong habit that is near unbreakable. He is near retirement, has made his fat 401k with years of high insurance reimbursement while having no student loans to speak of. We will call him the T-Rex and we can’t really blame him too much. However, I’m going to dare to say that there are numerous new grads and mid-career PTs gracing our hospital floors and outpatient clinics that fall into the dinosaur category as well. I’m sure of this because I’ve worked with them, I’ve talked with them, and I’ve had them hate mail my blog posts. You came out of school and took a job working with Mr. T-Rex from above and you’ve done a nasty little thing called becoming complacent. You have fallen into these same practice patterns listed above because:

A.      You weren’t taught any better in school

B.      It is the easy route and you are lazy

C.      You are scared of the flack you will catch by challenging Mr. T-Rex’s ways

D.      You aren’t invested in giving your patients the best care you can

E.       You have been slowly morphed by your environment and you don’t even realize it

 

I’m going to lovingly refer to this group as the velociraptors. You are smarter than the T-Rex, you tend to run in packs, you tend to slice at people’s throats if they challenge you, and lastly you can be controlled by the T-Rex. I understand why you are where you are. I really do, I remember the fear I had as a new grad when challenging what my more experienced colleagues were doing. I was just lucky enough to be born with the personality flaw of being a cocky bastard.

 

 

 

This style of physical therapy is hurting us all. It isn’t serving our patients to the highest level they could be. It is leading to sub-par care. It is perpetuating ideas and myths that have long been disproven and need to die. It continues to show us in a poor light to our counterparts in the medical field we work so closely with. It makes my job harder to show referring physicians what we can do for a patient much harder. It makes my job as a PT educator much more difficult. It needs to fade into extinction like the dinosaurs did. Is there an asteroid plummeting towards the PT world that could make this impact?

 

 



If you are reading this and you are a T-Rex, I want to kindly ask you to please just go ahead and ride off into the night and retire. If you aren’t ready to retire please stop roaring so loud and biting off the heads of velociraptors that challenge you and are ready to evolve. If you are a velociraptor, stand up to the T-Rex. Use your greater education and ability to obtain information to push forward past the ways of the previous era. Continue to learn and grow. Continue to read and be open to ideas that challenge your own biases. Be better and evolve constantly. Come across my blogs years from now and laugh about how little we knew.

 

*** This is all in good fun. Please try not to get too upset if you felt like you got called out.

 

Thanks for taking the time to read,

Jarod Hall, PT, DPT, CSCS



 







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