As the title suggests, my thought process when I assess a patient has changed tremendously from when I was a PT student and during my initial months of practice to where I stand now; a year and a half of experience, a few courses and certifications under my belt and countless hours of studying (for all the physio students out there, sorry to burst the bubble but if you want to stand out in your profession, studying will be a life long endeavor). Back in Physio school, all my assessments and therapy were based on treating the site of pain for the most part. The good old routine of electrical stimulation, some ultrasound, a few strengthening and stretching exercises to the local area along with a sign of hope in my heart that the patient would get up from my treatment table with considerable relief resulting in a pat on my back from my clinical instructors and general happiness and satisfaction all around. I would jokingly tell my non physio friends that in my OPD, on a regular day I would ultrasound more people than an OB/GYN clinic (obviously both the ultrasounds being different). Unfortunately, this tunnel vision approach left me and my patients with much to be desired. Having realized early that i was missing a piece of the puzzle I have changed my strategy and started investigating globally and so should you. The body does not work in isolated units. So now, my shoulder impingement patients are not just assessed and treated for the site of pain at the shoulder but also screened for posture especially thoracic kyphosis, rotation and extension. My back pain patients will be evaluated not just for the back but for hip ROM, core stability and thoracic mobility. A chronic knee pain patient especially with non-traumatic history of onset of pain will be assessed for the joint above and below (hip and ankle). I have seen far too many patients with over pronated feet and valgus collapse of the knee go under the surgeon’s knife for an investigative arthroscopic procedure without being assessed for foot mechanics to last me a lifetime leaving me looking like this
The take away messages is this, while treating the site of pain is a good start, finding out ‘WHY??‘ it hurts and correcting it will bring long term resolution to the problem. In my next few blogs I will discuss some of the above stated examples with mucho details. Please feel free to leave comments. Until next time.
Abhijit Minhas PT
I have had the opportunity to learn rehab, exercise science and physiotherapy in two different countries. I did my bachelors in physiotherapy from India and my masters in exercise science from the US. While I have learnt a good deal from both my experiences, there are certain clear advantages of studying here in the USA that we still lack in India. The teaching styles are absolutely different and our Indian educational system surely has some catching up to do. Here are a few- Here’s how
o Emphasis on evidence based practice– during my bachelors a typical day in College entailed going over a particular topic from our prescribed textbook (sometimes written years ago) where in the professor would talk about it for an hour with some discussion. To me this was a little dry and had me ‘zone out’ in between classes often. What we learnt was often considered the gospel truth which I followed to the T without much question. All that changed as I set foot into my introduction class in my masters program. Here, for every class the professor came in with the latest peer reviewed literature and research papers which constantly challenged some of the archaic information present in books followed by a healthy debate to keep us engaged and thinking. Now I don’t suggest throwing away our required textbooks as the major chunk of the learning still comes from them but my point being this, always challenging or questioning our current knowledge and facts with new findings points to two thing- how little we still know and the fact that we are stepping in the right direction. Like one of my professors used to say- “they call it research for a reason, RE- SEARCH.” It must be a never ending process.
o Flawed testing– To add to this was our examination process which tested us on all we could memorize and how many pages we could write about the shoulder joint, disc prolapse, best rehab exercises etc in a long answer pattern. In my humble opinion, this does not test or train our thinking skills and this thinking-on-the-fly is what we will eventually do for the rest of our professional lives. It will be similar to detective work. Do you think this analogy is far fetched? After all every patient stepping in our clinic will be different and not everyone will have pain due to a bulging disc and external rotation theraband exercises are not a panacea for all shoulder problems. The American testing system from my masters to the NPTE board examination for physical therapy is all based on MCQ’s that will present itself with a situation and will have you critically analyze and come up with the most appropriate solution based on that unique situation. Sounds similar to the real world? If you plan to study in the US or take the board, understanding this now will work in your favor later.
o Experience- the average age of a 1st year BPT student in India is around 18 years. We are fresh of high school and frankly a little distracted because of our newly gained freedom and excitement and promise of a fun college life. Well!! It was at least for me. We are young and have no experience. Here it’s a different story. An entry level DPT student (yes they have done away with bachelors and masters) has to first clear prerequisite which means a lot of them go through a bachelors in exercise science and have worked as personal trainers, strength and conditioning coaches and exercise physiologists. One of the prerequisite also requires you to volunteer in a physical therapy clinic as a aide to get some perspective. They have been in the trenches for a few years, have trained clients and athletes. So the people who make it to PT school are highly motivated, more experienced and wiser than a fresh high school graduate.
I write these points not to demoralize or trash talk about our education system as it has got me where I am today but with the hope that it brings to you an epiphany moment like it did to me or a deeper realization of how we square off with the rest of the world and raise our bar.
On the eve of almost completing a year and a half of working as a physical therapist in the USA and a equal amount of time procrastinating, I have decided to happily devote my time to this great undertaking of writing my blog. I came to the US in 2011 to get my masters in exercise science and it has been a roller coaster ride ever since. In this blog I intend to write about my experiences in the world of physiotherapy, rehab, strength and conditioning along with the good, bad and the ugly in my great profession. Join me in my journey, as I begin as a nascent physio and geek out on all things physical therapy.