Physical therapists are not the expert when it comes to exercise. I am a physical therapist, and I consider myself an expert when it comes to exercise. Am I just a standout with exercise knowledge, or are we underwhelming with our entry-level expertise as a profession? Doesn’t the public perceive us as primarily treating with exercise? How can this be?
I have long told students that we have a ways to go before solidifying ourselves as the experts in exercise. My growth as an exercise professional is almost entirely due to learning outside the classroom from the greats. Eric Cressey, Mike Robertson, Mike Boyle, Charlie Weingroff, Chad Waterbury, Ben Bruno, and the list goes on. Only one of those currently has PT after their name, and even he considers himself a strength coach first. Thank God for the internet, as blogs/podcasts/books have all filled in the gaps for me in the fitness world. Physical therapy school filled almost none. My opinion is that great fitness coaches are the leaders, and we must either catch up by leading from the front or the train will pass on by as we watch from afar.
As a clinical instructor for PT students I am constantly underwhelmed by the lack of knowledge regarding exercise beyond band-resisted external rotation and clamshells. Certainly some of this has a place at times, but clamshells aren’t helping your Crossfit patient that can’t compete this weekend. Cleaning up his or her hip hinge to load the deadlift properly might have a better shot.
Wait, you’ve never deadlifted, let alone heavy, but you have the fix for that person’s deadlift? They have knee pain during a kettlebell metabolic circuit, but you’ve never heard of the goblet squat, clean or swing? Hopefully your manual therapy techniques clean up the pain quickly, because you can’t coach techniques you’ve never heard of.
Now I’m not suggesting that we all have to be certified in the olympic lifts, strongman lifts, Crossfit lifts, etc. I’m just suggesting that we should at least be able to share the same language with our active population that we treat. I’m also suggesting that 3 sets of 10 clamshells might get someone moving, but it probably doesn’t build much fitness, motor control or tissue resiliency after the first couple visits (if ever).
We must be humble and admit where we are weak. We must seek out strength coaches, personal trainers and sport coaches to help us understand who we are treating. We must incorporate evidence-based exercise into orthopedic curriculum at a higher level. We must become experts at what we hang our hat on for the public to see.
This is the first post in an upcoming series to describe how I incorporate “higher level” strength work into a rehab program. I don’t care if your patients are 80, they’re still human beings that move. I don’t have all the answers, but hopefully this will spark some excitement about what we can be as rehab professionals. Hopefully this approach will lead us to where we must be in the future.