How to get the Most out of Physiotherapy School
Physiotherapy school is the necessarily evil we all must go through to become licensed to practice. Now, thanks to my friend and mentor Dr. Stuart McGill, I learned even before starting physiotherapy school that some of the information taught was out of date and not in line with the current evidence. This may have been the most important piece of “inside information” that I got in my life as I took the below steps, which I’ll share with you in this article, to get the most out of physiotherapy school and get to where I am today.
This blog may ruffle some feathers, but hear me out!
1) Be open minded yet skeptical at the same time
I’ve said many times before that, if I had to do physio school again, I don’t think I would take it as seriously as I did (don’t get me wrong, you still have to take it seriously) because of how much outdated material is taught. There was an overemphasis on passive treatment, lack of exercise and education as well as an emphasis on assessments lacking reliability, validity and/or correlation with pain (1-12).
When I started physio school I was lucky enough to be skeptical and critical of the material I was learning – but I was also open minded enough at the time to learn and get through the program. It is a delicate, yet necessary balance to learn.
2) Don’t go too crazy about marks
Students who get into physio school are the cream of the crop and are often the top 5-10% of whatever undergraduate class they were in before. We’re “Type A” people.
While this mentality can be helpful to get to physio school – it can create a lot of issues during school such as:
- High levels of stress, depression and even suicidal ideation
- Psychological burnout
- Not getting on with classmates
I don’t want this point to be taken as “marks don’t matter” because they do. But, it’s better to be an average/good student and still have your mental health (and time for a beer) rather than being stressed and having issues with classmates in the process of trying to be top dog.
3) Learn strength & conditioning and actually train hard yourself
One of my biggest beefs with the current physiotherapy education system is that there’s nowhere near enough proper training on exercise prescription. I’m biased as a strength coach and semi-retired powerlifter, but taking the time to learn proper S&C principles was one of the best decisions I ever made both before and during physio school.
When I see people who have not made much progress with other physiotherapists, some of the common reasons include:
- Reliance on passive treatment and not given much (if any) exercise.
- Given a generic “cut and paste” program.
- Or, in the case of people with high level athletic or work demands, not pushed hard enough and not prepared to withstand the stresses of the goal activities.
If you’re looking to level up your knowledge with exercise prescription I recommend you check out the following resources:
- This piece from my old blog in 2018 which provides a lot of names & resources for physios to use for learning exercise prescription (13).
- The following Physio Network Masterclasses:
I also do recommend you train hard yourself or at the very least play a sport. You don’t need to be a high level bodybuilder, powerlifter or athlete but when working with athletic or weight training clients, it is helpful to understand what it’s like to be active.
4) Learn pain science & the biopsychosocial model
My other big beef with the education system is that there’s too much emphasis on outdated biomechanical models and almost nil training in the biopsychosocial model. I see this all the time when I get people with persistent pain who have been to other physios or chiros before who just did not have the proper training and education to give these complex, and challenging, clients what they needed.
Three of the main reasons, in addition to inappropriate (or lack of) exercise prescription, that I see people that weren’t successful with previous physios are:
- Clients being rushed through an assessment and not listened to.
- Nocebic, negative advice given to patients.
- Comorbid mental or physical health conditions not taken into account.
Take the time to learn pain science and the biopsychosocial model. Resources like Explain Pain and Know Pain can be very helpful but there are a lot of free papers (particularly featuring Peter O’Sullivan) and free resources on the internet (like this PhysioNetwork blog!).
5) Learn about psychology & communication
One of my biggest regrets in university was not learning more about psychology and communication. Maybe I’m biased due to my own health history – but I hear a lot of other physios and new grads say that communication can be the most difficult part. Some research shows (14) skills like therapeutic alliance and interaction effects may account for more than what we originally thought. But these aren’t taught at all and are overlooked in favour of sexy skills such as manual therapy.
Some of the best courses and resources I’ve done, and am doing, pertain to understanding psychology and communication. Examples of these include:
- The Cognitive Functional Therapy courses and papers
- Listening Is Therapy: Patient Interviewing From A Pain Neuroscience Perspective (15)
- Integrating Motivational Interviewing With Pain Neuroscience Education (16)
- Motivational Interviewing In Healthcare (book)
- Mike Stewart’s Masterclass on pain
Communication is not a sexy skill but damn it is important.
6) Build the base of a pyramid
Admittedly learning about hospital physiotherapy, spinal cord rehab and (a tiny bit about) pediatrics wasn’t a super-fulfilling part of my experience during physio school but now I realize its importance.
Many people, especially students or new grads, want to “specialize” in an area as soon as possible. Physiotherapy is too broad of a profession to be good at everything – yet I sometimes see people rush to specialize before building a base. Specializing may not be so big of an issue with certain demographics (i.e. sports) but in most other settings you’re going to be dealing with clients who have many multiple conditions and comorbidities on top of what they may be seeing you for.
With this in mind, it is critical to build a proper base of general knowledge across cardiopulmonary, neurological, musculoskeletal and multisystem conditions BEFORE going up the ladder to specialize. Take the time to learn as much as you can while you’re still in school and not having to worry about managing a full caseload.
7) To quote The Rock “Know Your Role”
It’s important to understand that physiotherapy can only influence certain parts of a clients’ recovery. If a client smokes, is overweight and/or has comorbid mental illness those can be very significant barriers to recovery that may very well be outside of your scope to address.
Make sure to keep the following variables in mind:
- Set realistic goals: I tell clients that I can only address pieces of the pain pie and that I, within my legal scope of practice, can’t address everything that may be contributing to their pain and as such I can’t always guarantee full, pain free recovery.
- Don’t beat yourself up if a client doesn’t recover, you can only do so much.
8) Don’t neglect self care
In first year physio school I burned myself out on more than one occasion and this was one of the worst points in my life from a mental health perspective. I see this a lot in people who are ambitious students and who stop at nothing to do well. In my case, being in an outdated curriculum didn’t help either.
In between first and second year, after the tragic death of comedian Robin Williams, I made the call to seek counseling help and dial back the intensity of my school effort. By seeking counseling, and going at 90% instead of 100% everyday, I felt much better and actually did better in school.
I hope these tips help you with getting the most out of your schooling. If you have any additional recommendations leave them in the comments section below. As always, thanks for reading.
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- Odom, C.J., Taylor, A.B., Hurd, C.E., Denegar, C.R. (2001). Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys Ther,81(2),799-809. http://www.ncbi.nlm.nih.gov/pubmed/11235656. Accessed July 8, 2017.
- Struyf, F., Nijs, J., Meeus, M., et al. (2013). Does Scapular Positioning Predict Shoulder Pain in Recreational Overhead Athletes? Int J Sports Med,35(1),75-82. doi:10.1055/s-0033-1343409.
- Struyf, F., Nijs, J., De Graeve, J., Mottram, S., Meeusen, R. (2011). Scapular positioning in overhead athletes with and without shoulder pain: a case-control study. Scand J Med Sci Sports,21(6):809-818. doi:10.1111/j.1600-0838.2010.01115.x.
- Lewis, J.S., Green, A., Wright, C., Kennedy, J., Kennedy, R. (1990). Subacromial impingement syndrome: the role of posture and muscle imbalance. J Shoulder Elb Surg,14(4),385-392. doi:10.1016/j.jse.2004.08.007.
- Grob, D., Frauenfelder, H., Mannion, A.F. (2007). The association between cervical spine curvature and neck pain. Eur Spine J,16(5),669-678. doi:10.1007/s00586-006-0254-1.
- Tüzün, C., Yorulmaz, I., Cindaş, A., Vatan, S. (1999). Low back pain and posture. Clinical Rheumatology,18(4),308-312. http://www.ncbi.nlm.nih.gov/pubmed/10468171. Accessed July 8, 2017.
- Nourbakhsh, M.R., Arab, A.M. (2002). Relationship Between Mechanical Factors and Incidence of Low Back Pain. J Orthop Sport Phys Ther,32(9),447-460. doi:10.2519/jospt.2002.32.9.447.
- Schroeder, J., Schaar, H., Mattes, K. (2013). Spinal alignment in low back pain patients and age-related side effects: a multivariate cross-sectional analysis of video rasterstereography back shape reconstruction data. Eur Spine J,22(9),1979-1985. doi:10.1007/s00586-013-2787-4.
- Laird, R.A., Gilbert, J., Kent, P., Keating, J.L. (2014). Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord,15(1),229. doi:10.1186/1471-2474-15-229.
- Christensen, S.T., Hartvigsen, J. (2008). Spinal Curves and Health: A Systematic Critical Review of the Epidemiological Literature Dealing With Associations Between Sagittal Spinal Curves and Health. J Manipulative Physiol Ther,31(9),690-714. doi:10.1016/j.jmpt.2008.10.004.
- Nakipoğlu, G.F., Karagöz, A., Ozgirgin, N. The biomechanics of the lumbosacral region in acute and chronic low back pain patients. Pain Physician,11(4),505-511. http://www.ncbi.nlm.nih.gov/pubmed/18690279. Accessed July 8, 2017.
- Mitchell, T., O’Sullivan, P.B., Burnett, A.F., Straker, L., Smith, A. (2008). Regional differences in lumbar spinal posture and the influence of low back pain. BMC Musculoskelet Disord,9(1),152. doi:10.1186/1471-2474-9-152.
- Kinney, M., Seider, J., Beaty, A.F., Coughlin, K., Dyal, M., Clewley, D. (2020). The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract,36(8),886-898. doi: 10.1080/09593985.2018.1516015.
- Diener, I., Kargela, M., Louw, A. (2016). Listening is therapy: Patient interviewing from a pain science perspective. Physiother Theory Pract,32(5),356-367. doi: 10.1080/09593985.2016.1194648.
- Nijs, J., Wijma, A.J., Willaert, W., Huysmans, E., Mintken, P., Smeets, R., Goossens, M., van Wilgen, C.P., Van Bogaert, W., Louw, A., Cleland, J., Donaldson, M. (2020). Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians. Phys Ther,100(5),846-859. doi: 10.1093/ptj/pzaa021.
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