As with many professions, physiotherapists come out of school knowing a little bit about everything, but not a lot about anything and are forced to ‘fake it, until they make it’ in a clinical setting as a very green professional. The schools and the regulatory boards have made sure that new physiotherapists have achieved a core level of competency, but nothing can compensate for a lack of experience. Our profession tends to thrust young therapists into situations that are very intimate, emotional, physical and potentially stressful without an established mentorship structure that exists in professions like medicine or law. We tend to not have residencies or junior partnerships that we are required to work through, but instead have an open world of continuing education and a broad scope of practice that requires us to navigate our own path to develop into the physiotherapist that we want to become.
I believe that there are pros and cons to the situation that young physios find themselves in; they are free to chart their own path, but they can end up feeling like they are afloat alone with the paradox of choice. Structure is best for some, while freedom allows others to thrive, and this need seems to be a factor in whether a physio chooses to work in a hospital setting or opts to apply for a job in a private clinic. I was exposed to both experiences during my school placements and as fascinating as I found some of the hospital work to be, I knew that I was a person that would find the structure of the hospital frustrating and the open world of physiotherapy clinics more intriguing.
I graduated from McMaster University’s Physiotherapy program in Hamilton, Ontario in 2003 and promptly moved back to Vancouver, BC leaving all of the professional connections that I had made behind to start fresh in my hometown. I had my Master’s degree and passed the certification exam, but was technically not required to do any further training to work as a physiotherapist in British Columbia going forward. My first priority was to get a job, any job, because I was broke and didn’t really know where to start, but I clung to two pieces of advice from school, one from a professor and one from a preceptor. My instructor that was in charge of teaching us about levels of evidence, research and statistics paradoxically told us in one class that we should try our best to search out the gurus, know who they are and try to learn as much as you can from them. A few weeks later, my last physiotherapy placement was in a private clinic in Beamsville, Ontario where my preceptor handed me Diane Lee’s book The Pelvis on the first day and said ‘here read this,’ which I did and then realized that she seemed to be a guru and happened to own a private clinic near Vancouver where I was about to make the 4000km drive back home.
McMaster made me appreciate the importance of evidence-based-practice, but I knew that I was going to learn way more from human interaction than I was from dry research papers that all seemed to conclude that more research was required. I looked for a job that could provide me with some mentorship and/or an opportunity to simply get some experience and become less ‘green.’ I reached out to Diane Lee and arranged an interview and also applied to a job posting at a rundown clinic in Surrey owned by a relatively faceless corporation. Diane happened to be the first clinic owner that agreed to meet with me, but unfortunately I showed up and she hadn’t put it in her schedule and the position had already been filled. Thankfully she graciously agreed to meet with me and chat for ten minutes before she had to get back to work, which served as my first professional networking experience and ultimately lead to me working with her at her new clinic three years later. My first job ended up being at the dumpy clinic with no mentorship, but lots of clients that gave me the opportunity to get my feet/hands wet.
As a new physio, every job is going to have a steep learning curve and opportunities to learn, but without some form of mentorship from a more experienced therapist that curve will flatten out and you should start to consider moving on to the next challenge. I lasted seven months in my first job before I realized that I wasn’t getting anything beyond a paycheque from the experience and I needed more. I moved to an upstart sport performance clinic that offered good mentorship, but not very many clients, which put me in an ‘eat what you kill’ environment requiring sales and networking skills in order to have a decent paycheque. I sponged all the knowledge I could from a mentor that was very keen to teach, but really wasn’t very good at running a business. I ended up quitting my job three weeks before my wedding out of pure frustration, but walked away a better physio with strong networking skills and a sense of how not to run a business.
I went on to work a series of locums for both a paycheque and to get more exposure to how different physiotherapy clinics were run and in the end decided to start my own business three years after graduating. Coincidentally, Diane Lee offered me a job two weeks later and I decided that the opportunity for more mentorship was too important to turn down so I drove back and forth to her clinic and mine for the following two years again trying to be a human sponge. Through this period I also spent most of my weekends taking continuing education courses to try to make sense of what I was doing clinically at both locations. It was an exercise in critical thinking that molded the physiotherapist that I have become today.
Continuing education courses, gurus and research don’t always align with each other, which makes it your job to extract what you believe to be true and think about what you want to do on a day to day basis while trying to help people. It is great to go deep in a particular area of interest in order to really develop your skills with that technique or approach, but be careful to not naively ‘drink the Kool-Aid’ and think that your new found expertise is the only way to treat something. I started by taking all the orthopaedic manual therapy courses that drew everything back to people’s joints while seeing Diane Lee practice IMS dry needling, visceral voodoo, real-time ultrasound and the occasional joint mobilization with great results.
I spent five years learning about joints, core muscles, muscle balancing and movement training then turned it all on its head by taking Dr Gunn’s IMS Dry Needling course that seemed to give me a super power and made me appreciate the role of neuromuscular control on the joints that I had been wiggling. I think it was important that at that point I stopped taking post graduate courses for a number of years which allowed me to process what I had learned and make it all my own (and have three children in three years). It is important to become a lifelong learner, but you have to make the time to learn from yourself and not just the others that are willing to teach. It is also important to not become complacent with one approach and every so often take a course that is fundamentally different than what you already know. It gives you the opportunity to throw everything you know up against the wall and see what sticks.
I jumped back into courses by going down the visceral voodoo rabbit created by osteopath Jean Pierre Barral and the Barral Institute. I didn’t find the overall approach of visceral manipulation to be the most effective or appropriate to apply to all of my clients, but I found that it filled in gaps in my knowledge and opened my eyes to the emotional component of the tension that people hold in their bodies. I encourage you to work and learn with a variety of people early in your career, be open minded in your approach and your interpretation of what constitutes supporting evidence. Clinical practice and physiotherapy research are both developing at their own pace so you are best to stay attuned to both, but not be constrained by either.
I write this today as I am launching my IMS Dry Needling online mentorship course as a means of helping physiotherapists improve their skill and critical thinking with dry needling. In my experience, many physiotherapists will take one form of dry needling like acupuncture, IMS or FDN and then fail to further their skillset with the technique or not receive much mentorship after the certification course. I offer my course, not as a certification, but as a detailed look at how an experienced clinician uses a very powerful tool. I also point out that it is not the only way to treat people, but best used as an integrated tool with mindful education, visceral/fascial work and postural exercises. It is very hard to learn how to integrate a skill with others until you are competent and confident with each of them, which is why I have made this course focussed entirely on the use of IMS Dry Needling. I will most likely create a series of future courses on manual therapy and postural exercise, but until I do I suggest looking into the following post graduate courses in something close to the suggested order…
Understand Movement & Muscle Balancing
Look for courses like the Functional Movement Screen (FMS)
Read Shirley Sahrman’s book Movement System Impairment syndromes and look for the course
Develop your palpation skills
Start with orthopaedic manual therapy courses because bones are easier to feel
Consider a muscle based course like Active Release Therapy to get used to feeling tension in muscles and better learn the anatomy
Read books about trauma, mindfulness and personal development
Your job is to motivate people so you need to understand how and why they think the way they do….click here for a suggested list
Appreciate what needles can do
Depending where you are in the world will depend what training you have access to and what your regulatory body requires, but look into acupuncture, IMS Dry Needling, Functional Dry Needling and see what works for you, then consider taking my course for another deep dive online.
Try to Understand fascia, organs and the nervous system.
Pull it all together.
Diane Lee’s Integrated Systems Model and LJ Lee’s Connect Therapy offer excellent models of how to look at the body as a whole and utilize the variety of tools that you have hopefully developed in your tool belt.
Physio only gets boring if you let it because there is always more to learn about anatomy and human nature. Find a mentor, think critically and try your best to be empathetic to the people that you are trying to help.
Click Here to Learn More about my IMS Dry Needling Online Mentorship Course
Click Here to Learn More about my book Why Things Hurt Life Lessons from and Injury Prone Physical Therapist
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