Thursday, August 15, 2013

Why You Shouldn't Listen to Your Physical Therapist

Physical therapy is a great field and ever-evolving. It's filled with practitioners who are intelligent, highly educated and frequently just want to help people. These are all good things. Unfortunately physical therapy in it's current form has some severe limitations. As with most things, the issue is not the field itself. The field is moving in the right direction. The problem is the individual clinicians.

The main issue with the average therapist is not one of capability or education. You can't be what they are or do what they do if you lack either. No, the problem actually happens to be the place from where they precede; in other words, the motivation that drives their practice. My initial foray into human physiology came through the window of human performance. Most of my education and research was driven by the pursuit of lifting massive amounts of weight, running absurdly fast and being able to hit things with the force of a sun-drunk Superman. As such, the paradigms that I developed in my mind on how to deal with and improve human movement dysfunctions all had their basis in performance enhancement. On the flip side, most therapists' educations begins deeply embedded in the hippocratic oath: the desire to do no harm.

This is not, in and of itself, a bad thing. It's situational. If you are elderly and your body is all jacked up from years and years of misuse, you have a low pain tolerance and all you really want to be able to do is go up and down your stairs then the therapist who's main goal is not to hurt you may be entirely capable. This is a fairly hyperbolic example but there are plenty of cases where the desire to fix as much as you can while never hurting your patient is entirely useful. Not everyone is trying to become a monster athlete. Physical therapists are incredibly effective at getting you back to baseline because it is exactly what they are taught to do.

The system breaks down when you're dealing with people like me, or, chances are if you're reading this blog, someone like you. If you are always trying to push yourself to be bigger, faster and stronger then taking "do no harm," approach is like driving with the parking brake on. No matter how much you floor the pedal it's still going to hold you back.

As long as we have therapists telling athletes not to lift heavy and to keep their arms below overhead if it hurts their shoulder we're going to have a damaged field. These are simply not acceptable responses. Yes, of course there are going to be situations where the damage to the patient is so severe that there are activities they will no be capable of, but if you are willing to clear a patient to go play college football yet you still advise them to not lift heavy weights then, simply put, you're a f*cking idiot. So, you think this person's body is capable of performing dynamic, multi-planar movements at explosive speeds and possesses the physical integrity to take hits that are thousands of pounds of force and they're going to be okay... but performing repetitive exercises in a controlled environment is dangerous because the load is too high? Seriously guys?

The problem, once again, comes from the initiation of the advice. Most physical therapists don't care how much you can squat or bench press. All they care about is that you are pain free and you don't have inflammation. Therefore all of their recommendations and modifications have this goal in mind: don't go past parallel on a squat, don't deadlift heavy weight, don't do overhead presses and for the love of god don't ever lift more than your bodyweight because all of that stuff might hurt you. If that's all I ever cared about I would never get out of bed in the morning and as a clinician if these are the goals for your patients you're f*ckin' up.

That being said both Grey Cook and Kelly Starrett are DPTs and not only are they brilliant clinicians but they are spearheading the movement in the field to integrate strength and conditioning into clinical practice. I am a huge fan of their philosophies and practices because they believe what I believe: whether you're rehabbing a post surgical joint or improving the efficiency of a power clean it's all the same thing. Healthy is healthy, disordered is disordered and no matter how you slice it movement is movement.

So that's my rant for today but it raises an important question I think. You all know how I feel about the average personal trainer and now I'm telling you you can't trust DPTs either? But then whoever shall I trust for all of my exercise science needs?!?! Who?!?!

RELEVANT. Really. Batman is always relevant. 
My goal was not tell you that PTs are bad. They're not. Nor was it to tell you that they don't know what they're doing. They do. This post, like a few others, was more aimed at broadening your horizons and helping you guys see the big picture a little bit better. If you are an athlete you need a PT who understands and respects that. You need a PT who can show you how to do what you want to do better and prevent you from re-injuring yourself, not a PT who tries to prevent re-injury through avoidance. Becoming Invincible is about confronting your weaknesses head on and beating the sh*t out of them until they become strengths. Next time your PT tells you not to do something ask them why. If their response is anything other than "your joint is so compromised that doing this movement in any way will absolutely lead to injury," then it might be time to start looking for a new clinician. 

Do me a favor though? Don't use this post as an excuse to talk to them like they're dumb. They may not be perfect for athletes yet, but that same therapist who told you not to break parallel with your knees might have just helped a little boy walk for his first time. It's all relative, kids. 

Good luck and good lifting.



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