I recently took some time to reflect on my career as a physiotherapist to date, particularly how I have developed as an expert clinician over my many years of practice.
I was fortunate to have the opportunity to complete a Masters Degree in Manipulative Physiotherapy at the prestigious University of Queensland, Australia. The UQ physiotherapy department is widely regarded as one of the finest centres for education and research in musculoskeletal physiotherapy in the world. During this time of study, I had the good fortune to be taught and inspired by Professor Gwen Jull, Professor Bill Vicenzino and other exceptional educators, researchers, and most of all, physiotherapists whose clinical expertise has helped so many.
Completing my postgraduate degree set me on a path that included working as the lead physiotherapist for Riverdance and the opportunity to work with Leinster rugby as early career highlights before settling into private practice and lecturing at University College Dublin.
The learning did not stop; it never does as I, like many, realised that the more you learn, the more there is to know. With an abundance of new research becoming ever more accessible and the wide range of quality further education courses available, I made a commitment to continuing education which remains. Since graduating, I have completed several postgraduate certifications, including the Pilates exercise method and medical acupuncture.
Over the last 20 years, I have seen trends in physiotherapy come and go. The first shift was from a more electrotherapy based treatment approach towards a hands-on, manual therapy emphasis. Manual therapy began to incorporate more focus on therapeutic exercises until exercise became the dominant treatment approach. In recent years, exercise combined with pain management education and counselling has taken over, with many experts now advocating what may be referred to as a biopsychosocial approach to physiotherapy. Studying each of these treatment approaches and related techniques has allowed me to add many tools to my ever-expanding toolbox.
I have learned, mainly through experience, that there are many ways to achieve great results. Given that, like so many areas of medicine, and in particular physical medicine, the research may be inconclusive, subject to bias and misinterpretation, the expert clinician must be thoughtful and reflective.
The founder of evidence-based medicine, David Sackett, has highlighted that practising in an evidence-based manner means considering the prevailing research along with patient preferences and the clinical experience when making decisions about how best to go about planning treatments.1 I always keep this in mind, reminding myself that there is no right or wrong way to practise physiotherapy; there is no gold standard approach. The very best we can do is adopt an evidence-informed approach that relies heavily on the experience of the physiotherapist to achieve the best results for their patients.
How does a physiotherapist gain experience?...by treating patients, lots of patients over many years according to the well-touted 10,000-hour rule. Over the last 20 years, I have well exceeded 10,000 hours and probably treated as many patients! Over this time, I have learnt, and my patients have taught me a considerable amount about what it means to be an expert clinician. I have mainly learnt that it is not always what you do, but how you do it, how you communicate, the therapeutic relationship.
Approaches will come and go in terms of popularity, but our innate biological programming does not change as humans. May active and reflective listening be more important than anything we say? We all like and need to be touched, but manual therapy should always be provided carefully to facilitate movement, integration and positive behavioural changes when required. Using other techniques, such as medical acupuncture or laser therapy, that may help people feel better can significantly impact how they think, feel and behave, especially regarding exercise and movement.
So when asked by a young, new graduate physiotherapist, what is the key to success and longevity as a physiotherapist? I tell them to keep an open mind and that effective treatment should always be safe, flexible, creative, responsible, and a collaboration with your patient.
By Lorraine Carroll MPhty(Manips), BPhysio, MISCP
Chartered Musculoskeletal Physiotherapist Specialist
1. Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't.