Quorthon,

What I like about your practice is that you seem sincere in wanting optimal patient Outcomes. This is, in the end, all that matters. I tell my patients that if juggling chainsaws would make them better then that is what we should do. I really like that you have the courage to change your practice, since so many just plod along year after year, doing same old- same old ...

I would caution you about how you exercise that boldness. I personally, am very good at exercise, and communicating the need for that exercise. I have built and run regional athletic performance centers that serve the needs of major cities elite and developing athletes. I say this to say that I am " an exercise guy."

Even though I am an exercise guy, there are many things that I can change better with my hands. If we use exercise to adapt a body tissue, can't we also use our hands to adapt other body tissues? If exercise "fixes" everything, why has manual therapy existed for centuries? Why do people pay good money for it?

Until ALL of your patients get Fast, Complete, and Total outcomes, why would you limit yourself in the tools that you would use to advance the patients case. hopefully not because of sparse research evidence on a subject matter that is light years away from being Fully explored by science. The jury is not in when it comes to clinical orthopedics. We musn't look at what we have and assume that its the whole picture.

Not using our hands in our PT practices, to me would be like choosing to not use my mouth (like when there is a language barrier), or my eyes ( a physio in my home town is completely blind), or exercise equipment (you can get a great strength workout with an eight inch step and a stopwatch) ... We all know that none of these clinical situations is 'optimal', but they are all 'doable'. We owe it to our clients to become experts in All areas, and use whatever we can to help optimize outcomes. Lets keep our boots firmly on the ground and our hearts attentive to the struggles of the injured folks in the trenches.

The danger in reading another handful of research papers is if we let those papers blind us. Science should open our eyes so we need to be cautious in throwing out what any grey haired clinician can tell you can help. There is a qoute from an old doc named Osler, asking physicians to listen to their patients. Many of the best of us would agree, from Mckenzie, to Maitland, to Mulligan, to Cyriax.

Good luck with your practice. If you stay dedicated to your clients needs, they will notice, and your practice will thrive ... And most importantly, you will help your community.

Canuck clinician
From Total Outcomes Physio Surrey