For most of my time as a physio and even more so since reading wait but whys blog on Elon Musk I have been contemplating the first principles of physio. I had many questions: What is it that truly works? With each unique person what unifies our approach? How can it be that gurus teaching wildly different approaches are getting people better at a higher rate than the rest of us? If I had to explain to my son what a physio was in simpler terms how would I do it? I wrote about this topic a little here, but I was never satisfied with my own explanations and the explanations provided in other courses.
This changed of over the weekend. I took my first course in over a year and as I had hoped Greg Lehman provided me with clarity on the topic. I was excited going into the course and I did not leave disappointed. Greg was someone I had been following and listening to (podcasts 1, 2, 3) since before physio school. Reading his pieces on fascia and core stability in those early years shaped the way I thought through school and into private practice.
Straight out of school I was fortunate enough to work at Diane Lee’s clinic. The fit and care model however, were not for me. There were too many things that I questioned and I never felt comfortable or authentic. Even though it wasn’t the right fit, it forced me to question my own biases and had me asking, what connected the “gurus” of the world? Some of the connections were obvious. They listen well, they reduce noxious stimuli, they use a meaningful task, they have conviction in their plan, and they all spoke very well. My issue with many, not all of of course, of the physio guru’s is they tend to over complicate, use pessimistic language, and create an environment of dependency (even though I know they are we’re trying to “empower”). I felt there must be another way. By listening to other thought leaders and incredible thinkers in other fields, on my favourite medium of podcasts (1, 2, 3 ), I came to realize that you can still be humble as both a thought leader and success story in your field.
Greg was the first physio thought leader that I have been introduced to that was humble, self deprecating, but all the while incrediby well spoken, smart, and well read. What really struck me was not his reliance on one study but his ability to find the common thread of research from seemingly disparate areas. Josh Waitzkin of, the art of learning, believes that the best in the world are able to take seemingly disparate fields of study and find the similarities. It seems that Greg constantly asks what the underlying themes are that connect the papers he reads. He asks the question, what can we learn from other fields of study, both healthcare and science in general. He is looking for those first principles and he is comfortable questioning himself.
If we as physios truly stepped back and reflected upon our our profession and our approaches I think we would start to see some massive change. Like many things in our life a balanced approach that holds high esteem for research but doesn’t throw all other techniques out with bath water is probably best. If we choose to keep a passive treatment that is not fully supported by research, own it, be humble about and ensure you use it without the context of “fixing.” We must be humble enough to change our approaches and open enough that we discuss and not argue the merits of others.
Go to Greg’s course, keep reading, and continue to challenge your own approaches. We will move ahead of other professions if we do.
Thanks for reading.