Holistic Physio - Science VS GUesswork Pt I
Holistic care simply means treating someone as a whole. Considering all the factors that could be influencing how they feel. Basing our treatment approach on all of the information presented to us and making sure that our intervention starts at the cause and through a positive ripple effect, solves the problem.
In physiotherapy, phrases such as ‘root cause’ and ‘imbalance and compensation’ get thrown around a lot and it is viewed as the highest level of care to identify and fix the root cause of the pain. The reason for this is that bye nature, this means the problem won’t come back.
The problem is that during my two physio degrees, we were never taught how to do that.
What we were taught was this - first the anatomy of a region, then how to investigate that area with specialised questions and physical tests to determine how well it was functioning. Then we were taught common conditions and how the answers to the questions and tests would ‘fit’ one condition over another. We then moved on to the next part of the body. Then when somebody came in with knee pain, I would conduct my knee assessment. For a shoulder issue I would deliver a shoulder assessment.
However, life is nowhere near that simple so let’s play devils advocate. What if the pain and the cause of that pain are not in the same area? The assessment would miss what is going on and the diagnosis/treatment wouldn’t work. Or, suppose the person has pain in two regions say their foot and their hip, what then?
In this instance, we need a way of assessing one area of the body in relation to another. We need to be able to test different regions and see how the function of one impacts the other. We need to know how they connect.
The fundamental problem is that we as physios were taught absolutely no method or deductive way to figure out those connections. Let’s really spell that out - during two degrees I was taught zero way of accurately deducing how an issue in one area of the body is directly causing symptoms in another.
Without that framework, the only option we have is to use an inductive reasoning process to find the root cause of a problem. And this is where our entire profession let’s itself down.
Inductive reasoning means to make an assumption based on a set of specific observations. We know the patient has symptom A, then we observe through testing that they have B issue. We then decide B is causing A and provide a treatment to fix it. We hope that result of fixing B is that A changes.
The problem is that physios apply this logic on top of itself. We are so determined to be holistic that we don’t just stop at A and B, instead we add layer upon layer. I have seen physios try and fix knee pain in a runner by pushing on the spine between that patient’s shoulder blades. Their ‘logic’ to get to that hypothesis involved assumption based on assumption.
It is key to remember that every assumption is a guess, and therefore could be wrong. And if one of those guesses is wrong then the entire diagnosis is wrong and the patient will be given a made up story and a treatment plan that will never work.
While I am sure many people have got to this point and are feeling just as disappointed and frustrated with physio as I was after 5 years of working in the profession. But there is hope… Part 2 coming soon!
