This negativity shit has got to stop.
I’ve had some health issues pop up that have basically kept me couch-ridden, and it’s given me time to step back and more time to actually get a feel for the pulse of the lifting, physical therapy, iron sports communities, and what’s happening on the rehab side of things. Maybe it’s because I follow a combination of each physical therapy-, coaching-, and lifting-based accounts, but I’m starting to think that we desperately need to shift the culture.
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One of the most common sentences I hear from athletes with whom I am working or athletes who have reached out to me when they don’t know where to start is that they are confused because it seems like every physical therapist and coach says to do something different, and everyone’s saying what an idiot everyone else is. I explain that having many ways to solve a problem is inherently a very good thing — we want variability and acknowledgment that the body is multifaceted. Last I checked, people with similar issues can respond very differently to the same treatments, so having multiple solutions is a great way to increase the likelihood of success. That is a net win, all around.
The problem isn’t that we’ve been presented with options — it’s that we’ve been given as much at the cost of other practitioners’ reputations with the danger of unconscious incompetence or self-inflated importance. Constant derision, undermining, and squabbling for the sake of educating and providing information isn’t empowering for athletes: it’s chaos and confusion-causing. I see more info about how much things are bullshit (which is important information, too), but it is always presented without a “try this instead” or “here’s why,” and often directed at an individual rather than idea. Things become personal very quickly, especially with keyboard warriors on social media.
This has grated at me for a long hot while and has made me SO grateful that I get to have my professional life thrive locally and not just remotely. Most of us who treat patients, train, have family obligations and have an online presence don’t have the time to nitpick over every word we write. It’s tough to approach an audience while trying to simplify and not overcomplicate, while also being intellectually honest. There is no perfect wording, and someone will inevitably disagree and discredit your professional education and ability.
I bring all this up because of an Instagram post that Stefi Cohen made a few months back about there not being one perfect solution or exercise to prevent low back pain. She’s freaking spot on… but given how many views her posts get, it’s no wonder she gets quite a few keyboard warriors who want to attack her post under the premise of “No, you just don’t know the answer.”
I literally could not eyeroll harder. If you are a coach or therapist who has a method that works for you, that is awesome, and keep rolling with it… but don’t assume it’s the only way or that you have seen it all.
I talked to Stefi for a few minutes about how many keyboard warriors (even students!) who want to sit on social media and wave one article against another like steel weapons. I understand wanting to educate others and wanting to see the best for people, but doing so by claiming everything you haven’t personally seen as effective is idiotic and also saps hope from a lot of lifters: it removes a potential solution that quite frankly, given how many different physiological influences there are with regards to pain and rehab, MIGHT have otherwise helped in part.
If you want to lead and change our field, discrediting people who don’t agree with you has zero net positives at all. I’m not a huge manual therapist; I can’t remember the last time I did some manual technique simply because “evidence showed that this combined with exercise, blah, blah,” but I’m not going to say someone is a bad therapist because they decide to do a thoracic or lumbar manipulation. None of this should be about us. It has to be about those we are seeking to serve. The more you go to war, the more in one camp you stay, is to their detriment, as the “why” gradually shifts to camping an ideology rather than serving those looking for help.
We have to change this, and it isn’t just up to coaches and therapists. Athletes have a say in this, too. Know your role and understand that there are a lot of very intelligent people with widely differing viewpoints, but understand that we all are playing for the same team: we want results. The more we show what does work and what can help, the more options we have when “nothing else I’ve tried has worked.”
There are solutions, there are things you can look for, and there are tendencies you can feed or starve depending on your actions, your mindset, and whom you decide to work with. As an athlete, parent, or coach, you have far more say than you think you do when it comes to shifting the pendulum toward the net-positive-seeking win-win.
Konrad Bak © 123rf.com
The Consumer
You want and need to work with someone who is positive, relatively open-minded, and more interested in your goals and thoughts than their own. Someone who is willing to admit they are wrong or has been wrong, who instead of thinking an idea is bullshit; they are inherently willing to try to understand why another party may think a certain way. This ability to think laterally and gather the whole of the situation with a less rigid thought process (because what if their first idea doesn’t work?) is more likely to find whatever solution it is you need.
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I truly believe the best coaches and clinicians are ones who go through the fire of looking through others’ lenses and come out with a conviction and a track record to prove it. Most who have gone through that, you’ll find, are ones who operate in openness rather than rigidity; truly there is nothing new under the sun, but we’re a generation that thinks we have it all figured out. Professionals who have gone through that growth will be creative problem-solvers and educators rather than strict bashers and fear-instillers. The most skilled clinician in the world, if he or she is a total asshole, may not actually get you better. You need someone looking to serve you and is not served by ideology, agenda, or social media popularity.
Warning Signs
I hate to say it, but if you scroll through an individual’s activity on social media and see more comments or posts regarding why something is wrong without an alternative, GTFO. If you see someone constantly flagging their own posts, or reposting when something they did worked and gets shared (not a few times, but constantly!), personally, I might start to think they’re less concerned with serving you and more concerned about getting a gold star. It’s concerning to me when people have TOO many clients, as it means you will likely have less attention to detail unless you have the bandwidth of a supercomputer.
Positive Indicators
Track record (duh!) aside, there are some incredible, amazing therapists out there who don’t get nearly enough credit for their ability to rehab a strength athlete. You are in good hands if someone, either remote or local, is willing to learn about what it is you do or want to do, about how you respond (mentally and physically) to different communication and training styles, and different movement patterns. You’re on the right track if someone doesn’t immediately tunnel vision into fixing but seeks to understand first. You’re on the right track if you’re with someone who’s willing to say, “Honestly, I’m not sure.” You’re on the right track if you talk to one of their clients, and they tell you that “It took some time (because injuries do, sometimes!), but I’m doing WAY better, and I’m really pleased with the relationship that formed.” As much as it is helpful to work with therapists who understand strength and conditioning, anatomy and biomechanics should be universally appreciated, and the dissemination of things that we pride ourselves on in strength and conditioning is becoming much more universally accepted. TL;DR: if your physical therapist lifts, awesome. If they don’t, don’t write them off, either!
Ways to Engage
Rehab can be a long process… and the relationship that develops is hugely important. You want to think about working with someone who you would want to use as a resource for much longer than you need.
Do a Little Interviewing
Talk to them, their athletes, their training partners. Ask questions. Really. The more comfortable you can get working with someone, the better.
How to Get the Best Results
Ultimately, isn’t this what we’re after, anyway? I’d implore consumers to keep in step with the same things that we as clinicians should or need to do: keep an open mind, be patient and compliant (the hardest), communicate, and be under the same team mentality. This is about you but work with the person you’ve chosen to work with.
Fellow Rehab Specialists or Coaches
If you want to help, if you want to lead, putting others down is NOT the way to do it or how to advance our fields. You are dividing, creating a construct of survival, rather than lending to a culture of growth. You are contributing to people’s defensive positions that inherently align with a fixed mindset, keeping them in their camp, rather than growing in understanding.
READ MORE: Troubleshooting Strength Injuries: Dealing with Injuries
You want to help? You want to lead? Being inflammatory, degrading, and arguing for the sense of right does absolutely nothing but confuse athletes and discourage other clinicians from continuing to learn.
We are all trying to get better, and I understand that our field is in this awkward evolution where everyone wants to be a physio that lifts, but this is not a me-versus-them industry, and it shouldn’t be.
Please be willing to entertain that maybe you don’t fully understand something, just like I will not fully understand or agree with your need to do a manipulation or specific manual mobilization… but I want to know what kernels give you an idea of who may have the most success with it!
Athletes, Parents, and Coaches
Please hang on, don’t mind the “everything is bullshit” trend that’s going around, and do not take anything one therapist or doctor says with absolute authority, ever.
If you’ve got myths or ideas you want to be debunked or even want to be shown other viewpoints, let me know. It would be an interesting series to write. As always, I’m available for questions at danicashdpt@gmail.com.
First I was going to write to you privately. Then I thought "nah... why bother". Then I decided that maybe we could start a conversation on this topic here.
You sound upset and indeed, the issue you mention is probably something that goes from annoying (1-) to devastating (-10). Let me first contextualize my response:
1. I have no idea what you are talking about concerning physical therapy. In fact, I only follow physical therapy or nonsense accounts on Instagram but I don't read anything except the author's text. I don't know why... It never interested me. But having received some nasty comments myself in the past, I can imagine them. I'll list some of the accounts I follow below. Mostly I do it because of the cool drills and animations. You know, I'm an old beaten up athlete, I spend more hours on them than actually on the lifts. I don't even know if the accounts are good - I just like the videos.
2. Unfortunately, during the past decades, the beauty industry (let's leave that for another topic), which includes the fitness industry, developed an incredibly powerful marketing complex. Although in sheer economic size it pales in comparison to, say, the pharmaceutical industry, their marketing is completely different. In all compartments of the beauty industry, charlatanism and scamming are a rule rather than the exception. With the growth of the internet, the number of potential consumers reached by the "emotionally-laden persuasive discourse with loose ties to truth" (aka charlatanism) is orders of magnitude bigger than the number of consumers who can be reached by sound, honest marketing and much more than the number of consumers who even know what "evidence-based" means.
3. It doesn't help that all the health sciences are undergoing a state of turmoil that different epistemologists give different names to: "accumulation of anomalies", "scientific controversy", "paradigm shift", whatever. I actually disagree. I believe the nature of scientific consensus changed. We are now facing problems of a different nature, too complex in terms of the number of variables involved and which can be framed in almost infinite ways. Scientists are engaging in fights that I could translate as two people building up animosity in a conversation using different languages: I don't understand Russian, he doesn't speak Portuguese but we keep fighting.
4. The "borderline consumer", the one that is consumer and participant (like "coaches" who consume other coaches intellectual production, marketing, image, etc) is the one that bothers you. They are very motivated because they don't really know where they stand. My S.O. follows a fight forum and the most educated participants still quote gurus that "surely know their science". But - alas - they don't.
5. They are not real people. They are digital thinggies. They really don't matter (to anyone). Digital thinggies are either consumers (meaning: they will paypal you your consultation fee) or they are just thinggies. You delete them. In two occasions in the past 3 years I remember some lay person replying "oh, yeah? If you know so much then post the list of studies that..." and I replied: "absolutely. My reports start at US$1500.00 and you get a preliminary review of the literature. I require 50% of the payment upfront and the other half as I deliver the report" (which is true). End of conversation. You have a doctorate. It is YOUR choice who you decide to educate (or the university's choice, if they hire you as a professor, but you are being paid to educate folks). If you decide to educate anyone for free, well, they'd better be very, very well behaved and polite.
4. What you call the keyboard warrior will still outnumber us in orders of magnitude. They still shape the beauty and the fitness industry. Is there anything you can actually do to change this? No. But there are still good doctors, physical therapists, dietitians and coaches out there. They are not great in marketing and that's kind of good: they wouldn't be able to handle a large wave of new clients/patients.
5. I keep to my little corner of the world of ideas which is research (a little) and science education (a lot). One of the things I do for free is teaching folks how to read primary sources. It should be a required class in any science-related college program but it isn't. I still do it. Am I changing things? Not even close. Nothing at all. I do it because... I do it. I'm too old to change. But there's a bunch of us around... :) Come hang out with us :)
Oh, I have lots of ideas for you to write about: I confugured my Pubmed account to notify me about certain topics but I have just superficial and "reading" knowledge about them. I'd love to read what a real physical therapist has to say. Or, as my friends are calling themselves in the Inner Sanctum joke community, "actual coaches".
Here are the IG account I watch:
https://www.instagram.com/theprehabguys/
https://www.instagram.com/mobilitywod/
https://www.instagram.com/pfs_mobilityproject/
https://www.instagram.com/joetherapy/
https://www.instagram.com/animalflowofficial/
https://www.instagram.com/dr.jacob.harden/
https://www.instagram.com/thebarbellphysio/
https://www.instagram.com/movementfix/
https://www.instagram.com/thestrengththerapist/
https://www.instagram.com/rethinkingphysiotherapy/
https://www.instagram.com/dr.giardina.dpt/
https://www.instagram.com/deskboundtherapy/
https://www.instagram.com/kchu.dpt/
https://www.instagram.com/repthereds/
https://www.instagram.com/muscleandmotion/
https://www.instagram.com/musclematics/
https://www.instagram.com/chicagosportsdoc/
https://www.instagram.com/dr.nick.dpt/
These are the weightlifiting accounts (because I am an OWL too, you know, and I love it very much)
catalystathletics
olychad
squat_university
internetweightliftingcoach
hookgrip
atginsta
Awesome feedback- I very much agree with your points! The difficulty in writing articles like this and as a PT in a sport where there is so much overlap between roles of coach/pt/athlete/hybrid of multiple roles is that it is always so diffficult to fully speak to the audience. That is something I need to get much better at. It is interesting, though, that this week I've seen quite a few PT accounts I follow post much along the same lines, basically that there is a net effect that devalues the service we provide via two primary mechanims. 1. by consistently deriding those who's opinions we disagree with. There are going to be different ways to solve similar issues and by varying the nature of the issues (I appreciated how you articulated that!), solutions are going to be multifaceted. I have seen FAR too many clinicians swing to one side of the pendulum or t he other with choosing "camps" to reside in, and quite frankly, being incredibly toxic to those who share a different opinion or experience. 2. Devaluing the service that can be provided- while I think that there are some amazing learning opportunities for finding different drills, ideas, etc, on social media, and that it is necessary to rattle the cage a bit at times to gain exposure to different ways of thinking, athletes are starting to turn away from acknowledging the need for parameters and/or proper application- really, where the knowledge comes in. Some of the BEST coaches, therapists, doctors, and other professionals are the ones I follow online to broaden my own view a bit and because the habit of learning from others should be encouraged, but there comes a point where there needs some product delineation from, "quick fix drills" to truly personalized care. At the end of the day... taking care of people is what this has to be about. My frustration comes into the fact that while there are plenty who DO care a lot about getting people better, there are also many who care substantially about ego and their following. I hope that athletes, parents of athletes, and coaches can be judicious in who they work with. Learning from avenues such as social media can be a tremendous tool- but there are a plethora of individuals that use it as a platform to go to war, rather than lead our professions to dialogue and empowerment.