The following scenario is fictitious but not unlike what I encounter in the clinic on a routine basis…
Clinician: Have you seen any other providers for your knee/hip/back/shoulder pain?
Patient: Yes. I see an acupuncturist once a week. He/she sticks needles along the length of my leg and it seems to help. The chiropractor I see two times a week adjusts my back because it gets out of alignment every few days. My physician prescribed anti-inflammatory medication and provided a series of injections. I saw a physical therapist for a few months and we worked on core strengthening. My personal trainer says I’ll feel better when my fitness improves. My yoga teacher says I need to be more flexible.
Physical therapy students in the United States are unable to practice unconditionally until they graduate from an accredited program and pass the National Physical Therapy Exam (NPTE). Many states permit students to sit for the NPTE within 90 days of graduation. Even in these states, however, program directors at the university level must authorize these students to take the exam. In Ohio, for example, program directors must certify that pre-graduation NPTE applicants are “bono fide candidates”. In other words, program directors, not state and federal adjudicators, ultimately control when a physical therapy student is eligible to take the NPTE. Any physical therapy student within 90 days of graduation, however, is effectively a “bona fide candidate”. A program director’s written endorsement of a candidate should therefore be more of an administrative formality than a permission slip.
Last week, three University of Oregon football players were hospitalized following a workout supervised by the strength and conditioning coach. The suggestion from many media outlets is that the workload was sufficiently excessive that it posed a danger to the participating athletes. Whether the ultimate suspension of the strength coach for one month without pay is a reflection of his complicity or a capitulation to political pressure (e.g. scapegoating) is something we may never know. Hopefully, the university conducts a thorough internal investigation and addresses whatever issues, systemic and personal, contributed to this unfortunate outcome. Regardless of the strength coach’s culpability here, the popular narrative that certain coaching practices build character warrants further scrutiny.
The following post is inspired by Stu McMillan’s “Evidenced Based Coaching” piece on Brett Bartholomew’s site. McMillan’s article is intellectually honest, nuanced, and refreshingly uncontroversial. His thesis is that practical experience and science are complimentary, not dichotomous, because neither paradigm is comprehensive in itself. In full disclosure, Stu and Brett have greatly influenced my clinical thought process and I am grateful for their transparency. They actually demonstrate what they do with their athletes, which leaves them open to criticism when somebody’s lumbar spine visibly budges while performing a maximal effort lift in one of their Instagram videos. McMillan’s article was primarily directed at the coaching profession but is equally applicable to physiotherapy.