The 5 Most Stupid Things I Didn’t Do Early in My Career: Part 2
October 28, 2010 
7 Comments
Earlier this week, I shared with you a couple of things that I regret not doing earlier in my career. We reviewed how I missed to boat on integrating soft tissue work and understanding movement. Today, I wanted to finish up the series with part 2 of the the 5 most stupid things I didn’t do early in my career. Some of the feedback I have received after part 1 was great, hope this one helps too. If you haven’t yet, please read part one here.
Understand The Spine
When I first started practicing, I worked in a fast paced orthopedic and sports medicine clinic. We were so heavy on sports medicine, that we even had our own “spine” department that worked exclusively with spine patients while we worked with extremity patients. I went a few years without even seeing a spine patient!
This was really bad for a couple of reasons. One, I missed the larger picture on a few patients. For example, the lateral epicondylitis patient that was actually being referred from the cervical spine. More importantly, it took me a while to truly understand the spine. I had a rudimentary understanding of the spine, but I had no experience.
Luckily, I identified this deficit and addressed it over time. How did I do this? Well, it took some time. I started my quest in understanding the spine by search out books and continuing education courses. I learned a lot, don’t get me wrong, but I continued to lack confidence in my ability to treat the spine. It seemed like everything I was searching for wasn’t there and I would always leave a CEU course or finish a book with the thought, “OK, that’s it…”
It took me some time, but I now realize that you can’t treat the spine like you do the extremities. There isn’t a simple clinical examination process that gives you a fairly definitive diagnosis and subsequent treatment program. The spine is much more gray than black and white. That is why I always felt something was missing after attending a seminar that recommended evaluating a patient, find the patterns of movement that cause symptoms, and then treating accordingly. I would be the person asking, “why?” And I never received a good answer, usually just, “we don’t know why and we don’t care! I just works!” That didn’t sit well with the scientist in me, especially the lack of evidence-based recommendations.
What I started to realize was that problems with the spine were usually the result of poor movement, posture, and stability. Train this accordingly, and you solve your problem. Trying to “fix” a disc bulge obviously isn’t going to produce good results! Rather than try to learn how to exam and rehabilitate the spine, I learned how to understand the spine.
What can you do? Don’t get me wrong, you need to know the foundation behind the spine and classification of dysfunctions etc. You can start with some of the popular groups of thoughts such as Maitland or McKenzie, these are great places to start. But I think you want to quickly advance your understanding of the spine by migrating more towards how the spine works and stabilizes and how to train the spine to work better. I know this is when I made a significant step in the development of my understanding of the spine.
Try these resources below from Stuart McGill and Craig Liebenson, names I am sure you have heard of by now. They do a great job breaking down spine function and treatment based on movement and stability. Once you break free from the thought process of evaluating and treating an injury and focusing more on dysfunctional movement and spine pathology, you’ll see what I mean.
Network Outside My Clique
Do you know what happens when you always hang out with the same kind of people with the same thought process? Not much. No one is pushing and challenging one another. I don’t like this. I always feel bad for people that I meet at conferences that say they work by themselves in clinic. It must be so hard for them to grow, no one to bounce ideas off, no one to push them.
I spent many years in this position. I learned a lot from my network of like-minded individuals and continue to do so, but those that know me realize that I like to learn from everyone. I attend PT meetings, ATC meetings, CSCS meetings, orthopedic surgeon meetings, everything. I have discussed in the past how much I have learned from collaborating with people from the manual therapy, athletic training, chiropractic, and strength and fitness realms. Understand that everyone has something to offer and learn from everyone. Many people have different perspectives and collaboration is great for you but even better for your patient’s outcomes! It will make you a better clinician in whatever field you choose.
Expand your pool of people to learn from. Try to visit with other people in different disciplines. Read up on some great websites outside of your primary domain, which the strength and fitness groups seem to do so well now. And more importantly, network and collaborate with different groups. You’ll be surprised at how people will challenge some of the basic thoughts that you take for granted.
Share and Learn From My Mistakes
Ah, ego can be a bad thing sometimes, don’t you think? When you are just starting off one of the biggest things you lack (other than experience, of course) is lack of self confidence. I’ve always been a big believer in attitude and the need to always focus on repeating your successes rather than your failures. I recommend reading a good John Maxwell book called The Difference Maker, a book that discusses how your attitude can be your greatest asset. I know, I don’t want to get too much into the “self-help” thing on this website, so take it with a grain of salt if that isn’t your thing.
But reflection is just as important as attitude, as long as you know that you are reflecting to learn from your mistakes rather than dwell on your failure. This is one of the purposes of this series. I am way past the point in my life and career to be embarrassed or too proud to admit mistakes. But this does come back to attitude and self confidence. I know that we all make mistakes and that this is how we learn.
I also think it is important to share my mistakes and recommend you do as well. You will come across many people that may have been through a similar experience and may offer some great advice.
Well, I hope that helped a little. We can all learn from our mistakes, I know I have, and I hope you can learn a little from mine too! Please share with everyone some mistakes that you have learned from as well so we can all discuss and learn!
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Mike, I empathize and sympathize. We've all done our share of stupid things eh? Thank goodness for hindsight. Your success is proof of the valuable knowledge and experience gained since then. Cheers.
Rick Kaselj
ExercisesForInjuries.com
Mike,
Very good insight on your mistakes. Everyone has them but also very humble of someone in your figure in the field to admit to them to help others. These are VERY similar to what I hear from my own mentor and guardian in the field. So, these are very relevant!
Nothing is ever as unforgettable as your OWN mistakes, but the more you learn from experiences, either yourself or another; the better clinician we all can be, especially to give optimal results and further progress the profession.
Why re-invent the wheel when this information can just make us better as persons.
Harrison
That is a great and very complete post. In addition to all the importance given to the clinical portion of Physical Therapy, I believe that attitude and motivation are both critical aspects that should always been taken into consideration. As a current graduate student in Boston, self-confidence I think is one of the major barriers commonly seen among PT students, including myself. THat, however, could be improved by constant study, practice and experience.
THanks for that great post,
Thanks for this series, Mike. I really enjoyed all of your points.
Mike,
I recently started a quest to become more proficient at spine treatment. One good resource is from the Michigan State University Osteopathic School. They have online CME material that can be accessed for free, you have to pay for the CME credits. I has great information on anatomy and biomechanics. The section on the pelvis has some treatment techniques also. Here is a link:
http://hal.bim.msu.edu/cmeonline/start.html
I hope you and your readers find this useful.
Brendan Smith, PT, ATC
Mike, you stated in your excellent explanation of possible shoulder "shrug" causes that the inferior capsule tightness or lack of mobility causes the humeral head to migrate Superiorly. I'm a little confused, if the inferior portion of the capsule is attached to the neck of the humerus wouldn't that prevent superior migration? I could see how upper capsule tightness would cause this, pulling the head up. Thanks, Steve Bartz D.C.
Steve, where I think you may be confused is in the arthrokinematics of the GHJ. Remember that there is an osteokinematic roll+glide that occurs. Therefore, instead of thinking that a tight inferior capsule will pull the humeral head inferiorly, think of it as preventing an inferior glide. This is termed "obligate translation". It occurs in the GHJ when there exists asymmetric capsular tightness and describes translational motion in the opposite direction of the tightness. If interested, look up Harryman, et al., 1990 and Werner, et al, 2004.
HTH.