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Why Don't They Teach Everything in PT School?

by Nicholas Mazzone

I remember when I used to think that everything I learned in PT school was the end-all-be-all of physical therapy. This was an innocent, but understandable thought in the mind of a chronically sleep-deprived and stressed out graduate student. I had plenty of other things to worry about, like the massive student loan debt I was accruing, that test coming up, or that fourth PowerPoint project that was due soon. However, my preoccupation with all things school related led me to believe that PT school had all the answers.

Anatomy and physiology are the basis of what we do as physical therapists. We spend so many hours memorizing and understanding muscle location and function. We try to make sense of the countless origins, insertions, and nerve innervations. At some point in our studies, it all seems to make sense. We understand how complex our bodies are, but we also learn that not all patients present the same with a similar diagnosis. However, by this point we have only scratched the surface of all there is to know.

Be open to new ideas

I remember sitting in class listening to a lecture on alternative therapies, such as acupuncture and ayurvedic medicine and thinking, “wow, this is a load of garbage. Why do people pay for these services?” I am a bit ashamed to think that I was once so pessimistic and closed-minded.

Now let me get one thing straight: I am not trying to push you into believing in alternative therapies. I just used this story as an example to introduce a thought I am about to put out there for you: it is important to keep an open mind.

We are taught anatomy to help us form a basis for everything we do. This doesn’t necessarily mean that if something isn’t spelled out for us in a basic science textbook that it cannot be possible or that it must be pseudo science.

I now realize that our professors in PT school had to hold back a lot of their individual beliefs and philosophies. They did this to help us gain an understanding of basic principles so that we can make our own sense of them in the future.

Let me give you an example.

PT school is just the beginning

When we learned about stretching muscles, we were taught that consistent stretching programs caused muscle length improvements by the addition of new sarcomeres in the muscle. This idea makes some sense anatomically.

One day during a lab class early in the first year of our studies, we were learning how to use muscle length tests and how to treat from those positions. We were confused as to how we could see range of motion improvements directly after performing static stretching techniques.

One of our most trusted and knowledgeable professors with an Orthopedic Clinical Speciality (OCS) from the APTA smiled at us in passing and said, “do you really think you just added sarcomeres?” He then laughed as he walked away.

Naturally, we ran after him in an effort to soothe our minds, which were on the brink of explosion. He proceeded to explain a recent theory about central nervous system regulation of muscle tone and length.

Think beyond the textbooks

I am very thankful to this professor for being real with us (Thanks, Eric). I feel that some therapists, especially in the early years of their careers, tend to focus on textbook knowledge and therefore leave themselves at risk of not improving. Think about how many clinical hours are spent in the first two or three years of one’s career. This is precious time that we can dedicate to personal advancement.

At this current moment, I am studying myofascial meridians and anatomy trains (Thomas W. Myers). In doing so, I am attempting to understand the connections between networks of muscles and fascia and their clinical significance.

Do you remember how dense the reading material on fascia was in PT school? Or how much time we took dissecting the fascial connections in anatomy lab before diving into the muscles, nerves, and blood vessels?

Neither do I.

Are you up for the challenge?

I would like to challenge you to take a course on something that is new and foreign to you. Take something that you don’t necessarily believe in. Take something that you do not think makes sense. Take something with a lab component to it so that you can try it yourself. Take the road less traveled. Question your instructors. Ask for the evidence.

Am I motivating you enough to sign up for a local course or purchase a new textbook?

Just remember this: our patients are getting smarter and they have more information available to them via the internet. Why should they spend time and effort with a therapist who has been treating the same way without improvement for the past three years? The question I frequently ask myself is, “if this was my mother, what kind of therapist would I want to treat her?”


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