Saturday, March 8, 2008

Physical Therapy and Cults...

I think we're all guilty to a certain degree. We like the self-affirmation that comes along with being correct. A good diagnostic catch in the clinic...a good outcome when you weren't sure their would be. The sports analogy is snatching victory from the jaws of defeat.

But like the great poet Rudyard Kipling said in his famous coming-of-age poem "If", becoming a man involves knowing successes and failures should be kept in perspective. You are never 'always right' nor 'always wrong'. This simple humbling lesson should be in the back of our minds during our personal and professional lives. At least it should be.

Yet some in our profession would speak as if this weren't the if some are indeed always right or always wrong. Most notably, these ideologues tend to speak in absolutes with very little equivocation. They will actively recruit easily led individuals and defend the faith at any cost. Questioning is met with often harsh admonishment that you must be part of some central orthopedic conspiracy designed to bring them down. It's the behavior expected of someone who always got picked last for kickball.

Interestingly , there are likely credible features to some of these approaches that have some basic science and case-studies to support their unique way of looking at the clinical world. However, unless they submit to the rigorous scrutiny of consistent peer-review, they must be placed in the bin of other popular but unsubstantiated therapies. As evidence mounts, a groundswell of support will emerge for new "cutting edge" treatment methods.

Make no mistake, the credibility and growth of our profession will stand upon our willingness to back what we say and do with evidence. No amount of emotion or ideology will ever compensate for a lack of it. Ideology without evidence is faith healing.

If your goal is to become one of the emerging leaders in conservative management of movement-based disease, I implore you to be vigilant in maintain the ideals of evidence-based practice as articulately defined by Sackett. I also strongly suggest reading an editorial in the Journal of Manual Therapy entitled "Manual Therapy Cults" (Rivett, 1999).

This is an exciting time in our profession. There are providers out their busting their tails to make us better as a profession. I say busting their butts because this process will not be easy. Nothing worth earning is or should ever be easy. We need to move beyond being part of the problems in our profession by becoming part of the solution.


  1. That's funny TexasOrtho.
    You name everything a cult when you are unable to grasp it.

  2. So anyonymous (Greek?), to which cult do you belong? I will welcome any lessons you can provide to help me grasp why I too should become a member of your cult. I'd ask you for some peer-reviewed evidence in support of your statements, but I think we both know where that would lead.