Initial Perspectives For Professionals – P.T.

I am beginning this perspective with an enjoyment that I did not experience with the others. My memories of working with P.T.s have mostly been happy and, I believe, mutually rewarding. I’m writing this to old friends as well as newer generations who I hope will read this. To my friends, please contact me. I would greatly enjoy hearing from you.

Especially in my earlier years in general practice, I was acutely aware of my orthopaedic medical limitations, and since my practice included many industrially injured patients, I employed the best physical therapists I could find. But I never, not early – not now – ever wrote a “prescription” for P.T. I always regarded the therapeutic decisions mutual consultations, and I innately understood that the professional who had his/her hands on the patient had to have the confidence to reasonably proceed according to what was happening at any particular time. (At the same time, early on I wasn’t aware that physical therapy was in its infancy in its confluence with clinical biomechanics.) During that same early time, I would observe physical therapists working in institutions where I saw otherwise. I saw acceptance of passivity, sometimes with visible resentment. I became acquainted with “shake ‘em, bake ‘em, ultra violate ‘em” mentalities who would do what uneducated doctors “prescribed” with such orders as unvarying exact doses of ultrasound and, worse, exact poundage and times for traction. The word, “mobilize” was never seen.

As I relate in Release From Pain, my learning of the manipulative procedures, and the thinking that goes with them, was already in progress when I entered the PM&R residency at the University of Southern California (USC). In the end, it was not a good year for me. 

Until then, I could not conceive that members of my future specialty would actually consider themselves in a “life and death struggle” with physical therapists. I had never experienced the paranoia of the physiatrist miserably subservient in spirit to other doctors, begging only to be allowed to do electrodiagnostics – unskilled in hands on patient contact.

Early on, one of the P.T.s came to me with an incidental question, one I was able to answer well in what, to me, was a respectful conversation between two colleagues. It was no big deal. Until I was suddenly being pounded on by one of medical faculty smashing me repeatedly on the back while excitedly screaming in my ear that did I realize what I had just done? I had showed “them” we know something! What I had done was a major triumph for the department! What was revealed to me was, in fact, a small tragedy that thankfully is mostly only history now.

I was the only American physician to attend the first Canary Island meeting, in 1972, where FIMM, The International Federation of Manual Medicine, was formed. Freddy Kaltenborn and Olaf Evjenth called the month long meeting and conducted the teaching to about sixty P.T.s plus doctors mostly from Europe, some from Canada, over a hundred attendees all told. Many of the P.T.s were well into their training in the manipulative techniques. That was where I first encountered the “young Turks” among you, agitators for professional independence.

When I was appointed the consultant for orthopaedic medicine to the Veteran’s Administration, for about two years, the senior P.T. from each of the hospitals around the country were flown into Los Angeles for me to teach, predominantly in mobilization techniques. Peter Edgelow and I were already friends. He would fly down from the San Francisco area to assist me. The first meeting, they sat there as if they’d been sent into a minor purgatory, many competing with each with repressed expressions. The atmosphere changed dramatically very soon – as soon as they realized that I respected them and that they’d be foolish not to respect me. After a few times back, I had a regular “sick call” for their assorted injuries. That was where I found myself performing the smallest manipulation, maybe, in history (except for deep cranial). It’s Randy’s story in my book. On one occasion, about six of them lined up, and in a short time all of them were relieved. It was one of those fun times where everything clicked. Then I heard myself comment, “And just think. I was able to do all of that without using one hot pack.” From the gasps at procedural habit attacked, you could think I’d pole axed them.

As Peter suggests in the physical therapy Foreword to Release From Pain, we are hopefully entering a time when his profession, your profession, are restoring fundamentals as a foundation of the clinical wealth that represents physical therapy’s therapeutic contribution. I hope you realize that as you read this. There is much here for you. I think you will find it so. Please read Release From Pain - and join the restoration.