Why physiotherapy doesn't want to become science

what the syllabus should be

We all want PT to be based on science and not on opinions, fancy and tradition. But in reality as we all know it is littered with bad science and pseudoscience.

Even though there are many issues in making PT science based- i think it should start from the university syllabus. A key concern lies with the outdated syllabus, seemingly entrenched in the 1940s and resistant to updates. Several noteworthy aspects demand revision, and I will outline some of the crucial changes needed.

In subjects like anatomy, physiology, biochemistry, pharmacology ( not sure we need all these are in all universities)a two-part approach is essential, wherein some parts of the syllabus should be taught in details and other topics in brief. Say, in physiology- Core subjects, such as cardio, respiratory, and neurophysiology in physiology, require thorough and meaningful instruction. I mean in proper detail- not the useless way we teach and learn now. Meanwhile, other topics like digestion, excretion, reproduction, and similar subjects can be covered in a more concise manner, aligning with the existing teaching practices. This two-tiered strategy can be applied to all fundamental science subjects.

Pray what is the value you ask?

Firstly, this approach results in an increased emphasis on the in-depth study of topics which holds greater relevance for clinical physiotherapy. This shift addresses a significant issue—our current struggle to distinguish between genuine physiological and pathological understanding and the pseudoscientific concepts put forth by so-called "experts."

In terms of PT subjects, I personally find the situation most concerning in the realm of exercise therapy. It's perplexing that we, as a profession, are unique in not delving into the fundamentals of exercise physiology or the principles of exercise therapy before delving into the subject itself. I strongly assert that the book by Dena Gardner should be entirely discarded and not considered a foundational text. PT educators who claim it to be a basic book should either seek opportunities outside of the PT field or undergo a comprehensive re-education (pun intended).

Likewise we don’t read pain science but study exercises and electro therapy to reduce pain. How delightfully stupid. The same goes to Ortho, where we seldom bother with pain science, and instead, everyone becomes a so-called expert in mystical remedies like trigger points, K-tape, repositioning the SI joint, and other magical pain syndromes. It's a downright foolish approach that blinds us to the most effective treatment—good old exercises.

In Neurology, we can continue believing in the timeless wonders of PNF, Bobath, and the rest of the gang, right? I mean, who doesn't enjoy perpetuating outdated methods? But wait, here's a revolutionary thought: let’s read motor control, motor behaviour and learning then, of course, we can generously spare some time for those quaint, science-based treatment methods.

I'm on a mission to declutter our curriculum, and subjects like psychology and sociology are next on the chopping block. The current versions are downright useless. I vividly recall delving into socialization, only to wonder how on earth it's relevant to people with disabilities or how optical illusions play a role in clinical PT. And don't get me started on community medicine – a total overhaul is in order. Let's shift the focus to non-communicable diseases and prevention. It's time for a much-needed update.

I also want a bit of spring cleaning in our curriculum. Let's consider removing substantial chunks from subjects like biomechanics, neurology, ortho, microbiology, and perhaps a few more. Frankly, these topics contribute little to the practical realm of clinical PT. It seems like we mindlessly lifted them from a medical textbook, possibly the ortho bible by M.N. Natarajan or Brain neurology. Lets make our syllabus nimble and useful.

I also think we need to add some subjects to our curriculum: basics of logic, basic maths, and statistics. I know, I know, we all entered the realm of biomedicine to escape the clutches of mathematics. But, alas, medicine happens to be deeply entwined with statistical mathematics. Unless we face these numerical demons head-on and truly comprehend them, the dream of becoming truly science-based practitioners will remain elusive.

If we start here we may reduce gullible PT falling into moving the immovable like the cranium, the fascia, correcting which does not need correcting or not correctable and much more.

I acknowledge that some may feel defensive and question how to determine what constitutes a core subject. If uncertain, feel free to seek clarification from me. You may also feel, is these are possible? is this guy right in claiming these sweeping changes are important. Well, let’s discuss.

Additionally, I am not naive in expecting an immediate transformation in PT clinical practice, but this proposed adjustment marks a small yet significant initial stride.

PS- i know there is no cure for stupidity, but we can reduce our ignorance.