Create a movement – think horizontally

This post is my first attempt at being all philosophical and stuff and it is mainly directed at healthcare professionals but it benefits everyone. I’ve been writing my blog for a very short time now and I joined twitter around the same time for the purpose of connecting and engaging with other like-minded health professionals that I could share experiences, knowledge, learn from and of course a bit of banter.  There are some that really stand out! Something dawned on me recently, I respect that most reading this will probably say “yeah we already knew that” but I felt I had to share it……

When I say there are some individuals that really stand out it’s nothing personal I just have a clinical interest that I share with those professionals. On my bio page I explain that I share a rare passion – to understand more about how the body works, how we move, how it repairs and how our beliefs and behaviours can influence these processes.  I have discovered something else unrelated to my passion a new passion.  Transparency…. in sharing, in thinking, in working. I believe a shift is coming, a paradigm shift is coming…. currently I work in a disengaged environment.

What do I mean by this?  I mean the end of hierarchy is before us, it hasn’t really worked up until now has it? A shift in our thinking, in our way we work and communicate within healthcare, it needs to move from a vertical (hierarchy) way to a horizontal way of thinking.  Let me explain….. When I went through my training there seemed to be a certain order of rank within healthcare and even within profession.  Clinical specialists would teach seniors, seniors would teach juniors, historically doctors/surgeons would be at the top of the pecking order etc.

I have experienced a wee bit of animosity within my profession perhaps due to threat or being undermined. I have found physio to be really quite clicky, things were said to me that were just not true but because of seniority that was the end of it. Perhaps my enthusiasm was seen as overconfidence or, because of bureaucracy, it was seen as wasted energy, perhaps it was just me..  The need for transparency and horizontal thinking is stronger than ever now, the top down approach is over.  Let me give you some examples…

I draw your attention to the research field, it is growing and growing beyond our imagination.  I understand that there are well over a million academic science articles published each year, of that I read a morsel in comparison.  What does stand out to me is the academic research that is driving my clinical practice and is showing how important we are in healthcare and how we can create a movement.  Physiotherapy, Strength and Conditioning, Dietetics, nutrition, pain science, neuroscience, critical thinking, (the list goes on) all have their own voice. Research in areas such as pain science, psychology, mechanotransduction, tendinopathy, exercise physiology, and critical thinking; I have a vested interest (there are many others I’m sure I haven’t discovered yet). They are shaping the way that we appreciate our standing as allied health professionals and strengthening our autonomy through clinical reasoning and best practice. Ditching the dogma will serve us favorably because we can’t and won’t know it all. Being transparent as clinicians, respecting one another, and being horizontal in our approaches and thinking is better for all of us.

As a physiotherapist I have always been a strong advocate of recognising and educating the importance of the reciprocal relationship between structure and function, which is encompassing to the entire body not just the neuromusculoskeletal system. In respect to my clinical practice, papers such as mechanotherapy (one example) make very clear sense to me about what we should be doing to address healing in our bodies as opposed to taking a pill. Our cells are active so why not stimulate them in the way they want to be stimulated, with activity rather than passively i.e. a pill. That last statement could be seen as rather ambiguous which is the intention I leave it open to interpretation. Furthermore, papers surrounding pain science and cognition and behaviour have begun to open doors into a whole new approach to treatment.  Physiotherapists in particular have used passive therapies for years, now discovering that the buck definitely does not stop at just shoving a couple of needles into someone or pushing a couple of times on a back. I always understood physio’s to be movement therapists. Understanding the physiology of the body and how movement and exercise and positive and negative thinking can affect our physiology shows how that is better than any needle, mobilisation or pill. I was taught very little in terms of exercise prescription on my physiotherapy degree it was all about electrotherapy and manual therapy.  The point I’m making here is that other professions have also grasped and researched the exercise field with groundbreaking discoveries, such as positive thinking increasing muscle strength.  Transparency and horizontal thinking and reciprocal relationships are needed here too.

Social media is a perfect example of horizontal thinking. You can access clinical specialists at the swipe of a finger or touch of a button.  I regularly go on twitter and I just sit back and read conversations that emerge amongst clinical specialists, sharing their knowledge, opinions, papers, anecdotal experience, with a ‘thanks’ or a ‘what an interesting read’ or a ‘what’s your poison?’ for a PT Pub Night. It’s that easy for anyone to access these individuals including the public, we can’t have a hierarchical system anymore when it comes to education or informing the public of best practice.  I have spoken to many physio’s that are not on twitter and I worry that we will fall behind.

Finally, who is this mostly beneficial too?  The public. Dr Google is mind-boggling, intimidating and confusing.  Sharing our ideas and thoughts is so important to the future of public health.  We owe it to ourselves and the public to communicate openly, sharing our experiences and knowledge amongst all professions and respecting one another. Create a movement – thinking horizontally.

Thanks for having a read, take what you will from this piece, there will be more thoughts to come!







3 responses to “Create a movement – think horizontally”

  1. Bart de Vries Avatar

    Awesome read! On point.


  2. Sean Case Avatar

    Its a great enthusiatic blog and your passion for learning and developing is clear. I admire your commitment to transparency and expressing your self publicly in a blog and youve highlighted some great discussion points. Whilst reading this i wondered is there a place for hierachy – what are the benefits of hierachy. Does open access to all information improve its value or lessen it. Should the hierachy of acadeamic research be abandoned? It would be challenging to justify ones practice by the evidence of research if the research has not been judged prior to publication – and thats acccepting that no research is full proof nor whether that research applies to you and your patient and the context of the situation. My other thoughts were that it it may be interesting to condider why people have defensicve thinking and what may cause opacity and would that change in a horizontal system. Hope the above is useful. Keep the blogs coming


    1. the naked physio Avatar

      Hi Sean

      Thanks for the comments, I think that a lot of other clinicians have expressed their thoughts on academic research such as having an open mind and not jumping onto band wagons, which we have so frequently done in the past. The beauty of being autonomous is that you can moderate academic research for yourself. Our ability to critically think and clinically reason, drawing from our own practices allows us to question the very hierarchy that we assume academia to be.
      I agree that people can be defensive, which seems strange to me as I don’t understand how that provides us with opportunities to learn from one another particularly in the context of physio our approach should be patient centred..

      Thanks again


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: