PT Braketology: Stop the Madness

It is that time of year again when the “madness” of March descends upon us and the competition for the perfect bracket begins. Sixty-four teams, one championship and two weeks of games, buzzer beaters, upsets and victories. A wide field of hopefuls in a single-elimination bring your best competition where underdogs have the chance to walk away as undisputed champions.

Remind you of anything? The PT field, perhaps? We have several competing interests and a lot of teams. For starters, there are the “Manual Therapists,” the “Pain Neuroscience Educators,” the “Needlers,” the “Instrument Assisted Soft Tissue Mobilizers,” the “Non-Specific Exercisers” and the “Evidence Based Practitioners.” Juxtapose this with the opinions of clinical educators (and multiple systems of education), physician-owned practices, hospital-based and private practitioners and you have a totally different bracket to fill out. This can be confusing for peers, new grads and especially for our most important group—our patients.


Follow the discussions in peer-reviewed journals, blog posts and on several different social media platforms and you see each team competing. New research articles supporting the case of one team and refuting the other. A cleaver tweet, cutting down the opposing viewpoint, and lifting the new “evidence” as the gold standard. In the end, the best team is not left standing, and the evidence, which is clear in a study, gets muddled in clinical practice. Also, clinical practice cannot convey to researchers what exactly we do in the confines of our treatment rooms. But newer research models are starting to change this barrier.

I have had the pleasure of working, teaching and growing as a professional in the eclectic NAIOMT system and multiple settings. At the end of the day, I think David Butler sums it up best in his 2013 post “The Rollercoaster of Professional Life” where he says, “the interactional power needs better analysis and understanding.” And as Pat Wall would say ‘in the end, if the majority of the outcomes are based on placebo, do not fear, but work out what it was in the placebo which gave the outcome.” This interactional power is important both for patient interaction, but also for peer-to-peer interaction.

If we continue to treat PT like a sporting competition we will not reach the final goal of providing the best care for each of our patients and deriving ultimate enjoyment in our unique and amazing profession. The key is collaboration—between clinicians and researchers, between competing systems of clinical practice and differing modes of therapy. Innovation is best when art and science connect. Dianne Lee states that the “treatment room is our laboratory” where we create and test out different innovations. But is this scientific and does it conform to the rigors of evidence-based practice?

The balance between the scientific (evidence) and creative aspects of PT (art) is tenuous. If we stick just to algorithmic-based PT, we will fall into the same trap innovators do when looking at artificial intelligence without human interaction. Take Walter Isaacson’s words in The Innovators:

“People … provide judgement, intuition, empathy, a moral compass and human creativity. We humans can remain relevant in an era of cognitive computing (or I would say evidence based, algorithmic practice) because we are able to think different. Something an algorithm, almost by definition, can’t master. We possess an imagination … bring together things, facts, ideas, conceptions and new original though, in endless ever varying combinations. We discern patterns and appreciate their beauty. We weave information into narratives. We are storytelling as well as social animals.” (Emphasis added.)

The greatest innovators are collaborators, benefiting from the work of the people who came before them. This is true in PT as well. In the words of Einstein, “Intuition is nothing but the outcome of earlier intellectual experience,” and this can only be derived if we all work together, collaborate and stop the “madness.”

Terry (left) with NAIOMT Fellow Austin Sheldon

-Terry Pratt (AKA @PrattPhysio)

Faculty Instructor at North American Institute of Orthopaedic Manual Therapy (NAIOMT)


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