When I graduated physical therapy school, I thought I had a firm grasp on all things PT. My patients had been improving during my clinical rotations, I received a stellar report from my final clinical instructor, and I had added few letters behind my name after passing the national boards. Plus, I was a Doctor of Physical Therapy! I soon realized, though, my grasp wasn’t as firm as I initially thought. My clinical rotations had done a wonderful job preparing me for the majority of what I could expect to see in an outpatient clinic, but hadn’t prepared me for the level of chronicity I would experience in the tribal system. 

My lack of understanding and difficulty in treating patients with chronic pain frequently left me frustrated, eventually leading me on a search for answers. Initially, I took a long-term orthopedic manual therapy course, which improved my manual skills and honed my evaluation skills but didn’t address chronic pain. I continued taking continuing education courses, primarily in the really of orthopedic manual therapy, none of which resolved the issues I had been encountering in the clinic. This cycle continued until a year or so ago, when I stumbled across the blog of Dr. Erson Religioso. I was introduced to new approaches in the treatment of chronic pain, as well as a new perspective that altered how I viewed various aspects of my practice. This transition didn’t happen overnight and frequently left me on my couch, in the fetal position, questioning past treatments and current views of both physical and manual therapy. I questioned my treatment approach, my manual skills, my evaluative skills, everything.

I later learned I was experiencing cognitive dissonance, a state in which current values/beliefs are challenged by new information. Over time and through self-reflection, the dissonance faded and I was able to integrate a few bits and pieces of what I’d come across into my current approach, which then led to further discoveries, further reflection, and further integration. Wash, rinse, repeat. As my studies continued and I continued to challenge myself, my patients’ outcomes started improving. My manual techniques remained the same, as did a number of my clinical interventions. So what had changed? Why were my patients’ outcomes improving? I believe its was due to a change in the “why” behind my clinical interventions. My clinical framework had changed, becoming an amalgam of different systems that allowed to view the same problem from a variety angles and modify my treatment accordingly. Altering my approach resulted in improved efficiency and improved nearly every aspect of my clinical practice.

I didn’t throw away what I learned from physical therapy school, the skills I learned from my clinical rotations, or hours of continuing education classes. Instead, I evolved. I improved my clinical reasoning, thereby improving my clinical practice, which in turn improved patient outcomes. I learned to push the boundaries of what I currently knew, to embrace change, and to appreciate the discomfort of cognitive dissonance.

Zach Huff, DPT, PT

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