This is an addendum to my article on Adam Meakins The Sports Physio’s blog.
Dinosaur physiotherapist is a term coined by Adam Meakins to describe the “iconic, influential and idolised clinicians and researchers who, despite a new era in understanding pain and growing evidence of the biopsychosocial model, still stubbornly refuse to change their methods or mind-set, and continue to promote and teach outdated methods of assessment and treatment” (1).
Typical dinosaur therapist statements (adapted from Neil Meigh from The Kettlebell Physio great post):
1. If your therapist proposes to “fix” or “correct” something in you, he or she is most likely a dinosaur!
2. If your therapist suggests that lifting is “bad” or “dangerous”, he or she is most likely a dinosaur!
3. If your therapist is talking about spiritual forces and vital energies or imbalances and appeals to ancient wisdom and ‘‘other ways of knowing, he or she is most likely a dinosaur!
4. If your therapist proposes that your pain is due to “crossed syndrome”, he or she is most likely a dinosaur!
5. If your therapist proposes that you have pain because of spinal instability, he or she is most likely a dinosaur!
6. If your therapist proposes to “release” or “activate” something in you, he or she is most likely a dinosaur!
7. If your therapist proposes that you have pain because of a “weak core” or tight muscles, he or she is most likely a dinosaur!
8. If your therapist proposes to be able to change the way your muscles are firing, he or she is most likely a dinosaur!
9. If your therapist proposes that you have pain because of “bad” posture or muscle “weakness, he or she is most likely a dinosaur!
10. If your therapist uses interventions like acupuncture, dry needling, ultrasound, electrotherapy (like TENS), Kinesio Tape, he or she is most likely a dinosaur!
The problem of misinformation and outdated clinicians
People living with pain contact me frustrated and want to find a therapist who stays current with the pain research literature. The statements above can serve as a guideline to differentiate the bad apples (dogmatic and outdated clinicians) from good apples (up-to-date and person-centered clinicians).
“I have tried physiotherapy, and it did not help me!”
This is a typical comment from many people living with pain; they have been to 2-3 physiotherapists and have tried numerous interventions, but often only low-quality treatments and passive modalities.
It is disheartening to hear vulnerable and disabled people share their stories and realize they did not get a single high-quality treatment. They got served up a platter of misinformation, told scary shit, and persuaded into outrageous amounts of useless low-quality treatments.
“We owe it our patients and to ourselves to be a generation of skeptical, inquisitive, and reflective physical therapists that always seek to be less wrong.” Dr. Nicolas Ferrara, DPT
Misinformation in the healthcare industry or the medical field is a severe problem and potentially can do a lot of harm. Clinically, I see examples of misinformation daily, and the research here, especially qualitative research, is full of examples (2, 3, 4). I believe a good clinician does not perpetuate myths or base their clinical judgment on unproven or false traditionalist beliefs.
A good clinician should see any misinformation as an opportunity to inform the patient or client so they leave more informed with better and more correct factual information. Clinicians and therapists that promote fearmongering and perpetuate myths and misinformation do not deserve our politeness! They need to be called out; as professionals, we must hold ourselves and our colleagues to a higher standard. Misinformation can do a lot of harm!
“Health care delivered in ignorance of available research evidence, misses important opportunities to benefit patients and may cause significant harm” (5).
1. Meakins A. Dinosaurs among us causing chaos and confusion. Br J Sports Med. 2016 Apr;50(7):384-5.
2. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34.
3. Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A. Easy to Harm, Hard to Heal: Patient Views About the Back. Spine (Phila Pa 1976). 2015 Jun 1;40(11):842-50.
4. Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskelet Disord. 2017 Nov 17;18(1):466.
5. Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J; Second International Conference of Evidence-Based Health Care Teachers and Developers. Sicily statement on evidence-based practice. BMC Med Educ. 2005 Jan 5;5(1):1.