Sadly, more than half of Continuing Education (CE) in the Musculoskeletal field courses are not supported by research, and they often misrepresent the current state of evidence (Peterson et al.). Consequently, signing up for a new CE-course is a coin-flip; you may get what you pay for. However, you may also get served up a platter of misinformation, told a fairytale-like and bogus explanation without substance, and persuaded into learning outrageous, useless, dogmatic treatments. And aren’t we getting a bit old for fairy tales?
So, how do we avoid getting ripped off when signing up for a CE course? How can we assess if the course is not just an old book but with a new fancy cover?
Teachers continue to promote outdated assessment and treatment methods
Sadly, some CE teachers continue to promote and teach outdated assessment and treatment methods. Suppose the instructor will claim to “release” something in the body or “activate” or “deloade” a specific structure, feel “instability”, or use Orthopedic “Special” Tests to find the source of pain. In that case, the course is likely still using knowledge from the Stone Age! Take your hard-earned money elsewhere. The same applies if they recommend acupuncture, dry needling, laser, taping, anything with fascia, or other modalities with questionable evidence. In that case, the course is likely still using knowledge from the Stone Age! Take your hard-earned money elsewhere!
If the course equals structural findings with pain, the course is also likely still using knowledge from the Stone Age! Take your hard-earned money elsewhere! Pain does not equal pathology. This type of clinical reasoning is only a testament to the outdated thinking that still lingers in the musculoskeletal field, showing its ugly face repeatedly; at this point, it is getting tiresome.
Pain felt in the body is not a “thing”; however, many courses conceptualize pain as a thing in the body, like a kidney or a patella. Pain is not a somatic entity. Pain is an experience, as noted by The IASP (Raja et al.) Pain should be recognized as a “multidimensional experience produced by multiple influences” (Melzack et al.) The experience part is wholly overlooked when we try to find pain in the body. Ignoring that pain is a complex human experience.
People do not exist in isolation; instead, we are biological, psychological, and social creatures living in an environmental context. Multiple factors in this context will influence the worsening and maintenance of pain and disability (Turk et al).
To clarify, Orthopedic Special Tests have value if they test the likelihood of a structure being compromised and do not attempt to link a specific structure to pain. Obviously, they need to have good to excellent specificity and sensitivity. Sadly most do not and therefore have very little clinical value. This also means that courses focusing heavily on using Orthopedic Special Tests in assessments have little clinical value!
If the course comes with extraordinary claims but is short on citations to support the extraordinary claims, that is also a strikeout, and you should take your hard-earned money elsewhere! If the course or supporting research uses many surrogate endpoints or surrogate outcomes, that is also a strikeout.
“Reliance on surrogate outcomes may be harmful and even lethal. Trial results obtained with surrogate outcome measures should be regarded as preliminary, analogous to results obtained in using animal models. Large trials with clinically relevant outcomes should always be performed before new interventions are introduced into common use.” Gøtzsche et al.
Surrogate endpoints and outcome measures like “circulation”, “adhesions”, “fascial restrictions” or “blood flow” just to name a few, they have been used to lure unsuspecting and novice clinicians into believing in fairytales without any correlation to real patient-specific outcomes.
So, please be very cautious when choosing a Continuing Education (CE) course in the Musculoskeletal field. Many of the big CE-companies are still promoting assessment and treatment methods unsupported or even refuted by the research. Ask critical questions to the teachers if they do not come up with any support; that is a strike. Take your hard-earned money elsewhere!
Peterson S, Weible K, Halpert B, Rhon DI. Continuing Education Courses for Orthopedic and Sports Physical Therapists in the United States Often Lack Supporting Evidence: A Review of Available Intervention Courses. Phys Ther. 2022 Jun 3;102(6):pzac031.