This weekend I attended a training at the Parnassus campus at UCSF through the Dept of Physical Therapy & Rehab Science entitled “Medical Screening for the Physical Therapist: The Sherlock Holmes Approach” taught by Dr William G. Boissonnault. “Why a PT course (again!)?” you might ask. Well, frankly, it’s because I’ve been really impressed with the quality of the continuing education curriculum at UCSF for their therapists, and I want to utilize my limited finances, time and brain capacity wisely! The course’s main premise is that it is not the therapist’s role to diagnose disease, but rather to recognize patterns and be clinically aware and confident enough to know when it’s appropriate and prudent to refer a patient to their Medical Doctor, with clear instruction of what to tell them. And even though I hold a different licensure than a Physical Therapist, there is a lot of overlap between our two professions, especially with how I choose to practice, and the roles we play with our patients.
I’d estimate that the overwhelming majority of the patients I see for back pain and other musculoskeletal ailments have a joint misalignment and/or muscular-fascial imbalance, spasm or weakness that responds really well to chiropractic adjustments, soft tissue therapies such as ART, rehab stretches & strengthening exercises, and postural/ergonomic changes. However, I want to be adept at recognizing those clinical red flags that warrent a medical referal.
For example, did you know that it’s generally OK to feel stiff in the morning for up to 30 minutes after getting up, but that if it takes hours to loosen up, it’s an indication that there might be other arthritic processes involved? And did you know that it is possible to pretty accurately determine the likelihood of a longbone fracture (think arms & legs) using a tuning fork or (more acurately) a stethescope?! Those findings make it more clear when to order an X-Ray.
And why Sherlock Holmes? Well, I once had a mentor many years ago who used to say that the patient walks into the room with all the answers, and it’s the practitioner’s job to ask the right questions. It doesn’t get any more Sherlocky than that!