The Greeks thought they were so intelligent. The Romans thought they were more knowledgeable. The renaissance put them both to shame. And here we are, the most brilliant of all. We practice medicine and rehab so well. We trust the science. We’ve corrected the mistakes of the past.
But what will “they” say about physiotherapy in the year 2100?
They used to think that back pain was a result of cold exposure. In the 1860s they called it rheumatism and lumbago. Those are funny words to us now. In the 1900s, a new paradigm emerged: back pain with a mechanical cause. When we entered the 2000s, some argued that back pain is a purely neurological impairment.
See how we’re on a journey? When we’re on a journey, it’s important to step back and remember that there is a destination coming. We’re just not there yet. This is why some of us cringe at the words “trust the science”. What if we still trusted the science from 1860? What if we still trusted the science from 1960 or even 2005? The world famous physiotherapist Gwen Jull told a room full of PTs in the year 2015 “don’t read anything we published on the deep neck flexors before 2002. We were wrong.” We get it wrong sometimes. (Even the best scientists)
Is there something magical about the 2020s that concludes the final say on things? We know what we know, but so did everyone throughout the ages. Someday, we’ll laugh to think “what if we trusted the science from the 2020s”.
The history of our science is like the history of art.
Let's take a quick and artful journey through the Getty Museum & Villa in Los Angeles, California to visualize our progress as health care providers and clinical scientists. And maybe you can help me solve an anatomical puzzle in some 19th century charcoal drawings.
Here’s a Greek sculpture from more than 4000 years ago. It’s not too bad, considering what they had. No iron tools. Just pumice and volcanic rock to scrape away the stone. It’s the best they could do, and it’s one step on man’s journey through the arts. And considering how hard life was back then, it’s pretty darn impressive that someone took the time to tap into their creative side and even bother with this.
Here’s a Roman sculpture from about 2000 years ago. Look at it from an anatomy perspective, since you’re a physiotherapist. It’s quite a bit different as they had iron tools now and if you look closely, a better appreciation for anatomy and the contours of the human body. The slope of the shoulders is right. The head is in good proportion to the torso. Still, this truly isn’t very lifelike. It’s a rough outline of what a woman would look like, but without much detail.
Now we’re getting somewhere. Here’s a Roman sculpture from just over 2000 years ago that was found buried at the bottom of the Sea, preserved in the cold, waiting for its resurrection. Here the artist has taken note of more specific features of human musculature. This art is starting to express more knowledge about human anatomy.
Let’s move ahead to the 19th Century, and your puzzle to consider. Here’s a series of portraits done by 3 different French artists of the same model. There’s a huge amount of anatomical detail here. Look at all 3 photos and think about what you see.
I see a beard that would make a 2010 hipster jealous. I see a kyphosis that is likely fixed and immobile. And I see an interesting pattern of shoulder muscle development. Why is there severe atrophy of one particular muscle? I have my theory, which you can read at the very bottom*.
Back to the big picture:
What we know about how pain and disability work is evolving. We are at a moment in time. We certainly have not solved pain yet. I think it’s important to remember that we’re on a journey. The rehab care we provide right now is probably more like a rudimentary Roman or Greek statue than we’d like to admit. Clinicians are experimenting with new tools, and making new discoveries, and we’re advancing towards a true understanding of injury and recovery. But where we are on that journey is unknowable. We’ll only be able to look back on it and decide.
Artists and poets always find the truth in life before scientists do. And I would argue that each of us clinicians has the opportunity to be both a scientist, and an artist. In fact, it’s our duty.
Are our regulators offside on this?
The new 2025 Standards of Practice for the College of Physiotherapists in one province makes this new statement: (this did not appear in the previous version:)
When using social media platforms, [the physiotherapist] communicates with clients, potential clients, members of the public, and others honestly, transparently, and professionally [and] conveys scientifically sound, evidence-based information.
Think about this for a minute. Wouldn't we all agree that it would be wrong to communicate to the public about treatments that have been proven by the science to be ineffective? But that's not what this statement suggests. It says that we should only convey information that is evidence based. Does it mean that we should not convey information if there is no evidence for it? Should we really only limit ourselves to the scientifically proven evidence? What if the artists did that, and stuck with pumice and volcanic rock all these years? What kind of sculptures would be have missed out on?
Those of you who are practicing your art in the clinic each day, developing creative solutions for your patients’ conditions… Bravo. No doubt you’ll be finding solutions before the scientists can prove you right.
I hope you’ve enjoyed a perspective on where we are at in our medical knowledge in 2024.
Jeff
*Regarding the charcoal drawings:
Do you notice the atrophy of the supraspinatus muscle? You can see it in multiple pictures, so each artist observed it. I find this curious because the size of the arm, including the triceps and biceps is notable. Is this an older fellow who tore his rotator cuff at some point, and learned to cope by using the strength of his brachium rather than his shoulder girdle itself?
There’s a story here somewhere. These charcoal drawings were made around 1878, and we can assume this man is in his late 50s or 60s. Was he a soldier in the Liberal Wars of the 1830s, when he was in his 20s? Maybe he had a complete supraspinatus tear from a war injury, and when he returned back to the farm, he found a way to provide for his family anyway - using his biceps and triceps without using his shoulder much. That’s a possibility. Who knows for sure.
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