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The world of perfection.

The idea of an ideal.

Since the time of inception.

Has never been real.

If we were to refer to the dictionary to define ‘utopia’ – it would say perfect and imaginary! Well, we all know that all ideal things are imaginary – yet we never stop aiming for perfection! Paradoxical right?

All of us physios are wearing thinking caps that say – movement scientist – which is legit. However, when we call ourselves movement scientists, it somehow builds a need in our minds to define and correlate every dysfunction resulting from movement abnormalities.

It is like we are gardeners who wish to have an impeccable garden. All bushes pruned, no fallen leaves. Forgetting that nature is another name for diversity. If all leaves look green, the beauty and diversity that shaded yellow ones add are lost. The garden would no doubt look too perfect – but it would also be imaginary!
Such is the case with the human body.

The ideal postures, the ideal gait, the ideal length-tension relationships – don’t exist. There is variation. There is always variation.
And these minor variations provided by nature need not be corrected to fit the ideals that we have defined.

But does that really happen in our practice? Are we able to look at a patient and not define anything that isn’t ideal as abnormal?

The answer is no.
Most of us would immediately suspend a plumb line and start noting down minor details away from the ideal. A natural, slight bowing of legs would fall in the clinical reasoning section of OA knees at times leading to ignoring other factors that might have contributed to the degeneration process. Endomorphs are automatically classified as pre-obese while they just have a natural genetic predisposition to a bigger size and might actually be healthy.
This continues even when designing a treatment protocol and expecting results.

Classic examples would be – bending is terrible for your back, knees not beyond your toes while squatting, cross-legged sitting, and low stool sitting to be avoided for your knees.

The list is endless.

We aren’t trying to say that these reasons and factors are totally irrelevant. We are trying to highlight that these aren’t the only factors contributing to a particular condition. And fixing them is not the only solution to treat that condition.

The idea of a perfect and utopian body and the pursuit of achieving it is a mirage. The oasis lies in having a broader vision and being able to see the bigger picture.

In my formative years as a physiotherapist, I was treating a stroke patient using the Bobath approach. One of my professors told me that teaching your patient a wrong pattern of movement and then expecting him to unlearn it and relearn the right pattern is a tedious detour. Hence she told me to pick only the relevant principles of Bobath and not promote the development of the abnormal synergy pattern and instead work on functional training.

This concept really stuck with me, and I applied it everywhere, always trying to gather all the information I could and pick the right concepts to skip the unlearn-relearn process whenever possible.
Most of our freshers are taught to view the body as symmetric, ideal, and close to a Greek God-like model. The utopia is instilled in them, and if/when they realize that it may not necessarily be the final goal, they have spent precious time with the idea of the ideal.

They have to rely on their own brilliance, zeal, and curiosity to break the contemporary tradition or be lucky enough to have crossed paths with an updated guide. And even then – the process of unlearning and relearning is tedious and challenging. Although unlearning and relearning are always better than no learning, when we already have the means to learn the right thing why the detour?

If our education system devoted itself to be updated frequently and discard the idea of achieving the impossible, by the time our newbies kick off their careers, they would be on an exponentially speeding journey of growth and patient satisfaction, in turn shifting the mindset of the physiotherapy community as a whole.

The education system doesn’t update itself lies in the rigid mentality of Gen X, who is in charge of formulating the structure of the syllabus. Many position holders wouldn’t move an inch despite the literature screaming otherwise. They would neither update themselves nor the syllabus. So their clinical practice, as well as their teaching careers, continue to be traditionally utopian.

However, blaming Gen X is the easiest way out.

When we know they aren’t changing, should we make peace with the situation? It is like blaming the government for not doing anything while we, as responsible citizens, don’t even feel like taking up the responsibility of running the country. The governments change their MO; it only takes a drop of revolution in each individual to stir the ocean of reform.
If Gen Z takes the reigns of applying the holistic approach and brings out better results while shifting from the generalized utopia, naturally, the entire community would see a paradigm shift.

Many physios will be found rolling their eyes if their colleagues ask their patients to eat well, sleep well and have some mindful ‘me time!
These suggestions are frowned upon because we don’t want to look like motivational speakers and go beyond the physical domain to adapt the bio-psycho-social one! This is where the problem lies.

Our prefrontal cortex is directly connected to our amygdala. All our thoughts have emotions. If we focus on the emotions, we can deal with pain, kinesiophobia, anxiety, stress, hormonal imbalance, concentration, compliance, and what not! This would, in turn, promote the healing and functional rehabilitation of our patients.

But, instead of finding the cause-effect relationship, we just see the outcome. We complain that the patient isn’t compliant but don’t check why.

We think they’re lying about their pain only because we cannot find a physical dysfunction that attributes to the intensity of their symptoms. We keep our movement scientist thinking caps on and our minds closed because we think we aren’t dieticians or counselors to include other factors in our assessment or reasoning.

We have defined our utopia, and we spend our clinical time proving it right.

To rehabilitate is to take our patients back to their lives or at least a life that closely resembles it. It is to make our patients independent. To make them happy and improve their quality of life. It doesn’t have to be perfect. It doesn’t have to be ideal. It only has to be holistic. Whenever we see ourselves shifting away from the essence of rehabilitation and focusing on perfection, we cue to re-evaluate our approach, read and update ourselves and always see the bigger picture!

I believe that slowly but surely, we would shift from the utopian imagery while treating patients because rehabilitating our patients in the best possible ways would always be our first priority!

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