A clinical mentor of mine once made an interesting commentary on the world of sports, or indeed all realms, of physiotherapy. It was an analogy comparing sports physiotherapy and the assessment of athletes to a murder mystery. It was so captivating I decided to expand on it here.
The crime is the athlete’s clinical presentation. An athlete comes to the sports physiotherapist with a problem, for example anterior knee pain, for which you do not initially know the cause. There is a definite pathology that has committed this ‘murder’. However, if you are too solve the murder, or ultimately diagnose and treat the athlete, you must investigate for clues.
There are clues which we, as trained sports physiotherapists, search for. As we interrogate (or subjectively examine) the athlete we identify, eliminate and confirm suspicions about the case with focused questioning techniques. From the interrogation the physiotherapist quickly builds a list of suspects (or competing hypotheses).
During the physical/objective examination each of the suspects are scrutinised. The suspects are cross examined and evaluated. The sports physiotherapist quickly recognises that most of the suspects have convincing and watertight alibis and could not be the killer. However, soon you will build a convincing case of evidence against one suspect.
This is the best bit. The sports physiotherapist gains a conviction when the suspect is proven guilty. This is when you have identified the ‘killer’, implemented interventions aimed at this killer, and had a positive treatment effect. This is proof that you have identified the right suspect.
This is why the world of physiotherapy is so exciting. As primary care practitioners we must assess, diagnose and treat patients. It is a special kind of thrill to develop competing hypotheses, prove one through use of the physical examination and implement an effective treatment program.
Ask Dick Tracy – there is nothing quite like the thrill of getting your man.
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