“What’s the difference between a military physiotherapist and a civilian physiotherapist?” As a former military physiotherapist, I used to get this question often.
This is the second post in a three part series that illustrates what I found to be unique about being a Physiotherapy Officer (PTO). This one’s about the PTO mentality.
The mental difference
While many civilian physiotherapists likely share them, I’ve found these characteristics to be essential for being a successful PTO:
Being a successful PTO is more than just being a good soldier and a good clinician (although you have to be both simultaneously). It’s about recognizing quickly your patient’s ability, what that means for his or her military job, and how quickly, and safely, you can return him or her back to full duty.
For example, I had a patient who was completing his jumping course (yes, jumping with parachutes from planes). He had a rough landing (a few cartwheels as he recalled) and ended up with some pretty important sacroiliac pain. Being cleared of any red flags or fractures and with some handy McKenzie-based exercises and manual therapy, the patient was feeling pretty great. But great enough to return to his para course and finish his last two jumps? (If he did not complete all of his jumps, he would not receive his qualification and would have to repeat the entire course the following year).
As his physiotherapist, I had a strong influence over whether he was fit to return to his course. What was the likelihood that he would reinjure or aggravate his condition? What might be the consequences on his body? What are the consequences on his career? Your medical decision can unfortunately carry a great deal of weight for a soldier’s future. Navigating through a medical grey area in a military context can be a challenge.
Leadership: One of the aspects of training I enjoyed the most was leadership development. Physiotherapy is an officer’s occupation, which means you are expected to always be a leader. You may be called upon one day to take charge of a clinic, a department in the hospital, or even a field unit.
Mentorship: You are a constant mentor for medical technicians (similar to paramedics), physician assistants, and even doctors who want to know if naproxen is the best medication to prescribe for an ankle sprain (hopefully we all recognize the answer as being no!). You are not only a leader within the medical chain but you are a subject matter expert (SME) on all things musculoskeletal.
Flexibility: Not only are you expected to live all over the country, participate in field exercises, fly around the world for military taskings and support humanitarian operations, but you can also be deployed on missions. The military physiotherapy trade was developed to meet the need for efficient rehabilitation services for deployed military personnel. The military health care system is much more efficient and cost effective when a physiotherapist can be part of the preventative and rehabilitation team.
Having a physiotherapist on hand to give advice, perform a technique, or prescribe exercises not only provides front line care to the patient, but also encourages a rapid return to duty for the soldier on a mission. After all, the roll of a PTO is to support military efforts. PTOs are responsible for the maintenance and support of the military’s most valued asset: the soldier. PTOs aim to “keep soldiers fit for duty.”
Creativity: From a physiotherapist point of view, you need to be comfortable with doing as much as possible with as little as possible. When out on an exercise or when deployed, you might only have your trainer bag and your hands. You don’t have access to fancy modalities, electrical equipment, or even an adjustable table. It was not uncommon, from my own experience, to perform a lumbar Mulligan with Movement technique (MWM) with a patient’s sweater or to prescribe specific resistive training with a sandbag. Your tools are all around you and your treatments are limited only by your own creativity.
Efficiency: You may only get one meeting with a patient during sick parade (a concept I will explain in the next post) before he leaves on a six-week tasking in northern Canada. Your advice and exercise prescription may be the only means toward stabilizing and (hopefully) improving his condition.
The upside? Your patient is generally extremely driven to heal. PTOs are blessed to be able to work with a population that greatly adheres to their advice and treatment plan, almost to a fault. PTOs by nature are excellent motivators, but they also have to recognize when to apply the brakes and convince the patient that relative rest is the best temporary approach (not always an easy task!).
Lest we forget / On se souvient.
I welcome your questions or comments about my post. If you want to know more about the unique challenges of this environment, please feel free to comment below with your thoughts.
Learn more about military physiotherapists in Canada here.
Have you read part one and three?