Generalising in a Specialised World

In order to be a specialist you must be a generalist. The likes of Tiger Woods may be the exception rather than the rule. In current context even when we look at the recent documentary ’The Last Dance’, Michael Jordan, arguably the greatest basketball player of all time excelled in baseball.

Its no different to other professions. To become a specialist yes, we must have depth of knowledge which comes with experience and being well read in your body area. But, you must also have breadth of knowledge. Hear me out.

Every injury is a puzzle, and if you can’t understand and find the other integral pieces then I don’t believe you can put the WHOLE picture together. The best ‘experts' in the physiotherapy world have breadth of knowledge in many areas. They understand the influence of other regions of the body, but also have a good understanding of the principles of human movement such as biomechanics, physiology, pain science and human psychology. 

If we think solely on the understanding of other body regions other than your ‘expert’ field we can see how knowing more may be advantageous. Lets look at the impact of the foot and ankle complex on the hip and groin. The work from Cara Lewis has shown that appropriate calf function reduces anterior hip joint loads. Work performed by Marshall in 2014 showed the primary physical determinant in change of direction performance is plantar flexion power. These are just two examples of how appropriate calf function can affect performance and injury. But do you know how foot function can impact on calf function? The foot can have a drastic impact on how the calf functions and we’ve seen this from Farris et al in 2015.

Yes its like a rabbit hole as you can continue to delve deeper but its not about getting lost in the noise but understanding what else may be impacting on the patient you have in front of you. This helps you to bring all the pieces of the puzzle together and then you can decide on what’s the main pieces and what are the supplementary pieces. If you’re the 2nd or 3rd physiotherapist they have seen yes you need to get the basics right and ensure appropriate local function, but we also need to broaden the horizon and assess whether other parts may be influencing the presentation.

Here I encourage you all to have your interests and make them your ‘expert area’ but to not get too closed minded and only focus on that area. Like I said at the beginning the best specialists are generalists.