The Trouble with NDIS, Medical Insurance and Registered Practitioners
I've been holding this post back for a while because the unholy alliance between government, private medical insurance, and health practitioners such as physios, exercise physiologists, osteopaths, chiropractors, and other healthcare providers has bugged me for quite some time. I haven't quite found the words to explain myself that don't sound bitter.
Firstly, I'd better explain why I might be personally irritated by this, the main reason being that it has a drastically negative effect on my business. Why? Well, as a posture and movement specialist, I am a generalist that works in the realm of prevention and treating the body as a system, not the relieving of specific conditions (although this can certainly happen). Because I am not in the habit of treating a condition or injury specifically, I do not need letters after my name, but I also can receive no specific credit for it either. This makes it very difficult for anyone to claim any money back from the government through the NDIS scheme or through medical insurance companies. I can't possibly compete with essentially free services from government-backed and insurance company-backed practitioners.
This is sort of understandable and is just the way the world works. We have had a health system obsessed with treating the symptom once it occurs for an awful long time and this is probably the result of human nature as much as anything else. People don't tend to concern themselves with potential ill-health or injury, but when they actually get ill or injured, they obviously cannot ignore it.
I wouldn't be so annoyed about this situation if I didn't see it being taken advantage of and abused from all sides. I'm sure the NDIS scheme in Australia is valuable for many people, there must be many that use it with due respect, and I'm sure health insurance provides a good service for many also, but in terms of the care and expertise provided by the practitioners I have seen in my field, it is beyond terrible.
Let me give an example. I have frequented gyms since I was about 16 years old. They were almost always dominated by personal trainers. Personal trainers have almost no nuanced knowledge or expertise about what they are doing (in general, there are always exceptions). But the good ones do often have real-world knowledge about the basics, i.e., losing weight and building muscle.
You can go to an exercise physiologist for advice on how to cut weight and build lean muscle mass if you like, but there is a cheaper and easier way. Just go to the gym and ask that muscle-bound guy or girl with hardly any fat how they did it. They are likely to give you far better advice in my experience. Why? Because they actually did it. Their whole persona in revolves around it, they live that life and have achieved results.
In my field of expertise, injury prevention and movement efficiency there is a good way to tell who you should see. Pick the person who doesn't get themselves injured, and who moves freely and efficiently. But how would a lay person know what efficient movement looks like?
I think people have a pretty good instinct what a good mover looks like. It is somehow aesthetically pleasing on the eye. We can tell bodybuilders look stiff and awkward, but we can also tell yoga devotees looks a bit flimsy. We can watch a sport we have no expertise in and see whether a player looks smooth or fluid in their movements. I always mention Roger Federer in tennis to people and they know immediately that this guy was a smooth mover around the court. But why does everyone say that if they have no idea what good movement looks like? Because they actually do.
If your injury prevention specialist doesn't know how to move, doesn't know how to teach people to move, doesn't know how to teach themselves, and then on top of it all continues to be injured or simply does limited physical activity so to avoid injury, why would you think they can help you at all in the long-term? This is the reality of 99% of physios, exercise physios, gym trainers, high-level sports coaches, and basically everyone in this industry. They know next to nothing in this area.
The useful expertise of physios in particular lies only in the immediate aftermath of an injury as they have the detailed knowledge about the kind of damage done and the anatomy of that area so as to not cause more damage. If you have any chronic problem, I honestly think the average physio has very little knowledge that is useful that they can apply to you.
There are always physios and other health professionals who buck trends and continue to develop their skills properly, the trick is finding them.
A Spy in the Gym
The use of exercise physiologists in gyms in Australia these days is so prevalent, I get to see them in action almost every time I go to the gym. I have been watching one girl in particular train some very vulnerable clients for the last couple of months.
She does pretty much the same routine with all her clients. She starts by sitting them on a stationary bike for 10 minutes while she sits on the one next to them scrolling on her phone. She then proceeds with the same old weights exercises, usually not even looking at what her clients are doing, hands in pockets or scrolling on her phone some more. It is really that bad. I want to say something to her, but hold myself back.
Obviously not all exercise physiologists are as bad as this, especially in terms of attitude. But they do fall short on giving the right advice to their clients, particularly if these clients have movement or postural issues (which is most of them as far as I can tell). Most of the exercise physiologists I have seen look young, inexperienced, and to be honest in way above their heads with the kind of clients they are seeing.
All they seem to be achieving is setting exercises that don't injure the person in the moment. The exercises are basic, mostly safe, and largely pointless. So much more can be done for these people. It is frustrating to watch.
These exercise professionals also look very bored at the same time, the reason is something I think I can relate to.
When I graduated with my degree in Sports Science I - like most graduates in this subject I suspect - wanted to work with high-level athletes. Just like any other profession though, you need to cut your teeth with the less inspiring stuff first. In the realm of health and fitness, this means mainly old, immobile people who really can't do very much. Unfortunately, these are the very people who need the most expertise. Professional athletes are usually driven and naturally physically gifted, almost anyone can get them in shape. Vulnerable people who move poorly and are always injured or in pain on the other hand, that really requires some effort and know-how in order to get them results.
It took me a number of years of being bored training such people before I realised that these people were not boring at all, and I have been a passionate practitioner training people of all backgrounds and abilities ever since. Getting an ordinary person, or even a person who is spectacularly lacking in physical prowess to move like an athlete, now that's a challenge.
A Lack of Accountability
For a while now, I have marveled about how low people's expectations are when it comes to the treatment and advice they receive from health and fitness practitioners. Most people seem to be happy as long as they aren't getting hurt in the moment (and some even get hurt and still come back to the same trainer/physio). But people who suffer chronic pain seem to just accept their fate, going to the same physio or exercise physiologist again and again, even as they deteriorate further.
People don't expect or demand results from their health professionals. This means that these professionals can basically do whatever they like with them, even get them injured, and their customers will still keep coming back. If you have ever gone through someone's history of chronic pain and treatment, this pattern keeps on appearing; "I've seen many physios, chiros, osteos, etc, and they all suggest different things, but nothing works". The reason is they don't need to give their clients things that work, they are paid regardless and their clients keep coming back. As long as you have a few letters after your name and an affiliation with the NDIS or insurance companies, it is like a license to print money without ever actually showing you are making a difference in people's lives.
Not only is there a lack of accountability for the practitioners, but the consumers as well. If someone's physio sessions are covered by some government disability scheme or by private medical insurance, they are essentially free. The lack of results is not costing them money, so why not keep going? The trouble is that it is the not paying that is stopping them seeking-out other sources that they may have to pay for, but could be more effective.
These people live in chronic pain, spend lots of money on treatments and are doomed to keep spending money on their health for the rest of their lives. If they had to pay for the service, they may expect and demand some results from it. In the long run, this may save them lots of money and actually help alleviate their problems. Instead they are stuck in a comfortable cycle of free weekly sessions, a friendly chat with a faux expert, and no progression at all.
It is hard to watch these so-called, "experts", training people. I know they are at least not helping, and in many cases actually making their client's worse, yet still getting paid top dollar for it, and retaining the clients. It's beyond frustrating, but also remember they are earning far more than I am, so maybe it's just sour grapes on my part. I'm working hard every day to get my clients real results, and to promote my way of doing things in a market saturated with wrong answers, fads, false promises, and malpractice.
Anyway, rant over.
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