Sports Med Physician Vs Physiotherapist

[Guest Physioprospect]

I was wondering what the difference in skill set would be between a sports med physician and an Orthopaedic Manual Physiotherapist in terms of diagnosis of MSK issue etc. Any insight into the field would be much appreciated.

[futureGP]

I was wondering what the difference in skill set would be between a sports med physician and an Orthopaedic Manual Physiotherapist in terms of diagnosis of MSK issue etc. Any insight into the field would be much appreciated.

 

idk much about physiotherapists,

 

a sportsmed doc would be responsible for diagnosing/treating injuries related to athletics or just normal MSK injury

 

so everything that can occur in the bones/muscles/joints of the body except for rheumatologic stuff will be diagnosed/treated by a sportsmed doc

 

shoulder dislocation, shoulder separation, instability problems with shoulder, arm/upper extremity fractures from the clavicle all the way to the hands

 

issues with the back, lower extremities, diagnosing fractures, strains, sprains, etc etc

 

they then work with orthopedic surgeons or refer to them if surgery is required, if not they could do primary treatment for a fracture by splinting, stabilizing etc, or supports for sprains etc

 

they then would refer to physiotherapists who would then proceed with exercise/muscle balance/specific movement modalities that would help with rehabilitation aspects of getting back to walking etc

 

 

in our system, the gate-keeper is a primary care physician and someone could directly go see a sports med doc if they have an issue and he would refer them to the appropriate services

 

we rarely have patients going to physiotherapists since insurance may require a referral from a physician in order to cover fees for physiotherapists

[Guest Physioprospect]

Hmm other than referring for surgery, and medications, all of that stuff falls under the scope of a physiotherapist as well.

[thebouque]

Hmm other than referring for surgery, and medications, all of that stuff falls under the scope of a physiotherapist as well.

 

Physiotherapy = therapy. You do exercises with the pt and you prescribe exercises.

 

Sports medicine = medicine. You diagnose msk injuries through physical examination, x ray or other imaging modalities and sometimes blood works. You then treat by prescribing ortheses, medications, injections, referrals to specialists (ortho) or allied health professionals (physio, nutrition etc).

 

Both fields are complementary but are very different. In one of them you practise medicine, in the other you apply a form of therapy. You don't refer to physio for a diagnosis. Usuly, the dx is made before the pt sees the physio. The physio can challenge the dx, but ultimately its the md's responsability to make the difference between a bad bursitis and a fracture of the humerus that can be caused by many medical causes (including metastases).

[coastalslacker]

As an orthopaedic surgeon, I don't see much difference between the two, except that a sports med doc will get paid a lot more and it takes longer to become a physician. As a physician you will also have a broader knowledge of less common, non-sports related, conditions which in rare cases will be the cause of the athlete's problems.

 

Honestly, physiotherapists probably have more knowledge about the MSK system when they come out of their training than a family doctor has after their two years of residency. For MSK issues, I would trust the average physiotherapist's diagnosis over that of the average family doctor. Many family doctors specifically interested in sports do an extra year of training in which they become extremely proficient. That said their total training time is 11 years (4 years undergrad, 4 years med school, 2 years family med, 1 year sports) versus 6 years for a physiotherapist (4 years undergrad, 2 years masters). That's a 5 year difference, in which time a physiotherapist with an interest in sports would accrue tonnes of experience and expertise.

[Guest Physioprospect]

Physiotherapy = therapy. You do exercises with the pt and you prescribe exercises.

 

Sports medicine = medicine. You diagnose msk injuries through physical examination, x ray or other imaging modalities and sometimes blood works. You then treat by prescribing ortheses, medications, injections, referrals to specialists (ortho) or allied health professionals (physio, nutrition etc).

 

Both fields are complementary but are very different. In one of them you practise medicine, in the other you apply a form of therapy. You don't refer to physio for a diagnosis. Usuly, the dx is made before the pt sees the physio. The physio can challenge the dx, but ultimately its the md's responsability to make the difference between a bad bursitis and a fracture of the humerus that can be caused by many medical causes (including metastases).

 

Wow you really know nothing about the field, why bother commenting. PT does way more than doing exercises.. a personal trainer can do that.

[goleafsgochris]

PT primarily will help train ppl to do movements and exercises to recover from injury and illness. They will treat ppl over the long term, i.e. going over exercises for several hours a week, which docs just dont have time to do. They have excellent functional MSK anatomy knowledge.

 

Sports med docs do injections, imaging, perscribe meds, and diagnose.

 

Both are MSK specialists. If you want next level specialization, consider residency training in Physiatry--these are the true MSK non-surgical "experts".

 

Source: R2 in neurology, have done a lot of work with physiatrists and orthopods.

[ralk]

I was wondering what the difference in skill set would be between a sports med physician and an Orthopaedic Manual Physiotherapist in terms of diagnosis of MSK issue etc. Any insight into the field would be much appreciated.

 

Physiotherapists cannot give diagnoses, sports medicine physicians can.

 

That said, physiotherapists must tailor their treatment based on their opinion of the problem a patient is facing, and in that sense often have very strong abilities to determine the nature of that problem. In the course of treatment, communication of their opinion is usually necessary, to explain what is happening and why. Therefor, they communicate information that is very much like a diagnosis (and to the patient, may be more valuable than a diagnosis), but cannot be considered a diagnosis.

 

It's the difference between saying "You have an ACL tear" and "You have some pain in your knee which seems like an ACL tear, so we'll do this treatment". Only a physician can say the first, legally.

[Guest Physioprospect]

Physiotherapists cannot give diagnoses, sports medicine physicians can.

 

That said, physiotherapists must tailor their treatment based on their opinion of the problem a patient is facing, and in that sense often have very strong abilities to determine the nature of that problem. In the course of treatment, communication of their opinion is usually necessary, to explain what is happening and why. Therefor, they communicate information that is very much like a diagnosis (and to the patient, may be more valuable than a diagnosis), but cannot be considered a diagnosis.

 

It's the difference between saying "You have an ACL tear" and "You have some pain in your knee which seems like an ACL tear, so we'll do this treatment". Only a physician can say the first, legally.

 

I cant stand when people talk about things and dont know what there talking about. The scope of practice of physiotherapists is "The practice of physiotherapy is the assessment and diagnosis of neuromuscular, musculoskeletal and cardiorespiratory systems to diagnose, treat and prevent disorders or diseases that cause or are associated with physical dysfunction, injury and/or pain; develop, maintain, rehabilitate or augment function; relieve pain; or promote mobility and health Physiotherapists have also been legislated to order diagnostic imaging. Please dont spread information that you are not educated on.

[thebouque]

I cant stand when people talk about things and dont know what there talking about. The scope of practice of physiotherapists is "The practice of physiotherapy is the assessment and diagnosis of neuromuscular, musculoskeletal and cardiorespiratory systems to diagnose, treat and prevent disorders or diseases that cause or are associated with physical dysfunction, injury and/or pain; develop, maintain, rehabilitate or augment function; relieve pain; or promote mobility and health Physiotherapists have also been legislated to order diagnostic imaging. Please dont spread information that you are not educated on.

 

Are you in a PT program? If not then you're in for a big reality check.

[goleafsgochris]

Are you in a PT program? If not then you're in for a big reality check.

 

I was just gonna say the same thing lol. If youre aiming for PT and think this is what youre getting into, seriously consider shadowing a physio 1st. I have worked with them A LOT. Docs perscribe PT, PT does exercises. Atleast in a practical sense, they dont diagnose, or even treat except what docs have perscribed

[Guest Physioprospect]

I was just gonna say the same thing lol. If youre aiming for PT and think this is what youre getting into, seriously consider shadowing a physio 1st. I have worked with them A LOT. Docs perscribe PT, PT does exercises. Atleast in a practical sense, they dont diagnose, or even treat except what docs have perscribed

 

I am in a PT program and worked in an orthopaedic clinic for two years. 30% of patients coming to the clinic did not have a referrel for treatment and those that did have a referrel from a GP rarley had an accurate diagnosis. In an efficient clinic PT don't even do the exercise, that whats PTA's are for. PTs spend their time restoring arthrokinematics, manipulating joints and diagnosing issue that havent been diagnosed by sports med or orthopods etc. I feel like there is a large disconect between what people in the medical field think PT's do and what is actually done. This isnt the 1930's where PT just helped people strengthen muscles after Polio. My mom is a GP and says the MSK training that a PT recieves is way way more than she ever recieved and would always rely on their diagnosis over her basic MSK knowledge. GPs dont spend 2 years straight dedicated to learning about the MSK system, there scope is broad and general.

[tb123]

I think it depends on where you work and your continuing education. My parents are both in rehab, one is a private practice physio one works in hospital rehab. While the one in a hospital generally does what goleafs states, performs prescribed exercises with limited opportunity to make diagnoses. This is because most patients are still in acute recovery and unable to complete more complicated exercises.

In other practice settings physios do far more. They diagnose walk in patients, create long- term rehab plans and can order limited diagnostics. Many athletes including myself go straight to our physio before seeing a doctor, as they DO have more knowledge in the area. I know several orthopedic surgeons who defer to physios for anything obviously non- surgical, even for their own children. Additionally the rehab orders most surgeons give do not extend past the first few weeks, leaving the rest to the physio who can assess the situation fully.

[ralk]

I am in a PT program and worked in an orthopaedic clinic for two years. 30% of patients coming to the clinic did not have a referrel for treatment and those that did have a referrel from a GP rarley had an accurate diagnosis. In an efficient clinic PT don't even do the exercise, that whats PTA's are for. PTs spend their time restoring arthrokinematics, manipulating joints and diagnosing issue that havent been diagnosed by sports med or orthopods etc. I feel like there is a large disconect between what people in the medical field think PT's do and what is actually done. This isnt the 1930's where PT just helped people strengthen muscles after Polio. My mom is a GP and says the MSK training that a PT recieves is way way more than she ever recieved and would always rely on their diagnosis over her basic MSK knowledge. GPs dont spend 2 years straight dedicated to learning about the MSK system, there scope is broad and general.

 

PTs receive a ton of training and have MSK knowledge undoubtedly beyond that of an average physician who does not work directly in the field, but they are not allowed to give diagnoses in many jurisdictions. That is not a statement on the typical physiotherapist's knowledge or abilities, but on the legal framework of the medical system in Canada.

 

Now, this is changing. I will stand corrected in that I was too absolute in my first statement; in Ontario, they have been given the right to communicate a diagnosis, but this is a relatively new development (not even two years old). Not all jurisdictions have this in place. They still cannot order tests, though this is coming. Further, the scope in which they are allowed to diagnose conditions is limited.

[coastalslacker]

and those that did have a referrel from a GP rarley had an accurate diagnosis.

 

This is true from my experience as well.

 

Who gives a crap who gets to "give the diagnosis"? What matters is who gets it right. We'd probably save a lot of money by sending all MSK problems to a physiotherapist before a primary care physician can order an MRI....

[BoyInTheBubble]

Are you in a PT program? If not then you're in for a big reality check.

 

Don't forget about physiatry (aka physical medicine and rehabilition)

[futureGP]

kkk werent we comparing sports med docs with physio,

 

Not family docs with physio?

 

Well no **** physio would have more msk knowledge than a normal fam doc,

 

2 years of intense msk training vs maybe ~3 mths in medschool and possibly some electives in physiatry.

 

physiotherapists in theory can diagnose, if u cant diagnose a ac separation after studying msk for 2 years then theres a problem

 

We gotta get into the real issue here

 

Stop comparing gp to physio and start comparing sports med docs to physio.

 

the reason why i mentioned gp is becuz sports med docs who are not orthopods or physiatrists are typically gps who did +1 certification in sports med

 

And legally speaking, the current model is such that a family doctor is the gatekeeper for public health care incl msk injuries, such that a sports med doc who is also a gp acts as a gatekeeper to msk medicine

 

All u idiots talking about private health care and how u as an athlete can see ur physio first, well no ****, u pay out of ur pocket u can see anyone u want without an md's referral

 

Get in context guys, physios def can diagnose but in our current health care model, typically physios are unique in the sense that they do therapy.

And im sure within physio there are people who just do private clinics and so get private patients with insurance, and others who work in the public system which typcally means working after a condition is diagnosed (rehab, therapy for in-patients, or referred patients)

 

seriously this family doctor bashing needs to end, nobody said a 2 year rez fp has better msk training than physio,

 

But to OP, if u want therapy, do physio

If u want more disgnoses, other medicine-related stuff do sports med doc

 

That is the reality

 

I respect physio for their knowledge on msk and therapies but seriously u need to stop glorifying urself by comparing physios with gps with no extra training, esp u physioprospect

[Guest Physioprospect]

kkk werent we comparing sports med docs with physio,

 

Not family docs with physio?

 

Well no **** physio would have more msk knowledge than a normal fam doc,

 

2 years of intense msk training vs maybe ~3 mths in medschool and possibly some electives in physiatry.

 

physiotherapists in theory can diagnose, if u cant diagnose a ac separation after studying msk for 2 years then theres a problem

 

We gotta get into the real issue here

 

Stop comparing gp to physio and start comparing sports med docs to physio.

 

the reason why i mentioned gp is becuz sports med docs who are not orthopods or physiatrists are typically gps who did +1 certification in sports med

 

And legally speaking, the current model is such that a family doctor is the gatekeeper for public health care incl msk injuries, such that a sports med doc who is also a gp acts as a gatekeeper to msk medicine

 

All u idiots talking about private health care and how u as an athlete can see ur physio first, well no ****, u pay out of ur pocket u can see anyone u want without an md's referral

 

Get in context guys, physios def can diagnose but in our current health care model, typically physios are unique in the sense that they do therapy.

And im sure within physio there are people who just do private clinics and so get private patients with insurance, and others who work in the public system which typcally means working after a condition is diagnosed (rehab, therapy for in-patients, or referred patients)

 

seriously this family doctor bashing needs to end, nobody said a 2 year rez fp has better msk training than physio,

 

But to OP, if u want therapy, do physio

If u want more disgnoses, other medicine-related stuff do sports med doc

 

That is the reality

 

I respect physio for their knowledge on msk and therapies but seriously u need to stop glorifying urself by comparing physios with gps with no extra training, esp u physioprospect

 

Wtf are you talking about glorifying? People who obv have no idea about the field were saying all physio does is do exercise and I said there is way more to the scope?

[thebouque]

Wtf are you talking about glorifying? People who obv have no idea about the field were saying all physio does is do exercise and I said there is way more to the scope?

 

If you're happy as a physio who diagnoses through careful physical examination, uses X rays to make your dx more accurate and to rule out serious stuff, who follows up on his patients and who can prescribe and perform therapy/exercises, then probably being a sports md won't satisfy you since it will only add prescriptions and injections to your practice.

[Physio_Grad]

As a practicing physio, I'll chime in, as this discussion is getting quite interesting!

 

I’d say the biggest difference between sports med doc and Physiotherapy is indeed diagnosis and rehab/treatment. Sports med docs as well as physiatrists, are mostly responsible for making a diagnosis and then usually refer to physio for therapy or in other more severe cases, decide to refer for surgery. The referrals, I often get are quite basic like: Physio for rotator cuff strain. It is then up to the physiotherapist, to do an assessment and decide whether they agree with the diagnosis and then make a rehab plan. The clients then come a couple of times a week for a number of weeks for treatment that includes exercises, modalities and manual therapy.

 

As of right now, we are able to communicate a diagnosis, but the legislation procedure to get the right to order diagnostic tests is still in progress and will most likely take a couple more years to go through, so right now, if we want a client to get an U/S, we have to refer them back to the referring doctor.

 

The interesting thing, is for a lot of very common injuries, diagnostic imaging is not needed to determine a diagnosis and treatment plan. For example the ontario government is actually trying to reduce the number of X-rays and MRI’s that are ordered for standard low back pain. As the diagnosis of a disc injury vs muscle strain vs stenosis can be made through a clinical exam, so therefore an MRI showing a disc bulge vs DDD wouldn’t add much to the treatment. Imaging is also not the always an accurate way of determing whether someone needs surgery or not. Personally, I think there should be more focus on level of functioning and their quality of life vs what an X-ray/MRI shows and rehab should be at least attempted before more invasive procedures are considered.

 

In terms of education, I cannot say, that I’m better at determining a diagnosis then a sports med doc as they see 3-5pt/hour and do have access to imaging and diagnostics. I will say we’re better at looking for muscle imbalances and contributing factors that can cause the injury, as well as putting together a rehab plan to get the person back to doing what they enjoy (work/sports).

 

There is a lot of good collaboration btwn practitioners now, and often times, sports med docs have PT’s that work with them in the same clinic to treat patients and can then discuss and problem solve for more difficult to treat conditions. More docs are also hopefully realizing that pain meds and cortisone injections don’t solve the underlying issue, and only mask the problem for a short time period and are looking more into research regarding laser, shockwave, as well as manual therapy as having better outcomes for patients in the long-term.

[ralk]

As a practicing physio, I'll chime in, as this discussion is getting quite interesting!

 

I’d say the biggest difference between sports med doc and Physiotherapy is indeed diagnosis and rehab/treatment. Sports med docs as well as physiatrists, are mostly responsible for making a diagnosis and then usually refer to physio for therapy or in other more severe cases, decide to refer for surgery. The referrals, I often get are quite basic like: Physio for rotator cuff strain. It is then up to the physiotherapist, to do an assessment and decide whether they agree with the diagnosis and then make a rehab plan. The clients then come a couple of times a week for a number of weeks for treatment that includes exercises, modalities and manual therapy.

 

As of right now, we are able to communicate a diagnosis, but the legislation procedure to get the right to order diagnostic tests is still in progress and will most likely take a couple more years to go through, so right now, if we want a client to get an U/S, we have to refer them back to the referring doctor.

 

The interesting thing, is for a lot of very common injuries, diagnostic imaging is not needed to determine a diagnosis and treatment plan. For example the ontario government is actually trying to reduce the number of X-rays and MRI’s that are ordered for standard low back pain. As the diagnosis of a disc injury vs muscle strain vs stenosis can be made through a clinical exam, so therefore an MRI showing a disc bulge vs DDD wouldn’t add much to the treatment. Imaging is also not the always an accurate way of determing whether someone needs surgery or not. Personally, I think there should be more focus on level of functioning and their quality of life vs what an X-ray/MRI shows and rehab should be at least attempted before more invasive procedures are considered.

 

In terms of education, I cannot say, that I’m better at determining a diagnosis then a sports med doc as they see 3-5pt/hour and do have access to imaging and diagnostics. I will say we’re better at looking for muscle imbalances and contributing factors that can cause the injury, as well as putting together a rehab plan to get the person back to doing what they enjoy (work/sports).

 

There is a lot of good collaboration btwn practitioners now, and often times, sports med docs have PT’s that work with them in the same clinic to treat patients and can then discuss and problem solve for more difficult to treat conditions. More docs are also hopefully realizing that pain meds and cortisone injections don’t solve the underlying issue, and only mask the problem for a short time period and are looking more into research regarding laser, shockwave, as well as manual therapy as having better outcomes for patients in the long-term.

 

Very well said!

[Guest Physioprospect]

As a practicing physio, I'll chime in, as this discussion is getting quite interesting!

 

I’d say the biggest difference between sports med doc and Physiotherapy is indeed diagnosis and rehab/treatment. Sports med docs as well as physiatrists, are mostly responsible for making a diagnosis and then usually refer to physio for therapy or in other more severe cases, decide to refer for surgery. The referrals, I often get are quite basic like: Physio for rotator cuff strain. It is then up to the physiotherapist, to do an assessment and decide whether they agree with the diagnosis and then make a rehab plan. The clients then come a couple of times a week for a number of weeks for treatment that includes exercises, modalities and manual therapy.

 

As of right now, we are able to communicate a diagnosis, but the legislation procedure to get the right to order diagnostic tests is still in progress and will most likely take a couple more years to go through, so right now, if we want a client to get an U/S, we have to refer them back to the referring doctor.

 

The interesting thing, is for a lot of very common injuries, diagnostic imaging is not needed to determine a diagnosis and treatment plan. For example the ontario government is actually trying to reduce the number of X-rays and MRI’s that are ordered for standard low back pain. As the diagnosis of a disc injury vs muscle strain vs stenosis can be made through a clinical exam, so therefore an MRI showing a disc bulge vs DDD wouldn’t add much to the treatment. Imaging is also not the always an accurate way of determing whether someone needs surgery or not. Personally, I think there should be more focus on level of functioning and their quality of life vs what an X-ray/MRI shows and rehab should be at least attempted before more invasive procedures are considered.

 

In terms of education, I cannot say, that I’m better at determining a diagnosis then a sports med doc as they see 3-5pt/hour and do have access to imaging and diagnostics. I will say we’re better at looking for muscle imbalances and contributing factors that can cause the injury, as well as putting together a rehab plan to get the person back to doing what they enjoy (work/sports).

 

There is a lot of good collaboration btwn practitioners now, and often times, sports med docs have PT’s that work with them in the same clinic to treat patients and can then discuss and problem solve for more difficult to treat conditions. More docs are also hopefully realizing that pain meds and cortisone injections don’t solve the underlying issue, and only mask the problem for a short time period and are looking more into research regarding laser, shockwave, as well as manual therapy as having better outcomes for patients in the long-term.

 

Do you have your FCAMPT certification? From the therapists I have talked to when it comes to MSK assessment and treatment having this skill set makes a world of difference. Also what kind of setting do you work at? The therapists I worked with saw 4 patients/hr and had access to diagnostic imaging as well.

[Physio_Grad]

I’m currently working towards my FCAMPT certification but it will take another 2-3 years to complete all the required courses as well as challenge the exam! There is a bit of a divide in the physio community whether manual therapy is truly the holy grail that some people make it out to be. There are a lot of other therapy avenues to explore including, mulligan, McKenzie, acupuncture, IMS, as well as newer modalities, and the best therapists are the ones that use a combination of different approaches and tailor it to the individual client.

 

Manual therapy and FCAMPT knowledge does increase our MSK skillset and allows for more efficient treatment. With more courses we learn to manipulate joints after traditional mobilization has stopped working. The biggest difference between FCAMPT therapists and chiro’s is that physio’s are a lot more conservative and selective in screening and choosing whether to manipulate or not, and usually combine it with exercise to get the maximum results.

 

I work in an outpatient orthopaedic physio clinic and usually see 2-3pt/hour. As it’s a general clinic, I see everything from sports injuries and post-surgical rehab to chronic back and neck problems. It get’s harder to provide the quality of care you’d like to give if you see more than 3pt/hour, especially for more complex injuries but some therapists make it work.

[Guest Physioprospect]

I’m currently working towards my FCAMPT certification but it will take another 2-3 years to complete all the required courses as well as challenge the exam! There is a bit of a divide in the physio community whether manual therapy is truly the holy grail that some people make it out to be. There are a lot of other therapy avenues to explore including, mulligan, McKenzie, acupuncture, IMS, as well as newer modalities, and the best therapists are the ones that use a combination of different approaches and tailor it to the individual client.

 

Manual therapy and FCAMPT knowledge does increase our MSK skillset and allows for more efficient treatment. With more courses we learn to manipulate joints after traditional mobilization has stopped working. The biggest difference between FCAMPT therapists and chiro’s is that physio’s are a lot more conservative and selective in screening and choosing whether to manipulate or not, and usually combine it with exercise to get the maximum results.

 

I work in an outpatient orthopaedic physio clinic and usually see 2-3pt/hour. As it’s a general clinic, I see everything from sports injuries and post-surgical rehab to chronic back and neck problems. It get’s harder to provide the quality of care you’d like to give if you see more than 3pt/hour, especially for more complex injuries but some therapists make it work.

 

Thanks for your great input, could you please check your private messages.

[Justin Vanderleest]

On 5/5/2013 at 11:53 AM, Physio_Grad said:

I’m currently working towards my FCAMPT certification but it will take another 2-3 years to complete all the required courses as well as challenge the exam! There is a bit of a divide in the physio community whether manual therapy is truly the holy grail that some people make it out to be. There are a lot of other therapy avenues to explore including, mulligan, McKenzie, acupuncture, IMS, as well as newer modalities, and the best therapists are the ones that use a combination of different approaches and tailor it to the individual client.

 

Manual therapy and FCAMPT knowledge does increase our MSK skillset and allows for more efficient treatment. With more courses we learn to manipulate joints after traditional mobilization has stopped working. The biggest difference between FCAMPT therapists and chiro’s is that physio’s are a lot more conservative and selective in screening and choosing whether to manipulate or not, and usually combine it with exercise to get the maximum results.

 

I work in an outpatient orthopaedic physio clinic and usually see 2-3pt/hour. As it’s a general clinic, I see everything from sports injuries and post-surgical rehab to chronic back and neck problems. It get’s harder to provide the quality of care you’d like to give if you see more than 3pt/hour, especially for more complex injuries but some therapists make it work.

Only 4% of physiotherapists in Canada achieve FCAMPT status. It makes a huge difference to their level of practice. It isn’t just about acquiring the ability to manipulate joints; their mobilization skills improve dramatically and their clinical reasoning is markedly better than average. This is our highest credential in orthopaedics and manual therapy, other than perhaps the orthopaedic and manual therapy specialists, which are exceptionally rare and may also be FCAMPTs. If you aren’t working through the CPA orthopaedic division syllabus or one of the MClScPT programs like those at Western or Mac, engaging in peer review of your skills by other high achieving therapists, doing ongoing mentorship, and advanced skill acquisition, then it could be argued that you aren’t taking your orthopaedic physiotherapy career particularly seriously.