Dr. Jared Powell:
Good day. It's Jared. This episode is about something that I don't think gets talked about enough. Physiotherapists and indeed all musculoskeletal clinicians are knowledge workers. They're not manual therapists, they're not exercise prescribers, they're not diagnosticians, they're knowledge workers. And if that sounds abstract, stay with me because once you see it, you can't unsee it and it may change how you think about your entire career.
Dr. Jared Powell:
If you are indeed a musculoskeletal clinician yourself, let me start with something we all know is implicit, but as rarely said, out loud, two physiotherapists or two musculoskeletal clinicians can spend the same amount of time with the same patient, prescribe the same exercises, use the same hands-on techniques, and get completely different outcomes. I think we've all seen it. Sometimes this may be due to individual factors at the patient level, but it also has something to do with the clinician I submit. So if time doesn't determine the outcome, if exercises don't determine the outcome, if techniques don't determine the outcome, then what does judgment, the quality of your clinical reasoning, how you communicate, what you prioritize, what you ignore, what you adapt when you stop. This is critical thinking and critical thinking and thinking in general is what knowledge workers do for a living. Knowledge work is think for a living.
Dr. Jared Powell:
If you think for a living, you are a knowledge worker. So a knowledge worker is someone whose value comes from expertise, analysis, and judgment, not from mundane or routine manual labor or obediently following instructions. It's not about what you do with your hands, it's that the quality of the outcome is in some way related to the quality of thinking. Not a hundred percent. There are times when thankfully patients get better, irrespective, or in spite of the quality of care they receive. Just like an engineer can design and construct a building that is flawed, but good enough not to fall down. But the quality of thinking of a clinician is not a trivial matter or an afterthought in my view. It is crucial. So by that definition, musculoskeletal clinicians or physiotherapists, whoever you are, whatever you do, are unambiguously knowledge workers, but not in the way that the phrase is usually used or understood.
Dr. Jared Powell:
You see, our capital is knowledge, but we trade in understanding. Understanding that helps another human being. Navigate uncertainty about their body, uncertainty about their future, uncertainty about their pain and their options, and return them to what they value. And this is where things get interesting, at least for me. There's a quote from physicist Richard Fireman, who's one of my intellectual heroes that absolutely nails this. He says, what I cannot create, I do not understand. Understanding isn't being able to repeat something or recite it superficially. It's being able to reconstruct it, to build it from the ground up or from first principles to adapt it, to use it when the context changes. For example, if you really understand rotator cuff pathology and how it may contribute to somebody's shoulder pain experience, you don't just simply recite the research. Same goes for anterior knee pain or ACL pathology or non-specific low back pain or an L four five nerve root pathology, whichever condition it might be.
Dr. Jared Powell:
You can explain it in five different ways or more depending on who's sitting in front of you. You adapt the information and the knowledge that you have to the patient that is facing you. That's deep knowledge. You can spot when the textbook answer doesn't fit in where you need to adapt it or change it or modify it. You can create a solution on the fly when the protocol runs out. And protocols always run out. They are finite. However, the individuals in this world are almost infinite. That's the difference between following instructions and doing proper knowledge work. So here's why I think this is important. Knowledge is your capital. It's not the repertoire of techniques that you have, the equipment that you use or the certifications behind your name or on the wall. It's your knowledge. And unlike techniques, knowledge compounds, each new insight reshapes or strengthens what came before. The more you understand, the faster you can understand, the more efficiently you can understand. Because understanding builds scaffolding for more understanding. Knowledge begets more knowledge. That's why 10 years of reflective practice creates expertise and 10 years of repeating the same thinking does not. So simply, time on the tools doesn't make you an expert. I think that is a fallacious philosophy. Knowledge doesn't grow by simple accumulation. It doesn't grow by scrolling Instagram, TikTok, LinkedIn, or whichever platform you prefer.
Dr. Jared Powell:
It certainly doesn't grow by passively watching webinars as well. It grows by thinking, by wrestling with uncertainty, by testing ideas against real patients in the real world by noticing when something doesn't fit and then promptly revising your model. This process is effortful and it can be uncomfortable because uncertainty is uncomfortable, but it could also be joyful. You know that flow state feeling we have all experienced, be it when you're gaming or playing your favorite sport or tinkering on your car, when you're in the grips and throws of solving a problem that you care really passionate about, it is hard. It is effortful, it is all consuming. But in my view, there is no better feeling in the world. I think this is where the leverage comes from as well. Deep knowledge gives you leverage. It lets you simplify without being simplistic. It lets you adapt without losing coherence.
Dr. Jared Powell:
It lets you create solutions for the patient in front of you, not just the patient in the textbook or the randomized control trial. 'cause You can build, not just recite it or parrot what you heard on the internet from your favorable influencer or at school. However, I think clinicians can go wrong. When we forget when knowledge workers, we start treating information as if it were the mechanism of change. So we simply start to explain more. We start going deeper into pain science, and we start explaining the neurophysiology of pain, et cetera, et cetera. We educate harder, we be more forceful in our education. We refine our wording. We change what we're saying. We add diagrams and then we're confused when behavior doesn't change. Behavioral psychologist William Fordice said it perfectly. Information is to behavior change as spaghetti is to a brick. That line stings, especially for clinicians because it challenges a deeply held assumption that if we just explain things clearly enough, change will follow.
Dr. Jared Powell:
But if that were true, most of our patients would already be better. The problem isn't that information is useless. The problem is that information is not the same as understanding. And understanding unfortunately cannot be poured into somebody. This is where the old bucket theory of mind creeps into healthcare. The idea that the mind is a passive container or a passive sponge. Information goes in and behavior comes out. That's not how the mind works. Learning isn't passive, knowledge isn't absorbed. Understanding is constructed. It's built through active engagement through problem solving, testing, revising, making sense of experience, which if you think about it, mirrors clinical reasoning almost perfectly. Carl Popper one of my favorite philosophers, and I'm sure somebody will pay me out for saying that. He said, all life is problem solving. We don't learn by collecting facts. We learn by forming ideas, testing them against reality and correcting them when they fail.
Dr. Jared Powell:
And I think that's what good clinical practice looks like as well. It's about navigating uncertainty with someone else. For musculoskeletal clinicians, knowledge alone, however, is not enough. It is necessary, but it is not sufficient to get philosophical for a second. Knowledge, I think, is causally dormant until it's wrapped in trust. You can know everything about shoulder biomechanics, rotator cuff pathology, pain, science, hip pain, whichever condition you might have a special interest in. And none of it matters if the person in front of you doesn't feel safe enough to engage with it and with you. So trust is absolutely not a soft skill. Let's let that idea die. It's not a vibe. It's not the thing you do before you get into the real work. Trust is indeed a mechanism of change. And change is what most patients want. They don't want to be where they are anymore.
Dr. Jared Powell:
That's why they're in front of you seeking your help. So without trust, ideas don't get tested. Uncertainty feels threatening. People protect rather than explore. And exploration of movement, particularly I think is such a powerful tool in rehabilitation. However, if people aren't willing to explore because they don't trust the information that you give them, they will remain in status quo. So knowledge gives direction, but care gives permission together. They create something powerful, a relationship that can think, reason, and ultimately heal without being too woo woo. So this is where the identity of physios and musculoskeletal clinicians as knowledge workers becomes human. Because our work doesn't just occupy the cognitive realm, it's also relational. We don't think for people, we think with them, we help them make sense of complexity. We also help them tolerate uncertainty and we can re help them regain agency, which in many cases is the driver of recovery.
Dr. Jared Powell:
And when we forget that, when we reduce our work to time, slots, techniques, or just simple information delivery, 'cause we feel like we've got something to say, I think predictable things happen. Education can turn into information dumping on people, and nobody wants that. Our techniques become our commodities that we think we trade in. Patients can get blamed for non-adherence and clinicians burn out despite doing everything they were told was right. So what does this mean for you? I think it's pretty easy. Keep learning, keep relentlessly learning, but invest in knowledge that compounds deep understanding of mechanisms or explanations of context, of reasoning, of critical thinking. Not just the next technique, not just the latest protocol. And as you build that knowledge, remember, knowledge only becomes wisdom when it helps someone else navigate uncertainty. So yes, we are knowledge workers, but perhaps we're not knowledge workers in the traditional sense.
Dr. Jared Powell:
We're knowledge workers in service of people. And I think that's what makes this profession, this work, this job that we do so profoundly human, so profoundly rewarding and very useful in this world. The Shoulder Physio Podcast would like to acknowledge that this episode was recorded from the lands of the Ang people. I also acknowledge the traditional custodians of the lands on which each of you are living, learning, and working from every day. I pay my respects to elders past, present, and emerging, and celebrate the diversity of Aboriginal and Torres Strait Islander peoples and their ongoing cultures and connections to the lands and waters of Australia.
