To God be the glory forever and ever Amen. Romans 11:36 1

Purpose & Goal

The Exercise Thought Journal exists to:

1. find (or become) the world’s best physiotherapist,

2. document proven methods for world-class physiotherapy, and

3. elevate the standard of physiotherapy globally.

World’s Best Physio

The primary objective of the Exercise Thought Journal is to find (or become) the world’s best physiotherapist. We begin by proposing definitions for “world’s best” and “world’s worst” to get both creative and competitive juices flowing. The author may in so doing offend or disgust members of this noble profession. Any physiotherapist not yet committed to pursuing world-class outcomes need read no further. Those who possess that rare combination of moral duty and skill to serve humanity at the highest conceivable standard are most welcome to join this search.

“There is something ticklish about the truth and in the search of the truth and if man goes about it too humanely I wager he finds nothing.”

Friedrich Nietzsche in Beyond Good and Evil 2

Definitions

Preliminary conversations produced the following definitions. Additions, edits & merges are welcome.

“The World’s Best Physiotherapist…

1 “…serves the whole of humanity across two planets at near-zero cost, 24-hours per day and in multiple languages."

2 “…is famed for treating movie stars, Olympians & Presidents.

3 “…is of greatest service to humanity. Joseph Pilates continues to serve beyond the term of his natural life, for example”

4 “…is selected to serve the Mars colonisation when astronauts need relief from “space back” and “helmet neck”

5 “…is the physiotherapist who helps. To a person suffering pain or injury, the effective physiotherapist is “world’s best.”

6 “…creates or attracts the most scientific research. So much has been said of Robin Mackenzie 3”

7 “…attract other great physiotherapists to work with them.” **

“The World’s Worst Physiotherapist…

A “…is unable to diagnose or address the cause of a person’s pain or problem.”

B “…uses scare tactics or nocebo to worsen clinical outcomes for personal or material gain”

C “…is unavailable to help with new pains or injuries because they are fully booked, holidaying, retired or exhausted.”

D “…does not have faith in their own abilities or trust from the people they serve.”

E “…cannot avail themselves to serve the growing demand for physiotherapy in Africa and Asia.”

F “…appears the moment you think you can fix every problem. Only you.”

** Contributed by Leo Ng of Swinburne University as part of peer-review

++ Contributed by Jakob Mogensen of Elite Fys

Thought Exercise

Which definition is most worthy?

Which definitions would you add, delete or edit?

Facts underpinning the feasibility of definition 1

11 billion

Earth’s population will exceed 11 billion within the lifetime of today’s physiotherapy students 4. It is noted that historical predictions of population have not always proved reliable.

Interplanetary

China intends to send human crews to Mars in 20335 with the USA aiming for the goal in the mid 2030s 6. Experts and industry leaders expect Mars to be colonised before 2050 7. Wherever go humans, goes also the need for physiotherapy.

85% connected in 2024

7 billion smartphones connect 85% of the world’s population 8. Globalisation, free markets, technological advancements & affluence are a rising tide that lifts every boat. Humanity’s progresses continues to advance the wealth of every socio-economic strata 9. The production and integration of personalised and global data sets will enable faster diagnosis, more precise interventions & access to world-class practitioners.

Increasing demand

Physical disability is projected to continue increasing by 50% in the coming decades 10. Back pain already burdens 619 million people which is expected to increased by 36.4%, with the highest increases in Asia and Africa, by 2050 11.

Resistance to technology

Within one lifetime, the word “computer” was employed as a job title and then made redundant by advancements in technology and nomenclature that are now so ubiquitous we can scarcely remember life without them 12. The same evolution for physiotherapy is not unthinkable should the predictive accuracy of Moore’s Law continue 13. But do the hands-on skills of physiotherapists no protect them from technology’s advancements? How reliable is human touch in diagnosis & treatment? Practitioners had resisted the clinical application of the Florentine thermometer for 150 years because they felt it displaced their hands in judging the temperature of their patient. Thermometry is now the gold standard 14. A physiotherapeutic robot could simultaneously document the exact barometric pressure applied in palpating a person’s trapezius muscle, communicate with the person as to whether the pressure provokes symptoms, reference the pressure-response from the previous consultation with that same person, and search global data via the internet sets for the dosage of massage that has highest probability of alleviating pain and tension in this case. Oh, and you needn’t leave the comfort of your own home. Easy to imagine.

The future is here

A free mobile phone app accurately ranks the probability of competing diagnoses when a pain or injury is described by written or spoken response to simple questions15. Having tested this app with clients and physiotherapists at Exercise Thought, we found the app to be accurate, helpful and user-friendly in every case tested. Other affordable tools are proving themselves in accurately producing clinical treatment notes, handover letters and client summaries 16. Already six years ago, IBM’s Watson Computer demonstrated a 90% diagnostic accuracy for lung cancer compared to 50% by human doctors 17. Watson was 90-96% accurate for binary concepts like diagnosis but significantly poorer (63-65%) with time-dependent predictions such as prognosis and recovery timelines. My observational of internet search results over 10-years indicates that the later is improving. Further intelligence is globally available via the privatisation, globalisation and online publication of physiotherapy education 18, 19, 20, 21 and large language models 22, 23, 24. Could this personal assistance robot demonstrate rehabilitative exercises or massage a sore neck with the tender touch shown in 2023 demonstration video 25? Check out timepoints 1min 0sec and 1min 14sec, respectively.

Thought Exercise

Would you have faith in a robot as your physiotherapist?

Could you compete with Siri against Definition 1?

Siri, your personal physiotherapist

You “Hey Siri, why does my back hurt?”

Siri

“Data from your devices indicates you have been sitting more. Prolonged sitting is a common cause of back pain according to scientific research26.  Walking around for a few minutes, say every half hour, may relieve your pain. Would you prefer to try this strategy for the next 12-hours or start a clinical conversation to diagnose your back pain?

You Diagnosis, please

Siri

Of course. We can identify the most likely diagnosis based on a few questions. Are you more conscious of your back when you slouch in sitting or when you walk around?

…

Do you have any symptoms referring down your leg?

…

Have you had any difficulty emptying your bladder in the time since your back became sore?

…

There is a 91% probability of discogenic lumbar pain. I anticipate full recovery within 5-7 days. Further conversation in the coming days will increase recovery speed and identify any need for further investigation.

You So how do I fix it?

Siri

Walking more often, sit less and practice MacKenzie back extensions. Shall I create an demonstrative video in your native language?

You Yes, please

Siri

Can do. Will you tell me how your back feels during and after the exercises so that I can update your treatment plan?

You Can do

Siri

Great. I also recommended making tomorrow’s meeting a video call to reduce sitting time and quicken recovery…

Publication

The Journal is published monthly by Exercise Thought. Interviews of nominated physiotherapists are posted on YouTube.

Peer review

2024.12 was submitted to:

• The executive of history.physio

• World’s Best Physio Nominees Adedayo Awotipe, Andrew Lock and Rikke Høpfner

• The Australian Physiotherapy Association’s InMotion magazine

• Heads of physiotherapy schools in Australia & Denmark

• Physiotherapy students in Denmark & Australia

• Physiotherapists at Exercise Thought

Next month

2025.01 will submit an ethical framework for pursuing the primary, secondary and tertiary objectives.

Author

Samuel Christiaan Suke Gregersen was Australian Physiotherapist of The Year and Australian Allied Health Educator in 2022. A year later, the practice he founded (Exercise Thought) was named Australian Physiotherapy Practice of The Year. In 2024, Samuel operated that practice from 16,000km abroad in Denmark while he studied notable physiotherapists. Samuel’s search to find (or become) the world’s best physiotherapist began with interviewing physiotherapists from Nigeria, Denmark and Australia.

Contributions welcome

Email sam@exercisethought.com to

• nominate a physiotherapist

• subscribe to World's Best Physio

• comment, question or joke

• write a chapter