On June 29, 2017, I had the great pleasure of interviewing one of the leading young physiotherapists in the field of today, Jean-Francois Esculier. He is both a clinician and researcher. He is also the Vice-President, and Director of Research and Development for The Running Clinic. InfoPhysiotherapy has the exclusive interview:
- How long have you been a physiotherapist for? What made you choose this field?
JF Esculier: I graduated in 2009 from the University of Ottawa. I was the last cohort of the Bachelor’s program in Physiotherapy. What I like about the profession of physiotherapy is to be able to work with people and help them to attain their objectives and hopefully, make a difference in their life, whether they are an elite athlete, or recreational athlete or even a sedentary individual. That’s why I chose to be a physiotherapist.
- Where do you currently work? What kind of population do you treat in clinic?
JF Esculier: I work at a clinic called Allan McGavin Sports Medicine Clinic in Vancouver. As the name states, it is a sports injury clinic for the most part. 60% of my caseload are runners or triathletes. I work about 10 to 12 hours a week with patients in the clinic. I am also a postdoctoral fellow at the University of British Columbia, so I do research full-time and treat in the clinic part-time.
- When and how did you get involved with The Running Clinic?
JF Esculier: When I graduated in 2009, I went back to Quebec City, my hometown. I started working at PCN Physiotherapy in Quebec City with my colleague, Blaise Dubois, founder of the Running Clinic. I worked mostly with running patients so I developed a special interest for treating running injuries. Blaise and I got along pretty well and then I got involved in 2011. I started to teach as an assistant in the course “New Trends in the Prevention of Running Injuries” with him. I’ve always been interested in evidence-based practice and research, and at the same time I was doing my Master’s in research as well, so it all fell into place nicely.
- Evidence-based practice is a huge part of what you do. Why is it so important to your mission?
JF Esculier: At the end of the day, as physiotherapists, we need the recognition that our profession is beneficial, and that we can help people. Evidence-based practice is really a cornerstone of that. We need to prove that what we do is actually working. There is science behind it and we can actually help people. I think it comes back to the credibility of our profession. So if I want to do something with my patient and there’s nothing that’s been done in terms of research, then I will go with my clinical reasoning and experience. However, if there’s research that has been done with a good level of evidence to support a specific treatment option, then as physiotherapists, we need to make use of this and apply it in our clinical practice!
- How are the courses given by The Running Clinic different from other running courses?
JF Esculier: I think the major strength of our course compared to other courses that I have done on running injuries is that we are clinicians, first and foremost. We have significant field experience. We are runners! That’s an important factor. I’ve done courses where the instructor is not a runner or even a clinician. You can’t directly apply that information with your patients if you don’t put it into practice. Anotherstrength is the constant updating of the course content. We update slides every month based on the latest research. We really want to optimize what we teach based on the latest research.
- What can clinicians expect from the introductory 1.0 course “New Trends in the Prevention of Running Injuries”?
JF Esculier: During the first day,we cover everything on physical assessment. We go over what’s relevant or not. We look at running biomechanics from a theoretical but mostly practical stand point. We go over how to assess running mechanics with the patient, as well as how to implement gait retraining. We have 2-3 hours of theory and practice on running shoes (i.e. fitting, running shoe suggestions, clinical reasoning, etc.). During the second day, we go over treatment. We look at how to quantify mechanical stress based on specific injuries or for prevention, training modulation, plantar orthoses, stretching and evidence-based treatment for the main running injuries we see out there.
- Where do you see The Running Clinic in 10-15 years?
JF Esculier: So far we’ve been teaching in 15 countries around the world. The course has been taught more than 150 times. Our goal is to be the worldwide reference in running injury prevention. That’s our goal. In 10-15 years, maybe we will have gone to maybe 30 countries! The goal is to stay updated and make sure to continue knowledge translation around the world.
- If you recommend one book or article, what would it be?
JF Esculier: I don’t think you should be reading one book or article. You should always consider both sides of the coin. Challenge your own biases! I can’t recommend just one article or book. You have to read as much as you can, put it all together with your clinical reasoning and build your practice.
- What are the most common questions you have been asked (either by a patient or a colleague)?
- Should I stretch or not? I’d rather take that time for you to do some strengthening exercises. If you look at the evidence on this topic, it’s much more useful to strengthen your body or increase your tolerance to stress by doing some resistance exercises than stretching. It is not necessary to stretch to prevent running injuries!
- Will running mess up my knees? No, it won’t, as long as you listen to your body and don’t push through the pain.
- Do you have any advice for graduating physical therapy students?
JF Esculier: Yes, I have two pieces of advice for graduating students. The first would be to always challenge what you have been taught and to challenge your own biases. You shouldn’t have to believe that what you learned in school is the absolute truth. I think good clinicians, especially when they start, are those who ask a lot of questions and not assume that they know everything. When I graduated, I felt like I knew nothing and you need to question what you learned and take your clinical reasoning to another level. My second piece of advice would be to take time with your patients. I’m always one on one with my patient for thirty minutes. I never have two patients at the same time. I really want to focus on that person and make them feel like I have their full attention and not teaching someone an exercise while my patient is waiting for me to come back. I am really an advocate of the patient-therapist relationship. I like to relate to the quote by Voltaire, “medicine is the art of amusing the patient while nature cures the disease”. You listen to your patient and take care of them and most of the time, they will get better!
- According to you, what is the profession of physiotherapy doing right? Where is there room to improve?
JF Esculier: I think what we are doing right is getting people to move. I like the new trend of “Exercise is Medicine”. It’s a key aspect as rehabilitation professionals to get people more active and I believe we are known for that. Another thing I think we’re doing right is that we’re involved in various aspects of rehabilitation, such as neurology, cardiopulmonary rehabilitation and orthopaedics. What I think can be improved is our reliance on passive modalities. I think there is too much focus on manual therapy and modalities. I am not saying manual therapy isn’t good. I use manual therapy with some of my patients. Manual therapy can work, but for reasons other than those we thought initially. We need to get people moving. We need to replace passive modalities like ultrasound and various currents. They’re overused. We need a more active biopsychosocial approach to treatment.
Anthony Teoli MScPT