Every clinician remembers their first cast. Mine, however, is burned into memory with cinematic clarity. I began my journey as a new graduate at a major teaching hospital in Sydney. My earliest memory of casting still lives vividly in my mind. I was on a three-month secondment in a small rural hospital in southern New South Wales. The senior therapist there was… well, let’s just say, not exactly the nurturing, hand-holding type.

One day, she informed me that an 81-year-old lady was attending the fracture clinic with a fresh Colles’ fracture. “She needs a backslab,” she said flatly. “You’re doing it.”
No discussion. No “Have you ever done one before?” Just go do it.

Now, like many junior physios, my casting experience at that point was limited to theory and blind optimism. The task felt monumental, she may as well have told me to paint the Sistine Chapel ceiling. Start from the top, and by the way… there’s no ladder.

So, I did the cast. And oh, what a masterpiece of mediocrity it was. That poor woman, she’d already had a terrible day: first the fall, then the fracture, then the hours in emergency… and now, she was rewarded with a fresh accessory, a plaster brick, courtesy of me.

Strangely enough, later that day my senior colleague reported that the doctor had said, “Good job on that plaster.” Now, compliments from her were rarer than hen’s teeth, so I took it as genuine. But in hindsight, it probably said more about their benchmark for success than the quality of my craftsmanship.

From that day onward, I made a promise to myself, never again would I feel that sickening guilt of adding insult to injury (literally). I was determined to master the art of casting.

Years later, after running countless fracture and specialist clinics (a true baptism of fire), attending workshops, watching skilled colleagues, and occasionally fielding complaints, I can say with confidence that casting is a craft worth learning properly.

So, for those of you new to it, take heart. I’ve been in your shoes (and plastered stained clothes). Don’t be the one winging it and hoping for the best. Be the clinician who walks in, spots a dodgy cast from a mile away (usually done in ED), and reassures your patient:
“Let’s get you something better.”
Not only will you say it with confidence, you’ll mean it. And you’ll deliver.