Podcast Episode #29: Dealing With Burnout


Jamie Johnston 0:12
You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston.

Eric Purves 0:17
And I’m Eric Purves. This is a podcast by massage therapists for massage therapists.

Jamie Johnston 0:22
Our objective is to simplify how to be a more evidence informed practitioner. Let’s dig into this episode. Well, it seems as though the pandemic is over, I’m sure there’s still repercussions of going on in different places. But one big repercussion of it in the last year for both of us was how it affected our mental health and some other aspects of life. So we thought what we would do with this podcast is talk about some of those things, because we’re pretty sure we’re not the only ones who went through some major stuff, either pandemic and post pandemic or just post pandemic, but we thought we’d have a conversation around that. So that those of you who are out there that listen to this, for one thing, hopefully you feel like you’re not alone, because we went through it as well.

Eric Purves 1:20
Yeah, it’s encouraging to have these conversations to know that you’re not alone. Because, I mean, I’m sure that I’m sure the I mean, there’s still lots of new cases of COVID. And there’s still, you know, I don’t know, I think the World Health Organization said that the pandemic was the worst. So it was over, they did release something recently about it, but there’s no more lock downs, you know, we’re kind of back, everything’s open. And, you know, everyone’s had COVID a few times, it seems, or at least once and, you know, and we’re having to live with, and we’re still unsure of what the long term consequences what that means. But, yeah, when this, this whole thing happened, you know, you’re, you’re kind of just living in the moment. And then now it’s been we’re into our, I guess, year, three, three years after we’ve in March of 2023. Depending on you’re listening to this, it’ll be three years, and you don’t realize how much the whole chaos of the world impacts us until it’s kind of behind you. And then you realize, oh, shit, like, this was? This was hard. Major. Yeah, there was a lot of things that we at the time we used to put your head down, you’re going through it, you’re just doing the things. And then you realize, yeah, there’s actually consequences too, for a lot of us in the isolation and the change in the world has been significant.

Jamie Johnston 2:35
Yeah. 100%. So we, the brief little chat that we had before we started recording here is the thing that both of us realized we went through, is both of us suffered from a lot of burnout. And the interesting thing to that is that we both dealt with it differently. You know, and, and I think, I think an important thing to mention, and I might get some hate for this is that as as guys, we generally don’t talk about this kind of stuff enough. And I think that’s one of the, towards the end of this episode is one thing that I’ll probably like to bring up a little bit more is that, you know, if you need help, then, you know, talk to somebody. But when we look at the way that we both managed or burnout, you managed to turn it into, like, hyper focus on on business things and online things. Whereas for me, it kind of just shut me down. And I had, I had little to no focus. And we’ll get into some of the reasons for that for me later. But it just really interesting how it sort of affected us differently.

Eric Purves 3:42
Yeah, and we’ve talked about this a lot. It’s, it’s tough, because, you know, you don’t realize, like I said, you don’t realize you’re you’re burnt out until you’re burnt out until you’re out

Jamie Johnston 3:51
of it. And especially if you don’t know what it is or why it’s happening. Yeah. And

Eric Purves 3:55
so I’ve spent a lot of time in the last six months to six to eight months really reflecting on on it. And you know, there I should have, this is very unresearched episode. But I there’s like, there’s like, there’s like 10 or 12, like, steps of like burnout. And I know, from presentations that we’ve seen at St. in San Diego, they’ve talked about this, and I ticked off all of those boxes, right with, you know, the anxiety and the depression and unhelpful coping mechanisms and all these things. You you go through until you just are like, done, I can’t function effectively anymore. And I went through all that. And I think what happened for me was that initially with when, with the shutdown, I felt like this massive sense of loss because we were preparing for 2020 for both individually and collectively to be like, the biggest year we’d had from a business perspective. There was courses scheduled and sold out like all year. Yeah, as of like, as of February and we’re like, this is gonna be great. And then all of a sudden everyone From that, to nothing. Yeah. And then it was a panic of like, oh my god, like, how am I gonna pay the bills? How am I going to feed the family? What am I going to, you know, all these things are like there’s this huge sense of loss. That’s what I felt I felt there was a sense of loss. So I needed to somehow make up for that. And part of,

Jamie Johnston 5:20
in addition to like, clinics being shut down, and it was one of the things. So you know, it wasn’t just the loss of income from that it’s several sources of income, that it was all gone.

Eric Purves 5:29
Everything was gone, and you didn’t know and you’re like, how am I like, how are we going to pay the bills? How are we going to feed the family? Right? How are we like are is the clinic going to have to shut down because I was the owner of the clinic at the time. And luckily, we had good landlords, and that was, okay, we were able to make that work. But there was a lot of stuff that was really stressful, and at the time. Medium is stressful was,

Jamie Johnston 5:51
yeah, good. Because you put your head down and just dealt with it as I dealt

Eric Purves 5:55
with it as best you could. And, and for me, like you said, like, I had a hyper focus. So I became so like OCD, I’m like, I need to figure this out, I need to find a way. So that’s where I went to create, like, went to all this online stuff, I created all these online courses. And I just spent so much of my time learning and studying how to create and market online content, how to create online courses, and they weren’t great, but they just did. And I made them happen. And they became very, very, very successful, like way more successful than I ever could have imagined. And fortunately, you know, once things kind of came back and COVID became less of a restriction on our life, people were still wanting to stay at home for the next year or two. And so people were just really consuming this online content at like, crazy high levels. And so the more I put out there, the more success it had, the more people were buying, the more money that was being made, the more people that were coming into wine to learn from me, and it became almost this like, like, I look, now it almost became addictive. Where you’re like, Okay, if I just keep working hard, if I just keep putting out content, I keep interacting, people will keep doing all the stuff, I’m going to get rewarded for it. And it gets those dopamine pathways going. And so it just became this like terrible positive feedback loop. Where I did, the more you do, the more reward you get, and the more people and bla bla bla bla bla and just kept on cycling through. And it got to the point where I just was working nonstop, seven days a week, 1012 hours a day, a lot of the time, not sleeping. And when we got to the point where I was like, I just couldn’t function anymore, because it was so unhealthy. Yeah. And that’s how I dealt with my burnout was working.

Jamie Johnston 7:40
Yeah, yeah. Whereas for me, it went the other way. It kind of shut me down. You know, before that I’d had several productive years with the blog, and, you know, writing content and doing all that stuff. And I don’t remember the last time I put out a piece of content. And I think the I think the last time we recorded a podcast was in July. It’s been that long. Yeah. So February now for anyone listening. Right? So So yeah, my year just was not productive. And, and you talk about for you not being able to sleep, I actually got early last year, was diagnosed with insomnia and had to go through treatment with a psychologist in order to figure out just how to sleep. Because it’s, you know, I was maybe getting a few hours of sleep a night, even though I would go to bed at 930 and get up at six, in addition to already having sleep apnea. So sleep just enlightened. So that really, obviously took a toll on not only mental health, but physical health throughout that year. And fortunately, he was able to get some help and and figure it out, and figure out how to get back to sleeping again, but for a really long time. You know, there was no sleep, and you’re trying to function and you know, you’re you constantly have a total brain fog, because you’re not sleeping properly, which leads to not eating properly and not exercising enough and not being productive and all those other things. So the burnout was just, it was Mitch,

Eric Purves 9:11
how are you sleeping now?

Jamie Johnston 9:12
A lot better. Yeah. Yeah. That’s good. That was it’s very interesting, what he what the psychologist did and if anybody out there is dealing with insomnia right now, this is the approach that he took with me. And I encourage anybody if you if you are dealing with that to get some help, because it makes a big difference and it’s important to ask for help when you need it. But what he would do is probably have a piece of paper here he basically yes, there’s well. So he gave me a piece of paper that looked like this. And this is all like time throughout the day. And

Eric Purves 9:48
when people and for people that are listening,

Jamie Johnston 9:51
you can see basically a graph of each day with our our time slots in it. So what have you been do is like, Okay, if you’re gonna go to bed at 930 color in what time you go to sleep in the morning, and then for every, for all the times that you wake up in the night, leave a space empty and then color in when you go back to sleep. So you’d see these big white boxes where I was awake throughout the night. And then I go back sleep for half an hour, and then a bit another big white box where I’d wake up and over like a 10 hour span, he looked at it and he said, You’re really only getting like four to five hours sleep in that 10 hour span, but you feel like you should have gotten more sleep. So after a week or so that he looked at it and he goes, Okay, now what I want you to do is if you want to be up at six in the morning, I want you to stay up until like midnight, or one and then condense that sleep into that four or five hour span. And you’re gonna sleep like that for a few weeks. And then we’re going to start adding 15 minute increments into it, so that your body gets used to that again. And when he explained it to me, he said, so in the morning, when you get up, you need to expose yourself to light right away, because that resets your circadian rhythm. And he said, But what most people don’t understand is that a circadian rhythm actually runs on a 24 and a half hour cycle, not a 24 hour cycle. So he explained to me that in his treatments, that’s where they run into some difficulties with blind people who have insomnia, because they don’t get that light exposure in the morning. So that circadian rhythm automatically wants them wants to make them go to bed a half hour later every night. Because they don’t get that exposure. So really interesting thing there. But what he did is he just said, okay, so go to bed at midnight, get up at six, a week or so later, you’re gonna go to bed at 1145 a week or so later 1130 until, you know, up to about 10. And then I would start sleeping like a normal, relatively normal eight hours. But he really stressed to me and said, you know, people think that you’re supposed to sleep a solid eight hours and never wake up. He’s like, it’s totally normal to wake up, roll over and go back to sleep. He’s like, that should happen four or five times a night. So don’t think that that’s like your insomnia keeping Yeah.

Eric Purves 11:59
Oh, interesting. So it’s okay to wake up in the nighttime. Yeah,

Jamie Johnston 12:03
he’s like, it’s totally normal. And you’re supposed to, he’s like, nobody sleeps for. I mean, you’re very lucky if you do, but he was like, very few people just sleep a consistent eight hours and never ever wake up. But he’s like, just, you know, if you wake up in your roll over and you go back to sleep, that’s normal. So he’s like, but if you’re up for like an hour, that’s where the insomnia is the problem, but

Eric Purves 12:25
I find that happens to me sometimes is I will get up in the middle of the night, and then I can’t fall back asleep. Yeah, my brain starts going, it’s better now than it was months ago. But it I would usually I’ll get up sometimes, like three o’clock in the morning. And I’d be on and I gotta do this, I gotta do this, I start going through right, the the wheels start spinning. And then I, you know, I get up for a couple hours I’m trying to go to bed for and I’d sleep for an hour and then get up again and be like, got six o’clock yesterday. And then you’re just like, if like you said, you feel like garbage, right and just can’t function when you’re tired.

Jamie Johnston 13:00
And he even recommended that he’s like, if you wake up and you can’t get back to sleep, he’s like golden watch TV, go read a book, go to out of the bedroom, go do something else. Which was also super interesting. Because as we were having the appointments, he goes all that stuff that you’ve learned about. What’s the term now? sleep hygiene, where they’re like, you know, no, no light before bed and no TV for half hour before he’s like, it’s all BS. Don’t worry about it. Just if you want to watch TV till you go to bed, watch TV till you go to bed and go to bed just right.

Eric Purves 13:29
Yeah. Whenever that stuff comes from, I guess it might be one of those just things people say enough. Maybe and maybe

Jamie Johnston 13:35
there was some research that was done or something that that showed it was beneficial. But according to and this is just the psychologist that treated me you might go to another psychologist that says something different. But that was just the information that he gave me. But yeah, super interesting stuff.

Eric Purves 13:50
Yeah. But you’re feeling more productive now. From that?

Jamie Johnston 13:55
Not from that? Well, I mean, I feel better from that. But I mean, the other thing that we were talking about too, is in November, I got an ADHD diagnosis. So I, to be honest, and I say this with absolutely no offense to anybody out there who, who has ADHD. For years, I was like, that’s a scam. That’s not a real thing. And I know of course I get diagnosed with it and but it’s it’s really funny. The more that I read about it, the more that I’m like, Oh, this totally makes sense. Now. It totally like, like, if you look at the like the symptoms and things of ADHD, it’s like yeah, that one that one that one that one yeah, that’s me to a tee. So so super interesting with that is now I’m getting regular doctor appointments for medication prescription that’s supposed to help with to get the brain kind of working properly again, but one of the things that that I learned from it is that people who have ADHD they don’t really get the dopamine release from things so we look for that dopamine release from other things, and it’s one of the reasons we’re not productive is because we don’t get a dopamine release from being super productive. And so you sit on the couch and procrastinate about something because you get a dopamine release from like watching TV. Because it’s like a half hour thing that you enjoy. Meanwhile, your brain is going, but I need to get this other stuff done. But you continue to procrastinate about it.

Eric Purves 15:18
So interesting. Yeah. So it’s

Jamie Johnston 15:21
like, there’s all these things that I’ve been reading about and learning that I’m like, Oh, my goodness, yes. And there’s even I forget what it’s, I forget what the term is. But there’s a term associated with it, where it’s where you just assume that people don’t like you, which I’ve dealt with for years and have the imposter syndrome and all that kind of stuff. And now I find out, Oh, that’s a result of having ADHD, it’s like, it’s one of the symptoms of that. So

Eric Purves 15:49
it says, I’m assuming and October wrong, tell me if I’m wrong. The ADHD in adults presents My shuffling the dozen children,

Jamie Johnston 15:56
I think, but I from from the bit of reading I’ve done when it comes to kids is that they’re, they tend to be more hyperactive, and things like that when they’re in class, or when they’re at school, or they’re fidgeting and things like that, because they can’t focus on the thing that they’re doing. And so they need an outlet to write for that energy that they have where they can’t focus on something. Whereas I think, and I’m sure it’s different for everybody. Whereas I think with the the adult, it’s more like the procrastination and different things like that, that that occur, because things feel overwhelming, and you can’t just focus on one thing to get it done. You feel like you have to attend things on the go. But you also can’t properly multitask either. So

Eric Purves 16:40
it’s Is that is that? Is that working for you? Is it getting better now?

Jamie Johnston 16:45
It Well, I had a pretty productive day yesterday, I think the medication is starting to help a little bit. But like I said, I’m going to be having a meeting with somebody tomorrow, who’s a coach for ADHD, people who have ADHD with productivity and things like that. So I’m trying to put some things in place that make it so that, you know, every day is, you know, we at least get a few hours of productivity out of it. So that, you know, then I can have multiple online courses and all those things as well. But it’s been Yeah, it’s been a bit of a kick in the jump per se to look back and be like, you know, I should have had these things done a couple of years ago, but But now I understand why I just couldn’t focus enough to get it on properly. So, right. Yeah.

Eric Purves 17:28
Yeah, I think the adult age age or ADHD in general seems like one of those things, it was probably not probably under diagnosed. Or probably. Yeah, I know. Some, some people have to learn simply because people I talk to the as adults have been given that kind of diagnosis and just, like a lot of things, right, if you have some insight into it and a rationale, then you don’t feel crazy. Okay. It’s not I’m not, there’s nothing. There’s nothing really wrong with me. I’m not lazy or I’m not a I’m not. Not a loser. You know, it’s just like, oh, no, I’m like, why? Our brains all work differently.

Jamie Johnston 18:04
Yeah, yeah, there’s an actual reason for it. It’s not just that I’m lazy. Yeah, exactly. Because I, because that’s the, like, you hit the nail on the head there. Because I know for a fact I’m not lazy. I’ve worked hard my entire life, but it’s just a matter of, you know, figuring out now, how how to get the brain to work the way I want it to, or how me to work with it to.

Eric Purves 18:26
Yeah, yeah. So so interesting. One thing, I mean, it’s, it’s funny, because, like, you know, bring this back to the talking about kind of the burnout and the ADHD, which is probably contributed to it for you as well. And I know, for me, that when I was just like, basically a workaholic, I was probably a lot of different holics I was just doing a lot of that I was just doing a lot of things that were not, not healthy. But I feel like you know, in the last few months, I’ve kind of, I feel better, I feel like I did pre 2020 I feel more like my old self again, and which is great. It feels good. But I know one thing for me to manage my workload, because I do have a tendency to overwork and people often like Eric, how do you do so much? I’m like, I it’s not it’s like Don’t Don’t be like me, right? Like, it’s not healthy. But now I feel like I’m gonna go much healthier habits. And whereas like I’m I say no to things, right, put things off until I’m ready to deal with them. But the biggest thing that worked for me was, I learned that a strategy called time boxing, which is where I do every day I print out like a like a block schedule. And at the beginning and I get up in the morning and my coffee and usual plan the whole week ahead or a couple days ahead, and I just go in and I’ll write down between 10am and 11. Between 10 to noon or whatever it is I usually start my dad 10 Collect toward the gym if I can first after I take the kids to school and so and then I just write down what I’m gonna do that day and I have an end to my day where I won’t respond to emails. I won’t Text Message anybody has work related. I just leave the work stuff within a work time. And following this this time boxing schedule has worked really well, to manage my, my time. So if anyone’s listening and you’re and you feel like you’re can never say no or I don’t know how to how to manage your time totally works well.

Jamie Johnston 20:18
Yeah, yeah. Yeah. Cool. I’ll have to give it a whirl. What my ADHD coach says tomorrow,

Eric Purves 20:25
yeah, yeah, it works really well. It works really well for keeping you know, if you haven’t, like I’m, there’s probably you’re probably similar. You go on your computer, and you got 25 tabs open.

Jamie Johnston 20:37
You can see my other screen right now. There’s a small amount of,

Eric Purves 20:41
okay, I was just being I was just being nice. But if I opened up mine, right, I usually have like that many of so many. Open and it’s it’s like you’re sometimes you’re there and you respond to an email, you’re like, Oh, I gotta check this, and I gotta do this. And you’re kind of going all over the place. So let me post it on social media here. Let’s see, someone replied to my email. And you’re just like back and forth. Meanwhile, maybe you’re creating some, some slides for a course or you’re responding to something that people have commented on. And you’re like, it’s just like, Oh, my God, I’ve done nothing, except just spin in circles. So now with this, I just, I can block out my day. And it makes a big difference. So

Jamie Johnston 21:18
this keeps the brain calm. So my tabs open anymore. Yeah,

Eric Purves 21:24
I usually Yeah, you have a few open, but I’m like, they’re, I would I would have done actually is I rather than having an all in one, like browser window, I’ll have multiple browser windows, I’ll just, like minimize them and open up the one I need. Right. So that way, I’m not distracted by something shiny that says so and so replying to your message or whatever. Yeah.

Jamie Johnston 21:45
And it’s so easy to get distracted, and go down a different rabbit hole that you didn’t want to go down in the first place.

Eric Purves 21:50
Yeah. And I like labs. Me too, as I like to read a lot of like, research articles or things. So I will have like, 20 articles open. And then I’ll, like, want to read through them to see and then, you know, you read one, you’re like, Oh, what about this? And then you like, read or you’re like, Oh, I gotta find a reference for this. I opened up another one. And just next thing, you know, it’s just like, she just takes off, right? Yeah, yeah.

Jamie Johnston 22:16
Yeah. Yeah. So did you? Did you find the burnout affected you in in any other ways other than the ones that we talked about?

Eric Purves 22:26
Well, yeah, I mean, there was definitely I think, you know, the, it’s easy to say that the positive was it allowed me to, to create, because that was my way of managing. And but I would say they eventually got to a point where I just didn’t wanna do anything. Yeah. You know, like, I just became not like I did, you don’t want to do anything, you just kind of become you feel lazy because your body is, your mind is just like, we need to disapprove. So let’s just shut everything down. So there was a while there, like in the summer, I didn’t do her. I didn’t do any work. Really, I very little, I just did a couple things. But that was all I could handle. So my capacity to be able to deal with as many things as I had going on at one time became difficult. And also, yeah, burnout, like my physical health as well. Like I, I wasn’t exercising as much. You know, I was not eating as well, it was, you know, probably drinking too much. And, you know, just doing things that you’re just like, this isn’t healthy. Why am I doing this? I don’t know why I’m doing it. Yeah. When you start to form these kind of like, habits that are, you know, unhelpful. And so, yeah, I think for me, now, I’m doing a lot more like I’m trying to develop more purposeful time reading. Just for pleasure. Yeah, I might you know what, maybe I could just watch shows tonight rather than my computer. And like, you know, I’ve watched in the last few months, I’ve watched a lot of Netflix and prime and crave all the streaming networks, Disney Plus, we’ve got Paramount plus,

Jamie Johnston 23:54
that’s pretty good. I got a I don’t know if I should admit this out loud. But one of the guys that were programmed to a Google Chrome for me, I get everything on that thing, though. Oh, yeah. Yeah, no one’s listening. It’s fine. Yeah. But that’s interesting. Because they, because yeah, that’s what the last year has been. For me. It just didn’t feel like doing anything. And even like, when we went and taught the courses that we taught last year, I’d like I didn’t feel like myself in any of the courses and don’t even feel like I was teaching well, even though I know that I’m pretty good teacher. So you know what even affected a bunch of those things. So fortunately, it feels like things are starting to come around a little bit now.

Eric Purves 24:34
Yeah. Yeah. It’s funny because we the way it was before, it was the we had like the teaching seasons, there was like a spring and a fall and always the fall like before the end of the credit cycle was just crazy. cramped. Yeah, it’s crammed. And, you know, we could probably do a whole other episode on that. But that I think that’s one thing that, you know, we’re very fortunate that we were able to have successful, successful CE courses and courses that were are very well attended over the last number of years. Now, obviously, we talked about I think we talked about in a previous episode there, they’re changing the CEC thing. So there’s not going to be that mad drive for it. But I would find myself every single September October, particularly, like, so burnt out. Oh, yeah. Because even if you if you’re teaching, like every weekend, or every second weekend, there is just it wasn’t the teaching itself. Like the day the teaching itself was fine. Like, I really enjoyed that. But it was all of the constant admin background stuff. People asking questions and certificates now many credits is this and, you know, can you tell me more about this course? And, and we’re just stuff which I’m totally happy to answer, because you’re like, Yeah, I want to be fully transparent with anybody that wants to get a course. But what I did find was, once November hit, I was like, I don’t want to talk to anybody. Because I’m, like, I see like too much overload. Because it was just too much it was constant. And so I don’t want anyone to listen to think that I’m complaining because I’m totally thankful. But there is that, that when you’re constantly on, yeah, you never get a chance to kind of turn it off. And that’s, I felt, I feel that it was something that was very hard to manage.

Jamie Johnston 26:22
And I didn’t understand it for years. But with me, because I know, I’m an introvert, there was especially like, early in my massage therapy career, I would come home at the end of the day and be like, I don’t want to talk to anybody. I don’t want and I mean, I was I always lived alone. So it didn’t really matter. But, you know, people would call and be like, Oh, do you want to go out tonight, you want to do this, I’m like no, and I come to realize it was because I had to be on all day, talking to people, like you know, six patients a day, or however many I had, where you just had to be on all day. And so when when we were teaching courses and things like that, where even if I’m doing first aid courses, or some of my other stuff here, you gotta be on for that, you know, four hours, eight hours, two days, whatever it is. And at the end of the day, I’m just like, I just want to talk to anybody, I just want to be alone. I just want to chill out. Yeah, I don’t want to be on anymore.

Eric Purves 27:13
It is a thing, hey, that I don’t know, if people talk about it enough. It would be really interesting actually, to have like a like a focus group with a bunch of the seats or like people that teach as much as we have. And see, like, how do you guys feel about this, because I know when I’ve had some conversations with people, you know, you kind of feel high on the day, like it’s a good thing. Like I love the feeling of teaching, particularly a live course online is good, but not nearly the same. But I love the feeling of that in person course. We’re just like their their energy and you kind of feel high like you feel a rush and it’s really good. And then afterwards, you go in for dinner and having some social time haven’t drink. And you know, it’s really fun. But then by the time that weekend is over, you’re exhausted, exhausted. And it’s like it’s like a week recovery. And I think that you said is it for a lot of us that. You know, I think a lot of massage therapists probably are a little bit of introverts, because these mostly, a lot of us have similar personalities is that you? It’s hard, it is tiring. It’s very tiring. And I don’t know if that would say that led to any burnout. But it’s definitely something I’m more mindful of now is like, Oh, I feel really exhausted after these weekends. I need to make sure that I recover. So that way I can be on my best again for the next time.

Jamie Johnston 28:29
Yeah, give yourself the Monday off or something like that to just to have a day to get feel like you’re in your own skin again and get back to feeling normal. Yeah,

Eric Purves 28:39
I did that the second half, or this slot? 2022. I did that. But previous that I didn’t do that enough. Like I would be like, Oh, I gotta go back to work. I gotta go back to clinic, I got to do my things. And yeah. never recovered. You just and it was that constant, constant, constant constant. Go, go, go, go, go go. Yeah. Which probably leads to well, you know, it’s never one thing that leads to the burnout. I think it’s a combination of it. All right. So let’s teach a course on the weekend. And those come home. And then let’s not take any time off. And let’s go and start like promoting the next course. Or let’s, let’s let’s start responding to all the emails and saying there’s certificates like today because people want them because they need them. And, and let’s, let’s go and, you know, let’s go to podcast and let’s go record a podcast and let’s Yeah, you start doing all these things. You’re like, whoa, whoa. Yeah. doesn’t need to happen today. Don’t wait. It can wait a week, and the world’s not going to end. That was the hardest thing for me to do was to like, No, it’s okay. I’m good. I could just couldn’t wait. I need to look after me first. Because then I’ll be better for everybody else that is paying attention to me and my content, my courses and better for like, family and those around me too. When I’m like, give the time.

Jamie Johnston 29:50
Yeah. Yeah. And I think I think the takeaway that I’ve gotten from this past year, is that it’s okay to be kind to yourself because we’re I mean, I mean, you and I have spent a lot of time together over the last number of years. And I know that both of us are pretty hard on ourselves. And I know for me like, it’s, especially this year, last year where I haven’t felt like doing anything and I’ve been unproductive, then you’re even harder on yourself, because you’re like, well, I should be getting some content out, I shouldn’t be doing this stuff. But I’ve come to realize it’s okay to just take a step back and go, You know what, that stuff can wait, because I’ve got other stuff going on. That That should take precedence over this. So. So for, for those of you out there are that are listening, don’t be afraid to be kind to yourself, when you need to be kind to yourself, because that’s really what’s most important, and for, for all the reasons that you just mentioned, because then you’re more present with your family, you’re more present with all the other things that you have to do and, and while making money is great, and doing things to improve the profession is, is awesome and great. If you if you don’t have the capacity to do it, and you don’t take care of yourself, you’re never going to be able to do all that stuff.

Eric Purves 31:03
That’s very well said, Jamie. And that’s something that we should really a society and at least for us as individuals to be mindful of is that we are in this kind of buy field that we’re like almost in this success, obsessed profession or success obsessed, maybe a profession, lifestyle. In society, where we’re we tend to identify we I’m obviously generalizing a lot of us identify by our accomplishments. Now we’ll look at all the things we’ve done, look, look, look at look at how, you know, the success that we’re having, and or look at the person we look at the success they’re having, I want to have that success too. You know, why are they having that I’m not. And so we, I think it can create this very unhealthy mindset where we’re always looking to achieve, we’re always looking to, to make a big impact on the world. And, and I think sometimes if we do that, without looking after ourselves, first, we’re going to have less of an impact. Yeah, and that is, for me, something that I’ve been very mindful of is that you look after yourself, first. You maintain your own genuine who you are, and you start focusing on you. And then when you can look after you, then you can start being more productive or being better. And you know what, just because you’ve had success one year doesn’t mean the next year, you have to be as successful. And how you define success is totally different for everybody.

Jamie Johnston 32:34
Totally, it’s individual to each person, you know, my idea of success compared to, to another person’s idea of success, where maybe their idea is to just go to work every day and come home and really enjoy their family. Yeah, that that might be one person’s idea of success. And that is a complete success. For anybody who does that. But for somebody who doesn’t have a family, you know, my, my ideas of success are going to be different from that. So, in each case, let’s just make sure that no matter what we’re being kind to ourselves

Eric Purves 33:07
brilliant advice. It’s really, really important. Because if we, if for so for our people like you, and I teach courses and have online, a lot online presence, if the goal of that is just to make sales or is just to, you know, get people to follow you or if it’s any of those type of things, which are these kind of superficial things. It becomes that’s not like that’s, there’s there’s no is that a reason? It’s not the reason, right? And so I started looking at things, I might start to realize that, you know, I would rather have, I’d rather have more of an impact, because the stuff that I teach the stuff that I believe in is like, it’s it’s who I am. And, you know, for me, you know, I’m, you know, evidence based practice around the science of pain is so fundamentally important. Because if we don’t understand that, and we don’t apply that to our clinical situation, and people are suffering needlessly, potentially, right, we follow the evidence, because it helps make us less wrong. And so for me, you know, I’ve really had to take a step back and realize that, you know, I can’t push this onto people, but I can at least the people that are here that want to follow the one Listen, that want to take my stuff, they want to ask me questions, I’d rather help them really well. Yeah. And a whole bunch of people. A tiny little bit. Yeah.

Jamie Johnston 34:33
Yeah. And if you if you think about how that affects people who are working clinically, if you’re not taking care of yourself, how are you going to take really good care of the people who come to see you? 100% and we would constantly give them the advice, to be kind to themselves and go home and do some home care, do do things that are important to you do the things that you enjoy. But if we’re not taking that advice ourselves, then we’re not going to be able to help those people as much. No Yeah,

Unknown Speaker 35:01
yeah. Be kind be kind to each other because yourself.

Jamie Johnston 35:05
Yeah. So this might be a good spot to transition into the other thing that I want to share. Yeah, please, that I just dropped on you. My cousin, who was one of my lifelong friends took his own life on December 19. So, really, you know not to say that people are having those thoughts, and I’m sorry if this is triggering for anybody. But I think it’s just important thing to talk about, because it’s something I’ve seen lots in my life, just happened to my cousin happened to my brother, six years ago, happened to my uncle when I was a kid happened to one of my captains when I was at the fire hall in Campbell River. So I don’t know if I’m just a jinx on people or what it is. But for whatever reason, I’ve seen this lots in life. And I think the as much as we’ve been talking about being kind to ourselves, it’s also important to ask for help, like, critically important to ask for help, whether it’s that you’re dealing with burnout, or insomnia, or you’re having negative thoughts or whatever those things are. And like I touched on, earlier on, I think as guys, we don’t do it enough. We don’t ask for help enough. And we don’t, we don’t talk about our feelings and all those things enough. So it’s just, I think it’s a really important thing to bring up. That, in addition to being kind to yourself, ask for help when you need it, no matter what it is you need help with.

Eric Purves 36:37
I couldn’t agree more. Yeah, I mean, that’s, that’s awful to hear that you’ve had so many people close to you. I’m really sorry to hear that, that have committed suicide. That’s I can’t even imagine. I’m very fortunate that I don’t have that many people in my life that have that’s happened to so it’s hard. I know, one, one thing I didn’t want to share, because I don’t know how many of our how many of our listeners are men. I know men are the minority in our profession. One website that I found, which really helped me in kind of realizing my like what was going on in like, the burnout was a website called Heads up guys.org. And it says for men about men, and you can find therapists on there, they have articles, they got, it’s all about depression and stress, and they’ve got like, the self checks on there. It was really, really, I found it really, really useful to just kind of be like, okay, like, so this is how this kind of meant these mental health things appear in men that might be different in men and women. And this is, you know, and knowing that, okay, like, I’m not alone. And I think I believe this website actually is run from the UBC, University of British Columbia. Yeah, University of British Columbia. So it’s there. It’s kind of their website on anyway. Male mental health. So anyway, really useful if anyone Heads up guys.org. Really, really

Jamie Johnston 38:03
useful? Yeah. And just quickly buzzing through it, it looks like a great site, and it’s got some good resources on there as well.

Eric Purves 38:11
Hmm. Yeah, I couldn’t recommend it enough for men, the men’s out there, the men’s

Jamie Johnston 38:17
side. Yeah. Okay. So that’s probably a bit of a somber way to, to bring the podcast to an end. But, you know, it just I thought it was an important thing to bring up that, you know, if you need help, don’t, don’t be afraid to ask for it. I’m sure there’s lots of I know, there’s lots of phone numbers out there and, and things like that, that are, you know, free resources and things like that for people when they’re, they’re having, you know, depressive thoughts or negative thoughts or things like that. So, if you’ve been through that, as far as this pandemic and coming out of it, then, you know, reach out to maybe one of those programs or reach out to a friend or, or somebody and and talk about it, which I think is it wasn’t the sole reason we did this episode. But I think one of the things we want to get across is that, you know, if you’re going through something like that, we’ve, we’ve been through it, too, and still coming out of it. So don’t be afraid to ask for help.

Unknown Speaker 39:17
That’s all I have to say about that. Right.

Jamie Johnston 39:20
There. All right. We’ll see you next time on the pockets. We hope you enjoyed this podcast. These kinds of topics are what we’re all about. If you’d like to learn more, go to our websites, the mtdc.com or Ericpurves.com. If you know of any other therapists that could benefit from this, please tell them to subscribe.


Podcast Episode #28 With Great Educational Power, Comes Great Educational Responsibility



Jamie Johnston 0:12
You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston.

Eric Purves 0:17
And I’m Eric Purves. This is a podcast by massage therapists for massage therapists.

Jamie Johnston 0:22
Our objective is to simplify how to be a more evidence informed practitioner. Let’s dig into this episode of education, education, education, I was told as a young man that you say things three times as a repetition for emphasis. However, when we look at the emphasis that is being put on our education, by many of the conferences and things that we see across across Canada, in the US and other places, all too often. We’re never learning from RMTS. And we’re not promoting other massage therapists to step up and present at these conferences, and we’re learning from people who don’t do what we do. And as we have said so many times before, we believe that that’s something that needs to drastically change within our profession.

Eric Purves 1:19
Definitely, and this is a conversation that we’ve had before in a previous one, I think we had one called RMTS, learning from RMTS. And I think it’s really important for us to, to kind of keep hammering that point home, right, the repetition, repetition, repetition, is is really is important. And, you know, the, for too long, we both believe and I can speak for myself, I won’t speak for you right now, Jamie, but we’ve looked at the professionals look outwards, right look upwards towards different health care providers, to look for leadership and to look for guidance on on, you know, things like best practices or different approaches, or, you know, the incorporating the research into practice that type of thing. But we now have, I think we’re at a time in the profession where we are at a point in time where we can, we should be taking the lead ourselves and stop looking at words. And, you know, when the I remember saying this quite a few years ago, I’m gonna say about four or five years, I was having a conversation with a colleague. And I basically said, you know, why is there not more arm T’s presenting at conferences? Why isn’t it more on T’s, teaching these continuing education courses? And the answer I got was, because there’s not really enough good quality RMTS out there. Now good quality, meaning as educators is to teach kind of current best practice type stuff. And I remember thinking, Oh, well, let’s seems to be a problem. But I never really thought about it much more than that. And the courses I took, oftentimes, were not by our own teachers, because that was what was available that we met my interest. But now we look at the amount of good quality evidence based educators out there that are starting to take the lead, we should really move towards that where we started looking to learn from within rather than looking outwards. And there is in a lot of levels, a lot of ways some of the associations are doing really well listen, some are not doing as well as we would expect.

Jamie Johnston 3:20
Yeah. Yeah. And I think we, we chatted about it a little bit before we got on but but before we get into who we’re gonna say, is doing a good job, just to add to what you were saying, the other thing that we’re starting to see is that people from some of those other professions are now coming in and challenging our exams, or they’re taking a bridge course, to become an RMT. So that they can get in to teach RMTS or massage therapists, not, you know, not just strictly, you know, people in our province, but we see, you know, some chiropractors and athletic therapists and different professions that are going in wanting to get to the title of massage therapist so that they can get into teaching massage therapists and with only that goal in mind, not to actually advance the profession and to be to be a you know, a better manual therapist or hands on therapist or anything like that. So I think we also need to look at like, okay, what are the motives behind some, some of the ones who are doing that? And is that where we should be looking for our courses?

Eric Purves 4:36
Yeah, that’s a great point, actually. Yeah. What’s the motivation for why would you want to do that? Right. So if you are, say, a chiropractor, or athletic therapist, which are I think probably the two most competitive athletic therapists probably the most common, there are

Jamie Johnston 4:48
certainly a lot more of them and many of them are doing it not necessarily become teachers but because they they don’t get the the insurance coverage and things like that like an RMT does. So they do that to you. To be able to make more money billing out,

Eric Purves 5:02
because because they’re unregulated, they don’t have like a body to advocate or for insurance. Yeah. So which makes sense, right? You’re, you know, you’ve got the your education, and you’re really great at, you know, assessment and musculoskeletal rehab stuff from like, say, being an athletic therapist, but then you can’t, you’re like, if I’m not busy, because I have people have to pay out of pocket, and they can get something maybe similar from somebody else or that person get reimbursed. So that makes sense. But I think yeah, with what you’re saying that with, with the motivation as to why I want to have this title, I want to add the RMT designation, after seeing my chiropractic for, for example, the Yeah, why are you doing that? Right, other than to maybe just try to be like, Yeah, I’m one of you as well. Yeah. But I don’t understand why somebody would want to challenge the exam. I mean, I’d like to, that’d be something I’d be very interested to hear more about that. Yeah. I was Why would you challenge the exam? If you’re just like, are you actually going to build for massage therapy, or just want to put that in your course type in your bio when you’re teaching? I don’t know. It’s, it’s an interesting thing. And I, if someone listening hasn’t answered for that be great.

Jamie Johnston 6:14
Yeah. I’m not sure. Yeah. But I think it’s still it sort of goes back to that thing is if you went and did that, just so that you can get into teaching gigs, to teach other massage therapists, then I think as people who are taking the courses, we should be analyzing that before we take the course. Because we firmly believe that the more that we can build up other people within our profession to become educators, and the more that we can learn from each other, then the better off that is for the profession. For sure, for sure.

Eric Purves 6:46
And also to uh, you almost wonder, though, hey, like, what does it say about our profession? When we can’t go challenge somebody else’s board exam unless we unless we go through their entire curriculum? Why is it? For some reason, our profession is the only one we’re like, Oh, your physiotherapist, your therapists, your chiropractor, your naturopath you’ve got you’ve got education. Okay, just right, just right, our exam if you pass it, yeah, go ahead.

Jamie Johnston 7:11
It should be mandatory that you have to go through the full program, because it’s the same with we will try to do it in another program.

Eric Purves 7:16
Yeah, I remember back when I first started looking into being a massage therapist in the late 90s, early 2000s, date myself here a little bit, I remember the guy that I used to get massage from was actually an athletic therapist, and back then you could go to, you could just challenge the exam, whenever you want it, you go to cmtbc and challenge it. And then they got rid of that for a long time. You couldn’t challenge it right? You had to go through the program. And if you made the word RMT, outside of BC, and maybe you moved here from Ontario, you could then do like a upgrade. Yeah, bridging them. There’s been a couple people in my school that were great therapists, but they had to jump through the hoops, but they went and they got licensed here. For some reason. I’m sure there’s somebody that might listen, that might know the reason why. But from a, from a logical perspective, it doesn’t make any sense. Why somebody could just come in and challenge the exam, I understand that, hey, if you’re not RMT, anywhere in Canada, you shouldn’t be able to move again, aren’t you? You’re an RMT you’ve been to school in Canada and regulated province. Education is gonna be very similar based on knowledge and very similar. Yeah, like don’t make it difficult people. But if you’re in a different profession, you’ve never actually been through a you’re not educated as a massage therapist. And you haven’t had that clinical practice, yet. Like if you’re just doing exercise rehab and, you know, spinal adjustments, and then you go and try and massage somebody. You know, and you don’t have the experience, like how many hundreds of hours you’re you’re working with your classmates and your clinic and all that stuff? I think, I don’t know, I decided to I think it doesn’t say a lot enough. It’s not a positive thing for our profession to be. Say, oh, yeah, come on in and pass the test. Here you go. Here’s your title. Absolutely.

Jamie Johnston 9:02
Because it’s funny, because I know some people who have gone to challenge the test to ask me to teach them how to drape people. Right? Because like something as simple as that, that’s so simple to us, is not something that they’ve ever done in any of those other professions. But anyways, that’s a that’s a bit of a rant about that, but I think they have changed it and you have to go and get schooling now. I don’t think you can just go in and challenge the examiner. I keep going back and forth. flip flopped. Yeah, yeah. And I think and I could be totally wrong. But I think part of the reason was because the the college would refer back to the schools. And it was the schools who said no, no, they’ve got to come and take at least our Bridging Program. Okay. Right. I think that’s how it happened. But don’t quote me on it. Because I 100% can be wrong. Yeah.

Eric Purves 9:52
We both are wrong a couple of times. Every day. Yeah, less wrong, hopefully. Yeah. So So yeah, let’s let’s Talk about some of the we just kind of preparing for this talk we had this episode, we looked through just some of the upcoming or past conferences that some of the associations put on across the country. And just, and just looking at seeing how the associations are doing in terms of who’s presenting and the kind of content that they’re they’re presenting on. And, you know, we’ll kind of I think we’ll just kind of provide some opinions and ideas about some of these things. And then maybe, you know, believe the final decision to be made by the listener about how they feel

Jamie Johnston 10:32
totally. So one of the and I’m just looking at their webpage now. But one of the things, one of the ones that we thought are doing a great job is the the RMTAO. So the Massage Therapy Association of Ontario, and if you look at the conference that they’re putting on, every single presenter is an RMT. Except for the keynote, okay, which is a doctor, okay. Which is, I mean, kind of a cool, good co host of a CBC radio show and veteran emergency room physician. That’s right up my alley is first responder. But yeah, when you look down that list, it’s all RMTS, which is great. And I wish more more associations would look at that and go, that’s what we should be doing. We should be building up the people in our profession, in our province, or state, or whatever it is, wherever you live, that we want to get these people up to show what we can do as a profession, but also to show what other people in the profession could possibly do. Because the more that we promote other RMT stepping up, and educating and educating, getting more education for themselves, and bringing that content to the rest of us. It doesn’t just benefit the profession. It benefits the general public, which is what we should all want.

Eric Purves 12:00
It’s everyone’s best interest. Totally. Yeah. Yeah, I think and I think I think that the RTO is doing a much better job than they were I think they I don’t know why. But they used to only do their conferences every second year. I think they are doing them every year now. I was a presenter there in 2018, or 19. I can’t remember one of few years ago, and their keynote then was Melanie Knoll. And that was her first keynote she did for a manual therapy. Conference, first first time I encountered her so I don’t whatever was 18 or 19. Can’t remember. But then all that time to they had every single presentation there was done by RMTS. And that seems to be something consistently, you know, and then just looking through their what they have here they’re on to which, which makes me very happy to see is is they have the keynote, and it looks like they break it down into they have three different kinds of overlap, like plenary sessions, which which go all kind of at the same time, say the Business Strategy Session. They have an interprofessional collaboration session, and they have evidence based practice sessions. So pretty cool stuff really important. I think it’s really important for us as arm T’s. The only thing I don’t like about this, this this format, is that you could miss something.

Jamie Johnston 13:19
Yeah, if you’re focused on one area, you could miss out on really important information and the other one,

Eric Purves 13:25
like I’m just looking at one here, this is this is this is just my bias coming out here. But I look at it at the end of the day, they at the same time they have one working within an MBA care team for solo practitioners by Danny Felcher. We both know, but at the same time, you also got Richard Lieber doing one chronic pain evidence based person centered approach. So like, well, I find to see both of those. You couldn’t use this one. And I don’t know if this recording you get access to recordings afterwards. But I know for me, oftentimes I get recordings from things and I don’t really watch them.

Jamie Johnston 13:54
Yeah. Lost with other things. And

Eric Purves 13:57
yeah, he’s busy. So that’s the only thing I would say that is that I was like, oh, it’d be nice if it was like a two day conference. I don’t know if it’s expensive or these things are expensive. But yeah. But that you look at that you look at the content of the stuff they’re doing here, right, they’ve got, you know, stuff on and this is by no order of importance, but just looking at it here they got, you know, things that appeal to me is how to assess the impact of trauma safely. So keeping clients safe so they’re kind of trauma informed practice stuff. Mastering difficult conversations to be a great one. Be a great one right. Opening the doors to collaborative healthcare introduction evidence based practice by PCs own Bodhi who we know and then yeah, and then you have these other ones talking about the working with MBA care team and chronic pain. Which is which is great. And I bet you the Richards chronic pain when he was probably just to promote it. We just published paper together. So I’m promoting that the other day. Yeah. And I was one of the authors on that. So I’m assuming that part of the what he’s in present there is on that And that was his. That was his baby. He took the lead on that. So I think I’d like to see his presentation on that. Anyway, pretty cool stuff and RMT forward, right? Very RMT focused actually,

Jamie Johnston 15:11
especially like when you look at the title of Danny’s presentation, working within an MVA care team for solo practitioners. And I know like, how much frustration do we have especially like, when we’ve been teaching courses over the years and communicating with people where they’re like, Well, yeah, but I’ve got this person that’s come to me then they go to a Chiro then they go over to their physio, and then they go to their doctor, and they’re going to five appointments a week in all different places. So what a what a great topic of something to be like, Okay, how do I work together with these other practitioners when I’m in a silo in my own clinic or whatever? Like, very, very RMT approach?

Eric Purves 15:45
Yeah, yeah. I and this is this is great, too. And they had their panel discussions as creating an inclusive healthcare practices is another really important kind of thing that’s finally being talked about is this inclusivity and I’m just looking to see and I can’t see it off top my head here. Who is? Who is in that?

Jamie Johnston 16:05
It’s Damien John. Oh, doctor, Dr. Alex Abramovich. Hopefully I’m crucifying the gentleman’s name Sharon Davis Murdoch. Who’s a cm I don’t know what cm stands for?

Eric Purves 16:20
Yeah, I don’t know, either. And Damien, who you know, and other BC former, or as he’s still an RMT? I’m not sure. Anyway,

Jamie Johnston 16:29
I don’t think he’s practicing anymore.

Eric Purves 16:32
And then you had another person, Jessica city, who I don’t know, but you got a couple of RMTS in here. And people who look like they have kind of special focus or education or advocacy and that kind of inclusive healthcare practice, which is great. These are conversations that need to be had, and information needs to get out there. So it’s good that these things are happening. I Yeah. So I don’t really have any, I don’t have anything bad to say about that. What I do oh, well, what we’ll just keep pumping up the tires of their RMTAO do I mean, we’re not members of them? So I don’t I’ve never paid it was there anything. So I’m just going based on what we see. But also, when you look at their their website, this is really great as they have a whole thing on education and events, where you can actually add a course listing, you can you can actually make a request for them. And I know they do, I think monthly webinars available for members. So you could say, hey, you know, Jamie, you could go in there, hey, I want to do one on fear avoidance model. And why this is important for massage therapists, you could go and request for them to do that. And they would promote it. Which is to being an advocate for the profession for the members to build up the profession, to be leaders. And I love that and and we don’t see that as much unfortunately, with many of the other associations.

Jamie Johnston 17:51
Yeah. Yeah. And one thing I’ll say, too, is that they, from the things that I’ve seen, is they’ve done a really good job with their social media, promoting evidence based things and, you know, different. Not means but what am i What’s the thing I’m trying to think of? Where it’s like, like, pictographs of things that are evidence based? Yeah, like different graphics, and things like that, that are promoting evidence based practice and things and, and I know, there’s been a couple of times I’ve seen them promote something where people call that out, and they’re like, this isn’t cool. But for the most part, the things that I’ve seen, I’d say they’re doing a really good job with their social media and things.

Eric Purves 18:29
Yeah, I really liked their their social media stuff, too, I find that it’s like what they do. Okay, portion, like being with a bias of the RMT focuses, they do seem to share a lot of posts made by their members. So good quality information, good quality information, and they seem to be doing, you know, being advocates for as much as they can for their for their members. Yep. Yeah. And, you know, what I would like to see is I would like to see them do more, all Association, but I would like to see them do more of that. But also, I think we really good. I mean, these guys have money to spend, right? Like we you know, maybe we should make this statement. We are former board on the board of directors with the arm TVC. So our opinions expressed here are not necessarily those of MTV seeds, and we’ll get that out of the way. But the would be nice. And actually, I would like to see them do more like Facebook ads. Like it’s not very expensive. If you’ve got a web team to do stuff out to promote, say, Hey, here’s something that one of our members did, or here’s something that you know, a paper that was published or here’s a something that the association has done.

Jamie Johnston 19:54
Yeah. And show the benefit of what you’re the benefit of

Eric Purves 19:57
it. Because when you just make these passive posts It’s on like, you know, business page on Facebook, for any of us that use business pages on Facebook, you have to interact like on a very regular basis in order just to get it to get it built up. And in order to get it to show up people’s feeds, Facebook ads, it’ll, it’ll go to anybody. Well, and that is a massage therapist, for example, within, like you’ve been targeted, I would like to see that more so that way you could lose as RM TVC memories like, Well, yeah, what are you doing? Like, I have to go searching for it? And never, it’s never like, delivered to me.

Jamie Johnston 20:31
Yeah, well, and my opinion, too, is that every Association should have their own Facebook page. Yeah. You know, as somebody who’s a member, you can go on to that page and ask questions about your practice and get a legitimate answer from somebody within the association, whether it’s like a practice advisor, or whether it’s, you know, if you just have questions about your membership, that you can get the answers to that on that page. And it’s monitored so that people who aren’t members aren’t on that page. And it’s only delivered to the people who are members. Because, you know, there’s so many different options for Facebook pages out there that anybody can just open up a massage therapy Facebook page for their province, and you’re not necessarily getting accurate information and accurate advice, according to your practice on there. Whereas, you know, if you had a practice advisor in place, part of their job could be to log on and look at that page every day and answer whatever questions are coming in and have that discussion. So that people are getting accurate information.

Eric Purves 21:36
And I do see, I did see the other day that at least at NBC, they are actually hiring a practice advisor a full time. Job. So I don’t know why I didn’t read through it in depth. But that would be that would be ideal, right? Because what I find with the way a lot of the the association or they kind of work in this, like an older model of like, it is way things were done 20 years ago, 15 years ago with email, and you know, mail outs and stuff, but having a social media presence, in today’s day and age is what a lot of people want. And I know for me personally, like I will go on Facebook or Instagram often to look for information, or that’s where I get a lot of, you know, things that they’re looking for to find something I’ll often go there first, yeah, you see if someone’s posted, if there’s a length or something, it’d be lovely to have that as a resource.

Jamie Johnston 22:27
Only, and I mean, be able to go in, you know, if you had that practice advisor that once a week could go in and drop in a research paper and be like, Hey, here’s the paper that really applies to your practice, give this one a read. And, you know, put some bullet points in there of like, what it covers? Yeah, simple stuff like that, I think would go a long way to the user experience of the people who are members of associations.

Eric Purves 22:51
Definitely, definitely. And that would that would be that would be ideal. I think that would be that would be ideal. But yeah, I do like that the arm to come back to that point is like did a really good job of promoting good evidence based practice to the members, right. And if I think that the leadership needs to take a role in changing kind of some of these unhelpful, common narratives within the profession, we’ve talked with this probably every episode before, about, you know, the, the leadership about, you know, changing curriculums or updating best practice, or educating the profession should come from the associations, and then the associations trying to, you know, provide resources or influences to the to the school, so then that information can then be adopted and taken into the curriculum. And then you can put that upward pressure on the colleges and say that the regulatory bodies, regulatory colleges say, Hey, here’s, this is what we want to be teaching. This is consistent within our scope of practice. Let’s update Let’s Let’s update our competency documents. And I all I hear, we’ve probably talked about it was a million times, and we probably talked about it many times on the on the This podcast is pointing, what you often hear is finger pointing and excuses rather than somebody being like, Yeah, let’s do this. Yeah, there’s stakeholders to make it happen. And everyone’s like, why we’re not gonna do this on our response, but it’s their responsibility. That person says, No, it’s not my responsibility to responsibility. It’s a circle of circle. And it’s been this conversations been happening forever, right? Everyone kept blaming somebody else. And I would say, to RMTS, to be leaders of our own teams, we need our associations, we need your stakeholders, we need the colleges to take a leadership role, to promote the profession, to deliver good quality, evidence based curriculum that’s within our scope of practice. And then to use things like these conferences, to show the great work that massage therapists are doing, and promote that content and promote that content. Right, like the rmta, who’s doing a great job promoting that content. I think it’s just great.

Jamie Johnston 24:51
Which is funny because this is this is also on the outside looking in and there could be people who are rmta or members that would listen to this and go what are you talking about? They’re doing a shit job, right? Yeah, maybe differences of opinion, but this is just what we’re seeing from the outside looking at so. So yeah, props to the rmta over what we see them doing. Yeah. Yeah. However, you know, across North America also because I don’t see much in the way of like New Zealand or Australia and conferences that they do over there or if they even do them.

Eric Purves 25:25
No idea. I’m sure they do. I just it’s Yeah, but I

Jamie Johnston 25:28
just don’t see it. But you know, so I’m talking to a few friends that are AMTA members, I know that there’s, there’s a bit of a push happening in the states to get things changed around to be, you know, some more evidence-based courses and things like that. I haven’t noticed a lot about who they bring in for presenters. But but it sort of goes back to the same thing that all too often we’re relying on people who are not in the profession to be presenters at these things. And that really, really needs to change. Because how do you, you know, you wouldn’t, you wouldn’t go to a mechanic and try to learn how to do an oil change, and bring in a geologist to do it. To educate you on how to do it. Yeah. So why are why are we still bringing in a different profession? To teach us how to do what we do? Right? It doesn’t make sense. No, no. And I, you know, and maybe, maybe part of this is also on us that we should be putting pressure on our associations, that, that if they’re putting a conference on, there’s individuals there who maybe every individual presenting is from out of province or out of state, or maybe, you know, half of the people presenting aren’t massage therapists, that we should be putting pressure on our associations and saying, no, stop doing that. But like, you know, and probably the biggest way to do that is by not buying tickets to a conference. But I mean, I think they usually sell out because people are getting credits and things like that, which will be interesting when we see the credit criteria change next year. But, you know, maybe the, the dollar sign is the biggest way to put pressure on them. Or maybe it’s emails and phone calls to be like, you know, we have great people who can present on this and this and this, who work within the province, why aren’t those are the ones that you’re that you’re bringing up? Or within the state or, you know, wherever, wherever it is that you live?

Eric Purves 27:46
I yeah, I think the I like we said there were the dollars and cents the money talks. Yeah. And I don’t know what membership is like another profession or another member or another. Professional associations, sorry. But I would say if your numbers are going down, or your percentages are going down, your association start to look and see why. Maybe we’re not delivering what the members want, and they’re going to put their money elsewhere. If you’re getting more a higher percentage of your of the profession is deciding to become a member, then I think that says that they’re doing good things. So when they start going down, we start looking at why is that?

Jamie Johnston 28:30
Yeah. Yeah. And like I said, I don’t know how it works with the am ta down on the states. I don’t know if like, you have to be a member with them in order to maintain your license. Or if they’re an optional one, like associations are

Eric Purves 28:46
here. I think they are I just pulled up their website here and just looking to see this because they just had their their national convention just a couple days ago in Cleveland. Of all places.

Jamie Johnston 28:57
Yeah, I think, Justin, Justin Kobe Solace, I think winter that you and I were messaging the other day and mentioned that it was a

Eric Purves 29:04
good conference. Yeah, he sent me some some messages with them out in the night in the town, some pictures, and then some other people that we know, haven’t having a good time. So yeah, just looking at that there is the the mission statement of the MTA is to is to serve a MTA members while advancing the art science and practice of massage therapy. I think that sounds almost identical to the RM TBCs one and probably very similar to Ontario’s it looks like they’re they’re a nonprofit association for massage therapy profession. So that yeah, they’re just they’re not mandatory. They’re just because I think

Jamie Johnston 29:39
I think they have a different chapter in every state. It’s not like it’s not like the US AMT. Like that covers everything. I think it’s different by state. But I think they also have different regulations by state.

Eric Purves 29:52
Yeah, we’re just we’re just throwing out things right now.

Jamie Johnston 29:56
This is my understanding. It doesn’t mean it’s right. Yeah.

Eric Purves 29:59
So by Just looking at their conference, though, again, just quickly looking through who who’s presenting and what it what are they presenting on? It looks like it is almost just bread, a brief introduction, it does look like it is predominantly massage therapy focused. Now, when we look at this, though we can, you know, without critiquing the evidence or the or the topics, because that’s, you know, for a different podcast, because that would go on forever. It is still it is still all looks like it is RMT. Focused. Good. Yeah. Which is good, which also goes to another Association, which I’m just gonna clear my screens here is I looked through this is in Manitoba, right. So they are starting to lease I’ve started taking notice with the work that they’re doing, they’re starting to do some some great work there in terms of getting trying to promote and build up evidence based educators and conferences and, and their conference they recently had in this ring, which was another one that I was I was fortunate enough to present that I didn’t, but I was out of town busy doing stuff. And just was able to present and I didn’t get a chance to observe any other presentations that were there. But afterwards, looking back and seeing who was presenting and the topics they were presenting on. There was all RMTS as well. Nice. So empty, focused,

Jamie Johnston 31:35
just quickly looking at it, too. It looks like they’re their keynote speaker was Michael Phelps. And that, to me, that’s really cool, because that’s somebody who, I don’t know how many gold medals I got ones, but I think it was like a dozen or something like that. Who obviously would have used massage therapy. And for somebody who works in high-level sport, like every athlete wants a massage after they’re done training, right. So I think that’s invaluable to have a guy like that come in and be like, what you guys are doing is great. You know what I you know, I used you regularly as a as a Olympic level athlete. So I think it’s really cool that they bring him in and convince him to come in and be a keynote speaker for them.

Eric Purves 32:18
Yeah, that’s great. Yeah, I didn’t know that. That’s pretty cool. Yeah. Well, what BC? What’s that? They’re talking about BCRMT. Their conference coming up too?

Jamie Johnston 32:34
Sure. I’ll say that I’m not as big a fan.

Eric Purves 32:39
Yeah, I’m a little bit disappointed with with the direction that this conference has gone.

Jamie Johnston 32:47
Yeah. It’s. Yeah, it’s not as massage therapist presenter-focused, as I would like to see. And I don’t know that it ever has been. Even though like, last year that, you know, there was Sandy Hilton and Walt Fritz and Cory Blick and staff and some great presenters that were there. And you know, and then the year they brought Lorimer Moseley out, like, granted, that’s, that’s a case where you’re learning from somebody who’s not a massage therapist, but when you’ve got one of the leading pain researchers in the world to come out, that’s a phenomenal way to spend a conference, I think,

Eric Purves 33:24
for sure, but really important information. Yeah.

Jamie Johnston 33:27
But looking, you know, when you’ve got when you have very capable people within your association, that could be presenting and you’re not using them? I think that’s, I think that’s a mistake.

Eric Purves 33:41
Yeah, and what I’m curious about, and I agree, and I think what I’m, what I am curious about, though, is that there’s so bomb teen BC RMTS. Yeah, I mean, it’s kind of ingrained into us is that like, you know, we’re kind of the lead, we’re told, like, we’re the leaders in the profession. And we are, our education is great. And, you know, we’re doing those wonderful things. And for years and years and years, I think the association has done a really good job at hosting good conferences with good presenters and you know, like, those examples are used, but they have not been predominantly be see RMT focused in terms of who’s presenting, whereas other profession, other associations. You know, maybe some of the content isn’t as good in terms of the topics. But you’re still promoting RMT is with in that association. And when we look at this one here, you got your first three people I see on the presenter list are lmts. So they’re American trained, and educated.

Jamie Johnston 34:48
Not that there’s anything wrong with that. But you’re not within the profession. You’re not promoting from within.

Eric Purves 34:54
Yeah. And then you’ve got a professor UBC. Okay. And then you’ve got a physiotherapist. right from BC, Neil Pearson, okay, I’ve seen you speak, he’s got good information, but he’s not an RMT. And then you’ve got Aaron. And then you’ve got a panel speaker, which are all RMTS. So of all of the kind of presenters, you have one person that is a BC RMT. And then you’ve got a panel discussion, which is BCR. Empty. So it’s a very, very small segment of the day. And I find that just unfortunate when there is when you look at some of these other conferences, where you have BC RMTS presenting on their stuff, yeah, two different associations. But our own Association isn’t isn’t using the same people isn’t using the same people or when there’s tons here? And we know that and, yeah, it’s unfortunate. Yeah.

Jamie Johnston 35:47
Yeah. I mean, I could probably name 10 people off the top of my head, that would be great people to have present at a conference like this, like that, that aren’t used. And I know that those people are members in that association. So I, I’m not sure where, where the disconnect is, like, I don’t I don’t know who decides who’s presenting.

Eric Purves 36:11
Even when board members, we had no idea how that Yeah, that’s fine.

Jamie Johnston 36:16
But it’s disappointing because I just think there’s so much more that can be done to promote from within. Where, and if I think that’s one of the important things to talk about is if you did promote from within think about how much more you could do for the profession, and for your association. So let’s just give an example. I’m putting together a course with Megan Mounce on how to help people who have had mastectomy and have dealt with breast cancer and how to use movement and things like that. So you’ve got, you’ve got this individual who has a Bachelor’s degree, who’s an RMT, who’s a personal trainer, who has real life experience, going through something like that. And yet, you’re not utilizing that person to talk about that, and then being able to utilize a person like that. For other people who were there were that’s their interest, where you can almost hire them and be like, we want you to be like a mentor to other people who want to do the same thing. Yeah, right. If we promoted from within more, there’s just so much more we could do.

Eric Purves 37:32
Yeah, that’s it. I think it’s such a great point, it makes so much sense when we look at it that way that you could write like Sophie. So using Megan’s because we know Megan, and I’m sure of the content you guys are going to put out is is is fantastic. You know, and that’s a big thing now, too, is the the, like cancer recovery, oncology or breast cancer, right? You have a real world experience as somebody who’s had two bouts of cancer, or Anyway, she’s recovered from breast cancer. And has been through that process. And as well as she’s, you know, she has all these other personal life experiences. She’s really well educated on the topic. Like she would be somebody that’d be fantastic, too. Yeah. And so, no, or, you know, can we blame the arm TBC for not asking or they might not know, but they may all but they also don’t have like these other associations. They don’t have. They don’t request they don’t put requests out there. No. Right to like, they don’t they know, there’s nothing that we ever received. I’ve never signed anything like, Hey, you want to present? You know, we’re doing a thing on rehabilitation? And, you know, we’ve helped pay for your education. So, you know, why don’t? Why don’t you come present? Or, you know, or like, they’re like, Oh, hey, you know, we were looking for for people. You know, I’m sure if they have a team of people they find to look for, why don’t you if you’re doing a thing on rehabilitation? Why don’t you ask like, why don’t you put a thing out there and be like, Hey, we’re looking, we want to include something on breast cancer. And I see they do have a talk here on it. But maybe you have a couple different presenters on that topic. Right, rather than just one, and then all these other things that doesn’t really tie together? No, like, I don’t know, for somebody that if I was organizing a conference, it would, they would have more of a theme of rehabilitation is so vague. Yeah.

Jamie Johnston 39:23
Because it can be any 10 different directions. Like, like, I think tobacco point you said was a couple years ago, they did that oncology conference where they brought the folks up from here well to present which they did a great job presenting, but then if you can have somebody like Megan and somebody else with some experience there to present at that same conference, you know, and you’ve got a you’re talking about a certain population and you’re talking about, okay, how you how can you do rehab with that population or, you know, how can you support their support network, how can you do, you know, five other things with that population of people. So, So maybe it’s more important to this has gone off on another rant, but to make the conferences more about a population, and things within that population of how you can do things to help them.

Eric Purves 40:10
For sure. i That’s such a great point too, because the conference is should be focused on on something specific, I believe it should be based on, you know, the this conference is going to be on oncology, which they did, but then there was something there that wasn’t on Oncology at all. Yeah, you know, or there’s wine like they didn’t want on aging. And there was some stuff there that wasn’t aging, but some stuff that wasn’t and this one’s on rehabilitation. But what is rehabilitation? Like? It’s such a broad thing, like, they got stuff here on, they have a one on pain science and rehabilitation. Okay. It’s one thing, which is important. One on multidisciplinary, you know, you got the breast cancer one. But then you got like this other one on tendinopathy. So it’s, it’s it’s all over the place. I just find that it doesn’t it’s not cohesive at all.

Jamie Johnston 41:10
Yeah. Yeah. That I mean, we pump it up all the time, because we always talk about San Diego paints on it. And granted, every everything that’s presented down there might have a different angle to it. But it always comes back to talking about pain and helping people in pain. Yeah. Right. Whereas like, yeah, rehab, I mean, great, great topic for a conference, but it could be, you know, rehab with athletes. It could be rehab with MBA people, it can be in rehab in the workplace. It could be, there’s so many ways you could go with it. Yeah. Which would be maybe we should put a conference on?

Eric Purves 41:45
I think so I think we do. I think you’d do great job. It’d be Yeah, because it’d be cohesive, because there’s a whole bunch of stuff in here that has nothing to do with the topic of rehab. Yeah. You know, it’s weird. It’s a bit of a disconnect. And for anybody that’s has any experience in kind of marketing or sales, if there’s a disconnect between the message and the content, it people are become unsure of what is they’re getting? You know, I would imagine that some sort of, you know, I guess we’re being probably overly critical here. And, you know, we’re not trying to be critical of the association’s saying how we think this, these, this conference could be done better. Yeah. And how some other ones seem to be better with getting back into focus of r&d, led education. Is that okay, yeah, this conference sold out. But did it sell out because of the content? Or did it sell out? Because it’s because of credits? And that might be I think we already had a conversation with that about getting rid of the credits and how that impact? Yeah. Fashion. I’d be very curious to see if this type of President or this type of conference still sells out? I don’t know.

Jamie Johnston 42:59
Yeah. Well, it’s interesting, because the rmta will rmta Oh, one is a virtual conference. But they, they don’t have credits anymore. So I don’t know what the what the take up is on their conference, like how many people they’ve had registered. But, but obviously, they wouldn’t do it if conferences didn’t work. Yeah. Right. So hopefully, because of the way they’re doing it, hopefully there’s uptake because RMTS shouldn’t be learning from r&d.

Eric Purves 43:29
Yeah. There was a conference a couple years ago, on May, I think it was during the COVID. year, maybe just before just before. During COVID, there was a conference, an online conference that several people in Ontario did, and it was for charity. But they had hundreds of people, but it was all RMTS presenting. Perfect. And it was like it was cheaper. Like, oh, it’s like 50 bucks. I think all the money went to charity. And none of the presenter has got a penny. But it was great. A great conference and extending it was all warranty. focused and really well attended. And I thought it was a great idea. I think it’s a great idea. So it isn’t being done out there. It’s just doesn’t seem to be focused here where we live.

Jamie Johnston 44:14
Yeah. Well, maybe we’ll have to change that. And but

Eric Purves 44:18
yeah, you know, yeah. Could be could be. Anyway. So RMTS leading r&d is what we’re looking for, is we’re advocating for, you know, sounds like we whine and complain a lot, but I think it’s just because we want better.

Jamie Johnston 44:29
Yeah, it’s, I mean, literally, every the whole reason that we even have this podcast is just to build the profession up. It’s not about trying to complain about other people and what they’re doing, even though it probably sounds like that sometimes, but But really, we would just want the profession to move forward and we want the people in the progression to move forward. You know, we need more people to be presenters. We need more people to share their knowledge and share those things that they’re interested in so that we all get better Look, I know you and I have had conversations before, and I’m like, I will forever be the team guy. And I think the bigger team that we can make of presenters within this profession that are presenting evidence based information. Yeah. And you make that team bigger and bigger and bigger all the time, it’s only going to help

Eric Purves 45:18
you because everybody’s gonna build up everybody else. Right? Yeah. It just makes sense. Yeah. And, you know, it’s, and for someone like myself, who’s I presented it? I don’t know. 10 different conferences, maybe over the over the years. And with all the courses and lectures and stuff, what you do see when you have RMTS, presenting and leading as you do, and I’ve had people, many people reach out to me, like, Oh, I saw your presentation, or I saw your webinar, or I was I was, you know, I was sitting in the front row and asked all the questions, I’ve been really empowered to, to start to wanting to teach her to lecture or to research or whatever it is that they’re interested in. And I’ve since seen many of those people over the years that have that have that have said, hey, look, thank you. Yeah, they are now presenting. Yeah, great. And so if you’re going to help one person, and then that person gets up there, and then they inspire somebody else. And my inspiration for starting to wanting to teach and wanting to present. And all the things that I do now was from that first and you go paint Summit, where I saw all these people talking about stuff they were passionate about knowledgeable about America thinking, I want to do that one day. I don’t know if necessary want to present San Diego because I think that would stress me out too much. Because I like to go there for a good time not for just to enjoy a holiday and enjoy holiday doing some stuff here for a conference. But anyway, I was really inspired by that. And I and I would not be doing what I’m doing now if I didn’t attend that conference. So it’s really, really important. The association’s to realize the power that has great power become comes great responsibility.

Jamie Johnston 46:58
100%. Yeah. And with the amount of members that most of the associations have. They need to look at that responsibility very seriously and take it seriously and build up the people in the profession. I think that’s a great way to end this podcast

Eric Purves 47:16
yesterday and my friend.

Jamie Johnston 47:19
All right, everybody. We’ll see you next time. We hope you enjoyed this podcast. These kinds of topics are what we’re all about. If you’d like to learn more, go to our websites,

Eric Purves 47:31
themtdc.com or ericpurvescom. If you know of any other therapists that could benefit from this, please tell them to subscribe

Transcribed by https://otter.ai

Podcast Episode #27 Myofascial Release And CLB, What Does The Evidence Say?


James Johnston RMT 0:12
You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston.

Eric Purves 0:17
And I’m Eric Purvis. This is a podcast by massage therapists for massage therapists.

James Johnston RMT 0:22
Our objective is to simplify how to be a more evidence informed practitioner. Let’s dig into this episode.

So often said that you can’t judge a book by its cover. And I think you could say the same when it comes to research. We’re going to look at a paper today called myofascial release for chronic low back pain, a systematic review and meta analysis. And funding when I looked at it, I just assumed that they would be trying to point out wonderful and effective myofascial releases. But the paper tells us otherwise.

Eric Purves 1:04
Yes, I liked that. The, the title kind of brings you in, I use that as a manual therapist, as massage therapists, you’re like, okay, my apologies, chronic low back pain, all of a sudden, my, my alarm bells were up and I was like, Oh, I’m going to tear this paper apart. It’s going to be crap. You know, my bias was coming into effect. And I was like, oh, no, you would send me you’d send this you’d found this paper and send it to me. I thought, Okay, well, let’s just let’s just see what it has to say. And I was pleasantly surprised. There’s a few things in here, which, you know, I didn’t agree with it. I’m sure you as well. But I was pleasantly surprised how they went about it. And the findings that they came up with? was not what I expected.

James Johnston RMT 1:44
No. And it turns out, I did confirm my bias as I read through it.

Eric Purves 1:47
Yeah. Yeah, yeah. I mean, it basically, you know, you know, slow, stretchy skin techniques to the low back aren’t as wonderful as some people claim. But there is some positives, and there’s some nothingness of this. What is what did it find, though, is lost or is never mentioned in these studies? And I think this is the problem with these type of studies like this, like these quantitative studies, where there’s like, assigning value or numbers to things is there’s no qualitative aspect of like, what does this mean to the personally, the person getting the most is going to put into this air quotes MFR treatment for the low back? Do they value that? Or do they value exercise? Or do they value rescue? They value medication? Do they value that type of massage technique? Or like, what is it that they want, because when we’re looking at these kind of patient centered care stuff, you know, all these buzzwords we hear all the time. And that’s really the way things should be going as person centered care. If someone comes in and you give them this, like slow, stretchy skin, technique, of varying forces, whatever feels good for you, and the person receiving it, you know, we say we call that myofascial release is the person value, that is what they want.

Jamie Johnston 3:05
Yeah, yeah. And rarely,

Eric Purves 3:07
that makes a big difference in terms of the outcomes are going to come because you can’t, you can’t force somebody if something they don’t want and expect them to get better. Yeah.

James Johnston RMT 3:15
And like to go along with that, it’s they also never mentioned anything about contextual factors of treatment, the interaction between therapist and patient, the, you know, all those other things that we know, matter so much. And granted, in this case, because it’s systematic review. You know, they’re just looking at all the papers that have been done. And so it’s not necessarily necessarily their responsibility at this level of the research to, to look at that. But at the lower levels of the of the research of the papers that they would have looked at, they it’s still not talked about, none of those things are, are taken into account. And, you know, it’s not talking about the confidence of the therapist and doing those techniques, compared to one that they don’t like, right, and so, even though it’s, you know, one of the things they looked at was myofascial release versus Sham, and I’m not sure what the sham was, but, but it still showed that, you know, it wasn’t getting better. So, so it’s, you know, I wish that they would start doing research papers to take all of those things we just talked about into account as as part of it.

Eric Purves 4:20
And that’s the thing that that I find is seems to be a problem is they keep on doing these studies, and people putting these papers when they’re looking at the same thing again, and again and again. And again, you think, why do you like and then they always a conclusion always is more research is needed. But why don’t you do the other research as needed rather than doing the same research again? I mean, this is this paper was done at universities, some china and Italy looks like this where the researchers were, and it was just done last year, and it’s just time Yeah, July 2021. So it’s relatively like it’s a newish like a very new study. But you have to keep putting these resources and times into it and you’re studying. Myofascial release for chronic low back pain. And I think this is the problem with this, when you call things like this, it tends to probably add more validity to the term myofascial release than it really deserves. Because if you’re doing myofascial release, and someone can be like, That’s what I do, I guess why I call my technique. And I think, you know, myofascial release sounds nicer than slow, stretchy skin technique, if you know, for sure, probably triple s t technique. But the problem is, is that it’s inferring that you’re making that you’re like imparting change, or you’re like creating change in the muscles and fascia. Yeah. And that is and that and in order for that to be true, that has to be validated first. And we know that from other studies, that your manual techniques don’t actually create long standing changes in that tissue. Yeah, through the mechanisms proposed, proposed, right. So we know it’s, there’s this neurophysiological things which have these more reflexive effects. But that’s, that’s, you know, when when you’re using it, you’re myofascial just, it makes a lot of assumptions, right. And it, I think it creates this idea that tissue needs to be addressed in a specific way for a specific problem in order to get results. And you know, and there’s a lot of assumptions made about how this works. I think in the paper, they talk about, like changing this visco elasticity of the fascia and increasing blood flow and, you know, increasing neural function through like opening space, creating space from I can’t remember. Yeah, the like, Okay, well, that’s a lot of assumptions. Those are assumptions. Those are not science facts. Those aren’t those are hypotheses or theories,

James Johnston RMT 6:47
which was, which is what a lot of the myofascial release research has been based on.

Eric Purves 6:54
Yeah, and even in here, and his paper when they talk about near the end when they’re there, and we’ll get to there. And when they talk about the, you know, how this is supposed to work, they’re using old research, which isn’t even, like, physic neuro, are there even physiological anatomical studies, really, they’re like, just old, like ideas by like, SCHLAPP. And our, you know, and just just going like, Okay, well, these are ideas, and they helped us get to where we are now, but those ideas are kind of not fully complete, we have

James Johnston RMT 7:25
to put those in them are completely wrong. Yeah, we have to put those away now, and, and go with, you know, start looking at the stuff that Bilasa T is doing. And that’s the more modern interpretation of what’s going on, right. So that’s the stuff that should be included in their paper like this, when we’re talking about how things work. And interesting, like, towards the end of this paper, or even talked about, like, looking through all the papers, they couldn’t define one specific technique that was used, it was all different myofascial release techniques that were used. So they can’t, It can’t even be narrowed down to say, you know, doing a hold on the area around the QL, for X amount of time in this direction, was is the way to do it. Because there were so many different styles that were used, that they couldn’t pinpoint that. And kind of funny to go with that because I just was looking at a paper recently about manual lymph drainage. And they were trying to say that manual lymph drainage works. And then when you read through the paper, all they do is say we did general Swedish massage in that area. So they weren’t doing MLD technique. They were using Swedish massage and saying manual lymph drainage works. Wow. Right. So so so that’s, that’s like one of the big issues with all of these modality based or technique based things is that there, there’s nothing concrete about it. And the more that we understand about how things work, when we put our hands on people, we can realize that none of these are all outdated ideas and theories that should really be

Eric Purves 9:03
put to bed. Totally, totally agree with these things to what you see is, you know, all these studies, like all these manual therapy studies, right, they all kind of show doesn’t really matter what you do, you name your technique. And they all show that you’ll have a short term decrease in pain and maybe a little bit of increase in physical function, depending on how those are measured short term, but doesn’t matter what these myofascial release are cranial sacral or Swedish or anything else, they all kind of show the same thing, which I know some people might who are listening maybe people who listen to this podcast before and like oh my god, these guys are who are they? They don’t know what they’re talking about. We promise has a million times the last thing on the podcast we’ve done now 2530 of them something like that. That it’s it actually should be empowering to us because it means we have more opportunities. 100% And it doesn’t have to follow the specific protocols and in the courses that we teach together or individually, you know, we always talked about that like, it’s just like, beaks, explore, be curious, find something that feels good that you like to do that the person likes to do. That’s, you know, harder, softer stretch, your faster, slower doesn’t matter as long as it feels good to the person, that’s the person centered care. You don’t have to worry with these very specific interventions. And I know that people are that, you know, are gonna argue that, but that’s okay. You can argue that all you want, like, there’s not the data sport, you may have your clinical experience to support it. And I would never argue with clinical experience. But the reasons why you’re getting those results from your clinical experience are probably very different than what you think. Yeah. And this is where we have that ethical obligation as healthcare providers to to be less wrong. Yeah. Don’t claim you’re releasing fascia.

James Johnston RMT 10:46
When we know that that’s not possible.

Eric Purves 10:50
Exactly. But you can make people feel good doing those techniques. Yeah. And that’s, I think, where the the discussion gets bogged down a little bit.

James Johnston RMT 11:01
Yeah. Funny enough, you know, the discussion that we were involved in offline this morning was something around, I think the term was used, elitism. Where, you know, people that are, you know, they’re discussing things with physios and things like that. And there seems to be this manual therapy elitism. And, and as I was watching some of the comments around that, I was like, Well, you know, people could probably point at us and say the same thing. Because we’re pushing so much for evidence based care, there’s probably a certain population of massage therapists that look at us and go, Well, these guys are, you know, they’re, they’re trying to be elitist in what they’re doing. But it’s, it’s just not the case, we’re just trying to bring the education around what we do. So this sort of a little bit of a tangent off track there. But you know, it’s a podcast. But it’s, you know, I think we just got to be, be careful when we’re, you know, when we’re interacting with other therapists and things like that. And like you said, there’s probably lots of people that listen to this, and these guys are idiots. They don’t know what they’re talking about. Because we’re looking at this stuff and trying to get rid of those old narratives. So, you know, we just probably want to get across that we’re not trying to be elitist about anything, we’re just trying to bring forward the most the most up to date information about the things we do in order to help other therapists.

Eric Purves 12:26
And I think that what happens sometimes is that, you know, I know, we’ve seen people before, I’ve seen have said things like, oh, you know, I’m tired of the myth busting. And, you know, I don’t believe that when you we educate, we just spend so much time busting myths. And I agree with that to some way. But the problem is, is that having been teaching CCS for so many years now, I’ve done them over 100 plus times, when you experiment to try something different, and you don’t do the mythbusting aspect of it, things go sideways, because people don’t know what you’re talking about. Yeah. And so

James Johnston RMT 13:03
as well as, as long as the myths still exist. Yeah, we have to do something about that.

Eric Purves 13:10
Yeah. Yeah, and I would say we do way less now than we used to, I used to spend so much time on it, but I just kind of got like, well, you know, I’m just kind of tired of doing it, because been doing it for seven or eight years now. And you think, how many more times do we need to do these bust these myths like these things are, but they’re still there, and the society is still there. And the profession? So yeah, we maybe would call there’s a term myofascial release. And it’s like, Oh, my God, I’ve heard these guys say this a million times. But the thing is, is still the common narrative is still the common idea within the profession of what’s happening. And there’s this like, higher level of value assigned to certain techniques over others. And, you know, I don’t think yeah, we’re not trying to be elitist. We’re just trying to say, look, we spent it, this is what we do for a living. This is like, we read this stuff, we talk with the stuff, we teach this stuff, you know, and we’re trying to change the profession to be more evidence based, be more up to date, because we don’t make these changes, then we’re gonna be left behind. And I think that we don’t want to be left behind. We want to be seen as leaders, like we know we can do we can be leaders that MSK care. And, you know, we made that comment before and of course, we be leaders and we’ve had people be like, Well, I don’t think it’s fair to put down other people or other professions where that’s not what we’re saying. But yeah, why would we not want to strive to be the best set like hands on and movement based musculoskeletal care? Why do we not want that? We can do it is within our scope? Yeah. Yeah. And then the also to sorry, I’m gonna go on a tangent here. Now just thinking of like, previous like courses we’ve taught and other podcasts we’ve been, haven’t necessarily been ours. Where people hear us terrible things. Like I think we made some discussions and some stabs at the importance of the psoas muscle on someone else’s podcast, thinking practitioner, maybe In the last pod, yeah, we talked about that. And then we got, we got some, like, from this one listener and got some very kind of like upset emails. Yeah. Basically saying that, you know, you should be better than calling out this stuff. And, you know, it makes it sound like you’re like you’re, you think you’re above everybody. And we’re like, no, like, that’s not we think at all. We’re just talking about this stuff, because this is to what we hear all the time. Now, it was a while ago, I can’t exactly remember the context of that. Maybe you might remember, but I remember thinking people hear what they want to hear. Yeah. And, and if you say something that makes them feel uncomfortable, they oftentimes will come at you as trying to be elitist or being trying to make yourself feel superior or making trying to make others feel dumb. And there’s never that’s never my intention was the intent. And so sometimes, maybe if people feel that way, I’m like, Okay, well, maybe I could have said that better. Maybe we could have had that discussion better. I don’t know. But or maybe somebody you think, well, maybe, maybe that’s, maybe that’s you listen to the listener, which I like. Because not everybody feels

James Johnston RMT 16:06
that way. Yeah. And we’re not going to be able to make everybody happy. No, right. There’s always going to be somebody who, and everybody has the right to take things the way that they want. And that’s fine. But, you know, but I think it really comes down to like, when people get their beliefs challenged, is is typically when we get that that kickback. Right? You know, I, we could go that’s a whole other podcast we could talk about. Sure. Yeah. You know, and I’ve been, I’ve been doing some, some learning and some reading around that lately. And it’s some really interesting stuff about how the brain always switches to a safety mechanism, even when it comes to that stuff. So when those beliefs get challenged, you know, it’s an automatic automatic reaction for the person to get upset and pull back and be like, no. So, you know, could we have done a better job of trying to change the opinion of somebody? I think we’re, I think we’re doing our best and, and all you can do is do your best. So if people can be offended, that’s okay. But we’re, we know that there’s other people and there’s people in the population that we’re helping, because because those narratives are getting changed.

Eric Purves 17:20
Yes, yes. All right, you want to

Unknown Speaker 17:25
paper after that ramp?

Eric Purves 17:26
Yeah. We shouldn’t, we shouldn’t go put it like thing. Fast forward 15 minutes, and you actually hear the paper.

James Johnston RMT 17:34
So one of the things that that I looked at with it, and I’ve just got the paper in front of me, so I’m gonna have my head down reading but is when they looked at the when they were selecting the papers they were going to look at and they looked at the comparison, they looked at my alpha myofascial releases versus sham myofascial release versus exercise, myofascial release versus exercise, myofascial release, and exercise versus exercise, myofascial release and spinal spinal manipulation versus spinal manipulation alone, and myofascial release and phys ed physiotherapy program versus just a physiotherapy program. And really interesting when they looked at the outcomes, the outcomes weren’t any better. Let’s just myofascial release, so and, and that was strictly just looking at pain, and doing like the disability pain questionnaires and things like that. But it wasn’t any better. But then when it looked at things like that, what really stood out to me is like physical function and mental health. And when they looked at things like that, so what really jumped out to me was like kinesio phobia, when they’re looking at mental health that myofascial release did not help at all, when it came to things like that. And, and when we look at it, it’s like, well, especially with something like kinesio phobia, how could it possibly help? Because, you know, that’s fear of fear around movement, that it’s going to cause more pain. So how would somebody laying on the table being passively touched, have any effect on that whatsoever? And that’s one of the big reasons why we need to incorporate more movement into the treatments that we do in order to help with that aspect of goals.

Eric Purves 19:04
Oh, for sure, for sure. And I think with what I get from from this, just from the very kind of like, general aspect of it is that, you know, six, manual therapy or myofascial release, right, it works for pain, and it works for certain types of function. And depending on the studies and how they measured it, but everything else kind of works, too. So, you know, it’s I think this goes back to that initial statement we made were like, it really depends on the person wants. Yeah, and what’s gonna work for them. You know, the one thing that I find is is you see a lot in the musculoskeletal literature, which I find to be, I don’t know, almost lazy research is that they do with like a plus b, right? So you look at myofascial release and spinal manipulation versus just spinal manipulation, myofascial release plus physiotherapy program versus physiotherapy program, you’re getting two interventions to one. So maybe two interventions are getting more care and more is being done to them. So oftentimes, what you see as those studies will produce better outcomes than just one thing alone. Yeah, to make this, you know, to make myofascial release as that technique to be seen as more validated that you’d have to compare that with another similar technique.

James Johnston RMT 20:31
Yes, so say you did myofascial release versus cranial sacral? Sure, yeah. But

Eric Purves 20:38
or myofascial release versus general Swedish or, or maybe just myofascial release versus spinal manipulation? Yeah. Or myofascial release versus, you know, dry needling or you’d see like, you know, intervention, you know, comparison, what are the outcomes and see which one is better? My assumption would be based on the data I’ve seen for other things is they’re kind of the same.

James Johnston RMT 21:01
Yep. And then be interesting to if they if they did a study that way, if they were to say, taking 100 People who had low back pain, and before they got there, say, What do you prefer acupuncture or hands on technique, and they put the people into the things that they thought would work better, and then see what the outcomes are? Yeah, I think that we’ll show them the opposite one, and see what the outcomes are.

Eric Purves 21:25
Yeah, Mark Bishop and his research group in Florida, they did something like that with it with acupoints. Like, they put people into different clinicians who had a different preferred way of treating spa money for the therapy or exercise. And then they, they just randomly allocated people to the treating clinicians, I could be wrong. And this I’m probably telling someone, if someone knows the studies they’d like, yeah, you’re wrong. But general idea. And what they did is what they found is that when they ask people afterward, are they the people treating the clinicians treating, didn’t know what the person’s preference for treatment was? Okay. Right. And so the clinician got to be able to do a treatment on somebody. And then afterwards, what they did is they I believe, they looked at the data and said, Okay, these 50 people got spine, we have a therapy, these 50 people had a light touch, or an exercise intervention came out it was, what they found was, if I remember correctly, is that when those people that one of those people that were given spinal manipulative therapy, if that’s what they liked, and that’s what they preferred from, and then the provider loved that was their preference and confident with it. And those things matched the person reported better outcomes, which goes with kind of with what we’re saying here is if the person values it, and I should values it, you’re gonna probably get better outcomes than if neither party does or if one party values and the other one doesn’t. Work, which, and there’s a bunch of other studies on that. That’s just the one that comes to my mind. I think that was one the first ones I read years ago, and maybe we didn’t have a podcast about that, cuz I’m probably bastardizing. The

James Johnston RMT 23:11
Yeah, we should find that paper and look at it be cool.

Eric Purves 23:15
Yeah, I haven’t someone. One thing to just when you’re talking about the manufacturer is one thing I wanted to just mention, which I thought, this is the thing that I think is something that’s very problematic for people that are reading study. So if you’re reading the studies, have a look. And if you see these type of statements, make sure you read the references that they’re coming from, because one study or that they talked about in the introduction, it says, Previous studies have found that the psoas muscle fascia may be related to chronic low back pain, that all of a sudden for me, I thought, Really, okay. And then so I went and read the other two papers that they took that reference from and what the author’s said that the conclusions. And then the conclusion is where we see changes in connective tissues and people with low back pain, this could be either the cause or the effect. So all they’re saying is that when you have low back pain, it looks like all the tissues that we’re attaching are round to low back. We’re different than those who didn’t have low back pain. And so that’s a big leap to say the psoas muscle fashion is contributing to it. Yeah. Can you be and then the author’s go on to say, and there’s other studies that, you know, when people have chronic low back pain, they’re different motor control? You know, I think a lot of them had were heavier, they might have been, like, heavier people will be in my mind might have been bigger or less active, that kind of thing. And so, you know, maybe the changes that we’re seeing because they did it all through ultrasound, or not causative, but maybe they’re a response to being in pain for a long time. And that’s what other studies I’ve read, too. So I think when you see these kinds of statements like so as muscle fashion, maybe related, well, those those authors didn’t Let’s say that they said they see a change there. It didn’t say it’s necessarily causative. I think that’s, that’s a, that’s something that we need to be very mindful of when we’re reading these papers is that these kind of bold statements, go check the references and see what those references have to say.

James Johnston RMT 25:13
Yeah. And whenever I read something like that, when it says, the psoas muscle may be a contributor, that that to me isn’t a, that doesn’t tell me that the source is a contributor. That when whenever it says May, I’m like, okay, that that just means that there’s a possibility. It doesn’t mean if it’s not a for sure thing. So, you know, just when you’re reading it, to me, anytime that it says it may do this, isn’t it’s not a be all end all. It’s a, you’re referencing a possibility, not a not an absolute.

Eric Purves 25:44
Exactly. Exactly. And yeah, if you familiar with some of the debates about the fascia, rather than so as muscles relevance, I think

Jamie Johnston 25:54
we have a whole other podcasts that sort of motivate a whole podcast

Eric Purves 25:56
on that. And TJ did a big and I think human image Austin might have done a Facebook Live on that maybe. Anyway, yeah, it’s been that’s been beaten to death. So

Jamie Johnston 26:06
yeah, so we don’t need to be

Eric Purves 26:09
talking about that too much. But it was just something I think, people if they’re listening, make sure you check the references, the references, if something seems to be a bold claim that doesn’t resonate well with you see where they came from?

James Johnston RMT 26:19
Yeah. So it is really mean. Like I said, this paper confirmed my biases. But it goes through and talks about physical physical function, quality of life, balance, function, printing, pressure, threshold, trunk mobility, mental health, all these other things that they picked apart with the information, and it still showed that myofascial release didn’t have much of an effect on any of it.

Eric Purves 26:46
No, that’s something I would I would I would love to see is that they did talk about it. And if you looked at some of the other studies, the researcher they did they usually analysis, they looked at myofascial release, and how often people got it, and how long the treatments were. And that was quite very, they used the treatments, I think, or somewhere 40 minutes or so. Yes, as your 40 minutes once every two weeks or 40 minutes once every three weeks or eight weeks, some are 40 minutes each once every two weeks for two weeks. My family six times in total. But they don’t actually describe what the author or what the clinician did. Like what was what are you calling myofascial release? Like? How are you? What’s the is it the same for everybody? A same protocol in person centered, like what what techniques are you doing? That’s the kind of stuff that would be really important for us as massage therapists to know. Now, we don’t want to follow a cookie cutter recipe approach, because that’s boring and lame. But it would be nice to know if they’re like, Yeah, we did this technique. And maybe it was just like a slow hold, you know, for two minutes. Yeah.

James Johnston RMT 28:01
Well, that’s like what I was mentioning before, just to back up, what you’re saying is right, right, at the end of the paper somewhere, makes the statement that they couldn’t they couldn’t recreate it, because they didn’t because it was all different styles of myofascial release that were being used. It was all different techniques. So

Eric Purves 28:18
yeah, exactly.

James Johnston RMT 28:21
And it’s kind of funny, because you know, this, this probably sounds like we’re picking on myofascial release as we discuss this. But you could probably take any manual therapy technique and put it at the title of this, and it would still apply the same way.

Eric Purves 28:36
Right? Yeah, I think that what you see, what I seem to see is because myofascial release is something that, you know, it’s for some reason we’ll have for whatever reason it is it’s, it’s a term, it’s a treatment style, it’s very popular in the world, and, you know, we have fashion everywhere. And so let’s try and manipulate it. And when we do these techniques, they work and so you have clinical experience of like, hundreds of 1000s of people and clients that are respond well to it. But yeah, you there’s so many different ways of doing it. And there’s so many different ways of touching and moving and manipulating people that how could you ever say that one is right and one’s wrong? Obviously, the one way is better than the other. And that’s, I think it was one of the problems that we see with this stuff. And but because myofascial release is so popular, and it does and they do saying here somewhere that, you know usually involves holding for like 100 to 300 seconds. Right? And so, and then we’re like and they’re like and then people feel better. But then if we look at what some of the neurophysiological things that occur with the slow, sustained stretch techniques, and when you put that force into tissue, we do see that there is an anti nociceptive effect through activation of a variety of things, but one of them being I believe it’s Ruffini corpuscles.

Jamie Johnston 30:03
Yep. Pressure receptors, right?

Eric Purves 30:05
Yeah, I think it’s really so and so and so I can’t remember I should know, when I teach this stuff I should know if I’m mad, but I’m tired. I just got back from vacation. So my brains a little bit. When you do the slow stretchy skin, Teddy’s a certain receptors in the skin and upper layer of the connective tissues that do actually slow down noxious stimuli through the spinal cord. So that’s why people feel better after a massage, right? It doesn’t have to be necessarily that slow, sustained one, but from what I’ve read before and other neuro physiological studies is that when those things are held for a certain period of time, they become more activated. And that’s going to create a larger antinociceptive effect. So maybe myofascial release isn’t changing the fascia, maybe it is more likely being that you’re activating these receptors, which is changing the sensory input that your bodies that your spinal cord in the brain is receiving. That, to me is makes more sense because we can measure that.

James Johnston RMT 31:02
And that’s how, that’s how every technique works.

Eric Purves 31:05
And so every time Yeah, so that’s a, that’s something I really wish that we would embrace as a profession, rather than chasing all these these techniques.

James Johnston RMT 31:15
Well, I I was having a thought the other day. And this can this can go back to that I was writing a blog post about it. The the whole thing where we will get our beliefs challenged. And I was thinking, Well, what if, what if, when we were in college, we didn’t actually name any of the technique courses? It was just called manual therapy technique. Class one. Yes. And then we had equal amounts of classes in research and exercise. And we did two manual technique courses. So what if we had five classes on how to do a massage five classes on some exercise and five classes on some research? And all we called all the classes were massage therapy technique, manual therapy technique. Yeah. Then when we got into school, we wouldn’t run into this whole identity thing where it’s Well, I’m a myofascial release therapist, or I’m a cranial sacral therapist, or I’m a general Swedish massage therapist, or I’m this and that, it would be just a manual therapist. And then it wouldn’t be so daunting when those beliefs get challenged. Because the beliefs wouldn’t be there for the most part, right?

Eric Purves 32:33
Well, because they’re put in there by school, or any, you know, thing I’ve talked about before is that the what you learn in school forms the foundation for what you’re how you’re gonna practice. And it’s very hard to unlearn those things. And I agree, I love that idea. That if we could just stop naming these techniques is like the special thing, but teach a variety of those techniques, but teach them under like a general manual skills thing. Use those techniques to work with specific populations. So teach people some manual skills. Well, here’s some different ways this is, this is like what we would normally call Swedish massage, it’s kind of long or slower or faster. Yeah, sliding and gliding techniques. And there’s ones over the stretch here, ones and ones that are maybe a little more specific, maybe you want to use like your thumbs, your fingers, your knuckles, your elbow, whatever, you know, here’s ones that are maybe a little more pressure. And here’s what’s more, like, maybe you’re doing some trigger point type things with little more pressure in a certain spot, or whatever that looks like, you know, like get people to teach everyone the skills and how to touch because that’s really important. And that’s what I think separates us from other MSK professionals is we do as a profession have our touches is better in terms of that, because we do all day more experience with more experienced patients like betterment, and we’re more experienced with it. So but yeah, just so that we you move away from all these different name techniques and creates people to kind of pick and choose what they want to do, rather than just gravitating towards a specific way of thinking. Yeah, and you could easily do you could be here’s to all these populations that you’re going to treat. Here’s a class on geriatrics. Here’s a classroom class, no sport, here’s a class on, you know, surgical rehab, you’re the one on like, I mean, we do I do anyway, did some neurological stuff. And all this stuff was very, it was kind of very, it was quick, quick, and there wasn’t really a lot of thought process. It’s like, well, I can use these techniques and use these techniques for this person. Yeah, but you don’t really have to think about it. I mean, I know some schools probably do a better job than than others. But when we went to school, you were really taught to think you were taught just to basically copy and paste. Yeah, yeah.

James Johnston RMT 34:37
Yeah. What was it the neural stuff was like roots techniques and things like that. Yeah. And

Eric Purves 34:42
a couple other other other technique, things that you learned, but the focus was always on technique, technique, technique, and it was never enough on like critical thinking or interaction or how would I communicate with this person? How would I explain to them what’s going on? They’re gonna be like, Why do I hurt what’s going on? What are some strategies that you can use that aren’t like pathway anatomical tissue blaming. Unless there is a tissue, you’re injured, yeah, yeah, there it is inflamed here that’s going to take, you know, for six weeks to recover, like just to learn these basic things, which we do in clinic. But I find that when people come out of school, they’re not given that they’re just given a visit to basic. Yeah. And I think that can result in more. Not not the total

Jamie Johnston 35:27
results and what we have now. Let’s, it results in what we have, though.

Eric Purves 35:32
Yeah, exactly. Exactly. So yeah, that would be that’d be nice to change those techniques. And I like that you brought that up? That’s good.

James Johnston RMT 35:40
Yeah, I’ve been looking at a lot of stuff about that whole belief system thing lately, and I’m trying to make change. So yeah. Yeah, some thought reversal kind of stuff.

Eric Purves 35:54
For sure, ya know, as important stuff, right?

James Johnston RMT 35:58
Well, I think we beat a lot of that to death. But I think getting towards the end of the paper, it also pointed out, there was like five or six points that it made about, basically why the research they looked at wasn’t good. Which is important to take into account. And some of the things that they pointed out is like, a lot of the papers didn’t have long term follow up with the patients to show whether the whether the pain relief or whatever lasted for them. You know, it talked about like, it didn’t include things about disease duration, how long this has been going on for them. The risks in terms of randomization, so there was like, a whole list of things that he pointed out by there needs to be more research done on this stuff, because the research we have isn’t good.

Eric Purves 36:46
Yeah, they said that the quality of evidence to was only the best, it was moderate. And that was for pain, and physical function, which is what they that was what they said the conclusions were from the data that painted physical function is the best thing for that we can say myofascial release does, based on the current data we have, all the other stuff was low or very low. And the but there’s only moderate. So it’s not like high quality level of evidence. So it’s like, less. So okay, it’s not great. But that’s seems pretty consistent with what you see most other any type of manual and massage therapy, literature’s the outcomes can be monitored, at best for short term. And we all know clinically, right? People come to see us they leave, they often will feel better. And

James Johnston RMT 37:33
it’s, there’s so many things that go into that more than just us putting our hands on them.

Eric Purves 37:38
Exactly more than just the technique. Right? So yeah, what I did like, though, in his paper, there was they did say, you know, when they’re talking about the limitations and talking near the end, right, they’re talking about, like, they say, you know, integration of sensory information, central nervous system processing, neuromuscular activity, and they start using a lot of appropriate receptors, the overall adjustment of the nervous system, they talked with all this, they started talking about all these other things that occur. So it’s funny, it’s just funny to me that they, they started paper being like myofascial release is supposed to do these things. And then when we go to talk about the outcomes, and the things that, that you see in people with, you know, when they’re looking at their measurements, like these are all the things that we see in proprioception, sensory challenges and this kind of thing, and you’re like, now they’re talking about neuro physiological stuff, which I feel like they should have been talking about it earlier, when they kind of were building the background.

James Johnston RMT 38:36
Or when the it’s funny when they’re building that that background part, the part you’ve commented on a couple times, it was like a long couple paragraphs where they were basically saying, This is what the papers say myofascial release does. And then they went through and I, honestly, I kind of glossed over a bunch of that, because I’m like, No, it doesn’t do that. But they were referencing what the papers say and then, and then get into what manual therapy actually does with this stuff. You’re just talking about the neurophysiological input and things like that. So it’s good that they came around to almost correct that part of it.

Eric Purves 39:10
Yeah, which made me feel feel happy with the two and and they did say yeah, like, it kind of has short term impacts, but sounds great. It’s gonna be better than much else that’s out there. But they did say, you know, at the end, too, which was just great. As I said, future randomized controlled trials should strictly limit interventions and reduce the use of combination interventions, which is what we’re saying earlier, like the a plus b, right? You do this and this, versus that. So just do like, a single one to see is this type of treatment. And you can you can you put that, can you quantify that Troodon? Or can you put it into like something like, this is something that we’re going to deliver, like this is how we’re going to do it, which I know isn’t very person centered, but if you wanted to see if a technique work, it has to be standardized. Yeah. Like do you have to like this is what we’re going to do for all these people that come in, at SCORE whatever it is on this Back Pain measure? Yeah, and that we’re gonna do this very specific protocol, and we’re gonna see what happens. Right? And you probably the results probably aren’t gonna be great, but at least you, you know, they’re not gonna, it’s not gonna be like, Whoa, amazing. We’ve, you know, found the cure. But it’s, it’ll, I think that’s what the better way of doing you say. So we can say, Look, this type of technique can help or the technique type per technique, man doesn’t is. That’s what we like to do. Go ahead and do it, which I think is what I got from this. If you’d like to do it, go ahead, do it. It’s not going to be the be all end all the works for you, of course, people who come to see you, then it is part of the overall treatment plan.

James Johnston RMT 40:37
Yeah. I mean, the other thing that I take from papers like this as well is it really reinforces to me why the clinical guidelines of MSK care or education reassurance movement and some manual therapy, right? Because we know that reassurance and education plays a huge role in the mental health and the functional aspect of things. And then, of course, so does integrating the movement into things because of things like kinesio phobia, and, you know, other issues that that people have. So it really reinforces to me why manual therapy is the thing at the bottom of the list, and why those other things are more important, because it shows that the technique alone doesn’t really do a whole lot, by comparison with pain and physical function and all these other things. It’s a piece of the overall

Eric Purves 41:25
puzzle. So yeah.

James Johnston RMT 41:29
So I think to kind of wrap it up, and to go back to what you were just commenting on is, if you really liked doing myofascial release techniques, and your patients like it, continue to do them. But the problem is that we just need to change the narrative around it, we need to stop telling people that we’re releasing fascia, we have to, you know, change those things and start talking about, you know, inputs to the nervous system and how things actually work. And then of course, start if you’re not already start into integrating more movement, education and reassurance as part of your treatment plan with your people.

Eric Purves 42:05
And people feel good to catch on when it feels nice, as we always say, TPN touch people nicely, that can such a subjective thing, right? That’s totally different for everybody. So it doesn’t mean you have to be super gentle, it doesn’t mean you have to be, you know, it doesn’t mean don’t touch them, it just means fine touch that feels good. Make them feel good. Give them movement, if they value moving to find them to do something that they that’s important to them as well, because yeah, that’s the a plus b right there. If they can do something else as well, or when they’re not in a treatment with you, that’s gonna be in most of the population, that’s going to be

James Johnston RMT 42:37
good for them. Yeah. And make that make that interaction with them meaningful to them. Right, make the make the treatment, make the movement, make the homecare all meaningful to that person, and you’re probably going to have better outcomes than just doing myofascial release

Eric Purves 42:52
alone. And I think what you said beautifully in our last podcast, was he talked about engage in treatment, rather than just give or provide human engagement. So I think I like that I think it plays really well with kind of wrapping up this discussions. Yeah, engage with people and have them, have them have a say in what they want to do like to do and facilitate that for them.

James Johnston RMT 43:13
Perfect, we’ll end it there. Alright, see you next time, everybody. We hope you enjoyed this podcast. These kinds of topics are what we are all about. If you’d like to learn more, go to our websites,

Eric Purves 43:26
themtdc.com or Ericpurvs.com. If you know of any other therapists that could benefit from this, please tell them to subscribe.


  1. Wu Z, Wang Y, Ye X, Chen Z, Zhou R, Ye Z, Huang J, Zhu Y, Chen G, Xu X. Myofascial release for chronic low back pain: A systematic review and meta-analysis. Frontiers in medicine. 2021 Jul 28;8:697986.

Being Of Service, While Still Being Kind To Yourself

Several years ago, I started this blog, and the whole reason was to be of service to my community of like-minded Massage Therapists while trying to educate and lift up the profession. 

Well, the last year has been really tough to do that, and I feel like I’ve kind of let you down as a reader of this blog. 

So, I thought I would share why. 

Like it has been for most of us, this pandemic over the past couple of years hit hard, but I truly didn’t understand how hard it hit me and ended up going through some health issues if any of you were going through something similar, I’d love to hear back from you. 

There were a few big things I dealt with and what I learned about them along the way. 


I was dealing with major bouts of insomnia, and several things contributed to it; and fortunately for me, I live in a part of the world where I could get referred by a doctor and get help with this as part of our medical system. So I was referred to a psychologist who helped me start sleeping again. 

I didn’t know this, but there are two types of insomnia, one where you have a hard time getting to sleep and one where you have no problem getting to sleep; staying asleep is the issue (this is what I had). 

During our sessions, the doctor had me make a sleep log, and we determined that, on average, I was getting about five and a half hours of sleep a night. I’d go to bed around 9:30 and usually try to get up between six and seven in the morning. When I made my sleep logs, there were big gaps throughout the night where I was awake. So, the strategy we used was to “condense” my sleep. 

We picked a time I would like to get up in the morning, so I chose 6:30 am. The doctor counted back 5.5 hours and said okay, then I want you to start going to bed between 12-12:30 pm. Basically, getting myself to the point that I’m so tired around midnight would make sleeping easier to stay asleep. 

We continued to fill out the sleep log, and as the sleep became more condensed, we would start adding 15 minutes to my go-to bedtime. So instead of 12 pm, I’d go at 11:45 pm, and as that sleep got better, then 11.30 pm and so on, until I was going to bed around 10 pm and sleeping much better. 

He also recommended that when getting up in the morning, I immediately expose myself to light as this helps reset the circadian rhythm, which made going to bed that night more inducive to sleep. 

Interestingly he also told me that all the things we are told in the media etc about “sleep hygiene” doesn’t really matter. If you wanna watch TV right until bed, go ahead, and many of the other things we are taught don’t really matter either…except one. 

Alcohol. I enjoy my wine, and I know over the pandemic, probably enjoyed it a bit too much. Now, I was told there’s nothing wrong with having a glass of wine at night, just don’t have any alcohol three hours before bed because while we quite often think it helps our sleep, it actually messes it up pretty good. So avoiding it three hours before bed is a good rule if you’re trying to sleep better. 


I know I’m not alone on this one. 

But over the past year, burnout has played a big role in my life, and my mental health has taken a beating for it. I’m sure it contributed to insomnia as well. 

However, there were a few things to learn with this as well. 

Figuring out the things that are important to you and focusing on those things. 

For me, I know exercise does a lot to help my mental health. Especially if it’s sports like hockey, or golf where I get to hang out with the boys and enjoy camaraderie in conjunction with an activity. Going to the gym was helpful as well, but getting that social aspect helps a lot as well. 

It’s also really important to give yourself a break and be kind to yourself. 

If you’ve been dealing with the same and are wanting to become more productive, one thing that’s helped me is just setting small daily goals of accomplishment. Everything seems so overwhelming most of the time but it has helped to just break things up into small chunks and try to accomplish a little each day, even if it’s just a half hour to an hour of work, at least I’m getting something done.

While the outside pressure of careers etc will never go away, sometimes we just have to accept that we can’t do it all, all of the time. It’s okay to take a break, it’s okay to have downtime, and it’s okay to step away from some things if you don’t have the capacity to do it all without beating yourself up about it. 

A Break-Up and Mental Health In General

As I know probably happened to many, I also had a good relationship come to an end. 

So taking into account insomnia, burnout, and, more recently, the end of a relationship, my mental health over the past year, as I said, has taken a bit of a beating. 

BUT, I came to learn that it’s okay to ask for help. 

I think all too often in our career we don’t ask for help. We are considered the ones people come to for help, but how often are we asking for help ourselves?

Yeah, we see posts online about “self-care” which is usually followed by suggestions for yoga or some other thing (not that there’s anything wrong with these suggestions), but how often do we really ask for help regarding our mental health?

We have people come in every day, lay on the table and vent about what’s going on in life (yet it’s suggested we don’t influence mental health at all), and quite often, we take some of that on ourselves. But how often are we talking about it? 

I’d venture to guess not nearly as much as we should be. 

So I’ve started having regular counselling appointments so that while the gym and sports for me is beneficial, especially for my physical health, it’s time to really start making mental health just as much of a priority. 

Now, I didn’t write this article to gain sympathy or anything like that, I don’t want that. 

I did it to highlight the need that we as healthcare professionals need to recognize our health is just as important as the people we are helping. To show that it’s okay to talk about it and that yes, sometimes WE need help, and it’s okay to ask for it. 

As I mentioned at the beginning, I started this blog to be of service to my community, so if you’ve been dealing with anything similar, I hope you know you’re not alone, there are probably more of us dealing with this than we care to admit. 

And if there’s some way I can help you, please email me and know there’s someone on the other end who’s going through the same but still pushing forward.


Podcast Episode #26 The Biopsychosocial 40 Years Later


Jamie Johnston 0:12
You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston. And I’m Eric Purvis. This is a podcast by massage therapists for massage therapists. Our objective is to simplify how to be a more evidence informed practitioner. Let’s dig into this episode.

As somebody who just turned 47 years old, I can’t quite remember things that happened 40 years ago, but the biopsychosocial model of pain has been around for about 40 years now. And it’s very important for us to take a look at anything like this and understand what changes have taken place in 40 years. And how have we improved?

Eric Purves 0:57
And this is a this is actually a really kind of Hot Topic, really the the bio, psychosocial, social model and, you know, is it like, how do you apply it in practice, you know, and there’s a lot of arguments back and forth about like, you know, it’s on a predictable model, right? It’s not like a mathematical model. It’s, it’s a conceptual framework and the authors of this paper, this paper is called the biopsychosocial, social model of pain. 40 years on time for reappraisal, it’s in a relatively recent journal of pain. And, yeah, it’s good because I think it it challenges or brings into discussion, a lot of the points that you hear, especially those of us that spend time reading the debates on social media, and a lot of problems people see in the bio, psycho social. And I what I feel is that in, in my experience, my understanding is, the bio psycho social model is itself not much of a problem, because it just it seems, has been around right for over 40 years, in the pain world longer. I think it first was talked about 1947 or 1977, I think, by George angle, and then, you know, loeser or loeser, have you printed him and Waddell had it? You know, and, you know, fears after that. But the facility is still around, I think there’s there’s still a lot of value. But the biggest problem seems to be is how was it used in clinic? Or how was it researched? And then that’s what we’ll talk about today is in this, this research paper, or this discussion paper, they talk about how when people use the terms biopsychosocial oftentimes, the studies are just looking at one aspect of it. They’re not well defining other like, well define the psychosocial or what is social? Or what is conservative psychological. And, you know, in the bio, like when we’re looking at bio, what, like what’s included in that. So there seems to be lots of a gray area there. And I think that’s probably when people are critiquing the model. And I think they do have reason to critique it. It’s because more often of how the model is applied, rather than the muscle word to use the conceptual, conceptual framework of what the model is supposed to represent, which is this full person care.

Jamie Johnston 3:14
Yeah, and one of the things that really stood out, as I read through it is how much they touched on multidisciplinary care, where they had psychologists that are dealing with the psychological end of it and physios that are maybe handling the bio, and you know, and then the social factors that come into play, and the importance of communication between all parties, when they’re trying to help that person and, and interesting, I’m sure we’ll get into it when we’re looking at the the social aspects of the person returning to work, the importance of communication with the workplace, from the people who are delivering care so that it’s more of a, it’s more of a person centered approach, when you’re trying to help that person get back to their job or get back to those things that they enjoy doing.

Eric Purves 3:59
What I found funny with this, though, when you think about it, you know, you think about medicine, and you think about musculoskeletal care and MSK pain and, and whatnot. And you look at this, this model has been used for pain for 40 years, or it’s been talked about for 40 years. And the reasons that they say here was Waddell and Loeser. They observed that many of their patients with low back pain didn’t improve after corrective surgery. So the pain cannot be attributed to only biological influences. It’s funny though, cuz it makes you think what happened to all the years before that when people didn’t get better? You know, it’s funny how like, it took that long for people to actually start wondering if there’s something else going on. Yeah. And excited. Seems like, that’s like, seems to make sense, but it’s funny to think of how people must have thought about the body and pain.

Jamie Johnston 4:54
Yeah, and really interesting that those two, those two people that you mentioned was with Wadell and Loeser. You I would almost say that they were surgeons.

Because I wouldn’t have thought that that was coming from surgeon because we, I mean, we say it tongue in cheek a little bit and maybe make fun a little bit that we’re like, oh, you’ve, if you’re a scalpel, you just want to cut everything. Yeah, right. So great to see that they that it was surgeons who were looking at, hey, maybe we need to change the way that we’re doing things. And also really interesting that, you know, that happened 40 years ago. And maybe it’s just because you and I haven’t been therapists for 40 years, obviously. But we’ve only really seen it catch on and become more of more of a thing when we’re helping people in the last 10 years. Yeah, I would say model.

Eric Purves 5:43
Yeah, yeah. Oh, for sure. And even if I think you know, back to when I first started diving into the stuff and trying to understand it, and think I did my first CE course teaching in 2015. And I remember just kind of bringing these very basic ideas, because I was only still learning to two courses to try to be like, hey, there’s some interesting stuff that’s out there, maybe, you know, like, let’s, let’s talk about this. And then that was kind of the general idea of those early course stakes. Nobody, nobody knew about a psychosocial as then. Yeah. So it’s been around for 30 years. Yeah. And so nobody knew. And I was only had just been I’d heard of it before, but I didn’t really pay attention to it. Like, I didn’t really mean much to me. I was like, oh, yeah, okay, whatever. But it’s interesting to to, to see like those early days. And we know from our experiences, when we searched for spare teaching together in 2018, we started talking about things and bring up the biopsychosocial. And little bit of myth busting in there and some of the science of pain stuff, and how that stuff was completely new. To like, 99% of the people, whereas now, obviously, the last three or four years or two or three years, particularly. It’s everyone’s, yeah, it’s a common term. And people can have a general idea of Oh, biopsychosocial, yep. That’s like treating the whole person like person centered care. You know, what that exactly means? How do you do that in practice is still that’s the difficult thing. But that’s what we call our practice. Not a perfect. Right is to that’s the hard part, but at least people become more aware of it. But yeah, it’s taken 40 years. Yeah. It isn’t our profession where we are in our part of the world. Yeah.

Jamie Johnston 7:21
But then you look at, like the Louis Giffords that we’re doing this ages ago. Right. So like you said, it might be that it’s our profession or part of the world. Because I think Louie was a UK guy. He was yeah, nice, 80s and 90s. So maybe that was more prevalent there than then it was here. We don’t know.

Eric Purves 7:42
And this without going on too much of a tangent, which we might want to and we’ll see what happens here is the is when we look at the stakeholders involved in our profession, at least here in BC, right, we got the association, we’ve got the college, the cmtbc. And we’ve got all the all the schools that and there’s now 10 of them, maybe I think it was probably about 2014 2015 around there. If you tried to teach a Con Ed course, that said, and I said had bio psychosocial and you would not they would not approve it is out of scope. With the argument being that they hadn’t really the idea was they had no idea. They had no idea what it meant. Our own regulatory body had no idea what it meant. And even you know, our association in the schools and stuff still don’t adequately teach that stuff like the association. You know, they have conferences, and they put out content out there, but I don’t ever see anything on there being I think what biopsychosocial Yep. And you know, the it but it however, in Ontario, they put out some really good stuff. You had some great stuff there too. And so if we want to compare ourselves right to to another province has been around for a very long time and Ontario regulated province, is what I meant to say if I didn’t say that, there’s no province has been around for a very long time. So I’m tired back from the gym, my brain still foggy. The they had a conference in 2019, which I was fortunate enough to be at. That was I think it was called like bio psychosocial care or something for RMTS or something. So they actually had a conference those three years ago now. And they’ve had other things subsequently, which have been been kind of trying to bring us this idea to to the professional to the members. So we don’t have that here. And I really wish you know, this is a call to action thing. I wish the schools known I know some schools are great. I’ve talked to some the the people that are clinic directors and stuff of schools here and they are trying to do it but it’s just not widely accepted and just not widely accepted or maybe understood. And so I would suggest anybody that’s curious about what biopsychosocial means this is this is actually a pretty good paper to start at.

Jamie Johnston 10:04
Yeah, yeah. Well, and it’s it’s very cool that there was a lot of things in here as I read through that resonated with me because of my, because of my background. And also, because I’m somebody who works at a job in industry where people get hurt. So a lot of this really stood out to me. And it’s funny, one of the guys at work, told me he’s like, why don’t you go to the chief and see if you can come in once a week? And just do what you do with guys here who who need the help, but I think there would be a big conflict of interest. If I did that. If I, you know, if I was working on guys, and WCB was like, well, you’re one of his co workers, you can I think there would be too much of a conflict of interest for me to do that. But it would be very, yeah. Yeah.

Eric Purves 10:48
And that would be really cool, actually. Because that way, you would have the social and the bio, and the psycho all together in the workplace, in with their colleagues and their, their social network. And then yeah, you became the new exercising, which would be bio and Psycho and social would be the whole thing, right, are getting moving. And we’re going to be doing any hands on stuff. I mean, that’d be brilliant idea.

Jamie Johnston 11:12
I think so. And I’d love to just take a portable table and and be able to set up the table in the gym and be able to go through rehab with guys and do some treatment. And like I mean, guys are coming to me all the time anyway. And being like, Hey, this is sore. What should I do? So yeah, it’d be cool to just have like, you know, a day of clinic hours at the fire hall. So that somebody who needs it could come in and, and get what they need. But, but I think the problem is once WCB or something like that was involved, they’d be looking and going, No, you can’t have one of his co workers doing the work, because we’re not going to get an honest feedback about what’s going on with him. I think I think there would be too much of a conflict of interest score. Yeah. Yeah, that would be really cool. Yeah, very cool. Yeah. So just quickly skimming through, of course, we talk about psychological treatments, when we’re talking about the bio psychosocial and quite often, quite often, we’re looking at things like mood disturbance, and high levels of unhelpful thoughts like catastrophization, you know, the person kind of thinking that they’re broken, and lowered self efficacy. So when they talked about it throughout the paper, that’s a lot of the things that they talked about. And that was, were they, in my understanding it anyways, as I read through the paper, that those things were better handled by, say, a psychologist or a mental health expert, to be able to help them through that as part of that multidisciplinary care that we talked about a little bit at the beginning.

Eric Purves 12:36
Yeah, this paper, what I thought was really interesting was they broke down, like they broke it down into that, like a psycho bio social, and looked at the research. Because I think it’s just really important, you know, that the common term, you know, if you’re a hammer, you see nails, right. And if you’re a psychologist, and you’re treating people with that are hurting, of course, you’re going to be viewing them through a psychological lens, of course, your interventions are going to be more on the psychological end of things, right? Just like when we, as massage therapists, were treating people we’re going to we should be aware of the psychological and social stuff. But really, I mean, we’re working primarily on bio things. We’ve meant in touch and exercise, you know, a little bit of education, but most of our more focuses in the bio like so. It’s I liked that they they broke it down into this and talked about, like, what was included in psychological research, and what was included in bio was good in the social stuff. But what I thought was really interesting, though, was like the little quote here says that, you know, there is positive effects is positive outcome seen with the psychological interventions to focus on the things you said thought processes, beliefs, behaviors, this type of thing that says that the size of these effects have generally been found to be a small or moderate, and systematic reviews of randomized controlled trials with chronic pain samples. So with this, I mean, go shows is that, and I think if you look at all the research, they’ve probably I think they quote this all and throughout this paper, is that it doesn’t really seem to matter what you do. When you look at the literature, the outcomes are all relatively small to moderate at best. Yeah. So what that can sound to some people defeat us, to me that sounds Oh, that’s actually sounds pretty good. Because if you’re doing something done, or you’re doing something, you’re seeking care and someone is providing care to you, chances are you’re probably going to feel better than not. So doing something is like this is good. And that lets us know that there’s not like a right or wrong but they do say in here, though, is it’s not necessarily providing a specific treatment. It’s finding the treatment that works for that person. Right. So it’s not like you need this. It’s like what’s going to work for this person, this presentation here today. I like that rather than you step was the person need rather than what are we going to do to the person?

Jamie Johnston 15:04
Yeah. Interesting as we go through like, there’s a couple things that stand out to me is when they’re talking about the psycho psychological treatments, they mentioned how there hasn’t been a lot of research about involving the the person’s family, but one place that they did look at. And I would like to know if this was any of Melanie wells research with stuff that she does with kids. But it showed that the more that the parents are involved in, in helping the kids, it can actually have a positive effect on the parent and the parent experience. So when you’re when you’re teaching, how do they say they’re teaching kids and adolescents, about different strategies that they could use, whether it’s communication or how they handle things at school, and the more that the parents involved, it can actually have a positive effect on the pain experience that a parent feels? Yeah, unreal. Is that great stuff.

Eric Purves 15:58
And there’s nothing that I thought was really interesting wasn’t like, you’re talking about how, yeah, when the way kids are treated with that, with chronic pain is very different from adults are treated with chronic pain. Because in adults, it’s like the individual is being but is being treated, whereas kids, they involve the whole kind of their social narrative family, which is, I mean, just makes it makes sense. But it’s just funny how you’re like, Oh, you’re no longer a child, you’re now an adult. So therefore, we’re just screw up family. Like, we’re all gonna involve you. Right? That’s not necessarily included. But I guess it does make sense though, because the kids need to be cared for. And so the parents have to be involved in care as an adult, you’re independent, least in our most of our cultures out so we distance ourselves from our family a little bit. Yep.

Jamie Johnston 16:45
Yeah, or different circumstances. I mean, you look at me 47, single, no family in town. So the experience that I would go through if I was experiencing pain is a lot different than, say, somebody who has a family at home that they come home to, right. And if the kids were dealing with something, then the parents dealing with that is going to have more of that connection, feeling between the family and probably better care and all those things, especially if, say, the doctor or the physiotherapist is in really good, or having good communication with the family, about me, and education and all those things, then it’s it’s a more cooperative experience. Yeah, yeah. Oh, yeah.

Eric Purves 17:25
Which would be more biopsychosocial that would actually be a better application of the model, right, involving everything. Yeah.

Jamie Johnston 17:34
So they, I mean, they went into, and they talked about a lot of the biological stuff, and separating that into different categories, about how people are experiencing pain, and you know, whether it’s peripheral or central mechanisms, inflammatory pain, chronic pain, and all those kinds of things. And then talked about the treatments that they can use for those things. And what I found very interesting is that when they started talking about exercise, because exercise, obviously, I’m a big fan of that. But when they talked about the exercise, they were they were talking about usually exercises is driven towards building muscle or loading the joints and doing these other things. Whereas they found or my understanding is they found if you geared the exercise more towards just what they were doing at work, or or their chosen activity, and getting them back to doing that thing, then they had more success.

Eric Purves 18:30
Which makes sense, because it’s that your your task or your goal, your functional desire, whatever it is, it’s tailored towards that specifically. Yeah. Makes sense. Yeah. Well, I thought it was interesting that they it says exercises, you know, it’s considered they consider that bio, but I think it’s almost, I mean, obviously, there’s bio going on there, but I would say, Well, yeah, like, it can’t just be bio because you’re not, you know, there’s going to be psychological and probably social unless you’re like in your garage by yourself. Okay. There’s, there’s not like a social influence ever. There’s a psychological influence, like exercises, if something of value something you enjoy doing that it’s not just gonna be bio, so I think that was fine when they said it’s exercise is considered a bio intervention. We’re like, well, it’s I think it probably includes the whole bio psychosocial.

Jamie Johnston 19:23
Yeah, yeah. And I think that’s, I’m trying to remember who the presenter was in San Diego this year when he, he stood up and he said, Okay, who wants to go home and do some homework tonight? And then he’s like, Yeah, neither do your patients. So stop giving them homework, stop giving them exercises to do.I forgot what that yeah, that was great. Great, which was brilliant. Because they and I think that’s whereand, you know, I was on a podcast a little while ago with some some of our friends down in the US and when I was talking about therapeutic exercise, and they’re saying it’s not in our scope. I’m like, well, movement is so I think we have to Start also approaching this and being like, well, let’s stop talking, let’s stop calling an exercise. Let’s just call it movement. And let’s just talk about what meaningful movement is for this person. And how do we get them back to that meaningful movement. And that meaningful movement might be a specific task that they do at their job that they can’t do right now. So how do we, how do we change that task? Or how do we make it so they can do that task? So it becomes more meaningful, and they feel more fulfilled? At their job, or whatever the recreation thing? Is that, that they’re trying to get back to doing

Eric Purves 20:32
that’s a weird thing. Hey, still movement is allowed. But exercise, isn’t? We?

Jamie Johnston 20:38
Yeah, well, it’s funny. How do they define exercise? Well, so my understanding of it, because when I was on the podcasters, two folks from the US, and I said, but you guys can do active range of motion and passive range of motion and a treatment under like, Yeah, that’s fine. Like, so why can’t you do movement? They’re like, it’s that we can’t prescribe exercise for them to do at home. I’m like, But what about if your prescription was gonna work in the garden for half an hour? They’re like, yeah, we can do that. I’m like, so just prescribe movement. And, yeah, that’s, what about if it’s get on the ground and play with your kids? Yeah. What if it’s, you know, so let’s, let’s change, let’s change the opinion around those things. And I think a lot of times, we’re also really, really scared that we’re going outside our scope. And we might get disciplined for going outside of our scope. You know, and then as soon as it’s got the word, in this case, as soon as it has the word exercise attached to it, they people automatically say, Oh, well, that’s out of scope. But if we say it’s movement, there’s no reason that can’t be in your scope.

Eric Purves 21:46
Yeah, just move lots. That’s your that’s your prescription. And that’s exercise.

Jamie Johnston 21:51
Yeah, there’s no reason you want to do you know, somebody comes in and they’ve got a shoulder issue, there’s no reason you can’t grab their arm and passively move their shoulder and get it into different ranges, or do some adaptive movements with them, you’re not prescribing an exercise for them to take home, you’re not prescribing something, you’re, you’re just helping them get back to doing the movements that they enjoy or that are meaningful to them. So and to me, it makes more of a psychosocial. Not psychosocial sense. But it makes more sense to me to, to talk about rather than us giving a treatment or delivering a treatment. We’re engaging in treatment with our people. Yeah. Because we’re, we’re engaging and educating and conversing and finding out what’s important to people, rather than us just saying, okay, get on the table, and I’m going to do this to you.

Eric Purves 22:40
Yeah, yeah, sure. Yeah, I 100% agree, that’s such a great point to make, right? You’re engaging with with the treatments, you’re not just doing it, you’re not doing something to them. Now, some of them is great. Like, I mean, I mean, sometimes when I go, if I go for a massage, I often want something done to me, because I don’t necessarily have something wrong that is bugging me. It’s just like, I want to feel good. That’s different. Right? There’s the field, I think, is a seven point distinction to make is that, yeah, you can go and get the table and just someone just like spoil yourself. That’s fantastic. But if it’s like, if it’s something that you’re suffering with, it’s bugging you for a long time. And, you know, that passive approach isn’t working. Yeah, try and engage a bit more with with your clientele.

Jamie Johnston 23:18
Yeah. Like, well, like we’ve talked about so many times before, too, you know, we were fortunate here, because we have so many people that have unlimited benefits that, that maybe they come in once a week, but that’s just an hour break from life that they get, which is good. And there’s no reason you can’t just do a passive relaxation massage. Maybe I shouldn’t say that a relaxation, massages password, because you’re still having an influence. But you know, in those cases, there’s no reason but somebody comes in and they’re like, I’m having a hard time moving my shoulder, or moving my hip or my knee or whatever, then, you know, we want to, we want to engage more with them and figure out how we can get them back to doing the moving that shoulder or so that they can do the things important to them. Yeah, yeah.

Eric Purves 24:00
I agree. I love that term, engaging in treatment, rather than just doing something, doing a tree gauging your dramatic that’s, that’s a very important distinction to make. So hopefully, I’ll catch on. I hope you should do like a social media campaign hashtag engaging in treatment or something.

Jamie Johnston 24:15
Yeah, yeah. Well, I’m working on some stuff now, but doing some thought reversals and things about that to cool. Medicine, but but we’ll see. We’ll see if anybody wants to listen to me now.

Eric Purves 24:28
Yeah, well, some people listen, some people listen this podcast so enough to keep it keep us keep doing them. So there we go.

Yeah. What it was, it’s just kind of keep talking about this, the biotherapy about it and just kind of expanding on the bio to like expand into the bio psychosocial. And this is a there’s gonna be a bias statement here, but it’s okay. It’s our podcast. I just I just think it’s really important for us to emphasize that. Even though we are engaged, we are educated in a bio dominant biomedical We’ll thing and we are hands on therapy is mostly, mostly by Oh, there is always going to be psychosocial stuff, right? With moving exercise coming for treatment, there’s an interaction between two people that’s social, right and psychological. So it’s just that we are, regardless of what you think of the biopsychosocial. Every aspect of a human is being engaged with during a during a treatment. And this was the thing is, though I find interesting is I find it very difficult to understand how any other MSK profession other than massage therapists and physical therapists are able to actually provide a full BPS experience in their treatment. Like if you’re coming in and say it’s chiropractic, and it’s like five minutes and just getting adjusted and gone. Is that biopsychosocial? Like, can you actually apply all the kind of aspects of this? I don’t know, I would say that I think what we have as physios is we have time. Some points are short, but I would say on average, they’re, you know, 30 to 45 minutes long. Least we are.

Jamie Johnston 26:09
And I think that, in fairness, some chiropractic appointments are as well, depending on the look.

Eric Purves 26:16
Yeah, yeah, I am not saying all I’m just saying, like, if you look in general, the two professions that are set up to be able to really do this properly with the problem if we have proper education or proper understanding, I think we we should, you know, chiropractors only are listening to this podcast anyway. But massage therapists, you know, I think we really are set up to do this, because we have so much time with people, we can listen and validate. And we can educate, and we can rule out red flags. And we can reassure when, if it’s, you know, there’s nothing nasty going on, and we can revive touch, soothing, safe, comfortable environment, and educate and engage with people to do the things that are important to them. And that’s something you can’t do in 10 minutes. 15 minutes. No, I and some people I mean, I’m sure somebody’s gonna bother, you can you’re full of shit. Okay, maybe. But I would say that’s, I’m not convinced. No, no, anytime you do this. And so when you’re looking at just quick, quick, quick appointments, boom, boom, boom, those are bio nature, bio focused, you’re missing the bigger part of treating the person.

Jamie Johnston 26:40
And interesting, if you look at the psychosocial aspect of things, I don’t know, of any, or if there are any psychologists or counselors that offer a 15 minute treatment. They’re all 45 minutes or an hour. Exactly. Because they want to have a long discussion with people they want to, they want to have that chat, and they want to figure out what’s going on with them. So, you know, when we look at the other aspects, there’s very few that are that short of a treatment. Unless it’s maybe a quick check in about something. Right?

Eric Purves 27:57
Even medical doctors right like USC Medical Doctor for something like they they’re gonna rule then a like, Oh, you have psychosocial that might be that stuff happens. But they’re looking at the bio, they’re looking, what’s the disease? What’s the pathology? What can I rule out here? Right? So it’s when you read this stuff, and we can go and talk about, you know, the, you know, how this is often applied in these kind of interdisciplinary or multidisciplinary pain clinics. You know, those little requirements, we will have a long time, these are something you can’t just like, have, I don’t think you can have like a high volume, bio, psychosocial practice, and do really good work with engaging in small amount of time, a small amount of time, I think it’d be really hard. Yeah,

Jamie Johnston 28:40
I agree. So this, this is where I think we could get into it now is when we’re talking about, they’re talking about the social aspects. And they they talked a lot about the workplace, and people who are on a return to work program. And this is where it kind of hit home to me because of my past, being a first aid attendant in a, in a sawmill, and watching, you know, treating dealing with people who got injured, and then watching them deal with compensation and coming back to work. And they really focused on this about the importance of communication with the workplace, and how important that is for, you know, the person who’s trying to get back to their job, where the physiotherapist or the therapist who’s helping them should be in contact with the workplace, but then also in the workplace, that the supervisor should be trained in how to speak appropriately to the person who’s injured. And to me that just like that would be phenomenal compared to what I’ve seen in the past, because, from what I’ve seen in the past, companies would always be like, Oh, safety is our number one priority, until it cost $1 To change the safety program, and granted, you know, this is back in like 2006 Next one, I was doing this. So hopefully things have changed a lot since then. But the I just think it’s amazing that they looked at it and said, if you’re in communication with the workplace more, then you’ll have better outcomes for the person who’s trying to get back to work. Right? just phenomenal. And that’s where, like we talked a little bit before we came online. That’s where our friend Corey Blickenstaff who is a physio who works in a workplace, and helps people who are injured, like how, how that, like the outcomes that he must have, compared to somebody who was maybe off site. And I don’t know if there’s ever been a study done on it, but it must be amazing. And give the workers confidence that they’ve got somebody there, who’s there to help, should they get injured? So the social aspects of that must be phenomenal.

Eric Purves 30:50
Yeah, it makes sense to me, it just, I mean, okay. Sometimes things that make sense logically, aren’t always true. But, you know, using making an informed opinion, based on this, some this body of research, you know, if you had if, if a large enough workplace could afford it, and I’m places probably could write, you know, a large enough workplace could afford to have a physiotherapy physiotherapist, for example, on on staff or on a contract to come by? I mean, that would that would be such a benefit. And I bet you, I would be, I would love to see if that increased productivity, if that decreased, miss. Locks, work, you know, less work safe for workplace injuries, you know, I think that would be such a great thing. And there’s probably studies out there and for anybody has them, please send them our way. I just thought it would be that would be such a brilliant thing. And maybe some parts of the world they do it in. But if that’s I’ve never heard of that here in Canada. No. Having like an on site, or something that comes by once a week or whatever, or every two weeks to to treat staff.

Jamie Johnston 32:02
I’m actually starting to hear a bit more because I have a friend who is an athletic therapist. And I can’t remember the name of the company. But she had me come in to do some first aid stuff with the company. And she’s there as like, a director of like exercise and things. So they have an exercise room there for the employees where she can take them in. She has somebody who’s a massage therapist that comes in once a week. And she she organizes all of this for for everybody who works for that company. So it must be catching on a little bit. That to the point that she’s got a full time job doing this. Yeah. That’s brilliant. Yeah, great. Yeah. It’s very cool.

Eric Purves 32:37
Shouldn’t you think it’s such a hard worker, particularly in the the environment we’re in right now where it’s impossible to find workers like, like everyone, everyone’s hiring and you know, what a great perk it would be to if you’re like, hey, it comes with our workplace. We got you a massage and physiotherapy come in. It’s all included as part of your years. Part of working in package. Yeah, that’d be brilliant.

Jamie Johnston 32:59
Yeah, I’m sure it would be a draw. Yeah, huge. Bigger companies like Google in that have, like full time massage therapists to work there. And yeah, and things like that. So but I mean, that’s a multibillion dollar company. So you know, compared to smaller companies, that’s a lot tougher. But one of the things that I that I think is important to touch on that I would love to see is they didn’t, they didn’t talk in here about educating the workplace, about educating all of the other employees who aren’t injured.And I don’t mean that like when somebody’s injured, the rest of the people have to be educated about that person’s injury, it’s educating them about why Return to Work Program is important. Because like, for instance, when I worked at the mill, it was always if somebody was off injured, they’d come back to a place that’s, you know, full of bravado that guys are going, you’re just a wimp, you’re just trying to get a claim, or you’re an idiot, there’s no reason you weren’t hurt. And so when you look at that social aspect of it, that can be really detrimental for the person who’s trying to get back to work. So if they would be really interesting to see if there was a really good education program they could do in those places to be like, Hey, we know that we’re going to have better outcomes if this person isn’t made fun of if, you know, your opinions are kept to yourself, and we’re able to work through whatever the person’s injury is, and we’re here to support you as well. So that if you get hurt, we can take the same approach with you. And, you know, research has shown us we have better outcomes, and this is going to be better for your home life. It’s going to be better for when you have to pay the mortgage, and all those other things and explain to them, you know, the benefits of that? Because I think that would make a drastic improvement on those return to work programs withwith people coming in.

Eric Purves 34:51
I think that sounds like a brilliant idea. You just said. Education regardless, it seems like doesn’t matter what The topic is, you know, education often seems to be the answer. Yeah, you know, the more you understand what’s going on, the more accepting we are the better decisions we make about things, generally, right? These things all play a role. So, you know, why would that be any different in the workplace? I think it would just be a brilliant thing for it to educate the workers as well. What’s going on? And why it’s important? Yeah.

Jamie Johnston 35:24
Yeah, it would be cool. Maybe I shouldn’t approach the firewall a little bit and be like, hey, once a month, I could do like a safety education thing or something?

Eric Purves 35:31
You really should, I think you should see it just I think it’d be probably more rewarding as well as probably see, I would, I would be surprised if you didn’t see. Cause of benefits from that with your coworkers. Yeah, yeah.

Jamie Johnston 35:44
Cuz and it’s great, because we have a, like a light duty program, because we do our own dispatch. So if somebody is injured, we have it set up that they can actually just go and do dispatch, so they get to sit in the in the room, and they’re answering the phones and doing all that stuff. So they’re not out, you know, having to find a structure fire, but they still get an hour or two a day to go in the gym and do some movement. And you know, try to be healthy. So it’s, it’s a pretty good program. But there’s definitely improvements we can make.

Eric Purves 36:10
What it mean for meeting this paper here, too, it’s definitely in the workplace, engaging workplace is under utilize, you know, the one of the quotes here says, engaging with the workplace as part of the treatment seems to be rarely attempted. And I don’t have the paper in front of some notes I made. And I think it said where it was, like maybe only three papers that actually involved, you know, family or social networks in kind of Pain Rehab. So it’s almost it’s rarely done.

Jamie Johnston 36:42
Yeah, I’m just scrolling through to see if I can find it. But yeah, that’s basically what’s sad is that it’s rarely done in that way. So yeah, and I think the maybe the difficulty as well is that, you know, if we’re trying to help somebody who’s injured, the workplace isn’t necessarily going to want to talk to us. Right. So it might be a big hurdle for us to overcome, if we’re trying to engage in that way, whereas they probably be more likely to listen to a physio if they if they recall it, but hopefully, hopefully, if it’s a multidisciplinary approach, and we’re working with a physio about and with somebody, then we can have some input on that as well. But it would be, it would be great. If you know, even if you could, if you could have the person go back to work and say, hey, if your employer wants to talk to me, I’m happy to have a chat with them about, you know, what we can do to help you out, then that might be an approach where the employee is making the approach rather than us approaching the employer?

Eric Purves 37:43
Yeah, yeah. Yeah. The I think one of the barriers you do you have, though, at least in our profession here in BC, and probably throughout Canada, as well, is that nobody wants to work with the, like, WorkSafe or, like, workers compensation. Yeah. Because it’s a pain in the butt lot of paperwork for like, no pay. So even though, it’s probably would be really good to have more of this return to work, thing involved in our profession, and these opportunities to be able to go into people’s work, you know, finances are gonna are gonna win, right? Like, I could treat somebody my clinic and make this much money, you know, or I could go over here and leave my office and treat people that are returning to work and make like, totally, like, no money, almost. Right? What am I gonna do, people are gonna look after their families or unpaid bills and mortgages, food, you know, the gas, they’re going to say, in the clinic, so the idea would be not lovely to do this. But it’d be I would be so I would think that in a lot of these cases, the the money’s out there for it. Yeah.

Jamie Johnston 38:50
Absolutely. And but I mean, again, hopefully, that’s changing as well, because 10 years ago, there was absolutely no money. Yeah, to be able to do it, and now there’s a bit so hopefully, that will continue to go up and we can have more of a roll.

Eric Purves 39:05
Yeah, for sure. No, yeah, I think it definitely be beneficial. Yeah. to kind of wrap up the the the rest of this paper, they talked about the interdisciplinary bio psychosocial treatments for chronic pain, and camper did a review. And so despite their concerns about definitions of bio psychosocial interventions, camper et al found that a coordinated intervention covering several domains of the biopsychosocial model and delivered by clinicians from different backgrounds is more likely to benefit patients with chronic low back pain in the long term than his usual care or physical treatment alone. Which I thought was good because it talks about like the interdisciplinary right so involving multiple different disciplines the problem that you’re going to find me obviously in a in a like this was in a like a pain, kind of rehab or pain. in clinic, everybody’s going to all the treating clinicians are going to be working from the similar model and understanding about pain and they’re gonna stay in their lanes of what their areas of expertise and education are. What we see all the time in practice, I’ve seen other papers on this I don’t have I don’t have a reference here, unfortunately, is that there is an association between seeing too many different people. Oh, yeah, and poor longer term outcomes. But what what I understood from this and other parts of this, this paper is that you see multiple people as long as you’re working together under the same framework, to provide the best care for that person that they need. So that’s an important distinction to make. So I know oftentimes, in the courses I teach, I’m like, get the more people someone sees the less the worst, their outcomes tend to be, right clinically, as well as there’s data to support that. But doesn’t that that’s if you’re getting, I think, if you’re getting different stories different, you know, you see your physio, your car, your massage, your osteopath, your acupuncturist, your medical doctor, specialist, they’re all telling you something different. They’re all doing something different to you, and there’s no coordinated care. And that’s when you get these problems. But it seems, seems this one, if you have a singular model of care, everyone’s kind of falling as bio bio psychosocial. And they’re working together, outcomes tend to be better than doing nothing more than what they call the usual care, which is usually medications or rest.

Jamie Johnston 41:26
Yeah, and I think the, you know, I’ve seen that so many times in my career where, you know, somebody’s coming to see me on a Tuesday, they’re going to their chiropractor, Wednesday, they’re going to Doctor Thursday, they’re going to physio Friday, and they’re just appointment hopping. And the added stress that that gives them of having to go and see all these other practitioners to satisfy what the insurance company wants them to do. Is that added stress that’s taking away from a better outcome. So like you said, if it was all under one roof, and you know, it was a conjoined group of people that are trying to provide that care in a reasonable amount of time and things like that, then you’re likely to have better outcomes. But the, the current way that it’s done, or that I’ve seen is when you’re constantly hopping from practitioner practitioner appointments all week. It’s just stressing people out.

Eric Purves 42:13
Yeah. And I’ve never gonna be careful saying never and always, I very rarely have seen that benefit people by seeing multiple practitioners over time forever, years and years and years. Because we’re all just looking for that fix, right? Everything’s like, oh, my gosh, scar tissue here or this isn’t here. No, this is weak, this is tight. This is short, this is inhibited. This is out, you know, they’re constantly just being put back together is that kind of general understanding they have their body and that that rarely works. And and each practitioner is trying to make a living and rebooking people. Yeah. Money, Money Talks, right, that the financial aspect of it is is as powerful. And that’s, you know, that’s a different conversation, I guess. But that’s comes down to the ethics of it, right? We have to pay our bills. But you know, ethically, if we know better, should we still be doing that? Probably not.

Jamie Johnston 43:06
Yeah, I know. I’ve fallen on the sword a few times and told people, you’re going to hold these appointments. Don’t come and see me next week, take the day off. Yeah, take a rest. I mean, somebody else will look at it. It’s not that big of a deal. Just go take a rest. And but it always comes back to that same thing. And really what this entire paper is about is patient centered care.

Eric Purves 43:24
Yeah, yeah. Based on its care, and providing team based care seems to be the thing too, right, that involves all of the domains. And it’s what I understand is it seems very difficult for one specific professional to treat all domains because we’re not educating them. We’re not We’re not bio psychosocial therapists. It’s not like its own brand is. It would be attendance. Yeah. Well, it’s, it would be a 10 year course.

Jamie Johnston 43:50
Yeah. Oh, manual therapy, and psychotherapy and social therapy, you’d be. So not it’s not a terrible thing. But you’d be in school for a long time to be able to do all that.

Eric Purves 44:00
So yeah, I think what we should get from this is that, you know, we have to start thinking about psychosocial, thinking, there’s a lot of influences on people. We never want to just say it’s just the bio, we don’t wanna swing too far. We don’t say it’s just a psychosocial we want to kind of, you know, play in that middle. There’s a pendulum swinging too far and be aware of, you know, is this more of a bio driver? Oh, yeah, you’ve got it. Like there’s tissue injury, there’s inflammation, there’s brake, there’s whatever, there’s something you know, or is this more like, is there more psychosocial things going on that are amplifying kind of some of that nociceptive sensory stuff that’s going on? Right. These things all work together. And it’s, you know, part of the problem we see in the research as well as what we see in these online discussions is, it’s like one swing to the right of one swing to the left, it goes back and forth. Right. And, you know, the quote that the authors use here, which I thought was great, it said when they’re talking about bio psychosocial interventions, it says, working closely together with regular team meetings, face to face or online agreement on diagnosis. therapeutic aims and plans for treatment and review is important to know the emphasis on the need for the treatment team to reach agreement on diagnosis goals and treatment plans, hopefully, before the plan is implemented. And this is just basically saying like, this is what you should be doing and ultimately, multidisciplinary treatment environment. But that in reality, at least for our profession, I, we’ve lived our lives before, that’s very difficult. When you’re one on one with person in a room for 45, 60 minutes, and you’re busy and everyone else is busy. It’s very, very difficult to coordinate care appropriately, at least the way things are set up here. But ideally, in a proper pain clinic. This is how things should be done. And I think some places they’re the only I got I can’t speak from my own knowledge, but I would hope that some places they do things that way.

Jamie Johnston 45:50
Yep. Yeah, hopefully, it’s, hopefully that’s coming. But we know how long it takes to implement research. So as long as as long as as long as we’re working towards providing better care whether it’s individually or as a team. And as long as we’re going after patient centered care, then hopefully that means we’re doing whatever’s best for the person in front of us.All right, everybody. We’ll we’ll see you next time on the podcast.

We hope you enjoyed this podcast. These kinds of topics are what we’re all about. If you’d like to learn more, go to our websites, themtdc.com or ericpurves.com. If you know of any other therapists that could benefit from this, please tell them to subscribe.


Nicholas, Michael K.. The biopsychosocial model of pain 40 years on: time for a reappraisal?. PAIN: April 19, 2022 – Volume – Issue – 10.1097/j.pain.0000000000002654
doi: 10.1097/j.pain.0000000000002654

Podcast Episode #25 Making Sure Your Continuing Education is Evidence Based


Jamie Johnston 0:12
You’re listening to the massage therapist Development Initiative. I’m Jamie Johnston.

Eric Purves 0:17
And I’m Eric Purves. This is a podcast by massage therapists for massage therapists.

Jamie Johnston 0:22
Our objective is to simplify how to be a more evidence informed practitioner. Let’s dig into this episode. We’ve been talking lots lately about continuing education seems to be a bit of a theme with us. And talked recently about how the standards are changing for us here in British Columbia. And while that seems to only affect us, I think it’s going to have a wide ranging reach how that’s actually going to affect things. Because it seems like our college kind of followed suit of what Ontario did. And if that keeps going, it’s probably going to happen in other places as well. So good conversation to have. But the the bigger thing we want to talk about is when you’re deciding to take a continuing education course, we it’s almost like a buzzword. Now. There’s actually a couple of buzzwords for a long time that seem to be pain science was the buzzword for a course. And now evidence based seems to be the other buzzword. So the question remains, how do you decide whether the course you’re taking is actually based in pain science? And isn’t actually evidence based?

Eric Purves 1:31
Really not a question. Yeah,

Jamie Johnston 1:33
it can be a very tough thing to weed out when you’re looking at just say course titles or descriptions. So how do we dig in deeper to decide whether the course we’re taking is what we should be taking?

Eric Purves 1:47
Yes, and to be in full, open, honest and clarity. I mean, we teach a course called clinical applications of pain science. And we first launched that course in 2018. That was a bit of a buzzword, because it was a good way to market a course. Yeah. And it was

Jamie Johnston 2:05
designed for that. Now, that’s not the title we’d use. No, and I’ve

Eric Purves 2:09
taken pain science out of a lot of the stuff that I use, because I feel that it has become a bit trendy. And also it makes it that makes you people think that pain science is a thing. Yeah, it’s just science is just research evidence. It’s and we’re just focusing on understanding pain. And so when we look at like the the pain science courses that we teach, it’s a little bit more but like, it’s kind of the some of the sensory mechanisms involved in kind of the science, the science, and then they just kind of the nature of the complexity of the pain experience. It’s not this kind of linear, find that dysfunction, find that problem thing, and that’s kind of what we focus on. So I think the way pain science is often perceived or explained is, is is I think people are using it as a buzzword. But then when you go and take a course, people will use pain science as a way to justify a more specific modality. Yes, I think that’s a strong word, use bastardization of the term, it’s an improper use of the term AI, in my opinion, because you can’t, if you actually understand the science of pain, it does not validate your specific modality or modality. Pain is not a singular thing. It’s a complex thing. So therefore, you can’t apply your modality to pain science doesn’t work that way.

Jamie Johnston 3:35
Yeah. You can’t come in and say, My not not that I want to pick on one thing. So I’m just going to use this as an example is when I’m doing a myofascial release technique, I’m altering pain with this modality. Yeah, like, it’s, there’s so much more behind it. So to do incorporate that into I mean, important that we incorporate the science into any modality or technique course. But to say that a technique is the application that pain science is probably not overly accurate. Yes, for and

Eric Purves 4:10
you see that in all in all the courses now to start seeing, and people started using terms like nervous system and using evidence based using pain science, and these kind of buzzwords, and I know that we use them as well. But I like to think that when you look at how we apply or teach or communicate those things, it’s more about it’s not about a fix. It’s more about like, this is just what this body of knowledge informs us in the material that we’re talking about. It’s not like we’re teaching you or teaching you pain science. We’re teaching you evidence based practice, right teaching we’re using the evidence or the science raise areas, the framework to provide content like so like therapeutic movement, you’re using movement and stuff and you’re using that within a framework of of understanding how, in a less wrong way how that these things might have an impact on someone’s experience of pain. Yeah. Or on their level of function doesn’t have their pain maybe helps their function like so I think there’s, I mean, I’m very critical. I’m critical of the stuff that I put out on purpose stuff that we talk about all the time. And I look at some of the things I even did a year or two ago. I think I yeah, that’s, I don’t, I don’t like how that sounds.

Jamie Johnston 5:27
Yeah. I like what, what TJ put up yesterday when he said the nervous system, nervous system is the new trigger point. Yes. Because it’s almost be like, it’s the nervous system is becoming this new thing that we’re blaming for pain and dysfunction and, and these other things, right? So we want to be very careful that we’re, we’re not just finding another tissue to blame. But we’re looking at the overall concept of how the nervous system influences things and how we’re influencing the nervous system when we’re communicating and touching and moving people in and working with

Eric Purves 5:58
them. Yeah, and that’s, you know, and you sometimes you see those things, and you think, Oh, I wouldn’t be surprised if part of that nervous system dominant narrative was probably some of the stuff that myself and yourself have probably contributed to that because you try to focus from moving people away from like, connective tissue. And so I think more about like nociceptors and sensory mechanisms and more the nervous system and the neuro immune system, and how all this stuff plays a role in transmitting information. And and, and so you try to you, you take the focus away from like the fascia and muscles and stuff and try to think more about what’s the what’s the tissue that is responsible for making change, for creating or implementing change making change? Right, that’s, that’s the nervous tissue. So you try to you but then I think what happens is people will then swing too far towards the nervous is, oh, what’s the nervous system? Everything I’m doing is just impacting the nervous system really? Well. You’re impacting all the systems. Yeah. Right. So we can’t just pick one. I think that’s, that’s, that’s one of the things that I am trying to be more mindful of, too. We communicate, teachers vote, yes, I use the nervous system a lot. But it’s, the goal of it was to move people’s focus away from the structural anatomical stuff. But it wasn’t meant to replace it with a completely different narrative that blames the nerves or the dresses.

Jamie Johnston 7:20
And it’s kind of funny, I was having a conversation with somebody in the UK this week. We talked about how they’re trying to get more recognized as, as medical professionals so that they could possibly bill insurance or do things like that. And I was talking about how when we teach, we we come across these people that have been therapists for 20 and 30 years who are like, all the stuff you’re saying is the stuff we were saying 20 years ago until we tried to medicalize everything? Yeah, so it’s almost like the the pendulum swung so far towards the description of a technique or modality and how that’s going to work back to the nervous system. And now we need to come somewhere down in the middle. Yeah. And talk about because there’s, you know, I mean, there’s so many, so many more ways to make change in somebody’s pain or their experience than just hands on. I mean, communication movement, all those things are, are such pivotal areas. So let’s, let’s try to get that pendulum to come back down. Yeah, to the middle, so that we, we have a better understanding of everything.

Eric Purves 8:18
Yeah. And this is what happens right over time to um, we’ll see these days, we’ll see somebody new come up or something, further development in something, and that’ll become more important. And I think it’s just a matter of by being evidence based, it’s kind of a topic of this, it really allows us to kind of check our biases and into into incorporate with the current evidence suggests, right, so it avoids us from swinging too far one way, and kind of keeps keeps things in check based on what the body of evidence says

Jamie Johnston 8:44
that it should make change a lot easier for us. Yeah,

Eric Purves 8:49
if you follow a large body of evidence to inform your practice, the practice and the profession and everything and the courses that are taught, then you know that it’s your you’re basing it on a body of knowledge that is defensible, less wrong, rather than belief based off and so what we see lots of times we see courses being called evidence based, but there’s still the body of evidence that they’re drawing for these courses is, is based on a very small or very specific area. Yeah. And a lot of this goes, I strongly believe into is a bias mine into how are introduced will inter jurisdictional competency documents, guidelines for foundational knowledge, the practice competencies and practice indicators that basically create the guide or the framework for how the profession is educated and how people learn what they learn in school, then how the regulatory body does their licensing exams and yeah, Create scope of practice and all that stuff is based on a very narrow bit of evidence and lot of time does not even have this love. It’s just faith or historical stuff. And when I think we’ll come back to the beginning of like, these courses are evidence based, but I think in order to do that, we should probably pick apart some of the reasons why there’s a problem with the so called Evidence based courses, and where that information is coming from.

Jamie Johnston 10:25
Yeah. And I think, like, I know, you’re gonna go into the inter jurisdictional company report, but I think we touched on it on the last podcast a little bit. But if we look at our education, just from our college education, like, everything is so modality based, we take so many courses that are based on modality so that when people come out, there’s a belief that that’s the best way to help people in pain. So then when somebody’s putting a course together, and I’m gonna say that they’re putting a course together with the absolute best of intentions in mind, you know, they’re not doing it to cause harm or to not be evidence based. They’re looking at it and going, well, of course, it’s evidence based, because it’s blame, but it’s not blame. It’s based on all of these techniques that we learned in school. And we were taught that this was the evidence in school. So that makes it makes it difficult for the person who’s putting the course together. But then also difficult for the person who’s deciding what course to take, because there’s a true belief system behind it that these things are evidence based, because they’re based on the things that we’ve learned in college that are already out of date. Right?

Eric Purves 11:36
Yeah. And this, and this is, yeah, this is where it becomes I want to be careful where we’re mindful. We’re not blaming any individual. No, I would say that what I if I can put blame, I blame on the stakeholders for not taking more of a leadership role, not just the college, not just cmtbc, or any other massage colleges, but also all the associations across across the country, as well as educational institutes, which are the ones that create are the ones that are the ones teaching the material. And if you think if you’re teaching a course you’re like, oh, evidence based techniques for the jaw and neck, for example. But what’s that mean? Jason? Yeah. So yeah, so what’s, what isn’t evidence based course was evidence based techniques, you know, and usually, when you look at those things, I’m just put, I haven’t, I don’t know if there’s a course that a name of a course that I didn’t, wasn’t aware of. So if somebody teaches that course, I’m sorry, this is not a direct picking on you not picking on you at all. But I’m just saying that that’s the kind of a name of a course that you might see. But that’s going to probably be a modality courts, this is the modalities that you use that I have learned in my practice, work that work, and UK. Okay, so when we’ve talked about the definition of evidence based practice, I’ll give that a second here. That’s part of evidence is your clinical expertise. Yeah, it’s an important part. However, what’s really important, I think, with evidence based practice for like our teas, is that you have to have that kind of foundational knowledge based, and that foundational knowledge needs to be based on the current research evidence. So let’s look at what’s the current research evidence suggests about pain or about certain populations? Or about certain conditions or presentations, or the role of manual therapy? What does manual therapy do? What does movement do? What does exercise do? How does communication and self management, right, how are these things? What’s the research suggesting all that for a specific presentation, right? So if we look at like, okay, so if you’re looking at, say, TMJ course, for example, and it’s like, evidence based TMJ course, in order to teach that course, and make it evidence based, you would have to have the foundational knowledge based on all those things. Yep. And then you say, okay, look, I understand, you know, this is what we know about the TMJ, this will be understandable pain, is this some some risk factors, this is how it might present. Maybe this is a way that we can assess what might be contributing to it. I don’t know, I don’t have a breadth of TMJ knowledge. So I’m just throwing stuff out there. But then you’re like, and in my practice, I have found that these techniques work well for this population. Fine, that’s great. That’s that could be an evidence based course. However, it’s not evidence based. If your foundational knowledge is not up to date. If you’re like, Oh, well, the reason why people have TMJ pain is because they’ve got, I don’t know, protracted shoulders, they have a rounded posture and bad posture with a scapular. dyskinesias. Maybe they’ve got a little bit of, you know, maybe they maybe they I don’t know, there’s the mild feathers, myofascial adhesions that need to be released. And there’s like all this always mechanical stuff. But the thing is, as massage therapists as any I would say, I’m gonna say every MSK profession is is that we are educated to think within that narrow lens, totally. We are educated to think about, okay, jaw, joints, connective tissues, mechanics, such as posture, these things are really important. So if I can correct or fix those things, then the pain is going to go away. Yeah. And it might be. And we know that everything can work. People wouldn’t. Yeah, there’s certain groups, people that’s going to work. But it’s not evidence based if you’re teaching that

Jamie Johnston 15:30
stuff. No, no. And then that really goes back to what I was talking about before. Because like, we had 10 modality courses in college and one course on research, that wasn’t a very good course. And I was I don’t know who I was talking to. But somebody recently said that the research course now in school is even worse than the one that we had. It’s sort of like, just enough to show you how to look up some stuff to do your case study. Yeah. Right. So unfortunately, we’re geared for this right from school. So to focus on the certain things and, and not really be evidence based.

Eric Purves 16:07
And this goes back to a lot of the research too, that I did in my in my graduate studies. What we learned in school forms the foundation of the rest of our careers. And I know Dr. Gallin danielda. We had her on Facebook live back in pandemic lockdown a

Jamie Johnston 16:26
couple years ago, couple years ago, and her her

Eric Purves 16:30
Master’s study looked at the use of evidence based practice for massage therapists in Saskatchewan. And what she found, if I remember correctly, is about 60% of people. And this is consistent and this was because of the research I did as well in my studies was that across all all allied health professions, but 60% of people will not change their practice behaviors or their beliefs, if what they learn contradicts what they learned in school, so they learned it outside of school. For 60%, people won’t change if it contradicts what they learned in school. Yeah. What’s that called? As part of that might be what’s called the sunk cost fallacy. Is that part of it, like you’ve invested his time and energy into school, maybe even money into it? I think that might be the right term, if not something I’m sure will tell

Jamie Johnston 17:14
me. Well, probably also that, you know, I mean, I’ve talked about my background before, but I was watching a Netflix documentary last night, but it was about some of the Adventists down in Utah. And so it’s almost the same thing, they were confronted with things that that was the exact opposite of what they believed in, some of the people decided to leave, but some stayed and were faithful to the exact opposite information of what they were led to believe someone, I think, all too often with many of these modalities, that becomes a and some of the history of massage becomes a bit more of a belief system that is really easy to, to hang on to. And when you’re confronted with things that are against it, it’s it’s hard to recognize that that’s the way you should

Eric Purves 18:06
Oh, yeah. Oh, for sure. For sure. Yeah. So probably, before we move on, we should just like the definition of evidence based practice we’re talking about so what is evidence based practice, and simply, it’s just an integration of the best evidence with your clinical expertise, and a patient’s unique values and circumstances and requires healthcare professional to take into account the characteristics of the practice content in which they work. And so the process of integrating all this information is your clinical reasoning. So we said before, your best research evidence should inform the population or the base of knowledge, and then use your clinical expertise to kind of help navigate that with what the patient wants. That’s what evidence based means. evidence base doesn’t mean I have a paper that shows me that it’s important to people got results when I changed when they changed. You know, the way the scapula moved? Yep. Well, that’s one paper that doesn’t sound abroad. That’s not the best research evidence because a lot of stuff that contradicts that so there’s not the Sonic, scapula dyskinesias I’m just picking random things on top of the air, or I’ll top my head is not an evidence based thing that we talked about shoulder pain. Yeah. So anyway, but I think what what goes what you say to beliefs and this was this is actually plays right into what we’re want to talk about when we’re looking at the competency documents was in the competency documents, there’s a thing called entry level proficiency. And I’m not gonna read the whole thing, but says, the entry level massage therapist applies relevant competencies in a manner consistent with generally accepted standards in the profession. I see that generally accepted standards in the profession as very problematic.

Jamie Johnston 19:49
Yes, because we accept that these modalities are the the way to treat and the way to do things. Yeah,

Eric Purves 19:56
yeah. And the and this means that I read this and says, Well, it that’s it so okay to do what we’ve done historically, and that is okay. And say, well, it doesn’t necessarily change your touch. But it might change how or why you do something. But maybe if we understand the science of pain a little bit better, we understand or say, we understand that, you know, aggressive techniques on an area that’s already sensitive and sore, might actually make it more sensitive and sore, because we understand, kind of somehow the nociceptive system works, and that might not be good, or understand how inflammation works. Now, like that kind of information. That film goes into the evidence base that goes into the clinical reasoning. And in all the years of doing this stuff, and we’ve been teaching this stuff, I’ve been teaching stuff since 2015. And always learning and adapting, you start to realize that when you talk with stuff with students that are still graduating now, students, Dr. Seuss, Mr. RMTS are still graduating now, or people that are still in school. They’re still being taught these kind of historical accepted standards and belief systems that are not based on evidence. Yeah, based on beliefs,

Jamie Johnston 21:08
and like, the things that you’ve just talked about are pretty crucial things for us to understand and know, you know, similar to, like doing cross fiber friction is on a tendon. Right? Those are the things that we were taught in school were like, and all of the research now is like, Don’t massage a tendon at some point. Yeah, right. And yet, we were told to go in and aggressively work on these things. And I don’t know if that’s still being taught in school. But if that’s one of those things that hasn’t been updated, that’s a pretty crucial thing to know, if you’re trying to help somebody with a tendinopathy in any way.

Eric Purves 21:42
Because when I’ve asked people before, and courses either on my own or we’ve done together, I like to I out will often ask about, you know, what do you do with tendons? And it’s usually stretch and friction. Yeah. Not anything about low progressive load, you know, which seems to be the predominant, best available research evidence. Yeah. One thing that another thing too, which is, which is interesting is that when they the in the doc documents, it goes on to the a little definition about the practice competencies and performance indicators. And it says at the entry level RMT, must practice in a manner that’s safe, effective, and ethical. All three doesn’t mean safe or effective or ethical. It’s like safe, effective and ethical. There’s all three. Yeah, and we’ve discussed that previously. And it’s important for us to understand that the narrative or belief system is not based on evidence, then it can cause harm and harm doesn’t have to be physical harm, harm, do we anything that kind of takes away the person’s ability to look after themselves or to feel comfortable in their body. And if that’s the case, then that’s unlikely to be safe. Right. And also, the most important thing that you’ve taught it was before you might want to go on this, again, is that it’s not ethical either. If the information we’re providing the treatments we’re providing, the language we’re using, is is a Mipro is a misrepresentation of reality, or of our current less wrong understanding of manual therapy, Pain Rehab, disability. So people come to see us, and we don’t have this evidence base to support that knowledge. And we’re like, oh, yeah, I seem to correct this dysfunction are going to, well, I can feel this here yet feels like your, your liver isn’t rotating properly, or Oh, you’re your sacrum is stuck up here. And these things, which we know don’t have evidence to support them. And there’s different explanations, which are more based on evidence, so we could use to explain why you might see or feel something that area. That’s not ethical, because we are actually giving a misrepresentation to the person about what is actually happening in their body.

Jamie Johnston 23:50
Absolutely. And, and funny like, just to add to the ethical thing, when I when we look at the statements on the entry level proficiency, when it talks about if it gets to, you know, a massage therapist recognizes that something’s unusual, difficult to resolve, or it’s a complex situation, which might be on their ability, then they take the appropriate and ethical steps to address those situations by seeking consultation supervision or mentorship or reviewing research literature or making a referral. So it’s, and this I don’t think, should just be an entry level proficiency. This should be if you’ve been a person who’s been at in for 10 years, and you get something in front of you that you’re not sure about, you should still be referring to the latest research, maybe talking to some colleagues who have a bit more knowledge on something that you are taking an appropriate course. That is an evidence based course that is going to help you deal with said population that you’re confused about.

Eric Purves 24:46
Yes, you know, and guarantee there’s people gonna be listening to this. And they’re going to suddenly be like, Why do that? You know what, you guys are full of crap. Yeah, and I think I saw like I have every right to say that. I think less Cleany posts Did something recently, and one of the one of the groups about how in Ontario, they’re like, they don’t have a list of the modalities anymore, because we’re putting that onto the massage therapists to decide what should be used or what shouldn’t be used. And I think it’s great that yeah, the college didn’t tell us what to do. But But you probably provide a framework and the thing is, I think with the comment he made, he listens to our podcast so maybe he’ll maybe he’ll copy and

Jamie Johnston 25:33
he’s a beauty I love him. Maybe

Eric Purves 25:34
he’ll he’ll put he’ll he’ll he’ll have a point to say about this. But we do live in an echo chamber of those of us that are more than like to be where we are, there were like, we describe ourselves as evidence base, or describe ourselves as trying to be advocates for the profession by, you know, reading and trying to like, you know, apply evidence of the course we teach having this podcast where we’re kind of putting our thoughts out there. So hopefully, people will listen. And they’ll think, hey, you know what, like, this is, you know, these guys have something worth worth listening to. Yeah, and are worth doing to change. And so so he said that we’re in a bit of an echo chamber. And so I think that we talked about the stuff that makes sense to us. Other people might read this, or might listen to this and be like, Yeah, of course I do that. But we can guarantee from our experience, so anecdotal experience, okay, not evidence based. But there is a lot of stuff we’re talking about, we see every friggin day. Yep. At this non evidence based way is still the predominant way of thinking doing and teaching see courses?

Jamie Johnston 26:41
Well, and the thing is, there’s probably just as many echo chambers out there that are modality based echo chambers, or belief based echo chambers, where those people are probably looking and going, those two guys are idiots in the wrong. Yeah. Because they don’t understand how this technique works, or this modality works. And there’s probably a large group of people that are all, you know, based their practice around a certain modality that they have their own private Facebook groups, and they talk about that, right. So I’m sure that you know, every, every little thing within our profession probably has its own echo chamber with people that are that are deeply involved into those things just as much as we are into the evidence base. Right.

Jamie Johnston 27:24
Yeah. And you know, by slurred again, is, I would say that our echo chamber, though, changes based on the evidence that stops and thing and I think we are like to think of ourselves a little more malleable. Whereas there is a group out there who people are going to know when I say this, that is very popular in BC now, you made a comment about what they are heart centered framework that is used. That group there would not respond well to research, or probably anything we’re saying, or anything that we’re saying. And because they are their own echo chamber, and that’s what they do. And I don’t want to quote them, I don’t want to out them because I don’t want to be that person. But they that that there is groups out there for sure.

Jamie Johnston 28:19
Yeah. Where are they, you know, they have the Edit kit. And it could be very small silos of, of people who, who have that echo chamber and, and rely on each other, which, as a concept is a wonderful thing. You know, that if you’re focusing on a certain population or mean, hopefully, you’re not focused on a certain modality. But if you’re focused on a certain population or a pathology, that you’ve got people that you can bounce ideas off of and work together, but we would just hope that you’re using the most recent research on it. But I’m not sure that’s happening.

Eric Purves 28:56
Who knows? Right? I mean, I think it’s great that there is you do, we are seeing more of this, where people are there is more kind of courses and and communities are more population focused rather than technique, focus. So that is that is a shift, there still is the modality techniques up there, the acronyms stuff is still out there. But there is more population based things, which is great. The hope would be that those populations would those courses and groups that are focusing on populations would not just take their personal experience. So they’d say, hey, look, people with this in this population, these are things that we need to be aware of this is this is what we know is best practice behavior, you know, and how can we incorporate this with our within our clinical experience? How can we use our clinical experience within this evidence?

Jamie Johnston 29:42
We use that evidence to shape our experience

Eric Purves 29:45
or Yeah, attempt to to make it even better. And I would say that that is something that I would love to see. It might be happening in subtle levels. In some ways. It’s slow. But I would say based on what I see in my perusing and listening and teaching experiences that That’s still not out. They’re not there yet. There’s a lot of this comes down to, though right to the, to the things like the foundational knowledge that we learned in school. Is this one statement here and the document says, massage therapy relies heavily on application of principles of the physical, biological, health, social and behavioral sciences, does it? It’s a great statement. But if the principles of biological, social and behavioral sciences contradict the Moral Majority of the content instructed in the curriculum, examined on the exams, and taught in the CEE network, then that’s an untrue statement.

Jamie Johnston 30:36
Well, that and how many times over the years? Did you or I or us together apply to get a course approved? And when it’s a biopsychosocial? It got denied? Yeah. Yeah. Because it said biopsychosocial, even though right there, it says, Yes, we’re taking all these things into account.

Eric Purves 30:57
I know. That’s funny. That’s such a great point. And I didn’t see that when I read through this. But that makes that makes perfect sense. It says massage therapy relies heavily on the application of principles of bio psychosocial.

Jamie Johnston 31:07
Yeah. Yes. If that’s in your course, we will deny it for credits. Yeah. And in all fairness, I don’t think they’re doing that anymore. That was no years ago that that was happening, but quite

Eric Purves 31:17
a few years ago. Wow. Yeah. Not long enough ago. Yeah. Yeah. But yeah, that’s, that’s right. That’s funny. But still, right. And you look at all this stuff, and the foundational knowledge, and it says, you know, says here RMTS have a specialized foundational knowledge base related to the structure function and interrelationships of the body systems, and their response to manipulation. That sounds great to have, these are great statements, but how they are applied in curriculum, emphasize and see, not all see a lot, many C E courses. I’d say again, that’s not really that accurate, because if this were true, then the cricket and then the curriculum is emphasizing things like patho anatomical and structural ideas. If two students are still being taught all these different modalities, and each modality has a different story, changing fashion, I’m increasing circulation, I’m changing, writing joint alignment, whatever it is, this information actually, that’s that’s being taught that directly contradicts the current research evidence can’t be evidence based. No. But then when you look and you go through, we don’t have to go through the entire document. But there is a thing in there that says, massage therapists must employ critical thinking. And they must utilize research and professional literature and utilize self reflection to identify personal strengths and areas for improvement. This is within the documents. This means that the call the schools are supposed to have like performance or competencies and indicators, practice competencies, performance indicators. But I would say, I would be very surprised if this stuff was taught well, well, because if you how are you supposed to utilize research and professional literature when they’ve actually gotten rid of that quote that course in a few colleges? I know that and you said that they’ve changed it and some people you’ve talked to, to maybe even make it even less? How are you supposed to? If you don’t learn that information in school? You don’t you’re not sure of like, how do you ask researchable questions? Do you know how to search for it? What are good questions to ask? How do you critique it? Is a study good is a bad isn’t relevant? Right? Is is the type of research you’re looking at appropriate to answer the type of question you want answers to. Yeah, like this is big stuff like this is this is stuff that you can’t just learn in like a weekend workshop, this isn’t stuff that you can learn. Even it’s a late master, it’s a lifetime, but you should learn this stuff kind of threw out like every core every term of school, there should be some that and about how to use that information to employ critical thinking, look at your biases to do self reflection to understand where’s your knowledge come from? Why do I think this way? If something contradicts my my knowledge? What process do I do to reflect on that and understand, to go through, and it’s a very complex thing. Very, very important. This stuff is supposed to be taught, but it’s not. And you see this then is reflected in the evidence based courses that are out there are suppose evidences of courses out there, because this stuff isn’t routinely understood or used our profession. We could talk about it’s not like we’re experts on this either. And I’m like, I’m an expert on this. But I’ve done a lot of work on this stuff. So I know that I’m can be less wrong. Well and more comfortable in uncertainty than I used to.

Jamie Johnston 34:31
And part of the problem is it’s not only influencing the kitchen, the education courses that are provided, it’s influencing the people who are deciding what course to take. Yes. Right. So it’s, it’s it’s like a multifaceted tiered level of things going down and like to look back at the college education that like the, the piece that stood out to me when he read that stuff was the critical thinking aspect because like, I don’t know about you, but what I was going through I mean, I was in my early 30s, when I went through and I hadn’t been in school for 15 years or something like that. It was like I was drinking from the firehose, and I’m just trying to memorize as much stuff as I can to get through that two years. At no point, did I critically think about anything? As I went through, because I was just trying to memorize an origin assertion action, what do I do with this? What you know, all those things? And it’s always funny when I tell that story about, you know, the myofascial release class and the cranial sacral class that are teaching me the same thing. At no point did I critically think and go? Well, that doesn’t make sense. It wasn’t until like, 10 years later that I could critically think about that. So if that was, if that was a fundamental part of the education, that you could critically think it, then when you’re citing what forced to take, you’d have a better a better understanding of how to critically think whether that’s an appropriate course to take or not.

Eric Purves 35:55
It’s that’s actually that’s a really that’s a really great a great point. Because yeah, the critical thinking we were never taught really critical thinking it was, you always learned a pathology, yep. Right, or a presentation of some kind. And then you would learn a technique. So in that technique course, the myofascial release in that technique course you would then apply myofascial technique to correct or alleviate that methodology or presentation and then remember we did when when you know kind of near the end of the program, you could kind of pick and choose the modality you want it will help that Yeah, to to help to help that presentation. And the thing the problem is is that we we learned recipes, yeah, even if a teacher even if teachers said oh, you know you’re you’re not learning recipe. You learned a recipe you had Rattray that said you do diaphragmatic breathing you do do a hat do a number of big sweep superficial, superficial deep you know, do the Palmer and eating knuckle Nene finger kneading, be more specific? Bow back out? It was a very, like it was it taught you how to give a massage of felt really good. Yeah. Which is, which is a great thing, which is amazing. But it didn’t tell you how to critically think about why am I doing this? Yeah. And do I have to do it this way in order for in order to get the result? Or can I do something else like it

Jamie Johnston 37:24
didn’t we never were taught or inspired to think it was just do do to remember it like, because it was so hammered into you that I was working like it was in one of the tests where you had to do a treatment in front of a supervisor. And I was working on somebody’s back and I was starting at the hip and I was working up towards the shoulder. And then I kind of turned around and I went the other they told me they’re like, try going the other direction. I’m like, That’s okay. And I was like, shocked that I couldn’t go the opposite direction because it was always proximal to distal or distal to proximal, whatever, whatever it was, but I just remember being like, but no, you’ve told me and that that’s the other thing that drove me crazy when we got into the ML D class because all these teacher teachers have been saying for like two terms. You know, don’t don’t stick to a recipe do you do how you like it? And then I get into that class they’re like, No, this is a very specific recipe where you have to touch this way touch this weight. And I’m like, you’ve been telling me for two terms not to do that

Eric Purves 38:27
it’s it’s kind of it Yeah, it’s it’s bit funny to think of how things are and there is some there is some schools I know from people I’ve talked to it’s different institutions that are doing good work, but it’s still it’s I think we’ve we’ve probably talked about before that you have a couple individuals you know trying to make change but you still have a whole faculty that is still like no I’m gonna teach people how to do what I like to do that and they have they just like pass the board exams, pass your tests and that’s the way it is critical thinking and the use of the research isn’t there? Yeah. If you did do that though, and this is this something I’ve heard before from people and I this is a statement I don’t agree with but I’ve heard this from a school I won’t say which one is they were like well if we if we teach if we take out all this stuff, what do we replace it with?

Jamie Johnston 39:21
You can still do this with a better narrative.

Eric Purves 39:24
And my response was actually you know what if you took all this stuff you could you could create a massive program Yeah, like a huge program. They can be as big as you want it to be or you can can you know if you want to do the five semesters which is way too little in my opinion you could you could you could you could still you could fill it with way more beneficial stuff and you’re gonna have therapists are gonna come out they’re gonna be better to be more knowledgeable even more skeptical. They’re probably be a little more frustrated in school, but I can guarantee you that once those of want to be good therapists are gonna get out and they’re gonna, and they’re gonna be they’re gonna be the ones that are gonna be a leaders number. Question. Yeah. Which is what we need more of? Yeah, we definitely need more of that. Because there’s more people talking about this stuff now than it was. But so,

Jamie Johnston 40:08
oh, compared to five or six years ago, when we started teaching this stuff, it’s it’s late years now. But one thing I think is important to bring up because we touched on it at the beginning is how do you decide when you’re taking a course? So some of the things that I’ve seen online that I’m going to say, as a red flag, is, if you see a course provider online, that when they get challenged, lashes out at everything that’s being sent to them. That’s probably a good indicator that that course isn’t overly evidence based. Yeah. You know, if because, I mean, I mean, we say it all the time, whenever we teach a course. And I’ll say it to anybody who follows my page or blog or anything like that, if you want to challenge me Go right ahead. Because I 100% can be wrong. And I may not, I may not know the answer to the question that you have, I can try to find it. But I certainly don’t know everything. I actually, I only know a tiny little bit. And that’s the old saying to have like, the more I learned, the less I know. But if you’ve got somebody where they get challenged, and they are lashing out, and for lack of a better term spewing kind of hatred, and, and that kind of talk, then it’s, it might be a course that you want to shy away from. That’s true.

Eric Purves 41:34
Lashing Out is a big red flag. I’d say another one too, is research dumping. Yeah, we know, we’ve seen that lots where people will question a course. And they’ll just throw a whole bunch of research at you hoping that it’s like overwhelms you with like, your berries,

Jamie Johnston 41:50
you Oh, it must be true. Because these.

Eric Purves 41:53
And then that’s a big red flag too. And other one, too, is and I’ve seen this recently. We’ve seen a lot, but I did see it recently, which brings it to my mind is that somebody was asking about research for a course. And the person was like, Well, when you take my course I’ll give you all my research. Oh, and that, to me is a bit of a red flag to it’s like, well, I have the secret information. Yeah, that if you only have access to, once you pay me and take the course. And you know, I think we can both be honest is that, like we if someone wanted research before the course I’d give it to them. No one’s ever asked though. I don’t think there’s a rush. But after a course. So we always give like I always send people a big document with all the references, with references. And if anybody ever was like, hey, I need a specific I get these occasions of these questions occasionally. You meant in your course you mentioned whatever. Can you do you have any specific papers to back that up? Yeah. And that’s a Yeah, I do or actually, no, I don’t. But this is where I got that information from. So I’m glad you challenge me on that. You know, maybe I’ll be more mindful of how I say that next time. Yeah. So rather like I don’t know, I just the only time I think that we you and I when we’ve talked I’ve ever had negative interactions with people talking about research is I think when they themselves have been challenged. Yeah. And they are like, Well, I’ve been I’m, you know, I’ve been teaching for 25 years, or I’ve been doing this for forever. And, you know, what you’re saying completely contradicts my experience. Okay, great. That’s what research is for your, your, your what your assertions are? Well, no, but this is my I know, okay. Well, I’m saying that. That’s your opinion. Yeah. And this is why it’s important for us to employ things like to understand critical thinking, to understand our biases, to understand the evidence, because if we just rely on our personal anecdotes, or personal opinions, those are subject to so many flaws, so many errors of thinking and fallacies. That that’s why we have the evidence to say look, I think I used to think because I did when I did all my content stuff, when I first practically got out of practices, is my favorite stuff was fashion. I loved it. I did all the fashion stuff and took a bunch of courses on it went to the fascial research Congress in 2011. Which actually, was the starting point for the thing that got me challenging what I thought I knew, because it was some people were like, Oh, that was some of you are probably listening. Think that was great. I love that. I’m gonna say no, that actually there was nothing in there and that core in that conference that really validated anything about what we do about fascia. That information actually contradicted what we had what we knew about fascia. Yep. As manual therapists. Yeah. Anyway, I learned I did all that stuff. And so I you To think that when I was seeing changes in people when I was doing stuff, and they felt better, they’re getting areas getting softer, it’s getting warmer to get more movement. That was because I was changing their fashion. Because my evidence base said, that’s what you were doing was so narrow, and I looked through at everything through that fascia lens. It wasn’t until I was able to, to zoom out and look at the bigger picture that realized, oh, maybe that’s happening for a different reason. Yeah. Right. And but because like you said, before we learn this stuff in school, or in our lives, our lens is so narrow, that we’re looking for courses based on one school. Well, I want to learn more about this thing.

Jamie Johnston  45:40
Yeah. Yeah. And with that, you know, that like, like you were saying, with the research and stuff that you’ve got, but I’ve had people reach out over the years. And they’re like, do you have anything on low back pain, and I’ve got a Google Drive that has like, research things for all those things. And I can just send somebody a link to a Google Drive and be like, yeah, there’s like 10 papers in there, and low back pain, which I’m based what we use for the poor. So you know, that sort of thing. But I think it’s also important to mention too, is that if you’re going to challenge somebody, whether it’s online or in a courses, just to be respectful in the way that you do it. Right, if you’re if somebody, if somebody has gone through the effort of putting the course together, and they’re promoting their course, and maybe you don’t agree with them going on, and maybe calling them an idiot, or something like that is not the way to do it. But, you know, respectfully challenging them. And I, you know, I’d look at some of the things that you and I have done over the years, where, like, I can think of one example, that was great to where somebody who has now become a mutual friend of ours took our course. And there was a discussion around the link between depression and low back pain in the course, and the person came up and pulled us both aside, didn’t do it in front of the class and said, hey, you know, you might want to change the way that you talk about that, or the way that you word that and spoke from personal experience and said, you know, as somebody who deals with this, you know, the way you said it was maybe not the best than that. And then that gives the instructor time to kind of step back and go, Okay, so the next time I teach, maybe this is the way to verbalize that, to make it to make it better, right. So just making sure that if you’re, if you are challenging somebody do it in a respectful way. And not not to try to grandstand in front of a whole bunch of people, whether online or in person, you know, just

Eric Purves 47:22
just be respectful. And if I remember that situation, and that you recall there correctly, I think I believe that I think it was at break. And then after break, we actually went back and we’re like, just wanted to clarify what we’re saying here. Because this is this is how it might have been heard by by someone. And that was great. And personally, when I’ve taken courses and the the instructor has a little bit of humility, like you want to be confident, because you want them to know their stuff. Like that’s why I want to learn this course me because you know your stuff. Yeah. I don’t want you to be cocky about it. Yeah. And I think I mean, I don’t know, cockiness is a thing. And confidence is often a perceptual thing, too. Yep. Right. You know, you’re like, Yeah, we teach courses and there’s, there’s information, you’re confident that you’re gonna be competent about it. But you know, if if it comes across or you’re like, Oh, my God, these guys, they think they know everything. I say, Okay, well, that’s, that’s a you problem. Yeah. Because because I think that both of us are like, this is the best available research. This is just our interpretation of it. This is how we are applying it to what we’re teaching. And also not not is this this is not a right or wrong thing. These are ideas based on this research that we’ve put together.

Jamie Johnston 48:29
Yeah, and this is, this is the best available research that I could find. Yeah, right. If you found some better research than by all means, throw up my way. I’m happy to take a look at it. And if it changes what I’m teaching that all the better. Yeah. Right. But But again, just making sure that whether online or in person, you’re doing it in a respectful way, to the person who’s put the effort into to build a course and is is trying to better the profession through what they’re teaching.

Eric Purves 48:56
And actually might be a good topic for another another podcasts in the future. We the amount of effort it takes it for to do courses like to put them together and I think it’s something that not a lot of people understand. And I never understood from when I’d be fine till I started teaching courses. I never realized the hours what it took to do it and you know, I’ve seen things before not necessarily in BC but another in other provinces, other parts of the world. Why are courses so expensive? And you know, I can’t afford that and you think okay, I understand finances are was a thing, and it’s a thing. But I also think this is going to probably well, I guess this goes into the the evidence based course thing. That if you have a course that is thoroughly researched, and it’s like you can defend with good quality research what it is, you really as the learner really need to I think it’s important to understand how much time they put into that. Yeah. And developing it like how Drudes of hours. Yeah. So maybe you’re paying 500 or 600 hours for that course. But that person is probably put in hundreds of hours to get to that, and plus the constant updating it, plus the marketing and the admin side of it. And, you know, the expenses, especially so as much now if you’re teaching it online, but still, when you’re traveling, Detroit is 1000s of dollars. So there’s a lot of things there that people might not be aware of.

Jamie Johnston 50:27
Yeah, that’s one thing I was gonna say is the, if the instructor is worth their salt, they’re they’re continually updating. Right, the hopefully, whatever course you take right now is not going to be the same course from that person two years from now. Because as new research comes out, they shouldn’t be updating it. Yeah, and making it better for you and whoever else is taking it, for sure. So I think that’s a good way to wrap up. That’s probably a long winded way to talk about how to choose an evidence based course. But we hope that it, it’s an effective way to look at things. For those of you who are looking to spend your hard earned money on a course and we’re not saying that it has to be one of our courses that you take. But when you are looking to spend that hard earned money into progress your career, just make sure that you’re making wise decisions when you choose your course. Love it. All right. That’s it. We’ll see everybody next time. We hope you enjoyed this podcast. These kinds of topics are what we are all about. If you’d like to learn more, go to our websites,

Eric Purves 51:32
themtdc.com or ericpurves.com. If you know of any other therapists that could benefit from this, please tell them to subscribe