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.
Jamie Johston 0:33
It’s often been said that, you know, you’re doing something right when you’re making other people mad. And I don’t mean that in a in an aggressive way that you’re going out and attempting to make people mad. But when you’re putting out content consistently, and it’s starting to disrupt the norm, within an industry, which is what both of us are trying to do, it’s obviously starting to have that effect. Because we’ve noticed after our last podcast, that we’ve been blocked by somebody who was a colleague and a friend for many years. So we just find it interesting that, that maybe we’re actually having some success, because now people are starting to get upset by something that we’re saying.
Eric Purves 1:19
Yeah, it’s interesting. I mean, I’m sure there’s, there’s probably, there’s probably a handful of people that don’t like what we have to say, or, or want to want to block. So it’s funny, though, that, you know, because people have said certain things to me before, they’re like, Well, why do you teach? What Why do you? Why do you have a podcast? Why do you do your courses? Why do you blog and all that stuff, because a lot of times, it comes across as being like calling, calling stuff out, right? Calling out the crap. And as can be, and there’s there can be a negative undertone sometimes. But the goal always is, is to elevate our profession to inspire people to think more in line with the science and, and I would say that the vast majority things that we talk about are not always our own opinions. I mean, I think will state its own opinions or own beliefs or our own thoughts or experiences when when we need to, when that’s relevant, but a lot of time, we’re just, we’re just the messengers, right? We just were reading research or attending conferences or having conversations with with, with smart people. And we learn and we try to bring that information to our listeners and to our students. And sometimes people don’t like that message. But I would say that if you don’t like the message, then maybe listen to what we’re saying. And don’t take it personal. Because it’s never a personal attack on somebody. It’s more about, well, these are things that we’ve said, and these are things that, that maybe other people believe, but what’s the evidence suggest? And what is the what is a biologically plausible explanation for these things? We talk about that quite a bit. Just question don’t attack the messenger, so to speak, just accept that, you know, what, maybe what you think is not 100% supportable. And let’s just let’s just, and let’s look at what is supportable, and, and this is happens all the time, right? I mean, you read stuff, or you see conversations or hear conversations with people that people have. And they’re like, Oh, well, you know, what’s wrong with saying that you’re releasing fascia? Well, it’s wrong. For one thing, you’re not doing that you’re not doing that. But maybe the experience of the person is they feel like there’s something lengthening or softening. But okay, we have there’s a different explanation for that. So let’s not just keep perpetuating these these unhealthy these narratives, which can be unhelpful, maybe they’re not, but at the very least, are not correct. And this goes to something I think you’ve talked about before, I don’t know if you want to touch on this about the idea of informed consent.
Jamie Johnston 3:53
Yeah. And I mean, really, I think what it comes down to is like not only informed consent, but it also comes down to being an ethical practitioner. Because if you’re, if you’re still preaching those old narratives, you’re not getting informed consent from your patient. So when you’re when you’re doing work on them, and I’ve really been thinking about this a lot, I could go off on a rant, but I feel like we need to stop saying that we’re working on people or we’re treating people and I think we need to start talking more about engaging with our patients, and having them engaged in the, in the therapeutic treatment. Because it it should never be that we’re doing something to them. It should be that we’re collaborating with them and engaging with them. So I want to start changing. I wanna start changing my language around that, but I’m gonna start changing all of the language around that too. Let’s engage in treatment with people anyways.
Eric Purves 4:49
That’s brilliant. I really liked that. Because because we are often do I think the way we’re taught and the kind of common expectation is that people come in and we fix them. We do Do something to them to fix them. Yeah. But that’s,
Jamie Johnston 5:03
that goes back to that old narrative thing. That’s a belief. Yeah.
Eric Purves 5:07
But the reality is that we we aren’t actually fixing people, but we’re facilitating or collaborating or engaging gauging was offered to us, right? Yeah. Like we’re engaging with another human to try and find out a way to make them feel better. Maybe that is them just lying on the table for an hour and getting a beautiful massage. Yeah. Or maybe it’s involving Exercise and Movement and lifestyle changes, right, whatever else is in our scope of practice, wherever you where you live.
Jamie Johnston 5:31
Yep. But to go back to the ethics thing. I would think that most of us would, when we think about being an ethical practitioner, we’re, we’re probably looking more at the things like, Well, I wouldn’t build their insurance company, when I didn’t provide a treatment, I wouldn’t overcharge them here, I wouldn’t do this. So I want my practice to be ethical. But when it comes to treatment, and I’m not saying that anybody is intentionally not providing an ethical treatment, but if we’re not staying up to date and getting rid of those old narratives, then we’re not providing an ethical treatment, because we’re giving people misinformation, no different than if we’re giving an insurance company misinformation about what we did for treatment. So if we’re going to remain as ethical practitioners, we have to stay up to date with the new information that’s coming out. And I realized that can be difficult. But it’s, it’s part of what we have to do. So in order to get informed consent on all those other things, we have to treat ethically, and that means staying up to date on things. So there’s, there’s been plenty of times where other people and actually just recently, there was a thread where people were knocking the NOI group and stuff like that. And I was kind of getting pissed off reading it, because obviously, I liked those guys and like what they do. But when you start to get that pissed off feeling, maybe it’s time to take a step back and go, Well, maybe it’s just because I’m getting challenged, and I don’t like it. So maybe I should just take a deep breath, look at what they have to say, and see if there’s any validity to it. And sometimes it can be somebody that you just don’t like that saying it. And then in that case, fair enough, if you want to just ignore it and move on, that’s fine. But if you’re starting to get challenged, maybe that’s just a sign that you need to take a step back and go, Okay, maybe I need to look a little closer at this, rather than getting upset. Yeah. Or maybe reach out to that person. If you’re friends with them and be like taken, we have chat about this. Like, where are you coming from? What does the research say and have a legitimate professional colleague chat with each other, and see what you can do to help each other?
Eric Purves 7:28
It my experience, in all the years doing this is that when people block you or they don’t want to, they don’t want to hear what you have to say it’s because they are usually they’re challenged by or they don’t like what you have to say, because it doesn’t fit with what, how they think. And I mean, I’ve never, I don’t think I’ve ever blocked anybody or I’ve ever. I don’t think I’ve ever attacked anybody. Personally, I’ll attack ideas all day. But I don’t think I would ever attack a person. Because, you know, I know from my own experience that I I use the word thought wrong. My thinking was incomplete for a lot of years until you start to be able to learn more and put pieces together, you start to realize, okay, how I practice and how I thought and how I communicated was incorrect. But I knew that I was often helping people, but the reasons why I was helping them were very different from what I thought. And when people didn’t get better. Oh, rather than, you know, now thinking, knowing what you know, now you realize, oh, there’s an explanation for that. Because, you know, this person didn’t need to be fixed. They needed some support. They needed some, some management, they need to be engaged with not to be fixed. And, and that that, that I think we need to have that humility and say, Yeah, I was wrong. I made mistakes. Every day I make every day. And that’s okay. Because that’s part of it. That’s why they call it a practice. Yeah, we, yeah, we try and do the thing that’s less wrong. So no, it’s it’s tough, tough business to be in. We’re always putting ourselves out there.
Jamie Johnston 8:58
Yeah. And you got to, you got to, I think you have to expect some reaction. But you also have to accept that, you know, just sometimes you’re just gonna say things that people don’t like, unfortunately, in this case, the person had an issue with it. And it’s too bad that there couldn’t be more professional discourse on on whatever we said to upset the person if that’s what happened. And maybe down the road one day that will be hopefully exemplary. So they say, Yeah, so we’ve got a couple. Now that we’ve got that ramps out of the way. Yeah, no, it’s
Eric Purves 9:31
good. Just as good to adding some memes just to talk about that.
Jamie Johnston 9:34
Yeah. So a couple papers that we’re going to look at. I’m just bringing it up here on my iPad. The first one is called comparison comparison of an exercise program within without manual therapy for patients with chronic neck pain, neck pain and Upper Cervical rotation restriction, and randomized controlled trial. So there’s a bunch of stuff I liked about this paper and some stuff they didn’t like. And one of the things I thing that I really liked about it is they, and it’s just confirming my bias, again, is that they talked more about preventing disability in this paper than they didn’t talk about just treating a person’s pain. Because they talked more about, you know, getting that person back to for full cervical rotation, and then flexion and extension and things like that. So there was less of a focus on pain, even though there was some mention on that. But it was more about getting people back to doing the things that are important to them, which I think is the most important reason people come to see us. So that it totally confirmed my bias in that. So that’s one of the things that I really liked about it. And we’ll get deeper into it. But the other thing that I really liked about it, is that so like all of the movements, and all of the exercises they provided, were really simple things that you can do on your treatment table. It didn’t require a gym, it didn’t require, you know, going and having to do all these fancy things, it was literally just simple things you can do right on your table. And, and I think all too often, as I try to push with the course we teach together and in my own courses is that we need to stop being scared about doing exercise and movement with people, we need to do more of that. And this was a great example of how you can just do it in your treatment of
Eric Purves 11:16
it, there’s a few things I mean, with this paper that were good, and there’s there’s some as bad and I’m very critical when I read these things. So I’m gonna, I’m gonna start off with kind of some myths if I didn’t like. And the first one was the journal that it was in, never heard this journal before. So it is an open access journal, which means you can access the papers for free, there’s no paywall. You don’t have to go to Sai hub and, you know, go back door on it. Yeah, do the back door. But when I did find it, it was like its impact factor and its ranking was quite low in this field. So I was like, you know, that’s, that’s usually a concern, which means these papers might not have the best peer review process, or they may not go through a very rigorous process before they publish it with the editors. So that was a little bit of a, I was always a little bit skeptical. I read those things. A couple of things. Which Who is it these tests, these type of studies? There’s lots of them out there probably 1000s. It’s like a one plus one study. So this is exercise plus manual therapy compared to just exercise.
Jamie Johnston 12:23
Which is that? Actually, I don’t want to take you off your neck. No, no. But that’s one of the things that I liked about it is, is usually it’s the other way. It’s okay, could we add exercise to manual therapy? To get an outcome, whereas this was going the other way? It’s like, Well, we already do exercise. So is adding manual therapy to the exercise gonna help. So I actually liked that, that they’re, they’re going that direction rather than it’s always manual therapy and then adding exercise.
Eric Purves 12:52
Yeah, and that and it’s it is I mean, there’s nothing wrong with that, per se, because the lot of these days we’ll say we’ll show and there’s, there’s 1000s that are out there, where you add one thing to a treatment. It’s usually better. Yeah. Then then note, like if there’s like another paper we’ll talk about maybe later, it’s like talks about doing exercise. Well, doing exercise is better than not doing exercise.
Jamie Johnston 13:13
Yeah, doing something is better than nothing. Yeah, so it’s doing something better, I
Eric Purves 13:16
think so this was kind of like, doing something is better than nothing. But doing something plus something is better than just the one thing. So that is, you know, it’s good to know, but the studies are also are pretty common that you do one thing, it’s better than you’re gonna have better outcome. Yeah, better. The other. The other thing, one of the things that, you know, when the that was a little bit when they’re looking at their measurements, one of the things they’re, they’re looking at range of motion. And so range of motion also is and the way they assessed it was subjective, it was the examiner doing it, and when they felt an end feel, or the person reported pain, you know, and then they would measure that that’s very, that’s not very reliable. So it’s, you know, that there is like, a measurement, not so sure. And the other one they did is they looked at what they called hypermobility through manual assessment where they actually just, you know, we’re testing the movement of the of the joints through manual techniques, and we know that those things well aren’t very reliable. But there was a couple things in here which think you know, I did all those are kind of big red flags for me. But I didn’t put I would normally read those things and throw the paper away. But because we were going to talk about this one, we’re like, okay, let’s just dig a little bit further.
Jamie Johnston 14:32
Yeah, I know like there was a number of were there like the measurement of upper trapezius the measurement of lips gap and you can’t really do a measurement just on those things when you’re looking at rotation because it’s a group of muscles that are doing the action not one singular muscle so
Eric Purves 14:47
yeah, yeah, yeah, cuz they also this way looked at so their their primary outcome measure which was the NDI which is an architect’s disability index, which is good because that’s a that’s a very common reliable disability measure. which, which was good, I liked it. That was the primary one, which goes with what he talked about about function, which just should be the primary goal, reduce secondary measures, lower pressure, print pressure, pain, threshold, pain, intensity and range of motion. Those are also kind of very subjective things. So there, those are not always the best. But well, when we looked at the how they did manual therapy, in this, it was basically it was spinal manipulation. We were I didn’t really like it. Yeah. Okay, well, it’s not massage. Yeah, we things. We don’t see a lot of papers like massage therapy papers looking at this. And so you know, they were they were doing chiropractic manipulations, or hivelocity, although I think it was physios physiotherapy, but they did hivelocity manipulations. And they also did low velocity manipulations on different areas to see. So anyway, it was there’s a few things there. But I think the if we were like, Okay, let’s try and be positive with this. It wasn’t complete garbage. There were some things they could have done better. But they did look at function. And they did find, you know, that doing a combination of these manual techniques with exercise helped. In the short and longer
Jamie Johnston 16:19
term. Yeah. Which was great. Yeah, like I said, that was one of the things I didn’t really like is that they were doing spinal manipulation or thrusts. Although looking at a couple of the explanations, they were talking about doing a glide, which is basically a joint modal, which is something that we learned in school. So obviously something that massage therapists can use. But a version one sentence specifically that I highlighted, that said, Another possible explanation for the gain of motion of the lower cervical spine, since this region has not been directly addressed could be through neurophysiological mechanisms. There you go, I would like to take away the could be and say it was from neurological neurophysiological mechanisms. So but we know like when we look at Bilasa T stuff that, you know, everything. Every manual therapy technique that we use, has a neuro physiological mechanism. So even though in this case, they’re using, you know, manipulation, and thrusts and things like that, that doesn’t mean that that specific technique is better than doing a massage, or doing a joint modal or doing other stuff. Because all manual therapy works the same. So we shouldn’t take this as the only way that this is going to be a benefit as if we’re doing spinal manipulations plus exercise. Yes, we can just put that as long as we’re doing manual therapy and exercise, we should have a better outcome.
Eric Purves 17:41
And I would say that’s a fair. That’s a fair statement. Yeah, based on on how we know manual therapy works with all you know, there’s a million different stories about how it works. We’ve talked about this a million times in the podcast, you know, do the technique you like, Yeah, do it well, and do the technique that the person is expecting. And that works for them. Yeah, right. If someone comes in to see you, and they’re expecting a massage, and you just give them joint moebs, you’re probably not going to have a good Oh, you’re not going to be as and especially if you’re not confident with joint ropes, maybe, yeah, right. Or the other way around, they come to see a chiropractor, a physio, where they’re expecting like a, like a crack thrust of some kind, and they don’t get that they’re probably going to be the outcomes probably aren’t going to be as beneficial. So I think that patient or person, their expectations, in a study like this are that they are going to be receiving some type of spinal manipulation. So therefore, there’s there’s already set up to have that expectation. And probably that’s what they want as well. So that’s going to also I would say that’s going to bias the results towards favor, but that’s okay. Because, you know, people come to see us for massage, and we don’t give them a massage or outcomes are probably not gonna be very good. Very good.
Jamie Johnston 19:00
Yeah. Which doesn’t mean that every single treatment they come, every single person who comes in, you should just strictly do massage. There’s a whole gamut of things that are included in manual therapy that we shouldn’t be including as well. So. So yeah, but it’s it’s funny the points that were making there. I had a lot of the same opinions of the next paper that we’re going to talk about as well. Okay. Yeah. Yeah. Did we beat that one to death? And we should get into the next one?
Eric Purves 19:29
Yeah, that was pretty good. I think the it did show that there was decreased self reported pain over time, there was increased range of motion over time. The neck disability. They didn’t really talk about that as much. They they gave us a chart, but they usually in the results section, they’ll go and they’ll explain in more detail, but the next is really they showed a chart and said Oh, things got better, but without explaining the data. Yeah. That that’s a huge chart. And it’s a huge chart. So I thought that was a bit. I don’t know if there were a word count. issue, but I thought that would have been, that would have been the one that they should have I felt they should have gone into more. Yeah, because reading those charts on those numbers sometimes can be very time consuming and difficult. It’s nice when they kind of paraphrase what the results were in like a couple of sentences. So that that was a bit of a concern. But it basically showed that yeah, if you incorporate exercises, with these are simple exercises, like you said, with some type of manual therapy, people are probably going to feel better. So don’t be afraid to put exercise in your treatments,
Jamie Johnston 20:33
definitely get people moving. Yep, reduce reduce that disability. And it would be good to like with these papers, if they, like you said got in more detail with the neck disability index, but also how they incorporated it, how you can incorporate it more into treatment and natural your outcomes and things like that. Rather than it just being oh, here’s what we used. Go ahead and see if you can figure it out. Yeah. So it would be good if that sort of stuff was included as well. But that’s a probably a conversation for another day. Okay, so the other paper that we’re going to talk about is from Journal of physiotherapy title is some types of exercise are more effective than others, and people with chronic low back pain and network meta analysis. So it’s funny, the more of these papers that I’m reading, the more I’m just going well, Pilates for the wind.
Eric Purves 21:24
Jamie Johnston 21:28
I don’t know how to do Pilates, and I’ve never done it before. But consistently, it seems like it’s coming up more and more and more that Pilates is a really effective management tool for different muscular musculoskeletal conditions, but low back pain, especially.
Eric Purves 21:42
Yeah, yeah, this was interesting paper. I really liked this one, I did a I did a brief review for this in my membership community. And just one thing that like I said before, the last, the last we were talking about was this journal, actually, from the Australian physiotherapy Association, this has a journal ranking of 11 out of about 240, physiotherapy specific journals. So it’s definitely it’s definitely up there. And in the journal rankings, it’s got a good impact factor, which means that the papers that they publish are referenced and used by other research. And so this was good. And I quite liked it. Because, you know, they’re looking at what type of exercise is more effective. So usually, when we we’ve talked this all the time about, you know, clinical practice guidelines or talk about, you know, education reassurance exercise, yeah, are kind of the three things. But what does exercise and what exercise do you do for low back pain? Because exercise is just a vague term.
Jamie Johnston 22:43
Yeah. And I’m at the point now that I’m also, like, when it comes to courses and things like that, I’m gonna, I want to get away from using the word exercise and just have it be movement. Because most people don’t want to go home and do exercise. But they do want to go home and do the movements and do the things that are important to them. So how about we reclassified as therapeutic movement?
Eric Purves 23:07
Yeah, yeah. Yeah, make some it’s, it’s, I think there’s less of a negative connotation with some people.
Jamie Johnston 23:14
Yeah. And it’s, I mean, obviously, it’s not everybody, you can have some people that are like, Oh, they want to get in, do their exercise and do everything else. But you know, some people, it’s, they want to just go home and pick up their kids. Yeah. And if we can adapt that movement, not the exercise, so that they can pick up their skins. And maybe repeatedly picking up their kids is a great movement that they can do to strengthen their back. And by doing a thing that’s meaningful to them, so I’m putting that there’s two things I’m saying we should engage in movement, we could start and stop calling it exercise, coming up into things.
Eric Purves 23:47
When that goes, that goes back to the last, the last podcast we did, where it was basically when we were looking at walking for low back pain versus swimming and cycling and running. I was the last the last podcast we did, which might have upset some people. The end and basically, the findings of that paper we’re doing something is better than nothing. But whatever physical exercise that you do, which one you like, which one you’re going to do, if you don’t like running, but you like swimming, or whatever combination might be then why don’t you do the one that you like, and that was kind of the findings of the of that paper as well. And what I liked with this one, though, is they it was just a huge meta analysis. So I think there was something about 17,000 Participants included in all the studies that they use and the analysis for this, so it was quite significant. And I liked how they they actually categorized all the interventions. And so they included core strengthening or motor control, mixed exercise types, which I don’t really know what that means. It could be Yeah, they didn’t get specific about
Jamie Johnston 24:53
specific exercises were but yeah, but it wasn’t that one I was looking at it and it was more like a global full body type. Yeah,
Eric Purves 25:00
I think so exercise. Yeah. Yeah. Which I think goes in goes kind of along with that. The other section they looked at which was our papers on general strengthening, there was aerobic exercises, once again, very general, pilates, stretching, yoga, functional restoration, which is a term that was an intervention I’m not familiar with, though. We might talk about that again a little bit later because I wouldn’t seem to be one of the top three.
Jamie Johnston 25:25
Between that McKenzie method and Pilates I think it is. Yeah. So McKenzie
Eric Purves 25:29
therapy, flexibility to other exercises. So they looked at, you know, all these different exercises and looked, they use good outcome measures. They looked at, you know, not just pain but also a disability measures. So the Roland Morris disability questionnaire, the Oswestry so for those of us in BC, that treat motor vehicle stuff, the Oswestry is a common one that you’re supposed to use when you’re reporting motor vehicle stuff for low back pain. So yeah, there’s lots of there’s lots of good good stuff in here. But like you said, I think the thing that came down to was really was Pilates for the when Pilates seemed to be the one that had the most Pilates McKenzie therapy and functional restoration. Were the were the three that seemed to be the best exercise as compared to stretching, which I think stretching after read through this again, it was like just passive stretching had kind of like was the the bottom like that was the one that didn’t? Comparatively didn’t wasn’t very good. Yeah. Yeah.
Jamie Johnston 26:25
But it’s really funny because I, I look at that. And I go, what are those three things haven’t What do Pilates Mackenzie, and I’m assuming this functional restoration have in common is that both of them, or all three of them? Whoever’s teaching it to you to be really confident in what they’re teaching. My my understanding of Pilates is they they have those machines that they do Pilates on, and then you know, we looked at it and some of it is doing like yoga type movement with Dan’s different things like that. But I think from what I understand of it, is it’s quite often with somebody and you’re being coached on how to do it, which I know is the same for the McKenzie method, because they look that up. And it’s like providing an assessment working with the person giving exercise plus homecare. So I’m wondering, things that they didn’t address in this paper is the contextual factors of being, you know, people having this extra training, that they’ve done neither McKenzie method or Pilates or whatever, and that you’re more engaged with the person. And you’re being Yeah, and the person is being coached by you, as opposed to like, go home and stretch. Yes. Right. So how much of an effect and awesome that it’s in a positive manner. But how much of an effect is because of the contextual factors as opposed to the other exercises that they were looking at?
Eric Purves 27:42
Yeah. And there’s, yeah, we look at these things, too. And one thing I thought that was really interesting with this paper, which you don’t see is they talked about Pilates, McKenzie and functional restoration as being the most expensive.
Jamie Johnston 27:58
And yeah, how much does that play into it? Yeah. And
Eric Purves 28:00
then he talked about how socio economic status might play a role those things when they’re looking at the the studies. The people that could afford to do those things, were more likely to are probably in a higher socio economic status. And there’s loads of research. And of course, I can’t remember top my head, but we know is a lot of research out there, that suggests that the lower your Setia socio economic status is, the lower your outcomes are wellness is on pretty much all measures of health related things. So, you know, the postal code that you live in a country you live in is, is gonna have a big influence. So that is something that should be I think, is important. This isn’t this has to take with this as well as that, from the study, it says Pilates is the best. But not everybody is gonna be able to afford to go to a Pilates class, or hire someone to teach them how to do it. But if you can, then it’s this is a good option for you.
Jamie Johnston 29:00
Yeah, yeah. And I mean, even, you know, you looked at I Know, Like, we’re so lucky in BC, because people have, you know, so much continuing, or extended health that pays for treatment, you know, and if you’re living in a place that doesn’t have any of that, what a profound impact that can make as well. Right? That goes back to that socioeconomic if you if you can afford to pay for 10 treatments, and go in and have them then likely to have a better outcome as opposed to maybe somebody who can afford to pay for one and then it’s gone. I can’t afford to keep coming back. But I still need to deal with this pain and which could lead to more disability. So yeah, there’s just so many other factors, but I just found it interesting that, you know, we look at the things that they found had the best outcomes were also the things that required more training and more personalized, individualized care, with the person who’s coming
Eric Purves 29:49
in. I think a really important thing to acknowledge with this, though, is that just because those ones had the best outcomes, everything else it was That was in the study had a benefit. Yeah, it just wasn’t as great. So even if it’s stretching seemed to be the one that was like kind of the one they talked about how wasn’t very effective, but it’s still more effective than doing nothing. Yeah. So if the only if you liked and this and they also mentioned this too, which, which is great to see is doing something is better than doing nothing. Right? And if you’re going to do something, they talked about this in the paper, as well as you need to do it at a higher intensity or higher load. Yeah, yeah, the lower that wasn’t as effective. Yeah. So the more and they didn’t really go into too much detail now. But my interpretation of that would be either more into that point of fatigue, right. So you’re doing to the point of where it’s, you’re, you can’t do any more either, like, it’s starting to get uncomfortable, and you’re gonna back off, because you don’t want to flare it up too much. Or you do it to the point of is, I can’t do any more, because I’m shattered. Yeah. Which is going
Jamie Johnston 31:02
to be different for everybody. Yeah. So that’s where you have to have that clinical decision making in place to go, okay, you know, my first person of the day is going to be completely different from my second, third, fourth, and fifth. So, you know, load them differently, do it to their capabilities. And that really comes back to that whole patient centered approach, right?
Eric Purves 31:21
Yeah. Yeah. Yeah. And this is, this is this last sentence they had here to the section of paper called implications for clinical practice. And this just summarizes what you just talked about. The author’s say, if the observed pain and function outcomes align with the patient’s goals, it may be appropriate to recommend these types of exercise programs, if they are available and financially feasible for the patient.
Jamie Johnston 31:45
Back to everything we’ve been talking about.
Eric Purves 31:47
Yeah, exactly. And then if we, if we look at the, you know, that kind of evidence based framework, right, you’ve got like relevant research, you’ve got your clinical expertise, your clinical experience, and you’ve got kind of patient values. And then you also have kind of that fourth part, which you don’t read too much about, it seems to be the ignored part is basically the contexts and the availability of exercise for interventions for people. Now, I would say that that will be where the financial feasibility of it is, you know, what can you do? Yeah, no. And so if we’re looking at, we’ve got evidence to suggest that research, or the research suggests that, you know, these type of exercises are good, any kind of exercise for low back pain seems better than none. And your clinical experience, what works for you, what do you like to do? What do you feel comfortable, and instructing people on if you don’t know, McKenzie therapy, and you don’t know, pilates, and you don’t know, functional restoration? Well, what other type of things can you recommend that you feel comfortable with? And what’s the person want? There we go. Yeah.
Jamie Johnston 32:58
I mean, the other side of that, too, is I could also be, you know, maybe another good thing is to make some professional referral relationships with people who do these specific things. Because I, I mean, looking around here, I don’t I only know of maybe a few Pilates Studios, where we live. Yeah, like for where I live, I think there’s one call one and it’s the only, you know, which is a couple minute drive from here, but it’s the only one I can think of, but there’s, you know, there’s a manual therapy clinic on every corner and like Starbucks around here. But, you know, that specific thing, there’s not that many. So, you know, maybe if we’ve had a patient that we’re doing some movement and exercise with, and maybe they aren’t progressing along to the point that we would like them to, or they would like them to then maybe having that professional referral relationship with, with somebody where you can get them these things. If, if the patient is able to do it, or if the person is able to do it, then then that’s a good thing for us to do as well. Yeah.
Eric Purves 33:54
I guess brilliant. Yeah, exercise is good. manual therapy is good. Combine them is better,
Jamie Johnston 33:59
even better. Yeah. So I think the big messages, for me anyway, is don’t be afraid to incorporate more movement into your treatments. The more that we can do that, I think the more disability we prevent, which is really our main goal with with anybody who comes to see us so make sure you’re incorporating movements in your treatments. Perfect. 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 34:35
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