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Articles Of The Week February 25, 2018

 

It can be a bit stressful when we think about treating patients with chronic pain as there is a lack of understanding and tools for treating this population. However, the biopsychosocial approach is a framework that can be effective, and this post shows why.

“A Plea To Providers: This Is Why Biopsychosocial Treatment Of Pain Works” – Devra Sheldon

I know there is some research being done at our local university on this exact topic, but can a blood test actually diagnose a concussion? Well, not yet, and this post shows four reasons why.

“Can A Blood Test Diagnose A Concussion?” – Complete Concussion Management

I hate paying taxes, but unfortunately, it’s that time of year again. Maybe next year I will have to use some of the advice from this post to make sure I’m ready at tax time.

“Tis The Season For Taxes (Again)” – Cath Cox

It seems as though the real learning in our industry happens after college and in continuing education courses. However, we need to be careful when choosing which courses to take because they can actually reduce our credibility.

“Fantasy Physiology And The Post Hoc Fallacy” – Whitney Lowe

Have you ever looked at the cost difference between getting a new client, or retaining the ones you have? Over the long term, you’re better off to build solid relationships with your current patients, and since they love your treatments and trust you, they’re more likely to refer their friends to you. While this post is directed at personal trainers, there’s some solid advice in there for therapists too.

“The Importance Of Client Retention” – Michael Anderson

The Difficulty Of Challenging Our Beliefs

Growing up I was raised with a certain belief system.

It worked well for my parents, family, and most of our friends. However, I always felt like a bit of an outsider. I tended to question things, and couldn’t always get a good answer (or at least an answer that satisfied me).

Quite often when I asked questions, I was told not to question things (and was sometimes reprimanded for it), that there were some things we just didn’t know the answer to. It rarely felt right to me, not to be able to get, or find those answers, to just accept things as they were.

It got to the point, I would just stop asking. Sometimes out of mere frustration, sometimes out of fear, sometimes because I just got fed up with feeling out of place. It was probably just easier to follow along and not try to push the envelope as it were.

Later in life, I took a different direction.

I went back to school to learn something new and would be the first one in my family to go to college. It seemed pretty daunting, but I took the same approach. Don’t ask questions!

I went through college assuming that everything I was being taught was correct, so there was no reason to question it. I knew all the things I was learning was what I would be examined on both in school and at our board exams, so really there seemed to be no reason to question the information.

Challenging More Beliefs

For some reason, I’ve been seeing a lot more discussion online lately about some of the old theories around Massage Therapy (specifically about pregnancy and massage for some reason). I’ve even heard of a patient being denied treatment because they were pregnant and a therapist thought it was contraindicated.

I still find it remarkable that some of those ‘myths’ are still being spread around and believed.

But then I think back and realize just how hard it is to challenge our beliefs. If there are certain modalities or contraindications we have been using for long periods of time and we’re having a reasonable amount of success treating this way, why would we ever question it?

The difficulty isn’t just within our own practice, sometimes it means challenging the establishment, and even other colleagues. There can be significant kickback from those same colleagues, especially if you’re starting to challenge their belief system.

Part of the issue is that when our beliefs are challenged, we feel threatened. Look at any of the many facebook groups about massage therapy, and watch how people react when certain modalities are challenged (and even proven wrong with research). It is usually met with harsh denial from some parties, quite often to the point of getting quite angry.

Regularly I have people comment on blog posts or unsubscribe, then send emails citing their complete disagreement with an article, and their years of experience proving the article wrong as the reason. And for a long time, I was that guy! I took it as a personal attack when going through various facebook threads, or seeing comments challenging what I had learned in school. I had to leave some of those facebook groups because they got me so angry.

Then for some reason, I started to reflect on those experiences growing up when I would ask questions and people would get upset. It didn’t seem reasonable to me then, so why was I reacting like this?

I started taking courses where the instructors were challenging the old ways of thinking and didn’t mind being challenged by students in the class. Usually, they were able to come back with reasonable explanations to the students who were challenging them. And the best part was, they never got upset. They took it in stride and were able to change the students view with updated relevant information.

I started to go back to some of those groups watch, learn, and try not to take things personally. Turns out lots of good information was being shared and there was never any ill intent behind the discussions taking place, they were just that…discussions. While some debate takes place, I came to realize there is such a thing as healthy debate, and debate causes progress. What I always thought was just people arguing and puffing their chest out, was actually just people challenging beliefs and literally trying to help advance professionally. While sometimes better language and communication could have been used, I don’t think anyone was ever trying to personally attack anyone.

Rather than expecting others to change, I had to step back, look at those groups and say “it’s not you, it’s me,” but rather than it being a break-up, I was trying to stay in!

The Results

While there is always the chance of repercussions when we start to challenge things, there is a positive side to it as well.

If I hadn’t challenged my beliefs all those years ago, I would have never gone back to college, never gotten the chance to work in sport, and most certainly wouldn’t be sitting here writing this blog. However, there were major repercussions I had to consider when challenging things, mainly around relationships with family and friends. Even though there was a real possibility those relationships would fade away or end, to my surprise (for the most part) they didn’t. The ones who mattered are still around today.

The same thing happened over my concerns with colleagues. The more I started to challenge ideas within our profession, the more relationships actually grew, became stronger, and new ones developed. The kickback I expected (because of the way I was interpreting things online) didn’t really happen, and I noticed more people started questioning things as well.

The other thing that happened…my interaction with my patients got better.

When we start to challenge things and leave those old ideas in the past, there is a certain amount of freedom that comes with it. So many of the things I thought were contraindications with massage aren’t, so I don’t have to worry about those things anymore. I also don’t have to give my patients fancy explanations around what I do, because I’m not wrapped up in explaining biomechanical things that aren’t relative to a treatment, or trigger points, innominate rotations, and certainly not worried about touching a pregnant woman’s ankles! What’s even better is the simpler explanations I give now, make more sense to the patient.

In a conversation I had with Alice Sanvito last week, she made a really great point about this kind of communication. If we are using the explanations around some of these old beliefs we aren’t actually getting proper consent from our patients when treating them. How could they consent to treatment when what we’re describing isn’t actually an issue, or the modality isn’t backed by evidence?

I hope as a profession we start to question things more, in fact, to become more respected and evidence-based, we HAVE to start challenging information more. While there will be resistance from some (and probably some anger), with any hope it will also bring us all a little bit more freedom. I also hope no one will be left feeling like an outsider, worried about the reactions of others, but rather open to asking questions and finding appropriate answers.

Articles Of The Week February 18, 2018

I may be partial, but I gotta say I love this post. It might be because I think this has happened to all of us. We have a patient come in who has been told by another practitioner that they will never get better, or they’ve been given some false information. Well, this is an open letter to everyone in our industry to do better.

“An Open Letter To My Patients Previous Therapists” – Sarah Haag

We all treat patients with low back pain. But, what are the appropriate guidelines for treatment? Well, some pretty reliable practitioners teamed up to look at the evidence, and explain the difference in guidelines, implementation, and controversies.

“Low Back Pain, A Ride Through The Guidelines” – Body In Mind

I don’t know about you, but I LOVE sleep. But how much do we really need? Well, that may vary, but it’s important to pay attention to our own individual needs, as well as looking at how to make sleep a priority.

“How Much Sleep Do We Really Need?” – National Sleep Foundation

One of the great things about massage therapy is the many ways we can focus on certain conditions or populations. If you’d like to focus on cancer treatment, this site has some good info. They present different recommendations as far as altering your treatment when someone is going through chemotherapy, and their reasoning seems pretty sound.

“Cold Caps, Frozen Feet, And Massage During Chemotherapy” – Tracy Walton & Associates

Our communication with patients is so important. So how do you present new ideas or research to them when you learn it? How about when it comes to your pain education? It doesn’t have to be complicated (in fact it’s probably a lot better if it isn’t), just explaining that certain areas of their body may be a bit more sensitive, is probably a lot better than a complicated description.

“Pain Science Education” – Lynita White

 

6 Ways To Develop Leadership As A Massage Therapist

 

As I observe the current status of our industry, I find myself wanting more for us. I want massage therapy to be viewed with higher esteem, receive greater respect, and as an integral part of our society’s wellness.

The next thought, logically, is how does this happen? What do we need to do to grow our field?

We need to become leaders; all of us, in our own special ways, need to lead. There’s a quote that has been attributed to many, in fact, it’s even a book title…” you don’t need a title to be a leader.”

I fell into the trap of believing a title was required to lead. I cannot say I ever had aspirations of positioning myself as a leader in the industry, but when you’re gently volun-told by a highly respected colleague, it is, sometimes, difficult to say no. I become involved, first at a local level, then a state level.

Working on a local and state level provided me with the opportunity and challenge of creating engaging events and garnering participation, and I didn’t feel any substantive change was created. There was a discussion about the future of the industry and the direction within the state; the ability to create substantive change or make measurable progress was lacking. This created frustration for me because I believed we would have the opportunity to truly influence the field.

After these experiences, I can tell you, I didn’t feel like a leader.

This experience left me wondering…how do we then create change? How do we lead? Where are all the leaders?

The leaders, I’ve discovered are right in front of us.

We have the daily opportunity to create change by the influence we have on our clients, the professionalism of our behaviours, and the respectable image we perpetuate in our practices. We can be effective in every aspect of our practices. It depends on how our clients feel when they walk out the door. Did we meet their expectations? Have we treated them with the respect and dignity they deserve? Did we give them our full attention? What will they tell their friends and family about their experience?

We have a very unique industry. While we can work in environments with multiple therapists, we are often left to our own devices in the execution of our sessions. Not only do we tend to work in an isolated environment, massage therapy is, for most, a second, if not a third career. I believe our field has such an incredible array of talent, knowledge, and skill I wonder why we aren’t doing more to mine and utilize this valuable resource.

Why do some of our colleagues feel threatened by other therapists? Why are we so unwilling to share our expertise and talents with each other?  Even further, why are we intimidated to share our knowledge? I’ve decided, instead of passively wondering, it’s time to take action…and here are some thoughts on simple things we can do every day.

1. Learn More

There are over 100 modalities in massage therapy.

What have you learned lately?

If your practice and bodywork are starting to feel stale and you’re getting bored, trust me, your clients know.

If your clients know, will they keep coming back or will they start looking for something else? I would take the initiative and become the something they need that they don’t know they need; let that weird sentence rattle around your brain for a little bit. This can be tricky though. I know many therapists who become CEU junkies or end up following some of the modality empires. They go from one workshop to the next without truly applying the knowledge and integrating their new-found skills into their sessions.

There is great power in understanding the concepts of skilled touch. Once we have mastered the skill of varying angles of entry into muscle, communicating effectively with our clients, understanding the anatomical and physiological repercussions of our work, we can elevate ourselves, and our practice to better serve our clients and the profession.

Once we fully understand concepts rather than just modalities, they can be easily applied and integrated with our previous knowledge. While I am a strong proponent of education; there are light years between book learning and practical learning. We have to strive to find the balance to truly become exceptional; through that example alone, we can lead our profession.

2. Share Your Knowledge

I suffer from imposter syndrome. I often ask, “why would anyone want to hear from me?” or “who am I to tell people what to do?”

As an educator, I’ve learned, those that are interested will find useful information in anything you share; those that aren’t motivated won’t; ultimately, it isn’t our responsibility to get everyone on board.

Those of us with experience have gained a vast amount of knowledge and wisdom. This information can always be shared with new therapists. If you’re working in an environment with other therapists, take the time to reach out to those that are new and share with them some of the knowledge you’ve gained.

It can be as simple as how to maintain a client base; a solid technique to use for someone’s shoulder; how to build a strong rapport with clients. Sharing knowledge doesn’t always mean leading a workshop or a huge event; it’s the little things we can do every day to help our colleagues grow and improve; this, in turn, has a direct, positive effect on our industry.

3. Network

When was the last time you were able to refer a client to another therapist?

We all have those clients that don’t necessarily fit in our treatment style, or are our ideal client; why not collaborate with another therapist that can meet their needs? Personally, I do not perform prenatal massage well. I have colleagues to whom I can refer those clients during their pregnancy.

It is not important if the client returns to my practice. The focus is the service to their needs. If they know my goal is their well being, they will be willing to refer friends and family because there is comfort in the knowledge that the client’s needs are the priority and every effort will be made to ensure their satisfaction.

Photo by Tim Gouw from Pexels

4. Lead By Example

Let’s be honest, some of us don’t like public speaking.

If we behave in a manner that demonstrates professional behaviour, confidence, and understanding, others will begin to emulate those characteristics. These can be very subtle and natural practices.

Show up on time, speak respectfully to your clients, listen intently to others, treat others the way you’d like to be treated. It can manifest as sharing your experiences in a workshop or class, talking about an article/blog/social media post that you read and sharing it with your colleagues, showing enthusiasm and excitement for the field, and smile and say hello to everyone along your path.

5. Appreciate Others

Acknowledge a colleague’s accomplishments. It doesn’t have to be a significant accomplishment; it can be something as simple as a full schedule or handling a difficult client with grace.

Always say thank you.

I liked to thank my colleague that properly prepared the treatment room at the end of their shift; it made the transition into my shift so much easier and, because of the way I was treated, I wanted to make sure I left the room in the same condition.

We can all agree that people enjoy talking about themselves the most, so ask them about their interests; find out what’s important to them, or what I like to do…ask them about their favourite food or candy and randomly bring it to them for absolutely no reason. I’d also suggest giving a random or well-placed compliment; we could all use a pick me up in the middle of a tough shift; find the opportunity to put a smile on someone’s face.

And most importantly…

6. Choose To Lead

All of these actions have one thing in common…we have to make the conscious decision to take on these challenges. As Mahatma Gandhi said, “Be the change that you wish to see in the world.”

I’ve noticed that as I’ve decided to take on some of these actions, my own perceptions of my colleagues and workplace have changed. If we provide positive energy and optimism, it begins to infuse us, as well as our environment. The best part; this can go beyond the workplace. All of these actions can easily be translated into our personal lives.

Reviewing these options reinforces the idea that we don’t need a title to be a leader; we just have to make a conscious choice to make a positive impact on our clients’ and colleagues’ lives. We have to decide what we want in our workplace and community. Once that is identified, the actions required to influence change will become apparent. Frustration was my motivation to seek change; I hope your inspiration comes from a more positive space. Leadership comes from within…are you ready to be the one to inspire growth and change? Warren Bennis, widely regarded as the pioneer of contemporary leadership said, “Becoming a leader is synonymous with becoming yourself. It is precisely that simple and it is also that difficult.” It appears the fundamental question begs…who then, are you?

 

Articles Of The Week February 11, 2018

Like so many things in our industry, there is lots of confusion around youth strength training. Does it improve health? effect bone growth? is it even appropriate? Some great information in this article covering those questions and many others.

“Youth Strength Training”  – Mario Chavez

Chronic disease is a massive expense on our healthcare system, and yet there doesn’t seem to be much done to prevent it. So how can we start to change things to start making prevention a regular part of our healthcare systems?

“An Ounce Of Prevention Is Worth A Pound Of Cure” – Jarod Hall

Quite often I have patients and colleagues ask where to get good information on pain. Well, Lissanthea Taylor is stepping up with this great resource she is developing. There will be lots of information on pain so that we can give accurate information to others.

“Where’s The Good Information About Pain?” – Lissanthea Taylor

Do you know the difference between Varus and Valgus? This post will help to give you a better understanding of the differences between the two and what can contribute to it. One of the things I like about the article is how the author points out that someone may have this kind of condition, but not experience any pain, so it may not even need treatment.

“Valgus, Varus, Vargus…What Is It?”  – Whitney Lowe

Being in business for yourself is hard work! It seems there is a never-ending list of things that have to get done and we’re constantly hustling to accomplish more. But could we be more successful if we hustled less? Here are four tips on how to do just that.

“How Not To Hustle Your Way To Success: 4 Tips For Aspiring Entrepreneurs” – MeiMei Fox

 

Three Reasons It Matters Why A Treatment Works

Why exactly does someone feel better after a massage? Or acupuncture? Or foam rolling? Or a chiropractic adjustment, or wearing K-tape, or doing mobility drills, or a hamstring stretch?

There are some good answers to these questions, and the interesting thing I’d like to point out in this post is that quite often, the therapist doesn’t know them. Or even care about them! Or maybe the therapist has heard the good answers, but prefers alternative bad answers that are far less plausible given the current state of relevant science.

Speaking of bad explanations: Foam rolling probably doesn’t work by breaking adhesions or melting fascia. Chiropractic manipulation doesn’t put joints that are “out” back “in.” Deep tissue massage doesn’t get rid of toxins or “muscle knots.” Acupuncture doesn’t access special points or meridians – putting the needles in random places works just as well. Some sham surgeries work just as well the real thing. Motor control exercises often work to reduce pain even though motor control hasn’t changed.

None of this means that the above treatments can’t work to make someone feel better. It just means they don’t work in the manner advertised. And no this doesn’t mean that everything is just placebo (that’s a confusing word without a clear meaning.)

In general, it seems that therapists have a strong bias towards the idea they are fixing “issues in the tissues.”  And they tend to ignore issues in the more complex systems in the body – nervous, immune, autonomic – which are very sensitive to even minor inputs and have a great influence over how we move and feel. Maybe this is because these systems are less visible, or tangible, or just not what practitioners learned about when they were in school.

I was trained as a Rolfer and taught that Rolfing works by changing fascia. So when people got up from the table and said they felt taller, or looser, or had less pain, this was because their fascia had somehow changed for the better.

After doing some research about the deformability of fascia in response to manual pressure, I decided this was not a good explanation for our observations. A better explanation would involve the nervous system, which is constantly adjusting muscle tension, movement patterns, perception, and pain sensitivity in response to new sensory information, including the highly novel sensory information caused by bodywork.

Of course, it’s kind of a bummer to learn that a central premise of your education is incorrect. But the good news is that this doesn’t mean people can’t be helped with your treatment. That is a completely separate issue. So my attitude was – OK, it’s not about the fascia, but that doesn’t mean I can’t help people.

But for many Rolfers, it just has to be about the fascia. And for chiros, it has to be about the subluxation, and for Reiki practitioners, it has to be about energy, and for others, it needs to be about posture, or core strength, or muscle imbalances, or movement patterns.

And of course, many others will say: “I don’t care how the treatment works, I just know that it works does so who cares why?”

Here’s three reasons why it’s important to know why your treatment works.

1. If You Know How Something Works, You Can Make It Work Better

This should be obvious. If you know where the target is, it’s easier to hit the bullseye.

Let’s assume that stretching or massage works to create better range of motion by getting the muscles to relax. (Reasonable enough, right? And supported by research!)

But if you think that it works by forcefully breaking adhesions or physically lengthening tissues you might lose focus on whether your clients are staying relaxed.

When I work on someone I always ask “how does that feel?” Here’s a common response from clients who think it’s all about the fascia: “Don’t worry about me, I have a very high pain tolerance, just do what you have to do.”

And I will think to myself: “Well, I need to know how you feel because that is one of the main targets for this work.” But if my target was breaking up fascia or muscle knots then indeed I wouldn’t care how they felt. And I wouldn’t do as good of a job.

2. Unintended Consequences

Imagine someone with neck pain goes to the chiropractor, is told their neck is “out”, gets cracked to put it back “in”, and then immediately feels much better. What’s the harm if they think that pain relief came from some form of realignment?

Maybe in the short term, there is no harm, but false beliefs have a mischievous way of eventually causing problems in the long term.

Let’s say the neck pain comes back. The client thinks her neck must be “out” again so she needs another crack. So she overlooks other potential solutions like exercise, rest, or gentle movement. If the neck pain continues, she might eventually develop the pathological belief that her neck is fragile and unstable. This can have a nocebo effect – creating further pain and avoidance of healthy movement.

I have seen many clients with similar misconceptions, and this has cost them significant time, money, anxiety, and confusion.

And I’m not just talking about the clients of chiropractors.

I have seen yoga people who are always stretching; Pilates people always stabilizing; corrective exercisers looking for microscopic muscle imbalances; joint mobility fans perpetually mobilizing, as if their joints need a constant bath in synovial fluid, or will start knitting themselves together with some sort of fascial “fuzz” after just a few minutes of stasis. Rust never sleeps!

All these pathological behaviours ultimately stem from false beliefs about why certain therapies have worked for them in the past. These beliefs cluster around the idea that they have corrected “issues in the tissues” as opposed to temporarily adjusting the sensitivity of the nervous system.

The bottom line is that false beliefs, no matter how small, are like viruses – they multiply, get passed to others, mutate to form superbugs, and can eventually cause disease. Don’t spread them, people!

3. The Truth Matters

The truth has inherent value, even when its practical application is not immediately obvious. Knowledge is always powerful – for you, your clients, and the whole community.

We don’t yet know exactly why people have chronic pain and the best ways to treat it.

Even though that knowledge hasn’t been created yet, that doesn’t mean it’s useless to learn more. Every step away from misinformation and confusion is a step in the direction of the truth.

Let’s face it. The truth is good and ignorance sucks. Here’s some quotes from smart people to prove it.

“All evils are caused by lack of knowledge.”

–David Deustch

“I think it’s much more interesting to live not knowing than to have answers which might be wrong.” 

— Richard Feynman

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

— Mark Twain

 “The truth will set you free, but first it will piss you off.” 

–Joe Klaas

Many thanks to my readers and members of my social media community who are thinkers, skeptics, and unafraid to follow where the evidence leads.