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
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- Podcast Episode #27 Myofascial Release And CLB, What Does The Evidence Say? - August 30, 2022