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Articles Of The Week April 19, 2020

 

How often do you have a patient come in who is dealing with pelvic pain? I haven’t seen it much in my practice but I think this is also partially because it’s not common for a Massage Therapist to treat this area. Well, perhaps it’s time we change that.

“Treatment of Pelvic and Abdominal Pain for the RMT” – Jocelyn Kirton

We all know I have mad respect for Todd Hargrove, so when he puts on a master class about pain, movement, and play (while also doing it for free), I think we should all take advantage!

“Pain, Movement, And Play: Common Sense For Complex Problems” – Todd Hargrove

I haven’t had a chance to do this course myself but it was recommended by someone I have HUGE respect for, so it must be good. Another great way to get some learning done during the pandemic.

“Exercise And Physical Activity For Knee Osteoarthritis” – Rana Hinman

Still not sure where to start learning about pain? This is a phenomenal resource put together on some of the top pain resources available.

“Pain Resources: A Deeper Dive” – Rebecca Hall

We all know how important exercise is. As this review points out, it’s actually very important to help decelerate cognitive decline. Although exercise might not enhance cognitive function, it does effectively decelerate the decline in cognitive function.

“The Effect of Physical Exercise on Cognitive Functioning in Individuals with MCI and Dementia” – Scott Buxton

 

Looking at Pain From Different “Levels”

 

Pain can be a complex phenomenon, meaning that many different factors might contribute to pain, and that these factors can be interwoven in a way that makes it very hard to separate one from the other, either for purposes of explaining pain or intervening to treat it in some way.

This is a major theme of my recent book Playing With Movement, where I argue that complexity science has many concepts that are useful in understanding movement and pain.

One of these concepts is that complex systems are often nested. That means the system as a whole is composed of smaller subsystems, which are also composed of smaller subsystems and so forth.

 

Example of pain complexity

Where is the pain?

For example, people are made up of organ systems (like the nervous system or musculoskeletal system), which are in turn composed of organs (like the brain and spinal cord, muscles, and tendons), which are composed of cells (like nerve cells and muscle cells) and so forth. Further, people are parts of larger systems like families and communities and economies. This is interesting because each nested system provides a different level from which we can attempt to explain and treat pain.
Here’s a diagram to illustrate:
Screen Shot 2018-05-11 at 7.17.42 PM.png

At the “lower” levels, you can analyze the health status of cells and organs like muscles, tendons, discs or nerves. For example, maybe your foot hurts because of a stress fracture. This is where you can find “issues in the tissues”, which is where traditional pain treatment has focused most of its attention. This is often called the “biomedical approach” or the “bio” part of the biopsychosocial model. You find the structure that is damaged and work to repair it.

At the “higher” levels of analysis, such as the person or the environment, you are looking at more complex phenomena – the role of thoughts, emotions, or social relationships. These are the “psychosocial” issues that are known to have very important effects on chronic pain.

Problems in these areas are often relatively subtle, more about dysregulation or imbalance than something being broken or injured. These issues are also invisible if you look for them at a lower level. For example, you can’t see catastrophising by assessing a foot – you need to talk to a person.

Fields Of Study

There are many different formal disciplines you could study to get a better understanding at each level. Note that they are very different from one another, and very few people will have significant knowledge at more than one level.

Screen Shot 2018-05-11 at 7.19.35 PM.png

At the lower levels, you could study biomechanics, exercise physiology or neurodynamics. Each would give you a better understanding of how physical structures in the body respond to stress – either by breaking down and getting injured or adapting to get stronger.

You could move up a level to study the behavior of a larger system like the nervous system, immune system or endocrine system. This would help you see that pain functions like an alarm. The nervous, immune and endocrine systems help set the sensitivity of the alarm, and determine the kinds of events that cause it to go off. “Pain science” is mostly education in the basic physiology of these systems as they relate to pain. 

We can move up another level to the “person”, where we are studying the role of cognitions and emotions in pain. This is the realm of psychology, the relevance of which should be obvious – pain is a psychological event.

Psychological concepts can be very useful in understanding why movement and physical activity help with pain. For example, cognitive behavioral therapy can explain how exercise might extinguish fears or expectancies that contribute to pain. In many cases, this perspective is more helpful in choosing an exercise program than one focused on “lower-level” concerns about muscle groups, reps, and sets.   

You could move yet higher to study the role of social and economic systems. Many social critics argue that the real pathologies causing a wide variety of chronic diseases – including drug addiction, anxiety, depression, and even chronic pain – live more at the level of society than the individual. For example, low socioeconomic status is a big predictor of chronic pain. Most readers of this blog are not active in trying to solve problems at this level but are quite aware that they have a big impact on clinical outcomes.

Comparing The Different Levels

The terms “high level” and “low level” don’t reflect any value judgment. They merely indicate different perspectives: one is taking a “micro” view of relatively small and simple things like tendons or muscles, and the other is taking a “macro” or big picture look at larger complex things like nervous systems and emotions.

In general, if you’re moving down levels in your effort to explain some problem, you could call that “reductionist.” And if you’re moving up, that might be called a more “holistic” or “systems thinking” approach.

Screen Shot 2018-05-11 at 7.37.06 PM.png
Again, there is not necessarily any right or wrong here – the right level depends on the context.  Some problems with pain, especially those related to acute injuries, benefit from a lower-level approach – strengthen this, stretch that, do X sets of Y reps for Z weeks and then you will be fixed. Other pain problems can never really be “fixed” and may be hard to manage even with a whole team of psychotherapists, social workers, and attorneys.
Although each end of the spectrum has its costs and benefits, there is no doubt that until very recently, manual and movement therapists have spent way too much time at the lower levels, looking for issues in the tissues with their microscopes, while ignoring some very real big picture human issues sitting right in front of them. If the “pain science revolution” means anything, it is trying to improve basic literacy at the higher levels. “Playing with movement” means exploring a problem from as many different levels and perspectives as possible. To put it simply, finding physical activities that are challenging, meaningful and variable will go along way toward engaging us on almost any level that matters.

Articles Of The Week April 12, 2020

 

Right now we can all use a little help. While this is directed towards our friends in the U.S. there is some valuable advice for all of us during these trying times.

“Corona Virus And Massage Therapist Resources” – Laura Allen

With social distancing in place and many fitness facilities closed, we are seeing a lot more people outside running, biking, and hiking. However, during these activities we may need to actually increase our social distancing.

“Belgian-Dutch Study: Why In Times Of COVID-19 You Should Not Walk/Run/Bike Close To Each Other.” – Jurgen Thoelen

While everyone is dealing with their own issues around this new pandemic, it presents a new challenge for our patients dealing with chronic pain. Many of the treatments they use can affect their immune system and the effects of the virus itself can actually make their pain worse.

“Clinical Challenge: Chronic Pain and COVID-19 — Pain Patients May Be Hit Harder Than Others” – Judy George

While we are all concerned with our immune system right now, it’s important to know this system has a role in dealing with pain. While we cannot treat infections, it is important for us to know how the immune system plays a role in pain modulation.

How Immune System Contributes to Pain With Nervous System” – Nick Ng

Wondering what to do during isolation? Here’s a great list of videos which all contain the latest knowledge about pain from experts in modern pain science.

“Pain lectures with Pain Experts like Moseley, Stanton, Butler, O’Sullivan, Nijs, O´Connell, Zusman, Lehman, Reme, Thacker, Louw, Pearson and Dr. Kieran O’Sullivan” – Lars Avemarie

 

Coronavirus And Massage Therapist Resources

*This was written before the US stimulus package was passed and some independent contractors may be able to get unemployment pay

We are living in extraordinary times. Everyone I know has experienced hard times at some point, individually, but as a whole nation, and as the collective of massage therapists, we are currently going through things that we didn’t expect to go through. When this started (before it was acknowledged as a pandemic, and unfortunately even since), some people had the belief that it was something that existed on the other side of the world and wouldn’t affect us. Others have claimed it’s just a germ, or just the flu, or a political conspiracy. As a nation, we were ill-prepared. I will save my political rant about that for another day (or another book). Right now, people need help.

Many massage therapists have voluntarily shut down their practice, and that includes those who have no savings and are worried about where their next rent payment will come from. Others are continuing to work, citing their finances. Others work for chains that threaten that they will have no job if they refuse to work. Harder times are coming unless we do everything we can to stem the spread of this illness.

I have put together some information and some resources that massage therapists will hopefully find beneficial.

Financial Help

    • Today (Saturday, March 21 2020) as I am writing this, the Senate and the House are in session, putting differences aside, and working with White House negotiators trying to finalize the details of the economic stimulus plan. Current thought is that individuals and small businesses will receive $1000-$1200 checks, and the plan is to get them out there very quickly, hopefully, April, and there may be an additional payment in May. The current thought is that if you filed taxes last year, you will not have to do anything special in order to receive it; it will automatically be mailed to you. I suggest watching national news shows to keep updated on this.
    • The Department of Labor has several important announcements on its website. While there is a statement to contact your individual state, the Federal government has issued specific new guidance for the states. Under the guidance, federal law permits significant flexibility for states to amend their laws to provide unemployment insurance benefits in multiple scenarios related to COVID-19. For example, federal law allows states to pay benefits where:
    • An employer temporarily ceases operations due to COVID-19, preventing employees from coming to work;
    • An individual is quarantined with the expectation of returning to work after the quarantine is over; and
    • An individual leaves employment due to a risk of exposure or infection or to care for a family member.
    • In addition, federal law does not require an employee to quit in order to receive benefits due to the impact of COVID-19.
    • Obviously, I cannot list resources for specific states. My suggestions are for you to contact your state unemployment office to find out. There are local offices in most towns. I live in a very small town, but there is one here.
    • If you are a business owner, the Small Business Administration is helping small businesses with long-term (up to 30 years) loans at 3.75% interest that can cover operating expenses, payroll, etc. When you call your local office, say you are inquiring about the Economic Injury Disaster Loan (the name they are giving to this instance).]
    • If you have credit card debt, don’t panic. Call your card company. Many of the major credit card companies are offering cardholders the opportunity to skip payments without interest. 
    • If you have a student loan, now is a good time to ask for forbearance. Contact your particular lender.
    • Many utilities, phone, and internet companies are giving people a break right now by easing shutoffs and forgoing late payments. Call your utility company to find out what they are doing.
    • There is further help for both renters and for homeowners. The Forbes website states that they will update this list as more information becomes available.  Best advice, though, is if you feel you are going to get behind on your mortgage, call the lender now. Don’t wait until you’re in real trouble of being foreclosed on. In this environment, and because lenders often get the information about financial developments before they do, they will often be sympathetic and help you out by deferring payments or accepting partial payments or even refinancing at a favorable rate. They do not want to get stuck with a bunch of defaulted foreclosure properties in the midst of a recession, which we are undoubtedly heading for. They would probably rather take some money that no money, or give you a grace period on making payments.

If you rent or your home (or office space) is financed by an individual, all the more reason to handle it and call them now. See if they are able and willing to work with you. I have seen quite a few therapists on FB who said that their landlords were very sympathetic and willing to work with them. If you don’t ask, you’ll never know. Some landlords may take a hard line or just not be in a financial position to do so themselves and refuse, but if they think about it carefully, they may decide that they would have difficulty replacing their reliable tenants in this environment, and work with you.

    • Seek LOCAL resources. Now is not the time for pride to stand in the way of doing things you wouldn’t normally do, such as going to a food bank or going to local charities to ask for assistance. Rutherford County NC, where I live, is NC’s largest county, area-wise, largely rural, and only has a population of about 60,000. There are probably at least 20 food pantries here that are operated by churches and community organizations. There is also a soup kitchen open somewhere every day of the week. There are several local non-profits that help people with rent, heating expenses (thank God the need for that is close to over in most places).
    • Insurance tip from Allissa Haines: If you buy your health insurance on the national or your state exchange, you can probably edit your application to reflect your new income and get a lower rate. Allissa and Michael Reynolds have also made a lot of their podcasts available for free at https://www.massagebusinessblueprint.com/free-stuff
      Speaking of insurance, keep in mind that your liability insurance will not cover you in the event of a client catching the virus in your practice. Allissa, incidentally, was exposed to the virus and was in the uncomfortable position of having to call her clients to tell them that they had been exposed. You do not want to find yourself in that position.

Seek a temporary job. Go to a local temp agency and see what’s available. MANY grocery stores are currently hiring due to the food panic that’s going on. Yes, you will still be in contact with people. However, grocers are not a licensed profession, and they do not swear to a code of ethics that they will First Do No Harm. Amazon is hiring. Walmart announced yesterday that they plan to hire 150,000 additional workers. Ingle’s announced the same.

There are many massage therapists that have other degrees, other trade experience, and/or other skills. I personally know many who are everything from CNAs, nurses, truck drivers, and formerly (or still part-time) work in other professions. Medical personnel is in great demand right now, and so are all kinds of support staff in hospitals, from the janitor to billing coders.

I’ve also seen some enterprising therapists who are doing home deliveries for people who can’t get out…doing errands, going to pick up groceries or to the drugstore for the elderly or immune-compromised. Some are even doing it as volunteers. If you are in the position of being able to do that, what service to your fellow inhabitants of the planet.

Now that schools and daycare centers have been shut down in many places, it’s possible that neighbors who are still able to work may need reliable temporary child care.

  • Unless you are 100% self-quarantining, there is hardly any work situation we can be in where we will not be exposed to someone. Social distancing is the best way to flatten the curve. It gives us the best chance of not passing this on to anyone. Going out anywhere to work is a risk, but again, those who work outside of licensed health professions do not swear that they are going to uphold a code of ethics to first do no harm. If you are a licensed therapist, you took that oath. Uphold it. We cannot maintain any social distance with our hands-on unclothed bodies and our face inches away from theirs.

Be creative. You may possess skills that other people need that you can do at home, such as website building skills or baking bread (since there seems to be a run on that at the grocery store), proofreading, sewing, preparing taxes if you’re that savvy, or any number of things.

  • If you are a member of a professional massage association, contact their leadership and ask for their assistance in getting unemployment coverage for massage therapists during this unusual circumstance. They pay lobbyists in nearly every state. You will find the links to their leadership on their websites.

ABMP has a link on their website supporting the effort to obtain benefits for massage therapists. It allows you to send a pre-written letter that they have supplied to your congressperson by filling in your info and submitting a form. PLEASE take advantage of this call to action. They also have updates on their website about the actions in different states as far as shutting down or limiting massage therapy. ABMP also has a link to state shutdown orders on their website. 

AMTA has a link on their website supporting the effort to obtain benefits for massage therapists. It allows you to send a pre-written letter that they have supplied to your congressperson by filling in your info and submitting a form. PLEASE take advantage of this call to action. AMTA also has a link to state actions on their website. 

Keep Up With The Latest Updates

PLEASE keep abreast of your state’s situation by checking the website of your governor, your local health department, and your state massage board. There has been a lot of criticism of state boards, due to confusion that state boards have the legal authority to shut down the practice of massage on a statewide basis, which is not true. They are regulatory boards, not legislative. They can and should make an announcement once your governor has signed an executive order to curtail massage or order the shutdown of anything in your state, but they cannot personally mandate that massage therapists have to shut it down.

City councils have in some cases taken it on themselves to shut it down on a local basis. Here in my state of NC, Asheville’s council has shut it down. Other places may do the same.

Some state boards have extended the deadline for CE/license renewal and/or made allowances for taking your CE, due to the cancellation of massage meetings and conventions. In my state of NC, we are allowed to do all 24 hours online this time, instead of the usual 12. Check your board website for info.

Professional association members can get CE online at no additional charge; it’s included in your membership dues.

Centers for Disease Control

World Health Organization

Wise Words From Massage Therapists I Listen To: 

From Ruth Werner:
Ignore My Earlier Advice. Shut It Down.

My friends and colleagues, it’s time to shut it down. It’s past time to shut it down.
I wrote a piece two weeks ago that provided some ideas about how to take care of your practice, assuming you were still seeing clients. I hereby rescind that advice, and I apologize to anyone who was misled.

Close your practice.

For how long? Who knows?

If it were me, I would start with four weeks and re-evaluate after three.
Wouldn’t it be great if we had all the information we needed to make informed, non-panicky decisions that we knew would maximize effectiveness against the spread of COVID-19 virus, and minimize financial hardship? Sadly, we don’t have that data.

No one is going to make this decision for you. Not your membership organization, not your state board, only you.

No one is going to make this any easier for you.

This is your call. And if you want my opinion (and presumably you’re interested, because you’re reading this), here it is: close your practice.

Here are some things we know that have led me to this point of view:

1. The time between exposure and symptoms can be up to 14 days.

2. The virus is contagious for days before symptoms develop, so your “healthy client” might not be.

3. The virus stays intact on surfaces for several days; it stays intact in the air for several hours (at least).

4. COVID-19 is extremely contagious, and it doesn’t take a lot of exposure to spread from one person to another.

5. The virus appears to be contagious after symptoms subside—but we don’t know how long.

6. At this point, older people and those with impaired immune systems are not necessarily more likely than others to catch the virus, but they are more likely to need extensive medical interventions. (Although that may be changing. In some countries the number of people in hospital care is skewing much younger.)

7. We don’t have enough medical capacity to manage what’s coming—which makes it even more vital not to add to that load in any way.

There are so many things about this situation that should have been different. I could list a bunch, but (A) it wouldn’t help and (B) isn’t our blood pressure high enough without recounting all the ways our systems have failed us? And this frustration doesn’t even include some of the nutso crazy pants stuff I’ve seen on Facebook and other outlets. For the record, keeping your throat moist will not prevent you from getting sick with COVID-19. Neither will holding your breath for 10 seconds.

But if we all commit to extreme social isolation, it is practically for sure that the impact of COVID-19 in this country will be less extreme, at least in the short run. While roughly the same number of people will get sick, it will happen over a longer period of time. This “flattening of the curve” means our health-care facilities might be able to keep up with our needs, which means the mortality rate will fall. And the day will come when we might be able to look back and say, “Wow, that wasn’t so bad—weren’t we silly to over-react?”

This Will Demonstrate That We Did It Right

The naysayers and virus-skeptics and my-immune-system-is-strong-so-I’ll-do-what-I-want folks will point fingers and scoff and say we all fell for a huge hoax. Let them. They are wrong.

There’s a parallel in our recent history. In the 1970s, massive changes were put in place to limit the type of air pollution that caused acid rain. At that time, the rain was literally melting our forests and corroding our buildings, not to mention what it was doing to groundwater. The changes, while expensive and inconvenient for many industries, worked. Acid rain is no longer considered a threat. And the result: some people (including some politicians who should *swearword* know better) suggest that the changes were unnecessary because look: acid rain isn’t really a problem! Argle bargle. You can’t *swearword* win.

Let’s Make Some Lemonade!

The financial burden of losing several weeks of business is undeniable. I’m sorry, there’s no easy way out of this. Once this crisis has passed, it will be important to plan ahead for the next one. Financial planners recommend having at least a month’s worth of expenses put in an accessible savings account—just for events like this.

That said, having some dedicated but unscheduled time to devote to business holds a lot of potential.

This is a great time to do a really thorough cleaning of your office. Go in when it’s empty, and disinfect your equipment and surfaces. Do a top-to-bottom refresh. Dust, launder, swab, decontaminate, and shine up all your stuff. Listen to loud music while you do it. It will be fun. And when you go back to work—oh, such a joy it will be to enter your gorgeous, sparkling workplace!

This is a great time to take some continuing education online. Go shopping in the rich ABMP collection of online CE classes, here. You could take some business classes, and use this time to make plans for a grand re-opening. You could take some research literacy classes, and go on a PubMed.gov treasure hunt for articles that are up your alley. Have you always been curious about a certain technique or approach to bodywork? Here’s an opportunity to explore it to see what you might want to pursue in live classes.

Do you send out blogs or newsletters for your clients? Get ahead on your writing, and put some pieces away for later. It’s more important than ever to keep those lines of communication open, so this is a good investment of your energy. Let your clients know that while you can’t see them in person, you’re thinking of them.

It’s tax time: get ahead of your taxes for this year, and set up your books for easy use next year.

If you are caring for children during this time, include them in appropriate activities. Make them your model while you watch a technique video. Learn, or re-learn, some anatomy together. Make this time a gift.

Most of all, breathe deeply and be kind. Let’s take care of each other and help each other through a scary time. We’re going to be OK. We will emerge, poorer in money, but richer in experience because we took the right actions. And we will be ready to help our clients and our communities come back up to full speed when the time is right.

From Cal Cates

Dear everyone who offers a service or type of care that is (when we’re being truly ego-free and honest) non-essential, but who is still staying open and touching/interacting in close proximity with people, but who is “being careful” and “prescreening”,
I have taken the liberty of creating a simplified form to support said caution and prescreening.
1. Please use the space below to list every surface you have touched, every place you have gone and the names of every person who has been within 6 feet of you over the last 14 days.
2. Please use the space below to do the same for each person that you listed above.
When you’re done thoroughly completing this form, the COVID-19 crisis should be over and we’ll be cool to proceed.

From Tracy Walton:
I understand that professional organizations are finding it hard–really hard–to discern right action right now. I have compassion for them and for all of us.
At the same time, this directive falls short (note–she was speaking of the original statement from AMTA, which did not advise therapists to stop doing massage).
The guidelines and messages from other countries are crystal-clear:
Social distancing now. Not tomorrow, now.
Massage is not in accord with social distancing.
Massage therapy may be health care, and important and essential, but it is elective and requires close contact by its nature.
Asymptomatic clients and therapists can and most likely are transmitting the virus.
We cannot afford to miss this. The stakes are unfathomably high.
My practice is closed for 3 weeks and probably longer.

About Me

I started taking bodywork classes back in 1993, finished massage school in 1999, and was in the first wave of people to get licensed in NC. I taught Ethics and marketing classes to my own class in massage school. They needed an instructor and I was qualified, so I was hired. I love massage therapy. I received my first one over 30 years ago when I woke up one morning and couldn’t turn my head. My enlightened mother took me to get a massage. After spending over 20 years in the restaurant business, I sold out and started massage school. I became an Approved Provider of Continuing Education, and since that time, I’ve taught more classes than I can count, mainly in the areas of Ethics, but also teacher training classes, marketing, and massage classes.

I also spent several years volunteering as a Unit Coordinator and later as the administrator of all the coordinators for the NC Chapter of AMTA. I spent five years serving on the North Carolina Board of Massage & Bodywork Therapy and was twice a delegate to the FSMTB. I’m the author of Heart of Bodywork, the Ethics column of ABMP’s Massage & Bodywork Magazine and the author of numerous books. Most are massage related; a few are on other topics, including one on the state of healthcare in every nation in the world.

I spent 13 years as a clinic owner employing a chiropractor, numerous massage therapists, a naturopath, an acupuncturist, an esthetician, and at various times, other practitioners. I closed it in 2016 when my deceased husband, Champ Allen, was sick. I spent three years working as the Massage Division Director of Soothing Touch, the massage product company, and for a little over a year, I have been working for CryoDerm, the pain relief, and massage product company. They are a family-owned company located in FL; I live in NC. I am fortunate to get to work from home. I was recently promoted to President of Sales & Marketing there.

I have also maintained a very small client list for massage that I see in a local spa, usually about 6-8 clients per month. I am not seeing anyone at this time, and don’t intend to until I can be sure it’s safe to do so. I don’t know when that will be. None of us do. I am practicing social distancing and as close to self-quarantine as I can get. My mother, who lives a few miles away from me, is 81, in compromised health, and needs help at times, so I will continue to go there as needed. She has a  home health care aid most days. I will run the necessary errands to keep her from going out. Otherwise, my husband James Clayton (I remarried last year) and I are staying at home with our dogs. Even my brother, who lives directly behind me, and I are maintaining 6 feet between each other. He was injured in a serious accident last year, has had 7 surgeries as a result of that, and has implanted antibiotics. James is a two-time cancer survivor who has had a lot of chemo and radiation, which does a whammy on the immune system, so I certainly don’t want to bring anything home to him.

I wish you all the best in these trying times and I hope you all remain well.

Articles Of The Week April 5, 2020

Due to the COVID-19 pandemic, we’re going to try and keep things as positive as possible around here.  So let’s look at some good things we can do while we’re sheltered at home.

Here’s some great advice on how to keep the kid’s active while at home. While some of it may not be allowed in your area (I know here playgrounds are shut down), there are still some great suggestions on how to keep the little ones active.

“Keeping Children Active during the Coronavirus Pandemic” – Exercise Is Medicine

Have you considered using this downtime to make some changes around the office? Did you know that just simply changing some of the things in your waiting room could influence a patient’s pain experience? Check this video out to see why.

“Pain Pearls, Office Environment” – Richard Mcilmoyle

Some of you may be chatting with patients while we’re dealing with this epidemic. Here’s some great practical advice on how to make those conversations a little better.

“10 Practical Tips To Make Your Online Consults Better” – Ben Cormack

This is a pretty cool little giveaway if you’re looking to get some exercise at home. After you sign up you’ll be emailed a spreadsheet and the author has a little tutorial on the website of how to use the spreadsheet (you may be like me and have to google some of the exercises). But, this is a great way to get some exercise at home with whatever equipment you have available.

“Home Workout Builder” – Mladen Jovanovich

So, many of us are probably getting bored with being isolated at home. But here’s a list of 30 different things you could do right from the comfort of your own home to stave off that boredom!

“30 Ideas To Entertain Yourself During Social Distancing” – Brain Injury Canada

 

How Challenging Our Identity Can Make Us Better Therapists

I struggled to write this post but decided I would go ahead with it anyways.

Over the past couple of weeks, I have received a couple of scathing emails from someone who unsubscribed from the blog saying that the information on here is misleading, arrogant, disrespectful, has nothing to do with basic massage therapy skills, and is a disservice to the profession.

It’s not the first time I’ve received a message like this, and I’m truly sorry the information we try to spread made someone feel this way.

But then I have to take a step back and ask why?

Why would a couple of articles get someone this upset?

Then I witnessed some discussion on a couple of Facebook threads and there was a word used… this word can incite some pretty big emotions in people.

The word was “cult” (and for the record, I’m not saying any group within our profession is a cult, I was just reading) and for some, this is a word that can incite anger. Especially when we’re referring to different groups within our profession!

According to one source, what makes this word so powerful is the “us vs. them” mentality which is sometimes seen in Facebook group discussions. 

So, I want to use this post to dissect why I think this kind of stuff happens and how we can all grow together.

Challenging Our Identity

I have written an article before that touches on this topic but for those of you who haven’t read it, I’ll give you a little bit of my story.

I was raised in a very religious family by loving well-meaning people. However, as I grew older and got into my teenage years, I started to question things and couldn’t always get an answer that satisfied me. Most of the time when I questioned things, people would get upset because I was questioning the very foundation of their belief system.

As I got into my twenties I started to take more of a step back from my family’s faith, I kind of still had a foot in it, but the rest of me was pretty much out.

Then in my thirties, I got to the point that I had to make a decision. Being involved in the faith didn’t make me happy, but there was genuine concern over leaving it altogether. How would my friends and family react? This was all I had ever known, how do I just leave and start a new life?

It was scary!

My entire identity revolved around being a part of this religion, I was identified by my faith!

Now, I’ll be the first to admit that as scary as that was, I still have supportive parents and family, sometimes we just have to put our differences aside. I realize you may be looking at this and thinking, what does this have to do with massage therapy, so just be patient with me for a minute.

I saw an interesting video the other day where the person was talking about the way we teach things to children can have a profound effect on them later in life.

They talked about grabbing the brain of a person when they’re young and if we dictate things to them in a way that presents something as fact, their very lives can be shaped by what has been put in their head.

They will genuinely believe whatever has been told to them.

I can’t help but liken this to my experience in college.

I didn’t really question the information being presented to me (in all fairness, I had no other advanced education past high school, so hadn’t really been taught critical thinking skills) because all the information I needed was in the textbooks and why would the instructors tell me something that was incorrect? I had complete faith in what was being taught to me.

I think for most of us, once we’re done college we look for the next best thing in continuing education and go down a road of looking for the best manual techniques we can find. Sometimes this results in following a couple of instructors (or maybe just one), then investing in Levels 1-4 of manual technique “X” and shaping our careers around these specific technique styles.

All of this could be happening in the early or “youth” stage of our careers, everything being taught to us is being presented as fact and we genuinely believe it because…why wouldn’t we!?

Knowing all of this, I can’t help but liken it to some of the things I see happen in our profession and I think I realize why I get some of these scathing emails once in a while.

We can spend several years doing these courses having great success with the patients who come into our practice, all the while this is shaping our identity as a therapist. Your patients refer their friends because you’re the best manual therapy “X” provider they’ve ever been to!

You have the absolute best of intentions and you genuinely help most of the people who come and see you (none of us have a 100% success rate) because your hands and the technique you use works so well. Your practice is thriving, so why question it? Plus, you go to another course from the same provider and you’re surrounded by like-minded people who are also having great success with these techniques!

Then somebody questions it.

Your very identity, intentions, practice, and success are all questioned.

If you changed, how would your colleagues react? what about your patients? their referrals? your place in the community?

Your very identity could be changed…and that’s REALLY SCARY…trust me, I know!

Challenging our own belief system, whether its the one you were raised in, or the type of therapist you are might be one of the most difficult things you could ever do, but the thing is, it doesn’t have to be!

Evidence-Based Practice

Last year at our associations AGM there was a huge discussion around evidence-based practice.

Some of the discussion centered around reading research and applying it in practice. I wouldn’t say it was a heated discussion but there was certainly a bit of controversy. Much of this was around how to make research easier to access and making the information easier to digest.

Then when it was all over, an interesting thing happened.

An accountant came up and asked me “what does evidence-based practice mean?”

I said: “well, it means using your experience in practice while reading the most current research and staying up to date on new findings so we can better serve our patients for better treatment outcomes.”

She said: “isn’t that just a given!?”

You’d think so?

This is where I have to give a shout out to Erik Meira, he wrote a post on his blog a while ago about the “evidence-based funnel” instead of the evidence-based stool many of us had come to know, it looks like this:

Evidence Based Practice Funnel

Evidence-Based Practice funnel via Erik Meira

 

 

Quite often with discussions I see online, and from the odd scathing email I get, some of the things people say are:

“I deny research in my practice because my experience is more important than research”

“I question YOUR research and you do not accept our anecdotal experience”

Well, first off, I don’t actually conduct any research, I just read the available research. But the thing is, no one is saying your experience doesn’t count. In fact, as you can see in the illustration, clinical expertise is a HUGE part of being an evidence-based practitioner. If you’ve been in practice for any length of time and had clinical success, your expertise is vastly important to you and your patients.

As you can see, another critical part is patient values and circumstances. You are part of their values, they trust you, they like you, you have helped them!

In fact, one paper shows us how patient’s expectations play a huge role in recovery from pain and rehab from injuries. If one of these patients has come to you for treatment before and you helped them, their expectation is that by coming to see you again, you will help alleviate their pain.

This helps to show us how treatment outcomes do not depend wholly on the type of technique we use but are also influenced by patient attitudes and beliefs. 

Another aspect of this is the confidence of the provider. When you suggest how a technique or treatment will help it can enhance the expectation of the patient that they will, in fact, get better, which can improve those clinical outcomes.

One thing that also comes up is that some of us are trying to discount what has come before us. Well, this isn’t true either, all of those who wrote textbooks, developed new techniques, and taught us in the early years deserve a huge amount of respect for what they did. The only issue is that some of these books were written in the ’80s and much of what is taught, research has shown to no longer be accurate.

However, at the time these people were visionaries and they should completely be given due credit for that.

While it is important to give these past authors their due respect it is equally as important (if not more so) to give respect to the new information coming out which is helping to shape current practice. Just like how those in the past pushed the profession forward, so is the new research, and we must include this in our practice. 

Great Examples And Putting Differences Aside

The whole point of this blog and many others similar to it is the sharing of new knowledge and trying to help educate other practitioners.

When I get some of these scathing emails, while it can be disheartening, I look out and see the other side, which are some great examples of those who changed their narrative for the better.

MTDC coach Walt Fritz travels the world teaching his courses on “Foundations In Myofascial Release”, and is quite well known for it. Yet, just recently he changed the name to “Foundations Of Manual Therapy” because this is a more accurate description of what he does.

Walt has been doing this for a long time and that title change could have alienated him from his audience and some of his mentors from the past. I know it was probably hard, but he challenged things and had to change his identity because he is doing his best to keep up with current evidence.

I look to our friend Ann Sleeper. For years Ann taught courses in “Muscle Energy Technique” with a narrative that was used for many years. When faced with what new research says and coming to a better understanding, she has changed the narrative in her courses.

While she is essentially teaching the same “technique” her description behind what is happening has been updated. This is another example where I’m sure she found it quite difficult, she was known for years as the person who taught this technique, it was part of her identity.

I recently heard of another instructor who for years has taught “Muscle Energy Technique” and has also decided to update the narrative of their course due to the new things we understand around biopsychosocial aspects of pain and what new research has been telling us.

These are great examples, and part of what makes them great examples is how long they have been teaching, they have a huge following, and could have easily kept teaching the same thing. Instead, they decided to update, change, and adapt, which in turn will hopefully happen to their respective audiences.

We don’t have to have the “us vs. them” mentality (and I know this happens in the technique, pain science, and other groups) if we could be open to sharing ideas and actually looking at what good quality research says. Growing up, one of the things I used to hear at home was how we could get our point across better “if we season our words with salt”. So, perhaps I can do a better job of that when writing these posts, perhaps we can do that within Facebook groups, and perhaps we can all do this when attending live courses and events? We all want the same thing…to help our patients as much as possible and be successful therapists. To do this, we don’t have to learn a new technique, but we do need to give an accurate description of the one we’re using, communicate well with our patients (and probably season our words with salt here too), and do things they like. 

And maybe sometimes we just have to put our differences aside.