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Why Your Body Is A Hypocrite

What you see is affected by what you know, and what you hear, and what you touch, and vice versa. This is an example of multi-modal perception. The brain is very complex, and all its different parts integrate and share information acquired from any source – eyes, ears, touch, memories, predictions, expectations, Facebook, etc. We often think pain relates only to “issues in the tissues” but in fact other sources of information about the state of the body matter as well. It’s all connected.

Or is it?

I am currently reading a great book by Robert Kurzban called Why Everyone (Else) Is a Hypocrite. The title is a little bit misleading because the book is not so much about explaining why people lie, but more about working through implications of the modular theory of mind. Kurzban is an evolutionary psychologist, and one of EP’s main theoretical claims is that the mind is modular, meaning that it evolved to have certain specific competencies, as opposed to a general all-purpose problem-solving intelligence.

This idea is best understood in reference to creatures that are far less intelligent than humans, such as spiders. Spiders are architectural geniuses when it comes to building webs, and are also very good at solving problems related to getting food, avoiding predation, and finding mates. But outside these specific contexts, they are idiots.

Natural selection provides living things with specific cognitive competencies, not general all-purpose intelligence. We can look at the mind as a smartphone with various apps, or a swiss army knife with separate tools. Humans have far more computing power and apps than spiders, but it is the same basic modular operating system, which is why we are amazing geniuses in certain areas, such as motor control and language (where we outperform any computer), and not so strong in others, such as math computation (where we are put to shame by simple calculators.)

Kurzban’s interesting twist on this idea is that the different modules don’t necessarily share information with each other. They often work independently, and mistakes in one area can’t necessarily be corrected by more accurate information in another. He uses two common visual illusions to illustrate.

What do the dots in this picture show?

Hidden-Dalmatian.jpg

If you don’t already know the answer, you might struggle for a few minutes before you “see” the dalmatian. As soon as you know what’s in the picture, you can see it almost immediately, and in fact, it becomes hard to “unsee” as well. According to Kurzban, this means that a conscious module in the brain shared information about the picture with a visual processing module, and this affected its computations and therefore your perception of the picture. For similar reasons, this is why wine tastes better when we think it is expensive, and pain hurts more when we think it is caused by major damage in the body, as opposed to some innocuous healing process. But “top-down” information sharing won’t always change your perception.

Consider the checkerboard illusion. Squares A and B are actually the same color!

Figure-ground_Organization_2.jpeg

There is a visual processing module that processes a ton of information to provide you with this (incorrect) perception. It considers the location of the cylinder, the shadow that it casts, the regularity of the squares on the checkerboard. Based on all of this computation, it “decides” that the squares are different colors, and therefore you see them that way. You are never provided with the “raw data”, the set of assumptions, or the thinking process that led to this conclusion. You just get the final product – a mental picture showing the squares as the same color.

And, interestingly, your conscious knowledge that the squares are in fact NOT the same color does nothing to change your perception. Unlike the dalmatian photo, conscious knowledge is not used by the visual processing module to make your perception more accurate. So the illusion remains. According to Kurzban, this is evidence that the work done by the modules is often fairly independent, immune to correction or maybe even input from other modules that know better.

(This is part of why Kurzban thinks we can be hypocrites – there is a social relations module in the brain – a public speaker – whose priority and function is giving you high social status. It doesn’t really care or maybe even know about information located in other modules of the mind, which proves that you aren’t as smart or moral or innocent as you claim in public. The separation of the modules creates “strategic ignorance.”)

Now consider this idea in the context of pain. Sometimes our knowledge and conscious thought processes about the body will affect how a body part feels. If we think that a body part is broken, degenerated, falling apart, unstable, this can make pain worse. And if we think that our body is robust, strong, and capable, this can make us feel better. This is multi-modal perception – sharing of information between the different modules. It explains why in the Dalmatian picture, conscious knowledge about the meaning of the picture affected our perception.

But pain is unfortunately sometimes more like the checkerboard illusion – immune to logic. People often have pain in areas where there is no damage, and sometimes in areas where there aren’t even body parts! Having conscious knowledge about these facts sometimes cannot affect perception. In terms of modules, we could say that the pain module is just not very interested in hearing corrective information from the cognitive modules. It was designed to be strategically ignorant about their conclusions. This is frustrating, but I think an interesting theoretical way to look at the problem of pain having “a mind of its own.” If the pain module won’t “listen” to the more cognitive modules, which modules might be better at speaking its “language?” The movement modules would be first on my list. If you move in a way that demonstrates strength, endurance, or skill, you will get a visceral “bottom-up” feeling of safety that speaks a different and more powerful language than Stuart Smally-style top-down daily affirmations.

Articles Of The Week October 27, 2019

 

The number one reason patients come to see us is to help them with their pain, which makes it important for us to understand how pain works and in turn how we can help them. This is a great post that shows us how our brain and central nervous system modulate pain and how it applies to us.

“Descending Modulation: Why Massage Therapy Can Alleviate Pain” – Mark Olson

While it’s important to share content on therapy topics, we are all in business, so it’s great when another therapist shares what they’ve learned from making mistakes. Here’s some help on what you can do with SEO for your therapy website. 

“An SEO Odyssey” – Jennifer Fleming

For those of us who work in sport (and perhaps some of us who don’t) how many times have you been asked for a “leg flush”? Well this stems from some old school thinking that we could somehow flush toxins, more specifically lactic acid out of the legs to help with recovery after exercise. Well, we can’t actually do that and this post gives us some great clarity on that. 

“Mythbusting: Massage Removes Lactic Acid” – Daniel Wonnocott

We are constantly recommending self care to patients, but how often are we taking it ourselves? Another question is, are we taking the right type of rest? It turns out there are seven types of rest we need and different ways to get it.

“The 7 Types Of Rest You Need To Actually Feel Recharged” – Molly Shea

When you’re working with female patients do you interact or communicate with them differently than male patients? Are the narratives we use different between genders? According to our friend Ellie Somers, there is.

“Considerations for Female Athletes Part 1: Fragility Narratives” – Ellie Somers

Learn How Community Involvement Can Improve Your Business

 

Absolute Therapy is a clinic in Victoria BC, home to an amazing team of fifteen talented practitioners and a collaboration-based treatment environment that epitomizes the ideals of client-centered care. 

However back in 2010 during our humble beginnings, I was the clinic’s sole practitioner – it was just me. With a brand new lease in place and tenant improvements complete, it was time to sink or swim. 

I knew I loved being an RMT, but how would I fare as an entrepreneur? How would I succeed? Well, there’s that old saying: it’s not what you know but who you know.

Anyone who has spent any time in Victoria will tell you that despite its size, it behaves very much like a small town, so to me, just getting out and getting involved seemed a good place to start.

Getting Involved In The Community

I started by offering free educational opportunities (about injury prevention, stretching, workplace wellness – you name it!) to any group keen to host me. 

I did casual talks for office groups in my area, banks, local fire halls, or sometimes more formal engagements such as ProD workshops with schools – I was happy simply to chat about wellness and provide education that would make massage therapy more accessible. Initially, much of my motivation with these talks was of course to promote my practice and business, but the more time I spent with local groups made the larger impact I was having become evident. 

Not to mention the support I was receiving for my business was inspiring. The more connections I made, the more motivated I became to find new and different ways that I could engage with and provide value to this community that was supporting me in my own entrepreneurial journey.

That same year, a friend of mine suggested I join a local business networking group (Business Networking International, or BNI), and it was through this group of connections that Absolute Therapy became involved in its first on-site fundraising gig. One of the members of my group was married to an organizer for Turf Burn, a local soccer tournament. 

The second year of the event was being planned and the organizers were excited about the opportunity to have a couple of RMTs present to provide short treatments for participants (by this time I had one other RMT working with me). We agreed to provide the treatments by donation and, in return for the exposure and the marketing we received, we would donate all the proceeds back to the tournament to go towards their fundraising initiatives. 

And so it began.

 The model of “help-us to help-you to help-them” was officially adopted by Absolute. (Side note: we had our 10th consecutive year with Turf Burn this past Summer; it has grown into a much larger tournament with a great following and now fundraises big bucks for local non-profits – so cool!)

I began researching other local events in which the participants or people involved could benefit from on-site massage therapy and reaching out to the organizers to pitch our “in-kind” sponsorship. We soon became involved in the Victoria Dragon Boat Festival, another event that we would end up sponsoring for many years to come. The Victoria Dragon Festival Society has been a long-standing supporter of the BC Cancer Foundation, and the participants were very appreciative to have the option of pre and post-race treatment. 

The resulting donations we collected on behalf of the VDBF for the BC Cancer Foundation were sizable, and I was once again filled with gratitude for the opportunity to be included in such an amazing local event and awed by the fundraising potential of our involvement.

Building A Reputation By Helping

Event by event, and year after year we gained more notoriety as a clinic passionate about being involved in local events and fundraising initiatives. We became more established in Victoria’s healthcare community, and through our events and other marketing endeavors, garnered a large client-base able to sustain new practitioners on an ongoing basis. 

Throughout all of this, I volunteered with a number of event committees, which of course led me to know other event organizers, which led to more events. As a clinic we have been lucky enough to work with so many local organizations over the years; groups like MEC who tirelessly fundraise for non-profits like Power To Be, or the Victoria Goddess Run who have raised countless dollars for groups like the Victoria Transition House and the Victoria Sexual Assault Centre. 

Trust me when I say that in the amazing community we live in, the opportunities are endless.

I am immensely proud of the efforts that the Absolute team members contribute each year at our on-site events. They come out to events on Saturdays and Sundays in the middle of Summer (when I’m sure there’s a part of them that would much rather be at the beach!) and provide treatment after treatment – and they do it with smiles on their faces.

Sure, we make it fun; we have good snacks, and we goof around and we treat each other during the downtime – but I do not want to minimize the amazingness of how much this team gives. It is part of OUR community – our clinic culture. When I am considering new practitioners for our team – we talk about this. I always endeavor to be clear that this is not a clinic where you can come in and do your daily treatments and leave; we expect greatness, but the personal and professional support one can expect in return from simply being a part of this remarkable team is pretty great too.

I asked our friends at the Victoria Foundation (a registered charity that funds hundreds of initiatives large and small, both locally and throughout BC and Canada – if you don’t know them please look them up) to help me summarize the important part that local business plays in Victoria’s community:

“The Victoria Foundation has a vision to make our community stronger, and our shared quality of life better now, and for the long term. We’re inspired by the shared commitment of the local businesses we’ve worked with to help make this vision a reality, and by their passion to make positive changes in Greater Victoria and in communities across B.C. and Canada.”

-Sandra Richardson, CEO

In short – just get out there and get involved. Your clinic will receive recognition in the community, your practitioners will thrive, massage therapy as a profession becomes more accessible, events have more to offer, and local non-profits and charities receive more support to continue doing all the awesome things that they do! Everyone wins.

Would You Pay For That?

 

As an educator in the continuing education setting, I occasionally get a participant in one of my seminars who seems resistive to what I’m sharing. While I’ve not had any full-blown hecklers (I’m confident that that day will come) but I have had a few who seem utterly unimpressed by my approach. Most times, I’m able to roll pretty well, but occasionally someone rocks me more than I wished.

The following happened a few months ago.

I was teaching one my MFR for Neck, Voice, and Swallowing Disorders Seminars and had just finished performing a demonstration of some manual therapy to the anterior neck region. While I’m not sure what the person’s issues were I believe that they were voice-related.

There appeared to me to be someone in the group who impressed me as someone who was not buying what I was selling. The arms-crossed posture may have been my first clue.

It was the second day of the seminar, and many demos had already been completed, as well as a fair amount of one-on-one learning time. My demo model sat up form the table, and we were fielding comments and questions from the group as a whole. She had shared how the hands-on work I applied felt and how she felt after the quick session, as compared to how she felt before. Again, details are lost, but I remember her saying how she thought it was easier to speak and felt an internal sense of change (my goal!).

At this point, the arms-crossed skeptic raised his hand and asked, “would you pay for that? Would you pay for what he just did with you?”

It’s not common knowledge that I can have some anxiety issues, one of which is fueled by self-doubt. Arms-crossed pushed my self-doubt button big time. But I kept my anxiety in check, and shot arms-crossed a bit of a dark look before turning my head to my demonstration model, who thought for a few moments and said, “yeah, I think I would.” My anxiety meter dropped down a bit after that response and, as my model spoke as to why she answered the question the way that she did, I thought a bit about the question. Damnation to crossed-arms rather quickly turned into respect.

People pay us for what we do, whether their insurance is paying some or all of the bill or the patient reaching into their purse or wallet to pay us directly. So, why wouldn’t that be a fair question? No matter who is paying the bill, our work should be of sufficient value that people would pay for it. It turned out that arms-crossed was spot on when it came to asking the tough (though accurate) question. When someone gets up out of my chair or off of my table, they should be noting changes; change in what brought them into my office. Those changes need to be apparent and lasting, or I’m not delivering a valuable commodity. While I tell new patients that they should be noticing lasting, positive changes within three sessions at most, I like the notice change immediately. Immediate alteration in whatever they came to see me for allows their brain to begin a process of change, with the potential being quickly noted and the potential for progress as real. Those are the expectations I place on myself and for the work that I teach to others. So why shouldn’t we be asking those tough questions?

Would you pay for that?

Articles Of The Week October 13, 2019

 

We know that certain things like lifestyle, genes, diet, and habits contribute to the chances of having dementia later in life. However, there is growing evidence that chronic use of certain over the counter medications and prescription drugs are linked to the development and exacerbation of dementia and it’s symptoms.

“Study: Common Types of Medications Linked to Increased Dementia Risk” – The Hearty Soul

As soon as I saw this, I knew I had to share it! Ontario is working a trial where drones deliver an AED to cardiac arrest patients, and they’re arriving on average seven minutes before EMS crews. Imagine the difference this could make if one of your patients was suffering a cardiac condition in your clinic.

“Drones Arrive 7 Minutes Before EMS Crews In Policy-Changing Trial” – EMS 1

Sometimes (well…most of the time), we have to educate the public that there is more to what we do than just simply “massaging” people. In order to change this we not only need to educate the public, but also other health care professionals, providing advocacy, and educating other therapists.

“Physical Therapy, More Than Just Stretches” – Jennifer Stone

I don’t know about you, but for me massage therapy college was stressful, it felt like I was drinking from a firehose with the amount of information being thrown at me. I wish I had this advice with tips on studying while in massage therapy college.

“Tips For Studying In Massage Therapy School” – National Holistic Institute

I’m a TERRIBLE procastinator, so if you’re anything like me, you’ll find value in this article. Even if you’re not, I’m sure we’d all like to find ways to be more productive, so here’s some help with that.

“A Simple Trick For Getting More Done” – Carmen Ohling

 

Manual Technique Courses Don’t Matter As Much As You Think

 

Let’s say you need to hire a carpenter. As you shop around online and browse the different potential hires, you see one who advertises his set of 20 different drills and power saws he likes to use to get the job done.

Is this the feature that gives you confidence in hiring him to build your deck, though?

Likely not.

Then why, as therapists, do we so often assume we will become better practitioners simply by taking countless continuing education courses on manual techniques and adding additional treatment tools to our practice?

I see many fellow professionals jumping on the con-ed train straight out of the gates, often as soon as they are immediately out of school. IASTM, ART, IMS; everyone wants to add to their toolkit. With so many options on how to treat a client’s pain, we would undoubtedly be able to reap the rewards of client and financial success, right?

Here is the deep, dark, reality of it, however. 

At the end of the day, these courses just teach you multiple different ways on how to touch people. My explanation when clients ask me about the benefits of different types of treatment techniques is this:

“They are simply different methods of achieving the exact same goal”.

Essentially, having three different techniques under your belt is like having a hammer, a mallet, and a nail gun to join the same planks together to build a fence. It makes little to no difference in the finished product.

When I entered the work field, my first initiative was to simply get my hands-on clients and work on refining my foundations. Regardless of how many different methods I had to “release” a client’s quadriceps muscle, none of them will help me one bit if I don’t know when and why to do so and have a long-term plan to follow up with it. Whether I use the ART technique that I pay annually to display on my cards or the traditional massage strokes that I learned in my undergrad, I am going to achieve the same outcome.

What will be the difference-maker in your practice, then? 

It will be if you can learn to use those techniques mindfully. It’s knowing where in the tissue to address instead of simply chasing pain. It’s creating an exercise plan coupled with proper education to put the onus of control into the client’s hands,

The only con-ed course I have taken to date, in fact, has been a joint-specific one on the TMJ. I didn’t feel the need to learn new techniques. I needed to understand anatomy and physiology better. Courses that help us refine our knowledge of how the body is structured and how it moves will be valuable. Even more valuable will be courses on truly understanding the mechanisms of pain, how to speak to our clients, how to properly educate them, and methods of moving them through stages of change as they recover.

“Soft skills” such as client communication and an ability to build a positive relationship with them are a much more valuable asset to a practitioner than manual techniques. We know from current research that a client’s predicted outcome improves based on how much they like their therapist, how much control they feel over their situation, and their belief in a treatment’s ability to get them better. The tool that you use to get these results isn’t made of metal, it’s made of trust.

In a professional climate where both clinicians and clients can find ourselves hung up on the latest, trending techniques to address pain, we often see a drop in quality of care because the clinician has forgotten to use those foundations. These types of practices, unfortunately, run the risk of poor client outcomes and treatment-reliance. While it’s ok to add a tool to our kit here and there, where appropriate, we owe it to our clients to constantly return to our basics (whether or not you want to incorporate con-ed techniques) and educate them on the real things that will help them find relief.

I don’t care how many different types of power saws the carpenter has. I care about if he knows how to properly measure and place the cut.