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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.

Articles Of The Week March 29, 2020

 

These are unprecedented times and it’s really important for us to stay active and healthy, so a big thanks for this article on how to exercise at home during the Covid-19 quarantine.

“Top 10 Exercise at Home Ideas During Coronavirus Quarantine” – Nick Ng

 

Obviously, this pandemic is at the top of everyone’s mind and one of the big questions is whether or not you can become immune to the virus. This article gives some great answers (and would probably be a good one to share with your patients while our clinics are closed down)

Both for physical and mental health, we all understand how important exercise is. However, what exercise is the healthiest? There are many factors contributing to this question and fortunately, they are answered here.

“What Kind of Exercise is Healthiest?” – Todd Hargrove

We all know how important mental health is and at this time, we are all faced with different things that are challenging our mental health. So here’s how we can improve our mental health during this pandemic.

“Improving Mental Health During COVID-19” – Jerome Perera

This one is a little tongue-in-cheek, but gives us a good visual on why it’s important to self-isolate right now.

“Places To Visit This Weekend”

 

5 Things You Can Do During The Covid-19 Pandemic

In 2007 I worked at a sawmill and the union gave us direction to strike.

We had no idea how long we’d be out (although we were fortunate to receive strike pay). The first month went by, then two, then three, until eventually, we were out for over 17 months. None of us saw that coming!

These are surely unprecedented times.

In my 44 years of life and my nine years of practice, I have never seen anything like this.

The Covid-19 virus has become a global pandemic and none of us are sure when the end is in sight. There are good news stories coming through of how some are battling through and getting back to health, and then other stories of life lost on a large scale in some areas.

Hitting closer to home is how many of us (if not all) are having to close our practice with no opening date in sight, only estimates. None of us know when this is going to end and with that comes the uncertainty of what the future holds, not only for our health and our families but also for our businesses.

So, in the meantime, what can we do?

1. Exercise

We all know how beneficial exercise is, not only for the body but also for the mind.

For us introverts being isolated is kind of fun, we get to stay at home in quiet places, read a book and recharge, but at some point, it’s probably going to become a struggle.

However, for our more extroverted friends, this can be a very stressful time as they don’t get the fulfillment they need from social interaction, which can definitely take a toll on mental health.

Exercise is one of the most beneficial things we can do for mental health, so if you’re starting to feel down think about doing some exercise at home. If you do a search on youtube it’s pretty easy to find some different bodyweight, yoga, or other programs that might help you with your mental health, but also keep you fit and healthy so when your clinic opens you can return to work and help those patients that have been desperately missing your treatments.

Here are a few articles with some suggestions for stay at home exercise:

You Can Take Care of Yourself in Coronavirus Quarantine or Isolation, Starting Right Now* – Anna Goldfarb

These fitness studios are live-streaming workout classes for free during the coronavirus outbreak* – Sophie Lewis

Do Yoga With Me* – doyogawithme.com

Top 10 Exercise Ideas to Do at Home During Coronavirus QuarantineNick Ng

I haven’t tried any of these, nor am I giving them an endorsement, but there are at least a few different things you could try from home to get some regular exercise, just see which ones (if any) work for you.

If you don’t like these options, see if you can connect with some friends to do some sort of exercise together via skype, zoom, facetime, or messenger so you not only get some exercise but some of that valued social interaction as well. 

*these free offerings are temporary during the coronavirus pandemic

2. Learn Something New

We are going to have a lot of time on our hands during the coming weeks/months…who knows how long.

So why not take the time to learn something new?

Over on theMTDC Facebook page, we have been trying to do some Facebook lives to look at some new research and had a discussion last night about how a few of us changed our narratives on some old massage therapy myths when were faced with research that told us otherwise. We are going to try and do this as often as we can during this pandemic so that we can at least learn something and share some ideas with our colleagues while having some social interaction and helping each other out.

You can watch the one we did on research hereand the one on how we managed facing massage myths we truly believed in when faced with research that told us otherwise here.

Here are some other free offerings you could use:

Again, I haven’t used any of these freebies (yet) but if you know of any others please share them with us so we can get the word out to as many of our therapist friends as possible to help with this downtime.

*these free offerings are temporary during the coronavirus pandemic

3. Connect With Other Therapists In Your Community. 

Now more than ever we need to support each other.

Believe it or not, this is a golden opportunity to connect with other providers in your community. Try sending other therapists, or clinics an email and see if there is a way for you to connect online while we’re closed down.

Maybe talk about whatever you focus your practice on and find out what they focus on. Perhaps then a referral system can develop once we’re back up and running again.

Or maybe you can discuss marketing strategy, confusing conditions, patients who you’re not sure how to help, or just talk about how hard things are right now being business owners.

This might even be a way to discuss how your government is handling things in your area, how it affects you and your practice, along with understanding how your business can take advantage of government assistance at this time.

Our businesses are quite different than most, so the more we can help each other with this, the better off we will all be. 

The point is to connect with other healthcare professionals in your area and see if there’s a way you can help each other, we all need that right now.

4. Start A Blog

If you’re not already blogging to support and market your business, now is a great time to start.

Perhaps you’ve considered it in the past but never really had the time to do it…well…now’s your time!

While blogging can sound difficult, it doesn’t have to be. We’ve written tips about creating amazing blog posts before, which you can read hereThe great thing is that you can do it for free! WordPress and Wix are both options that provide free websites for you to start blogging with if your business doesn’t already have a website to blog from. 

One of the great things about having a blog in our industry is that it positions you as the expert in your community. As long as you are putting out some quality content regarding your treatment and what you do, it gives you an opportunity to reach new patients and build more trust in your current ones by showing them you care enough to write about and research a topic to educate them. It can be invaluable!

5. Communicate With Your Patients

Arguably this could have been ranked as the #1 thing to do, but I thought self-care was more important.

As much as we need each other right now, your patients may need you even more. 

Everyone is freaked out and they are looking for good information from trusted resources. You are that resource!

So, don’t be that annoying therapist that is emailing them a few times a week, but once a week or every two weeks just check-in and see how they’re doing is a good way to remind them you’re still there and you care about their welfare.

Look for trusted websites with trusted information you can share with them.

Especially if you know they are elderly, or immune-compromised and this pandemic could be a big issue for them. Be that trusted healthcare professional that cares enough to send the odd email just as a check-up to see how things are going. If you know they had something big coming up, check-in and see how it went, or send condolences if you know a big event got canceled, be personable ab0ut it, you know your patients and what matters to them.

Most of the time our patients see us more than they do their doctors and our relationship with them is far different. Be that trusted healthcare professional. I hate to say this is a “marketing tactic” (and I’m definitely not a marketer), but you want to be front of mind with your patients once it’s safe for them to come and see you again, so it’s important to stay front of mind and honestly how hard is it to send a couple of emails here and there for the people who support your business? It will be well worth the time investment.

If you know your patients have businesses in town, do what you can to support them as well. Order take out from their restaurant, get groceries delivered from their store, or use their delivery service company, just try to support the ones who support you. 

This is a weird time and we’re all in this together, so the more we can do to help our families, our colleagues, our careers, and our patients, the better! While we don’t know how long this is going to last, we should use the time as wisely as we can. Like I spoke of at the start, when we were out on strike for 17 months there was a lot of wasted time, sitting and waiting. If I had known we were going to be out that long, I wish I had used the time in a more productive fashion. It wasn’t until month 15 that I actually registered for and took a course. There is so much I could have gotten done in that time, but we just didn’t know when it was going to end. I don’t plan on taking this time as lightly and I want to be as productive for my business as possible. I hope you do that same too. If there’s anything we can do to help and support you at this time, don’t hesitate to reach out, we’ll see what we can do to help. You’re not alone, we’re all in this together.

 

Caring For The Caregiver

 

Caregiver: a person who cares for someone sick or disabled.

Recently I have had a few massage therapy patients become caregivers for their spouses. One day they are going through life normally, with their own routines, their own chores, and their independence. The next day they are taking on their spouse’s routines and chores.

Both spouses have lost their independence.

The caregiver suddenly has had to take on roles at home such as chef, chauffeur, life coach, physical care aid, etc. Roles that maybe they hadn’t done in a long time, some possibly never. The transition has not been easy, but my patients have done it with patience and grace.

Having been both a cancer patient and a cancer patient-caregiver, I can honestly say that it is often harder to be a caregiver. It is hard to watch your loved one go through something challenging. A caregiver often feels helpless. As a patient you have goals: get through surgery, get through rehab, get through the next oncology appointment. Your adrenaline moves you through. The caregiver watches you recover from surgery, cry from pain and frustration, and have side effects from treatment. The caregiver worries.

When I was going through cancer treatment my husband was always asked, “How’s Meaghan doing?”. I wish they would have asked him, “How are YOU doing?”.

Understanding For The Caregiver

Here is a real-life example of what I have seen in my massage therapy practice.

Last year one of my patients had a stroke. He suffered extensive physical weakness on his dominant side. He could no longer drive, he had to relearn how to get out of bed, walk, get to the bathroom in time, he even had to find new ways to get dressed. A lot of these things are still challenging for him.

For the first several months his spouse had to help him with everything. She diligently drove him to his massage therapy appointments with me, to his physical therapy appointments, to his neurology appointments. She had an appointment book with her that was filled with daily appointments for her husband.

One day I looked her in the eyes and said, “How are you doing?”. She looked back at me and after a moment said, “I’m tired.” I suggested maybe she should book herself in for a massage one day. Just to have an hour of quiet time alone. A couple of months later I saw her name in my schedule and she hasn’t looked back. She comes in each month, talks a bit about how different her life feels, and then has peaceful silence for 60 minutes on my massage table.

It’s so important for us as massage therapists to take care of those that need our help physically, but it’s also important to take care of the caregivers.

What Can We Do?

Here are somethings we as massage therapists can do to help.

  1.  Encourage the caregiver to take time for themselves. As I did, I suggested my patient’s wife come in for massage herself. I think she values this time now. Some other suggestions excellent suggestions are:
    • making time for exercise
    • making time for rest or sleep
    • participate in social events
    • ask for and accept help. Accepting help can be very hard. Let the caregiver know it is ok to have help
    • find a hobby they can do alone or with their spouse
    • find a few hours a week that brings them joy
  1. Let them talk. Chances are the spouse who is suddenly sick or disabled often complains about how their life has changed. We must remember the caregiver’s life has changed too. They may need to get some frustration, anger, or sadness out. Let them.
  2. Allow them into your life. Maybe they would like to hear about a “normal” life. Share your life with them. Tell them positive stories about your kids or family. Something that made you laugh on the weekend.
  3. Limit negative talk. You might be sick of the rainy weather. Maybe you are also be going through some challenging times. Life is hard! But try to limit negative talk with clients who are going through the hard stuff. Negativity can become competitive. How much are they suffering compared to you? Their life is hard now, don’t let them downplay it and don’t downplay it for them.
  4. Be quiet and calm. Maybe they don’t want to talk at all. Maybe they want a gentle massage. You are the professional and should gage their mood each time you see them. While my massage practice is focused mainly on relaxation first, I can easily tell if a patient wants to talk throughout the entire treatment or if they want to be silent. Let your patient guide this.
  5. Encourage them. Tell them how great they are doing. After each treatment with my patient I say, “You’re doing amazing things for your husband. He is lucky to have you.” I also remind her to do something for herself again that week. Perhaps they will remember these words on a day seems harder than normal.
  6. Find resources. Perhaps the caregiver will need some further resources, such as support groups or counseling. Having a list or offering to look for more information that could help your patient. From personal experience, there are a lot of social media support groups where people with similar life challenges can ask questions and share stories. I have met several new friends through these support groups.

While this post has stories about becoming a caregiver by surprise, the content would be excellent for all caregivers. There are a variety of different types of caregivers. Some may have cared for a disabled child since birth some may be hired caregivers, some may be new caregivers.

Caregiving asks you to lean into love you didn’t know possible. It asks you to change your life. It asks you to give.

Let us give something to the caregivers.

 

Articles Of The Week March 15, 2020

 

The Covid-19 virus is filling all of our news feeds right now and I’m sure we’ve all had a few cancellations in our clinic because of it. One good thing we can do is actually demonstrate to our patients what we are doing to keep things clean, this article gives some great advice on how to do that.

“Massage Therapy—Demonstrating How You Are A Safe Space For Your Clients” – ABMP

I’m sure we’ve all been hearing some new terms in the past couple of weeks with this coronavirus outbreak. A new one for me is: “Social Distancing,” which is explained in this article along with the reasons why we should do it.

“Social Distancing: What It Is And Why It’s The Best Tool We Have To Fight The Coronavirus” – Thomas Perls

Sleep deprivation can cause a whole host of issues for a person, but this is amplified when someone is dealing with a concussion. New research is showing how blue light can actually help those with a concussion get better sleep.

“Light Improve Your Sleep Following Concussion?” – Complete Concussion Management

Leadership is not something that comes easy, but we could use more leaders in our profession, not only for the benefit to other practitioners but also to benefit our patients. This post outlines seven attributes of good leadership that we all could learn from.

“Leadership Matters” – Jason Giesbrecht

Athletes commonly use cortisone injections in their knee to mask pain, but research is starting to show this may actually cause more harm than good.

“Cortisone Injections For Hip And Knee Pain Are More Dangerous Than Was Thought” – Laura Donnelly