Alright, I have a confession to make.
I came to the realization a week or so ago while listening to a podcast that I’ve…well…I’ve been playing it small.
While I put out a blog post or so a week, teach some continuing education courses on first aid along with pain science and exercise, I’ve still been playing it small.
There are certain things I’m really comfortable with and other things that make me pull back and question myself, my abilities, and my thought processes. So rather than just face, those things head-on I shrink back.
This happens especially on social media.
I see some of the groups where people are asking questions, or making statements, and rather than throw my $0.02 in, I shrink, and it’s usually out of fear.
The fear I’ll get called out, fear I’m not smart enough, fear that my voice or my opinion doesn’t matter (well truly to some I know it doesn’t but that’s not the point here).
So, then a strange thing happened. I was sitting with my buddy Eric Purves telling him this as we started discussing doing a mastermind group. I looked at him and said f@#k it, I’m not playing it small, I’m putting this out there.
I opened the laptop and put it out on Facebook. To my surprise, the post got 83 reactions and 117 comments.
Also to my surprise was the response in the comments. From physio friends asking what they can do to help promote, lots of people wanting to attend, and of course a couple of negative ones. BUT, the positive far outweighed the negative.
As I pondered this I realized I’m not alone. It’s not just me that needs to stop playing it small…so does our profession, and here’s why.
I will forever be a proponent of advancing our education and making it better.
As I talk to other colleagues in different parts of the world (and it happens here too) we sometimes shy away from sharing our opinions or challenging the opinions of other healthcare practitioners because our education was shorter, or not perceived to be as good a quality as theirs.
This was the way I felt for MANY years.
However, a few years ago I came to realize that if you talk to any of those other healthcare practitioners (if they’re worth their salt) they want their education to get an overhaul as well. If any of them are taking any quality continuing education courses, they soon come to realize that many of the things they were taught in college aren’t worth the textbook it was written in.
Now I’m sure there will be some who argue with me on this, but with those other professions, their education isn’t better, it’s just different. Yes, they get more recognition because they have a degree behind their name (and their associations probably lobby a lot harder) however, it’s no more evidence-based than ours (maybe even less in some cases).
In reality, we’re all fighting the same uphill battle, our entire healthcare system needs an overhaul when it comes to helping people in pain.
So if you’re trying to have a discussion with another manual therapist there’s nothing wrong with challenging their treatment narratives as long as you’re approaching it from an educated standpoint (and obviously done with some sort of decorum).
We can’t challenge and say ” your approach is wrong because I do ‘x’ treatment which works because I do it and I know it works!” However, if we can approach the topic with a statement like: “the newest research shows us that our understanding of ‘x’ isn’t what we thought it was and has since changed to …” will get us much farther into the discussion.
I realize this might be tough because there seems to be a hierarchy within our manual therapy world and for some reason, we are frequently seen as the bottom of this. But, I have to wonder, is this reality, or are we playing it small?
The reality is, our entire healthcare system needs an overhaul in education when it comes to helping people in pain, not just our education.
Time Is On Our Side…Yes, It Is!
This may be our greatest asset.
The more I come to understand the patient perspective on persistent pain (thanks to Keith Meldrum’s help) the more I realize just what a difference time with a patient makes.
I love this quote from Ken Leong from a Facebook thread, and glad I was able to use it with his permission.
Massage therapy is almost tailor-made for [the biopsychosocial] approach. The therapist has much more time than a MD to really get to know their patient or client: where they’re from, their culture, customs, what their family life is like, their history with athletics, sedentary actives, repetitive activities, their stresses, their sleep patterns, their nutrition, their living situations, who they live with and interact with daily and weekly, their commuting stress, their occasional (and therefore dangerous) heavier physical exertions, etc.
The patient or client also has time in treatment to reconnect with their mind and body, to figure out where the aches and pains came from, what are their self-perpetuating patterns are, how they can change them…
It’s like you’re tall and in front of the volleyball net, and someone sets you up for ‘the spike.
We’d be blind NOT to use all this biopsychosocial opportunity!
Ken G. Leong, RMT
If this quote doesn’t make you feel all warm and fuzzy inside for being a Massage Therapist, I don’t know what will.
Compared to every other manual therapist we have a massive opportunity to help patients simply because of the time we get to spend with them.
If we reel back to the above discussion around talking to other practitioners, how many of them spend the amount of time with their patients that we do? How many truly get to know their patients? How many understand what their patients are going through day to day?
While a few of them might, I’d say as a general rule (yes there are some outliers) they don’t get to in the same way we do.
This whole time thing isn’t just a matter of our interaction with the patient either. I’ve seen some discussions on different platforms where practitioners say things like: “I have a patient who wants a 60-minute treatment, but I only need 45min to get done what they need”.
While there’s nothing really wrong with this (as I hope the practitioner was trying to do effective treatment planning) but think about what that amount of time actually means to a patient.
This could be their time! This could be their break from the typical stresses of life. Maybe that hour is a break from being a parent, boss, caregiver, entrepreneur, or whatever other thing is causing stress in their life. That 60 minutes can make a massive difference in their weekly, or monthly (or however often you are seeing them) routine and life.
And this my friends puts us into a very valuable position in not only helping, but making a difference in our patient’s lives.
Exercise & Movement
I know, I know, you don’t think this is in your scope.
Well, in some places it is well within our scope and for others it’s questionable.
So I’d like to somewhat address where this is questionable.
From everything I’ve heard the argument is usually “it’s not in our scope to prescribe exercise, we have to refer out for that”. Every time I hear this I also notice that AROM (active range of motion) and PROM (passive range of motion) are still within scope. So, how is a patient actively moving not an exercise? If we are passively moving a part of the patient’s body while they’re on the table, how is this not exercise? If you can help a patient stretch on the table, how is this not an exercise?
We seem to think that recommending an exercise is always prescribing that you do a certain number of reps for a certain number of sets of ‘x’ movement (bench press, squat, deadlift, etc).
What if recommending exercise was simply recommending:
- Go for a walk with a friend (one of the best things for low back pain).
- Get on the floor and play with your kids.
- Dig your hands into the garden.
- Pick up your groceries.
Just get them to do something they enjoy!
Half of recommending an exercise for someone can be just giving them permission to do an activity. When they’re on your table if you can do AROM & PROM, then there’s no reason you can’t do isometric, concentric, and eccentric movements and this doesn’t require any fancy machinery or even a set of dumbells, you can simply just resist the movement while the patient performs them.
Doing this can be very effective in not only rehabbing an injury but they can also demonstrate self-efficacy, resiliency, capacity, and really isn’t that what we’re trying to do with any treatment? I hope so.
I think the bottom line here is that we have every opportunity (and probably more so than other healthcare professions) to make a massive difference to help people who are dealing with a painful experience. We need to use everything we have at our disposal to not only help our patients but to help push the profession forward. In no way am I saying everything is fine and we should stick with the status quo, we certainly need to continually push for better education to create evidence-based practice for all of us. So, I implore the profession to stop acting like me and playing it small. Let’s challenge the bad narratives regardless of who is using them and take a firm grip on the benefits we have as a profession to not only help our patients but help each other.
If you’re interested in learning more about these topics, we’ll be launching an online course about pain science and therapeutic movement soon and you can join the waitlist by clicking HERE.