The Thinking Practitioner Podcast:

Til Luchau  

Welcome to the Thinking Practitioner podcast, a podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today. 

 

Whitney Lowe  

I'm Whitney Lowe 

 

Til Luchau  

and I'm Til Luchau. 

 

Til Luchau  

Welcome to the Thinking Practitioner.

 

Whitney Lowe  

Welcome to the Thinking Practitioner podcast, where Books of Discovery has been a part of the massage therapy and bodywork world for over 25 years. Nearly 3000 schools around the globe teach with their textbooks, e textbooks and digital resources, Books of Discovery, likes to say learning adventures start here, and they find that same spirit here on the Thinking Practitioner podcast, and are proud to support our work, knowing that we share the mission to bring the massage and body work community thought provoking and enlivening content that advances our profession.

 

Til Luchau  

Instructors of manual therapy education programs can request complimentary copies of Books of Discovery's, textbooks, and they're really cool to review for using your programs, listeners can explore their collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics and business mastery at booksofdiscovery.com where you as a Thinking Practitioner listener, can save 15% by entering "thinking" at checkout. How are you doing? Whitney, 

 

Whitney Lowe  

I'm doing well. Good to see you here today. 

 

Til Luchau  

Good to be here with you today. We have an interesting thing to talk about, 

 

Whitney Lowe  

yeah, what are we jumping into today? 

 

Til Luchau  

Yeah, we were gonna take a look at this recent study. It explored the immediate effects of suboccipital myofascial release on pressure, pain thresholds, range of motion and proprioception. And the researchers compared a actual pressure-based technique to a "sham" version that just involved light touch.

 

Whitney Lowe  

Yeah, interesting. At first glance, reading over this, these results seemed pretty promising, saying that there was some some benefit in the pain, pressure sensitivity sensations that they were testing. But there was also some other interesting kind of twist that came along with this too, yeah, because we saw, and we'll get into this a little bit more, so we they found that didn't seem to be a whole lot of difference between the "sham treatment" and the the sort of "real treatment" that was being done there. So they both worked. Yeah, so we'll dig into some of those fine points and look and explore a little bit more about what's doing what's done in there. One thing I did want to say here is that I was really glad to see something like this getting published, because it's the type of study that we need a whole lot more of, which is looking at comparing and really trying to zero down on what are the specific physiological effects of the different methodologies and techniques and approaches and things that we perform on a regular basis, which we're often touting the benefits of, but we don't have a lot of good research supporting those things. So nice to see something being done along those lines to investigate that.

 

Til Luchau  

Yeah, and of course, it caught my eye. And it was in Terra Rosa's, really cool newsletter where I first saw it. Caught my eye because of the P word implications, the P word being placebo and as a "sham technique", it's a placebo controlled trial, essentially. And there's lots of in my thinking, there's lots of effects in that realm that we can actually take advantage of, and this study teased some of those apart, plus it had "myofascial" in the title, which is, you know, the full study was called "contextual and placebo effects of suboccipital myofascial release", so how could I not read that. That's right. The authors, Ertugral Safran, I'm probably massacring their names, and Yaren Kaya from the Bezmialem Vakif University in Istanbul. I'm sure I didn't get that right. But they're Turkish researchers. They're physiotherapists who have studied manual therapy and proprioception and neck function and published before on these topics, and the study doesn't actually this is interesting, doesn't list any outside funding and appears to be internally supported by the university, and there's no declared conflicts of interest. There's lots of studies out there sponsored by some of the benefits economically from the results, and this, at least from what we can tell, doesn't seem to be the case.

 

Whitney Lowe  

Yeah, well, maybe we should go start off with kind of like a nutshell overview of what they studied and what they were finding, to kind of summarize that.

 

Til Luchau  

Yeah, sure, their goal was, they wanted to see what the immediate effects of suboccipital myofascial release were on the pain threshold. That's the pain pressure threshold, the cervical range of motion and proprioception. And they had a control to capture or to compare the. contextual placebo effects of just being on a table and just being touched. But here's the question, why do you why do you think they chose the suboccipitals? I mean,

 

Whitney Lowe  

I wondered that, you know, I looked at in reading the studies, I thought like, that's an interesting muscle group to focus on here. And, you know, one of the things they really kind of didn't get into is, I mean, there's some anatomical things to talk about here is that with the levels of pressure that they were using in there, you got a lot of things that are more superficial than the suboccipital that you're pressing through to get to them. So, you know, how do we necessarily identify that those changes were attributed to the suboccipital muscles changing versus, let's say, you know, upper trapezius or semispinalis, or something else that they're working through to get there.

 

Til Luchau  

Yeah, they didn't specify any mechanisms or speculate about any anatomical effects. They limited it to those measured effects, the pain, pressure threshold, cervical range of motion, proprioception, so which is probably very practical, good set of design say, hey, look, what are our effects? They're not going to speculate about, like, what tissue we're affecting. Yeah. So who were the participants and why were they? Here's the question that might need some thinking through. Why were they symptomatic? They chose asymptomatic participants.

 

Whitney Lowe  

Yeah, I'm just going to guess that it's a whole lot easier to get a group of asymptomatic individuals that are a little bit more cohesive as a group, because you can just exclude anybody that's got particular types of pain problems that that might be conflicting with what you're what you're investigating. So I think from a research design standpoint, it's just it's easier to start with asymptomatic individuals. But again, these probably aren't the people who would be seeking out this particular type of treatment for, you know, what's going on. So eventually we want to see a study like this replicated with people who are having maybe, let's say, significant cervical pain headaches, you know, things that were indicating problems in in those particular parts of the of the upper neck and head region.

 

Til Luchau  

Well, yeah, I think it's because they wanted to focus on their measures, and they didn't want confounding factors like symptoms in there. They wanted to see what happened with pain, pressure, threshold, range of motion, proprioception. And if you started with a group with varied symptoms, that would be a confounding variable. They're just more in there. If they Yeah, be interesting to have them study neck pain. And in that case, that would be a qualifying factor. You'd want people with neck pain in but this case, they didn't want those in there, I think, because they wanted to focus on their measures. Yeah, it was 30 healthy adults, and they put 15 into the myofascial release arm and 15 into the "sham" arm.

 

Whitney Lowe  

Can we pause for just a moment and talk about for those people who may not be as familiar with reading research papers and things like that, for just a moment about what is a sham treatment and why we would maybe want to include something like that.

 

Til Luchau  

Sham treatment is a treatment that is purposely chosen thinking that it will not produce the desired effects, so that you can have a comparison a control, you have a group that goes through many of the same variables that might be producing effects, but try to isolate a particular thing you're studying by having that in the main arm, but not in the sham arm and placebo, sham - these words have become synonymous with fake or not effective. But interestingly enough, so many of the effects, it's really hard not to have an effect. So many of the effects that are therapeutic in any context with us, with the pharmaceutical or with manual therapy, seem to come along with the context, which is often relegated to the placebo or the sham arm of a study.

 

Whitney Lowe  

This certainly highlights one of the most challenging aspects of massage and manual therapy research is, you know, if you've got a drug trial, it's a lot easier to create a sham treatment when you just have a chemical that has no active components to it. But when it comes to something like manual therapy, it's pretty darn hard to create a sham treatment, because anything that you do has some kind of impact or effect with the encounter, the therapeutic encounter, the level of touch, and things like that. So it's particularly difficult to create sham treatments and massage research?

 

Til Luchau  

Well, it's so does, I mean going back to pharmaceuticals, even in pharmaceutical trials, it's really just giving a pill has an effect, and that's why, yeah, the sugar pill. But yeah, you're right. People know if they've been touched or not, and in this case, let's compare. Let's see if we can compare their myofascial technique to the sham technique they did for the this technique they were studying myofascial technique, they're calling it. They did sustain pressure over five minutes and in the sham technique, they mimic the positioning and the five minute duration, but they only did light touch. And there was no, interestingly enough, of course, for me as a myofascial guy, there wasn't any particular branding attached to the myofascial release, using it in a more generic way, as as manual therapists would. And that's where the name of my  advanced myofasical techniques, osis lineage. It was the name that we used for work that focused on a particular way of thinking or type of tissue back in those days. Now it's more of a way of thinking. And they're saying, yeah, from that long standing repertoire that goes back into the at least the 1970s and can see roots of it back into osteopathy, they're doing gentle, sustained pressure with the fingers under the occipit for five minutes, allowing the head to rest passively in their hands and it was straightforward manual therapy approach with pressure in the main arm.

 

Whitney Lowe  

So essentially, and I found this really kind of interesting, because, you know, in the sort of massage and body work world, we have a major, I think problem just that we have this plethora of different techniques and modality names for all kinds of stuff. And somebody calls one thing a certain name, and somebody calls the exact same thing, something different. And the idea of when they called this myofascial release, I was particularly curious to read the study design like, what are they actually doing? because the way they describe the treatment, I would probably say there's a lot of folks who would put the sham treatment in the bucket of myofascial release, also very light touch, you know, possibly, you know, getting neurological responses from the touch factors on some of those other soft tissues in the region there, because there's a lot of myofascial techniques that are kind of just described that way. 

 

Til Luchau  

You're saying that a lot of us would include a light touch like their sham technique in what we call myofascial. Yeah, I think myofascial has the generic meaning of soft tissue work with pressure in this context, in the manual therapy context, if there's a massage therapist design, they probably would have just said massage. So all right, so we get a little more specific about what they were measuring, yeah, and how they did that, yeah. So tell us about pain, pressure threshold,

 

Whitney Lowe  

So this is, you know, one measure that they were particularly focusing on, this would be something I think, pretty relevant for anybody who's having neck pain and wants to know, like, can they do something about it? So they had specific devices that they were using to measure the amount of pressure that a person could that the practitioner was applying before the person was feeling a pain sensation. So that's what they're calling the pain pressure threshold, and that's one of the things that they were able to measure. That is sort of fancy device they were using to measure the pain pressure threshold, and that was then compared against the pain pressure threshold in the sham treatment as well, to see which one of those, if either of them had a reduction, or, let's hope not an increase, from the results of treatment. But yeah, they were seeing

 

Til Luchau  

checked. Everybody gave a measurement. How much pressure does it take to cause pain? Then they gave him the five minute treatment, yeah, pressure, no pressure. And then checked again. And then they also checked cervical range of motion, flexion, extension, rotation, and they use the goniometer to measure that. And interestingly to me, they did proprioception tests via repositioning error test, which is basically you start at neutral, you turn to your comfortable full range, and then the therapist with your eyes closed, the therapist positions your head somewhere in that range, and you go back to neutral and try to go back to where you felt that last position. So it's checking the client or patient's internal sense of position with their head and neck, which is interesting. Yeah, it

 

Whitney Lowe  

was an interesting choice, I thought too. And again, this being of significant importance. We kind of didn't touch on some of the other factors about those suboccipital muscles, but they have a tremendously large number of proprioceptors in them, and are also significantly active in maintaining and aligning head position in a lot of different planes. So that's one of the reasons that that is the proprioceptive sense would be of particular importance.

 

Til Luchau  

Let's talk about what changed. Yeah, so within the myofascial group, the pain pressure threshold increased, meaning they could take more pressure before it evoked pain. The range of motion improved, and they In other words, they got bigger flexion, especially flexion, for example, and then proprioception errors dropped. So they, you know, they got a more accurate ability to reposition their head after the Myofascial pressure technique. So what happened in the sham group?

 

Whitney Lowe  

Yeah, so in the sham group. So this is interesting because, yeah, they had improvements as well. So there was some increases in range of motion, and similar to what happened in the control or in the treatment group, they had similar types of improvement, not to the same degree, but still some significant improvements that they were finding in the sham treatment as well, well, you

 

Til Luchau  

say not to the same degree. There were actually some, if I remember right, there were some measures that were greater in the light touch, but overall slightly less in the less pressure group, but not statistically significant. So if you looked at it over time, on any one of the outcomes, they had similar improvements overall, and especially with that small of a group, just 15 in each arm. They were saying there's actually no statistical difference in the outcomes for movement, pain, pressure or proprioception between the two groups.

 

Whitney Lowe  

Yeah. And again, for those, especially those of us in the massage world who don't really read a lot of statistics and understand those that term that you mentioned about statistical significance, this is an important concept about you can have two things in a research study and find a difference in the results, but the differences are not greater than what we might expect with let's say, a chance variation between those Two things, and that's what we call the level of statistical significance. So if there's, you know, the likelihood like flipping a coin is like, if you get six you flip a coin 10 times, and six times it comes up heads, that's not really statistically significant. If it comes up heads nine times out of 10, that would be significant, statistically significant. But again, when you have those kinds of things that don't really have enough difference to occur much more frequently than that's what we're sort of indicating, is what we call this, the level of statistical significance. Thanks

 

Til Luchau  

for the statistics and probability lesson. That's great. To keep that in mind what that in mind. What that means, yeah, especially when you have smaller samples. This is like a medium, small sample, 15 in each arm. There's that greater range, and so it's harder to be precise, yeah. But this study does replicate or show similar results to other past studies that have tried to compare similar things like Pinero and 2021 saw improved postural stability with suboccipital release Kong 2023 found distal joint changes in suboccipital intubation and Perez Martinez in 2020 had a self treatment for chronic neck pain, and in like This study, they found improvements, but no significant difference between their real and sham treatments. So that's been, you know, different different studies testing slightly different things, but showing that, again, it's the contextual effects are just as strong as the therapeutic effects. In other words, pressure or whatever it is they're trying to test doesn't seem to leverage the effect of just getting a treatment.

 

Whitney Lowe  

Yeah, let's, let's peel that apart for just a moment and talk about, what are contextual effects? Like, what, what are we talking about when we say that contextual effects?

 

Til Luchau  

Yeah, it's, it's everything other than what you think you're doing, meaning the place the treatment is happening, the expectations on both the therapist and the patient or client, the mood or the ambience, the effects of just being touched, as you mentioned, just getting a treatment, it's you might include, I don't know, astrological effects. You know, there's all sorts of things outside of our realm of of even being able to track or list them all. It's everything else that's about the context that the treatment is happening within. Yeah, and like we've said, so many studies show that much of what happens is because of the context. And being touched and being to touch in a skillful way is important, but it's hard to say which part of being touched is the most important part. It doesn't seem to be more important to context at all. Yeah. So let

 

Whitney Lowe  

me, um, we poke the bear here just a little bit on this context issue, because this is something that we get into a whole lot. And I just want to ask your question,

 

Whitney Lowe  

ask you a question about this, and get your take on this. So does this study support the idea, or say, or maybe I should say, suggest that technique is not relevant, because both these things got a beneficial result

 

Til Luchau  

are pressure based techniques still worth using if it didn't get any better results in this study and a few others, good question. I like pressure. It feels better to me sometimes than no pressure. And that's. Enough reason for me as a client, yeah, to want pressure. Now if, with that said, it's also means that I got to pay a lot of attention as a practitioner to my contextual effects, to the expectations I have, to our interaction, our relationship, to setting things up in a way that makes it likely they're going to have the results they want. But I think it comes down in my mind to preference, also just the nature of studies. Studies are an average. They find an average for this group. Yeah, and there's going to be people that are different than the average. So it's even more important to tune what we do to the individual, then just always shoot for the thing that works on average for everybody, which is what this is saying. There might have been people on the study, I don't know who pressure gave them a huge benefit over if they've been in the other arm and not had pressure, right? What do you think? What did I leave out on that answer,

 

Whitney Lowe  

My take on this is there are going to be people who are going to read something like this, or other future studies that are like this, and we're going to say like, well, the takeaway is the technique doesn't matter, because both those things got results. Yeah, and I think that's carving off some important context about context, if we can say that meta context maybe, which is that the way in which you deliver a technique is a lot about what the context is about. And so, yes, that does mean that your skill, in your skills and abilities in performing really good and effective manual therapy are still really important, because that's part of what is the contextual relationship for a positive outcome. So I do think it still does matter a lot about doing something well and doing it right, to be able to get those contextual to maximize, let's say, to maximize the benefit, to milk those contextual factors as much as possible,

 

Til Luchau  

well as a in a study, or when I'm teaching a class, or when I'm trying to think of what my client might need, it's really easy to get seduced by the what, what are we going to do? What is the technique? What is the protocol, what is the progression? And this is saying the how is probably even more important, how we do it, and that includes the timing, the when, you know, all that kind of stuff, but that the way, the manner in which we do it, the way we approach it, the interaction we have those kinds of things, are even more important. So I think it's true  in my teaching, too. I mean, this is a myofascial study. I teach myofascial techniques. It's showing that sham treatments were the same. This is not good advertising for me, except to say that the only reason I teach what to do in my trainings is because how we do it is the most important thing. We're learning together, too. It really is the context. I mean, the what is just an excuse for getting really good at the context.

 

Whitney Lowe  

Yeah, always. So maybe the the what is the bait on the end of the line or something like that that's got to hook somebody to be able to get into the how or something like that.

 

Til Luchau  

Yes, that's right.

 

Whitney Lowe  

That's good. You have to get within the magnetic orbit of the of the how and the what is, what pulls you into the magnetic orbit of it, or something, maybe.

 

Til Luchau  

And it's not that, like you said, it's not that skill is nothing. Or these narratives we have that inform our choices, they're important too, all of this technical education that we do, or technical knowledge can be really helpful too. That's those, like you said, those do? Those do get included in the context?

 

Whitney Lowe  

I also think, you know, the the descriptors, the narratives that we use, the narratives that we talk about with our clients, about what we're doing, why we're doing, the things that we're doing, those are really relevant on a level of having the client have a better understanding of what's happening in their body, and be able to get sort of on the same page with us about what we're trying to achieve together in our goals of treatment. So having some kind of framework for understanding the nature of what we do, even if there's a lot of subtleties and varieties things like that, I still think that's that's still really

 

Til Luchau  

beneficial the ways we think about the metaphors we use, you know, all everything from, am I kneading dough, or am I like massaging the clay til it's soft? Am I moving fluids in my work? Yeah, am I changing layer glide? Am I refining proprioception? Am I increasing mobility? All those things we think we're doing we think about when we're doing you're saying, there's some benefit to be able to communicate about that with the client and get them on the same page at least a little bit, so that we can be communing in our narratives. Yeah? And be. Organizing around the same context expectations, yeah.

 

Whitney Lowe  

And I think too, you know, when you talk about, and we didn't kind of like dive into a lot of the detailed anatomy about this, but as we said, you've got some really short, very small muscles here at the base of the cranium, between that and the first and second cervical vertebrate that we're talking about here, these suboccipital muscle groups, a group of four on each side, and they didn't make a reference in the study here to something called the Myo Dural Bridge, which is a little slip of connective tissue going between rectus capitis posterior minor and the dura mater, and a more precision oriented treatment, I think, you know, like a, let's say, a small focus contact surface, like what they were doing here, with the fingertip pressure in these regions is more likely to potentially have a neural and or mechanical impact on these different tissues than would be, for example, A broad based contact with the whole palm of your hand, working on the backside of the neck or something like that. So again, the nature of that way in which the touch is applied, I think, still can have some significant physiological ramifications and benefits.

 

Til Luchau  

You're saying that the anatomy based narrative that includes some pretty precise details and some accumulated learning from the last few centuries. Can be a useful narrative in getting precise and getting specific about things that might be related to the patient's symptoms.

 

Whitney Lowe  

Yeah, I certainly think so. 

 

Til Luchau  

And this is back to the person that says, well, then this study proves that techniques don't matter. It's a small study. It's one study. Like I said, there have been others that have similar results, but it's it checked five minutes of a treatment too. So all we can say from this one is, yeah, five minutes of pressure and no pressure had about the same results. I wonder what would happen if it was a full session, for example, or if they were checking more than immediate effects, because they checked it immediately after the treatment, if they checked it in follow up, could could work with pressure, be expected to have more effects the next day, for example, or the next week? Yeah. And there the other limitations they listed on their study was, there was no follow up. There was no blinded assessor. The assessor knew which technique the clients had patients. 

 

Whitney Lowe  

one of the things that I didn't hear in the discussion of the limitations of this study, and they probably, I don't know if it's something that didn't occur to them or like this, is it's challenging because it's things differ in various different countries in terms of who does what kind of thing. In the manual therapy world, some of those definitions are quite different, but certainly like here in the US, you know, a lot of the physical therapist, or what are called physiotherapists in other countries, mostly, or not generally as a law. Again, this is a very broad generalization, but not doing as much manual therapy, all day long, every day, as they might be doing in some other situations. And so the this is another interesting question, I think, for future research, is like, does that practitioner I mean, how much does that practitioner matter in terms of their developed and refined palpation skill levels in doing these types of techniques? You know? Does that make a significant difference that this was, you know, they did say these people were trained in this specific version of Myofascial release. So that certainly is beneficial. And I think it'd be interesting to look in like, how much does that matter? You know, how much does who the practitioner is and what their level of skill and training is, and we're getting into other contextual factors there, but I think it's relevant.

 

Til Luchau  

Certainly, when someone who has a lot of experience touches me, I respond differently. Yeah, I can feel that. And that's, that's, there's a lot to be said for native talent too, but there's the training piece where just go, Okay, I'm not the first person they touched. Yeah. I can relax into this.

 

Whitney Lowe  

Yeah. And another one of the very difficult things is, this is why, you know, manual therapy research is so challenging, because we have so many of these confounding factors to tease apart and just try to get something that eliminates all those confounding factors. Gives you an extremely sterile and unrealistic kind of treatment environment where this isn't just this isn't how it works. Maybe you want to study this particular type of technique done with five strokes only, with X amount of pressure in this context here, like that might be helpful for making a clean study, but it's just not what happens in the real world.

 

Til Luchau  

No, well, what's what do you think are the takeaways? What do you think we should be? Just to recap here, to pull it pull it together. What are the main things you'd like our listeners to be? Thinking about,

 

Whitney Lowe  

yeah, I mean, I think, first of all, I think this is a good illustration of, we need to dive into, what are the impacts of some of those contextual factors in some different ways, like, maybe we can design some studies that can look at those different contextual factors. And this is, this is one of the we don't have a lot of these kinds of studies that compare different techniques and methods in manual therapy. They were oftentimes con we're oftentimes comparing it against something else, like no therapy, or, you know, some other type of radically different type of treatment, so or

 

Til Luchau  

like this one, lumping all the contextual factors into one bundle, and you're saying there's a lot to be learned by teasing them apart, yeah? Why are we just studying the pressure, no pressure? Why don't we study the like talking, no talking? Or eye contact, no eye contact, yeah? Or incense, no incense? Well, cold room, warm room, right? Or whatever. There's lots of things, session duration, all kinds of contextual factors in there that could be having just as much impact.

 

Whitney Lowe  

Yeah. So there's, there's a lot of further places to go with these kinds of things, but I, I absolutely applaud them for moving in this direction and then starting to look at some of these things and giving us some other things to think about in terms of, like, how do we want to try to to get more precise in our understanding of what we're doing?

 

Til Luchau  

I'm still riffing on that white coat, no white coat. Stethoscope around your neck, right? Crystal around your neck. We could just go down the list of all the contextual factors and start to compare them. That'd be pretty Yeah, there are no gongs, yeah, whatever. But it also makes me think that, as you know, I'm I'm working now with people that have been practicing for a long time, but I know you and a lot of our audience works with people just coming into the field, I think there's a lot to be said at any stage in our practice for learning more about contextual factors. We do tend to get, like I said, seduced by the what and the how seems to be just as important, and that includes not just the nuances of applying a technique with your hands, but the way you set up the whole interaction experience for yourself and for your client, I think there could be a lot we a lot of we could leverage. We could get from training and attention to those skills as well.

 

Whitney Lowe  

Yeah, and you and I both are in the same boat as educators who are trying to, you know, sell education strategies for people. It's, it's hard to sell that in in an educational setting of, oh, yeah, the context, yeah, no,

 

Til Luchau  

there's no need. Yeah. If I taught a context class, I don't know how many some, some people would sign up, but if I taught, like, a injuries class, like, that's gonna get some takers, yeah? You know, something with a problem in the title that's going to get some takers. Yeah.

 

Whitney Lowe  

So, alright, well, what's, what's next on our we talked a little bit about any other takeaways that for you from this, that other than what, what I was saying,

 

Til Luchau  

I think it's just an argument for, again, being people doing this work, doing them in the way that feels right to us as a person, working with another person, the whole human side of it. This is just more evidence, if you will, that that's where things really count, that when we show up as a person, we listen to each other as people, that then the effects are really good. That includes, like, for sure, empathy touch itself, the communication around expectations of what we're doing, all those things I think are just such crucial skills and the essence of what we offer. 

 

Whitney Lowe  

and let's not also, I think, bury the magic that's elevate that's sort of illustrated with something like this, which is simply touching somebody in this area had some significant benefit and effects for them. And that's what lots of our folks are doing every day, day in, day out, in the treatment room, with their clinic, with their clients. And sometimes I think that gets lost in the shuffle about how incredibly powerful and magical all this stuff really is. On a regular basis,

 

Til Luchau  

it is magic to experience, but then also just thinking about it, you mean someone can position their head more precisely after I've touched them, either with pressure or non pressure. Just from five minutes at touch, they get more precise in their positioning. That seems magic to me too. Yeah.

 

Whitney Lowe  

So some good things, I think, that are illustrated in this

 

Til Luchau  

inquiry. That's right, we'll put a link to the full study in the show notes. Again, thanks to buddy mon mencie from Terra Rosa for spreading the word about this study, and I want to thank our sponsors, Associated Bodywork and Massage Professionals. They proudly support us, and they are the premier association for dedicated massage and body work practitioners like you. When you join ABMP, you're not just getting industry leading liability insurance. So you're gaining practical resources designed to support your career, from free, top tier continuing education and quick reference apps like pocket Pathology and Five Minute Muscles. ABMP equips you with the tools you need to succeed and grow your practice,

 

Whitney Lowe  

and ABMP is committed to elevating the profession with expert voices, fresh perspectives and invaluable insights through CE courses, the ABMP podcast and their Massage and Bodywork Magazine, featuring industry leaders like my co host til and myself thinking practitioner listeners like you can get exclusive savings on ABMP membership at abmp.com/thinking. So join the best and expect more from your professional association. Thanks again to all of our listeners. Thanks for hanging out with us today and to our sponsors. You can stop by our sites for the video, show notes, transcripts and any extras. You can find that on my site at academyofclinicalmassage.com. Til where can they find that with you?

 

Til Luchau  

advanced-trainings.com. We want to hear from you with your ideas or input about the show. Just email us at info@thethinking practitioner.com or look for us on social media and YouTube. I am at Til Luchau.  Whitney, where can people find you?

 

Whitney Lowe  

Also on the channels under my name, Whitney Lowe, thanks very much. People can find me over there, and we would really appreciate it if you would rate us on Spotify or Apple podcast, wherever you happen to be listening to the show, it really does help other people find the show and helped us keep it going here. So please take a few seconds if you can, to do that, and thanks always for sharing the word. And tell a friend, share the word as well, and we'll see you again next time. I'll look forward to that winning. Thanks for today. Okay, thank you.