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🎙️In this episode Whitney discusses a 2024 paper on modern manual therapy teaching and practice. The paper describes traditional manual therapy principles, including clinician-centered assessment, pathoanatomical reasoning, and technique specificity, and their criticisms based on recent research. He then outlines a proposed new framework for manual therapy practice and education. Lowe encourages listeners to read the paper and reflect on how these concepts align with or differ from their current practices, aiming to stimulate critical thinking about the evolution of manual therapy approaches in light of current research and understanding.

Scroll down for the full video and transcript! 

Key Points in the Podcast

  1. Introduction to the podcast (0:00-0:30)
  2. Discussion of a paper titled "A Modern Way to Teach and Practice Manual Therapy" (0:30-3:50)
  3. Overview of traditional manual therapy principles (3:50-9:30)
  • Clinician-centered assessment (4:10-6:50)
  • Pathoanatomical reasoning (6:50-11:00)
  • Technique specificity (11:00-16:00)

Proposed new framework for manual therapy (16:00-23:00)

  • Safety in the therapeutic alliance (16:30-18:00)
  • Creating a comfortable environment (18:00-19:30)
  • Efficiency in therapy delivery (19:30-21:00)
  • Communication and context (21:00-22:00)
  • Person-centered care (22:00-23:00

Implications for teaching and practice (23:00-29:00)

  • Challenges in reframing teaching methods (23:30-25:30)
  • Importance of safety, comfort, and person-centered care (25:30-27:30)
  • Questions for practitioners to consider (27:30-29:00)

Resources:

A Modern Way to Teach and Practice Manual Therapy: https://bit.ly/45tGfHj

Sponsor Offers:

About Whitney Lowe  |  About Til Luchau  |  Email Us: info@thethinkingpractitioner.com
(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

Your Hosts:

Til Luchau Advanced-Trainings        whitney lowe

        Til Luchau                          Whitney Lowe

Thanks for listening and subscribing to the podcast! Make sure to connect with us on Twitter, Instagram and Facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

Your Hosts:

Til Luchau Advanced-Trainings Til Luchau

whitney lowe Whitney Lowe

Thanks for listening and subscribing to the podcast! Make sure to connect with us on Twitter, Instagram and Facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

Full Transcript (click me!)

The Thinking Practitioner Podcast:


Episode 121: Analyzing Manual Therapy (with Whitney Lowe)

Key Points in the Podcast

Introduction to the podcast (0:00-0:30)

Discussion of a paper titled "A Modern Way to Teach and Practice Manual Therapy" (0:30-3:50)

Overview of traditional manual therapy principles (3:50-9:30)

  • Clinician-centered assessment (4:10-6:50)
  • Pathoanatomical reasoning (6:50-11:00)
  • Technique specificity (11:00-16:00)

Proposed new framework for manual therapy (16:00-23:00)

  • Safety in the therapeutic alliance (16:30-18:00)
  • Creating a comfortable environment (18:00-19:30)
  • Efficiency in therapy delivery (19:30-21:00)
  • Communication and context (21:00-22:00)
  • Person-centered care (22:00-23:00

Implications for teaching and practice (23:00-29:00)

  • Challenges in reframing teaching methods (23:30-25:30)
  • Importance of safety, comfort, and person-centered care (25:30-27:30)
  • Questions for practitioners to consider (27:30-29:00)

Whitney Lowe:

Welcome to The Thinking Practitioner Podcast, which is supported by ABMP, the Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package, including individual liability insurance, free continuing education, and quick reference apps, online scheduling and payments with Pocket Suite, and much more. ABMP's CE courses, podcast, and Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, including Till and myself, and Thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking.

This is Whitney Lowe, and today I'm doing a solo episode here, Til is off this week, and I wanted to talk a little bit about a paper that was recently released and give some insights into it and look at some of the things that we might be thinking of what this paper says about the world of massage and manual therapies and look at some of the questions and issues that this brought up.

There's been a fair amount of discussion around social media around this. This paper is called A Modern Way to Teach and Practice Manual Therapy. It was published in 2024 by Roger Kerry at all in the Chiropractic & Manual Therapies journal this past year, recently. So, the idea behind what they're talking about in this article, is looking at the vast array of manual therapies, and this is one of the challenges in grasping a topic this big, which is what do you call manual therapy and what do you limit it to? Because there's a big difference in terms of the way manual therapies are applied, if you look at the range of things from high velocity manipulations that might be done in the chiropractic profession, versus techniques performed in osteopathy, to the things that we do in massage therapy and other types of soft tissue manipulation. All those are within the bigger umbrella of manual therapy.

But there's a more distinct focus on some of those specific techniques performed predominantly, I think, a bit more in the worlds of physical therapy and chiropractic and osteopathy in this particular article, but there's a lot that's very relevant to what we do in massage and other soft tissue therapies as well. So, I want to talk a bit about that on this episode here.

Now, getting back to why we're looking into this, manual therapy has become a very significant part of healthcare system for lots of folks in terms of addressing what might be going on with them, various pain and injury conditions, or things that they want to do to improve their overall health and wellbeing. It's become widely used and widely accepted and there's a very substantial amount of research showing a lot of benefits for manual therapy approaches. But there's also some things that have been coming up that have been questioning a lot of the ways in which manual therapies have traditionally been both practiced and taught. And that's one of the main thrusts of this particular article, is looking at is it time for a pretty substantial paradigm shift around what goes on with manual therapy and how it's practiced and how it is taught?

And so, I want to address a couple of those different pieces in this particular episode, and it's going to bring up a lot of questions and maybe even some controversy around some of the ideas that are presented here. But that's always good to challenge our models and to challenge what we have, is the way we've been taught and the way things have been done in the past. So, that's what I wanted to take a moment to do here.

So, the first place I want to start is looking at some of the background concepts that they bring up here around manual therapy and how it's practiced. The authors of this article refer to what they call Traditional Manual Therapy, so we're going to call it TMT, Traditional Manual Therapy principles. And this is the way it is currently practiced and currently taught, and there are some three key factors and three key indicators that they highlight in this article that characterize the way traditional manual therapies are done. And I want to look at each one of those in a little bit greater detail.

So, the first of these is clinician centered assessment. And what we're talking about here with clinician centered assessment, this might be a variety of different things, but imagine when somebody comes in to see a practitioner and that practitioner talks with them a little bit and then decides they want to go through a certain group of evaluation procedures. Some of these, again, are very specific to certain professions, let's say motion palpations that might be done in a chiropractic or physical therapy practice, versus some other types of assessment processes, all the way to the clinician centered assessment that involves diagnostic imaging.

When you go in and you go to the doctor and say, "I did this particular thing to my shoulder or my knee or whatever," and they say, "Well, let's go get an X-ray or an MRI," that's basically a clinician centered assessment, it's something that's really focusing on what the clinician's determination of how to evaluate this particular complaint that you've brought to them. And something like an X-ray or MRI has, for a long time, been considered the gold standard around clinician centered assessment processes because of its accuracy of looking at certain types of structural qualities within the tissues. But in the recent years, in the last several decades, especially since the advent of the MRI and our capability of looking at a lot of these images without exposing people to detrimental doses of radiation, which you couldn't really do a lot of these experimental studies with X-rays in years past, because you're dosing people with a fair amount of radiation to do a larger number of X-rays.

But with the MRI, we can do that kind of thing. And one of the really significant factors that's come out of all this process, is recognizing that many problems, or what we call problems or lesions or pathologies, whatever you want to refer to them as, in the tissues are just as common in people with pain as in those without pain. And so, we recognize that just the presence of some type of structural abnormality in tissues, and also the fact that somebody has pain, is not something where we can actually say there's a causal relationship. So, it's back to that whole thing of correlation does not equal causation. Two things might be occurring at the same time, but that does not necessarily mean that one caused the other. So, for example, this idea of a structural problem.

Let's say you've got a disc herniation and you have back pain. This is a real common one we've seen with the MRIs. A person's got disc herniation and they've got back pain. Previously, we probably would've looked at it and said, "Oh, okay, well there's the cause of your pain problem is because you've got a disc herniation and that's why your back hurts." But we do now realize that, because so many people have disc herniations and no pain whatsoever, we can't make that assumption that that's what the nature of the pain problem is. We've also come to recognize that there are a lot of pain complaints that don't seem to have any kind of structural pathology associated with them at all. They're a lot more complex and seem to involve some pretty significant problems in the higher order processes in the nervous system.

And so, consequently, this throws a wrench in the direct correlation between those images and what we see and what the person is experiencing. So, this is some of the ways in which this is done in a clinician centered assessment. The other things, the clinician centered assessment when it's over-focused and overemphasized, might be looking at posture and just saying, "Okay, well, a person's got some forward head posture there. Well, there's why your neck hurts. That's the determination of why you've got upper back, shoulder, neck pain or whatever it is, because I see you not following this particular postural ideal that we're really looking for."

So, that's something that's very little involvement with the client or the patient, the person that's being seen, a whole lot more decision-making and determination based on what the practitioner is identifying there. So, these are some of the things that we really are wanting to look at there and recognize that, sometimes a comprehensive physical examination process needs to be a lot more thorough and complete, and determine is there's maybe something else that's possibly causing some of these problems.

Now, also to be on the other side of that equation say, that doesn't necessarily mean that we throw a clinician centered assessment out. We don't want to throw the baby out with the bath water on this, because there's a lot of instances where a practitioner might be making some determinations when they're looking for a particular tissue possibly being a major nociceptive driver. And what we mean by that is, essentially, you do something to your knee or your ankle or whatever it is, you come in and you talk to your practitioner and say, "Yeah, I was out working in the yard. I stepped in a hole, twisted my ankle, and I got this pain now on the lateral side of my ankle and it's really swollen and it hurts me to walk."

You're doing some evaluations based on what's going on there, and have identified a very likely scenario for that particular pain complaint, is an overstretching and damage to the anterior talofibular ligament of the ankle. And so, there is still significant benefit, I think, in that clinician centered assessment process, especially when we look at the realm of pain problems that are nociceptive in their category. So, backing up for just a moment, think about this in terms of pain complaints, can often be described in one of three categories.

There's the nociceptive pain complaints, and these are ones where there is a particular tissue problem or pathology which is causing the pain sensation. So, this is your muscle strains, your ligament sprains, myofascial trigger points a lot of times in tissues will produce significant pain sensations. All kinds of tissue problems and/or pathologies may be driving that pain sensation. And you can target that particular tissue usually with palpation or some other type of tissue stresses, and exacerbate or increase that pain sensation. And that usually is an indicator that that is where those nociceptive pain signals are generating from. So, we refer to this as nociceptive pain.

The second category being neuropathic pain. And neuropathic pain is where there is pain generated within the nervous system itself, and this might be from pressure on a nerve or some type of chemical irritant near nerve tissue or something like that that's causing the nerve tissue to up its level of reporting signals back to the central nervous system out of proportion to what's really going on there, or some other type of irritant to the nervous system itself. And that's what we refer to as neuropathic pain.

The third category of pain complaints is often referred to now, frequently more commonly called nociplastic pain. What this means is, these are the ones that are really tricky and really tough, and there's also the ones that we tend to see a lot of in the treatment rooms with soft tissue treatments, because these are pain complaints where there doesn't seem to be a real significant indicator or pathological problem causing the pain, but a person has very significant pain complaints that might be much more complex and wrapped up into an entire biopsychosocial pain process. There may be something where there is a systemic disorder, there may be other things going on with metabolic problems, there can be all kinds of things. Job stresses, things at home, there's various different types of factors that all play into whether or not a person might be getting a pain complaint in a certain area that doesn't seem to be directly related or correlated with a particular tissue pathology.

So, looking at these different categories, this is at least the framework and the way I see it, is that the category of nociceptive pain problems is one where there's still a lot of benefit to a clinician centered assessment, because a high quality assessment and evaluation of that particular tissue problem can give you good direction about the best way to address this, or maybe even note that this is something I should not be working on, this needs to be referred to somebody else. So, those can be some really good and important indicators of why a clinician centered assessment will be particularly valuable in those approaches.

It seems to be, at least to me, like decreasing, to some degree, in its effectiveness as you move through those other two types of pain complaints into the neuropathic and the nociplastic pain, because those are so much more complex and involve a lot of other factors that maybe a lot of those factors can be replicated in the clinical treatment room with the person right in front of you there. So, these are some of the things that would be indicators that we might want to look at for the pros and cons of that clinician centered assessment. But that is one of the key factors that makes up this whole traditional manual therapy approach.

Now, the second category they point out here in this traditional manual therapy approach is what's called pathoanatomical reasoning. And this is basically the process of always looking for some pathological culprit or causation of a pain complaint that somebody has. And I see a lot of soft tissue manual therapists doing this a lot, whereas they come in, maybe they have some type of postural alignment that is slightly off from what we've all been taught is normal or ideal, and then the practitioner pathologizes this for them, say, "Oh, well, no wonder your back hurts. Look at that exaggerated lumbar lordosis that you have. Or look at that anterior pelvic tilt that you have."

And so, these types of things of creating or producing some type of pathological, anatomical structural tissue-based problem in there, that's got a lot of benefits to it if your treatment approach approach is one that targets and focuses on, "I'm going to do something to fix this problem with my particular treatment." Those two things go hand in hand very well, so we can see why this has really evolved over time as a common approach in the manual therapy world, because as manual therapy practitioners, it gives us a reason to be. It gives us a reason to do the things that we do, because we're going to take our particular skillful techniques and we're going to do something to change that tissue abnormality or aberrant system that's going on in there.

So, there's a good rationale, I think, for how this developed and why it has developed. The problem is, again, the more we have learned about structure and function, pain principles and things like that, we often see there's very poor correlation between many of these things, like structural aberrations and whether or not somebody is going to necessarily feel pain from them. And in fact, we can make their pain worse with noceboic messaging around this. What that means is, referring to a nocebo, which is the opposite of a placebo process, where you can, with the things that you might say or you might indicate to somebody, cause a pain sensation to become more prominent or more significant.

I've talked about massage therapist doing this, because that's the group that I'm most familiar with, but clients come into them and they're working on this person and saying, "Oh, man, wow, these are the tightest shoulders I've ever seen. No wonder your neck hurts." When you say something like that, you're creating a nocebo or noceboic message to that person, and that is going to have an impact on them in many instances. It can make their pain feel worse or make them feel like, "Man, I really got to do something about this, because obviously I'm really messed up."

And that's not the message that we want to get across to somebody at all. It's really important that we try to stay away from any of those types of noceboic messages, and that is a characteristic factor of a lot of this traditional manual therapy approach in that pathoanatomical reasoning. So, that's one of the things that they highlight as, at least a recommendation from this paper, something that needs to change.

Now, this third one is one that's probably going to be some of the most, I think, controversial around these topics, and this is something they refer to as technique specificity. And I want to talk a little bit about some of the things they said here and also weigh in a little bit with my own personal opinion about this and probably ruffle some feathers in the process in doing that. But the idea here is, many of the manual therapies that we have practiced and advocated and taught and promulgated over the years are built around specific models of doing something particular to the tissues of the body.

So, one of the things that's been a problem a lot of recent research has been looking into many of these manual therapies, is finding that many of these narratives that have been created around these techniques and methodologies don't hold up when you do the clinical research about them and find out, are they actually doing what they say they're doing? And this runs the gamut from manipulative procedures that are done in the chiropractic, osteopathic professions, saying that you're going to take a particular joint segment and do this manipulation and move just that one joint segment and move it back into position because it's gotten out of position. That just doesn't really seem to occur, according to what we've now learned with a lot of the biomechanical research. And so, there's still a lot of theories and models that are based on those concepts and ideas, and still promote that kind of thing.

And we've got a lot of stuff also in the world of soft tissue treatments where we say, "I'm going to do, A, some type of fascial release technique and going to release somebody's fascia by doing this thing with my hands." And the reality is, it's extremely difficult. I'm not going to necessarily say impossible, because I think that's very difficult for us to know, but really, really difficult that we can target one specific tissue, multiple layers down, and say that we're going to do things to that tissue and cause a mechanical change in it, when we know now from biomechanical research that we can't really produce the forces necessary to cause mechanical tissue elongation and fascial tissue through what we do in manual therapies.

And I'm guilty of this as well, because I've taught things over the years about various different techniques where I was taught a particular thing that, let's just say something like broad cross fiber applications, the idea that we were spreading apart muscle fibers or deep transverse friction that was performed with the idea that we're breaking up scar tissue and realigning scar tissue fibers in damaged muscle or tendon tissue. A lot of these things have not withstood the investigative eyes of when you look at this and actually do research on these techniques.

Now, that doesn't mean they don't get a beneficial effect, and that's an important thing to remember here, is that we're not saying that these things don't work and they're not beneficial, because people often get great pain relief from them. What we're saying here is that, it's very unlikely that we have a lot of specificity in what we're actually doing and describing that we're doing with most manual therapy techniques that are taught out there. There's research studies and they cited a very large number of papers in putting together this comprehensive analysis. I think it was something in the excess of 150 papers that they had cited in here, so they did a lot of background literature review on this for looking at these issues.

There was papers that were looking at the fact that they tried to use different types of manual therapy techniques, some of which were sham techniques, not really doing the thing that was supposedly being done, and many of those sham techniques were just as effective as the supposed specifically targeted treatment technique that had to be done one particular way or one specific way. And we know now, of course, that a lot of this gets down to, what is that patient-therapist relationship? What is the physiological and psychological relationship between the practitioner and the recipient? And how does that manual therapy impact them based on what that person is doing? That's a lot of where these things are really getting their biggest benefits, I think. This is a lot more in the neurological sphere and the whole psycho emotional sphere and all kinds of other things happening to do with very complex processes in the nervous system that make these things do the things that they do.

So, keeping in mind this whole idea of technique specificity, this is one of the third rung of the ladder, or the third leg of the stool that they said on the traditional manual therapy techniques that needs to be reevaluated, because we just can't continue to teach and promote the idea that there is this high degree of specificity to a lot of these techniques that we're doing, because that just doesn't really work. It doesn't really happen that way.

Now, I know a lot of people's professions and businesses and things like that are based around the teaching of these specific types of techniques. And let me just talk about this on the flip side a little bit. Again, that doesn't mean that it's not beneficial to teach a lot of these things, because there's some real significant benefits to teaching highly specialized and targeted ways to touch tissue and to touch a person's physiology and their anatomy structures and contact certain places that seem to be painful or generating pain sensations, because that, in and of itself, can have a very powerful therapeutic benefit by making that person feel, "Oh, wow, that person found exactly where my pain problem was and they went right to it. I really have great confidence in this person."

And that has therapeutic benefit. We know there's a lot of power and benefit that comes in that process of the confidence that that patient exudes or that client exudes in the treatment that's being given by that individual. So, again, this is something that really supports the idea of, we shouldn't stop teaching a lot of these techniques, but I do think it may be time to reframe the rationales and the narratives around why they do what they do and what they're actually getting at and what they're actually doing. So, that's, in essence, what they talk about in terms of the model of this traditional manual therapy.

Now, they proposed a new framework. That's the key thrust of this paper, was looking at a potential new framework for how manual therapy might be taught. And this new framework that they discuss here, it has several core components and I want to go through them one by one here. So, the first one I want to talk about, they refer to as safety in the therapeutic alliance and in the therapeutic encounter, and this is absolutely critical. The person has to feel safe in the type of treatment that's being given to them and what you're doing. And this safety refers to both the safety of what you're going to be doing to them. I know a lot of people who have gone in and said, "I don't want to go get a chiropractic adjustment, because I don't want to have my neck twisted and cracked."

That is a scary sensation for them. So, that is a sense of safety that somebody might not have around that. Or, "I don't want to go see a massage therapist, because I'm afraid, I've read a story in the paper about somebody who was sexually inappropriate in the massage treatment room and I don't want that to happen to me." So, that sense of safety, emotional safety, psychological safety, physical safety, all of those things have to be absolutely paramount in order for this treatment to be effective.

The next thing is, creating a comfortable environment and this goes along with safety. A comfortable environment that produces positive interactions during the therapy process. Now, when we say comfort, that's a lot more than just, "Does this table feel warm? Does this table feel comfortable?" This is, are you comfortable in your interactions and engagement with that practitioner? Does that person make you feel open and like you're being listened to, and you're being valued, and you're being seen as an individual who's trying to get some help and that person is there to help you? This is one of the most powerful and beneficial things that we can do with, especially in massage therapy and some other manual therapy approaches, where you take a lot of time with each individual.

There's so many people who get rushed through the treatment process and the medical and healthcare systems, spending 10 minutes with their healthcare professional and then they're out of there and the person, they feel like, didn't really listen to them, didn't pay attention to them, and didn't have time for them, and really was maybe even sitting taking notes on the computer the whole time and not really paying attention to them. So, that sense of comfort and safety are key and paramount to an effective form of this new framework of manual therapy. The modern form of manual therapy, in their mind, also should have a high degree of efficiency, meaning that therapy should be effectively delivered without wasting a lot of time and spending a lot of time doing things that are not necessarily beneficial.

Now, there's some reasons that this also has a sort of a... I don't know, maybe I push back on this one a little bit, because what some people might consider as waste of time and inefficiency, because your billing system is based on seeing X number of people per hour, you're going to want to find treatment methods that are efficient for you to be able to get work done and change that room over and get somebody else through there. That's about a business efficiency. But what that person might refer to as wasted time, in another person's mind is an important part of that therapeutic process, that they got to actually spend an entire hour with their practitioner completely dedicated and focused to them and working specifically on them for that dedicated period of time.

So, this idea of efficiency, I'm on board with the idea of being efficient with your treatment and being effective with what you're doing, but also, I'm not necessarily buying into the idea that that always is going to mean you don't have to spend a lot of time doing things, and you can do them much more quickly necessarily. Not always true, I don't think.

Now, one of the other things that's critical, I think, in this new framework here too is about communication and also the context under which a lot of the therapy treatments work. Communication is absolutely ideal, and here's an example of where this whole idea of the clinician centered assessment, which mostly might focus on the things that the clinician is going to determine as necessary in the assessment and evaluation process, misses the boat because they haven't spent time really listening to people. Again, like I was saying a minute ago, one of the most common complaints I hear from people about their experiences in the traditional healthcare system, is they feel like people didn't listen to them.

I've had people many, many times in the treatment room say to me, "This is the first time somebody really listened to me about what's going on here." And I hear that all the time from other practitioners saying they don't feel like people really took the time to listen to them and pay attention to them. So, that aspect of appropriate communication, time spent, the critical role, and empathic process of being there in that therapeutic space with your attention completely devoted to that person who's in front of you, that has power and that has effect for what's going to make a much more effective manual therapy treatment. Just the very process of being there and knowing that that person is your entire focus for that period of time, is so critical for having beneficial outcomes.

A lot of this stuff should seem like a no-brainer, like, "Well, yeah, duh, that makes sense that that's going to be beneficial." But we just see a lot of people not doing it all the time. I've said this on a couple other podcasts and other times too where I've seen some of these discussions on social media about massage therapists on these forums, asking about, "Why is it not appropriate for me to listen to a podcast while I'm doing massage?" And, for me, it's just like, the whole idea that you are so not present with a person, that you're listening to a podcast or something else while you're practicing, I think misses that piece. It misses that direct attention focused on the individual and what you're doing. I know it can be boring. I know sometimes you feel like you want to do something to keep you awake and inspired and things like that, but there's a lot of subtle things that you'll miss if your attention's not really zeroed in completely on what's going on with that person. So, those aspects of context are critically important, context and communication.

The last thing we want to mention here that they say is so critical, is what's referred to as person-centered care. And this is a big theme in the whole healthcare arena of looking at, how do we get much better with the type of care that we're offering people? We have had a system that's not really based on the person, patient, client, whatever you want to call them, being at the center of this process. And now, we're really trying to make a lot of those changes. We had a podcast episode a while back when we talked with Walt Fritz about shared decision making and the important role of getting that client or patient, whatever you refer to them as, engaged in the process and knowing that they're part of the decision-making process, they're part of the determination of how the treatment is going to proceed and what are the goals and the strategies and what they think is going to be really best for them.

That whole idea of person-centered care really evolves, also, a great deal out of what we're doing, the assessment and evaluation process, when we take a comprehensive history. I found this interesting in this article with the discussions about clinician centered assessment processes. So much of what they talked about was related to physical assessment strategies and methods of examining tissues, without talking at all about the critical importance of taking a comprehensive and detailed history. And I've really harped on this for years, that the history is the most important part of that assessment process, that's where you're getting the story. And we oftentimes don't train ourselves, in these different professions, to do a really comprehensive and thorough job of the history taking process during the assessment. So, that's a critical component of a really good person-centered care approach.

So, that's a key process that I think is going to be part of this new framework that they're advocating here. So, that's, in a nutshell, the traditional manual therapy approach highlighted in this article, and also the new framework that they advocate.

So, I want to talk for just a moment about how this gets implicated; the implications for teaching and for practice. For teaching in particular, and education is certainly something that I'm very passionate about, and wanting to look at how do we do a better job of teaching the things that we're doing with manual therapy? This one's going to be a challenge for a lot of people, because the way massage therapy, in particular, education is structured is more of a lineage education model, which is based on, "I learned this thing from so-and-so who learned it from so-and-so, and they learned it from their guru or head honcho person." And that person oriented lineage approach to teaching is often highly built around these technique specific models.

And so, getting out of that framework and getting people to think more in terms of how manual therapy approaches might be organized with a more accurate description of the physiology of what's going on and what's happening in the tissues and what's happening with the individual person, that's going to be a big leap for a lot of teachers. So, it's going to take some reframing and paradigm shifts, and probably some real discomfort for a while of getting to that place. And the same thing is true with practitioners who've, let's say, you've been doing something for 10, 20 years or something like that, and you have a particular technique methodology or something that you learned, and you learned a particular narrative around that, and now you're hearing a lot of people saying, "Well, that doesn't really happen."

That really rocks your world. That's something that I went through this whole crazy thing like a lot of people did, when I started learning a lot of this stuff and recognizing that many of the things that I had believed and taught and practiced, based on for many years, wasn't really very well-supported in a lot of the research literature. And it creates this challenging situation of having to reexamine what you're doing and say, "Well, what really is happening here?" And that can be very disconcerting and very feeling like the rug is pulled out from under your feet.

So, find supportive communities to talk about these kinds of things and talk about how this framework might change what we're doing, and how it might also change and relate to the things that we're talking about with our clients, because this is another one that can be pretty challenging is, it's not only us practitioners. A lot of it is the clients and patients that we see who have many of these pathoanatomical models and technique specificity concepts ingrained in them, because they've heard it also over many, many years, and they've had other practitioners tell them these things. "Oh, yeah, I know I've got scoliosis. Or I've got this forward head posture or whatever it is that I'm not going to be able to get rid of it. I constantly have it. This is going to be my problem or my thing forever."

So, they've got this mindset or idea based around some of these concepts, and sometimes you might have to find some ways to unwind some of those things with the people that you're working with. So, these are some of the challenges that we're going to have to face us. And I have to say too, I don't necessarily agree with everything that was described the way it was in this paper, there are a couple places where I feel like that wasn't necessarily an accurate description of what we do in massage therapy or the way in which we work or address things, but as a general guideline, I really liked what they came up with in terms of looking at some of the existing problems in that traditional manual therapy model, and also some things that might be related to how can we do a better job of both teaching and practicing more accurate concepts and things that will be beneficial ways of addressing better manual therapy for the future?

So, some of the things that came up for me, questions I would just kind of leave you with, a few things to ponder here. And by the way, I would really encourage you to take a look at this article, read it, and think about some of the things that they've mentioned here. And I'd love to hear your ideas. Send us an email too at info@thethinkingpractitioner.com and let me know what your thoughts are on the article and how it impacted you, or affected you, or pushed your buttons, or whatever it was, and see how does this model look like? It might fit into what you're doing. But also ask some of these questions, like how do you see these traditional principles of manual therapy aligning with or diverging from what you currently do in your treatment room? Do you look at things that same way, or does it sound like, "Nah, that's not really how I see it. That's not really how I look at my practice at all."

So, look at some of those things. See maybe, do they fit, do they not fit there? Maybe what are some practical steps that we could take as practitioners and educators for enhancing that sense of safety, comfort, and person-centered care that we want to try to engage in the treatment room? These are things that I think will be really important for us to constantly think about, and how can we encourage a much more beneficial therapeutic environment in what we're doing. So, these are a number of things that are challenges for us as both educators and practitioners, but man, this is how we grow. This is how we get a better sense of doing a better job of what might be, potentially, the growing edge of where we need to get better at what we're doing.

So, again, let me know what your thoughts are, I'd be curious to hear about that, and then we'll jump into some further discussions. We may bring on some other guests here in a little while to talk about this article and see what their thoughts are on it as well, because I do think it's a real significant thing that we're looking at. So, thanks again today for hanging out on The Thinking Practitioner and looking at this particular article and turning the lens a little bit on ourselves and seeing what's going on with our own practice here.

And do remember, Books of Discovery has been a part of the massage therapy and bodywork world for over 25 years, with nearly 3,000 schools around the globe teaching with their textbooks, eTextbooks, 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 bodywork communities thought-provoking and enlivening content that advances our profession.

Also note that instructors of Manual Therapy Education programs can request complimentary copies of Books of Discovery's textbooks to review for use in their program, so please reach out at booksofdiscovery.com. And listeners of The Thinking Practitioner Podcast can explore their collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics, and business mastery at booksofdiscovery.com, where Thinking Practitioner listeners can save 15% by entering Thinking at checkout.

So, thanks again to all of you for hanging out with us today and we appreciate your listening, and also thank again to our sponsors for helping support the show. You can stop by our sites for the video, show notes, transcripts, and any extras. You can find that over on my site at academyofclinicalmassage.com, and also over on Til's site at advanced-trainings.com. If you have comments, questions, or things you'd like to hear us talk about, you can just record a short voice memo on your phone and email it to us at info@thethinkingpractitioner.com, or just old school, send us an email, do the same thing.

Or you can look for us on social media. I'm @WhitneyLowe and you can find Til under his name also @TilLuchau on social media over there. If you've got some time, we sure would appreciate it if you'd hop on over to Apple Podcasts and rate us over there, as it does help other people find the show, helps expand the reach of what we're talking about a little bit here, and you can hear us wherever you happen to listen to your podcasts, so please, do share the word and tell a friend, and we'll look forward to seeing you in the next episode.

 

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