People change their minds--sometimes, radically. Learning, improving, refining, all involve changing how we saw things before. But is there a cost? And what makes changing our views such a challenge? Whitney and Til compare notes about how their perspectives have taken a 180° from how they used to think, and, about how that's played out.

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(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.)

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Whitney Lowe

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Full Transcript (click me!)

The Thinking Practitioner Podcast:
Episode 63: Turnabout is Fair Play: Our Favorite Perspectives Reversals

Til Luchau:

The Thinking Practitioner Podcast is supported by ABMP, Associated Bodywork and Massage Professionals. ABMP membership giver professional practitioners, like you, a package, including individual liability insurance, free continuing education, and quick reference apps, legislated advocacy, and much more.

Whitney Lowe:

ABMP's CE courses, podcasts and message and bodywork magazine always feature expert voices and new perspectives in the profession, including one from both Til and me. So, thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking.

Whitney Lowe:

Til, very good to have you back with me here today, sir, how are things going out there in Colorado?

Til Luchau:

They're going fine, thank you. And thanks for the time off, it was good to have it and it was fun to listen to what you're up to, you had some good conversations going.

Whitney Lowe:

Yeah, I had some fun things going with a number of different people there, and we do want to let you know that you were missed. So, it's good to have you back.

Til Luchau:

Oh, thank you. Nice. And we have an interesting topic lined up for today, what are we talking about, Whitney?

Whitney Lowe:

Yeah, today we decided we're going to talk about changing our minds, essentially, is the big picture here. So, the topic that we've got focused here today is reversals, or perspective reversals. Essentially meaning, things that we've changed our perspective about from some time previously, either when we first learned about things earlier on in our career or more recently, we might've been advocating, or teaching, or presenting things, and then we've changed our perspective and changed our minds. SO, we're going to talk a little about why we might've done that, what those things are about and what happens when you change your perspective and change your mind on things.

Til Luchau:

And you invited me to share some of my top things that I've changed my mind about, or changed my perspective on. So, I got a little list here. And then it's a fascinating topic because, well, it's really relevant to the world now because we have so many different opinions about things clashing with each other. And, of course, each side want the other to change their mind, and so that raises the question of, "Is that even possible, and when it happens what makes that good or bad, and why people don't change their mind?" I know that reflecting back on these topics I had to think through a bunch of those things myself, I look forward to dig into that as well.

Whitney Lowe:

I'm curious, based on what you just said right there, in a more general sense, what makes you change your mind about something?

Til Luchau:

Facts.

Whitney Lowe:

Is it reading somebody's post on Facebook or-

Til Luchau:

Facts, evidence. I'm saying with a smirk, because I like facts and I like evidence, I'm totally into that stuff but the modern view and the research shows that it's not facts, it's not evidence that actually gets people to change their minds. It really isn't, it's a deeper more mysterious process what also emerges our biases, or our proclivities, or things we already think true. We find evidence for that, but it's a mystery to me, actually, because we do change our minds, I certainly have. And I haven't changed my mind about this topic yet, but give me enough time and I might. But-

Whitney Lowe:

And I would assume, probably, it's some combination of those things too. I mean, joking aside, I think facts and evidence do play a role in that to some degree. They help shape our perspectives and help change some of the things, to a certain degree, but I think it's certainly saying that they are the soul piece of it is probably oversimplification.

Til Luchau:

Yeah, and I had a few arguments with people, they won so I just totally change the way I though about things too. Not. SO, that's the other thing that doesn't seem to happen, is that we don't seem to be very good at convincing each other to change our minds. But, yeah, change happens. We do change our perspectives on things.

Whitney Lowe:

So, you would not necessarily advocate for the, "He who shouts loudest wins, and their perspective is the one adopted."

Til Luchau:

It depends on what you define as wins, but in terms of changing perspectives, no, not usually. Loudness doesn't really do that so much.

Whitney Lowe:

All right, well, we'll try to keep it civil here today as we talk about those things that we've changed our mind about. So, where do we start looking at this?

Til Luchau:

Well, you gave me a little preview of your list, can I invite you to share one, and I got to call you and raise you, or whatever.

Whitney Lowe:

Sure, yeah I'll start talking about, in making this list and thinking about these things I try to think of, like, what are some things that are more general and what are some things that are really specific? I'm going to start with the specific one on the top of my list here, and these are in no particular order but they're just things that really came to mind. And this one has to do with thinking more deeply about physiological accuracy and understanding some more from applying thoughts and facts, and things like this. But early on I was teaching a lot of things about specific massage techniques, such as broadening techniques where you go across the direction of a muscle fiber, for example, with large sweeping movements, or even ore specific things-

Til Luchau:

Is this like cross-fiber or-

Whitney Lowe:

Yeah, cross-fiber application. And I was teaching a lot that what we're doing is sort of spreading muscle fibers apart, but with our broad cross-fiber applications and helping enhance pliability of tissue by just making it more mobile through this spreading apart. And I think that also would kind of relate to what I taught early on about deep friction techniques, of breaking up scar tissue with tendon scars, and things like that, from friction techniques separating those individual fibers with our pressure techniques.

Til Luchau:

Okay, so we got the broadening idea and then we have the separating or Adhesions idea.

Whitney Lowe:

Yeah, and the more I looked at the physics of this process and the physiology of it, and looking at individual muscle fiber size compared to the capability of applying more specific pressure to individual fibers, I changed my perspective a lot. I'll just say right now because things, again, could change somewhere later down the road, but I just don't think we can do that, I don't think when we press through layers of skin, subcutaneous fascia, fatty tissue, and all kind of stuff, by the time we get down to those fibers the pressure is disbursed across a larger area compared to the size of those individual fibers. I just don't think we can spread them apart and broaden them.

Whitney Lowe:

Now, that has not changed the effectiveness of those techniques in getting results with people, and I think those results are probably for different reasons, a variety of different reasons, but I no longer stick to that narrative of broadening and separating fibers, or doing this to separate fibers with deep friction treatments, and things like that.

Til Luchau:

All right, that's very specific, and I think you probably gave away the take away for most of these for me too, which is that, well, maybe they're effective but maybe not for the reasons we thought. At least that's the theme these days, I know for the last decade, or whatever its been, in our field, but also in my work. SO, there's an example, you're not thinking that you're physically spreading out the tissue anymore or affecting individual muscle fibers in the same way. But to let your perspective change, did that change your work?

Whitney Lowe:

I still tend to do a lot of those same things the same way for certain types of things that I'm working on, because they got good results. And that brings up another question that gets asked a lot, "Well, does it really matter then? Does it even matter if you're still doing the same thing and getting good results? Why does this matter?" And I would call people's attention, also, to a really good blog post that Todd Hargrove did a number of years ago, I think it was titled something like, "Why It Maters What We're Doing," or what happens.

Whitney Lowe:

And he was advocating for, "Yeah, we've changed a lot of perspectives and we might still be doing some of the same things but it actually does matter for us to understand why we're doing this, or what happens." And that's primarily because we might come up with erroneous assumptions that get applied to some other thing that are not correct about what we're doing, or we're explaining things incorrectly to people and just being accurate does, in fact, matter and might lead us astray down to make other decisions somewhere down the road that are just not as accurate.

Til Luchau:

We'll put a link to Todd's... You said it was a podcast or it was a article, or it was a blog post?

Whitney Lowe:

It was a blog post, if I remember correctly.

Til Luchau:

Blog post, okay. Yeah, we had him as a guest-

Whitney Lowe:

Yeah, we'll dig that up.

Til Luchau:

... here but I remember that one he did. I sure am familiar with the discussion, so thank you for that great encapsulation of it. Any more to say about that?

Whitney Lowe:

No, that would be, I think, a good example of something, refined perspective and change some of those things on my list there. So, what's something on your list that can-

Til Luchau:

Well, I got a number of those. And you were very specific anatomically, I'm probably going to be more general. I'll get into my comparable one. But before I do that I want to say, I actually drew a blank when you asked me this question, which was weird because I think a lot of my teaching in this last 10 years has been about going back and revisioning what I was teaching before. For example, these old recordings you and I were just talking about, that we have recordings of ourselves. Me from the '90s teaching in a golf shirt, and those are still in the market, people are still buying and watching, and writing about those. From, amazing to me, still complimenting them, but it was really awkward, I could say, for me to realize that what I'm saying now is very different in my mind, my ears, to what I was saying then. And so, to have that out there puts me in a funny position.

Whitney Lowe:

Do you see instances where what you're talking about now actually contradicts those things, or is has it just sort of changed a little bit direction, or...

Til Luchau:

Both. Some of it's like you said, a lot of the techniques are still effective, maybe my explanation's different, but there's things I've completely changed. And that's why I went to my faculty and said, "Okay, you guys, what would you say that you've seen me change?" Because we've been working together for many years. And the first thing, of course, that came back was very similar, "Do we release ad quote fascia?" And that was the model I was trained in, that it was about fascial change, the change in people's posture, position or experience even, were explained by the mechanism fascial change and it turns out we maybe didn't understand as much about fascial change as we thought we did.

Til Luchau:

And one of the changes that our work produces, and we've done so many episodes about this I don't mean to try to repitch like that. But basically that my perspective reversal has been from trying to change the tissue to produce a good result to just trying to produce a good result. And really looking at what defines that for the client and for me, and getting as honed in, as direct and clear about that result as I can as opposed to trying to work through the medium of tissue, for example. Since tissue isn't quite the same as we understood it as when I trained.

Whitney Lowe:

Yeah. And so, in doing that, has that also changed perspective of what you do clinically in working with people about-

Til Luchau:

Yes.

Whitney Lowe:

... for example, thinking about fascial work, do you still think along the lines of that tissue as something you're targeting or do you think more along the lines of, "I want to help get this person, let's say, moving better, moving more in their body," or whatever.

Til Luchau:

I think it's really raised the role of the subjected report of the client. It's the short answer, I do some of what you're saying but rather than me doing a passive assessment of their posture, like I was trained as a Rolfer, or even their movement as I was also trained as a Rolfer, or Rolfing Movement practitioner. I'll do a very detailed conversations, it's not that complex it's just mostly I want to understand what are they bothered by, what are they disturbed by, what are they motivated by, why don't they come in to see me? If there's some issue they're wanting to address I want to really understand it from their point of view, I want to understand how they know they even have something they want to deal with. And then that helps me to find the domain.

Til Luchau:

Sometimes it's rare but sometimes people come and says, "Yeah, my deep cervical fascia on my left side is just feeling a little over connected with my thoracal lumbar region." That's pretty rare. It's harder to turn my head and it hurt, I feel a funny thing right here, so I work more on that level now. And I am using some of the same techniques that are shown in those videos but I'm also doing a lot more, I would say, inside-out work with the clients where I'm really getting them to, in a simple way, report o their experience and play with movement options, and things like that, while they're on the table.

Whitney Lowe:

Yeah, and I think what's interesting, we probably all, to some degree, over emphasize what we think our clients really know or understand about we're doing. And probably it's not as complex and deep as we might think it is, in terms of their perspective about, "Well, you're doing this kind of work and getting this kind of result with me."

Til Luchau:

No, it's great to educate clients, it's so fun when someone's interested and I can just raddle away about my geeky stuff, but I actually, as much as I can, I want to work from my hands and from the present moment experience, and from there inside-out experience too. Because it's gone from being a tissue technician to be more of a experience technician or artist, or something like that.

Whitney Lowe:

Yeah, I like that. Yeah, that sounds good.

Til Luchau:

Okay, what else you got?

Whitney Lowe:

Well, I would say I would kind of take off from where you started right there and just say along a similar line, a very similar kind of perspective shift, also getting back to the whole thing of posture and structure, for me, has changed a lot. A lot of the way that I did early training and focused a lot on stuff that I had learned early studying postural analysis through NMT, and working in the field of orthopedics for quite a number of years. I would look at certain types of things with a postural evaluation and say, "Okay, this individual has a anterior pelvic tilt, so obviously we need to work on those tissues that are hypertonic. And creating that and then get them to shorten, and the that's going to correct this person's posture and we'll get them changed and fixed."

Til Luchau:

Upper crossed, as well as so many... Yeah, there's so many models there we could use.

Whitney Lowe:

Exactly. And what was interesting, and I was thinking about this, there were some instances in which I remember coming across some techniques, and this came back in, I'm thinking maybe like late 1990s perhaps, when I was doing a bunch of research for my orthopedic massage book. And with studying a lot of the stuff that was currently out there from other practitioners, teachers, about how to do things, like how to fix an anterior pelvic tilt, or how to fix lateral pelvic tilt. And some of the techniques and things that some people were advocating I thought, "This must be right because this person's a well known authority and they must have done all this stuff and had this work, but I'm not sure I believe that would really make those changes." But I went down that road anyway and sort of said, "Well, it must be working because they must be getting results doing this." And I think-

Til Luchau:

You had a wondering or doubt but you went with it.

Whitney Lowe:

Yeah, and that's one of those conformation biases of appealing to authority of just saying, "Well, so and so is an expert, they must know that this works correctly, or something." But I think over time I've really become much more accepting of the fact that these are models that are sometimes created out of something as simple as structural mechanics or physics, and it would make sense but that ain't how the body works. And that's just, for example, those kinds of things, just simply working on those tissues does not necessarily magically fix somebody's posture to make it be correct in a way that's going to stay there, and that this fix really did it to them. I'm not so sold on that-

Til Luchau:

And you don't think that's just because you never got good enough at it?

Whitney Lowe:

That could be, I should enter that as a possibility. That's definitely one of the possibilities there, so...

Til Luchau:

Okay, because that's often the critique, that if we don't radical posture change it's just because we haven't evolved enough as practitioners, or whatever it is.

Whitney Lowe:

Because, certainly, that's part of a whole imposter syndrome thing of like, "Well, maybe that's really true. Maybe I'm just not good enough at it." But I think the thing that led me away from putting a whole lot of coins in that basket was studying more about motor learning, and recognizing that you can do some things, and people love to do these little postural treatment things and put people up in front of the classroom, and make things change and do all this kind of stuff. Have you ever seen Andreo Spina's video about the easily fooled nervous system?

Til Luchau:

Doesn't ring a bell, no, tell us about it.

Whitney Lowe:

We got to put this in the show links and also just have you take a look at this wonderful demonstration video called, I believe if I remember the name correctly, The Easily Fooled Nervous System, and it's done by Andreo Spina. And, if I remember correctly, I believe he's a chiropractor and movement specialist, brilliant guy. And he does this demonstration of just showing, this is something that happens all the time in workshops and training programs. You get a student to come up in front of the class and you do some kind of movement thing with them and you just look at them and stop, then you do this little treatment thing and all of a sudden they're dramatically better. And he does this little demonstration where he's trying to show improving this guy's hamstring length.

Whitney Lowe:

And he does some little thing to his leg and it gets greater range of motion, and he does something to one of the audience members and then comes back and looks at this guy and his range of motion is improved by not even working on that person, by doing something to somebody else in the audience. And whole idea-

Til Luchau:

Well, that's because our fascia is all interconnected.

Whitney Lowe:

There's our fascial in connection, yes, and of course the Star Treky fans will say, "Well, there's the board connection right there of everything is connected to the higher mind through fascial connection between individuals." But, the point is that in that particular instance, what I was trying to get back to, in the treatment room we'll do this in a workshop or classroom position where we put somebody up, and we love to see that immediate change and think, "Wow, this is great, my work did this." But there's all kinds of things wrapped up in that, having to do with expectation and the being up in front of the classroom and of course you want to see those changes happen so you're going to make certain things happen to the nervous system that allow it to occur. But in many of these instances a lot of this stuff will happen and you'll think, "Wow, I did great work here." But then tomorrow morning, or at the end of the day when the person gets home after driving home from their massage treatment on the freeway, and getting all wound up in the car from road rage, you've lost that.

Whitney Lowe:

And so, a lot of this I think is, to me, a lot more related to motor learning and retraining the body how to move than it is, "What I did with my hands that fixed that," so to speak.

Til Luchau:

So, your perspective was from postural analysis and postural correction to motor learning, you said, which explains those things that you're seeing in that video.

Whitney Lowe:

Yeah, I think that is a greater percentage of what's happening, and a greater percentage of the changes that I think we see in some people have to do a lot more with impacting, like we talked about, proprioception awareness, interoception, those things that really change our sense of how we feel and how we move, and how we are in our bodies. I still think the role that we play as practitioners is crucially important because we are a facilitator for that change, but I kind of moved away from this idea that I'm doing something to people and making it fix positionally, especially.

Til Luchau:

Nice. Even if people don't go through that exact transformation you spoke about, I think a lot of people, just as they get more mastery and artistry becomes much less about fixing and treating, and doing too. And we're about catalyzing, facilitating, encouraging some sort of shift on the other side of the table. Well, can I share my-

Whitney Lowe:

I was going to say, what's next on your list there?

Til Luchau:

You make me think about the shift I made from posture and position, and symmetrical alignment, which is what I was trained in and valued a lot, and got pretty good at analyzing. So, from that point of view to a point of view that was much simpler and probably more pragmatic, and in the end at least as effective, if not more. So, I'm just thinking about my process of teaching how to work with scoliosis. And you and I did a whole episode on scoliosis where you helped me articulate that some, but with scoliosis in particular it helped me to realize that my goal wasn't just to make people straight, that there were other things along the ways that were really helpful to the person.

Til Luchau:

And then when I put together a class on working with the sacroiliac joints, and especially intrasegmental pelvic dynamics. Upslips, downslips, that kind of thing, which are postural descriptions, positional descriptions. It really challenged me to think through a rational and a way of articulating it that made sense to me, because I was trained in some pretty complex ways of assessing bony landmarks and extrapolating the different positional anomalies, or distortion was the word, I'm doing air quotes around the pelvis. And yet I had to really step back and look and say, "What seems to really make a difference to the person on the table?"

Til Luchau:

And my perspective reversal at that point was, "It did seem to be either a shift in mobility and/or a shift in the perception or the perceptive, interceptive perception."

Whitney Lowe:

Yeah. Would you say this is one of those instances possibly where facts and maybe research studies, and things like that, also helped shape that to some degree? Because a lot of the studies that had come out in recent years have said, "There's just some pretty poor inter rater reliability about position of landmarks in correlation with pain and dysfunction," kind of thing.

Til Luchau:

That's right. Yeah, the idea that you can't put a lineup, like a police lineup, whatever you call that. You get three people with pain, three people without, put them in a lineup and have te experts through just visual analysis pick out the people with pain based on position and things. You can't do it, there's no... And then, more specifically like specific assessments don't even match up person to person or day to day with the same person. SO, no, that wasn't the facts that convinced me at that point.

Til Luchau:

I found those facts later and it was really validated in my conformation bias that it was probably mobility and experience that was more impactful that position, but it was something that I was really questioning when I would really have to say, "What do I see working and what fits for me? And the also what can I teach?" All those things are coming together to really help me make that reversal, that shift, from just paying attention to alignment or symmetry to more of a options removement, which includes by the way the option not to move, so it isn't just the same a range removement it's really, "Do you have a full range of options of movement?"

Til Luchau:

And the refining the pre-perception, which really a great return for me of harkening back to my, and you have talked about our early training is, or studied in the field of psychology, for e early training was psychotherapy which is really more of an awareness-based or process-based practice. I think there was a clash for me, and I've talked about it here before so I'm not trying to repeat the stories too much, but there was a clash for me coming out of the Rolf Institute in the '80s and then going to study with some of either Rolf's former students, at that time, like Judith Aston or Don Johnson, or Robert Hall, who were really taking what they learned either Rolf and shifting it to more functional approach, or really questioning some of the ideals there.

Til Luchau:

And it really mixed me up as a young practitioner because, to oversimplify it for sure, it was a shift away from a tissue-based or a optimal functioning approach to a more process oriented awareness, unfolding the developing evolution of the organism approach. That's not to make it so black and white, for sure, my Rolfing background gave me that too but it's just as simple as at some point, and this is maybe 20 years in, it didn't make sense for me to try to push things into alignment anymore. And it didn't make sense for me to try to measure bony landmarks position, and then assume that because the position was "distorted" that, that was problem. That was the reversal.

Til Luchau:

And then I had to come up with a set of tools and principles that would help me as a practitioner, and help my students to do the good they do.

Whitney Lowe:

And I think some of those ideas are really highly seductive to many of us, especially early on, as we're beginning to find our way into these places. I remember, this is probably 1989 maybe, going to a workshop or training program with a very prominent CE educator in the massage field who was talking about work they had done with a professional basketball team, and they were called in as some kind of consultant. And this individual saying they went to watch the team practice one day, and watching one particular player and said, "This guy is going to have these particular injuries because I can see what's going on with his biomechanics, this is going to be a problem."

Whitney Lowe:

And I felt like, "Wow, that is awesome, I want to be able to do that." Really get sucked into that idea, and it took me many years, I think, to really get back to realizing that's pretty presumptuous in terms of predictive processing.

Til Luchau:

Maybe so, for sure.

Whitney Lowe:

And there's a lot of factors in there that may or may not play out.

Til Luchau:

Ut just to be the Devil's advocate for a second, it's not like posture's nothing and especially at high levels of performance in a sport situation or something, but I would never presume to go up against a trainer or coach, or something that had that model and used it effectively. I can't say that they're wrong and I'm right at all. And there is, especially as you look at either really extreme levels of, say, scoliosis, or really extreme levels of pelvic asymmetry, you do get more symptoms, but in the range of most people's scoliosis and most people's pelvic asymmetries there's not a greater incidence of pain. And probably the same is true with athletics too, at high levels of performance, then those little differences really do matter in position, you could say, are certainly for them.

Til Luchau:

But at the level that most of us work at in private practices and that I was working at, it was a really effective perspective reversal for me to start looking at the things I do now. Also, you mentioned before something about accuracy and we want the narratives to be as accurate as we can, I would not argue with that at all, except to say that I have given up, for myself at least as a working hypothesis, trying to be accurate or truthful, or even find out what's right.

Til Luchau:

Because it's such a movable target for me I do change my perspective, and so I think my current benchmark is what seems to be useful but, of course, what resonates, what feels right to me, and I acknowledge that as an emotional valance, as evaluation of that, it fits and feels right. It's not to say that that's confirms it but that's to say that it helps me be more effective at it, and then my test is useful because it seem to help the client with what they're after as well.

Whitney Lowe:

Yeah, and I think you hear a lot of people talking, nowadays, about the movement towards trying to be less wrong as more of a goal than necessarily saying something like-

Til Luchau:

I want to be less right.

Whitney Lowe:

I want to be- yeah right-

Til Luchau:

I want to be less right and less wrong. I'm like doing the 90 degree axis from that, or something. I'm going to begin to try to evaluate in terms of right and wrong, it's more like, "Does it seem to get good feedback from me and from my client? And try not to present anything else about it being whatever else."

Whitney Lowe:

Yeah, you're shooting for kind of a middle ground of more, I think I heard you say this one time, something like, more towards results oriented treatments and away from descriptive rationales of what you're doing and why you're doing necessarily. Is that accurate?

Til Luchau:

Yeah, that's nice. I'm just thinking about a Rolf's quote of... Some parent debate was going on and she says, "Everybody, stop trying to figure it out, just go finger it out." Go finger it out, it's the pragmatic of working with what we actually feel and what our clients actually feel, that very empirical-based ground that is the groundwork for science and such.

Whitney Lowe:

Sure, yeah. So, good pieces there, for sure. So, well, I was going to bring up another one here-

Til Luchau:

Another one? Yeah, please.

Whitney Lowe:

... that I think both you and I probably, and almost all... Well, I won't say almost all but a huge, of course, number of people throughout the whole world of musculoskeletal or manual therapy care have been impacted by, and that's some of the more recent research in explorations of pain and pain science things. So, for me, that brought on a lot of big changes. Probably if you boil it down to a few simple statements or a few simple concepts and ideas, recognizing, for example, that pain does not necessarily equal tissue damage or there's not a direct correlation between the degree of pain someone feels and the degree of tissue damage that is present, or vise versa, that the-

Til Luchau:

That's become one of the axioms of say the biopsychosocial approach that...

Whitney Lowe:

Yeah, it certainly has. And, like a number of things, I've also seen this get off track, in my opinion, by boiling this down to oversimplified concepts or perspectives. For example, I think there was blog posts that I saw or some Facebook post, or something like that, where I believe it was Diane Jacobs had send this because she's a major thought leader in this area, and lots of people have glommed onto this statement and repeated it numerous times of saying, "There's no correlation between the degree of tissue damage and the degree of pain."

Whitney Lowe:

And, to me, that really oversimplified the statement because I can't get on board with saying there's no correlation, because if there was no correlation between the degree of tissue damage and the degree of pain we may to need anesthesia for surgery, or something, in cases like that. So, yeah, there's a correlation between tissue damage and pain in many cases. I think it would be accurate to say, "There is not always a correlation between the degree of tissue damage and the degree of pain." And, to me, I'm comfortable with that statement but I think we have to be careful jumping too far into these things without being a little bit more specific about different types of situations, but the crux of the matter being that I always kind of went along the assumption that those two things were directly related and I had to do something to the tissue damage and fix it, in order to address and alleviate somebody's pain.

Til Luchau:

That's really big, and I owe Diane Jacobs a debt of gratitude just for her indirect influence, I never studied with her during her modulation work, but just the thoughts that she's put out there. That one, it's not her thought I think I first heard it from Lorimer Moseley when his, I think it was Why Things Hurt video got popular, and this was a long time ago. But she really articulated that from a manual therapist point of view, and she read a line that resonated for me, at the time we were way too mesodermal and we need to think more ectodermally, and that made a lot of sense for the things I was thinking and putting together. But you're saying that can be taken to excess too, that can become it's own dogma with its own absolutist point of view in a way that people can get carried away with.

Whitney Lowe:

Yeah, I think there's certainly pendulum swings on all these kinds of things, and the whole pain science movement of going toward a more biopsychosocial models, and things like that, has been really ground shifting for lots of us, in ways that really helped us be more robust and comprehensive in our treatment approaches, and things like that. But part of the problems from this, also, that come out of this is sometimes the pendulum swings too far or there is some degree of... I heard somebody say this one time and I think it might've been you or somebody else, but it was a really eloquent statement about the potential problems of bad pain education with clients when we try to teach them about these things that we've learned, and we just really botch it up and we make the situation worse, because that can certainly happen as well.

Til Luchau:

No, that wasn't me but I get it. It's true that we learn something that's radically reversed our perspective, and then to bring somebody else along is another order magnitude in skillfulness and perspective. But that idea that there is not necessarily, I think you said, a correlation between tissue damage and the triggered pain is actually pretty liberating for a lot of people, a lot of people in pain, to really help to ease their assumptions about what going on because they're hurt. And the possibility is that, that opens up for them but also for us as therapists.

Whitney Lowe:

Yeah, and you know what's interesting about this too is that I see this sometimes also doing both things as it can liberate a lot, like you said, of those kinds of things and yet at the same time there're also people who really adhere to that kind of model. And when you can't find something that's wrong with a particular tissue through an X-ray or an MRI, or whatever it is-

Til Luchau:

Physical finding.

Whitney Lowe:

... get really frustrated because they want a reason that make sense to their models, or their conceptional ideas, of why this hurts. And what can end up happening in som of those instances, and I've seen this occurred before, is you have some finding on a diagnostic test, like a person with a disk herniation and an extreme pain that they have their back and down their leg, or whatever. And that may or may not be the cause of it, but once they see that or once some health professional sees that thing it gets blamed for that stuff when it may or may not be the case, and sometimes people really want to have a reason for that is and they'll really put a lot of eggs in that basket, which can be helpful but it can also potentially be problematic for- progress-

Til Luchau:

Yeah. Well, especially when there is something like a disk bulge that has a poor correlation overall. There's definitely people that have disk bulges that, that is what is hurting them, definitely. But, like you said, if we latch onto that as the explanation, that might limit our possibilities or influence our treatment choices. On the other hand, I don't know why I'm doing this Devil's Advocate thing, there's a special kind of purgatory reserved for those who don't have a diagnosis who can't get one too. Som to not know why I have something going on is also pretty awful sometimes.

Whitney Lowe:

Absolutely.

Til Luchau:

Yeah, you admit, it can be really, actually, relieving to have an explanation that seems to at least explain it, if not offer some ways out, but then we get the other downfall which is getting too attached to that explanation so that we miss some of the possibilities.

Whitney Lowe:

Yeah, and I think we need to, and this is kind of some of the things you and I've talked about before and certainly one of the areas where your background in studying things like understanding a little bit more about relationships and communication in the therapeutic environment through your work in the psychotherapy world is so valuable because we're trained well in how to manage some of those kinds of things of those relationship things, or the challenges, the perspectives that people come up with. And we try to sometimes impose a model that we have on people and we're not really listening to what it is that they're looking for, and what's going to be therapeutically beneficial for them, and that's where-

Til Luchau:

Where there's postural analysis or doing pain science, or whatever it is.

Whitney Lowe:

Yeah.

Til Luchau:

That was a good point.

Whitney Lowe:

Yeah, those kinds of things become much more finessed fine points of good clinician-ship, so to speak.

Til Luchau:

That's right.

Whitney Lowe:

What else have ou got, any other-

Til Luchau:

Yeah, I do have one or two more, I got a whole list but one or two more I could pul out. This is a pretty arcane one but this is basically the question of, are we stimulating a parasympathetic response when we work with the sacrum? I like it because it's so geeky and so specific, but basically the model has been and is that the parasympathetic nervous system has a whole group of sacral nerves, and that it's also concentrated up in your neck and the cranial nerves so that there's two main centers of parasympathetic nerve exiting. The cranial cervical group which includes the vagus nerve, and a sacral group which includes the ganglian empire and some other structures which were... This idea, those are the two centers of parasympathetic response, and parasympathetic being the relaxation and healing response that we think we're evoking when we do body work, and explains a lot of its benefits.

Til Luchau:

This was basically the rationale behind cranial sacral work, cranium sacrum being the two centers of parasympathetic nerves, reportedly. As well as lots of other trauma therapies like thierry, and things like that, that assumed that the sacral nerves were parasympathetic, and so untraumatising, relaxing the nervous system. There was a very careful research project a few years ago, and I'll put a reference in the show notes too, that analyzed the molecular structure of these nerves, compared them throughout the spine, and came to the pretty clear conclusion that the sacral nerves were sympathetic rather than parasympathetic.

Whitney Lowe:

Interesting.

Til Luchau:

Yeah, and that caused a stir in some of the neuroscience community saying, "Wow, this is really bizarre that we can assume we know the structure of the autonomic nervous system for so long, and all of a sudden have a whole branch of it get reclassified." But it was fascinating to me, in this question that we're talking about, how can we think we're doing something for so long and have an explanation that, again, more detailed research uncovers it being different.

Til Luchau:

And I wrote it up from massage and bodywork, so I'll put a link in that to the show notes. But I chose it because, well, my faculty suggested it, they said, "That's one of the places you changed your mind." But it was question dogma at the time, but it was an interesting where I actually got some pushback I didn't expect either, and I should have because every one of these reversals we've talked about has offended somebody, I think, or caused some kind of disbelief or challenge from people that know me, I think, and maybe lost me some friends, I don't know.

Til Luchau:

But this one in particular, I got some really specific pushback after I put that article out, that said, "Well, sacral nerves probably aren't parasympathetic after all." To say it was something like, "I was really surprised at how quickly you repudiated Ida Rolf's teachings around this. It's almost like a tension between preserving the wisdom of our lineage, and what we do when have different conflicting information. And that's certainly an old story in the structural integration community.

Til Luchau:

And I'd be curious about what you think, Whitney, if that appears in the massage community as well, but it was one of those moments when I go, "Okay, there's a whole lot more here than molecular types in the nerves. There's the implications of what that means for our work." And my takeaway was what you said in your first one that, well, even if those sacral nerves are sympathetic, in other words more associated classically with fight or flight mechanisms. So what, a pelvic lift still relaxes people and has been really shown to increase vagal tone in a bunch of the parasympathetic effects. Does anybody but us geeks care?

Whitney Lowe:

Yeah, that's a good questions.

Til Luchau:

I mean, you got me going, I want to do an episode now on sympathetic, parasympathetic classifications because it turns out that whole concept was not empirical it was theoretical. Never really validated with the effects of the nerves, it was based on presumed functions based on their location and appearance, and things like that.

Whitney Lowe:

Yeah, and what a good illustration too of those things that would make sene theoretically that we think should happen, but have not really been tested and conformed to be the way it really is or, at least, a better understanding of this being the way it is.

Til Luchau:

Well, my sacral technique still pass the test of usefulness, if not for accuracy. So, it's just that I had to shift the thing I was telling my clients and myself, and my students, about why they seem to work.

Whitney Lowe:

Yeah. Well, if we get near wrapping up here, you had also asked a couple of other questions for us to think about, and I'm curious to touch base on that, what makes some of these things difficult, some of these role reverse or perspective reversals difficult or challenging. What, from your perspective, make some of those more challenging or difficult sometimes?

Til Luchau:

Well, it's pretty difficult to reverse my perspective if I'm attached to being right about my own one. And who isn't attached to being right about their perspective?

Whitney Lowe:

What is that quote from, I can't even remember who it's from, about it's very difficult to get somebody to change their perspective about something if they're income depends on them not understanding-

Til Luchau:

Mark Twain.

Whitney Lowe:

Was that from Mark Twain?

Til Luchau:

Yeah, if a ma has to choose between an explanation that supports his livelihood or contradicts it, he's going to choose the one that supports it. Yeah, there's that. I think-

Whitney Lowe:

And the more you have invested into it, probably, the stronger you'll hold on to those ideas.

Til Luchau:

That's right, and there's a fun podcast I happen to listen to before you even proposed this topic the other day, Freakonomics: How To Change Your Mind, where he's basically talking about interviewing a few interesting people about what makes it hard and the cost. Say you're in politics, changing your mind, it could haunt you your whole career to go from one position to the next. It going to be something your opponents use against you.

Whitney Lowe:

Yeah, you have to predict the shifting winds of where public perception's going to be about something and suddenly jump on the bandwagon with it. Well, one of the other things that I had noticed about this too, and this is more of an issue, I think, probably for some of us who've been producing educational content, is that you put stuff out there in books or videos, or whatever, some time ago and then something comes along and you change your perspective or ideas about that and it's still out there. And somebody pulls it up and quotes on it, "Well, so and so believes this. Whitney believes this because he wrote it in this book." And so, once that's put out there for posterity, that's hard sometimes too.

Til Luchau:

I still get that. During one of my most fun COVID projects, though, was going back to those old videos and doing a new commentary over them. Almost like a director's cut but in a more interesting way than that, where we actually got to go through and look at the old stuff as a way to look at how the field has changed, and I changed too, and that we did a surge of classes on that. So, that was a way that I made lemonade out of all those lemons in my background.

Whitney Lowe:

All right, yeah.

Til Luchau:

And then just to put a, again, Devil's Advocate here, certainly it's hard to change our perspective and there's reasons why, especially if I have an investment in, it's difficult. But I suppose the counterpoint to that is, there can be, and I know we've seen this in the social media debates around pain science stuff, there can be a lot of value just on changing for changing's sake too, where in the dialogue there's certainly a role for the wisdom of things that might've turned into tradition, we can say, or the work that's gone before us even if it doesn't stand the current test that we call valid now.

Til Luchau:

So, there's certainly a role for preserving and honoring traditional wisdom, or older forms of knowledge than we have right now too. Such a paradox, such a tension between those two points. If you orthodox and reformed that's been going on so many places for so long.

Whitney Lowe:

Yeah. Well, those were some interesting things. Anything else you want to-

Til Luchau:

Yeah, I want to ask one more.

Whitney Lowe:

Okay, definitely.

Til Luchau:

Maybe it's just time for one because I don't want to draw out the episode forever, but what's a reversal that you ask your students to consider?

Whitney Lowe:

I would say I ask them to consider every one that I present to them that have reversed things for me. And I also simultaneously ask them to challenge me on those reversal of ideas, things like the things that we've talked about with fascial elongation, like a lot of push back on that because of narratives that have been around for a long time, or things like structural changes, and can we do those kinds of things? There's a fair amount of pushback on those kinds of things from students, and I always encourage the pushback because I think that's a valid means of developing clinical reasoning and developing skills in critical analysis, and things like that. Lots of people are not comfortable with pushback from students on those kinds of things but I actively encourage that because I think it's just really important for sharpening the sword of our minds, and our analysis on things.

Whitney Lowe:

But I do encourage everybody to look at those things, and all those things that I fond for myself that are problematic or challenged, or changed, I ask them to look at those things too and tell me where they are with it.

Til Luchau:

That's great. No, I think my answer would be the same, it is those things that I've reversed on, or shifted my position on, that I enjoy bringing those up for students. And either getting that mind blown light bulb's gone look, or getting that furrowed brow, it's like, "Wait a minute, mister," kind of look. Either one of those gets me interested, and I lean into those conversations as well-

Whitney Lowe:

Yeah, for sure. Good. Well, we'll continue to change our minds, I would Imagine, and continue to look at new and different ways that we can develop things, but hopefully the world doesn't change too much in the next little piece here while we finish up our places and things that we're doing. So, anything else that you have to... before we wrap up today?

Til Luchau:

There's so much, this could go so many places but that's a great place to wrap it up. Let's see, I am doing the closing sponsor today, and that's a pleasure because the closing sponsor today is Handspring Publishing. And when I was looking for a publisher for a book I want to write, I was fortunate enough to end up with two offers, one from a large international media conglomerate and the other from Handspring, a small publisher in Scotland that's been around by four great people who love great books, and who love our field. And, by the way, we're going to have an episode with them coming up, I don't have the number quite yet but we're going to get them on and actually let them tell their story, and they've had a really interesting one.

Whitney Lowe:

Yeah, fascinating story from them. I'll look forward to hearing that.

Til Luchau:

Anyway, I'm glad I chose them. And they're catalog has emerged as one of the leading collections of professional level books written especially for body workers, movement teachers, and all professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:

And do remember, Handspring's move to learn webinars, or free 45 minute broadcast featuring the authors, including one that you have, Til. So, head on over there to their website at handspringpublishing.com to check those out, and be sure to use the code TTP at checkout for a discount. And we thank you again very much, Handspring, for constantly the Thinking Practitioner Podcast. And we would like to say thank you to all of our sponsors, and also thank you to all of the listeners who've hung out with us here. You can stop by our site for show notes, transcripts and extras. You can find that over on my site at academyofclinicalmassage.com, until working people find that on yours.

Til Luchau:

Advanceddashtrainings.com, if there are questions you have about what we have said, things you want to quibble about, lean into, mind blowing light bulb moments you want to share, or anything you want to hear us talk about, email us at info@thethinkingpractitioner.com or look for us on social media. And I want to say, too, your reviews that you post on Apple Podcasts or the other places where you can review things, we read those as well and they are so appreciated, so valued. So, anyway, you can find me on social media at my name Til Luchau. How about you, Whitney?

Whitney Lowe:

Same thing, you can find over on social media on my name, Whitney Lowe. And as Til mentioned, it is helpful if you will write us on Apple Podcasts, it does help other people find the show. Ad you can hear us on a variety of platforms such as Spotify, Stitcher, Google Podcasts, or wherever else you happen to listen. Please do share the word, tell a friend so they can listen in with us too. And, of course, if you're unable to find us in any of those locations, you can grab a vinyl copy of the Boston Philharmonic Orchestra doing a cover of My Sharona, and you can hear us on the flip side of that.

Til Luchau:

With French Horn accompaniment.

Whitney Lowe:

With French Horn accompaniment, indeed.

Til Luchau:

Dang.

Whitney Lowe:

Yeah, absolutely. So, that will wrap it up for us here today. And great to have you back, sir. Mr. Luchau, welcome back and-

Til Luchau:

Thanks for holding down the fort, good to be back. And I look forward to more with you.

Whitney Lowe:

Yeah, that sounds good. We'll see you all in the next go around.

Til Luchau:

Bye.

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