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The Thinking Practitioner Podcast:
Episode 29: First Season Retrospective - Best of the Thinking Practitioner

Broadcast date: 12/23/2020
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Til Luchau:

Welcome to The Thinking Practitioner. Hello, Til Luchau here. When I was looking for a publisher for a book that I wanted to write, I was lucky enough to have had two offers. One from a large international media conglomerate, and the other from Handspring Publishing, a small publisher in Scotland run by four great people. And I'm glad I chose them, Handspring, as not only did they help me make the books that I wanted to share, the Advanced Myofascial Technique series, but their catalog has emerged as one of the leading collections of professional level books written especially for body workers, women teachers, and all professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:

And I'm Whitney Lowe. Thanks very much for that, Til, and also Handsprings has a new webinar series called Move to Learn! It's a series of 45 minute segments featuring their authors, including a recent one from Til. So, head on over to their website at handspringpublishing.com to check those out. And while you're over there, be sure to use the code TTP at checkout for a discount. Thanks again Handspring for your support of the podcast. So, hello, Til. How are you today? It is a cold sort of blustery day here in Central Oregon. How are things out in the Front Range?

Til Luchau:

Here in Front Range in Colorado, it's a winter day. We're getting snow and it is cold. My son's visiting from Canada. And he says, "Boy, it's cold here." And then we're also trying to figure out how to get together. We were going to have an outdoor dinner, but now with this single digit temperature, whatever, I don't know if we're going to do that.

Whitney Lowe:

Yeah. So time for the Zoom holiday festivities.

Til Luchau:

Oh, boy. Yeah, that's right.

Whitney Lowe:

I think people are really getting zoomed out. But that's sort of what we're up to in a lot of instances here.

Til Luchau:

Yeah, that glass is half full and this has been quite a year, and you and I decided to talk about the year here in today's episode to go back and look at some of the topics.

Whitney Lowe:

Mm-hmm, yep. It has been just about... It's been an interesting year, and about a year since we started the podcast. So, we've been going down the road for about a year on this, in this venture. So, it's been, I think, a great deal of fun, and we thought it would be interesting to take a look back and reflect on some of the things that we had learned, discovered, and that we've heard about from everybody in the time being here.

Til Luchau:

Yeah. Best greatest hits of our first season. Thought we're going to go back and review the topics, update, and maybe give you the listener a chance to go back and target the ones that you didn't listen to because we've been putting them out just about every couple weeks. So, most people haven't listened to them all, but this was a chance to get a preview or review as it were.

Whitney Lowe:

Yeah. Yep, indeed. So, where do we start here? I guess we start at the beginning.

Til Luchau:

Yeah, the beginning was you and I interviewed each other in the first couple episodes, in the backstory episodes where I got your backstory, you got mine, and it was great. I learned some stuff about you because honestly, we didn't know each other that well. And gave a great groundwork for understanding both your perspective, and it was fun to answer your questions and talk about mine.

Whitney Lowe:

Yeah, and I think fun for both of us to realize the places that we had a lot of similarities and places where our pasts had academically and virtually crossed in the past and how they've led to our current perspectives on a lot of the other topics and things that we tackled here. So, always helpful to have an understanding where the lenses that we're looking through.

Til Luchau:

That's right. And so, have you updated your biography at all? Have you gone back and done a revision since we talked?

Whitney Lowe:

Not that I can think of, yeah. Feeling like revising my biography, like changing my history, or-

Til Luchau:

There you go. Why not?

Whitney Lowe:

Yeah. No, that's a good idea, mate. I'll do that though, being my new year's resolution.

Til Luchau:

That's it. Well, we're writing history as we move forward. So, there's always that opportunity. We dove right into sacroiliac in episode number three. Sacroiliac joint pain, causes, controversies, and considerations we said. And that was a look at the controversies around sacroiliac joint pain, and the idea that when it hurts, that may, or there's evidence that it's not really related to mobility because there's stiffness. That those are independent variables, which flies in the face from the way I was trained, and that are instinctive tendencies as a manual therapist to feel something that's stiff or tight. And to think that if we loosened up, it's going to feel better. But then it also flies in the face of conventional sacroiliac joint wisdom that says, "If it's hyper mobile, it's going to hurt too." And it turns out that neither one of those is statistically replicable. We couldn't find that relationship there.

Whitney Lowe:

Yeah. And I think that there's a lot of interest in this topic. It's actually, if we go back and look at our podcast statistics, this episode has landed at the top of the download list. So, I think lots of other people have been interested in these ideas. And one of the things that you said here, too, is really relevant that a lot of people in the manual therapy fields may not be thinking about, are aware of, but there is a predominant... I guess I most frequently refer to this as a perceptual bias, I think, from many of the other fields in manual therapy toward joint disorders as the cause of many types of pain or pain complaints or dysfunction.

Whitney Lowe:

And so, looking at the structure, and position of the sacroiliac joint has been a keystone in many, many different manual therapy fields. And I think now based on some of the stuff that we were talking about here, it's not as easy to paint that picture as we once thought it was because there's a lot of things it seemed, as you mentioned, to be inconsistent in looking at position and alignment issues and all kinds of other things. There's a lot of other factors in there.

Til Luchau:

Oh, yeah. That's water way under my own bridge in terms of the practice, even the position question. Yeah, that's the way I was trained. That's the way I practiced for a long time. But then at some point I go, "Whoa, this just doesn't make sense to me, the position thing." But so then going to movement is typically a much clearer lens for me and most other parts of the body. But then it turns out in the sacroiliac joint, there's one study that's been influential that says, "If the left and right sides are uneven in their movement, those people tend to have more symptoms." But that's just one study. Because otherwise, it's been really hard to find a correlation.

Til Luchau:

Forget it, like you said, with position up slope, down slope, that kind of stuff. But even movement differences that gets... There's a whole lot of disagreement about how much it moves. And it doesn't seem that people that move a lot have more pain. It doesn't seem that people who move a little have more pain. Go figure. There seems to be the pain is its own thing, and then we can work with it. I was questioning that. But yeah, our stories, our narratives about the mechanisms need some serious revising there.

Whitney Lowe:

And one of the most important things, I think, takeaways on this, are this… I see this debated a good bit in some of the social media posts when there's a lot of debate, especially around the idea of what many people call structuralism or the focus on structure that alignment problems, as we're noting here may not necessarily correlate well with certain pain complaints. And for that reason, we can't always think that they are the cause of a particular pain complaint. But that also does not mean that they're not. And that's an important thing to remember is that, yeah, they may be an issue and there may not be an issue, but it's not an absolute cause-effect just because something's there that it's the cause. That's a sticky one for people to discern because then you're left looking and saying, "Well, hey, well it-"

Til Luchau:

Yeah, one possible contributor rather than being the main lens or main focus. It's not as nihilistic as it sounds. It's not as just like anything is okay, and nothing matters as it sounds. It's really not like that. It's more like, okay, so let's not assume that just because there's a positional difference, or movement difference that that is the causes of its pain.

Whitney Lowe:

Yeah, absolutely. So, yeah, so where does that take us? Where we ventured into. We looked at some challenges facing our field.

Til Luchau:

Yeah, that's right. Episode four, and then we went back to it in episode eight. We broke it into two parts because we had a lot of challenges we wanted to talk about. If I remember right, yours was what you call the split personality of the profession.

Whitney Lowe:

Yeah.

Til Luchau:

What was that?

Whitney Lowe:

Well, this is something I have been on the soapbox about for years just talking about the fact that at least in the massage therapy field, which is my lens of bias that we are a field that is focused on, for lack of a better term, two different tracks. One being the more personal care service, which is massage when it is in non-healthcare settings like spas and cruise ships and salons and things like that mainly for personal wellbeing and enhancement. And then there is the massage as healthcare, which is the big question about the role that we may play as a potential health care professional. And we just don't do an adequate job of training at the entry level for both those tracks because there's different needs on those tracks. But this has been a big constant tug, I think within our profession for decades, obviously, and careening towards having to do something about it at some point.

Til Luchau:

You and Cal were talking about that in our last episode.

Whitney Lowe:

Yes.

Til Luchau:

You got to unfold that some more and update on some, and I think that would have been 28. So, skip ahead a little bit, episode 28 you did some of that too.

Whitney Lowe:

Yeah, we were talking about the same thing again there in a different perspective. But yeah, and what were you focusing on highlighting with? Some of your key challenges.

Til Luchau:

Yeah, I really thought about the fact that... Maybe I was speaking personally, but I really thought about the fact that we are aging as a field. The practitioner base is aging, so is the population, and that presents some interesting transitions and challenges. We spoke about some on that episode. And then I also talked about the epidemic of over-busyness. It's- everyone was so full. This was... Was this pre-COVID?

Whitney Lowe:

It was.

Til Luchau:

It was. Who knew that things were about to change in that sense?

Whitney Lowe:

Yes, indeed.

Til Luchau:

We've gotten back to the norm of over-busyness since, but there was a period there where it looked like we had a different epidemic coming in. Before COVID, people were complaining about too busy. And then they weren't.

Whitney Lowe:

The universe heard that complaints and said, "Okay, we'll do something about that."

Til Luchau:

I mentioned episode eight as the other one. So, we're going a little bit out of the numerical order. But in that one, you talked about increasing the accuracy of explanations. That you saw that as a challenge. What is the crisis facing that?

Whitney Lowe:

Yeah, I think it's something that we're seeing a whole lot more of, and I'm really glad about that. But that also creates a lot of problems because our educational system is set up as one where it's more about narratives passed down from mentor to mentee than it is a traditional academic model. So, we don't always take really well to having things challenged from our teachers, or the specialists, or the gurus, and the people in the field. But we're at a point now where more and more people are coming into our field and asking really good penetrating and critical questions about what we do and how what we do works? And all that kind of stuff. And I think that's great, and it also poses some challenges for us.

Til Luchau:

Mm-hmm, it does. It really does. I mean, what a tradition we have, and what a chance to move beyond it. And yeah, there's a lot of turmoil around that question too. What is the role of say, the oral tradition or the wisdom tradition, which can focus around personalities in our field? And what is the role of increasing our standards, our consistency, our academic depth, intellectual basis for the work we do see?

Til Luchau:

My episode eight challenge was the polarization, divisiveness, and infighting within our profession, and how that was mirroring what was happening in the country and perhaps the world. I have grave concerns about that still, of course. I think it's the biggest crisis facing us. And I wish I could update us and say it's gotten better. But if anything, I'm only looking at it differently because it seems at this point to be a feature of our landscape. So, it's more like, I think I'm less optimistically hopeful that it'll change and more optimistic, if I have some optimism, that we'll figure out at least how to live with the fact that we are so divided. 

Whitney Lowe:

Yeah, yeah. When we see, we talk about those kind of pendulum swings, social pendulum swings that move from one side to the other. It makes me wonder, I mean, well, I probably won't be around long enough to see us move into a culture that is less polarized. I have a feeling we're going to be this way for a while. But I know we have historically, within at least our country, had some of these different shifts where there's incredible polarization, and then coming back together at different times. So, I’m certainly going to hope.

Whitney Lowe:

I did have to chuckle. The other day I was looking at... I was reading a Facebook stream, and there was a physical therapy forum that I listen to or subscribe to. And somebody posted a message on there said, "Do you all find that there's people in other professions besides ours that are constantly backbiting and polarizing and shouting at each other on social media?" And a couple people said, "What group doesn't?" It just seems to be a... It's not certainly unique to us. It seems to be prevalent pretty much everywhere.

Til Luchau:

Yeah, I think maybe that is that the root of the new optimism perhaps I'm going towards is just that, that is the way things work. And as painful as it is, that's the natural order of things, in some ways.

Whitney Lowe:

Yeah. And unfortunately, I think a lot of times what it is that brings us out of those is tremendous tragedy where-

Til Luchau:

Yeah, that's been true.

Whitney Lowe:

Yeah. And so, I'd love to think, for example, our current global health tragedy would be the kind of thing that would pull us together, but it seems to be ripping us apart also in many ways , so hard to know.

Til Luchau:

Maybe together isn't the goal. Maybe it's like how do we be apart, or a little apart, or have different views. How do we... Who knows that?

Whitney Lowe:

Yeah.

Til Luchau:

Well, on that note, episode five was documentation of electronic health records. You talked to Diana Thompson. What did you guys talk about?

Whitney Lowe:

This was a solo interview I did with Diana Thompson, one of my dear friends for so many years. And she's been such a ground breaker in putting forth things to help us do accurate... Get more accurate with what we're doing as healthcare professionals in the documentation process. We were talking a bit about the move towards electronic health record. She wrote that book on soap notes many years ago, which has become sort of like a main text in our field for a long time, and got people focusing on the importance of documentation, and health records. And again, this is focusing in a bit... She and I talked a little bit about that split personality of the profession, and for those that are working along the realm of being healthcare professionals, how crucial and important it is for us to learn how to communicate with other health professionals because we don't get trained in the same environment that they do.

Whitney Lowe:

And there's a lot of a lot of things that need to happen, I think, in our world around interprofessional education. That means, for example, learning a lot more about what other people do. And so, if we say, we may want to refer to another health professional, what does an acupuncturist do? What does a chiropractor do? Or what does an osteopath or some other type of manual therapy practitioner? What does a Feldenkrais practitioner do? So, the importance of understanding some of those capacities of other health professionals is really important part of us building a network of people that'll be helpful for us as practitioners, I think.

Til Luchau:

Episode six, tendons and tendinopathies. I remember a couple things from that. Do you remember anything?

Whitney Lowe:

I do remember some things, especially having to do with the preparation work and study. We do some prep work before we get going on this. And some of the things that we were reading based on this were, again, as in many other instances, sort of shaking some of my long held both beliefs and teaching strategies and things that I've been focusing on about tendinopathies. And especially, the emphasis now seemed to be so much more on push those tendons in the rehabilitation process, load them, and things that we're trying for so many years. Rest them, friction them, and do these other things. 

Whitney Lowe:

And so, that's been a big paradigm shift for me, and a little bit more of a challenging one to get working with.

Til Luchau:

Well, there's also the... I mean, for me training as a Rolfer it was, if it's inflammatory, don't Rolf it, don't work on it. I wouldn't say that I'm questioning that don't Rolf it thing. But I'm saying you there's a lot of direct work we can do with tendons and tendinopathies. Even things that are inflamed. And so, that was an entry point for me into the whole inflammatory story, which we came back to. Maybe I'll mention that now. Is that all right?

Whitney Lowe:

Sure. Yeah, yeah.

Til Luchau:

Episode 13, that was really a continuation. That's kind of that inflammation has been a pet project of mine to understand, and we skipped ahead to episode 13 where we really looked at how you can't rub inflammation better. But you can help... There's a lot of ways you can help with inflammatory conditions, including tendinopathies with your hands, and in that context of a hands on body work session, and they're things that you wouldn't even expect. Packed that a little bit there.

Whitney Lowe:

Yeah. As I was looking over our list of things. One of the things that I was trying to focus on as I was looking at this list is like, well, why did we do this whole podcast to begin with? And a lot of it was I wanted to learn more. This is a great example of that is that I learned a lot from you in that episode about some of these newer perspectives on inflammation and some different ways to focus on this, and this has been really valuable for me in that respect.

Til Luchau:

Well, it's kind of you to say. I've been learning a lot, too. Yeah, I mean, some of the stuff you bring in, but then, of course, our conversations, but honestly, having this deadline to have to go get caught up on some stuff to have something that I can stand by to put on recording and have out there. That's a good practice for me to get me to keep updated and as much as I can.

Whitney Lowe:

It is. Absolutely.

Til Luchau:

Yes.

Whitney Lowe:

Yeah. And so, we went from there to-

Til Luchau:

To scoliosis and manual therapy in episode seven where we talked about scoliosis, and how manual therapy might help with it or even the question of why do we assume we need to help it? Because in so many cases, scoliosis is not a painful condition. Turns out that back pain is not more common in moderate to mild scoliosis than it is in people without that. And there's certainly a point at which scoliosis gets so severe that it can be correlated with pain, but also with organ compromisers gets harder to breathe, too, if you have a lot of scoliosis. So, at some point it is obviously a mechanical issue. But in the mild to moderate range, pain is not more common, it turns out. That question, if it's not broken then why do we fix it? How can we help people be comfortable and continue to lead active satisfying comfortable lives with what we do rather than just trying to iron them straight?

Whitney Lowe:

Yeah. I do think this is another example of one of those things that's a question that a lot of people are probably asking themselves a little bit too because this did turn out to be another one of our very most popular episodes-

Til Luchau:

That's interesting.

Whitney Lowe:

Yeah, because I think a lot of people are asking those questions. And again, we're sort of coming up against that issue of structuralism, which has been so embedded in manual therapy for a long time. If something is not straight, you got to fix it. And I'm really asking those questions. Well, maybe, maybe not. 

Til Luchau:

And when should you, and how should you? Because what are the limits of straightening? How effective are we at that anyway? But then also, what are some of the strategies that do help people experience, live more comfortably and things like that? Or what are the times? I remember one of the key points in that episode too is the age window when there's times in development where it's pretty clearly accepted and shown that interventions during this window have lasting improvement, lasting effect. And so, don't miss those windows, right around puberty, a couple of years of puberty.

Whitney Lowe:

Yeah. So, well, after that we moved into one of my favorite episodes.

Til Luchau:

Which one was it, descending modulation?

Whitney Lowe:

Yeah, yeah. This is a topic I have loved to delve into in the last several years trying to get at the root of what the heck are we doing?

Til Luchau:

What the heck are we doing? What the heck is descending modulation anyway? What's the quick definition of that, Whitney?

Whitney Lowe:

So, essentially, the quick definition is that there are neural impulses that go from the higher brain centers down that may modulate or either ramp up or ramp down the intensity of nociceptive signals that then get interpreted as pain. And we can help facilitate that process, in many instances trying to tamp down those sensations so that they are not as intense and help in decreasing the pain process. But there's other things that may also ramp them up that we can help encourage our clients to become aware of. So, we base this episode on an article from Mark Olson that appeared in, I believe it was one of the other massage, the online massage and bodywork... It's escaping me at the moment here. The publication that, that article originally appeared in. Do you know where-

Til Luchau:

Wish I could help you. No, I'm sorry. I remember the article. I don't remember the publication.

Whitney Lowe:

Yeah. So, anyway, a great article, and he had put together what I thought was one of the best descriptions of that whole concept of descending modulation.

Til Luchau:

Well, I got to say, kudos to you, Mark, if you ever hear this, and if you haven't read it, go check it out. He did a really good job. And it's linked in the show notes there. I could say that it is from, what's the opposite of a structuralism point of view? Nuero-centrist?

Whitney Lowe:

Yeah.

Til Luchau:

Is that the term that we're using?

Whitney Lowe:

Perhaps, yeah.

Til Luchau:

Yeah, you could say that the bias comes through pretty clearly there. We all have our biases. So, there might be some interesting rebuttals, you could say, or modifications on that point of view, I don't have it right here in front of me, but that would be interesting revisit to that as well. But that said, it's a concept that I found really useful, the concept of descending modulation. The way that pain is changed from the top down, not just from the bottom up, not just from the periphery in, but from what was happening in our brain, and the nervous system as well.

Whitney Lowe:

Yeah. And I think that our discussion there was a sort of we set up essentially a segue into talking about tissues and how they function in the next episode of asking when does the tissue matter because we've focused a lot on tissue results for so many years and now we've gone on a pendulum swing and looked at a lot of other things in the neurological realm, but the question comes up for a lot of people, do they matter and to what extent they do?

Til Luchau:

What did we decide? What did we determine? Do they matter?

Whitney Lowe:

Well, certainly, and I noticed that we got a good bit of feedback on some this episodes. This touched a couple nerves on some people. Lots of people saying, yeah, they definitely matter, but how and to what extent, and in what realm is the big kicker there.

Til Luchau:

I thought that was good. We got tangible. We got clear. We said, "Okay, here's how I think about my practice." In spite of all of this interest and education, you and I both have in terms of this perspective on the nervous system's role. When do we still go back to say, "Okay, is that tissue quality that I feel when I'm actually working with that, or when am I thinking about tissues, per se, and not just the nervous system?"

Whitney Lowe:

Yeah. And I always, and this to me also comes back to assessment because I always put a lot of emphasis on identifying whenever you can, if there's a pain and injury problem that seems to be localized into a particular tissue trying to identify the potential involvement of certain types of structures that might orient or determine how you're going to most effectively address that problem.

Whitney Lowe:

And like right now for me, for example, I have an anterior shin splint problem in my left leg. It started five days ago or so. And I have that kind of... Always, I've found this description interesting, and it's probably not relevant for people who don't live in a snow environment. But do you know how the snow squeaks sometimes in your finger, or under your foot when you're walking with it? There's that sensation in the tendon, and it feels like the tendon and tendon sheath are not sliding efficiently with each other. When I pull my foot in dorsiflexion I can feel the grading and grinding sensation in that tendon. And to me, that's a relevant aspect of the tissue mattering of having a good sense of there's something that's going on there that needs to be somehow rather enhanced, thawed, or smoothed, sanded down to make it, inject some WD-40 in there maybe, or something like that.

Til Luchau:

Interesting. Yeah it is. There's interesting ways of thinking about that.

Whitney Lowe:

Yeah. But something about that, to me, knowing that that represents also where the primary pain is in that tissues. It matters for me to be thinking about it in those terms to get it fluid again, I think.

Til Luchau:

Okay, I'm with you. I mean, it's such a great... It's such a clear example. I'm so tempted, Whitney, to dive into that with you because there's so much there. You just got a really clear tissue type of signal. It's like something that's happening in the tissues. And you also described it as a sensation, and then in metaphorical terms in terms of snow and WD-40, and everything else, which is, those are tissues, by the way. That's how you're perceiving it. And those are going to up regulate or down regulate your experience of it, as well as inform your reactivity or acceptance of what's happening as well. Or the remedies you try, the practitioners you go see. It sounds like you're going to be looking for either a good snow removal company, or a lube job WD-40.

Whitney Lowe:

Something like that, yeah. So, we'll see how it goes. Yeah, we'll see how that goes. So, after that, where did we go? We went to-

Til Luchau:

Jules Mitchell's book. Episode 11, stretching the tissues or the truth. We really dove into Jules Mitchell's book.

Whitney Lowe:

I loved the book, yeah.

Til Luchau:

I'm pulling it off my shelf, Yoga Biomechanics.

Whitney Lowe:

Yeah, last summer when it first came out. I learned of Jules Mitchell, I think it was in a another podcast, in The Liberated Body Podcast was where I first heard an interview with her and I thought, "Oh, this is wonderful." I had followed her work, and I knew she was working on this book with Handspring, by the way, is the publisher, and really loved her consolidation of the current research and thoughts about stretching because this is one of those things that I think has been misunderstood, and needs to be updated with some of better understanding of what we know now about both neurophysiology and biomechanics of tissue elongation processes.

Til Luchau:

That's right. Now, you turned me on to that. You alerted me to her book. And I agree, she did such a good job of laying out the science of stretching, but then also the controversies around stretching in a way that really she does have a point of view. It's not like we're all any of us without bias. But she lays it out in such a clear way that you can really see how the debates are going. How they're proceeding over the years, and get some usefulness from that meta perspective of seeing all sides of this conversation.

Whitney Lowe:

Yeah, yeah. So for those who have not taken a look at it, I would really highly recommend take a look at the book. Again, the book is Yoga Biomechanics and Jules Mitchell is the author-

Til Luchau:

Handspring is the publisher. Use that TTP code.

Whitney Lowe:

That's right. There you go. Yeah. Jules is a yoga practitioner, yoga teacher, and massage therapist also. So, she's got a really good perspective on how these things play into what we're doing individually with the people that we're working with, and in a lot of different ways. So, after that?

Til Luchau:

Yes, so after that?

Whitney Lowe:

Where did we go?

Til Luchau:

Do we need to take an exhale or drink water or anything here? This is like, we're up to episode 11. We got 28. So, I'm going to try to keep it short here.

Whitney Lowe:

Yeah. So, I think we were starting to realize that we were all getting inundated, and we did an episode on the cytokine storm of COVID-19.

Til Luchau:

Yes. That was episode 12, and this was about the emerging role at that time that we understood that inflammation had in some people's reaction to being infected with COVID-19. That it was actually their inflammatory overreaction that was causing the problems as much as the virus or more than virus itself. Now, that's an interesting thing has come out since then. There was a bunch of interest over the summer in bradykinin, which is a peptide. It seemed to fit through... And this has actually emerged through some detail computer modeling of the symptoms that people were getting from COVID. What would explain the symptoms and it turned out that bradykinin abnormalities could be explaining a whole lot of what was going for people even better than the cytokine storm theory.

Til Luchau:

Now, I did a little bit of updating on that this morning to see, and there hasn't been a whole lot more published on that since that came out. But people are still understanding COVID reactions in at least a certain percentage of people as inflammatory overreactions. And that needs to be, turns out managed in much of our progress and survival rates for COVID has come from an increased understanding of that COVID storm kind of idea. And how to turn down the immuno-reactivity at certain points, but also turn it up or boost it. So, it's not like we just want to boost the immune system that turns out to boost the inflammatory storm too, the cytokine storm. So, it's that careful modulation of timing and when things are turned down and turned up that seemed to be getting the results.

Whitney Lowe:

Yeah, it has been interesting to see that despite the huge increase in case numbers, that we've been able to be more successful with some treatments than we were initially with at the outset. And I think a lot of that is, as you mentioned, applying those things that we've learned about how to manage that storm. And what is going to also I think be interesting is to see how this plays out with many of the things that we're finding to be the long term effects of people who have gotten over the initial illness of COVID-19, but have lingering coagulopathies, and other types of inflammatory issues and bronchiole things, respiratory distress that will linger on for quite some time. It will be interesting to see-

Til Luchau:

Certain percentage of people who do have persistent symptoms, and like other things such as Lyme disease, or things the jury's out about is this still the organism's work or is this an effect in the immune system of having dealt with that organism? Or actually it's not organism in the case of a virus. Is it the pathogen rather? Or is it the immune system's reaction to the pathogen? We'll learn more. Stay tuned.

Whitney Lowe:

Yeah. Right. So, and where did we go? Well, we talked about inflammation after that, in our next episode, and we talked about that. Anything else that you wanted to say?

Til Luchau:

No. That's good. Because we were so... starting to really face the COVID question. The question was, do we keep doing this? We did an episode 14 on all the things you and I were hearing about the reasons people were thinking of quitting the profession at that time. Could I earn what I need? Are people going to come back to me? I don't want to be exposed to the illness myself? Am I going to lose my skills in the meantime? And I'm so glad to announce that we've handled all those questions so well, and then we can put that well behind us, and just turn the page on that whole topic. What do you think?

Whitney Lowe:

Lovely. Yeah, I think we are still in the midst of about a bunch. What to me has been sort of sad in looking back on this is knowing there's… at that time when we did this, and I don't remember the actual dates, but I'm thinking along the lines that this was somewhere around June, maybe July when this episode came out. Since that time I have... I know of a number of good friends, colleagues, very highly successful practices, clinics with multiple people in them that just can't keep it going. The length of time of the impairment has been too long, and they've not been able to do that. And it's a tragic loss for our field but sometimes out of adversity comes a new venture somewhere other. So, I like to think that some of the people who've had the biggest challenges here will find ways to make those things work for themselves as a result-

Til Luchau:

Yes, that's great.

Whitney Lowe:

I just want to say kudos, and a really special shout out to all the people who've worked through all kinds of adversity to keep things going, whatever they've chosen to do. Whether that's pivoting their practice to doing more remote things with their clients, or engaging in the people who've been back in the clinic doing stuff with lots of PPE gear and much more time in between people and all the things that they've had to do. A lot of people have really, really put forth a lot of effort to try to make things happen and keep it going.

Til Luchau:

That's for sure.

Whitney Lowe:

So, this field of hands-on manual therapy is so absolutely crucial. And I hope we will be able to make our way out of this thing without too much long term impairment from this time period, but it will be certainly making a mark on us.

Til Luchau:

Well, and then all the ways that people are adapting in the meantime as well because some people are seeing clients, some people are not seeing clients, and there's everything in between. So it's this is kudos to the people that have found something else to make ends meet, or are still looking for something else to make ends meet until they get back to the place where they want to practice what they want.

Til Luchau:

There one interesting thing too that I remember in that episode was data that came out of a project I did with ABMP back in 2014, or so that people with a part-time practice, people with another source of income. It turns out, it's not that they liked bodywork less. They actually were happier with the size of the practice, with the quality of their practice. On average, there was a really significant increase in people's satisfaction with their body work practices when they had another source. In some ways, no shame in doing that, and in traveling around the world. I see that, elsewhere as well, that some of the people that love their work the most have other ways to make ends meet, and other ways to keep their passion, and their love for the work alive.

Whitney Lowe:

Yeah, that's fascinating. Yeah. And after that you had a fascinating discussion with Robert Schleip about fascial things.

Til Luchau:

Yeah. A fascial researcher, and former Rolf Institute faculty, and now head of research for the European Rolf Association, as well as University of Ulm working in the laboratory with fascia. I got to talk to him about a retrospective of his views and his research on fascia and how his initial message was, "Hey, it isn't just the fascia. It's a lot the nervous system." He's actually been picked up far and wide, and although he's seen as somehow the catalyst for a lot of the interest in fascia science, and he rightfully has that reputation. He was also the guy that said, "Hey, it isn't just the fascia. It's actually we need to think about how the nervous system is responsible for a lot of the changes we're seeing as a result."

Whitney Lowe:

Yeah, I think one of his pieces that he had done that was a two-part series that was in the Journal of Bodywork and Movement Therapies a number of years ago that everybody, so many people have cited and gone back to and looking at that. It was one of the early pieces that was introducing the idea of contractile cells within the fascial tissue. Perhaps the most impactful thing to me on there was his comment in there about how the myofascial system was the most richly innervated tissue structure we have in the body. That really makes you think about the role of what we're doing with touching people, and how tremendously impactful we can be on the nervous system impacts because of those effects as well.

Til Luchau:

On the average, fascial septa, and facial membranes are about six times more sensitive in terms of nerve endings than muscle tissue. The fascia is about six times more innervated than muscle tissue itself.

Whitney Lowe:

Yeah. And if we're looking at... There's been a lot of focus on, and we've touched on this a little bit. The biomechanics of the perceptions that we've had in the past that we were pulling, stretching, elongating fascial tissue to change a lot of these patterns with that. We may be doing things that involve the fascia, but it may be a lot more about the neurological responses that are occurring within the more than the mechanical elongation of that tissue, which doesn't seem to elongate very well.

Til Luchau:

At least not permanently.

Whitney Lowe:

Yeah, right.

Til Luchau:

It was about this time that we had Benny Vaughn, episode 16, and this was shortly after George Floyd was in the news, and all of our attention, and all of... Just the shocking news and reactions that came out of that whole time. And so, Benny kindly offered to join us on the episode and talk about his experience as a leading originator in the specialty of sports massage, and then also talk about his perspective as a black man working in this field and stories over the years. That was enormously moving for me to sit with him and you and talk about these things.

Whitney Lowe:

Yeah, he has certainly been such an icon in our field, and a guiding light for so many different individuals. But more than anything too, just to see an example of working through tremendous difficulties and adversity, which he has faced because of that throughout his field. He's always an inspiration to listen to and talk to about that. And he's just a really good guy. I really have always enjoyed hanging out with him a great deal. So, that was a lot of fun.

Til Luchau:

We get a lot of feedback about that episode. All sides of the issue, all perspectives. But it was interesting to me too that that was the episode where people had the most concern about typos in the podcast. I know there's much bigger issues here at stake. But that was the one where the typos in the podcast really irritated people, and we upped our game on those-

Whitney Lowe:

So, was that in the transcripts?

Til Luchau:

In the transcript of the podcast. Yeah, that's right.

Whitney Lowe:

Yeah. So, always a learning process for us as well.

Til Luchau:

That's right. No, the transcripts are there for every episode, and it turns out they are much more widely used than even I would have imagined.

Whitney Lowe:

Yeah, yeah. And then after that, we were starting to talk about an episode we said, "Who Charts our Path?" This is sort of, I think we were getting a little bit into the fact that we don't have traditionally academic structured instructional programs, and a lot of us are deciding for ourselves what it means to push ourselves further to further development in our profession because it's up to us in terms of what we were doing. That was the overall theme of what we were tackling there. Anything else you pulled out that episode.

Til Luchau:

No, it was the question of medically necessary was in that one too. Is what we do medically necessary in terms of, say, restrictions on COVID, in particular. But then, yeah, the question that you've been raising repeatedly here is, how do we sort this out in terms of the different levels, or the different focuses, or different orientations that people take in this profession?

Whitney Lowe:

Yeah.

Til Luchau:

Ann Blair Kennedy joined us along with Kemi Balogun for episode 18, and they came, and they talked about a research project you're doing on how COVID has been affecting different health practitioners, including massage practitioners Project COPE. And they also spoke at depth and in a very informative and moving way about issues of diversity and inclusion in our field.

Whitney Lowe:

Yeah, some great examples from both of them with Kennedy being a student of Dr. Kennedy's and talking about how some of the teams they were putting together to look at things they were recognizing there was a great need for diversity in these academic teams exploring some of these projects. And so, both this issue for me, and the one with Benny were very valuable wake up calls to look at those parts of myself that I don't recognize, “oh, there is something in there that might be perceived as lack of equality, diversity, etc, that I might not think about.” The unconscious bias things that we have going on. So, it was really helpful to have some of those things pointed out to us in that episode there.

Til Luchau:

Yeah. The episode 19, what about risk? Because the question of going back to work was in our minds, and then also just the day to day existence with the risk, or the disagreements we even have about the level of risk we face working with COVID. Ruth Werner joined us as a third voice in that conversation. It was great to have her perspective as well. And we talked about a lot of things, and that's also been the one that people have gotten back to me personally and said, "That really helped me think through these questions." Because I think the premise... I was feeling like we know each other's perspective, but we can't eliminate risk in life. And yet… so how do we decide intelligently or effectively what our level of risk is in different activities? How much we need to mitigate what risks we take, and which ones we don't take? And then especially in an environment where we don't even agree all the time on what the risks are.

Whitney Lowe:

Yeah, clearly, it would be one of those situations where it would be ideal if there was some black and white rules that we could say have to be followed exactly. But there's… this so illustrates the gray area that we have to operate in so much of the time, and that was really good to have a lot of things pointed out. And like you said, recognize that there's all kinds of facets or aspects of risks that we deal with, and everybody's different. Just really different for everybody.

Til Luchau:

Yep. Episode 20 we dealt with cervical pain, and pain in the neck. And we kind of brainstormed. It was fun to pick your brain about how you think, and what you do around that. Effective ways we found to work with neck pain. You brought some assessments and things like that.

Whitney Lowe:

Yeah. And this was sort of like, for us, it was a means of getting back into some more clinical applications after exploring a lot of the other stuff that we had been doing with COVID, and the diversity issues and things like that. And it was always fun to get back onto some of these things that I think are at the root of why we do the things that we do. And yeah, there was some interesting things that we talked about both in terms of treatment applications, stretching strategies, and other types of things addressing some of the common neck complaints because it is so very common for almost all the people that come in to see us as something that they want to have focused on.

Til Luchau:

It turns out that the next episode's topic, the upper back, pain in the upper back is really common too. A lot more common than I would have expected, but in my little bit of polling, or market research that emerges, an area that a lot of people feel in their own body. Maybe it's all the time on Zoom, but especially getting from the clients about what needed addressing. So we did episode 21 on the upper back, thoracic spine pain.

Whitney Lowe:

Yeah. And it is interesting. I think we acknowledged in that episode, too, that there seems to be sort of a skip bias in a lot of the research. If you go down the spine, lots of stuff on the cervical region, lots of stuff on the lumbar region, and a real paucity of information related to thoracic spine pain, especially musculoskeletal thoracic spine pain. Of course, we don't have as many types of problems there because of the way the rib cage and the skeletal structures are limiting some aspects of movement in the thoracic region. But there's also, I mean, how common is it for us to come in and our clients say, "My upper back hurts." It's just all the time that people are saying those things.

Til Luchau:

Yeah. Which goes in the face of that idea that it's not as prone to problems because again, other practitioners were coming to me saying, "I'm hearing a lot of this." Certainly that as well.

Whitney Lowe:

Yeah. And I think that also illustrates what we spoke about earlier with the structural bias in many of the fields that do a lot of the research in this area. They're just skipping over the soft tissue pain that lots of people feel in that area, and looking at, well, there's not that many spinal structural problems there. So, yeah, we won't focus so much attention on it.

Til Luchau:

You've probably had that. The client that comes and says, "Hey, I went and saw x practitioner." Fill in the blank of what kind of practitioner and they said, "Oh, it's just soft tissue."

Whitney Lowe:

Yeah, right. Just soft tissue. Or it's just arthritis or something like that. So, yeah.

Til Luchau:

That was episode 21 where we did our first handout, and that's been a successful experiment. There's been a lot of downloads of that. The free handout we put up for some of those more technical episodes, where we actually shared some of the techniques we're talking about, and some of the outline of the conversation, and some of the resources too, so that's still available, episode 21.

Whitney Lowe:

And then after that you had a conversation with Gil Hedley on some anatomical stuff, the fascia fuzz, and furor, the debate around his whole process there.

Til Luchau:

Right, it's fun just to catch up with him. He came and studied at the Rolf Institute when I was a teacher there, and I was one of his first teachers there. And I remember him catching my eye as a particularly bright thinker, and interesting and fun person to be around. So, we've had a long conversation going for many years now. It was fun to catch up with him. And one of the topics there was his fuzz speech, which he gave on YouTube. I remember him. He texted me or something, "Hey, I just did this. Check it out. It's so cool."

Til Luchau:

Well, he caught a lot of flack for the way he was talking about what he was seeing as dissections. And saying that this fuzz he was seeing is probably what happens when you go to sleep and you wake up, you start moving, the fuzz goes away. And some of that taken out of context. People really went after that. So, he did a bunch of work to clarify that, and to say things that were probably less controversial or at least more practical, and we got to talk about that sum as well. It's just what else he's up to, and some of the other things there in the episode as well.

Whitney Lowe:

Yeah. And then we had a very interesting discussion with another guest after that, which was our discussion with Mark Bishop on expectations, which I had expectations at the outset. Like I wonder what we're going to get into here was really fast than with where we went on that discussion about how the expectations impact our work. We're doing that with our clients as well.

Til Luchau:

Bishop is a manual therapist, and he was a presenter at the San Diego Pain Conference last year. In fact, I think he was probably one of the only manual therapists that presented there. But it turns out that his research backs up what other research has shown to that if a client or patient thinks that treatment is likely to work, they're more likely to be right. And in fact, their expectation that a particular treatment will help is one of the most significant factors in them gaining benefit from that. Maybe more even then the type of treatment that they're getting that their expectation of that helping ends up correlating much better with the results they get.

Whitney Lowe:

So, yeah, good stuff of that particular issue with him. And he's really brought up some interesting and fascinating means of us thinking about how we can take advantage of that I thought with the work that we're doing too in our dialogue, in the nature of the way we talk with our clients too about those kind of expectations.

Til Luchau:

Yeah, and what kind of things predispose someone's conditions and the things we have control over, the things we seem to be aware of. I should just give a plug to ABMP. They're not one of our official sponsors of today's episode, but they've been a long term and faithful sponsor of this first season. And they have kindly published some of the excerpts from this conversation with Dr. Bishop, and with Dr. Schleip as well in the Massage and Bodywork Magazine. You can find some of the key excerpts there as well for these conversations.

Whitney Lowe:

Yeah. Right. And then we dealt with some plantar foot pain issues in the next episode. And trying to also do some things there associated with ABMP on that particular episode as well.

Til Luchau:

That's right. They had a summit, a CE summit where you and I got to teach together virtually. That was pretty cool. And this episode was the audio version of that teaching together and the video version with some of the extras was on there, the ABMP's website. We did another handout for that one, and it was all about plantar fasciitis, right?

Whitney Lowe:

Yeah, we tried to delve into a number of other potential causes of plantar foot pain, some other nerve entrapment problems, and other things that may mimic plantar fasciitis and often be misinterpreted as that.

Til Luchau:

That's what I learned a bunch from the work you've done around that and different sorts of potential things to think about when you're treating someone that shows up says, "Hey, I got plantar fasciitis."

Whitney Lowe:

Yeah. So, some really good other things to check out. And we had also handouts and other additional resources on that one, too. So those are available to through the site. You can go back and take a look at those if you're interested. 

Til Luchau:

Yes.

Whitney Lowe:

That's where we were next.

Til Luchau:

That's right, and natural progression up the body. Episode 25, is psoas work safe? Is it necessary? What do people think they're doing when they work with psoas? Why would they do that? And is that even a good idea? And some of the controversies there we explored. And we actually did... A spoiler alert here, we did actually put together a handout that shows some of the things that we do with the psoas as well.

Whitney Lowe:

Yeah, we got good feedback on this particular issue of people saying, "Hey, thanks for bringing some of this stuff up. I hadn't really thought about that that way." Or like I was just like I was they were saying, "Hey, I was taught to do this, what you're saying here with treating psoas, and I didn't realize that there was some potential problems that might crop up. So, a really good example of being aware of the impact of our work because it isn't benign. There are potential detrimental effects of some of the types of things that we do. And this is important to be aware of this. Psoas, especially, there's some real serious potential complications that could arise from that.

Til Luchau:

That's right. The next episode, Wojtek Cackowski, a physical therapist and teacher in the Anatomy Training System joined me for a conversation. I've been hosting him as a part of our training where he does movement for manual therapists. He calls his methods Zoga, and he and I have been wanting to catch up and talk about some of the things that led him to develop that form and some of the ways that us as manual therapists can take care of our own bodies. And I really enjoyed that time that we had to talk about that.

Whitney Lowe:

Yeah, that was a great episode. I enjoyed listening to that. It was great too to hear some of your discussions too about the way in which manual therapy was perceived in these different cultural contexts. Him being from Europe and the way that some of that stuff was perceived in Eastern Europe as opposed to the way that we're doing it here. So, that was also very fascinating there.

Til Luchau:

I love that interchange of the different perspectives we get from just working in different contexts as well.

Whitney Lowe:

Yeah, exactly. And we went from there back into the neurological realm, once again, with the little man in the brain, talking about the homunculus.

Til Luchau:

That's right. The homunculus diagram of the distorted man that you have that goes in your brain that maps out the amount of brain dedicated to the different parts of your body. And turns out that it's not even. There are some places like your face and your hands that have huge amounts of brain dedicated to their sensation and their movement. So what are the implications for that? That's been a very influential map in terms of understanding about pain, and the way we work. And not just the descending modulation piece, but the cortical smudging idea, or the ways that our work might help clarify those body maps, or the idea that the brain is like a coloring book. And maybe the touch we use is recoloring or coloring in the blank spots in this neurological coloring book. History there, and some of the ways that this map may or may not actually reflect what's going on in the brain, some of the simplifications or perhaps even misses that came about in the formation of that theory.

Whitney Lowe:

Yeah. And fascinating things for us to think about in terms of, again, the impact of sensory systems in throughout the body. And we talked a little bit about this, too, with so much sensory innervation in that homunculus in the hands, and we work with them all day long. There's a lot of stuff that happens to us while we're doing the therapeutic interventions, I think as well. So, that's fascinating to think about it going both ways there.

Til Luchau:

True. That's right. We're hands-on therapists, and then how plastic that is. It turns out not to be fixed at all, but the mapping changes radically. The studies that have looked at how that changes over time show about a two week threshold where it's very different. Observably, different within two weeks of using your body in different a way. You have a different size portions of your brain dedicated to the body. So, you get more of the brain that goes to the places you're using, and less of it to the place that you don't use.

Whitney Lowe:

Yeah. So, cool. It was good stuff. Fascinating stuff digging in there. And then-

Til Luchau:

To episode 28, where you were speaking with Cal Gates.

Whitney Lowe:

Yeah. So, Cal's a wonderful friend of mine for many years, and we were delving into these issues of back to what we talked about with the split in the profession, essentially, but looking at how for those massage therapists or other healthcare or manual therapists who are working in a healthcare environment. How do we determine who is qualified to be doing that kind of stuff? Because our training programs and credentialing processes don't have a way to distinguish people who are just fresh out of school with a very minimal amount of training. And they might be thrust into a place where they're working in an environment with people with pretty seriously compromised healthcare conditions, and making important clinical decisions about that.

Whitney Lowe:

We I think are tiptoeing around the potential for a lot of challenging issues to occur if we don't develop some type of designations to determine what kind of training is necessary above and beyond our initial training levels here. So, that's the main thing that we were getting into in those discussions. And it's obviously a long way to go on doing this. I've been working on these issues for decades now. And I know many other people have been working on them even longer than that. So no easy answers there, for sure. But very important.

Til Luchau:

Good conversation. I haven't made it quite all the way through. I've listened to most of it. But you get into some good ideas. I think probably the listeners of this podcast, and the people that come to our trainings are interested in going further with their work, are interested in dealing with, say, advanced level concerns, and as a result, do come into contact with people with medical conditions or situations that require a certain level of training, care, and understanding. And that's just one of the topics you touched on I know as well.

Whitney Lowe:

Right. So, it's been a great year. Lots of stuff that we've gotten through there. And we sort of a nice little overview of these things. Anything else that you want to touch on before we leave our year in review here?

Til Luchau:

Well, I mean, there's the next steps. I know that you got some things in mind. I got some things in mind. We're hearing from listeners. I'm really got some fun interviews lined up. I know that we're going to do a New Year episode right now slated to be around the idea of resolutions and taking responsibility for our own health, and the way our clients do or don't do that as well, which is a fascinating topic. We also have another episode, one of those hardcore techie episodes coming up about cervicogenic headaches, and a bunch of new fun stuff planning for the year.

Til Luchau:

And I just got to say, thank you, Whitney. Thanks for having this idea. This was your idea. You came and said, "Hey, what do you think about doing a podcast?" And I was like, well, it took me about half a second to go, "Well, of course. Especially if you're asking me,” so I'm so glad I have, and I'm so glad we're doing it together. Like I said, I learned a lot, and I've enjoyed a lot. And I think I've finally learned how to mute my mic when I'm coughing and things like that. So, maybe the editing isn't so hard. I've learned a lot along the way as well.

Whitney Lowe:

Yeah, there's certainly been a lot of technical things that we have gone through, but I too just want to say I have absolutely cherished our discussions because they have been very enriching for me. And also, I think, from the feedback that we've gotten from people, well, helpful for other people out there. Also to see in some instances us model the ability to have differences of opinion and not get into aggressive disagreements about things that we can have a lot of different perspectives. And that really enriches both of us about those kinds of things. So, that's a really-

Til Luchau:

I disagree on that point, by the way.

Whitney Lowe:

Well, you would.

Til Luchau:

I would. I also appreciate it. We do come from different backgrounds. We're different people with different perspectives, but that ability to both find the places we share, but also name and think through the places we differ is one that I'm working on for myself. So, thanks for being my collaborator in that as well.

Whitney Lowe:

Absolutely. Well, it's been a pleasure. And we will keep it going as long as there seems to be some interest in there, and people do seem to be getting some benefit. So, we'll keep it going for another stretch here. And I also do want to say a big thank you to our sponsors who have helped make this podcast work for us. So, in particular, Books of Discovery also is sponsoring this episode here for us today. They have been a part of massage therapy education for over 20 years, and thousands of schools around the world teach with their textbooks, e-textbooks, and digital resources.

Whitney Lowe:

And in these trying times, this beloved publisher is dedicated to helping educators with online friendly digital resources that make instruction easier and more effective both in the classroom or virtually. So, they like to say at Books of Discovery that learning adventures start here. And they see that same spirit here on the Thinking Practitioner Podcast, and are proud to support our work knowing that we share that mission of bringing the massage community in loving content that advances our profession.

Whitney Lowe:

So, they invite you to check out their collection of e-textbooks and digital learning resources for pathology, kinesiology, anatomy, and physiology at booksofdiscovery.com. So we thank the team over there in your neck of the woods in Boulder for supporting the Thinking Practitioner Podcast. So, thanks again to them. And if you will stop by our sites for show notes, transcripts, handouts, and any extras, information that you would find over there. You can find that stuff through my site at academyofclinicalmassage.com, and Til where can they find that for you as well?

Til Luchau:

advanced-trainings.com. Right up at the top of the podcast link advanced-trainings.com. If you got questions or things you'd like to hear us talk about in the coming year we love hearing from you. Email us at info@thethinkingpractitioner.com or look for us each on social media. I'm at my name, @TilLuchau. How about you, Whitney?

Whitney Lowe:

Same. I'm at my name @WhitneyLowe. And you can also follow us on Spotify, rate us on Apple Podcast with stars over there, wherever else you listen. Tell a friend, share the information, and again thank you for your time in listening with us today. We really appreciate you hanging out with us. So, been a pleasure, and we will see you again in two weeks.

Til Luchau:

See you. Thanks, Whitney.

Whitney Lowe:

Great. That sounds good.