Finding Balance as a Clinician and Continuing Education Instructor with Walt Fritz

In this episode Walt tells us about his clinical and educational experiences and how he made the transition from being heavily invested as an MFR focused therapist into being an evidence-based clinician.

We discuss the importance of finding an acceptable balance in our understanding, our communication and how we teach continuing education. Our treatment interventions aren’t always just about one tissue or a special technique, they are more complex than that and the outcomes people experience are more strongly related to the strength of the therapeutic relationship.

The willingness to embrace shared decision making is the core premise of what he wants learners to take away from his courses.

Research articles:

(Geri, 2019) Manual Therapy: Exploiting the Role of Human Touch
(Bialosky, 2017). Unravelling the Mechanisms of Manual Therapy: Modelling an Approach

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www.ericpurves.com
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IG: @eric_purves_rmt

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Transcript

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0:08  
Hello, and welcome to the purpose vs podcast. My name is Eric Purvis. I am an RMT course creator, continuing education provider and advocate for evidence based massage therapy. In this episode, we welcome Walt Fritz, who is a physical therapist from New York. And he's going to tell us about his clinical and educational experiences and how he made the transition from being heavily invested as a NFR focused therapist into being an evidence based clinician, thank you for being here. And I hope you enjoy this episode. Oh, well, thanks for being here today. It's nice to finally meet you virtually I know, we've chatted on Messenger and stuff before and email. So thanks, Tom, for being here. Just thanks for having me. Yeah, yeah, no, it's, it's great. It's, it's great. I think it's gonna be a really good conversation. I know from some of the offline stuff we've had before I think we, we are probably going to confirm a lot of biases, we're probably going to say a lot of the same things, but maybe, maybe not. Maybe we can have some some heated discussions on things or maybe we can just, you know, agree on what what needs to be done and, and how we view the the industry that we're in the manual therapy industry. So I'm looking forward to this. But what I want to start with, though, is just kind of tell everybody, just something about you. Who are you? Something about me? Well, I'm a physical therapist from New York State had been doing this for a long time graduated from PT school in 1985, long before physical therapy was even a master's profession, much less the doctorate profession that it is in the United States now. And now, you know, kind of seeing a lot of trends come and go and including a lot of trends that I was, you know, fully immersed in and, you know, took a while to sort of watch myself clean from now. So

1:51  
I have a practice in upstate New York, you know, five and a half, six hours from New York City, more in the country than it is what city living looks or looks like. But I see patients here halftime and I, I have a fairly robust teaching and travelling schedule, and writing and all sorts of good things like that. So

2:12  
no, I've noticed too, that you you teach a lot. Like you're on the road, like almost every second weekend, aren't you? I am. So how do you manage that? Because I know from my own experience as like, being a sea instructor is exhausting. So what are your tricks of the trade?

2:30  
Don't get exhausted.

2:33  
You know, I hear it boy, well, not working full time. In my practice, I think that makes a difference. Right? I have, you know, like I said, a part time practice, I don't try to build it up. So I'm really packed here. But also, you know, what, just be comfortable with your content. I think that's a, that's a huge part of it. Not that we go in on autopilot. But you know, being comfortable with the content, understanding it understanding your audience really well.

3:00  
And I don't know, I just, that's what I've done now, for a long time. COVID certainly put a put a stop or change and all that. But I I switched things up over the last couple of years in terms of who my target audience is and who I'm trying to be and who I'm not trying to be. And that kind of made it I think a lot easier on me. And, and in honesty more comfortable and more enjoyable. So

3:26  
yeah. Besides that, I don't know. I mean, it's just it's, I consider it my job.

3:32  
But it's funny, because can your job be your your hobby and your enjoyment, your passion too? You know, some people say, no, no, no, you got to separate those two. But I think if you're really drawn into what you do, there is no such thing as work. It's just getting up to do what you enjoy doing. Yeah, I love that. I love that. I love teaching too. And that's why I wanted to get you on here was to hear your take as a sea instructor and kind of your journey and we'll get into that but it is it there's nothing more satisfying. I feel that when you go and you deliver a good workshop and you get great feedback and you feel like you've impacted people and you've changed lives in a positive way that there's Yeah, I mean there's it's like it's like a drug it can be so just feel so powerful. And so you're like okay, what I'm doing is I can stand behind it. I know what I'm doing is helping people and when that resonates with with learners it's it's it's great isn't it?

4:28  
It is and you know, given my background in one of those, you know, the rabbit hole modality empires the power is often through

4:38  
you know, passing along secret science secret handshakes all that sort of stuff that a lot of us have either been through or still involved with and you know, that kind of my past is there's definitely definitely delineation were separated past from present. And now what I'm not trying to do is to wow everybody would you know, Guru medicine but

5:00  
Can I just say, you know, we can be our authentic selves in speaking evidence based language patient centred language, and still have a huge impact on people. And I think that's, I think that's, that's rather, it's uncommon, I don't want to say rare in our shared communities, because you know what it's all about the big sell. It's all about the big,

5:21  
the mystery, it's all about the draw, getting people to keep coming, which, you know, what it, it fills people's bank accounts, and we all need we, you know, that's what we do for a living, so I don't totally disavow that. But I just, I don't know, I just seen a lot of the dark side of that world, and I kind of want to stay away from it. I don't blame you. It's, it's tough, though. Yeah. Cuz like you could, you could sell the quick fix, you could sell the magic and people would fill up your courses. And, and I've experienced that too, when you're trying to, to sell or get people to attend something as evidence base that you're like this is I can defend everything here with good quality research, I'm not teaching any magic tricks. I'm just trying to help to integrate this into your practice. And you know, with the bet kind of patient centred care client or person centred care model.

6:10  
But that's not really like sexy and attractive to the learners. Because we're always looking for that, that magic technique, that magic thing that's going to like, provide the fix. And it's always it's always disappointing when people are looking for that, and you're like, the stuff that we want to share with you is probably more powerful. It just requires that that shift in thinking and shifting in application and communication.

6:35  
And that's hopefully something that people like yourself are getting that that shift more

6:44  
and more noticed or more talked about? Yeah.

6:47  
Yeah, I mean, doing podcasts like this certainly gets my message out. And I appreciate that. And, you know, being a big mouth and social media doesn't hurt.

6:56  
You know, you were up against the people with, let's face it, you know, a big budget years of

7:04  
years of exposure of their model. And, you know, that fan club mentality is just so strong in our shared professions that and it's really it's, it's a difficult road road to kind of travel I, you know, after I left myofascial release, which is my sort of my gateway drug into manual therapy.

7:25  
It was difficult for me, I was I was really trying to sort of fight that and almost compete for that. Not the dollar but the years of people who are doing MFR are interested in, in coming into MFR. And, you know, basically, it was just sort of saying, Well, you look over here, looking here, don't look over there. But then it's the realisation that it's like, you know, you got to, you know, marketing one on one is know your audience and know who you are and who you're not. And I realised that's not who I wanted to be. That's not what I wanted to attract and draw.

7:57  
And, you know, being in this evidence based if that's what I call myself,

8:02  
in a perspective, it's difficult when you've got people just with the ear of, of a lot of people saying, you know, the only evidence that matters is patients outcomes and patients happiness, which Sure, man that matters, but you can pull a lot of crap on people and tell them a lot of really lousy things. And if they're better if they get better from it, if they like you, then they believe everything you said. And I mean, I just see that post hoc fallacy type of a model just like all over the friggin internet all over Facebook. It just, it's it's frustrating. And I know it's effective marketing. Let's face it. I mean, I fell for it. I don't know your background, Eric, but I'm guessing you fell prey to some of that earlier in your career? I don't know. I totally I totally did. And I'm, if anyone asks, I'm the first one to say like I'm myofascial release was my was my gateway drug, you know, into into, you know, kind of pigeon holing how I was thinking about about manual therapy, like as a massage therapist, we learn all these different techniques in school and then you kind of what happens to a lot of us at least you know, when I'm to school 1617 years ago, 20 years ago, now, the you kind of choose your kind of path, you can choose your way you like to you like to work with people, and I was really drawn to that myofascial narrative, and you know, everything I saw how to fascial connection, everything I saw was a fascial problem. And I realised I wish I could say I realised sooner than later, but let's be honest, it took me a long time to realise that I had blinders on and I was just everything was a fashio everything was fascia, fascia, fascia, fascia. And then when I actually started digging into the science of it, and the route and the research that was that was being used to support it, I realised this is nonsense. This actually doesn't support what you say. Or there's a lot of big claims that are being made from tiny little studies that are totally irrelevant. And I felt like I

10:00  
I was being I had been lied to right like this, this kind of very structural fascial paradigm I was working under was, didn't have anything to stand behind, and I felt so wronged. And then that's how I kind of took a dive into the pain science stuff, which we could probably discuss that too. There is some stuff there too, where the pendulum swings totally the other way. And so now you're trying to find that that balance, but yeah, for sure, the, you know, you're the myofascial stuff was was where I came from. And it's been hard to, I don't know what your experience is like, as an educator, but it's hard to get people to think outside of that. Because they've had success. Yeah, yeah, people feel better. It's just, it's hard for clients or patients to you know, they just a myofascial release therapist or craniosacral therapist, or, you know, fill in the blank of all the other named modalities, right? That person helped them. So then they assumed that it was everything that they said was right, you know, oh, no, my problem was a cranial lesion. And that was why their gentle hands on touch helped me so much, etc, etc. And that's something really, really difficult to unpack. And it's also, I think, it's difficult to unpack for us when we have so much, you know, what do they call it the time sunk narrative, right? We time and money that we put into this. And you know, you don't put it's really hard when you really see evidence that conflicts with what you were taught what you believe, and what you want to believe, you know, my whole, you know, great undoing was in 2005, on some was simple, where they just, like, beat the living crap out of me, and I deserved all of it. But I still wouldn't look at what they were giving me in terms of, you know, here's what you might want to look at. Well, to see that there's other ways to view the work that you do. There's other ways to view how a person responds when we touch them. And it took me a good year after that, myofascial release the great conversation debate, before I had my come to Jesus moment and left that MFR community and really then went back and started looking through a lot of that evidence from that group. And it's been like, you know, not look, I've not looked back since then.

12:15  
That's actually why I'm

12:17  
so sorry. No, I was there. That's why I first saw you was on so much simple. I never commented on something simple, but I lurked heavy, and I've read a great myofascial conversation or whatever it was, and everything else not sight. And that was such a powerful, important site. Such a powerful conversations that were had on there. It was great. And I don't have anything like that now. I mean, that was pre Facebook. Like I came into stuff. Probably I first found something simple, maybe around 2012, maybe 2013. And it didn't make a lot of sense to me, because I was still at that time. I was I always say that. I was I was curious. I was like evidence curious. I was like, I knew stuff that I was learning didn't make sense. But I didn't know what the answer with a different answer was. So you're, I was kind of left in this place of confusion. And, you know, didn't didn't know where to go. But I remember someone turned me on to something simple. I remember reading that and I think it's so great. It says a lot about you as a person to as an educator, that you're like, Yeah, I was totally into this. And then and then these people just beat the snot out of me. And then I realised okay, you know what, maybe I could still do what I do, but I don't have to hold on to this conceptual framework, which is

13:34  
doesn't doesn't doesn't

13:37  
have any support? Yeah, that's ironic, too, because that you know, over the last 10 years, man I've been not, not exactly a mouse about you know, kind of voicing my disdain for all things. Now, for sure, at least all things mouth fascia, when it comes to that Guru base mentality that it's all about the fascia, the emotions are stored in the fascia and all that crap, excuse me for being suppressed but

14:02  
and then early this year, I get an invitation from one of these, you know, world fashional congresses, or something, to present to teach a course at the fascial the third, whatever it is that it's, I can post it here, but I emailed the organiser back, it's like, really? Have you actually read my website? Do you follow me on social media? Do you understand that? I don't believe that one can select fascia for intervention to the exclusion of a human being. And you know, in this long email where I went on my diatribe of tribe without trying to be too disrespectful, you know, I proposed to a talk that goes something like, you know, seeing the forest for the trees, treating the whole person instead of the fascia and the organiser actually thought it was a good idea to see, you know, the sense of balance and I'll probably just get sort of virtually booed out of the building because I'm doing it online. I think it's being held in Brazil or something like that.

15:00  
But I think it's important to, I think it's important for all of us to see that sense of balance. We do get so unbalanced when we go into these rabbit holes of beliefs. And it's not just in manual therapy, it's in politics, religion, you know, you name it, it's difficult, really difficult to see that. The perspectives of the other side was the tribal mentality. Yeah, we're one sides. Right, the other side's wrong, and the side is wrong must be against me. And we, yeah, I mean, I see it all the time. You know, I one of the things that drives me crazy is all like the acronym based kind of learning, because we're all focusing on a tissue or we're very specific approach. And I like what you said there was there's a person, right, so you can do and this is the thing I think that gets lost in the translation. Now, tell me your thoughts on this, but doesn't in my, in my experience, is that you kind of, you know, push back on these these let's use fascia, these fascial narratives. And what people hear is that what I'm doing is garbage isn't helping people. Yeah. And you're like, that's, I've never said that. You probably haven't said that. Most of us that are trying to change things or don't say that, but that's the message people hear because you're challenging their the way they think their their their conceptualization of what their hands on techniques are doing. I'm like, I'm not saying that. But maybe that you're maybe we can think of a more scientific and more evidence based explanation for that. What do you think? What's your experience with that when you're when you're trying to be full full disclosure, when I left, my father was a time when I would basically did all those things that you said.

16:33  
You talk about pendulum swinging, right. And then, and then you know, the pendulum slows down, and you get a chance to kind of look around and realise, you know, you're not making any friends, it doesn't do any good. Most people don't respond well to that sort of confrontation. And if, you know, if you want to change some minds, or at least start with some fresh minds, I think it takes some some

16:56  
politeness, which took me a little while to learn.

17:01  
And it was useful, though it was useful, not just in my education, or, you know, the CEE model, but in life in general, you know, it couldn't be a long time to kind of work through all the different models that are out there. And, you know, I learned a lot of it in PT school, we have, you know, fairly robust background in manual therapy, especially more manipulation and mobilisation, but also massage and some deep tissue work. But, you know, I had my share of continuing ed and in the various manual therapy modalities in the first part of my career, after I left MFR, I studied, I was very fortunate to take a class from Diane Jacobs, who was really, she was actually the, one of the few people on some simple, who basically didn't delete any email or messages sent her she was kind enough and patient enough with me to, I want to call it holding my hand as I crossed that bridge, instead of just, you know, flicking me off or being rude in that original 2005 conversation. And since that time, you know, I've kind of moved into understanding more about the hidden behavioural sites, explanations for why what we do can be helpful and a lot of manual therapists, massage service PTS really take offence, when you start talking about contextual factors and other more behavioural neurologic info influences that we have when we're one on one with a person that are less about the tissues and less about the, the skill of our technique and more about the relationship that we build with people, you know, I am I tell a story in my classes about about what's if someone could ask you,

18:41  
if you had to put up one paper, one study one, whatever it is, that basically like nutshells, what you believe as a clinician, your approach, etc. Could you do that? Because I know, I thought about that. And, um, so you know, shameless plug my book came out a couple of months ago, and while I was doing that three year process,

19:04  
you know, you had I went into a lot of other rabbit holes, and I came upon a paper that was written in 1957, by Carl Rogers psychotherapist, Carl Rogers, which obviously has nothing to do with massage with PT with manual therapy or anything. And it was a paper that basically got Carl Rogers roster size from his mental health profession for time, because what he was proposing was that positive clinical outcomes in a mental health setting were minimally dependent on a modality that one used, even though at the time, the prevailing belief was the modality matter. That's why somebody got mad, better. It's because of, you know, fill in the blank of whatever intervention you're using. Much like, you know, our acronym driven SeaWorld that were a part of right. And what what Carl Rogers was proposing was instead of the modality it was the relationship that we build with the client, that was more peer

20:00  
But all in helping them to, you know, self discovery to to be to basically improving. And to me that was that was sort of the embodiment of how I saw myself as a clinician here, my practice, and what I teach to professionals now around the world that's about that relationship we build and share. We didn't we need a story. But I think it helps to have multiple stories instead of it's all about your fashion. And I'm going to say, well, it could be about the fashion because some people believe that, but it could also could be about, you know, the nervous system, it could be about all these different possibilities. But you know, instead of trying to explain that, as the reason, can we do something that you as an individual can appreciate that it's safe, that feels effective that you have input in? And to me, that's sort of the embodiment of Carl Rogers work that we're bringing forth? Here in 2023? You see the papers from the 50s 1957? Yeah, yeah.

21:00  
Yeah, I, I, it's funny because I, my background is like I did my undergrad in psychology.

21:08  
Much younger. And it's funny that some of the now that I'm learning more over the last number of years learning more about the behavioural sciences and learning more about these relationships, it's kind of bringing back all these kind of fundamental things you get you learned in your undergrad degree. And you start to realise, like, Oh, if I had, if I was, if I'd been able to put these things together sooner it would be I probably would have be a lot further ahead. But you don't think that way? Right. You're not thinking you're thinking modality, you're thinking, fixing your thinking tissue, you're not thinking those human relationships. But then we started looking at human relationships, you realise, like, oh, this, this makes so much more sense. Yeah. So it was a paper that was released early last year, which was a really breakthrough one for me, because in MFR, and I don't know your back on and I'm apparent, we don't need to get into names. But I learned a lot about that emotional holding of fascial restrictions. And until you deal with the fascial restrictions, or personally, truth doesn't truly air, quote, heal their emotional baggage that they hold and all that stuff. And, you know, there was there was never a doubt that sometimes when we touched people, I only saw it with him afar, but when we touch people, they often have an emotional connection to that emotional memory, sometimes a cathartic type experience, and that was leveraged in MFR to release those emotions or unwind those emotions and all that, I saw that there was a lot of flawed logic in explaining that. But I didn't really have a great a great counter argument to that until 2022, there was a recent paper by the lead researcher by that was a last name MC Parlin. And I can share this and you could post it in the show notes if you want. And it was from an entire issue of frontiers in psychology that was devoted to touch. And in Macfarlanes article, they talked about touch being able to relate a person the touchy if you will, to the priors, how, basically, the priors relate to the pet present, right? priors in a mental health setting are about trying to bring a person to an understanding of why their past relates to the present, right. And what they were doing in the paper. And it was it was basically it wasn't about manual therapy or touch it was about touch in general, right. And but what they're talking about how the ability of touch to relate a person to the priors, and they talked about an experience that when the touchy and the touch here are basically resonate, if you will, without getting too too esoteric with the language. But when I do something with someone that they then can relate that touch to the past. They call it being in synchrony with them. You know, there's a lot of that that sort of crosses over into body work, narratives and the whole paper was about about interoception. Right, the interoception and si tech delay ferrets and our ability to basically fuel into someone's own self regulating mechanism, which is a whole lot different than me being the fixer of fascia, right? It's basically allowing somebody their own control, which I think is hugely powerful, but it sort of strips us of those ego based models that we paid so much money and we've invested so much into when you know if if touch can convey the sense of of self regulation maybe it's not about our magic techniques. Maybe it's just to being

24:33  
present in the relationship.

24:35  
I totally confirms a bias oh my god, I did I do. I don't remember that magazine article as well as you recite it but I did remember seeing that and buying that frontiers of psych magazine I did read that article that time but I need to find it probably just to read it again because I love drill scription because that Yeah, great. Well for your for your listeners here. It's now the I think the entire journal is available.

25:00  
in open access, you can access not just article but a number of other articles buy it and, you know, then reading it, that article gave me some fuel for the book, I did do an addendum in the book because I was almost done. But it also led me down some rabbit holes to understand not just a deeper understanding of a lot of different concepts that really, you know, sort of tie in that behaviour sciences with the physical science. And I think that's hugely impactful and important work for us, we got to come out of our of our, like you said earlier blinders, and really open our eyes to see that, you know, we might be touching, and we might have been taught that it's all about a muscles nod or a fascial restriction, or a trigger point or whatever. But you know, those are these closeted concepts that we just as, as professions, I think it's really time to pack away and move on from. Yeah, I would totally agree. And that's one thing that I've been a big advocate for, for many years is trying to, like get this the stakeholders in my professional list in Canada to, to acknowledge that we need to update, like our curriculum, and our understanding stuff is so behind. And if we look like so you see the big fashion debate, that's 2005. And that information that was being shared with you by them 2005, which is, you know, 18 years ago now, as of this recording, and that information that they were talking about, then was from like the 90s A lot of it, you know, and so this information is not new. Yeah, it's actually old information, but there's such a slow or almost ignorance to adopt it. And, and yeah, and I agree that what you said with everything you said there that, you know, the kind of the behavioural sciences and the relationship kind of Sciences is really one that's going to inform what we're doing way more than, you know, the, like you said, the muscle and the connective tissue stuff, which is why

26:48  
is it that simple? Is it more important than the behavioural stuff? I would say? No, yes. And then we have the messiness of outcome based studies versus mechanism of action studies. And let's face it, it seems like 95% of the studies that people especially in, in our kind of closeted Facebook group world, you know, the kinds of studies that people like to post are the ones that support myofascial release for neck pain or whatever, right. And you could fill in the blank on, you know, 1000 different modalities and 100 different disorders, but they all sort of run a similar path. And it's like, you know, fashion is the, the, you know, the thing nobody pays attention to, and people say that when fascia gets restricted at least pain, and they get away in in a in a peer reviewed journal, with posting that and then they go into a study, which basically says, when they did something when their hands that we call myofascial release, the person's neck felt better. Now, that's, that validates that the relationship and the thing that person did with their hands, it has nothing to do with fascia. But yeah, that's that's basically what fills our journals in full, you know, mechanism of action studies, or papers. They're out there, but people don't like them because they're boring. I quote, regularly like Joe Bilasa keys 2018 paper on manual therapy effects. A paper in 2019 by Jerry Zhi, er, I is one of my favourite as well as one by 2020 by cold Kol B, which basically says, in manual therapy, education, what are we waiting for? We know all these things, why is our education so stuck in the past and claiming all these tissue based problem and tissue based solutions, when we know so much more, and those are my three things that I just I just beat like Don Quixote, you know, windmills and all whatever, you know, the story there, but ultimately, it's a tough sell, Eric? Oh, yeah. It Yeah, it is. It's not it's not easy, because it's, it's different challenges, right, you're going against the status quo. I love that. You said those three papers too. Cuz funny, because before we, I'm just looking at right now, before we came on, I brought up a couple papers here, and the one that I have in front of me, one of them is the bielawski, the unravelling the mechanisms in massage therapy, the other one is one by Jerry, manual therapy, exploiting the role of human touch. I love those those papers and anyone that's listening, you know, I'll see if I can post them in the show notes. Or if I'll put the titles there. They're great because they do provide

29:18  
value of touch, but from a different perspective. Yeah, yeah. You know, my new, but I suppose one of the reasons I'm so happy is in my career as an educator and travelling is not because I left pts and massage therapists behind that's not why. But the new market, the new field that I teach primarily to a speech pathologist, right in terms of dealing with voice and swallowing disorders. And the reason I bring that up now is there's a paper in 2019 that a researcher from the University of Utah, they Nelson Roy was the lead author on it, where they did a study for looking at muscle tension

30:00  
Ponyo muscle tension dysphonia is vocal hoarseness, which since the 1980s has been viewed as due to primarily

30:09  
excess in Perry laryngeal muscle tension, too much tension in the larynx causing a retraction of the larynx against the spine, and a reduction in Upper and Lower movement of the larynx, right. And it must manual circum laryngeal techniques are basically going in there and wank in the larynx around to reduce the muscle tension. And it started, they started using it in the 80s. And you know what there's, there's a remarkable parallel to our shared professions in terms of, you know what we need to get in there and break this up. And I'm Don Quixote in the speech pathology world or the anti world etc, trying to say, You know what, there's better stories than that. But in 2019, Nelson Wright did a paper where they basically put a person with muscle tension dysphonia, hoarseness, which was said to be due to too much tension here. They slit her in an MRI, and had her read a script. Okay, they had to read the script. And they watched what happened during the MRI, they noticed that in her brain, the various parts of the brain which showed dysregulated behaviour, abnormal brain activity, when they compare it to a normal speech pattern, and how her brain was basically Miss misrepresenting things in dysregulated pattern it's called. And then they pulled her out. And they basically linked her larynx for an hour. But they also do something called tapering, where they'll they'll manipulate the larynx and then they'll, they'll lower it because they feel if the larynx is too high, vocal tension is too high, etc. So they held the larynx down, and then they start the person talking. And if the person can talk with a more normal voice, they'll begin to taper that pressure away to see if the patient can hold it, which is admirable in a way. And it's kind of what I do in my clinic, not just for for muscle tension dysphonia. But then what they did, once she was able to hold a voice, they split it back into the machine, and they had to read this great same script again. And what they saw was a different brain a different brain activity, that in an hour's time went from completely or very dysregulated, to much more regulated. Now, the the study doesn't prove that the problem was here and not here. That's not what the study is, was set up or anything like that. But to me, it shows that okay, even if, even if the problem was partially here, and the solution was partly hear how completely a part of it the brain and central nervous system was to both the problem as well as the intervention. And to me, that's the kind of that's the kind of study that we need to be doing studies that we need to be doing in the manual therapies. And somebody could say, well, there's no money for it. Well, you know, these aren't studies funded by big pharma as people like to, you know, can put out there when they want to sort of dispel why big Greek why research is flawed and all that, you know, these are university based studies, it can be done. I just, I see that as holding up what's possible, you know, in terms of a beacon for all of us to see, you know, I think we can do better.

33:07  
We need to do better. Yeah, we have to do better. And that's, that's such a great example there. I really appreciate you sharing that. Because oftentimes people hear is like, Oh, well, the science hasn't caught up yet. Or like, no.

33:21  
Yeah, drives me nuts, right? Or like, oh, research, you know, there's no one there's no money for it or whatever. But you look at, like we're just talking about I'm sure we could list hundreds of crappy papers that people use to try and support their things like someone's spending money on garbage to research garbage, why can't Why not do designs, like the one you just said, for the manual therapy world like there, there just has to be a will to do it. And there's for whatever reason, I don't know why. I don't have an answer. Why there's not more like there's, I think a few more coming up like that Jerry papers from 2019. bielawski has got his stuff from 2018 2017, whatever it was, and then the cold winds are going from 2020. And there is some out there but like we need more of that stuff to say look like this is if we want to change how we're thinking and how we're treating people. Let's, let's let's Let's fund it, because

34:08  
this is one thing that I don't I feel very strongly about, and I don't hear talked about a lot, but I think I think I've seen you comment on this before. And, you know, like I said, our closed Facebook groups is about the ethics of what people are thinking or what they're being told. So if we use let's use the myofascial example, right, if you if you feel that you are your pain, so your low back pain has resulted from adhered fashion, some emotional stuff, and then you as fascial therapists go in there, you do the thing and the person gets better than they're made to believe that their fascia was the problem. But we don't have evidence to support that.

34:49  
I would say that's unethical and as well as the person isn't giving informed consent, as well as also we're looking at health care ethics, there's that there's that the non maleficence right there's the Do No Harm well

35:00  
How do we know that evil a person might not have experienced physical harm by what we did? There might be that kind of that long term harm that they could feel from being weak or feeling, you know, losing their self efficacy. And I think that that's something that's not talked about enough about the problem with these unsupported narratives. Yeah.

35:22  
And I think I mean, we can we can, you know, not just bust on MFR, but you can bust on so many things, including any exercise based profession, in terms of the posture people out there, you know, people who feel that they're so incredibly vulnerable and fragile, if they don't maintain the posture that someone said they do. Or if their their core heaven forbid, got weak that you know, that the backs just can explode. I mean, talk about talk about fear base, but then again, you know, that fear is what drives people to continue therapy. So, you know, what, there's, there's an ulterior motive there, I, you know, I have empathy for,

36:02  
for myself from the past, seeing that dilemma of needing being shaken to give it up. And I think, you know, is it is it totally unethical to continue to pass along, what you've been taught? I think, I think there might be a line in there where, you know, we can we can navigate that, as long as we realise that just because we were taught, it doesn't make it fat, right. And I think ways around it are by using phrasing, like, what some people say that it's your fascia. Some people say that it's your posture. Some people say that it's your strength. But there's a lot of disagreement on that. I one of my motives is to introduce the concept of uncertainty not just to my patients, but also to clinicians that I teach, let them know that. Yeah, there's a lot of these popular narratives out there that that people take us back, but yet are really poorly explained. You know, when we were talking before we went on about I was in BC in 2016, for your RM BCT. Am I getting the initials right, on TVC? There you go. That one for I was a keynote at the 2016 conference, and Al Lederman was, was one of my co presenters there. And you know, his whole thing, the paper that he wrote on the myth, of course, stability, you want to talk about lighting, some fires on social media, holy crap, you, you put out a paper like that, and you're just gonna get vilified, and he did you know, but yet, there's so many. There's so many explanations for all of this. And I, what I'm trying to do is in my work in my writing, and my teaching, and my practice, is trying to look at the common denominators, shirts, it might be posture might be strength, and might be fashion restriction, it might be trigger point. But what are the common denominators in all there? Right? And I think that's we can go back to Carl Rogers and see maybe it's the relationship that we build is at least one of the major common denominator maybe not the only impactful one, because it's almost impossible to say which one it is, if you read, you know, by Alaska's paper, and Jerry's papers, they're talking about multifactorial explanations for manual therapy impact, but they're not talking about, you know, this here is the sequence that every intervention follows based on peripheral essential, they're introducing these as potential variables. But there's a lot of, of wiggle room in there. So my point in this is, I don't want to totally stomp on anybody anymore by saying, you know, somebody said, It's my fascia. And what I do is at least I validate their beliefs, which isn't, isn't that important without being too placating? Right? I validate a person's lived experience and yeah, Eric, it could be your fashion did get restricted. And but it could be, it could be holding pattern that your nervous system hasn't let go of yet, which is one of my favourite. But basically, it says everything that says nothing at the same time, but it moves me past that awkward moment. And if they want to know more, a bore the hell out of them, right. But most patients don't make most patients want to know that we know what we're doing. But I let them know I know enough about what I'm doing to know that there's more than one way to explain all this. And if you want to know more, we can talk if you want to know more, I can send you information. But I think I think it's important is for me as an educator not to totally trash another person's beliefs, even if I don't believe they're not valid, because again, I've not lived their life. And I could I see a lot of flaws and a lot of things a lot of people believe including myself, and I don't have all the answers either.

39:42  
And that's a huge thing that says boat about us as educators person is that we don't have the answers, right? We have to be have a little bit of a level of kind of humility and be humble and say yeah, I don't know. I know when I first started teaching, I was very I would say I was too aggressive and calling out to crap. Me to be good.

40:00  
because I was just angry, I was frustrated. And now I wouldn't be I would, I would assume that probably just listening to what you say, like, we use a lot of the same language you and I, and a lot of the same kind of ways of going about things. And that's the thing I always say to is about being we have been, we have to be comfortable with being uncertain, because we don't have all the answers. But if someone comes in, they say this thing and validate that that's their experience. But let's introduce if they're interested in maybe a different understanding, or a more complex or more complete understanding, and maybe that's part of it. And when No, my course is to like, we'll go through I call it like a sceptical hour, I'm like, tell me the things that you're sceptical about. And people usually say something will fascia or trigger points, or cranial sacral. And we'll have a conversation about it. And then we bring it back, like what's all common about these things, for a manual therapy perspective, don't have different ways of touch. They're different ways of hacking into someone's system. So how can one be right and one be wrong?

40:54  
The story are all different. But how can all these stories like which one's more right, which one's more wrong? And I found that that brings people more together rather than pushing them back? And we're like, okay, let's, let's talk about how do we do these things, to help this person in front of us that suffering, rather than then competing narratives, which can be confusing for people. There's nothing worse than a pain patient who has been told eight different things. Yeah. And they don't know what to believe. So yeah, and you and I have been through enough of this in terms of pain education, and all those arguments that happen on social media. And, you know, there's a lot of people who basically dismiss people who are looking at pain as a peripheral thing instead of a central thing. And all those things. We've seen how that goes. And I

41:42  
read a paper a number of years ago, before I started collecting them, and I wish I could get back to this paper by that can never find it. So I have to paraphrase it. Basically, it was a study that the researchers wanted to know, what was the effect of pain science education on low back pain patients in the physical therapy setting. So what they did was they set it up. So the entire intervention was pain, education, air quotes, and they did a questionnaire at the beginning of questionnaire with the patient at the end. And you know, they had basically the, the script down, if you went, here's the education we're going to provide to this person about their back pain about muscle, not necessarily being injured tissue, and all those good things, etc. And what they found that no matter no matter, the quality of the education, most people left the session, still with a similar set of beliefs that they came in with, that there was something going on in their tissues. Not that that means we shouldn't we should just give up on it. Right? But how much of our effort, how much of our time how much of our ostracising, or separating ourselves from our patient or student in the education world? How much of that should be spent, you know, trying to dispel myths, and how much of it could be more, maybe productively, productively used not to lie to people, but realise that, you know, a lot of us cling hard to our belief system. And most of us don't let go of it in one session.

43:05  
It's almost impossible to change it in one session. Yeah, yeah. It's very rare. And I know from my experiences, too, that, you know, I used to try and give a lot more pain science education, because that's what I jumped into when I was, you know, the pendulum and realise that it didn't work. And it just often made people feel that I was there was something else wrong with them that, you know, there was maybe their brain or their nervous system that was now the thing. Yeah. Fixed rather than the tissue. And so yeah, I, I don't know what the best answer is, I think it's like anything is uncertainty. And it's every it's every, every individual is different, right? The N equals one thing. Yeah. You know, somebody may want to know all the pain science education stuff, and that might be what works for them. Most people probably don't know, and it's probably they don't care, I just want to feel better. And, you know, we don't need to waste our time. They say waste your time spend pains, planning to them is not always the best option. I know for a while though, right? And social media, that was the option that was like you had to you had to explain to people had to understand, they had to think differently.

44:11  
But even a lot of those pain education resources are being questioned. Now, you know, some of the originals from 10 years ago, and it's even explained pain gets a lot of critics in terms of, you know, the, what they're saying how they said it, and everything evolves. You know, I look back on the neurodynamic concepts that were introduced it, you know, were viewed as pretty mechanistic. And now, while they're still it's still a valid way of looking at things, they've evolved so much to see that even that

44:37  
it's more complex than a nerve getting trapped within its tunnel, right, and how that is explained from a cause as well as an impact perspective. So, you know, everything evolves and I I'm, I'm of the mind that the more I learn, the less of which I'm certain about, right, which to some people is very disquieting, disconcerting because if you come across

45:00  
says not knowing you, you're viewed as as being ignorant, when in reality not knowing might be the greatest compliment. You got to pull it off, right? Someone says, Well, what do you think it is? Well, just saying, I don't know, isn't enough. But I think what I do is I'll say, Well, you know what, there's uncertainty it could be, it could be that fascial problem that someone had told you about validating their perspective. Or it could be and here's where you fill in the blank of your favourite narrative or your variety of narratives. And, you know, to me, that gives them the explanation that okay, there is uncertainty, even I'm uncertain. Do we need to spend time here trying to figure it out that out? Or can we move into things to work on trying to help you and that's what I try and do it, we try and try and sort of like, slide them slowly push them along that path, if they want to stay back there that they want to talk about, or argue about what it is, you know, what if that's how you want to spend your money with me, that's fine. But I think you're here for help. And maybe together using the combination of those two models, and the uncertainty that's within it, let's see if we can come up with something that means something new. And to me, I'm very different in this world that I use your decision making a lot more than is taught and is used, which, again, seems very much

46:18  
makes people uncomfortable as a clinician, because you're giving up your power and the therapeutic relationship and asking your patient to take a role in that. And it's pretty foreign to a lot of people. Yeah, well, the shared decision making, there's, there's a lot of good data out there that supports that. It's it's a, it's a good, great approach. I know, shameless plug here, I just co authored a paper that went out last year, and it was all about, you know, person centred care and shared decision making. And when you go and read through the research, there's a lot out there. And this is that's kind of the current less wrong way of engaging with people, particularly people that are suffering. And I would say a lot of the times when there's that uncertainty, because we know, right, listeners probably hopefully know this too, is that when we're talking about MSK pain, a lot of times we don't know what the causal mechanisms are.

47:06  
People hurt, we could spend all our time trying to figure it out. Or maybe we could just like you said, you can just try and figure something that feels good for that person. And that might change from day to day, but spend your time, you know, figuring out and having that conversation. And exactly, I have a free.

47:23  
Yeah, I have a free one hour course on my website on shared decision making in the manual therapy setting, I actually filmed it for

47:31  
a Canadian massage conference a year or two ago, and then just put it up on my website for free. That, you know, it gives information on what it is and, and kind of gets over the hurdle of, okay, how can you apply it because it's really foreign to me, the way I interpret your decision making, and I see it, art of those three rings of the evidence based practice model, right, patient preferences and values. And that's, it's about giving up ego, it's about saying, you know, if you got a problem in your face, your new TMJ, we're taught to say, okay, the muscles too tight, so we need to lengthen it, or whatever that might be right. But yet, that may not feel right to the person. So it's about doing something, and then saying, Okay, what do you think? Does this feel useful? Does this feel helpful? Does this feel like it might be harmful or a total waste of time? And I'll tell you that patients really struggle with it sometimes, because they're not used to being asked like that. Right? They're not used for to be giving input? Because they say, Well, I don't I don't know. Right? You're the expert. And it's like, yeah, I'm the expert in this stuff. But I'm not the expert in your lived experience. So what do you think, does this feel useful? And, you know, that's a really hard one to get through with the patient, even with me in my in my practice, sometimes. But I think it's so worth it, to give them the sense that they own this, that they have, they have power, and they have contribution to this, not everybody will participate. In fact, I know that some people stop seeing me because I'm so much work. They bid literally, you know, why do you ask them these questions? Can't you just fix me or help me? Or they want to go and bliss out on my table. It's agnostic and a work here. And if you want, please go somewhere else. If you want someone who doesn't ask you questions, to make this more meaningful for your past and present life, go somewhere else. But if you're interested in this, I work with you. Right. So that's, that's available for free on my website. So now that you know there is a shameless plug, but there's nothing to be gained by that because I think it's worth I think part of what you and I have gotten into involves some altruistic aspect of sharing. Are we you know this in order to kind of move this narrative along?

49:46  
Oh, yeah. And I it's one thing I always have to come back to if myself is why did I get into this? Why did I start teaching and it was became it really became a matter of like, I'd seen too many people suffer, and people close to me suffer.

50:00  
are being treated with these kind of tissue based pathway anatomical approaches, and that's what motivated me to start learning more. And I went back to school, I did my masters and I started teaching and I, I started, really, but then there is a point to where you're like, You got to balance that's what you're you're teaching with your, your personal life. And if you want to have a clinical practice, how do you do all these things? You have to make money, right? There's you have to be money. So how do you how do you do all the things and still maintain, maintain that altruism and, but what I would offer what I always tell tell clients that come to see me and my personal practices, I say, you know, like, don't ever feel you need me, but I'm here, if you require me.

50:40  
One thing I always want people to take my courses to learn to is that, yeah, you're gonna pay money for these courses. But hopefully, that you do this, and it's gonna save you time and money in the end, because you're gonna stop chasing all these certifications, and all these things that aren't probably that helpful. And maybe the most important thing is maybe those people that have come to see you that are suffering,

50:59  
maybe now they will suffer a little bit less, because you're helping them in a different way. And so, you know, that's the stuff that I get I get I get really excited about is when people reach out to me and say, hey, you know, I took your course a year ago, or two years ago or whatever, last year, two weeks ago, whatever they reached out, and they took a course, they did something that would change the practice, and they come back to you. They're like, this is really helped. And you think, thank you. I'm so happy to hear that. Yeah, I'm not saying at the beginning of each class, and I tell people, you know, you, you came here thinking you're gonna learn some nifty hands on stuff. And I said, I hope you do. But what I really hope you leave here with is the willingness to,

51:40  
to embrace shared decision making, not just in the work that I'm teaching here, but in all the interventions that you do, whether it's manual therapy, or exercise or no kind of educational, cognitive behavioural type work. And, you know, unlike you, I was began became an educator. Before I transition, I became an educator, as soon as I left that MFR model teaching sort of a copycat version, if you will, of MFR, but then that slowly evolved, and, you know, my classes changed considerably and actually got, you know, criticised because I was constantly changing. That's from my previous edge, you know, my previous mentor and employer, in in helping with his seminars, like, like, somehow change is a bad thing, changing your mind and your story, right. And, you know, I'm still learning unlike you, you're a lot younger than me, I'm 63. And I'm finishing up a master's right now, because I never got one back then I got a couple of bachelors back in the 80s. But you didn't need a master's to become a PT back then. And now, you know, I'm finishing up my master's and my final project is, is basically a survey study on how implementing shared decision making has, you know, changed a person's practice. So that's going to be a fun one, once we get that one out there. And, you know, what, maybe one or maybe I'll have my doctorate done, and we'll, we'll do something else on that. But, you know, I hope by then that we're not having these conversations of why people are still selling it and why people are still buying it that those tissue base rabbit hole silo base whenever you want to play, right, those closed group

53:17  
models that are just so darn popular today. Yeah, I get that you're doing your masters as well as with all your teaching, and you're you're a busy man. Yeah. Yeah. Good for you. Well, one thing I did want to ask you about, and this is kind of I think, it kind of goes with what you're saying is because you you were part of a I know you taught for somebody else. Doing your your myofascial stuff and then you you went and you did your your Wolfowitz NFR seminars, I believe they're called.

53:48  
And you still call them that for quite a long time, though, even though you weren't teaching NFR? How did you go about changing that name and How was that received within your community?

54:01  
Which community the MFR community? I would say the department as well as the people that were learning from you. Yeah. Well, I would guess that the people in the MFR community said, finally good. writtens. Right, because I was I was actually encouraged by a lot of them. Well, if you don't believe in it, stop calling it right. So for a long time, I was like, back then I believed it was all about the fascia right. And then I saw the distinction between MFR as an explanation of what's wrong with somebody right, their fascia is restricted, and MFR, sort of this brand of thing that we do with our hands that it's a description of an intervention. And for a long time, I was sort of drawing the line and say, You know what, I don't believe that, you know, a person's problem are solely due to fashion or that we're somehow you know, jumping through all these other tissues or jumping through the skin as Diane Jacob likes to say, to, you know, attack somebody's fascia, but I was still calling it that, maybe because I didn't want to give up that's my blankie. Right. That's it.

55:00  
purity, or the potential market, if you will, of those the fascists out there who, who were still willing to, to see that. And then finally, after getting the crap beat out of me on social media for about two or three years by a lot of our shared friends who basically said stop it, you know, and I was in no mood to stop it because it was it was my brand. Finally, during COVID, when nobody had anything to do I, I reformatted all of my my curriculums, and I decided that was the time to rebrand away from myofascial release and into manual therapy. And even manual therapy carries along some connotations that I don't necessarily

55:41  
relate to, right? If you if you mentioned manual therapy to a physio or physical therapist, a lot of times they're thinking, spinal adjustment, joint manipulation, they're thinking manipulative type therapies.

55:53  
You know, to other people, manual therapy is like the ambiguous term, I'd love to someday just completely wash myself of even that term and call my work, Steve. Right, Steve? Steve builds absolutely no mindset of well, what it is that we're doing, and it's like, okay, let's just start right here. This is Steve, we're going to introduce this as, as a client centred way of helping people with their problems. I think from people who have taken my courses in the past, most of them are pretty supportive, because I'm guessing the people that migrated toward me especially during the more recent years had had begun sort of that crossing of the chasm as they said, on some a simple and, you know, we're seeing me for the kind of the duelists that I was that call that in a fire, but I was really seeing it from a different lens. And, you know, there's always, you know, I still, I can still be a noxious person when it comes to my past MFR, gurus and everything and all those, you know, kind of poking poking the bear and things like that I'm, I'm childish in some ways, but you know, most of it's done in good fun anymore, that you take swipes at people online, it doesn't mean you necessarily don't respect them or don't appreciate what, what you learn from them. Because I learned a lot from my flash release and go, Okay, go into the other rabbit holes, craniosacral therapy, zero balancing, you know, all that all my past modalities, I learned a lot from that. And I think a lot of it was was learning grace with what we do with the patient learning to come in slowly, learning not to just, you know, beat the crap out of people. And I think learning Grace was a big thing that I have a lot of gratitude for. And in order to, to learn critical thinking I simply had to move on to other sources.

57:37  
Right. It's, it's interesting that you said that to about not beat the crap out of people. And that's the thing that, you know, for a lot of leasing and massage world that I live in, there's a huge belief, it seems to be the most common one that if it hurts, if it's harder, you're doing, you're doing better. But it's once once you understand kind of some of the nociceptive system in the pain experiences and all that neuroscience and neuro immune stuff that's out there, which we don't need to go into

58:09  
the, you realise that that approach isn't always the best. But then then But then, you know, then you can't say that the light touch approach is always the best either. It's, and that's closer, where you said, the shared decision making thing is like, what feels best for you, and what's going to work for you. And I would say to that, I liked what you said about, you know, you learned a lot of grace, you learned a lot of things from all these other courses and gurus and people you learn from. And I would say the same thing with my own journey, as well as that you take something from each of it, and then you, you know, it's you don't throw it away. I mean, a lot of the techniques that I do now look very similar to I would have would have done 10 years ago. Yeah. But I think there's also you know, from the person centred perspective, you know, we got, I'm gonna pick two polar extremes, you got cranial psychotherapy, and you've got ground and pound, okay, you know, fill in the blank, whatever ground and pound is to you.

59:02  
It's so easy for somebody to say, well, you know, that kind of psychotherapy is just fluff and buff, right? If you really have a problem, you got to do ground and pound. But there are people who are genuinely impacted in a lasting positive way from those light touch interventions. And there's people who are genuinely help from grounded power, right. To view your your modality is being totally accurate for certain kinds of disorders is totally missing, missing the boat, a person centred care, because I will not beat the crap out of somebody I, you know, I tell my patients, a lot of times, I think you're metaphorically looking for the basket of sticks when you walk in my office that you have to bite on. While I'm treating you to get rid of the pain that said, we're going to take the stick out of your mouth, and I'm going to let us decide together. Yep, it is shared decision making. So I I make some of these decisions too. And there's times when a patient asks me for more pressure than I appreciate, and there was a time and

1:00:00  
My career 10 years ago where I said, No, that's not necessary. But I would be missing out on your lived experience, on your expectations on your belief and your past and present experience. Is it totally wrong? Did you use ground and pound on somebody? Absolutely not. Especially, if that's what they feel they have the best luck with. And that's what's best for them. Just like, there's times when a patient challenges me to lighten up to a point where I wonder if I'm doing anything. But if I actually open my ears to what they're telling me, I'm doing something and that's what I look for one of my favourite questions when when I'm trying to establish here decision making when we start touch is Alaskan, does it feel like I'm doing anything? Totally vague question. And I let them chew on it. And they struggle with it. Right? Does it feel like we're doing something I try and make it a we're not a me, right?

1:00:53  
Because sometimes we're doing things at levels that I would never know, because I'm so stuck in my rabbit hole. I can't appreciate that somebody's living in another rabbit hole just next door, you know?

1:01:04  
I like that term, too. I use that. And when I'm treating people, when I'm in my courses, I often say does this fit? Is this feeling important? Oral? Or is this feeling for just being one of the demands on the day? Or you know, just getting helpful is I think, useful? Yes. Well, yeah, it is. And then another term, which I can't claim, but I heard a colleague say once was, they said, Tell me when this feels boring, like meaning, like, when do you want me to move on? And that usually is, you know, I love that because it puts the power the control into the person, not you. And that way they have the decision to say yeah, like this is can you move on, and I find that such a great a great approach. And it feels as a clinician, that feels

1:01:47  
that's the word, it feels

1:01:50  
better, like, it feels like you are just like your, this person has welcomed you into their world, and you were there to help them. Rather than you being the all knowing, you know, therapist, you're just using your skills to try and make them feel better. And it's, it's, they have some control of it. And I think that just it feels, it feels so satisfactory. Whereas before, you know, I would often blame myself or blame the person depending on the day. If they got better. Of course, it was me if they didn't, that was their fault. Well, Pts do it all the time, because you weren't compliant with the with the 15 pages of exercise, I told you do it four times a day, right? They set the bar so high, right, or the other piece of homework is that somehow we know what's best for another human being. I mean, that's, that's, that's a lot of power. And I tell my patience, if this doesn't feel useful, and I don't care whether it's a it's a stretch, or it's an exercise, if it doesn't feel useful, let's let's work on it until it does. I had a shoulder repair about six or seven years ago now. And you know, I went through rehab, my 13 year old physical therapist, he did a decent job, right? Except it felt like he was he was doing it. He pulled it out of a file drawer and said here, here's your rehab for rotator cuff repair. Right. And that was a horrible patient, I really was because as soon as he would turn around to do what PTS do, and they're working with number of people at once, I totally get that. I wouldn't go from doing that, you know, okay, the Thera bands over there. And I'm doing that external rotation. And I'm thinking, Okay, this is really lame. And you know, that that sceptical, cynical part of my brain, but I'm realising I'm doing this. But it's not really, it's not really making a connection from here to here. It's not really connecting me to my pain, or to my weakness, or any sense of of my experience. So I would go off, and I would start wondering who there it is right there, right? And he'd come back and say, What are you doing? I told you to do it like this. And I said, Yeah, but that didn't feel useful. This does. And he, he really wanted nothing to do with it. So I basically discharged myself pretty quickly. And I continue my worry about my own bad patient that I am. But now I transfer that to my own patients, whether it's exercise, right? Can you make an exercise? Truly, something that resonates up here? And not just something that I tell you is good for you? Can I do? You know, the traditional kind of stretching that we might do with a manual therapy patient or you know, even education? Can we make this resonate with you? And to me, that's part of my embodiment of shared decision making.

1:04:25  
And that's, that's, that's crucial. And what you say makes so much sense. And I'm always curious. So people hear that and you're like, Oh, that's so that sounds so logical, it makes so much sense. But because of how our foundations of our education is, whether it's PT, or massage, or Cairo or any type of manual therapy, we don't learn that way. So it's like learning a new language.

1:04:45  
And that's what I find too is you can talk to people that get it right, this makes so much sense. They go back into practice, and then it's, oh, this is confusing. I don't have any teddy bear to hold on to. So therefore, I'm just gonna go and do what I've always done and

1:05:00  
That's that's the that's the hard part, I think is that knowledge translation to changing clinical practice is very difficult. And I don't know what the best answer is for that. I don't know if you have any thoughts on that?

1:05:12  
No, I just think it takes an evolution over time. I think that as continue as new grads have come up, I hope that the education system is improving. Because how many times have you read on social media? Somebody's justifying what they do, because that's what they were taught in, in massage school or PT school. You know, it's like, big hairy deal. That doesn't mean anything. Right? And then, you know, then you're calling into question somebody else's past expert, and I totally get that, right. Hopefully, our educational standards are, are continuing to rise, you know, the physical therapy profession in the United States as a doctoral profession. But that doesn't mean there's there people are learning, you know, completely, you know, on the truth narratives, right, they're still learning a lot of crap, they're still they're still passing on to patients that the reason you're having pain is because you're weak, that if you get strong, you'll have less pain, as if that's the transition right there from weak to strong as the reason why exercise works. And I think my profession does a lousy job of letting them know, it's much more complex than that, just like, it's much more complex than, you know, your masseter is too tight. That's why you're having TMJ pain. And I just think those stories, they're always going to be popular, because patients love those simple stories. And then we like telling Simple Stories, so we please our patients, and it also takes up less of our time. So we can get on to things that matter, when in reality, the elevator speech for telling somebody that pain is more complex than just weakness or tightness, it doesn't take long to add just a little bit more to that to let someone know that a lot more to it than just that little snippet that you read on Facebook, or that even your your doctor told you, you know, I think it's going to take, it's going to take an evolution and I'll be gone by that time, before education really steps up to the plate. But let's face it, you know what, I guess education is always going to be slightly behind the groundbreaking type of evidence and viewpoints. That's just I kind of accepted that. And, you know, we move on, how are we can?

1:07:18  
Do you have any plans to retire anytime soon? Well, sounds like you're kind of can't afford it.

1:07:25  
No, I I just totally enjoy, at least what I'm doing right now. You know, the book came out, I'm working on my master's. This whole thing with the speech pathology is just like a, I feel like I just graduated from school again, because it's a whole new, it's a new world with me, and I'm getting a chance to work with.

1:07:46  
You know, I'm getting a chance to work with dental hygienist, right, who are doing myofunctional based work, which is which is so different than things that I learned. I'm working with vocal coaches who are working with elite level performers that you've heard of, right, they're travelling around the country with I'm working with speech pathologists working with head neck cancer, post radiation work with all these different things, which just, I mean, they get me up in the morning and make me want to come into work again, you know, so I don't have any plans to retire for a while. And my wife is pretty good with, with my rather robust international schedule. She comes with me, we're going to Athens, Greece next week to teach a class there and you know, fun stuff. I love teaching and, you know, Rochester, New York near where I'm at. And I like teaching. I'm teaching Taiwan and ship in January, and I love that stuff. So no, I don't have any plans. So if you're waiting to take my place, get mine.

1:08:44  
I really enjoyed this conversation. I thought it was great. And why don't you just give listeners a little plug about how to get in touch with you and your contact and easiest ways is, won't for its.com it's it's pretty easy to find me.

1:09:00  
And I'm on social media with a big mouth on all sorts of places are pretty easy to find there. I you know, I have live classes. I have online classes. I have an online class that I put together, you know, it's pretty much for massage therapist, called the whole body class that covers the shared decision making model from head to toe. Yes, it's done from an MFR type perspective, at least when you watch it with your hands of what's going on. But it's very different from how the engagements work. I have a lot of shorter courses, a couple of free classes on there to not just to kind of get you in the funnel, but basically as standalone ways to learn more about all the weird stuff that I'm talking about. I also, you know, I made it a practice to make myself available when people have questions, concerns problems, and they're really struggling because I look back at those simple Soma simple days and I and I find people like Diane Jacobs who were so giving with their time

1:09:59  
to

1:10:00  
Be patient with me and I'm kind of giving back to the community in a similar way. So if you have any questions, don't ever hesitate to reach out to me as an email or on social media.

1:10:10  
Lovely. Well, thanks for being here today, my friend and we will connect soon okay. Yeah, thanks for doing the good work that you're doing. Appreciate it.

1:10:17  
Thank you for listening. Please subscribe so you can be notified of all future episodes. previous verses is available on all major podcast directories. If you enjoyed this episode, please share on your social media platforms. If you'd like to connect with me, I can be reached my website, Eric purvis.com. Or send me a DM through either Facebook or Instagram at Eric Purvis RMT

Transcribed by https://otter.ai