The Intelligence of the Body

EP 2 | The Future of Hands-On Healing: Virtual Reality, Education & Therapy with Aubrey Gowing

• Paula Nutting • Season 1 • Episode 2

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 1:08:48

What does the future of hands-on healing look like in a rapidly evolving digital world? In this thought-provoking episode, Paula Nutting sits down with educator and therapist Aubrey Gowing from the Holistic College Dublin to explore the intersection of technology, therapy, education, and human connection.

Drawing from decades of experience in holistic health education, Aubrey shares insights into how emerging technologies — including virtual reality and immersive learning tools — may shape the future of therapeutic practice. Together, Paula and Aubrey discuss the importance of maintaining human-centered care while embracing innovation within massage therapy, rehabilitation, and wellness education.

The conversation also dives into clinical reasoning, pathology education, therapist confidence, and the evolving challenges practitioners face in modern healthcare environments. With warmth, humor, and curiosity, Paula and Aubrey explore how therapists can continue adapting without losing the essence of hands-on healing.

This episode offers valuable insights for massage therapists, bodyworkers, educators, and wellness practitioners interested in the future of therapy, learning, and patient care.

In this episode:
• The future of virtual reality in therapeutic practice
• How technology is changing health education
• Balancing innovation with hands-on healing
• Clinical reasoning and therapist confidence
• Pathology education for modern practitioners
• Human connection in healthcare and bodywork
• The evolution of massage and holistic therapy education
• Creating engaging and interactive learning environments
• Challenges facing therapists in today’s healthcare landscape
• Why curiosity and lifelong learning matter in clinical practice

Timeline Highlights:
00:26 – Paula Nutting introduces Aubrey Gowing and opens the discussion on virtual learning, therapist education, and hands-on healing.
02:09 – Aubrey shares how growing up in a family rooted in yoga, massage therapy, and holistic health shaped his career path.
03:34 – The conversation dives into lifelong learning, continuing education, and why experienced therapists never stop studying.
05:48 – Aubrey explains how virtual training became essential during lockdown and why online education can still be highly effective for therapists.
07:37 – Discussion about live virtual coaching, camera feedback, and how educators can still guide hands-on techniques remotely.
10:49 – Paula and Aubrey discuss why online courses need interaction, demonstrations, and experiential learning instead of static PowerPoints.
12:10 – Aubrey demonstrates how augmented reality anatomy tools create more engaging and memorable learning experiences for students.
16:24 – The challenges of teaching full-day virtual workshops and keeping students engaged through live feedback and interaction.
17:19 – Aubrey introduces his “micro modules” concept for teaching practical treatment approaches in short, focused learning sessions.
20:54 – Deep dive into posterior tibialis dysfunction, movement compensation, and treating pain through nervous system regulation.
27:15 – Discussion around deep tissue therapy, pain scales, and why effective treatment should never feel aggressively painful.
33:07 – Aubrey breaks down the four elements that influence treatment intensity: area, angle, pace, and pressure.
35:35 Q&A segment on neck cracking, nervous system responses, and why recurring stiffness often points to deeper dysfunction.
38:45The conversation shifts toward understanding complex conditions and identifying root causes instead of chasing symptoms.
43:50 Aubrey explains why combining soft tissue therapy with joint mobilization often creates dramatically better client outcomes.
48:14 – Closing discussion on corrective manual therapy classes, virtual learning resources, and building accessible education for therapists worldwide.

 🎥 Watch on YouTube
https://youtu.be/Qz4j81l7iOE

If you enjoyed this episode, make sure to follow the podcast, leave a review, share it with your colleagues, and rate the show on your favorite podcast platform.

Connect with Aubrey Gowing:
🌐 https://holisticcollegedublin.com/
📘 https://www.facebook.com/HolisticCollegeDublin
⏯️ https://www.youtube.com/@holisticcollegedublin

Disclaimer:
The following program is for informational and educational purposes only. The content discussed regarding musculoskeletal health, injury recovery, and physical therapy techniques is not a substitute for professional medical advice, diagnosis, or treatment.

Listening to this podcast does not establish a therapist-patient relationship between you and Paula or her guest presenter. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition or physical injury.

If you think you may have a medical emergency, call your doctor or emergency services immediately. Reliance on any information provided in this podcast is solely at your own risk.

Therapist testimonial highlighting the value of Paula Nutting's Supercharged Therapist Group, mentorship, ongoing support, and professional guidance for therapists seeking continued growth and clinical confidence.

The Supercharged Therapist Method, ONLINE option to treat in ONE session what can take THREE or more

Paula Nutting talks about her educational journey and why it has made putting the technique of facilitating the Chapmans Reflexes so effective, powerful, and useful for any therapist whether you are a Massage Therapist, Myotherapist, Remedial Massage Therapist, and more!

If you are a massage therapist, myotherapist, or remedial massage therapist and been in the industry for less than five years then this message is for you!

Learn the Techniques that you might have not done yet like How to do your Muscle Energy Technique, How to do your Myofascial Release Technique and more. Learn from your peers and get valuable mentoring to become a fully booked massage, myotherapist, or remedial massage therapist. 

🎁 FREE Resources for Therapists

▶ Watch the FREE webinar:
https://vimeo.com/577539672?fl=pl&fe=sh

🎥 Watch therapist testimonials & clinical education content:

💡 Learn more about my Mentorship Programs & Therapist Training:
https://yourmusculoskeletalspecialist.com

🔗 Access all of my resources, courses, events & links in one place:
https://smartlink2.metricool.com/public/smartlink/paulanutting

📩 Got questions or want to collaborate?
paulanuttingyms@gmail.com

SPEAKER_02

Welcome everybody. It's Paula Nutting, your musculoskeletal specialist here today, and I'm really, really excited that today I can present to you one of the most amazing educators that are coming from the northern hemisphere this time. So we're lucky enough to be grabbing Aubrey Gowing, who is from Dublin, the Holistic College of Dublin. And he and I are going to have a chat today for about an hour. The event is all about interaction. So what it means is that you can actually access the chat box and come on in and type away questions, and we can facilitate the answers to the um to for Aubrey to answer as much as he can. So it's your time to pick an expert's brain. So hopefully we're going to get uh Aubrey right now to come on in and join us.

SPEAKER_00

Hi Paula, how are you doing? How are things?

SPEAKER_02

Good, good, excellent. How are you?

SPEAKER_00

I'm really good. It's good to see you. Uh, thanks for inviting me on. Really appreciate it. Uh love the idea of people asking live questions. You know, I always about these kinds of events, the one thing I really enjoy is those real brain teaser kind of questions. So, really encourage people to jump in and ask questions. It's gonna be fantastic.

SPEAKER_02

Perfect. No, I know I was super excited about that. We were talking to Ruth Werner about uh her topic was stump the pathology teacher. So, guys, it's your chance to actually try to stump the pathology teacher here with uh with Aubrey. Aubrey, I'm really interested. We were just before we were talking, I I was asking, I was actually asking Aubrey how long he has been involved in in teaching and how long he's owned the college. And it was really interesting, interesting. It's not just you, yeah. You it's it's a background of family.

SPEAKER_00

Absolutely. Like I sometimes jokingly say, you know, I actually started this in Utro before I was born because uh my parents took up yoga when my mom was pregnant with me. Uh, that was the only kind of prenatal sort of stuff that was available in Ireland in the 70s, and they got so interested in it. My mom went on to study to be a massage therapist, my dad went on to study to be a yoga teacher, and then opened the Holistic Healing Center in Dublin in 1986. And we started learning yoga as kids. So, like when I was four, I was doing breathing exercises, meditation, yoga postures. So it's really something I've grown up with literally my entire life.

SPEAKER_02

That's amazing. So you've been downward dogging for as long as anyone I've ever known.

SPEAKER_00

Literally all my life, yeah. And the great thing about it is the the college, in its uh current iteration, is run by myself and my sister. So it's really great to have that partnership that we both have this absolute passion for therapists for therapies that continues to drive us. Um, Alison actually started the year before me. She started in 88 uh with Halistic Massage. I started in 89, and the two of us are absolute therapy junkies that we've just continued to study throughout our career. I think I'm up to about 55 different qualifications and certifications at this stage. So I'm still loving it.

SPEAKER_02

That's incredible. That's so exciting. I love that you that that even the experts and the people who are you think they're at the cream of their of their crop still do lots of self-development.

SPEAKER_00

Totally. Yeah, yeah. I mean, I love learning. We were both myself and Alison were in Costa Rica recently with Eric Dalton. Uh, I was a special guest this year, which was really exciting. And it was about my third or fourth time there, where it was Alison's first time to go to Costa Rica. She was getting her master of myoskeletal certification. And we were just saying, you know, we're such therapy nerds that even 30 plus years, I think Ali's about 33 years, I'm 32 years, and we're going, we're still really excited. The classroom is still our favorite place in the world to be.

SPEAKER_02

Isn't that funny? Um, Libby Jones of Flarity, who's actually, I could see her in the comments section. Um, she is an absolute advocate of yours, and she and I were talking about um about how we're gonna meet up in Costa Rica and do Eric's course in 2023. So I think we'll highly recommend it.

SPEAKER_00

I mean, it's it's one of those experiences that the you'd literally say everything about it is amazing because you're in this kind of like enclosed compound in absolute paradise. The place is beautiful, the people are lovely, there's great trips you can do. So there's it's not just the the quality education, which is amazing in and of itself, it's the whole experience that people really bond because you're you're living and working with other therapists from all over the world for a week straight. So it's it's phenomenal. It's hard to be.

SPEAKER_02

I cannot wait. I'm so excited. Um, so did you feel like you learnt much new techniques, or did it cement the things that you probably already know and made them a little bit more easier to use?

SPEAKER_00

I think it was probably a little different for me compared to Allison because I was there working. So the last few times I've been there, I've been teaching with Eric. And I do a lot of the A V stuff as well. So you're you're doing kind of all aspects. Um, you always learn something. Uh, there's always a couple of new little tweaks. I'm quite familiar with uh Myoskeletal work at this stage. So I wouldn't say new techniques as such, but like little twists on things. I find what I learn most from is interacting with the students, with the participants on those seminars, because it's trying to figure out a new way to put something that clicks with the particular individual. So it's not necessarily new techniques, but new interactions that I always still learn from that I like.

SPEAKER_02

Okay, yeah, that's cool. Which kind of brings me into the next part of this. Well, actually, the start of this because the things that we were talking about is a passionate play for this hour, is virtual training experience because right now, with lockdown, you know, people still want to learn. You you've just said, you know, you've got 30 plus years experience and you want to learn. So now we've changed the ball of the playing field to having to learn things in in a virtual format. Now I saw that you were talking about that there's ways that you can improve the quality for students and for educators. And I really like to pick your brain about that because I know you must you probably know my background is I run virtual life courses as well.

SPEAKER_00

Yeah. Well, I do think that there's um there's kind of a couple of things that people can bear in mind. I think the virtual experience can be phenomenal, and I know there's been quite a resistance to this pre-pandemic that a lot of people are saying therapy is hands-on, training has to be hands-on. And I can see the like to that because there's stuff you can do in person that you can't quite do virtually. Like one of my favorite things in class is to go around and put my hands on top of the other person's hands, tell them to relax so I can feel the tissue texture, and then they get that experience, you know, when they're particularly in the early stages of learning. So I think when you're starting out, particularly at foundation level, hands-on is essential to get those kind of tactile feedbacks, the checks on pressure, all those sorts of things. But once you move into even slightly more advanced training, there's a lot you pick up visually because you have a lot of the kind of touch tools. You understand about sinking into the depth of resistance within tissue, what's an appropriate pressure, all those kinds of things. So a lot of it then is kind of learning just new positioning, different tools for practice, if you like. And the one thing that I've really found with the virtual experience is if students engage in the same way that they do in class. So, particularly like, say, when we do our myoskeletal weekends or any of our um connective manual or corrective manual therapy classes, we encourage students to have somebody there at home that they're working on turn on their camera, and we can actually give feedback so they not only see us, we can see them. And I'm oftentimes saying to people, yeah, you need to step a little closer, your elbow's too far forward, you need to bring that back, you know, whatever it might be. You can really coach people on positioning, body mechanics, placement, where exactly making sure they're in the right spot on the person they're working on. So there's a huge amount that can be garnered, particularly for the more experienced therapists from the virtual world. So I'm a big fan of that. Engagement, turn on your camera, ask questions. So I really think this is a big thing as well. One of the things that we use is we'll have a producer, my brother Tom actually does a lot of our producing for us, and it means people can pop stuff into the chat that you oftentimes have people that are maybe a little bit self-conscious about asking a question in a big class. They either don't want to look foolish or they just they're not comfortable public speaking, even though it's not overly public, they just they feel so self-conscious they don't want to ask the question. So they get to type that into chat, and the producer then can pop that in at an appropriate time. You know, when there's a little bit of a pause in I don't tend to pause that much, I talk a lot when I'm teaching, but there's there's times when you're focusing on what you're doing, and Tom will oftentimes pop in with a question, then saying, Oh, so-and-so had. And you get to ask follow-ups as well. So it's a hugely interactive experience from the participants' point of view. From the the presenter's point of view, I find that you are because you're kind of talking to camera. Now we've done a couple of different versions of this. We've done hybrid seminars where we've people in the room and we've people at home, and then we've done some seminars where they're purely virtual.

SPEAKER_01

Yeah.

SPEAKER_00

But in the hybrid, people always say like they feel like they're in the room because the camera always has the best view for starters. And then when the other people are practicing in the room, we'll oftentimes have teaching assistants going around, and I'll actually be talking to camera, showing people, well, if you don't have somebody to work on, here's a way to apply this as a self-care treatment. So we'll look at if you're going to work this yourself, here's how you can get the angles, you can do self-treatment. So people still get to work.

SPEAKER_03

Yeah.

SPEAKER_00

But in the purely virtual as well, what I find is talking to camera, it's like I remember, I don't know if you guys have heard of the Scottish comedian Billy Connolly.

SPEAKER_02

Oh, yeah, yeah.

SPEAKER_00

Well, he used to talk about when he was doing a gig, he said, I love when you bring the crowd together to the point that you feel like you're talking to just one person, it creates that real sense of intimacy and community at the same time. And doing the virtual events is a bit like that because when you're talking to camera, it's like you're talking to each person directly. So there's a really strong um connection and rapport that you can establish through the virtual, that I think is harder to do in a big class because you're trying to make contact with so many individuals and it's not quite the same experience.

SPEAKER_02

Yeah, I absolutely agree. And if there's anyone out there who are um uh educators and are thinking about doing courses online, then those are salient words. They're they're things that we should be all doing. I know with the courses that I run, because they are virtual live, like you know, a three-hour um once a week or whenever they are, we always make sure that you you get the information. It is that one-on-one. We run through um maybe the PowerPoint just so that they feel like it's a familiar, um, as if they were sitting in front of a desk doing that whole feel of listening to and watching. And then we drop into a couple of videos and then we do the experiential thing, have a feel of what this is like, now go through that range again. So you have to be smart. You can't you just can't not um be flippant and lazy, it's not just PDF files and chatting through. And I like that Tracy's just said down there, and that you can ask lots of questions, and and she's right, because you're saying that anonymity, you feel you feel safe just tapping.

SPEAKER_00

Yeah, absolutely. And even the the group chats that get going as well. Like it's it's amazing the the sense of camaraderie that people in the virtual environment can develop because they can be chatting amongst themselves offline, which you can't do in a real class because it's disruptive for other students. Whereas typing in information, no problem at all. And it's interesting what you say about like not just using kind of like static stuff like PowerPoint as well. One of the things I really like doing is using some of the augmented reality stuff so people can see as though you're looking through the device, like say on an iPad or something, we'll use a 3D for medical program or something and we'll show the anatomy, we'll be able to place it in the room, look at it on the table, go through layers, all that kind of stuff. And when you're watching that at home, it's like you get that again first-person view. So it's it's really, really impactful and really engaging when people see that augmented reality stuff when they see like a an anatomical representation standing in the room or lying on the table, it just has that emotional impact. And they always talk about emotion as being a big driver for memory, so it really helps people to connect with the information and to retain it.

SPEAKER_02

Yeah, you it and anyone who's listening to this, I urge you go back and and just look up Aubrey Gowing and uh I think there was one on Planet Fasciitis and talking about the foot, like just uh or a neural entrapment or something, because it was really clever, and you know, just talk about that bang, it's straight in my head. The patient lying, augmented lying prime uh supine, and you were just going through the feet.

SPEAKER_00

Yeah, and you can you can see the anatomical structures in 3D. And what's great is we can oftentimes get in front of the camera and point to stuff and go, you see this here? This is the plantar fascia, and over here we have the you know, like you're saying, the tibial nerve coming down or something. Um, so people get to have a very, very clear, very vivid visual of the structures that you normally you can palpate, but you can't see. So it gives it that again, another dimension, uh another depth of understanding, I think that's hard to reach in different ways in any other way.

SPEAKER_02

Yeah, a virtual wet lab.

SPEAKER_00

Yeah, yeah, exactly. Without the the difficulties of actually having to do cadaver work. Yeah.

SPEAKER_02

I know we we've all been there. So and it's one of those things you take students to wet labs and that they come out and it's like they've had this bulb that's just brightly shining, and they've got, I didn't ever realize that the performance was actually quite impossible to access because of all of that gluteus maximus or all that deep muscle, and people that are saying I'm palpating it by tapping at that depth is not actually reality. Um, let me just say augmented reality. Um, now how does if if you're an educator out there, how do you make that a great experience for them? How do you give the them tips and skills to like have you got other people who are teaching at the college?

SPEAKER_00

Yeah, yeah. Um, one of the things I find with the augmented reality is it can be a great time saver because you can set up images the way you want them ahead of time. You can actually store them in a library in some of the apps. The particular one that I like, a lot of people have probably heard of at this stage, it's called Complete Anatomy. That's actually developed by an Irish company. I mentioned 3D for Medical. They've a range of different apps, but Complete Anatomy is particularly good. And when you use that augmented reality, you can preset the things you want to show. Um, and then when you bring it into the augmented reality, like basically it uses the camera of your device and it overlays their anatomical structures. So, like, literally, you can lie a body on the table and you can have it pre-dissected, if you like, to show nerve pathways or blood vessels and their relationship to other muscles. So that stuff can be really, really interesting.

SPEAKER_02

Yeah, it's super smart. So, anyone who's thinking again about this kind of stuff, that's that complete anatomy is is amazing. Um there's quite a few people I know that are using that just in their clinics to explain to their patients when they've complete what they want to be doing with them. So if we're looking at somebody sitting down, I remember having to do it, and I'll never ever do it again. We I had to do an eight hour a full weekend uh virtually. So I was supposed to be in Perth and we were locked down the weekend before, and I had all these people going to the the course um clinic. So rather than me cancelling everybody, we just got a large screen, and we had the person that was in charge of it walking around with the video camera. It I it was the most exhausting thing I've ever done trying to teach for two eight-hour days and going, okay, like just put your laptop a little closer. I just want to have no move your fingers a little bit. So you talk about um micro modeling or micro models.

SPEAKER_00

Yeah. Because we actually did the same thing in January of January of this year, actually. Uh we went into complete lockdown here in Ireland and we had a Myoskeletal seminar on. And I did three eight-hour days in a row, nine hours including the lunch break, so eight hours of teaching. Um and we found it great. Um, because the the interaction with the the group, we did exactly the same thing. We had uh a camera so that they could see us, but then we had the uh a big screen with the individuals on it, and we could give them feedback. And it is a lot of work. I don't think maybe people appreciate that from the presenter's point of view, that it's like a live performer saying that they don't have the audience. So that part of it can be a bit exhausting. Um, but I find it really good. I enjoyed the experience. But yes, leading on to our micro modules, the the flip side of that, the easy way to do that, I think, is these kind of like short bite-sized kind of pieces. So we started off developing these. We did a series called The Essential Eight, and this kind of came about from chatting to students in class and saying, what were kind of the most important muscles to treat in each part of the body? Now, it's very hard to say what's the most important because you know everybody's different, all that kind of stuff, people do different movement patterns. But we were narrowing it down and we were saying, well, there's oftentimes if I had just one muscle I could treat in a particular body part, the one that is most predictably dysfunctional. So the widest number of people are going to need this muscle treated, but also that it contributes to the greatest number of dysfunctions. So an example of this would be say posterior tibialis in the lower leg. Posterior tip causes an imbalance in the stirrup system that stabilizes the foot, so it leaves you more prone to lateral ankle sprains. Because its antagonist is anterior tibialis for dorsiflexion plant reflexion, it leaves you more prone to shin splints. Because of the direction of force, it can cause taler shift, which can jam up the ankle, leave you more prone to syntesmosis type sprains. Um, it can tension the tarsal tunnel and cause things like uh it can mimic Morton's neuroma. So it can drop metatarsal heads, it can affect the arch of the foot. It just is so broad in the number of things it can have a negative impact on. We said if there was just one muscle I could treat at the lower leg, it'd be posterior tip. So we went through the body, we broke this out into eight, I'm sorry, four one-hour modules. So there's two muscles in each one, and we talked about what would be the thing to treat for knee conditions, what would be the thing to treat for low back pain, what would be the thing to treat for the neck, for the shoulder, for the arm. And that really is a very manageable way for people to take in information because the way we generally approach these with the micromodules is we'll talk about what the condition is, why this muscle is so important, then we'll do assessments. So you're not assuming that the person has this thing, you're actually able to test and validate yes, okay, this client does have difficulty or dysfunction in their posterior tibialis, or maybe even injury. Then we go into the treatment phase and we show how to address dysfunction within this muscle, and then we do home retraining as well. Is it weak? Is it tight? Do you need to stretch? Do you need to strengthen? So it's very, very targeted. We also reassess at the end as well, so you know, are you stretching or strengthening? That we're not just assuming that a muscle is tight. Uh, people talk about this a lot with psoas, for example. People say, Well, not everybody's psoas is tight. Some people's psoas is weak, not everybody should be stretching their psoas. And I go, Yeah, but most people should evaluate and see if it's tight, do you stretch weak, do strength train it? So these are very kind of targeted micromodules that people can go back to time and time again, but it's like one hour of study. And to me, the most important part is it has that unbroken chain that I think is really important for successful treatment outcomes. That you understand the condition, you know what assessments are relevant, you know how to provide treatment based on that assessment, and then based on the outcomes, what kind of home care you need. Yeah, that to me is the real start to finish process.

SPEAKER_02

It is. I and I think that that's kind of a part of that thing that you were talking about is um uh like making a roadmap of what how and you know, there'll be people out there that will be will be going, what treatment do you do for Tip Post? Like I can guarantee there's people out there going, Oh, do I do do I strip, do I stick needles into it? What's like you know, yeah. So you can't you can't give that little nugget without giving them a couple of maybe is do you have two or three um sample kind of things we could say?

SPEAKER_00

Okay. So typically uh posterior tibialis is going to be, we would describe it as short, tight, and facilitated, which actually is describing different things. You know, it has lost extensibility now, not always because sometimes people have a low arch. It can be kind of bound mid-length, that it's not really shortening very effectively, but it's not really lengthening very effectively either. So this is where the assessments come in. But it's rarely completely overstretched. We can inhibit it. Posterior compartment muscles and deep posterior compartment muscles are typically tight. So short, tight, and facilitated. Short meaning they've lost extensibility, tight meaning they have elevated tone, or their fascia, uh the actual layers of fascia have become too stuck together from lack of variety of movement. So we've lost some of that slide and glide. And then facilitated is more to do with how the nervous system is controlling tone within that muscle. So it means it usually has elevated tone. It's being like if you think to facilitate is to encourage, to help. So it's being encouraged to work nearly too well at the expense of its antagonistic muscles, which are oftentimes there. The flip side of that is they are inhibited. They neurologically are prevented from developing enough force to counteract what's happening in posterior tip. So typical one of my favorite techniques, and it's hardly a technique, it's so simple. We did this in Costa Rica and it blew people away. I was saying simply pumping the tissue to create a nervous system response that the nervous system stops guarding, the tissue starts to soften. It also creates an increase in hydration. Robert Schlag demonstrated this a couple of years ago in the University of Alm. They talked about measuring the actual fluid content in tissues. And they said just from simple pumping, there was a 2% increase in fluid. So it was phenomenal. So I talked about this kind of just pumping nearly to settle down the nervous system. Then once you feel that kind of hydration, you start to move the tissues. And you can work right down to muscles like psoas without any pain. When we did this in Costa Rica, the person on the table had that real pinching on extreme hip flexion, they had weakness, they had all kinds of psoas dysfunction. And as we worked our way down, when we got to PSOAS, I was like on a scale of one to ten, what would you rate your pain as? And she was like, zero. And this is with her legs straight. We worked our way down in about three, four minutes. We actually, I think somebody posted some of these videos on Facebook, so you can probably see some of these on I think our Facebook page where we're working down through PSOAS. So we do something similar with posterior tip where we kind of get in around the back of the tibia, we pump the muscle, we stretch to mobilize the fascial sheets. We'll oftentimes do a bit of soft tissue release, um, some active isolated stretching or some MET. We kind of you can use those kind of interchangeably, but that's not to say that those things are exclusive. You mentioned about needling. Uh I personally I'm not a big fan of dry needling, and I hate to, I don't want to offend anybody.

SPEAKER_01

Thank you, thank you.

SPEAKER_00

I always say to students, it's personal preference. You know, there's nothing wrong with dry needling. I would just think I would rather work layer by layer because this kind of comes to some of our overarching principles. I'm always going to work from superficial to deep. Now, needles can be a quick way of shortcutting that. So I'm not against the use of needles, it's a personal preference.

unknown

Yeah.

SPEAKER_00

I don't know what people come on going, ah, you can't sing dry needles. It does work. I'm not not bashing it at all, but I'm just not particularly a fan. What's your take on it?

SPEAKER_02

No, no, no. I think that if if you've got um a something that is giving you uh an alarm uh that you can palpably find, you can palpate bang, there's your alarm bells. It's like a stop sign. Why would you remove the stop sign at the start of a program, like the start of treatment, versus leave it there as a guide and then do your other techniques and go, is it still there? No, it's not. So it's it's not the cause, it's a symptom. And then we we pull back to find it. No, I'm not a I'm not a fan on I can do my facial dry needling, I'm qualified in it. Do I do it? No, I don't yeah, I don't need to. I don't need to. But I do like the the fact that we're working on the nervous system, lots and lots and lots of practitioners now are swaying towards the nervous system as the first point of call in a lot of cases to you know calm the nervous system down or to stimulate it. So that I'm I'm loving that. Um it talks about maximizing learning. So you did you did um one hour times eight where you packed the times four, yeah.

SPEAKER_00

I was getting ahead of myself. There was four of those micromodules. We call it the essential eight, but it's actually four modules.

SPEAKER_02

Yeah, yeah, incredible. And I get that it's about a quick reference library by by building these up means that people just have them kind of set that this is easy to not easy to do, but this is something that I can apply quite effectively in my clinic. Uh and I suppose and I'm noticing that for for an hour, I most people are gonna hang around.

SPEAKER_01

Most people aren't kind of drifting off somewhere, you know, like you see often.

SPEAKER_02

But I want to ask about complex conditions because tibialis posterior is not something that a lot of therapists would automatically consider. They just that's just not where they they go. They go, Oh, oh, maybe the the the gas doc or the salius or the or the the Achilles or something, but in actual fact, yeah.

SPEAKER_00

Posterior tip can oftentimes be the culprit. And this again comes back to some of the overarching principles that we keep coming back to time and time again, because I think if you understand principles, you can apply them anywhere in the body. And one of the things we talk about is working from superficial to deep, but also superficial muscles tend to be less dysfunctional. So I actually find in clinic gastruck is the least dysfunctional, Sileus is a little bit more, and posterior Tib is the most dysfunctional. So you tend to find that as you go deeper, you find more stuff, and that's the relevance of deep tissue work. Unfortunately, deep tissue has become synonymous with aggressive, painful manual therapy, which it really shouldn't be. It just means accessing the deeper tissues. And again, if you work layer by layer, particularly using that kind of pumping, mobilizing, stretching the tissues, using whatever techniques you're used to using, myofascial release, soft tissue release, whatever uh methodology you're using, but go down at a layer that the nervous system is happy with. We talk about never exceeding four out of 10 on a pain scale. So we'd say strong enough to be effective, but light enough to be pain-free. That's our Goldilocks zone. Kind of three to four that the person says, I feel it, you're on it. There's maybe a little bit of sensitivity, maybe even discomfort, but not pain. I talk about this in my book, actually. I talk about, you know, what are the key indicators? Because people have different kinds of um perceptions of pain. You know, sometimes you'll have people going, Oh, that's like a four, and you're going, that's a lot more than a four. If you have that kind of response. So we talk about well, what are the recognized markers? So it is about what the person says. That's a valid subjective interpretation of their pain. But then there's objective responses as well. So there's things like the person flinching away, there's the change in pitch of voice, there's the change in their breathing, the the kind of squinting. I mean, you've probably had this experience, the client is nearly asleep on the table, they're snoring, they're like, and they'll give this, they'll twitch, their eyes will flutter, their eyebrows will go. They will show visible signs of distress that it's starting to tip over from discomfort into pain. So I talk about like, what do you see at kind of a three or four? What do you see at a five or six? What do you see at a seven or eight? What's a true nine or ten? Because I've had some clients and they just don't like any discomfort. And you're pressing on the tissues, and they're like, you know, what's that on a scale of one to ten? They're like, Oh, that that's definitely a 10. And you're like, You're so calm, there's no sign of distress, you just don't like discomfort. So I talk about like, how do you recognize these kind of markers of, you know, what is genuine pain? What when is it getting to be too much? When is it really alarming the nervous system? Is the big thing. And if you don't alarm the nervous system, you'll be surprised how quickly you can get down through those layers, alter tissue texture, that those tissues are actually much more functional as a result, and really change the muscle balance, change what the nervous system is doing with those muscles. It can be a very, very quick process.

SPEAKER_02

What's your take on comments and and yeah, you I hear it over the decades, loads of times. Um, oh my gosh, that that hurts, but it feels like it's so good. It feels like it's it's doing something. What's I think that's got to be working at the nervous system. But if you're are they working at do you unpack that into something that if they are they like pain?

SPEAKER_00

Well, like when when they go that's sore, but it feels really good. That's actually what I would call good pain. That is where it is really about four out of ten, maybe even five out of ten, where it's strong enough to really draw the brain's attention to that area. So the brain is really focused on what's going on. The tissue change that you're creating is a positive thing. That you'll you'll have clients even in on a first treatment, and they'll go, Oh, that's it, that's what I need, oh, that feels so good. Because they recognize unconsciously they don't know anything about the techniques you're doing, they don't know the physiology, they don't know the structures, but their nervous system knows what it needs. Yeah, so that's the kind of person who'll say, It hurts, but it feels great. You're you're really getting to where it needs to be. That changes once you get into the kind of sevens out of tens, eights out of tens. They won't be saying that's great, they'll be gritting their teeth. Now, unfortunately, because aggressive manual therapy was such a thing for so long, still being practiced, still being taught in some uh areas, unfortunately. But clients then have this impression that it has to hurt to do them good. It's a bit like the old you know training adage of you know, no pain, no gain. And they proved that's not true. So, you know, sometimes people are a little cruel and they say no pain, no brain. Um, where you'd say, if if you want to be hurt that much, you really have to, I think, re-educate your clients to a certain extent. And I've never had a client, I don't do aggressive manual therapy, never have, even from the start, my tendency was always to be light, and for quite a while I went through this fascination with how light can I go and still be effective? I was trying to be minimally intrusive, and that's changed. I mean, I still do a firm, strong treatment, and I've never had a client say, You didn't go heavy enough, or you can go heavier. Within five minutes of being on the treatment table, they're feeling the change and the improvement and you not hurting them. They kind of they buy in straight away. And I I haven't had a client get off the table going, uh, you know, it wasn't really that good. Because I've had students come back and say to me that they have difficulty with clients that are, you know, they nearly feel like they have to inflict a little bit of more extreme discomfort just for that person to feel like something was done, for them to be satisfied with the session. And I think that if you are working at the right intensity, again, strong enough to be effective, light enough to be pain-free, the client will feel the benefit. They will get to the point that they realize, oh, it doesn't have to hurt. It can still be therapeutic, it can still be beneficial. And I'd even say those times when it is sore, I would say it should be momentary, mild, therapeutic discomfort. If it's all of those things, it's fine.

SPEAKER_02

And new new students, new therapists in the industry, they haven't quite learnt that what how deep is deep enough that you can feel a sense of where the tissue's coming back at me. And that's where I think they're worried about their touch, which is that they're not there being introspective to themselves, they're not actually working with the patient on the table. So they actually don't have that connection. And I part of that connection I think is when the patient says, Uh, you can work harder on me, and it's almost like a cry for, I want you to connect with me. And sometimes it's about saying to the student, that the more times you can get your hands on people, even if it's just massaging your dog, you just get a feeling of what it feels like. Yeah, we have to learn how to work these things, it's not like jumping into a Tesla and expecting to take off.

SPEAKER_00

Yeah. Well, one of the things I talk about a lot is body mechanics. That I think if you're using body weight, you can get intensity without necessarily actually intensity is an interesting point because we don't talk so much about pressure in our school. Um, a lot of people focus on pressure, pressure, pressure. And I would say really it's more about intensity. And pressure is only one of four elements that contribute to intensity. So you have the area that you're using, the angle, the pace, and then the pressure. So pressure gets you to the required depth. So there's other things you can change to make it more or less intense. If you use a broader surface area, pressure is dissipated, it's less intense. Smaller surface area, so you don't have to go any heavier if the client goes, can you go deeper? Switch maybe to the pads of your fingers, even the tips of your fingers. And it can feel an awful lot deeper, and you don't have to go heavier. So it's not strenuous for the client or for the therapist, it's not damaging tissue for the client. Changing the uh the um the area is one, the angle is another. So if they say it's too sore, instead of dropping your pressure, drop your angle because then you've still got depth, but you've reduced the intensity. So I talk about these almost like dials you can adjust, or think about like the old um what do they call the the equalizers on an old stereo you see those anymore? That you can dial up and dial down. So you can keep the pressure, but dial down maybe the angle that you're working at, or slow the pace. To be honest, if uh somebody says something is starting to creep above a four out of ten, the first thing I'm gonna do is slow down. Yeah, think about something like a soft tissue release, you know, do the movement more slowly, and it's tolerated a lot better. So I'm gonna adjust the other three elements the area, angle, and pace, before I adjust pressure. And if you do that, you can really moderate intensity and get to the point that you're really being effective without straining yourself without hurting the client, but using good body mechanics, leaning into the treatment, literally committing to the technique, and as you said, communicating through touch that I'm literally getting behind this technique, I'm prepared to put my weight into it, have that much confidence in it. That comes through to the client and that creates a really positive experience.

SPEAKER_02

Yeah, yeah. And that's it. Well, that there's more and more studies on it. That the the placebo, which is not a dirty word, the placebo of coming into a client and uh coming into your therapist and knowing, you know, I had pain this morning and then I knew I was coming to see you, and for some reason it's it's you know, it's half the pain that it had before.

SPEAKER_00

So um that's just seeing an interesting question coming in there. Somebody's asking, uh, what should I do uh if I always have a stiff neck? I always feel like cracking my neck. That's a really interesting one because people talk about is cracking joints bad? Not bad at all. All it does is it creates more space within the joint. As a result, you have the same volume of fluid in a bigger space. So pressure drops. Now, I was an Irish man, Boyle discovered this that there's the Boyle's law uh that at different pressures, gases will fall in and out of solution. So when you reduce the pressure, the gases that were in solution in your synovial fluid fall out of solution and form an air bubble, and it's that forming of the air bubble that creates the recognized crack. That does you no harm whatsoever. There's a doctor, I have the name somewhere and I can't remember. You may have heard of me, cracked the knuckles on one hand every day from the time he was like five or six years old, because mom said, That will give you arthritis, and he cracked the knuckles on one hand and didn't on the other. And he said, Now, 63 years later, or something, he says he's more mobility in the hand that he cracked every day.

SPEAKER_02

Oh, my grandmother would be going, you get arthritis and you crack your knuckles.

SPEAKER_00

Doesn't do it at all. Now, the one thing I would say is when you feel like you need to crack your neck, there is irritation there. There's tight muscles compressing the joints, and they feel like they need a release. So the feeling like it needs to crack is actually like you were saying about the stop sign. It's a warning to you. There's something going on in this area that needs attention. Cracking the neck won't do any harm, but it won't alleviate the problem. You need to address which muscles are tight, and quite often it's actually the scalenes. My one muscle in the neck, we talked about posterior tibialis in the lower leg, my one muscle in the neck would actually be anterior scalene because it affects rib movement, it affects breathing, it affects rotation of the cervicals, uh, it affects the thoracic outlet, the entire nerve supply for the arm. So when those muscles are tight, usually you have a dominant side. Most people are right side motor dominant, and it will rotate the vertebrae a little bit. So they're not in ideal alignment.

SPEAKER_03

Yeah.

SPEAKER_00

When you crack the vertebrae, it'll help, it'll change neural input a little bit, but the muscle is still tight and it'll pull it out again. So oftentimes doing some simple kind of like pin and stretches for your anterior scalene, talking about self-treatment, yeah, or stretching the anterior scaline. And the best way to do this is you actually sidebend and turn in opposite directions. So if I'm going to stretch my right side anterior scalene, I'm going to turn my head to the right, but then sidebend left. And you'll feel this come down almost to the back of the collarbone. And I recommend uh Aaron Mattis' active isolated stretching. So you stretch for two and come back out. Another two seconds and come back out. When you get used to this, you can add just a tiny little bit of overpressure. So you don't want to go cranking on your neck, particularly with that rotated and side-bent in opposite directions. That's known as non-neutral spinal mechanics. So you don't want to be jamming on your neck at that. So, like you notice I'm using a fingertip. Just because these muscles aren't necessarily strong enough to overcome the tense ones. So sometimes these guys will help by activating these, you'll reciprocally inhibit the muscle you're trying to stretch, but you may need to get a little bit more lengthening with a very gentle assist.

unknown

Yeah.

SPEAKER_00

So stretching the neck muscles are get to a therapist, get some treatment. That should stop you cracking your neck.

SPEAKER_02

Exactly, exactly. So, how do we learn the difference between what is a simple condition and a complex condition? Because we can't patients or clients are coming to see us and they might come back time and time and time again with a shoulder pathology or lower back, and they go, Yeah, it's good for a couple of couple of days or a couple of weeks and then it's back again.

SPEAKER_00

Yeah, that's my real interest is kind of getting to the core of a problem. And I mean, looking in this in a very simple way, we talk about people who have a forward shoulder posture, and they would say, Oh, I'm really tight across my back. And the answer is, you're not tight, those muscles are overstretched, they're weak and inhibited. And the interesting thing is it's more often the weak muscles that are pain generators because they're really stretched out. I describe them as being taught. You know, you think about like a guitar string being wang taut, you can twang it. It's not short. So the problem is with the vocabulary, when we think about a muscle being tight, we think about it being short. So people start going, Oh, I must stretch that. In a yoga class in Costa Rica, Ali was saying the yoga instructor kept going, and stretch out your tight upper back muscles, and you're like, the only person who should be doing a rhomboid, uh, infrasprinatus, posterior deltoid stretch like that, is somebody with retracted shoulders. So if you see people walking around with this posture, that's the person who needs to do that. But most people are the opposite way, they're forward shoulder. So looking at treating flexors first, treating tight muscles before you can successfully address weak muscles is one of our core principles. That can demystify some conditions for people. When we talk about a complex condition, it's usually that the there is a layering up that the person may have had an early injury or maybe just overuse, and then the body has gone through an adaptation, then the adaptation itself starts to cause an adaptation, and then you get a further adaptation. So you get this kind of layering up, and that's what really makes a complex condition. Or when the person has more than one thing, you know, we talk about doing muscle resistance tests, and initially the person might indicate that they've a myofascial restriction. So let's say I'm testing pec minor, bring the arm up 135 degrees, bring the arm back, have the person push forward so they're engaging pec minor. When you do a muscle resistance test, it's important not only to know how to do the test, but how to interpret the results. So what the client indicates tells you a lot. There's three primary things. Well, four if we count a false positive. I'll come back to the fourth one. So the first one is a myofascial restriction, when everything is just a little bit stuck. And in that case, when they test, they'll point to the muscle you're testing and they'll move around. They'll indicate the vicinity, the length of the muscle. Because usually there's it's not a point, it's an area of the muscle that is adhered. The fascial layers are stuck and it feels pulled and uncomfortable. And they go, Yeah, I'm feeling that here. Then there's a tear. If the person actually has a tear, the tears are very small. So when you test them, they'll put their finger on a point and they'll go, Oh, there, it's sore there. It's very definitive. If it's neuromuscular or if there's kind of nerve impingement, they'll usually point to the structure, but it will radiate along a known nerve pathway or a dermatome, myotome or dermatome, most likely dermatome, which is just a section of skin supplied by a particular nerve. So they'll indicate kind of a known referral path. The fourth thing is they'll say they feel it somewhere else, like, oh, I'm feeling that on the back of my shoulder. That's a false positive. Yes, they're feeling something, there's something there, but it's not to do with the muscle you're testing. It's not a pec minor problem per se. But what we find is once we do treatment and we do some myofascial release, there may be an underlying issue as well. So when you test it, they might initially go, it's myofascial. You do your treatment and you retest, and they'll point to a spot going, oh, there's actually a tear there as well. So sometimes with complex conditions, you have to go down through the layers. You have to normalize tissue texture at each layer and treat each type of dysfunction. But then for that again, I wrote an article recently for uh MMA's magazine on the knee, complicated knee conditions. There's so many pain generators in the knee, and almost all of it comes from a tight short head of bicep fumoris. It's generally rotation in the tibia because that messes up the ligaments, it messes up the patellar tracking, it puts pressure on bursa, it causes so many problems, it puts pressure on points of the meniscus, and it's one cause.

SPEAKER_03

Yes.

SPEAKER_00

That's a lot of what we look at with our treating uh complex conditions in our corrective manual therapy classes. We actually look at well, what's the common thing that will contribute to all of these different things? In that article, I actually talked about 15 different potential pain generators in the knee, how to test for them, and still come back and treat posterior tib and derotate the tibia. Yes, I think. That is the roadmap, that's the shortcut. That's what we talk about a lot in our classes.

SPEAKER_02

I can get that. Um so Marfay's had the follow-up question for for our poor girl with the with the do I crack my neck or not? Commenting about um uh will the will chiropractor help?

SPEAKER_00

So, yes, is the simple answer. Um, I would usually say though that these things, unfortunately, these divides that uh exist within our industry of your soft tissue, your joints, you're an osteoor chiro, you're a myotherapist, you're a massage therapist, whatever it might be. The body doesn't separate that way. One interacts with the other. So, what I used to find prior to doing myoskeletal work, where there is a lot of joint mobilization. Not to the point of manipulation. We don't do high velocity thrusts. Not that there's anything wrong with those. They get a bad press because I think if you have tight muscles and you go to a chiropractor and they crack out the neck, the positive outcome may be that you change neurological input and that allows the muscles to relax. But if the muscles are tight from something else, from some other guarding or for some overuse, some activity you're doing, they tighten up and they lock the joints again. So you're going back to the chiropractor again and again to crack, crack, crack, the underlying cause is not being dealt with. Equally, if you go to a massage therapist and they treat the muscles, but the joints are locked up, their muscles keep tightening up to protect this dysfunctional joint. So this is where I think myoskeletal alignment really brings those two together, where you treat the soft tissue and you mobilize the joint. If that's outside the scope of your practice, I would say go to a massage therapist to have the soft tissue work done and then go to a chiropractor. That's the perfect blend because then you're getting the soft tissue and the joint work. Before I was doing myoskeletal, I used to um send people to a chiropractor who was a friend of the family, and he goes, I love getting your clients. He said the word he used was their joints are buttery. It's like they've they've been pre-oiled or something that they can just slide into place because the soft tissue work has been done. The original cause of what was pulling on those bones has been removed. So all he has to do is get the bones back. There's no muscle resistance to that the way he would experience with a client who's just coming for chiropractic work. And equally, he would send people to me saying, These people, their muscles are too tight, I can't move the bones. Can you treat these muscles? And then I'll send them back to him. So that actually works really well, the combination of the two. But I think sometimes pure soft tissue work on its own can fall short, and sometimes chiropractic work or osteopathic work on its own can fall short. It's the combination of the two. Soft tissue and joint work is phenomenal.

SPEAKER_02

And the more the more therapists out there that get the opportunity to do joint mobilization techniques, um, you'll you'll just increase the quality of your outcomes dramatically by linking the two. We I'd been doing that forever, and I think there's so many of us that are now starting to learn that once you've maybe not in the Certificate 4 program, but in the diploma, they start to learn a little bit about um joint joint mobilization.

SPEAKER_03

Yeah.

SPEAKER_02

And the value is is again we're coming back to the neurological system, aren't we?

SPEAKER_00

Absolutely. Yeah, because there's a huge amount of both nocioceptors and mechanoreceptors around a joint, and there's a really interesting interplay between these two types of nerves. Noseoceptors are really kind of threat receptors, they're telling you the joint isn't in a good place. For years, people have simplified this and said nocioceptors are pain receptors, which isn't really true. They're telling you there's threat as a problem. Mechanoreceptors actually dampen down nocioceptive response. So the more you move, the less threat you feel. Isn't that interesting? And one of the things they say that causes increased pain as we age is actually that we lose mechanoreceptors. We don't lose nocioceptors because we really need to understand threat. But then because there's less of a turning down of the volume, as we lose mechanoreceptors, the nocioceptive signal becomes stronger. Now that's not bad news for the aging process. What it means is as you age, you should actually start to move more, not less. Stimulate the kind of receptors you have, and you will have less pain.

SPEAKER_02

Yeah, yeah. Move it or lose it.

SPEAKER_00

Absolutely. Yeah. It's simple. I mean, we know these things, but we don't always implement them. But understanding the science behind it can be really informative as well. But I totally agree that moving joints, I found when I started doing joint mobilization work that uh conditions that would take me maybe four to six sessions to really see significant significant improvement with, I would actually be seeing in one session. So I mean, talk about shortcutting the treatment time, it's unbelievable. And sometimes people think then, oh, I'll be less busy. Is that not a financial disadvantage? Quite the opposite, because you successfully treat somebody, they'll send in everybody they know. And I've tended to, I don't do as much clinic work now, but I used to be booked out six months ahead of time. So doing really effective work is not a bad thing.

SPEAKER_02

No, no, exactly. That's that's yeah, I get that. Um, so tell me about your college, your virtual classes, too. The the CMT?

SPEAKER_00

What's yeah. So we're doing these kind of every two months. Yeah, we're we're picking different subjects for these CMT classes, and invariably what we'll do, people can go onto our website, it's hcd.ie, and if they go to the cmt classes, they can oftentimes watch the we do like or go onto our Facebook page either. You'll see there's like a four or five-minute anatomy review that we do. So it's a good way of kind of getting yourself interested in is this something I want to do? Um, and then in the live class, we actually will broadcast. I've actually been talking to a couple of people in Australia, so we're looking at maybe doing one that will suit Australian time zones. Might start doing that in uh the early 2022. Um, but at the moment, what we're doing is they're usually evening time here in Ireland, so that's gonna be very early morning for the Australian audience. Um, but it's a live class. We do about an hour, hour and 15 minutes. We go through that process of uh an overview, checking and talking about what the condition is, um, and then we do the anatomy review live, and then we do assessment, treatment, and home retraining. But then we always allow a little bit of time for live QA as well. And you get access to that recording if you sign up for the module, they're 50 euro. I'm not sure what that is in dollars. Um, but when you sign up for the module, you actually get lifetime access to the recording afterwards. So you can go back. This is the thing of like building up a reference library that we were talking about.

SPEAKER_02

Yeah, excellent, excellent. Because we've got therapists out here of just looking at Tracy going, yes, all those all nighters are a killer, and uh they are like the time zones. We're trying to work out how I can make this work. So we've got 5 a.m. for uh the eastern eastern like Florida, um, 8 p.m. here for me, 10 a.m. there for you. But yeah, that's right, you do an hour, but if you've got three hours or whatever, it it is a bit of a killer.

SPEAKER_00

So that's yeah, we're that's why I like those being really kind of condensed, concise, just giving you what you need as a therapist. You know, I think as therapists we tend to be kind of technique junkies, so it is like here's what to do, start to finish, just for this thing. And it simplifies things because otherwise, when you go, there's so many things it can be with the knee, there's so many this it can be with the wrist, there's so many things in the ankle, and you go, Well, here's one of them. Let's let's take an in-depth look at that on its own. And people will even see the commonality. I mean, two of the ones we've done so far was uh taller dysfunction and plantar fasciitis. And the treatment you're going to do for the lower leg is pretty similar, but then there's the specifics for that condition, assessing that condition, recognizing if the person does have it, recommending the home care, all that kind of stuff. It just gives you that, like I said, tight focus, something you can really have a bite-sized piece of information that's really digestible that you can then take to clinic and use with your clients.

SPEAKER_02

Now, are these library like if it if I've got a couple of patients have come to see me and they've both got something that's going on that I'm recognizing it's probably Taylor related. Can I go into the HCD uh web space and go this one on and then buy that?

SPEAKER_00

Yes, yeah. So you'll see on our homepage when you go to HCD.ie, you'll see um plantar fasciitis and taller dysfunction are still up. The essential eight is there as well. So that kind of covers, like I said, my top muscles in each area of the body. There's the lower leg, there's pelvis, there's low back, and then there's neck and shoulder. So it kind of covers a lot of the the um the general kind of things, the the things that people are gonna see most frequently in clinic. But then the CMT classes are more specializing on each area. We're looking at in January, we're either gonna do the wrist or the neck. We haven't quite decided. So we're gonna do one or other of those in January, so you can tune in for those. But yeah, you can go back and you can buy those past modules as well, which is a nice way of accessing those.

SPEAKER_02

Well, it's a great way to access because I mean sometimes it's it's one of those things we go, well, heck, how am I gonna do this? And people that are listening to this, then you can go, well, all right, well, I've got someone who's got you know securely I just say, and then kind of flicker back in and go look through the library and go, yes, there's something now. I know what to do about it. And yeah, it's because we don't have our access to the college as much as we used to. We don't we can't kind of rip in and have a chat to our teacher anymore and say, Listen, can you show me this technique?

SPEAKER_00

Yes, absolutely. Um, and we are we have some free articles on the website as well. Um, I mentioned about writing an article for uh MMA's magazine um on the knee, but we have one on subachromial impingement because I've got a quite interesting take on subachromial impingement. I'm just looking, how do I post something in comments?

SPEAKER_02

And we've got uh I think you put it into the private chat and they can pop it into comments. Ah, okay. Yes, and I was looking at that talking about um uh subacromial impingement and like what because you said there's a few little bits of pieces. I thought, ooh.

SPEAKER_00

Yeah. So we've got a we've got a free article that's got three short videos embedded in it as well. So that's on our website. I've just posted a link there into the private chat. So I'm presuming one of the guys will pop that into the the public. Um and that article talks about my take on what is the biggest cause of shoulder pain. Any guesses, Paul? What do you think? Biggest cause of shoulder pain? I would say possibly so oh oh um well, I would I'd see most people are gonna go for superspirnatus, right?

SPEAKER_02

I'll probably go into subscopularis.

SPEAKER_00

I would have thought that as well, but actually bicep. Yeah, bicep is the big cause of shoulder pain because what it does is when we get fascial adhesion at the distal end, when we go to straighten out our elbow, it actually acts like a sling, it drives the humeral head up. So it reduces the space between the humeral head and the acromion. This is what this whole article is about, but it also talks about how to test for it to see is that what the person has. Then we talk about a little bit of treatment. That's only because it's an article, there's only a little bit on treatment, but it suggests some treatment for bicep. Uh, and then there is uh homery training as well. So when the humeral head gets driven up, it does affect all of the rotator cuff muscles. It particularly has a tendency to pinch the tendon of supersprinatus. And unfortunately, supersprinalis gets blamed for it, and super's like, it wasn't me, because its tendon is getting pinched. We can get subachromial brusitis, we can get all kinds of limitation in pain. And what drew my attention to this first was people benching tend to get this a lot, and you're going, well, you're not really using supersprinalis when you bench, but it's this overdevelopment of bicep really drives the humeral head up. And then, of course, if we're overworking the pecs, we get this forward shoulder, uh, the shifting in the angles of the scapula, the change position of the glenohumeral joint, all those kind of things contribute. But bicep is actually the biggest driver that I found when I started treating bicep, I was getting phenomenally better results with treating shoulder pain, regardless of which other muscles were involved. Treating bicep allowed me to drop the humeral head, which helps to normalize tone in all the other muscles. I would still treat subscapularis. I love doing pain-free subscap work.

SPEAKER_03

Me too. Me too.

SPEAKER_00

That is phenomenal. I mean, you've had this experience with clients that get off the table and they're like, oh my god, that's amazing. They feel like their arm is just going to float away like somebody's tied a balloon to it.

SPEAKER_02

Yeah, yeah. And I've noticed a couple of times you've gone, and for people watching this, if they're thinking that I'm actually ignoring um uh or it's because that it's non-mirror image. So when I'm I'm actually looking at him here, which means I think I'm looking away. So I'm not being rude to everybody, it's just that's the way it works. But I have noticed that I'll be using this arm, I have noticed that you've been doing some myfascial glides at the biceps at that distal end, and and absolutely we've been doing uh find great results, and also looking at doing uh low load muscle activation at the the two ends of the um of the subscap just to try to encourage because as you said, inhibited not not probably doing its its job independently.

SPEAKER_00

So yeah, well those kind of low load ones are really interesting because it's oftentimes um stimulating the GTO, the goggai tendon organs, and that's been shown to have quite an effect on resetting muscle tone, not just in the target muscle, but in the surrounding musculature as well. So, even like muscles like levator scapula, that you know, in the early days of my training, I used to spend a lot of time, you know, frictioning this terrible levator scapula, and then realized oh, if you actually bring the shoulders back into a good position, levator's okay. And then you do a simple GTO release and it alters tone on all of the muscles that attach to the scapula. It's phenomenal. You can completely change tone. And people will talk about oh, if this terrible knot at one time is like El Diablo, you know, this was this was the one that was killing them, and then you go, bring the shoulders back, and you go now feel it. Oh, it's kind of gone.

SPEAKER_02

Yeah, yeah. What what pain? Yeah, where's it gone?

SPEAKER_00

I know that's those light bulb moments of of treating that's not a particularly complex condition, but it is in terms of the fact that in the early stages of of your practice as a therapist, you tend to go where the pain is, and you'll treat levator and treat levator, and it keeps coming back, it keeps being painful. And you're going, it's because it's under so much tensile load, rubbing it is only a short-term solution. The long-term solution is balancing out the muscles so the scapula sits better, and there isn't that tensile load on levator, then it gets better.

SPEAKER_02

Yep, exactly. So Libby's just put a little thing saying uh GTO release. She's wanting to see that goggy tendon organ release to find out.

SPEAKER_00

Okay, so uh her to demonstrate this position with me. I would only does she she want it, but she wants the particular target monster. She wants a demonstration of it. Okay, so I would have the client sideline on the table with the shoulder that I'm going to treat up, like towards the ceiling. You put your fingers kind of along the uh out on the acromion, the other one on almost like the inferior angle, and then your two thumbs are right on the attachment of levator. So from the root of the spine of the scapula to the superior angle, you're covering that entire attachment. The client then shrugs the shoulder, they pull up, and really for an effective GTO release, you want to be right on the tendon. So you're adding pressure to the tensile load, that mild load that Paula was talking about. So when they gently shrug their shoulder, you're pressing on the tendon. They do that for maybe five seconds, doesn't even have to be as long as an MET. When they relax, the shoulder will drop a little bit more. They contract again for five seconds and relax, contract, relax, contract, relax. And then you'll find that if you have treated, say, the pectoral muscles, you've treated bicep, you've allowed these muscles to come back, you've maybe done a bit of spindle stem work on the rhomboids and lower traps and mid-traps. When you do that GTO release on levator, the shoulders just sit really well. You don't have to do any friction. You don't, I don't do any other treatment on levator because I think of it as being the victim in the scenario, it's not the cause. If you treat the other muscles, pressure comes off this, and the GTO release is just kind of the final step to normalize tone within levator.

SPEAKER_02

Yeah, well. And and victim is absolutely right. There's a few victim muscles out there that that uh we tend to abuse.

SPEAKER_00

So we we get in and beat up them, they're like, hey, I was trying to do my job. I'm the one that's being tortured here. Yeah, I know.

SPEAKER_02

It's like people going up and down and up and down along the the spine of like the erectus spinae thoracically, and and all they're doing is is rubbing straight over nerve plexus.

unknown

Yeah.

SPEAKER_02

Oh, it's it here, get harder, get harder.

SPEAKER_00

Or even sometimes the rib heads, people go, Oh, there's a really hard knot here, and you're going, That's a rib head. You're trying to break down bone. Not a good idea.

SPEAKER_02

No, no, no, exactly. Talk to John Sharkey about that. That's his bet. Well, um, it's been an absolute pleasure. I can't believe the hour has just flown by. Is there anything else that we can we we know that the therapist can jump in and we've got the hcd.ie and follow holistic college Dublin on Facebook. So we've got those links in there. We've also got a link down here that they had with regards to where'd it go? It went the subacromial impingement. So they should be able to link into that.

SPEAKER_03

Yeah.

SPEAKER_02

And in a perfect world, people that want to get courses, virtual courses, uh from for Christmas presents, they can go on. In fact, people that you love, they can come in there and get the Christmas gifts of your courses.

SPEAKER_00

Absolutely. And like those those micro modules and the uh the CTM modules, like I said, when you purchase those, you have access for life. It's different with some of our virtual seminars because we have intellectual property rights and stuff like that. If you sign up for one of our Myoschatical seminars, actually, we have one coming up in January. Uh Whitney Lowe is going to be our special guest, actually. I know you talked to Whitney recently. You had a great interview with him. Uh Whitney's going to be our special guest. If you sign up for that, you can join us live for the three days in January. I think it's the Friday, Saturday, Sunday. I think it's the 16th, 17th, 18th, something like that. It's on the website. Uh, but you get access to the recordings for three months afterwards as well.

unknown

Yeah.

SPEAKER_00

So those are those are more kind of limited, whereas the other ones you get lifetime access.

SPEAKER_03

Yeah.

SPEAKER_02

Tracy's asking, are you still planning to come to Australia in May? We're hoping so.

SPEAKER_00

I am. Yes, yes. That is the plan. We'll have to see because I don't think Australia has yet opened up its international borders. I think it's due to at the end of the year or something was the original.

SPEAKER_02

We were supposed to until Omicron uh reared its ugly head.

SPEAKER_00

Yeah, actually, just read something this morning and they were saying that uh the WHO and one of the I think it was the American one of those uh uh authorities, CDC or something, were saying that they've just they've uh investigated and they said Omicron isn't any more dangerous. So it's just a variant, it's not any worse. They they feared that it was gonna be much more severe or much more contagious, and they're saying it's it's actually not any different. So good news, hopefully, there.

SPEAKER_02

Yeah, well, I was actually hoping if I was gonna get like we're all gonna get the virus at some stage and multiple times because it just it is as it is. But I thought if I have that Omicron, because I wouldn't mind a bit of fatigue for a day, because that apparently is about it, and maybe that will um build up my natural resistance to some of the other nasties.

SPEAKER_00

Yes, yes.

SPEAKER_02

So yeah, the plan is maybe let everyone put out their their their hands on all you Aussies that are there going with we want we really want Aubrey to come back in, get to Australia versus doing a virtual. If it's not 22, maybe 23. I'm planning to get to Costa Rica with Libby in um in 2023. We're gonna meet there and and have a great time. Hopefully, Eric might ask me to do some presenting, and that will um help me on my on my journey to learn and catch up with everybody.

SPEAKER_03

Excellent.

SPEAKER_02

And thank you everybody who's made comments. Um it's been it's always helpful and engaging to get comments, and uh this will be out on um all of our our Facebook pages accessible for um I don't know a month or so, and then then it'll go, it'll be buried into the dust where all the other they all go otherwise. But thank you again, Aubrey. It's been amazing. I'll let you go out into the sunshine.

SPEAKER_00

Oh, it's pretty stormy here at the moment, pretty wintry. Yeah. The vague bit of tan I have is from Costa Rica. I you can't even see it in this light, but people were commenting in class, so there's a supposedly a bit of tan there. But yeah, I want to say a big thank you to you, Paula, for having me on, and thanks to everybody for joining us. Hopefully, you found that interesting. So hopefully we'll talk to you soon and hopefully be on the Australia.

SPEAKER_02

Thanks everybody, and hopefully, we'll catch up with you soon. Bye everyone.