EP 6 | Can Exercise Replace Hands-On Therapy? | Daniel Lawrence

As healthcare and rehabilitation continue to evolve, where does hands-on therapy fit in? In this thought-provoking episode, Paula Nutting sits down with UK-based physiotherapist Daniel Lawrence to explore the changing landscape of rehabilitation, movement therapy, and patient care.

Drawing from nearly two decades of clinical experience, Daniel shares insights into the ongoing shifts happening within musculoskeletal healthcare and discusses the growing conversations surrounding exercise-based rehabilitation versus hands-on treatment approaches.

Together, Paula and Daniel unpack the differences in healthcare models across countries, the influence of research and social media on treatment trends, and the ongoing debate between manual therapy and exercise-focused interventions. Rather than creating an “either-or” mindset, this conversation explores how different therapeutic approaches can work together to create better outcomes for clients and patients.

This episode offers valuable insights for massage therapists, physiotherapists, bodyworkers, rehabilitation professionals, and anyone interested in the future of movement, therapy, and evidence-informed practice.

In this episode:
• The changing landscape of modern rehabilitation
• Hands-on therapy versus exercise-based approaches
• How healthcare systems influence treatment styles
• Differences between UK, Australian, and US rehabilitation models
• Research, evidence, and clinical practice discussions
• The impact of social media on therapy trends
• Why professional divides can limit treatment outcomes
• Integrating movement and manual therapy approaches
• Clinical reasoning and adapting to changing healthcare environments
• Finding balance in evidence-informed practice

Timeline Highlights
00:22 – Paula introduces Daniel Lawrence and modern rehabilitation approaches.
04:03 – Daniel shares his 20-year journey in physiotherapy.
06:28 – Discussion around manual therapy versus exercise rehabilitation.
09:22 – Exploring fascia and emerging research in movement science.
11:27 – Why treating only one system can limit outcomes.
13:43 – Different treatment approaches can still achieve similar results.
24:18 – Pain, rehabilitation, and person-centered treatment approaches.
37:12 – Tendon rehabilitation and managing loading strategies.
54:39 – How massage and hands-on work support tendon recovery.
57:07 – Daniel shares advice for therapists creating YouTube content.
01:02:11 – Books, education, and resources for therapists wanting to learn more.

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Connect with Daniel Lawrence:
🌐 RockTape UK: https://rocktape.co.uk/
📘 Facebook: https://www.facebook.com/RocktapeUK/#
𝕏/Twitter: https://x.com/rocktapeuk
📸 Instagram: https://www.instagram.com/rocktape_uk/
🎥 The Physio Channel: https://www.youtube.com/@ThePhysioChannel
🔗 Daniel's Links & Resources: https://linktr.ee/thephysiochannel
🎓 FREE Online Courses: https://lawrenceacademy.mykajabi.com
📚 Published Books: https://t.ly/dGLvT

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.

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Transcript

0:21

Good morning, good evening, good afternoon, depending on where you are on this beautiful planet. It's Paula Nutting here, your musculoscribal specialist, and today's Ask Me Anything, I've gone back over to the UK again and have the opportunity to talk to someone who has been involved in more the rehab kind of side of things. We're looking at kinesiology or kinesiotaping, um exercise physiology, rock tape, um, things to get our our our clients and our patients not so much, maybe as much hands-on during the clinic, but some awesome things to do when they have left the clinic. So without further ado, I'm going to get Daniel Lawrence, who is going to come on board for me with me for the hour. Hey Dan, join us when you can. Hi, Paula, thank you very much for inviting me. Yeah, I'm looking forward to having a chat. Um so yeah, thank you very much. Excellent, excellent. So a couple of housekeeping things, two things. One, this hey, Libby Jones O'Flarity, she's she's from Ireland, so she's one of the people who actually know how to get onto StreamYard. Um, if you are new to the streaming service that we've got going on here, it's not or in uh new to the ask me anything, it's about ask me anything. Like the the the verb here is ask. So if you want to be able to have questions answered from uh Dan or myself, but mainly Dan, um please type them in the text box. We'll address them as we can. So be vocal, ask loads of things because we can answer them in the next between 45 and 60 minutes. Um sometimes we get a little bit long, as Livy knows. We can have some crazy stuff, aka John Sharkey who doesn't know how to stop a conversation. Um secondly, I just want to do a quick plug to Q Academy and all of the staff, the campuses, the online training, the face-to-face um courses, and the the combinations of online and face-to-face component. Q Academy is a Queensland-based um education facility. It focuses on um what used to be CERT 4s, now they've kind of been embedded into the diplomas and our um advanced diploma of um Maya therapy. So if you're interested in changing your career path from something that you have been doing to something that you probably think that you would like to learn a bit more on. So you might be listening here as a Pilates instructor or a yoga teacher or uh someone who's who's done their spa training and you want more information, go to these guys. They do accelerated learning techniques. Every moment of your uh educational experience will be fun and full of laughter because we all know that's how we learn and absorb best. So um contact Q Academy for all your educational needs in this environment. So there's the plug back to Dan. Dan, please, I don't know much about you aside from the fact that when I was talking to Emma Holly last month, she said, you have got to contact Daniel because he is the duck's guts. So give us the Daniel Lawrence story. Well, on the one hand, I'm thankful to Emma Holly for putting me forward. Um, but it sounds like she may have put me uh on a on a high butt on a high pedestal. Um but uh it's uh very kind. So uh yes, well, um I'm I'm a UK-based physiotherapist. This year I would have been qualified for 20 years, which is an interesting amount of time because uh you you can do a lot of reflection on the past 20 years and things you've seen and things that you are experiencing and witnessing in the in the in the profession and the therapeutic industries at large, um, and the changes that uh that are coming through. And sometimes you see things you know um coming round again, but with different names and different labels. And I always remember uh my senior colleagues saying to me, Oh, we've seen this before, this you know, just a different name and a different um you know, different marketing, etc. Um, and I you know I'm I'm witnessing witnessing that my myself as well. I think there's always changes in healthcare, more specifically in musculoskeletal healthcare. And I think it's always interesting to see those changes come in and um and and discuss them um and you know uh talk them through with with other professionals such as yourself, uh, because the the the the range of opinions are always very interesting. Sure are. Um tell me, because there's a there's a Australian physiotherapists have a different mindset to the massage industry than from what I gather America, and I'm gonna ask you what is it like with the uh UK? They look at a lot of the stuff that we do as in hands-on soft tissue manipulation, whatever you want to call it, like touch, as um having no credibility because there's no research that says that it actually works. Is that the same as the UK? Yeah, that's very interesting. You mentioned the the Australia and America and the UK there, and I think there's definitely significant differences with the way that a physiotherapist or physical therapist in America would would work. And um I think as you've already uh highlighted, it's it's a kind of professional and cultural thing, but I think it's also due to the way that healthcare is funded differently in in those three countries, perhaps the UK and Australia being more closely aligned, and America having much more of a private healthcare model. Many of my colleagues through my work with Rocktape are in America, so I've I've heard a lot about the way the American healthcare system works. Yeah, so yeah, there's there's key differences. Like even within the countries though, so here within the UK, for a long time there has been a camp of um uh exercise rehabilitators, um, and a camp of say manual therapists, perhaps including massage therapists, but also physiotherapists and osteopaths and chiropractors, for example. So um, there's there's often been a um sometimes an unnecessary divide between manual therapy versus exercise rehabilitation, and uh I think social media has certainly um strengthened that and perpetuated that that divide. Uh, but it's always an interesting debate. So if there's anything in particular you wanted to to discuss within that, then then that would be uh perhaps an interesting place to start. I find that it's um just from my experience, um looking at places like the Fascial Hub, which is your the UK, uh the amount of of research that they're dropping into there and and fantastic speakers, yeah, especially in the in the area of Maya Fascia and the fascial uh systems and um moving from there to fluid how how's the lymph and you know what's going on from there. So it's it started to get hard research with ultrasounds on real-time ultrasounds on you know a technique versus how the fascia was before and after, the hyaluronin um mobility flexibility. But when we start mixing how does fluid affect or how does lymph affect fascia, then we're putting two systems in, then we lose the research model again. Yes, I I I I I find uh fascia fascinating. I've been involved with um the the sort of fascial movement here in the UK. I had the uh honour of speaking at a UK fascial conference a few years ago, and um uh I was on the stage before uh or just after Robert Schleip, which was uh which was fantastic. Um he's he's a very fascinating guy and a great great speaker. Uh and also my work with um with with rock tape has has involved a good understanding of of fascia uh as well. And you mentioned the different systems there, which is really interesting, Paula, because I think um that uh one of the issues that I've seen over the last 20 years is people get too wedded and embedded in different systems, yeah uh, and um think that all of the issues with an individual's health are to do with a particular system, and sometimes that's because there's uh certain research is popular at the time, or there's uh uh a move to talk more about particular systems, but the fascial system, the neurological system. I think at the moment we're becoming much more aware of uh say psychology and behavior and behavior change, which I think is very, very interesting. So there are definitely popular themes within understanding and within the within the research. I always remember meeting a particular lady at the fascial conference who said that she only treats fascia, nothing else. Yeah, I'm glad that landed well with you. Um, because to me it just seemed a bit a bit bit bizarre because when you treat somebody, you know, whether you know it or not, you're treating all of the systems. Um, even if you do not speak to the person, you're still you're still changing their psychology and probably bringing about some behavioral change, even if you do not have a conversation with them. Um just the very fact they're spending time with you in a in a therapeutic sense is is gonna have an element of psychology, uh, not to mention you know neurology and uh the the changes to cellular metabolism and all of these things which occur with either hands-on therapy, massage, um, or or or or exercise therapy. I I really don't think we need hard lines between those those two things. I'm glad I'm so glad to hear that because I think that that's the that the model that we need to be looking at is person-centered approaches and whatever that's going to look like to the benefit of that that that individual because you can be two people come in with the same shoulder pathology, the same symptoms, the same injury, like the ultrasounds the same, blah blah blah. You can do the same technique on both people and have different outcomes. So exactly the same. And how many times do we hear just to um expand on that? Uh sorry, I was thinking about something else that I wanted to mention. Uh, I have a habit of drifting off. Uh, it's not the Wi-Fi, it's my brain. Um so where were we? Uh yes, you were saying that you can do the same treatment and get different outcomes, but and and absolutely, I'd also say that you can do different treatments and get the same outcome because we we um I I think you and I probably meet a lot of other therapists through through our educational work, yeah, and um I'm quite certain that I could meet many people that treat in different ways, maybe from different professions, and they still all have happy patients that are that are pleased with the results and they're helping people, but they're all doing different things. Um, so perhaps the question is what's the key um key ingredient which is providing the good outcomes? And I have an idea what that might be, but be interested to know what you think. Well, I I you know how many times do you hear someone who books in to see you, and then when they arrive, they go, It's been terrible. And I woke up this morning and I knew I was coming to see you, and it's gone. Yeah, well, then there's your placebo. And placebo is not a dirty word. You talk to Whitney Lowe, and we had a big conversation on paint, and there Livvy's going, the biopsychosocial model. Um, and that's it, it's it's how we ultimately start our own healing journey when um we go, I feel confident, I'm gonna see Daniel. What's the first thing that happens? We drop our inflammatory markers, our stress levels drop down, we start producing that the serotonins and the you know, all the all the things that are actually going to help our own healing process before we've actually come into your room. And then trust. So there's for me, I think that the more you can get rid of inflammation, the greater opportunity you'll ever have to get better outcomes. Yes, yeah, very much so. Uh, I'm very much aligned with with what you what you said there. So just wondering what I can uh add to that. And I think um possibly, I mean, firstly, it's very hard to separate the placebo from any active component of treatment. Research always tries to do that, um, but it's very very difficult to do that. Uh the surgical research is fascinating where they use sham surgery, uh, pretend fake surgery, so that the individual goes through the surgical procedure and maybe even has um an investigative procedure, so they still you know anaesthetized and have a scar to show and so on. Uh, and when they compare the two groups that actually had a surgical intervention and the group that just had um uh a surgical exploration, so no intervention, then the two groups in in many cases in the musculoskeletal world have the same outcomes. And and I think that research is very powerful because therefore surgery is the biggest placebo, and there's a fascinating, fascinating book that I read. You've probably seen it. Um, I think it's by Ian Harris, and it's about surgery and the placebo effect, and it talks about and presents the the research there, um, which is and and let's not talk about the ethical ramifications of that, yeah, right. Yeah, yeah, of course. And this is off point as well, but again, it's that um I've got back pain, therefore I must have a problem with my like, oh, I've got disc problem, oh I've got degeneration, oh it's back pain, I'll never get better. They had um, I was listening to something on this topic last night because I have no life, and probably nor do you, Daniel. So I'm watching this thing, and and there was a study that took a hundred people with no back pain, healthy from the age of 80 onwards, and they did MRIs on all of them, and over 90 percent had either spurs, significant degeneration, andor discal compromise. So that's fascinating, yeah. Uh I uh I wonder then if um if I can uh mention my YouTube work here because that ties into what you've just said. So my YouTube channel is called the Physio channel, and there's videos on there for uh professionals and for patients, and I um wanted to mention a couple of things. Firstly, the placebo effect, because one of if I was ever to persuade people to start a YouTube channel as a as a as a health practitioner, so to be a health creator, I would highly recommend it because one thing that it does is it allows people to get to know you, it builds trust, and it's a very easy way for people to uh make contact with you, you know, without your actual live involvement, so that they can start to understand how you work uh and be be confident in contacting you and speaking to you, because uh word of mouth, of course, is is very big in our profession, but sometimes people want to do some research and see, you know, where where is where is Paula based and what does she treat? And are there some Google reviews? But if they can go on to watch some of these uh uh podcasts, for example, then they can you know they can listen to you and they can get to know you and they can feel more confident. So I had uh I made a video on um uh uh bicep tendinopathy, and uh many people have watched it, but I had one chap contact me and travel uh a few hours to come and see me, which is quite rare in the first case. But when he came, when he got here to see me, um he uh he knew me. Oh, hello, hello Daniel, nice, nice to see you. And he was already very, very confident and very pleased, and he knew me because he'd spent time uh watching at least this particular video and uh possibly some some other videos, and it was quite strange because normally, which the positive in a positive way, by the way, normally when we meet a patient for the first time, we're the ones that are confident because we know what we're doing, we know why they're there, it's our clinic and it's comfortable, but they're usually nervous because they haven't met us before, they're not sure what to expect, um, and and they're the ones that are sort of you know a little bit uncomfortable, and we need to break the ice and build rapport. But this is almost the other way around. Um, he was he knew me, but I didn't know him, uh, which was um which was bizarre. But then that links into the placebo effect because he'd already been to see lots of people I consider to be quite specialists and experts in the in the area in the in the shoulder area. And I did say to him before he came, you know, I I you've seen some really good people, and I'm not sure if I can help, but if I can, then I'll probably be looking at this and trying this and doing this. So he still came to see me, despite the fact that I said, I'm not sure if I can help you because you've already seen some brilliant people. Um, and he still wanted to come and see me based on his time watching the video, and he was very confident in my ability, and that I'm pretty sure that was a very powerful placebo effect, and he came to see me with high expectations. And I think one way of describing the placebo is a positive outcome expectation. Yeah, and if if ever your your patients can have a positive outcome expectation, then um I think that's a very powerful part of the placebo effect, as is the relationship with the practitioner. Uh, I believe that of all the different things that we might do and that different professionals might do, the reason that we might be arriving at the same result of uh you know a happy and a satisfied recovering patient is probably the um the empathy and the relationship with the patient. If that's strong, then I think there's a whole range of different things you could do to potentially arrive at the same uh the same uh the same result. And I made a video recently on on just what you were talking about there, which is uh the the misunderstanding and the misnomer of a slipped disc and the fact that that isn't that is not a thing, but of course people still think it is, uh, and it's it is a problem because if you think you've got a physical slipped thing in your spine, then it's gonna make your pain worse and you're gonna move less. And uh I looked in the in the in the video at some research, and it was very similar to what you mentioned about disc bulges being um common, especially in the latter decades of life, and often not being related to back pain. So you can have many people with a disc bulge that don't have symptoms, they're asymptomatic. So, although a disc bulge could be a cause of pain, it's a rather unreliable um marker of the problem. Yes, I agree. Uh it's but it is quite easy to actually well, it's not quite easy, but you can always do specific orthopedic tests to wind that bad boy up and upset it to create the symptom picture, um, which we probably don't really like to do, nor do we like to do surgery without actually doing anything and thinking that that's. ethically fine. Um yeah, absolutely. Whine that bad boy and upset it. That sounds like a an Australian originated test. Yes. What sort of tests what sort of tests would you do there out of interest? Just um well all the val salv like the val salva automatically to see if there's any compression in there. Anything that's going to increase your intra-abdominal um uh like you can do all your your straight legs and your all of that you know the the whole neural but it still doesn't really capture like it it's capturing nerves it's not necessarily capturing disc. One of the big things I normally say to my patients who I see um and I don't do a lot of like I don't do hospital from where where I sit in in my industry I would get a degree in health science musculospetal so I'm kind of like getting a massage therapist an osteopath and a physio and putting them all together that's kind of what my three year learning educational pathway took for me so I'm not at that acute stage um there's um I'm trying to think where I was going with this the um where was I going on a rant then it's very sorry I think I talked I talked for too long and probably threw threw you off. We were talking about discs and I just asked you about the tests and um we talked about placebo. We when we were here like when we went through our degree we'd be doing uh tests say say the mcmurrays you know at Lotland's and checking say knee pathologies and and they said really like really really go hard on those orthopedic tests because when the surgeons do it they actually do it to see if they can snap so then they just go right we've it's we've we've snapped that we've torn that ligament or it was disrupted it and it's evolved or whatever so we are going to do the surgery. It's not like this this gentle are you getting uh are we getting a touch of that so let's back off I don't actually do the hard rapid moves because I just think that like there's patient care and then they don't come see you because you've created a nocebo and that's the last thing that we need. Yes. I'm gonna I'm gonna throw down to find out some stuff about you YouTube channel because I'm seeing the physio channel coming through here but talk to me because um your main passion I think it looks like it's kinesiotaping is that like that's yes I I have many uh passions in in in physiotherapy and I um I'm always probably like yourself always learning and and want to explore new new areas so I'm trying to learn yoga at the moment but uh we can't talk too much about that because my efforts have not been too impressive but um but prior to that uh some Pilates and and you know before that various other things uh including um topics around the the books that I've um published over over the years. Oh you should have published as well in in rock tape so uh yes my my first book so I will get to the question about taping but my first book was on on on tendinopathy lower limb tendinopathy uh the the um four main lower limb tendinopathies and then uh expanded it to seven with an online course so tendinopathy was perhaps my first uh passion and then uh I published a book on the modern use of clinical cupping which sits alongside a course that I teach which links to my work with rock tape because we have a product called rock pods which are myofascial decompression cups and then a book on exercise for pain relief which is an exploration of how exercise reduces pain the different mechanisms and what to do when it doesn't work because exercise rehabilitation for pain relief um doesn't work as well as we we would like it to so we look I looked at why how it works and um why it might not work and what what can be done about it. So that's very much I'm gonna jump into that one component there because my my thing is all about muscle firing sequences working to stabilize a joint that will stabilize a region. Do you find that like is that for me if an exercise doesn't work it's because muscles the are not like the patient hasn't got the neurological pathway to create the exercise pattern that you want them to do. Yes there's many reasons and that's certainly a a key reason absolutely Paula but I wonder about your question was when exercise doesn't work I would ask what we mean by that like what do we mean by exercise doesn't work um I would perhaps suggest it doesn't work as in it's not reducing the pain because that's often what what what patients would um would report is is you know my knee still hurts so therefore the exercise isn't working and the fact that you've measured better muscle function um might not be of any interest to them because you know their knees still hurts so even if they're stronger they would be somewhat dissatisfied with the exercises if if they were still in some uh some discomfort um so yeah I mean in in the in the book it was fascinating to look into how exercise works because I I really don't think and this is in in rehabilitation not in performance I really don't think that exercises work by strengthening the joint um sorry strengthening the muscles and supporting the joint that's a very simplistic way of explaining it to patients and they can understand that but I think it works um in many other ways and one key way is is is is descending inhibition and those natural pain relieving chemicals being released by the brain uh off the back of of doing exercise so therefore it's not about the specific exercise um any form of exercise that that that increases the blood pressure in a way that stimulates that descending inhibition can lead to pain relief um throughout the body and particularly at a joint um but that doesn't always work and we know for a long time but it's sort of emerging now into into more general knowledge that that the the evidence base points towards exercise rehabilitation so like the UK physios are perhaps known for in the in the hospital setting hands off exercise rehabilitation is evidence based yes it's evidence based but as far as patients can't concern it's still not good enough and it often doesn't provide satisfactory uh outcomes it's not the panacea that we thought it was and I was looking at some research just yesterday um to do with the reduction of knee pain so is a is a good study there's a group of patients and um two groups one group did exercise for their knee pain the other group did not do exercise for their knee pain and the passage of time went by a number of weeks and uh the non-exercise group had a six percent reduction in pain just probably just because of the passage of time and the exercise group had a reduction of pain of 24% so like if you you think brilliant so doing the exercise 24% that's hugely improved compared to the six percent so obviously you'd want to do the exercise now they did that exercise for like quite a number of weeks I can't quite recall but let's say like six to eight weeks it was quite an extensive length of time so we know what it's like for patients to do their exercises for six to eight weeks it's quite they're not required none of us are no but let's just say they did and they were diligent they had a 24% reduction in pain would you be satisfied as a patient with only a 24% reduction in pain that's not quite 25% of I'm not loving you right now. Why am I spending money why am I losing my time and I'm getting a better result? Yeah it's usually better than 6% so from a research point of view it's great but if we talk about expectations again if the patients have an expectation of uh being I don't know pain free and that's an issue in itself because that might not be a reasonable expectation and they only get a 24% reduction um yeah I think there's there's still a lot of dissatisfaction there. So what the research says versus the reality of patient expectations are often quite quite sort of um very very uh separate and and challenging. No sorry you asked about taping so taping I'm wondering if that drops into there then like you increase it as I said because you're actually supporting yes so um taping's been a big part of my uh career I'm the education director for uh for a company called IMPLUS but my focus within that is on the brand rock tape and I've been involved with taping for all of my career but particularly with rock tape for around 14 to 15 years and it's been fascinating to see the uh the emergence of of of kinesiology taping um in the UK and uh we had um uh we have strong partners in in Australia too and and America uh it's been fascinating to see it's it's it evolve um over the years in terms of its usage by a broader range of professionals its usage on animals as well as humans and the emergence of a huge body of research is probably one of the most well researched um musculostic leak interventions out there it's um I agree there's a huge amount of research to lean on which is really interesting because although it's been around since the 1970s it's really only been popular since the um early 2000s in in in the in the West and around that time there wasn't that much proper research and uh we often would get people come up to us at um conferences and events and say where's the research and it would be like you know almost accusatory or you know you must present the research as well you know there is some research emerging and now nobody says that because there's a huge amount of research out there to lean on to talk about and to inform uh inform the use um of the of the tape some people wonder what the difference is by the way between rock tape and kinesio tape so rock tape is a brand of kinesiology tape it's well known for its quality and the fact that it sticks because um some tapes you know the adhesion is is not not so good um rock tape started because a a Californian a Californian entrepreneur Greg van derndrijes he used kinesio tape and he loved it but found that it wasn't quite durable enough for his um endurance sports for cycling at the time so he went to the company with a background in in health tech and uh offered to work with them and and and improve the product um that that never happened that never went anywhere perhaps even an email wasn't answered I don't know so he then um started his own company where he made tape which uh which was more um which was better for endurance athletes because it was a bit tougher a bit more elastic and and the glue was stronger and then that was the birth of um of rock tape but it's not used just in sport it's often associated with that but here in the UK one of our most popular courses is um for neurological physiotherapists who just work in in hospital healthcare settings and there's there's research for its use with um uh post-stroke shoulder uh hemiplegia uh Parkinson's disease cerebral palsy yeah there's great research around the the use of the tape there and there's sort of if someone's had a left sided stroke and they've got weakness on their right are they are they talking about taping to support the like run me through some run me through that Batman because that sounds like like really interesting like really really interesting of course so there's the different ways of looking at or um explaining or theorizing how how um taping can work and the mechanism of action that's talked about most with taping for neurological conditions is its influence on the nervous system. So when you apply tape in the first instance uh it stimulates the nervous system this the the it can boost proprioception the brain becomes more aware of that area because you've got a low level of light touch afforded by the application of the tape and then you've got the ability to manipulate those variables because the tape is elastic. So if you stretch the tape straight away it starts to contract and when it does that it pulls on the skin and it further stimulates the skin's mechanoreceptors which then heightens the stimulus and perhaps gives even more awareness of an area where the nervous system might be uh you know um uh reduced or or dulled or the sensitivity is reduced so you're boosting sensitivity in areas where it's been reduced and of course when you have better sensory input you have the ability to improve the motor output and motor control um and so on as well. Tape can also be used uh in in areas sorry just to finish that point um if there's areas of high tone because of course with with um neurological issues you can have areas of high tone then the tape can be used in um in different ways to try and reduce the muscle tone as well and as I say there's there's research uh where the tape's been used for in specific neurological conditions and scenarios and the um the the types of professionals that are doing the training are using the tape um you know they're very um evidence based professionals it's being done in the NHS and and that means it has to have not only an evidence base but it has to be proven to be useful and a good a good spend of the limited resources for for it to be uh you know credible um Libby's just asked a question with regards to the um accessibility for rock tape in the UK and and in Ireland can can you talk to her on that yes of course uh the accessibility to training to buy it or buy or or train uh yeah well okay we have the rocktape.co.uk website which is where most professionals would would um would buy their buy their tape and um if you sign up as well on the website you can get some professional discounts for buying the tape there's rock tape offices in in other countries too uh so in um we have a uh a a reseller in Ireland um she's in dublin yeah quite in dublin's seller's pub i I went to Dublin and I taught I can't recall that pub but I did go to a very um a very nice one but we have um yeah rock tape is sold there's a company in Dublin which sell rock tape so that would be the place to get it we have an issue it's I I believe that rock tape has taken off because A it started in America and B it went straight into the into the universities and taped footballers and swimmers and you know your athletes and and they have the you've got you know the the people who can fund or any research and anything over there. It's just automatically it's a steam train so um that's that's that's where I think that it if it hadn't been anywhere else it may not have had this impetus that it has had but it's really like it's really really gone um to an area that we can afford to get research and it's not saying that rock tape is the only stuff that that doesn't work it's just the one currently that we've got um the most research on yeah Diane okay so Diane said she did a rock tape tape course late last year I really enjoyed the benefits we had uh we had a guy Ron Alexander who used to teach functional facial taping with tape that wasn't we at that stage it wasn't elastic it was it was your old BDF tape or whatever they call it and he could pin and then just take tiny little bits of skin and then tape and like so it was just doing this creep and the creep was he was doing a lot of stuff uh for ballerina like for in for ballet classic dance made a huge huge difference yeah I I I'm aware of Ron Alexander um and have looked at some of his work and and techniques and you you're quite right. Yeah very good um very good techniques great for feet and smart with feet what we might do is we might jump over to a quick plug for the Q Academy and then uh come on back to more about the taping and then maybe some EP some exercise physiology yes yes absolutely be good to talk about the the exercise and and um how that could work fantastic back in a moment my name is Jane Afu I studied um I said for massage in 2014 and then went on to remedial in 2015. My was working in Essex I was retainable yeah born a jam the real reason why I went and studied was my my daughter was um she's been quite sick for about seven years on and off she's had a couple um chronic conditions so um I found it hard working in a job and then having to leave because my children are sick or I've gone to hospital or there's just so many things going on. For me I needed another option. I've been set up from about eight years now working from home having a home business has been like such a blessing to my life I I don't think I could have done what I've done somewhere else just with my own circumstances. My life's very busy I've got three kids um and this team has been a little bit different again because now I've got three kids playing sports every afternoon. So I do try if I can work in between school hours feel like you can make it work to your advantage so you can either work as hard as you want and be stressed and all the things or you can make it flexible. If you're just in Australia or even if you're in Southeast Asia or even over here because they do do online courses and they are amazing. I used to teach for them and Monday through Thursday we would um teach and then Friday we would learn the next curriculum and how to apply it in a neurolinguistic programming to like fun and brain breaks and everyone like you'd you'd see a class come out and they were all drawn on like they the full elementary system or you know whatever that it was just a fun fun place. That was a great advert and I I couldn't help notice the cupping um cupping marks on the on the client in that um so I wondered if uh if you wanted to talk at all about uh about cupping because that's that certainly kept me busy as an educator for for the last four or five years. You talked about uh what was it pop pop pod pod cups or something? Yeah so rock tape has the the tape and then we have the rock blades which are our metal massage tools and then we have rock pods and the pods are silicone uh cups silicone decompression cups new slide um yes yes there's different types there's the rock pods which uh are to fix on the skin and mobilize the soft tissue or to wear whilst you're doing stretches they're amazing they're fantastic if if people have not tried them I'd recommend it because it's such a unique feeling and patients clients tend to really benefit from it and and request it next time they come back. We have the rock pod glides which of course Paula as you say they they glide so that's what they're designed to do. And then we have the rock pod vibes which are rock pods that vibrate With a high frequency vibration, and the best place to use those is over the back of the pelvis, lower back or pelvis for any pain or discomfort around that area. They can work wonders for reducing pain. The methodology around there is working on the mechanoreceptors and the yes, it's just uh it's just the vibration, really. The high frequency vibration is um is is is analgesic, so it it immediately reduces pain and and reduces the sensation of stiffness, which then allows you to move and mobilize with a lot more comfort, and then that can lead to you know longer-term um positive outcomes because you're engaging in movement that you were previously um uh avoiding. So they're my favorite product. Okay, so I'm gonna go back to the young Daniel Lawrence who wrote his first book on lower limb tendinopathies. Um, how would you apply what you know now? Pick pick a tendinopathy, whether you're gonna like just pick one of the ones from the hips down, yeah. And talk me through how you would with the tools you know, the the tools that you have, how would you um how would you design a treatment program? Yes, of course. Uh well I might choose um uh the most common tendinopathy I I I used to think was was Achilles, but actually, according to the research, it's gluteal tendinopathy, which is sometimes called trochenteric bursitis. Um, to a patient it would be hip pain or hurts here, uh, but it's often confused with hip arthritis, um, or people compound it with potential hip arthritis, and of course, that makes them um a lot more fearful and a lot more worried about their prognosis and their outcome. So, yeah, um gluteal tendinopathies, lateral hip pain, it's usually quite easy to get on top of. Um, and the patient, however, is usually quite uh worried, anxious, and somewhat disabled by it. So there's very quick ways that you can uh identify what the issue is. The first thing is to move the hip in a in a testing procedure to see whether the hip is mobile and um identify where the pain is. So if the hip is mobile and still has a good range of motion, particularly up into flexion and some internal rotation, then it's most likely that it's not um an arthritic hip. So they're case yes, passive or active, but but passive. Um, the location of the pain, if they're getting the pain in the groin, it indicates it might be more jointy. But if the pain is on the lateral side, once again it's very unlikely that that's um osteoarthritic related pain, it's going to be the tendon. There's usually some things that they're doing which are aggravating the tendon, and they can be very subtle things, but not only are these important from experience, but they are specifically mentioned in the research as well. And one of them is standing and hanging on the hip, which is where you stand and yeah, take the weight, take the weight through one leg, particularly mothers holding a child on one hip and taking all the weight on that leg, it it bows the hip and it puts um passive strain down through the ITB, and that in itself causes compression against the lateral hip and can irritate the tendon. So that's one thing, and often with these things, the pain is not uh directly linked to the activity, so the pain might be more um less specific and quite diffuse and quite sort of random, but the activity is potentially aggravating it or even causing it. The other ones lying on their side at night, which can often be painful, and simply putting a pillow between the knees can make a huge difference, and you know, not everything needs to be complicated with what we do. Sometimes the simplest intervention in the right place at the right time can make a huge difference. So, stopping the aggravating factors is a key thing, and um uh the exercise for tendinopathies. I'm a firm believer in isometrics for tendinopathies for all tendinopathies, from the shoulder to the Achilles to the hip, the gluteal one we're talking about now. So all they need to do is lie on their back, knees up in kind of a Pilates pelvic tilt type position. One of us is frozen, strap of some sort and push their knees apart. I hope I'm still with you. Push their knees apart against the rigid against the rigid straps, so it's a it's a forced um uh abduction, but it's it's a it's stick because you're pushing against a resistance. Um, and to hold that for a duration of time, say 30 seconds, do that a few times. Um, and yeah, that removing the aggravating factors, adding in that simple exercise usually makes a big difference within within a couple of weeks. Do you find that they're more female than male with that lateral gluteal? Yes, like it would be female that I see uh versus uh there's there's yes, the research shows there's definitely a heavier weighting for it being more common for females, and I think that's probably a biomechanics thing. Um, but uh but yeah, of course, I still see it in in males um as well. But yeah. I was I was watching uh there was a um massage magazine or one of those JM JBMs, uh one of the courses, uh yeah, online information magazines, uh podcasts, and talking about the women that cross, like we historionically cross legs much more than men do. Like it's just us. Um, you know, we don't mansplain. Well, most of us don't. And I spend my whole time with cross legs, so I know it's like, oh, stop doing that. But talked about the what happens at the hip joint when you've got the piriformis that's continuously lengthened, and the psoas group that's continuously shortened, just sitting in in these fixed, you know, your antagonists and agonists are doing you're actually putting them into a constant mix match of what they should be doing. Um, and again, applying isometric, like getting them to be in supine with the the knee bent and dropped out, and just get them to like you put your palpation hand underneath the buttocks, hand on top of that where where you're actually feeling for the TFL, really, peripherous TFL area, and getting them to do an external rotation isometrically, and then an internal rotation isometrically, and get them to try to feel the connection at a deeper, like a much deeper level, and it's it really is talking to your patient about an awareness. And I remember doing a video for one of my courses, um, and I was I didn't prequel that to be anchored, I just said, okay, this is what I want you to do. What's your feedback? And it was almost like she'd watched that video. The words that came out of her mouth were it just feels like there's much more connection. I didn't really understand, it just feels like it's going all the way through, and I'm getting a picture of what my hip's supposed to feel like. I was like, wow, okay. It must work, but I find that doing other component muscles, like for me, I go, right, there's a tendinopathy. What else can we deload? Have the are the short adductors so short because of standing in that that hip position that we could maybe do some myofascial gliding or cupping or whatever on the short adductors? Yes, okay. Um so a couple of other aggravating positions to avoid uh because I mentioned the uh side lying um and hanging on the hip. One you mentioned already, which was the cross cross-leg position to be avoided with gluteal tendinopathy, and the other one is low chairs to be avoided as well. Um, so so those are key things. In terms of soft tissue work and massage, I found that getting into the glutes is one of the first areas that you can do some good work and reduce muscle tone and sensitivity. So getting into the glutes using either your you know, hands, elbows, cups are great for getting deep into the tissue because you can decompress instead of compressing, uh, and even using some mechanical tools like massage guns. I'm not a huge fan of massage guns pulverizing people all over the place, but um the glutes and the uh the feet, in fact, are kind of I find very responsive to to the use of a massage gun and possibly for respiratory too, for loosening secretions, but that's that's beyond musculoskeletal. But um interesting use of those for using them for the vibs. Um, so yeah, that's that's a bit about um the the gluteal tendinopathy, and and you can absolutely do hands-on uh, and in my book there's a chapter on massage for the tendinopathies because uh the patients, the clients respond really well to massage to help manage tendinopathies. It's not curative, of course. The curative element comes from loading and load management, but there's you can certainly get some quick wins and symptom reduction from doing some hands-on work around tendinopathies, and that can be very beneficial. That's great to read that. I'll hear that, and I'll look at Diane again, has said that she did the course um the rock tape therapy tools for soft tissue. That that course, um, using blades and rock pods, etc. So, well, it's coming across to Australia. So, Libby, you'll find it over there in the UK, definitely. Um, we I look at the time, oh my god, we're like we have five minutes left, the time goes so fast. But um, I want to know two things because I'm busting to ask um how how I've got a YouTube channel, I've got hundreds of videos, and every time a patient finishes in my clinic, I will then do us a small video. Hey Daniel, it was great to see you today. Just recovering, remember what we're gonna do, we have to stimulate showing the exercises on Vimeo, shoot it across to them. But and then I've got the in in the patient vimeo file, but I have got YouTube for loads and loads of other things. How it was it a big stumble? Was it are therapists too scared to put stuff on YouTube? Have your three take homes, don't be terrified because this is the easy bit to do, or that's like sell YouTube, baby. Okay, so the first thing is the barrier to entry. Well, there is no barrier, it's never been easier to start a YouTube channel. Used to be the case that you had to, you know, learn how to use an expensive camera or something like that, but now um phones are no longer phones, they're pretty much high-tech cameras ready to go, and they take care of most things for you. So uh one of my colleagues over here in the UK has a wonderful YouTube channel, pressure point massage training, um, Claire Riddell. I was with Claire just last week, and we made a YouTube video together, um, which is on the latest one on my channel at the moment, and it's on Claire's two. Anyway, Claire uses an iPhone and has done for some time, and you know, her channel's popping away, popping really well and building, and it's fantastic to see. But she just you know uses her iPhone, but you know, it's like oh, I just use an iPhone. Those things are really expensive these days, and they are very high tech. So you've probably got the equipment already, um, ready to go. And uh the next thing is um you would be worried, you know, like talking to an audience, public speaking, talking on camera. I understand completely, and I still don't feel that comfortable doing it quite often. But the key thing is you are um in a profession where you help people, you want to help people, and therefore that should be your focus with the video is simply make a video that can help somebody. Um package something that can help somebody. You might simply show some massage techniques, and if you do that, you can make a faceless YouTube video. You you don't need to show your face, you don't even need to talk, you can just demonstrate some massage techniques um and then work with that content, and and that can create a video which helps somebody because they want to do the techniques for their friend, or they're doing a massage course, and they can look at the techniques, yeah. Um, so you can do that. And I've seen channels where the nobody appears on the channel, it's just hands and the massage techniques, and it works really well. Um, also, again, the key focus is on making something that can help somebody. So rather than I'm not a big fan of posting stuff on social media and over-sharing, um, I think that's the the younger generation generally seem more comfortable with that, but for me, I just want to make a video that will help somebody from a physiotherapy perspective, and um, and and that's the that's the key the key thing. So, yeah, that's it really. You're ready to go, make a video that can help somebody, and the third thing, you said three things. No, like not that that's not important, but I wouldn't prioritize it in the top three. It's difficult, Paula. Top three here. Um, I would say planning. Don't just put the camera on and then start waffling away, that'll be an uncomfortable experience for you and for the viewer. Uh, I would say plan. It's okay to literally plan what you want to say, what you want to show, and plan how you're gonna film it. You know, is the camera you know close up or is it further back? So if you plan what you're gonna do, then all you need to do when you go to film is follow your plan. If you're nervous, if you're gonna quick loss loss of Dan for a moment. Um, I'm also gonna point in there that we can have um if you think about uh what you love watching, how much do we love watching bloopers? How much do we love watching the outtakes at the end of the Marvel movies or whatever like we we love watching people cock up and do stupid things and laugh and all that. So so don't be afraid if you do a if you do a a seven-minute video on on stretching the piriformis and you know blah blah blah, whatever you think, and you run through it and you make some mistakes, you can look there's so easy to edit that stuff out, like that the YouTube editor is like ding ding ding. Keep those and keep them as your Christmas special for just your patients so that because it's it's hilarious, it's great fun. Yeah, absolutely. So, yeah, um, that's my three. I hope they came across okay. They did. I'm sorry that we lost you for a moment. Now, what how can people learn and get to you? They go through your not through the YouTube channel, but I mean they can learn stuff from your YouTube channel, but how do they come and do your courses or get your books, your books or online teaching? Yes, of course. So the books are on Amazon. I have an author page, Daniel Lawrence, on Amazon to find the books, lower limb, tendinopathy, clinical cupping, and uh exercise for pain relief. And the um education is through rocktape.co.uk. Um, we have education in Australia for Rocktape 2, uh, with an Australian team, and um in other countries around the world as well, so worth looking up, whichever country the listeners are in. And then um for the YouTube, which is the physio channel, and then there's some links through there for some other online courses, and I do offer some mentorship for people that want to learn how to create videos and how to start and manage a YouTube channel. That's called the Health Creator Pro uh program. Um, so that's that's me. That's excellent. That's excellent. Well, two of the people that are here Chattyway are on my mentorship massage mastery mentorship program. So um, yeah, it's that I think that's a lot of educators where we go now is how do we pass our skill sets on? Because we suddenly like I've been in this industry for 30 years now. Um, not that I look that old, but uh there you go. Um, we're after the hour. It's been an absolute pleasure. The time always flies. I don't know about you, Dan, but it's like, oh god, oh my god, like I looked up at the clock and went, well, that's 37 minutes. Um, where did that time go? Um, some great nuggets. Please, if you're interested in getting any information on assisting your patients, even talking about our um turning, inhibiting the nervous system, that in itself, you can get loads of information from Daniel's website on how to do treatments that will help you um help your clients and patients in that space. But uh I'm not sure who we've got next month. Uh might even have a chat to see about what Claire Ridell's doing. Or was that her name? Claire. Claire, yeah, um Claire Riddle. Yeah. Uh runs a massage massage school in Nottingham and um has been involved with education for many years, decades, and uh she runs a successful massage YouTube channel as well. Okay, yeah, we'll either be there or we'll be crossing over to the other part of the northern hemisphere and getting a couple of yanks in for a while, or Canadian, so that we can share the time zones. But um, thanks everybody for showing up. Uh, keep your eyes on the Your Musculoskeletal page, the the free Facebook page, because that's where we'll find out where the next one is, or in our massage mentorship group, guys. And Daniel, thank you so much. It's been an absolute pleasure. And stay safe. See you later, everybody. I think he's he's lost again, lost in translation again. Have fun, be safe, love you all. My little heart. Yes. Thank you very much, everybody. See you everyone, Monday. Thanks for joining us. Goodbye.