The Intelligence of the Body
The Intelligence of the Body is for therapists ready to move beyond techniques and truly understand how the body works as an integrated system. Through clear, practical teaching, each episode helps you refine your thinking and deliver results that last.
The Intelligence of the Body
EP 10 | Could Your Daily Habits Be Making Your Pain Worse? | Doug Nelson
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What if some of the things you do every day are quietly contributing to your pain? In this thought-provoking episode, Paula Nutting sits down with internationally recognized educator and clinician Doug Nelson to explore the complexities of pain, clinical reasoning, and what therapists can learn from the struggles that show up in practice.
Drawing from more than four decades of clinical experience, Doug shares insights into the art and science of therapeutic touch, the importance of staying curious, and why the most valuable learning often happens when treatment doesn’t go according to plan.
Together, Paula and Doug discuss pain validation, patient experiences, clinical uncertainty, and the responsibility therapists have to listen deeply—not only with their ears, but also with their hands. They explore how practitioners can avoid falling into default patterns of care and instead develop thoughtful, individualized approaches that honor each person's unique experience.
The conversation also touches on chronic pain, communication, professional growth, and the evolving role of manual therapists in modern healthcare. Doug offers a powerful reminder that transformation comes not from having all the answers, but from embracing the journey of discovery alongside clients.
This episode offers valuable insights for massage therapists, manual therapists, bodyworkers, and healthcare professionals who want to deepen their clinical reasoning and create more meaningful outcomes for their clients.
In this episode:
• How everyday habits can contribute to persistent pain
• Why pain is more complex than many people realize
• The importance of validating a client's experience
• Listening with your hands: therapeutic touch as communication
• Clinical reasoning and embracing uncertainty in practice
• Why the greatest learning often comes from struggle
• The role of curiosity in becoming a better therapist
• Understanding chronic pain and patient experiences
• Avoiding default treatment patterns and staying adaptable
• The power of transformation over transaction in healthcare
• Building confidence while remaining open to new possibilities
• Why the world needs skilled manual therapists now more than ever
Timeline Highlights:
00:02 – Paula introduces Doug Nelson and his decades of clinical experience.
02:39 – Doug reflects on 45 years in practice and the joy of clinical work.
03:57 – The growth of Precision Neuromuscular Therapy and online education.
07:20 – Why the greatest learning is hidden inside clinical struggles.
10:16 – Treating every client as a unique individual, not a diagnosis.
14:50 – Vulnerability, trust, and partnering with clients in recovery.
18:56 – When to refer clients and why collaboration matters.
24:45 – Pain invalidation and the importance of being believed.
30:59 – Why language often fails to describe pain experiences.
33:27 – Using touch to ask questions instead of making statements.
37:40 – Clinical reasoning: challenging assumptions and testing hypotheses.
44:52 – Why even experienced therapists still feel lost sometimes.
48:54 – Building a clinical toolbox through experience and reflection.
50:04 – Moving beyond transactional care toward transformation.
55:19 – Doug’s message on the future of musculoskeletal therapy.
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💼 LinkedIn: https://www.linkedin.com/in/douglas-nelson-993969b/
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📸 Instagram: https://www.instagram.com/precisionnmt
🎥 YouTube: https://www.youtube.com/pnmtdoug
🎓 PNMT Portal: https://pnmt.org/portal/
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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Sh.
SPEAKER_03Hello, everybody, it's Paula Nutting, your musculoskeletal specialist, and I'm really excited because it is the next month, as in May, and we've got our other Ask Me Anything group, and today I'm really excited to have Doug Douglas Nielsen, who is from the Midwest, Illinois, and he's coming on board with oodles and oodles and oodles of experience to talk a little bit different from what we normally um we normally speak about. So this is really about focus on um our patience and our expectations and embracing the struggles, really. So I'm going to get Doug to come on board and join us for the next hopefully hour.
SPEAKER_01Thank you so much. Really good to see you. Thanks for inviting me to be part of this.
SPEAKER_03Excellent. Oh, I'm so excited. I'm like, I'm really, really excited. Before we get kicked on, you'll see just down oh hey, Belinda's here already, so fabulous. We've already got people staying to come in and say hi. Um, we've got the sponsor by Q Academy, so I'm just going to do a quick shout out to these guys. They are a Queensland-based uh educational platform. They do work face-to-face and uh and online and a combination of studies for it. Used to be the certificate for, now it's primarily diploma for remedial massage, which is a global, uh it's a national translation, which is great, and our um the advanced diploma of myotherapy. So that's the next structure up that we have in in uh higher than remedial massage, and again it's transportable around our country, which is great. Hey Karen, it's great to see you as well. Um, so these guys are amazing. If you're looking to go from one kind of area of study, but you don't live in Australia, you can still hook on to find out more details. And other side than that, if you're in Brisbane or Southeast Queensland, give them a yell. They also offer free clinics or really, really reduced clinics to help the therapists become more skilled as practitioners. Anyway, um, we'll be hopefully getting more information for Q Academy middle of this uh anything group.
SPEAKER_01So um, so I have been a massage therapist. Oh my gosh. I think this April has been 45 years. Um my gosh, you know it's a little wild to hear myself say that, but um what a journey it's been. Um so so I'm in the, you know, the thing I think that I want most people to know if if I'm kind of describing my career, it's really about being in the clinic. And that's the thing that I find most fulfilling and just gives me great joy with the clinic. I also so I have a clinic here in Champaign, Illinois, which is a city of about 120,000 people. And I've had the clinic has 21 therapists, and I've had it now, it just celebrated its 42nd anniversary. So so I see people, but I also have a clinic with many therapists, and then I have a teaching institute called that teaches precision neuromuscular therapy, um, and that's um pnmt.org. And for 20 some years, we've been teaching seminars around uh the United States and and a few internationally as well. So just sharing what we know and what we learn in the clinic, and it's all about the learning. So, but for me, it's the thing, all of it is anchored around being in the clinic and seeing people.
SPEAKER_03The thing that I I first found out about you because many people in Australia would didn't, I wasn't aware of you, and it was only because I went in and I was looking at the research perch with uh that Whitney lows quite often in, and um I saw you in there, and then I started to dig in a little bit deeper. You offer a lot of practical skills on video as well, don't you?
SPEAKER_01It's true, yeah. So, we in addition to the live courses, especially with the assessment stuff, we found that people really struggled with that after the you know seminar. So we thought, oh, well, we'll put a few of those on uh on a you know on a platform. And then that just kept building, and now there's four or five hundred different videos of all sorts of different aspects to it, which we call the PNMT portal. You know, there's a there's a place for everything. There's certainly nothing beats the hands-on instruction of having someone guide you through uh, you know, the the nuances of what great treatment looks like. On the other hand, there is so much to be gained by doing things that transcend time and space and uh and the the ability to view it again at your own time and your own, you know, in your own context. So there are advantages to all, it's just how you choose which domain and why.
SPEAKER_03Yeah. And you know, in a perfect world, you you incorporate all of it. It's like in the original learning styles, we used to learn auditory, visual, and kinesthetic, and I and audio digital, and that's what I commonly do all the time now when I'm teaching both face-to-face and online. Uh, but now it's the same thing, is that you have a library of brilliant information that you can video and offer to therapists out there, so it's kind of like a really nice space to say, I've built a library of information, I've got a client who's coming in, they've got an ankle that's playing up on them. I remember something from Doug about four years ago. I'm gonna dig that up and have a look. So that's and it's different from pulling out the old uh McGee or orthopedic manual assessment or you know, um, all the thousands of Leon Chathouse, neuromuscular, like all of those books that we have in our libraries. And I learn better videos, yeah.
SPEAKER_01And you know, one of the reasons, like in the past, I was vehemently opposed to like creating DVDs or that sort of thing, because um the the clinic is my learning laboratory, and this is also true for the people who are on my staff, which means we're always changing, we're always refining, we're always shifting things. So, like we print our manuals that that we use in teaching for every seminar, you know, there's no closet filled with manuals. So the idea of videotaping something and then having this is how we do this, just like, uh-uh, that's that's not possible. But what and again, with this web base, we can go in and look at that and go, you know what, there's a better way to do this that we didn't think of before. So we just replace it and just keep on, you know, it's not I'm not stuck with anything. And I feel very comfortable about that because again, if you're not learning and growing, you know, that's that doesn't save much for what you're teaching.
SPEAKER_03And you know, that's a perfect segue into this where I wanted to go. And here is that uh therapists can get really stuck and bogged down into their old system of treatment without opening up and seeing what's happening. And so sometimes you can have, I do this all the time and I don't and I should get great results, but I haven't got the result with this patient or this client. So um, and you you talk about the clinic struggles, so you know that's part of that. If people aren't aren't moving themselves forward uh and and learning to be more open-minded about uh again, we're talking about listening to what the the client has to say when they come in, all of the extra bits and pieces. So, what is that struggle embrace challenge that you talk about?
SPEAKER_01Yeah, well, the learning, Paula, is really hidden inside the struggle. Um, when you think about it, if if I have a client who comes in and they describe this kind of sharp pain behind their uh, you know, in the mid-scapular region, it happens only when they breathe and I treat their Leviticus storm and it goes away and they're like, oh, this is amazing. Well, that's nice. I've actually learned nothing, right? It's only when the client comes in and says, you know, all that great stuff you did last week. Actually, that really didn't help at all. And and that's when it's like, wow, um okay then. Now you have to go back to the drawing board and say, well, why didn't it? And and that's about being reflective in practice. I have to say, I'm embarrassed to say this, but I think years ago you could describe my teaching style as I have a fabulous answer. And I hope you find a question that goes with it, you know, and what a dumb way to go about stuff, right? And really now it is about here are skill sets that you can use. It's about more about having a compass than a map, right? Because who knows what the context of the client that you are going to see will be. And that's you know, often in seminars, people say, Well, I have a client who what do you think about it? It's like, uh, the odds of me being correct are so small because the nuances that could happen inside of that are hard to even calculate. What you need are the skill sets to make those decisions, and that is also what makes the work so rich is that you know, I think therapists, I certainly did not have any concept as to the multitude of decisions that every therapist makes in every session. I mean, if you videotaped a session, just think of all the decisions in terms of where you put your hands, the questions that you ask them, the sequence that you did, why did you go from here to there? All of those are decisions. The question is, did you do it by design or by default? And default mode is uh, you know, something you can fall back on, but that's hardly how you get great results, and results that are tailored to individual clients instead of some broad-based idea of you know, some concept. The person sitting in front of you is a real human being with unique set of circumstances. Every person is unlike the last person you just saw, even if the symptoms are identical. And for me, that's why I have hanging outside my um my treatment thing is a scroll I brought back from Kyoto in Japan, and it's Ichikoichie, which is every moment for service is an is a moment never to return. And that's why you know I feel like I have that scroll hanging outside of my my treatment thing because when I see a lot of people, I want to just remind myself that every person is unique, and I have to bring that skill set to each session to fully honor them.
SPEAKER_03Yeah, they're beautiful words. I mean, like in my terrible broken internet that I've got over here, but that that's exactly right. Every person comes in with their own story, and we can get fall into a trap where, as you said, when you first started teaching, I've got great questions, I've got great answers, I'm just waiting for you to ask the right one so I can peel out and tell you how amazing this is. Yeah, and I suppose it's even right down to the picture of the same person that you might be treating over a number of sessions.
SPEAKER_01Absolutely, absolutely. I mean, the you know, the me that is talking to you is not the same me that was in the clinic this morning or the same me that was in another uh, you know, I did another interview earlier today. And so so uh to stay in the moment is actually, I think, one of the most difficult things. When um when people ask me, Paula, about the work and if it's difficult, if it's taxing for me, I think it's not taxing physically as much as it's taxing mentally. It's much more difficult to stay focused, to um to be in in locked on focused concentration um when I'm seeing one client after the other. That's actually, I think, incredibly hard to be able to do that. The physical skills, yeah. I mean, there's a certain uh aspect to that, but the mental focus of staying focused and seeing multiple people during the day, that's much harder. And that's something that's a skill set that I've come to celebrate and um uh kind of develop, actually.
SPEAKER_03It's nutritionally that would make a difference too, right? So if you're sitting there going, um, yeah, I'm great at the start of the day.
SPEAKER_01Yeah, I wish I had something brilliant to add in terms of uh like a nutritional thing, but I think it's it's really a discipline. It's for me, like every day is a bit like a a meditation in that way. Can I stay focused and keep up the same energy during the day? Um, you know that there are certain little breaks that happen, but honestly, I don't get many. And and I think over the years, it's just that that consistency, that being able to sit down with with the person who I'm in front of and and let that be the sole director of my attention. It's something I really relish and and something I uh I feel like it's really important. And and it's about building that relationship with the people who come in, who often will show the soft underbelly of their existence with with the struggles that they are having. Um, yeah, if I if I might say one thing, Paula, you know, um I I uh one time I was uh talking on the phone with someone, and this person went into a 45-minute discussion of her saga in healthcare and how difficult it was. And when I got to um uh where I was an office that I was working, actually was the Massage Therapy Foundation when I was president of that. I was sharing with them just the that I had this conversation, and and one of my staff up there said, I it's hard for me to believe that someone who you've never met has been that vulnerable to you, right? And my comment to her is yes, but she's not the only person that's vulnerable. I am also vulnerable because in that meeting, within five minutes, she's gonna find out I have no idea what the answer is, right? Yes, so we're both vulnerable at that point, and I feel like in that way, you know, I'm holding hands with the client and we jump off the precipice together, and it's you know, I don't know what the answer is, but I understand something about the process, and and I will be here and we will figure this thing out. And we did, it took a while to figure out, but yeah, within five minutes, she figured out, yeah, he really doesn't have an answer here. Yeah, there's this trust that he does understand something about the process and was courageous enough to say, I do not know, I don't know what the answer is.
SPEAKER_03That's so clever, like honestly, that's so clever. And and I think that that is also part of the I trust you as as you've been my practitioner maybe maybe for years, maybe you are um referral, and there's somebody else who's referred you um who I trust implicitly, and and and we know that there's part of the placebo effect of healing at the at a cellular or body level or a mind-body connection. The second that you put your hands in in like we're we're gonna work this together. Somehow we're gonna do, I'm gonna do my best to honor you to move us forward. And and and like you said, I don't know the answer right now, but that doesn't mean that we're not gonna we're not gonna work it out.
SPEAKER_01Yes, and the thing is, I don't know the answer, but I understand the process of discovery. And you know, if it's this, then these things will be true and this won't. If it's this, then these things will be true, but these things won't be true. But if it's this, and then they get the thing right away that that I do understand something about the process of discovery, and this is not a singular event, this won't happen in the first session, but you know, I tease people that if you say yes to me treating you, just know what you're in for. Um, I'm full-blooded Norwegian, we don't solve problems, we bore them to death. So, you know, so um I'm in it for the long haul. Um, if I refer you to someone else, I'm still gonna stay in touch with you. It is not over until it's over. So just understand if you say yes to this, that's what you're signing up for. And I think people are a little like stunned because mostly oftentimes in their past, they've seen a practitioner who says, uh, you don't have what I, you know, in my ecosphere. So, you know, see you later. You don't have this. Well, that's great, except they're kind of cast adrift trying to figure this out on their own. But to have a practitioner who says, No, I will stand beside you and I will uh we'll be together on this journey no matter where it goes. It's like you've said here, you've got to take is it the red pill or the green pill?
SPEAKER_03That reminds me of uh like I've in the past, and I've and I probably do stick to this. I normally go if in three sessions we haven't made any progress whatsoever, I'm it's either the wrong practitioner or the wrong modality for you, but it certainly doesn't mean that I'm not going to be sharing your path that we'll find either it's an exercise physiologist or it's a physiotherapist or it's a naturopath or it's an acupuncturist or it's a surgeon or it's it's a whomever, and we'll work that so that that we resolve the problem from where you are now. And I I hadn't thought about it as it's I'm on the journey with you, but it it is actually the case, and I that that comes with age, really, doesn't it? Like the the length, the runs on the board that long been around.
SPEAKER_01I th I think that's true, and and you know, I do the same thing, Paula, where um I want clear and demonstrable, measurable evidence that we're making progress within that three to five session thing. And if not, then it's do we re-evaluate completely? You know, maybe the whole hypothesis is wrong. Is the approach wrong? Is the frequency wrong? Is the duration wrong? Um, or you know, is this just not the right, you know, thing? And as they should say, maybe we should go to a different practitioner, a different discipline. Those are things that we need to explore, but we will have that conversation uh at the end of three or sometimes five sessions. I I have to say there have been a few times where I've tried to do that, and people will say, Oh no, no, no. Like this is the I know you don't, I know you're not impressed with the progress, but this is the only hope I've ever had. And you know, this while a 15% improvement is nothing to you, to me, it's everything. So you're not getting out of this so easy. And it's interesting because I've had a few people do that to me and I would have bailed and they just wouldn't let me, you know. And I've had a few people where after five sessions, you know, I still think it's in my domain, and I think it's that I have not figured it out, and I just tell them, okay, this is now officially personal, you know. So I'm not charging you, but this is not over until I figure this out. So yeah, yeah, yeah.
SPEAKER_03No, that's cool. I kind of I've always what I used to teach, I'd say to the students, if you haven't had any changes and you cannot get like you, especially if you can't reproduce the patient's symptoms. If you cannot get a change, how do you know it's not referral from some kind of mass that's in the viscera? Absolutely. Like you've got to refer on. If you cannot find out, you can still be working code junctly, but you have got to refer then for further investigation. Absolutely. And that's that's totally duty of. Here. And again, that's the process that you're talking about. Like the process is still, even if we go, we're not making change, I've got a process around it, that that's that's what we're doing.
SPEAKER_01That's exactly right. And and remember the domain that we're in, we treat mechanical pain. So that's pain that can be made better or worse with movement or position. So if someone presents with pain that is kind of unrelenting and not altered by movement or position, boy, a flag goes up in my head. And I've had at least three of those in my career where it was the worst possible news. None of them lived very long. It was the worst possible news. So I think practitioners always have to keep that in mind. Even if you make someone worse, if you aggravate the symptoms, at least you know where the devil lives, right? You approached it and you know, you found out there's a snake in the bushes by kicking the bushes, probably not a good idea, but at least you know what you're dealing with. If you can't and if you can't aggravate it, if you can't change it at all, that's seldom good news. Yeah, I totally agree.
SPEAKER_00My name is Jade Afu. I studied uh CERT for massage in 2014 and then went on to remedial in 2015. I was working in Essex, I was retail, yeah, Lorna Jane. The real reason why I went and studied was I my daughter was um she's been quite sick for about seven years on and off, she's had a couple of um chronic conditions. So um I found it hard working in a job and having to leave because my children are sick, or I've got to go to hospital, or there's just so many things going on. For me, I needed another option. I've been set up for about eight years now. Um, 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 year has been a little bit different again because now I've got three kids playing sports every afternoon. Um, so I do try if I can work in between school hours. I 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.
SPEAKER_03Pain and invalidation. Talk to me about that.
SPEAKER_01Yeah, boy, it's something, you know, a few years ago, Paula, I wrote the a book called The Mystery of Pain. And um, in researching and just researching that book and talking to a lot of people in pain and with my own clients, a theme that just kept coming up over and over again is that either through providers or family or friends, that people just not believing them. And you know, that um especially when nothing plausibly explained it, which we now know there's a classification of pain called nosoplastic pain. You know, it's really great when something's validated, when you can look at an image and go, oh my gosh, well, that's the source of your pain. And and this is the idea that that pain could be seen, identified, and therefore eliminated. And it's a lovely idea. It's not very often true, but it's a lovely idea. A lot of the pain that folks like you and I see aren't really validated by an image, but just because somebody can't see it doesn't mean that you don't have it, right? Yeah, and and so this becomes such a struggle. And I could, I mean, it happened today, you know, with um, you know, uh, I'll I'll just tell you, somebody I saw today, she had had a hip replacement immediately after the replacement, had pain down the lateral thigh. I suspect there might have been just you know an injury to the lateral femoral cutaneous nerve, but you know, here's her thing. She goes back to the surgeon, the they take an x-ray, the the replacement, you know, looks excellent. And then finally, the surgeon just said, It's not my fault. It's like nobody's looking for fault here. It's like, I just want to feel better, right? And and and there was this question of since the the um hip replacement looks great, then there's like, are you really feeling the pain that you feel? And and she and in the session was kind of questioning herself. It's like, how crazy is that, right? You know what you feel, but having a provider question it is one thing. Turns out in the research world, it's very clear what's worse is if your significant other questions the pain that you feel, and as you can imagine, that happens more often than you think.
SPEAKER_03Oh, yes, absolutely. God, my mother was horrendous at that. She had five children, eight miscarriages, uh a very busy world. And she would go, unless I can see a bone sticking out through the skin, you are going to school. My sister whinged and whinged and whinged for weeks about a sore throat. Mum's like, I don't care, you're going to school. I don't care. It's you know, stop putting it on. Finally, uh, went and saw the doctor, and he said, These are the worst tonsils I have ever seen in my entire life. Oh boy. And then had them removed. But yeah, then she felt like the worst parrot on the planet. Yeah, yeah.
SPEAKER_01So it's really it's it's a common theme, Paula, and it happens in multiple dimensions. And and I think one of the things that we are really lucky is in our treatment, like someone presents with uh you know, a symptom, like for instance, I mentioned earlier that kind of stabbing between pain between shoulder blades. I put my finger there and I reproduce that pain. And the person says, Oh my god, you know, like that's what I feel. There's not much to talk about at that moment, right? Because you've just reproduced through touch exactly what their experience is. That matters, and and we are lucky to be in a in a discipline where we can do that quite often.
SPEAKER_03Yeah, yeah, exactly. And and I suppose what they're saying then from you is thank you. Like that you're finally my husband won't listen to me, or my wife won't listen to me, or or the doctor thinks that it's it's become oh yeah, and you have these it's a centralized model now, so it doesn't exist, it's gone away, and you're crazy, you're malignant.
SPEAKER_01And then, yeah, again, some you know, skinny Norwegian comes along, puts his finger right there, and then replicates the pain, and then like, wow. Um, you know, I've told this story several times, but there are there are many uh of this, but like one young woman with chest pain, two years, and I was treating her uh external oblique, she sideline, and all of a sudden she blurts out, I knew it. Like, what? You know, like what? And so she finally she told me that she said, I knew there was something wrong. I knew there was something wrong. The last doctor that she had seen had give her a book on psychosomatic pain, right? And and now again, somebody comes along and can replicate her symptoms, and I mean it was just this massive turning point um uh for her personally, and then and then you know the tears came afterwards, and and so many of my clients being validated, it's it's such a powerful emotional experience to them. And from that point, now we have a connection, right? It's through, in a way, through touch and through listening and compassion. I understand, and now let's move forward, let's understand that this exists. The question is, how is what is the best way to then deal with it? And I think that's but but let's establish the it that you experience is where we're going forward. And um, may I just add one more thing? I'm sorry to but you know, from the today, you know, this this woman said something so interesting because she said, I do not have the language to convey what I'm experiencing to you. It's so beautiful, and she's so correct. There's oftentimes one of the ways that people are invalidated is that we struggle with the language to communicate experience with regard to pain. So, you know, if you if you don't have that language, you just sound completely inarticulate, and when you sound that inarticulate, then people kind of doubt the credibility of the whole process. But what's at risk, what's at at the heart of that struggle is really language to describe different qualities. For instance, when I certain things when I was at the transverse process of L2, that was a very sharp pain. The just lateral to that on the iliocostalis, that pain actually created um uh uh heterotopic pain, a referral to the lateral thigh, which is really interesting. When I was at the top of the iliac crest, uh looking for nerve involvement there, that had a very different feel to it. When I was over like vastus lateralis, that was actually uh hypogesic. So she had very little sense, uh it felt like numb and distant to her. Underneath that, almost like a hyperalgesia. So in one person, this massive range that she had a struggle to describe the qualities to.
SPEAKER_03Yeah, and no wonder she did. I mean, that's like there's there's three things happening all at once. You've got the the referral from the L2 area, and then this hyper and hyper. So no wonder she couldn't. And I suppose if you've if English is not your first language as well, and I'm not sure whether she is or not, but that's then then you've got that other problem. I mean, and we can sit there and say, does it feel like it's sharp or burning? Like we can give a lot of words, but if they're not actually words that they use, then how do we how do we garnish that?
SPEAKER_01How do we and you know always what we're trying to do, just like you and I right now are having this conversation, we're using words to convey meaning and experience, but do those words really convey that experience and and what is the fullness of that? And and I find that more and more, I'm just fascinated by that. And that that's what we're trying to do. And when when we ask questions with our hands, I'm also trying to understand the experience of that person in in their somatic life, right? And so so I feel like that same conversation happens with my hands, and I'm asking questions with my hands, not making statements with my hands.
SPEAKER_03Yeah, oh wow, okay. So allowing the touch to absorb the information versus bullheadedly going in and and stripping muscle or or presumably doing whatever you think you're doing.
SPEAKER_01Yeah, exactly. And and before you do something, maybe you should think about what is appropriate, right? And and so if we're gonna have a conversation, I need to listen to you. I need to fully uh hear your question and make sure that the answer is in response to the question. And I think if uh the first rule of communication verbally is to listen first, right? And then clarity and brevity is the second thing. Why is that not true with touch as well? Right? So the first rule is to listen first, you know, not to make statements with your hand, and then the second thing is not a barrage of sensory information, but I think the brain understands information delivered through the hands that is clear and concise.
SPEAKER_03Yeah, don't waffle. So if you're waffling here, it's translating. That's that's very cool. I hadn't thought about that, and you're right. I like if someone will come in, and if you are, oh I'm not quite sure what I'm doing, come on in. It's a different treatment than if you're like, come on in, take a seat, let's take this journey together. One mouth, two ears, I'm not going to and we had this this this conversation just before we started, when we had perfect reception. Um that I learned from a college or a lecture one time is that when someone is talking to you about something specially that's important to them, a honor it, but B, stop thinking about the next question you want to ask them whilst they are talking to you because you're not going to be hearing, you're not open to hearing probably what then the meaning behind it is.
SPEAKER_01Absolutely. And it's so difficult to do that in verbally, and I think it's also difficult to do that tactily, right? So to listen first with your hands to really pick up information and respond to that in very thoughtful ways, it's very hard to do without the rush of I just need to do something. I mean, it'd be like, well, we're having this interview, I just should say something. Really say what? You know, uh it's more important to say less and have that less be more meaningful. Yeah.
SPEAKER_03Yeah, this is gonna challenge me a little bit because part of my treatment process is I would go, all right, I'm gonna do supine, knees bent, feet on the table, do a lumbar rotation just to see where they move. And then my brain is already saying I'm gonna do either this or this or both, because it's automatically programmed into going, well, I know they work, but do I now should I now be going, I'm gonna wait, and with my hands more on to feel if there's something different I need to do, and that's gonna challenge I actually I just think you questioning yourself is the best thing, right?
SPEAKER_01Uh the the way you typically do it might be good, as long as it's not a default mode, right? But I think the best thing we can all do is question ourselves. And I think you know, it's one thing when I uh was president of the foundation, not not being a researcher myself, one of the important lessons I learned is in research, the goal is to falsify, not verify. Oh shoot, you are right, right? So so now when I'm seeing people, I just did it with my last client. Um, you know, I was treating uh something and she said, Oh my goodness, that is so right on target. And then I moved off of that and to a different muscle and said, Whoa, what about this? She said, No, not really. How about this different muscle? Not really. Finally, she said, You know, you were on it a while ago, but now you're off of it. It's like, yeah, actually, I know what I'm doing. I I was just seeing if I could, if it was really what the guy I thought, and I think it is. And and so if I try to prove myself right, I seem to have no trouble doing it, you know, unfortunately. But but if I if I question myself of, you know, the two questions I always ask myself, Paula, is number one, what makes me think it's soft tissue? Because that's my expertise, that means it's also my blind spot, right? Yeah, and then and then probably maybe 60% through a session, when I think I have a a formulation, a hypothesis of what's going on, and I'm feel pretty confident about it, then I'll say, okay, what else would explain this? If none of that were true, then what else would explain this? And almost always the person walks out the door, and I have two kind of treatment methodologies that I'm doing. One of them will prove itself correct, but almost never do they walk out the door and I think, wow, got that narrowed down to one thing. That hardly ever happens, yeah. And usually when it does, I'm wrong.
SPEAKER_03So yeah. Uh, and salient words, exactly, like that. We are soft tissue practitioners, and it's the same as um, if you're an orthopaedic surgeon, everything needs a hammer. If you're a musculoskeletal therapist or a massage therapist, everything needs work on the muscle, maybe. And and I think it's we should probably also say um hands-on assessment. Does it feel like it's a joint or the joint capsule? Does it feel like it's the connective tissue? Does it feel like it's the muscle? Does the muscle feel weak or tight or strong or loose? Does it feel like the nerves uh are involved? Like we can unpack that. Does it feel like it's referral from something more sinister? Does it feel like it's coming in from uh what's happening here in the head? Does it come in from screaming at the kids or sitting in a certain position in front of your computer? Um yeah, to be presumptuous and think it's only one thing, we we're really not our genuine care, are we?
SPEAKER_01You know, it you bring back a memory for me. So every year I've lectured at the medical school, it's really been fun. And uh I'm just gonna say this and I'm quoting, so uh, but uh I was explaining just that, just having just one little area and the multitude of things that could present as this. And I remember this fourth year in the back said, and I quote, this shit's complicated. You know, because personally I think taking out somebody's gobbladder is kind of complicated, right? And and it's like, yeah, it's just uh when you look at it at a surface level, it seems pretty simple, right? And you know, I watched somebody, you know, putt a golf ball across a green, and I think how hard could it be, right? When you don't everything is easy unless you actually understand it. And it turns out the more you understand the complexity of what's underneath your hand and all the different influences, it is staggering, actually. And it can be overwhelming for in the beginning, I think, for people, um, which I understand, but that's where the richness lies, is in the complexity, and and and that we get to be um an artist by the wisdom in the choices that we make, and and we have a wonderful feedback system, it's called results, right? And uh uh it's it when you look at, you know, it's funny, it's just Paul. Today somebody called me back and was just telling me they had fabulous results. And you know what? When I hung up the phone, I I wanted to say, you have no idea, you have no idea how many variables that were involved in that and how that could have gone nine waves from Sunday. Yeah, and I'm glad it worked out, but they just think I came in, this guy did this stuff, and you know, things are better. It's like wow, uh, it's a little more complicated than that.
SPEAKER_03It is more complicated, which which makes me think why why an orthopedic surgeon could go, it's not my fault. I've had a look at the x-rays, the bone and and the the the actual head and and the whole ball and socket's fine. So there's nothing wrong. Yeah, because they've never seen a nerve or they don't think about it, or it's it's it's the insurance. What you you kind of wonder because the old country doctor, yeah.
SPEAKER_01I can't uh you know, this uh I can't explain somebody's behavior, but this is certainly somebody who's young and and uh yeah, she's uh I think a probably a good surgeon, but um you know, in the end, uh you know, it it's it's care for the patient. The patient is telling you, this is my experience. So then it's our job is just to think what would explain that, and and and it's and to take ourselves out of that, you know. And if if I'm being unsuccessful with a client, you know, the thing is uh, you know, I tell people in the beginning when I see a new client, here's the deal if we do that five sessions and if this fails miserably, it says everything about me and nothing about you, right? You know what you feel, the fact That I couldn't figure out it out is that's on me, right? But there's an answer somewhere, and somebody will have it. So you have to promise me if this fails, you will keep, I will help you look, you know, for the right person. But honestly, what you experience is real and it is your experience.
SPEAKER_03And I'm not God. People sit there and go, hang on, I thought you were gonna help me. I was like trying, but like I'm not God, and and maybe what I'm doing is like we'll find you you're right. Um be patient with yourself as a therapist, like don't automatically assume that um you're gonna get everybody right.
SPEAKER_01You know, it's so frustrating to me, Paul, because I say this over and over when I'm teaching, and I don't think people believe me. And I I do have this uh level two seminar where people uh, you know, once they hit a certain level of training with us, they come and we spend uh three days together seeing clients together. I've never met any of these clients before. This is real, this is new, and it just blows me away when you know some of these therapists will say, you know, you looked a little lost. Like, no kidding, I've been trying to tell you this for months, right? Like, this is real life. And I think therapists think that you'll get to a place where you are never lost. Um, and it I think it's a sad thing that sometimes has been perpetuated by people up on the stage who um, you know, who kind of purport themselves to know every answer to every question and uh and have very simple answers to very complicated questions. And that is why I so relish being in the clinic because it keeps you just rock solid, grounded to yeah, uh, it's all about results and delivering them consistently. And it's a you know, most of the time it's a struggle. So that that's the reality. And I think for if you're a therapist who struggles out there, welcome to the real world, right?
SPEAKER_03We're all like that. Yeah, and and for some reason the universe seems to give you that the the better equipped you are to get uh reasonable results, the more complex and chronic the people that come through your door.
SPEAKER_01Absolutely right. Once I feel like I figure out some condition, I think, well, I'll never see that again. Uh as the next one coming in, it's like, wow, you know, I I my my joke with my wife when she says, How's your day? It's like on the edge of greatness or total incompetence.
SPEAKER_03You know, do you know what I love? That the the thing that I'm loving doing right now is is prehab, uh prehab prior to the rehab, obviously, but for total knees uh is a big one that I'm loving right now because you start looking at the the fine motor patent recruitment stuff and going, nope, nope, nope nope, no, no. That's not how you that's not how you initiate the initial contraction, and then it's like this wonderful journey between the client and my and myself, or who, if if you're doing this as well, going, my god, this is so exciting. It's like we've just got the Cluedo thing, and we're looking, going that those fibers there are amazing, and congratulations to them. However, they're not serving you right now because they're creating a jamming in the space that shouldn't happen. So let's try to get these other ones to do the job, and then it's it is so exciting. Like I I can even feel my energy coming up when I'm when I'm doing the stuff with these people, and then we do some of the weird neuro lymphatic stuff.
SPEAKER_01And how cool is that? I mean, really, and and to be involved in something where we can have that that again, that excitement in ourselves and ways to communicate that with clients, and they feel that excitement, and it's genuine and it's authentic.
SPEAKER_03We get amazing experiences, and that brings you back as a therapist. So the message I was trying to get out there was even though, as a clinician, if you start to get really complex clients come into you, see that as a valuable struggle, like you're saying, Doug, about getting improving your quality of becoming a more rounded practitioner. Don't be fearful of the journey of going, let's say I might make a few mistakes, but as you say, clinical reasoning, is it this hypothesis? Is it this hypothesis? Are we working towards a differential diagnosis? How are we going through it together? And embrace those really scary, horrific people like conditions that come in to see you.
SPEAKER_01Yeah, you know, it's it's always it's again the the learning is hidden inside the struggle, and it's from those struggles that you know, if I uh see someone and they present with whatever symptom it is, and I try four different strategies that fail miserably, and then I creatively think of two more, three more, that still no results, and then the next one works. When someone else comes in with that same symptom, I now have eight different strategies with which to choose from, where initially I had three or four, but now so everything adds to our database that uh are the potential tools that you can pull out. The wisdom is really in the choosing, right? And but in the beginning, you have to build that database, and then and then what you learn over time is the different combinations and ways that you can combine things together. So, you know, it's like you're building the color palette, you know, to put on the thing, and then you learn later you can blend colors together to create whole different shadings and some, and this is all great, but the end goal of it all is to create a picture that moves people, you know, and I think that's the important thing. And I I do take a little bit of an well, maybe a lot of an issue with the idea of massage therapy, for instance, as a commodity, like I could buy a massage, you know, I'm not interested in the transactional, I'm interested in the transformational, you know, that that that time on the table when someone has this process of internal discovery that feels like something has shifted that is transformational. And I think for me, nothing less is acceptable. I you know, I want every person to get up and go, wow, you know, that that something profound and deep just happened. And uh for me, nothing short of that is acceptable.
SPEAKER_03That that is the goal, you know, and that is a perfect place to to to finish as a as as a listener, just to kind of go transformational is is that what you're getting from each each experience? And you're not gonna be transformational if you do the same old routine, i.e.
SPEAKER_01No, and and that's the and and to that end, Paula, you know, um this is the thing to be able to have the skills to provide that, like for instance, three weeks ago, uh I got to listen to one of my heroes, uh, which is Yo-Yo Ma. Uh, I'm a new cello student, and so I got to see Yo Yo Ma in concert. And I can guarantee you that if if you were sitting next to me, you would not be impressed with his playing, you would be moved, right? It's a level way beyond being impressed with it, it's a level of of heartfelt, profound uh inspiration. You know, you are moved by his playing. The the reason you are is because of all the work that he put into making this possible. Uh, because of my role at the performing arts center here a few years ago, five, six years ago, uh I was on stage at a reception when Itsak Perlman uh had just finished playing. And so we're on stage, and and I was standing next to Mr. Pearlman, and this woman came up and said, that was amazing. She said, I would give my life to play like that. And he looked at her and he said, I did. Oh well, go baseball. Boom. And so here's the thing we our task, our responsibility, each one of us as therapists, is to work really, really hard building that database, building the skills, studying, doing the hard work that no one sees to be ready when that person comes in to draw from that well of experience that they they deserve nothing less than our best in that moment. Um, maybe the best thing is that great philosopher Mary Poppins who said, if you want to learn to fly, you have to take off from something solid. And and you know, that solid base that we spring from is all the hard work that we put in before you actually enter that treatment room. And so um, you know, the when people talk about working intuitively and all that's like, yeah, intuitively means that you understand something so deeply that it is no longer cognitive, but that takes, oh my god, so much work to make that happen. And there is, I'm sorry, no other way.
SPEAKER_03Yeah, that's implicit memory, isn't it? It's it's stuff that is I always say it's our brains got like a a roleidex that's at the back there, and we've felt that tissue enough times that it's it goes back into the educational matrix, something that we kind of connect with and go, okay, I'm familiar with this, I'm not going blind anymore.
SPEAKER_01Exactly right. Exactly right. And so when I read, you know, I you know, uh when I'm build when I'm doing the work of just developing my craft, my skill set, it's in honor of that future client who's gonna come in and say, you know, it's the weirdest thing. And then, you know, I've already done that. The time to work on that is not, I mean, yes, I do it then, but that's why you work and study and and and be ready to honor that person who then presents in that moment of vulnerability, and you can say, you know, I I understand something about this, and and here we go.
SPEAKER_03Yeah, yeah, fantastic, fantastic. Any last um gems for therapists out there to maybe make to be to it mindfully keep to uh keep in the clinic?
SPEAKER_01Yeah, well, one I would say, you know, the world needs what we do more now than really ever before. Um, you know, peace begins in ourselves and in our bodies. And I, you know, 40 years ago, um 40 some years ago now, when I first started this journey, I felt like musculoskeletal stuff and the power and promise of hands-on therapies was really underappreciated and underutilized. Boy, is it now I feel even stronger. When you look at the data, I'll just, if you don't mind, between 1990 and 2020, the world incidence rate of musculoskeletal problems went up 123%.
SPEAKER_02Wow.
SPEAKER_01In the next 20 years, the estimate is it's going to go up another 115%. So while that is increasing the number of people who do what we do who who are actually working in that musculoskeletal realm realm is actually decreasing. The world needs us now. We have an important role to do, and it and now is our time. I've never seen it the way it is now. I've so one of my favorite ways to present is to present to other disciplines, you know, uh across the healthcare sphere. I've never seen the kind of openness that I see now. Um, it's like a welcoming, like, good lord, we need what you do. I've never seen that before in all these decades. I've never seen from the public the kind of acceptance and that. Um, it this is our moment to step forward and make a difference in the world. And it's up to us now. We are not limited by perceptions out there, we are only limited by ourselves. Now is the time for us to step forward and make a difference in the world.
SPEAKER_03Yeah, well, well done. Say thank you kindly. That's thank you kindly. Uh Blyn said when the student is ready, the teacher appears, and usually it's the client.
SPEAKER_01Amen to that. Absolutely, amen to that. Beautifully said.
SPEAKER_03Yeah, well, Doug, thank you so much for for mentoring the the first 15 minutes of this when I was MIA.
SPEAKER_01Uh all good.
SPEAKER_03Party reception. Um, and if people want to know, uh, we've been putting links down about the Pn M T online uh courses and offerings at Pn M T is it dot think f dot or g dot oh dot or g not dot c O M. It's a dot or g so yes. Um and hopefully they'll get some really good you'll get a good uptake of that because you've got some crazy fantastic information out there, and and now is the time, as you said, to be to be bringing that all on board, getting as much information to your own personal library as you possibly can. Um big shout out to Q Academy. I normally do a plug in the middle, but guys, we're all kind of tricked up here. So thank you. They are incredible. They do a lot of um NLP stuff. So when I was teaching there, we would teach Monday through Thursday, Friday. All of the teachers would get together in the classroom and work out how to design the next week's um education to go across all the streams. So they look after the students. Once you've done one course, you could do the course for life. So they've always been really open and generous of their time and support. So if you're looking for really good, effective ways to learn remedial massage or the myotherapy, and hopefully, in the wings, we're going to have an um uh associate degree in myotherapy, which will be across the higher education stream. So look out for them if you're looking for more education. Uh, if you've got any questions or comments for Doug or myself, put them down in the um chat box later. We've got some great comments. Thank you, Lauren, for coming in. Thanks, Belinda. Thanks, Esther, for coming in. Thanks, Marfae. It's been great to see some of you on board. And until you won't see me next month because I'm going to be in Canada and the states for all of June. So there'll be something happening in July back on the Ask Me Anything. But thank you very much, Doug, for your time. It's been brilliant. I was so excited you have not failed to deliver.
SPEAKER_01Uh thanks. It's it's what an honor to be asked, and thank you for the important voice that you're adding to the conversation in the profession. Thank you for the work that you do.
SPEAKER_03Oh my gosh, it's a pleasure. It's actually fun, as you know. All right, everybody, take care. We're gonna see you in July. Um, thanks again, Doug, and be well, everybody. Treat mindfully and with your heart and soul.