This blog is significantly delayed being posted. Better late than never.
The Registered Massage Therapists’ Association of Ontario (RMTAO) educational conference was held in Toronto on June 1st/2019. The conference theme fit my personal bias, biopsychosocial (BPS). The idea was to introduce some current evidence based BPS topics to RMTs. I loved the idea of the conference, but the structure was a bit awkward. There were 3 distinct streams, biological, psychological and social. Each presentation was supposed to focus on one theme. I understand the organizers likely did this to try and guide participants to an area they were most interested in. From what I observed, the topics were relevant, interesting and the participants seemed to enjoy the material. I would have preferred no distinct separation of themes as this can further divide the misunderstanding that each domain is unique and must be addressed singularly for treatment success. We know the BPS can never be separated into distinct groupings, as each domain is constantly interacting and influencing the others.’
The RMTAO had come up with a great idea and I was hopeful they would deliver. The keynote speaker was Dr Melanie Noel. A researcher and professor at the University of Calgary. I have become familiar with some of her research over the past year. She has produced some great studies in the field of paediatric pain. She is also scheduled to be the keynote speaker at my favourite conference, the San Diego Pain Summit in February 2020. I was genuinely excited to see her presentation.
As is consistent with my sceptical nature, I was unsure if the presentations would actually be consistent with the theme. Would they deliver the goods? Or would this be BPS light? All too often, organizations and educators use ‘the words’ of current science. Lip service is paid to science in a way to disguise some type of preferred non-defensible biomechanical or connective tissue narrative which is flawed with outdated beliefs about how our anatomy and physiology functions.
Melanie Noel was better than I imagined. She was a great speaker who presented her research with passion and excitement. Her 75 minute presentation went quickly which is always a good sign of an engaged and entertaining presenter. It was interesting and informative to learn about early pain episodes and how this can shape future pain related behaviours. I will need to do more reading on this topic to better understand how this works. There was another keynote, but I slept through his presentation. The 3 hour time change flying East is always a struggle for me so I opted to sleep in. A decision I do not regret!
The only other presentation I saw was from my friend and colleague Monica Noy. She did an amazing job presenting, ‘Pain Care Through an Ethical Lens.’ She spoke about the ethical dilemmas regarding how current pain science influences patient autonomy and therapist integrity. We have taught courses together previously and we think very similarly so it was no surprise that I enjoyed her presentation.
I love attending conferences where I can hear a variety of speakers on different topics and then discuss this information with my colleagues as we try to make sense of how we would apply this to practice. This was the first time I presented at a conference so my personal experience was very different. I was thankful to be selected, and was both nervous and excited to present on two separate topics, (1) osteoarthritis treatment guidelines and (2) the importance of listening to the patient’s story and understanding how psychological factors can impact pain and recovery.
Speaking and teaching courses on BPS principles and how these are relevant to our profession is obviously a huge area of interest for me. Being given the opportunity to do this in front of a large audience was an amazing opportunity. Luckily, there were many other RMTs presenting on a variety of topics. I thought this was a great idea as too often our profession looks outside its own for educational opportunities. I love the idea of interdisciplinary learning as this is a model I support in my own educational endeavours. There is value in learning from other professions but RMTs have a unique clinical environment which other professions cannot replicate. I think RMT conferences would benefit from having RMTs as the predominant presenters. This could help advance our profession by encouraging knowledge acquisition and knowledge transfer to a wider audience. There are many educated and evidence informed RMTs who have lots to offer and are often overlooked for presenting at conferences or teaching workshops. My bias makes me think this could change if we decided to be leaders in advancing the pain science/biopsychosocial narrative.
Future Directions
There are still too few who care about the direction our profession takes. Sometimes this feels like a hopeless exercise where you work so hard at creating change and still encounter pseudoscientific nonsense everywhere you look. There is still a reluctance within many of the regulatory colleges and professional associations to forget old dogma. There is an apathy to adopt current science informed understandings about pain and how manual therapy, movement and exercise impacts the rehabilitation process.
This conference is hopefully the start of positive changes in Ontario. The RMTAO has taken a very important step in the right direction. This was very encouraging to me as it suggests the profession of massage therapy in Ontario is starting to understand the limitations to the pathoanatomical and connective tissue based rationales which have permeated the profession for too long. I am cautiously optimistic that the approximately 180 attendees left with a better appreciation of how pain and disability is impacted by all aspects of the human experience. The more healthcare professionals recognize the importance of adopting a BPS based practice the greater the pressure becomes on the regulators and educational institutions to change their outdated and potentially harmful system to a more scientifically informed one that puts current evidence and best practices at the forefront of an educational and regulatory framework that focuses on client centred care.
