In my opinion, too many people in our profession do not want to hear ‘the truth.’ I know there are no absolute truths in manual therapy, but for the sake of the meme it hopefully gets my point across. If the meme associated with this blog offends you, that is not my intent. My objective is for our profession to start asking critical questions and debating what the current scientific literature means to us. If we ignore it we can never move forward as a profession. Science constantly changes and informs us of what may be a more defensible explanation regarding what massage and manual therapy accomplishes from mechanistic and outcome based perspectives.
Change is constant. It is not to be feared. Allowing oneself the openness and acceptance that standards of practice, beliefs, behaviours, and ways of thinking will change is what allows us as therapists to think different and be better. Being resistant to change and fighting against evidence and the overwhelming scientific developments in the fields of pain, manual therapy and rehabilitation is a futile exercise that will harm your practice and not be in the best interests of your patients.
My good friend and colleague Jamie Johnston recently discussed the resistance to change and how science should be utilized to inform our treatments in this Facebook post.
I love his analogy of how we accept changes in protocols and beliefs regarding first aid, yet if science informs us it is best to change our beliefs and practice behaviours regarding manual therapy and exercise, there is often significant resistance. If we know that change is constant, then it shouldn’t be feared, it must be embraced. Rather than arguing against science, question it and try to understand its implications . Ask questions and discuss about what the research means and try to incorporate it into your daily practice. Other professions use science to create clinical guidelines, practice standards and inform curriculum development. Yet, many of the manual therapy professions, and massage therapy in particular, do not make theses changes? We need to start demanding more from each other and from our regulatory and educational institutions in order to advance our professional and educational development. I’ve written previously on the need for curriculum change here.
For many years I followed the pathoanatomical and tissue based reasoning for pain and dysfunction. I blindly accepted that what I learned in school and subsequent continuing education classes as being accurate. When I started to ask questions and looked to understand what the research and experts were saying, I realized very quickly that most of what I thought to be true was not. Initially, I was very resistant because I was trying to make sense of this new to me narrative. Once I jumped into the pain science rabbit hole and immersed myself with the research and spent the time asking questions and discussing it with others, it all started to make sense. Pain isn’t always about tissue, medical imaging findings or biomechanics and posture. Pain is much more complex than that. Neuroimmune processes, psychological and social influences all work together to shape an individuals pain experience. The complexity of pain and how it influences people’s behaviours was initially difficult to grasp, but it has led me to feel more empowered in the education I deliver and the treatments I provide because by simplifying treatments, I believe it has allowed me to be more effective.
I wish for all clinicians regardless of their education, professional title or experience to be aware of the latest research. Make the time to read and discuss what you have learned. Ignorance is not acceptable. What we learned in school is mostly outdated and it’s necessary to change and adapt. Even many of the continuing education courses available are peddling information and unsupported frameworks that do nothing more than make manual therapy and rehab more confusing for therapists and patients. A good example of an overly complex clinical reasoning process that is based on structuralist ideals, not supported by current evidence and clinically overcomplicated can be seen here. In this video they are showing how to “correct” a dysfunction as if there is only one way to “fix” this person. I am sure there is more context which is missed, but I include it to emphasize that pain and human behaviour is not always easily influenced by simple fixes.When attending courses and conferences ask hard questions and demand evidence to support the instructors claims.
Let’s start by changing our narratives. The story we tell ourselves and the information we present to our patients who seek us out for help in managing their pain needs to be consistent with what we currently know regarding the complexities of the person’s unique pain experience. Science informs us, guides our behaviours and it is always changing. That concept is necessary and needs to be embraced for the profession to move forward.