This is a guest post by my colleague Chrystal Ladouceur RMT. She discusses some very important concepts for RMTs and manual therapists. In order to become an evidence based profession we need to challenge unhelpful and unsupported ideas. Challenging these ideas does not mean your techniques or interventions are useless. Please read her article below for further insight.
You still matter
I make the assumption that a number of people within our profession know of me (Chrystal) as the former assistant to Scott Larke, Vancouver Island’s own Muscle Energy and Joint Mobilization Technique Guru. What you may or may not also know is that I’ve been a prolific proponent of evidence-informed practice since before I virtually attended my first San Diego Pain Summit (SDPS) back in 2016. Right out of school I was writing blog entries debunking labels like deep tissue massage and concepts of things like trigger points. My obsession specifically with pain started in 2015 when I lay in bed crippled by my own chronic pain, months after a traumatic fall I’d had off an obstacle. Out of sheer hope for my own relief and understanding, I read a book called “Understanding Pain” by Fernando Cervero. It was enough to whet my appetite for more evidence. I’ve attended SDPS online every year since and I’ve read more textbooks on the topics of chronic pain and treatment, motivational interviewing and neuroplasticity than I care to list (or you care to read about). I went to Greg Lehman’s Reconciling Biomechanics course in Vancouver in 2018, and I attended Eric Purves Clinical Applications of Pain Science course twice in 2020, the second time just so that I could accompany a friend I felt could (and who did) gain a lot of information from the same workshop. The point I hope to make clear to you right now is that in addition to working side-by-side with a well-known technique guru for 5 or so years, I am far from unfamiliar with the science of pain and evidence-informed practice. You should also probably know that I don’t do bullshit well, because those two things together are relevant when I say this: Your work, your massage therapy techniques, YOU still matter.
evidence-informed practice for rmts
It’s true that evidence-informed practice means we need to come to terms with the fact that the stories we’ve believed, the very foundations we’ve built our entire often very successful practices on, were simply untrue. Massage therapy does not improve our patient’s general circulation, reduce cortisol levels or even have positive measurable effect on delayed onset muscle soreness. Massage therapy cannot change fascia or your patient’s connective tissue even if your work tends to be deeper. On that note, it turns out that with deep tissue treatment you’re not actually affecting deeper tissues at all!
It’s also true and we must recognize that a large percentage of our population have general structural or disc abnormalities like degeneration, bulging, protrusions and with those same so-called anomalies they have no pain and no dysfunction! If I recall correctly more than 20%-30% of all asymptomatic 20-year-old’s have some sort of arthritic abnormality of the spine – and that percentage simply increases as we age. There is such poor correlation between arthritic conditions and pain that we simply cannot consider arthritis a reliable cause of pain despite the stories we’ve been told and tell. We know that bad posture isn’t a thing. Instead, too much time spent in any posture can lead to discomfort. We are dynamic beings who are meant to move! Who would have thought?
But these facts, as difficult as they may be to hear, they do not mean all is lost. It does not mean that all your education and experience is void and null. It doesn’t mean your practice isn’t relevant or that your patients don’t need you. None of this means that you have to change the way you treat or that any of your treatment outcomes have been a sham. Indeed, your treatments worked! When your patients reported they were feeling better, it is because they were! Their pain was real. Their relief was real. You are the great therapist you were before you learned all this and you still have immense value!
This just means that we have more information now. It’s better information to help guide us in treating our patients so that more of them do better than ever before. It means we have an opportunity to become even better therapists! We can take the good that we know we were doing right, and throw away the bad we keep perpetuating that was, in spite of our every effort, stalling our patient’s progress. And that bad I speak of really is nothing more than the stories we tell our patients about why they hurt or why our modalities can make them feel better.
Stop telling your patients their back pain is caused by the stuck facet joint or sacral torsion that your manual muscle tests indicated. There’s a reason those tests were so hard to figure out in school. It’s because we were trying to measure virtually unmeasurable things! Imaging has shown many of these conditions do not actually exist. Hear this clearly: this does not mean that your patient does not or cannot FEEL like the SI joint is stuck, a rib is out, or the hip is out of whack. It just means that this is NOT what’s actually happening, regardless of how it feels.
Pain is a liar my friends – remember this!
And remember that if we tell our patients that this is what’s happening to them, that their flat feet cause their pain, or their hip is torsional, they will believe it. In believing it they will think there is something wrong with them or at least that part of them. And that belief delays, even prevents their recovery.
Your treatment, the same treatment you offered last year and the year before is still just as effective without the story. The evidence is showing us that the narration needs to change in order that our patients get better treatment outcomes. You can become a better therapist by simply omitting the old narrative. Our bodies are strong, brilliantly resilient things. Most of us recognize this. Our bodies adapt in incredible ways to the forces we progressively place on them. Let’s remember this and remind our patients of this too. Because it turns out that patients who believe they will get better or those who believe they won’t, tend to do exactly that.
What we tell our patients matters and it affects their treatment outcomes. The number one predictor in how long it will take a person to recover after an injury is how long they think it will take them to recover. If we teach our patients that a part of them is broken, or fragile, or inept in some way, we leave them susceptible to manifesting that exact thing as their chronic reality.
Stop telling your patients they have a bad back or that a problematic SI is the culprit! Instead explain to them that area on their back is sensitive, and that a little modified movement in more comfortable ways may get them on the path to feeling better sooner than later. Stop telling patients that their flat feet or leg length discrepancies are responsible for their shoulder or neck pain. Instead, explain that their shoulder or neck is feeling hypersensitive and we’re best to find ways to move it that feel better instead of worse. And then offer positive tactile input because it helps them feel better.
Your touch is valuable
Understand that the positive tactile input you offer as a manual therapist has value – no matter what techniques or modalities you prefer to use. Evidence shows that manual therapy can reduce symptoms of anxiety and depression, improve sleep, offer temporary pain relief and can result in short term movement changes. Our patients need these things. All of these things are incredibly important, arguably lifesaving for some, even. These things serve to help our clients in every aspect of their overall health, and certainly in far greater ways than simply correcting some mythical biomechanical ailment ever did! This is especially true if while working that mythical magic we’ve also taught our patients to demonize a body part along the way. That demonized body part has the potential to become a chronic problem, because of a belief seed you placed in their minds about their very own resilience. Stop telling those stories. They hurt.
Finally, remember that our patients are as individual as the techniques we offer. Some will prefer your touch and other’s will prefer mine. That’s one of the greatest reasons your modality of choice still matters. Keep doing what you do. Your techniques still work. What you do still matters. You still have value.
It’s just the story that needs to go.
About the author:
Chrystal is an RMT in Victoria, BC. She is the owner of Aspect Health and Registered Massage Therapy. She can be contacted through her website – https://aspecthealth.ca