Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 69: Crack is Whack - Adam Meakins and A Modern Approach to Manual Therapy
1.8k Plays6 months ago
Welcome to Episode 69 of the Movement Logic podcast! In this episode, Laurel and Sarah are joined by Adam Meakins, also known as The Sports Physio, to discuss his recent co-authored paper, “A modern way to teach and practice manual therapy.” Adam highlights the major issues in current manual therapy practice and education, as detailed in this extensively cited paper, which draws on decades of research. He also outlines what a modern, evidence-based approach to manual therapy could look like.
In this episode you will learn:
- The distinction between clinician-centered and patient-centered care.
- How traditional manual therapy relies on pathoanatomical reasoning and what research reveals about its reliability and validity.
- The potential harms of traditional manual therapy, including the propagation of harmful, fragilizing, and disempowering narratives about the body.
- Why manual therapy treatments cannot precisely target individual joints and tissues, nor produce specific outcomes for those areas.
- How human biases, such as appeal to authority, sunk cost fallacies, cognitive dissonance, and big egos, hinder the evolution of beliefs and practices in manual therapy.
- Predictions for the future of manual therapy.
And more!
Sign up here to get on the Wait List for our next Bone Density Course in October 2024! It’s the only place you’ll get a discount on the course plus fun free bonus content along the way.
References:
Laurel and Sarah’s interview on the Conspirituality Podcast - Episode 205: Dismantling Movement Dogma
Episode 62: Make McGill Make Sense
Adam Meakins’ publication - A modern way to teach and practice manual therapy
Recommended
Transcript
Season Finale & New Course Announcement
00:00:00
Speaker
Hey everyone, it's Sarah here. We just wanted to jump on ahead of this week's episode because we realized that this is our last episode of season four, which ah is amazing and also never seems possible that we've done that many episodes, but that here's where we are. We've had a great time. This season, we've got a new season coming up for you soon as well, but a couple of things before we get into the episode. We talk about it all the time, but we wanted to make sure that you know we have another bone density course, Lift for Longevity, coming up in October of this year, which might seem like it's a far ways away, but it's actually not. It's only four or five months from now.
00:00:38
Speaker
And we've had such an incredible time the first time around. I wanted to read you a testimonial from one of the participants from last year. This is anonymous because it was as part of a survey that we sent out to get feedback from people, so I don't know exactly which practitioner this is. ah But she says, who knew I could be this proud of my own body? Back squat over 100 pounds, press a 45 pound Olympic bar plus additional weights over my head, and hip thrust 115 pounds. As a result of this program, I'm living in the strongest body I have ever had and I am 62 years old in a few short
Testimonials Challenge 'Too Late' Mindset
00:01:16
Speaker
weeks. I can't offer praise enough. This program is comprehensive, unique in its presentation and form, and built for learning. The live classes and the form feedback videos facilitated learning not only from my own training sessions and the feedback I received,
00:01:32
Speaker
but from the feedback giving to others during theirs. This is what I think makes this program so unique. It's not something you can replicate in a gym with a trainer. It's just to complete. Thank you, Laurel and Sarah, for the time, energy, and deep thought you put into designing and delivering the bone density course. It rocks, and now so do I. Oh my gosh. I know, I know, I know. so So good. Fucking awesome. Strongest body I've ever been in at age 62. Yeah.
00:02:03
Speaker
Wow. Yeah. I mean, you know, I, I work with a lot of older patients and some of what I have to overcome with them is this idea that it's too late. Nope. That it's too late for them, that they can't improve, that they can't get any stronger. And just like, uh, Luther Vandross likes to say, it's never too late. It's really never too late. You can always improve your strength. You can always improve your balance, your flexibility, all of these things. We're excited to do this program again. We have some of the participants from last year who will be rejoining because they enjoyed it so much. They got so much out of it. And so you can think of them like big sisters are going to help guide the way.
Sign Up for Course Perks
00:02:37
Speaker
Yeah. And so you can get a discount, the only discount on this course by going to the link in our show notes or on Instagram and signing up for the mailing list. You will also get access to a whole bunch of freebies that we've been giving out along the way. yeah And even if you haven't signed up just until now, you'll still have access to the ones that came
00:03:01
Speaker
already, which includes the PDF of how to decide what to do when you're injured, how to exercise safely when you're injured. That's what it's called. And a bunch of other fun stuff as well. So definitely get on the list, even if you're like, I don't know, maybe I will maybe I won't. it doesn't It's not going to hurt to get free stuff. And then you also get to hear about everything else we do. So we think it's a win-win. Yeah, for sure. All right, Sarah, so who who are we interviewing today?
Introducing Adam Meekins, Sports Physio
00:03:30
Speaker
Today we have the distinct pleasure of interviewing Adam Meekins. And if you don't recognize him by his name, you probably know him as the sports physio on social media.
00:03:39
Speaker
and And what's kind of a funny story because it's been a while since we've done one of these duos where we're kind of just chatting online with each other, but like so much has happened. One big thing is that Sarah and I went on the Conspiratuality podcast a couple of weeks ago. And our friend, Julian Walker, reached out to us. Julian's one of the three hosts of the Conspiratoriality podcast to talk to him and Derek Barris about movement dogmas. And Julian has been in our sphere for a while, but he wanted to interview us because he listened to our episode on Stu McGill. Make McGill make sense.
00:04:11
Speaker
and wanted us to come on and talk about just the crossover between what our two podcasts cover, which has a lot to do with gurus and pseudoscience and myths and things like that. And so he asked us a bunch of questions about McGill, but a couple more about some of our other episodes, like the one on movement dogmas, a series on long and lean.
Podcast Appearance Recap
00:04:28
Speaker
That was kind of a big moment for us, right, Sarah, to be invited on spirituality. Yeah, it was a huge moment for us. I mean, we I was so excited. And you know I'm a big fan of that podcast, as I know you are as well. We got to talk about a lot of things that are really important to us. I really admired the work that Conspiracy Podcast is doing, and I listen to their podcast episodes weekly. We're going to link in the show notes that episode, episode 205, Dismantling Movement Dogmas with your brave and intrepid hosts of this podcast, um who are now being invited onto other podcasts, which is very exciting. yeah But yeah, but so you know this ties into our interview today with Adam Meekins, because what happened, Sarah?
Discussing Manual Therapy Paper with Adam
00:05:07
Speaker
Because Adam listened to that episode.
00:05:09
Speaker
and had some sort of experience like, holy shit. And he posted about it on social media, like, go check out these this interview. And so we started talking with him. And we as it turned out, he had also just recently published been co-author on a ah paper about manual therapy. So we said, hey, why don't you come on our show so you can talk about your paper? And that's what we did. Yeah, we struck while the iron was hot. and right We're like, oh, Adam Eakins is giving us a shout out on Instagram. Well, maybe he'll come on our podcast. maybe if we ask him nicely now
00:05:41
Speaker
ah and and he did So yeah, so we're super excited to share this interview with you all today. It's a good one.
Adam's Philosophy on Therapy and Movement
00:05:51
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher. oh
00:06:25
Speaker
um
00:06:31
Speaker
Welcome to season four of The Movement Logic podcast. I'm Dr. Sarah Court, physical therapist, and I'm here with my co-host, Laurel Beaversdorf, strength coach and yoga teacher. And today we are thrilled to have Adam Meekins, aka the sports physio, as our guest. Adam is a specialist physiotherapist, sports scientist, and strength and conditioning coach working in the NHS and private practice in the UK. But if you're on social media and you are a movement person, you are probably more familiar with his account, the Sports Physio, as he is one of the top 50 physiotherapist social media influencers. I did not know that. um I'm teaching Adam things already. It's amazing. Okay.
00:07:12
Speaker
His main philosophy is to do the basics really well and save the complex fancy shit for later. Those are his words, if at all. He strongly believes in a practical and pragmatic approach and is passionate about educating patients and clinicians on the evidence and effectiveness or lack of it for many treatments within the profession. Adam, thank you so much for coming on the podcast. Thank you very much for that glowing introduction and the kind invitation to come on and have a chat to you. Oh, it's our pleasure. We're big fans. And before I get started, I just want to say kudos and congratulations to you too as well. So it sort of kind of pissed me off that I've only just found out about you two. Thank you. I've been binge listening to your podcast for the last
00:07:59
Speaker
week or so since I discovered
Outdated Practices vs. Evidence-Based Framework
00:08:01
Speaker
you and I'm immensely impressed. So I just wish I found out about you earlier because I think what you two are doing is absolutely awesome. amazing the We are sorely, sorely lacking more female voices in this strength and conditioning community trying to promote exercise and lifting. You know, it's just full of muscly white dudes and stream trying to promote the benefits of strength and conditioning. And we desperately need more females to to join us and and help promote the message out to the female community, because I think it's better well-recepted and taken on board by other females when they hear it from females. So please keep on doing what you're doing. It's great. And I just love the way you,
00:08:50
Speaker
you critically analyze things as well, because that sort of strokes my biases as well, rather than just accepting stuff. You are ah so good at breaking things down logically, critically, skeptically. and And I love that as well. So yeah, I'm going to give you lots of kudos for for doing that. And I can't wait to go through your back catalog. Thank you. By the way, you're one of our favorite muscly white dudes. It means anything at all. There's a lot of them that we don't enjoy, but you are one muscly white dude that we do enjoy. ah Also, thank you very much. That's that's clearly our sound bite for the rest of our lives is yeah Adam Meekins being like, there needs to be more of you. I'm listening to your back catalog.
00:09:27
Speaker
Alright, well, we invited Adam on today to talk about a recent paper that he co authored entitled a modern way to teach and practice manual therapy. And in this instance, we're talking about manual therapy, not just as massage, right, soft tissue mobilization, but also things like joint mobilizations, or what you might know as chiropractic adjustments, and also things like neurodynamic movement. And it's a pretty heated topic of debate among PTs, kairos, massage therapists, and any movement teachers who incorporate it into their work. Yeah, this is a great topic of conversation for us because Sarah and I actually met in the context of massage, just not the manual kind. We were teaching people how to use therapy balls to administer self-massage, and we were both at various times teachers of self-massage to other teachers, so teacher trainers.
00:10:18
Speaker
Sarah currently offers manual therapy in her PT practice. And I still occasionally teach self-massage as a complement to other formats I teach online. We talked about manual therapy before on the podcast in episode three, focusing mostly on myths surrounding fascia and how massage may or may not influence it. In this episode, we're looking forward to unpacking many more myths surrounding manual therapy with Adam. what it may or may not do, and specifically its value as a rehabilitative tool, meaning not just as a way to feel good. Adam, your paper proposes what you call a modern evidence-guided framework for the teaching and practice of manual therapy, and it avoids the more outdated principles of what you call traditional manual therapy. Can you take a moment to outline these two different frameworks, the traditional manual therapy framework versus the modern framework,
00:11:11
Speaker
that you propose in this paper so that we can understand the main differences between them? Yeah, sure. Happy to. sir The three principles that we saw commonly through all the various different types of traditional manual therapy ah training and education that's out there focus around three key areas. That is a clinician-centered assessment. with some patho-anatomical reasoning and then technique specificity being needed and required. So these are the three sort of commonalities that we found that a lot of outdated traditional manual therapy are promoting. So the Clinician Centered Assessment is basically historically before any manual therapy is applied in a therapeutic setting, a clinician would spend some time going through an assessment and it's normally a diagnostic palpation assessment
00:12:03
Speaker
looking for some dysfunction in a joint or some lesion in a soft tissue that is considered to be a problem or a pathology. ah So we're talking things like sometimes a and ah ah therapist will go down and palpate through the spine looking for a segment that doesn't move as well as the other ones, a hypermobile segment. or that they'll be running their hands through some soft tissues, feeling for a palpable knot or a taut band. And this clinician-centered assessment is basically hunting for dysfunctions, hunting for pathologies. But there is decades of research out there that shows the ah reliability, sensitivity, and specificity of these diagnostic skills that are taught to therapists is just really, really poor.
00:12:52
Speaker
Would you say that the patho-anatomical reasoning and this idea that technique techniques need to be hyper-specific or specific is really falling under the umbrella almost of clinician-centered assessment? That like, clinician-centered assessment tends to involve patho-anatomical reasoning and this idea that techniques need to be specific or is clinician-centered assessment more than that? Does it include more than that? we We think it's separate. So you've got this clinician centered assessment requirement first, and then they go on to, well, I found this particular problem, it therefore needs this particular type of treatment. So that's where we get into the specificity of the technique. Got it. But yes, and in the middle wind between there, the bridge to go from the clinician-centered assessment to the technique specificity is a lot of pathoanatomical reasoning. and And so this is sort of these three areas that sort of flow from one to another that are traditionally taught to manual therapists. So you have to go and hunt for a dysfunction, a pathoanatomical lesion, a manipulable lesion,
00:13:57
Speaker
You then apply that patho-anatomical reasoning to say, OK, this is wrong. This is what should be there. There is something stiff. There is something out of place. There is some lesion in some soft tissue. And therefore, I need to do a specific type of treatment, a particular manipulation in a particular direction, a particular amplitude of oscillations and mobilizations, or a particular type of soft tissue treatment to correct said dysfunctions. But again, we've got decades of research that shows not only are we really bad at identifying these so-called dysfunctions and lesions, that we have absolute very low to no reliability. So what one therapist will feel in one patient, another therapist will feel something completely different.
00:14:48
Speaker
The the the theory theory about these things, even if we could find them, being dysfunctional hasn't been proven either. So the causation of a stiff, vertical segment being the source of nociception and pain and problems hasn't been established. And then we've got absolutely no evidence about the specificity of the manual therapy that we apply either. So there is so much of manual therapy that is built on a house of cards. It's built on pillars of stand. And say what we're trying to do is just highlights this research that's out there. And we're not saying what we have said in this paper is anything new. There's been people that have published papers going back 25 years.
00:15:30
Speaker
first highlighted this. And this is why the reference list is so long in our paper. There's over 159 references that we've used to support all these opinions and and these these ah things that we're saying. And as I said, it goes back decades. It's just that, unfortunately, manual therapy within healthcare is just really stubborn. at trying to change
Promoting Resiliency Over Fragility
00:15:50
Speaker
its mind, at really trying to move forward. And there's a lot of kickback, and there's a lot of resentment, and there's a lot of holding on to archaic, outdated, dogmatic principles for various reasons. um you know There's the financial vested reasons, there's cognitive dissonance, there's sunk cost fallacies, there's all of these things that just make it really, really hard.
00:16:13
Speaker
for therapists to move forward and use manual therapy in a much more rational, simplistic, honest, and evidence-based way. And it is so infuriating. If that's that traditional manual therapy framework, what is the modern framework that you propose in this paper? How is it different? Yeah. So we got sort of two elements to it. We got practical elements and conceptual themes. So the practical elements of manual therapy, we've got three areas here. Manual therapy needs to be applied safely. It needs to be done with comfort considerations and it needs to be done efficiently. So these are the three sort of practical elements. So safety first means do no harm. You know, it's a principle of all healthcare clinicians. So basically, am I going to be doing this patient detriment by applying some manual therapy? yeah Now from a you know safety point of view, we have very low risks with manual therapy. There are obviously some in
00:17:10
Speaker
the higher velocity type of manipulations, but the actual physical risks of manual therapy, the adverse effects are very, very low, which is very fortunate for us, which is great for the manual therapists out there. However, the other part of safety that we we talk about isn't just about physical safety, but it's also about psychological safety as well. So what we're trying to say here is well that the most harm we think manual therapy does to people is by giving them shitty narratives and outdated beliefs, right? And makes them feel fragile and broken and dysfunctional and that they need to be dependent on manual therapy treatments and techniques to be fixed and corrected.
00:17:52
Speaker
yeah And we're trying to get people and manual therapists to move away from this harmful language that they use when they're explaining what manual therapy does and how it helps people. I feel like we see a lot of that in particular in the chiropractic world, at least we do in the United States. I don't know if it's different in the UK, but you know, I'll have patients come in in theyre and I'll say, you know, are you doing any other kind of treatment? They're like, well, I have to go to my chiropractor. ah but every week ah because he puts me back in alignment. So this idea that you're out of place and you need to be to put back into place and that the only person who can do it, it's someone outside of you, that you don't have any you know ownership of it. It's like taking your car in and getting a mechanic to do something to it. And then you're like, I guess that fixed it. I don't know. What do I know about cars? It is, again, a more clinician centered approach, um but it is very disempowering, I find.
00:18:39
Speaker
Yeah, can you speak to the the harm, specifically you mentioned the harm done by these fragileizing narratives, right? So I feel like this plays in very closely to this concept of patho anatomical reasoning. And then also you mentioned that we're being told that we need the clinician to fix us because their techniques are hyper specific and we couldn't possibly get the same result in any other way. Can you speak more to that reading of the word safety? Yeah, sure. So I think, you know, these narratives that the the patho anatomical reasoning tend to do to people that is detrimental is a number of things. One, it can start to create dependency on treatments and interventions that are, you know, can feel nice, but they're not essential or necessary.
00:19:30
Speaker
And I think there is a lot of ah selling of sickness out there in certain manual therapy circles where they they use this, I don't know whether it's knowingly or unknowingly as a sales technique, as ah as a high pressure sort of, you need to have this amount of sessions to correct this type of problem. And and that is, I think, unethical and immoral. And again, what we're trying to do is just is just get manual therapists to recognize that you know this isn't a good way to practice. It's not an ethical, moral way to be using manual therapy. And then the other sort of harm, as we said, is is say is just making people feel like they are fragile.
00:20:13
Speaker
you know the fragileization of the human body I think happens a lot in healthcare and I'm not just going to say with physio or chiro it happens in doctors ah surgeries and and in surgical appointments as well yeah but you know we just got to try and promote a more you know resilient robust view of the human body yes okay it causes us problems from time to time we get pain we get pathologies we get diseases But we want to try and help people by promoting the robustness and the resilience of the human system, the human body of being able to heal and regenerate and repair with assistance and guidance and facilitation by us in healthcare, helping along.
00:20:58
Speaker
And so that's what we're trying to promote and just move away from, you know, all this doom and gloom about, oh, this is what the problem is. And this is what means it's going to be like for the rest of your life. And this is what you shouldn't do. And this is where you should never do this again. You know, all these narratives that come from this patho anatomical reasoning just needs to be moved on from now. Right. Thank you. um Laurel, I think maybe it's time to get into some of the myths. For sure. All right. Well, let's ah let's do a little bit deeper dig into some of the specific myths that this paper debunks thoroughly through those multiple dozens of citations. All right, so we're gonna talk about, can I just break in for a second? Yeah, yeah, yeah. I've got no reason at all to break in right now, but I just wanted to say, when we were first looking at the paper, and I i sort of went through, I was like, wow, it's a lot of pages. And then I realized how many pages were the citations. And I so i was like, whoa, there's like over 150 citations. She was like, that's awesome. And then the next thing she texted me was like, wait, do we have to read all of them? I was like, no, no, no, no, no, no. But it does it does give this,
00:22:06
Speaker
ah It gives a ah lot of reliability to the paper. So we were very impressed by how many citations. yeah we do we We do want people to go and look at some of these papers, as I said, not just from the historical perspective, but there is some absolute gold in there about how, you know, everything that has been or still is being taught around manual therapy just doesn't hold up very well. And, you know, I think the more students and the more, you know, people that have this when they go to these courses, when they're being taught these things that are out of date by educators who are either ignorant of it or just don't want to to accept it or acknowledge it and they're confronted with the hard evidence, the black and white evidence to say well what about this reference here, what about this paper here, what about this that says the complete opposite of what you've just said and taught. I think that's going to help promote change as well because I think the more
00:23:01
Speaker
educators who are promoting shitty narratives out there to their students who get challenged and questioned and made them feel more uncomfortable rather than just feeling like they're rolling over their students by just giving them some old nonsense. I think you know the educators will start to think, okay, I need to explain things differently now. I need to start teaching it in a different way. Yeah. This non-evidence-based education we're charging a lot of money for is maybe not working anymore, right? We're going to have to get on board with the evidence.
00:23:33
Speaker
Well, it's not pleased. It's not got any quality control. The only quality control is the amount of people who turn up actually to the courses. That's what drives the courses to be done. yeah How many students sit in front of them and what is the demand for the course? yeah And I think the more shittier the course is now and the more informed people are, the less likely word of mouth promotion is going to start to help these courses survive. right So I do hope that I say the more people are going to these courses are better informed, better educated. When they start to hear the city bullshit being taught, they're going to start to question it and challenge it. Yeah, I hope so. Yeah, I've always been that student and I find that I'm not. kind i'm I'm not always. throughs flat The like, oh, God, she put her hand up again. Yeah. yeah well
00:24:26
Speaker
You know, your paper states that one of the principles of the traditional manual therapy framework is built on technique specificity, which we've discussed a little bit already, in contrast to modern evidence guided framework, and that we should avoid this assumption that techniques need to be specific, and instead acknowledge that research does not support the superiority of specific interventions. Now, when I learned self massage, I was guided toward developing palpation skills for finding bony landmarks as well as understanding muscle anatomy like which muscles attach to these bony landmarks. I was also taught different massage techniques like pin and stretch, stripping, cross-fibering.
00:25:03
Speaker
ah contract relax and and more. In other words, I was taught to move the balls in a very precise, specific direction across a muscle or a group of muscles, or I was taught that if I could locate specific parts of a muscle or even move joints in specific ways so as to stretch or contract certain muscles, that all of this precision was important. Now, I wasn't learning this to treat tissues obviously because I'm not a clinician. But I imagine massage therapists, PTs, Kairos, and massage therapists aren't clinicians either, but these types of professionals are learning this stuff. um And they're learning to do with their hands, so that kind of ups the stakes a little bit. And they're definitely going into way more depth than ah weekend training, which is what I took. ah They're learning to treat specific tissues.
00:25:51
Speaker
in these very specific ways.
The Role of Anatomy in Therapy Critique
00:25:53
Speaker
And that's really what they're paying for when they receive this training. And yet, um in your paper, you note through, again, numerous citations, that research does not support the superiority of specific interventions. So here's my question. What does this mean? Does this mean that it's a waste of time for anyone administering massage or facilitating self-massage to learn these bony landmarks, to learn muscle anatomy, to learn specific therapy ball techniques? Or does this stuff just not matter for the things we think it matters for? What do you have to say about that? That is a great question, Laurel. And um I think when it comes to you know specificity of treatments, we've got to look at it different. So to go back to that first bit that you said is, do we need to stop learning anatomy? Absolutely not.
00:26:45
Speaker
I think there's still, you know, a need for therapists to understand the human body, to understand anatomy, to understand physiology and pathophysiology. So I think that is really important still to learn as a therapist. But when it comes to, you know, the specificity of our treatments, what we got to recognize is that we are not just affecting the target tissue. You know, one of the things that really annoys me is these soft tissue techniques that are just named after things that are biologically implausible and impossible. Can you give us some examples? ah Yeah, myofascial release is the classic one. yeah It's just implausible to think that by pressing on somebody's body, you're only, only affecting their facial tissue.
00:27:39
Speaker
You have to, first of all, press through their dermis, their skin. Skin is richly innerviated. It's highly vascularized. It is extremely proprioceptive. And we just totally ignore the skin. We always say, you know, the tissue the soft tissue technique I'm doing is working on the surface underneath the fascia or the muscle or the tendon. And yet the first thing we actually touch is the skin. Yeah. I haven't heard anybody come up with a manual therapy technique called dermis integration. Well, Adam, that's because the three of us are going to, the three of us are going to create it. We need a good three letter name for it. Cause they always have three letters and we're going to make a shit ton of money. I'm running integration technique. There you go. You've heard here first, and it'll be a three-part course because we have to work through the different layers of the scheme. And like every year you're going to have to renew your certification. So yeah, we know how to make this into a money-making machine. Anyway, sorry. Get back on point. Yeah, but I'd say the point is to say we are just not affecting one tissue with any type of manual therapy. And that goes with our our joint techniques as well, this belief that we are specific to one vertebral segment.
00:28:55
Speaker
you know, that we are able to make an L5 S1 facet joint on the right hand side move separately from all the other joints and tissues around it is just unfounded. And again, there's evidence to refute it. There are some interesting studies done in MRI machines actually in vivo of people having joint manipulations and mobilizations. And you just don't see one isolation at the joint moving, you see, all the joints around it moving together and you know you see that with manipulations you you often when you do a manipulation you're not just going to get a single audible pop from one joint you can sometimes air three or four you can make people go off like a
00:29:38
Speaker
a machine gun sometimes and you know you've cavitated a good few joints all at the same time with this so-called specific technique so again we are not isolating individual joints we're not isolating individual tissues the effects of our manual therapy are multi-factorial we are we are doing lots of things to a body and but we're also playing around with their nervous system including their central nervous system we are modulating and playing around with perceptions of sensations of stiffness and pain.
00:30:16
Speaker
So you know we have to take that into consideration as well and understand that a bit better and recognize that a bit more and just understand that trying to determine the mediator of effect after you've applied a manipulation or a massage is is almost impossible to do because there are probably 10, 20, maybe 30 different potential mechanisms all occurring at the same time with every single manual therapy technique to do. Physiological, neurological, psychological. Your paper points out that there has been no difference shown in an outcome related to the way a technique is delivered, such that even when random techniques are selected, they perform about as well as clinician selected techniques, that there is no difference in outcome when different directions of force are applied, and that sham techniques perform as well
00:31:10
Speaker
as specific approaches. So when you say that there is value in learning muscle anatomy, there is value in, for example, being able to palpate some of the bony landmarks of the body. And perhaps, I don't know if I'm putting words in your mouth, would you say that there is also value in learning specific therapy ball or manual therapy techniques? But perhaps the value in learning these specific techniques isn't in the enacting of certain specific outcomes but rather does this specificity just allow perhaps a therapist or or a self massage teacher to have like a better intuition about the body or to be able to make more informed decisions about how to do something that maybe aren't based on like trying to achieve a specific outcome.
00:32:02
Speaker
but based on other things, like what what would you say then is the value of learning to apply techniques specifically if that value is somehow not really that connected to the the one-to-one relationship between specific technique causing specific outcome? Yeah. Great question again, Lauren. So I think that, you know, the value in learning different massage techniques, different joint mobilization techniques is not in the specificity of the technique to the tissues, but it's in the specificity to the individual that you're treating.
00:32:34
Speaker
So we, we got to look at specificity, not on a specific tissue or joint, but on a specific individual.
Adapting Techniques to Patient Needs
00:32:41
Speaker
And this is where we're trying to change this shift from clinician centered assessment to a patient centered assessment. yeah So, you know, we've all seen patients of various different levels of irritability and sensitivity with their painful problems and having a range of different manual therapy techniques that you can apply to a range of different people based on their sensitivity and irritability is really bloody useful. yeah If you've only got one type of tool in your toolbox for manual therapy, you're a chiro and you just do high velocity manipulations, what are you going to do with everybody who comes in, regardless of the levels of pain, sensitivity and irritability? Whack, crack, off you go. Fuck it, get out the door, next one comes in. You just crack them and whack them and off they go. And that's often what happens because they've only got one particular tool in their toolbox.
00:33:31
Speaker
If a manual therapist has those manipulations but also has you know other types of treatments that they could use for somebody that's got high levels of irritability, anxiety, fear, or just doesn't want to get into these positions that are uncomfortable to apply the manipulation, they can still use manual therapy based on that person's presentation. yeah So I think having a range of manual therapy techniques that comes in different pressures, different irritabilities, different velocities is really useful to do because it allows you then to be able to yeah find the right treatment for the person in front of you.
00:34:09
Speaker
I really like that. It makes me think about that it's actually, in a lot of ways, it takes the pressure off of you as the clinician in some ways, because if you're making this claim that you're going to adjust this specific vertebra, or you're making a claim that you're like breaking up the adhesions or whatever, and if that's not actually what you're doing, to me, it's like, oh, how that's really nice. I don't have to claim to be doing something I'm not doing. Instead, I get to get a sense of the person in front of me. get a sense of what they really need. Maybe it's just to like, let's go find a private quiet room and it turn the lights down, put a blanket on you. Like let's use this manual therapy to like calm down your nervous system, not like fix a problem, but maybe make you feel better overall. And then your pain interpretation changes as well, right? It seems like it's, this patient centered care is much more of a biopsychosocial approach than the sort of more typical clinician centered care, which is more sort of mechanical, like problem, fix it, problem, fix it.
00:35:01
Speaker
We know someone very much like that, Stu McGill. um Anyway, I just now like to drop his name into every single podcast. oh I wanted to ask as well, we talked a little bit before about how this clinician centered care where where someone's making an assessment based on what they're feeling and then they're applying a technique that's supposed to fix what they're feeling. None of the research shows that that's that that's the case. When you were talking about that before, I could feel in myself i and even knowing this to be true and even um actually really enjoying that it's true and feeling like it's a relief at the same time I had a little bit of that sort of cognitive dissonance of like oh PT school was you know a lot of money and attorneys were a lot of money and now is that possible that that this just I just have to whoo swallow it um I mean i'm I'm assuming and I've seen in fact on social media that you're getting a lot of pushback about this
00:35:57
Speaker
concept in particular that you cannot be specific. What are the kind of counter arguments that you're hearing from the clinicians that are pushing back or anyone who's pushing back? Yeah, a lot of the time is ah it's I just know um i I see it pain and day out so these these are the common you know, ah counter arguments I get here, they know that their specific techniques are working specifically, they just know, you know, that's the top of the evidence based hierarchy pyramid, got systematic reviews. And then above that, you got this arrow that says, I just know, I know i know somebody on social media who said this, yeah. yeah
00:36:35
Speaker
yeah I did my own research. yeah but you You make some great points there. you know i I think you know there is there is a large cognitive dissonance effect with a lot of manual therapists when this information is presented to them. There is a big kickback effect ah that nobody likes to think they've wasted a lot of their time, money, energy, and effort on things they didn't have to.
Changing Beliefs in Manual Therapy
00:36:59
Speaker
Uh, they perhaps don't like to think that they've been hoodwinked. They don't like to think that perhaps they've been misled lied to. They, they sometimes get a little bit defensive because of that. Uh, so yeah, sunk cost fallacies, human biases. These are all things that we have to work with and against when we're trying to change people's views and minds and opinions. And, uh, sometimes we'll be successful and other times we won't, we got to recognize, you know, change of behavior and beliefs.
00:37:29
Speaker
yeah There is no quick, simple way of doing it. There is no one fit-size-all approach to doing it. I do think presenting information is important, but you know it's about other ways as well. You so you speak about Sun cost fallacy and and the idea that you might have been lied to. I think as well for clinicians, you know there's no small amount of ego involved as well. Oh, absolutely. So if I if i believe in my you know advanced level of technique, because I've been doing this for 30 years, and then someone's coming along and trying to tell me that I don't know what i what I know, I feel like that might be an even bigger barrier to accepting that maybe it's not what you think it was.
00:38:12
Speaker
Yeah, and I totally agree. And again, you know, people think that I'm quite cold and callous when I present this information out there, but ah I know it comes across that way sometimes because that's social media. You can't, you know, see the the tone, the nuance, the the feeling behind it sometimes. You can't pick up on that. But I've been through this. I know exactly what these clinicians have because when I was in my career at the early stages, I wanted to perfect these dark, magical arts of manual therapy. I wanted to be the grand wizard of joint manipulations. I wanted to achieve all the certifications and I spent
00:38:48
Speaker
thousands and thousands of pounds of my own hard-earned money on postgraduate courses and certifications. And I've done them all. I've done all the myofascial release techniques, active release techniques. I even went to America to learn that one. It cost me a huge amount of money because I've told that this active release technique is the new way of helping people with soft tissue treatments and You know, I look back at it now and I'm thinking, Adam, you're so foolish, you're so gullible, you're so naive. So I totally get where a lot of these clinicians are coming from. It's hard to feel like that. It ah it is a bitter pill to swallow. It's a difficult chasm to cross when you are presented with this feeling that perhaps, as I say, you've been hoodwinked and you perhaps now have to do something a bit different.
00:39:38
Speaker
I got a lot of training in safe alignment in yoga teacher training and how to keep people safe in yoga with these very narrow like alignment rules. right And so if you deviated outside of these alignment rules, it was potentially unsafe. And then I broke out of that model and started to recognize there's really no such thing as you know safe and unsafe alignment, posture, and pain. don't correlate, they don't even have a relationship. And so then I started to understand that there was still value in my ability to be really precise in teaching alignment. And this sort of speaks to my question about, is there value in precision? And so when these therapists or chiropractors or massage therapists or teachers spend a lot of money on training after training after training, purportedly learning to be more and more precise,
00:40:30
Speaker
I don't know that all is lost, right? That this ability to be precise, to know the body in ah and ah in a more nuanced, detailed way, like you said, Adam, has value. I think that maybe the problem that we're running up against in these two sides, the traditional manual therapy Framework and then the the modern framework you propose is that is it more about how these? Precise techniques are being explained how they're being sold. That's the problem, right? Like I am doing this precise manipulation I am doing this precise massage on your body in order to make this precise change to your body because that's the mechanism driving your pain like that seems to be the problem. But if instead we took all of this training and all this ability to be precise and all this background knowledge that we've paid a lot of money for, and we used it instead to be more maybe responsive and intuitive with each individual that came to us to be able to find how to help that particular person feel better in the ways that they're sensitive. like It seems like we could still
00:41:39
Speaker
harness all of this training for good and we don't have to just throw it in the trash. No, I agree. I think, you know, I'm i'm on board with that ah description that you said there, Laurel. I think, you know, it's a case of sometimes this, you know, I'm going to use this word very loosely. This show that we put on to patients, this performance we put on, this theatrical display of spending time measuring things, assessing things. does come into play into the therapeutic relationship building effect, which then does help improve the outcomes afterwards. So one of the biggest drivers of outcomes with treatments is the relationship that the patient has with the therapist.
00:42:23
Speaker
So if the patient has trust and faith and feels safe and secure with a therapist who is spending time and it looks like they're taking precision and they're making everything as good as it possibly can be and the patient is seeing that and feeling that, that's going to improve the outcome of that particular treatment. Now, is that particular treatment doing the things that they think it's doing from a precision and specific point of view? Absolutely not. But is it helping improve their outcomes with that patient because of the show and the theater around it? Absolutely, yes. And one of the things I think as well as ah from PT school, these kinds of skills are what we think of as like soft skills, right? Your ability to, you know, be present with your patient, to listen well, to communicate well, to collaborate, which is one of the things you talk about as well.
00:43:14
Speaker
ah are Those are incredibly hard to teach, but I've got a three-year program ahead of me. I'm just going to so you know fill up all that time with all the mechanical stuff because I can teach that, I can test it, it can be on the board exam, it can be you know it gets you a license. um But I think about a lot of the stuff that i was that I was taught and I use some of it, but I use it maybe in different ways, more like more like you are suggesting. I'm the same as well. you know I've realized that a lot of this stuff that I was taught, is improved by manipulating the interactions and the communications that I have with the patients. It's not actually the treatment that gets the outcome. It's the it's the context around it that also has a huge part to play. My question kind of relates to that, which is it's not really my thing to pay a stranger to give
Professionalism & Regulatory Standards in Therapy
00:44:03
Speaker
me a massage. like I've probably had that happen two or three times.
00:44:06
Speaker
um I like getting massages, but I don't and don't really like the strangers. i don't feel like I feel like my money could be spent better in other ways. um much I don't see the value in it in terms of what it costs, but that doesn't mean that I don't think it has value and that other I don't understand why other people would do that. But I have had a bad massage. like I have had bad massages. like I think there's such a thing as a good and a bad massage. and i and i And I feel like people who are professionally trained to give massages might, I don't know, on Yelp, get higher star ratings than people who are amateurs running around giving massages because I do think there is some skill involved. right
00:44:47
Speaker
So can you speak to that? like What is the difference between saying that massage or you know manual therapy in general doesn't have to be specific and you don't need a high level of training in order to achieve positive outcomes? What's the difference between saying that and then saying that administering manual therapy or administering um sorry aistry manual therapy or mystery massage requires no skill? What's the difference between those two statements? Yeah, I think that comes more down to professionalism. and And I think that's more about, you know, perhaps certain professions are regulated and accredited, and therefore they have codes of ethics and mandates that they have to work to. Whereas others, you know, done weekend courses, they don't have any
00:45:37
Speaker
ah you know, anybody overlooking them to maintain their professional standards so they can be a bit relaxed, laxidasical, they can be unprofessional sometimes. And that then sometimes obviously makes things not feel good for patients. So I think there's perhaps this element of professionalism around the manual therapy that again helps improve things. you know the The perception of a patient that is seeing a licensed healthcare care professional who they know has a board of regulators overseeing them, who has got a certain criteria of training and safety, and you know you know they're gonna wash their hands you know and do all the basic sort of things you'd expect to do, opposed to somebody that you go and see in a back room around the side of a gym.
00:46:26
Speaker
who you know perhaps isn't licensed and has got no health and safety standards. I suppose that can come into play there in how those treatments feel because of the environmental contextual effect factors around it. but So Adam, does this mean that you can't improve your skill as a massage therapist or as a manual therapist? that like a I guess what I'm trying to get at is if the difference between someone who's trained and untrained goes beyond just professionalism. If it actually goes beyond that to include like the actual skill of touching someone in a way that actually feels good. Okay, because I have received bad massages and they are not
00:47:06
Speaker
I would say because I felt like the person hadn't washed their hands or it was in an inappropriate setting or anything inappropriate at all, unprofessional at all. It was really that this person didn't seem to know how to touch in a way that felt good. It felt a little bit like I was being poked and prodded. manhandled or just kind of not that they didn't have a real good sense of the body in general. um do what do you What do you say about that in terms of there there being a difference in how much skill someone can acquire through training? Like is training actually unimportant?
00:47:41
Speaker
I think it's not as important as people think. I don't think you need to spend hours and hours, days and days, weeks and weeks and sometimes years learning the so-called technical skills of doing a good massage. So i think I think there's a lot of complexity there that's just totally unnecessary. I do think experience matters. I do think it takes time to learn how to use your hands therapeutically. So I think, you know, years under the belt definitely comes into play here. You know, there is, you know, as all things, you know, there is some things that just, you know, takes time to start to get a better feel of you start to become a bit more intuitive with the pressures that you use.
00:48:29
Speaker
I don't think that's any technical skill that can be taught. That's just something that you acquire over time. Yeah. It's very relational. I mean, you can tell when someone isn't picking up what you're putting down just based on how they react. And and then I think there's an innate preference where there are some people just better suited for better ah results with certain jobs. Some people have the personality types and the communication skills who are better suited to do certain things than others. Some people just should not be healthcare professionals because they're not. They could not agree more. They need to be accountants. They're researchers.
00:49:08
Speaker
You know, radio be go be a radiologist. Our friend Trina's husband is a radiologist. He does not talk to people all day long. It suits him perfectly. Perfectly. I mean it as a compliment. Yeah. There's definitely been PTs that I went to school with where I was like, I would never want to be your patient. most Mostly based on like, I don't think you are even, you're not picking up any of the like quality of of the interaction, right? It's all about like, the there's a problem and I fix it. There's a problem and I fix it. And I'm like, well, what about the person underneath the problem? Right. It seems like it's kind of all coming down to this idea of using manual therapy and pointing it toward a problem.
00:49:49
Speaker
versus using manual therapy and really directing it to the whole person and going, how can we take this skill that has general benefit and help you in your individuality experience individually specific benefits? Like maybe don't massage my shoulder that way because it hurts when you do that. Let's massage it this way so that it doesn't hurt. Yeah, getting patient feedback is something else that we, you know, that comes under the communication side of it that we talked about as well in the sort of conceptual themes. You know, and I think that's something that is often not done. Manual therapists just apply the technique and don't get any feedback from the patient. They're very much strong advocates to say the patient is the one experiencing what you're laying down, therefore you need to get feedback from them to see if it is,
00:50:39
Speaker
doing things and and working on what they think it needs to be worked on, and is it at the right pressure, is there things, are they comfortable, etc. so yeah It's absolutely fundamental, that two-way communication, putting the patient in the center and getting communication from the key point. That kind of segues into what I wanted to ask you about next, which is the difference between, and you talk about this in the paper, the therapeutic intent by the practitioner believes that they are doing to the tissue, versus the patient's expectations around what is happening. And you know I'm curious what you see with your patients. I don't know if you still do any manual massage work on your patients, but I do have people who come in and their expectation is that physical therapy is only manual therapy. And then they're very surprised to discover that some of their return to function is their own responsibility through
00:51:31
Speaker
you know exercise, building strength, all this kind of stuff. Do you find that that just sort of general public laypeople are a bit misinformed about what physical therapy is, or do they just overvalue manual therapy as a fix-all, or maybe is it a little bit of both? Yeah, absolutely is a little bit of both. you know Physiotherapy does, I think, globally still have a reputation as being a service where you go and get something done to you.
Building Trust Through Manual Therapy
00:51:55
Speaker
So there is still that cultural societal barrier to overcome a lot of the time. you know A lot of patients don't really value our
00:52:05
Speaker
information, our education, you know, they often, you know, when I've tried to give them the best bit of a advice and guidance and lifestyle planning and kick-ass exercise rehab program to help them through, they'll say, yeah, that's all great. When I'm good, when's the physiotherapy going to start? i
00:52:24
Speaker
So, yeah, we have the same issues. as i yeah i want to be cracked and whacked. That's right. I just want to lie down and just come on, get on with the physiotherapy. Enough of the talking now. Okay. Yeah. I'll go and do the exercises like you said, you know, maybe in a couple of weeks time. Yeah. Fix me, please. Fix me. Yep. Yep. So we still have to say we have to work with patients here. And again, you know, this is where I think, you know, manual therapy can be a bridge. It can help therapists sometimes help them build that relationship, that trust and rapport. And then, you know, if patients start to like this person, they like what they're putting down, they're feeling nice and relaxed. after because I think they're going to be more receptive sometimes to to the information in the education that is then
00:53:09
Speaker
given to them by the therapist, which is probably the bit that's going to do the most good. But the manual therapy has been a bridge to allow that to be better received and well accepted. Yeah, I actually find that that I don't think I ever sort of put it together as like, I'm doing this is a concept that I'm using on purpose. But I have found sometimes that with a patient that is either very agitated, or just, you know, they they clearly want some manual therapy to start with, I'll be like, Sure, let's do what you want to do, right? And then I do what you want to do. And while I'm doing it, I just kind of, sometimes I put on my therapist voice, which is very gentle, and it's a little higher pitched and it's I soften the edges. And I'm like, you know, what would really help is if every day, just a few minutes a day, you started doing a little bit of this, what do you think of that idea? And then they're like, oh yeah. And then I'm like, all right, now now I've made it sound like it's your idea. So now you're gonna be more willing to do it rather than like, here's what you need to do, you know? So yeah, yeah, for sure.
00:54:10
Speaker
Yeah, I think it's say it's a nice way to to, again, just build a relationship and communicate with patients. You know, it's ah it just because we've got these barriers, these societal barriers to overcome, you know, being a hard arse about it, you know, and just saying, I am not going to give you what you want. The patient's expectations are going to be rock bottom. They are not going to do anything that you say and they'll probably think you're a bit of a knobhead. One of my favourite insults to throw at people. um And they'll probably go away and um yeah never come back to see you and go and see somebody else who may give them absolutely even worse.
00:54:46
Speaker
information and care. So again, we go got to recognize that, you know, every patient we see is an opportunity to, you know, give them, you know, the good stuff that we know that we can do, but we we have to meet them sometimes halfway. And it's a bit of give and take. It's again, it's putting the patient at the center. What are your expectations? What are your beliefs? What are your hopes and desires from coming to see me? You know, what can we look to try and achieve? Is it reasonable? Is it rational? If it is, yeah, let's go for it. I come from a long line of teachers, of of educators, and ah my husband is a a professor of education, and so we talk sometimes about frameworks of education.
00:55:27
Speaker
and There is such a thing as teacher-centered classrooms and student-centered classrooms, and teacher-centered classrooms are you know the old school way of teaching where the teacher is the holder of knowledge, the students are the empty vessels, the teacher pours their knowledge into the empty vessel of the student, the student's job is really just to memorize. what the teacher knows and contrast it with student-centered classrooms where students take a much more active, engaged role in their education. Learning is collaborative and co-created and the students themselves
00:56:04
Speaker
play a role in the education of their peers um along with the teacher. And the teacher responds to student desires, student questions, student problems, right? And what I love so much about reading this paper was that I could create this connection between healthcare care and educational contexts, which I'm more familiar with. And so I want to talk a little bit more about this concept of patient-centered care. um A lot of people listening are physical therapists, but I think many more of them are actually teachers. And so if they can hear this question through that lens of a
Positive Communication in Patient Care
00:56:42
Speaker
teacher, right? What does it mean
00:56:44
Speaker
for care to be patient-centered in this modern evidence-based way of providing manual therapy. Two of the principles that you use to specify what patient-centered care is are positive communication and a collaborative context. Can you speak to how positive communication and collaborative a collaborative context support this concept of patient-centered care? Yeah, absolutely. So, you know, as you and we've probably been discussing throughout this is that, you know, but we have to understand patients come in with certain ideas and beliefs and expectations and hopes and desires. And we we we need to know what they are. So this is where the communication comes in. It's about asking those questions.
00:57:32
Speaker
It's about finding out where patients' mindsets are about what they think is going to happen, what they hope is going to happen, what's their levels of self-efficacy. Is it high? Is it low? you know Do they have hopes that they can improve? Or have they lost all hope? Have they got low self-efficacy, which again can be a huge barrier for us to overcome? We then need to sort of say work around the context of their problems and their issues. Is it severely debilitating? Is it affecting things that are really meaningful for them? Or is it just frustrating and annoying for something that pops up every now and again? And then it's about understanding and putting the patient in the center of the decision-making process about how to try to help and improve these things. And it's about you know using our skills as clinicians who know
00:58:24
Speaker
ah outcomes and you know the evidence about what treatments probably have better ah chances of success than other ones. It's about explaining that, going through all the benefits of the treatments, but also the potential risks, but also the alternatives and other options that are available to them. And it's and it's helping guide the patient to make a informed patient-centered decision about what they think is the best treatment plan for them based on their particular current situation. I mean, it sounds a whole heck of a lot like teaching.
00:58:56
Speaker
it's It's exactly like teaching. And I'm glad you brought that up because I do think, you know, physiotherapists, we don't get taught to educate and teach and communicate very well. And these are all essential skills. You know, we all learned, as you said, Sarah, that the hard skills of the exercise protocols and, you know, how to apply the manual therapy and how to measure walking sticks and how to get somebody up and down steps and stairs, all very important stuff to do. But we also need to know how to do this other stuff, the the communication, the education, and the and the teaching, and the, yeah, all very important. And I also want to stipulate just before um I'm rattling on a bit here, sorry. That's okay. Not at all.
Blending Patient and Clinician-Centered Approaches
00:59:34
Speaker
It's our favorite. We love rattling on. Keep rattling on. Although I am a very strong key advocate of patient-centered care, I also think there is a time and a place for clinician-centered care in healthcare as well. Oh, say a little bit more about that.
00:59:46
Speaker
Yeah, just like you were talking about in education, I do think patients are empty vessels. They've got absolutely no idea, no clue how to feed and what to do. and And the clinician then has to step up and take responsibility ethically and sensibly. A classic example here is my my wife's recent health issue. you know She has had exceptional clinician-centered care around her diagnosis and her treatment because we I've got absolutely no clue or idea about the treatment processes. ah And so we are we are relying on the clinicians here to help guide us through this. Yes, they give us information. They inform us. They educate us as they're doing it. But they are the lead. they are they are
01:00:32
Speaker
making the decisions based on what they know on their skills and their understanding of the evidence based around treatments. And I think there is a time and a place in physiotherapy where that also has to be done as well. So it's about again, understanding when we can put patients in the centre of the decision making process. And sometimes when we perhaps have to say, Hold on a minute here. I know you want this. I know you think this is the best thing for you. But going for that 17th corticosteroid shot in your shoulder, is it's not the thing that we are going to proceed with. And I've been trained to use corticosteroid injections in my advanced role. And I come across this a lot with patients coming in with high expectations that they want it. And I go through the records and I say, you've had 17 of these already before. You know, the definition of madness is doing the same thing time and time and again, expecting a different result.
01:01:27
Speaker
i am I am making a clinician-based assessment and decision that I am not going to do an 18th quarter go steroid shot in your shoulder, Mrs. Megan. And, you know, we have to we have to sometimes do that as healthcare professionals. Yeah. oh That's a really important distinction and thanks for adding that. um Do we have time for one more question? I know we're coming up against your time. Yeah, sure. No problem. Awesome. Thank you. Adam, what do you see as the likely future of how manual therapy is taught?
01:01:58
Speaker
to clinicians. We know that academia changes at a snail's pace, and I was taught a lot of things in PT school that were even already debunked at the time, and yet I was taught them because they were going to be on the exam. you know Is your sense that that you and your co-authors are sort of stepping into you know somewhat are unchartered territory with the recommendations of this paper, or do you already see the tides starting to turn towards this approach?
Evolving Towards Evidence-Based Practices
01:02:21
Speaker
It is moving and turning in slowly, um but it's at a glacial pace. It is a slow old process. ah my My expectations 10, 15 years ago when I started on social media, I thought I was going to change the world. I thought everybody's going to listen to me.
01:02:40
Speaker
You know, they're going to take this, you know, and they're going to say, thank you so much, Adam, for telling me that I was wrong and incorrect. And yes, of course, I'm going to change my mind and do exactly what you say. That's how it always ends up, right? Yeah, people love that. oh it's a So I'm a bit more, as they rational now, I think, call that a bit of maturity and age now. I've realized you know if I can you know change things a fraction where I start to see manual therapy being explained and discussed and used more rationally and openly and honestly stripping away the pseudoscience and the bullshit around it I'll be happy and I know you know I'm not going to change people who have been
01:03:27
Speaker
Believing in things and doing things, 20 odd years now, I find, you know, I used to try and I realized when you've got that mindset and you've got all the other stuff going on, the cognitive stuff, it's just not happening. So my new mission now is to corrupt the youth. yeah
01:03:46
Speaker
I'm going to try more now focus to focus on the new grads to try and you know convince them because I think their minds are more flexible, adaptable and receptive. so you know I've said I've got myself in hot water by saying this, there are dinosaurs out there that just need to be left alone to fossilize. and They just need to fade away into obscurity, into distance and the new generation coming through. That's where we should be you know focusing our time, energy and attention. So that's that's my mission now to try and say corrupt the youth when it comes to manual therapy. And so you just get them using it more rationally and sensibly.
01:04:24
Speaker
Right on.
Adam's Impact and Online Presence
01:04:25
Speaker
Adam, thank you so much for coming on our podcast. We've super, super enjoyed talking with you. You've been an enormous influence on us. So if you wonder if you're making a difference, like you are making a difference in our world and we are making a difference because of you and your influence and and your extensive investigation and your ability to be critical and You know, to kind of put it bluntly, frankly, and not over complicate shit. um Well, I love how you tell people exactly what you're thinking and you don't apologize for it. And you're still very lovely person to to speak to and flattery will beat you every everywhere thank I super appreciate the way you approach things online. And I think that your approach is not for everyone, but it's very effective. We know we've gotten a lot ah out of this. We know our listeners are going to get a ton out of it as well. So thank you so much for coming on the show.
01:05:19
Speaker
Thank you very much for the invite. And again, and please just say, just carry on doing what you're doing because ah everything you've just said there to me, I'm going to reflect back to you and say, you know, you're you're doing great work and just yeah keep it up. And I can't say wait to go through your back catalog. Oh, thank you. So one more question is, Adam, where can people find you if they want to learn more? I'm across all of the social media platforms. X or Twitter. I don't know whether to call it X. I really don't like calling it X. It's so dumb. It's so stupid. It's the weirdest thing in the world, isn't it? It's not the same as it was. But yeah, that's where I first started off. So I'm on there, Instagram, Facebook. I'm even on TikTok. You just need to either look my name, Adam Meekins. There's not too many of us out there or the sports physio. And I've got a website as well, thesports.physio that you can go and check out if you want to.
01:06:08
Speaker
Fantastic. Thank you so much. Thank you. Thanks again. Enjoyed it. Laurel, that was super fun. and And I can't speak for you, but I think for me, the the biggest fangirl moment was hearing Adam Meekins say he wanted to go listen to our catalog. I was like, oh my god, backlog, our backlog. so Well, I think it's a back catalog versus a backlog. I think a backlog sounds like something that happens in a toilet. So yeah. That was very satisfying when he had all that praise right at the top of the show. He kind of broke in and like went on for a while and I was like, don't stop. We can talk about us for an hour. Why don't you interview us? What do you love about us? You know, I'll say it again, like he's been a huge influence on me.
01:06:55
Speaker
Yeah, me too. With his rather forceful, extremely clear and hilarious presence. So um it was a big honor. It was a big honor to talk to Adam. And I would say as well, you know, I think a lot of people maybe have a tough time with him because he doesn't sort of like serve it up in a nice, you know, spoonful of honey makes the medicine go down kind of a way. But what I also find for myself at least, and I think Maybe be might be a ah useful approach for people is whenever someone is pushing my buttons Then I know that like I gotta investigate something there. It's not it doesn't mean that they're wrong, right? I'm not like stop pushing my but you're wrong. You're pushing my buttons. I'm like, huh?
01:07:36
Speaker
Yeah, he's a button pusher. he is he's When I say he's not for everyone, it's it's he's not for people who aren't ready to have their
Adapting in the Movement Field
01:07:43
Speaker
biases challenged. But if you are ready for that, you're probably going to find his content very stimulating because he does he's not afraid to talk about the elephant in the room. He's also not afraid to call out what many have just accepted as conventional wisdom on topics around physiotherapy, movement, strength training. um And so I find that ah very refreshing. Definitely. And also, you know if you want to be any good at your job, whatever your job is, you should want to have your buttons pushed because you should want to be growing and learning. You should not want to be stuck in the model that you learned 10, 15, 20 years ago.
01:08:19
Speaker
Yeah, that's not a good sign. No, everything in this in our in the movement world changes. I think it's only a good thing to get your buttons pushed. um Speaking of pushing buttons, when does season five start? Season five is going to start July 17th. It's going to be a little different though in that we're going to start with every other week and then we're going to transition to every week in the same season. And I'm coming to visit you in LA. We're going to do a bunch of recordings together in the same room, which is always my favorite. Yeah, me too. um And I'm looking forward to to getting to LA for a week and seeing all my myp pals there. we're gonna We're going to go to the Hollywood Bowl. We're going to do all kinds of fun stuff. I'm excited. Well, listeners, if you are also excited, please ah give us some sort of acknowledgement to your excitement. You can do things like rate the episode and give us a high star review. We've been stuck on the reviews. It's been a review desert. We need that next person to step up
01:09:18
Speaker
and put fingers to the keyboard and clickety-clack. We need a review and we would love for you. One of the reviews you could give is request an episode for next season because we still haven't had our finalization of what episodes are we doing next season. So you could do that. You could also just give us a little love. I check the reviews. I'm a little bit um us obsessed. Obsessed? I check our reviews a lot. yeah so Just know that when you leave a review, I will see it within hours, maybe as long as 24. I will see it. I find out about our reviews because Laurel sends them to me. so We both get to we both to enjoy it, so we would really love it. If you had some love for us, please please let us know. You can also subscribe to this podcast on anywhere that you listen to your podcasts.
01:10:10
Speaker
And you can also follow us on social media if you're not already. We are at MovementLogic tutorials, at Laurel Beaversdorf, and at Sarah Court DPT. And what else? Laurel, is that everything we need to say for now? I think that's everything we need to say for now. we're going to say and We're not going to say goodbye. We're going to say so long for now. We're going to say see you soon. See you soon. Yeah. See you soon in, I want to say June, but see you soon in July, unfortunately. No. um We'll eat a pie in July. We'll catch your eye in July. We're going to fly in July. I could do this all day. <unk>ll tell We'll tell you why. In July. Nice. OK. How about we just say, see you in July. you and i get Ready?
01:11:01
Speaker
See you in July! Why are we so bad at that? um are are um are are
01:11:34
Speaker
are um