August 20, 2024 • 60 mins
There are many common misunderstandings about evidence based practice (EBP). It is not all about the reserach evidence, although that is a critical component.
Join us for a critical conversation with Nadine Hawyrluk, where we clear up the common misunderstandings surrounding evidence-based practice and the new standards set by the CMTBC. We dissect the requirements for maintaining an evidence-based approach, from staying up-to-date with the latest research to ensuring learning activities are taught by knowledgeable instructors. This is your chance to refine your learning plans and improve your practice to meet these standards, ensuring your patients receive the best possible care.
In this episode, Nadine and I address the nuanced challenges and contradictions that arise in evidence-based practices, focusing on differentiating current trends and techniques from those that simply rehash anatomical knowledge. We delve into the ethical implications of providing accurate information to patients, highlighting the responsibility of healthcare professionals to avoid perpetuating unverified treatment narratives. This conversation is essential for any RMT committed to ethical and informed practice.
Curious about the claims surrounding prenatal care techniques like Spinning Babies? We scrutinize the evidence supporting such bold claims and discuss whether these practices fall within the scope of massage therapy. Moving toward the broader picture, we emphasize critical thinking in research evaluation, using polyvagal theory as a case study to demonstrate practical techniques for challenging preconceptions. Tune in to discover valuable resources for evidence-based practice and research evaluation, and arm yourself with the tools to scrutinize educational courses and their claims effectively. This episode is a must-listen for every RMT dedicated to providing high-quality, evidence-based care.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Eric (00:08):
Hello and welcome to another episode of Purves Versus
.
My name is Eric Purves.
I'm a massage therapist, acourse creator, a continuing
education provider, a curriculumadvisor and advocate for
evidence-based massage therapy.
In this episode, nadine Harluckjoins me again for a discussion
on the importance of having anevidence-based practice, and we
also spend some time clearing upsome common misunderstandings
(00:30):
about evidence-based practiceand what this means for the
massage therapist.
We also will go through theformer CMTBC's resources for
appraising evidence and explainwhy this is so important when
choosing continuing educationcourses this is so important
when choosing continuingeducation courses.
If you enjoy listening to mypodcast, please consider
supporting it by making adonation, and you can do this by
visiting buymeacoffeecom.
(00:50):
Slash helloob.
Purpose Versus is alsoavailable on YouTube, so please
check us out there and subscribe.
Thanks so much for being hereand I hope you enjoy this
episode.
Hello and welcome to anotherepisode of Purpose Versus.
I'm excited to have Nadine back.
Nadine was on so far the mostpopular episode we've ever had,
where we talked about the newevidence-based practice standard
(01:11):
for massage therapists in BC,and today we're going to talk
more about the Standards ofPractice and Resources page
which the CMTBC had put out andtalk about the requirements.
And our focus today is going tobe on learning activities and
how an RMT is supposed to engagein these learning activities
consistent with this newevidence-based practice standard
(01:33):
.
We think this is super relevantbecause our learning plans are
supposed to be evidence-basedand there's certain criteria
they're supposed to follow, andif they don't, then we're
actually not supposed to beusing those in our learning plan
.
So we're going to have, I'msure, a very interesting
discussion today about what thismight look like for potential
(01:53):
learners.
So thanks for being here,nadine.
Nadine (01:55):
Yeah, thanks for having me.
I'm excited to dive into this.
Eric (01:59):
Let's just quickly talk about.
You know, I'm just going toreview for those that maybe
didn't listen to the lastepisode just the requirements.
I'm not going to read the wholething, but there's basically
four requirements set outincorporates evidence-based
practice approach to supportclinical decision-making when
determining appropriatetreatment plans.
An RMT takes reasonable stepsto maintain or remain up to date
(02:32):
on research evidence to supportan evidence-based practice.
And number four, this will beour focus today an RMT engages
in learning activities that Aare informed by research
evidence.
B present information withinRMT's scope of practice.
And.
C are taught by an instructoror presenter who holds
(02:53):
appropriate knowledge andexpertise to instruct RMTs in
the context of a regulatedhealth profession.
I like that.
I don't know if this is what'sgonna be happening right now,
though what are your thoughts,nadine?
Nadine (03:06):
um, I love how directed it is.
I think it really lays out agreat um guide for everyone.
Yeah, I think there's going tobe a transition there for people
, um, because it is so new, it'slike what does this mean?
Do we have the skills to dothese things?
So I think you're right.
I think it might take a bit oftime.
Eric (03:27):
When we look at this.
The thing that's so interesting, too, is now what we see is.
We see evidence-based as beinga term that's everyone using now
, because that's what you'resupposed to be using and that's
what we're supposed to be taking.
And it's important for us tounderstand that evidence-based
could be a marketing ploy usedto try to trick people or try to
(03:50):
convince people that whatthey're taking is supported by
latest evidence.
And I will admit for myselfthat I use, or have been using,
the term evidence-based for avery long time in much of the
content that I teach, but Idon't necessarily.
I don't.
I never thought of using it asa marketing boy.
(04:14):
I wanted to always use it asI'm not going to teach you
nonsense.
Everything that's in this courseis defensible by current best
practices, current evidencewhich meets a certain criteria
or certain standard For anyonelistening.
When you are looking to learnor build a learning plan if
you're in BC or if you're I knowwe have listeners from all over
(04:35):
the world if you are looking tolearn continuing education or
quality assurance orprofessional development
whatever it's called where youlive, it's really, really,
really important to be criticalof the evidence base.
We'll put that in air quotes,even though no one can see
because we're on a podcast.
We'll put that in because thatevidence base it's the minimum
(04:57):
standard that we should have asa healthcare profession in terms
of the information we areteaching each other, because the
public deserves to receivecurrent best evidence.
Nadine (05:10):
Yeah.
Eric (05:11):
When we're looking at this in terms of learning activities
, continuing education courses.
The other thing, too, is thepoint C, which talks about it's
taught by an instructor orpresenter who holds appropriate
knowledge and expertise toinstruct RMTs in the context of
a regulated health profession,that's another one, too, is how
(05:34):
is an RMT supposed to know ordecide who has the right
expertise or knowledge?
Nadine (05:42):
Right.
Eric (05:44):
I like that.
It's there, but it's kind ofvague.
What are your thoughts on that?
Nadine (05:49):
Yeah, I think that could be a tricky one to to parse out
, and I think we could have adecent discussion on that about
what are?
What are you looking for?
Who do you want to see?
What do you want to be able tofind about that person?
Are there certain credentialsyou want to see behind their
name, um, or is experienceenough?
(06:10):
Like, what are what makes thisperson an authority on whatever
topic that you're looking at?
Eric (06:16):
this is one thing, too, where I feel our profession
really needs to step forward isjust because you have 30 years
of experience doesn't mean whatyou're teaching is valid or in
terms of the science ornarratives or explanations
behind it yeah, yeah and this isa big problem that we see in
(06:36):
the massage therapy schools alot of them.
I was recently at a presentingat a school to some graduating
students and one of the biggestpieces of feedback I got from
the students was that wheneverthey questioned their
instructors during classes,during practical classes, it was
this well, I've been doing thisfor 30 years.
(06:59):
I've been doing this for 20years.
You know, I've been teachingthis since the school was opened
.
Yeah so they're using thisappeal to their experience or
their right as being.
Nadine (07:11):
Just don't question me right that somehow experience
trumps evidence or knowledge insome way yeah, and there has to
be a blend.
Eric (07:20):
I would agree, I would think yeah, would you agree with
that?
Absolutely you've just been outof school for five years and
you're teaching a course and youdon't have a lot of expertise
and maybe you don't have anyextra education.
Does that make an authority?
Well, probably not, because youprobably haven't built that
clinical expertise yet.
You don't maybe necessarilyhave an extra education.
(07:41):
But if you've been practicingfor 30 years and you've got a
massive amount of clinicalexperience, which we know is
part of that evidence-basedframework which is super, super
important, but you're theknowledge of your clinical
expertise, your understanding ofmechanisms, of mechanisms of
effect, or what's actuallyhappening when you're doing your
(08:02):
treatments.
That has to be based onevidence.
That's based on science.
Nadine (08:07):
Yeah, and that's where I think things are often missing
yeah, yeah, and I've I've hearda similar discussion happen
among people looking forcontinuing education, where
someone was like, oh well, Iheard, this teacher is fantastic
, they've been teaching for awhile, really engaging, super
great, super great.
And then I said, yeah, but whatare they teaching?
(08:28):
It's like do you go to aninstructor just because they're
super charismatic and exciting,or do you go because you're
going to learn something reallyvaluable?
So I think we just need to becareful, and especially if I
think we can think about thistoo.
What you're mentioning aboutevidence is that we can think
about other industries wherethere was, like greenwashing,
(08:49):
everything has eco stamped on itor whatever, right, and so you
want to be careful.
Is it really evidence-based ordid they find some random
citation and slap that on thebottom of their thing and it's
not really related?
So I think we just have to be,we have to go a little bit
slower and think a little bitharder going forward I love your
(09:09):
your comment there aboutgreenwashing.
Eric (09:12):
Same thing with, like organics or organic.
Yeah, it can just be like a, aterm that gets thrown around,
but it might not.
It might just kind ofmeaningless, right, and we have
to be mindful of that too inmassage therapy and in our
evidence-based stuff.
That just because it says it is,doesn't mean that it is yeah
(09:33):
just because you say something amillion times doesn't mean that
it is actually based.
Yeah, big red flag for me ifwhat I'm looking or critiquing.
You know I'm skeptical ofeverything and those people that
listen or know me, I don'tbelieve much of anything.
I don't even believe my ownstuff some of the times because
I'm skeptical of what I think Iknow which is fine and I'm the
(09:54):
first to admit thatno-transcript.
That's a big red flag becausethat usually be challenged.
(10:18):
If someone says to me hey, youknow I'm interested in your
stuff, you know can, can yousend me some, some content on
what it is that your course isabout?
I will always send them.
Depending on what the course isabout, I'll always send them a
couple of PDFs or some links tosome of the things that kind of
create some of the main topics.
(10:39):
I'm not gonna send themeverything because a lot of the
stuff that we have out there iswe've got hundreds or dozens and
dozens of references.
I'm not gonna send themeverything because a lot of the
stuff that we have out there iswe've got hundreds or dozens and
dozens of references.
I'm not gonna send all of thosebecause you know, time
consuming, it's a lot, but Iwould definitely send a few and
say if you have any questions,please, please, reach out.
Yeah, I never have a problemwith that at all because I, as
an instructor you know this iswhat I do for 99 of my living.
(11:03):
Now is you have to be, you haveto be open and honest with with
the people that are coming tolearn from you.
Nadine (11:11):
You should be okay to be questioned yeah, yeah, and I
think this is kind of you canthink of it like if you're in
the store and you pick somethingoff the shelf and you look at
the ingredients list, um, youwant to be choosy about what you
are putting into your mind.
You want to make sure that whatis in the box is actually in
the box, um, and and becauseit's a lot of time, energy and
(11:37):
potentially money that you'respending on on putting these
things into your mind and youwant to make sure it's good,
otherwise you're you're reallyrisking investing in, maybe
opinions, pseudoscience.
You know that's a big risk.
Eric (11:54):
I would guess that if you looked at every single course
that was being taught to RMTsacross Canada, I would think
that you could probably count onboth hands how many of them
would actually be properlyevidence-based and meet a good
standard of critique, and youprobably still have quite a few
(12:19):
fingers left over.
Nadine (12:23):
Yeah, so there's room for growth.
Eric (12:25):
There's a lot of room for growth.
Yeah, that's just from me look,spending.
I spent a lot of time lookingand seeing what's out there and
I think and a lot of the stuffsays it's evidence-based.
But evidence-based for what?
So you see a lot of stuff outthere too where people are
talking about oh, this is acourse on the the, you know,
assessments of the lower leg orlower extremity or whatever Say
(12:48):
it's a course like that.
I've seen stuff like that outthere and the person will go
take a, people will go take thatcourse and there's lots of time
spent on anatomy and kinematicsor joint kinematics and
kinesiology and you know all themuscles and ligaments and
tendons and those people getthis kind of anatomy review.
Well, that's evidence-basedbecause there's hard like that's
(13:10):
the science of how we move andwhere things are.
But when I look at a course likethat, I think, okay, what's the
evidence for assessments in thelower extremity that are
actually valid, reliable, havegood clinical utility?
There's like none you know youhave.
I believe lockman for the kneeis the only one for acl which
(13:33):
actually has good evidence tosupport it.
If you're practiced andexperienced, so you have an
entire course on treating andassessing the lower extremity,
but maybe the only evidencebased about it is the actual
anatomy right, you know, andoftentimes those courses will be
taught with this perspective of, like I'm changing tissue and
(13:56):
I'm loading this and we'rereleasing that.
Where's the evidence for thatother than just, oh, that's, I'm
seeing a change and sotherefore my narrative is valid?
Nadine (14:06):
Yeah.
Eric (14:08):
Which I think gets and that kind of-.
Go ahead, sorry.
Nadine (14:12):
I was just gonna say, that kind of stalls our
profession a little bit and itjust reinforces some of the
false things we've learnedalready.
So how is that helping?
How are we helping to improvethe outcomes of patients?
Eric (14:29):
when we see these types of courses and we see these types
of you know it's evidence-basedbut it's really just rehashing a
lot of the stuff we alreadylearned in school.
But maybe putting an extraadvanced technique label to it
right, is that really doinganything extra, anything special
?
And if we look at the evidence,I would say no, because when we
(14:52):
are deciding to label ahands-on technique with a tissue
label to it or descriptor to itand we're not actually basing
what's happening on the scienceof touch, right then that's not
(15:13):
evidence-based.
From the evidence part right,and this is something that I've
been hammering around for a longtime and I should probably let
it go, but I won't.
So too bad.
The mechanisms of all of ourtouch are the same.
It doesn't matter what you do,you're interact.
You're either the mechanisms oftouch.
It doesn't matter whether it'show you touch somebody, you're
(15:36):
interacting primarily with theskin and the sensory receptors
in the skin and the kind ofreflexive effects of of what
happens with that.
Without going into a bigneurophysiology, neuroimmune
kind of description.
But people, when people teachcourses, they attach a label to
it's myofascial, it'scraniosacral, it's lymphatic,
(15:57):
it's circulatory, it's whateveryou want to, whatever you want
to call it.
There's a million differentnames out there and they all
claim to be doing somethingdifferent.
They're interacting with adifferent tissue.
But if we take a step back andthink, well, how can we interact
with only this tissue whenwe're actually interacting with
the skin and all the tissues allat once?
(16:18):
It's way bigger than just fascia, it's way bigger than just
bones and joints, because youcan't get to that tissue without
going through the skin so whyis there this massive
fascination with all thesedifferent name techniques when
the science of touch is veryclear that they all do the same
(16:39):
thing, right, there's adifferent way of interacting
with the person.
Yeah, stories behind them, thenarratives behind those
techniques don't meet anevidential standard.
Nadine (16:50):
There's no evidence to support them yeah, but they can
create buy-in, I think is whatpercent?
Yeah, people find interesting,because if we switched over to
calling it light, fingertippressure, long cheering force,
(17:11):
um, how much would you spend onthat?
To be like, oh, you just sortof fold and push, okay, done,
like um, yes, we have to becritical and think, think a
little bit more about that kindof stuff.
I think, and especially when wecommunicate that to patients,
what we believe shows up aswe're treating and then they
(17:34):
take that home and is that anempowering thing for them to
think, or is it actually goingto create their reliance on you
or believe somehow that they areless capable or fragile in some
way?
Eric (17:53):
Yeah, that's such a great point, nadine is that the how we
think impacts how wecommunicate, which impacts what
we, the information we provideto our patients, which impacts
our expectations of outcomes,and a lot of times those, those
narratives or beliefs, you know,maybe they're they don't impact
(18:15):
the person at all, maybe it's.
There's no negative outcomewhatever.
I don't care if I'm what you'redoing it, just as long as it
feels better.
Right, and that is the counterargument which I get often.
By often, I mean pretty muchevery time I have this
conversation with a group iswell, who cares, as long as
people are feeling better?
And I say, yes, the outcomesare what matters most.
(18:35):
What's the most important thingfor massage therapy appointment
?
The outcome.
People might not care how theyget there.
However, if we are going tolook at this from a informed
consent and ethical perspective,we shouldn't be telling things
to our patients that we can'tdefend.
Nadine (18:55):
Yeah.
Eric (18:55):
That are based on historical beliefs or based on
oh.
I learned this in this weekendworkshop and this is just what
I've been told.
Yeah that's what I believe yeahwas that good enough?
Is that good enough for thepublic?
Nadine (19:07):
is that what is expected of a regulated health care
profession and I would say no,but that's the way it often is
yeah, and I I hope it shifts aswe start talking.
You know, another big wordright now is trauma-informed
practice.
Right, and if you read throughthe literature on that, some
(19:31):
people have experienced medicaltrauma in which medical
professionals have lied topeople about their bodies,
misinformed them, leftinformation out, these sorts of
things.
And I think we're doing exactlythat every time we feed a
patient pseudoscience, like it'snot trauma, informed to say, oh
, you've got this pulse in yourbody, that, oh, you didn't know
(19:53):
about, but I do and I can takecare of it for you.
That's a power over me, and soI think that really needs to be
considered carefully too that'ssuch a great point.
Eric (20:04):
I love that.
Would you call a power, move apower like a power over like
power over.
Yeah, yeah, yeah, yeah.
That's brilliant and it's true.
That puts us, as a clinician,centered.
Just the exact opposite of whatit says here.
When we go back and look at therequirements for evidence-based
practice standard is it shouldbe patient-centered.
(20:26):
If we are the one with thepower, we're the ones that can
feel and do these things to you.
That's not.
That's not centered on theperson on the table or the
person in our treatment room.
I like what you said there, too, about the power over them and
that us being able to feel andand and and be the the, the ones
(20:51):
that are responsible.
It makes it doesn't make senseto me in this kind of patient
center shared decision-making,biopsychosocial, evidence-based
all these buzzword things.
Right, we use all these wordsand a lot of these, the
pseudoscience stuff.
We'll use those same words, butthen it still puts the
(21:11):
practitioner as the one in powerexactly totally contradictory
to all those other kind ofbuzzwords we just mentioned, and
that's not in the person's bestinterest no, no, and it
perpetuates.
Nadine (21:28):
Like how many of us have had someone come in and say, oh
well, I feel out, likesomething's out, or like, oh
yeah, I just really need, um, myenergy realigned or whatever it
is?
Um, and now they've got thatbelief about themselves and they
are coming back constantly toget it treated.
(21:50):
Um, and you're slowly trying tobe like, encourage them to say,
you know, yeah, you maybe feeloff and I'm here to support you
with that, but there's nothingwrong with you.
You know you're not out.
What does that even mean?
Eric (22:07):
yeah, that's such a weird term too, isn't out, you know
out is a feeling.
It's a subjective thing, like Ifeel like we've all heard our
back, or heard it, yeah, or aneck and you, you feel out and
it doesn't move the way you wantit to, but it doesn't go on
anywhere.
But so it's often used as adescriptor.
But it's used as a descriptor,I think, by patients, so that a
(22:29):
practitioner can then be the oneto put it back where it belongs
absolutely yeah and whereasthat's not evidence-based.
But what is evidence based issay okay, you know what you feel
that way, like you said, youfeel like it supports you.
All we could really say is thatI'm going to do some things
Massage movement, maybe a littlebit of joint mobilization stuff
(22:50):
within our scope of practiceand we'll see if that creates
enough change for that to feelbetter.
That's all we can really say.
I think we can't make these bigclaims.
Nadine (23:04):
Yeah.
Eric (23:06):
Because there's not evidence to support that.
And a lot of people might belistening to this or they've
heard me say this before andthey feel like we're being
dismissive.
And again, neither you or I areclaiming that things are
ineffective or all bs, but we'resaying the stories and beliefs
definitely are often bs.
Yeah, and going back to what yousaid a few minutes ago about
(23:27):
the trauma informed thing, whichstories and beliefs definitely
are often BS.
Yeah, and going back to whatyou said a few minutes ago about
the trauma informed thing,which is another, another big
term that's being used right nowand I feel that it's quite
important, but I feel that a lotof us don't really understand
what it is.
Nadine (23:40):
Right.
Eric (23:41):
Yeah, I was very fortunate that a colleague shared a
trauma-informed webinar with mewhich I put up on my website.
That was done by a psychologistwith a specialty in trauma.
Nadine (23:55):
Yeah, speaking of qualified expert.
Eric (23:58):
And that's and kind of going back and thinking about it
.
This is somebody that youshould be learning a
trauma-informed course from,somebody who is probably not
just an rmt I mean just you knowwhat I mean like somebody
that's an rmt, that's maybetaken a couple courses on it,
that's probably not enough to beproperly trauma-informed.
But we should be learning frompeople that have expertise and
(24:19):
extra training in a specifictopic, particularly if it's
something like that, where thereis a lot of potential to to
re-traumatize people or to makethem, make them worse.
Yeah, absolutely.
You also mentioned to Nadineabout us re-traumatizing people
(24:41):
and about the medical storiesand stuff that we we use and
this is something which I justwanted to come back to and
emphasize again was that thepower of our words, our
narratives, are very strong andwe often don't realize that and
(25:02):
when I'm teaching courses orspeaking with groups, they don't
realize that there could be aproblem with that and it's not
always a problem.
But for those that it is aproblem for it can be a big
problem.
And you know the world that Icame from.
Before I started, or I startedgetting into teaching and
(25:23):
furthering my education waschronic pain and reading the
chronic pain literature andspending time with people that
had lived that lived withchronic pain and realizing that
a lot of their coping behaviorswon't use that term, but how
they lived with their pain,which was oftentimes not very
(25:51):
well.
They struggled.
A lot of times it was theirbeliefs and ideas about what was
actually happening in theirbody that were put into them by
well-meaning healthcareproviders that were negatively
impacting their quality of life.
It was stopping them from doingthings that were important and
valuable to them.
Oh yeah, I've got, you know,I've got this, this pain in my
(26:13):
leg.
Oh yeah, I've got, you know,I've got this, this pain in my
leg.
You know, I just you know, I'vebeen told my nerve is, is, is
is damaged beyond repair, and soevery time I move, you know,
I'm just going to just severthat nerve.
That's the story I heard fromsomebody that had a disc injury
and had permanent kind ofsciatic type symptoms.
So they didn't want to evermove, they didn't ever want to
(26:37):
load their leg, they didn't wantto do anything because they
were worried every time they didthat it was just going to
basically cut that nerve off andthey would just be completely
gone, rather than saying, hey,you know what.
You've got damage in your nerve.
It's going to be.
This might be something you haveto manage for a very long time
the rest of your life but you'renot going to.
Based on on the history andbased on what you've been going
through, it's probably.
You're not going to.
Based on the history and basedon what you've been going
through, you're not going tomake it worse beyond.
(26:58):
It's not going to getsignificantly worse if you get
up and move around and do life.
Well, let's now move thisdiscussion towards.
Maybe we can do a live critiqueof a course ad or of ideas,
rather than than a specificcourse per se.
We can talk about some ideas,because we haven't taken these
(27:19):
courses so we don't know exactlywhat it might look like.
However, a popular one whichwe've seen, that's shown up on
social media is spinning babiesseems very popular.
You go the website.
It's a trademarked thing andthere's lots of stuff that just
shows up right on the, on thefirst page, which makes you
(27:40):
think is this real?
Nadine (27:45):
Yeah, cause the.
You Google it and the firstthing you're going to see there
is spinning babies.
Comfort in pregnancy and easierbirth Like that's a that's a
big claim.
Eric (27:54):
comfort in pregnancy and easier birth Like that's a
that's a big claim I want to seesome proof for that, for sure,
a hundred percent, and I agreewith with you with that, because
that would be amazing.
But if you're making big claims, you have to be able to support
that with evidence.
Yeah, we can all use clinicalexperience to say, oh yeah, why
(28:14):
do this?
And people have lesscomplicated births, they have
more comfortable births, lesslikely to have cesarean sections
.
But that's also.
We have to be mindful that it'sa very biased perspective and
and when I look at the spinningbabies website, there's a lot of
great stuff on here.
Like it's a beautiful website.
It's got a lot of great things.
It talks a lot about, you know,birth education and it's a lot
(28:34):
of great stuff on here.
Like it's a beautiful website.
It's got a lot of great things.
It talks a lot about, you know,birth education and how.
It talks a lot aboutanti-racism and gender
inclusivity and there's a lot ofyou know, ways of of, of of
like healthy living andinformation about pregnancy.
So I think there's a there'sprobably a lot of really great
stuff on here.
Just from looking at thewebsite that they include.
(28:57):
But so we're not.
This critique is not about theoverall value in this group,
this organization, but let'sjust talk specifically about can
you spin a baby with externaltechniques.
Nadine (29:15):
Right yeah, if.
I was looking at this course.
What am I looking for to see ifI want to invest my time and
energy and brain space intolearning this?
Eric (29:26):
Let's talk about it.
So they have workshops.
What is it?
What are you learning in theseworkshops?
What are they teaching you?
What are you?
What are you learning in theseworkshops?
What are they teaching you?
They are oftentimes teachingyou about someone.
You can spin a baby throughpositioning and external
techniques.
Is that something that, asmassage therapists, is that
(29:47):
within our scope of practice?
Yeah, that's a big questionshould we, should we actually be
?
Can we be doing this to, to tohelp, and is there evidence to
support it?
right you know, looking at thewebsite here looks like a lot of
stuff is geared towards nursesand doulas, you know, and
there's massage therapists thatare doulas as well, and I think
(30:10):
the more support we can give tosomebody that's pregnant, that's
or, you know, a mom, duringlabor, just before she goes into
labor, I think is is there's alot of value in that.
But can you actually spin thebaby and should you spin the
baby?
Nadine (30:25):
Right, I don't know.
And should we?
Should we be saying those sortsof things?
I always think it's like shouldwe?
Eric (30:35):
be saying these kinds of things to a patient.
Yeah, because what's that?
You know, if you, if you'relike, oh yeah, I've been trained
in this and this is whathappens.
And then what happens if thebaby doesn't spin?
Nadine (30:44):
Right yeah.
Eric (30:46):
And then they have to do a C-section.
The thing is too, that is wehave to be mindful of and I just
know this because you know froman outside observer and having
two daughters that oftentimesthe babies will not be sitting
properly until just before birth, right where they will then get
into the position that theyneed, and that happened with
(31:07):
both my kids.
So by by a sample, I saw twicewhere they're like oh, we're
worried about this, oh, and thenwithin the last few days, baby
spins and gets ready to enterthe world.
Let's be critical of that.
If you're taking a course,you're talking about spinning
babies and the mom is concerned,the family is concerned that
(31:31):
the baby is sitting improperly,and then they go through this
whole process.
The family's concerned that thebaby is sitting improperly, and
then they go through this wholeprocess and the baby then
rotates and baby, and thenthere's an, and then they have a
natural birth.
Is that because you didsomething to them or is that
just something that would havehappened regardless?
Nadine (31:45):
Right, yeah, yeah, it's that.
Pushing on spleen six point,that acupressure point, it's
like, did that help?
Probably not.
Eric (31:56):
Yeah, pushing on spleen six point, that acupressure
point, it's like, did that help?
Probably not.
Yeah, but we are highlysusceptible to these types of
biases and these types of thesetypes of things.
We kind of see what we want tosee yeah yeah.
so I don't know, like I seethese courses and I think do you
need to take this course tolearn how to help somebody who
(32:20):
is pregnant or going into labor?
Are the claims are being madein it supportable by science?
And you did a wonderful job.
You found one paper, I think,that actually studied spinning
babies and the method, and whatdid it find?
Nadine (32:39):
It seems to show that there may be a reduction in
likelihood of cesarean, and Ithink it was a specific group of
pregnant people, not um, notall um, but the numbers were
(33:00):
pretty close and you brought upa good point that the the sample
sizes for the spinning babiesgroup and the non-spinning
babies group were actually verydifferent yeah, I believe there
was twice as many non-spinningbaby mothers spinning baby
(33:21):
situations versus, you know, Ithink it was 800 that were just
went through natural and about400 that just went through like
a spinning babies thing.
Eric (33:30):
So obviously there's the there's a huge variety or big
difference in terms of theyweren't equal.
It wasn't like 400 and 400.
So that can change the numbers.
Nadine (33:42):
Yeah, yeah, and because it was a review of literature
too, you know it depends on thequality of what was studied as
well.
So we don't know for sure.
And this particular paper rightoff the hop says, yeah, there's
not any research evidence onthis, and so they were trying to
fill that gap.
So, as it stands, I wouldn'tsay there's a really well
(34:08):
supported base of evidence forthat.
And you head even into thespinning babies research and
references page and there's one,two, three, four.
There's a pilot project.
Eric (34:21):
You know there's not a lot here so you've got entire
treatment registered trademarktreatment that's based on four
research papers and clinicalexperience.
Is that evidence-based?
And so for listeners anyonewho's listening to this would
that, knowing that, would youstill consider investing money
(34:43):
in something that's based onfour papers and an idea that
hasn't been supported?
I think that's.
That's something that peoplereally need to consider before
doing things like this, and youcan say that for a lot of other
courses too.
I mean, there's a lot of otherones out there too which will
make big claims, but then if youlook at their research evidence
(35:06):
, a lot of the times they'lljust blast.
Maybe they'll have hundreds ofresearch papers on there If you
look at their website andthey'll have like all this
research evidence on there.
But is that evidence consistentwith what they're saying in
their courses or is it just kindof sound similar?
Nadine (35:24):
Yeah, and maybe something to discuss too, is
like OK, so you look at this andthe research isn't very strong,
but something in your cycle,I'm going to take it anyway.
I might consider being reallyclear on what you're going to
get out of it.
And, yeah, what you might wantto consider is if I take it,
what am I looking for?
(35:44):
Is it actually just maybegetting better at working with
pregnant people?
Is it learning some techniquesand positioning that feel good
for that population, rather than, oh, I'm going to get this very
specific skill.
Eric (35:59):
That's yeah, that's fantastic, because this is a
question I get often too frompeople.
Is that?
Well, if I'm, you know, I'maware of the limitations of all
these different named modalitiesand stuff, but I just really
don't feel like I'm not reallysure, like I don't feel
comfortable working with the jawor the head or I'm not really
comfortable working, you know, Idon't really know how to.
(36:19):
You know, maybe I want to workwith more positionings for
helping people the abdomen orthe low back or the pelvis and I
would say, yeah, you can takethe stuff, Like we're not saying
I'm not critiquing that youshouldn't say you shouldn't take
these things because maybe it'sa population that you're
interested in, maybe it's anarea that you're interested in
that you just don't.
You want to learn more ways ofputting your hands on people or
(36:40):
interacting with people or maybemore understandable what's
happening with that particularpopulation.
I think that's great, butplease, if we're going to be
based on what we know and basedon the requirements from the
cmtbc and should be therequirements of all health care
providers, professionals is beskeptical of the claims that
(37:04):
they're making in those coursesyeah and I've had people that
have taken stuff from me andthey are totally aware of the,
the greater amount of evidenceout there on touch.
But they're like you know Ireally want to work on.
I want to learn some nicepositioning and soft touch type
things.
I'm just not really sure andthey'll go and take like a
craniosacral course or they'llgo take like a visceral course,
(37:27):
just so they can.
But they were just like I justwanted to learn how to treat
this area differently.
But I'm going to just say say,forget all, that's all that
nonsense and I'd say that's fine.
You know I, I know for me a lotof the stuff that I've did in
my early career was was all likemyofascial stuff, like I did
all like the structuralintegration and fascia things,
and I still use a ton of thatstuff.
(37:49):
Like the technique I lovebecause it's like slow sinking
in, connecting with somebody,getting them to feel safe,
putting them in some differentpositions which things you I
didn't learn in massage school.
It's fantastic yeah but there'sno way that I'm telling them I'm
releasing fascia, becausethere's no evidence to say that
(38:09):
and people yeah yes, there is,there isn't, show me.
Nadine (38:12):
Yeah, yeah, yeah.
Eric (38:14):
It doesn't exist.
Nadine (38:15):
Yeah, and I think there was some discussions recently
too about shiatsu too, and Ihave a background in shiatsu and
it feels great.
I learned you know differentpositions, different ways of
applying pressure, and they'reawesome.
I've brought that with me andleft all of the other organ
(38:36):
diagnosis and meridian stuffbehind.
I don't think there's anythingwrong with that.
Eric (38:41):
So that's fantastic.
And you do that you still usethose techniques and those
approaches?
Oh, absolutely.
Nadine (38:46):
I wouldn't be able to help myself, like it's just so
ingrained in what I do.
So a hundred percent.
Eric (38:52):
Yeah, that's, that's awesome and that's the key thing
I want to.
One of the key points I'd likelisteners to this episode and
any other episodes too, then weare kind of critiquing things is
that you know, the clinicalpractice doesn't necessarily
have to change, but the claimsand the beliefs, yes, need to be
evidence-based and if you aregoing to learn something that is
(39:16):
beyond just normal massagetechniques, so you're going to
learn maybe something morepopulation specific, you know.
Nadine (39:24):
Make sure that you.
Eric (39:25):
You do your due diligence to assess the evidence that's
being used and and maybe ask theinstructor what?
What's your experience Like?
Why should I learn from youversus from somebody else?
Nadine (39:38):
Yeah.
Eric (39:39):
And I would say that most instructors should be able to
all instructors should be ableto answer that yeah, and be able
to say yeah, because of this iswhy and this is what we teach,
and this is the framework, orthe framework or the the base of
the evidence that we come fromfor this course yeah, and I
(39:59):
would encourage people to armorthemselves before even that
conversation and have a littlelook at the evidence what is
sort of our understanding ofthis area or whatever currently?
Nadine (40:10):
and then compare that when that information comes from
the instructor and say, okay,is this jiving with sort of the
body of knowledge that's outthere?
Eric (40:21):
and it's a big thing too that we just don't have this in
our.
In our curriculum there is aresearch course, but when I talk
to new grads or students, stillI'm very fortunate I get these
opportunities to see kind ofwhat's going on.
You know what's happening inschools these days.
There are very few of themactually do proper like a proper
(40:45):
research course that isactually good quality, right.
Oftentimes it's just like findsome papers and tell us about
them without actually propercritique and it's just not part
of the our curriculum and and Ireally wish it should be in this
.
Maybe that's time for anotherdiscussion about you know, the
benefits of us being a in auniversity somewhere where we
(41:07):
would have more instructors andexposure to that, because you
know most rmt's don't have that,that education or that
experience, and so therefore, ifyou don't have that and you
can't teach it, like you can'thave an RMT teaching about
research evidence if they don'thave any experience or education
on that yeah so that's.
(41:29):
That's a big thing, so when welook at stuff.
So, moving on to the next thingwe want to talk about here,
about the resources page, so theCMTc, and this is open to
everybody.
So if you're listening to this,doesn't matter where in the
world you are, you can access.
This is on the website.
It's on the cmtbcca website,which is going to be gone soon
and it's going to be moved to anew website which I can't
(41:50):
remember the name, but it's theCollege of Complementary Health
Professionals or something yeah,see, there's a lot CCP, there's
a lot of letters so it'll be.
The same information will behere, but it'll be based on a
new website.
So if you're listening to thisand you can't find it in the
CMTBCA website, I think itshould probably hopefully auto
(42:12):
direct you to the new website.
Yeah, I'll probably set that up, hoping so.
Nadine (42:13):
Yeah, that's what we'll do, but we don't know yet
because website, I think itshould probably hopefully auto
direct you to the new website.
Yeah, hoping hoping.
Eric (42:16):
So that's what we do, but we don't know yet because as a
recording, we don't know.
However, on the cmtbc's website, public access under their
standards of practice, they havean evidence-based practice
thing.
It actually goes through awhole fantastic section here on
research evidence.
What is it locating it, youknow, critiquing it or
(42:36):
evaluating it and differentquestions to ask.
Biases are all there.
It's got a whole bunch of, Ithink is is actually really good
quality resources for rmts oranybody in the public to look at
.
Yeah, and it's got some greatexamples too about, I believe,
(42:57):
on evaluating sources, and maybewe can discuss that in a moment
.
There's a great course on therecalled Visceral Kinetics, which
is a made-up course, which Ithink is hilarious.
So why don't you talk for amoment here, nadine, about kind
of the things under the locatingresearch and talk about some of
(43:18):
these?
Nadine (43:24):
sort of in the top part, before you get down to the
course, they've got just a tonof links on like where to go and
look to start.
And then I really love thatthey included in the evaluation
piece some well establishedframeworks.
For what questions do I askwhen I'm looking at something?
So maybe you've listened tothis podcast but you don't
(43:45):
remember what we talked about.
So maybe you've listened tothis podcast but you don't
remember what we talked about.
Um, right here there's the 5w,there's sift, and it just will
walk you through.
Here's some really key thingsto look for, and then they even
provide more resources if that'snot enough.
So like this is actually areally great guide, and I also
like even defining bias, becausemaybe that's something a lot of
(44:05):
us haven't even thought aboutin research and in our thinking
bias is huge.
Eric (44:13):
Yeah, that that we, we, everyone needs to admit that
we're all biased.
I'm biased, absolutelyeveryone's bias.
And you know, if we're thinkingabout a critical thinking
perspective, right, we're like,we're always thinking and being
critical of our thinking and howwe're thinking, right, that's
kind of one of the mainframeworks of that.
So, if you acknowledge yourbias and say, hey, you know, I
(44:34):
have biases, this is where I'mcoming from, this is what I
think and this is why I thinkthis way, then it allows you, I
feel, to critique and be mindfulof other information, knowing
that you are coming from aspecific mindset or specific
(44:54):
thinking framework, and that ishow you're going to approach new
information.
If we don't recognize ourbiases, then I think it opens us
up to basically linear thinking, because we're just constantly
looking for that confirmationbias.
I want to see the things that Iwant to see.
I want to find the support.
Nadine (45:15):
Yeah.
Eric (45:16):
And this is a question that we see all the time, don't
we online, and we see people.
Well, I'm looking for researchpapers to support whatever in
certain here.
Is that really what you'reshould we looking for?
Should we look for something toconfirm what you're should we
looking for?
Should we look for something toconfirm what you want to find,
cause you can find that.
Nadine (45:31):
Yeah, absolutely.
Eric (45:33):
You know, uh, you can find a single study that will
basically support any bias.
Nadine (45:37):
Yeah.
Eric (45:37):
And that's not critical thinking, that's not
evidence-based.
Nadine (45:41):
Yeah, yeah, and a technique I use um, and I have
to catch myself.
It really really is.
You do have to catch yourselfand go oh, I'm really excited
about something.
notice, when you're like, ah,this is really good and I bet
it'll make a big difference, Itake whatever that phrase is and
in google I'll type in thatthing and then after it I write
debunked and I look for all thecontradictory stuff where people
(46:07):
saying this part doesn't seemright or like there's some
evidence against this bit orwhatever, to give myself a much
more rounded view of somethingand kind of calling myself out
on my bias.
Yeah.
Eric (46:23):
I love that.
Nadine (46:25):
Yeah, really important.
Eric (46:26):
I love that, yeah, really important.
And you know, choosing learningactivities, which is kind of
one of the focuses of thisconversation, and using
resources, you know we should,you should be able to, to try to
challenge yourself and and notjust chase the current fad.
If we wanted to go down thatroad of challenging polyvagal
(46:47):
theory and fad, if we wanted togo down that road of challenging
polyvagal theory just veryanother popular one and we
wanted to evaluate the source.
You know, using some of theseideas that are listed on the
cmdb's website and you know wecould say, well, you know these
questions who is the author?
What is the purpose?
When was the item written orpublished?
Where is the author?
What is the purpose?
When was the item written orpublished?
Where is the content from?
(47:09):
Why was the research written?
We get asked these questionsthe sift Stop.
Pause to think about theinformation critically.
Investigate the source, Findbetter coverage.
Is there alternative resourcesthat cover the same area?
To see if there is a consensus.
Trace claims, quotes and mediato the original context.
Claims are cited, look into theoriginal source and repeat the
(47:29):
safe process.
Now radar the other one theytalk about on here relevance how
is the information relevant?
Relevant to your projectauthority?
Who created the resource andhow credible are they?
Date when was the informationpublished?
Is it still accurate, relevanttoday?
Appearance does the resourcelook clean and professional?
Is the language formal andacademic?
And reason for writing why wasthe resource created?
(47:51):
Was it to sell or promotesomething?
These things here we could, sojust using polyvagal, because
another one of the ones that'sout there, who's?
Who's the person that's writingthat?
Who's the one that's published?
All the research on that?
yeah it's the same guy no sameone guy yeah, same one person,
so it has.
And then you're like, okay,well, has anyone else written
(48:14):
about it other than him?
And I believe I could betotally wrong.
But I believe that there'sother people out there that have
looked at it and they like no,it doesn't stand, it doesn't.
Whatever you're saying doesn'tfit yeah with what you're saying
.
So there's there's contradictionto it, and when you're looking
at the the claim, so using thesefive w's, the sift, these radar
(48:38):
ideas, you can kind of say,okay, well, this is all created
by one person who's claiming allthis research, but it's based
on an idea that's got no scienceand there's actually stuff that
contradicts these claims doneby the researchers yeah, and why
?
Nadine (48:58):
why did?
Why is it being carried forward?
Oh, there's a whole bunch ofcourses for sale.
Oh, there's books for sale, oh,okay, and then you go.
You know, and I like I've seensome interesting discussions of
people starting to wise up tothat and being like wait, is
there anything to this?
Okay, well, what if there'snothing to it?
(49:19):
What is still valuable?
And I'm not sure that for ourscope of practice that it's
super valuable but, say, forpeople in the mental health
field, does it help themcommunicate about something in a
more simplified way?
Is there a benefit that way?
But I wonder if there's just abetter, more honest, in in
(49:39):
keeping with being honest withpeople about what we know about
our bodies, is there a morehonest, um, research-based way
to communicate with people aboutthat?
There probably is, yeah.
Eric (49:52):
There probably is.
It's a great kind of I knowit's kind of a rhetorical
question but can we impact like?
We talk a lot?
You know the kind of newbuzzword is nervous system and I
would admit that I'm probablyone of the people that was.
I've been definitely usednervous system, nervous system,
nervous system system probably alot more than I should have,
but you know it helped me moveaway from connective tissue
(50:14):
explanations to more of anervous system explanation.
Now it's more of kind of like Ithink of it more of like a
system, more and that we'reinteracting with rather than
just a specific tissue ortissues.
Evolution of our thinking rightas time moves on.
See, people talk all the timetoo about the vagus nerve.
Can we actually do anythingwith the vagus nerve?
Can we impact it with our touch?
(50:36):
It's nervous system.
So a lot of people think, yeah,we're impacting the nervous
system.
So therefore, you know I'mgoing to, I can impact the
nervous system by working with,with, with the vagus nerve, and
can you?
Nadine (50:50):
well, it looks like in very specific cases in uh, is it
a seizure or something?
But in a very medical place andit's not a nice massage touch,
like it's a medical procedureand like apparently you can
directly affect it.
Eric (51:05):
But it's that that has nothing to do with us yeah, and
and that's the thing is that canyou maybe create some type?
We know the vagus nerve isresponsible for a whole bunch of
stuff yeah you know I can'tremember off the top of my head
what they all are.
But does massage have come sometype of you know impact on that
(51:33):
?
Maybe, but we can't say forsure because it's not going to
be just the vagus nerve.
Nadine (51:41):
Yeah, well, and that, and I think that's the point the
point is is we love things tobe one thing oh it's fascia, oh
it's lymph, oh it's the vagusnerve, yeah, so we're.
We're complex animals, complexbeings, and we can't reduce us
(52:01):
to just one tissue or one nerveor you one process in any way.
Everything is deeply connected.
Eric (52:14):
So, again, I think we do a disservice to people by trying
to just be like oh, it's thisone thing 100% agree with you,
and it's important for us toacknowledge that when we're
working with people, we'reworking within a human, within a
whole bunch of differentsystems that are integrated, all
working together, and to saythat, oh, I'm going to take this
(52:35):
, this polyvagal course or thisvagus nerve course, rather than
just talking about that specificthing.
Nadine (52:41):
why don't you have a course on.
Eric (52:42):
Like stress, like this we're going to teach you a
course on how to help withstress and in this course, we're
going to learn about the thefight, flight, freeze reactions
we're going to talk about.
You know how social engagementand the clinical environment can
, can help to regulate or change, or, you know, influence, uh,
our systems.
(53:03):
Why don't we talk about courses?
We'll do some touch, we'll dosome some visualization, we'll
do some movements.
Some exercises help to calm asensitized system, or whatever
it is.
You want to use whatever kindof terms you want to use.
Right?
That, I think, is a less wrongapproach, where you're probably
still doing a lot of the samething, but you're not just
(53:23):
focusing on the work of one guyand his one theory.
Yeah, and yeah, polyvagal theory, theory me, it shouldn't be
polyvagal hypothesis yeahbecause a theory means it's
based on known science.
Nadine (53:40):
There's hypothesis and it's pretty well established.
A theory is well established,yeah and polyvagal.
Eric (53:44):
So it's not really a theory.
So that right there too is abit of a marketing ploy yeah,
marketing point point and a bitof a red flag.
So yeah if we went and lookedthrough all the different
learning activities that wereout there for massage therapists
across north america.
A lot of it yeah, it's kind ofa lot of it is like I said
before at the beginning, thispodcast.
(54:05):
A lot of it's based onpseudoscience, but there is the
possibility for most of thesecourses that we could tweak them
and turn them into somethingthat was evidence-based If you
just kind of brought in some ofthe science to help to explain
(54:28):
and inform what's going on inthose courses absolutely and so
I think we can do better.
We need to do better yeah, yeah.
Nadine (54:37):
I'd like to see people commit to taking what works,
whatever touch, whatevertechniques and doing the work to
say, okay, well, what?
What do we actually know?
Eric (54:52):
That would be better for the profession.
Yeah, that would be better forthe public, which is really the
ultimate goal, because we'retaking these courses so we can
learn how to help people.
Nadine (54:57):
Yeah.
Eric (54:58):
And I'm sure there's people listening Maybe not,
maybe people in pseudosciencedon't listen to my podcast but
there's people that arelistening that are probably
really upset by that, by that.
But I would just say, if youfeel defensive or you feel upset
by these things, no one isattacking your clinical practice
, no one is attacking what youdo.
But we are going to challengethe ideas behind why things, why
(55:22):
you think things are workingyeah because that needs to be
based on evidence yeah and ifyou're, and why?
Nadine (55:28):
not take a risk on being better.
Eric (55:30):
Yeah, and if you're in BC and it's part of your learning
plan, make sure that you'rechoosing instructors and courses
that are consistent with thatevidence-based practice standard
, because it's actuallysomething we're supposed to be
doing.
And if you haven't, visit theCMTBC's resource page, because
(55:54):
there is a ton of stuff on hereA ton of stuff on here and it
actually gives you thesedifferent case scenarios.
Like I said before aboutsomebody who wants to learn a
course called visceral kinetics,they're evaluating the sources
from an unregulated healthpractitioner with no noted
certifications or licenses.
There's a lot of claims in herethat the person finds and then
they decide you follow the storythey decide that they're going
(56:16):
to keep searching for somethingelse because this doesn't meet
the standard.
Yeah, if you're listening tothis, please follow these steps
to choose stuff that works foryou.
There's a lot of good stuff outthere.
We are kind of throwing some ofthese popular ones under the
bus, but there is a lot of goodstuff out there and,
particularly if you use thesestandards and and you, you think
(56:37):
about your thinking, you willfind that a lot of stuff that
you might think isevidence-based actually isn't
yeah, sad, but true we need todo better yeah, that's really
what it comes down to yeah, andit's, and it really is.
Nadine (56:53):
I think you you spoke to that and it's not a personal
attack.
But we really have to thinkabout our patients and our
society and what informationwe're spreading out there and
what impact it could have andand that's the doing better,
it's not just making oneindividual therapist life more
difficult or challenging them insome way.
Um, it's, it's about.
(57:15):
It's about our patients in oursociety.
For me, 100.
Eric (57:19):
I agree with you there too .
Uh, nadine, that's such a greatpoint, and just to kind of
finish this off here.
You know, to build on that, thatas a profession massage
therapist whether whether you'rein a regulated or unregulated
province in canada, whetheryou're overseas or you're in the
united states, the goal isalways to elevate the profession
(57:42):
to the level that should be andcould be.
I often like to, when, when I'mtalking to people, I always
like to say well, my whole goalis what is?
To try and put massage therapyto be what it could be, not what
it currently is, to raise us toour standard.
And that starts with theeducation we have.
That starts with the courses wetake.
(58:02):
It starts with thecommunication.
We use the words, we use theexplanations, the narratives,
more so than the actual hands-onthe explanations, the
narratives, more so than theactual hands-on.
It's the bigger ideas behindthat inform our hands-on.
And if we want to be sitting atthe table with physiotherapists
and occupational therapists andmedical practitioners, if we
want to be in these alliedhealth camps, which a lot of
(58:25):
people do in our profession,they feel like, oh, we're the
inferior people do in ourprofession.
They feel like, oh, we're theinferior, we're the bottom.
And I think we don't have to be.
But until we change these ideasand until we challenge the
pseudoscience that justpermeates through our profession
, we will not reach those otherlevels.
(58:45):
We'll consistently stay down,kind of, with this imposter
syndrome we're not good enough,we're not smart enough, nobody
respects us, right?
We have to earn that respectand by doing that we need to be.
We need to jump into theevidence, deep end, fully,
immerse yourself in there, yeah,and then we'll start to see
(59:06):
these bigger systemic changes.
Nadine (59:08):
I I strongly believe that is possible yeah, yeah, and
that comes through committingto a lot of the stuff that that
you've got in your courses, too,of like what do we actually do,
and capitalizing on thosethings and making making that A
hundred percent.
Eric (59:28):
Yeah, what do we do and how do we do it better?
That's our language, ourassessments, our treatments, our
self-management or home care.
How do we make thatevidence-based and how do we do
that in a way that's consistentwith what we know?
We start doing that.
Our profession will reach ahigher level.
I'm certain of that, and we dostart to see it a little bit in
(59:50):
some of the.
Some of the grads are comingout from certain schools that
are doing a really good job.
You start to see these likehigher level of understanding
because they've been exposed toit and they're open to change
and to challenging the statusquo.
Nadine (01:00:04):
Yeah.
Eric (01:00:05):
So more of that is needed and hopefully, before you know,
you and I get leave this planet.
We'll, we'll, uh, we'll, we'llsee.
We'll see some, some, somebigger changes in throughout the
profession yeah, agreed okay,we'll leave it that.
Nadine, thank you very much forbeing here again today.
That was a amazing conversationI really enjoyed and we will.
(01:00:27):
I'm sure we'll have another onein the future.
Nadine (01:00:29):
Awesome, I look forward to it, thanks.
Eric (01:00:32):
Thanks again for listening .
I appreciate all of you fortaking the time to be here.
If you enjoyed this episode,please give it a five star
rating and share it on yourfavorite social media platforms.
You can follow me on Instagramor Facebook at Eric Purvis RMT,
and please head over to mywebsite, ericperviscom to see a
full listing of all my livecourses, webinars and
self-directed course options.
Until next time, take care.
Hello and welcome to another episode of Purves Versus
.
My name is Eric Purves.
I'm a massage therapist, acourse creator, a continuing
education provider, a curriculumadvisor and advocate for
evidence-based massage therapy.
In this episode, nadine Harluckjoins me again for a discussion
on the importance of having anevidence-based practice, and we
also spend some time clearing upsome common misunderstandings
(00:30):
about evidence-based practiceand what this means for the
massage therapist.
We also will go through theformer CMTBC's resources for
appraising evidence and explainwhy this is so important when
choosing continuing educationcourses this is so important
when choosing continuingeducation courses.
If you enjoy listening to mypodcast, please consider
supporting it by making adonation, and you can do this by
visiting buymeacoffeecom.
(00:50):
Slash helloob.
Purpose Versus is alsoavailable on YouTube, so please
check us out there and subscribe.
Thanks so much for being hereand I hope you enjoy this
episode.
Hello and welcome to anotherepisode of Purpose Versus.
I'm excited to have Nadine back.
Nadine was on so far the mostpopular episode we've ever had,
where we talked about the newevidence-based practice standard
(01:11):
for massage therapists in BC,and today we're going to talk
more about the Standards ofPractice and Resources page
which the CMTBC had put out andtalk about the requirements.
And our focus today is going tobe on learning activities and
how an RMT is supposed to engagein these learning activities
consistent with this newevidence-based practice standard
(01:33):
.
We think this is super relevantbecause our learning plans are
supposed to be evidence-basedand there's certain criteria
they're supposed to follow, andif they don't, then we're
actually not supposed to beusing those in our learning plan
.
So we're going to have, I'msure, a very interesting
discussion today about what thismight look like for potential
(01:53):
learners.
So thanks for being here,nadine.
Nadine (01:55):
Yeah, thanks for having me.
I'm excited to dive into this.
Eric (01:59):
Let's just quickly talk about.
You know, I'm just going toreview for those that maybe
didn't listen to the lastepisode just the requirements.
I'm not going to read the wholething, but there's basically
four requirements set outincorporates evidence-based
practice approach to supportclinical decision-making when
determining appropriatetreatment plans.
An RMT takes reasonable stepsto maintain or remain up to date
(02:32):
on research evidence to supportan evidence-based practice.
And number four, this will beour focus today an RMT engages
in learning activities that Aare informed by research
evidence.
B present information withinRMT's scope of practice.
And.
C are taught by an instructoror presenter who holds
(02:53):
appropriate knowledge andexpertise to instruct RMTs in
the context of a regulatedhealth profession.
I like that.
I don't know if this is what'sgonna be happening right now,
though what are your thoughts,nadine?
Nadine (03:06):
um, I love how directed it is.
I think it really lays out agreat um guide for everyone.
Yeah, I think there's going tobe a transition there for people
, um, because it is so new, it'slike what does this mean?
Do we have the skills to dothese things?
So I think you're right.
I think it might take a bit oftime.
Eric (03:27):
When we look at this.
The thing that's so interesting, too, is now what we see is.
We see evidence-based as beinga term that's everyone using now
, because that's what you'resupposed to be using and that's
what we're supposed to be taking.
And it's important for us tounderstand that evidence-based
could be a marketing ploy usedto try to trick people or try to
(03:50):
convince people that whatthey're taking is supported by
latest evidence.
And I will admit for myselfthat I use, or have been using,
the term evidence-based for avery long time in much of the
content that I teach, but Idon't necessarily.
I don't.
I never thought of using it asa marketing boy.
(04:14):
I wanted to always use it asI'm not going to teach you
nonsense.
Everything that's in this courseis defensible by current best
practices, current evidencewhich meets a certain criteria
or certain standard For anyonelistening.
When you are looking to learnor build a learning plan if
you're in BC or if you're I knowwe have listeners from all over
(04:35):
the world if you are looking tolearn continuing education or
quality assurance orprofessional development
whatever it's called where youlive, it's really, really,
really important to be criticalof the evidence base.
We'll put that in air quotes,even though no one can see
because we're on a podcast.
We'll put that in because thatevidence base it's the minimum
(04:57):
standard that we should have asa healthcare profession in terms
of the information we areteaching each other, because the
public deserves to receivecurrent best evidence.
Nadine (05:10):
Yeah.
Eric (05:11):
When we're looking at this in terms of learning activities
, continuing education courses.
The other thing, too, is thepoint C, which talks about it's
taught by an instructor orpresenter who holds appropriate
knowledge and expertise toinstruct RMTs in the context of
a regulated health profession,that's another one, too, is how
(05:34):
is an RMT supposed to know ordecide who has the right
expertise or knowledge?
Nadine (05:42):
Right.
Eric (05:44):
I like that.
It's there, but it's kind ofvague.
What are your thoughts on that?
Nadine (05:49):
Yeah, I think that could be a tricky one to to parse out
, and I think we could have adecent discussion on that about
what are?
What are you looking for?
Who do you want to see?
What do you want to be able tofind about that person?
Are there certain credentialsyou want to see behind their
name, um, or is experienceenough?
(06:10):
Like, what are what makes thisperson an authority on whatever
topic that you're looking at?
Eric (06:16):
this is one thing, too, where I feel our profession
really needs to step forward isjust because you have 30 years
of experience doesn't mean whatyou're teaching is valid or in
terms of the science ornarratives or explanations
behind it yeah, yeah and this isa big problem that we see in
(06:36):
the massage therapy schools alot of them.
I was recently at a presentingat a school to some graduating
students and one of the biggestpieces of feedback I got from
the students was that wheneverthey questioned their
instructors during classes,during practical classes, it was
this well, I've been doing thisfor 30 years.
(06:59):
I've been doing this for 20years.
You know, I've been teachingthis since the school was opened
.
Yeah so they're using thisappeal to their experience or
their right as being.
Nadine (07:11):
Just don't question me right that somehow experience
trumps evidence or knowledge insome way yeah, and there has to
be a blend.
Eric (07:20):
I would agree, I would think yeah, would you agree with
that?
Absolutely you've just been outof school for five years and
you're teaching a course and youdon't have a lot of expertise
and maybe you don't have anyextra education.
Does that make an authority?
Well, probably not, because youprobably haven't built that
clinical expertise yet.
You don't maybe necessarilyhave an extra education.
(07:41):
But if you've been practicingfor 30 years and you've got a
massive amount of clinicalexperience, which we know is
part of that evidence-basedframework which is super, super
important, but you're theknowledge of your clinical
expertise, your understanding ofmechanisms, of mechanisms of
effect, or what's actuallyhappening when you're doing your
(08:02):
treatments.
That has to be based onevidence.
That's based on science.
Nadine (08:07):
Yeah, and that's where I think things are often missing
yeah, yeah, and I've I've hearda similar discussion happen
among people looking forcontinuing education, where
someone was like, oh well, Iheard, this teacher is fantastic
, they've been teaching for awhile, really engaging, super
great, super great.
And then I said, yeah, but whatare they teaching?
(08:28):
It's like do you go to aninstructor just because they're
super charismatic and exciting,or do you go because you're
going to learn something reallyvaluable?
So I think we just need to becareful, and especially if I
think we can think about thistoo.
What you're mentioning aboutevidence is that we can think
about other industries wherethere was, like greenwashing,
(08:49):
everything has eco stamped on itor whatever, right, and so you
want to be careful.
Is it really evidence-based ordid they find some random
citation and slap that on thebottom of their thing and it's
not really related?
So I think we just have to be,we have to go a little bit
slower and think a little bitharder going forward I love your
(09:09):
your comment there aboutgreenwashing.
Eric (09:12):
Same thing with, like organics or organic.
Yeah, it can just be like a, aterm that gets thrown around,
but it might not.
It might just kind ofmeaningless, right, and we have
to be mindful of that too inmassage therapy and in our
evidence-based stuff.
That just because it says it is,doesn't mean that it is yeah
(09:33):
just because you say something amillion times doesn't mean that
it is actually based.
Yeah, big red flag for me ifwhat I'm looking or critiquing.
You know I'm skeptical ofeverything and those people that
listen or know me, I don'tbelieve much of anything.
I don't even believe my ownstuff some of the times because
I'm skeptical of what I think Iknow which is fine and I'm the
(09:54):
first to admit thatno-transcript.
That's a big red flag becausethat usually be challenged.
(10:18):
If someone says to me hey, youknow I'm interested in your
stuff, you know can, can yousend me some, some content on
what it is that your course isabout?
I will always send them.
Depending on what the course isabout, I'll always send them a
couple of PDFs or some links tosome of the things that kind of
create some of the main topics.
(10:39):
I'm not gonna send themeverything because a lot of the
stuff that we have out there iswe've got hundreds or dozens and
dozens of references.
I'm not gonna send themeverything because a lot of the
stuff that we have out there iswe've got hundreds or dozens and
dozens of references.
I'm not gonna send all of thosebecause you know, time
consuming, it's a lot, but Iwould definitely send a few and
say if you have any questions,please, please, reach out.
Yeah, I never have a problemwith that at all because I, as
an instructor you know this iswhat I do for 99 of my living.
(11:03):
Now is you have to be, you haveto be open and honest with with
the people that are coming tolearn from you.
Nadine (11:11):
You should be okay to be questioned yeah, yeah, and I
think this is kind of you canthink of it like if you're in
the store and you pick somethingoff the shelf and you look at
the ingredients list, um, youwant to be choosy about what you
are putting into your mind.
You want to make sure that whatis in the box is actually in
the box, um, and and becauseit's a lot of time, energy and
(11:37):
potentially money that you'respending on on putting these
things into your mind and youwant to make sure it's good,
otherwise you're you're reallyrisking investing in, maybe
opinions, pseudoscience.
You know that's a big risk.
Eric (11:54):
I would guess that if you looked at every single course
that was being taught to RMTsacross Canada, I would think
that you could probably count onboth hands how many of them
would actually be properlyevidence-based and meet a good
standard of critique, and youprobably still have quite a few
(12:19):
fingers left over.
Nadine (12:23):
Yeah, so there's room for growth.
Eric (12:25):
There's a lot of room for growth.
Yeah, that's just from me look,spending.
I spent a lot of time lookingand seeing what's out there and
I think and a lot of the stuffsays it's evidence-based.
But evidence-based for what?
So you see a lot of stuff outthere too where people are
talking about oh, this is acourse on the the, you know,
assessments of the lower leg orlower extremity or whatever Say
(12:48):
it's a course like that.
I've seen stuff like that outthere and the person will go
take a, people will go take thatcourse and there's lots of time
spent on anatomy and kinematicsor joint kinematics and
kinesiology and you know all themuscles and ligaments and
tendons and those people getthis kind of anatomy review.
Well, that's evidence-basedbecause there's hard like that's
(13:10):
the science of how we move andwhere things are.
But when I look at a course likethat, I think, okay, what's the
evidence for assessments in thelower extremity that are
actually valid, reliable, havegood clinical utility?
There's like none you know youhave.
I believe lockman for the kneeis the only one for acl which
(13:33):
actually has good evidence tosupport it.
If you're practiced andexperienced, so you have an
entire course on treating andassessing the lower extremity,
but maybe the only evidencebased about it is the actual
anatomy right, you know, andoftentimes those courses will be
taught with this perspective of, like I'm changing tissue and
(13:56):
I'm loading this and we'rereleasing that.
Where's the evidence for thatother than just, oh, that's, I'm
seeing a change and sotherefore my narrative is valid?
Nadine (14:06):
Yeah.
Eric (14:08):
Which I think gets and that kind of-.
Go ahead, sorry.
Nadine (14:12):
I was just gonna say, that kind of stalls our
profession a little bit and itjust reinforces some of the
false things we've learnedalready.
So how is that helping?
How are we helping to improvethe outcomes of patients?
Eric (14:29):
when we see these types of courses and we see these types
of you know it's evidence-basedbut it's really just rehashing a
lot of the stuff we alreadylearned in school.
But maybe putting an extraadvanced technique label to it
right, is that really doinganything extra, anything special
?
And if we look at the evidence,I would say no, because when we
(14:52):
are deciding to label ahands-on technique with a tissue
label to it or descriptor to itand we're not actually basing
what's happening on the scienceof touch, right then that's not
(15:13):
evidence-based.
From the evidence part right,and this is something that I've
been hammering around for a longtime and I should probably let
it go, but I won't.
So too bad.
The mechanisms of all of ourtouch are the same.
It doesn't matter what you do,you're interact.
You're either the mechanisms oftouch.
It doesn't matter whether it'show you touch somebody, you're
(15:36):
interacting primarily with theskin and the sensory receptors
in the skin and the kind ofreflexive effects of of what
happens with that.
Without going into a bigneurophysiology, neuroimmune
kind of description.
But people, when people teachcourses, they attach a label to
it's myofascial, it'scraniosacral, it's lymphatic,
(15:57):
it's circulatory, it's whateveryou want to, whatever you want
to call it.
There's a million differentnames out there and they all
claim to be doing somethingdifferent.
They're interacting with adifferent tissue.
But if we take a step back andthink, well, how can we interact
with only this tissue whenwe're actually interacting with
the skin and all the tissues allat once?
(16:18):
It's way bigger than just fascia, it's way bigger than just
bones and joints, because youcan't get to that tissue without
going through the skin so whyis there this massive
fascination with all thesedifferent name techniques when
the science of touch is veryclear that they all do the same
(16:39):
thing, right, there's adifferent way of interacting
with the person.
Yeah, stories behind them, thenarratives behind those
techniques don't meet anevidential standard.
Nadine (16:50):
There's no evidence to support them yeah, but they can
create buy-in, I think is whatpercent?
Yeah, people find interesting,because if we switched over to
calling it light, fingertippressure, long cheering force,
(17:11):
um, how much would you spend onthat?
To be like, oh, you just sortof fold and push, okay, done,
like um, yes, we have to becritical and think, think a
little bit more about that kindof stuff.
I think, and especially when wecommunicate that to patients,
what we believe shows up aswe're treating and then they
(17:34):
take that home and is that anempowering thing for them to
think, or is it actually goingto create their reliance on you
or believe somehow that they areless capable or fragile in some
way?
Eric (17:53):
Yeah, that's such a great point, nadine is that the how we
think impacts how wecommunicate, which impacts what
we, the information we provideto our patients, which impacts
our expectations of outcomes,and a lot of times those, those
narratives or beliefs, you know,maybe they're they don't impact
(18:15):
the person at all, maybe it's.
There's no negative outcomewhatever.
I don't care if I'm what you'redoing it, just as long as it
feels better.
Right, and that is the counterargument which I get often.
By often, I mean pretty muchevery time I have this
conversation with a group iswell, who cares, as long as
people are feeling better?
And I say, yes, the outcomesare what matters most.
(18:35):
What's the most important thingfor massage therapy appointment
?
The outcome.
People might not care how theyget there.
However, if we are going tolook at this from a informed
consent and ethical perspective,we shouldn't be telling things
to our patients that we can'tdefend.
Nadine (18:55):
Yeah.
Eric (18:55):
That are based on historical beliefs or based on
oh.
I learned this in this weekendworkshop and this is just what
I've been told.
Yeah that's what I believe yeahwas that good enough?
Is that good enough for thepublic?
Nadine (19:07):
is that what is expected of a regulated health care
profession and I would say no,but that's the way it often is
yeah, and I I hope it shifts aswe start talking.
You know, another big wordright now is trauma-informed
practice.
Right, and if you read throughthe literature on that, some
(19:31):
people have experienced medicaltrauma in which medical
professionals have lied topeople about their bodies,
misinformed them, leftinformation out, these sorts of
things.
And I think we're doing exactlythat every time we feed a
patient pseudoscience, like it'snot trauma, informed to say, oh
, you've got this pulse in yourbody, that, oh, you didn't know
(19:53):
about, but I do and I can takecare of it for you.
That's a power over me, and soI think that really needs to be
considered carefully too that'ssuch a great point.
Eric (20:04):
I love that.
Would you call a power, move apower like a power over like
power over.
Yeah, yeah, yeah, yeah.
That's brilliant and it's true.
That puts us, as a clinician,centered.
Just the exact opposite of whatit says here.
When we go back and look at therequirements for evidence-based
practice standard is it shouldbe patient-centered.
(20:26):
If we are the one with thepower, we're the ones that can
feel and do these things to you.
That's not.
That's not centered on theperson on the table or the
person in our treatment room.
I like what you said there, too, about the power over them and
that us being able to feel andand and and be the the, the ones
(20:51):
that are responsible.
It makes it doesn't make senseto me in this kind of patient
center shared decision-making,biopsychosocial, evidence-based
all these buzzword things.
Right, we use all these wordsand a lot of these, the
pseudoscience stuff.
We'll use those same words, butthen it still puts the
(21:11):
practitioner as the one in powerexactly totally contradictory
to all those other kind ofbuzzwords we just mentioned, and
that's not in the person's bestinterest no, no, and it
perpetuates.
Nadine (21:28):
Like how many of us have had someone come in and say, oh
well, I feel out, likesomething's out, or like, oh
yeah, I just really need, um, myenergy realigned or whatever it
is?
Um, and now they've got thatbelief about themselves and they
are coming back constantly toget it treated.
(21:50):
Um, and you're slowly trying tobe like, encourage them to say,
you know, yeah, you maybe feeloff and I'm here to support you
with that, but there's nothingwrong with you.
You know you're not out.
What does that even mean?
Eric (22:07):
yeah, that's such a weird term too, isn't out, you know
out is a feeling.
It's a subjective thing, like Ifeel like we've all heard our
back, or heard it, yeah, or aneck and you, you feel out and
it doesn't move the way you wantit to, but it doesn't go on
anywhere.
But so it's often used as adescriptor.
But it's used as a descriptor,I think, by patients, so that a
(22:29):
practitioner can then be the oneto put it back where it belongs
absolutely yeah and whereasthat's not evidence-based.
But what is evidence based issay okay, you know what you feel
that way, like you said, youfeel like it supports you.
All we could really say is thatI'm going to do some things
Massage movement, maybe a littlebit of joint mobilization stuff
(22:50):
within our scope of practiceand we'll see if that creates
enough change for that to feelbetter.
That's all we can really say.
I think we can't make these bigclaims.
Nadine (23:04):
Yeah.
Eric (23:06):
Because there's not evidence to support that.
And a lot of people might belistening to this or they've
heard me say this before andthey feel like we're being
dismissive.
And again, neither you or I areclaiming that things are
ineffective or all bs, but we'resaying the stories and beliefs
definitely are often bs.
Yeah, and going back to what yousaid a few minutes ago about
(23:27):
the trauma informed thing, whichstories and beliefs definitely
are often BS.
Yeah, and going back to whatyou said a few minutes ago about
the trauma informed thing,which is another, another big
term that's being used right nowand I feel that it's quite
important, but I feel that a lotof us don't really understand
what it is.
Nadine (23:40):
Right.
Eric (23:41):
Yeah, I was very fortunate that a colleague shared a
trauma-informed webinar with mewhich I put up on my website.
That was done by a psychologistwith a specialty in trauma.
Nadine (23:55):
Yeah, speaking of qualified expert.
Eric (23:58):
And that's and kind of going back and thinking about it
.
This is somebody that youshould be learning a
trauma-informed course from,somebody who is probably not
just an rmt I mean just you knowwhat I mean like somebody
that's an rmt, that's maybetaken a couple courses on it,
that's probably not enough to beproperly trauma-informed.
But we should be learning frompeople that have expertise and
(24:19):
extra training in a specifictopic, particularly if it's
something like that, where thereis a lot of potential to to
re-traumatize people or to makethem, make them worse.
Yeah, absolutely.
You also mentioned to Nadineabout us re-traumatizing people
(24:41):
and about the medical storiesand stuff that we we use and
this is something which I justwanted to come back to and
emphasize again was that thepower of our words, our
narratives, are very strong andwe often don't realize that and
(25:02):
when I'm teaching courses orspeaking with groups, they don't
realize that there could be aproblem with that and it's not
always a problem.
But for those that it is aproblem for it can be a big
problem.
And you know the world that Icame from.
Before I started, or I startedgetting into teaching and
(25:23):
furthering my education waschronic pain and reading the
chronic pain literature andspending time with people that
had lived that lived withchronic pain and realizing that
a lot of their coping behaviorswon't use that term, but how
they lived with their pain,which was oftentimes not very
(25:51):
well.
They struggled.
A lot of times it was theirbeliefs and ideas about what was
actually happening in theirbody that were put into them by
well-meaning healthcareproviders that were negatively
impacting their quality of life.
It was stopping them from doingthings that were important and
valuable to them.
Oh yeah, I've got, you know,I've got this, this pain in my
(26:13):
leg.
Oh yeah, I've got, you know,I've got this, this pain in my
leg.
You know, I just you know, I'vebeen told my nerve is, is, is
is damaged beyond repair, and soevery time I move, you know,
I'm just going to just severthat nerve.
That's the story I heard fromsomebody that had a disc injury
and had permanent kind ofsciatic type symptoms.
So they didn't want to evermove, they didn't ever want to
(26:37):
load their leg, they didn't wantto do anything because they
were worried every time they didthat it was just going to
basically cut that nerve off andthey would just be completely
gone, rather than saying, hey,you know what.
You've got damage in your nerve.
It's going to be.
This might be something you haveto manage for a very long time
the rest of your life but you'renot going to.
Based on on the history andbased on what you've been going
through, it's probably.
You're not going to.
Based on the history and basedon what you've been going
through, you're not going tomake it worse beyond.
(26:58):
It's not going to getsignificantly worse if you get
up and move around and do life.
Well, let's now move thisdiscussion towards.
Maybe we can do a live critiqueof a course ad or of ideas,
rather than than a specificcourse per se.
We can talk about some ideas,because we haven't taken these
(27:19):
courses so we don't know exactlywhat it might look like.
However, a popular one whichwe've seen, that's shown up on
social media is spinning babiesseems very popular.
You go the website.
It's a trademarked thing andthere's lots of stuff that just
shows up right on the, on thefirst page, which makes you
(27:40):
think is this real?
Nadine (27:45):
Yeah, cause the.
You Google it and the firstthing you're going to see there
is spinning babies.
Comfort in pregnancy and easierbirth Like that's a that's a
big claim.
Eric (27:54):
comfort in pregnancy and easier birth Like that's a
that's a big claim I want to seesome proof for that, for sure,
a hundred percent, and I agreewith with you with that, because
that would be amazing.
But if you're making big claims, you have to be able to support
that with evidence.
Yeah, we can all use clinicalexperience to say, oh yeah, why
(28:14):
do this?
And people have lesscomplicated births, they have
more comfortable births, lesslikely to have cesarean sections
.
But that's also.
We have to be mindful that it'sa very biased perspective and
and when I look at the spinningbabies website, there's a lot of
great stuff on here.
Like it's a beautiful website.
It's got a lot of great things.
It talks a lot about, you know,birth education and it's a lot
(28:34):
of great stuff on here.
Like it's a beautiful website.
It's got a lot of great things.
It talks a lot about, you know,birth education and how.
It talks a lot aboutanti-racism and gender
inclusivity and there's a lot ofyou know, ways of of, of of
like healthy living andinformation about pregnancy.
So I think there's a there'sprobably a lot of really great
stuff on here.
Just from looking at thewebsite that they include.
(28:57):
But so we're not.
This critique is not about theoverall value in this group,
this organization, but let'sjust talk specifically about can
you spin a baby with externaltechniques.
Nadine (29:15):
Right yeah, if.
I was looking at this course.
What am I looking for to see ifI want to invest my time and
energy and brain space intolearning this?
Eric (29:26):
Let's talk about it.
So they have workshops.
What is it?
What are you learning in theseworkshops?
What are they teaching you?
What are you?
What are you learning in theseworkshops?
What are they teaching you?
They are oftentimes teachingyou about someone.
You can spin a baby throughpositioning and external
techniques.
Is that something that, asmassage therapists, is that
(29:47):
within our scope of practice?
Yeah, that's a big questionshould we, should we actually be
?
Can we be doing this to, to tohelp, and is there evidence to
support it?
right you know, looking at thewebsite here looks like a lot of
stuff is geared towards nursesand doulas, you know, and
there's massage therapists thatare doulas as well, and I think
(30:10):
the more support we can give tosomebody that's pregnant, that's
or, you know, a mom, duringlabor, just before she goes into
labor, I think is is there's alot of value in that.
But can you actually spin thebaby and should you spin the
baby?
Nadine (30:25):
Right, I don't know.
And should we?
Should we be saying those sortsof things?
I always think it's like shouldwe?
Eric (30:35):
be saying these kinds of things to a patient.
Yeah, because what's that?
You know, if you, if you'relike, oh yeah, I've been trained
in this and this is whathappens.
And then what happens if thebaby doesn't spin?
Nadine (30:44):
Right yeah.
Eric (30:46):
And then they have to do a C-section.
The thing is too, that is wehave to be mindful of and I just
know this because you know froman outside observer and having
two daughters that oftentimesthe babies will not be sitting
properly until just before birth, right where they will then get
into the position that theyneed, and that happened with
(31:07):
both my kids.
So by by a sample, I saw twicewhere they're like oh, we're
worried about this, oh, and thenwithin the last few days, baby
spins and gets ready to enterthe world.
Let's be critical of that.
If you're taking a course,you're talking about spinning
babies and the mom is concerned,the family is concerned that
(31:31):
the baby is sitting improperly,and then they go through this
whole process.
The family's concerned that thebaby is sitting improperly, and
then they go through this wholeprocess and the baby then
rotates and baby, and thenthere's an, and then they have a
natural birth.
Is that because you didsomething to them or is that
just something that would havehappened regardless?
Nadine (31:45):
Right, yeah, yeah, it's that.
Pushing on spleen six point,that acupressure point, it's
like, did that help?
Probably not.
Eric (31:56):
Yeah, pushing on spleen six point, that acupressure
point, it's like, did that help?
Probably not.
Yeah, but we are highlysusceptible to these types of
biases and these types of thesetypes of things.
We kind of see what we want tosee yeah yeah.
so I don't know, like I seethese courses and I think do you
need to take this course tolearn how to help somebody who
(32:20):
is pregnant or going into labor?
Are the claims are being madein it supportable by science?
And you did a wonderful job.
You found one paper, I think,that actually studied spinning
babies and the method, and whatdid it find?
Nadine (32:39):
It seems to show that there may be a reduction in
likelihood of cesarean, and Ithink it was a specific group of
pregnant people, not um, notall um, but the numbers were
(33:00):
pretty close and you brought upa good point that the the sample
sizes for the spinning babiesgroup and the non-spinning
babies group were actually verydifferent yeah, I believe there
was twice as many non-spinningbaby mothers spinning baby
(33:21):
situations versus, you know, Ithink it was 800 that were just
went through natural and about400 that just went through like
a spinning babies thing.
Eric (33:30):
So obviously there's the there's a huge variety or big
difference in terms of theyweren't equal.
It wasn't like 400 and 400.
So that can change the numbers.
Nadine (33:42):
Yeah, yeah, and because it was a review of literature
too, you know it depends on thequality of what was studied as
well.
So we don't know for sure.
And this particular paper rightoff the hop says, yeah, there's
not any research evidence onthis, and so they were trying to
fill that gap.
So, as it stands, I wouldn'tsay there's a really well
(34:08):
supported base of evidence forthat.
And you head even into thespinning babies research and
references page and there's one,two, three, four.
There's a pilot project.
Eric (34:21):
You know there's not a lot here so you've got entire
treatment registered trademarktreatment that's based on four
research papers and clinicalexperience.
Is that evidence-based?
And so for listeners anyonewho's listening to this would
that, knowing that, would youstill consider investing money
(34:43):
in something that's based onfour papers and an idea that
hasn't been supported?
I think that's.
That's something that peoplereally need to consider before
doing things like this, and youcan say that for a lot of other
courses too.
I mean, there's a lot of otherones out there too which will
make big claims, but then if youlook at their research evidence
(35:06):
, a lot of the times they'lljust blast.
Maybe they'll have hundreds ofresearch papers on there If you
look at their website andthey'll have like all this
research evidence on there.
But is that evidence consistentwith what they're saying in
their courses or is it just kindof sound similar?
Nadine (35:24):
Yeah, and maybe something to discuss too, is
like OK, so you look at this andthe research isn't very strong,
but something in your cycle,I'm going to take it anyway.
I might consider being reallyclear on what you're going to
get out of it.
And, yeah, what you might wantto consider is if I take it,
what am I looking for?
(35:44):
Is it actually just maybegetting better at working with
pregnant people?
Is it learning some techniquesand positioning that feel good
for that population, rather than, oh, I'm going to get this very
specific skill.
Eric (35:59):
That's yeah, that's fantastic, because this is a
question I get often too frompeople.
Is that?
Well, if I'm, you know, I'maware of the limitations of all
these different named modalitiesand stuff, but I just really
don't feel like I'm not reallysure, like I don't feel
comfortable working with the jawor the head or I'm not really
comfortable working, you know, Idon't really know how to.
(36:19):
You know, maybe I want to workwith more positionings for
helping people the abdomen orthe low back or the pelvis and I
would say, yeah, you can takethe stuff, Like we're not saying
I'm not critiquing that youshouldn't say you shouldn't take
these things because maybe it'sa population that you're
interested in, maybe it's anarea that you're interested in
that you just don't.
You want to learn more ways ofputting your hands on people or
(36:40):
interacting with people or maybemore understandable what's
happening with that particularpopulation.
I think that's great, butplease, if we're going to be
based on what we know and basedon the requirements from the
cmtbc and should be therequirements of all health care
providers, professionals is beskeptical of the claims that
(37:04):
they're making in those coursesyeah and I've had people that
have taken stuff from me andthey are totally aware of the,
the greater amount of evidenceout there on touch.
But they're like you know Ireally want to work on.
I want to learn some nicepositioning and soft touch type
things.
I'm just not really sure andthey'll go and take like a
craniosacral course or they'llgo take like a visceral course,
(37:27):
just so they can.
But they were just like I justwanted to learn how to treat
this area differently.
But I'm going to just say say,forget all, that's all that
nonsense and I'd say that's fine.
You know I, I know for me a lotof the stuff that I've did in
my early career was was all likemyofascial stuff, like I did
all like the structuralintegration and fascia things,
and I still use a ton of thatstuff.
(37:49):
Like the technique I lovebecause it's like slow sinking
in, connecting with somebody,getting them to feel safe,
putting them in some differentpositions which things you I
didn't learn in massage school.
It's fantastic yeah but there'sno way that I'm telling them I'm
releasing fascia, becausethere's no evidence to say that
(38:09):
and people yeah yes, there is,there isn't, show me.
Nadine (38:12):
Yeah, yeah, yeah.
Eric (38:14):
It doesn't exist.
Nadine (38:15):
Yeah, and I think there was some discussions recently
too about shiatsu too, and Ihave a background in shiatsu and
it feels great.
I learned you know differentpositions, different ways of
applying pressure, and they'reawesome.
I've brought that with me andleft all of the other organ
(38:36):
diagnosis and meridian stuffbehind.
I don't think there's anythingwrong with that.
Eric (38:41):
So that's fantastic.
And you do that you still usethose techniques and those
approaches?
Oh, absolutely.
Nadine (38:46):
I wouldn't be able to help myself, like it's just so
ingrained in what I do.
So a hundred percent.
Eric (38:52):
Yeah, that's, that's awesome and that's the key thing
I want to.
One of the key points I'd likelisteners to this episode and
any other episodes too, then weare kind of critiquing things is
that you know, the clinicalpractice doesn't necessarily
have to change, but the claimsand the beliefs, yes, need to be
evidence-based and if you aregoing to learn something that is
(39:16):
beyond just normal massagetechniques, so you're going to
learn maybe something morepopulation specific, you know.
Nadine (39:24):
Make sure that you.
Eric (39:25):
You do your due diligence to assess the evidence that's
being used and and maybe ask theinstructor what?
What's your experience Like?
Why should I learn from youversus from somebody else?
Nadine (39:38):
Yeah.
Eric (39:39):
And I would say that most instructors should be able to
all instructors should be ableto answer that yeah, and be able
to say yeah, because of this iswhy and this is what we teach,
and this is the framework, orthe framework or the the base of
the evidence that we come fromfor this course yeah, and I
(39:59):
would encourage people to armorthemselves before even that
conversation and have a littlelook at the evidence what is
sort of our understanding ofthis area or whatever currently?
Nadine (40:10):
and then compare that when that information comes from
the instructor and say, okay,is this jiving with sort of the
body of knowledge that's outthere?
Eric (40:21):
and it's a big thing too that we just don't have this in
our.
In our curriculum there is aresearch course, but when I talk
to new grads or students, stillI'm very fortunate I get these
opportunities to see kind ofwhat's going on.
You know what's happening inschools these days.
There are very few of themactually do proper like a proper
(40:45):
research course that isactually good quality, right.
Oftentimes it's just like findsome papers and tell us about
them without actually propercritique and it's just not part
of the our curriculum and and Ireally wish it should be in this
.
Maybe that's time for anotherdiscussion about you know, the
benefits of us being a in auniversity somewhere where we
(41:07):
would have more instructors andexposure to that, because you
know most rmt's don't have that,that education or that
experience, and so therefore, ifyou don't have that and you
can't teach it, like you can'thave an RMT teaching about
research evidence if they don'thave any experience or education
on that yeah so that's.
(41:29):
That's a big thing, so when welook at stuff.
So, moving on to the next thingwe want to talk about here,
about the resources page, so theCMTc, and this is open to
everybody.
So if you're listening to this,doesn't matter where in the
world you are, you can access.
This is on the website.
It's on the cmtbcca website,which is going to be gone soon
and it's going to be moved to anew website which I can't
(41:50):
remember the name, but it's theCollege of Complementary Health
Professionals or something yeah,see, there's a lot CCP, there's
a lot of letters so it'll be.
The same information will behere, but it'll be based on a
new website.
So if you're listening to thisand you can't find it in the
CMTBCA website, I think itshould probably hopefully auto
(42:12):
direct you to the new website.
Yeah, I'll probably set that up, hoping so.
Nadine (42:13):
Yeah, that's what we'll do, but we don't know yet
because website, I think itshould probably hopefully auto
direct you to the new website.
Yeah, hoping hoping.
Eric (42:16):
So that's what we do, but we don't know yet because as a
recording, we don't know.
However, on the cmtbc's website, public access under their
standards of practice, they havean evidence-based practice
thing.
It actually goes through awhole fantastic section here on
research evidence.
What is it locating it, youknow, critiquing it or
(42:36):
evaluating it and differentquestions to ask.
Biases are all there.
It's got a whole bunch of, Ithink is is actually really good
quality resources for rmts oranybody in the public to look at
.
Yeah, and it's got some greatexamples too about, I believe,
(42:57):
on evaluating sources, and maybewe can discuss that in a moment
.
There's a great course on therecalled Visceral Kinetics, which
is a made-up course, which Ithink is hilarious.
So why don't you talk for amoment here, nadine, about kind
of the things under the locatingresearch and talk about some of
(43:18):
these?
Nadine (43:24):
sort of in the top part, before you get down to the
course, they've got just a tonof links on like where to go and
look to start.
And then I really love thatthey included in the evaluation
piece some well establishedframeworks.
For what questions do I askwhen I'm looking at something?
So maybe you've listened tothis podcast but you don't
(43:45):
remember what we talked about.
So maybe you've listened tothis podcast but you don't
remember what we talked about.
Um, right here there's the 5w,there's sift, and it just will
walk you through.
Here's some really key thingsto look for, and then they even
provide more resources if that'snot enough.
So like this is actually areally great guide, and I also
like even defining bias, becausemaybe that's something a lot of
(44:05):
us haven't even thought aboutin research and in our thinking
bias is huge.
Eric (44:13):
Yeah, that that we, we, everyone needs to admit that
we're all biased.
I'm biased, absolutelyeveryone's bias.
And you know, if we're thinkingabout a critical thinking
perspective, right, we're like,we're always thinking and being
critical of our thinking and howwe're thinking, right, that's
kind of one of the mainframeworks of that.
So, if you acknowledge yourbias and say, hey, you know, I
(44:34):
have biases, this is where I'mcoming from, this is what I
think and this is why I thinkthis way, then it allows you, I
feel, to critique and be mindfulof other information, knowing
that you are coming from aspecific mindset or specific
(44:54):
thinking framework, and that ishow you're going to approach new
information.
If we don't recognize ourbiases, then I think it opens us
up to basically linear thinking, because we're just constantly
looking for that confirmationbias.
I want to see the things that Iwant to see.
I want to find the support.
Nadine (45:15):
Yeah.
Eric (45:16):
And this is a question that we see all the time, don't
we online, and we see people.
Well, I'm looking for researchpapers to support whatever in
certain here.
Is that really what you'reshould we looking for?
Should we look for something toconfirm what you're should we
looking for?
Should we look for something toconfirm what you want to find,
cause you can find that.
Nadine (45:31):
Yeah, absolutely.
Eric (45:33):
You know, uh, you can find a single study that will
basically support any bias.
Nadine (45:37):
Yeah.
Eric (45:37):
And that's not critical thinking, that's not
evidence-based.
Nadine (45:41):
Yeah, yeah, and a technique I use um, and I have
to catch myself.
It really really is.
You do have to catch yourselfand go oh, I'm really excited
about something.
notice, when you're like, ah,this is really good and I bet
it'll make a big difference, Itake whatever that phrase is and
in google I'll type in thatthing and then after it I write
debunked and I look for all thecontradictory stuff where people
(46:07):
saying this part doesn't seemright or like there's some
evidence against this bit orwhatever, to give myself a much
more rounded view of somethingand kind of calling myself out
on my bias.
Yeah.
Eric (46:23):
I love that.
Nadine (46:25):
Yeah, really important.
Eric (46:26):
I love that, yeah, really important.
And you know, choosing learningactivities, which is kind of
one of the focuses of thisconversation, and using
resources, you know we should,you should be able to, to try to
challenge yourself and and notjust chase the current fad.
If we wanted to go down thatroad of challenging polyvagal
(46:47):
theory and fad, if we wanted togo down that road of challenging
polyvagal theory just veryanother popular one and we
wanted to evaluate the source.
You know, using some of theseideas that are listed on the
cmdb's website and you know wecould say, well, you know these
questions who is the author?
What is the purpose?
When was the item written orpublished?
Where is the author?
What is the purpose?
When was the item written orpublished?
Where is the content from?
(47:09):
Why was the research written?
We get asked these questionsthe sift Stop.
Pause to think about theinformation critically.
Investigate the source, Findbetter coverage.
Is there alternative resourcesthat cover the same area?
To see if there is a consensus.
Trace claims, quotes and mediato the original context.
Claims are cited, look into theoriginal source and repeat the
(47:29):
safe process.
Now radar the other one theytalk about on here relevance how
is the information relevant?
Relevant to your projectauthority?
Who created the resource andhow credible are they?
Date when was the informationpublished?
Is it still accurate, relevanttoday?
Appearance does the resourcelook clean and professional?
Is the language formal andacademic?
And reason for writing why wasthe resource created?
(47:51):
Was it to sell or promotesomething?
These things here we could, sojust using polyvagal, because
another one of the ones that'sout there, who's?
Who's the person that's writingthat?
Who's the one that's published?
All the research on that?
yeah it's the same guy no sameone guy yeah, same one person,
so it has.
And then you're like, okay,well, has anyone else written
(48:14):
about it other than him?
And I believe I could betotally wrong.
But I believe that there'sother people out there that have
looked at it and they like no,it doesn't stand, it doesn't.
Whatever you're saying doesn'tfit yeah with what you're saying
.
So there's there's contradictionto it, and when you're looking
at the the claim, so using thesefive w's, the sift, these radar
(48:38):
ideas, you can kind of say,okay, well, this is all created
by one person who's claiming allthis research, but it's based
on an idea that's got no scienceand there's actually stuff that
contradicts these claims doneby the researchers yeah, and why
?
Nadine (48:58):
why did?
Why is it being carried forward?
Oh, there's a whole bunch ofcourses for sale.
Oh, there's books for sale, oh,okay, and then you go.
You know, and I like I've seensome interesting discussions of
people starting to wise up tothat and being like wait, is
there anything to this?
Okay, well, what if there'snothing to it?
(49:19):
What is still valuable?
And I'm not sure that for ourscope of practice that it's
super valuable but, say, forpeople in the mental health
field, does it help themcommunicate about something in a
more simplified way?
Is there a benefit that way?
But I wonder if there's just abetter, more honest, in in
(49:39):
keeping with being honest withpeople about what we know about
our bodies, is there a morehonest, um, research-based way
to communicate with people aboutthat?
There probably is, yeah.
Eric (49:52):
There probably is.
It's a great kind of I knowit's kind of a rhetorical
question but can we impact like?
We talk a lot?
You know the kind of newbuzzword is nervous system and I
would admit that I'm probablyone of the people that was.
I've been definitely usednervous system, nervous system,
nervous system system probably alot more than I should have,
but you know it helped me moveaway from connective tissue
(50:14):
explanations to more of anervous system explanation.
Now it's more of kind of like Ithink of it more of like a
system, more and that we'reinteracting with rather than
just a specific tissue ortissues.
Evolution of our thinking rightas time moves on.
See, people talk all the timetoo about the vagus nerve.
Can we actually do anythingwith the vagus nerve?
Can we impact it with our touch?
(50:36):
It's nervous system.
So a lot of people think, yeah,we're impacting the nervous
system.
So therefore, you know I'mgoing to, I can impact the
nervous system by working with,with, with the vagus nerve, and
can you?
Nadine (50:50):
well, it looks like in very specific cases in uh, is it
a seizure or something?
But in a very medical place andit's not a nice massage touch,
like it's a medical procedureand like apparently you can
directly affect it.
Eric (51:05):
But it's that that has nothing to do with us yeah, and
and that's the thing is that canyou maybe create some type?
We know the vagus nerve isresponsible for a whole bunch of
stuff yeah you know I can'tremember off the top of my head
what they all are.
But does massage have come sometype of you know impact on that
(51:33):
?
Maybe, but we can't say forsure because it's not going to
be just the vagus nerve.
Nadine (51:41):
Yeah, well, and that, and I think that's the point the
point is is we love things tobe one thing oh it's fascia, oh
it's lymph, oh it's the vagusnerve, yeah, so we're.
We're complex animals, complexbeings, and we can't reduce us
(52:01):
to just one tissue or one nerveor you one process in any way.
Everything is deeply connected.
Eric (52:14):
So, again, I think we do a disservice to people by trying
to just be like oh, it's thisone thing 100% agree with you,
and it's important for us toacknowledge that when we're
working with people, we'reworking within a human, within a
whole bunch of differentsystems that are integrated, all
working together, and to saythat, oh, I'm going to take this
(52:35):
, this polyvagal course or thisvagus nerve course, rather than
just talking about that specificthing.
Nadine (52:41):
why don't you have a course on.
Eric (52:42):
Like stress, like this we're going to teach you a
course on how to help withstress and in this course, we're
going to learn about the thefight, flight, freeze reactions
we're going to talk about.
You know how social engagementand the clinical environment can
, can help to regulate or change, or, you know, influence, uh,
our systems.
(53:03):
Why don't we talk about courses?
We'll do some touch, we'll dosome some visualization, we'll
do some movements.
Some exercises help to calm asensitized system, or whatever
it is.
You want to use whatever kindof terms you want to use.
Right?
That, I think, is a less wrongapproach, where you're probably
still doing a lot of the samething, but you're not just
(53:23):
focusing on the work of one guyand his one theory.
Yeah, and yeah, polyvagal theory, theory me, it shouldn't be
polyvagal hypothesis yeahbecause a theory means it's
based on known science.
Nadine (53:40):
There's hypothesis and it's pretty well established.
A theory is well established,yeah and polyvagal.
Eric (53:44):
So it's not really a theory.
So that right there too is abit of a marketing ploy yeah,
marketing point point and a bitof a red flag.
So yeah if we went and lookedthrough all the different
learning activities that wereout there for massage therapists
across north america.
A lot of it yeah, it's kind ofa lot of it is like I said
before at the beginning, thispodcast.
(54:05):
A lot of it's based onpseudoscience, but there is the
possibility for most of thesecourses that we could tweak them
and turn them into somethingthat was evidence-based If you
just kind of brought in some ofthe science to help to explain
(54:28):
and inform what's going on inthose courses absolutely and so
I think we can do better.
We need to do better yeah, yeah.
Nadine (54:37):
I'd like to see people commit to taking what works,
whatever touch, whatevertechniques and doing the work to
say, okay, well, what?
What do we actually know?
Eric (54:52):
That would be better for the profession.
Yeah, that would be better forthe public, which is really the
ultimate goal, because we'retaking these courses so we can
learn how to help people.
Nadine (54:57):
Yeah.
Eric (54:58):
And I'm sure there's people listening Maybe not,
maybe people in pseudosciencedon't listen to my podcast but
there's people that arelistening that are probably
really upset by that, by that.
But I would just say, if youfeel defensive or you feel upset
by these things, no one isattacking your clinical practice
, no one is attacking what youdo.
But we are going to challengethe ideas behind why things, why
(55:22):
you think things are workingyeah because that needs to be
based on evidence yeah and ifyou're, and why?
Nadine (55:28):
not take a risk on being better.
Eric (55:30):
Yeah, and if you're in BC and it's part of your learning
plan, make sure that you'rechoosing instructors and courses
that are consistent with thatevidence-based practice standard
, because it's actuallysomething we're supposed to be
doing.
And if you haven't, visit theCMTBC's resource page, because
(55:54):
there is a ton of stuff on hereA ton of stuff on here and it
actually gives you thesedifferent case scenarios.
Like I said before aboutsomebody who wants to learn a
course called visceral kinetics,they're evaluating the sources
from an unregulated healthpractitioner with no noted
certifications or licenses.
There's a lot of claims in herethat the person finds and then
they decide you follow the storythey decide that they're going
(56:16):
to keep searching for somethingelse because this doesn't meet
the standard.
Yeah, if you're listening tothis, please follow these steps
to choose stuff that works foryou.
There's a lot of good stuff outthere.
We are kind of throwing some ofthese popular ones under the
bus, but there is a lot of goodstuff out there and,
particularly if you use thesestandards and and you, you think
(56:37):
about your thinking, you willfind that a lot of stuff that
you might think isevidence-based actually isn't
yeah, sad, but true we need todo better yeah, that's really
what it comes down to yeah, andit's, and it really is.
Nadine (56:53):
I think you you spoke to that and it's not a personal
attack.
But we really have to thinkabout our patients and our
society and what informationwe're spreading out there and
what impact it could have andand that's the doing better,
it's not just making oneindividual therapist life more
difficult or challenging them insome way.
Um, it's, it's about.
(57:15):
It's about our patients in oursociety.
For me, 100.
Eric (57:19):
I agree with you there too .
Uh, nadine, that's such a greatpoint, and just to kind of
finish this off here.
You know, to build on that, thatas a profession massage
therapist whether whether you'rein a regulated or unregulated
province in canada, whetheryou're overseas or you're in the
united states, the goal isalways to elevate the profession
(57:42):
to the level that should be andcould be.
I often like to, when, when I'mtalking to people, I always
like to say well, my whole goalis what is?
To try and put massage therapyto be what it could be, not what
it currently is, to raise us toour standard.
And that starts with theeducation we have.
That starts with the courses wetake.
(58:02):
It starts with thecommunication.
We use the words, we use theexplanations, the narratives,
more so than the actual hands-onthe explanations, the
narratives, more so than theactual hands-on.
It's the bigger ideas behindthat inform our hands-on.
And if we want to be sitting atthe table with physiotherapists
and occupational therapists andmedical practitioners, if we
want to be in these alliedhealth camps, which a lot of
(58:25):
people do in our profession,they feel like, oh, we're the
inferior people do in ourprofession.
They feel like, oh, we're theinferior, we're the bottom.
And I think we don't have to be.
But until we change these ideasand until we challenge the
pseudoscience that justpermeates through our profession
, we will not reach those otherlevels.
(58:45):
We'll consistently stay down,kind of, with this imposter
syndrome we're not good enough,we're not smart enough, nobody
respects us, right?
We have to earn that respectand by doing that we need to be.
We need to jump into theevidence, deep end, fully,
immerse yourself in there, yeah,and then we'll start to see
(59:06):
these bigger systemic changes.
Nadine (59:08):
I I strongly believe that is possible yeah, yeah, and
that comes through committingto a lot of the stuff that that
you've got in your courses, too,of like what do we actually do,
and capitalizing on thosethings and making making that A
hundred percent.
Eric (59:28):
Yeah, what do we do and how do we do it better?
That's our language, ourassessments, our treatments, our
self-management or home care.
How do we make thatevidence-based and how do we do
that in a way that's consistentwith what we know?
We start doing that.
Our profession will reach ahigher level.
I'm certain of that, and we dostart to see it a little bit in
(59:50):
some of the.
Some of the grads are comingout from certain schools that
are doing a really good job.
You start to see these likehigher level of understanding
because they've been exposed toit and they're open to change
and to challenging the statusquo.
Nadine (01:00:04):
Yeah.
Eric (01:00:05):
So more of that is needed and hopefully, before you know,
you and I get leave this planet.
We'll, we'll, uh, we'll, we'llsee.
We'll see some, some, somebigger changes in throughout the
profession yeah, agreed okay,we'll leave it that.
Nadine, thank you very much forbeing here again today.
That was a amazing conversationI really enjoyed and we will.
(01:00:27):
I'm sure we'll have another onein the future.
Nadine (01:00:29):
Awesome, I look forward to it, thanks.
Eric (01:00:32):
Thanks again for listening .
I appreciate all of you fortaking the time to be here.
If you enjoyed this episode,please give it a five star
rating and share it on yourfavorite social media platforms.
You can follow me on Instagramor Facebook at Eric Purvis RMT,
and please head over to mywebsite, ericperviscom to see a
full listing of all my livecourses, webinars and
self-directed course options.
Until next time, take care.
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