January 17, 2024 • 53 mins
In this episode we welcome Nadine Hawryluk to discuss her academic and professional journey while exploring what the CMTBCs new standard of practice for evidence-based massage therapy could mean for the future of our profession, both in schools as well as in practice. As a recent master's graduate and an RMT from Courtenay, BC, Nadine brings a wealth of knowledge and experience to the discussion.
Nadine details her journey from body worker to registered massage therapist, unveiling the pivotal role that advanced education plays in bridging the gap between theory and practice.
We highlight the skill sets required for excellence in the realm of massage and manual therapy education and practice. We delve into the importance of a solid grasp of physiology and the art of patient communication, emphasizing that therapy extends beyond mere technique to encompass compassionate, holistic care. My own narrative of educational transformation serves as a testament to the power of knowledge, illustrating how it has reshaped my professional identity and enhanced my patient interactions.
Navigating the changing tides of healthcare regulation in British Columbia, we explore the anticipated shifts within professions such as massage therapy, chiropractic, and acupuncture, envisioning a future where evidence-based practice is the cornerstone of our professions. We confront the challenges of integrating into the broader healthcare system, emphasizing the necessity for continued professional development grounded in scientific rigor. By adhering to such stringent standards, we advocate for the elevation of manual therapies and the creation of a more credible and respected community of health practitioners.
To connect with Nadine please visit her on Linkdin through this link:
https://www.linkedin.com/posts/nadine-hawryluk_when-thinking-about-evidence-based-practice-activity-7151696770148831232-f1x-?utm_source=share&utm_medium=member_desktop
Or you can connect with Nadine here:
https://nadinehawryluk.wordpress.com/
Head on over to my website. This includes a list of all my upcoming courses, webinars, self-directed learning opportunities as well as some helpful learning resources.
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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 coursecreator, continuing education
provider, curriculum advisor andadvocate for evidence-based
massage therapy.
In this episode, we welcomeNadine Harlech, who is an RMT in
Courtney, bc.
She tells us about her journeyinto academia and the valuable
education and insight she gainedwhile completing her master's
(00:29):
degree in applied science.
The focus of our conversationis on the new CMTBC's new
standard of practice, onevidence-based practice and how
we think this could potentiallyshape the profession in BC.
If you enjoyed this episode,please rate it and share it on
all your favorite social mediaplatforms.
Purpose Versus can also befound on YouTube, so please
check us out there and subscribe.
So thanks for being here and Ihope you enjoy this episode.
(00:52):
Welcome to another episode ofPurves Versus.
Today we have Nadine Hawryluk,and she just told me how to
pronounce her name, so hopefullyI got that right.
She lives in Courtney and I'mexcited to have you here.
We're going to talk about ohmany things, but we're going to
talk a little bit about kind ofthe focus is going to be on
evidence-based practice and kindof what that means for the
(01:12):
professional massage therapy,and we did talk offline about,
kind of, some of the ten tenetsof evidence-based practice.
So it's going to be fun andexciting for us to break this
down a little bit.
But before we get started, justtell everyone a little bit more
about you.
Who is Nadine?
Nadine (01:29):
Oh, that's a big question.
Well, professionally, I've beenan RMT since 2017, but before
that I was working in spas andsort of other sort of practices,
being a body worker since 2011,when I graduated from a Shiatsu
program at Langara College manymoons ago, and currently I'm
(01:51):
running a product practice inCourtney here and Courtney's
awesome.
Personally, I love the outdoors.
I ski, paddleboard, that kindof thing and if I can get out to
a trivia night and host amurder mystery party, that's my
jam too.
Eric (02:08):
What kind of trivia do you ?
Like.
Nadine (02:10):
Oh well, I mean I do best with like science-y stuff.
Eric (02:14):
Usually I'm that person at the table, so I love trivial
pursuit and I love like justrandom stupid trivia.
My brain seems to not rememberimportant things like what I
need to do from day to day, butI can remember useless facts
from you know, an 80s TV show orsomething.
It's ridiculous.
Nadine (02:36):
Yeah, it's good fun though.
Eric (02:38):
I love trivia.
I always in my younger days weused to do a lot of like music,
bingo, trivia.
I don't know if that'ssomething you ever were into.
Nadine (02:49):
Oh, music for some reason doesn't stick.
Yeah, oh okay.
Yeah.
Eric (02:55):
My previous life I was heavily involved in music, so
for me it's something that Ilove.
So, yeah, so I don't think Iknew that you were involved in
like I didn't realize that youdid like body work before you
became a massage therapist.
What was the reason for goingfrom an unlicensed body worker
to getting your licenses and RMT?
Nadine (03:18):
I had worked in some big spot well, one big spot in
Whistler and I think it wasreally just recognizing like it
was a bit of a slog beingunregulated, getting enough
hours, getting enough work andyou know, just seeing RMTs were
booked solid and I needed tolive.
So that was a big push.
(03:39):
And I think I also noticed whenI was working with people like
they'd be asking me questionsand I didn't really know how to
answer them properly.
So it was kind of I was justready to sort of grow in that
profession and learn more andbecome more of an expert in that
realm.
Eric (03:59):
So did you go back to Langara then to do your RMT
degree or your RMT.
Nadine (04:04):
No, I moved out to Victoria for WCCMT.
Eric (04:08):
Okay, see, I'm learning all kinds of things.
I didn't realize that.
Okay, so you went to WCCMT here.
That's why I went to school aswell, but I think well, well
before you.
So when I mean we've connectedbefore, because I think you've
taken some courses of mine andwe've chatted kind of just for
email over the last few years,but you recently completed your
master's degree, is that correct?
Tell, tell everyone a littlebit more about that experience
(04:32):
and kind of what you learned orwhat you focused on learning on.
Nadine (04:36):
Yeah, so I in August actually wrapped up my master's
in clinical science at WesternUniversity, which is an awesome
program.
It was online If anyone's sortof interested in looking at
programs, that might fit in wellwith working full time.
It was an awesome program andit it sort of focused on sort of
(05:01):
becoming a leader in healthcareand I definitely chose the
leadership focus.
So we really like thefoundation of that program was
one evidence based care,learning how to appraise
research and critical thinking.
Everyone had to take a criticalthinking course as well.
So, and then beyond that, Ichose the leadership stream and
(05:26):
got into program evaluation andimplementation science, which
was really interesting.
I didn't realize that was abranch of science that's sort of
a newer field and I think it'ssuper applicable of being like
you know how do we get newpractices into into healthcare
(05:47):
and what makes them catch on,and you know what the barriers
are there.
Eric (05:52):
So that sounds really fascinating.
It sounds.
It sounds something that'scould be hopefully appealing to
RMTs, because as far as I know,there's only really two programs
that you could do, likedistance wise for massage
therapy, and get a master'sdegree and something that is
could keep you still within theprofession.
Nadine (06:14):
Right.
Eric (06:15):
And once the the program I did at UBC, the rehab science,
and I think there's alsoMcMaster has a rehab science, I
think there's.
I think they actually are thesame program, just different
universities.
And then you were at Westernwith the applied science and I
think Western has quite a fewdifferent options within that
Cause.
I've done some mentoring, aclinical mentoring, with
(06:37):
students who are RMTs throughWestern, but they weren't doing
the applied science, I don't, orthey were, but they were doing
maybe something else.
I'm not sure what the otherprogram is there and I'm just
kind of spinning words outwithout making any sense right
now.
Nadine (06:50):
Yeah, they've got a few different options and I know
Susan Shepton did her programthere and that was really
focused on pain, multi sort ofall the approaches to pain.
Eric (07:04):
Yeah, that's what it was.
Nadine (07:05):
Yeah, and so it's.
This one is like a similarbranch, but off, so there's just
so many options.
If you're depending what you'rereally interested in there's,
there's an option for you Nice.
Eric (07:16):
Yeah.
So, susan, I remember it was afew years ago when she did that
and she, yeah, it was the multi,multi-disciplinary pain
management, I think, was kind ofthe focus, which was seemed
like a really cool program aswell.
So I think it's great becauseyou know what you and I
obviously are going to come fromthe same probably a lot of the
same beliefs about the ways toadvance the profession and to
(07:37):
become more recognized or moreaccepted within kind of the
academic fields, to advance thepractices and the researches.
We need more people withgraduate level education, and
what's nice is that there issome of these other options
available for you.
The only problem, though, Ithink that a lot of people run
(07:57):
into is you have to have abachelor's degree first.
Nadine (08:00):
And you had a bachelor's first, I'm assuming.
Yes, yeah, yeah, an undergradin zoology, right yeah?
Eric (08:08):
Yeah, so that's the thing too.
Is is that's the one thingthat's unfortunate about our
profession is because it is justa diploma.
If you wanted to go and do moreadvanced education, you
basically have to you'd have togo back and do an undergrad and
then go into it, so it's notavailable.
It's not something that's on anoption for everyone and it's
obviously something that not alot of people don't want.
But over the years I do, I havenoticed that there's a lot more
(08:30):
RMTs getting master's degreesnow than there was when I
started practicing almost 20years ago.
So that's encouraging.
Fingers crossed.
Hopefully that keeps going.
Nadine (08:40):
Yeah, yeah.
It seems like you know, aftersome time you've been in the
field and there's something thatsays, hey, maybe I want to grow
and learn some new stuff.
So I see more people beingcurious about getting there.
Maybe they're undergrad at TRU,which is an easier way to go
about that.
So yeah, hopefully people justkeep growing.
Eric (08:59):
Yeah, so what are your thoughts about having a like a
Bachelor's of Science orBachelor's of Health Science
degree as kind of like the entrylevel point for massage therapy
?
That's something that you'refor or against?
Nadine (09:18):
I've thought a lot about that.
I'm not sure I think where Iwould settle with it would be
like a two-year associatesdegree Would be maybe the more
appropriate way to go and likestill getting a really good
foundation.
I've like to see morephysiology, like getting into
(09:41):
second-year level physiology tobe included in our program.
But to make it, you know,accessible is like yeah, you can
do two years of study and thenstart working, but maybe then
you can sort of work your way up, similar to social work.
Eric (09:59):
That's a good actually yeah, that's a great idea.
Yeah, yeah, I'm not.
I've not thought of it that way.
I've always thought of it aslike an all-or-nothing, like
keep it as diploma or get yourdegree.
But having that a two-year kindof associate degree would be
kind of a bridge.
That would be very possible.
Those credits would be in auniversity or a college.
(10:23):
That would be transferable, alot more recognized than the
current system with the privatepractices or the private school.
So, yeah, I like that idea alot.
I think that the yeah, because alot of people are just gonna
I'm gonna go to school two years, I want to work, and then you
know you.
How do you know it?
Say, you go to school whenyou're in your early 20s.
(10:43):
How are you gonna know what youwant to do in your 30s and 40s?
And maybe you're not gonna wantto be a full-time massage
therapist working with clientsand maybe you want to do other
things.
That would give you anopportunity to try and expand
and do other stuff and I thinkthat's a fantastic idea.
I guess the key with that wouldbe we'd have to get things out
of the control of the privateschools.
Nadine (11:07):
Yeah, and I don't know anything about sort of the
motivations.
Yeah, I don't know either.
Eric (11:14):
That's the topic for another conversation.
Nadine (11:15):
I think yeah, absolutely yeah for sure.
Eric (11:17):
Yeah, digress here a little bit, but I like what you
said, though too.
You mentioned second yearphysiology or more physiology.
I have my thoughts on why Ithink that's important.
What are your thoughts on?
What would that provide?
Massage therapists.
Nadine (11:32):
I think it gives you a little bit more context for
critical thinking.
Honestly, like when I'm justout in the world and I hear
claims about health, I have abackground that makes me go.
That doesn't sound right orlike, based on what I know about
how the human body functions,like that doesn't seem like it's
(11:54):
possible and maybe just givesyou a little bit more context
about how things work.
I think.
Eric (12:05):
Yeah, I would feel the same way too.
I feel that in our massageeducation we learn so much
anatomy and physiology andpeople.
You know it's a lot ofinformation and it's very
detailed, but I feel that thestuff that's detailed and it's
stuff that doesn't really matter.
You spend a lot of timelearning like attachment points
between little, tiny musclesthat have no relevance to
(12:27):
anything.
You learn about all the systemsof the body in like learning
about cellular respiration stuffand these things, which is, I
think, is really cool, but youdon't really learn.
You kind of learn at least myexperience and when I talked to
others, you learn thisinformation.
Then you you're like either,like it's okay, it's great, it's
(12:48):
information, it's interesting,and you never think about, you,
never use it, it's notapplicable.
But then you learn a lot ofstuff and then you're taught
well, this is, this is how youcan fix these things with your
techniques.
And I feel that there's athere's a gap there and that
knowledge between what'sactually happening
physiologically when we put ourhands on people.
(13:09):
You don't really learn.
Like you look, you do, but it'snot.
There's no science, there's noevidence to support a lot of
that stuff.
So I agree that if you actuallyunderstood, had a good level of
, you know, not graduate level,but a second or third-year level
university understanding ofanatomy and physiology and what,
how the body works, more a stepabove what we learn in the SARS
(13:29):
school.
A lot of those health claims orkind of mess, mechanistic
claims or things that peoplelike to talk about, a massage
just wouldn't make sense.
You're like, that doesn't makesense.
I can't increase yourcirculation by massaging your
skin, because we understand howthe venous and the circulatory
system and the allostaticallostasis and all these things
(13:52):
you know balance everything outand blah, blah, blah.
We understand how the kidneysand the liver and all the stuff
works.
At a different level that stuffwouldn't make sense and you
would.
Just it wouldn't even be anissue.
Nadine (14:01):
Yeah, yeah, yeah, although yeah, and I think like,
in addition to sort of thatphysical aspect, we really need
to understand how peoplefunction and how they feel and
like how they interact withpeople.
Like there's that whole side ofthings too, and and I think
that, because that would debunka lot of the like oh, we can do
(14:22):
so much with our hands is likerecognizing how much else
affects people, you know, beyondthat.
Eric (14:32):
Yeah, and that's one thing too that is not commonly
addressed in a lot of oureducation, whether it's in
school or in other CE courses,is it's very focused on
technique, technique, technique.
Right, I was just spent themorning kind of going through a
lot of social media stuff andjust reading some things is for
my own interest, to see what arepeople talking about.
And it's all about whattechniques should I learn or
(14:54):
what's the best technique to dothis, and everyone's talking
about techniques, not talkingabout you know, how do I help
this person who's suffering with, I don't know, severe
osteoarthritis of the neck?
It's like what techniques can Iuse to help this person with a
neck?
I'm like, well, should you notunderstand about, like, maybe,
some of the, the processesinvolved and the experiences
involved?
And, and maybe it's more, maybeyou should just take your folks
(15:17):
away from your hands and likehow can you support and work
with the human in front of you?
That's gonna be more valuable.
But we don't.
That's not something we reallylearn, and I think when we have
those conversations a little,what I feel is a lot of times
when we talk about how wecommunicate and how we interact
with people and and the wholeclinical encounter.
It sometimes think people thinkwe're working out of scope of
(15:38):
practice.
Oh well, you're counseling them, you know?
No, we're just working onmechanics.
I'm like, no, you're workingwith a human mm-hmm, and that's
something that definitely needsto be better understood and we
probably it sounds like we're onthe same page of that.
Stuff should be entry level topractice, at least in the basic
fundamental concepts well, yeah,it's well we're working with
(15:59):
human beings, like and we don'thave.
Nadine (16:03):
I think we talked about active listening in passing for
five to ten minutes in mytraining and we didn't even do
any practice exercises like it'slike, here are the concepts of
active listening.
It's like, no, we're workingwith people.
How do we not focus on on thatmore?
And and I get that it maybe itfeels really nebulous, maybe,
(16:27):
and and the ones taken on thatchallenge to be like, okay,
let's break it down, let's makea framework for what that looks
like.
Instead, it's just this bigopen gap that no one knows what
to do with the thing.
Eric (16:42):
Yeah, maybe your implementation science training
could help with some of thatstuff.
Nadine (16:51):
Yeah, that would be an interesting approach to take.
Eric (16:55):
Yeah, what did you focus on in that aspect of your
education?
Nadine (16:59):
So that was just really learning about breaking down
implementation science into it'slike understanding what it is.
For one thing, it's a verystructured approach to problem
solving and it's looking at.
So you have a situation, youunderstand what the current
approach to a treatment or apolicy or a policy or something
(17:20):
like that, and then you go, okay, well, there's a better way to
do it.
Maybe it's more cost effective,maybe it just has better
outcomes Like there's somebenefit to it, and you go, okay,
why isn't it being adopted?
And so you want to identifywhat the barriers are, what are
the things that can helpimplement it, and then come up
(17:41):
with a plan to deal with thosebarriers.
And then, of course, a hugefactor in it is monitoring and
evaluation after.
It's like how well did this go?
Like, did our plan work?
That sort of thing, yeah.
Eric (17:58):
Yeah, that's a good point that you make there, because I
feel that a lot of times there'sno policies or things that are
put out there or implemented butthere's not that evaluation of
like.
Did it have the desired effect?
Yeah, and that's good.
I mean, part of what I did whenI was doing my master's degree
was we did stuff on like, like alot of folks with a knowledge
(18:18):
translation.
So you know, how do we, whatare some of the best strategies
and ideas to translate knowledgeinto practice?
But the last part of that wasyou couldn't just give people
knowledge, you had to see if itwas actually working, is it
actually changing their practice?
But that's the stuff that wedon't as clinicians, and even in
(18:40):
our like kind of CE world, youdon't really know if it's
actually making a difference,right, because you have to ask
for an evaluation afterwards.
So that's a really importantthing, which I'm glad that you
were able to do.
That.
It sounds really fascinating.
Yeah, but before I digress toomuch, what do you think?
So you did your master's degreeFantastic, congratulations.
(19:03):
I think that's great.
And add your name to the listof growing, a growing number of
RMTs with higher level education.
I think that's fantastic, butwhat was your rationale for it?
What did you want to do with it?
How do you think it's going toimpact, what were your plans for
that?
To how it was going to impactyour future.
Nadine (19:21):
I wish I had like a really clear answer for you on
that one.
But I was just curious.
I was looking for moreinformation, I was looking to
grow.
That was sort of my sense and Iwas like what does my future
look like?
Do I want to move into more adecision making role, policy
role, something like that?
But what I came out after theprogram, I just recognized how
(19:44):
much more confidence I had inlike looking at information and
synthesizing ideas and feelinglike, oh, I do have something to
say about this.
And it made me recognize too Ithink what's so important about
education is that you realizelike the more that you know, the
more you realize you don't know.
(20:04):
And I think that is soimportant even in our profession
, to just have people maybe be alittle bit more humble with
information and be more carefulwith it.
So I'm not sure where it'sgoing to go yet.
I think things are stillpercolating, but I feel like I
(20:24):
just have the confidence to goforward.
Eric (20:27):
And that's huge.
Yeah, I'm the confidence tofeel it, feeling it, feeling
better about that.
Do you feel that it changedyour practice at all, like how
you treat or work with patientsevery day?
Nadine (20:42):
Good question.
I think what I have noticedrecently is like really wanting
to empower people, like I wantthem to have the information too
, without overwhelming them andI have to watch that too.
It's like when is itappropriate to?
But yeah, like I want people tofeel like they understand their
(21:09):
bodies better and even ifthey're not working with me, so
that they can make betterdecisions.
I actually sent the webinar youdid for the renal foundation.
Eric (21:25):
Oh, yeah, yeah.
The kidney foundation inAtlanta, canada, yeah.
Nadine (21:29):
Because I thought that was such a great little
concisital thing of like.
Here's what manual therapy does.
Eric (21:34):
Oh, good, thank you.
Nadine (21:35):
And I want people to be like, oh okay, well then, how
does that translate into whatother kinds of care that I would
get?
You know so more informed, moreempowered.
Eric (21:46):
Yeah, yeah.
And I was like, the reason Iasked is because when I was
doing my degree, that was aquestion I got all the time from
people what difference is itgoing to make?
Are you going to charge more?
I was like, well, no, I'm incharge of the same as whatever
Everyone else in the clinic andthe region is charging.
Well, then, why would you do it?
And I felt that for me, when Iwent and did my master's degree,
(22:08):
it was probably I'm not goingto say probably it was
definitely the best professionaldecision I ever made.
I felt that so, clinically, Ifelt more, like you said, more
confident, more comfortable,like I felt, like I had I was
definitely gave me anunderstanding that I didn't,
like you said, I didn't know alot, but I knew what I didn't
(22:29):
know and I knew what I didn'tknow.
So it gave me that sense ofhumility, of like, yeah, that's
a good question, but I'm goingto help find you the answers.
Yeah, you know, that kind ofattitude was.
It was definitely.
I definitely got from that andit was.
I felt more comfortable too inmaking suggestions to people or
(22:49):
having those conversations withpeople when they were like, well
, what should I do.
What's the bet?
What, like you know, this isn'tworking.
This isn't working.
You know what are my optionsand it gave me and, because of
what I was studying, it gave mea lot of.
I'm like, well, here's somepapers, here's some things I've
read.
You know, here's kind of someof the least wrong, maybe
potential solutions ormanagement strategies for you.
(23:12):
So I felt like, yeah, theknowledge helped didn't really
change much with what I did withmy hands, but it definitely
changed a lot with how Iinteracted with, with my
patients.
I felt, and then also too, formy CE aspect, my CE business.
It was hugely beneficial forthat because I got basically got
to spend three years justreading papers and researching
(23:34):
all the stuff that I wanted to,and then I could use that to
build, inform the content forthe courses.
It was great and if anyone'slistening and they feel that is
it going to make a difference.
You don't really know until youtry.
You know, and it's opened up somany doors for me, like so many
doors of different things Inever even thought of doing.
(23:54):
You know, working with, withcurriculum development at
schools and working withcolleges and associations, and
you know being able to presentat conferences and, and you know
, speaking at universities andthings that never would have
been an opportunity before, butthat you have that piece of
paper where it says you did thework.
So therefore, it opens up a fewmore doors for you.
So I think it's it's somethingthat is really worth exploring.
(24:16):
If anyone's into it, it'slistening.
Nadine (24:19):
Yeah for sure, and I think even being a confident
voice in someone's life who ismaybe experiencing pain or
recovering from injury too, andbeing just being able to say,
yeah, you're going to be okayand let me help, support you,
find the best way for youforward, Thank you.
I think it's just such a greatinfluence, rather than maybe
(24:44):
someone's like okay, well, weneed to solve the problem this
way and this way and this waywho might be a little less
confident in understanding howall of that works.
Eric (24:55):
That's a thing that is a big shift in thinking, I feel,
for our profession.
Not just us, but any MSKprofession is moving.
That shift from I got to focusto fix and try all these things
to how can I best support you onyour journey.
That's not typical conversationthat we see a lot of.
We see more of it now than 10years ago, but it's still a long
(25:18):
ways to go because often,patients or clients come to see
us and they expect us to fixthem.
I see there's a lot of dangerthough and I saw this all the
time in the chronic painpopulation that I treated.
Anybody, but particularly thatpopulation, is when you've had a
number of therapists trying toconvince you or to sell you a
(25:40):
wellness plan or like this iswhat you need to do.
You go and you spend months oryears in some cases, and
thousands of dollars with yourown money or insurance company's
money trying to fix the problem, and then they end up just the
same or worse, because the focuswas on the problem, not how can
we support the person.
(26:01):
That subtle shift, I find, ismassive because it takes the
pressure off you trying to fixand it creates this more
relationship between you and theother person where you're there
to support them and help themmake decisions, and your massage
is part of it, but it's not thefix.
One thing I always say topeople is that the danger when
(26:26):
you make big promises to clientsor patients is that if you
don't live up to it, then whatare they left with?
They're left finding somebodyelse who's going to make big
promises and they keep onchasing and chasing and chasing
and you get on this healthcareprofessional wheel.
They just keep spinning whereyou see all these people and
(26:46):
you're going nowhere.
Nadine (26:48):
Yeah, I would say that's analogous to and I experienced
this early on in my career tooof looking for the next
technique.
I can thinking, oh, otherpeople are helping people better
than me, what's the nexttechnique I need to learn?
Then you end up on that hamsterwheel trying to find the right
thing to do just on the otherside of the table.
Eric (27:13):
Sure, I did that too early in my career, for sure.
I think I've said this probablynumerous times.
So people probably who listento this podcast regularly are
like yeah, eric, you keeprepeating yourself.
But I'll say it again.
It took me longer than I'd liketo admit to realize that I was
mistaken.
Like I was wrong because I gotheavily involved in structural
(27:36):
integration and myofascial stuffbecause it appealed to me and
I'd had those kind of treatmentsand they helped for me.
Of course I need to learn howto be as amazing as everybody
else.
Then it took too long but Irealized after quite a few years
.
I was like this doesn't makeany sense anymore.
Nadine (27:55):
Yeah.
Eric (27:56):
I wish I could have noticed that earlier but we get
hyped up on those things andit's attractive because of big
promises.
Nadine (28:04):
Yeah, when you're not learning anything different,
then what are you supposed to do?
I remember in our programsomeone brought up the point
okay, well, if we're givingpeople home care and saying this
is what you need to do andthey're not doing it, what do we
do?
The advice came back.
Well, all you can do is justkeep telling them over and over
(28:26):
and over until it clicks.
Or maybe you think this mightnot be appropriate for this
person.
They're like what's anotheroption?
I think that's a new thinkingthat I'm so glad to see is
coming forward.
But on the other side of that,I have seen it swing the other
(28:49):
way, where it's like well, it'sno longer my responsibility to
fix you, it's all on you.
Yeah, if you're not going to dothe work, then you're not going
to get better.
So I'm like let's come back tothe middle here.
Eric (29:03):
Yeah, that pendulum swings pretty far both directions.
Yeah, when I was in school too,I remember learning that what
you said about you got to justkeep telling them, you know if
they're going to get better,they got to do their stretches,
they got to do their exercises.
Now I look back and I laugh andI think the amount of rehab
stuff that we got educated, butit was terrible.
(29:25):
It was all very passivestretching and just very linear
strength training.
It was so ridiculous and it waslike do this many sets, this
many reps, repeat this?
It was so poor and I think alot of places they still do that
and yeah, and then now you seethe shift where, like, well,
(29:47):
it's up to you, I can't fix you,so you got to take care of
yourself.
No, it's supportedself-management, which means you
help the person find thingsthey can do on their own.
And I know we have theseconversations that can seem kind
of vague, kind of gray, likewe're talking about.
But clinical practice is gray.
There's not a lot of answers,there's this lot of kind of less
(30:09):
wrong ideas that you can kindof play with.
Nadine (30:11):
Yeah, yeah, yeah.
And how do you get that?
Really, I think switching tothe idea of function is like
what's going to make thisperson's life enjoyable,
worthwhile, like functional, andif that's the question you ask,
rather than oh, how do we getrid of this person's pain, then
(30:32):
it would totally shift how weapproach people 100% it would.
Eric (30:37):
Yeah because how pain.
How often can you just say, oh,I'm going to get rid of all
your pain?
Yeah, If someone's been in painfor a long time, maybe you can
turn the volume down a littlebit on their pain experience,
but you're not going to get ridof it.
Yeah, and everyone's probablyhas a case where someone's been
in pain for 10 years and you didsomething and then they got
(30:57):
better, Right, and you're like Ifixed them.
But that's like one in 1 in1,000.
Yeah, it's not good odds, butwe always remember that one.
We always remember that oneperson who had pain forever and
we did this one thing and theygot better.
Nadine (31:14):
Yeah.
Eric (31:15):
That's not the majority.
Nadine (31:16):
Yeah, no, life is painful.
There's no way around that.
Yeah.
Eric (31:19):
But function is key, because I think in MSK world and
in our massage therapy world wecan help people with function,
hopefully more so than we could.
I should say hopefully.
But we have a better claim ofhelping people with function
than we do of reducing theirpain significantly.
(31:40):
We can modulate pain for ashort period of time during and
after massage, but long term theevidence is not good.
Nadine (31:50):
Yeah.
Eric (31:50):
Yeah, it's a very short term, but function is something,
yeah, and we see that all thetime too, if you look at and
we're just going to segue intoour next conversation about
evidence-based practice but wesee that a lot in evidence-based
practice stuff is that gettingpeople to function better is a
(32:12):
more reasonable and moresupported goal, and all the
clinical practice guidelines arefocusing more on function
rather than just 100% painrelief, because pain modulation,
pain control, not painelimination, and the goal is
always function.
Nadine (32:28):
Yeah, yeah, always in service of getting back to
things that you love.
Yeah, yeah.
Eric (32:34):
Yeah, for sure.
So, as we kind of move intotheir little conversations here
on evidence-based practice, Ijust wanted to ask your opinion
on what do you think some of thebiggest issues are that our
profession is facing today, andlet's put that within the realm
of evidence-based practice.
Nadine (32:55):
Yeah, I think, given the new standard that just came out
, I think a big challenge isgoing to be that transition.
What does that look like?
How are we going to havedifferent conversations?
How we yeah, how we movethrough?
(33:20):
This transition is going to bea big challenge, I think, for a
lot of people, but I thinkthere's so many opportunities
for people such as yourself toprovide resources and support
and information in a reallysupportive way to help us move
(33:40):
forward.
Eric (33:42):
Yeah, yeah, that's a good point because there's many
issues facing our profession inBC the college amalgamation with
the other.
What are they calling it?
Complimentary or integrativehealth?
Nadine (33:56):
No, I forget, I forget.
Eric (33:59):
I know a lot of us want to be in the Allied Health one,
but the Allied Health College isall basically university degree
colleges or university degreeprofessions, and then the one
that we're in, which I can'tremember what it's called, is
all basically just like tradeschool, like private school kind
of stuff, right?
So it's naturopaths, massagechiropractors.
(34:21):
Chinese medicine, acupuncture,yeah, so those ones are all in
that college, so that'll beinteresting to see how that goes
.
I don't know if it's a bigissue, but I know personally I'm
not too concerned about it.
I don't there's nothing we canreally do about it, but I think
a lot of people in ourprofession do are like freaked
out about it and I think it's abit of a slap in the face, I
think, for those of us that arekind of evidence-based or
science-based in our thinking.
(34:43):
It's kind of like oh, now we'regoing into these other
professions which maybe we don'tidentify with.
Nadine (34:51):
But I think there's movement in those other
professions too, similar to us,where there's, like some sets of
people who are pushing for amore evidence-based approach.
So maybe we could all sort ofwork together in that direction.
Eric (35:03):
Yeah, and that would be a great solution, because we can
talk about problems I want, butsolutions, I think, are the key
thing and I talked about in aprevious podcast episode that I
released, about just like someof the options for solutions.
Right, and there is options outthere depending on what it is
you're looking for, but yeah,there is.
I know a handful ofchiropractors that are.
(35:24):
You know they don't like thedirection that their profession
has gone, but you know, withlike the kind of before, you
know a lot of chiropros weredoing the x-rays to you know,
pathologize your spine and thenselling you a series of
treatments, and you know, I know, that stuff's been kind of
taken away and there's a hugepushback on that.
So there is definitely anevidence-based contingent to all
(35:47):
the professions, but this mightbe an opportunity for them to
get together, hopefully and pushfor better.
So, fingers crossed right.
Nadine (35:56):
Yeah, that would be.
Another big issue, though, is Ithink we kind of need to.
You know, identity is a big onefor us, and I'm sure that's
been mentioned before on yourpodcast.
But I've even noticed it's likewhen we were talking about the
name of the new college and likehow people want to be
considered, be it complimentaryor integrative, or you know,
(36:20):
it's like trying to figure outhow we relate to the healthcare
system.
Are we something separate orare we a compliment?
Are we a support?
I think that's a big thing thatwe'll work on as we move
forward.
Eric (36:36):
I think from the conversations I've had with a
lot of RMT is that they wouldlove to be part of a full
healthcare system, kind of likehow physiotherapists are or
occupational therapists are, oreven opportunity to work in a
hospital or an outpatient care,or you could work in private
practice, like there's moreoptions, and I know a lot of
massage therapists would likethat and I think it would be
(36:56):
fantastic if our professioncould get to that point.
But I think we're saying in thebeginning of this podcast,
without that entry leveleducation being higher, without
having a degree, it's justprobably not going to happen
just in terms of how we areperceived by the public and how
(37:17):
we are perceived by thehealthcare world.
And to be honest, you know,when we look on a lot of the
nonsense that's out there, a lotof the pseudoscience that is
really common in our profession,that really holds us back
Because it's not helping.
(37:37):
And so hopefully, with this newevidence-based practice
standard which we're going totalk about here, hopefully
that'll kind of help to push usin the right direction.
Where there won't be, it won'tbe tolerated anymore by our
regulator, and it's that youcan't say and do things that are
not evidence-based, and this isa thing too, I guess we should
(38:00):
say.
Just some people I know, and Ilike the term science-based
because it talks more aboutbiological plausibility, but I
think, in terms of where thecollege is going with this, I
think evidence-based is a goodstart.
So I think that just wanted toput that in there.
For those who are like I, likescience-based.
I like science-based too, butlet's go with a term that's been
(38:21):
used for a long time, soevidence-based, but the and it'd
be interesting to see how thisif this has any teeth, though
like, can they do anything?
Like, are they going toactually say no, like you can't
have those things on yourwebsite?
Oh, we've had these complaintsfrom the public whether you've
been saying or doing thesethings, and that's actually not
(38:41):
evidence-based.
It's your responsibility tounderstand what evidence is for
what you are treating.
And also, too, I'm hoping and Idon't, this is a big hope too is
I'm hoping that it will reallyinfluence the type of continuing
education or quality assurancethat massage therapists pursue.
So that way, they're going tohave to say, okay, well, if I
want to take this course, isthis evidence-based?
(39:04):
And what does that mean?
And that's the question is, youcould take anything, but is it
going to satisfy therequirements of the college to
take I don't want to throw anynames out there, but to take a
course that is notevidence-based.
And then the problem is, Ithink that we're going to have
those, I think we're going tohave instructor but like, oh,
(39:26):
it's evidence-based, and thenthey'll throw down a couple
studies and they'll be, and youlook at the studies and they're
probably totally irrelevant toother crap science.
Nadine (39:34):
Yeah.
Eric (39:35):
So there's going to definitely that's going to be a
bit of a learning process, but Ihope that the CMT will be able
to have some teeth and sayinglook, that's not okay, this is
how we have to improve.
So we're going to have to havesome good quality resources and
maybe some audits or something'sgoing to have to happen to see
how that all plays out.
Nadine (39:57):
Yeah, and that's the thing is like.
Policy is one thing, and thenhaving the support to implement
it successfully will be the bigthing there.
Eric (40:09):
So what are your thoughts on the new standard?
Nadine (40:14):
I wish we had like a little celebratory party, but I
think it's a pretty big dealhonestly.
Yeah, me too.
But I think it's great and Ithink there were some statements
in the actual verbiage of itthat were really I think they
took a really strong stancehonestly about like thinking
(40:36):
about how what you say toclients, like how is that going
to affect them, and it's likethis is really important stuff
to consider.
So I think it's great.
I'm really interested to seewhere it goes.
Eric (40:51):
Yeah, it's so too fresh it takes it starts.
It'll already in place by thetime this podcast is live, but
as of today, it hasn't actuallytaken effect.
It takes effect on January 15th, so a few days from now.
So, yeah, it'll be interestingto see what actually happens.
But I agree, I think we shouldhave had some kind of party
because I think, compared to theonly other place I think that
(41:13):
has an evidence in theirStandards is in Ontario.
But they have that, theyusually have it.
It's informed and it's quitewatered down and it's Not nearly
the same, it's not nearlystrongly worded as BC.
So we should really commend the, the college and people there
that put this through yeah.
(41:33):
Yeah, did you want to?
So let's, let's talk about yourkind of ten tenants of
evidence-based practice, becausewe had a conversation, I don't
know, a month or two ago and andyou would come up with this.
I thought this was such a greatidea.
Did you want to go through andkind of list off those, those
ten?
Sure, this is as a learningopportunity for people that are
(41:55):
listening, just to see.
Nadine (41:58):
Yeah, I mean in context too, it was.
I like when I'm thinking aboutconcepts and I'm trying to sort
of solidify them for myself.
I love frameworks, you know.
I just started scribbling downI'm like what would be kind of
like the essential things youneed to focus on if you want to
(42:19):
grow your evidence-basedpractice, and so I just started
Do lightning things down andthis is what I came up with.
So if other people have ideasor things they want to add, yeah
, let me know.
Or add them to your own littlereflective piece.
But I'm hoping this could be atool for people to sit down and
think, oh, these are littleareas that I can improve upon or
(42:42):
be interested in.
So let's just go top to bottomhere.
So I've broken it up into threesections and it's kind of those
three stool legs is it in theevidence-based practice Model of
?
So I've broken it up into onelike how you relate to
information, how you relate topatience and how you're relating
(43:07):
to yourself, and so we'll startat number one, which is develop
the skills to search for andevaluate reliable information.
And then I've put little subpoints under of do not make
assumptions, ask questions.
Number two is stay up to datewith current pain science,
(43:28):
health research and bestpractices.
Three is do not spreadmisinformation, and I've put
under that, evaluate claims andsources carefully before sharing
and know the dangers and harmsof false narratives.
Number four is be aware ofvarious resources available for
(43:49):
patients in your community andonline.
And Then, if we move into therelating to patients piece, it's
.
Five is know your role.
So who are you to this patient?
And I've there's, um, there's abook out there it was four
physios, but I've pulled outsome of the titles that I
(44:10):
Thought were kind of great ofbeing a confident, being a coach
, a detective, a teacher, butnot a healer.
So we're a support person, nota fixer.
And then, under that Be is knowthe mechanisms of action for
massage, along with realisticgoals and outcomes.
Number six is know your limits,so knowing how to identify red
(44:36):
flags and referring on is Underthat, and being comfortable
saying I don't know, okay.
Moving on to seven, bepatient-centered, so learn how
to determine, support thepatient's values, beliefs, goals
and preferences.
Number eight is pay attentionto your communication, so learn
(45:00):
how and when to sharepotentially helpful information
in a supportive way.
And be know the effects oflanguage and other communication
on the therapeutic relationship, that person's pain and
disability experience, and thenwhen we're thinking about how we
relate to ourselves.
Nine is develop regularreflective practices.
(45:21):
So a is understand yourmotivations, your biases,
strengths and areas of growth.
Be be curious about youremotional experience in the
process of transference andcounter transference.
See, get support when you needit and regularly discuss cases
with colleagues.
And then, finally, number ten,commit to constant improvement.
(45:43):
You know, continue to learnabout pain, rehab, healthcare,
disease processes, communicationyourself, research, literacy
and appraisal.
So those are my ten rules.
I love it.
Eric (45:59):
I love it, I think it that's, that's such a great, a
great way to kind of put thatall together and it's you know,
these are things that are, youknow, we should all be able to
do.
And then and you could read,it's like oh my gosh, ten things
, but it's, these are notimpossible.
No, and they all interplay aswell.
Nadine (46:15):
Yeah there's so much overlap between them, right,
which is evidence-based practiceas well.
Eric (46:18):
There's an overlap between you know what's the relevant
research evidence say, versusyour clinical expertise, versus
the person in the context of theenvironment, and and they all
kind of overlap together.
And so this is this is this isfantastic, so maybe I will.
In the show notes I will put acopy of this.
Yeah with with your name on it,so so people can can have a
(46:42):
look at that.
I think it's really useful.
Nadine (46:46):
Yeah, because I just think it's so important, when
we're moving forward withsomething, to have Tools to fill
that gap of like well, what doI do?
Well, here are the things youcan work on.
Eric (46:57):
And when I read this to this kind of goes into another
conversation we've had beforeand we can wrap up the the
podcast with with this littleconversation is is the idea of
of patient safety and then andmaking the person feel safe.
(47:18):
Because when we look at how thisevidence-based practice stuff
is, you know, if we look atunderstanding pain science and
we look to Not spreadingmisinformation, we look at our
role about being more of a coachor a coach or a coach or a
coach or a coach or a detectiveand not a healer.
You know, knowing how do I,knowing the science and the
knowledge, but how to identifyred flags, saying I don't know a
(47:41):
lot of the stuff you can putinto this idea of like just Of
safety, of making the personfeel less threatened, less
broken.
Yeah, and I know that in somethe idea of safety is some
(48:03):
people don't necessarily agreewith that and we're not talking
about pain science or painexplaining.
We're not talking aboutneuroscience education where
you're like I'm gonna tell youeverything that you need to know
about pain to make you feelsafe so you're not feeling
threatened by what's happeningin your body.
We're not talking about thatkind of safety because that is
that's an idea, is popular and Iused to teach more of that.
(48:26):
Now I think I try and do abetter job of putting that pain
science stuff into properclinical context.
So you're not just painexplaining.
But I think if we, if we Istill strongly believe and when
I look at the evidence and welook at come to your comments
here if our goal is just to makethe person in front of us feel
(48:47):
good, can our touch feel good,can our clinical environment
feel good, can our words feelencouraging?
It's not just being like, oh,I'm so nice, it's not like over
the top, but it's justeverything we do is how can we
support you, how we make youfeel like this is a good place
to be.
Nadine (49:05):
Yeah, yeah, and a little metaphor that I sort of after
thinking about these things andwhat it is that people really
need from us and I always thinklike we're really adults or just
bigger kids and, at the end ofthe day, like this is gonna
sound a bit reductive, but in away like we're professional boo
(49:27):
boo kissers right, it's like.
I love that.
How do you be the best possibleboo boo kisser that you can be?
How do you cause?
You know, someone hurtsthemselves, like come and they
say I have an awi, and you say,oh, you're gonna be okay, so
reassurance, right, and then youprovide some sort of care,
(49:47):
touch that's gonna support thatperson.
So how do you create anenvironment that's super
supportive, super safe andyou're gonna create that
resilience and that empowermentfor that person?
And you're not saying, oh, I'mgonna do some magic to it and
like fix you.
You're just saying like, is it?
(50:08):
Do you need some informationright now?
What do you need to feel likeyou can go forward confidently?
Eric (50:15):
I love that Professional boo boo kissers.
Nadine (50:18):
Yeah.
Eric (50:19):
A lot of people probably very offended by that, but it's
okay.
Nadine (50:21):
Oh, I guarantee.
Eric (50:23):
I love that, though, and it's okay, cause I think we
should be able to laugh at kindof what we do, but that's so
true.
And you use the termreassurance, which is important,
because if we look at theclinical practice guidelines for
pretty much any MSK condition,it's like reassurance is usually
the first thing.
Nadine (50:41):
Yeah, and that creates safety.
Eric (50:42):
You're gonna be able to, and that creates safety.
Nadine (50:44):
Yeah, yeah.
Eric (50:46):
Yeah, it's usually reassurance, education and then
usually some type of dependingon what it is some type of touch
or movement within comfort andtolerance, like.
It's usually pretty basic andyou can apply those principles
to pretty much any MSK condition.
You'd see, obviously you don'twanna reassure when it's a red
(51:06):
flag.
No no, so you can.
Yeah, and that's the thing.
I think that someone said thatto me once before.
But what if you know it's this?
I'm like, well, that's whenyou're not reassuring.
Yeah, if a person has, likebowel bladder dysfunction and
you know saddle anesthesia andthey've had a low back injury,
you know that's a red flag.
Nadine (51:24):
Yeah.
Eric (51:24):
I'm pretty sure they say you're gonna be okay, don't
worry about it.
You know it's not that.
Yeah, it's not that, it's notfor every situation, but I would
say 90 was the data, it's like96, 97% of all MSK.
Things are kind of benignanyway.
It's very rarely to somethingserious.
So more often than not, if it'ssomething serious, you're
(51:47):
probably gonna know.
If it's not, you can reassurethem and give them a nice boo,
boo kiss.
Nadine (51:52):
Yeah.
Eric (51:55):
I love.
That's great.
Well, thanks, aileen, for beinghere.
It was really fun.
I really enjoyed thisconversation and we'll you know
we have some other.
I'm sure we have lots of otherthings you could talk about, but
maybe we'll get you back onagain in the future and we can
maybe see how this standard ofpractice thing played out and
have a Absolutely.
Another revisit thatconversation.
(52:15):
So did you want to provide yourcontact information for anybody
if they wanna have anyquestions for you?
Nadine (52:24):
I'm wondering.
Yeah, I was asking myself thatquestion before, but I think
probably LinkedIn's actually thebest way to get me right now to
search for my name, which wouldbe in this show notes, and
connect with me that way.
Eric (52:36):
Perfect LinkedIn.
Okay, nadine.
Well, thanks very much forbeing here and have a good day,
and we'll talk soon.
Nadine (52:41):
Thank you so much.
Eric (52:43):
Thank you for listening.
If you enjoyed this episode,please give it a five star
rating and share it on socialmedia.
You can follow me on Instagramor Facebook at EricPervisRMT,
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, have a greatday and thanks for listening.
Hello and welcome to another episode of Purves Versus
.
My name is Eric Purves.
I'm a massage therapist coursecreator, continuing education
provider, curriculum advisor andadvocate for evidence-based
massage therapy.
In this episode, we welcomeNadine Harlech, who is an RMT in
Courtney, bc.
She tells us about her journeyinto academia and the valuable
education and insight she gainedwhile completing her master's
(00:29):
degree in applied science.
The focus of our conversationis on the new CMTBC's new
standard of practice, onevidence-based practice and how
we think this could potentiallyshape the profession in BC.
If you enjoyed this episode,please rate it and share it on
all your favorite social mediaplatforms.
Purpose Versus can also befound on YouTube, so please
check us out there and subscribe.
So thanks for being here and Ihope you enjoy this episode.
(00:52):
Welcome to another episode ofPurves Versus.
Today we have Nadine Hawryluk,and she just told me how to
pronounce her name, so hopefullyI got that right.
She lives in Courtney and I'mexcited to have you here.
We're going to talk about ohmany things, but we're going to
talk a little bit about kind ofthe focus is going to be on
evidence-based practice and kindof what that means for the
(01:12):
professional massage therapy,and we did talk offline about,
kind of, some of the ten tenetsof evidence-based practice.
So it's going to be fun andexciting for us to break this
down a little bit.
But before we get started, justtell everyone a little bit more
about you.
Who is Nadine?
Nadine (01:29):
Oh, that's a big question.
Well, professionally, I've beenan RMT since 2017, but before
that I was working in spas andsort of other sort of practices,
being a body worker since 2011,when I graduated from a Shiatsu
program at Langara College manymoons ago, and currently I'm
(01:51):
running a product practice inCourtney here and Courtney's
awesome.
Personally, I love the outdoors.
I ski, paddleboard, that kindof thing and if I can get out to
a trivia night and host amurder mystery party, that's my
jam too.
Eric (02:08):
What kind of trivia do you ?
Like.
Nadine (02:10):
Oh well, I mean I do best with like science-y stuff.
Eric (02:14):
Usually I'm that person at the table, so I love trivial
pursuit and I love like justrandom stupid trivia.
My brain seems to not rememberimportant things like what I
need to do from day to day, butI can remember useless facts
from you know, an 80s TV show orsomething.
It's ridiculous.
Nadine (02:36):
Yeah, it's good fun though.
Eric (02:38):
I love trivia.
I always in my younger days weused to do a lot of like music,
bingo, trivia.
I don't know if that'ssomething you ever were into.
Nadine (02:49):
Oh, music for some reason doesn't stick.
Yeah, oh okay.
Yeah.
Eric (02:55):
My previous life I was heavily involved in music, so
for me it's something that Ilove.
So, yeah, so I don't think Iknew that you were involved in
like I didn't realize that youdid like body work before you
became a massage therapist.
What was the reason for goingfrom an unlicensed body worker
to getting your licenses and RMT?
Nadine (03:18):
I had worked in some big spot well, one big spot in
Whistler and I think it wasreally just recognizing like it
was a bit of a slog beingunregulated, getting enough
hours, getting enough work andyou know, just seeing RMTs were
booked solid and I needed tolive.
So that was a big push.
(03:39):
And I think I also noticed whenI was working with people like
they'd be asking me questionsand I didn't really know how to
answer them properly.
So it was kind of I was justready to sort of grow in that
profession and learn more andbecome more of an expert in that
realm.
Eric (03:59):
So did you go back to Langara then to do your RMT
degree or your RMT.
Nadine (04:04):
No, I moved out to Victoria for WCCMT.
Eric (04:08):
Okay, see, I'm learning all kinds of things.
I didn't realize that.
Okay, so you went to WCCMT here.
That's why I went to school aswell, but I think well, well
before you.
So when I mean we've connectedbefore, because I think you've
taken some courses of mine andwe've chatted kind of just for
email over the last few years,but you recently completed your
master's degree, is that correct?
Tell, tell everyone a littlebit more about that experience
(04:32):
and kind of what you learned orwhat you focused on learning on.
Nadine (04:36):
Yeah, so I in August actually wrapped up my master's
in clinical science at WesternUniversity, which is an awesome
program.
It was online If anyone's sortof interested in looking at
programs, that might fit in wellwith working full time.
It was an awesome program andit it sort of focused on sort of
(05:01):
becoming a leader in healthcareand I definitely chose the
leadership focus.
So we really like thefoundation of that program was
one evidence based care,learning how to appraise
research and critical thinking.
Everyone had to take a criticalthinking course as well.
So, and then beyond that, Ichose the leadership stream and
(05:26):
got into program evaluation andimplementation science, which
was really interesting.
I didn't realize that was abranch of science that's sort of
a newer field and I think it'ssuper applicable of being like
you know how do we get newpractices into into healthcare
(05:47):
and what makes them catch on,and you know what the barriers
are there.
Eric (05:52):
So that sounds really fascinating.
It sounds.
It sounds something that'scould be hopefully appealing to
RMTs, because as far as I know,there's only really two programs
that you could do, likedistance wise for massage
therapy, and get a master'sdegree and something that is
could keep you still within theprofession.
Nadine (06:14):
Right.
Eric (06:15):
And once the the program I did at UBC, the rehab science,
and I think there's alsoMcMaster has a rehab science, I
think there's.
I think they actually are thesame program, just different
universities.
And then you were at Westernwith the applied science and I
think Western has quite a fewdifferent options within that
Cause.
I've done some mentoring, aclinical mentoring, with
(06:37):
students who are RMTs throughWestern, but they weren't doing
the applied science, I don't, orthey were, but they were doing
maybe something else.
I'm not sure what the otherprogram is there and I'm just
kind of spinning words outwithout making any sense right
now.
Nadine (06:50):
Yeah, they've got a few different options and I know
Susan Shepton did her programthere and that was really
focused on pain, multi sort ofall the approaches to pain.
Eric (07:04):
Yeah, that's what it was.
Nadine (07:05):
Yeah, and so it's.
This one is like a similarbranch, but off, so there's just
so many options.
If you're depending what you'rereally interested in there's,
there's an option for you Nice.
Eric (07:16):
Yeah.
So, susan, I remember it was afew years ago when she did that
and she, yeah, it was the multi,multi-disciplinary pain
management, I think, was kind ofthe focus, which was seemed
like a really cool program aswell.
So I think it's great becauseyou know what you and I
obviously are going to come fromthe same probably a lot of the
same beliefs about the ways toadvance the profession and to
(07:37):
become more recognized or moreaccepted within kind of the
academic fields, to advance thepractices and the researches.
We need more people withgraduate level education, and
what's nice is that there issome of these other options
available for you.
The only problem, though, Ithink that a lot of people run
(07:57):
into is you have to have abachelor's degree first.
Nadine (08:00):
And you had a bachelor's first, I'm assuming.
Yes, yeah, yeah, an undergradin zoology, right yeah?
Eric (08:08):
Yeah, so that's the thing too.
Is is that's the one thingthat's unfortunate about our
profession is because it is justa diploma.
If you wanted to go and do moreadvanced education, you
basically have to you'd have togo back and do an undergrad and
then go into it, so it's notavailable.
It's not something that's on anoption for everyone and it's
obviously something that not alot of people don't want.
But over the years I do, I havenoticed that there's a lot more
(08:30):
RMTs getting master's degreesnow than there was when I
started practicing almost 20years ago.
So that's encouraging.
Fingers crossed.
Hopefully that keeps going.
Nadine (08:40):
Yeah, yeah.
It seems like you know, aftersome time you've been in the
field and there's something thatsays, hey, maybe I want to grow
and learn some new stuff.
So I see more people beingcurious about getting there.
Maybe they're undergrad at TRU,which is an easier way to go
about that.
So yeah, hopefully people justkeep growing.
Eric (08:59):
Yeah, so what are your thoughts about having a like a
Bachelor's of Science orBachelor's of Health Science
degree as kind of like the entrylevel point for massage therapy
?
That's something that you'refor or against?
Nadine (09:18):
I've thought a lot about that.
I'm not sure I think where Iwould settle with it would be
like a two-year associatesdegree Would be maybe the more
appropriate way to go and likestill getting a really good
foundation.
I've like to see morephysiology, like getting into
(09:41):
second-year level physiology tobe included in our program.
But to make it, you know,accessible is like yeah, you can
do two years of study and thenstart working, but maybe then
you can sort of work your way up, similar to social work.
Eric (09:59):
That's a good actually yeah, that's a great idea.
Yeah, yeah, I'm not.
I've not thought of it that way.
I've always thought of it aslike an all-or-nothing, like
keep it as diploma or get yourdegree.
But having that a two-year kindof associate degree would be
kind of a bridge.
That would be very possible.
Those credits would be in auniversity or a college.
(10:23):
That would be transferable, alot more recognized than the
current system with the privatepractices or the private school.
So, yeah, I like that idea alot.
I think that the yeah, because alot of people are just gonna
I'm gonna go to school two years, I want to work, and then you
know you.
How do you know it?
Say, you go to school whenyou're in your early 20s.
(10:43):
How are you gonna know what youwant to do in your 30s and 40s?
And maybe you're not gonna wantto be a full-time massage
therapist working with clientsand maybe you want to do other
things.
That would give you anopportunity to try and expand
and do other stuff and I thinkthat's a fantastic idea.
I guess the key with that wouldbe we'd have to get things out
of the control of the privateschools.
Nadine (11:07):
Yeah, and I don't know anything about sort of the
motivations.
Yeah, I don't know either.
Eric (11:14):
That's the topic for another conversation.
Nadine (11:15):
I think yeah, absolutely yeah for sure.
Eric (11:17):
Yeah, digress here a little bit, but I like what you
said, though too.
You mentioned second yearphysiology or more physiology.
I have my thoughts on why Ithink that's important.
What are your thoughts on?
What would that provide?
Massage therapists.
Nadine (11:32):
I think it gives you a little bit more context for
critical thinking.
Honestly, like when I'm justout in the world and I hear
claims about health, I have abackground that makes me go.
That doesn't sound right orlike, based on what I know about
how the human body functions,like that doesn't seem like it's
(11:54):
possible and maybe just givesyou a little bit more context
about how things work.
I think.
Eric (12:05):
Yeah, I would feel the same way too.
I feel that in our massageeducation we learn so much
anatomy and physiology andpeople.
You know it's a lot ofinformation and it's very
detailed, but I feel that thestuff that's detailed and it's
stuff that doesn't really matter.
You spend a lot of timelearning like attachment points
between little, tiny musclesthat have no relevance to
(12:27):
anything.
You learn about all the systemsof the body in like learning
about cellular respiration stuffand these things, which is, I
think, is really cool, but youdon't really learn.
You kind of learn at least myexperience and when I talked to
others, you learn thisinformation.
Then you you're like either,like it's okay, it's great, it's
(12:48):
information, it's interesting,and you never think about, you,
never use it, it's notapplicable.
But then you learn a lot ofstuff and then you're taught
well, this is, this is how youcan fix these things with your
techniques.
And I feel that there's athere's a gap there and that
knowledge between what'sactually happening
physiologically when we put ourhands on people.
(13:09):
You don't really learn.
Like you look, you do, but it'snot.
There's no science, there's noevidence to support a lot of
that stuff.
So I agree that if you actuallyunderstood, had a good level of
, you know, not graduate level,but a second or third-year level
university understanding ofanatomy and physiology and what,
how the body works, more a stepabove what we learn in the SARS
(13:29):
school.
A lot of those health claims orkind of mess, mechanistic
claims or things that peoplelike to talk about, a massage
just wouldn't make sense.
You're like, that doesn't makesense.
I can't increase yourcirculation by massaging your
skin, because we understand howthe venous and the circulatory
system and the allostaticallostasis and all these things
(13:52):
you know balance everything outand blah, blah, blah.
We understand how the kidneysand the liver and all the stuff
works.
At a different level that stuffwouldn't make sense and you
would.
Just it wouldn't even be anissue.
Nadine (14:01):
Yeah, yeah, yeah, although yeah, and I think like,
in addition to sort of thatphysical aspect, we really need
to understand how peoplefunction and how they feel and
like how they interact withpeople.
Like there's that whole side ofthings too, and and I think
that, because that would debunka lot of the like oh, we can do
(14:22):
so much with our hands is likerecognizing how much else
affects people, you know, beyondthat.
Eric (14:32):
Yeah, and that's one thing too that is not commonly
addressed in a lot of oureducation, whether it's in
school or in other CE courses,is it's very focused on
technique, technique, technique.
Right, I was just spent themorning kind of going through a
lot of social media stuff andjust reading some things is for
my own interest, to see what arepeople talking about.
And it's all about whattechniques should I learn or
(14:54):
what's the best technique to dothis, and everyone's talking
about techniques, not talkingabout you know, how do I help
this person who's suffering with, I don't know, severe
osteoarthritis of the neck?
It's like what techniques can Iuse to help this person with a
neck?
I'm like, well, should you notunderstand about, like, maybe,
some of the, the processesinvolved and the experiences
involved?
And, and maybe it's more, maybeyou should just take your folks
(15:17):
away from your hands and likehow can you support and work
with the human in front of you?
That's gonna be more valuable.
But we don't.
That's not something we reallylearn, and I think when we have
those conversations a little,what I feel is a lot of times
when we talk about how wecommunicate and how we interact
with people and and the wholeclinical encounter.
It sometimes think people thinkwe're working out of scope of
(15:38):
practice.
Oh well, you're counseling them, you know?
No, we're just working onmechanics.
I'm like, no, you're workingwith a human mm-hmm, and that's
something that definitely needsto be better understood and we
probably it sounds like we're onthe same page of that.
Stuff should be entry level topractice, at least in the basic
fundamental concepts well, yeah,it's well we're working with
(15:59):
human beings, like and we don'thave.
Nadine (16:03):
I think we talked about active listening in passing for
five to ten minutes in mytraining and we didn't even do
any practice exercises like it'slike, here are the concepts of
active listening.
It's like, no, we're workingwith people.
How do we not focus on on thatmore?
And and I get that it maybe itfeels really nebulous, maybe,
(16:27):
and and the ones taken on thatchallenge to be like, okay,
let's break it down, let's makea framework for what that looks
like.
Instead, it's just this bigopen gap that no one knows what
to do with the thing.
Eric (16:42):
Yeah, maybe your implementation science training
could help with some of thatstuff.
Nadine (16:51):
Yeah, that would be an interesting approach to take.
Eric (16:55):
Yeah, what did you focus on in that aspect of your
education?
Nadine (16:59):
So that was just really learning about breaking down
implementation science into it'slike understanding what it is.
For one thing, it's a verystructured approach to problem
solving and it's looking at.
So you have a situation, youunderstand what the current
approach to a treatment or apolicy or a policy or something
(17:20):
like that, and then you go, okay, well, there's a better way to
do it.
Maybe it's more cost effective,maybe it just has better
outcomes Like there's somebenefit to it, and you go, okay,
why isn't it being adopted?
And so you want to identifywhat the barriers are, what are
the things that can helpimplement it, and then come up
(17:41):
with a plan to deal with thosebarriers.
And then, of course, a hugefactor in it is monitoring and
evaluation after.
It's like how well did this go?
Like, did our plan work?
That sort of thing, yeah.
Eric (17:58):
Yeah, that's a good point that you make there, because I
feel that a lot of times there'sno policies or things that are
put out there or implemented butthere's not that evaluation of
like.
Did it have the desired effect?
Yeah, and that's good.
I mean, part of what I did whenI was doing my master's degree
was we did stuff on like, like alot of folks with a knowledge
(18:18):
translation.
So you know, how do we, whatare some of the best strategies
and ideas to translate knowledgeinto practice?
But the last part of that wasyou couldn't just give people
knowledge, you had to see if itwas actually working, is it
actually changing their practice?
But that's the stuff that wedon't as clinicians, and even in
(18:40):
our like kind of CE world, youdon't really know if it's
actually making a difference,right, because you have to ask
for an evaluation afterwards.
So that's a really importantthing, which I'm glad that you
were able to do.
That.
It sounds really fascinating.
Yeah, but before I digress toomuch, what do you think?
So you did your master's degreeFantastic, congratulations.
(19:03):
I think that's great.
And add your name to the listof growing, a growing number of
RMTs with higher level education.
I think that's fantastic, butwhat was your rationale for it?
What did you want to do with it?
How do you think it's going toimpact, what were your plans for
that?
To how it was going to impactyour future.
Nadine (19:21):
I wish I had like a really clear answer for you on
that one.
But I was just curious.
I was looking for moreinformation, I was looking to
grow.
That was sort of my sense and Iwas like what does my future
look like?
Do I want to move into more adecision making role, policy
role, something like that?
But what I came out after theprogram, I just recognized how
(19:44):
much more confidence I had inlike looking at information and
synthesizing ideas and feelinglike, oh, I do have something to
say about this.
And it made me recognize too Ithink what's so important about
education is that you realizelike the more that you know, the
more you realize you don't know.
(20:04):
And I think that is soimportant even in our profession
, to just have people maybe be alittle bit more humble with
information and be more carefulwith it.
So I'm not sure where it'sgoing to go yet.
I think things are stillpercolating, but I feel like I
(20:24):
just have the confidence to goforward.
Eric (20:27):
And that's huge.
Yeah, I'm the confidence tofeel it, feeling it, feeling
better about that.
Do you feel that it changedyour practice at all, like how
you treat or work with patientsevery day?
Nadine (20:42):
Good question.
I think what I have noticedrecently is like really wanting
to empower people, like I wantthem to have the information too
, without overwhelming them andI have to watch that too.
It's like when is itappropriate to?
But yeah, like I want people tofeel like they understand their
(21:09):
bodies better and even ifthey're not working with me, so
that they can make betterdecisions.
I actually sent the webinar youdid for the renal foundation.
Eric (21:25):
Oh, yeah, yeah.
The kidney foundation inAtlanta, canada, yeah.
Nadine (21:29):
Because I thought that was such a great little
concisital thing of like.
Here's what manual therapy does.
Eric (21:34):
Oh, good, thank you.
Nadine (21:35):
And I want people to be like, oh okay, well then, how
does that translate into whatother kinds of care that I would
get?
You know so more informed, moreempowered.
Eric (21:46):
Yeah, yeah.
And I was like, the reason Iasked is because when I was
doing my degree, that was aquestion I got all the time from
people what difference is itgoing to make?
Are you going to charge more?
I was like, well, no, I'm incharge of the same as whatever
Everyone else in the clinic andthe region is charging.
Well, then, why would you do it?
And I felt that for me, when Iwent and did my master's degree,
(22:08):
it was probably I'm not goingto say probably it was
definitely the best professionaldecision I ever made.
I felt that so, clinically, Ifelt more, like you said, more
confident, more comfortable,like I felt, like I had I was
definitely gave me anunderstanding that I didn't,
like you said, I didn't know alot, but I knew what I didn't
(22:29):
know and I knew what I didn'tknow.
So it gave me that sense ofhumility, of like, yeah, that's
a good question, but I'm goingto help find you the answers.
Yeah, you know, that kind ofattitude was.
It was definitely.
I definitely got from that andit was.
I felt more comfortable too inmaking suggestions to people or
(22:49):
having those conversations withpeople when they were like, well
, what should I do.
What's the bet?
What, like you know, this isn'tworking.
This isn't working.
You know what are my optionsand it gave me and, because of
what I was studying, it gave mea lot of.
I'm like, well, here's somepapers, here's some things I've
read.
You know, here's kind of someof the least wrong, maybe
potential solutions ormanagement strategies for you.
(23:12):
So I felt like, yeah, theknowledge helped didn't really
change much with what I did withmy hands, but it definitely
changed a lot with how Iinteracted with, with my
patients.
I felt, and then also too, formy CE aspect, my CE business.
It was hugely beneficial forthat because I got basically got
to spend three years justreading papers and researching
(23:34):
all the stuff that I wanted to,and then I could use that to
build, inform the content forthe courses.
It was great and if anyone'slistening and they feel that is
it going to make a difference.
You don't really know until youtry.
You know, and it's opened up somany doors for me, like so many
doors of different things Inever even thought of doing.
(23:54):
You know, working with, withcurriculum development at
schools and working withcolleges and associations, and
you know being able to presentat conferences and, and you know
, speaking at universities andthings that never would have
been an opportunity before, butthat you have that piece of
paper where it says you did thework.
So therefore, it opens up a fewmore doors for you.
So I think it's it's somethingthat is really worth exploring.
(24:16):
If anyone's into it, it'slistening.
Nadine (24:19):
Yeah for sure, and I think even being a confident
voice in someone's life who ismaybe experiencing pain or
recovering from injury too, andbeing just being able to say,
yeah, you're going to be okayand let me help, support you,
find the best way for youforward, Thank you.
I think it's just such a greatinfluence, rather than maybe
(24:44):
someone's like okay, well, weneed to solve the problem this
way and this way and this waywho might be a little less
confident in understanding howall of that works.
Eric (24:55):
That's a thing that is a big shift in thinking, I feel,
for our profession.
Not just us, but any MSKprofession is moving.
That shift from I got to focusto fix and try all these things
to how can I best support you onyour journey.
That's not typical conversationthat we see a lot of.
We see more of it now than 10years ago, but it's still a long
(25:18):
ways to go because often,patients or clients come to see
us and they expect us to fixthem.
I see there's a lot of dangerthough and I saw this all the
time in the chronic painpopulation that I treated.
Anybody, but particularly thatpopulation, is when you've had a
number of therapists trying toconvince you or to sell you a
(25:40):
wellness plan or like this iswhat you need to do.
You go and you spend months oryears in some cases, and
thousands of dollars with yourown money or insurance company's
money trying to fix the problem, and then they end up just the
same or worse, because the focuswas on the problem, not how can
we support the person.
(26:01):
That subtle shift, I find, ismassive because it takes the
pressure off you trying to fixand it creates this more
relationship between you and theother person where you're there
to support them and help themmake decisions, and your massage
is part of it, but it's not thefix.
One thing I always say topeople is that the danger when
(26:26):
you make big promises to clientsor patients is that if you
don't live up to it, then whatare they left with?
They're left finding somebodyelse who's going to make big
promises and they keep onchasing and chasing and chasing
and you get on this healthcareprofessional wheel.
They just keep spinning whereyou see all these people and
(26:46):
you're going nowhere.
Nadine (26:48):
Yeah, I would say that's analogous to and I experienced
this early on in my career tooof looking for the next
technique.
I can thinking, oh, otherpeople are helping people better
than me, what's the nexttechnique I need to learn?
Then you end up on that hamsterwheel trying to find the right
thing to do just on the otherside of the table.
Eric (27:13):
Sure, I did that too early in my career, for sure.
I think I've said this probablynumerous times.
So people probably who listento this podcast regularly are
like yeah, eric, you keeprepeating yourself.
But I'll say it again.
It took me longer than I'd liketo admit to realize that I was
mistaken.
Like I was wrong because I gotheavily involved in structural
(27:36):
integration and myofascial stuffbecause it appealed to me and
I'd had those kind of treatmentsand they helped for me.
Of course I need to learn howto be as amazing as everybody
else.
Then it took too long but Irealized after quite a few years
.
I was like this doesn't makeany sense anymore.
Nadine (27:55):
Yeah.
Eric (27:56):
I wish I could have noticed that earlier but we get
hyped up on those things andit's attractive because of big
promises.
Nadine (28:04):
Yeah, when you're not learning anything different,
then what are you supposed to do?
I remember in our programsomeone brought up the point
okay, well, if we're givingpeople home care and saying this
is what you need to do andthey're not doing it, what do we
do?
The advice came back.
Well, all you can do is justkeep telling them over and over
(28:26):
and over until it clicks.
Or maybe you think this mightnot be appropriate for this
person.
They're like what's anotheroption?
I think that's a new thinkingthat I'm so glad to see is
coming forward.
But on the other side of that,I have seen it swing the other
(28:49):
way, where it's like well, it'sno longer my responsibility to
fix you, it's all on you.
Yeah, if you're not going to dothe work, then you're not going
to get better.
So I'm like let's come back tothe middle here.
Eric (29:03):
Yeah, that pendulum swings pretty far both directions.
Yeah, when I was in school too,I remember learning that what
you said about you got to justkeep telling them, you know if
they're going to get better,they got to do their stretches,
they got to do their exercises.
Now I look back and I laugh andI think the amount of rehab
stuff that we got educated, butit was terrible.
(29:25):
It was all very passivestretching and just very linear
strength training.
It was so ridiculous and it waslike do this many sets, this
many reps, repeat this?
It was so poor and I think alot of places they still do that
and yeah, and then now you seethe shift where, like, well,
(29:47):
it's up to you, I can't fix you,so you got to take care of
yourself.
No, it's supportedself-management, which means you
help the person find thingsthey can do on their own.
And I know we have theseconversations that can seem kind
of vague, kind of gray, likewe're talking about.
But clinical practice is gray.
There's not a lot of answers,there's this lot of kind of less
(30:09):
wrong ideas that you can kindof play with.
Nadine (30:11):
Yeah, yeah, yeah.
And how do you get that?
Really, I think switching tothe idea of function is like
what's going to make thisperson's life enjoyable,
worthwhile, like functional, andif that's the question you ask,
rather than oh, how do we getrid of this person's pain, then
(30:32):
it would totally shift how weapproach people 100% it would.
Eric (30:37):
Yeah because how pain.
How often can you just say, oh,I'm going to get rid of all
your pain?
Yeah, If someone's been in painfor a long time, maybe you can
turn the volume down a littlebit on their pain experience,
but you're not going to get ridof it.
Yeah, and everyone's probablyhas a case where someone's been
in pain for 10 years and you didsomething and then they got
(30:57):
better, Right, and you're like Ifixed them.
But that's like one in 1 in1,000.
Yeah, it's not good odds, butwe always remember that one.
We always remember that oneperson who had pain forever and
we did this one thing and theygot better.
Nadine (31:14):
Yeah.
Eric (31:15):
That's not the majority.
Nadine (31:16):
Yeah, no, life is painful.
There's no way around that.
Yeah.
Eric (31:19):
But function is key, because I think in MSK world and
in our massage therapy world wecan help people with function,
hopefully more so than we could.
I should say hopefully.
But we have a better claim ofhelping people with function
than we do of reducing theirpain significantly.
(31:40):
We can modulate pain for ashort period of time during and
after massage, but long term theevidence is not good.
Nadine (31:50):
Yeah.
Eric (31:50):
Yeah, it's a very short term, but function is something,
yeah, and we see that all thetime too, if you look at and
we're just going to segue intoour next conversation about
evidence-based practice but wesee that a lot in evidence-based
practice stuff is that gettingpeople to function better is a
(32:12):
more reasonable and moresupported goal, and all the
clinical practice guidelines arefocusing more on function
rather than just 100% painrelief, because pain modulation,
pain control, not painelimination, and the goal is
always function.
Nadine (32:28):
Yeah, yeah, always in service of getting back to
things that you love.
Yeah, yeah.
Eric (32:34):
Yeah, for sure.
So, as we kind of move intotheir little conversations here
on evidence-based practice, Ijust wanted to ask your opinion
on what do you think some of thebiggest issues are that our
profession is facing today, andlet's put that within the realm
of evidence-based practice.
Nadine (32:55):
Yeah, I think, given the new standard that just came out
, I think a big challenge isgoing to be that transition.
What does that look like?
How are we going to havedifferent conversations?
How we yeah, how we movethrough?
(33:20):
This transition is going to bea big challenge, I think, for a
lot of people, but I thinkthere's so many opportunities
for people such as yourself toprovide resources and support
and information in a reallysupportive way to help us move
(33:40):
forward.
Eric (33:42):
Yeah, yeah, that's a good point because there's many
issues facing our profession inBC the college amalgamation with
the other.
What are they calling it?
Complimentary or integrativehealth?
Nadine (33:56):
No, I forget, I forget.
Eric (33:59):
I know a lot of us want to be in the Allied Health one,
but the Allied Health College isall basically university degree
colleges or university degreeprofessions, and then the one
that we're in, which I can'tremember what it's called, is
all basically just like tradeschool, like private school kind
of stuff, right?
So it's naturopaths, massagechiropractors.
(34:21):
Chinese medicine, acupuncture,yeah, so those ones are all in
that college, so that'll beinteresting to see how that goes
.
I don't know if it's a bigissue, but I know personally I'm
not too concerned about it.
I don't there's nothing we canreally do about it, but I think
a lot of people in ourprofession do are like freaked
out about it and I think it's abit of a slap in the face, I
think, for those of us that arekind of evidence-based or
science-based in our thinking.
(34:43):
It's kind of like oh, now we'regoing into these other
professions which maybe we don'tidentify with.
Nadine (34:51):
But I think there's movement in those other
professions too, similar to us,where there's, like some sets of
people who are pushing for amore evidence-based approach.
So maybe we could all sort ofwork together in that direction.
Eric (35:03):
Yeah, and that would be a great solution, because we can
talk about problems I want, butsolutions, I think, are the key
thing and I talked about in aprevious podcast episode that I
released, about just like someof the options for solutions.
Right, and there is options outthere depending on what it is
you're looking for, but yeah,there is.
I know a handful ofchiropractors that are.
(35:24):
You know they don't like thedirection that their profession
has gone, but you know, withlike the kind of before, you
know a lot of chiropros weredoing the x-rays to you know,
pathologize your spine and thenselling you a series of
treatments, and you know, I know, that stuff's been kind of
taken away and there's a hugepushback on that.
So there is definitely anevidence-based contingent to all
(35:47):
the professions, but this mightbe an opportunity for them to
get together, hopefully and pushfor better.
So, fingers crossed right.
Nadine (35:56):
Yeah, that would be.
Another big issue, though, is Ithink we kind of need to.
You know, identity is a big onefor us, and I'm sure that's
been mentioned before on yourpodcast.
But I've even noticed it's likewhen we were talking about the
name of the new college and likehow people want to be
considered, be it complimentaryor integrative, or you know,
(36:20):
it's like trying to figure outhow we relate to the healthcare
system.
Are we something separate orare we a compliment?
Are we a support?
I think that's a big thing thatwe'll work on as we move
forward.
Eric (36:36):
I think from the conversations I've had with a
lot of RMT is that they wouldlove to be part of a full
healthcare system, kind of likehow physiotherapists are or
occupational therapists are, oreven opportunity to work in a
hospital or an outpatient care,or you could work in private
practice, like there's moreoptions, and I know a lot of
massage therapists would likethat and I think it would be
(36:56):
fantastic if our professioncould get to that point.
But I think we're saying in thebeginning of this podcast,
without that entry leveleducation being higher, without
having a degree, it's justprobably not going to happen
just in terms of how we areperceived by the public and how
(37:17):
we are perceived by thehealthcare world.
And to be honest, you know,when we look on a lot of the
nonsense that's out there, a lotof the pseudoscience that is
really common in our profession,that really holds us back
Because it's not helping.
(37:37):
And so hopefully, with this newevidence-based practice
standard which we're going totalk about here, hopefully
that'll kind of help to push usin the right direction.
Where there won't be, it won'tbe tolerated anymore by our
regulator, and it's that youcan't say and do things that are
not evidence-based, and this isa thing too, I guess we should
(38:00):
say.
Just some people I know, and Ilike the term science-based
because it talks more aboutbiological plausibility, but I
think, in terms of where thecollege is going with this, I
think evidence-based is a goodstart.
So I think that just wanted toput that in there.
For those who are like I, likescience-based.
I like science-based too, butlet's go with a term that's been
(38:21):
used for a long time, soevidence-based, but the and it'd
be interesting to see how thisif this has any teeth, though
like, can they do anything?
Like, are they going toactually say no, like you can't
have those things on yourwebsite?
Oh, we've had these complaintsfrom the public whether you've
been saying or doing thesethings, and that's actually not
(38:41):
evidence-based.
It's your responsibility tounderstand what evidence is for
what you are treating.
And also, too, I'm hoping and Idon't, this is a big hope too is
I'm hoping that it will reallyinfluence the type of continuing
education or quality assurancethat massage therapists pursue.
So that way, they're going tohave to say, okay, well, if I
want to take this course, isthis evidence-based?
(39:04):
And what does that mean?
And that's the question is, youcould take anything, but is it
going to satisfy therequirements of the college to
take I don't want to throw anynames out there, but to take a
course that is notevidence-based.
And then the problem is, Ithink that we're going to have
those, I think we're going tohave instructor but like, oh,
(39:26):
it's evidence-based, and thenthey'll throw down a couple
studies and they'll be, and youlook at the studies and they're
probably totally irrelevant toother crap science.
Nadine (39:34):
Yeah.
Eric (39:35):
So there's going to definitely that's going to be a
bit of a learning process, but Ihope that the CMT will be able
to have some teeth and sayinglook, that's not okay, this is
how we have to improve.
So we're going to have to havesome good quality resources and
maybe some audits or something'sgoing to have to happen to see
how that all plays out.
Nadine (39:57):
Yeah, and that's the thing is like.
Policy is one thing, and thenhaving the support to implement
it successfully will be the bigthing there.
Eric (40:09):
So what are your thoughts on the new standard?
Nadine (40:14):
I wish we had like a little celebratory party, but I
think it's a pretty big dealhonestly.
Yeah, me too.
But I think it's great and Ithink there were some statements
in the actual verbiage of itthat were really I think they
took a really strong stancehonestly about like thinking
(40:36):
about how what you say toclients, like how is that going
to affect them, and it's likethis is really important stuff
to consider.
So I think it's great.
I'm really interested to seewhere it goes.
Eric (40:51):
Yeah, it's so too fresh it takes it starts.
It'll already in place by thetime this podcast is live, but
as of today, it hasn't actuallytaken effect.
It takes effect on January 15th, so a few days from now.
So, yeah, it'll be interestingto see what actually happens.
But I agree, I think we shouldhave had some kind of party
because I think, compared to theonly other place I think that
(41:13):
has an evidence in theirStandards is in Ontario.
But they have that, theyusually have it.
It's informed and it's quitewatered down and it's Not nearly
the same, it's not nearlystrongly worded as BC.
So we should really commend the, the college and people there
that put this through yeah.
(41:33):
Yeah, did you want to?
So let's, let's talk about yourkind of ten tenants of
evidence-based practice, becausewe had a conversation, I don't
know, a month or two ago and andyou would come up with this.
I thought this was such a greatidea.
Did you want to go through andkind of list off those, those
ten?
Sure, this is as a learningopportunity for people that are
(41:55):
listening, just to see.
Nadine (41:58):
Yeah, I mean in context too, it was.
I like when I'm thinking aboutconcepts and I'm trying to sort
of solidify them for myself.
I love frameworks, you know.
I just started scribbling downI'm like what would be kind of
like the essential things youneed to focus on if you want to
(42:19):
grow your evidence-basedpractice, and so I just started
Do lightning things down andthis is what I came up with.
So if other people have ideasor things they want to add, yeah
, let me know.
Or add them to your own littlereflective piece.
But I'm hoping this could be atool for people to sit down and
think, oh, these are littleareas that I can improve upon or
(42:42):
be interested in.
So let's just go top to bottomhere.
So I've broken it up into threesections and it's kind of those
three stool legs is it in theevidence-based practice Model of
?
So I've broken it up into onelike how you relate to
information, how you relate topatience and how you're relating
(43:07):
to yourself, and so we'll startat number one, which is develop
the skills to search for andevaluate reliable information.
And then I've put little subpoints under of do not make
assumptions, ask questions.
Number two is stay up to datewith current pain science,
(43:28):
health research and bestpractices.
Three is do not spreadmisinformation, and I've put
under that, evaluate claims andsources carefully before sharing
and know the dangers and harmsof false narratives.
Number four is be aware ofvarious resources available for
(43:49):
patients in your community andonline.
And Then, if we move into therelating to patients piece, it's
.
Five is know your role.
So who are you to this patient?
And I've there's, um, there's abook out there it was four
physios, but I've pulled outsome of the titles that I
(44:10):
Thought were kind of great ofbeing a confident, being a coach
, a detective, a teacher, butnot a healer.
So we're a support person, nota fixer.
And then, under that Be is knowthe mechanisms of action for
massage, along with realisticgoals and outcomes.
Number six is know your limits,so knowing how to identify red
(44:36):
flags and referring on is Underthat, and being comfortable
saying I don't know, okay.
Moving on to seven, bepatient-centered, so learn how
to determine, support thepatient's values, beliefs, goals
and preferences.
Number eight is pay attentionto your communication, so learn
(45:00):
how and when to sharepotentially helpful information
in a supportive way.
And be know the effects oflanguage and other communication
on the therapeutic relationship, that person's pain and
disability experience, and thenwhen we're thinking about how we
relate to ourselves.
Nine is develop regularreflective practices.
(45:21):
So a is understand yourmotivations, your biases,
strengths and areas of growth.
Be be curious about youremotional experience in the
process of transference andcounter transference.
See, get support when you needit and regularly discuss cases
with colleagues.
And then, finally, number ten,commit to constant improvement.
(45:43):
You know, continue to learnabout pain, rehab, healthcare,
disease processes, communicationyourself, research, literacy
and appraisal.
So those are my ten rules.
I love it.
Eric (45:59):
I love it, I think it that's, that's such a great, a
great way to kind of put thatall together and it's you know,
these are things that are, youknow, we should all be able to
do.
And then and you could read,it's like oh my gosh, ten things
, but it's, these are notimpossible.
No, and they all interplay aswell.
Nadine (46:15):
Yeah there's so much overlap between them, right,
which is evidence-based practiceas well.
Eric (46:18):
There's an overlap between you know what's the relevant
research evidence say, versusyour clinical expertise, versus
the person in the context of theenvironment, and and they all
kind of overlap together.
And so this is this is this isfantastic, so maybe I will.
In the show notes I will put acopy of this.
Yeah with with your name on it,so so people can can have a
(46:42):
look at that.
I think it's really useful.
Nadine (46:46):
Yeah, because I just think it's so important, when
we're moving forward withsomething, to have Tools to fill
that gap of like well, what doI do?
Well, here are the things youcan work on.
Eric (46:57):
And when I read this to this kind of goes into another
conversation we've had beforeand we can wrap up the the
podcast with with this littleconversation is is the idea of
of patient safety and then andmaking the person feel safe.
(47:18):
Because when we look at how thisevidence-based practice stuff
is, you know, if we look atunderstanding pain science and
we look to Not spreadingmisinformation, we look at our
role about being more of a coachor a coach or a coach or a
coach or a coach or a detectiveand not a healer.
You know, knowing how do I,knowing the science and the
knowledge, but how to identifyred flags, saying I don't know a
(47:41):
lot of the stuff you can putinto this idea of like just Of
safety, of making the personfeel less threatened, less
broken.
Yeah, and I know that in somethe idea of safety is some
(48:03):
people don't necessarily agreewith that and we're not talking
about pain science or painexplaining.
We're not talking aboutneuroscience education where
you're like I'm gonna tell youeverything that you need to know
about pain to make you feelsafe so you're not feeling
threatened by what's happeningin your body.
We're not talking about thatkind of safety because that is
that's an idea, is popular and Iused to teach more of that.
(48:26):
Now I think I try and do abetter job of putting that pain
science stuff into properclinical context.
So you're not just painexplaining.
But I think if we, if we Istill strongly believe and when
I look at the evidence and welook at come to your comments
here if our goal is just to makethe person in front of us feel
(48:47):
good, can our touch feel good,can our clinical environment
feel good, can our words feelencouraging?
It's not just being like, oh,I'm so nice, it's not like over
the top, but it's justeverything we do is how can we
support you, how we make youfeel like this is a good place
to be.
Nadine (49:05):
Yeah, yeah, and a little metaphor that I sort of after
thinking about these things andwhat it is that people really
need from us and I always thinklike we're really adults or just
bigger kids and, at the end ofthe day, like this is gonna
sound a bit reductive, but in away like we're professional boo
(49:27):
boo kissers right, it's like.
I love that.
How do you be the best possibleboo boo kisser that you can be?
How do you cause?
You know, someone hurtsthemselves, like come and they
say I have an awi, and you say,oh, you're gonna be okay, so
reassurance, right, and then youprovide some sort of care,
(49:47):
touch that's gonna support thatperson.
So how do you create anenvironment that's super
supportive, super safe andyou're gonna create that
resilience and that empowermentfor that person?
And you're not saying, oh, I'mgonna do some magic to it and
like fix you.
You're just saying like, is it?
(50:08):
Do you need some informationright now?
What do you need to feel likeyou can go forward confidently?
Eric (50:15):
I love that Professional boo boo kissers.
Nadine (50:18):
Yeah.
Eric (50:19):
A lot of people probably very offended by that, but it's
okay.
Nadine (50:21):
Oh, I guarantee.
Eric (50:23):
I love that, though, and it's okay, cause I think we
should be able to laugh at kindof what we do, but that's so
true.
And you use the termreassurance, which is important,
because if we look at theclinical practice guidelines for
pretty much any MSK condition,it's like reassurance is usually
the first thing.
Nadine (50:41):
Yeah, and that creates safety.
Eric (50:42):
You're gonna be able to, and that creates safety.
Nadine (50:44):
Yeah, yeah.
Eric (50:46):
Yeah, it's usually reassurance, education and then
usually some type of dependingon what it is some type of touch
or movement within comfort andtolerance, like.
It's usually pretty basic andyou can apply those principles
to pretty much any MSK condition.
You'd see, obviously you don'twanna reassure when it's a red
(51:06):
flag.
No no, so you can.
Yeah, and that's the thing.
I think that someone said thatto me once before.
But what if you know it's this?
I'm like, well, that's whenyou're not reassuring.
Yeah, if a person has, likebowel bladder dysfunction and
you know saddle anesthesia andthey've had a low back injury,
you know that's a red flag.
Nadine (51:24):
Yeah.
Eric (51:24):
I'm pretty sure they say you're gonna be okay, don't
worry about it.
You know it's not that.
Yeah, it's not that, it's notfor every situation, but I would
say 90 was the data, it's like96, 97% of all MSK.
Things are kind of benignanyway.
It's very rarely to somethingserious.
So more often than not, if it'ssomething serious, you're
(51:47):
probably gonna know.
If it's not, you can reassurethem and give them a nice boo,
boo kiss.
Nadine (51:52):
Yeah.
Eric (51:55):
I love.
That's great.
Well, thanks, aileen, for beinghere.
It was really fun.
I really enjoyed thisconversation and we'll you know
we have some other.
I'm sure we have lots of otherthings you could talk about, but
maybe we'll get you back onagain in the future and we can
maybe see how this standard ofpractice thing played out and
have a Absolutely.
Another revisit thatconversation.
(52:15):
So did you want to provide yourcontact information for anybody
if they wanna have anyquestions for you?
Nadine (52:24):
I'm wondering.
Yeah, I was asking myself thatquestion before, but I think
probably LinkedIn's actually thebest way to get me right now to
search for my name, which wouldbe in this show notes, and
connect with me that way.
Eric (52:36):
Perfect LinkedIn.
Okay, nadine.
Well, thanks very much forbeing here and have a good day,
and we'll talk soon.
Nadine (52:41):
Thank you so much.
Eric (52:43):
Thank you for listening.
If you enjoyed this episode,please give it a five star
rating and share it on socialmedia.
You can follow me on Instagramor Facebook at EricPervisRMT,
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, have a greatday and thanks for listening.
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