March 27, 2025 • 31 mins
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Eric (00:08):
Hello and welcome to the Massage Science Podcast.
My name is Eric Purves.
I'm an RMT course creator,continuing education provider
and advocate for evidence-basedmassage therapy.
So thank you for being here andI hope you enjoy this episode.
So thank you for being here andI hope you enjoy this episode.
I realized that it has been fourmonths since I last released a
(00:31):
new podcast.
I was doing really well withthese for a while and for a
couple years there I had abacklog of them.
I was trying to release oneevery couple months, but life
just got away from me and Irealized that I was not
prioritizing these, and I reallyenjoy doing these.
I have probably about half adozen that were or are recorded
(00:54):
and they're sitting on my harddrive.
But when I went back andlistened to them, some of them
were good, some of them werejust not.
I didn't like them.
I didn't like the way theyflowed.
I didn't like the way I was'tlike the way they flowed.
I didn't like the way I wascommunicating stuff.
Here's a new one and Ihopefully that this one will
resonate with some of you Nowthat I have rebranded the
(01:16):
website and my podcast.
For those that are unaware, mynew website is thecebecom.
So I've rebranded myself from apersonal brand, which was Eric
Purvis, to a more of a businessthat is focused on continuing
education and continuingeducation topics.
(01:39):
It's not just me, so I'mstarting to try to bring in
other people to teach relevantcontent and to kind of expand
the offerings to other areas andand other topics and courses
that are really really importantfor those of us in the massage,
the manual therapy, themusculoskeletal healthcare world
(02:03):
.
But people that are teachingtopics that are not my area of.
I don't know enough.
I don't want to say expertisebecause we're not experts.
We're just all trying to beless wrong every day with the
things we do.
So I hopefully will have somemore of those people and their
courses coming on board for youin the near future.
(02:24):
So that was why I decided to dothe rebrand from me to a center
for evidence-based education.
Can we actually use the wordevidence-based in massage
therapy?
A lot of people prefer the termevidence-informed and we've had
discussions about this beforeon this podcast, whether it's
with myself or with others,about this before on this
(02:45):
podcast, whether it's withmyself or with others, and I
don't want to beat that topicagain and again and again.
But the stuff that I want totalk about is things that are
evidence-based, so things thatstand up to scrutiny from
research, but also incorporateour own expertise and
(03:07):
experiences.
And obviously, what's the mostimportant thing is the person
that's in front of us.
So what's the patient, theclient, the person who's coming
to seek your care and supportEvidence-based for some people
think it just needs to be arandomized, controlled trial or
systematic reviews, and I'mgoing to say that when we're
talking about evidence-basedcare, we're talking more about
(03:32):
the knowledge that you bring,your understandings of what's
happening.
Humans are not able to, we'renot able to apply like a linear.
I'm going to do this thing toyou and you're going to get this
outcome.
It's not.
We don't have these causalcause and effect relationships
when we are treating somebody.
(03:53):
It just doesn't work that way.
I wish it did, because thenlife would be a lot easier, but
things are more complex thanthat.
So we're talking aboutevidence-based.
We're not talking about fixingit.
We're not talking about youknow, I'm going to do this
technique or this interventionto you and you're going to get
this predictable outcome.
What we're talking about, we'retalking about evidence of the
(04:14):
knowledge, and over the last fewmonths, I've really been
thinking about this a lot moreabout the evidence for what it
is that we do and how do we usethat information into something
that speaks to everybody,because I feel that oftentimes,
(04:34):
when we are talking aboutevidence, some people feel it's
very dismissive.
You know the idea that, oh,there's no evidence for that.
I'm going to say say that, yes,in a lot of cases, it can be
dismissive if the evidence orthe claims that somebody is
making are not based on reality.
(04:55):
But the evidence that we talkabout should be based on our
current understanding of howanatomy and physiology works,
how touch impacts people, howthe clinical encounter impacts
people.
That's where the evidence,that's where the knowledge base
should come from, more so thanthe techniques, and this is
(05:20):
something I've been trying tochange and incorporate a lot
into the things that I've beendoing, which is one reason why I
haven't had a podcast in awhile.
I've just been my brain and mytime my bandwidth has been all
over the place lately, trying toget all the stuff working
(05:41):
together and trying to justfigure out what's the direction
I want to go with what I do.
Since the start of 2025, I'vebeen busy doing a bunch of other
projects, creating some newcourses.
(06:01):
I did a TMJ webinar, which wasmy most attended webinar I've
ever had, which was wonderful.
So thank you for all of youthat came to that and supported
that.
I'm also doing a longer TMJ andheadache course.
I'm doing one of those inKelowna in the end of September
and that's already sold out.
So thank you for again, foreverybody that wants to learn
from me.
I don't think I've ever had acourse sell out six months in
(06:22):
advance.
So this topic of this TMJ stuffseems to be something people
really want to know more about,and what I've been trying to do
when I've been creating thesecourses is going back to the
evidence.
What is it that we can do thatis ethical, is based on best
(06:45):
practices and can involve avariety of different approaches?
And that's what we find whenwe're looking at the evidence is
that it creates this gray areaof uncertainty because we don't
really have all of the answers.
Uncertainty because we don'treally have all of the answers
(07:12):
and this is something I'm tryingto incorporate into more and
more and more of my content isthe idea that we don't have all
of the answers.
And then we're talking aboutevidence.
That actually gives us lessanswers per se, but it gives us
the flexibility to think bigger,and that's the biggest
difference that we need to takefrom the evidence.
How many times can I sayevidence in one podcast?
(07:35):
I don't know.
But speaking of that, you know,I've also realized that when we
talk about evidence-basedpractice, there's a
misunderstanding of it, which Iknow I already said.
So what I've decided to do is Ido have a webinar coming up
this year, which is a webinar.
It's an evidence-based practicewebinar, so it's about the
information and how do we think,how do we reflect, how do we
(07:57):
understand and interpret thisinformation?
I feel that's an area that's apain point for a lot of people.
They just don't.
It becomes confusing and I'vetried to take this approach of
you know, comforting or allowingpeople to be okay with that
uncertainty without having allof the answers, and to try to
(08:17):
simplify what it is that we aredoing.
You know some of the questionsI get and I had this from
somebody who attended the TMJwebinar who was asking me all
these very biomechanicalquestions, these very you know,
what about this, what about that, what about this muscle, what
about that muscle, what aboutthe joint and what about this
presentation?
And I really feel that we'vespent so much time over
(08:44):
complicating things and I don'tthink that does that works in
the best interest of ourpatients, because we over
complicate things and we try tosell a solution.
Question we need to ask is whathappens if that solution
doesn't work?
What are they left with?
(09:07):
If we tell them that they'vegot this lateral deviation their
jaw swings from one side to theother, or they've got jaw pain
and we try to fix it and wecan't, and maybe there is some
type of structural reason forthem, what if someone has
ongoing neck pain and we tellthem it's their posture, and we
(09:28):
tell them they have to sit up inthis perfectly aligned posture
and that is supposed to be thefix for their neck and their
headaches and that doesn't work,then what are they left with?
This is why we have to be soaware of the evidence out there,
because it doesn't give usthese one-size-fits-all
solutions.
(09:48):
It gives us ideas that arehopefully less wrong and gives
us room to explore, gives usroom to be curious, to try to do
our best to help people.
I think in a lot of my contentI've had before I've probably
been very dismissive or comeacross as being more dismissive
than I really wanted to orreally intended to.
But sometimes when we'retalking about things, there's
(10:16):
just so much out there that isjust so incorrect and so full of
belief-based systems ratherthan reality that sometimes I do
get a little bit excited aboutit in a negative way, and I just
, you know, I say things thatmaybe come across as a little
bit more firm than they probablyshould.
And I'm not going to go backand change what I said, but I
will moving forward and what I'mtrying to do is create more
(10:40):
room for questioning and forgrowth and for realizing what
the good that we are doing, butalso hopefully changing how we
think, and by changing how wethink we might impact how we do.
And if we can do differently,then maybe we can work in a
(11:01):
little bit more of anevidence-based way where our
communication, our thoughtprocesses, the philosophy of why
we're doing what we're doingmight shift a bit and hopefully
what that will do is that willallow us to provide better
quality care, more ethical care,care that hopefully meets the
(11:24):
needs and expectations better ofthe person that's in front of
us.
So for the last four monthsthere's a bit of a ramble there
Some of the things that I'vebeen doing.
I've been trying to refocus andkind of repurpose some of the
content I have into making it abit more of this, less, maybe,
less certain and more talkingabout the working within the
(11:51):
gray.
So, anyway, it's a lot of work,but I'm hoping that it's going
to come across in the futurewebinars that I have and courses
that I have this year.
The thing that really inspiredme, though, about doing this
podcast here today was I hadseen so much recently, so much
(12:12):
recently, online about peopleselling their courses.
I spend a lot of time on socialmedia.
I don't really engage as muchas I used to, but I do post more
.
More often than not, I'mposting about, you know, the
things that I'm doing.
Every now and again I'll engagein some conversations, but I
try to.
I'm trying to.
I spend more time kind ofreading and seeing what's going
(12:33):
on out there and in theprofession and seeing how, what
people are talking about andwhat kind of things are trending
, and the one thing I see allthe time is the talk about
evidence-based techniques.
So what is an evidence-basedtechnique?
Kind of drives me a bit crazy,because there is actually no
such thing as an evidence-basedtechnique.
(12:54):
It sounds like, when people aretalking about that, to
advertise their courses or toask questions about what
techniques should I do for this?
What techniques have the mostevidence for working on somebody
with low back pain, and this isfaulty thinking.
This is thinking that needs toreally be questioned, because
(13:17):
there is no such thing as anevidence-based technique or an
evidence-based intervention perse, specifically in manual
therapy.
Obviously, if we are talkingabout medicine, there is
evidence-based interventionsthat you can do where there is a
specific problem and you get anintervention and it gives you a
predictable solution.
(13:38):
You break your arm, you go forsurgery, or they reset it, they
do surgery, they cast it andit's going to heal.
That would be an evidence-basedintervention.
This is how you fix a brokenlimb or diabetes.
You know diabetes, for example,you take insulin If it's a type
1 diabetic, for example.
(13:59):
That would be an evidence-basedintervention to fix a specific
problem.
But in the musculoskeletalworld we don't have that.
We don't have that specificlinear cause and effect idea,
unfortunately.
Like I said before, I wish wedid, because it sure would make
life a lot easier, but peoplewill say that They'll say, oh, I
(14:20):
haven't come, take my course,it's full of evidence.
You know, we teachevidence-based interventions,
and when I read that I think, no, you're, you're missing
something, you're.
I understand what you're tryingto do, because you're trying to
say like we're teaching stuffthat works and and, but that
doesn't mean that theintervention itself is
evidence-based.
Because what we need tounderstand and I've probably
(14:42):
said this before in this podcast, if not, I know I've said it in
others is that we need tounderstand that all of the
interventions that we do when welook at kind of the research
about the science of touch andwhat happens when we put our
hands on people, what happenswhen we massage people, what
happens when someone gets ajoint mobilization or a high
velocity thrust if you're say inchiropractic or physical
(15:05):
therapy world the interventionsthemselves all work via similar
or identical mechanisms.
And so I made a post about this.
I had one thought one morning,having my coffee, thinking about
the world, and I had thesethoughts and then, you know, I
(15:25):
kind of wrote some of them downand then later on that day,
after kind of reflecting on them, I made a post on my Facebook
page, my Eric Purvis RMTFacebook page, and it blew up in
a good way.
There were some greatconversations, there were some
great comments.
It was shared a bunch of times.
It was liked 115 times and Ihad lots of messages sent from
(15:48):
people afterwards and I wasreally, really happy to see it
kind of people wanting to.
They like the message or theyor they had questions about it,
comments about it.
And I'm just going to read toyou what the post was and for
those that aren't on socialmedia, that way you can have an
idea of what I was thinking andI wrote.
(16:15):
I've never seen anything inmassage or manual therapy
research discussed aboutevidence-based techniques.
I'm very certain these don'texist.
Yet I see people mentioningthis all the time on their
websites and, in course,advertising.
What makes one techniqueevidence-based and another one
not?
All techniques probably workvia similar mechanisms.
Logically, it makes sense thatall hands-on approaches are
(16:37):
doing the same thing, becauseit's impossible to bias one
tissue over the other, despitewidespread beliefs to the
contrary.
We can't make claims about howone technique is better without
plausible explanations.
The evidence base is in theknowledge and the reasoning, in
how to interact, assess andtreatment plan with your
(16:57):
patients.
As a profession, I think wewould be much further in our
professional growth and see morerecognition as healthcare
providers if we could agree thattouch can feel great.
There's a wide variety ofstyles and approaches and none
is superior to the other.
The goal is to help people feelbetter, get them back to their
(17:20):
activities and increase qualityof life.
Spending time arguing aboutwhat techniques work best and
chasing different ideologiesfeels like an unhelpful use of
time.
I can relate because I spent alot of years doing that, gaining
a better understanding ofdifferent conditions, clinical
(17:43):
presentations and thecomplexities of the pain.
Experience shifted my focusaway from fixing tissues and
towards working with the personin front of me.
That was my post.
I had a lot of great commentsand a lot of great, great things
.
I'm not going to read.
Read through all of these thatwere here and if you want to go
(18:05):
to my Facebook page and readthem, please do.
But but this was really.
It felt good to put that outthere and to get a positive
response from people.
Now, obviously, when you putsomething on your social media
page and people that like it orshare it or comment on it are
probably people that they'rebiased, right.
They follow you for a reasonfriends or their followers for a
(18:30):
reason, and that's somethingthat we need to be very mindful
of too, when we are having thesekinds of conversations about
how we practice, whatinterventions we like to do,
what populations we like to workwith, because we will often
find ourselves in an echochamber, in the silo, where we
hear what we want to hear, andwe're all guilty of that, and
(18:53):
we're human.
That's just what happens.
But the key thing, though, thatI feel we need to do, moving
forward as a profession, is weneed to start having
conversations with those thatthink differently than us, so we
can look to see more about whatwe have in common rather than
our differences, because when westart to identify an us versus
(19:17):
them mentality, you see exactlywhat's happening, what happens
in the world right now, withthese political divisions that
are happening not just in the USand in Canada, but across the
world, where people identify anus versus them and they see the
(19:37):
other person is wrong or theother person is bad.
What I think is more helpful isthat, if we're talking about
evidence-based interventionswhich evidence-based techniques
which I said we don't existdon't exist, but we do know that
, regardless of what backgroundyou come or what your favorite
intervention technique modalityis, that you're helping people,
(19:58):
otherwise you'd probably notexist making a living.
So maybe the framework thatyou're working under is based on
incomplete science, based onpseudoscience.
Maybe it is based on reality,but rather than saying hey, but
rather than saying hey, you'rewrong, you're an idiot.
(20:21):
Why don't we look and see whatthe similarities are?
And the similarities are thatyou're providing touch, you're
(20:45):
providing probably some movement, some support, some guidance, a
safe place for them to be, andthey're feeling better.
And maybe, and just maybe, ithas little to nothing to do with
the specificity or thespecifics of your technique.
Maybe you could do any othertype of technique, maybe you
could do the same one and thinkabout it differently or
communicate with it differently,and maybe the person would feel
just as good.
(21:07):
One thing I've been going on andon about for over a decade now
is, you know, a lot of the mythbusting, because there's so many
myths in this profession thatseem to be getting worse.
I know I've I've called out thestakeholders in the schools
before for saying why do youguys keep teaching this stuff
when there's no evidence for it?
(21:28):
And they and the the theresponses I'll often get is they
don't listen to the messagethey.
They hear that I'm criticizing.
Therefore they're like we'renot gonna talk to you.
Oh no, we don't.
You know you're, you're, uh,you're not supportive, you know
you're, you're against us.
I'm thinking I'm not against you, I'm just trying to say we all
(21:48):
have a duty, we all have anethical obligation to to learn
and to change and to adapt.
And so if I ask somebody andsay well, you know why, why do
you say that your technique isthe best?
Why do you say that you know?
(22:09):
Why are you still teachingpseudoscience in your, in your
program?
Why is the accreditation agentsuh, company agency association
I can't remember what they'recalled cmtca, which is important
.
I think an organization likethat needs to to exist to
accredit schools.
But I wonder, well, why arethey accrediting programs that
(22:32):
are full of the?
Where the?
The curriculum is is full of alot of make-believe science and
belief-based things.
It doesn't mean that they'rebad.
It doesn't mean that whatthey're doing isn't.
It doesn't mean what they'redoing is wrong per se.
But I just like to have theseconversations, I like to ask
these questions because I reallywant people in the profession
to think more about the role inadvancing this profession and I
(22:58):
strongly believe that as long aswe keep with these belief-based
ideas and these, these ideasabout technique specificity and
one technique being better thanthe other, and all these
different frameworks of thinkingabout how our one technique
works on fascia and how anothertechnique works on joints and
(23:23):
how another technique works onmuscles and how another
technique works on the nervoussystem, and you think they all
work on all the things, youcan't just say that one
technique works on one systemand that's evidence-based.
Another technique works on viaanother another system.
It doesn't work that way.
(23:43):
They work on all the thingsbecause this touch, you're
putting your hands on the skinand you're pushing, pulling,
twisting and there's going to beimpacts on all the tissues and
functions that through throughthat touch.
So I really feel that we arespending a lot of time in school
and in continuing educationfocusing on the wrong things.
(24:05):
Yes, we need to know, we needto learn a variety of different
ways of styles of touch so thatway you can be comfortable
working in different regions ofthe body.
Try different things that workbest for you and for the people
that come to see you.
That's fantastic.
(24:25):
Maybe sometimes you're doingkind of Swedish flowing
techniques, because those justfeel amazing.
Maybe sometimes you're doingkind of a slower, slower
stretching into the tissue.
Maybe sometimes you're doingmore slow holes.
Maybe sometimes you're doingmore poking, more like point
(24:48):
specific stuff.
Maybe sometimes you do morebroad stuff.
Maybe sometimes you're doingsome contract relax, some
movements, some active orassisted stretching.
There's a variety of differentways that you can work with
somebody and I think it'simportant for us in school and
in the continuing educationworld to do all those things, to
try all those things to see, sowe become comfortable in it and
(25:09):
see what works with someone andwhat might not work.
And we all develop our own style.
We all develop our own approachthat is unique to us, and
oftentimes what we do is we justtake a blend of a bunch of the
different things that we'velearned over our careers and
turn it into our own approach,and I think that's great.
(25:30):
But let's stop focusing onlearning and collecting all
these different techniques andthese modality empires and let's
start having conversationsabout what is similar.
How can we take theseapproaches and not focus on
(25:52):
evidence-based techniques andfocus more of our energy on
learning about understanding thecomplexity of pain,
understanding how to be betterat communicating, understanding,
being better at treatmentplanning, at assessing, at
really getting a betterunderstanding of clinical
presentations and what's it meanif somebody presents with
(26:15):
shoulder pain and it's they havetrouble abducting, you know,
past, say, 45 degrees andthey've got pain and they are of
a certain age and they whateverwe could just go on and on
about you know differentpresentations and and understand
(26:35):
, like, the risk factors and andthe presentations for for
something, so that way we couldsay we could have a better
understanding of what like, say,a rotator cuff problem versus a
frozen shoulder potential.
Or we're looking at back pain.
Is this more of a disc or is ita radiculopathy pain?
(27:00):
Is this more of a disc or is ita radiculopathy?
Is it just a we don't know likea non-specific back thing?
Do we need to often try tosearch and find the thing that
is causing it?
Because we know we can't.
But maybe what we should do is,rather than searching for these
quick fixes and providing thisevidence-based technique, we
(27:21):
could learn to say, hey, let'srecognize the pain that this
person is in, let's recognizetheir functional limitations and
let's try a variety ofdifferent things with our hands
and with movement and withsupport and with guidance to try
to help that person to feelbetter, with support and with
(27:41):
guidance to try to help thatperson to feel better.
It's a shift, I think, in how weneed to think as a profession,
how the MSK professionsaltogether need to think.
But I'm quite comfortable insaying, in using the evidence
(28:04):
that's out there.
So, looking at, you know, allthe research evidence that's out
there, both quantitative andqualitative, as well as kind of,
you know, hypothetical,theoretical, as well as 20 years
of clinical experience, which Ihave now and having worked with
I don't know how many patientsin my career thousands maybe to
(28:25):
say that the approach that Iadvocate for is definitely less
wrong than the status quoapproach.
Way of thinking we need tochange.
I think, when we look at howwe're putting curriculums,
(28:48):
education together and licensingnew therapists, I think that we
aren't doing as best as wecould.
Some places are, some placesare not.
So this is not sayingeveryone's doing terrible.
This is not an all or nothingthing.
I think the continuing educationworld would be better served by
(29:10):
focusing more on working withspecific populations or areas of
interest rather than justtrying to teach techniques.
That's something that was mymain reason why I put my course
creators group which I do everyyear I've been three years now
with that and it's gone reallywell is to try to help people to
(29:34):
put course content togetherthat is different from the
status quo, that focuses on thethings that matter most, not
learning another thing.
So, in summary, what we do as aprofession is great, has huge
value, but it can still bebetter and the things that we
(29:57):
focus on so often in our socialmedia conversations and the
courses that are out there, Ifeel are not always focusing on
the things that matter most,which is critical thinking or
understanding and knowledge ofthe evidence about specific
regions or patient presentations, and focusing on working with
(30:19):
the uncertainty about what worksand what doesn't work, because
we don't know.
There is no one-size-fits-alltreatment, there is no
one-size-fits-all painmanagement.
It's whatever works best forthe person in front of you that
(30:42):
day, that time, and what worksone day for that person might
not work for them the next, andthat's okay.
That evidence-based practiceteaches us to be flexible.
The techniques we do, they allwork via the same way.
As far as we know, none isbetter than the other, but they
(31:06):
all help.
Let's have those conversationsmoving forward rather than us
versus them.
Let's focus on the similaritiesand how can we work together
rather than pushing each otheraway.
So thanks for listening.
I hope you enjoyed this episodeand I will try and get another
(31:28):
one out within the next fourmonths.
Have a good day.
Hello and welcome to the Massage Science Podcast.
My name is Eric Purves.
I'm an RMT course creator,continuing education provider
and advocate for evidence-basedmassage therapy.
So thank you for being here andI hope you enjoy this episode.
So thank you for being here andI hope you enjoy this episode.
I realized that it has been fourmonths since I last released a
(00:31):
new podcast.
I was doing really well withthese for a while and for a
couple years there I had abacklog of them.
I was trying to release oneevery couple months, but life
just got away from me and Irealized that I was not
prioritizing these, and I reallyenjoy doing these.
I have probably about half adozen that were or are recorded
(00:54):
and they're sitting on my harddrive.
But when I went back andlistened to them, some of them
were good, some of them werejust not.
I didn't like them.
I didn't like the way theyflowed.
I didn't like the way I was'tlike the way they flowed.
I didn't like the way I wascommunicating stuff.
Here's a new one and Ihopefully that this one will
resonate with some of you Nowthat I have rebranded the
(01:16):
website and my podcast.
For those that are unaware, mynew website is thecebecom.
So I've rebranded myself from apersonal brand, which was Eric
Purvis, to a more of a businessthat is focused on continuing
education and continuingeducation topics.
(01:39):
It's not just me, so I'mstarting to try to bring in
other people to teach relevantcontent and to kind of expand
the offerings to other areas andand other topics and courses
that are really really importantfor those of us in the massage,
the manual therapy, themusculoskeletal healthcare world
(02:03):
.
But people that are teachingtopics that are not my area of.
I don't know enough.
I don't want to say expertisebecause we're not experts.
We're just all trying to beless wrong every day with the
things we do.
So I hopefully will have somemore of those people and their
courses coming on board for youin the near future.
(02:24):
So that was why I decided to dothe rebrand from me to a center
for evidence-based education.
Can we actually use the wordevidence-based in massage
therapy?
A lot of people prefer the termevidence-informed and we've had
discussions about this beforeon this podcast, whether it's
with myself or with others,about this before on this
(02:45):
podcast, whether it's withmyself or with others, and I
don't want to beat that topicagain and again and again.
But the stuff that I want totalk about is things that are
evidence-based, so things thatstand up to scrutiny from
research, but also incorporateour own expertise and
(03:07):
experiences.
And obviously, what's the mostimportant thing is the person
that's in front of us.
So what's the patient, theclient, the person who's coming
to seek your care and supportEvidence-based for some people
think it just needs to be arandomized, controlled trial or
systematic reviews, and I'mgoing to say that when we're
talking about evidence-basedcare, we're talking more about
(03:32):
the knowledge that you bring,your understandings of what's
happening.
Humans are not able to, we'renot able to apply like a linear.
I'm going to do this thing toyou and you're going to get this
outcome.
It's not.
We don't have these causalcause and effect relationships
when we are treating somebody.
(03:53):
It just doesn't work that way.
I wish it did, because thenlife would be a lot easier, but
things are more complex thanthat.
So we're talking aboutevidence-based.
We're not talking about fixingit.
We're not talking about youknow, I'm going to do this
technique or this interventionto you and you're going to get
this predictable outcome.
What we're talking about, we'retalking about evidence of the
(04:14):
knowledge, and over the last fewmonths, I've really been
thinking about this a lot moreabout the evidence for what it
is that we do and how do we usethat information into something
that speaks to everybody,because I feel that oftentimes,
(04:34):
when we are talking aboutevidence, some people feel it's
very dismissive.
You know the idea that, oh,there's no evidence for that.
I'm going to say say that, yes,in a lot of cases, it can be
dismissive if the evidence orthe claims that somebody is
making are not based on reality.
(04:55):
But the evidence that we talkabout should be based on our
current understanding of howanatomy and physiology works,
how touch impacts people, howthe clinical encounter impacts
people.
That's where the evidence,that's where the knowledge base
should come from, more so thanthe techniques, and this is
(05:20):
something I've been trying tochange and incorporate a lot
into the things that I've beendoing, which is one reason why I
haven't had a podcast in awhile.
I've just been my brain and mytime my bandwidth has been all
over the place lately, trying toget all the stuff working
(05:41):
together and trying to justfigure out what's the direction
I want to go with what I do.
Since the start of 2025, I'vebeen busy doing a bunch of other
projects, creating some newcourses.
(06:01):
I did a TMJ webinar, which wasmy most attended webinar I've
ever had, which was wonderful.
So thank you for all of youthat came to that and supported
that.
I'm also doing a longer TMJ andheadache course.
I'm doing one of those inKelowna in the end of September
and that's already sold out.
So thank you for again, foreverybody that wants to learn
from me.
I don't think I've ever had acourse sell out six months in
(06:22):
advance.
So this topic of this TMJ stuffseems to be something people
really want to know more about,and what I've been trying to do
when I've been creating thesecourses is going back to the
evidence.
What is it that we can do thatis ethical, is based on best
(06:45):
practices and can involve avariety of different approaches?
And that's what we find whenwe're looking at the evidence is
that it creates this gray areaof uncertainty because we don't
really have all of the answers.
Uncertainty because we don'treally have all of the answers
(07:12):
and this is something I'm tryingto incorporate into more and
more and more of my content isthe idea that we don't have all
of the answers.
And then we're talking aboutevidence.
That actually gives us lessanswers per se, but it gives us
the flexibility to think bigger,and that's the biggest
difference that we need to takefrom the evidence.
How many times can I sayevidence in one podcast?
(07:35):
I don't know.
But speaking of that, you know,I've also realized that when we
talk about evidence-basedpractice, there's a
misunderstanding of it, which Iknow I already said.
So what I've decided to do is Ido have a webinar coming up
this year, which is a webinar.
It's an evidence-based practicewebinar, so it's about the
information and how do we think,how do we reflect, how do we
(07:57):
understand and interpret thisinformation?
I feel that's an area that's apain point for a lot of people.
They just don't.
It becomes confusing and I'vetried to take this approach of
you know, comforting or allowingpeople to be okay with that
uncertainty without having allof the answers, and to try to
(08:17):
simplify what it is that we aredoing.
You know some of the questionsI get and I had this from
somebody who attended the TMJwebinar who was asking me all
these very biomechanicalquestions, these very you know,
what about this, what about that, what about this muscle, what
about that muscle, what aboutthe joint and what about this
presentation?
And I really feel that we'vespent so much time over
(08:44):
complicating things and I don'tthink that does that works in
the best interest of ourpatients, because we over
complicate things and we try tosell a solution.
Question we need to ask is whathappens if that solution
doesn't work?
What are they left with?
(09:07):
If we tell them that they'vegot this lateral deviation their
jaw swings from one side to theother, or they've got jaw pain
and we try to fix it and wecan't, and maybe there is some
type of structural reason forthem, what if someone has
ongoing neck pain and we tellthem it's their posture, and we
(09:28):
tell them they have to sit up inthis perfectly aligned posture
and that is supposed to be thefix for their neck and their
headaches and that doesn't work,then what are they left with?
This is why we have to be soaware of the evidence out there,
because it doesn't give usthese one-size-fits-all
solutions.
(09:48):
It gives us ideas that arehopefully less wrong and gives
us room to explore, gives usroom to be curious, to try to do
our best to help people.
I think in a lot of my contentI've had before I've probably
been very dismissive or comeacross as being more dismissive
than I really wanted to orreally intended to.
But sometimes when we'retalking about things, there's
(10:16):
just so much out there that isjust so incorrect and so full of
belief-based systems ratherthan reality that sometimes I do
get a little bit excited aboutit in a negative way, and I just
, you know, I say things thatmaybe come across as a little
bit more firm than they probablyshould.
And I'm not going to go backand change what I said, but I
will moving forward and what I'mtrying to do is create more
(10:40):
room for questioning and forgrowth and for realizing what
the good that we are doing, butalso hopefully changing how we
think, and by changing how wethink we might impact how we do.
And if we can do differently,then maybe we can work in a
(11:01):
little bit more of anevidence-based way where our
communication, our thoughtprocesses, the philosophy of why
we're doing what we're doingmight shift a bit and hopefully
what that will do is that willallow us to provide better
quality care, more ethical care,care that hopefully meets the
(11:24):
needs and expectations better ofthe person that's in front of
us.
So for the last four monthsthere's a bit of a ramble there
Some of the things that I'vebeen doing.
I've been trying to refocus andkind of repurpose some of the
content I have into making it abit more of this, less, maybe,
less certain and more talkingabout the working within the
(11:51):
gray.
So, anyway, it's a lot of work,but I'm hoping that it's going
to come across in the futurewebinars that I have and courses
that I have this year.
The thing that really inspiredme, though, about doing this
podcast here today was I hadseen so much recently, so much
(12:12):
recently, online about peopleselling their courses.
I spend a lot of time on socialmedia.
I don't really engage as muchas I used to, but I do post more
.
More often than not, I'mposting about, you know, the
things that I'm doing.
Every now and again I'll engagein some conversations, but I
try to.
I'm trying to.
I spend more time kind ofreading and seeing what's going
(12:33):
on out there and in theprofession and seeing how, what
people are talking about andwhat kind of things are trending
, and the one thing I see allthe time is the talk about
evidence-based techniques.
So what is an evidence-basedtechnique?
Kind of drives me a bit crazy,because there is actually no
such thing as an evidence-basedtechnique.
(12:54):
It sounds like, when people aretalking about that, to
advertise their courses or toask questions about what
techniques should I do for this?
What techniques have the mostevidence for working on somebody
with low back pain, and this isfaulty thinking.
This is thinking that needs toreally be questioned, because
(13:17):
there is no such thing as anevidence-based technique or an
evidence-based intervention perse, specifically in manual
therapy.
Obviously, if we are talkingabout medicine, there is
evidence-based interventionsthat you can do where there is a
specific problem and you get anintervention and it gives you a
predictable solution.
(13:38):
You break your arm, you go forsurgery, or they reset it, they
do surgery, they cast it andit's going to heal.
That would be an evidence-basedintervention.
This is how you fix a brokenlimb or diabetes.
You know diabetes, for example,you take insulin If it's a type
1 diabetic, for example.
(13:59):
That would be an evidence-basedintervention to fix a specific
problem.
But in the musculoskeletalworld we don't have that.
We don't have that specificlinear cause and effect idea,
unfortunately.
Like I said before, I wish wedid, because it sure would make
life a lot easier, but peoplewill say that They'll say, oh, I
(14:20):
haven't come, take my course,it's full of evidence.
You know, we teachevidence-based interventions,
and when I read that I think, no, you're, you're missing
something, you're.
I understand what you're tryingto do, because you're trying to
say like we're teaching stuffthat works and and, but that
doesn't mean that theintervention itself is
evidence-based.
Because what we need tounderstand and I've probably
(14:42):
said this before in this podcast, if not, I know I've said it in
others is that we need tounderstand that all of the
interventions that we do when welook at kind of the research
about the science of touch andwhat happens when we put our
hands on people, what happenswhen we massage people, what
happens when someone gets ajoint mobilization or a high
velocity thrust if you're say inchiropractic or physical
(15:05):
therapy world the interventionsthemselves all work via similar
or identical mechanisms.
And so I made a post about this.
I had one thought one morning,having my coffee, thinking about
the world, and I had thesethoughts and then, you know, I
(15:25):
kind of wrote some of them downand then later on that day,
after kind of reflecting on them, I made a post on my Facebook
page, my Eric Purvis RMTFacebook page, and it blew up in
a good way.
There were some greatconversations, there were some
great comments.
It was shared a bunch of times.
It was liked 115 times and Ihad lots of messages sent from
(15:48):
people afterwards and I wasreally, really happy to see it
kind of people wanting to.
They like the message or theyor they had questions about it,
comments about it.
And I'm just going to read toyou what the post was and for
those that aren't on socialmedia, that way you can have an
idea of what I was thinking andI wrote.
(16:15):
I've never seen anything inmassage or manual therapy
research discussed aboutevidence-based techniques.
I'm very certain these don'texist.
Yet I see people mentioningthis all the time on their
websites and, in course,advertising.
What makes one techniqueevidence-based and another one
not?
All techniques probably workvia similar mechanisms.
Logically, it makes sense thatall hands-on approaches are
(16:37):
doing the same thing, becauseit's impossible to bias one
tissue over the other, despitewidespread beliefs to the
contrary.
We can't make claims about howone technique is better without
plausible explanations.
The evidence base is in theknowledge and the reasoning, in
how to interact, assess andtreatment plan with your
(16:57):
patients.
As a profession, I think wewould be much further in our
professional growth and see morerecognition as healthcare
providers if we could agree thattouch can feel great.
There's a wide variety ofstyles and approaches and none
is superior to the other.
The goal is to help people feelbetter, get them back to their
(17:20):
activities and increase qualityof life.
Spending time arguing aboutwhat techniques work best and
chasing different ideologiesfeels like an unhelpful use of
time.
I can relate because I spent alot of years doing that, gaining
a better understanding ofdifferent conditions, clinical
(17:43):
presentations and thecomplexities of the pain.
Experience shifted my focusaway from fixing tissues and
towards working with the personin front of me.
That was my post.
I had a lot of great commentsand a lot of great, great things
.
I'm not going to read.
Read through all of these thatwere here and if you want to go
(18:05):
to my Facebook page and readthem, please do.
But but this was really.
It felt good to put that outthere and to get a positive
response from people.
Now, obviously, when you putsomething on your social media
page and people that like it orshare it or comment on it are
probably people that they'rebiased, right.
They follow you for a reasonfriends or their followers for a
(18:30):
reason, and that's somethingthat we need to be very mindful
of too, when we are having thesekinds of conversations about
how we practice, whatinterventions we like to do,
what populations we like to workwith, because we will often
find ourselves in an echochamber, in the silo, where we
hear what we want to hear, andwe're all guilty of that, and
(18:53):
we're human.
That's just what happens.
But the key thing, though, thatI feel we need to do, moving
forward as a profession, is weneed to start having
conversations with those thatthink differently than us, so we
can look to see more about whatwe have in common rather than
our differences, because when westart to identify an us versus
(19:17):
them mentality, you see exactlywhat's happening, what happens
in the world right now, withthese political divisions that
are happening not just in the USand in Canada, but across the
world, where people identify anus versus them and they see the
(19:37):
other person is wrong or theother person is bad.
What I think is more helpful isthat, if we're talking about
evidence-based interventionswhich evidence-based techniques
which I said we don't existdon't exist, but we do know that
, regardless of what backgroundyou come or what your favorite
intervention technique modalityis, that you're helping people,
(19:58):
otherwise you'd probably notexist making a living.
So maybe the framework thatyou're working under is based on
incomplete science, based onpseudoscience.
Maybe it is based on reality,but rather than saying hey, but
rather than saying hey, you'rewrong, you're an idiot.
(20:21):
Why don't we look and see whatthe similarities are?
And the similarities are thatyou're providing touch, you're
(20:45):
providing probably some movement, some support, some guidance, a
safe place for them to be, andthey're feeling better.
And maybe, and just maybe, ithas little to nothing to do with
the specificity or thespecifics of your technique.
Maybe you could do any othertype of technique, maybe you
could do the same one and thinkabout it differently or
communicate with it differently,and maybe the person would feel
just as good.
(21:07):
One thing I've been going on andon about for over a decade now
is, you know, a lot of the mythbusting, because there's so many
myths in this profession thatseem to be getting worse.
I know I've I've called out thestakeholders in the schools
before for saying why do youguys keep teaching this stuff
when there's no evidence for it?
(21:28):
And they and the the theresponses I'll often get is they
don't listen to the messagethey.
They hear that I'm criticizing.
Therefore they're like we'renot gonna talk to you.
Oh no, we don't.
You know you're, you're, uh,you're not supportive, you know
you're, you're against us.
I'm thinking I'm not against you, I'm just trying to say we all
(21:48):
have a duty, we all have anethical obligation to to learn
and to change and to adapt.
And so if I ask somebody andsay well, you know why, why do
you say that your technique isthe best?
Why do you say that you know?
(22:09):
Why are you still teachingpseudoscience in your, in your
program?
Why is the accreditation agentsuh, company agency association
I can't remember what they'recalled cmtca, which is important
.
I think an organization likethat needs to to exist to
accredit schools.
But I wonder, well, why arethey accrediting programs that
(22:32):
are full of the?
Where the?
The curriculum is is full of alot of make-believe science and
belief-based things.
It doesn't mean that they'rebad.
It doesn't mean that whatthey're doing isn't.
It doesn't mean what they'redoing is wrong per se.
But I just like to have theseconversations, I like to ask
these questions because I reallywant people in the profession
to think more about the role inadvancing this profession and I
(22:58):
strongly believe that as long aswe keep with these belief-based
ideas and these, these ideasabout technique specificity and
one technique being better thanthe other, and all these
different frameworks of thinkingabout how our one technique
works on fascia and how anothertechnique works on joints and
(23:23):
how another technique works onmuscles and how another
technique works on the nervoussystem, and you think they all
work on all the things, youcan't just say that one
technique works on one systemand that's evidence-based.
Another technique works on viaanother another system.
It doesn't work that way.
(23:43):
They work on all the thingsbecause this touch, you're
putting your hands on the skinand you're pushing, pulling,
twisting and there's going to beimpacts on all the tissues and
functions that through throughthat touch.
So I really feel that we arespending a lot of time in school
and in continuing educationfocusing on the wrong things.
(24:05):
Yes, we need to know, we needto learn a variety of different
ways of styles of touch so thatway you can be comfortable
working in different regions ofthe body.
Try different things that workbest for you and for the people
that come to see you.
That's fantastic.
(24:25):
Maybe sometimes you're doingkind of Swedish flowing
techniques, because those justfeel amazing.
Maybe sometimes you're doingkind of a slower, slower
stretching into the tissue.
Maybe sometimes you're doingmore slow holes.
Maybe sometimes you're doingmore poking, more like point
(24:48):
specific stuff.
Maybe sometimes you do morebroad stuff.
Maybe sometimes you're doingsome contract relax, some
movements, some active orassisted stretching.
There's a variety of differentways that you can work with
somebody and I think it'simportant for us in school and
in the continuing educationworld to do all those things, to
try all those things to see, sowe become comfortable in it and
(25:09):
see what works with someone andwhat might not work.
And we all develop our own style.
We all develop our own approachthat is unique to us, and
oftentimes what we do is we justtake a blend of a bunch of the
different things that we'velearned over our careers and
turn it into our own approach,and I think that's great.
(25:30):
But let's stop focusing onlearning and collecting all
these different techniques andthese modality empires and let's
start having conversationsabout what is similar.
How can we take theseapproaches and not focus on
(25:52):
evidence-based techniques andfocus more of our energy on
learning about understanding thecomplexity of pain,
understanding how to be betterat communicating, understanding,
being better at treatmentplanning, at assessing, at
really getting a betterunderstanding of clinical
presentations and what's it meanif somebody presents with
(26:15):
shoulder pain and it's they havetrouble abducting, you know,
past, say, 45 degrees andthey've got pain and they are of
a certain age and they whateverwe could just go on and on
about you know differentpresentations and and understand
(26:35):
, like, the risk factors and andthe presentations for for
something, so that way we couldsay we could have a better
understanding of what like, say,a rotator cuff problem versus a
frozen shoulder potential.
Or we're looking at back pain.
Is this more of a disc or is ita radiculopathy pain?
(27:00):
Is this more of a disc or is ita radiculopathy?
Is it just a we don't know likea non-specific back thing?
Do we need to often try tosearch and find the thing that
is causing it?
Because we know we can't.
But maybe what we should do is,rather than searching for these
quick fixes and providing thisevidence-based technique, we
(27:21):
could learn to say, hey, let'srecognize the pain that this
person is in, let's recognizetheir functional limitations and
let's try a variety ofdifferent things with our hands
and with movement and withsupport and with guidance to try
to help that person to feelbetter, with support and with
(27:41):
guidance to try to help thatperson to feel better.
It's a shift, I think, in how weneed to think as a profession,
how the MSK professionsaltogether need to think.
But I'm quite comfortable insaying, in using the evidence
(28:04):
that's out there.
So, looking at, you know, allthe research evidence that's out
there, both quantitative andqualitative, as well as kind of,
you know, hypothetical,theoretical, as well as 20 years
of clinical experience, which Ihave now and having worked with
I don't know how many patientsin my career thousands maybe to
(28:25):
say that the approach that Iadvocate for is definitely less
wrong than the status quoapproach.
Way of thinking we need tochange.
I think, when we look at howwe're putting curriculums,
(28:48):
education together and licensingnew therapists, I think that we
aren't doing as best as wecould.
Some places are, some placesare not.
So this is not sayingeveryone's doing terrible.
This is not an all or nothingthing.
I think the continuing educationworld would be better served by
(29:10):
focusing more on working withspecific populations or areas of
interest rather than justtrying to teach techniques.
That's something that was mymain reason why I put my course
creators group which I do everyyear I've been three years now
with that and it's gone reallywell is to try to help people to
(29:34):
put course content togetherthat is different from the
status quo, that focuses on thethings that matter most, not
learning another thing.
So, in summary, what we do as aprofession is great, has huge
value, but it can still bebetter and the things that we
(29:57):
focus on so often in our socialmedia conversations and the
courses that are out there, Ifeel are not always focusing on
the things that matter most,which is critical thinking or
understanding and knowledge ofthe evidence about specific
regions or patient presentations, and focusing on working with
(30:19):
the uncertainty about what worksand what doesn't work, because
we don't know.
There is no one-size-fits-alltreatment, there is no
one-size-fits-all painmanagement.
It's whatever works best forthe person in front of you that
(30:42):
day, that time, and what worksone day for that person might
not work for them the next, andthat's okay.
That evidence-based practiceteaches us to be flexible.
The techniques we do, they allwork via the same way.
As far as we know, none isbetter than the other, but they
(31:06):
all help.
Let's have those conversationsmoving forward rather than us
versus them.
Let's focus on the similaritiesand how can we work together
rather than pushing each otheraway.
So thanks for listening.
I hope you enjoyed this episodeand I will try and get another
(31:28):
one out within the next fourmonths.
Have a good day.
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