Higher Education, Evidence-Based Practice and the Future of Massage Therapy

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/ 

Transcript

Eric: 0:08

Hello and welcome to another episode of Purves Versus. My name is Eric Purves. I'm a massage therapist course creator, continuing education provider, curriculum advisor and advocate for evidence-based massage therapy. In this episode, we welcome Nadine Harlech, who is an RMT in Courtney, bc. She tells us about her journey into academia and the valuable education and insight she gained while completing her master's degree in applied science. The focus of our conversation is on the new CMTBC's new standard of practice, on evidence-based practice and how we think this could potentially shape the profession in BC. If you enjoyed this episode, please rate it and share it on all your favorite social media platforms. Purpose Versus can also be found on YouTube, so please check us out there and subscribe. So thanks for being here and I hope you enjoy this episode.

Eric: 0:52

Welcome to another episode of Purves Versus. Today we have Nadine Hawryluk, and she just told me how to pronounce her name, so hopefully I got that right. She lives in Courtney and I'm excited to have you here. We're going to talk about oh many things, but we're going to talk a little bit about kind of the focus is going to be on evidence-based practice and kind of what that means for the professional massage therapy, and we did talk offline about, kind of, some of the ten tenets of evidence-based practice. So it's going to be fun and exciting for us to break this down a little bit. But before we get started, just tell everyone a little bit more about you. Who is Nadine?

Nadine: 1:29

Oh, that's a big question. Well, professionally, I've been an RMT since 2017, but before that I was working in spas and sort of other sort of practices, being a body worker since 2011, when I graduated from a Shiatsu program at Langara College many moons ago, and currently I'm running a product practice in Courtney here and Courtney's awesome. Personally, I love the outdoors. I ski, paddleboard, that kind of thing and if I can get out to a trivia night and host a murder mystery party, that's my jam too.

Eric: 2:08

What kind of trivia do you? Like.

Nadine: 2:10

Oh well, I mean I do best with like science-y stuff.

Eric: 2:14

Usually I'm that person at the table, so I love trivial pursuit and I love like just random stupid trivia. My brain seems to not remember important things like what I need to do from day to day, but I can remember useless facts from you know, an 80s TV show or something. It's ridiculous.

Nadine: 2:36

Yeah, it's good fun though.

Eric: 2:38

I love trivia. I always in my younger days we used to do a lot of like music, bingo, trivia. I don't know if that's something you ever were into.

Nadine: 2:49

Oh, music for some reason doesn't stick. Yeah, oh okay. Yeah.

Eric: 2:55

My previous life I was heavily involved in music, so for me it's something that I love. So, yeah, so I don't think I knew that you were involved in like I didn't realize that you did like body work before you became a massage therapist. What was the reason for going from an unlicensed body worker to getting your licenses and RMT?

Nadine: 3:18

I had worked in some big spot well, one big spot in Whistler and I think it was really just recognizing like it was a bit of a slog being unregulated, getting enough hours, getting enough work and you know, just seeing RMTs were booked solid and I needed to live. So that was a big push. And I think I also noticed when I was working with people like they'd be asking me questions and I didn't really know how to answer them properly. So it was kind of I was just ready to sort of grow in that profession and learn more and become more of an expert in that realm.

Eric: 3:59

So did you go back to Langara then to do your RMT degree or your RMT.

Nadine: 4:04

No, I moved out to Victoria for WCCMT.

Eric: 4:08

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 as well, but I think well, well before you. So when I mean we've connected before, because I think you've taken some courses of mine and we'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 little bit more about that experience and kind of what you learned or what you focused on learning on.

Nadine: 4:36

Yeah, so I in August actually wrapped up my master's in clinical science at Western University, which is an awesome program. It was online If anyone's sort of interested in looking at programs, that might fit in well with working full time. It was an awesome program and it it sort of focused on sort of becoming a leader in healthcare and I definitely chose the leadership focus. So we really like the foundation of that program was one evidence based care, learning how to appraise research and critical thinking. Everyone had to take a critical thinking course as well. So, and then beyond that, I chose the leadership stream and got into program evaluation and implementation science, which was really interesting. I didn't realize that was a branch of science that's sort of a newer field and I think it's super applicable of being like you know how do we get new practices into into healthcare and what makes them catch on, and you know what the barriers are there.

Eric: 5:52

So that sounds really fascinating. It sounds. It sounds something that's could be hopefully appealing to RMTs, because as far as I know, there's only really two programs that you could do, like distance wise for massage therapy, and get a master's degree and something that is could keep you still within the profession.

Nadine: 6:14

Right.

Eric: 6:15

And once the the program I did at UBC, the rehab science, and I think there's also McMaster has a rehab science, I think there's. I think they actually are the same program, just different universities. And then you were at Western with the applied science and I think Western has quite a few different options within that Cause. I've done some mentoring, a clinical mentoring, with students who are RMTs through Western, but they weren't doing the applied science, I don't, or they were, but they were doing maybe something else. I'm not sure what the other program is there and I'm just kind of spinning words out without making any sense right now.

Nadine: 6:50

Yeah, they've got a few different options and I know Susan Shepton did her program there and that was really focused on pain, multi sort of all the approaches to pain.

Eric: 7:04

Yeah, that's what it was.

Nadine: 7:05

Yeah, and so it's. This one is like a similar branch, but off, so there's just so many options. If you're depending what you're really interested in there's, there's an option for you Nice.

Eric: 7:16

Yeah. So, susan, I remember it was a few years ago when she did that and she, yeah, it was the multi, multi-disciplinary pain management, I think, was kind of the focus, which was seemed like a really cool program as well. So I think it's great because you know what you and I obviously are going to come from the same probably a lot of the same beliefs about the ways to advance the profession and to become more recognized or more accepted within kind of the academic fields, to advance the practices and the researches. We need more people with graduate level education, and what's nice is that there is some of these other options available for you. The only problem, though, I think that a lot of people run into is you have to have a bachelor's degree first.

Nadine: 8:00

And you had a bachelor's first, I'm assuming. Yes, yeah, yeah, an undergrad in zoology, right yeah?

Eric: 8:08

Yeah, so that's the thing too. Is is that's the one thing that's unfortunate about our profession is because it is just a diploma. If you wanted to go and do more advanced education, you basically have to you'd have to go back and do an undergrad and then go into it, so it's not available. It's not something that's on an option for everyone and it's obviously something that not a lot of people don't want. But over the years I do, I have noticed that there's a lot more RMTs getting master's degrees now than there was when I started practicing almost 20 years ago. So that's encouraging. Fingers crossed. Hopefully that keeps going.

Nadine: 8:40

Yeah, yeah. It seems like you know, after some time you've been in the field and there's something that says, hey, maybe I want to grow and learn some new stuff. So I see more people being curious about getting there. Maybe they're undergrad at TRU, which is an easier way to go about that. So yeah, hopefully people just keep growing.

Eric: 8:59

Yeah, so what are your thoughts about having a like a Bachelor's of Science or Bachelor's of Health Science degree as kind of like the entry level point for massage therapy? That's something that you're for or against?

Nadine: 9:18

I've thought a lot about that. I'm not sure I think where I would settle with it would be like a two-year associates degree Would be maybe the more appropriate way to go and like still getting a really good foundation. I've like to see more physiology, like getting into second-year level physiology to be included in our program. But to make it, you know, accessible is like yeah, you can do two years of study and then start working, but maybe then you can sort of work your way up, similar to social work.

Eric: 9:59

That's a good actually yeah, that's a great idea.

Eric: 10:03

Yeah, yeah, I'm not. I've not thought of it that way. I've always thought of it as like an all-or-nothing, like keep it as diploma or get your degree. But having that a two-year kind of associate degree would be kind of a bridge. That would be very possible. Those credits would be in a university or a college. That would be transferable, a lot more recognized than the current system with the private practices or the private school. So, yeah, I like that idea a lot.

Eric: 10:35

I think that the yeah, because a lot 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 when you're in your early 20s. How are you gonna know what you want to do in your 30s and 40s? And maybe you're not gonna want to be a full-time massage therapist working with clients and maybe you want to do other things. That would give you an opportunity to try and expand and do other stuff and I think that's a fantastic idea. I guess the key with that would be we'd have to get things out of the control of the private schools.

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 year physiology or more physiology. I have my thoughts on why I think 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 just out in the world and I hear claims about health, I have a background that makes me go. That doesn't sound right or like, based on what I know about how the human body functions, like that doesn't seem like it's possible and maybe just gives you 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 massage education we learn so much anatomy and physiology and people. You know it's a lot of information and it's very detailed, but I feel that the stuff that's detailed and it's stuff that doesn't really matter. You spend a lot of time learning like attachment points between little, tiny muscles that have no relevance to anything. You learn about all the systems of the body in like learning about cellular respiration stuff and these things, which is, I think, is really cool, but you don't really learn. You kind of learn at least my experience and when I talked to others, you learn this information. Then you you're like either, like it's okay, it's great, it's information, it's interesting, and you never think about, you, never use it, it's not applicable. But then you learn a lot of stuff and then you're taught well, this is, this is how you can fix these things with your techniques.

Eric: 13:02

And I feel that there's a there's a gap there and that knowledge between what's actually happening physiologically when we put our hands on people. You don't really learn. Like you look, you do, but it's not. There's no science, there's no evidence to support a lot of that stuff. So I agree that if you actually understood, had a good level of, you know, not graduate level, but a second or third-year level university understanding of anatomy and physiology and what, how the body works, more a step above what we learn in the SARS school. A lot of those health claims or kind of mess, mechanistic claims or things that people like to talk about, a massage just wouldn't make sense. You're like, that doesn't make sense. I can't increase your circulation by massaging your skin, because we understand how the venous and the circulatory system and the allostatic allostasis and all these things you know balance everything out and blah, blah, blah. We understand how the kidneys and the liver and all the stuff works. At a different level that stuff wouldn't make sense and you would. Just it wouldn't even be an issue.

Nadine: 14:01

Yeah, yeah, yeah, although yeah, and I think like, in addition to sort of that physical aspect, we really need to understand how people function and how they feel and like how they interact with people. Like there's that whole side of things too, and and I think that, because that would debunk a lot of the like oh, we can do so much with our hands is like recognizing how much else affects people, you know, beyond that.

Eric: 14:32

Yeah, and that's one thing too that is not commonly addressed in a lot of our education, whether it's in school or in other CE courses, is it's very focused on technique, technique, technique. Right, I was just spent the morning kind of going through a lot of social media stuff and just reading some things is for my own interest, to see what are people talking about. And it's all about what techniques should I learn or what's the best technique to do this, and everyone's talking about techniques, not talking about 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 I use to help this person with a neck? I'm like, well, should you not understand about, like, maybe, some of the, the processes involved and the experiences involved? And, and maybe it's more, maybe you should just take your folks away from your hands and like how can you support and work with the human in front of you? That's gonna be more valuable.

Eric: 15:22

But we don't. That's not something we really learn, and I think when we have those conversations a little, what I feel is a lot of times when we talk about how we communicate and how we interact with people and and the whole clinical encounter. It sometimes think people think we're working out of scope of practice. Oh well, you're counseling them, you know? No, we're just working on mechanics. I'm like, no, you're working with a human mm-hmm, and that's something that definitely needs to be better understood and we probably it sounds like we're on the same page of that. Stuff should be entry level to practice, at least in the basic fundamental concepts well, yeah, it's well we're working with human beings, like and we don't have.

Nadine: 16:03

I think we talked about active listening in passing for five to ten minutes in my training and we didn't even do any practice exercises like it's like, here are the concepts of active listening. It's like, no, we're working with people. How do we not focus on on that more? And and I get that it maybe it feels really nebulous, maybe, and and the ones taken on that challenge to be like, okay, let's break it down, let's make a framework for what that looks like. Instead, it's just this big open 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 that stuff.

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's like understanding what it is. For one thing, it's a very structured approach to problem solving and it's looking at. So you have a situation, you understand what the current approach to a treatment or a policy or a policy or something 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 some benefit to it, and you go, okay, why isn't it being adopted? And so you want to identify what the barriers are, what are the things that can help implement it, and then come up with a plan to deal with those barriers. And then, of course, a huge factor 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's no policies or things that are put out there or implemented but there's not that evaluation of like. Did it have the desired effect? Yeah, and that's good. I mean, part of what I did when I was doing my master's degree was we did stuff on like, like a lot of folks with a knowledge translation. So you know, how do we, what are some of the best strategies and ideas to translate knowledge into practice? But the last part of that was you couldn't just give people knowledge, you had to see if it was actually working, is it actually changing their practice? But that's the stuff that we don't as clinicians, and even in our like kind of CE world, you don't really know if it's actually making a difference, right, because you have to ask for an evaluation afterwards.

Eric: 18:49

So that's a really important thing, which I'm glad that you were able to do. That. It sounds really fascinating. Yeah, but before I digress too much, what do you think? So you did your master's degree Fantastic, congratulations. I think that's great. And add your name to the list of growing, a growing number of RMTs with higher level education. I think that's fantastic, but what was your rationale for it? What did you want to do with it? How do you think it's going to impact, what were your plans for that? To how it was going to impact your 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 more information, I was looking to grow. That was sort of my sense and I was like what does my future look like? Do I want to move into more a decision making role, policy role, something like that? But what I came out after the program, I just recognized how much more confidence I had in like looking at information and synthesizing ideas and feeling like, oh, I do have something to say about this. And it made me recognize too I think what's so important about education is that you realize like the more that you know, the more you realize you don't know. And I think that is so important even in our profession, to just have people maybe be a little bit more humble with information and be more careful with it. So I'm not sure where it's going to go yet. I think things are still percolating, but I feel like I just have the confidence to go forward.

Eric: 20:27

And that's huge. Yeah, I'm the confidence to feel it, feeling it, feeling better about that. Do you feel that it changed your practice at all, like how you treat or work with patients every day?

Nadine: 20:42

Good question. I think what I have noticed recently is like really wanting to empower people, like I want them to have the information too, without overwhelming them and I have to watch that too. It's like when is it appropriate to? But yeah, like I want people to feel like they understand their bodies better and even if they're not working with me, so that they can make better decisions. I actually sent the webinar you did for the renal foundation.

Eric: 21:25

Oh, yeah, yeah. The kidney foundation in Atlanta, 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 what other kinds of care that I would get? You know so more informed, more empowered.

Eric: 21:46

Yeah, yeah. And I was like, the reason I asked is because when I was doing my degree, that was a question I got all the time from people what difference is it going to make? Are you going to charge more? I was like, well, no, I'm in charge of the same as whatever Everyone else in the clinic and the region is charging. Well, then, why would you do it?

Eric: 22:04

And I felt that for me, when I went and did my master's degree, it was probably I'm not going to say probably it was definitely the best professional decision I ever made. I felt that so, clinically, I felt more, like you said, more confident, more comfortable, like I felt, like I had I was definitely gave me an understanding that I didn't, like you said, I didn't know a lot, but I knew what I didn't know and I knew what I didn't know. So it gave me that sense of humility, of like, yeah, that's a good question, but I'm going to help find you the answers. Yeah, you know, that kind of attitude was. It was definitely. I definitely got from that and it was. I felt more comfortable too in making suggestions to people or having those conversations with people when they were like, well, what should I do. What's the bet? What, like you know, this isn't working. This isn't working. You know what are my options and it gave me and, because of what I was studying, it gave me a lot of. I'm like, well, here's some papers, here's some things I've read. You know, here's kind of some of the least wrong, maybe potential solutions or management strategies for you. So I felt like, yeah, the knowledge helped didn't really change much with what I did with my hands, but it definitely changed a lot with how I interacted with, with my patients.

Eric: 23:22

I felt, and then also too, for my CE aspect, my CE business. It was hugely beneficial for that because I got basically got to spend three years just reading papers and researching all the stuff that I wanted to, and then I could use that to build, inform the content for the courses. It was great and if anyone's listening and they feel that is it going to make a difference. You don't really know until you try. You know, and it's opened up so many doors for me, like so many doors of different things I never even thought of doing. You know, working with, with curriculum development at schools and working with colleges and associations, and you know being able to present at conferences and, and you know, speaking at universities and things that never would have been an opportunity before, but that you have that piece of paper where it says you did the work. So therefore, it opens up a few more doors for you. So I think it's it's something that is really worth exploring. If anyone's into it, it's listening.

Nadine: 24:19

Yeah for sure, and I think even being a confident voice in someone's life who is maybe experiencing pain or recovering from injury too, and being just being able to say, yeah, you're going to be okay and let me help, support you, find the best way for you forward, Thank you. I think it's just such a great influence, rather than maybe someone's like okay, well, we need to solve the problem this way and this way and this way who might be a little less confident in understanding how all 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 MSK profession is moving. That shift from I got to focus to fix and try all these things to how can I best support you on your journey. That's not typical conversation that we see a lot of. We see more of it now than 10 years ago, but it's still a long ways to go because often, patients or clients come to see us and they expect us to fix them. I see there's a lot of danger though and I saw this all the time in the chronic pain population that I treated.

Eric: 25:32

Anybody, but particularly that population, is when you've had a number of therapists trying to convince you or to sell you a wellness plan or like this is what you need to do.

Eric: 25:42

You go and you spend months or years in some cases, and thousands of dollars with your own money or insurance company's money trying to fix the problem, and then they end up just the same or worse, because the focus was on the problem, not how can we support the person. That subtle shift, I find, is massive because it takes the pressure off you trying to fix and it creates this more relationship between you and the other person where you're there to support them and help them make decisions, and your massage is part of it, but it's not the fix. One thing I always say to people is that the danger when you make big promises to clients or patients is that if you don't live up to it, then what are they left with? They're left finding somebody else who's going to make big promises and they keep on chasing and chasing and chasing and you get on this healthcare professional wheel. They just keep spinning where you see all these people and you're going nowhere.

Nadine: 26:48

Yeah, I would say that's analogous to and I experienced this early on in my career too of looking for the next technique. I can thinking, oh, other people are helping people better than me, what's the next technique I need to learn? Then you end up on that hamster wheel trying to find the right thing to do just on the other side of the table.

Eric: 27:13

Sure, I did that too early in my career, for sure. I think I've said this probably numerous times. So people probably who listen to this podcast regularly are like yeah, eric, you keep repeating yourself. But I'll say it again. It took me longer than I'd like to admit to realize that I was mistaken. Like I was wrong because I got heavily involved in structural integration and myofascial stuff because it appealed to me and I'd had those kind of treatments and they helped for me. Of course I need to learn how to be as amazing as everybody else. Then it took too long but I realized after quite a few years. I was like this doesn't make any 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 and it'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 program someone brought up the point okay, well, if we're giving people home care and saying this is what you need to do and they're not doing it, what do we do? The advice came back. Well, all you can do is just keep telling them over and over and over until it clicks. Or maybe you think this might not be appropriate for this person. They're like what's another option? I think that's a new thinking that I'm so glad to see is coming forward. But on the other side of that, I have seen it swing the other way, where it's like well, it's no longer my responsibility to fix you, it's all on you. Yeah, if you're not going to do the work, then you're not going to get better. So I'm like let's come back to the 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 just keep 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 and I think the amount of rehab stuff that we got educated, but it was terrible. It was all very passive stretching and just very linear strength training. It was so ridiculous and it was like do this many sets, this many reps, repeat this? It was so poor and I think a lot of places they still do that and yeah, and then now you see the shift where, like, well, it's up to you, I can't fix you, so you got to take care of yourself.

Eric: 29:50

No, it's supported self-management, which means you help the person find things they can do on their own. And I know we have these conversations that can seem kind of vague, kind of gray, like we're talking about. But clinical practice is gray. There's not a lot of answers, there's this lot of kind of less wrong ideas that you can kind of play with.

Nadine: 30:11

Yeah, yeah, yeah. And how do you get that? Really, I think switching to the idea of function is like what's going to make this person's life enjoyable, worthwhile, like functional, and if that's the question you ask, rather than oh, how do we get rid of this person's pain, then it would totally shift how we approach 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 pain for a long time, maybe you can turn the volume down a little bit on their pain experience, but you're not going to get rid of it. Yeah, and everyone's probably has a case where someone's been in pain for 10 years and you did something and then they got better, Right, and you're like I fixed them. But that's like one in 1 in 1,000. Yeah, it's not good odds, but we always remember that one. We always remember that one person who had pain forever and we did this one thing and they got 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 we can help people with function, hopefully more so than we could. I should say hopefully. But we have a better claim of helping people with function than we do of reducing their pain significantly. We can modulate pain for a short period of time during and after massage, but long term the evidence 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 the time too, if you look at and we're just going to segue into our next conversation about evidence-based practice but we see that a lot in evidence-based practice stuff is that getting people to function better is a more reasonable and more supported goal, and all the clinical practice guidelines are focusing more on function rather than just 100% pain relief, because pain modulation, pain control, not pain elimination, 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 into their little conversations here on evidence-based practice, I just wanted to ask your opinion on what do you think some of the biggest issues are that our profession is facing today, and let'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 is going to be that transition. What does that look like? How are we going to have different conversations? How we yeah, how we move through? This transition is going to be a big challenge, I think, for a lot of people, but I think there's so many opportunities for people such as yourself to provide resources and support and information in a really supportive way to help us move forward.

Eric: 33:42

Yeah, yeah, that's a good point because there's many issues facing our profession in BC the college amalgamation with the other. What are they calling it? Complimentary or integrative health?

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 is all basically university degree colleges or university degree professions, and then the one that we're in, which I can't remember what it's called, is all basically just like trade school, like private school kind of stuff, right? So it's naturopaths, massage chiropractors.

Eric: 34:21

Chinese medicine, acupuncture, yeah, so those ones are all in that college, so that'll be interesting to see how that goes. I don't know if it's a big issue, but I know personally I'm not too concerned about it. I don't there's nothing we can really do about it, but I think a lot of people in our profession do are like freaked out about it and I think it's a bit of a slap in the face, I think, for those of us that are kind of evidence-based or science-based in our thinking. It's kind of like oh, now we're going into these other professions which maybe we don't identify 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 a more evidence-based approach. So maybe we could all sort of work together in that direction.

Eric: 35:03

Yeah, and that would be a great solution, because we can talk about problems I want, but solutions, I think, are the key thing and I talked about in a previous podcast episode that I released, about just like some of the options for solutions. Right, and there is options out there depending on what it is you're looking for, but yeah, there is. I know a handful of chiropractors that are. You know they don't like the direction that their profession has gone, but you know, with like the kind of before, you know a lot of chiropros were doing the x-rays to you know, pathologize your spine and then selling you a series of treatments, and you know, I know, that stuff's been kind of taken away and there's a huge pushback on that. So there is definitely an evidence-based contingent to all the professions, but this might be an opportunity for them to get together, hopefully and push for better. So, fingers crossed right.

Nadine: 35:56

Yeah, that would be. Another big issue, though, is I think we kind of need to. You know, identity is a big one for us, and I'm sure that's been mentioned before on your podcast. But I've even noticed it's like when we were talking about the name of the new college and like how people want to be considered, be it complimentary or integrative, or you know, it's like trying to figure out how we relate to the healthcare system. Are we something separate or are we a compliment? Are we a support? I think that's a big thing that we'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 would love to be part of a full healthcare system, kind of like how physiotherapists are or occupational therapists are, or even opportunity to work in a hospital or an outpatient care, or you could work in private practice, like there's more options, and I know a lot of massage therapists would like that and I think it would be fantastic if our profession could get to that point. But I think we're saying in the beginning of this podcast, without that entry level education being higher, without having a degree, it's just probably not going to happen just in terms of how we are perceived by the public and how we are perceived by the healthcare world. And to be honest, you know, when we look on a lot of the nonsense that's out there, a lot of the pseudoscience that is really common in our profession, that really holds us back Because it's not helping. And so hopefully, with this new evidence-based practice standard which we're going to talk about here, hopefully that'll kind of help to push us in the right direction. Where there won't be, it won't be tolerated anymore by our regulator, and it's that you can't say and do things that are not evidence-based, and this is a thing too, I guess we should say. Just some people I know, and I like the term science-based because it talks more about biological plausibility, but I think, in terms of where the college is going with this, I think evidence-based is a good start. So I think that just wanted to put that in there.

Eric: 38:17

For those who are like I, like science-based. I like science-based too, but let's go with a term that's been used for a long time, so evidence-based, but the and it'd be interesting to see how this if this has any teeth, though like, can they do anything? Like, are they going to actually say no, like you can't have those things on your website? Oh, we've had these complaints from the public whether you've been saying or doing these things, and that's actually not evidence-based. It's your responsibility to understand what evidence is for what you are treating.

Eric: 38:46

And also, too, I'm hoping and I don't, this is a big hope too is I'm hoping that it will really influence the type of continuing education or quality assurance that massage therapists pursue. So that way, they're going to have to say, okay, well, if I want to take this course, is this evidence-based? And what does that mean? And that's the question is, you could take anything, but is it going to satisfy the requirements of the college to take I don't want to throw any names out there, but to take a course that is not evidence-based. And then the problem is, I think that we're going to have those, I think we're going to have instructor but like, oh, it's evidence-based, and then they'll throw down a couple studies and they'll be, and you look at the studies and they're probably totally irrelevant to other 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 I hope that the CMT will be able to have some teeth and saying look, that's not okay, this is how we have to improve. So we're going to have to have some good quality resources and maybe some audits or something's going 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 then having the support to implement it successfully will be the big thing 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 deal honestly. Yeah, me too. But I think it's great and I think there were some statements in the actual verbiage of it that were really I think they took a really strong stance honestly about like thinking about how what you say to clients, like how is that going to affect them, and it's like this is really important stuff to consider. So I think it's great. I'm really interested to see where it goes.

Eric: 40:51

Yeah, it's so too fresh it takes it starts. It'll already in place by the time this podcast is live, but as of today, it hasn't actually taken effect. It takes effect on January 15th, so a few days from now. So, yeah, it'll be interesting to see what actually happens. But I agree, I think we should have had some kind of party because I think, compared to the only other place I think that has an evidence in their Standards is in Ontario. But they have that, they usually have it. It's informed and it's quite watered down and it's Not nearly the same, it's not nearly strongly worded as BC. So we should really commend the, the college and people there that put this through yeah.

Eric: 41:33

Yeah, did you want to? So let's, let's talk about your kind of ten tenants of evidence-based practice, because we had a conversation, I don't know, a month or two ago and and you would come up with this. I thought this was such a great idea. Did you want to go through and kind of list off those, those ten? Sure, this is as a learning opportunity for people that are listening, just to see.

Nadine: 41:58

Yeah, I mean in context too, it was. I like when I'm thinking about concepts and I'm trying to sort of solidify them for myself. I love frameworks, you know. I just started scribbling down I'm like what would be kind of like the essential things you need to focus on if you want to grow your evidence-based practice, and so I just started Do lightning things down and this is what I came up with. So if other people have ideas or things they want to add, yeah, let me know. Or add them to your own little reflective piece. But I'm hoping this could be a tool for people to sit down and think, oh, these are little areas that I can improve upon or be interested in. So let's just go top to bottom here.

Nadine: 42:48

So I've broken it up into three sections and it's kind of those three stool legs is it in the evidence-based practice Model of? So I've broken it up into one like how you relate to information, how you relate to patience and how you're relating to yourself, and so we'll start at number one, which is develop the skills to search for and evaluate reliable information. And then I've put little sub points under of do not make assumptions, ask questions. Number two is stay up to date with current pain science, health research and best practices. Three is do not spread misinformation, and I've put under that, evaluate claims and sources carefully before sharing and know the dangers and harms of false narratives. Number four is be aware of various resources available for patients in your community and online. And Then, if we move into the relating to patients piece, it's.

Nadine: 43:56

Five is know your role. So who are you to this patient? And I've there's, um, there's a book out there it was four physios, but I've pulled out some of the titles that I Thought were kind of great of being a confident, being a coach, a detective, a teacher, but not a healer. So we're a support person, not a fixer. And then, under that Be is know the mechanisms of action for massage, along with realistic goals and outcomes. Number six is know your limits, so knowing how to identify red flags and referring on is Under that, and being comfortable saying I don't know, okay.

Nadine: 44:45

Moving on to seven, be patient-centered, so learn how to determine, support the patient's values, beliefs, goals and preferences. Number eight is pay attention to your communication, so learn how and when to share potentially helpful information in a supportive way. And be know the effects of language and other communication on the therapeutic relationship, that person's pain and disability experience, and then when we're thinking about how we relate to ourselves. Nine is develop regular reflective practices. So a is understand your motivations, your biases, strengths and areas of growth. Be be curious about your emotional experience in the process of transference and counter transference. See, get support when you need it and regularly discuss cases with colleagues. And then, finally, number ten, commit to constant improvement. You know, continue to learn about pain, rehab, healthcare, disease processes, communication yourself, 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 that all together and it's you know, these are things that are, you know, 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 not impossible. No, and they all interplay as well.

Nadine: 46:15

Yeah there's so much overlap between them, right, which is evidence-based practice as well.

Eric: 46:18

There's an overlap between you know what's the relevant research evidence say, versus your clinical expertise, versus the person in the context of the environment, and and they all kind of overlap together. And so this is this is this is fantastic, so maybe I will. In the show notes I will put a copy of this. Yeah with with your name on it, so so people can can have a 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 with something, to have Tools to fill that gap of like well, what do I do? Well, here are the things you can work on.

Eric: 46:57

And when I read this to this kind of goes into another conversation we've had before and we can wrap up the the podcast with with this little conversation is is the idea of of patient safety and then and making the person feel safe.

Eric: 47:18

Because when we look at how this evidence-based practice stuff is, you know, if we look at understanding pain science and we look to Not spreading misinformation, we look at our role about being more of a coach or a coach or a coach or a coach or a coach or a detective and not a healer. You know, knowing how do I, knowing the science and the knowledge, but how to identify red flags, saying I don't know a lot of the stuff you can put into this idea of like just Of safety, of making the person feel less threatened, less broken. Yeah, and I know that in some the idea of safety is some people don't necessarily agree with that and we're not talking about pain science or pain explaining. We're not talking about neuroscience education where you're like I'm gonna tell you everything that you need to know about pain to make you feel safe so you're not feeling threatened by what's happening in your body. We're not talking about that kind of safety because that is that's an idea, is popular and I used to teach more of that.

Eric: 48:26

Now I think I try and do a better job of putting that pain science stuff into proper clinical context. So you're not just pain explaining. But I think if we, if we I still strongly believe and when I look at the evidence and we look at come to your comments here if our goal is just to make the person in front of us feel good, can our touch feel good, can our clinical environment feel good, can our words feel encouraging? It's not just being like, oh, I'm so nice, it's not like over the top, but it's just everything we do is how can we support you, how we make you feel 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 and what it is that people really need from us and I always think like we're really adults or just bigger kids and, at the end of the day, like this is gonna sound a bit reductive, but in a way like we're professional boo boo kissers right, it's like.

Nadine: 49:29

I love that. How do you be the best possible boo boo kisser that you can be? How do you cause? You know, someone hurts themselves, like come and they say I have an awi, and you say, oh, you're gonna be okay, so reassurance, right, and then you provide some sort of care, touch that's gonna support that person. So how do you create an environment that's super supportive, super safe and you're gonna create that resilience and that empowerment for that person? And you're not saying, oh, I'm gonna do some magic to it and like fix you. You're just saying like, is it? Do you need some information right now? What do you need to feel like you 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 kind of what we do, but that's so true. And you use the term reassurance, which is important, because if we look at the clinical 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 depending on what it is some type of touch or movement within comfort and tolerance, like. It's usually pretty basic and you can apply those principles to pretty much any MSK condition. You'd see, obviously you don't wanna reassure when it's a red flag.

Eric: 51:06

No no, so you can. Yeah, and that's the thing. I think that someone said that to me once before. But what if you know it's this? I'm like, well, that's when you're not reassuring. Yeah, if a person has, like bowel bladder dysfunction and you know saddle anesthesia and they'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 not for every situation, but I would say 90 was the data, it's like 96, 97% of all MSK. Things are kind of benign anyway. It's very rarely to something serious. So more often than not, if it's something serious, you're probably gonna know. If it's not, you can reassure them and give them a nice boo, boo kiss.

Nadine: 51:52

Yeah.

Eric: 51:55

I love. That's great. Well, thanks, aileen, for being here. It was really fun. I really enjoyed this conversation and we'll you know we have some other. I'm sure we have lots of other things you could talk about, but maybe we'll get you back on again in the future and we can maybe see how this standard of practice thing played out and have a Absolutely. Another revisit that conversation. So did you want to provide your contact information for anybody if they wanna have any questions for you?

Nadine: 52:24

I'm wondering. Yeah, I was asking myself that question before, but I think probably LinkedIn's actually the best way to get me right now to search for my name, which would be in this show notes, and connect with me that way.

Eric: 52:36

Perfect LinkedIn. Okay, nadine. Well, thanks very much for being 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 social media. You can follow me on Instagram or Facebook at EricPervisRMT, and please head over to my website, ericperviscom, to see a full listing of all my live courses, webinars and self-directed course options. Until next time, have a great day and thanks for listening.