WEBVTT 00:00:12.461 --> 00:00:12.641 All right, 00:00:12.660 --> 00:00:14.141 welcome back to another exciting 00:00:14.201 --> 00:00:15.962 episode of Orthostatic, 00:00:16.003 --> 00:00:17.263 the podcast from the 00:00:17.303 --> 00:00:19.144 Academy of Orthopedic Physical Therapy. 00:00:19.184 --> 00:00:19.445 Today, 00:00:19.504 --> 00:00:21.986 we have a guest who's as dynamic as 00:00:22.025 --> 00:00:22.966 he is distinguished, 00:00:23.146 --> 00:00:24.248 hailing from the land down under. 00:00:24.608 --> 00:00:26.268 He's made his mark in Australia, Canada, 00:00:26.649 --> 00:00:28.050 and now here in the United States, 00:00:28.129 --> 00:00:29.089 not only an associate 00:00:29.109 --> 00:00:30.510 professor at the University of Florida, 00:00:30.990 --> 00:00:32.911 but also a leading light in 00:00:32.932 --> 00:00:34.972 the management of musculoskeletal pain. 00:00:35.293 --> 00:00:36.374 When he's not shaping minds 00:00:36.414 --> 00:00:37.195 in the classroom or 00:00:37.234 --> 00:00:38.375 mentoring PhD students, 00:00:38.395 --> 00:00:40.796 he's unlocking the mysteries of pain 00:00:41.396 --> 00:00:43.198 through manual therapy and exercise. 00:00:43.478 --> 00:00:44.439 Let's welcome to the show, 00:00:44.740 --> 00:00:45.539 Dr. Mark Bishop. 00:00:45.560 --> 00:00:46.860 All right. 00:00:46.941 --> 00:00:47.781 Thank you very much. 00:00:48.563 --> 00:00:48.762 All right. 00:00:48.843 --> 00:00:50.283 We'll get the hard questions 00:00:50.323 --> 00:00:51.003 out of the way first. 00:00:51.024 --> 00:00:53.246 We'll give you the nice broad one. 00:00:54.127 --> 00:00:56.207 Mark, what's manual therapy? 00:00:56.808 --> 00:00:58.729 That can't be a simple question. 00:00:58.750 --> 00:00:59.610 Maybe I should say it's not 00:00:59.651 --> 00:01:00.290 an easy question. 00:01:00.332 --> 00:01:01.072 It's a simple one. 00:01:01.531 --> 00:01:02.512 And then we'll back it up. 00:01:02.533 --> 00:01:04.355 Why is it important in this 00:01:04.495 --> 00:01:06.536 area of orthopedic physical therapy? 00:01:06.575 --> 00:01:07.496 How would you answer that one? 00:01:09.010 --> 00:01:09.230 Well, 00:01:09.391 --> 00:01:13.513 manual therapy is a group of ancient 00:01:13.593 --> 00:01:14.474 techniques, actually. 00:01:14.493 --> 00:01:16.275 So with thousands of years 00:01:16.316 --> 00:01:17.555 of history of people 00:01:17.615 --> 00:01:19.617 performing manual therapy interventions, 00:01:19.677 --> 00:01:20.938 which are essentially 00:01:21.959 --> 00:01:23.400 skilled interventions for 00:01:23.439 --> 00:01:24.641 which you and I use our 00:01:24.700 --> 00:01:27.722 hands to deliver some sort of treatment. 00:01:27.763 --> 00:01:29.403 And so historically, 00:01:29.463 --> 00:01:30.984 we look across multiple 00:01:31.004 --> 00:01:32.185 different cultures and 00:01:32.245 --> 00:01:33.486 multiple different eras. 00:01:33.566 --> 00:01:34.626 There's always been manual 00:01:34.647 --> 00:01:35.808 therapy as part of 00:01:37.293 --> 00:01:39.944 healthcare and health improvement. 00:01:41.058 --> 00:01:43.560 I'd say the more modern 00:01:43.760 --> 00:01:45.841 definitions that you'll 00:01:45.861 --> 00:01:47.662 read about is like series 00:01:47.783 --> 00:01:50.144 of skilled passive movements. 00:01:50.224 --> 00:01:52.165 So types of things where I'm 00:01:52.246 --> 00:01:54.248 using my hands to perform 00:01:54.308 --> 00:01:56.009 very specifically 00:01:56.028 --> 00:01:57.790 goal-directed activities, 00:01:58.650 --> 00:02:01.373 and those can be directed at the joints, 00:02:01.993 --> 00:02:03.715 the muscles and soft tissues, 00:02:04.596 --> 00:02:06.356 neurovascular bundles. 00:02:08.057 --> 00:02:08.859 kind of broadly, 00:02:09.338 --> 00:02:11.300 and they're used mostly to 00:02:11.419 --> 00:02:13.040 manage neuromuscular conditions. 00:02:14.300 --> 00:02:15.382 And I'd say that one of the 00:02:15.421 --> 00:02:16.562 definitions I really like 00:02:16.602 --> 00:02:19.443 about it is that it's an 00:02:19.503 --> 00:02:21.944 approach that uses clinical reasoning, 00:02:22.164 --> 00:02:24.026 highly specifically 00:02:24.165 --> 00:02:25.546 directed treatments that 00:02:25.586 --> 00:02:27.647 include both manual 00:02:28.127 --> 00:02:29.448 techniques with my hands 00:02:30.229 --> 00:02:31.870 combined with exercise. 00:02:32.610 --> 00:02:33.289 And so for me, 00:02:33.330 --> 00:02:34.811 that's the definition I like 00:02:35.311 --> 00:02:36.352 the best for this. 00:02:38.006 --> 00:02:39.627 And I think why it's important, 00:02:41.707 --> 00:02:42.528 we certainly, 00:02:42.549 --> 00:02:43.949 you talked about tangents before, 00:02:43.990 --> 00:02:45.409 we can go off on plenty of tangents. 00:02:45.449 --> 00:02:47.050 I think that one of the 00:02:47.091 --> 00:02:48.431 reasons that manual therapy 00:02:48.491 --> 00:02:50.492 is very useful as a system 00:02:51.353 --> 00:02:52.693 is that it's a systematic 00:02:52.774 --> 00:02:54.775 approach for me to deal 00:02:54.814 --> 00:02:55.436 with someone's 00:02:55.475 --> 00:02:56.895 neuromuscular health condition. 00:02:57.736 --> 00:02:59.298 And for that reason, 00:02:59.337 --> 00:03:01.959 I think my opinion is the 00:03:02.019 --> 00:03:05.040 approach is important in orthopedic PT. 00:03:05.888 --> 00:03:07.248 We can certainly debate, 00:03:07.329 --> 00:03:08.250 and I know there's plenty 00:03:08.270 --> 00:03:09.390 of debate about which 00:03:09.471 --> 00:03:11.473 approach is most effective, but for me, 00:03:12.014 --> 00:03:14.496 the systematic application 00:03:14.716 --> 00:03:16.897 of manual interventions and 00:03:16.978 --> 00:03:19.281 exercise has been effective 00:03:19.320 --> 00:03:21.021 in my career and I think 00:03:21.042 --> 00:03:23.024 overall effective across 00:03:23.645 --> 00:03:24.526 pain in particular, 00:03:24.566 --> 00:03:25.506 but broadly lots of 00:03:25.546 --> 00:03:26.927 different orthopedic conditions. 00:03:28.197 --> 00:03:29.578 All right, so next question is, 00:03:30.118 --> 00:03:31.020 how does it mix? 00:03:31.099 --> 00:03:32.360 How does it play well with others? 00:03:32.782 --> 00:03:33.842 How does manual therapy 00:03:33.962 --> 00:03:36.465 integrate with other treatment modalities, 00:03:36.585 --> 00:03:38.366 or should it be all or one? 00:03:40.949 --> 00:03:42.770 Once again, you get plenty of debate here. 00:03:42.830 --> 00:03:44.693 I would say that I think it 00:03:44.752 --> 00:03:45.713 has to be integrated. 00:03:46.314 --> 00:03:47.596 It's not a standalone. 00:03:48.917 --> 00:03:49.418 Certainly, 00:03:50.657 --> 00:03:52.179 my preference mark bishop's 00:03:52.239 --> 00:03:55.260 preference is I've trained 00:03:55.360 --> 00:03:56.842 in a manual therapy system 00:03:56.882 --> 00:03:58.043 so that that's my original 00:03:58.103 --> 00:03:59.864 bias for thinking about how 00:03:59.903 --> 00:04:03.126 we uh look at how you're 00:04:03.186 --> 00:04:05.127 moving what uh what is 00:04:05.187 --> 00:04:06.668 happening so I use my hands 00:04:06.728 --> 00:04:09.349 a lot for that um and but 00:04:09.370 --> 00:04:12.512 when it comes to actually intervening 00:04:14.013 --> 00:04:16.574 I certainly may do some manual techniques, 00:04:16.634 --> 00:04:17.814 but it has to be part of 00:04:18.194 --> 00:04:18.934 the bigger picture. 00:04:18.973 --> 00:04:20.475 So it has to include things 00:04:20.875 --> 00:04:23.216 related to other systems, 00:04:23.536 --> 00:04:25.915 movement systems, cardiovascular system, 00:04:26.617 --> 00:04:28.057 as well as a bunch of other things. 00:04:28.117 --> 00:04:29.857 So you have to do the manual 00:04:29.877 --> 00:04:31.778 therapy part in conjunction 00:04:31.817 --> 00:04:32.898 with the exercise. 00:04:33.918 --> 00:04:35.858 You may include other modalities in there. 00:04:35.959 --> 00:04:37.418 I personally don't use a lot 00:04:37.660 --> 00:04:39.720 of other modalities, 00:04:39.879 --> 00:04:41.120 but certainly it has to be 00:04:41.180 --> 00:04:42.161 combined with everything. 00:04:43.141 --> 00:04:45.324 Don't know of any examples 00:04:45.403 --> 00:04:47.026 where it's just effective 00:04:47.245 --> 00:04:48.788 only to do the manual 00:04:48.807 --> 00:04:51.430 therapy part for broader recovery. 00:04:51.951 --> 00:04:53.552 I might just be able to do a 00:04:53.774 --> 00:04:54.935 manual therapy intervention 00:04:54.975 --> 00:04:56.757 and make some sort of change, 00:04:56.817 --> 00:04:57.497 but I don't think that's 00:04:57.538 --> 00:04:58.459 going to help the broader 00:04:58.499 --> 00:05:00.141 recovery of a health condition. 00:05:00.622 --> 00:05:00.781 Yeah. 00:05:01.709 --> 00:05:01.930 Now, 00:05:03.250 --> 00:05:05.072 if you ever looked or try to find 00:05:05.132 --> 00:05:05.894 misconceptions, 00:05:05.934 --> 00:05:06.694 you don't have to go very 00:05:06.733 --> 00:05:08.055 far because people will say, 00:05:08.115 --> 00:05:09.817 take something with this 00:05:09.916 --> 00:05:10.918 internet thing that we have. 00:05:10.937 --> 00:05:12.678 And typically it'll be a 00:05:12.699 --> 00:05:13.360 game of telephone. 00:05:13.560 --> 00:05:14.180 So what are some 00:05:14.721 --> 00:05:16.521 misconceptions about manual 00:05:16.583 --> 00:05:17.903 therapy that you come across? 00:05:17.923 --> 00:05:18.684 And then, you know, 00:05:18.723 --> 00:05:19.704 what would you say to those things? 00:05:19.764 --> 00:05:20.725 What are the frequently 00:05:21.807 --> 00:05:22.947 misconstrued ideas? 00:05:25.132 --> 00:05:29.016 Well, I'd say probably first and foremost, 00:05:29.096 --> 00:05:31.338 one of the things I think 00:05:31.519 --> 00:05:34.101 is that you have to be very, 00:05:34.221 --> 00:05:36.644 very specific with a 00:05:36.685 --> 00:05:38.807 particular biomechanical model. 00:05:40.122 --> 00:05:41.244 be effective I think that's 00:05:41.283 --> 00:05:43.444 a misconception certainly a 00:05:44.144 --> 00:05:45.904 lot of our historical 00:05:46.024 --> 00:05:47.425 theories about how manual 00:05:47.446 --> 00:05:48.726 therapy may actually 00:05:49.326 --> 00:05:50.547 improve someone's health 00:05:50.586 --> 00:05:52.528 condition were based on 00:05:52.608 --> 00:05:54.168 very complex biomechanical 00:05:54.228 --> 00:05:55.389 models that as they've been 00:05:55.449 --> 00:05:56.889 studied haven't necessarily 00:05:57.149 --> 00:05:58.449 stood up under all 00:05:58.529 --> 00:06:01.471 circumstances so the idea 00:06:01.512 --> 00:06:02.451 that I have to very 00:06:02.512 --> 00:06:04.333 specifically push or move 00:06:04.413 --> 00:06:05.492 something in a very 00:06:05.533 --> 00:06:06.774 specific direction at a 00:06:06.814 --> 00:06:08.473 very specific frequency may 00:06:08.514 --> 00:06:09.454 not actually affect me 00:06:11.704 --> 00:06:13.047 I think another 00:06:13.086 --> 00:06:15.348 misconception is that one 00:06:15.470 --> 00:06:17.331 particular system is better than another. 00:06:17.351 --> 00:06:19.435 I don't think we've seen that either. 00:06:19.495 --> 00:06:23.420 I think that when you look – 00:06:23.420 --> 00:06:25.081 when I have looked more 00:06:25.122 --> 00:06:29.536 broadly at systematic approaches – 00:06:29.536 --> 00:06:30.416 And by that I mean it 00:06:30.918 --> 00:06:31.958 doesn't matter what system, 00:06:32.038 --> 00:06:34.579 if I'm an advocate for a 00:06:34.858 --> 00:06:36.079 McKenzie-based system, 00:06:36.098 --> 00:06:37.560 a mechanical diagnosis and 00:06:37.579 --> 00:06:38.600 treatment system, I mean, 00:06:39.841 --> 00:06:41.321 or a Maitland-based system, 00:06:41.680 --> 00:06:43.161 it's the system that's important, 00:06:44.862 --> 00:06:45.802 not necessarily the 00:06:45.882 --> 00:06:47.822 specifics of the technique. 00:06:47.862 --> 00:06:50.144 But the more systematic my approach is, 00:06:50.244 --> 00:06:52.524 the more likely I am to get 00:06:52.564 --> 00:06:53.906 a comprehensive picture and 00:06:53.946 --> 00:06:54.745 make a good decision. 00:06:58.512 --> 00:07:01.793 with with that being said it 00:07:01.853 --> 00:07:02.774 sounds like there's there's 00:07:02.814 --> 00:07:04.475 no one best but it's better 00:07:04.495 --> 00:07:05.814 to have a process and 00:07:05.855 --> 00:07:06.995 follow that process so I 00:07:07.014 --> 00:07:07.735 was going to say you know 00:07:08.036 --> 00:07:08.836 what are some of the best 00:07:09.516 --> 00:07:11.156 uh trainings required in 00:07:11.216 --> 00:07:12.197 your in your mind to 00:07:12.237 --> 00:07:13.336 perform manual therapy 00:07:13.416 --> 00:07:14.617 effectively but it sounds 00:07:14.658 --> 00:07:16.177 like it sounds like I don't 00:07:16.278 --> 00:07:16.997 know if I should even ask 00:07:17.017 --> 00:07:17.677 that question because it 00:07:17.697 --> 00:07:18.499 sounds like the answer is 00:07:18.519 --> 00:07:19.619 it depends which we love in 00:07:19.639 --> 00:07:22.379 pt I think it does depend 00:07:22.579 --> 00:07:24.660 and where I have ended up 00:07:25.461 --> 00:07:26.380 on that personally 00:07:27.845 --> 00:07:31.045 is that we, in our own research, 00:07:31.125 --> 00:07:32.286 have done a few things that 00:07:33.026 --> 00:07:34.547 indicate that there's an 00:07:34.627 --> 00:07:35.807 intersection between what 00:07:35.846 --> 00:07:37.646 you want as a patient, what you prefer, 00:07:39.028 --> 00:07:40.728 what I prefer as a provider, 00:07:41.427 --> 00:07:43.949 be that manual therapy, be that exercise, 00:07:44.009 --> 00:07:44.668 be that whatever. 00:07:45.769 --> 00:07:46.829 And there's an interaction 00:07:46.870 --> 00:07:48.209 that occurs when these 00:07:48.269 --> 00:07:51.891 things happen that helps improve outcome. 00:07:52.151 --> 00:07:54.011 It's not responsible for all outcome, 00:07:54.031 --> 00:07:54.971 but it certainly helps 00:07:55.031 --> 00:07:55.951 improve the outcome. 00:07:57.420 --> 00:07:59.802 And so the way we kind of 00:07:59.862 --> 00:08:04.084 interpret that is the type 00:08:04.125 --> 00:08:06.045 of system that I endorse is 00:08:06.146 --> 00:08:09.067 perhaps not as important as 00:08:09.708 --> 00:08:11.949 how much I've practiced that system. 00:08:13.329 --> 00:08:14.310 The relationship that 00:08:14.350 --> 00:08:16.411 develops between you and I 00:08:16.492 --> 00:08:18.574 as patient and provider in 00:08:18.694 --> 00:08:20.394 part is driven by your 00:08:20.454 --> 00:08:22.475 perception of my competence. 00:08:24.052 --> 00:08:25.995 your perception of my 00:08:26.095 --> 00:08:27.615 competence is in part 00:08:27.656 --> 00:08:29.637 driven by my self-efficacy 00:08:30.557 --> 00:08:31.978 and my confidence in my 00:08:32.198 --> 00:08:35.522 ability to do an exam and 00:08:35.701 --> 00:08:36.701 do an intervention that's 00:08:36.721 --> 00:08:37.383 going to help you. 00:08:38.504 --> 00:08:40.044 That confidence comes from 00:08:40.164 --> 00:08:43.006 practice regardless of system. 00:08:43.126 --> 00:08:45.249 So if I find a set of 00:08:45.308 --> 00:08:46.889 techniques or a set of 00:08:46.970 --> 00:08:49.211 interventions or philosophy 00:08:49.292 --> 00:08:50.793 that I really endorse and 00:08:51.543 --> 00:08:54.366 then it behooves me to study that well, 00:08:54.466 --> 00:08:56.369 become good at that system. 00:08:56.909 --> 00:08:59.072 That improves my confidence in that system, 00:08:59.131 --> 00:09:01.014 which then helps drive your 00:09:01.053 --> 00:09:02.654 perception of my competence 00:09:02.735 --> 00:09:04.277 and helps build these interactions. 00:09:05.197 --> 00:09:07.240 So that's kind of where I've ended up, 00:09:07.440 --> 00:09:09.663 that as long as I endorse a system, 00:09:11.077 --> 00:09:12.399 and I've practiced that, 00:09:13.461 --> 00:09:14.522 then that's going to 00:09:14.542 --> 00:09:16.744 improve the outcomes that we have. 00:09:17.384 --> 00:09:18.885 And I think as I have talked 00:09:18.946 --> 00:09:19.907 to other people, 00:09:20.928 --> 00:09:23.370 that certainly there's not 00:09:23.410 --> 00:09:24.972 many people just in my 00:09:25.253 --> 00:09:27.956 circle of acquaintances and 00:09:28.015 --> 00:09:30.519 peers that endorse just a single system. 00:09:31.971 --> 00:09:33.011 There's many of them that 00:09:33.072 --> 00:09:34.633 will use elements of 00:09:35.373 --> 00:09:37.153 different theories and philosophies. 00:09:37.695 --> 00:09:38.796 They practice those, 00:09:38.895 --> 00:09:40.317 perhaps trained with the 00:09:40.616 --> 00:09:41.657 developers of those, 00:09:42.258 --> 00:09:44.318 and become confident in using them. 00:09:45.840 --> 00:09:48.381 So I think I kind of danced 00:09:48.442 --> 00:09:49.442 around your question there 00:09:49.482 --> 00:09:51.663 about is one system better than another. 00:09:51.803 --> 00:09:52.965 I think you just choose what 00:09:53.004 --> 00:09:54.245 system that you really like 00:09:54.566 --> 00:09:56.407 and get good at that by 00:09:56.466 --> 00:09:57.488 studying practice. 00:09:59.619 --> 00:09:59.839 Now, 00:10:00.480 --> 00:10:01.500 most of what we've been talking about 00:10:01.559 --> 00:10:05.562 is ideas and concepts, but is there a, 00:10:05.602 --> 00:10:07.043 this is all around people, right? 00:10:07.105 --> 00:10:07.284 I mean, 00:10:07.304 --> 00:10:08.184 you study these things to be able 00:10:08.205 --> 00:10:08.765 to help and make a 00:10:08.806 --> 00:10:09.787 difference in people's lives. 00:10:10.287 --> 00:10:11.908 Is there a particular case? 00:10:11.947 --> 00:10:12.447 Is there something that 00:10:12.489 --> 00:10:14.210 comes to mind where if you 00:10:14.230 --> 00:10:16.130 had to show the benefit of 00:10:16.250 --> 00:10:17.172 manual therapy and the 00:10:17.211 --> 00:10:18.133 techniques you've studied 00:10:18.153 --> 00:10:19.774 has made a significant difference? 00:10:19.953 --> 00:10:20.573 Is there something that 00:10:20.614 --> 00:10:21.115 comes to mind that you 00:10:21.134 --> 00:10:23.056 could actually put a face to? 00:10:24.857 --> 00:10:25.898 There's a couple. 00:10:25.918 --> 00:10:26.938 There's a couple. 00:10:27.539 --> 00:10:27.980 I'd say two. 00:10:28.720 --> 00:10:30.301 When I think about this, 00:10:31.761 --> 00:10:34.563 the person that I remember the most, 00:10:34.583 --> 00:10:35.725 that's part of the bias 00:10:35.764 --> 00:10:37.725 with this sort of recall stuff, 00:10:37.806 --> 00:10:38.746 is I remember the people 00:10:38.767 --> 00:10:39.907 who did really well, 00:10:40.027 --> 00:10:41.828 I remember the people who did not do well, 00:10:41.849 --> 00:10:42.969 and there's a group in the 00:10:43.028 --> 00:10:44.910 middle that I don't really remember. 00:10:45.831 --> 00:10:47.251 But a person I remember doing really, 00:10:47.272 --> 00:10:48.613 really well had headaches 00:10:48.653 --> 00:10:49.874 and a facial pain, 00:10:49.933 --> 00:10:51.455 and we were doing a few things, 00:10:51.495 --> 00:10:52.855 and then it wasn't until I... 00:10:54.394 --> 00:10:56.716 did a upper cervical manual 00:10:56.796 --> 00:10:58.457 technique that that 00:10:58.518 --> 00:10:59.458 particular person 00:10:59.519 --> 00:11:00.779 experienced or at least 00:11:00.860 --> 00:11:03.984 reported great relief to the orofacial. 00:11:06.020 --> 00:11:07.121 And I remember that that 00:11:07.162 --> 00:11:08.643 happened decades ago. 00:11:08.943 --> 00:11:10.404 And just remember that sort 00:11:10.485 --> 00:11:11.706 of person getting up off 00:11:11.745 --> 00:11:12.927 the table and say, oh, 00:11:13.027 --> 00:11:15.208 that feels so much better. 00:11:16.210 --> 00:11:17.932 We went on to do lots of other things, 00:11:17.991 --> 00:11:19.232 but it was just that 00:11:19.332 --> 00:11:21.895 particular technique that we did, I think, 00:11:22.976 --> 00:11:24.077 met a bunch of different 00:11:24.118 --> 00:11:26.159 needs and caused a big difference. 00:11:27.801 --> 00:11:29.121 Another person, if I may, 00:11:29.383 --> 00:11:30.844 that I remember a lot is a 00:11:34.010 --> 00:11:36.932 A colleague of mine had had, I don't know, 00:11:36.993 --> 00:11:39.634 long-term neck and thoracic pain. 00:11:39.815 --> 00:11:41.035 She got some shoulder pain, 00:11:41.096 --> 00:11:43.357 and she'd been going to see 00:11:43.418 --> 00:11:46.080 some people for a set of 00:11:46.120 --> 00:11:48.461 interventions that weren't 00:11:48.522 --> 00:11:49.481 working for her. 00:11:49.923 --> 00:11:50.822 And, you know, 00:11:50.903 --> 00:11:52.845 I had the benefit of her telling me, well, 00:11:52.884 --> 00:11:54.066 I've tried this, I've tried this, 00:11:54.145 --> 00:11:54.905 I've tried this. 00:11:54.926 --> 00:11:56.908 And so I could say, well, 00:11:57.048 --> 00:11:58.249 we won't do those because 00:11:58.269 --> 00:11:59.068 you've tried those. 00:11:59.109 --> 00:12:00.409 Let's do this. 00:12:01.629 --> 00:12:03.532 It turned out it was some 00:12:03.611 --> 00:12:05.634 simple sort of assisted movements, 00:12:05.673 --> 00:12:07.796 some thoracic patterns, 00:12:07.816 --> 00:12:09.778 some passive physiological motion. 00:12:10.138 --> 00:12:11.538 And she got up and said, oh my God, 00:12:11.558 --> 00:12:14.081 that's the best I felt in months. 00:12:15.466 --> 00:12:18.429 Um, and so those, those two stick with me, 00:12:18.470 --> 00:12:19.110 but like I said, 00:12:19.150 --> 00:12:21.131 that's a big recall bias. 00:12:21.493 --> 00:12:23.835 Um, uh, but there are two examples that, 00:12:24.054 --> 00:12:24.215 uh, 00:12:24.315 --> 00:12:27.518 people found really good immediate 00:12:27.558 --> 00:12:29.100 short-term relief and then 00:12:29.139 --> 00:12:29.941 didn't need a lot of 00:12:30.181 --> 00:12:32.182 follow-up manual treatment after that. 00:12:32.202 --> 00:12:33.043 And we were able to move 00:12:33.083 --> 00:12:34.125 into doing other things. 00:12:35.489 --> 00:12:38.389 Now, Mark, you work with students, 00:12:38.610 --> 00:12:39.690 and students always come 00:12:39.730 --> 00:12:40.811 with a lot of these things 00:12:40.850 --> 00:12:42.691 called questions and insecurities. 00:12:43.552 --> 00:12:44.971 If they're still listening right now, 00:12:45.032 --> 00:12:45.812 if you've got some either 00:12:45.873 --> 00:12:47.273 students or new grad PTs in 00:12:47.293 --> 00:12:48.052 the first three to five 00:12:48.072 --> 00:12:48.874 years of their career, 00:12:49.413 --> 00:12:50.754 where would you send them to start? 00:12:51.173 --> 00:12:52.235 They've got to start somewhere. 00:12:52.514 --> 00:12:54.054 You mentioned finding a paradigm, 00:12:54.075 --> 00:12:55.015 and the goal is to find 00:12:55.035 --> 00:12:55.875 something that works for you. 00:12:55.895 --> 00:12:56.836 It doesn't necessarily 00:12:56.875 --> 00:12:58.956 matter what it is necessarily, 00:12:58.996 --> 00:13:01.378 but where would you send them to start? 00:13:01.457 --> 00:13:04.359 What would your suggestion or advice be? 00:13:05.589 --> 00:13:07.769 I'd say to a mentor or a 00:13:07.850 --> 00:13:11.071 senior PT at wherever they're working, 00:13:12.051 --> 00:13:13.150 talk to that person about 00:13:13.171 --> 00:13:14.150 what works for you. 00:13:14.291 --> 00:13:15.932 How did you make those decisions? 00:13:16.011 --> 00:13:17.172 Why did you choose that? 00:13:18.032 --> 00:13:20.732 And then the next step is to 00:13:20.893 --> 00:13:22.594 learn a few different things. 00:13:22.673 --> 00:13:25.313 I'd say my own journey, if I may, 00:13:25.714 --> 00:13:27.434 we studied in Australia and 00:13:27.774 --> 00:13:28.754 our focus was on 00:13:29.235 --> 00:13:30.436 Maitland-oriented manual 00:13:30.456 --> 00:13:31.316 therapy techniques. 00:13:32.697 --> 00:13:34.177 Then I had the opportunity 00:13:34.557 --> 00:13:35.957 to go and work in Canada 00:13:36.057 --> 00:13:37.677 where the techniques were 00:13:37.798 --> 00:13:38.678 different and they were 00:13:38.698 --> 00:13:39.178 doing a lot of 00:13:40.139 --> 00:13:42.580 post-isometric holds and 00:13:42.659 --> 00:13:44.980 movements and some muscle energy things. 00:13:45.081 --> 00:13:48.042 And then it came to the 00:13:48.081 --> 00:13:49.562 United States and there was 00:13:49.601 --> 00:13:50.961 a whole group of soft 00:13:50.981 --> 00:13:52.442 tissue mobilization things 00:13:52.482 --> 00:13:54.123 that I had never encountered before. 00:13:54.202 --> 00:13:56.823 And so I took some of those courses. 00:13:58.225 --> 00:13:59.205 I'd say over that, 00:14:00.836 --> 00:14:03.677 couple of years um I found 00:14:03.717 --> 00:14:05.078 my favorite my favorite 00:14:05.099 --> 00:14:06.419 stayed with my base 00:14:06.480 --> 00:14:07.519 training which was the 00:14:07.720 --> 00:14:09.461 maitland and and stuck with 00:14:09.501 --> 00:14:10.861 that but I think if you 00:14:10.922 --> 00:14:12.624 have the opportunity to to 00:14:13.583 --> 00:14:15.044 try a couple of different 00:14:15.764 --> 00:14:18.807 philosophies can find one 00:14:18.826 --> 00:14:20.427 that conceptually said aha 00:14:20.467 --> 00:14:21.649 that makes a lot of sense 00:14:21.708 --> 00:14:23.890 to me then that would be 00:14:24.130 --> 00:14:25.892 where I would get you to start yeah 00:14:27.557 --> 00:14:29.798 that's a pretty big difference, right? 00:14:29.998 --> 00:14:30.918 That's international. 00:14:31.158 --> 00:14:31.879 I think a lot of the PTs, 00:14:31.938 --> 00:14:33.120 especially in the United States, 00:14:33.200 --> 00:14:34.721 aren't necessarily exposed to that. 00:14:35.721 --> 00:14:36.441 It sounds like you might 00:14:36.480 --> 00:14:39.842 recommend that because it's so different. 00:14:42.740 --> 00:14:44.282 I think I would. 00:14:45.302 --> 00:14:46.124 Philosophically, 00:14:46.203 --> 00:14:47.265 the Norwegian manual 00:14:47.306 --> 00:14:49.187 therapists are going to 00:14:49.207 --> 00:14:49.729 think a little bit 00:14:49.769 --> 00:14:52.152 differently from people who 00:14:52.272 --> 00:14:53.594 have developed their own 00:14:53.653 --> 00:14:54.615 system here in the United 00:14:54.674 --> 00:14:57.999 States versus the osteopathic origins of, 00:14:58.119 --> 00:14:59.620 say, Grieve or Maitland. 00:15:00.642 --> 00:15:02.124 And so each of those comes 00:15:02.163 --> 00:15:04.225 with a different set of 00:15:04.365 --> 00:15:06.187 sort of background philosophy, 00:15:06.386 --> 00:15:07.947 but we can debate about the 00:15:08.028 --> 00:15:08.928 accuracy of those. 00:15:08.989 --> 00:15:10.309 But their approaches are 00:15:10.330 --> 00:15:11.672 then a little bit different 00:15:11.751 --> 00:15:13.352 for how they do the techniques, 00:15:13.472 --> 00:15:15.014 combine the exercises with 00:15:15.073 --> 00:15:15.815 those techniques. 00:15:16.355 --> 00:15:18.157 And then you sort of find, 00:15:18.317 --> 00:15:19.378 it sounds as if you're saying, 00:15:19.418 --> 00:15:21.318 and find the things about 00:15:21.440 --> 00:15:22.721 those varied things that 00:15:23.120 --> 00:15:25.123 may align with you, work for you, 00:15:26.082 --> 00:15:26.864 and that's how you find 00:15:27.524 --> 00:15:28.946 your own skill set. 00:15:29.580 --> 00:15:30.039 Absolutely, 00:15:30.100 --> 00:15:32.201 I think you know Stanley Paris 00:15:32.241 --> 00:15:33.142 did a lot for manual 00:15:33.162 --> 00:15:34.062 therapy in the United 00:15:34.123 --> 00:15:35.303 States and has some great 00:15:35.364 --> 00:15:36.364 courses if people are 00:15:36.403 --> 00:15:38.524 interested in sort of joint 00:15:39.206 --> 00:15:41.167 focused things here in the United States, 00:15:41.206 --> 00:15:42.707 that's a somewhere they 00:15:42.727 --> 00:15:44.129 could start certainly the 00:15:45.289 --> 00:15:46.809 Norwegian PTs have a 00:15:46.870 --> 00:15:47.951 presence here in the United 00:15:48.030 --> 00:15:50.332 States the neurodynamic 00:15:50.393 --> 00:15:55.054 approaches Dave Butler and others 00:15:56.369 --> 00:15:57.029 of thinking about 00:15:57.090 --> 00:15:58.471 neurovascular bundle as a 00:15:58.530 --> 00:15:59.753 potential source of these 00:15:59.793 --> 00:16:01.354 type of things those are 00:16:01.374 --> 00:16:02.416 all available here in the 00:16:02.436 --> 00:16:03.876 united states for people to 00:16:04.076 --> 00:16:07.400 to try uh last thing we do 00:16:07.640 --> 00:16:08.861 on orthostatic is call 00:16:08.881 --> 00:16:10.543 words of wisdom is there 00:16:10.563 --> 00:16:11.365 something you want to leave 00:16:11.384 --> 00:16:12.525 the audience with either a 00:16:12.605 --> 00:16:13.788 soapbox statement or 00:16:13.888 --> 00:16:15.188 something that uh that you 00:16:15.249 --> 00:16:16.090 use as your mantra what do 00:16:16.110 --> 00:16:17.010 you want to leave with the 00:16:17.071 --> 00:16:17.871 audience as we exit 00:16:18.715 --> 00:16:20.076 Care about your patients. 00:16:21.155 --> 00:16:21.855 That's what I think. 00:16:22.176 --> 00:16:25.376 I think if some of our 00:16:25.476 --> 00:16:28.018 outcome is related to our relationship, 00:16:28.057 --> 00:16:29.499 then it behooves me to 00:16:30.499 --> 00:16:31.179 think about that 00:16:31.240 --> 00:16:33.701 relationship and truly care 00:16:33.880 --> 00:16:35.860 about the person in front of me. 00:16:37.461 --> 00:16:38.042 I don't know if this 00:16:38.081 --> 00:16:39.143 resonates with anybody, 00:16:39.202 --> 00:16:42.644 but I can tell if I'm not into it, 00:16:42.984 --> 00:16:46.504 if I'm maybe not having a great day, 00:16:47.105 --> 00:16:48.306 don't feel like talking, 00:16:48.990 --> 00:16:50.312 then my outcomes that day 00:16:50.351 --> 00:16:51.774 are just not as good. 00:16:51.793 --> 00:16:53.455 I don't feel good at the end of the day. 00:16:53.475 --> 00:16:54.716 The people I've seen don't 00:16:54.755 --> 00:16:56.017 necessarily feel as good. 00:16:56.097 --> 00:16:58.639 And so if I can just focus 00:16:58.700 --> 00:16:59.541 on being present, 00:17:00.221 --> 00:17:01.903 care about the person in front of me, 00:17:01.942 --> 00:17:03.283 then that goes a long way. 00:17:03.804 --> 00:17:04.664 Yeah, great words. 00:17:05.046 --> 00:17:05.705 Dr. Mark Bishop, 00:17:05.726 --> 00:17:06.727 thanks so much for stopping 00:17:06.747 --> 00:17:07.528 by on Orthostatic. 00:17:07.548 --> 00:17:08.788 You're welcome. 00:17:09.230 --> 00:17:09.529 Pleasure.