WEBVTT 00:00:03.617 --> 00:00:06.182 all right so well good 00:00:06.222 --> 00:00:07.484 afternoon I think it is 00:00:07.543 --> 00:00:09.226 jeremy in your time zone 00:00:09.266 --> 00:00:10.968 and it's uh eight thirty in 00:00:10.989 --> 00:00:12.590 the morning my time here so 00:00:12.691 --> 00:00:13.833 got a little bit of a time 00:00:13.852 --> 00:00:14.554 differential so I'll 00:00:14.593 --> 00:00:15.414 probably have different uh 00:00:16.204 --> 00:00:17.184 Hunger personalities and 00:00:17.204 --> 00:00:18.164 those kinds of things going 00:00:18.225 --> 00:00:19.585 on today with our show. 00:00:19.626 --> 00:00:22.327 But super excited to have 00:00:22.367 --> 00:00:25.068 you joining us at our AOMT 00:00:25.109 --> 00:00:26.748 conference this year and 00:00:26.949 --> 00:00:27.890 getting a chance to bring 00:00:27.929 --> 00:00:29.150 you over to the United States, 00:00:29.791 --> 00:00:31.472 bring you to sunny and 00:00:32.371 --> 00:00:33.552 hopefully not too humid and 00:00:33.593 --> 00:00:35.113 sticky Orlando, Florida. 00:00:36.435 --> 00:00:38.296 But I wanted to get an 00:00:38.356 --> 00:00:39.978 opportunity to get the 00:00:40.018 --> 00:00:40.838 attendees that will be 00:00:40.859 --> 00:00:41.859 showing up or maybe those 00:00:41.880 --> 00:00:42.960 that are considering coming 00:00:43.000 --> 00:00:44.682 to conference a chance to 00:00:44.703 --> 00:00:45.764 get to know you before you 00:00:45.823 --> 00:00:46.865 actually present our 00:00:46.984 --> 00:00:48.265 keynote and also our 00:00:48.345 --> 00:00:50.889 pre-conference course to 00:00:50.908 --> 00:00:52.831 our attendees by doing this show. 00:00:52.850 --> 00:00:53.691 So thank you very much for 00:00:53.750 --> 00:00:57.234 joining us today. 00:00:57.274 --> 00:00:58.256 It's my absolute pleasure 00:00:58.415 --> 00:01:00.258 and it's a great honor for me. 00:01:01.334 --> 00:01:02.875 Yeah, yeah, no, we're super excited. 00:01:02.914 --> 00:01:03.674 I know a lot of the people 00:01:03.695 --> 00:01:05.016 that I've talked to that 00:01:05.036 --> 00:01:06.477 are going to conference are 00:01:06.736 --> 00:01:07.936 really pumped to get to 00:01:07.977 --> 00:01:10.097 hear from you as well as 00:01:10.117 --> 00:01:11.418 the other keynote presenters. 00:01:12.138 --> 00:01:13.079 So, you know, 00:01:13.140 --> 00:01:13.879 I know a lot of people 00:01:13.920 --> 00:01:15.820 probably they know your work. 00:01:15.840 --> 00:01:16.501 They obviously know your 00:01:16.521 --> 00:01:17.302 work is probably in the 00:01:17.361 --> 00:01:18.942 shoulder and that sort of thing. 00:01:18.962 --> 00:01:20.222 But can you give our 00:01:20.263 --> 00:01:21.123 listeners a little bit 00:01:21.164 --> 00:01:22.944 about your journey that 00:01:22.965 --> 00:01:23.924 kind of led you to 00:01:24.876 --> 00:01:26.558 down your career path, if you will. 00:01:26.878 --> 00:01:28.879 I'm sure you've given this quite a bit, 00:01:29.058 --> 00:01:30.400 and you have a little bit 00:01:30.439 --> 00:01:31.280 of an elevator pitch, 00:01:31.379 --> 00:01:32.921 but just your journey that 00:01:32.960 --> 00:01:33.841 got you to this point. 00:01:36.063 --> 00:01:37.403 Well, each time I get asked to do this, 00:01:37.462 --> 00:01:38.183 I give a completely 00:01:38.224 --> 00:01:39.784 different story because I'm 00:01:39.844 --> 00:01:41.626 just trying to keep one 00:01:41.665 --> 00:01:42.865 step ahead of everybody else, 00:01:42.926 --> 00:01:44.206 but I'll try and be consistent. 00:01:45.027 --> 00:01:46.867 So I was originally born in New Zealand, 00:01:46.908 --> 00:01:47.588 grew up in New Zealand, 00:01:47.608 --> 00:01:48.569 had a wonderful childhood, 00:01:50.049 --> 00:01:52.271 moved to Australia as a teenager, 00:01:52.909 --> 00:01:53.891 struggled to try and work 00:01:53.971 --> 00:01:56.132 out what I wanted to do as a career, 00:01:56.332 --> 00:01:57.953 eventually settled on physio. 00:01:58.593 --> 00:01:59.694 Ten years after I finished 00:02:00.456 --> 00:02:01.537 undergraduate training, 00:02:01.576 --> 00:02:02.417 I did the one year 00:02:02.858 --> 00:02:04.759 manipulative manual therapy training. 00:02:04.899 --> 00:02:06.599 Jeff Malan was one of our teachers, 00:02:06.620 --> 00:02:07.840 so a great privilege of 00:02:08.361 --> 00:02:09.141 learning from him. 00:02:09.622 --> 00:02:10.823 And then a year after that, 00:02:11.183 --> 00:02:14.026 I did a one year sports 00:02:14.045 --> 00:02:15.467 physiotherapy course in 00:02:15.546 --> 00:02:18.229 Western Australia and 00:02:18.808 --> 00:02:19.949 twenty four years ago moved 00:02:19.969 --> 00:02:20.751 to the United Kingdom. 00:02:20.770 --> 00:02:22.192 The plan was to move here for a year. 00:02:22.847 --> 00:02:24.627 but really enjoyed living 00:02:24.668 --> 00:02:26.949 here and finished here 00:02:26.968 --> 00:02:31.051 another diploma in biomechanics. 00:02:31.931 --> 00:02:33.013 The scope of practice in the 00:02:33.032 --> 00:02:34.073 United Kingdom when I got 00:02:34.112 --> 00:02:38.376 here was rapidly changing. 00:02:38.455 --> 00:02:40.856 And soon after I got here, physios, 00:02:40.896 --> 00:02:42.217 physical therapists were allowed to 00:02:43.078 --> 00:02:43.919 refer patients for any 00:02:44.019 --> 00:02:45.819 imaging blood tests etc 00:02:45.919 --> 00:02:47.341 then we were allowed to 00:02:47.480 --> 00:02:49.002 train to do injections soft 00:02:49.021 --> 00:02:50.462 tissue and joint injections 00:02:51.063 --> 00:02:52.805 I did an extra year or so 00:02:52.925 --> 00:02:54.466 to become a to be able to 00:02:54.506 --> 00:02:55.706 use diagnostic ultrasound 00:02:55.727 --> 00:02:57.828 in clinical practice I 00:02:57.867 --> 00:02:58.848 don't use diagnostic 00:02:58.908 --> 00:02:59.830 ultrasound so much for 00:02:59.870 --> 00:03:01.170 diagnosis but I do use it 00:03:01.191 --> 00:03:02.230 for ultrasound guided 00:03:02.270 --> 00:03:03.872 injections for frozen 00:03:03.913 --> 00:03:05.674 shoulders which is clinical 00:03:05.713 --> 00:03:06.854 interest research interest 00:03:07.751 --> 00:03:10.313 And, uh, I believe it was, 00:03:10.334 --> 00:03:11.355 they changed the law again 00:03:11.395 --> 00:03:13.418 with an extra almost years training. 00:03:13.457 --> 00:03:14.318 We were allowed to prescribe 00:03:14.359 --> 00:03:15.881 any medicine that there was 00:03:15.901 --> 00:03:17.163 an evidence base for that 00:03:17.182 --> 00:03:18.645 could support clinical practice. 00:03:18.705 --> 00:03:20.387 So it's been a really 00:03:20.407 --> 00:03:21.407 interesting evolution. 00:03:21.487 --> 00:03:23.971 I still firmly believe that 00:03:24.031 --> 00:03:25.712 the most important, um, 00:03:27.923 --> 00:03:29.343 management that I can 00:03:29.383 --> 00:03:30.824 provide with patients with 00:03:31.264 --> 00:03:31.943 non-traumatic 00:03:32.163 --> 00:03:33.444 musculoskeletal shoulder 00:03:33.485 --> 00:03:36.224 problems is the traditional physiotherapy, 00:03:36.245 --> 00:03:37.906 physical therapy interventions. 00:03:37.925 --> 00:03:41.586 It certainly, from a risk point of view, 00:03:41.646 --> 00:03:43.787 a harms point of view, it's much safer, 00:03:44.067 --> 00:03:45.108 probably more effective 00:03:45.168 --> 00:03:49.808 than injection therapy and pharmacology. 00:03:49.968 --> 00:03:51.329 So I don't think we're in 00:03:51.389 --> 00:03:52.370 any way offering second 00:03:52.389 --> 00:03:53.810 best treatment with what we offer. 00:03:55.163 --> 00:03:56.704 So that's more or less what I do. 00:03:56.743 --> 00:03:58.463 I do two and a half days a week clinically, 00:03:58.503 --> 00:03:59.384 and I work two and a half 00:03:59.405 --> 00:04:00.604 days a week in research, 00:04:01.626 --> 00:04:02.705 doing my own research and 00:04:02.725 --> 00:04:04.247 supporting ten PhD students 00:04:04.287 --> 00:04:04.947 around the world. 00:04:05.586 --> 00:04:06.288 And I also have the 00:04:06.307 --> 00:04:08.808 privilege of teaching a shoulder course, 00:04:08.848 --> 00:04:09.848 which I've just come back 00:04:09.868 --> 00:04:12.289 from teaching in Korea, Hong Kong, 00:04:12.330 --> 00:04:14.730 Kuala Lumpur, and two courses in India. 00:04:14.830 --> 00:04:17.512 So please excuse the black under my eyes. 00:04:17.672 --> 00:04:20.432 It's jet lag and my voice is gone as well. 00:04:20.492 --> 00:04:21.593 So please excuse that. 00:04:22.367 --> 00:04:23.490 No, that is totally okay. 00:04:23.509 --> 00:04:24.170 I understood. 00:04:24.189 --> 00:04:25.151 Maybe I don't understand 00:04:25.172 --> 00:04:26.093 because I don't quite have 00:04:26.112 --> 00:04:27.795 that same level of a travel 00:04:27.834 --> 00:04:29.355 and teaching schedule for sure. 00:04:29.396 --> 00:04:30.757 But, you know, 00:04:30.798 --> 00:04:31.759 it's interesting that you... 00:04:31.798 --> 00:04:32.961 You're a lucky man. 00:04:35.863 --> 00:04:36.725 You know, 00:04:36.764 --> 00:04:38.206 fascinating background and 00:04:38.225 --> 00:04:39.206 fascinating history. 00:04:39.826 --> 00:04:40.607 It's interesting, too. 00:04:40.627 --> 00:04:41.367 I think we could probably 00:04:41.387 --> 00:04:42.509 have a lot of conversations, 00:04:42.588 --> 00:04:43.408 side conversation, 00:04:43.449 --> 00:04:45.870 just in terms of scope of practices, 00:04:45.911 --> 00:04:46.490 differences, 00:04:46.531 --> 00:04:47.572 and I'm sure that you've seen 00:04:47.651 --> 00:04:50.334 it in your travels throughout the world, 00:04:50.473 --> 00:04:52.915 you know, what certain physios can do. 00:04:53.596 --> 00:04:54.757 in certain countries. 00:04:54.817 --> 00:04:56.497 And that probably impacts a 00:04:56.536 --> 00:04:57.237 little bit of the way that 00:04:57.257 --> 00:04:58.017 you teach and manage. 00:04:58.038 --> 00:04:59.158 But I really appreciate that 00:04:59.218 --> 00:05:00.999 you mentioned that you 00:05:01.059 --> 00:05:02.040 firmly believe our 00:05:02.079 --> 00:05:04.920 traditional methods of physical therapy, 00:05:05.201 --> 00:05:05.380 you know, 00:05:05.401 --> 00:05:07.221 are really what matters the most. 00:05:07.281 --> 00:05:08.641 But it'd be fascinating to 00:05:08.701 --> 00:05:10.283 just even hear like at some point, 00:05:10.322 --> 00:05:12.324 not necessarily today, but, you know, 00:05:12.343 --> 00:05:13.264 just how that scope of 00:05:13.303 --> 00:05:14.925 practice looks in the UK, 00:05:14.964 --> 00:05:15.725 because I know the United 00:05:15.764 --> 00:05:17.005 States certainly is 00:05:18.045 --> 00:05:19.406 leaning into a lot of those 00:05:20.026 --> 00:05:21.427 sort of advanced practice 00:05:21.447 --> 00:05:23.288 skill sets within our own 00:05:23.327 --> 00:05:23.947 industry that it's 00:05:23.987 --> 00:05:26.288 obviously met with a lot of resistance, 00:05:26.348 --> 00:05:28.209 but that would be a fascinating topic. 00:05:28.668 --> 00:05:30.069 So I'm curious, 00:05:30.290 --> 00:05:31.870 and then I'm super excited 00:05:31.910 --> 00:05:32.810 also that you know, 00:05:32.891 --> 00:05:34.870 you you learn from Jeff Maitland, 00:05:35.031 --> 00:05:38.172 I know that that will ring, you know, 00:05:38.211 --> 00:05:40.132 true to a lot of our attendees. 00:05:40.870 --> 00:05:42.093 at AOMP conference. 00:05:43.153 --> 00:05:45.297 But more importantly, I was curious, 00:05:45.336 --> 00:05:47.959 how did you end up in the shoulder? 00:05:48.500 --> 00:05:50.583 I think everybody kind of has their ways. 00:05:50.603 --> 00:05:51.624 They may end up with low 00:05:51.644 --> 00:05:53.165 back as kind of their focus. 00:05:53.185 --> 00:05:54.908 Some people end up in the foot, 00:05:55.749 --> 00:05:56.430 in the neck. 00:05:57.011 --> 00:05:58.132 You ended up in the shoulder. 00:05:58.473 --> 00:05:59.293 How did you get there? 00:06:02.747 --> 00:06:06.009 It's sort of a bit like that movie, 00:06:06.028 --> 00:06:06.769 I don't know if you've seen it, 00:06:06.788 --> 00:06:12.391 the one with Gwyneth Paltrow, 00:06:13.271 --> 00:06:14.310 I forgot the name of it actually, 00:06:14.331 --> 00:06:15.572 but Sliding Doors, 00:06:15.591 --> 00:06:16.492 you might not have seen it. 00:06:16.711 --> 00:06:20.252 It's sort of, it's a movie where a person, 00:06:21.673 --> 00:06:22.774 half the movie is a person 00:06:22.834 --> 00:06:24.154 goes into the sliding door 00:06:24.214 --> 00:06:25.514 of an underground train in 00:06:25.555 --> 00:06:26.595 London and the other half 00:06:26.675 --> 00:06:28.076 is she doesn't meet the 00:06:28.857 --> 00:06:29.817 quite make the draw. 00:06:29.956 --> 00:06:31.317 So what happens in her life 00:06:31.338 --> 00:06:32.237 when you go down these two 00:06:32.257 --> 00:06:33.598 different opportunities 00:06:33.639 --> 00:06:36.259 separated by a few milliseconds, really? 00:06:38.281 --> 00:06:41.982 I wanted actually to 00:06:42.661 --> 00:06:43.983 specialize in an area. 00:06:44.682 --> 00:06:45.762 At the point in time when I 00:06:45.783 --> 00:06:47.204 was about to start my PhD, 00:06:47.384 --> 00:06:49.024 everybody was doing low back pain. 00:06:49.204 --> 00:06:51.105 Everybody was doing knee pain, hip pain. 00:06:51.646 --> 00:06:52.865 So I thought I'd go as far 00:06:52.906 --> 00:06:53.805 south as I could. 00:06:57.394 --> 00:06:59.276 and try and become as expert 00:06:59.295 --> 00:07:01.177 as I could managing feet problems. 00:07:03.237 --> 00:07:04.718 But I was really interested 00:07:05.019 --> 00:07:06.759 in the concept of posture 00:07:07.040 --> 00:07:07.761 and I was also very 00:07:07.781 --> 00:07:08.740 interested in the concept 00:07:08.821 --> 00:07:11.242 of subacromial impingement syndrome. 00:07:11.682 --> 00:07:12.942 So I decided my great 00:07:12.983 --> 00:07:14.043 contribution to the world 00:07:14.064 --> 00:07:15.144 would be to demonstrate how 00:07:15.204 --> 00:07:16.745 posture causes subacromial 00:07:16.766 --> 00:07:18.425 impingement and how when we 00:07:18.446 --> 00:07:19.286 improve posture, 00:07:19.786 --> 00:07:22.329 it reduces or alleviates the symptoms. 00:07:23.288 --> 00:07:25.810 and um three years later I'm 00:07:25.970 --> 00:07:29.129 uh probably my most 00:07:29.170 --> 00:07:30.269 confused person on the 00:07:30.290 --> 00:07:31.370 planet thinking that well 00:07:31.391 --> 00:07:32.391 there's absolutely no 00:07:32.451 --> 00:07:33.391 evidence for postural 00:07:33.411 --> 00:07:35.411 theory that we follow so 00:07:35.430 --> 00:07:36.891 strongly and there's no 00:07:36.951 --> 00:07:37.891 such condition as 00:07:37.932 --> 00:07:39.072 subacromial impingement 00:07:39.091 --> 00:07:40.692 syndrome and I think that 00:07:40.853 --> 00:07:42.692 uh subsequent our 00:07:42.752 --> 00:07:43.932 subsequent research and 00:07:44.012 --> 00:07:45.052 research and many others 00:07:45.093 --> 00:07:46.653 has has demonstrated that's 00:07:46.694 --> 00:07:48.613 the case that um the the 00:07:48.653 --> 00:07:49.994 postural beliefs we have in 00:07:50.053 --> 00:07:51.355 our profession um we're 00:07:51.375 --> 00:07:52.675 probably just disabling people 00:07:53.262 --> 00:07:55.624 by telling them how bad poor 00:07:55.644 --> 00:07:57.543 their posture is, their muscle imbalances, 00:07:57.624 --> 00:07:58.064 and, you know, 00:07:58.184 --> 00:07:58.963 asking them if they're 00:07:58.983 --> 00:08:01.064 related to Quasimodo. 00:08:01.345 --> 00:08:02.105 So, you know, 00:08:03.185 --> 00:08:06.185 so I think my PhD sort of 00:08:06.206 --> 00:08:07.505 blew that out of the water. 00:08:07.586 --> 00:08:09.887 And also it confused me 00:08:09.987 --> 00:08:11.726 knowing that this condition 00:08:11.747 --> 00:08:13.208 that everybody was saying 00:08:13.228 --> 00:08:13.788 is the most common 00:08:13.827 --> 00:08:14.728 condition of the shoulder, 00:08:14.747 --> 00:08:16.149 impingement syndrome, 00:08:16.168 --> 00:08:17.468 probably didn't exist. 00:08:17.548 --> 00:08:20.170 And I guess as a consequence of that, 00:08:21.069 --> 00:08:21.670 I tried to, 00:08:22.850 --> 00:08:23.711 think, well, okay, well, 00:08:23.750 --> 00:08:24.812 my first plan didn't work, 00:08:24.853 --> 00:08:26.074 but just stay with the 00:08:26.113 --> 00:08:27.375 shoulder and see what I can 00:08:27.435 --> 00:08:28.918 contribute with clinical 00:08:28.978 --> 00:08:30.680 knowledge and research knowledge. 00:08:30.740 --> 00:08:32.783 And that's where I got to. 00:08:33.003 --> 00:08:33.644 That's where I am. 00:08:35.265 --> 00:08:35.706 That's great. 00:08:35.726 --> 00:08:35.947 So, 00:08:37.168 --> 00:08:38.910 so the things like upper cross syndrome 00:08:38.931 --> 00:08:39.951 probably drive you nuts at 00:08:39.971 --> 00:08:40.592 this point now. 00:08:43.600 --> 00:08:45.582 I think what we're doing by 00:08:45.623 --> 00:08:47.124 perpetuating some of these 00:08:47.604 --> 00:08:49.946 clinical beliefs is just 00:08:49.985 --> 00:08:51.126 continuing to disable 00:08:51.147 --> 00:08:52.368 people who are seeking care 00:08:53.168 --> 00:08:54.688 and by telling them they've 00:08:54.708 --> 00:08:55.990 got impingement or telling 00:08:56.009 --> 00:08:56.471 them they've got 00:08:56.551 --> 00:08:58.111 subacromial pain syndrome, 00:08:58.152 --> 00:09:00.494 which is a meaningless, in my opinion, 00:09:00.514 --> 00:09:01.855 a meaningless diagnosis 00:09:01.894 --> 00:09:03.235 because then people ask, well, 00:09:04.115 --> 00:09:05.537 what what's the subacromion 00:09:05.576 --> 00:09:07.097 and then you talk about the 00:09:07.118 --> 00:09:08.138 structures in it and then 00:09:08.177 --> 00:09:09.719 you talk about well what 00:09:09.739 --> 00:09:11.399 could be causing harm or 00:09:11.740 --> 00:09:12.821 damage those structures I 00:09:12.860 --> 00:09:14.381 think that's another 00:09:14.581 --> 00:09:16.663 meaningless term we you 00:09:16.962 --> 00:09:18.443 give to patients and you're 00:09:18.464 --> 00:09:19.583 sort of asking or who's 00:09:19.625 --> 00:09:21.765 benefiting from labeling a 00:09:21.806 --> 00:09:23.366 term like that and to me it 00:09:23.386 --> 00:09:26.467 makes as as nonsensical as 00:09:26.668 --> 00:09:29.210 superhumeral pain syndrome so um 00:09:30.053 --> 00:09:31.195 So I think, you know, 00:09:31.215 --> 00:09:31.995 labeling people with 00:09:32.035 --> 00:09:33.658 pathoanatomical diagnosis 00:09:33.778 --> 00:09:36.059 is very harmful and telling 00:09:36.100 --> 00:09:37.301 people poor posture, 00:09:37.341 --> 00:09:38.942 and it makes it easy for us 00:09:38.962 --> 00:09:39.943 to explain symptoms. 00:09:39.964 --> 00:09:40.644 But the truth is, 00:09:40.664 --> 00:09:41.885 we've got really no basis 00:09:41.926 --> 00:09:44.969 for a lot of what we say in 00:09:45.009 --> 00:09:46.009 clinical practice. 00:09:46.090 --> 00:09:47.971 And I love medical, I love history, 00:09:47.991 --> 00:09:49.113 and I love medical history. 00:09:49.754 --> 00:09:51.095 And I've always tried to 00:09:51.134 --> 00:09:52.496 make an effort to go back to 00:09:53.562 --> 00:09:55.023 where some of these theories 00:09:55.182 --> 00:09:56.663 started from and how they 00:09:57.563 --> 00:09:59.404 snowballed or avalanched or 00:10:00.004 --> 00:10:01.225 how they perpetuated. 00:10:01.304 --> 00:10:04.105 And very often it's just, I guess, 00:10:04.126 --> 00:10:05.047 a couple of people had a 00:10:05.567 --> 00:10:07.528 couple of vodkas and had a thought 00:10:08.259 --> 00:10:10.782 or whatever the favorite tipple was, 00:10:10.802 --> 00:10:11.903 the drink was at that stage 00:10:11.962 --> 00:10:13.565 and came up with an idea 00:10:13.625 --> 00:10:14.985 and it just snowballed. 00:10:15.005 --> 00:10:15.706 That's probably what 00:10:15.725 --> 00:10:16.486 happened with postural 00:10:16.506 --> 00:10:18.008 theory sort of starting in Germany, 00:10:18.028 --> 00:10:19.048 a hundred and fifty years ago. 00:10:19.549 --> 00:10:22.792 It just sort of became existentially, 00:10:23.052 --> 00:10:23.773 that's the wrong word, 00:10:23.832 --> 00:10:24.994 but it became very 00:10:25.033 --> 00:10:29.398 increasingly a sort of myth 00:10:29.437 --> 00:10:30.879 build upon myth, build upon myth. 00:10:30.899 --> 00:10:31.840 And then it became fact. 00:10:31.919 --> 00:10:32.821 And I think that's the same 00:10:32.860 --> 00:10:36.524 for many medical, many 00:10:37.046 --> 00:10:37.926 conditions such as 00:10:37.966 --> 00:10:39.167 impingement syndrome as well. 00:10:39.187 --> 00:10:39.986 Because if you go back to 00:10:40.006 --> 00:10:40.908 the original paper in 00:10:40.927 --> 00:10:41.927 nineteen seventy two, 00:10:42.369 --> 00:10:43.448 Charles Near's original 00:10:43.489 --> 00:10:46.190 paper and you read it today, you'd say, 00:10:46.210 --> 00:10:47.230 well, hang on a second. 00:10:47.250 --> 00:10:49.011 This is just reading like a blog. 00:10:49.072 --> 00:10:50.611 This isn't a scientific paper. 00:10:51.493 --> 00:10:52.972 This is an opinion piece. 00:10:52.993 --> 00:10:54.053 This is what I've been doing. 00:10:54.073 --> 00:10:55.014 This is what I'm believing. 00:10:55.053 --> 00:10:56.335 This is what I'm suggesting. 00:10:57.054 --> 00:10:58.495 But I guess in the nineteen seventies, 00:10:58.515 --> 00:10:59.255 there was no such thing as 00:10:59.275 --> 00:11:01.297 a blog and it became a fact. 00:11:01.537 --> 00:11:02.738 But because of that blog, 00:11:02.778 --> 00:11:04.239 millions of people around 00:11:04.278 --> 00:11:05.139 the world and probably 00:11:05.791 --> 00:11:08.052 many thousands of people around the world, 00:11:08.111 --> 00:11:09.873 including in your country 00:11:09.932 --> 00:11:10.874 and in the United Kingdom 00:11:10.913 --> 00:11:11.913 and many others today, 00:11:12.414 --> 00:11:14.635 are having a subacromial decompression, 00:11:14.716 --> 00:11:14.936 which 00:11:15.865 --> 00:11:17.085 has clearly shown not to 00:11:17.144 --> 00:11:18.566 outperform placebo surgery 00:11:18.586 --> 00:11:19.966 and clearly shown with 00:11:20.005 --> 00:11:21.946 ten-year follow-ups not to 00:11:21.985 --> 00:11:24.966 outperform an exercise 00:11:25.006 --> 00:11:26.466 manual therapy approach. 00:11:27.826 --> 00:11:32.668 It's just adding expense to healthcare, 00:11:32.847 --> 00:11:34.249 reducing its sustainability, 00:11:34.288 --> 00:11:37.048 but it was started by basically a blog. 00:11:37.349 --> 00:11:39.149 And, yeah, so... 00:11:40.611 --> 00:11:41.533 And I think a lot of the 00:11:41.552 --> 00:11:42.413 elective surgery that 00:11:42.452 --> 00:11:43.394 happens on the shoulders, 00:11:43.413 --> 00:11:44.934 whether it's rotator cuff repairs, 00:11:45.495 --> 00:11:47.697 whether it's type two slap lesions, 00:11:47.777 --> 00:11:49.138 biceps tenodesis, 00:11:49.957 --> 00:11:52.799 so much of it is these 00:11:52.860 --> 00:11:53.941 elective surgeries that we 00:11:53.980 --> 00:11:55.101 think we're fixing problems 00:11:55.142 --> 00:11:58.443 with are clearly not 00:11:58.604 --> 00:11:59.985 outperforming placebos. 00:12:00.065 --> 00:12:02.846 And we have to ask ourselves, 00:12:04.488 --> 00:12:05.688 in whose best interest are 00:12:05.708 --> 00:12:07.570 these procedures being performed for? 00:12:08.331 --> 00:12:10.351 And, you know, follow the money sometimes. 00:12:11.980 --> 00:12:12.580 Yeah, you know, 00:12:12.620 --> 00:12:15.020 and I really appreciate all 00:12:15.041 --> 00:12:15.441 those thoughts. 00:12:15.480 --> 00:12:16.761 Actually, the history behind it, 00:12:16.782 --> 00:12:20.202 I'm going to have to go and look at that. 00:12:20.243 --> 00:12:22.864 Because obviously we 00:12:22.903 --> 00:12:24.245 resource that quite a bit. 00:12:24.705 --> 00:12:26.384 When I talk to PTs, you know, 00:12:26.424 --> 00:12:27.706 I think one of the things 00:12:27.745 --> 00:12:29.846 that always frustrates, you know, 00:12:30.106 --> 00:12:30.907 a physical therapist. 00:12:31.206 --> 00:12:32.567 So the example I give is. 00:12:33.668 --> 00:12:34.389 what do you do when a 00:12:34.428 --> 00:12:35.649 patient comes in and they say, 00:12:35.889 --> 00:12:37.652 I've got a herniated disc 00:12:37.711 --> 00:12:39.173 and it's causing my low back pain? 00:12:39.192 --> 00:12:40.173 Well, as a physical therapist, 00:12:40.214 --> 00:12:42.115 we're quick to jump in and say, well, 00:12:42.134 --> 00:12:44.317 it can't be your disc. 00:12:44.616 --> 00:12:45.317 There's so many people that 00:12:45.337 --> 00:12:46.578 are healthy that have healthy discs. 00:12:46.619 --> 00:12:47.239 There's people that are 00:12:47.278 --> 00:12:48.259 unhealthy that don't have healthy, 00:12:48.320 --> 00:12:49.160 so on and so forth. 00:12:49.181 --> 00:12:50.662 And so we jump onto that bandwagon. 00:12:50.701 --> 00:12:52.462 Yet, a few minutes later, 00:12:52.503 --> 00:12:53.244 we're quick to say 00:12:53.283 --> 00:12:54.705 something along the lines of, well, 00:12:54.725 --> 00:12:55.966 your posture is this. 00:12:55.985 --> 00:12:56.606 It's like, 00:12:57.366 --> 00:12:58.947 So almost like the physios 00:12:58.967 --> 00:13:01.690 version of a herniated disc, right? 00:13:01.710 --> 00:13:02.769 So like kind of talking 00:13:02.789 --> 00:13:04.291 about both sides of our mouths, which, 00:13:04.311 --> 00:13:04.850 you know, 00:13:04.870 --> 00:13:06.032 I certainly understand it's hard 00:13:06.052 --> 00:13:09.474 to get those, it's hard to, you know, 00:13:09.553 --> 00:13:11.414 untangle some of that mess 00:13:11.434 --> 00:13:13.716 that has been provided to 00:13:13.775 --> 00:13:15.277 us over the course of time. 00:13:15.317 --> 00:13:15.856 But yeah. 00:13:15.898 --> 00:13:17.899 Yeah, 00:13:17.918 --> 00:13:19.779 that's such an interesting reflection. 00:13:19.799 --> 00:13:21.179 You're a hundred percent right. 00:13:21.380 --> 00:13:23.461 You know, we, we, 00:13:24.446 --> 00:13:25.687 think that some of the 00:13:25.966 --> 00:13:27.128 medical diagnoses that are 00:13:27.168 --> 00:13:28.690 given are just so ridiculous, 00:13:28.730 --> 00:13:29.870 but then we just label 00:13:29.910 --> 00:13:30.751 people with other 00:13:30.772 --> 00:13:32.232 ridiculous diagnoses or 00:13:32.613 --> 00:13:33.894 explanations for symptoms. 00:13:33.974 --> 00:13:35.696 And I think one of the worst 00:13:35.735 --> 00:13:37.317 things we can do is just to 00:13:37.336 --> 00:13:38.899 confuse people seeking care 00:13:38.938 --> 00:13:42.481 more by denigrating somebody else's 00:13:43.783 --> 00:13:46.024 I'd never say to a patient, you know, 00:13:46.043 --> 00:13:46.923 it's ridiculous you've been 00:13:46.943 --> 00:13:48.884 given a diagnosis of impingement syndrome, 00:13:48.943 --> 00:13:50.384 or it's ridiculous that 00:13:50.924 --> 00:13:51.565 you've been told your 00:13:51.585 --> 00:13:53.065 symptoms are coming from your tear. 00:13:53.304 --> 00:13:55.025 This thing that's cruel to 00:13:55.066 --> 00:13:58.027 people seeking care, you know, 00:13:58.047 --> 00:14:01.167 that we all need to speak with one voice, 00:14:01.246 --> 00:14:02.927 but the one voice we speak 00:14:02.947 --> 00:14:05.268 with needs to be an honest voice. 00:14:05.307 --> 00:14:06.308 And I'm not sure that's 00:14:06.349 --> 00:14:07.869 happening in 00:14:08.208 --> 00:14:09.889 musculoskeletal practice 00:14:10.070 --> 00:14:10.730 around the world. 00:14:12.287 --> 00:14:12.626 Yeah, 00:14:12.947 --> 00:14:14.288 and I think there's a lot more we 00:14:14.308 --> 00:14:15.529 could be doing within our 00:14:15.570 --> 00:14:17.291 profession and between professions, 00:14:17.532 --> 00:14:18.653 reminding ourselves that 00:14:19.072 --> 00:14:20.094 the most important person 00:14:20.134 --> 00:14:21.134 in healthcare is not the 00:14:21.174 --> 00:14:23.116 physio or the doctor, it's the patient. 00:14:23.956 --> 00:14:26.600 And if we're not working to that ideal, 00:14:26.620 --> 00:14:27.200 that goal, 00:14:28.000 --> 00:14:29.162 it's questionable whether we're 00:14:29.201 --> 00:14:30.543 offering best healthcare. 00:14:32.325 --> 00:14:33.426 Yeah, no kidding, definitely. 00:14:34.188 --> 00:14:34.568 All right, 00:14:34.609 --> 00:14:36.350 so I want to take a little bit 00:14:36.370 --> 00:14:37.870 of a deviation here since 00:14:37.931 --> 00:14:41.993 we're getting to meet you in Orlando. 00:14:42.052 --> 00:14:44.553 So without giving away too much, 00:14:44.754 --> 00:14:45.934 because we don't want you 00:14:45.955 --> 00:14:46.754 to give away too much, 00:14:46.774 --> 00:14:48.056 we want people to come to the conference, 00:14:48.596 --> 00:14:50.157 but can you share a few 00:14:50.216 --> 00:14:51.977 takeaways that our audience 00:14:52.018 --> 00:14:54.919 will gain from hearing your keynote? 00:14:54.960 --> 00:14:59.022 Okay, well, I'm going to, 00:14:59.422 --> 00:15:00.341 if it's okay with you, Derek, 00:15:00.422 --> 00:15:01.322 actually work backwards. 00:15:01.363 --> 00:15:03.043 I'm giving a fifteen-minute lecture, 00:15:03.063 --> 00:15:03.323 I think, 00:15:04.078 --> 00:15:05.840 in the morning of the night 00:15:05.960 --> 00:15:06.880 after a pub crawl. 00:15:06.941 --> 00:15:07.802 So I guess it's going to be 00:15:07.861 --> 00:15:09.462 me and the sound engineer 00:15:10.083 --> 00:15:11.043 in the lecture hall. 00:15:11.625 --> 00:15:12.946 No, the physios come back. 00:15:13.145 --> 00:15:14.407 They bounce back really fast. 00:15:14.427 --> 00:15:15.268 You're going to be surprised. 00:15:15.288 --> 00:15:16.889 They're going to be a full audience. 00:15:18.490 --> 00:15:19.410 Yeah, OK. 00:15:19.610 --> 00:15:22.493 Do you want to bet ten dollars on this? 00:15:23.173 --> 00:15:23.453 Yes. 00:15:26.556 --> 00:15:27.437 Virtual handshake? 00:15:28.076 --> 00:15:28.356 All right. 00:15:29.884 --> 00:15:30.264 So anyway, 00:15:30.283 --> 00:15:32.785 so that lecture is going to be entitled, 00:15:33.326 --> 00:15:35.187 What Teaching in Iceland 00:15:35.427 --> 00:15:36.947 and Building a Shed Taught 00:15:36.969 --> 00:15:38.349 Me About Manual Therapy. 00:15:39.750 --> 00:15:40.971 And so that's the title of 00:15:41.490 --> 00:15:42.792 the short lecture, 00:15:43.231 --> 00:15:44.773 which I'm sure some people 00:15:44.812 --> 00:15:48.096 are going to find as 00:15:48.556 --> 00:15:50.417 somewhat as challenging as 00:15:50.456 --> 00:15:51.317 what I've been talking 00:15:51.337 --> 00:15:52.217 about with posture. 00:15:52.398 --> 00:15:54.960 I'm totally into touch therapy. 00:15:55.039 --> 00:15:57.461 I totally think as a profession, 00:15:57.520 --> 00:15:58.341 we should be doing 00:15:58.931 --> 00:16:00.392 manual therapy, touch therapy, 00:16:01.111 --> 00:16:02.052 touching therapies, 00:16:02.272 --> 00:16:03.753 but I think we maybe need 00:16:03.773 --> 00:16:05.052 to reframe it slightly, 00:16:05.092 --> 00:16:06.053 and I'm sure that's going 00:16:06.073 --> 00:16:08.054 to upset some people. 00:16:08.075 --> 00:16:09.195 I think there's ridiculous 00:16:09.235 --> 00:16:10.054 debates that are happening 00:16:10.075 --> 00:16:12.056 on social media about hands-on, hands-off, 00:16:12.755 --> 00:16:15.357 so irrelevant in terms of 00:16:15.778 --> 00:16:17.278 the important things we 00:16:17.378 --> 00:16:18.259 should be talking about 00:16:18.298 --> 00:16:19.879 delivering quality healthcare. 00:16:20.239 --> 00:16:21.340 We should absolutely be 00:16:21.379 --> 00:16:23.160 including touch therapy in our treatments, 00:16:23.201 --> 00:16:24.120 but maybe we should be 00:16:24.971 --> 00:16:26.913 thinking how we discuss them 00:16:26.952 --> 00:16:28.153 or explain them to patients 00:16:28.493 --> 00:16:29.833 and ourselves in different ways. 00:16:29.874 --> 00:16:32.174 So that's the second lecture. 00:16:32.195 --> 00:16:33.674 The keynote is going to be 00:16:35.015 --> 00:16:38.277 looking at what I would 00:16:38.297 --> 00:16:40.697 prefer to call my umbrella 00:16:40.738 --> 00:16:42.519 term for what people have 00:16:42.558 --> 00:16:44.198 called impingement syndrome, 00:16:44.778 --> 00:16:46.220 subacromial pain syndrome, 00:16:47.245 --> 00:16:48.846 partial full thickness tears 00:16:48.866 --> 00:16:49.606 of the rotator cuff. 00:16:49.626 --> 00:16:50.307 Because in truth, 00:16:50.346 --> 00:16:52.227 we do not know for the 00:16:52.248 --> 00:16:53.408 majority of people if the 00:16:53.447 --> 00:16:54.428 symptoms are coming from 00:16:54.469 --> 00:16:56.509 those pathoanatomical diagnoses. 00:16:56.528 --> 00:17:00.130 And I think they should be consigned to 00:17:01.721 --> 00:17:02.642 this is what we used to 00:17:02.682 --> 00:17:03.662 think and we need to come 00:17:03.721 --> 00:17:04.022 up with a 00:17:04.143 --> 00:17:06.845 non-pathoanatomical explanation 00:17:06.865 --> 00:17:08.105 for patient symptoms and 00:17:08.125 --> 00:17:09.727 I'm totally against the 00:17:09.807 --> 00:17:11.107 idea of calling it you've 00:17:11.147 --> 00:17:12.949 got simple shoulder pain or 00:17:12.989 --> 00:17:14.170 non-specific shoulder pain. 00:17:14.250 --> 00:17:16.471 I think that's derogatory for patients. 00:17:16.511 --> 00:17:20.034 People need, people who write about pain, 00:17:20.074 --> 00:17:21.075 people who are in pain 00:17:21.115 --> 00:17:22.455 write about the need for, 00:17:23.596 --> 00:17:24.958 who tell us that the worst 00:17:24.998 --> 00:17:26.439 pain is an unexplained pain 00:17:27.779 --> 00:17:30.102 and they also tell us that pain 00:17:30.741 --> 00:17:34.182 that if a treatment doesn't make, 00:17:35.124 --> 00:17:36.044 if the explanation for 00:17:36.064 --> 00:17:37.984 their symptoms isn't clear, 00:17:38.484 --> 00:17:39.625 then no treatment will make 00:17:39.664 --> 00:17:41.086 sense and they won't engage with it. 00:17:41.105 --> 00:17:43.406 So we need to provide, in my opinion, 00:17:43.446 --> 00:17:45.347 a non-pathoanatomical diagnosis. 00:17:47.009 --> 00:17:48.369 I've been promoting and 00:17:48.390 --> 00:17:49.671 pushing a term I came up 00:17:49.691 --> 00:17:53.452 with in twenty sixteen to 00:17:53.512 --> 00:17:54.753 replace all those other terms, 00:17:54.814 --> 00:17:56.375 rotator cuff related shoulder pain. 00:17:56.394 --> 00:17:57.454 So the keynotes about 00:17:57.494 --> 00:17:58.935 rotator cuff related shoulder pain. 00:17:59.616 --> 00:18:02.077 And I'm going to try and make a case that 00:18:04.465 --> 00:18:07.167 we need to be thinking way 00:18:07.188 --> 00:18:08.788 beyond a bit of exercise 00:18:08.808 --> 00:18:10.430 and manual therapy if we as 00:18:10.470 --> 00:18:12.511 a profession believe that a 00:18:12.531 --> 00:18:13.632 bit of exercise bit of 00:18:13.652 --> 00:18:15.153 manual therapy can make a 00:18:15.212 --> 00:18:17.654 difference to this 00:18:17.714 --> 00:18:19.576 condition in the presence 00:18:19.616 --> 00:18:20.757 of someone who's smoking 00:18:20.836 --> 00:18:21.938 not sleeping well not 00:18:21.998 --> 00:18:24.839 exercising well um and with 00:18:24.880 --> 00:18:26.981 poor nutrition where where 00:18:28.137 --> 00:18:29.599 fooling ourselves in a very 00:18:30.019 --> 00:18:31.141 large way we're being very 00:18:31.181 --> 00:18:33.123 naive and I'm going to try 00:18:33.143 --> 00:18:34.044 and make a case in the 00:18:34.084 --> 00:18:36.205 keynote that this could 00:18:36.246 --> 00:18:37.667 become a golden time for 00:18:37.708 --> 00:18:39.630 our profession because so 00:18:39.670 --> 00:18:40.549 much of the elective 00:18:40.590 --> 00:18:41.791 surgery that's occurring 00:18:42.332 --> 00:18:44.193 for trying to fix the pain 00:18:45.055 --> 00:18:46.296 are not fixes they're not 00:18:46.336 --> 00:18:47.396 fixing the pain at all 00:18:47.416 --> 00:18:48.278 they're not outperforming 00:18:48.317 --> 00:18:50.539 placebos or non-surgical 00:18:50.559 --> 00:18:52.041 intervention as I mentioned earlier 00:18:52.587 --> 00:18:54.069 But what I think we should be doing, 00:18:54.109 --> 00:18:54.869 and our competition 00:18:54.890 --> 00:18:56.192 shouldn't be with another profession. 00:18:56.271 --> 00:18:57.953 It should be within our own profession. 00:18:58.354 --> 00:19:00.016 How do we do a better job? 00:19:00.645 --> 00:19:02.105 And what I truly believe we 00:19:02.145 --> 00:19:02.967 need to be doing in our 00:19:03.007 --> 00:19:04.227 profession is stopping this 00:19:04.267 --> 00:19:05.807 ridiculous debate about hands on, 00:19:05.846 --> 00:19:06.366 hands off, 00:19:06.867 --> 00:19:08.167 and trying to work out how we 00:19:08.188 --> 00:19:09.807 become experts in assessing 00:19:10.307 --> 00:19:12.148 lifestyle factors and 00:19:12.209 --> 00:19:13.449 supporting people through, 00:19:14.088 --> 00:19:15.269 in a nonjudgmental way, 00:19:15.670 --> 00:19:16.630 supporting people through 00:19:16.650 --> 00:19:18.089 the process of behavioral change, 00:19:18.509 --> 00:19:20.290 which means we have got to 00:19:20.631 --> 00:19:22.490 put as much emphasis on 00:19:22.550 --> 00:19:24.771 assessing sleep quality, 00:19:25.192 --> 00:19:26.592 nutritional quality, 00:19:27.231 --> 00:19:29.093 general exercise participation, 00:19:29.913 --> 00:19:32.134 smoking behaviours, drinking behaviours, 00:19:32.194 --> 00:19:35.317 et cetera, as we do with anything else. 00:19:35.436 --> 00:19:38.179 And we need to think more 00:19:38.219 --> 00:19:39.980 holistically about the care 00:19:40.000 --> 00:19:40.681 we offer for all 00:19:40.721 --> 00:19:42.142 musculoskeletal conditions. 00:19:42.702 --> 00:19:43.702 We have to stop telling 00:19:43.722 --> 00:19:45.084 people we can fix them 00:19:45.183 --> 00:19:46.305 because the evidence would 00:19:46.345 --> 00:19:48.126 suggest that we can't and 00:19:48.146 --> 00:19:49.567 the orthopaedic surgeons can't. 00:19:50.288 --> 00:19:51.929 we need to just try and work 00:19:51.990 --> 00:19:54.852 out ways to restore people 00:19:54.872 --> 00:19:55.853 back to their valued 00:19:55.893 --> 00:19:58.795 activities and it's naive 00:19:58.835 --> 00:20:01.156 of us to think that a bit 00:20:01.176 --> 00:20:02.438 of exercise a bit of manual 00:20:02.458 --> 00:20:03.699 therapy can achieve that in 00:20:03.739 --> 00:20:04.519 the presence of other 00:20:05.240 --> 00:20:06.260 lifestyle factors so I'm 00:20:06.280 --> 00:20:07.521 going to talk about this at 00:20:07.561 --> 00:20:09.263 a cellular level how 00:20:09.344 --> 00:20:10.625 lifestyle factors can 00:20:10.904 --> 00:20:12.125 impact upon the health of 00:20:12.605 --> 00:20:17.369 tendon cells tenocytes um and um 00:20:18.877 --> 00:20:19.178 you know, 00:20:19.198 --> 00:20:20.382 it's not going to be only that 00:20:20.402 --> 00:20:21.545 that will send people to sleep, 00:20:21.605 --> 00:20:25.174 but we need to think more 00:20:25.415 --> 00:20:26.799 in terms of a Venn diagram 00:20:27.388 --> 00:20:29.871 than we can thinking that, you know, 00:20:29.911 --> 00:20:31.551 focusing in on what we tend 00:20:31.571 --> 00:20:32.711 to have focused in on for 00:20:32.731 --> 00:20:33.972 the last fifty or so years 00:20:35.433 --> 00:20:36.815 is probably naive. 00:20:36.835 --> 00:20:37.836 And maybe that's one of the 00:20:37.875 --> 00:20:39.477 reasons the outcomes that 00:20:39.497 --> 00:20:41.657 we're getting are less than desirable. 00:20:41.758 --> 00:20:42.659 So that's going to be my 00:20:42.699 --> 00:20:44.200 pitch in the keynote. 00:20:44.279 --> 00:20:45.721 But there'll be hopefully 00:20:45.760 --> 00:20:46.641 lots of good takeaway 00:20:46.661 --> 00:20:48.923 messages that people will value. 00:20:48.982 --> 00:20:50.063 And I hope it will also 00:20:50.103 --> 00:20:52.464 stimulate some robust 00:20:52.585 --> 00:20:53.766 conversation discussion. 00:20:54.125 --> 00:20:55.487 Be interesting to hear what people can 00:20:58.016 --> 00:20:59.237 how people react to that. 00:21:00.699 --> 00:21:02.500 No, I'm super excited for that. 00:21:02.721 --> 00:21:03.642 And I, you know, 00:21:04.021 --> 00:21:05.163 thank you a lot for putting 00:21:05.202 --> 00:21:06.765 something like that together. 00:21:06.805 --> 00:21:07.365 I think, you know, 00:21:07.385 --> 00:21:08.727 it resonates beyond 00:21:08.787 --> 00:21:09.867 obviously just the shoulder, 00:21:10.808 --> 00:21:11.630 but obviously it'll have 00:21:11.891 --> 00:21:13.491 the consequence with the shoulder. 00:21:13.531 --> 00:21:16.255 But, you know, I think that a lot of the, 00:21:17.195 --> 00:21:18.355 progression and movement is toward that. 00:21:18.375 --> 00:21:19.057 I think you're going to have 00:21:19.076 --> 00:21:20.156 an audience that'll be very 00:21:20.676 --> 00:21:23.857 engaged and interested in that as well. 00:21:24.278 --> 00:21:25.378 And I'm going to win ten dollars. 00:21:27.219 --> 00:21:27.939 You're going to have a full 00:21:27.979 --> 00:21:29.259 house in the morning. 00:21:31.720 --> 00:21:36.602 It depends who's most competitive. 00:21:36.622 --> 00:21:39.482 I might be prepared to pay a 00:21:39.522 --> 00:21:40.762 thousand dollars for people 00:21:40.782 --> 00:21:41.823 not to come just so that I 00:21:41.863 --> 00:21:42.584 don't lose face. 00:21:45.250 --> 00:21:46.392 All right. 00:21:46.432 --> 00:21:46.551 Well, 00:21:46.612 --> 00:21:48.133 I think that the topic title of 00:21:48.192 --> 00:21:49.394 itself is going to be interesting, 00:21:49.413 --> 00:21:52.516 especially, yeah. 00:21:52.576 --> 00:21:54.176 The people love those fifteen-minute talks, 00:21:54.196 --> 00:21:54.457 too. 00:21:54.497 --> 00:21:55.397 Those are fantastic. 00:21:56.999 --> 00:22:00.201 So the next question I have for you is, 00:22:00.661 --> 00:22:02.241 you know, and I think you actually, 00:22:02.801 --> 00:22:05.003 you kind of have said this already, 00:22:05.023 --> 00:22:05.564 so I don't even know if I 00:22:05.584 --> 00:22:06.284 want to ask a question, 00:22:06.305 --> 00:22:06.944 but I'll ask a question 00:22:06.984 --> 00:22:07.704 anyway because it may just 00:22:07.744 --> 00:22:08.826 generate a different thought. 00:22:10.500 --> 00:22:11.422 You know, 00:22:11.461 --> 00:22:12.321 you've already mentioned how 00:22:12.402 --> 00:22:13.563 management of shoulder pain 00:22:13.762 --> 00:22:14.823 has changed since you 00:22:14.863 --> 00:22:15.844 started and you've been 00:22:15.903 --> 00:22:17.464 kind of responsible for 00:22:18.345 --> 00:22:19.105 looking at some of those 00:22:19.145 --> 00:22:20.685 different ways about it. 00:22:20.705 --> 00:22:21.606 But, you know, 00:22:21.646 --> 00:22:25.028 how do what do you see in the next five, 00:22:25.048 --> 00:22:25.409 ten years? 00:22:25.429 --> 00:22:25.989 You kind of mentioned, 00:22:26.028 --> 00:22:27.069 I think it's I think I know 00:22:27.089 --> 00:22:27.750 where your answer is going 00:22:27.769 --> 00:22:29.070 to go a little bit with this. 00:22:29.211 --> 00:22:30.131 But, you know, 00:22:30.151 --> 00:22:33.353 in the management of shoulder pain itself, 00:22:33.373 --> 00:22:34.733 like how do you see it? 00:22:36.451 --> 00:22:37.792 I guess for lack of a better 00:22:37.833 --> 00:22:38.594 way of putting it, 00:22:39.115 --> 00:22:40.596 what keeps you excited 00:22:41.096 --> 00:22:43.097 about researching the 00:22:43.117 --> 00:22:45.880 shoulder going forward in the next five, 00:22:45.921 --> 00:22:47.301 ten plus years or whatever it might be? 00:22:50.582 --> 00:22:50.761 Right. 00:22:50.781 --> 00:22:53.263 I think if I realistically 00:22:53.284 --> 00:22:54.244 got ten years left. 00:22:54.684 --> 00:22:56.287 So the things that I would 00:22:56.326 --> 00:22:57.768 like to look at in the next 00:22:57.807 --> 00:23:00.049 ten years are I'm really 00:23:00.089 --> 00:23:01.691 interested in mechanisms. 00:23:01.971 --> 00:23:03.992 Why exercise therapy and 00:23:04.073 --> 00:23:05.253 maybe behavioral change, 00:23:05.674 --> 00:23:06.935 lifestyle change could 00:23:06.996 --> 00:23:08.696 influence symptoms. 00:23:09.278 --> 00:23:11.460 I think we have to move away from 00:23:13.060 --> 00:23:14.461 uh structural explanations 00:23:14.481 --> 00:23:15.782 we know that the surgery 00:23:15.962 --> 00:23:17.144 isn't repairing the tendon 00:23:17.163 --> 00:23:18.244 and even if it does that's 00:23:18.305 --> 00:23:19.305 not related to the reasons 00:23:19.345 --> 00:23:21.186 why people feel better so 00:23:21.227 --> 00:23:22.488 then we've got a whole lot 00:23:22.528 --> 00:23:23.627 of pain people coming and 00:23:23.688 --> 00:23:24.469 saying it must be just 00:23:24.489 --> 00:23:25.229 something that's going on 00:23:25.249 --> 00:23:26.130 in the brain but I think 00:23:26.150 --> 00:23:28.592 that's too far a leap 00:23:28.852 --> 00:23:29.771 forwards I think you know 00:23:29.791 --> 00:23:30.692 some of the evidence for 00:23:31.232 --> 00:23:32.473 some of the pain neuro 00:23:32.534 --> 00:23:34.174 educations pain beliefs is 00:23:34.796 --> 00:23:36.136 is on less stable grounds 00:23:36.156 --> 00:23:37.076 than some of the evidence 00:23:37.096 --> 00:23:37.917 for manual therapy 00:23:38.818 --> 00:23:39.920 What I'm really interested 00:23:40.000 --> 00:23:42.500 in is how exercise may 00:23:42.560 --> 00:23:45.843 change the biochemistry and 00:23:46.063 --> 00:23:47.483 may reduce some of the 00:23:48.044 --> 00:23:49.884 pro-inflammatory cytokines, 00:23:50.285 --> 00:23:51.726 the positively charged 00:23:51.786 --> 00:23:53.126 neuropeptides such as 00:23:53.567 --> 00:23:55.347 substance P may change 00:23:55.367 --> 00:23:57.128 their concentration in 00:23:57.288 --> 00:23:58.429 pain-sensitive structures 00:23:58.449 --> 00:23:59.089 in the shoulder. 00:23:59.869 --> 00:24:01.810 and seeing how is that the 00:24:01.851 --> 00:24:03.833 mechanism that white people 00:24:03.893 --> 00:24:04.873 many people come back and 00:24:04.894 --> 00:24:06.414 say I'm better not 00:24:06.454 --> 00:24:07.394 completely better but I'm 00:24:07.434 --> 00:24:09.797 better and it would also 00:24:09.856 --> 00:24:11.538 then make sense that when 00:24:11.557 --> 00:24:12.959 we add lifestyle factors to 00:24:12.999 --> 00:24:14.579 it do we even get a better 00:24:14.859 --> 00:24:17.842 uh restore restoration of 00:24:17.902 --> 00:24:20.263 homeostasis of the pain 00:24:20.304 --> 00:24:21.365 biochemistry around the 00:24:21.384 --> 00:24:25.527 tissues that may um uh that 00:24:25.567 --> 00:24:27.588 may help to explain why some people 00:24:29.441 --> 00:24:31.201 report improvement and maybe 00:24:31.962 --> 00:24:33.042 a lack of change in the 00:24:33.063 --> 00:24:34.503 biochemistry explains why 00:24:34.544 --> 00:24:35.424 others might not. 00:24:36.424 --> 00:24:37.345 So that's one thing. 00:24:37.526 --> 00:24:38.705 I'm also interested in how 00:24:38.726 --> 00:24:42.627 do we support people to 00:24:42.968 --> 00:24:44.189 participate in exercise 00:24:44.229 --> 00:24:46.210 programs and how do we mess 00:24:46.250 --> 00:24:47.750 with their brains in legal 00:24:47.770 --> 00:24:50.172 ways that they're not frightened to move? 00:24:50.731 --> 00:24:52.712 So I've got three PhD 00:24:52.752 --> 00:24:54.034 students at the moment who 00:24:54.074 --> 00:24:54.993 are looking at the role of 00:24:55.013 --> 00:24:55.775 virtual reality 00:24:56.765 --> 00:24:58.385 um in the management of 00:24:58.425 --> 00:25:00.506 shoulder problems and from 00:25:00.526 --> 00:25:02.567 my own clinical experience 00:25:03.487 --> 00:25:04.448 um of course you know 00:25:04.468 --> 00:25:05.528 there's a bias when a 00:25:05.647 --> 00:25:06.988 person talks about their 00:25:07.028 --> 00:25:08.888 clinical experience but um 00:25:09.169 --> 00:25:11.369 I'm so excited about the 00:25:11.410 --> 00:25:14.810 potential of this technology in terms of 00:25:16.231 --> 00:25:17.592 improving the adherence of 00:25:17.632 --> 00:25:19.053 people to an exercise program, 00:25:19.093 --> 00:25:20.373 helping people graduate 00:25:20.393 --> 00:25:21.413 through an exercise program, 00:25:21.834 --> 00:25:23.674 but also in a legal way, 00:25:23.734 --> 00:25:24.795 messing with their brain to 00:25:24.875 --> 00:25:26.635 maybe reduce the fear of movement. 00:25:27.395 --> 00:25:31.336 And we've had some spectacular failures, 00:25:31.436 --> 00:25:32.538 but we've also had some 00:25:32.798 --> 00:25:34.397 really spectacular positive 00:25:34.417 --> 00:25:35.479 changes in people who have 00:25:35.519 --> 00:25:37.519 not moved their shoulder for nine months, 00:25:37.558 --> 00:25:38.219 two years, 00:25:38.759 --> 00:25:41.000 that in a few minutes are 00:25:41.039 --> 00:25:42.740 moving normally and maintain that. 00:25:43.859 --> 00:25:46.321 well after the treatment and 00:25:47.462 --> 00:25:48.403 the initial treatment. 00:25:49.085 --> 00:25:50.905 And so I tend to divide my 00:25:50.945 --> 00:25:52.508 rehabilitation into three phases. 00:25:52.528 --> 00:25:53.248 The first phase is 00:25:53.308 --> 00:25:54.429 restoration of movement. 00:25:54.910 --> 00:25:56.270 Second phase is improvement 00:25:56.290 --> 00:25:57.211 of muscle performance. 00:25:57.231 --> 00:25:58.173 And the third phase is 00:25:58.633 --> 00:25:59.794 restoration of function. 00:26:00.515 --> 00:26:02.856 And so for me, 00:26:02.936 --> 00:26:05.098 virtual reality is a very exciting 00:26:08.049 --> 00:26:09.250 motor technology on the 00:26:09.290 --> 00:26:11.992 horizon it's here but it's 00:26:12.012 --> 00:26:13.193 going to become a bigger 00:26:13.233 --> 00:26:15.195 part of what we do I 00:26:15.236 --> 00:26:16.537 believe in assessment and 00:26:16.576 --> 00:26:18.117 management we just need 00:26:18.157 --> 00:26:19.338 more research on it so 00:26:19.378 --> 00:26:20.961 those those keep me excited 00:26:20.980 --> 00:26:22.521 I've got some research on 00:26:22.541 --> 00:26:23.803 frozen shoulders got some 00:26:23.843 --> 00:26:26.005 research on education and a 00:26:26.065 --> 00:26:27.046 bit of research on 00:26:27.066 --> 00:26:28.606 lifestyle so that will keep 00:26:28.626 --> 00:26:29.887 me occupied for the next ten years 00:26:30.965 --> 00:26:31.685 Yeah, well, good. 00:26:31.746 --> 00:26:32.487 I hope that you stick around 00:26:32.507 --> 00:26:33.247 for more than ten years 00:26:33.287 --> 00:26:33.886 then because we've got a 00:26:33.906 --> 00:26:34.988 lot of questions to answer. 00:26:35.807 --> 00:26:37.348 The mechanisms is very interesting. 00:26:37.568 --> 00:26:38.509 I think that that's coming 00:26:38.808 --> 00:26:41.890 back in terms of in play in 00:26:41.930 --> 00:26:43.330 regards to research as well. 00:26:43.431 --> 00:26:44.932 So that'll be interesting, 00:26:44.951 --> 00:26:45.832 especially when we don't 00:26:45.872 --> 00:26:47.032 know at this point. 00:26:51.477 --> 00:26:52.257 Yeah. 00:26:52.277 --> 00:26:53.616 So I have a, 00:26:53.636 --> 00:26:54.577 this question is actually very 00:26:54.678 --> 00:26:56.057 relevant because you just 00:26:56.657 --> 00:26:57.198 were a part of a 00:26:57.238 --> 00:26:58.178 publication that I think a 00:26:58.218 --> 00:27:00.179 lot of people are really interested in, 00:27:00.199 --> 00:27:01.358 in JOSBT. 00:27:01.398 --> 00:27:02.919 And that was the, you know, 00:27:03.019 --> 00:27:05.019 advice paper that just came out, 00:27:05.039 --> 00:27:07.000 I think ahead of publication. 00:27:08.339 --> 00:27:08.840 And so the, 00:27:09.080 --> 00:27:09.780 the question that I was going 00:27:09.800 --> 00:27:11.280 to ask you is, you know, 00:27:11.320 --> 00:27:12.401 for those that are, you know, 00:27:12.441 --> 00:27:13.340 either just entering 00:27:13.520 --> 00:27:15.981 physical therapy right now, you know, 00:27:16.461 --> 00:27:17.682 they're in PT school or 00:27:17.721 --> 00:27:18.622 maybe they're newly 00:27:18.662 --> 00:27:19.682 graduated and they're kind 00:27:19.702 --> 00:27:20.762 of thinking about what they want to do. 00:27:21.653 --> 00:27:23.394 you know, coming off that article there, 00:27:24.013 --> 00:27:25.074 what's some advice that you 00:27:25.114 --> 00:27:31.076 would give the new professional? 00:27:31.096 --> 00:27:31.936 Read the article. 00:27:32.257 --> 00:27:32.876 It's all there. 00:27:36.458 --> 00:27:36.618 Yeah. 00:27:36.638 --> 00:27:37.838 So it was a great team. 00:27:38.558 --> 00:27:39.179 Jared Powell, 00:27:39.199 --> 00:27:40.279 who's a PhD student in 00:27:40.299 --> 00:27:41.819 Australia coming to the end of his PhD, 00:27:43.260 --> 00:27:43.760 led on it. 00:27:43.840 --> 00:27:46.961 And it was co-authors were 00:27:46.981 --> 00:27:48.462 Chad Cook and Karen McCreish, 00:27:49.022 --> 00:27:51.284 who was another PhD student who's now, 00:27:52.518 --> 00:27:53.939 way surpassed me in her 00:27:53.959 --> 00:27:56.421 knowledge and her research skills, 00:27:56.601 --> 00:27:58.701 as Gerard will any minute now as well. 00:28:00.284 --> 00:28:02.525 So yes, it was a great team. 00:28:02.565 --> 00:28:05.747 And I think we had all 00:28:05.768 --> 00:28:07.888 slightly different ideas, 00:28:07.949 --> 00:28:09.930 but it came together in 00:28:09.950 --> 00:28:11.951 quite a hopefully useful 00:28:11.971 --> 00:28:13.913 way for new grads. 00:28:13.972 --> 00:28:16.795 And I think one of the big 00:28:16.835 --> 00:28:18.215 things that I've noticed 00:28:18.316 --> 00:28:19.257 that's changed is 00:28:21.332 --> 00:28:23.791 originally in my career, you'd go to the, 00:28:24.232 --> 00:28:25.073 after work on Friday, 00:28:25.113 --> 00:28:26.573 you'd go to the pub in 00:28:26.613 --> 00:28:28.853 Australia and you'd sit 00:28:28.873 --> 00:28:30.834 around all these manual therapy, 00:28:31.034 --> 00:28:32.294 physiotherapy experts and 00:28:32.334 --> 00:28:34.213 listen to their 00:28:34.253 --> 00:28:35.295 achievements of the week 00:28:35.335 --> 00:28:36.994 and you'd sort of say, well, my gosh, 00:28:37.115 --> 00:28:39.974 I'd like to be like them and, you know, 00:28:40.015 --> 00:28:40.674 I want to become the 00:28:40.694 --> 00:28:42.276 greatest fixer in the world, 00:28:43.756 --> 00:28:44.476 which I know a lot of 00:28:44.895 --> 00:28:47.037 people of my generation wanted to do. 00:28:47.696 --> 00:28:49.297 And so, you know, you apply for all these 00:28:49.844 --> 00:28:51.544 very difficult to get into 00:28:52.105 --> 00:28:53.164 postgraduate courses. 00:28:53.744 --> 00:28:54.625 And then you realise that 00:28:54.644 --> 00:28:56.365 maybe the reality doesn't 00:28:56.405 --> 00:28:59.486 live up to the expectation 00:28:59.705 --> 00:29:00.586 of those courses. 00:29:01.366 --> 00:29:03.326 And I think that's been replaced now, 00:29:03.346 --> 00:29:04.948 the Friday night pub, to a large extent, 00:29:05.008 --> 00:29:06.688 it's been replaced by social media. 00:29:07.428 --> 00:29:08.449 And, you know, 00:29:08.969 --> 00:29:11.730 you get these influencers in 00:29:11.789 --> 00:29:13.769 social media who are making 00:29:14.069 --> 00:29:15.691 ridiculous claims about 00:29:16.090 --> 00:29:17.590 what we should and shouldn't be doing. 00:29:18.220 --> 00:29:20.540 and to some extent bullying 00:29:20.580 --> 00:29:22.021 people and to some extent, you know, 00:29:23.123 --> 00:29:26.184 asking... And I think what 00:29:26.204 --> 00:29:27.326 we try to do in the paper 00:29:27.405 --> 00:29:28.506 is to try and balance that 00:29:28.665 --> 00:29:31.407 a little bit and hopefully give people, 00:29:31.647 --> 00:29:32.729 like we try to give patients, 00:29:32.769 --> 00:29:36.351 confidence to manage... 00:29:39.032 --> 00:29:41.034 ..to clinically reason, to problem-solve, 00:29:41.413 --> 00:29:42.654 to work things out for themselves. 00:29:42.674 --> 00:29:43.935 And I guess that was, for me, 00:29:43.996 --> 00:29:45.836 an important part of the paper and... 00:29:47.699 --> 00:29:48.038 you know, 00:29:48.318 --> 00:29:51.299 don't listen to people who are so 00:29:51.420 --> 00:29:54.961 adamant about the only way forwards is. 00:29:55.561 --> 00:29:57.701 And, you know, 00:29:57.721 --> 00:29:59.682 that was definitely part of the paper. 00:29:59.722 --> 00:30:00.643 But there's a lot more to it, 00:30:00.663 --> 00:30:01.824 and I strongly recommend 00:30:02.483 --> 00:30:03.923 that everyone get a hold of 00:30:03.963 --> 00:30:05.424 it and have a read of it 00:30:05.464 --> 00:30:07.164 and comment on it, what was good, 00:30:07.885 --> 00:30:08.665 what could have been better. 00:30:09.982 --> 00:30:10.644 Yeah, and the nice thing, 00:30:10.663 --> 00:30:11.505 we may even be able to link 00:30:11.525 --> 00:30:12.925 this in with this podcast, 00:30:12.945 --> 00:30:14.768 but it's open access at 00:30:14.807 --> 00:30:16.169 this point as well, too. 00:30:16.250 --> 00:30:17.490 So it should be able to be 00:30:17.971 --> 00:30:18.832 readable for everybody. 00:30:20.473 --> 00:30:21.255 I appreciate it. 00:30:21.434 --> 00:30:22.816 And obviously teaching in an 00:30:23.076 --> 00:30:25.838 entry-level PT program, 00:30:25.900 --> 00:30:27.780 it's important that we... 00:30:28.721 --> 00:30:29.962 retain and keep people 00:30:30.042 --> 00:30:31.564 excited about you know this 00:30:31.624 --> 00:30:33.586 profession you know I I see 00:30:33.625 --> 00:30:34.946 a lot of things on social 00:30:34.987 --> 00:30:36.048 media where like man it's 00:30:36.208 --> 00:30:37.008 like anything like even 00:30:37.028 --> 00:30:37.969 with my kids you know 00:30:37.989 --> 00:30:39.769 they're not um you know 00:30:39.809 --> 00:30:40.711 like they can be influenced 00:30:40.730 --> 00:30:42.132 by so much and a lot of it 00:30:42.172 --> 00:30:44.153 is not necessarily positive 00:30:44.193 --> 00:30:45.134 building or confidence 00:30:45.153 --> 00:30:46.595 building and some of my 00:30:46.654 --> 00:30:48.317 research area is actually looking at 00:30:49.436 --> 00:30:51.438 burnout in physical therapy. 00:30:51.458 --> 00:30:52.597 And I do think that that's 00:30:52.678 --> 00:30:54.618 part of the consequence of 00:30:54.638 --> 00:30:56.099 some of these things that we see. 00:30:56.160 --> 00:30:58.240 And certainly that what you 00:30:58.279 --> 00:30:58.859 mentioned there, 00:30:59.080 --> 00:31:00.580 the confidence going forward, 00:31:01.101 --> 00:31:02.061 I think that definitely 00:31:02.362 --> 00:31:05.762 helps people with regards to, you know, 00:31:05.803 --> 00:31:08.223 staying in this profession, being excited, 00:31:08.263 --> 00:31:08.884 hopefully about it. 00:31:11.166 --> 00:31:11.967 Yeah, I think that's, 00:31:12.047 --> 00:31:12.787 I'm aware of what you're doing. 00:31:12.807 --> 00:31:13.407 And I think that's, 00:31:13.587 --> 00:31:15.208 it's such a valuable contribution. 00:31:15.248 --> 00:31:17.209 And I wonder if, you know, 00:31:17.288 --> 00:31:18.689 if we also changed our 00:31:19.528 --> 00:31:21.150 belief system from an I can 00:31:21.190 --> 00:31:23.630 fix you model to I can work 00:31:23.650 --> 00:31:24.990 with you model to try and 00:31:25.570 --> 00:31:27.871 restore you to the greatest, 00:31:28.290 --> 00:31:29.892 highest level of function possible. 00:31:30.592 --> 00:31:32.112 And maybe we can stop 00:31:32.173 --> 00:31:33.772 burnout to some extent by 00:31:34.951 --> 00:31:36.373 by not going to work 00:31:36.393 --> 00:31:37.393 thinking I'm failing 00:31:37.593 --> 00:31:38.534 because I'm not fixing 00:31:38.594 --> 00:31:39.933 people the way that people 00:31:39.953 --> 00:31:42.214 on social media are claiming we can, 00:31:42.275 --> 00:31:43.415 or people in the past in 00:31:43.455 --> 00:31:45.997 pubs have claimed that they can. 00:31:46.557 --> 00:31:47.678 And maybe if we go back more 00:31:47.698 --> 00:31:48.698 to the nineteen fifties, 00:31:48.718 --> 00:31:49.398 which I think was one of 00:31:49.419 --> 00:31:50.919 the golden times of our profession, 00:31:51.599 --> 00:31:52.319 where if you think about 00:31:52.579 --> 00:31:53.599 your country in America, 00:31:53.640 --> 00:31:54.401 when there was the polio 00:31:54.441 --> 00:31:56.281 epidemic before Jonas Salk 00:31:56.321 --> 00:31:59.022 came up with the vaccine for polio, 00:31:59.853 --> 00:32:00.913 people in our profession 00:32:00.953 --> 00:32:03.135 were not trying to fix 00:32:03.155 --> 00:32:04.196 people with polio but 00:32:04.237 --> 00:32:05.438 trying to work out how can 00:32:05.478 --> 00:32:06.999 we restore them to the 00:32:07.019 --> 00:32:08.119 highest level of function 00:32:08.160 --> 00:32:10.982 possible and and obviously 00:32:11.002 --> 00:32:13.184 that needs to be exercised 00:32:13.325 --> 00:32:14.226 but like I said in the 00:32:14.246 --> 00:32:14.965 earlier part of this 00:32:15.046 --> 00:32:16.748 conversation it has to be 00:32:16.768 --> 00:32:17.848 through lifestyle factors 00:32:17.888 --> 00:32:20.730 as well and I wonder if we 00:32:20.830 --> 00:32:23.374 reduce burnout by um 00:32:24.337 --> 00:32:26.400 by actually changing our 00:32:26.420 --> 00:32:27.681 belief system and maybe 00:32:27.721 --> 00:32:29.343 making it more honest with 00:32:29.623 --> 00:32:31.144 moving away from the I can 00:32:31.183 --> 00:32:33.185 fix you to I can work with 00:32:33.226 --> 00:32:34.788 you in a non-judgmental way 00:32:34.827 --> 00:32:36.588 in a supportive way you 00:32:36.609 --> 00:32:37.730 know and we can just take 00:32:37.750 --> 00:32:38.832 this as far as you want 00:32:39.771 --> 00:32:40.971 um you know sort of like 00:32:40.991 --> 00:32:41.893 trying to help someone with 00:32:41.932 --> 00:32:42.992 depression or help someone 00:32:43.012 --> 00:32:44.593 with diabetes that there's 00:32:44.633 --> 00:32:45.853 so much we can do we can't 00:32:45.913 --> 00:32:47.673 fix these problems but we 00:32:47.693 --> 00:32:48.773 can reduce the long-term 00:32:48.794 --> 00:32:51.473 disability um you know it's 00:32:51.535 --> 00:32:52.474 it's interesting isn't it 00:32:52.535 --> 00:32:54.394 that so much not so many 00:32:54.494 --> 00:32:55.694 non-communicable disorders 00:32:55.714 --> 00:32:57.056 diabetes high blood 00:32:57.096 --> 00:32:59.516 pressure depression asthma 00:33:00.316 --> 00:33:01.797 no one goes in and says you 00:33:01.817 --> 00:33:02.876 know I want to be fixed of 00:33:02.896 --> 00:33:03.957 course we want to but no 00:33:03.977 --> 00:33:05.037 one's got a noble prize for 00:33:05.057 --> 00:33:06.538 medicine for that but what 00:33:06.557 --> 00:33:07.917 we can do is we can put together 00:33:08.795 --> 00:33:09.796 a package of care that 00:33:09.816 --> 00:33:11.798 involves educating why 00:33:11.877 --> 00:33:13.680 smoking is maybe not the great idea, 00:33:13.720 --> 00:33:14.921 why nutrition is important, 00:33:14.961 --> 00:33:17.222 why good sleep, hygiene, 00:33:17.262 --> 00:33:18.144 health is important, 00:33:18.505 --> 00:33:19.546 why a general exercise 00:33:19.586 --> 00:33:20.606 program is important. 00:33:21.047 --> 00:33:21.847 And by doing that, 00:33:21.887 --> 00:33:23.548 we can often reduce the disability, 00:33:23.589 --> 00:33:25.070 but when that patient's not fixed, 00:33:25.652 --> 00:33:27.373 but the disability is 00:33:27.713 --> 00:33:29.055 reduced and we can also 00:33:29.095 --> 00:33:30.236 work out ways to try and 00:33:30.936 --> 00:33:32.518 maintain that for as long as possible. 00:33:33.726 --> 00:33:35.487 help people problem solve if 00:33:35.507 --> 00:33:36.487 there's a flare up in blood 00:33:36.527 --> 00:33:37.528 sugars or there's a flare 00:33:37.587 --> 00:33:39.209 up in the depression, 00:33:39.249 --> 00:33:40.209 but we're always there if 00:33:40.648 --> 00:33:42.430 they can't help manage the flare up. 00:33:42.470 --> 00:33:42.890 And of course, 00:33:42.910 --> 00:33:43.951 all that can be supported by 00:33:43.990 --> 00:33:44.871 medicines as well. 00:33:45.371 --> 00:33:47.051 But I just wonder if we took 00:33:47.071 --> 00:33:48.333 that approach with our 00:33:49.373 --> 00:33:50.773 musculoskeletal practice, 00:33:51.374 --> 00:33:52.275 if we would be offering, 00:33:52.295 --> 00:33:53.095 we're definitely offering 00:33:53.275 --> 00:33:56.316 more honest care and maybe 00:33:56.476 --> 00:33:58.196 less burnout for people as well. 00:33:58.317 --> 00:33:59.758 And that's to me more important than 00:34:00.342 --> 00:34:01.423 a lot of the crazy debates 00:34:01.442 --> 00:34:02.644 that happen on social media 00:34:02.663 --> 00:34:04.025 at the moment that used to 00:34:04.065 --> 00:34:06.306 happen in the pubs, you know, 00:34:06.546 --> 00:34:07.866 back in the time when there 00:34:07.886 --> 00:34:10.389 was no social media in my life. 00:34:10.469 --> 00:34:11.869 Yeah, no, no, it's great. 00:34:12.556 --> 00:34:13.998 No, I appreciate it. 00:34:14.217 --> 00:34:16.018 So Jeremy, I want to respect your time. 00:34:16.059 --> 00:34:16.759 I want to respect our 00:34:16.798 --> 00:34:17.639 listeners' time because I 00:34:17.659 --> 00:34:18.619 think people's attentions 00:34:18.639 --> 00:34:19.579 are around thirty minutes 00:34:19.619 --> 00:34:20.601 or so and we're getting to 00:34:20.641 --> 00:34:21.440 about that point. 00:34:21.860 --> 00:34:22.922 And I'm going to leave a lot 00:34:23.161 --> 00:34:24.322 on the line because I want 00:34:24.543 --> 00:34:26.603 our listeners hopefully to 00:34:27.523 --> 00:34:30.405 come to Orlando, hear you speak, 00:34:30.905 --> 00:34:31.826 get a chance to meet you 00:34:33.126 --> 00:34:35.628 and see me win a ten dollar bet. 00:34:38.648 --> 00:34:38.989 All right. 00:34:39.030 --> 00:34:39.289 Well, 00:34:39.409 --> 00:34:41.150 I'm going to get out a crispy ten 00:34:41.170 --> 00:34:42.072 dollar bill and just in 00:34:42.092 --> 00:34:44.152 case I do lose because I'll stick to it. 00:34:44.492 --> 00:34:45.313 But we'll see. 00:34:45.514 --> 00:34:46.514 I'm pretty sure that it will 00:34:46.554 --> 00:34:47.996 be quite an empty hall the 00:34:48.036 --> 00:34:49.036 night after what is 00:34:49.135 --> 00:34:50.637 advertised as a pub crawl. 00:34:50.657 --> 00:34:53.860 I don't know. 00:34:53.880 --> 00:34:54.480 All right, Jeremy. 00:34:54.500 --> 00:34:54.639 Well, 00:34:54.659 --> 00:34:55.940 thank you very much for your time and 00:34:55.981 --> 00:34:56.760 have a great day. 00:34:57.842 --> 00:34:58.402 Thank you, Derek. 00:34:58.503 --> 00:34:59.342 It was a great pleasure. 00:34:59.362 --> 00:35:00.204 Looking forward to catching 00:35:00.264 --> 00:35:01.123 up in person next month. 00:35:01.143 --> 00:35:01.485 All right. 00:35:01.525 --> 00:35:03.465 We'll see you.