WEBVTT 00:00:02.248 --> 00:00:02.767 All right. 00:00:02.827 --> 00:00:04.229 Well, welcome to our listeners. 00:00:04.269 --> 00:00:06.610 Welcome to AOMP Hands On, Hands Off, 00:00:06.631 --> 00:00:07.532 where we're exploring these 00:00:07.572 --> 00:00:09.192 cutting edge ideas and 00:00:09.212 --> 00:00:10.573 trends in orthopedic manual 00:00:10.614 --> 00:00:11.513 physical therapy. 00:00:11.634 --> 00:00:12.474 And I'm your host. 00:00:13.294 --> 00:00:15.217 I have the pleasure to have 00:00:15.557 --> 00:00:16.698 Chad Cook on the show, 00:00:16.737 --> 00:00:18.379 which I am so excited for. 00:00:19.338 --> 00:00:21.280 And for our clinicians and listeners, 00:00:21.361 --> 00:00:22.201 what an exciting 00:00:22.280 --> 00:00:24.263 opportunity to have you 00:00:24.303 --> 00:00:25.143 learn a little bit more 00:00:25.182 --> 00:00:26.704 about manual therapy for 00:00:26.743 --> 00:00:28.686 better communications with your patients. 00:00:28.745 --> 00:00:29.025 And so 00:00:29.471 --> 00:00:31.231 For those educators that are listening, 00:00:31.251 --> 00:00:31.931 whether you're teaching 00:00:32.012 --> 00:00:33.033 entry level or advanced 00:00:33.472 --> 00:00:34.813 post-professional clinicians, 00:00:34.912 --> 00:00:36.274 Chad's discussion and his 00:00:36.374 --> 00:00:37.935 insights always help 00:00:37.954 --> 00:00:39.075 prepare the next generation 00:00:39.115 --> 00:00:39.975 of physical therapists. 00:00:39.996 --> 00:00:41.235 So we're so excited to have 00:00:41.256 --> 00:00:41.915 him on the show. 00:00:42.417 --> 00:00:44.957 And if you may be living under a rock, 00:00:44.997 --> 00:00:46.258 you may not know that Chad 00:00:46.317 --> 00:00:47.478 is an internationally 00:00:47.598 --> 00:00:50.000 recognized expert with his 00:00:50.079 --> 00:00:51.521 four textbooks. 00:00:51.581 --> 00:00:52.801 He's taught in over forty 00:00:52.841 --> 00:00:55.161 countries and significant 00:00:55.222 --> 00:00:56.402 publication numbers. 00:00:57.326 --> 00:00:59.207 This is a man who's truly 00:00:59.247 --> 00:01:00.408 transforming the way that 00:01:00.448 --> 00:01:01.829 we think about manual therapy. 00:01:01.890 --> 00:01:03.149 And I think you'll find him 00:01:03.570 --> 00:01:04.990 a delight to listen to. 00:01:05.271 --> 00:01:07.412 And Chad is not just a researcher. 00:01:07.451 --> 00:01:07.953 Believe it or not, 00:01:07.992 --> 00:01:08.893 I don't know where he finds 00:01:08.972 --> 00:01:10.293 time to do anything else. 00:01:10.674 --> 00:01:13.034 But he's super engaged in active life, 00:01:13.096 --> 00:01:14.456 which he is a biker and 00:01:14.495 --> 00:01:15.356 gets out in the mountain 00:01:15.376 --> 00:01:17.117 biking through rough terrain. 00:01:17.177 --> 00:01:18.177 So I'm going to bring this a 00:01:18.237 --> 00:01:19.379 little bit of an analogy. 00:01:20.201 --> 00:01:20.581 Chad, 00:01:20.602 --> 00:01:22.322 you've helped navigate some rough 00:01:22.364 --> 00:01:23.944 terrains in manual therapy, 00:01:23.984 --> 00:01:25.626 some of the swinging pendulum, 00:01:25.665 --> 00:01:27.326 whether manual therapy is a good thing, 00:01:27.367 --> 00:01:30.509 a bad thing to use it, not to use it. 00:01:30.688 --> 00:01:31.950 And yet you are injecting 00:01:31.989 --> 00:01:33.070 more knowledge into this 00:01:33.271 --> 00:01:35.111 area than anybody else knows. 00:01:35.132 --> 00:01:36.373 So we're so excited for you 00:01:36.393 --> 00:01:37.433 to help us navigate 00:01:38.030 --> 00:01:38.990 a little bit more of these 00:01:39.031 --> 00:01:40.512 challenging terrains and 00:01:40.572 --> 00:01:42.712 maybe relate to us some of 00:01:42.733 --> 00:01:43.774 the frameworks that we can 00:01:43.974 --> 00:01:45.956 use either as clinicians or 00:01:46.075 --> 00:01:48.236 educators and finding that 00:01:48.277 --> 00:01:49.757 perfect balance like you do 00:01:50.037 --> 00:01:50.838 on a mountain trail. 00:01:50.918 --> 00:01:52.599 So if you're all right, 00:01:52.640 --> 00:01:53.881 I'll go ahead and kick us off. 00:01:54.001 --> 00:01:56.283 And I would love to know more about this. 00:01:56.343 --> 00:01:58.263 So when I first contacted you, 00:01:58.784 --> 00:01:59.644 you said you want to 00:01:59.665 --> 00:02:00.986 discuss the scaffolding of 00:02:01.046 --> 00:02:02.167 manual therapy. 00:02:02.227 --> 00:02:03.867 So what does this actually mean? 00:02:05.543 --> 00:02:07.125 First of all, thank you for having me on. 00:02:08.045 --> 00:02:09.707 And it's wonderful to see you, as always. 00:02:09.768 --> 00:02:11.289 And thanks for everything you do for AOMT. 00:02:13.633 --> 00:02:15.134 Scaffolding, to me, 00:02:15.495 --> 00:02:17.657 it's a term we use in our 00:02:17.837 --> 00:02:20.341 NIH U-XXIV about really 00:02:20.360 --> 00:02:21.462 building the framework and 00:02:21.483 --> 00:02:23.625 the taxonomy around manual therapy. 00:02:24.545 --> 00:02:25.768 I think historically, 00:02:25.788 --> 00:02:28.311 when you think about manual therapy, 00:02:28.330 --> 00:02:29.673 you think about efficacy 00:02:29.752 --> 00:02:30.794 and effectiveness studies 00:02:31.694 --> 00:02:34.057 or maybe who manual therapy may benefit, 00:02:34.098 --> 00:02:34.739 that sort of thing. 00:02:35.520 --> 00:02:36.782 But there's a lot more to it. 00:02:36.801 --> 00:02:38.623 There are the treatment mechanisms, 00:02:38.723 --> 00:02:40.645 what actually happens with 00:02:40.665 --> 00:02:41.747 the particular treatment. 00:02:44.038 --> 00:02:44.859 There are all these other 00:02:44.899 --> 00:02:46.139 disciplines involved in 00:02:46.479 --> 00:02:47.640 measuring manual therapy 00:02:47.700 --> 00:02:48.822 like biomechanists and 00:02:48.861 --> 00:02:50.643 neuroscientists and imaging 00:02:50.682 --> 00:02:51.923 specialists and all these folks. 00:02:52.663 --> 00:02:53.283 And we're all using 00:02:53.324 --> 00:02:55.025 different language and our 00:02:55.044 --> 00:02:56.306 assumptions are all different. 00:02:56.705 --> 00:02:57.727 So the scaffolding is 00:02:57.947 --> 00:03:00.768 essentially structuring a 00:03:00.828 --> 00:03:02.229 framework around manual 00:03:02.248 --> 00:03:03.370 therapy so that we can all 00:03:03.430 --> 00:03:05.770 study it consistently so 00:03:05.790 --> 00:03:07.072 that when somebody is 00:03:07.111 --> 00:03:08.231 talking about something, 00:03:08.532 --> 00:03:09.332 another profession 00:03:09.372 --> 00:03:10.693 understands what we're talking about. 00:03:11.593 --> 00:03:13.376 It's about building almost a 00:03:13.436 --> 00:03:15.157 foundation and then the 00:03:15.197 --> 00:03:17.278 scaffolding up one current 00:03:17.318 --> 00:03:22.043 study so that it makes sense. 00:03:22.544 --> 00:03:23.243 That's great. 00:03:23.264 --> 00:03:24.344 So so you were relating this 00:03:24.365 --> 00:03:26.006 to your current grant and 00:03:26.066 --> 00:03:26.947 work that you're doing. 00:03:27.067 --> 00:03:28.929 So is that what led you 00:03:28.949 --> 00:03:30.270 towards your most recent 00:03:30.349 --> 00:03:31.350 efforts looking at this as 00:03:31.411 --> 00:03:34.633 a framework around manual therapy? 00:03:34.693 --> 00:03:34.894 Yeah. 00:03:34.933 --> 00:03:36.215 So you probably know that. 00:03:36.375 --> 00:03:36.615 I mean, 00:03:37.175 --> 00:03:39.497 my original manual therapy textbook with 00:03:40.205 --> 00:03:41.544 took a crack at trying to 00:03:41.626 --> 00:03:43.325 harmonize some terminology 00:03:44.346 --> 00:03:45.526 and really talked about all 00:03:45.567 --> 00:03:46.687 the different philosophies. 00:03:46.727 --> 00:03:48.728 And that's very, I think, 00:03:49.168 --> 00:03:50.169 a clinical focus. 00:03:50.808 --> 00:03:51.968 What we're doing now has 00:03:52.028 --> 00:03:53.849 even a preclinical and a 00:03:53.909 --> 00:03:55.090 basic science focus 00:03:55.590 --> 00:03:57.170 embedded into it as well. 00:03:57.871 --> 00:03:58.872 And if I could use... 00:04:00.051 --> 00:04:01.353 If I could use an analogy, 00:04:02.794 --> 00:04:05.075 when I presented at NIH in June, 00:04:05.716 --> 00:04:08.677 I started off my talk using 00:04:08.717 --> 00:04:11.741 the Christian Bible parable, 00:04:11.901 --> 00:04:12.860 the Tower of Babel. 00:04:13.421 --> 00:04:14.723 And I'm not going to get all the religious, 00:04:14.742 --> 00:04:15.924 so don't worry about that. 00:04:16.303 --> 00:04:17.845 But in the Tower of Babel, 00:04:17.884 --> 00:04:19.286 people think that this is 00:04:19.305 --> 00:04:20.547 where all the people got 00:04:20.607 --> 00:04:21.687 different languages and 00:04:21.747 --> 00:04:22.408 that sort of thing, 00:04:22.848 --> 00:04:24.110 because God was angry that 00:04:24.470 --> 00:04:26.851 he was building a tower to the heavens. 00:04:27.512 --> 00:04:29.173 But in reality, if you read the Bible, 00:04:29.713 --> 00:04:30.954 it actually says that this 00:04:31.014 --> 00:04:33.656 is God's attempt to confuse people, 00:04:34.137 --> 00:04:35.598 confuse the workers so they 00:04:35.658 --> 00:04:37.519 could not finish the job. 00:04:38.321 --> 00:04:39.581 And that's really what I 00:04:39.601 --> 00:04:41.002 mean by this is there's so 00:04:41.043 --> 00:04:44.105 much discrepancy, so much confusion. 00:04:44.365 --> 00:04:46.127 a lack of harmony around 00:04:46.927 --> 00:04:48.408 what we say we do and what 00:04:48.428 --> 00:04:49.589 we actually do and how it's 00:04:49.629 --> 00:04:51.591 studied and and what people 00:04:51.632 --> 00:04:52.892 say to patients and all of 00:04:52.913 --> 00:04:54.233 these other things that 00:04:54.254 --> 00:04:55.274 that's really what we mean 00:04:55.295 --> 00:04:56.615 about around the scaffolding. 00:04:56.975 --> 00:04:57.737 It's it's about. 00:04:57.757 --> 00:05:00.740 And yes, 00:05:00.819 --> 00:05:02.461 it's very much triggered by the 00:05:02.961 --> 00:05:03.742 force net grant, 00:05:03.781 --> 00:05:04.923 the year twenty four that we had. 00:05:05.684 --> 00:05:06.223 But I think it's a 00:05:06.283 --> 00:05:07.365 continuation of something 00:05:07.384 --> 00:05:08.665 that I was doing a good 00:05:08.706 --> 00:05:09.666 eighteen years ago, too. 00:05:10.788 --> 00:05:11.028 Yeah. 00:05:11.468 --> 00:05:12.548 You know, I think, yeah, 00:05:12.668 --> 00:05:14.029 I remember even just teaching with you, 00:05:14.130 --> 00:05:14.370 Chad, 00:05:14.411 --> 00:05:15.430 and I think one of the biggest 00:05:15.451 --> 00:05:16.692 things that you've always said is, 00:05:16.992 --> 00:05:18.494 you know, consistency of language. 00:05:18.553 --> 00:05:18.733 Like, 00:05:18.814 --> 00:05:20.454 what are we actually saying so that 00:05:20.574 --> 00:05:23.216 it has meaning and that we can understand, 00:05:23.276 --> 00:05:24.257 right, in the written word, 00:05:24.317 --> 00:05:25.778 especially in our publications, 00:05:25.819 --> 00:05:27.079 like the terminology. 00:05:27.480 --> 00:05:28.680 And so I love that that's 00:05:28.740 --> 00:05:29.942 come back even eighteen 00:05:29.982 --> 00:05:30.783 years later and you're 00:05:30.822 --> 00:05:31.762 putting more to it. 00:05:32.204 --> 00:05:33.865 And it's really part of the 00:05:33.904 --> 00:05:34.745 grant that you've had. 00:05:34.766 --> 00:05:36.367 So I think that that's wonderful. 00:05:36.983 --> 00:05:38.144 How does this challenge 00:05:38.204 --> 00:05:39.165 traditional teaching 00:05:39.204 --> 00:05:40.185 methods maybe that 00:05:40.245 --> 00:05:41.505 clinicians or educators 00:05:41.526 --> 00:05:42.706 have followed for years? 00:05:43.086 --> 00:05:44.028 And maybe you can kind of 00:05:44.048 --> 00:05:45.009 highlight some of those 00:05:45.048 --> 00:05:46.189 discrepancy areas that have 00:05:46.228 --> 00:05:46.990 caused some concern. 00:05:48.410 --> 00:05:49.430 I mean, that's a great question. 00:05:50.351 --> 00:05:51.773 You know, you and I spoke together, 00:05:51.812 --> 00:05:54.053 I think, at CSM earlier this year. 00:05:54.233 --> 00:05:55.475 And one of the things that I 00:05:55.495 --> 00:05:56.615 had mentioned was that 00:05:57.617 --> 00:05:59.158 science really started to catch up, 00:05:59.418 --> 00:05:59.838 I think, 00:05:59.879 --> 00:06:01.120 with the theories around manual 00:06:01.139 --> 00:06:02.420 therapy in nineteen ninety 00:06:02.901 --> 00:06:03.802 so that we had enough 00:06:04.262 --> 00:06:05.242 sophistication in the 00:06:05.262 --> 00:06:06.603 science to actually explore 00:06:07.163 --> 00:06:09.206 some of these concepts, terms, 00:06:09.805 --> 00:06:11.608 assumptions that you saw 00:06:11.648 --> 00:06:12.327 with many of the 00:06:12.348 --> 00:06:14.050 philosophies around manual therapy. 00:06:14.790 --> 00:06:15.670 And unfortunately, 00:06:15.910 --> 00:06:16.730 the science actually 00:06:16.771 --> 00:06:18.571 identified some areas where 00:06:18.591 --> 00:06:20.211 we were flat out wrong. 00:06:21.151 --> 00:06:23.331 We had these vanguards, 00:06:24.112 --> 00:06:25.653 manual therapy philosophers 00:06:25.692 --> 00:06:27.572 who they saw something in the clinic. 00:06:28.273 --> 00:06:29.473 They knew it was meaningful. 00:06:30.033 --> 00:06:30.874 And what they did is they 00:06:30.913 --> 00:06:33.935 tried to backfill it with these ideas. 00:06:34.694 --> 00:06:36.454 And unfortunately, those ideas, 00:06:36.894 --> 00:06:37.735 many of those haven't 00:06:37.755 --> 00:06:40.815 really stood up over time in science. 00:06:41.536 --> 00:06:42.976 The challenge, I think, comes when 00:06:43.836 --> 00:06:45.358 in the educational classroom 00:06:45.398 --> 00:06:48.019 or postgraduate or whatever, 00:06:48.459 --> 00:06:49.459 when we're still using 00:06:49.579 --> 00:06:51.821 outdated taxonomies or 00:06:52.040 --> 00:06:53.141 terminologies to try to 00:06:53.161 --> 00:06:55.341 train individuals or try to 00:06:55.401 --> 00:06:57.523 apply a philosophy that 00:06:57.562 --> 00:06:58.444 really doesn't fit. 00:06:59.283 --> 00:07:01.925 on to that patient that's in front of you. 00:07:02.687 --> 00:07:04.648 So we're running kind of 00:07:04.728 --> 00:07:05.928 butting into some of these 00:07:06.129 --> 00:07:08.290 concepts with with what 00:07:08.310 --> 00:07:09.831 we're identifying within 00:07:09.872 --> 00:07:10.932 the force that you're 00:07:10.952 --> 00:07:12.874 twenty four with some of 00:07:12.894 --> 00:07:13.894 the publications that we're 00:07:13.935 --> 00:07:14.656 putting together. 00:07:15.175 --> 00:07:15.716 But we're also 00:07:16.456 --> 00:07:17.418 Butting heads with some 00:07:17.458 --> 00:07:19.279 basic science research, too, as well, 00:07:19.319 --> 00:07:21.601 that suggests that certain things happen. 00:07:22.062 --> 00:07:22.942 And because they happened in 00:07:22.963 --> 00:07:24.524 a mouse in a controlled environment, 00:07:24.564 --> 00:07:25.365 that it means it's going to 00:07:25.386 --> 00:07:27.867 transfer to a clinical environment. 00:07:28.307 --> 00:07:28.668 You know, 00:07:28.689 --> 00:07:30.509 there are all kinds of areas that 00:07:31.130 --> 00:07:33.273 need tightening up and need 00:07:33.312 --> 00:07:34.353 the appropriate scaffolding 00:07:34.394 --> 00:07:35.535 for us to actually build 00:07:35.634 --> 00:07:37.396 upon that and move forward. 00:07:39.163 --> 00:07:40.644 So, you know, already with this, 00:07:40.963 --> 00:07:41.543 this grant, 00:07:41.564 --> 00:07:42.725 you're describing basically 00:07:42.785 --> 00:07:44.584 all these professions or disciplines, 00:07:44.665 --> 00:07:45.125 I should say, 00:07:45.165 --> 00:07:47.725 coming together and finding out, you know, 00:07:47.846 --> 00:07:49.386 debunking some of the ideas 00:07:49.425 --> 00:07:50.146 or the myths or the 00:07:50.165 --> 00:07:51.646 theories or the approaches, right. 00:07:51.687 --> 00:07:53.247 And understanding some of that language. 00:07:53.666 --> 00:07:55.406 So I think language is super important. 00:07:55.807 --> 00:07:56.648 How does that relate a 00:07:56.668 --> 00:07:57.827 little bit more maybe to 00:07:57.887 --> 00:07:59.548 the clinician and how would 00:07:59.567 --> 00:08:01.028 it refine maybe clinical 00:08:01.048 --> 00:08:03.149 reasoning or treatment planning? 00:08:03.728 --> 00:08:04.848 How does it have a direct 00:08:05.009 --> 00:08:06.310 impact on then maybe our 00:08:06.350 --> 00:08:07.490 listeners or who are in the 00:08:07.529 --> 00:08:08.370 clinics today? 00:08:09.673 --> 00:08:12.093 I think it has a lot of different ways. 00:08:12.675 --> 00:08:13.714 You know, to me, 00:08:14.315 --> 00:08:15.475 in one of the ways that we, 00:08:17.197 --> 00:08:18.398 we look at clinicians as 00:08:18.497 --> 00:08:20.338 another form of expert, right? 00:08:20.379 --> 00:08:21.600 So around manual therapy. 00:08:21.660 --> 00:08:23.500 So they have a domain of expertise, 00:08:24.120 --> 00:08:25.302 just as an imaging 00:08:25.341 --> 00:08:27.223 specialist has a domain of expertise, 00:08:27.783 --> 00:08:29.884 as a neuroscientist has a domain. 00:08:29.964 --> 00:08:31.786 Everybody has these different domains. 00:08:32.505 --> 00:08:34.587 And when the cogs start 00:08:34.607 --> 00:08:35.768 working together and everything, 00:08:36.509 --> 00:08:37.730 everybody is communicating, 00:08:37.769 --> 00:08:39.030 everybody agrees on something, 00:08:39.591 --> 00:08:41.451 then we have a common language. 00:08:41.491 --> 00:08:43.553 We have a common statement 00:08:44.073 --> 00:08:45.174 so that policymakers 00:08:45.235 --> 00:08:46.315 understand what we're doing, 00:08:46.395 --> 00:08:48.376 so that the patients get a 00:08:48.437 --> 00:08:50.677 real story behind what this is. 00:08:51.119 --> 00:08:52.600 The challenge is when we're 00:08:52.639 --> 00:08:53.740 independent of one another. 00:08:54.160 --> 00:08:56.722 And right now, it's fairly independent. 00:08:58.244 --> 00:09:00.065 This weekend, we had a summit. 00:09:00.485 --> 00:09:01.145 And in the summit, 00:09:01.186 --> 00:09:02.025 we had all of these 00:09:02.046 --> 00:09:03.167 different professions. 00:09:03.586 --> 00:09:04.727 And we were intentional 00:09:04.768 --> 00:09:06.168 about inviting people that 00:09:06.229 --> 00:09:08.971 had a foot in the space of 00:09:09.211 --> 00:09:10.971 force-based manipulations 00:09:11.032 --> 00:09:11.952 or manual therapy, 00:09:12.472 --> 00:09:13.594 but didn't necessarily 00:09:13.634 --> 00:09:16.456 collaborate with any of these areas. 00:09:16.495 --> 00:09:17.697 We had clinicians talk. 00:09:18.177 --> 00:09:19.738 We had imaging specialists talk. 00:09:19.857 --> 00:09:21.379 We had biomechanists talk. 00:09:21.399 --> 00:09:22.500 We had neuroscientists talk. 00:09:22.820 --> 00:09:23.780 We even had a basic 00:09:24.000 --> 00:09:25.322 scientist who worked only 00:09:25.361 --> 00:09:27.062 with mouse studies talk. 00:09:27.523 --> 00:09:28.724 to tell you all the things 00:09:28.744 --> 00:09:31.544 that are wrong with mouse studies. 00:09:31.804 --> 00:09:33.186 We even had a psychologist, 00:09:33.485 --> 00:09:34.066 a person who had a 00:09:34.105 --> 00:09:35.086 psychological background. 00:09:35.726 --> 00:09:37.067 It was the most dynamic 00:09:37.168 --> 00:09:39.688 meeting of all these people 00:09:39.769 --> 00:09:42.450 interacting with one another. 00:09:42.509 --> 00:09:43.990 How can it influence a clinician? 00:09:45.227 --> 00:09:47.909 there are such a rich amount 00:09:47.990 --> 00:09:49.451 of knowledge in these other 00:09:49.490 --> 00:09:51.511 fields that could influence 00:09:52.331 --> 00:09:53.332 our interactions with our 00:09:53.393 --> 00:09:55.053 patients so that clinicians 00:09:55.094 --> 00:09:56.875 can learn from these individuals, 00:09:57.215 --> 00:09:58.336 just like these individuals 00:09:58.395 --> 00:09:59.535 learn from clinicians. 00:10:00.076 --> 00:10:02.999 And our goal is to get that 00:10:03.139 --> 00:10:04.538 optimal connection, 00:10:05.500 --> 00:10:07.100 harmonize it the best we can, 00:10:07.620 --> 00:10:08.542 and then be able to 00:10:10.184 --> 00:10:10.404 you know, 00:10:10.544 --> 00:10:11.806 better improve the way that we 00:10:11.985 --> 00:10:13.005 manage our patients, 00:10:13.385 --> 00:10:15.047 understand better when to 00:10:15.147 --> 00:10:16.626 use manual therapy in the 00:10:16.667 --> 00:10:18.607 patient process and really tease out, 00:10:18.727 --> 00:10:18.967 is it, 00:10:19.488 --> 00:10:20.788 is manual therapy doing what we 00:10:20.808 --> 00:10:24.009 think it's doing? 00:10:24.049 --> 00:10:25.009 Basically, I mean, 00:10:25.029 --> 00:10:27.410 you're asking in clinicians, 00:10:27.490 --> 00:10:28.591 it's challenging right 00:10:28.610 --> 00:10:29.572 there in the day to day. 00:10:29.672 --> 00:10:31.711 So to reframe some of this 00:10:31.751 --> 00:10:33.692 mindset or ideas, right? 00:10:33.732 --> 00:10:34.952 Season clinicians may have 00:10:34.972 --> 00:10:36.734 had practices for a long time. 00:10:37.312 --> 00:10:38.595 And, you know, 00:10:38.634 --> 00:10:40.115 new clinicians are coming 00:10:40.297 --> 00:10:42.019 out from maybe entry level 00:10:42.058 --> 00:10:43.701 may not have been exposed to that. 00:10:44.140 --> 00:10:45.722 So where would be some 00:10:45.743 --> 00:10:48.426 places that you know, 00:10:48.485 --> 00:10:50.048 how could some of our 00:10:50.207 --> 00:10:52.210 audience gain insight to 00:10:52.250 --> 00:10:54.072 some of those different perspectives? 00:10:54.613 --> 00:10:55.714 Where are some resources 00:10:55.754 --> 00:10:56.956 that they should lean into? 00:10:58.472 --> 00:10:59.274 I think the first thing they 00:10:59.293 --> 00:11:00.294 need to do is be willing to 00:11:00.335 --> 00:11:02.436 go outside their narrow 00:11:02.456 --> 00:11:03.837 band of knowledge or 00:11:03.878 --> 00:11:05.599 training and learn from 00:11:05.639 --> 00:11:06.759 these some of these other 00:11:06.799 --> 00:11:08.041 professions who specialize 00:11:08.061 --> 00:11:08.782 in different areas. 00:11:09.802 --> 00:11:12.965 Just before this particular podcast, 00:11:13.004 --> 00:11:14.807 I was listening to the 00:11:14.826 --> 00:11:15.486 University of North 00:11:15.506 --> 00:11:16.868 Carolina had a seminar 00:11:16.908 --> 00:11:17.908 series and they brought in 00:11:17.948 --> 00:11:18.570 a speaker from the 00:11:18.610 --> 00:11:19.470 University of Delaware. 00:11:20.211 --> 00:11:22.634 And she was an imaging 00:11:22.673 --> 00:11:23.855 specialist who has a bond 00:11:24.195 --> 00:11:25.155 mechanist background. 00:11:25.677 --> 00:11:26.538 And she was talking about 00:11:26.577 --> 00:11:28.000 the three different tendons 00:11:28.179 --> 00:11:29.780 affiliated with the Achilles. 00:11:30.721 --> 00:11:32.443 And so a couple of things with that. 00:11:32.684 --> 00:11:33.004 All right. 00:11:33.065 --> 00:11:33.345 First of all, 00:11:33.365 --> 00:11:33.865 I didn't know there were 00:11:33.905 --> 00:11:35.488 three tendons in the Achilles. 00:11:36.509 --> 00:11:37.909 I didn't know that until last weekend. 00:11:38.250 --> 00:11:38.929 And then secondly, 00:11:40.471 --> 00:11:42.933 I learned a lot about fail 00:11:42.974 --> 00:11:44.534 rates across those, 00:11:44.975 --> 00:11:47.277 about how age influences that, 00:11:47.736 --> 00:11:49.859 about how prior injury influences that, 00:11:49.899 --> 00:11:50.919 and all these other elements. 00:11:51.200 --> 00:11:52.380 This is somebody outside of 00:11:52.400 --> 00:11:54.442 my profession that gave a 00:11:54.482 --> 00:11:55.964 talk that is going to be 00:11:56.024 --> 00:11:57.164 meaningful for me moving 00:11:57.184 --> 00:11:59.767 forward when looking at that. 00:11:59.807 --> 00:12:01.248 So the first thing definitely is 00:12:02.607 --> 00:12:02.768 you know, 00:12:02.988 --> 00:12:05.990 be open in the way that you learn 00:12:06.671 --> 00:12:07.591 and learn from people who 00:12:07.631 --> 00:12:10.214 you think may not actually contribute. 00:12:10.374 --> 00:12:11.075 I think we've done that 00:12:11.375 --> 00:12:13.216 really well as a profession 00:12:13.917 --> 00:12:15.258 for psychologists and 00:12:15.278 --> 00:12:17.359 really looking at that part for 00:12:18.179 --> 00:12:19.902 Pain science specialist, 00:12:19.942 --> 00:12:21.403 I think we've been very open on that, 00:12:21.964 --> 00:12:23.024 but I think we've ignored 00:12:23.666 --> 00:12:24.787 maybe some areas that can 00:12:24.807 --> 00:12:26.048 be really beneficial, 00:12:26.067 --> 00:12:28.490 like imaging and then biomechanics. 00:12:28.510 --> 00:12:29.331 We've kind of poo-pooed 00:12:29.351 --> 00:12:30.873 biomechanics and pushed it 00:12:30.932 --> 00:12:31.573 off to the side, 00:12:31.594 --> 00:12:32.375 but there's actually more 00:12:32.394 --> 00:12:34.856 there than I think people recognize. 00:12:36.327 --> 00:12:37.350 The second thing I think we 00:12:37.389 --> 00:12:40.852 can do is really challenge 00:12:41.033 --> 00:12:42.774 ourselves on some of these 00:12:42.815 --> 00:12:44.056 traditional paradigms that 00:12:44.076 --> 00:12:44.736 we learned from. 00:12:46.038 --> 00:12:46.238 I mean, 00:12:46.317 --> 00:12:48.640 everybody essentially has some 00:12:49.761 --> 00:12:50.802 background or they've 00:12:50.842 --> 00:12:52.124 learned from some philosophy. 00:12:52.163 --> 00:12:52.884 Mine is Maitland. 00:12:53.706 --> 00:12:54.706 So I learned very much a test. 00:12:54.726 --> 00:12:55.106 A test. 00:12:57.355 --> 00:13:02.398 retest philosophy and ignoring, you know, 00:13:02.498 --> 00:13:05.119 ignoring the complexity and 00:13:05.139 --> 00:13:06.519 then going toward more of the simple, 00:13:07.080 --> 00:13:08.221 you know, this is what we found, 00:13:08.260 --> 00:13:10.162 so we're going to move with it. 00:13:10.201 --> 00:13:11.923 I think it's okay to have 00:13:11.962 --> 00:13:13.322 that as a foundation, 00:13:13.403 --> 00:13:14.864 but to recognize that those 00:13:14.884 --> 00:13:17.485 have major gaps and to try 00:13:17.525 --> 00:13:19.166 to fill those gaps with as 00:13:19.225 --> 00:13:21.447 much science as we can tackle. 00:13:22.548 --> 00:13:23.129 I, 00:13:23.149 --> 00:13:25.549 without paralyzing ourselves and trying 00:13:25.570 --> 00:13:28.772 to find a single answer, I really, 00:13:28.932 --> 00:13:31.374 I spoke to a, at IFOMPT, 00:13:31.433 --> 00:13:32.455 I spoke to someone who I 00:13:32.475 --> 00:13:34.176 really respect and we just 00:13:34.196 --> 00:13:35.437 kind of ran into each other 00:13:35.496 --> 00:13:37.138 and the person said, you know, 00:13:37.177 --> 00:13:37.937 I appreciate what you're 00:13:37.957 --> 00:13:39.038 doing with mechanisms, 00:13:39.119 --> 00:13:40.080 but I'm not a hundred 00:13:40.100 --> 00:13:41.019 percent sure that we're 00:13:41.080 --> 00:13:41.821 ever going to fully 00:13:41.900 --> 00:13:44.523 understand how manual therapy works. 00:13:45.493 --> 00:13:46.594 And I said, I agree, 00:13:46.754 --> 00:13:48.294 but the journey is a 00:13:48.434 --> 00:13:49.655 wonderful experience. 00:13:49.836 --> 00:13:53.158 And learning from that as we go along is, 00:13:53.258 --> 00:13:53.538 I think, 00:13:53.557 --> 00:13:55.019 going to make us all better clinicians. 00:13:55.038 --> 00:13:56.179 Right. 00:13:56.659 --> 00:13:57.500 And so you may have this 00:13:57.841 --> 00:13:58.760 huge amount of knowledge. 00:13:58.780 --> 00:14:00.081 You may still use the same 00:14:00.121 --> 00:14:01.582 frameworks to go through in 00:14:01.643 --> 00:14:03.744 a clinical practice time, test, retest, 00:14:04.125 --> 00:14:04.304 right? 00:14:04.345 --> 00:14:05.205 Because if you're still 00:14:05.264 --> 00:14:06.265 using patient response, 00:14:06.306 --> 00:14:07.506 you might find something there. 00:14:07.527 --> 00:14:09.087 But maybe at a point where 00:14:09.107 --> 00:14:10.469 we're not finding the right 00:14:10.548 --> 00:14:11.629 information or the patient 00:14:11.688 --> 00:14:12.730 is not responding, 00:14:13.248 --> 00:14:14.489 certainly requires us to 00:14:14.528 --> 00:14:15.969 step back reframe and think 00:14:16.028 --> 00:14:17.509 again about what are we 00:14:17.549 --> 00:14:18.669 missing or what might else 00:14:18.710 --> 00:14:19.951 be going on here because 00:14:20.370 --> 00:14:21.390 certainly that's been some 00:14:21.431 --> 00:14:22.831 of the challenges that you 00:14:22.851 --> 00:14:24.111 know we have a great amount 00:14:24.172 --> 00:14:25.732 of who responds and then we 00:14:25.773 --> 00:14:27.133 have these non-responders 00:14:27.212 --> 00:14:28.634 and and so maybe it's worth 00:14:28.653 --> 00:14:29.693 that exploration I think 00:14:29.714 --> 00:14:30.254 you give a great 00:14:30.294 --> 00:14:31.274 perspective you gotta step 00:14:31.294 --> 00:14:32.615 back and like look at maybe 00:14:32.635 --> 00:14:33.855 what else could be going on 00:14:33.875 --> 00:14:35.177 there maybe something you 00:14:35.216 --> 00:14:36.897 haven't thought of and uh a 00:14:36.917 --> 00:14:37.738 little bit bigger maybe 00:14:37.758 --> 00:14:38.878 biomechanics or something 00:14:38.937 --> 00:14:40.458 else and you know something 00:14:40.479 --> 00:14:41.318 you bring up is that 00:14:42.375 --> 00:14:45.476 I think it was a different group. 00:14:45.517 --> 00:14:46.518 It's mainly out of 00:14:46.597 --> 00:14:47.638 osteoarthritis that we 00:14:47.697 --> 00:14:49.119 really learned that people 00:14:49.198 --> 00:14:50.900 respond differently to even 00:14:51.321 --> 00:14:52.341 efficacious treatment. 00:14:52.380 --> 00:14:54.942 So even a really good treatment approach, 00:14:55.383 --> 00:14:56.464 if you have a spectrum of 00:14:56.583 --> 00:14:57.684 maybe twenty people, 00:14:58.085 --> 00:14:58.544 you're going to get a 00:14:58.585 --> 00:15:00.287 variability in response with that. 00:15:00.567 --> 00:15:02.227 And that's just normal human nature. 00:15:02.788 --> 00:15:05.009 Even with drugs like 00:15:05.149 --> 00:15:06.610 pharmacological agents, 00:15:06.850 --> 00:15:08.172 you'll see variability in response. 00:15:08.871 --> 00:15:11.472 Knowing that is a tremendous asset, 00:15:11.533 --> 00:15:12.513 I think, as a clinician, 00:15:12.552 --> 00:15:13.253 that you have to be 00:15:13.293 --> 00:15:15.234 adaptable and recognize 00:15:15.254 --> 00:15:16.114 there isn't one thing 00:15:16.153 --> 00:15:17.234 that's going to help everybody. 00:15:18.715 --> 00:15:19.595 And we learn that from a 00:15:20.575 --> 00:15:21.934 different discipline, basically. 00:15:21.975 --> 00:15:23.196 But I think we can learn a 00:15:23.275 --> 00:15:24.816 lot from other areas. 00:15:24.836 --> 00:15:27.836 Yeah, that's great. 00:15:27.856 --> 00:15:28.336 So, Chad, you know, 00:15:28.376 --> 00:15:30.477 you speak to the concept 00:15:30.498 --> 00:15:32.817 that you've been exposed, right, 00:15:32.957 --> 00:15:34.379 in so many different areas 00:15:34.418 --> 00:15:35.698 and seeing so many different 00:15:36.426 --> 00:15:37.586 professionals and 00:15:37.647 --> 00:15:38.687 disciplines and the way 00:15:38.706 --> 00:15:39.647 they're approaching things 00:15:39.667 --> 00:15:42.249 from basic scientists to biomechanics, 00:15:42.288 --> 00:15:42.528 right, 00:15:42.609 --> 00:15:45.049 and imaging and all of these things. 00:15:45.570 --> 00:15:46.509 And I would even think with 00:15:46.529 --> 00:15:47.750 your extensive teaching in 00:15:47.850 --> 00:15:50.131 over forty different countries, you know, 00:15:50.211 --> 00:15:51.172 what international 00:15:51.211 --> 00:15:52.413 perspective has also 00:15:52.472 --> 00:15:53.253 influenced maybe your 00:15:53.293 --> 00:15:54.734 scaffolding and how could 00:15:54.754 --> 00:15:55.653 this have a global 00:15:55.734 --> 00:15:58.576 educational approach to, you know, 00:15:58.596 --> 00:16:00.196 orthopedic manual therapy 00:16:00.296 --> 00:16:01.856 as we're thinking about this framework? 00:16:02.621 --> 00:16:03.927 and its relevance, you know, 00:16:03.947 --> 00:16:05.311 across not just maybe the 00:16:05.392 --> 00:16:06.514 US and our listeners, 00:16:06.554 --> 00:16:07.578 but maybe across the world. 00:16:10.037 --> 00:16:11.958 So I'll first start by saying, well, 00:16:11.979 --> 00:16:13.100 I'm gonna answer it two ways. 00:16:13.399 --> 00:16:14.822 The first way is that 00:16:14.922 --> 00:16:17.663 regardless of where I'm at, 00:16:18.024 --> 00:16:20.167 and I have been very 00:16:20.187 --> 00:16:22.028 blessed to speak in many countries, 00:16:22.048 --> 00:16:25.912 very fortunate, is a PT is a PT is a PT. 00:16:26.293 --> 00:16:27.813 You can pick a physio out 00:16:27.894 --> 00:16:31.498 across the road and say, that's a physio. 00:16:31.538 --> 00:16:33.500 I can tell by the way they stand, 00:16:33.539 --> 00:16:34.259 the way they look, 00:16:34.961 --> 00:16:37.344 and how very observational they are, 00:16:37.583 --> 00:16:38.945 the way they interact with people. 00:16:39.586 --> 00:16:40.907 It doesn't matter where you're at. 00:16:41.347 --> 00:16:44.250 They're stamped out of the same mold, 00:16:44.530 --> 00:16:45.072 basically. 00:16:46.240 --> 00:16:47.421 Probably the biggest thing 00:16:47.541 --> 00:16:51.803 that has influenced me from 00:16:52.304 --> 00:16:54.807 my international experiences is that, 00:16:55.547 --> 00:16:56.888 and this is not a shot 00:16:56.927 --> 00:16:57.969 toward North America, 00:16:58.229 --> 00:17:00.951 but I think other countries 00:17:01.171 --> 00:17:02.111 are more curious. 00:17:02.653 --> 00:17:04.334 And it's probably self, 00:17:04.733 --> 00:17:05.815 it's a selection bias 00:17:05.855 --> 00:17:06.655 because they're usually 00:17:06.695 --> 00:17:08.757 coming to my courses or at 00:17:08.777 --> 00:17:10.238 the conference or something like that. 00:17:11.058 --> 00:17:11.819 But they're very, 00:17:11.859 --> 00:17:14.481 very curious on what is happening here? 00:17:14.761 --> 00:17:15.521 Why does it work? 00:17:16.363 --> 00:17:17.343 What do I need to know? 00:17:17.544 --> 00:17:18.804 What's the right thing to 00:17:18.844 --> 00:17:19.804 say to a patient? 00:17:20.585 --> 00:17:22.125 What happens if somebody 00:17:22.144 --> 00:17:22.846 doesn't get better? 00:17:22.885 --> 00:17:24.405 What does that typically mean? 00:17:24.486 --> 00:17:25.626 What could be some of the 00:17:25.666 --> 00:17:26.567 reasons for that? 00:17:28.248 --> 00:17:30.709 That part has been fuel for 00:17:30.769 --> 00:17:34.710 me to continue to look for that, 00:17:34.849 --> 00:17:35.931 to look for those answers 00:17:35.951 --> 00:17:37.570 and to be able to actually 00:17:37.611 --> 00:17:38.471 give those and say, 00:17:38.510 --> 00:17:40.112 here's some of the things 00:17:40.132 --> 00:17:42.053 that it could mean. 00:17:42.712 --> 00:17:44.294 And I think if there's anything... 00:17:45.213 --> 00:17:45.433 you know, 00:17:45.453 --> 00:17:47.855 the pain science revolution has 00:17:47.914 --> 00:17:49.336 brought us is an 00:17:49.375 --> 00:17:51.636 understanding that there 00:17:51.676 --> 00:17:52.897 will be differences in your 00:17:52.958 --> 00:17:53.877 outcomes and people are 00:17:53.897 --> 00:17:54.419 going to respond 00:17:54.439 --> 00:17:57.160 differently and having an 00:17:57.200 --> 00:17:58.280 underlying understanding of 00:17:58.320 --> 00:17:59.340 why that might be the case. 00:18:00.422 --> 00:18:01.801 So the big one for me 00:18:01.862 --> 00:18:04.263 internationally is the curiosity piece. 00:18:04.344 --> 00:18:06.525 It's just that part has been 00:18:07.464 --> 00:18:09.125 very rejuvenating for me, I think. 00:18:10.770 --> 00:18:13.156 Yeah, and I'm curious, like, why? 00:18:13.217 --> 00:18:15.102 Like, what is it that, you know, 00:18:15.663 --> 00:18:17.207 what stems their curiosity 00:18:17.247 --> 00:18:18.529 differently maybe than the U.S.? 00:18:18.569 --> 00:18:19.251 Is it the time? 00:18:19.291 --> 00:18:20.153 Is it productivity? 00:18:20.862 --> 00:18:23.443 What's the modeling that I 00:18:23.483 --> 00:18:24.424 think about factors? 00:18:24.724 --> 00:18:26.006 Why would you see such a difference? 00:18:26.026 --> 00:18:26.886 Do you have any idea? 00:18:27.606 --> 00:18:29.148 You brought it up, so now I'm asking. 00:18:30.108 --> 00:18:31.349 I think it's a lot of different things. 00:18:31.390 --> 00:18:32.230 I think part of it is the 00:18:32.270 --> 00:18:33.491 payment systems are different. 00:18:33.731 --> 00:18:37.174 So in many cases, in social environments, 00:18:37.194 --> 00:18:38.576 they're not incentivized to 00:18:38.615 --> 00:18:40.478 necessarily see more people 00:18:40.597 --> 00:18:41.858 or anything like that. 00:18:41.878 --> 00:18:44.260 They're more incentivized by 00:18:44.280 --> 00:18:46.281 their own passions to just do a good job. 00:18:47.742 --> 00:18:48.625 In other environments, 00:18:49.204 --> 00:18:50.246 it is very much fee for 00:18:50.286 --> 00:18:51.567 service and they have to 00:18:51.607 --> 00:18:52.970 deliver a superior product 00:18:53.390 --> 00:18:54.151 or that person is going to 00:18:54.191 --> 00:18:56.413 go a couple doors down and 00:18:56.433 --> 00:18:57.335 go to a different place 00:18:57.674 --> 00:18:58.797 because most of the places 00:18:58.836 --> 00:18:59.817 are privately owned and 00:19:00.679 --> 00:19:01.619 they hang their shingle out 00:19:01.660 --> 00:19:03.082 and hope that they can have 00:19:03.362 --> 00:19:05.344 a strong base with that. 00:19:06.453 --> 00:19:07.414 In other cases too, 00:19:07.714 --> 00:19:08.654 physio is a young 00:19:08.694 --> 00:19:10.236 profession in some of these countries. 00:19:10.276 --> 00:19:12.037 So it's very much in the growing phase. 00:19:12.637 --> 00:19:13.438 I would argue that it's 00:19:13.458 --> 00:19:14.358 similar to what we were 00:19:14.378 --> 00:19:15.659 like in the eighties and nineties. 00:19:16.380 --> 00:19:18.020 When everybody went to Conahead, 00:19:18.040 --> 00:19:19.580 you would go to five or six 00:19:19.642 --> 00:19:21.502 different major Conahead 00:19:21.702 --> 00:19:22.962 courses in a year and you 00:19:23.002 --> 00:19:25.244 had your employers would 00:19:25.285 --> 00:19:26.164 pay for it because they 00:19:26.204 --> 00:19:28.405 wanted you to grow as a clinician. 00:19:28.967 --> 00:19:30.907 So I see those parallels, 00:19:30.948 --> 00:19:32.388 but obviously I don't know 00:19:32.409 --> 00:19:33.368 the actual answer, 00:19:33.388 --> 00:19:34.490 but that's kind of what I think. 00:19:35.632 --> 00:19:36.833 Yeah, that's a great point. 00:19:37.212 --> 00:19:37.772 Great point. 00:19:38.212 --> 00:19:38.614 So now I'm going to 00:19:38.634 --> 00:19:39.834 transition back to the U.S. 00:19:39.874 --> 00:19:41.654 and the education side on our side, 00:19:41.674 --> 00:19:43.195 because I think we've hit 00:19:43.236 --> 00:19:44.977 some concepts around the clinical side, 00:19:45.017 --> 00:19:45.257 right? 00:19:45.297 --> 00:19:46.678 Curiosity, you know, 00:19:46.798 --> 00:19:48.137 it stems from somewhere. 00:19:48.898 --> 00:19:49.878 They've had some training, 00:19:49.898 --> 00:19:50.859 some basic training. 00:19:51.319 --> 00:19:53.500 So before students leave, like, 00:19:53.520 --> 00:19:54.540 so let's go back to that 00:19:54.580 --> 00:19:56.281 maybe entry level education. 00:19:57.262 --> 00:19:58.522 How do you envision some of 00:19:58.542 --> 00:19:59.443 the work that you're doing 00:19:59.503 --> 00:20:01.204 now or that you anticipate 00:20:01.265 --> 00:20:02.685 doing and hopefully some of 00:20:02.705 --> 00:20:03.526 the outcomes from that? 00:20:04.025 --> 00:20:05.747 How do you see that shaping or, 00:20:07.067 --> 00:20:07.488 I would say, 00:20:07.528 --> 00:20:08.888 helping to reframe maybe 00:20:09.009 --> 00:20:10.790 entry-level curricula or 00:20:10.871 --> 00:20:12.792 even early post-professional curricula? 00:20:12.853 --> 00:20:14.595 So whether it's fellowship 00:20:14.654 --> 00:20:16.737 level or even as students 00:20:16.777 --> 00:20:17.978 are kind of in those 00:20:17.998 --> 00:20:19.419 certificate courses before 00:20:19.459 --> 00:20:20.500 they go into fellowships. 00:20:21.769 --> 00:20:21.909 Well, 00:20:21.929 --> 00:20:23.509 I would hope it has a blueprint 00:20:23.548 --> 00:20:24.789 that's similar to exercise 00:20:24.829 --> 00:20:27.450 science and that you have 00:20:27.490 --> 00:20:28.951 these exercise prescription. 00:20:29.211 --> 00:20:30.191 This is what we know, 00:20:30.611 --> 00:20:32.651 what happens with exercise. 00:20:32.671 --> 00:20:33.692 Here are the mechanisms. 00:20:33.731 --> 00:20:35.192 Here's what it can actually 00:20:35.692 --> 00:20:37.412 influence in a person's 00:20:37.451 --> 00:20:38.512 disease mechanisms. 00:20:38.952 --> 00:20:41.133 Here's how its role during 00:20:41.153 --> 00:20:42.792 an inflammatory process, et cetera. 00:20:43.413 --> 00:20:45.013 So providing a framework, 00:20:45.513 --> 00:20:47.034 providing a taxonomy around 00:20:47.233 --> 00:20:49.335 application of how you would use it 00:20:49.934 --> 00:20:50.836 That's my goal. 00:20:51.037 --> 00:20:52.818 If if there's that and then 00:20:52.858 --> 00:20:54.141 that could be part of that 00:20:54.201 --> 00:20:56.644 educational process and so 00:20:56.664 --> 00:20:57.665 that there's everybody's 00:20:57.685 --> 00:20:59.950 kind of on common ground, then the 00:21:01.758 --> 00:21:02.698 treatment part of it, 00:21:02.917 --> 00:21:04.499 the application part of it 00:21:04.778 --> 00:21:06.138 can take whatever flavor 00:21:06.558 --> 00:21:07.659 the educator wants. 00:21:08.920 --> 00:21:10.339 My concern right now is that 00:21:11.200 --> 00:21:12.339 when I look at manual therapy, 00:21:12.359 --> 00:21:15.320 especially in an entry level requirement, 00:21:15.401 --> 00:21:16.601 it's a lot of techniques 00:21:17.820 --> 00:21:19.342 and it's not a lot of 00:21:19.442 --> 00:21:21.362 structure or understanding 00:21:21.442 --> 00:21:24.343 on when and how to use it. 00:21:25.282 --> 00:21:27.123 Yeah, that's a great point. 00:21:27.182 --> 00:21:29.003 And I think that's something 00:21:29.023 --> 00:21:29.923 that we could go further on. 00:21:30.757 --> 00:21:31.758 if they were to do, right? 00:21:32.097 --> 00:21:33.439 We all teach orthopedics or 00:21:33.459 --> 00:21:34.599 musculoskeletal, right? 00:21:34.680 --> 00:21:36.461 And so there's a desire for 00:21:36.480 --> 00:21:37.602 students to know how to do 00:21:37.642 --> 00:21:38.842 things with their hands. 00:21:39.222 --> 00:21:41.084 And I think what you've said 00:21:41.144 --> 00:21:41.864 is that it's just as 00:21:41.884 --> 00:21:42.565 important to really 00:21:42.625 --> 00:21:43.464 understand some of the 00:21:43.525 --> 00:21:44.266 understanding of the 00:21:44.306 --> 00:21:45.105 mechanisms that we 00:21:45.287 --> 00:21:47.407 understand and how it may 00:21:47.488 --> 00:21:49.730 work in that clinical approach. 00:21:49.769 --> 00:21:51.150 So the reasoning pieces to 00:21:51.170 --> 00:21:52.290 that may be helpful. 00:21:52.730 --> 00:21:54.011 Is there anything else that 00:21:54.512 --> 00:21:55.854 beyond reasoning that you 00:21:55.874 --> 00:21:56.913 feel like that really 00:21:56.953 --> 00:21:58.115 should be a focus of these 00:21:58.194 --> 00:21:59.496 entry level programs? 00:22:00.491 --> 00:22:00.612 Well, 00:22:00.652 --> 00:22:03.054 I think we need to understand where 00:22:03.673 --> 00:22:04.535 the manual therapies 00:22:04.595 --> 00:22:06.715 actually fit within the 00:22:06.736 --> 00:22:10.999 health care paradigm. 00:22:11.079 --> 00:22:12.200 And I teach a health 00:22:12.240 --> 00:22:13.401 services course at Duke. 00:22:14.061 --> 00:22:15.482 And in the health services course, 00:22:15.502 --> 00:22:17.044 we talk about the different approaches. 00:22:17.144 --> 00:22:18.305 One of them is stepped care. 00:22:18.884 --> 00:22:20.125 I'm a firm believer that 00:22:21.826 --> 00:22:24.170 safe interventions, low cost interventions, 00:22:24.349 --> 00:22:25.571 non-invasive interventions 00:22:26.031 --> 00:22:27.993 like the manual therapies, exercise, 00:22:28.034 --> 00:22:28.474 et cetera. 00:22:28.914 --> 00:22:30.136 It should be an early option 00:22:30.196 --> 00:22:33.220 for people with musculoskeletal problems. 00:22:33.461 --> 00:22:34.521 So understanding where it 00:22:34.582 --> 00:22:36.523 fits in that care process 00:22:37.204 --> 00:22:39.506 For the bulk of our patients 00:22:39.526 --> 00:22:41.606 with musculoskeletal problems, 00:22:42.207 --> 00:22:44.228 that should be an essential teach, 00:22:44.468 --> 00:22:46.709 I think, in entry-level programs, 00:22:47.210 --> 00:22:48.690 but also reinforced in 00:22:48.750 --> 00:22:50.290 postgraduate programs that 00:22:50.611 --> 00:22:52.791 we really have a role and, you know, 00:22:52.811 --> 00:22:53.511 I would argue a 00:22:53.531 --> 00:22:55.393 responsibility to make sure 00:22:55.432 --> 00:22:56.933 that everybody was 00:22:57.013 --> 00:23:00.536 following those preferred paradigms. 00:23:01.195 --> 00:23:02.696 And right now, stepped care, I think, 00:23:02.737 --> 00:23:04.477 is probably the best option 00:23:04.958 --> 00:23:05.758 within that framework. 00:23:08.478 --> 00:23:09.618 That's great. 00:23:09.638 --> 00:23:10.558 So let me ask you kind of a 00:23:10.618 --> 00:23:11.759 wrapping up question. 00:23:12.140 --> 00:23:13.401 Where do we learn more? 00:23:13.621 --> 00:23:14.101 And I mean, 00:23:14.121 --> 00:23:15.521 you've said listening maybe to 00:23:15.561 --> 00:23:17.863 different authors or going 00:23:17.923 --> 00:23:19.023 outside of our own comfort 00:23:19.064 --> 00:23:20.505 zones a little bit and 00:23:20.545 --> 00:23:22.246 maybe listening to others 00:23:22.266 --> 00:23:23.145 that may have interest. 00:23:23.465 --> 00:23:24.047 Obviously, 00:23:24.446 --> 00:23:26.667 ForceNet is a group and you guys 00:23:26.688 --> 00:23:27.828 have some podcasts that go 00:23:27.888 --> 00:23:28.528 or not podcasts, 00:23:28.548 --> 00:23:29.470 but some different speakers 00:23:29.490 --> 00:23:30.170 that come on to your 00:23:31.049 --> 00:23:32.050 your group that you do, 00:23:32.111 --> 00:23:34.054 where else can our audience 00:23:34.094 --> 00:23:36.178 and listeners gain more information, 00:23:36.198 --> 00:23:37.720 things that you would recommend, 00:23:37.839 --> 00:23:39.201 maybe next steps from them 00:23:39.403 --> 00:23:40.704 beyond today's talk? 00:23:41.666 --> 00:23:42.787 Well, the first step, I think, 00:23:42.866 --> 00:23:44.948 is keep an eye on some of 00:23:44.988 --> 00:23:45.968 our publications that will 00:23:46.009 --> 00:23:47.028 be coming out pretty soon. 00:23:47.469 --> 00:23:49.289 We have two in review and plus one. 00:23:50.289 --> 00:23:51.250 We have another one in the 00:23:51.289 --> 00:23:52.131 International Journal of 00:23:52.191 --> 00:23:53.290 Osteopathic Medicine, 00:23:53.730 --> 00:23:54.451 and then two more that 00:23:54.471 --> 00:23:55.432 we'll be submitting very 00:23:55.471 --> 00:23:56.951 soon that are really built 00:23:56.991 --> 00:23:59.232 around this concept of 00:23:59.573 --> 00:24:00.513 here's the scaffolding of 00:24:00.534 --> 00:24:01.294 what you need to know. 00:24:02.402 --> 00:24:03.884 ForceNet is a great place to start. 00:24:03.923 --> 00:24:04.785 We have a number of free 00:24:04.825 --> 00:24:07.027 webinars that are online 00:24:07.047 --> 00:24:08.268 that you can listen to. 00:24:08.828 --> 00:24:10.109 We throw so many different 00:24:11.791 --> 00:24:13.374 educators in those webinars. 00:24:13.394 --> 00:24:15.276 They're absolutely outstanding. 00:24:15.296 --> 00:24:16.136 That's actually been one of 00:24:16.196 --> 00:24:18.858 our best pieces, I think, of ForceNet. 00:24:19.579 --> 00:24:21.421 We actually have an online 00:24:21.740 --> 00:24:25.163 manual therapy conference in February, 00:24:25.304 --> 00:24:26.365 February the twenty second, 00:24:26.765 --> 00:24:27.945 two thousand twenty five. 00:24:28.266 --> 00:24:31.107 It's called Converge twenty twenty five. 00:24:31.748 --> 00:24:32.888 And in this conference, 00:24:33.189 --> 00:24:34.809 we have invited all 00:24:35.130 --> 00:24:37.192 different disciplines that 00:24:37.231 --> 00:24:38.992 work with it's called force 00:24:39.113 --> 00:24:40.213 based manipulations, 00:24:40.253 --> 00:24:41.273 but it's manual therapy. 00:24:41.815 --> 00:24:43.435 So this would go run the gamut from. 00:24:44.036 --> 00:24:45.176 the basic scientist who 00:24:45.217 --> 00:24:46.417 works in mouse studies, 00:24:46.919 --> 00:24:47.618 all the way to the 00:24:47.638 --> 00:24:48.980 clinician who has a full 00:24:49.000 --> 00:24:51.102 schedule of patients that 00:24:51.362 --> 00:24:52.663 they use manual therapy with. 00:24:53.763 --> 00:24:55.184 And we will have different tracks. 00:24:55.945 --> 00:24:56.926 But keep an eye on that. 00:24:56.987 --> 00:24:58.347 It's on our ForceNet website. 00:24:58.367 --> 00:25:00.230 We'll be advertising for that very soon. 00:25:00.910 --> 00:25:02.791 I think that'll be really interesting. 00:25:02.811 --> 00:25:04.292 The tracks are going to be imaging. 00:25:04.313 --> 00:25:04.874 They're going to be the 00:25:04.913 --> 00:25:06.134 clinician and mechanisms. 00:25:06.555 --> 00:25:09.176 There's going to be a 00:25:09.217 --> 00:25:10.278 neuroscientist track. 00:25:10.337 --> 00:25:10.919 And then there's actually 00:25:10.939 --> 00:25:12.359 going to be a modeling track, too. 00:25:12.990 --> 00:25:14.131 Oh, that's very cool. 00:25:14.471 --> 00:25:14.991 Very cool. 00:25:15.592 --> 00:25:16.133 Well, Chad, 00:25:16.153 --> 00:25:17.053 I think you just accomplished 00:25:17.073 --> 00:25:17.953 all that in one week. 00:25:18.034 --> 00:25:18.213 I mean, 00:25:18.253 --> 00:25:19.394 what are you going to do next week 00:25:19.434 --> 00:25:20.076 at this point? 00:25:20.135 --> 00:25:20.476 So, I mean, 00:25:20.496 --> 00:25:21.576 you're going to have like eight 00:25:21.616 --> 00:25:23.138 papers in one week already. 00:25:23.259 --> 00:25:24.960 So you're one of the most productive, 00:25:25.420 --> 00:25:26.240 productive scholar 00:25:26.260 --> 00:25:27.442 researchers I've ever met. 00:25:27.481 --> 00:25:28.663 You're exaggerating. 00:25:29.064 --> 00:25:29.983 Oh, I am not. 00:25:30.124 --> 00:25:30.464 I am not. 00:25:30.505 --> 00:25:30.845 Listeners, 00:25:30.865 --> 00:25:32.946 you all know I will not lie to you, 00:25:32.987 --> 00:25:35.788 but I so appreciate your time, Chad. 00:25:35.848 --> 00:25:36.630 And thank you for just 00:25:36.650 --> 00:25:37.671 making some time to have 00:25:37.711 --> 00:25:39.051 conversation about all the 00:25:39.071 --> 00:25:40.252 cool stuff you're doing. 00:25:41.083 --> 00:25:44.026 Introducing our listeners to scaffolding, 00:25:44.066 --> 00:25:44.266 right? 00:25:44.326 --> 00:25:45.727 Ways to navigate these 00:25:45.768 --> 00:25:48.170 trails and trials and 00:25:48.210 --> 00:25:51.271 challenges and orthopedic manual PT, 00:25:51.291 --> 00:25:51.732 as we know, 00:25:52.192 --> 00:25:53.614 it's about finding the right balance, 00:25:53.835 --> 00:25:54.095 right? 00:25:54.154 --> 00:25:55.175 And I think this relates to 00:25:55.195 --> 00:25:56.896 your biking and navigating 00:25:56.936 --> 00:25:57.817 the trails that you have 00:25:57.877 --> 00:26:00.180 navigated for us because 00:26:00.220 --> 00:26:02.501 you truly are a pioneer in what we do. 00:26:02.582 --> 00:26:03.963 And so thank you for all of 00:26:03.983 --> 00:26:04.943 your dedication to the 00:26:04.963 --> 00:26:06.685 profession and hard work. 00:26:07.050 --> 00:26:08.392 being inspired by our young 00:26:08.791 --> 00:26:10.173 our young attendees at 00:26:10.554 --> 00:26:12.234 conferences or continuing ed courses, 00:26:12.295 --> 00:26:13.435 challenging you to learn 00:26:13.476 --> 00:26:15.396 more and then help educate us more. 00:26:15.457 --> 00:26:16.298 And so we're grateful that 00:26:16.317 --> 00:26:17.058 you do that work. 00:26:17.959 --> 00:26:18.199 You know, 00:26:18.239 --> 00:26:19.559 I think that there is a perfect 00:26:19.760 --> 00:26:20.800 understanding that we do 00:26:20.840 --> 00:26:21.682 have to find balance 00:26:21.721 --> 00:26:23.103 between theory and practice. 00:26:24.003 --> 00:26:24.703 I don't think there's just 00:26:24.723 --> 00:26:25.924 the right one right size. 00:26:25.964 --> 00:26:27.165 And I really appreciate you 00:26:27.185 --> 00:26:29.028 giving us some insight into other ways, 00:26:29.607 --> 00:26:30.888 other areas and ways that 00:26:30.909 --> 00:26:32.190 we can get more information, 00:26:32.210 --> 00:26:33.050 be thoughtful about other 00:26:33.070 --> 00:26:34.632 disciplines as we we grow. 00:26:35.422 --> 00:26:37.301 as our understanding about 00:26:37.342 --> 00:26:38.803 how we can be better at 00:26:38.823 --> 00:26:40.343 manual therapy and its application. 00:26:40.403 --> 00:26:41.663 So thank you for that today. 00:26:41.884 --> 00:26:42.284 Appreciate it. 00:26:42.304 --> 00:26:43.983 Well, thank you for having me. 00:26:44.003 --> 00:26:44.423 Always. 00:26:44.784 --> 00:26:46.664 So Chad, we're grateful that you are here. 00:26:46.765 --> 00:26:47.765 We are grateful that we get 00:26:47.805 --> 00:26:49.204 to see you in our upcoming 00:26:49.325 --> 00:26:50.385 conference at AOM. 00:26:50.445 --> 00:26:51.786 So yeah, 00:26:51.905 --> 00:26:53.465 I get to put that AOM chat on and say, 00:26:53.526 --> 00:26:54.346 I get to see you soon. 00:26:54.886 --> 00:26:56.567 And we're presenting together again. 00:26:56.606 --> 00:26:58.106 So that will be very fun. 00:26:58.968 --> 00:27:00.087 And I look forward to having 00:27:00.127 --> 00:27:01.667 you in Orlando and listen, 00:27:01.847 --> 00:27:02.647 so many of our listeners 00:27:02.667 --> 00:27:03.608 are going to show up there too. 00:27:03.648 --> 00:27:04.808 So we're really excited for that. 00:27:05.565 --> 00:27:07.026 And for those who aren't there, 00:27:07.346 --> 00:27:08.207 Chad gave you another 00:27:08.267 --> 00:27:10.249 opportunity to catch up on 00:27:10.288 --> 00:27:11.789 the ForestNet website and 00:27:12.170 --> 00:27:12.950 see when their conference 00:27:12.990 --> 00:27:14.191 is coming up in February. 00:27:14.791 --> 00:27:15.672 So you can learn more about 00:27:15.711 --> 00:27:16.653 those manipulation 00:27:16.692 --> 00:27:18.653 opportunities and learn how 00:27:18.673 --> 00:27:19.815 you might broaden your 00:27:19.855 --> 00:27:21.096 horizons a little bit further. 00:27:21.195 --> 00:27:23.317 So thank you for your time today. 00:27:23.538 --> 00:27:27.119 And we will catch you on our next podcast. 00:27:27.299 --> 00:27:28.240 And again, remember, 00:27:28.340 --> 00:27:29.781 hands on or hands off. 00:27:30.162 --> 00:27:30.823 We'll figure it out. 00:27:30.982 --> 00:27:31.343 All right. 00:27:31.383 --> 00:27:32.284 Thanks so much, guys. 00:27:32.304 --> 00:27:32.763 Have a good one.