all right welcome to hands on hands off
i'm your host today moya tillery um and
for this episode i am joined by someone
i respect deeply um and i've had the
pleasure of working with for a couple of
years now dr ron shank ron is a
professor he's a mentor a thought leader
in ompd and mechanical diagnosis
Today we're talking about bridging the gap
between the evolution of OMPT and
directional preference.
And if you followed Ron's work,
you know that he's been involved in both
worlds, so to speak,
or are they the same worlds?
That's for us to get into today.
Welcome, Ron.
Please tell us a little bit about yourself
and we'll get the conversation going.
Well, thanks, Mo.
Thanks for having me.
I'm a graduate of Ithaca College Physical
Therapy Program,
and then I went on to do a
residency in Gulfport,
Mississippi with Mike Rogers,
who's one of the founding members of AOMT.
Later on,
I became McKenzie certified and earned my
PhD and became a fellow in AAOMPT.
And from the mid-nineties on,
I've tried to bridge the two schools of
thought
And I really do think there's a place
for directional preference in the schema
that we use for examination intervention
for people with musculoskeletal disorders.
Yeah, no, that's great, Ron.
Thank you.
It's such a pleasure to have you.
I'm glad we get this time to chat
about something that I think has been on,
you know,
maybe certain people's minds as far as
bridging this gap in these two very
clinically applicable and appropriate,
right?
Once you figure out which patient is
appropriate for what technique or mix of
techniques.
I want to know a little bit.
I think we can take it back, Ron,
if you're okay with that.
Let's start with maybe your personal
journey.
You've mentioned OMPT giants like Mike
Rogers and the late Dick Earhart in your
own training.
You've also had numerous publications on
directional preference.
Can you walk us through maybe how you
first encountered directional preference
and perhaps how your understanding of
directional preference has evolved?
Sure.
So back when I was at Ithaca,
one of our musculoskeletal professors was
Robert Sprague.
And Bob Sprague is well known to people
in AAMT.
Bob is a founding member of MAPS,
Maitland Seminars.
But he also taught with Robin McKenzie
himself early on when Robin McKenzie first
came upon his directional preference
approach.
And so Bob kind of integrated the two
back when I was an undergrad in physical
therapy.
And it was probably a little too much
to handle for someone who's not seen
patients yet.
And it didn't begin to make sense until
I took,
I started working at a hospital in
Buffalo,
New York and seeing outpatients and began
to apply some of that.
But to further that thinking in that area,
I took a McKenzie A course,
a lumbar course.
And around that time,
I was a clinical instructor,
and one of our students came into the
clinic and said, you know,
you ought to think about this residency
program they have.
I had just spent six weeks there,
and it's down in Gulfport, Mississippi.
And I said, wow, really?
He said, yeah,
he worked there for a year for this
guy named Mike Rogers.
And what he does is he integrates all
different schools of thought.
So I really do think Mike was a
forerunner in combining schools of thought
and utilizing what's best for the patient
and not necessarily trying to get the
patient to fit into your school of thought
or your way of thinking.
So we were exposed to osteopathic,
Maitland, McKenzie,
many different approaches for management
of people with musculoskeletal disorders.
And it wasn't until I returned back to
Buffalo and
continue to see patients that I thought I
maybe wanted to explore that directional
preference approach or the McKenzie
approach a bit more.
So I pursued certification in that while
still studying and practicing manual
physical therapy.
And I thought right from the beginning,
like Mike had told us,
if you have an understanding of many
different schools of thought,
you can apply them to a fairly high
level.
You can help more patients because we know
not every patient's going to respond to
one approach.
And although we may be biased towards a
particular system or approach,
and that's good,
we know that the reliability of these
different systems we have for examination
and treatment,
not one stands out as being more reliable
than another.
But what we do know is when you
have a system and you have a way
of approaching a patient in a systematic
manner,
that you tend to have better outcomes than
people who just kind of do things without
a treatment-based classification type of
approach.
And interestingly,
when we were down in Mississippi, Dr.
Dick Earhart,
also a founding member of AOM,
he'd come down to the residency every year
and do some teaching.
And he was, of course,
a proponent of the treatment-based
classification system.
So matching that impairment and those
functional limitations to a particular
classification.
And that fit very well.
It was very compatible with MDT,
I thought,
and also
the treatment-based classification
approach has a specific exercise category,
which is based on centralization.
So if patients with peripheral symptoms
were found to centralize with extension,
they'd be placed in that specific exercise
category.
So Dick Earhart too taught with Rob
McKenzie early on and appreciated some of
what he had to offer.
But being a chiropractor and a
manual physical therapist,
a physical therapist, Dick Earhart,
used a combination of schools of thought
as well.
So I had a lot of respect and
was influenced greatly by that.
And the fellowships and residencies that
we developed were based on that concept of
integrating approaches,
using the best features of different
approaches to find out what's going to be
best for that person sitting in front of
you.
And our ordainment program required
McKenzie A and B courses.
The McKenzie Fellowship,
which was post-diploma,
so these were people that reached the
highest level of training at MDT,
were then exposed to other schools of
thought as part of their fellowship
training.
So we utilized the same clinical
instructors and mentors.
And we think that that combination of
approaches still
giving respect to that person's bias and
understanding what's their go-to,
but still being open-minded.
And I see in our schema of examination,
which was developed by Ciriacs, active,
passive,
resistive movements,
we can put it after the active movements
testing end range.
Prior to testing passive intervertebral
motion or single segmental mobility
testing,
why not explore the potential for a person
to find a directional preference through
their own volition?
So before we would test end range,
we test the person's ability to go to
end range.
People can do it.
Some people need assistance in that.
And
Whereas extension may be in thought of as,
or neck retraction in the upper quarter
thought to be a movement that may produce
a centralization of symptoms,
there's actually many different loading
strategies and directions that may be
explored in order to find if that person
may centralize or exhibit a directional
preference.
And, you know,
I think it may be gaining some traction
when we look at
Patient empowerment,
people may be able to treat themselves and
not necessarily be dependent to as great
an extent on us.
However,
people do need hands-on and those
approaches that foster hands-on training
and cycles motor skill development,
when they treat the patients and they
encounter that patient,
they put their hands on,
regardless of the algorithm they follow to
determine
that intervention they're doing so in an
extremely competent and confident manner
which is then conveyed and the patient
thinks well this person is skilled and
knowledgeable and you're already halfway
there then you know the right alliance
And the trust, yeah, the trust is there.
Ron, there's so much in what you said,
and I think that this is part of,
you and I talked about this,
this is kind of why I immediately thought
about you in talking about something that
is foundational to OMPT.
You've kind of seen the evolution of how
we've gotten here and have spoken to that.
And what I'm pulling from a lot of
what you said just now too is,
you know,
those are the things that we're teaching
for those of us in academia.
And, you know,
even clinical teaching is it's still got
to be about the patient, right?
Like it still has to be patient focused
and the patient,
if you treat the impairments,
it almost doesn't matter, you know,
maybe what path or what,
what siloed thinking you choose because
you're tailoring it,
tailoring it to the patient.
And that's really important.
A lot of evidence now we know through
like the CPGs is that,
a multimodal approach to intervening for
our patients and I think
I've been guilty of it too,
especially when I first became a fellow.
I was like,
I want to do all these techniques on
everyone.
I want to practice, get my skills well.
But you may go a year and never
have to manipulate a talocrural joint
because you just don't have a patient that
needs that.
So I really have a deep appreciation for
the way that you have illustrated kind of
where we were
how you lived where we were and how
you are now living where we are.
I do want to shift a little bit.
You started to go into this a little
bit, Ron.
Let's shift to OMPT practice,
specifically where you've seen it evolve
from really hands-on,
heavily hands-on approach,
maybe clinician-focused approach,
to periodically,
what I would say now of somewhat of
a more hands-off approach,
while acknowledging the expertise of the
manual therapist who needs to put their
hands on.
Where does directional preference fit in
now as we're sort of bridging these two
paradigms where we're occasionally
hands-on, occasionally hands-off?
Where's directional preference?
What are your thoughts?
Yeah, well,
you said something I think that's pretty
profound in that
We have to have an examination that's
inclusive enough to appreciate a potential
impairment.
So if we go in and our only
tool is to test repeated end range
movements,
then we're kind of left with that in
terms of how we may manage the patient.
If we omit testing muscle balance,
we then lose the opportunity to encourage
people to stabilize or utilize exercises
that may address their chief impairment.
So when we have a thorough examination
that may be inclusive of testing repeated
end range,
I would certainly recommend that.
We could put an asterisk toward or at
that impairment and that tends to stand
out that we appreciate maybe the thing
that we go after initially.
And if we don't have a thorough exam,
then we're missing out.
We're really not doing that patient
justice.
And it could be done in an efficient
manner provided you have exposure and
training in these different approaches.
So we're finding that some people are
interested in pursuing further training in
MDT.
And we also find that our MDT fellows,
McKenzie fellows that are now part of the
Academy are learning more from our other
colleagues who
you know,
are approaching patients a bit
differently.
And that was really the vision of the
founding members of AOM.
They all had their very invested
approaches to treating patients,
but they had the vision to understand that
it wasn't the answer for everyone.
And it's the difference between an
institute and an academy.
So, you know,
the academy is comprised of a lot of
different institutes and schools of
thought.
And really, it's
It's very rewarding and exciting to go and
learn something new when we go to these
conferences and hear research and see
techniques taught in these breakout
sessions that maybe we wouldn't be able to
offer our patients without that exposure.
So you can pretty much say if you
go to a McKenzie conference,
you're going to hear about McKenzie.
If you go to a Maitland conference,
you're going to learn about
Maitland or Maitland seminar,
you're going to learn about Maitland.
That's fine.
And when you learn something to a very
high level and you're able to distinguish
signs and symptoms and come up with a
classification or diagnosis,
patients are probably going to do very
well.
And we had some McKenzie fellows go out
for mentorship from a Paris fellow and
both learned from one another.
And I've been a mentor for people from
James Dunning's program,
and other programs as well.
And I've learned and then adopted
techniques based on that.
So that's really a compliment to those,
Stanley Paris and Dick Earhart and Mike
Rogers and others, Bjorn Svensson,
who had that vision way back when that,
and they didn't always agree.
I understand that it was,
and I was a member of the board
at AOMT at that time, you know,
that
You know, there's, you know,
sometimes some very...
Some heated discussions.
Heated discussions.
Thank you, Ma.
Heated discussions in regards to how
things were being approached.
But still,
they were able to let that go.
And it's really for the betterment of the
patient.
Yes.
Yeah, I love that, Ron.
And I, you know,
you know that I went through MTI and
Tim and Krzyzewski and Peter Kroon
developed that program and similarly.
They were right after me, so.
So, you know,
you basically know what I learned and what
they taught.
Exactly.
And a whole lot more.
But that's part of what I really
appreciate about our community of practice
after going through MTI, which,
like you said, is an institute.
That's an important distinction that I
never thought about.
Institute versus academy is getting this
mix of techniques and schools of thoughts
and
It really deepened my appreciation,
I think,
to the homage that you paid to the
founders of AOMT,
which is that our outcomes are that much
better when we do kind of infuse these
different techniques versus walking in our
single silos.
And, you know,
one size fits all treatment has obviously
been disproven to be effective in managing
patients.
I love this community practice for that
reason.
So now I have to put you on
the spot.
Thank you.
before I go into mentorship,
because you talked about mentoring, uh,
different people from different programs.
We're going to end on that Ron,
because selfishly,
I really want to spend a little bit
of time there, but do you,
do you think Ron that at where we
are right now and what you've seen,
what you're seeing,
do you think that OMPT and MDT are
like finally coming together or do we
still have some work to do?
What does that look like?
What are your thoughts?
Well, it's moving in that direction.
And, uh,
You know, directional preference, I think,
is kind of a hard concept to argue
about in regards to asking people to move
in directions to end range and see if
that direction produces a lasting change
in their signs and symptoms.
So it isn't just a person moves in
a certain direction,
they feel a decrease in their symptoms.
It should be decreased and better or a
lasting improvement for it truly to be a
directional preference.
And originally, Robin McKenzie,
described it in terms of centralization.
So if symptoms were found to move from
a more distal to more central location,
then that would be directional preference.
But that's just one example.
It could also be localized pain that
decreases or remains decreased,
or maybe a baseline that improves.
It may be range of motion or maybe
a neural sign that changes and remains
improved as a result of moving in a
particular direction.
So there's been over fifty articles
published on centralization.
MDT is among the most researched
approaches in musculoskeletal practice.
And I think part of the reasons,
one of the reasons it's so researched so
extensively is that it seems so simple,
but it's not that simple, actually.
And in a scoping review that was recently
published in the Journal of Physical
Therapy,
there's found to be one hundred and
eleven, you know,
different definitions in the ten thousand
articles that were described,
not a hundred eleven different
definitions, but.
You know,
there is a quite a bit of discrepancy
in how it's defined,
so operationally defined as a lasting
improvement in a baseline as a result of
moving repeatedly or sustaining an end
movement.
So the evidence is emerging.
You know, it's not
You know,
in a systematic review published by
Halliday in Journal of Orthopedics and
Sports Physical Therapy,
they found when MDT or McKenzie was
operationally defined in the clinicians
operated according to that, you know,
those definitions that MDT did have a
greater treatment effect size.
when we looked at credentialed therapists
or people who've learned this approach in
a article published in twenty twenty five
by Hanneman and colleagues,
they found that those that were trained
had more favorable outcomes in comparison
to other approaches.
Yeah.
You know,
if they had that training in it.
So it's about exposure and
paying respect to the evidence in the
literature.
You know,
we have systematic reviews and
meta-analyses and randomized controlled
trials that might show the efficacy of a
particular approach,
but ultimately it boils down to the
evidence of the patient.
And like you said,
you're able to identify, you know,
functional limitations,
patient's perception of pain,
contextual factors,
and put it all together.
and determine what's best for that patient
right there,
because that can't be captured, you know,
in these, when we look at the,
you know,
the evidence synthesis from a systematic
review or meta-analysis or even a
randomized controlled trial.
So, you know, it's a balance.
It's a balance of the evidence literature
and the evidence of the patient.
You know,
we respect to the evidence that's there,
but we also have to pay respect to
the fact that sometimes,
evidence emerges over time.
Back when Dick Earhart taught us a
sacroiliac joint course during our
residency,
he did a gapping technique for the
sacroiliac joint and described it as being
effective for treating many different
diagnoses related to the SI.
And he showed us this one technique that
was a gap.
Some people wanted to learn, you know,
a number of SI techniques.
That's one that's good.
I'm good about that if we have one
go-to.
And you said it's more important that we
get a joint to move.
Correct.
And actually, years later,
that same technique,
which was described as a gap for the
sacroiliac joint,
became the technique lumbopelvic thrust
that was in Flynn's study of clinical
prediction rule for lumbar manipulation.
So the technique he was demonstrating back
in the eighties and nineties and teaching
ended up being part of our- Implemented in
practice.
Yeah.
Involvement of a clinical prediction rule.
You know,
we can't be dismissive of things,
especially when they come from expert
clinicians who've seen thousands of
patients over many years.
it works.
But then when they disseminated
information to people like Julie Fritz,
who was at the University of Pittsburgh,
Dick Earhart was there, you know,
and Julie Fritz helped influence the
development of that clinical prediction
rule, you know,
then we give respect to those that were
really providing evidence of those
patients they were seeing.
Yeah, I love that, Ron.
I think it's really important.
I'm glad you talked about that scoping
review because I had a couple thoughts and
questions and things.
But well,
I think it's important to go back to
what you said about variability and not
having that common taxonomy and shared
understanding.
It may seem like a silly parallel,
but it's like being in a relationship,
right?
If you're not speaking the same language,
your understanding of what the other
person is saying to you is going to
vary.
And not to mention the impact that could
have clinically on our patients who are
hearing, you know,
something completely different from a
provider who maybe shares the credentials.
Like, it can be...
You know,
and I think this applies not just to
directional preference, obviously,
and the variability in defining it,
but to manual therapy itself and OMPT,
which has lacked that common taxonomy.
You know,
Chad talked about this in the article a
couple of years ago,
I think it was twenty one,
where manual therapy has just been
demonized and and just, you know,
sort of tossed to the wayside.
And he's kind of advocating that we define
it by
it's evidence based function versus that
one technique, you know,
like the Chicago roll or whatever the case
may be.
This is the,
the definition has to encompass all of the
things, not just the techniques,
but also the clinical effects and the
outcomes.
So, I mean,
what are your thoughts around like,
why is directional preference so hard to
define?
Yeah.
Yeah,
I think I touched on a little bit
earlier in that it's not understood to be
a lasting change.
And it's sometimes thought of as someone
that's got low back pain and peripheral
symptoms.
They do extension and lying or standing
lumbar extension.
and it centralizes or it doesn't
centralize.
Then we move on to something else.
So looking at weight-bearing versus
non-weight-bearing movements,
not just in the sagittal plane,
but the transverse plane and a combination
of transverse and so forth.
And you also mentioned kind of the
language issues we have.
When I was in our manual therapy
residency,
we were taught a posterior to anterior
central vertebral pressure.
thought to be having an effect on the
zygopal seal joints potentially.
And then later on in MDT training,
we were taught a lumbar extension
mobilization,
the identical hand placement, location,
and we're moving
At that time,
it was thought to be moving the discs.
So we're moving away from pathoanatomical
diagnoses, which I think are good.
We're moving more towards classifications
based on movements and responses to
movement.
I think MDT fits in well with that.
We, though,
shouldn't lose sight of those
pathoanatomical diagnoses because they may
be very helpful in us establishing
parameters.
So we wouldn't treat
disc pathology,
if we hypothesize it to be disc generated,
the same way we would treat a muscle
that's weak or a power deficit.
So there's a balance, too,
between the pathoanatomical diagnoses and
the movement-based diagnoses.
And like, unfortunately,
many times in our profession,
it's got to be one or the other,
right?
It's got to be one.
oh,
I'm pathway anatomical or I'm
movement-based,
you need really to understand both.
And understanding, though,
that we don't always know the pain
generator.
But if we have an appreciation of how
that person moves,
then we may establish a parameter that's
quite different.
If it's ligamentous,
it may be a thousand reps.
If it's muscle,
it may be three sets of ten every
other day.
And when I got out of school,
everyone got three sets of tests
regardless of the diagnosis.
So we have some challenges with language
as you touched on.
And we need to work towards more
commonalities rather than pointing out
differences and discrepancies.
And that's a job.
That's not easy.
Well, it's a big job,
and I think the scoping review is really
starting to probe that a bit.
There seems to be this conflation of the
two terms,
centralization and directional preference,
which you're highlighting.
not just what the scoping review found,
but a lot of other studies use them
interchangeably.
I think because of my training with Tim
and Peter,
it's clear that there's a difference.
I think if you think about the fact
that there are those of us who were
in fellowship training programs and
treating patients,
We need clarification of those two terms
because the impact that this could have on
those of us as clinicians,
but also in our patients.
I think you already kind of touched on
the difference between the two,
but I just want to highlight that we
talk about taxonomy and common taxonomy.
It's not just words on paper or in
research.
The clinical application of these
mechanisms, both powerful but distinct,
It has a direct impact on clinicians who
are trying to learn,
clinicians who are
now in academia trying to teach,
but then of course the patient at the
center of all of it.
So I just want to underscore how important
what you're saying is and to also maybe
invite the listener to understand that
we're talking about directional preference
and OMPT and centralization,
but this applies to many things in
physical therapy.
So I just really appreciate that
conversation, Ron.
What are your thoughts on the scoping
review?
There's a lot in there.
Where are you going with this next, Ron?
Yeah,
so I think as was done by Halliday,
we need to look at those that
operationally define
directional preference and those that
didn't give a very clear definition of
directional preference and look at the
difference in outcomes in those studies.
So that's the next step with that.
And also one of our fellows in training
recently graduated,
I think he'll be recognized this October
or in November at AIOP.
is going to look at,
and Chad Cook's his advisor,
one of his advisors,
look at the mechanisms behind why
directional preference may work.
So we have these theories,
and Rob McKenzie originally had this DISC
theory, but he, right from the get-go,
said this is a theoretical model.
You know, it may apply,
but it may not apply.
I heard him say before his passing at
a conference,
I wish I had named this approach.
We're going to move people in the
directions that make them feel better and
avoid those that make them feel worse,
at least initially.
But that had been too long of a
name.
But he thought of it as being an
evolving approach.
definitions.
He originally described it as movement of
symptoms from a more distal to more
central location.
When we proposed development of a McKenzie
fellowship,
he was very supportive of that because he
originally was a manipulative
physiotherapist and thought that
you know,
maybe too many people have moved away from
putting hands on.
Putting hands on is going to be necessary
and it's part of the MDT approach.
So I think what we need to do
next is see when, you know,
these studies follow the operational
definition.
Does it make a difference in outcomes?
Yeah.
NMA, NMA, now we'll see,
but that's the purpose of exploring that
and looking at the mechanisms of why it
works.
So in our programs,
our fellowship programs,
we have the clinicians,
the fellows in training thoroughly
understand when we bring a joint to end
range, what tissues are affected.
So it's just not the disc,
it is ligament, it's cartilage,
it's muscle.
And when a person goes to end range,
things may change dramatically in terms of
a baseline.
And we know that with manipulation and
mobilization,
when we bring a joint to end range,
people may demonstrate improvement.
When a patient moves to end range,
if they can move to end range,
truly move to end range,
and are they a good candidate for end
range testing is another question that
hopefully is appreciated
by the clinician in terms of safety.
But there's tissues that are going to be
stressed.
And in our Damon Fellowship,
we had three people who were in the
program at the same time.
Megan Donaldson was one of our fellows in
training.
Corey Simon,
who is going to be a keynote at
the upcoming conference.
And Eric Miller, they studied together.
But Corey put together a joint manual,
which
you know, looked at, you know,
the biomechanics, arthrokinematics,
osteokinematics of all the joints from
cranial to caudal and what tissues are
brought to end range when we bring a
joint to end range.
And that became our study manual for both
programs,
both the McKenzie program and the Damon
program.
And it still is today.
So we thank him for that.
He used that as a study guide.
I asked him, you know, if, you know,
we could use it ongoing in the program.
He said, of course.
you know,
and we have a number of fellows in
training who, you know,
have to put in a considerable amount of
study time just learning that.
And as do most manual OMPT programs.
So,
but we want that to be integral so
that
We appreciate when we bring a joint to
end range or a person goes to end
range, what's happening?
And we can hypothesize.
And McKenzie had an original hypothesis,
which he later expanded to extremity
joints as well.
So obviously,
the DISC model wouldn't work in the
extremities.
But we're seeing emerging evidence for
testing end range with extremity
conditions.
And that is very interesting.
in terms of what, why,
and how does that person improve.
But it's all about baselines, you know,
rechecking a baseline to see if there's a
lasting improvement.
And we can't just go by symptoms.
So I think it's sometimes the MDT approach
is misconstrued to be,
it's only about symptoms.
And it could be a change in mechanics,
a myotome,
But it's got to be a lasting change,
a neural tension sign.
Ron, yeah,
I think you're really – we talked about
bridging the gap.
Everything you're saying sort of brings
those two schools together.
When we were talking,
we talked about how –
OMPT is also end range, right?
Like joint manipulations are at end range.
And I don't know if it's just something
about repeated movements that people
forget that it is we're talking primarily
about end range.
But, you know,
I think that's an important thing that
comment and phrase that sort of bridges
the gap.
And similarly, right,
like even with OMPT and kind of your
manual manipulative
approach it's it's we're also looking for
lasting change right you don't you don't
look for a cavitation and go yay as
many of you know and many of us
know it's it's about the test retest it's
Establish a baseline,
apply your technique or techniques,
and then retest.
And, you know,
when you phrase it like that,
which is why I really wanted to have
this conversation,
because I knew that you, again,
have bridged both worlds and still do and
can kind of help make sense of maybe
where...
they seem so separate,
but they're actually quite similar in the
clinical application and the things we're
looking for as far as the effect on
the patient.
So I really appreciate that, Ron.
Thank you.
And you know,
there's mechanical effects that we propose
with manipulation and a person moving to
end range,
but
you know,
we're seeing more and more evidence of the
neurophysiological potential effect and
even the placebo effect.
And that's if the person moves better and
continues to move better and it turns out
it's placebo, that's not a bad thing.
But how that person is being approached is
the difference maker in terms of whether
that placebo may be achieved or occur
And that's that they're confident in their
clinician.
They have a good working relationship.
They have shared goals in terms of the
patient's outcome.
And then when that clinician puts hands on
in a confident and skilled manner,
they're there, right?
They're there.
And then if they see a within session
change in a baseline,
they're really going to be there and buy
in, so to speak.
The question is,
can they treat themselves?
Do they require us to put hands on?
Many do.
Maybe we can move them along more quickly
if we do.
It can be a combination of the two.
But ultimately,
we want people to be able to be
empowered and self-treat because
we spend billions and billions of dollars
on musculoskeletal healthcare and we just
can't afford it anymore.
So we don't have enough evidence of this
yet,
but if the patients can become empowered
to self-treat,
maybe we can reduce recidivism and they
don't need to come back.
But if we don't give them that opportunity
to become empowered or take a role in
their own outcome,
then they're gonna be dependent on us
You know,
and I've made that mistake in my career,
putting hands on too soon or in a
patient who may have an external locus of
control and then becomes very difficult.
Even if we have a good working
relationship, you know,
they become dependent on us.
So I'd rather educate that patient on how
they could self-treat than me be the
person that is supposedly making them
better.
We want them to make themselves better.
And that's why I believe so strongly in
that testing of sustained and repeated
movements to see if that patient can use
that as part of their management.
But then if we just test that and
we don't test muscle balance,
we don't test activation of deep spinal
muscles,
if we don't check for yellow flags,
then we're going to miss out on something
else that person needs.
So it's just not about that.
Yeah.
Rated movement.
Yeah, it's got to be comprehensive, Ron.
I love that.
And I think both approaches certainly take
that on.
And as we're chatting,
you just kind of keep adding to this
bucket of this proverbial bucket that I
have in my head that says,
let's put all these things together that
tie these approaches together.
And obviously,
self-efficacy is one of those.
That's a...
That's the end goal, right?
It's you start with a therapeutic
alliance.
The name of the podcast is Hands On,
Hands Off for a reason.
So, you know,
I think you're speaking to a lot of
the similarities and commonalities in even
the approach, right?
The execution may look different,
but the approach and the foundation is
very similar as well as what we're trying
to achieve with our patients.
But the self-efficacy
self-efficacy piece is one that I just
want to underscore that you brought back
into this conversation appropriately.
Ron, I know you and I,
we could probably go on and on and
on and on,
but I told you that I am interested
in,
because you've done a lot as a clinician,
as a faculty member,
in higher education leadership and just
fellowship and residency and all the
things.
You've done all the things, Ron.
And one of the things that selfishly I
want to highlight is your mentorship of
some really incredible clinicians,
researchers, thought leaders, innovators,
Corey Simon, Megan Donaldson, Eric Miller,
who taught my last two students in the
clinic at D'Youville.
And so I feel like we're kind of
coming full circle where
a lot of the folks that you've poured
into, Ron,
are pouring into our profession and OMPT
in even more variable ways.
What is the secret?
What is your philosophy on mentorship?
Why?
You're humble,
so you will not appreciate me saying this
this way,
but why are you such a great mentor,
Ron Shank?
So I've had a lot of good mentors,
great mentors, and great leaders.
Interestingly, the other day,
Megan Donaldson, who's our Aon president,
as well as our program director at the
Medical University of South Carolina,
where I am now, put out a...
something for us to read is faculty on
teaching and leadership.
And I've always believed that effective
teaching or mentorship is really about
leadership.
So, you know,
and if you think about somebody that was
an effective leader or a coach that you've
had,
it's someone who you have a trust in
each other, a trusting relationship.
They have a belief that they're going to,
we can be led or learned
take you on a learning journal that you
have respect and appreciation for what
that student has done up to this point
and that they're willing to learn more.
Um, you know,
and I was always amazed of these McKenzie
diplomats who come in and, you know,
now they've learned something to the
highest level.
They want to learn more.
I mean, that's,
that's quite a impressive compliment,
but it's, um,
you know,
when you have that type of relationship
with your students,
or those who you're mentoring, you know,
you end up supporting one another,
and then just kind of guiding each other
along the next step in their journey or,
you know, in the mentors journey.
So I think really,
leadership is into effective teaching.
And when
When you can establish that rate,
it's kind of like patient care.
When there's a belief that you're going to
be led in the right direction,
then it just becomes a matter of keeping
our minds open and learning from one
another.
So I think that those people who are
good mentors or teachers tend to be good
leaders as well.
Yeah, I love that, Ron.
I love that so much.
The first thing you said was that you
had great mentors.
So, you know,
great mentors breed great mentors who
breed great mentors.
And I think in, obviously,
in the leadership of Megan, Corey, Eric,
and others that you have mentored,
there have been more leaders and this sort
of generation of leaders,
not just within AOMT,
but in the profession.
And
I love the parallel to patient care.
I think it is about trust.
And something that you said that I really
appreciate is that with your expertise and
wealth of experience,
you're still willing to learn from your
mentees.
And I love that.
When I was in the clinic and I
was taking students, it was selfish.
I wanted to learn from them.
I knew they were getting the latest and
the greatest
from whatever program they were coming to
me from.
And I wanted that knowledge.
And so it was a little bit selfish,
my approach to mentorship,
but I love that you, you know,
it's great to see the outcome of dedicated
mentorship, not just clinical,
but also professional development,
and to see where all these great thought
leaders are, thanks to, you know,
some influence from you, Ron.
So, and I know it goes both ways.
Oh, thanks.
Yeah, so Ron,
what's next for you in this space?
Maybe in mentorship or in leadership,
if I could put you on the spot,
what are you working on?
Tell us more.
Yep.
So, you know, a few things.
So we have a research task force that
explores studies on directional
preference.
And, you know,
we have quite a large and emerging or
growing group that's looking at that.
And some are McKenzie trained,
some aren't necessarily.
So, you know,
we're open to people that are interested
in kind of
putting out ideas as we do,
and then we go into breakout rooms.
on particular projects.
And so we meet quarterly.
And that's been very fruitful, I think.
And MUSC is very supportive of us doing
clinical research.
And having the ability and the freedom to
balance both teaching and clinical work
and clinical research is really critical,
because if you take
one element out, it's tough.
It's tough.
I think they all complement each other.
And I was very fortunate to have worked
for institutions that were always
supportive of that.
So continuing to do research,
clinical research,
once we
complete our build out of this new
program.
You know,
I have an office here that I see
patients,
so I want to get back into doing
more of that.
And of course, you know,
work with our students.
So, you know, Mo,
how fun and exciting that is to see
them, you know,
begin to learn and begin that process.
have them understand that this is just the
starting point.
DPP is just the starting point,
and it's kind of what you do after
you leave that makes the difference.
What greater compliment to an instructor
than to see the people you've taught do
very well?
And that makes it all really worthwhile.
A thousand percent, Ron.
Very well said.
I have nothing to add and I will
continue to be inspired by your work and
your leadership and hopefully be,
you know,
a force of some good in this OMPT
world and sort of bridging gaps where gaps
exist and for the good of the profession
and our academy.
So it's really
This has been such a rich conversation,
Ron.
I've never had one that wasn't with you.
So thank you for sharing your insights,
your history, your journey,
your experience.
And for those listening,
please hit the subscribe button,
stay tuned, share with your friends,
your students, your colleagues,
and we will see you next time.
Thanks again, Ron.
Thank you, Ma.
Take care.