In this episode of Hands On, Hands Off, we dive deep into the evolving world of orthopedic manual therapy with the internationally renowned expert, Chad Cook. Chad shares his insights on "scaffolding" in manual therapy, providing a new framework for better communication and clinical outcomes.
Whether you're a clinician, educator, or student, Chad’s discussion offers fresh perspectives on integrating treatment mechanisms, biomechanics, neuroscience, and more into your practice.
Main Topic/Theme:
Chad Cook introduces the concept of "scaffolding" in manual therapy, building a framework for clinical practice that enhances patient communication and interdisciplinary collaboration.
Key Points Discussed:
The evolving framework ("scaffolding") for manual therapy and why it's crucial for the future of patient care.
How to integrate diverse fields like biomechanics, neuroscience, and imaging into manual therapy.
The importance of consistent language in manual therapy to improve collaboration across disciplines.
Chad's analogy of navigating rough terrains in both mountain biking and the shifting paradigms of manual therapy.
Special Guest:
Chad Cook, PT, PhD, MBA, FAPTA – International expert in manual therapy, author of four textbooks, and speaker in over 40 countries.
Target Audience:
Clinicians & Physical Therapists looking for advanced insights into manual therapy practices.
Healthcare Educators aiming to refine their teaching methods with new frameworks.
Students and Post-Professional Clinicians eager to stay updated on cutting-edge research in orthopedic manual physical therapy.
Manual Therapy
Chad Cook
Orthopedic Manual Physical Therapy
Treatment Mechanisms
Physical Therapy Framework
Clinical Practice in Physical Therapy
Patient Outcomes in Physical Therapy
Biomechanics in Therapy
Neuroscience in Manual Therapy
00:00:02 --> 00:00:02 All right.
00:00:02 --> 00:00:04 Well, welcome to our listeners.
00:00:04 --> 00:00:06 Welcome to AOMP Hands On, Hands Off,
00:00:06 --> 00:00:07 where we're exploring these
00:00:07 --> 00:00:09 cutting edge ideas and
00:00:09 --> 00:00:10 trends in orthopedic manual
00:00:10 --> 00:00:11 physical therapy.
00:00:11 --> 00:00:12 And I'm your host.
00:00:13 --> 00:00:15 I have the pleasure to have
00:00:15 --> 00:00:16 Chad Cook on the show,
00:00:16 --> 00:00:18 which I am so excited for.
00:00:19 --> 00:00:21 And for our clinicians and listeners,
00:00:21 --> 00:00:22 what an exciting
00:00:22 --> 00:00:24 opportunity to have you
00:00:24 --> 00:00:25 learn a little bit more
00:00:25 --> 00:00:26 about manual therapy for
00:00:26 --> 00:00:28 better communications with your patients.
00:00:28 --> 00:00:29 And so
00:00:29 --> 00:00:31 For those educators that are listening,
00:00:31 --> 00:00:31 whether you're teaching
00:00:32 --> 00:00:33 entry level or advanced
00:00:33 --> 00:00:34 post-professional clinicians,
00:00:34 --> 00:00:36 Chad's discussion and his
00:00:36 --> 00:00:37 insights always help
00:00:37 --> 00:00:39 prepare the next generation
00:00:39 --> 00:00:39 of physical therapists.
00:00:39 --> 00:00:41 So we're so excited to have
00:00:41 --> 00:00:41 him on the show.
00:00:42 --> 00:00:44 And if you may be living under a rock,
00:00:44 --> 00:00:46 you may not know that Chad
00:00:46 --> 00:00:47 is an internationally
00:00:47 --> 00:00:50 recognized expert with his
00:00:50 --> 00:00:51 four textbooks.
00:00:51 --> 00:00:52 He's taught in over forty
00:00:52 --> 00:00:55 countries and significant
00:00:55 --> 00:00:56 publication numbers.
00:00:57 --> 00:00:59 This is a man who's truly
00:00:59 --> 00:01:00 transforming the way that
00:01:00 --> 00:01:01 we think about manual therapy.
00:01:01 --> 00:01:03 And I think you'll find him
00:01:03 --> 00:01:04 a delight to listen to.
00:01:05 --> 00:01:07 And Chad is not just a researcher.
00:01:07 --> 00:01:07 Believe it or not,
00:01:07 --> 00:01:08 I don't know where he finds
00:01:08 --> 00:01:10 time to do anything else.
00:01:10 --> 00:01:13 But he's super engaged in active life,
00:01:13 --> 00:01:14 which he is a biker and
00:01:14 --> 00:01:15 gets out in the mountain
00:01:15 --> 00:01:17 biking through rough terrain.
00:01:17 --> 00:01:18 So I'm going to bring this a
00:01:18 --> 00:01:19 little bit of an analogy.
00:01:20 --> 00:01:20 Chad,
00:01:20 --> 00:01:22 you've helped navigate some rough
00:01:22 --> 00:01:23 terrains in manual therapy,
00:01:23 --> 00:01:25 some of the swinging pendulum,
00:01:25 --> 00:01:27 whether manual therapy is a good thing,
00:01:27 --> 00:01:30 a bad thing to use it, not to use it.
00:01:30 --> 00:01:31 And yet you are injecting
00:01:31 --> 00:01:33 more knowledge into this
00:01:33 --> 00:01:35 area than anybody else knows.
00:01:35 --> 00:01:36 So we're so excited for you
00:01:36 --> 00:01:37 to help us navigate
00:01:38 --> 00:01:38 a little bit more of these
00:01:39 --> 00:01:40 challenging terrains and
00:01:40 --> 00:01:42 maybe relate to us some of
00:01:42 --> 00:01:43 the frameworks that we can
00:01:43 --> 00:01:45 use either as clinicians or
00:01:46 --> 00:01:48 educators and finding that
00:01:48 --> 00:01:49 perfect balance like you do
00:01:50 --> 00:01:50 on a mountain trail.
00:01:50 --> 00:01:52 So if you're all right,
00:01:52 --> 00:01:53 I'll go ahead and kick us off.
00:01:54 --> 00:01:56 And I would love to know more about this.
00:01:56 --> 00:01:58 So when I first contacted you,
00:01:58 --> 00:01:59 you said you want to
00:01:59 --> 00:02:00 discuss the scaffolding of
00:02:01 --> 00:02:02 manual therapy.
00:02:02 --> 00:02:03 So what does this actually mean?
00:02:05 --> 00:02:07 First of all, thank you for having me on.
00:02:08 --> 00:02:09 And it's wonderful to see you, as always.
00:02:09 --> 00:02:11 And thanks for everything you do for AOMT.
00:02:13 --> 00:02:15 Scaffolding, to me,
00:02:15 --> 00:02:17 it's a term we use in our
00:02:17 --> 00:02:20 NIH U-XXIV about really
00:02:20 --> 00:02:21 building the framework and
00:02:21 --> 00:02:23 the taxonomy around manual therapy.
00:02:24 --> 00:02:25 I think historically,
00:02:25 --> 00:02:28 when you think about manual therapy,
00:02:28 --> 00:02:29 you think about efficacy
00:02:29 --> 00:02:30 and effectiveness studies
00:02:31 --> 00:02:34 or maybe who manual therapy may benefit,
00:02:34 --> 00:02:34 that sort of thing.
00:02:35 --> 00:02:36 But there's a lot more to it.
00:02:36 --> 00:02:38 There are the treatment mechanisms,
00:02:38 --> 00:02:40 what actually happens with
00:02:40 --> 00:02:41 the particular treatment.
00:02:44 --> 00:02:44 There are all these other
00:02:44 --> 00:02:46 disciplines involved in
00:02:46 --> 00:02:47 measuring manual therapy
00:02:47 --> 00:02:48 like biomechanists and
00:02:48 --> 00:02:50 neuroscientists and imaging
00:02:50 --> 00:02:51 specialists and all these folks.
00:02:52 --> 00:02:53 And we're all using
00:02:53 --> 00:02:55 different language and our
00:02:55 --> 00:02:56 assumptions are all different.
00:02:56 --> 00:02:57 So the scaffolding is
00:02:57 --> 00:03:00 essentially structuring a
00:03:00 --> 00:03:02 framework around manual
00:03:02 --> 00:03:03 therapy so that we can all
00:03:03 --> 00:03:05 study it consistently so
00:03:05 --> 00:03:07 that when somebody is
00:03:07 --> 00:03:08 talking about something,
00:03:08 --> 00:03:09 another profession
00:03:09 --> 00:03:10 understands what we're talking about.
00:03:11 --> 00:03:13 It's about building almost a
00:03:13 --> 00:03:15 foundation and then the
00:03:15 --> 00:03:17 scaffolding up one current
00:03:17 --> 00:03:22 study so that it makes sense.
00:03:22 --> 00:03:23 That's great.
00:03:23 --> 00:03:24 So so you were relating this
00:03:24 --> 00:03:26 to your current grant and
00:03:26 --> 00:03:26 work that you're doing.
00:03:27 --> 00:03:28 So is that what led you
00:03:28 --> 00:03:30 towards your most recent
00:03:30 --> 00:03:31 efforts looking at this as
00:03:31 --> 00:03:34 a framework around manual therapy?
00:03:34 --> 00:03:34 Yeah.
00:03:34 --> 00:03:36 So you probably know that.
00:03:36 --> 00:03:36 I mean,
00:03:37 --> 00:03:39 my original manual therapy textbook with
00:03:40 --> 00:03:41 took a crack at trying to
00:03:41 --> 00:03:43 harmonize some terminology
00:03:44 --> 00:03:45 and really talked about all
00:03:45 --> 00:03:46 the different philosophies.
00:03:46 --> 00:03:48 And that's very, I think,
00:03:49 --> 00:03:50 a clinical focus.
00:03:50 --> 00:03:51 What we're doing now has
00:03:52 --> 00:03:53 even a preclinical and a
00:03:53 --> 00:03:55 basic science focus
00:03:55 --> 00:03:57 embedded into it as well.
00:03:57 --> 00:03:58 And if I could use...
00:04:00 --> 00:04:01 If I could use an analogy,
00:04:02 --> 00:04:05 when I presented at NIH in June,
00:04:05 --> 00:04:08 I started off my talk using
00:04:08 --> 00:04:11 the Christian Bible parable,
00:04:11 --> 00:04:12 the Tower of Babel.
00:04:13 --> 00:04:14 And I'm not going to get all the religious,
00:04:14 --> 00:04:15 so don't worry about that.
00:04:16 --> 00:04:17 But in the Tower of Babel,
00:04:17 --> 00:04:19 people think that this is
00:04:19 --> 00:04:20 where all the people got
00:04:20 --> 00:04:21 different languages and
00:04:21 --> 00:04:22 that sort of thing,
00:04:22 --> 00:04:24 because God was angry that
00:04:24 --> 00:04:26 he was building a tower to the heavens.
00:04:27 --> 00:04:29 But in reality, if you read the Bible,
00:04:29 --> 00:04:30 it actually says that this
00:04:31 --> 00:04:33 is God's attempt to confuse people,
00:04:34 --> 00:04:35 confuse the workers so they
00:04:35 --> 00:04:37 could not finish the job.
00:04:38 --> 00:04:39 And that's really what I
00:04:39 --> 00:04:41 mean by this is there's so
00:04:41 --> 00:04:44 much discrepancy, so much confusion.
00:04:44 --> 00:04:46 a lack of harmony around
00:04:46 --> 00:04:48 what we say we do and what
00:04:48 --> 00:04:49 we actually do and how it's
00:04:49 --> 00:04:51 studied and and what people
00:04:51 --> 00:04:52 say to patients and all of
00:04:52 --> 00:04:54 these other things that
00:04:54 --> 00:04:55 that's really what we mean
00:04:55 --> 00:04:56 about around the scaffolding.
00:04:56 --> 00:04:57 It's it's about.
00:04:57 --> 00:05:00 And yes,
00:05:00 --> 00:05:02 it's very much triggered by the
00:05:02 --> 00:05:03 force net grant,
00:05:03 --> 00:05:04 the year twenty four that we had.
00:05:05 --> 00:05:06 But I think it's a
00:05:06 --> 00:05:07 continuation of something
00:05:07 --> 00:05:08 that I was doing a good
00:05:08 --> 00:05:09 eighteen years ago, too.
00:05:10 --> 00:05:11 Yeah.
00:05:11 --> 00:05:12 You know, I think, yeah,
00:05:12 --> 00:05:14 I remember even just teaching with you,
00:05:14 --> 00:05:14 Chad,
00:05:14 --> 00:05:15 and I think one of the biggest
00:05:15 --> 00:05:16 things that you've always said is,
00:05:16 --> 00:05:18 you know, consistency of language.
00:05:18 --> 00:05:18 Like,
00:05:18 --> 00:05:20 what are we actually saying so that
00:05:20 --> 00:05:23 it has meaning and that we can understand,
00:05:23 --> 00:05:24 right, in the written word,
00:05:24 --> 00:05:25 especially in our publications,
00:05:25 --> 00:05:27 like the terminology.
00:05:27 --> 00:05:28 And so I love that that's
00:05:28 --> 00:05:29 come back even eighteen
00:05:29 --> 00:05:30 years later and you're
00:05:30 --> 00:05:31 putting more to it.
00:05:32 --> 00:05:33 And it's really part of the
00:05:33 --> 00:05:34 grant that you've had.
00:05:34 --> 00:05:36 So I think that that's wonderful.
00:05:36 --> 00:05:38 How does this challenge
00:05:38 --> 00:05:39 traditional teaching
00:05:39 --> 00:05:40 methods maybe that
00:05:40 --> 00:05:41 clinicians or educators
00:05:41 --> 00:05:42 have followed for years?
00:05:43 --> 00:05:44 And maybe you can kind of
00:05:44 --> 00:05:45 highlight some of those
00:05:45 --> 00:05:46 discrepancy areas that have
00:05:46 --> 00:05:46 caused some concern.
00:05:48 --> 00:05:49 I mean, that's a great question.
00:05:50 --> 00:05:51 You know, you and I spoke together,
00:05:51 --> 00:05:54 I think, at CSM earlier this year.
00:05:54 --> 00:05:55 And one of the things that I
00:05:55 --> 00:05:56 had mentioned was that
00:05:57 --> 00:05:59 science really started to catch up,
00:05:59 --> 00:05:59 I think,
00:05:59 --> 00:06:01 with the theories around manual
00:06:01 --> 00:06:02 therapy in nineteen ninety
00:06:02 --> 00:06:03 so that we had enough
00:06:04 --> 00:06:05 sophistication in the
00:06:05 --> 00:06:06 science to actually explore
00:06:07 --> 00:06:09 some of these concepts, terms,
00:06:09 --> 00:06:11 assumptions that you saw
00:06:11 --> 00:06:12 with many of the
00:06:12 --> 00:06:14 philosophies around manual therapy.
00:06:14 --> 00:06:15 And unfortunately,
00:06:15 --> 00:06:16 the science actually
00:06:16 --> 00:06:18 identified some areas where
00:06:18 --> 00:06:20 we were flat out wrong.
00:06:21 --> 00:06:23 We had these vanguards,
00:06:24 --> 00:06:25 manual therapy philosophers
00:06:25 --> 00:06:27 who they saw something in the clinic.
00:06:28 --> 00:06:29 They knew it was meaningful.
00:06:30 --> 00:06:30 And what they did is they
00:06:30 --> 00:06:33 tried to backfill it with these ideas.
00:06:34 --> 00:06:36 And unfortunately, those ideas,
00:06:36 --> 00:06:37 many of those haven't
00:06:37 --> 00:06:40 really stood up over time in science.
00:06:41 --> 00:06:42 The challenge, I think, comes when
00:06:43 --> 00:06:45 in the educational classroom
00:06:45 --> 00:06:48 or postgraduate or whatever,
00:06:48 --> 00:06:49 when we're still using
00:06:49 --> 00:06:51 outdated taxonomies or
00:06:52 --> 00:06:53 terminologies to try to
00:06:53 --> 00:06:55 train individuals or try to
00:06:55 --> 00:06:57 apply a philosophy that
00:06:57 --> 00:06:58 really doesn't fit.
00:06:59 --> 00:07:01 on to that patient that's in front of you.
00:07:02 --> 00:07:04 So we're running kind of
00:07:04 --> 00:07:05 butting into some of these
00:07:06 --> 00:07:08 concepts with with what
00:07:08 --> 00:07:09 we're identifying within
00:07:09 --> 00:07:10 the force that you're
00:07:10 --> 00:07:12 twenty four with some of
00:07:12 --> 00:07:13 the publications that we're
00:07:13 --> 00:07:14 putting together.
00:07:15 --> 00:07:15 But we're also
00:07:16 --> 00:07:17 Butting heads with some
00:07:17 --> 00:07:19 basic science research, too, as well,
00:07:19 --> 00:07:21 that suggests that certain things happen.
00:07:22 --> 00:07:22 And because they happened in
00:07:22 --> 00:07:24 a mouse in a controlled environment,
00:07:24 --> 00:07:25 that it means it's going to
00:07:25 --> 00:07:27 transfer to a clinical environment.
00:07:28 --> 00:07:28 You know,
00:07:28 --> 00:07:30 there are all kinds of areas that
00:07:31 --> 00:07:33 need tightening up and need
00:07:33 --> 00:07:34 the appropriate scaffolding
00:07:34 --> 00:07:35 for us to actually build
00:07:35 --> 00:07:37 upon that and move forward.
00:07:39 --> 00:07:40 So, you know, already with this,
00:07:40 --> 00:07:41 this grant,
00:07:41 --> 00:07:42 you're describing basically
00:07:42 --> 00:07:44 all these professions or disciplines,
00:07:44 --> 00:07:45 I should say,
00:07:45 --> 00:07:47 coming together and finding out, you know,
00:07:47 --> 00:07:49 debunking some of the ideas
00:07:49 --> 00:07:50 or the myths or the
00:07:50 --> 00:07:51 theories or the approaches, right.
00:07:51 --> 00:07:53 And understanding some of that language.
00:07:53 --> 00:07:55 So I think language is super important.
00:07:55 --> 00:07:56 How does that relate a
00:07:56 --> 00:07:57 little bit more maybe to
00:07:57 --> 00:07:59 the clinician and how would
00:07:59 --> 00:08:01 it refine maybe clinical
00:08:01 --> 00:08:03 reasoning or treatment planning?
00:08:03 --> 00:08:04 How does it have a direct
00:08:05 --> 00:08:06 impact on then maybe our
00:08:06 --> 00:08:07 listeners or who are in the
00:08:07 --> 00:08:08 clinics today?
00:08:09 --> 00:08:12 I think it has a lot of different ways.
00:08:12 --> 00:08:13 You know, to me,
00:08:14 --> 00:08:15 in one of the ways that we,
00:08:17 --> 00:08:18 we look at clinicians as
00:08:18 --> 00:08:20 another form of expert, right?
00:08:20 --> 00:08:21 So around manual therapy.
00:08:21 --> 00:08:23 So they have a domain of expertise,
00:08:24 --> 00:08:25 just as an imaging
00:08:25 --> 00:08:27 specialist has a domain of expertise,
00:08:27 --> 00:08:29 as a neuroscientist has a domain.
00:08:29 --> 00:08:31 Everybody has these different domains.
00:08:32 --> 00:08:34 And when the cogs start
00:08:34 --> 00:08:35 working together and everything,
00:08:36 --> 00:08:37 everybody is communicating,
00:08:37 --> 00:08:39 everybody agrees on something,
00:08:39 --> 00:08:41 then we have a common language.
00:08:41 --> 00:08:43 We have a common statement
00:08:44 --> 00:08:45 so that policymakers
00:08:45 --> 00:08:46 understand what we're doing,
00:08:46 --> 00:08:48 so that the patients get a
00:08:48 --> 00:08:50 real story behind what this is.
00:08:51 --> 00:08:52 The challenge is when we're
00:08:52 --> 00:08:53 independent of one another.
00:08:54 --> 00:08:56 And right now, it's fairly independent.
00:08:58 --> 00:09:00 This weekend, we had a summit.
00:09:00 --> 00:09:01 And in the summit,
00:09:01 --> 00:09:02 we had all of these
00:09:02 --> 00:09:03 different professions.
00:09:03 --> 00:09:04 And we were intentional
00:09:04 --> 00:09:06 about inviting people that
00:09:06 --> 00:09:08 had a foot in the space of
00:09:09 --> 00:09:10 force-based manipulations
00:09:11 --> 00:09:11 or manual therapy,
00:09:12 --> 00:09:13 but didn't necessarily
00:09:13 --> 00:09:16 collaborate with any of these areas.
00:09:16 --> 00:09:17 We had clinicians talk.
00:09:18 --> 00:09:19 We had imaging specialists talk.
00:09:19 --> 00:09:21 We had biomechanists talk.
00:09:21 --> 00:09:22 We had neuroscientists talk.
00:09:22 --> 00:09:23 We even had a basic
00:09:24 --> 00:09:25 scientist who worked only
00:09:25 --> 00:09:27 with mouse studies talk.
00:09:27 --> 00:09:28 to tell you all the things
00:09:28 --> 00:09:31 that are wrong with mouse studies.
00:09:31 --> 00:09:33 We even had a psychologist,
00:09:33 --> 00:09:34 a person who had a
00:09:34 --> 00:09:35 psychological background.
00:09:35 --> 00:09:37 It was the most dynamic
00:09:37 --> 00:09:39 meeting of all these people
00:09:39 --> 00:09:42 interacting with one another.
00:09:42 --> 00:09:43 How can it influence a clinician?
00:09:45 --> 00:09:47 there are such a rich amount
00:09:47 --> 00:09:49 of knowledge in these other
00:09:49 --> 00:09:51 fields that could influence
00:09:52 --> 00:09:53 our interactions with our
00:09:53 --> 00:09:55 patients so that clinicians
00:09:55 --> 00:09:56 can learn from these individuals,
00:09:57 --> 00:09:58 just like these individuals
00:09:58 --> 00:09:59 learn from clinicians.
00:10:00 --> 00:10:02 And our goal is to get that
00:10:03 --> 00:10:04 optimal connection,
00:10:05 --> 00:10:07 harmonize it the best we can,
00:10:07 --> 00:10:08 and then be able to
00:10:10 --> 00:10:10 you know,
00:10:10 --> 00:10:11 better improve the way that we
00:10:11 --> 00:10:13 manage our patients,
00:10:13 --> 00:10:15 understand better when to
00:10:15 --> 00:10:16 use manual therapy in the
00:10:16 --> 00:10:18 patient process and really tease out,
00:10:18 --> 00:10:18 is it,
00:10:19 --> 00:10:20 is manual therapy doing what we
00:10:20 --> 00:10:24 think it's doing?
00:10:24 --> 00:10:25 Basically, I mean,
00:10:25 --> 00:10:27 you're asking in clinicians,
00:10:27 --> 00:10:28 it's challenging right
00:10:28 --> 00:10:29 there in the day to day.
00:10:29 --> 00:10:31 So to reframe some of this
00:10:31 --> 00:10:33 mindset or ideas, right?
00:10:33 --> 00:10:34 Season clinicians may have
00:10:34 --> 00:10:36 had practices for a long time.
00:10:37 --> 00:10:38 And, you know,
00:10:38 --> 00:10:40 new clinicians are coming
00:10:40 --> 00:10:42 out from maybe entry level
00:10:42 --> 00:10:43 may not have been exposed to that.
00:10:44 --> 00:10:45 So where would be some
00:10:45 --> 00:10:48 places that you know,
00:10:48 --> 00:10:50 how could some of our
00:10:50 --> 00:10:52 audience gain insight to
00:10:52 --> 00:10:54 some of those different perspectives?
00:10:54 --> 00:10:55 Where are some resources
00:10:55 --> 00:10:56 that they should lean into?
00:10:58 --> 00:10:59 I think the first thing they
00:10:59 --> 00:11:00 need to do is be willing to
00:11:00 --> 00:11:02 go outside their narrow
00:11:02 --> 00:11:03 band of knowledge or
00:11:03 --> 00:11:05 training and learn from
00:11:05 --> 00:11:06 these some of these other
00:11:06 --> 00:11:08 professions who specialize
00:11:08 --> 00:11:08 in different areas.
00:11:09 --> 00:11:12 Just before this particular podcast,
00:11:13 --> 00:11:14 I was listening to the
00:11:14 --> 00:11:15 University of North
00:11:15 --> 00:11:16 Carolina had a seminar
00:11:16 --> 00:11:17 series and they brought in
00:11:17 --> 00:11:18 a speaker from the
00:11:18 --> 00:11:19 University of Delaware.
00:11:20 --> 00:11:22 And she was an imaging
00:11:22 --> 00:11:23 specialist who has a bond
00:11:24 --> 00:11:25 mechanist background.
00:11:25 --> 00:11:26 And she was talking about
00:11:26 --> 00:11:28 the three different tendons
00:11:28 --> 00:11:29 affiliated with the Achilles.
00:11:30 --> 00:11:32 And so a couple of things with that.
00:11:32 --> 00:11:33 All right.
00:11:33 --> 00:11:33 First of all,
00:11:33 --> 00:11:33 I didn't know there were
00:11:33 --> 00:11:35 three tendons in the Achilles.
00:11:36 --> 00:11:37 I didn't know that until last weekend.
00:11:38 --> 00:11:38 And then secondly,
00:11:40 --> 00:11:42 I learned a lot about fail
00:11:42 --> 00:11:44 rates across those,
00:11:44 --> 00:11:47 about how age influences that,
00:11:47 --> 00:11:49 about how prior injury influences that,
00:11:49 --> 00:11:50 and all these other elements.
00:11:51 --> 00:11:52 This is somebody outside of
00:11:52 --> 00:11:54 my profession that gave a
00:11:54 --> 00:11:55 talk that is going to be
00:11:56 --> 00:11:57 meaningful for me moving
00:11:57 --> 00:11:59 forward when looking at that.
00:11:59 --> 00:12:01 So the first thing definitely is
00:12:02 --> 00:12:02 you know,
00:12:02 --> 00:12:05 be open in the way that you learn
00:12:06 --> 00:12:07 and learn from people who
00:12:07 --> 00:12:10 you think may not actually contribute.
00:12:10 --> 00:12:11 I think we've done that
00:12:11 --> 00:12:13 really well as a profession
00:12:13 --> 00:12:15 for psychologists and
00:12:15 --> 00:12:17 really looking at that part for
00:12:18 --> 00:12:19 Pain science specialist,
00:12:19 --> 00:12:21 I think we've been very open on that,
00:12:21 --> 00:12:23 but I think we've ignored
00:12:23 --> 00:12:24 maybe some areas that can
00:12:24 --> 00:12:26 be really beneficial,
00:12:26 --> 00:12:28 like imaging and then biomechanics.
00:12:28 --> 00:12:29 We've kind of poo-pooed
00:12:29 --> 00:12:30 biomechanics and pushed it
00:12:30 --> 00:12:31 off to the side,
00:12:31 --> 00:12:32 but there's actually more
00:12:32 --> 00:12:34 there than I think people recognize.
00:12:36 --> 00:12:37 The second thing I think we
00:12:37 --> 00:12:40 can do is really challenge
00:12:41 --> 00:12:42 ourselves on some of these
00:12:42 --> 00:12:44 traditional paradigms that
00:12:44 --> 00:12:44 we learned from.
00:12:46 --> 00:12:46 I mean,
00:12:46 --> 00:12:48 everybody essentially has some
00:12:49 --> 00:12:50 background or they've
00:12:50 --> 00:12:52 learned from some philosophy.
00:12:52 --> 00:12:52 Mine is Maitland.
00:12:53 --> 00:12:54 So I learned very much a test.
00:12:54 --> 00:12:55 A test.
00:12:57 --> 00:13:02 retest philosophy and ignoring, you know,
00:13:02 --> 00:13:05 ignoring the complexity and
00:13:05 --> 00:13:06 then going toward more of the simple,
00:13:07 --> 00:13:08 you know, this is what we found,
00:13:08 --> 00:13:10 so we're going to move with it.
00:13:10 --> 00:13:11 I think it's okay to have
00:13:11 --> 00:13:13 that as a foundation,
00:13:13 --> 00:13:14 but to recognize that those
00:13:14 --> 00:13:17 have major gaps and to try
00:13:17 --> 00:13:19 to fill those gaps with as
00:13:19 --> 00:13:21 much science as we can tackle.
00:13:22 --> 00:13:23 I,
00:13:23 --> 00:13:25 without paralyzing ourselves and trying
00:13:25 --> 00:13:28 to find a single answer, I really,
00:13:28 --> 00:13:31 I spoke to a, at IFOMPT,
00:13:31 --> 00:13:32 I spoke to someone who I
00:13:32 --> 00:13:34 really respect and we just
00:13:34 --> 00:13:35 kind of ran into each other
00:13:35 --> 00:13:37 and the person said, you know,
00:13:37 --> 00:13:37 I appreciate what you're
00:13:37 --> 00:13:39 doing with mechanisms,
00:13:39 --> 00:13:40 but I'm not a hundred
00:13:40 --> 00:13:41 percent sure that we're
00:13:41 --> 00:13:41 ever going to fully
00:13:41 --> 00:13:44 understand how manual therapy works.
00:13:45 --> 00:13:46 And I said, I agree,
00:13:46 --> 00:13:48 but the journey is a
00:13:48 --> 00:13:49 wonderful experience.
00:13:49 --> 00:13:53 And learning from that as we go along is,
00:13:53 --> 00:13:53 I think,
00:13:53 --> 00:13:55 going to make us all better clinicians.
00:13:55 --> 00:13:56 Right.
00:13:56 --> 00:13:57 And so you may have this
00:13:57 --> 00:13:58 huge amount of knowledge.
00:13:58 --> 00:14:00 You may still use the same
00:14:00 --> 00:14:01 frameworks to go through in
00:14:01 --> 00:14:03 a clinical practice time, test, retest,
00:14:04 --> 00:14:04 right?
00:14:04 --> 00:14:05 Because if you're still
00:14:05 --> 00:14:06 using patient response,
00:14:06 --> 00:14:07 you might find something there.
00:14:07 --> 00:14:09 But maybe at a point where
00:14:09 --> 00:14:10 we're not finding the right
00:14:10 --> 00:14:11 information or the patient
00:14:11 --> 00:14:12 is not responding,
00:14:13 --> 00:14:14 certainly requires us to
00:14:14 --> 00:14:15 step back reframe and think
00:14:16 --> 00:14:17 again about what are we
00:14:17 --> 00:14:18 missing or what might else
00:14:18 --> 00:14:19 be going on here because
00:14:20 --> 00:14:21 certainly that's been some
00:14:21 --> 00:14:22 of the challenges that you
00:14:22 --> 00:14:24 know we have a great amount
00:14:24 --> 00:14:25 of who responds and then we
00:14:25 --> 00:14:27 have these non-responders
00:14:27 --> 00:14:28 and and so maybe it's worth
00:14:28 --> 00:14:29 that exploration I think
00:14:29 --> 00:14:30 you give a great
00:14:30 --> 00:14:31 perspective you gotta step
00:14:31 --> 00:14:32 back and like look at maybe
00:14:32 --> 00:14:33 what else could be going on
00:14:33 --> 00:14:35 there maybe something you
00:14:35 --> 00:14:36 haven't thought of and uh a
00:14:36 --> 00:14:37 little bit bigger maybe
00:14:37 --> 00:14:38 biomechanics or something
00:14:38 --> 00:14:40 else and you know something
00:14:40 --> 00:14:41 you bring up is that
00:14:42 --> 00:14:45 I think it was a different group.
00:14:45 --> 00:14:46 It's mainly out of
00:14:46 --> 00:14:47 osteoarthritis that we
00:14:47 --> 00:14:49 really learned that people
00:14:49 --> 00:14:50 respond differently to even
00:14:51 --> 00:14:52 efficacious treatment.
00:14:52 --> 00:14:54 So even a really good treatment approach,
00:14:55 --> 00:14:56 if you have a spectrum of
00:14:56 --> 00:14:57 maybe twenty people,
00:14:58 --> 00:14:58 you're going to get a
00:14:58 --> 00:15:00 variability in response with that.
00:15:00 --> 00:15:02 And that's just normal human nature.
00:15:02 --> 00:15:05 Even with drugs like
00:15:05 --> 00:15:06 pharmacological agents,
00:15:06 --> 00:15:08 you'll see variability in response.
00:15:08 --> 00:15:11 Knowing that is a tremendous asset,
00:15:11 --> 00:15:12 I think, as a clinician,
00:15:12 --> 00:15:13 that you have to be
00:15:13 --> 00:15:15 adaptable and recognize
00:15:15 --> 00:15:16 there isn't one thing
00:15:16 --> 00:15:17 that's going to help everybody.
00:15:18 --> 00:15:19 And we learn that from a
00:15:20 --> 00:15:21 different discipline, basically.
00:15:21 --> 00:15:23 But I think we can learn a
00:15:23 --> 00:15:24 lot from other areas.
00:15:24 --> 00:15:27 Yeah, that's great.
00:15:27 --> 00:15:28 So, Chad, you know,
00:15:28 --> 00:15:30 you speak to the concept
00:15:30 --> 00:15:32 that you've been exposed, right,
00:15:32 --> 00:15:34 in so many different areas
00:15:34 --> 00:15:35 and seeing so many different
00:15:36 --> 00:15:37 professionals and
00:15:37 --> 00:15:38 disciplines and the way
00:15:38 --> 00:15:39 they're approaching things
00:15:39 --> 00:15:42 from basic scientists to biomechanics,
00:15:42 --> 00:15:42 right,
00:15:42 --> 00:15:45 and imaging and all of these things.
00:15:45 --> 00:15:46 And I would even think with
00:15:46 --> 00:15:47 your extensive teaching in
00:15:47 --> 00:15:50 over forty different countries, you know,
00:15:50 --> 00:15:51 what international
00:15:51 --> 00:15:52 perspective has also
00:15:52 --> 00:15:53 influenced maybe your
00:15:53 --> 00:15:54 scaffolding and how could
00:15:54 --> 00:15:55 this have a global
00:15:55 --> 00:15:58 educational approach to, you know,
00:15:58 --> 00:16:00 orthopedic manual therapy
00:16:00 --> 00:16:01 as we're thinking about this framework?
00:16:02 --> 00:16:03 and its relevance, you know,
00:16:03 --> 00:16:05 across not just maybe the
00:16:05 --> 00:16:06 US and our listeners,
00:16:06 --> 00:16:07 but maybe across the world.
00:16:10 --> 00:16:11 So I'll first start by saying, well,
00:16:11 --> 00:16:13 I'm gonna answer it two ways.
00:16:13 --> 00:16:14 The first way is that
00:16:14 --> 00:16:17 regardless of where I'm at,
00:16:18 --> 00:16:20 and I have been very
00:16:20 --> 00:16:22 blessed to speak in many countries,
00:16:22 --> 00:16:25 very fortunate, is a PT is a PT is a PT.
00:16:26 --> 00:16:27 You can pick a physio out
00:16:27 --> 00:16:31 across the road and say, that's a physio.
00:16:31 --> 00:16:33 I can tell by the way they stand,
00:16:33 --> 00:16:34 the way they look,
00:16:34 --> 00:16:37 and how very observational they are,
00:16:37 --> 00:16:38 the way they interact with people.
00:16:39 --> 00:16:40 It doesn't matter where you're at.
00:16:41 --> 00:16:44 They're stamped out of the same mold,
00:16:44 --> 00:16:45 basically.
00:16:46 --> 00:16:47 Probably the biggest thing
00:16:47 --> 00:16:51 that has influenced me from
00:16:52 --> 00:16:54 my international experiences is that,
00:16:55 --> 00:16:56 and this is not a shot
00:16:56 --> 00:16:57 toward North America,
00:16:58 --> 00:17:00 but I think other countries
00:17:01 --> 00:17:02 are more curious.
00:17:02 --> 00:17:04 And it's probably self,
00:17:04 --> 00:17:05 it's a selection bias
00:17:05 --> 00:17:06 because they're usually
00:17:06 --> 00:17:08 coming to my courses or at
00:17:08 --> 00:17:10 the conference or something like that.
00:17:11 --> 00:17:11 But they're very,
00:17:11 --> 00:17:14 very curious on what is happening here?
00:17:14 --> 00:17:15 Why does it work?
00:17:16 --> 00:17:17 What do I need to know?
00:17:17 --> 00:17:18 What's the right thing to
00:17:18 --> 00:17:19 say to a patient?
00:17:20 --> 00:17:22 What happens if somebody
00:17:22 --> 00:17:22 doesn't get better?
00:17:22 --> 00:17:24 What does that typically mean?
00:17:24 --> 00:17:25 What could be some of the
00:17:25 --> 00:17:26 reasons for that?
00:17:28 --> 00:17:30 That part has been fuel for
00:17:30 --> 00:17:34 me to continue to look for that,
00:17:34 --> 00:17:35 to look for those answers
00:17:35 --> 00:17:37 and to be able to actually
00:17:37 --> 00:17:38 give those and say,
00:17:38 --> 00:17:40 here's some of the things
00:17:40 --> 00:17:42 that it could mean.
00:17:42 --> 00:17:44 And I think if there's anything...
00:17:45 --> 00:17:45 you know,
00:17:45 --> 00:17:47 the pain science revolution has
00:17:47 --> 00:17:49 brought us is an
00:17:49 --> 00:17:51 understanding that there
00:17:51 --> 00:17:52 will be differences in your
00:17:52 --> 00:17:53 outcomes and people are
00:17:53 --> 00:17:54 going to respond
00:17:54 --> 00:17:57 differently and having an
00:17:57 --> 00:17:58 underlying understanding of
00:17:58 --> 00:17:59 why that might be the case.
00:18:00 --> 00:18:01 So the big one for me
00:18:01 --> 00:18:04 internationally is the curiosity piece.
00:18:04 --> 00:18:06 It's just that part has been
00:18:07 --> 00:18:09 very rejuvenating for me, I think.
00:18:10 --> 00:18:13 Yeah, and I'm curious, like, why?
00:18:13 --> 00:18:15 Like, what is it that, you know,
00:18:15 --> 00:18:17 what stems their curiosity
00:18:17 --> 00:18:18 differently maybe than the U.S.?
00:18:18 --> 00:18:19 Is it the time?
00:18:19 --> 00:18:20 Is it productivity?
00:18:20 --> 00:18:23 What's the modeling that I
00:18:23 --> 00:18:24 think about factors?
00:18:24 --> 00:18:26 Why would you see such a difference?
00:18:26 --> 00:18:26 Do you have any idea?
00:18:27 --> 00:18:29 You brought it up, so now I'm asking.
00:18:30 --> 00:18:31 I think it's a lot of different things.
00:18:31 --> 00:18:32 I think part of it is the
00:18:32 --> 00:18:33 payment systems are different.
00:18:33 --> 00:18:37 So in many cases, in social environments,
00:18:37 --> 00:18:38 they're not incentivized to
00:18:38 --> 00:18:40 necessarily see more people
00:18:40 --> 00:18:41 or anything like that.
00:18:41 --> 00:18:44 They're more incentivized by
00:18:44 --> 00:18:46 their own passions to just do a good job.
00:18:47 --> 00:18:48 In other environments,
00:18:49 --> 00:18:50 it is very much fee for
00:18:50 --> 00:18:51 service and they have to
00:18:51 --> 00:18:52 deliver a superior product
00:18:53 --> 00:18:54 or that person is going to
00:18:54 --> 00:18:56 go a couple doors down and
00:18:56 --> 00:18:57 go to a different place
00:18:57 --> 00:18:58 because most of the places
00:18:58 --> 00:18:59 are privately owned and
00:19:00 --> 00:19:01 they hang their shingle out
00:19:01 --> 00:19:03 and hope that they can have
00:19:03 --> 00:19:05 a strong base with that.
00:19:06 --> 00:19:07 In other cases too,
00:19:07 --> 00:19:08 physio is a young
00:19:08 --> 00:19:10 profession in some of these countries.
00:19:10 --> 00:19:12 So it's very much in the growing phase.
00:19:12 --> 00:19:13 I would argue that it's
00:19:13 --> 00:19:14 similar to what we were
00:19:14 --> 00:19:15 like in the eighties and nineties.
00:19:16 --> 00:19:18 When everybody went to Conahead,
00:19:18 --> 00:19:19 you would go to five or six
00:19:19 --> 00:19:21 different major Conahead
00:19:21 --> 00:19:22 courses in a year and you
00:19:23 --> 00:19:25 had your employers would
00:19:25 --> 00:19:26 pay for it because they
00:19:26 --> 00:19:28 wanted you to grow as a clinician.
00:19:28 --> 00:19:30 So I see those parallels,
00:19:30 --> 00:19:32 but obviously I don't know
00:19:32 --> 00:19:33 the actual answer,
00:19:33 --> 00:19:34 but that's kind of what I think.
00:19:35 --> 00:19:36 Yeah, that's a great point.
00:19:37 --> 00:19:37 Great point.
00:19:38 --> 00:19:38 So now I'm going to
00:19:38 --> 00:19:39 transition back to the U.S.
00:19:39 --> 00:19:41 and the education side on our side,
00:19:41 --> 00:19:43 because I think we've hit
00:19:43 --> 00:19:44 some concepts around the clinical side,
00:19:45 --> 00:19:45 right?
00:19:45 --> 00:19:46 Curiosity, you know,
00:19:46 --> 00:19:48 it stems from somewhere.
00:19:48 --> 00:19:49 They've had some training,
00:19:49 --> 00:19:50 some basic training.
00:19:51 --> 00:19:53 So before students leave, like,
00:19:53 --> 00:19:54 so let's go back to that
00:19:54 --> 00:19:56 maybe entry level education.
00:19:57 --> 00:19:58 How do you envision some of
00:19:58 --> 00:19:59 the work that you're doing
00:19:59 --> 00:20:01 now or that you anticipate
00:20:01 --> 00:20:02 doing and hopefully some of
00:20:02 --> 00:20:03 the outcomes from that?
00:20:04 --> 00:20:05 How do you see that shaping or,
00:20:07 --> 00:20:07 I would say,
00:20:07 --> 00:20:08 helping to reframe maybe
00:20:09 --> 00:20:10 entry-level curricula or
00:20:10 --> 00:20:12 even early post-professional curricula?
00:20:12 --> 00:20:14 So whether it's fellowship
00:20:14 --> 00:20:16 level or even as students
00:20:16 --> 00:20:17 are kind of in those
00:20:17 --> 00:20:19 certificate courses before
00:20:19 --> 00:20:20 they go into fellowships.
00:20:21 --> 00:20:21 Well,
00:20:21 --> 00:20:23 I would hope it has a blueprint
00:20:23 --> 00:20:24 that's similar to exercise
00:20:24 --> 00:20:27 science and that you have
00:20:27 --> 00:20:28 these exercise prescription.
00:20:29 --> 00:20:30 This is what we know,
00:20:30 --> 00:20:32 what happens with exercise.
00:20:32 --> 00:20:33 Here are the mechanisms.
00:20:33 --> 00:20:35 Here's what it can actually
00:20:35 --> 00:20:37 influence in a person's
00:20:37 --> 00:20:38 disease mechanisms.
00:20:38 --> 00:20:41 Here's how its role during
00:20:41 --> 00:20:42 an inflammatory process, et cetera.
00:20:43 --> 00:20:45 So providing a framework,
00:20:45 --> 00:20:47 providing a taxonomy around
00:20:47 --> 00:20:49 application of how you would use it
00:20:49 --> 00:20:50 That's my goal.
00:20:51 --> 00:20:52 If if there's that and then
00:20:52 --> 00:20:54 that could be part of that
00:20:54 --> 00:20:56 educational process and so
00:20:56 --> 00:20:57 that there's everybody's
00:20:57 --> 00:20:59 kind of on common ground, then the
00:21:01 --> 00:21:02 treatment part of it,
00:21:02 --> 00:21:04 the application part of it
00:21:04 --> 00:21:06 can take whatever flavor
00:21:06 --> 00:21:07 the educator wants.
00:21:08 --> 00:21:10 My concern right now is that
00:21:11 --> 00:21:12 when I look at manual therapy,
00:21:12 --> 00:21:15 especially in an entry level requirement,
00:21:15 --> 00:21:16 it's a lot of techniques
00:21:17 --> 00:21:19 and it's not a lot of
00:21:19 --> 00:21:21 structure or understanding
00:21:21 --> 00:21:24 on when and how to use it.
00:21:25 --> 00:21:27 Yeah, that's a great point.
00:21:27 --> 00:21:29 And I think that's something
00:21:29 --> 00:21:29 that we could go further on.
00:21:30 --> 00:21:31 if they were to do, right?
00:21:32 --> 00:21:33 We all teach orthopedics or
00:21:33 --> 00:21:34 musculoskeletal, right?
00:21:34 --> 00:21:36 And so there's a desire for
00:21:36 --> 00:21:37 students to know how to do
00:21:37 --> 00:21:38 things with their hands.
00:21:39 --> 00:21:41 And I think what you've said
00:21:41 --> 00:21:41 is that it's just as
00:21:41 --> 00:21:42 important to really
00:21:42 --> 00:21:43 understand some of the
00:21:43 --> 00:21:44 understanding of the
00:21:44 --> 00:21:45 mechanisms that we
00:21:45 --> 00:21:47 understand and how it may
00:21:47 --> 00:21:49 work in that clinical approach.
00:21:49 --> 00:21:51 So the reasoning pieces to
00:21:51 --> 00:21:52 that may be helpful.
00:21:52 --> 00:21:54 Is there anything else that
00:21:54 --> 00:21:55 beyond reasoning that you
00:21:55 --> 00:21:56 feel like that really
00:21:56 --> 00:21:58 should be a focus of these
00:21:58 --> 00:21:59 entry level programs?
00:22:00 --> 00:22:00 Well,
00:22:00 --> 00:22:03 I think we need to understand where
00:22:03 --> 00:22:04 the manual therapies
00:22:04 --> 00:22:06 actually fit within the
00:22:06 --> 00:22:10 health care paradigm.
00:22:11 --> 00:22:12 And I teach a health
00:22:12 --> 00:22:13 services course at Duke.
00:22:14 --> 00:22:15 And in the health services course,
00:22:15 --> 00:22:17 we talk about the different approaches.
00:22:17 --> 00:22:18 One of them is stepped care.
00:22:18 --> 00:22:20 I'm a firm believer that
00:22:21 --> 00:22:24 safe interventions, low cost interventions,
00:22:24 --> 00:22:25 non-invasive interventions
00:22:26 --> 00:22:27 like the manual therapies, exercise,
00:22:28 --> 00:22:28 et cetera.
00:22:28 --> 00:22:30 It should be an early option
00:22:30 --> 00:22:33 for people with musculoskeletal problems.
00:22:33 --> 00:22:34 So understanding where it
00:22:34 --> 00:22:36 fits in that care process
00:22:37 --> 00:22:39 For the bulk of our patients
00:22:39 --> 00:22:41 with musculoskeletal problems,
00:22:42 --> 00:22:44 that should be an essential teach,
00:22:44 --> 00:22:46 I think, in entry-level programs,
00:22:47 --> 00:22:48 but also reinforced in
00:22:48 --> 00:22:50 postgraduate programs that
00:22:50 --> 00:22:52 we really have a role and, you know,
00:22:52 --> 00:22:53 I would argue a
00:22:53 --> 00:22:55 responsibility to make sure
00:22:55 --> 00:22:56 that everybody was
00:22:57 --> 00:23:00 following those preferred paradigms.
00:23:01 --> 00:23:02 And right now, stepped care, I think,
00:23:02 --> 00:23:04 is probably the best option
00:23:04 --> 00:23:05 within that framework.
00:23:08 --> 00:23:09 That's great.
00:23:09 --> 00:23:10 So let me ask you kind of a
00:23:10 --> 00:23:11 wrapping up question.
00:23:12 --> 00:23:13 Where do we learn more?
00:23:13 --> 00:23:14 And I mean,
00:23:14 --> 00:23:15 you've said listening maybe to
00:23:15 --> 00:23:17 different authors or going
00:23:17 --> 00:23:19 outside of our own comfort
00:23:19 --> 00:23:20 zones a little bit and
00:23:20 --> 00:23:22 maybe listening to others
00:23:22 --> 00:23:23 that may have interest.
00:23:23 --> 00:23:24 Obviously,
00:23:24 --> 00:23:26 ForceNet is a group and you guys
00:23:26 --> 00:23:27 have some podcasts that go
00:23:27 --> 00:23:28 or not podcasts,
00:23:28 --> 00:23:29 but some different speakers
00:23:29 --> 00:23:30 that come on to your
00:23:31 --> 00:23:32 your group that you do,
00:23:32 --> 00:23:34 where else can our audience
00:23:34 --> 00:23:36 and listeners gain more information,
00:23:36 --> 00:23:37 things that you would recommend,
00:23:37 --> 00:23:39 maybe next steps from them
00:23:39 --> 00:23:40 beyond today's talk?
00:23:41 --> 00:23:42 Well, the first step, I think,
00:23:42 --> 00:23:44 is keep an eye on some of
00:23:44 --> 00:23:45 our publications that will
00:23:46 --> 00:23:47 be coming out pretty soon.
00:23:47 --> 00:23:49 We have two in review and plus one.
00:23:50 --> 00:23:51 We have another one in the
00:23:51 --> 00:23:52 International Journal of
00:23:52 --> 00:23:53 Osteopathic Medicine,
00:23:53 --> 00:23:54 and then two more that
00:23:54 --> 00:23:55 we'll be submitting very
00:23:55 --> 00:23:56 soon that are really built
00:23:56 --> 00:23:59 around this concept of
00:23:59 --> 00:24:00 here's the scaffolding of
00:24:00 --> 00:24:01 what you need to know.
00:24:02 --> 00:24:03 ForceNet is a great place to start.
00:24:03 --> 00:24:04 We have a number of free
00:24:04 --> 00:24:07 webinars that are online
00:24:07 --> 00:24:08 that you can listen to.
00:24:08 --> 00:24:10 We throw so many different
00:24:11 --> 00:24:13 educators in those webinars.
00:24:13 --> 00:24:15 They're absolutely outstanding.
00:24:15 --> 00:24:16 That's actually been one of
00:24:16 --> 00:24:18 our best pieces, I think, of ForceNet.
00:24:19 --> 00:24:21 We actually have an online
00:24:21 --> 00:24:25 manual therapy conference in February,
00:24:25 --> 00:24:26 February the twenty second,
00:24:26 --> 00:24:27 two thousand twenty five.
00:24:28 --> 00:24:31 It's called Converge twenty twenty five.
00:24:31 --> 00:24:32 And in this conference,
00:24:33 --> 00:24:34 we have invited all
00:24:35 --> 00:24:37 different disciplines that
00:24:37 --> 00:24:38 work with it's called force
00:24:39 --> 00:24:40 based manipulations,
00:24:40 --> 00:24:41 but it's manual therapy.
00:24:41 --> 00:24:43 So this would go run the gamut from.
00:24:44 --> 00:24:45 the basic scientist who
00:24:45 --> 00:24:46 works in mouse studies,
00:24:46 --> 00:24:47 all the way to the
00:24:47 --> 00:24:48 clinician who has a full
00:24:49 --> 00:24:51 schedule of patients that
00:24:51 --> 00:24:52 they use manual therapy with.
00:24:53 --> 00:24:55 And we will have different tracks.
00:24:55 --> 00:24:56 But keep an eye on that.
00:24:56 --> 00:24:58 It's on our ForceNet website.
00:24:58 --> 00:25:00 We'll be advertising for that very soon.
00:25:00 --> 00:25:02 I think that'll be really interesting.
00:25:02 --> 00:25:04 The tracks are going to be imaging.
00:25:04 --> 00:25:04 They're going to be the
00:25:04 --> 00:25:06 clinician and mechanisms.
00:25:06 --> 00:25:09 There's going to be a
00:25:09 --> 00:25:10 neuroscientist track.
00:25:10 --> 00:25:10 And then there's actually
00:25:10 --> 00:25:12 going to be a modeling track, too.
00:25:12 --> 00:25:14 Oh, that's very cool.
00:25:14 --> 00:25:14 Very cool.
00:25:15 --> 00:25:16 Well, Chad,
00:25:16 --> 00:25:17 I think you just accomplished
00:25:17 --> 00:25:17 all that in one week.
00:25:18 --> 00:25:18 I mean,
00:25:18 --> 00:25:19 what are you going to do next week
00:25:19 --> 00:25:20 at this point?
00:25:20 --> 00:25:20 So, I mean,
00:25:20 --> 00:25:21 you're going to have like eight
00:25:21 --> 00:25:23 papers in one week already.
00:25:23 --> 00:25:24 So you're one of the most productive,
00:25:25 --> 00:25:26 productive scholar
00:25:26 --> 00:25:27 researchers I've ever met.
00:25:27 --> 00:25:28 You're exaggerating.
00:25:29 --> 00:25:29 Oh, I am not.
00:25:30 --> 00:25:30 I am not.
00:25:30 --> 00:25:30 Listeners,
00:25:30 --> 00:25:32 you all know I will not lie to you,
00:25:32 --> 00:25:35 but I so appreciate your time, Chad.
00:25:35 --> 00:25:36 And thank you for just
00:25:36 --> 00:25:37 making some time to have
00:25:37 --> 00:25:39 conversation about all the
00:25:39 --> 00:25:40 cool stuff you're doing.
00:25:41 --> 00:25:44 Introducing our listeners to scaffolding,
00:25:44 --> 00:25:44 right?
00:25:44 --> 00:25:45 Ways to navigate these
00:25:45 --> 00:25:48 trails and trials and
00:25:48 --> 00:25:51 challenges and orthopedic manual PT,
00:25:51 --> 00:25:51 as we know,
00:25:52 --> 00:25:53 it's about finding the right balance,
00:25:53 --> 00:25:54 right?
00:25:54 --> 00:25:55 And I think this relates to
00:25:55 --> 00:25:56 your biking and navigating
00:25:56 --> 00:25:57 the trails that you have
00:25:57 --> 00:26:00 navigated for us because
00:26:00 --> 00:26:02 you truly are a pioneer in what we do.
00:26:02 --> 00:26:03 And so thank you for all of
00:26:03 --> 00:26:04 your dedication to the
00:26:04 --> 00:26:06 profession and hard work.
00:26:07 --> 00:26:08 being inspired by our young
00:26:08 --> 00:26:10 our young attendees at
00:26:10 --> 00:26:12 conferences or continuing ed courses,
00:26:12 --> 00:26:13 challenging you to learn
00:26:13 --> 00:26:15 more and then help educate us more.
00:26:15 --> 00:26:16 And so we're grateful that
00:26:16 --> 00:26:17 you do that work.
00:26:17 --> 00:26:18 You know,
00:26:18 --> 00:26:19 I think that there is a perfect
00:26:19 --> 00:26:20 understanding that we do
00:26:20 --> 00:26:21 have to find balance
00:26:21 --> 00:26:23 between theory and practice.
00:26:24 --> 00:26:24 I don't think there's just
00:26:24 --> 00:26:25 the right one right size.
00:26:25 --> 00:26:27 And I really appreciate you
00:26:27 --> 00:26:29 giving us some insight into other ways,
00:26:29 --> 00:26:30 other areas and ways that
00:26:30 --> 00:26:32 we can get more information,
00:26:32 --> 00:26:33 be thoughtful about other
00:26:33 --> 00:26:34 disciplines as we we grow.
00:26:35 --> 00:26:37 as our understanding about
00:26:37 --> 00:26:38 how we can be better at
00:26:38 --> 00:26:40 manual therapy and its application.
00:26:40 --> 00:26:41 So thank you for that today.
00:26:41 --> 00:26:42 Appreciate it.
00:26:42 --> 00:26:43 Well, thank you for having me.
00:26:44 --> 00:26:44 Always.
00:26:44 --> 00:26:46 So Chad, we're grateful that you are here.
00:26:46 --> 00:26:47 We are grateful that we get
00:26:47 --> 00:26:49 to see you in our upcoming
00:26:49 --> 00:26:50 conference at AOM.
00:26:50 --> 00:26:51 So yeah,
00:26:51 --> 00:26:53 I get to put that AOM chat on and say,
00:26:53 --> 00:26:54 I get to see you soon.
00:26:54 --> 00:26:56 And we're presenting together again.
00:26:56 --> 00:26:58 So that will be very fun.
00:26:58 --> 00:27:00 And I look forward to having
00:27:00 --> 00:27:01 you in Orlando and listen,
00:27:01 --> 00:27:02 so many of our listeners
00:27:02 --> 00:27:03 are going to show up there too.
00:27:03 --> 00:27:04 So we're really excited for that.
00:27:05 --> 00:27:07 And for those who aren't there,
00:27:07 --> 00:27:08 Chad gave you another
00:27:08 --> 00:27:10 opportunity to catch up on
00:27:10 --> 00:27:11 the ForestNet website and
00:27:12 --> 00:27:12 see when their conference
00:27:12 --> 00:27:14 is coming up in February.
00:27:14 --> 00:27:15 So you can learn more about
00:27:15 --> 00:27:16 those manipulation
00:27:16 --> 00:27:18 opportunities and learn how
00:27:18 --> 00:27:19 you might broaden your
00:27:19 --> 00:27:21 horizons a little bit further.
00:27:21 --> 00:27:23 So thank you for your time today.
00:27:23 --> 00:27:27 And we will catch you on our next podcast.
00:27:27 --> 00:27:28 And again, remember,
00:27:28 --> 00:27:29 hands on or hands off.
00:27:30 --> 00:27:30 We'll figure it out.
00:27:30 --> 00:27:31 All right.
00:27:31 --> 00:27:32 Thanks so much, guys.
00:27:32 --> 00:27:32 Have a good one.