Dr. Moyo Tillery sits down with Dr. Ron Shank to explore the evolving relationship between Orthopaedic Manual Physical Therapy (OMPT) and Mechanical Diagnosis & Therapy (MDT). Drawing from decades of clinical practice, mentorship, and research, Ron reframes the debate — arguing that integration, not ideology, leads to better patient outcomes.
Together, they unpack directional preference, centralization, test–retest frameworks, patient empowerment, and the leadership principles that shape great clinicians. This is a must-listen for anyone navigating modern manual therapy practice.
Key Topics Covered:
- Directional preference vs centralization
- End-range testing as common ground
- Hands-on vs hands-off decision-making
- Patient self-efficacy and dependency
- Mentorship, leadership, and legacy in OMPT
00:00:02 --> 00:00:06 all right welcome to hands on hands off
00:00:06 --> 00:00:09 i'm your host today moya tillery um and
00:00:09 --> 00:00:12 for this episode i am joined by someone
00:00:12 --> 00:00:15 i respect deeply um and i've had the
00:00:15 --> 00:00:17 pleasure of working with for a couple of
00:00:17 --> 00:00:20 years now dr ron shank ron is a
00:00:20 --> 00:00:23 professor he's a mentor a thought leader
00:00:23 --> 00:00:26 in ompd and mechanical diagnosis
00:00:27 --> 00:00:30 Today we're talking about bridging the gap
00:00:30 --> 00:00:33 between the evolution of OMPT and
00:00:33 --> 00:00:34 directional preference.
00:00:34 --> 00:00:36 And if you followed Ron's work,
00:00:36 --> 00:00:39 you know that he's been involved in both
00:00:39 --> 00:00:40 worlds, so to speak,
00:00:41 --> 00:00:43 or are they the same worlds?
00:00:44 --> 00:00:45 That's for us to get into today.
00:00:45 --> 00:00:46 Welcome, Ron.
00:00:46 --> 00:00:48 Please tell us a little bit about yourself
00:00:48 --> 00:00:50 and we'll get the conversation going.
00:00:51 --> 00:00:52 Well, thanks, Mo.
00:00:52 --> 00:00:52 Thanks for having me.
00:00:54 --> 00:00:55 I'm a graduate of Ithaca College Physical
00:00:55 --> 00:00:56 Therapy Program,
00:00:57 --> 00:00:58 and then I went on to do a
00:00:58 --> 00:00:59 residency in Gulfport,
00:00:59 --> 00:01:01 Mississippi with Mike Rogers,
00:01:01 --> 00:01:03 who's one of the founding members of AOMT.
00:01:04 --> 00:01:04 Later on,
00:01:04 --> 00:01:07 I became McKenzie certified and earned my
00:01:07 --> 00:01:11 PhD and became a fellow in AAOMPT.
00:01:11 --> 00:01:13 And from the mid-nineties on,
00:01:14 --> 00:01:16 I've tried to bridge the two schools of
00:01:16 --> 00:01:17 thought
00:01:17 --> 00:01:19 And I really do think there's a place
00:01:19 --> 00:01:24 for directional preference in the schema
00:01:24 --> 00:01:26 that we use for examination intervention
00:01:26 --> 00:01:28 for people with musculoskeletal disorders.
00:01:29 --> 00:01:30 Yeah, no, that's great, Ron.
00:01:31 --> 00:01:31 Thank you.
00:01:31 --> 00:01:33 It's such a pleasure to have you.
00:01:33 --> 00:01:36 I'm glad we get this time to chat
00:01:36 --> 00:01:38 about something that I think has been on,
00:01:38 --> 00:01:38 you know,
00:01:38 --> 00:01:41 maybe certain people's minds as far as
00:01:41 --> 00:01:44 bridging this gap in these two very
00:01:44 --> 00:01:47 clinically applicable and appropriate,
00:01:47 --> 00:01:47 right?
00:01:47 --> 00:01:49 Once you figure out which patient is
00:01:49 --> 00:01:50 appropriate for what technique or mix of
00:01:50 --> 00:01:51 techniques.
00:01:52 --> 00:01:53 I want to know a little bit.
00:01:53 --> 00:01:56 I think we can take it back, Ron,
00:01:56 --> 00:01:57 if you're okay with that.
00:01:58 --> 00:02:00 Let's start with maybe your personal
00:02:00 --> 00:02:01 journey.
00:02:01 --> 00:02:04 You've mentioned OMPT giants like Mike
00:02:04 --> 00:02:06 Rogers and the late Dick Earhart in your
00:02:06 --> 00:02:07 own training.
00:02:08 --> 00:02:10 You've also had numerous publications on
00:02:10 --> 00:02:11 directional preference.
00:02:11 --> 00:02:14 Can you walk us through maybe how you
00:02:14 --> 00:02:16 first encountered directional preference
00:02:16 --> 00:02:20 and perhaps how your understanding of
00:02:20 --> 00:02:22 directional preference has evolved?
00:02:23 --> 00:02:24 Sure.
00:02:24 --> 00:02:26 So back when I was at Ithaca,
00:02:26 --> 00:02:29 one of our musculoskeletal professors was
00:02:29 --> 00:02:30 Robert Sprague.
00:02:30 --> 00:02:34 And Bob Sprague is well known to people
00:02:34 --> 00:02:36 in AAMT.
00:02:37 --> 00:02:40 Bob is a founding member of MAPS,
00:02:40 --> 00:02:41 Maitland Seminars.
00:02:41 --> 00:02:46 But he also taught with Robin McKenzie
00:02:46 --> 00:02:48 himself early on when Robin McKenzie first
00:02:48 --> 00:02:51 came upon his directional preference
00:02:51 --> 00:02:52 approach.
00:02:52 --> 00:02:54 And so Bob kind of integrated the two
00:02:55 --> 00:02:58 back when I was an undergrad in physical
00:02:58 --> 00:02:58 therapy.
00:02:59 --> 00:03:01 And it was probably a little too much
00:03:01 --> 00:03:04 to handle for someone who's not seen
00:03:04 --> 00:03:05 patients yet.
00:03:05 --> 00:03:07 And it didn't begin to make sense until
00:03:07 --> 00:03:08 I took,
00:03:09 --> 00:03:10 I started working at a hospital in
00:03:10 --> 00:03:11 Buffalo,
00:03:11 --> 00:03:14 New York and seeing outpatients and began
00:03:14 --> 00:03:15 to apply some of that.
00:03:16 --> 00:03:19 But to further that thinking in that area,
00:03:19 --> 00:03:21 I took a McKenzie A course,
00:03:21 --> 00:03:22 a lumbar course.
00:03:23 --> 00:03:24 And around that time,
00:03:24 --> 00:03:25 I was a clinical instructor,
00:03:25 --> 00:03:31 and one of our students came into the
00:03:31 --> 00:03:32 clinic and said, you know,
00:03:32 --> 00:03:34 you ought to think about this residency
00:03:34 --> 00:03:35 program they have.
00:03:35 --> 00:03:37 I had just spent six weeks there,
00:03:37 --> 00:03:40 and it's down in Gulfport, Mississippi.
00:03:40 --> 00:03:41 And I said, wow, really?
00:03:41 --> 00:03:42 He said, yeah,
00:03:42 --> 00:03:44 he worked there for a year for this
00:03:44 --> 00:03:45 guy named Mike Rogers.
00:03:45 --> 00:03:48 And what he does is he integrates all
00:03:48 --> 00:03:49 different schools of thought.
00:03:49 --> 00:03:52 So I really do think Mike was a
00:03:52 --> 00:03:54 forerunner in combining schools of thought
00:03:54 --> 00:03:57 and utilizing what's best for the patient
00:03:57 --> 00:03:59 and not necessarily trying to get the
00:03:59 --> 00:04:01 patient to fit into your school of thought
00:04:01 --> 00:04:02 or your way of thinking.
00:04:02 --> 00:04:04 So we were exposed to osteopathic,
00:04:04 --> 00:04:06 Maitland, McKenzie,
00:04:07 --> 00:04:09 many different approaches for management
00:04:09 --> 00:04:11 of people with musculoskeletal disorders.
00:04:12 --> 00:04:14 And it wasn't until I returned back to
00:04:14 --> 00:04:15 Buffalo and
00:04:17 --> 00:04:19 continue to see patients that I thought I
00:04:19 --> 00:04:22 maybe wanted to explore that directional
00:04:22 --> 00:04:23 preference approach or the McKenzie
00:04:23 --> 00:04:24 approach a bit more.
00:04:24 --> 00:04:29 So I pursued certification in that while
00:04:29 --> 00:04:32 still studying and practicing manual
00:04:32 --> 00:04:33 physical therapy.
00:04:33 --> 00:04:35 And I thought right from the beginning,
00:04:35 --> 00:04:36 like Mike had told us,
00:04:37 --> 00:04:39 if you have an understanding of many
00:04:40 --> 00:04:40 different schools of thought,
00:04:40 --> 00:04:42 you can apply them to a fairly high
00:04:42 --> 00:04:43 level.
00:04:43 --> 00:04:45 You can help more patients because we know
00:04:45 --> 00:04:49 not every patient's going to respond to
00:04:49 --> 00:04:50 one approach.
00:04:50 --> 00:04:53 And although we may be biased towards a
00:04:53 --> 00:04:54 particular system or approach,
00:04:54 --> 00:04:55 and that's good,
00:04:55 --> 00:04:58 we know that the reliability of these
00:04:58 --> 00:05:00 different systems we have for examination
00:05:00 --> 00:05:01 and treatment,
00:05:01 --> 00:05:04 not one stands out as being more reliable
00:05:04 --> 00:05:05 than another.
00:05:05 --> 00:05:06 But what we do know is when you
00:05:06 --> 00:05:09 have a system and you have a way
00:05:09 --> 00:05:11 of approaching a patient in a systematic
00:05:11 --> 00:05:11 manner,
00:05:12 --> 00:05:14 that you tend to have better outcomes than
00:05:14 --> 00:05:18 people who just kind of do things without
00:05:18 --> 00:05:22 a treatment-based classification type of
00:05:22 --> 00:05:23 approach.
00:05:23 --> 00:05:24 And interestingly,
00:05:24 --> 00:05:27 when we were down in Mississippi, Dr.
00:05:27 --> 00:05:27 Dick Earhart,
00:05:27 --> 00:05:29 also a founding member of AOM,
00:05:30 --> 00:05:31 he'd come down to the residency every year
00:05:32 --> 00:05:33 and do some teaching.
00:05:34 --> 00:05:37 And he was, of course,
00:05:37 --> 00:05:39 a proponent of the treatment-based
00:05:39 --> 00:05:40 classification system.
00:05:40 --> 00:05:41 So matching that impairment and those
00:05:42 --> 00:05:44 functional limitations to a particular
00:05:44 --> 00:05:44 classification.
00:05:45 --> 00:05:46 And that fit very well.
00:05:47 --> 00:05:49 It was very compatible with MDT,
00:05:49 --> 00:05:49 I thought,
00:05:50 --> 00:05:51 and also
00:05:53 --> 00:05:54 the treatment-based classification
00:05:54 --> 00:05:57 approach has a specific exercise category,
00:05:57 --> 00:05:59 which is based on centralization.
00:05:59 --> 00:06:01 So if patients with peripheral symptoms
00:06:01 --> 00:06:03 were found to centralize with extension,
00:06:04 --> 00:06:06 they'd be placed in that specific exercise
00:06:06 --> 00:06:07 category.
00:06:07 --> 00:06:10 So Dick Earhart too taught with Rob
00:06:10 --> 00:06:14 McKenzie early on and appreciated some of
00:06:14 --> 00:06:15 what he had to offer.
00:06:16 --> 00:06:18 But being a chiropractor and a
00:06:19 --> 00:06:20 manual physical therapist,
00:06:20 --> 00:06:22 a physical therapist, Dick Earhart,
00:06:22 --> 00:06:24 used a combination of schools of thought
00:06:24 --> 00:06:25 as well.
00:06:25 --> 00:06:28 So I had a lot of respect and
00:06:28 --> 00:06:31 was influenced greatly by that.
00:06:31 --> 00:06:34 And the fellowships and residencies that
00:06:34 --> 00:06:38 we developed were based on that concept of
00:06:38 --> 00:06:39 integrating approaches,
00:06:39 --> 00:06:41 using the best features of different
00:06:41 --> 00:06:43 approaches to find out what's going to be
00:06:43 --> 00:06:45 best for that person sitting in front of
00:06:45 --> 00:06:46 you.
00:06:48 --> 00:06:50 And our ordainment program required
00:06:50 --> 00:06:53 McKenzie A and B courses.
00:06:54 --> 00:06:56 The McKenzie Fellowship,
00:06:57 --> 00:06:58 which was post-diploma,
00:06:58 --> 00:07:00 so these were people that reached the
00:07:00 --> 00:07:02 highest level of training at MDT,
00:07:03 --> 00:07:04 were then exposed to other schools of
00:07:04 --> 00:07:06 thought as part of their fellowship
00:07:06 --> 00:07:06 training.
00:07:07 --> 00:07:09 So we utilized the same clinical
00:07:09 --> 00:07:11 instructors and mentors.
00:07:11 --> 00:07:15 And we think that that combination of
00:07:15 --> 00:07:16 approaches still
00:07:17 --> 00:07:21 giving respect to that person's bias and
00:07:21 --> 00:07:23 understanding what's their go-to,
00:07:24 --> 00:07:25 but still being open-minded.
00:07:26 --> 00:07:29 And I see in our schema of examination,
00:07:29 --> 00:07:31 which was developed by Ciriacs, active,
00:07:31 --> 00:07:32 passive,
00:07:34 --> 00:07:35 resistive movements,
00:07:35 --> 00:07:37 we can put it after the active movements
00:07:37 --> 00:07:38 testing end range.
00:07:39 --> 00:07:41 Prior to testing passive intervertebral
00:07:41 --> 00:07:43 motion or single segmental mobility
00:07:43 --> 00:07:44 testing,
00:07:44 --> 00:07:47 why not explore the potential for a person
00:07:47 --> 00:07:50 to find a directional preference through
00:07:50 --> 00:07:51 their own volition?
00:07:51 --> 00:07:54 So before we would test end range,
00:07:54 --> 00:07:56 we test the person's ability to go to
00:07:56 --> 00:07:56 end range.
00:07:57 --> 00:07:57 People can do it.
00:07:58 --> 00:07:59 Some people need assistance in that.
00:08:00 --> 00:08:00 And
00:08:02 --> 00:08:05 Whereas extension may be in thought of as,
00:08:05 --> 00:08:08 or neck retraction in the upper quarter
00:08:08 --> 00:08:11 thought to be a movement that may produce
00:08:11 --> 00:08:12 a centralization of symptoms,
00:08:13 --> 00:08:15 there's actually many different loading
00:08:15 --> 00:08:17 strategies and directions that may be
00:08:17 --> 00:08:19 explored in order to find if that person
00:08:20 --> 00:08:22 may centralize or exhibit a directional
00:08:22 --> 00:08:22 preference.
00:08:24 --> 00:08:26 And, you know,
00:08:26 --> 00:08:29 I think it may be gaining some traction
00:08:29 --> 00:08:30 when we look at
00:08:31 --> 00:08:32 Patient empowerment,
00:08:33 --> 00:08:35 people may be able to treat themselves and
00:08:35 --> 00:08:37 not necessarily be dependent to as great
00:08:37 --> 00:08:38 an extent on us.
00:08:39 --> 00:08:39 However,
00:08:39 --> 00:08:41 people do need hands-on and those
00:08:41 --> 00:08:45 approaches that foster hands-on training
00:08:45 --> 00:08:46 and cycles motor skill development,
00:08:47 --> 00:08:50 when they treat the patients and they
00:08:50 --> 00:08:51 encounter that patient,
00:08:51 --> 00:08:52 they put their hands on,
00:08:54 --> 00:08:56 regardless of the algorithm they follow to
00:08:56 --> 00:08:56 determine
00:08:57 --> 00:09:00 that intervention they're doing so in an
00:09:00 --> 00:09:03 extremely competent and confident manner
00:09:03 --> 00:09:05 which is then conveyed and the patient
00:09:05 --> 00:09:09 thinks well this person is skilled and
00:09:09 --> 00:09:12 knowledgeable and you're already halfway
00:09:12 --> 00:09:14 there then you know the right alliance
00:09:15 --> 00:09:17 And the trust, yeah, the trust is there.
00:09:18 --> 00:09:19 Ron, there's so much in what you said,
00:09:19 --> 00:09:23 and I think that this is part of,
00:09:23 --> 00:09:24 you and I talked about this,
00:09:24 --> 00:09:26 this is kind of why I immediately thought
00:09:26 --> 00:09:28 about you in talking about something that
00:09:29 --> 00:09:31 is foundational to OMPT.
00:09:32 --> 00:09:34 You've kind of seen the evolution of how
00:09:35 --> 00:09:38 we've gotten here and have spoken to that.
00:09:38 --> 00:09:40 And what I'm pulling from a lot of
00:09:40 --> 00:09:42 what you said just now too is,
00:09:43 --> 00:09:43 you know,
00:09:43 --> 00:09:45 those are the things that we're teaching
00:09:45 --> 00:09:47 for those of us in academia.
00:09:47 --> 00:09:48 And, you know,
00:09:48 --> 00:09:51 even clinical teaching is it's still got
00:09:51 --> 00:09:52 to be about the patient, right?
00:09:52 --> 00:09:54 Like it still has to be patient focused
00:09:54 --> 00:09:55 and the patient,
00:09:55 --> 00:09:56 if you treat the impairments,
00:09:56 --> 00:09:58 it almost doesn't matter, you know,
00:09:58 --> 00:10:00 maybe what path or what,
00:10:00 --> 00:10:03 what siloed thinking you choose because
00:10:03 --> 00:10:04 you're tailoring it,
00:10:04 --> 00:10:05 tailoring it to the patient.
00:10:06 --> 00:10:07 And that's really important.
00:10:07 --> 00:10:09 A lot of evidence now we know through
00:10:09 --> 00:10:11 like the CPGs is that,
00:10:11 --> 00:10:15 a multimodal approach to intervening for
00:10:16 --> 00:10:17 our patients and I think
00:10:18 --> 00:10:21 I've been guilty of it too,
00:10:21 --> 00:10:22 especially when I first became a fellow.
00:10:22 --> 00:10:23 I was like,
00:10:23 --> 00:10:24 I want to do all these techniques on
00:10:24 --> 00:10:25 everyone.
00:10:25 --> 00:10:27 I want to practice, get my skills well.
00:10:27 --> 00:10:29 But you may go a year and never
00:10:29 --> 00:10:31 have to manipulate a talocrural joint
00:10:31 --> 00:10:33 because you just don't have a patient that
00:10:33 --> 00:10:34 needs that.
00:10:34 --> 00:10:37 So I really have a deep appreciation for
00:10:37 --> 00:10:41 the way that you have illustrated kind of
00:10:41 --> 00:10:41 where we were
00:10:42 --> 00:10:44 how you lived where we were and how
00:10:44 --> 00:10:46 you are now living where we are.
00:10:48 --> 00:10:50 I do want to shift a little bit.
00:10:50 --> 00:10:51 You started to go into this a little
00:10:51 --> 00:10:52 bit, Ron.
00:10:52 --> 00:10:54 Let's shift to OMPT practice,
00:10:54 --> 00:10:57 specifically where you've seen it evolve
00:10:57 --> 00:10:59 from really hands-on,
00:10:59 --> 00:11:00 heavily hands-on approach,
00:11:01 --> 00:11:03 maybe clinician-focused approach,
00:11:04 --> 00:11:05 to periodically,
00:11:06 --> 00:11:08 what I would say now of somewhat of
00:11:08 --> 00:11:09 a more hands-off approach,
00:11:09 --> 00:11:11 while acknowledging the expertise of the
00:11:12 --> 00:11:13 manual therapist who needs to put their
00:11:13 --> 00:11:18 hands on.
00:11:18 --> 00:11:20 Where does directional preference fit in
00:11:21 --> 00:11:24 now as we're sort of bridging these two
00:11:24 --> 00:11:26 paradigms where we're occasionally
00:11:26 --> 00:11:28 hands-on, occasionally hands-off?
00:11:28 --> 00:11:30 Where's directional preference?
00:11:30 --> 00:11:30 What are your thoughts?
00:11:31 --> 00:11:31 Yeah, well,
00:11:31 --> 00:11:34 you said something I think that's pretty
00:11:34 --> 00:11:35 profound in that
00:11:36 --> 00:11:38 We have to have an examination that's
00:11:38 --> 00:11:41 inclusive enough to appreciate a potential
00:11:41 --> 00:11:41 impairment.
00:11:42 --> 00:11:44 So if we go in and our only
00:11:44 --> 00:11:46 tool is to test repeated end range
00:11:46 --> 00:11:47 movements,
00:11:47 --> 00:11:49 then we're kind of left with that in
00:11:49 --> 00:11:51 terms of how we may manage the patient.
00:11:51 --> 00:11:55 If we omit testing muscle balance,
00:11:56 --> 00:12:00 we then lose the opportunity to encourage
00:12:00 --> 00:12:05 people to stabilize or utilize exercises
00:12:05 --> 00:12:07 that may address their chief impairment.
00:12:07 --> 00:12:09 So when we have a thorough examination
00:12:09 --> 00:12:12 that may be inclusive of testing repeated
00:12:12 --> 00:12:12 end range,
00:12:12 --> 00:12:14 I would certainly recommend that.
00:12:14 --> 00:12:16 We could put an asterisk toward or at
00:12:16 --> 00:12:20 that impairment and that tends to stand
00:12:20 --> 00:12:22 out that we appreciate maybe the thing
00:12:22 --> 00:12:24 that we go after initially.
00:12:25 --> 00:12:28 And if we don't have a thorough exam,
00:12:28 --> 00:12:29 then we're missing out.
00:12:29 --> 00:12:31 We're really not doing that patient
00:12:31 --> 00:12:31 justice.
00:12:31 --> 00:12:33 And it could be done in an efficient
00:12:33 --> 00:12:35 manner provided you have exposure and
00:12:35 --> 00:12:37 training in these different approaches.
00:12:37 --> 00:12:39 So we're finding that some people are
00:12:39 --> 00:12:43 interested in pursuing further training in
00:12:44 --> 00:12:45 MDT.
00:12:45 --> 00:12:48 And we also find that our MDT fellows,
00:12:48 --> 00:12:50 McKenzie fellows that are now part of the
00:12:50 --> 00:12:54 Academy are learning more from our other
00:12:54 --> 00:12:54 colleagues who
00:12:55 --> 00:12:55 you know,
00:12:55 --> 00:12:57 are approaching patients a bit
00:12:57 --> 00:12:57 differently.
00:12:57 --> 00:12:59 And that was really the vision of the
00:12:59 --> 00:13:00 founding members of AOM.
00:13:00 --> 00:13:05 They all had their very invested
00:13:05 --> 00:13:07 approaches to treating patients,
00:13:07 --> 00:13:10 but they had the vision to understand that
00:13:11 --> 00:13:12 it wasn't the answer for everyone.
00:13:13 --> 00:13:15 And it's the difference between an
00:13:15 --> 00:13:17 institute and an academy.
00:13:18 --> 00:13:18 So, you know,
00:13:18 --> 00:13:20 the academy is comprised of a lot of
00:13:20 --> 00:13:23 different institutes and schools of
00:13:23 --> 00:13:23 thought.
00:13:24 --> 00:13:25 And really, it's
00:13:25 --> 00:13:28 It's very rewarding and exciting to go and
00:13:28 --> 00:13:31 learn something new when we go to these
00:13:33 --> 00:13:36 conferences and hear research and see
00:13:38 --> 00:13:39 techniques taught in these breakout
00:13:39 --> 00:13:42 sessions that maybe we wouldn't be able to
00:13:42 --> 00:13:44 offer our patients without that exposure.
00:13:44 --> 00:13:46 So you can pretty much say if you
00:13:46 --> 00:13:48 go to a McKenzie conference,
00:13:48 --> 00:13:50 you're going to hear about McKenzie.
00:13:50 --> 00:13:51 If you go to a Maitland conference,
00:13:51 --> 00:13:52 you're going to learn about
00:13:52 --> 00:13:54 Maitland or Maitland seminar,
00:13:54 --> 00:13:56 you're going to learn about Maitland.
00:13:56 --> 00:13:56 That's fine.
00:13:56 --> 00:13:58 And when you learn something to a very
00:13:58 --> 00:14:00 high level and you're able to distinguish
00:14:00 --> 00:14:02 signs and symptoms and come up with a
00:14:02 --> 00:14:04 classification or diagnosis,
00:14:04 --> 00:14:05 patients are probably going to do very
00:14:06 --> 00:14:06 well.
00:14:06 --> 00:14:08 And we had some McKenzie fellows go out
00:14:09 --> 00:14:11 for mentorship from a Paris fellow and
00:14:11 --> 00:14:12 both learned from one another.
00:14:13 --> 00:14:18 And I've been a mentor for people from
00:14:18 --> 00:14:19 James Dunning's program,
00:14:21 --> 00:14:22 and other programs as well.
00:14:22 --> 00:14:23 And I've learned and then adopted
00:14:23 --> 00:14:24 techniques based on that.
00:14:24 --> 00:14:28 So that's really a compliment to those,
00:14:29 --> 00:14:32 Stanley Paris and Dick Earhart and Mike
00:14:32 --> 00:14:34 Rogers and others, Bjorn Svensson,
00:14:34 --> 00:14:37 who had that vision way back when that,
00:14:37 --> 00:14:39 and they didn't always agree.
00:14:41 --> 00:14:42 I understand that it was,
00:14:42 --> 00:14:43 and I was a member of the board
00:14:43 --> 00:14:45 at AOMT at that time, you know,
00:14:45 --> 00:14:45 that
00:14:46 --> 00:14:47 You know, there's, you know,
00:14:47 --> 00:14:48 sometimes some very...
00:14:49 --> 00:14:51 Some heated discussions.
00:14:51 --> 00:14:51 Heated discussions.
00:14:51 --> 00:14:52 Thank you, Ma.
00:14:52 --> 00:14:55 Heated discussions in regards to how
00:14:55 --> 00:14:56 things were being approached.
00:14:56 --> 00:14:57 But still,
00:14:57 --> 00:14:59 they were able to let that go.
00:14:59 --> 00:15:01 And it's really for the betterment of the
00:15:01 --> 00:15:01 patient.
00:15:02 --> 00:15:02 Yes.
00:15:03 --> 00:15:04 Yeah, I love that, Ron.
00:15:04 --> 00:15:05 And I, you know,
00:15:06 --> 00:15:09 you know that I went through MTI and
00:15:09 --> 00:15:12 Tim and Krzyzewski and Peter Kroon
00:15:12 --> 00:15:15 developed that program and similarly.
00:15:15 --> 00:15:17 They were right after me, so.
00:15:18 --> 00:15:18 So, you know,
00:15:19 --> 00:15:20 you basically know what I learned and what
00:15:20 --> 00:15:21 they taught.
00:15:22 --> 00:15:23 Exactly.
00:15:23 --> 00:15:24 And a whole lot more.
00:15:25 --> 00:15:27 But that's part of what I really
00:15:27 --> 00:15:30 appreciate about our community of practice
00:15:30 --> 00:15:32 after going through MTI, which,
00:15:32 --> 00:15:34 like you said, is an institute.
00:15:34 --> 00:15:35 That's an important distinction that I
00:15:35 --> 00:15:36 never thought about.
00:15:36 --> 00:15:39 Institute versus academy is getting this
00:15:40 --> 00:15:42 mix of techniques and schools of thoughts
00:15:42 --> 00:15:42 and
00:15:43 --> 00:15:45 It really deepened my appreciation,
00:15:45 --> 00:15:45 I think,
00:15:45 --> 00:15:47 to the homage that you paid to the
00:15:47 --> 00:15:49 founders of AOMT,
00:15:49 --> 00:15:54 which is that our outcomes are that much
00:15:54 --> 00:15:56 better when we do kind of infuse these
00:15:56 --> 00:15:59 different techniques versus walking in our
00:15:59 --> 00:16:00 single silos.
00:16:00 --> 00:16:01 And, you know,
00:16:02 --> 00:16:04 one size fits all treatment has obviously
00:16:04 --> 00:16:07 been disproven to be effective in managing
00:16:08 --> 00:16:08 patients.
00:16:08 --> 00:16:10 I love this community practice for that
00:16:10 --> 00:16:10 reason.
00:16:10 --> 00:16:11 So now I have to put you on
00:16:11 --> 00:16:12 the spot.
00:16:13 --> 00:16:13 Thank you.
00:16:13 --> 00:16:15 before I go into mentorship,
00:16:15 --> 00:16:17 because you talked about mentoring, uh,
00:16:18 --> 00:16:19 different people from different programs.
00:16:19 --> 00:16:20 We're going to end on that Ron,
00:16:21 --> 00:16:21 because selfishly,
00:16:21 --> 00:16:23 I really want to spend a little bit
00:16:23 --> 00:16:25 of time there, but do you,
00:16:25 --> 00:16:27 do you think Ron that at where we
00:16:27 --> 00:16:30 are right now and what you've seen,
00:16:30 --> 00:16:31 what you're seeing,
00:16:31 --> 00:16:33 do you think that OMPT and MDT are
00:16:34 --> 00:16:37 like finally coming together or do we
00:16:37 --> 00:16:38 still have some work to do?
00:16:38 --> 00:16:39 What does that look like?
00:16:39 --> 00:16:40 What are your thoughts?
00:16:40 --> 00:16:42 Well, it's moving in that direction.
00:16:43 --> 00:16:43 And, uh,
00:16:45 --> 00:16:46 You know, directional preference, I think,
00:16:46 --> 00:16:50 is kind of a hard concept to argue
00:16:50 --> 00:16:53 about in regards to asking people to move
00:16:53 --> 00:16:55 in directions to end range and see if
00:16:55 --> 00:16:58 that direction produces a lasting change
00:16:59 --> 00:17:00 in their signs and symptoms.
00:17:00 --> 00:17:03 So it isn't just a person moves in
00:17:03 --> 00:17:04 a certain direction,
00:17:04 --> 00:17:05 they feel a decrease in their symptoms.
00:17:06 --> 00:17:07 It should be decreased and better or a
00:17:07 --> 00:17:10 lasting improvement for it truly to be a
00:17:10 --> 00:17:11 directional preference.
00:17:11 --> 00:17:14 And originally, Robin McKenzie,
00:17:15 --> 00:17:17 described it in terms of centralization.
00:17:17 --> 00:17:19 So if symptoms were found to move from
00:17:19 --> 00:17:21 a more distal to more central location,
00:17:22 --> 00:17:25 then that would be directional preference.
00:17:25 --> 00:17:26 But that's just one example.
00:17:26 --> 00:17:29 It could also be localized pain that
00:17:29 --> 00:17:31 decreases or remains decreased,
00:17:31 --> 00:17:33 or maybe a baseline that improves.
00:17:33 --> 00:17:35 It may be range of motion or maybe
00:17:35 --> 00:17:38 a neural sign that changes and remains
00:17:38 --> 00:17:41 improved as a result of moving in a
00:17:41 --> 00:17:42 particular direction.
00:17:43 --> 00:17:45 So there's been over fifty articles
00:17:45 --> 00:17:47 published on centralization.
00:17:48 --> 00:17:50 MDT is among the most researched
00:17:50 --> 00:17:54 approaches in musculoskeletal practice.
00:17:54 --> 00:17:56 And I think part of the reasons,
00:17:56 --> 00:17:59 one of the reasons it's so researched so
00:17:59 --> 00:18:02 extensively is that it seems so simple,
00:18:02 --> 00:18:05 but it's not that simple, actually.
00:18:05 --> 00:18:08 And in a scoping review that was recently
00:18:08 --> 00:18:09 published in the Journal of Physical
00:18:09 --> 00:18:09 Therapy,
00:18:09 --> 00:18:11 there's found to be one hundred and
00:18:11 --> 00:18:12 eleven, you know,
00:18:13 --> 00:18:15 different definitions in the ten thousand
00:18:15 --> 00:18:17 articles that were described,
00:18:17 --> 00:18:19 not a hundred eleven different
00:18:19 --> 00:18:20 definitions, but.
00:18:21 --> 00:18:22 You know,
00:18:22 --> 00:18:24 there is a quite a bit of discrepancy
00:18:24 --> 00:18:25 in how it's defined,
00:18:26 --> 00:18:28 so operationally defined as a lasting
00:18:28 --> 00:18:32 improvement in a baseline as a result of
00:18:32 --> 00:18:35 moving repeatedly or sustaining an end
00:18:35 --> 00:18:36 movement.
00:18:36 --> 00:18:39 So the evidence is emerging.
00:18:39 --> 00:18:40 You know, it's not
00:18:42 --> 00:18:43 You know,
00:18:43 --> 00:18:46 in a systematic review published by
00:18:46 --> 00:18:48 Halliday in Journal of Orthopedics and
00:18:48 --> 00:18:49 Sports Physical Therapy,
00:18:50 --> 00:18:53 they found when MDT or McKenzie was
00:18:54 --> 00:18:56 operationally defined in the clinicians
00:18:57 --> 00:18:59 operated according to that, you know,
00:18:59 --> 00:19:02 those definitions that MDT did have a
00:19:03 --> 00:19:04 greater treatment effect size.
00:19:05 --> 00:19:08 when we looked at credentialed therapists
00:19:08 --> 00:19:10 or people who've learned this approach in
00:19:10 --> 00:19:12 a article published in twenty twenty five
00:19:13 --> 00:19:14 by Hanneman and colleagues,
00:19:14 --> 00:19:17 they found that those that were trained
00:19:18 --> 00:19:20 had more favorable outcomes in comparison
00:19:20 --> 00:19:21 to other approaches.
00:19:21 --> 00:19:22 Yeah.
00:19:22 --> 00:19:23 You know,
00:19:23 --> 00:19:24 if they had that training in it.
00:19:24 --> 00:19:27 So it's about exposure and
00:19:29 --> 00:19:31 paying respect to the evidence in the
00:19:31 --> 00:19:31 literature.
00:19:31 --> 00:19:32 You know,
00:19:32 --> 00:19:33 we have systematic reviews and
00:19:34 --> 00:19:36 meta-analyses and randomized controlled
00:19:36 --> 00:19:38 trials that might show the efficacy of a
00:19:38 --> 00:19:39 particular approach,
00:19:39 --> 00:19:42 but ultimately it boils down to the
00:19:42 --> 00:19:43 evidence of the patient.
00:19:43 --> 00:19:43 And like you said,
00:19:43 --> 00:19:47 you're able to identify, you know,
00:19:47 --> 00:19:48 functional limitations,
00:19:48 --> 00:19:50 patient's perception of pain,
00:19:51 --> 00:19:52 contextual factors,
00:19:52 --> 00:19:53 and put it all together.
00:19:54 --> 00:19:56 and determine what's best for that patient
00:19:56 --> 00:19:57 right there,
00:19:57 --> 00:20:00 because that can't be captured, you know,
00:20:00 --> 00:20:02 in these, when we look at the,
00:20:03 --> 00:20:03 you know,
00:20:03 --> 00:20:05 the evidence synthesis from a systematic
00:20:05 --> 00:20:07 review or meta-analysis or even a
00:20:07 --> 00:20:08 randomized controlled trial.
00:20:08 --> 00:20:10 So, you know, it's a balance.
00:20:10 --> 00:20:12 It's a balance of the evidence literature
00:20:12 --> 00:20:13 and the evidence of the patient.
00:20:14 --> 00:20:14 You know,
00:20:14 --> 00:20:16 we respect to the evidence that's there,
00:20:17 --> 00:20:19 but we also have to pay respect to
00:20:19 --> 00:20:20 the fact that sometimes,
00:20:22 --> 00:20:25 evidence emerges over time.
00:20:25 --> 00:20:26 Back when Dick Earhart taught us a
00:20:27 --> 00:20:28 sacroiliac joint course during our
00:20:28 --> 00:20:29 residency,
00:20:29 --> 00:20:31 he did a gapping technique for the
00:20:31 --> 00:20:34 sacroiliac joint and described it as being
00:20:34 --> 00:20:37 effective for treating many different
00:20:37 --> 00:20:39 diagnoses related to the SI.
00:20:40 --> 00:20:42 And he showed us this one technique that
00:20:42 --> 00:20:43 was a gap.
00:20:44 --> 00:20:46 Some people wanted to learn, you know,
00:20:46 --> 00:20:48 a number of SI techniques.
00:20:48 --> 00:20:49 That's one that's good.
00:20:49 --> 00:20:51 I'm good about that if we have one
00:20:51 --> 00:20:52 go-to.
00:20:53 --> 00:20:54 And you said it's more important that we
00:20:54 --> 00:20:55 get a joint to move.
00:20:55 --> 00:20:56 Correct.
00:20:57 --> 00:21:00 And actually, years later,
00:21:01 --> 00:21:03 that same technique,
00:21:03 --> 00:21:05 which was described as a gap for the
00:21:05 --> 00:21:06 sacroiliac joint,
00:21:07 --> 00:21:09 became the technique lumbopelvic thrust
00:21:09 --> 00:21:12 that was in Flynn's study of clinical
00:21:12 --> 00:21:15 prediction rule for lumbar manipulation.
00:21:15 --> 00:21:18 So the technique he was demonstrating back
00:21:18 --> 00:21:20 in the eighties and nineties and teaching
00:21:20 --> 00:21:23 ended up being part of our- Implemented in
00:21:23 --> 00:21:24 practice.
00:21:24 --> 00:21:25 Yeah.
00:21:25 --> 00:21:27 Involvement of a clinical prediction rule.
00:21:28 --> 00:21:29 You know,
00:21:29 --> 00:21:30 we can't be dismissive of things,
00:21:30 --> 00:21:31 especially when they come from expert
00:21:31 --> 00:21:34 clinicians who've seen thousands of
00:21:34 --> 00:21:36 patients over many years.
00:21:37 --> 00:21:38 it works.
00:21:38 --> 00:21:39 But then when they disseminated
00:21:39 --> 00:21:41 information to people like Julie Fritz,
00:21:41 --> 00:21:43 who was at the University of Pittsburgh,
00:21:44 --> 00:21:46 Dick Earhart was there, you know,
00:21:46 --> 00:21:49 and Julie Fritz helped influence the
00:21:49 --> 00:21:51 development of that clinical prediction
00:21:51 --> 00:21:53 rule, you know,
00:21:53 --> 00:21:56 then we give respect to those that were
00:21:56 --> 00:21:58 really providing evidence of those
00:21:59 --> 00:22:00 patients they were seeing.
00:22:01 --> 00:22:02 Yeah, I love that, Ron.
00:22:02 --> 00:22:04 I think it's really important.
00:22:04 --> 00:22:07 I'm glad you talked about that scoping
00:22:07 --> 00:22:09 review because I had a couple thoughts and
00:22:09 --> 00:22:10 questions and things.
00:22:10 --> 00:22:12 But well,
00:22:12 --> 00:22:14 I think it's important to go back to
00:22:14 --> 00:22:18 what you said about variability and not
00:22:18 --> 00:22:20 having that common taxonomy and shared
00:22:21 --> 00:22:21 understanding.
00:22:22 --> 00:22:24 It may seem like a silly parallel,
00:22:24 --> 00:22:26 but it's like being in a relationship,
00:22:26 --> 00:22:27 right?
00:22:27 --> 00:22:29 If you're not speaking the same language,
00:22:29 --> 00:22:30 your understanding of what the other
00:22:30 --> 00:22:32 person is saying to you is going to
00:22:32 --> 00:22:32 vary.
00:22:33 --> 00:22:35 And not to mention the impact that could
00:22:35 --> 00:22:37 have clinically on our patients who are
00:22:37 --> 00:22:39 hearing, you know,
00:22:39 --> 00:22:41 something completely different from a
00:22:41 --> 00:22:43 provider who maybe shares the credentials.
00:22:43 --> 00:22:44 Like, it can be...
00:22:45 --> 00:22:45 You know,
00:22:45 --> 00:22:47 and I think this applies not just to
00:22:47 --> 00:22:49 directional preference, obviously,
00:22:49 --> 00:22:51 and the variability in defining it,
00:22:51 --> 00:22:54 but to manual therapy itself and OMPT,
00:22:54 --> 00:22:56 which has lacked that common taxonomy.
00:22:56 --> 00:22:56 You know,
00:22:57 --> 00:22:59 Chad talked about this in the article a
00:22:59 --> 00:23:00 couple of years ago,
00:23:00 --> 00:23:01 I think it was twenty one,
00:23:01 --> 00:23:02 where manual therapy has just been
00:23:02 --> 00:23:05 demonized and and just, you know,
00:23:05 --> 00:23:07 sort of tossed to the wayside.
00:23:07 --> 00:23:09 And he's kind of advocating that we define
00:23:09 --> 00:23:09 it by
00:23:10 --> 00:23:14 it's evidence based function versus that
00:23:14 --> 00:23:15 one technique, you know,
00:23:15 --> 00:23:17 like the Chicago roll or whatever the case
00:23:17 --> 00:23:17 may be.
00:23:19 --> 00:23:20 This is the,
00:23:20 --> 00:23:23 the definition has to encompass all of the
00:23:23 --> 00:23:24 things, not just the techniques,
00:23:24 --> 00:23:26 but also the clinical effects and the
00:23:26 --> 00:23:27 outcomes.
00:23:27 --> 00:23:29 So, I mean,
00:23:29 --> 00:23:30 what are your thoughts around like,
00:23:30 --> 00:23:34 why is directional preference so hard to
00:23:34 --> 00:23:35 define?
00:23:35 --> 00:23:35 Yeah.
00:23:36 --> 00:23:36 Yeah,
00:23:36 --> 00:23:39 I think I touched on a little bit
00:23:39 --> 00:23:42 earlier in that it's not understood to be
00:23:43 --> 00:23:44 a lasting change.
00:23:44 --> 00:23:48 And it's sometimes thought of as someone
00:23:48 --> 00:23:50 that's got low back pain and peripheral
00:23:50 --> 00:23:51 symptoms.
00:23:51 --> 00:23:53 They do extension and lying or standing
00:23:53 --> 00:23:54 lumbar extension.
00:23:55 --> 00:23:57 and it centralizes or it doesn't
00:23:57 --> 00:23:57 centralize.
00:23:58 --> 00:24:00 Then we move on to something else.
00:24:00 --> 00:24:04 So looking at weight-bearing versus
00:24:04 --> 00:24:05 non-weight-bearing movements,
00:24:05 --> 00:24:07 not just in the sagittal plane,
00:24:07 --> 00:24:09 but the transverse plane and a combination
00:24:09 --> 00:24:11 of transverse and so forth.
00:24:11 --> 00:24:15 And you also mentioned kind of the
00:24:15 --> 00:24:17 language issues we have.
00:24:17 --> 00:24:20 When I was in our manual therapy
00:24:20 --> 00:24:21 residency,
00:24:21 --> 00:24:22 we were taught a posterior to anterior
00:24:22 --> 00:24:24 central vertebral pressure.
00:24:24 --> 00:24:26 thought to be having an effect on the
00:24:26 --> 00:24:28 zygopal seal joints potentially.
00:24:29 --> 00:24:32 And then later on in MDT training,
00:24:32 --> 00:24:34 we were taught a lumbar extension
00:24:34 --> 00:24:35 mobilization,
00:24:35 --> 00:24:38 the identical hand placement, location,
00:24:38 --> 00:24:39 and we're moving
00:24:40 --> 00:24:41 At that time,
00:24:41 --> 00:24:42 it was thought to be moving the discs.
00:24:42 --> 00:24:45 So we're moving away from pathoanatomical
00:24:45 --> 00:24:47 diagnoses, which I think are good.
00:24:47 --> 00:24:49 We're moving more towards classifications
00:24:49 --> 00:24:51 based on movements and responses to
00:24:51 --> 00:24:52 movement.
00:24:52 --> 00:24:54 I think MDT fits in well with that.
00:24:54 --> 00:24:55 We, though,
00:24:56 --> 00:24:57 shouldn't lose sight of those
00:24:57 --> 00:25:01 pathoanatomical diagnoses because they may
00:25:02 --> 00:25:03 be very helpful in us establishing
00:25:03 --> 00:25:04 parameters.
00:25:04 --> 00:25:05 So we wouldn't treat
00:25:06 --> 00:25:07 disc pathology,
00:25:07 --> 00:25:09 if we hypothesize it to be disc generated,
00:25:10 --> 00:25:11 the same way we would treat a muscle
00:25:12 --> 00:25:14 that's weak or a power deficit.
00:25:15 --> 00:25:16 So there's a balance, too,
00:25:16 --> 00:25:20 between the pathoanatomical diagnoses and
00:25:20 --> 00:25:23 the movement-based diagnoses.
00:25:23 --> 00:25:25 And like, unfortunately,
00:25:25 --> 00:25:26 many times in our profession,
00:25:26 --> 00:25:27 it's got to be one or the other,
00:25:27 --> 00:25:28 right?
00:25:28 --> 00:25:28 It's got to be one.
00:25:29 --> 00:25:30 oh,
00:25:30 --> 00:25:31 I'm pathway anatomical or I'm
00:25:31 --> 00:25:32 movement-based,
00:25:32 --> 00:25:35 you need really to understand both.
00:25:35 --> 00:25:36 And understanding, though,
00:25:36 --> 00:25:38 that we don't always know the pain
00:25:38 --> 00:25:38 generator.
00:25:39 --> 00:25:41 But if we have an appreciation of how
00:25:41 --> 00:25:42 that person moves,
00:25:42 --> 00:25:46 then we may establish a parameter that's
00:25:46 --> 00:25:47 quite different.
00:25:47 --> 00:25:47 If it's ligamentous,
00:25:48 --> 00:25:50 it may be a thousand reps.
00:25:50 --> 00:25:51 If it's muscle,
00:25:51 --> 00:25:54 it may be three sets of ten every
00:25:54 --> 00:25:54 other day.
00:25:55 --> 00:25:56 And when I got out of school,
00:25:57 --> 00:25:58 everyone got three sets of tests
00:25:58 --> 00:26:00 regardless of the diagnosis.
00:26:00 --> 00:26:04 So we have some challenges with language
00:26:04 --> 00:26:06 as you touched on.
00:26:06 --> 00:26:10 And we need to work towards more
00:26:10 --> 00:26:12 commonalities rather than pointing out
00:26:13 --> 00:26:15 differences and discrepancies.
00:26:15 --> 00:26:17 And that's a job.
00:26:17 --> 00:26:19 That's not easy.
00:26:19 --> 00:26:20 Well, it's a big job,
00:26:20 --> 00:26:22 and I think the scoping review is really
00:26:22 --> 00:26:24 starting to probe that a bit.
00:26:27 --> 00:26:31 There seems to be this conflation of the
00:26:31 --> 00:26:31 two terms,
00:26:31 --> 00:26:33 centralization and directional preference,
00:26:33 --> 00:26:35 which you're highlighting.
00:26:37 --> 00:26:41 not just what the scoping review found,
00:26:41 --> 00:26:44 but a lot of other studies use them
00:26:44 --> 00:26:47 interchangeably.
00:26:47 --> 00:26:51 I think because of my training with Tim
00:26:51 --> 00:26:52 and Peter,
00:26:53 --> 00:26:54 it's clear that there's a difference.
00:26:55 --> 00:26:57 I think if you think about the fact
00:26:57 --> 00:26:59 that there are those of us who were
00:27:00 --> 00:27:03 in fellowship training programs and
00:27:03 --> 00:27:04 treating patients,
00:27:06 --> 00:27:08 We need clarification of those two terms
00:27:09 --> 00:27:12 because the impact that this could have on
00:27:12 --> 00:27:13 those of us as clinicians,
00:27:13 --> 00:27:15 but also in our patients.
00:27:16 --> 00:27:17 I think you already kind of touched on
00:27:17 --> 00:27:19 the difference between the two,
00:27:19 --> 00:27:22 but I just want to highlight that we
00:27:22 --> 00:27:24 talk about taxonomy and common taxonomy.
00:27:24 --> 00:27:26 It's not just words on paper or in
00:27:26 --> 00:27:27 research.
00:27:27 --> 00:27:29 The clinical application of these
00:27:29 --> 00:27:33 mechanisms, both powerful but distinct,
00:27:34 --> 00:27:36 It has a direct impact on clinicians who
00:27:36 --> 00:27:37 are trying to learn,
00:27:37 --> 00:27:38 clinicians who are
00:27:38 --> 00:27:40 now in academia trying to teach,
00:27:40 --> 00:27:41 but then of course the patient at the
00:27:41 --> 00:27:42 center of all of it.
00:27:42 --> 00:27:45 So I just want to underscore how important
00:27:45 --> 00:27:49 what you're saying is and to also maybe
00:27:49 --> 00:27:50 invite the listener to understand that
00:27:51 --> 00:27:53 we're talking about directional preference
00:27:53 --> 00:27:54 and OMPT and centralization,
00:27:54 --> 00:27:58 but this applies to many things in
00:27:58 --> 00:27:59 physical therapy.
00:27:59 --> 00:28:00 So I just really appreciate that
00:28:01 --> 00:28:02 conversation, Ron.
00:28:04 --> 00:28:05 What are your thoughts on the scoping
00:28:05 --> 00:28:05 review?
00:28:07 --> 00:28:08 There's a lot in there.
00:28:08 --> 00:28:11 Where are you going with this next, Ron?
00:28:11 --> 00:28:11 Yeah,
00:28:11 --> 00:28:15 so I think as was done by Halliday,
00:28:16 --> 00:28:18 we need to look at those that
00:28:18 --> 00:28:19 operationally define
00:28:20 --> 00:28:23 directional preference and those that
00:28:24 --> 00:28:26 didn't give a very clear definition of
00:28:26 --> 00:28:27 directional preference and look at the
00:28:27 --> 00:28:30 difference in outcomes in those studies.
00:28:31 --> 00:28:34 So that's the next step with that.
00:28:34 --> 00:28:38 And also one of our fellows in training
00:28:38 --> 00:28:39 recently graduated,
00:28:39 --> 00:28:41 I think he'll be recognized this October
00:28:42 --> 00:28:44 or in November at AIOP.
00:28:45 --> 00:28:46 is going to look at,
00:28:47 --> 00:28:48 and Chad Cook's his advisor,
00:28:48 --> 00:28:50 one of his advisors,
00:28:50 --> 00:28:52 look at the mechanisms behind why
00:28:52 --> 00:28:54 directional preference may work.
00:28:55 --> 00:28:57 So we have these theories,
00:28:57 --> 00:29:00 and Rob McKenzie originally had this DISC
00:29:00 --> 00:29:03 theory, but he, right from the get-go,
00:29:03 --> 00:29:04 said this is a theoretical model.
00:29:04 --> 00:29:06 You know, it may apply,
00:29:06 --> 00:29:07 but it may not apply.
00:29:08 --> 00:29:10 I heard him say before his passing at
00:29:10 --> 00:29:10 a conference,
00:29:11 --> 00:29:13 I wish I had named this approach.
00:29:13 --> 00:29:14 We're going to move people in the
00:29:14 --> 00:29:16 directions that make them feel better and
00:29:16 --> 00:29:17 avoid those that make them feel worse,
00:29:17 --> 00:29:18 at least initially.
00:29:18 --> 00:29:20 But that had been too long of a
00:29:20 --> 00:29:21 name.
00:29:22 --> 00:29:25 But he thought of it as being an
00:29:26 --> 00:29:27 evolving approach.
00:29:28 --> 00:29:29 definitions.
00:29:29 --> 00:29:31 He originally described it as movement of
00:29:31 --> 00:29:33 symptoms from a more distal to more
00:29:33 --> 00:29:34 central location.
00:29:35 --> 00:29:38 When we proposed development of a McKenzie
00:29:38 --> 00:29:39 fellowship,
00:29:39 --> 00:29:42 he was very supportive of that because he
00:29:43 --> 00:29:46 originally was a manipulative
00:29:46 --> 00:29:49 physiotherapist and thought that
00:29:50 --> 00:29:50 you know,
00:29:50 --> 00:29:52 maybe too many people have moved away from
00:29:52 --> 00:29:53 putting hands on.
00:29:53 --> 00:29:55 Putting hands on is going to be necessary
00:29:55 --> 00:29:58 and it's part of the MDT approach.
00:29:58 --> 00:30:01 So I think what we need to do
00:30:01 --> 00:30:03 next is see when, you know,
00:30:04 --> 00:30:07 these studies follow the operational
00:30:07 --> 00:30:08 definition.
00:30:08 --> 00:30:11 Does it make a difference in outcomes?
00:30:11 --> 00:30:11 Yeah.
00:30:12 --> 00:30:14 NMA, NMA, now we'll see,
00:30:14 --> 00:30:16 but that's the purpose of exploring that
00:30:16 --> 00:30:18 and looking at the mechanisms of why it
00:30:18 --> 00:30:19 works.
00:30:19 --> 00:30:22 So in our programs,
00:30:22 --> 00:30:24 our fellowship programs,
00:30:24 --> 00:30:29 we have the clinicians,
00:30:29 --> 00:30:32 the fellows in training thoroughly
00:30:32 --> 00:30:35 understand when we bring a joint to end
00:30:35 --> 00:30:36 range, what tissues are affected.
00:30:37 --> 00:30:38 So it's just not the disc,
00:30:39 --> 00:30:41 it is ligament, it's cartilage,
00:30:41 --> 00:30:43 it's muscle.
00:30:43 --> 00:30:45 And when a person goes to end range,
00:30:45 --> 00:30:48 things may change dramatically in terms of
00:30:48 --> 00:30:48 a baseline.
00:30:49 --> 00:30:50 And we know that with manipulation and
00:30:51 --> 00:30:51 mobilization,
00:30:51 --> 00:30:53 when we bring a joint to end range,
00:30:53 --> 00:30:55 people may demonstrate improvement.
00:30:55 --> 00:30:56 When a patient moves to end range,
00:30:56 --> 00:30:58 if they can move to end range,
00:30:58 --> 00:30:59 truly move to end range,
00:31:00 --> 00:31:01 and are they a good candidate for end
00:31:01 --> 00:31:03 range testing is another question that
00:31:04 --> 00:31:05 hopefully is appreciated
00:31:06 --> 00:31:07 by the clinician in terms of safety.
00:31:07 --> 00:31:10 But there's tissues that are going to be
00:31:10 --> 00:31:10 stressed.
00:31:10 --> 00:31:13 And in our Damon Fellowship,
00:31:13 --> 00:31:16 we had three people who were in the
00:31:16 --> 00:31:17 program at the same time.
00:31:17 --> 00:31:20 Megan Donaldson was one of our fellows in
00:31:20 --> 00:31:21 training.
00:31:21 --> 00:31:22 Corey Simon,
00:31:22 --> 00:31:24 who is going to be a keynote at
00:31:24 --> 00:31:26 the upcoming conference.
00:31:26 --> 00:31:29 And Eric Miller, they studied together.
00:31:29 --> 00:31:32 But Corey put together a joint manual,
00:31:32 --> 00:31:33 which
00:31:34 --> 00:31:36 you know, looked at, you know,
00:31:36 --> 00:31:38 the biomechanics, arthrokinematics,
00:31:38 --> 00:31:40 osteokinematics of all the joints from
00:31:41 --> 00:31:43 cranial to caudal and what tissues are
00:31:43 --> 00:31:45 brought to end range when we bring a
00:31:45 --> 00:31:46 joint to end range.
00:31:47 --> 00:31:49 And that became our study manual for both
00:31:49 --> 00:31:50 programs,
00:31:50 --> 00:31:52 both the McKenzie program and the Damon
00:31:52 --> 00:31:52 program.
00:31:53 --> 00:31:53 And it still is today.
00:31:54 --> 00:31:55 So we thank him for that.
00:31:55 --> 00:31:57 He used that as a study guide.
00:31:57 --> 00:32:01 I asked him, you know, if, you know,
00:32:01 --> 00:32:03 we could use it ongoing in the program.
00:32:03 --> 00:32:04 He said, of course.
00:32:06 --> 00:32:06 you know,
00:32:06 --> 00:32:10 and we have a number of fellows in
00:32:10 --> 00:32:12 training who, you know,
00:32:13 --> 00:32:14 have to put in a considerable amount of
00:32:14 --> 00:32:17 study time just learning that.
00:32:17 --> 00:32:21 And as do most manual OMPT programs.
00:32:21 --> 00:32:22 So,
00:32:23 --> 00:32:26 but we want that to be integral so
00:32:26 --> 00:32:26 that
00:32:27 --> 00:32:32 We appreciate when we bring a joint to
00:32:32 --> 00:32:33 end range or a person goes to end
00:32:33 --> 00:32:35 range, what's happening?
00:32:35 --> 00:32:37 And we can hypothesize.
00:32:38 --> 00:32:40 And McKenzie had an original hypothesis,
00:32:40 --> 00:32:42 which he later expanded to extremity
00:32:42 --> 00:32:43 joints as well.
00:32:43 --> 00:32:44 So obviously,
00:32:44 --> 00:32:46 the DISC model wouldn't work in the
00:32:46 --> 00:32:46 extremities.
00:32:46 --> 00:32:49 But we're seeing emerging evidence for
00:32:49 --> 00:32:51 testing end range with extremity
00:32:51 --> 00:32:52 conditions.
00:32:53 --> 00:32:56 And that is very interesting.
00:32:57 --> 00:32:59 in terms of what, why,
00:33:00 --> 00:33:02 and how does that person improve.
00:33:02 --> 00:33:04 But it's all about baselines, you know,
00:33:04 --> 00:33:06 rechecking a baseline to see if there's a
00:33:06 --> 00:33:07 lasting improvement.
00:33:08 --> 00:33:09 And we can't just go by symptoms.
00:33:09 --> 00:33:14 So I think it's sometimes the MDT approach
00:33:14 --> 00:33:15 is misconstrued to be,
00:33:16 --> 00:33:17 it's only about symptoms.
00:33:17 --> 00:33:21 And it could be a change in mechanics,
00:33:22 --> 00:33:23 a myotome,
00:33:24 --> 00:33:25 But it's got to be a lasting change,
00:33:26 --> 00:33:29 a neural tension sign.
00:33:29 --> 00:33:30 Ron, yeah,
00:33:31 --> 00:33:34 I think you're really – we talked about
00:33:34 --> 00:33:35 bridging the gap.
00:33:35 --> 00:33:37 Everything you're saying sort of brings
00:33:38 --> 00:33:41 those two schools together.
00:33:41 --> 00:33:42 When we were talking,
00:33:42 --> 00:33:44 we talked about how –
00:33:44 --> 00:33:47 OMPT is also end range, right?
00:33:47 --> 00:33:49 Like joint manipulations are at end range.
00:33:49 --> 00:33:51 And I don't know if it's just something
00:33:51 --> 00:33:53 about repeated movements that people
00:33:54 --> 00:33:56 forget that it is we're talking primarily
00:33:56 --> 00:33:57 about end range.
00:33:57 --> 00:33:58 But, you know,
00:33:58 --> 00:34:00 I think that's an important thing that
00:34:00 --> 00:34:03 comment and phrase that sort of bridges
00:34:03 --> 00:34:03 the gap.
00:34:03 --> 00:34:05 And similarly, right,
00:34:05 --> 00:34:07 like even with OMPT and kind of your
00:34:09 --> 00:34:10 manual manipulative
00:34:11 --> 00:34:14 approach it's it's we're also looking for
00:34:14 --> 00:34:16 lasting change right you don't you don't
00:34:17 --> 00:34:18 look for a cavitation and go yay as
00:34:19 --> 00:34:21 many of you know and many of us
00:34:21 --> 00:34:24 know it's it's about the test retest it's
00:34:25 --> 00:34:27 Establish a baseline,
00:34:27 --> 00:34:30 apply your technique or techniques,
00:34:30 --> 00:34:31 and then retest.
00:34:31 --> 00:34:32 And, you know,
00:34:32 --> 00:34:33 when you phrase it like that,
00:34:33 --> 00:34:35 which is why I really wanted to have
00:34:35 --> 00:34:36 this conversation,
00:34:36 --> 00:34:38 because I knew that you, again,
00:34:39 --> 00:34:41 have bridged both worlds and still do and
00:34:41 --> 00:34:44 can kind of help make sense of maybe
00:34:45 --> 00:34:45 where...
00:34:46 --> 00:34:47 they seem so separate,
00:34:48 --> 00:34:51 but they're actually quite similar in the
00:34:51 --> 00:34:53 clinical application and the things we're
00:34:53 --> 00:34:54 looking for as far as the effect on
00:34:55 --> 00:34:56 the patient.
00:34:56 --> 00:34:58 So I really appreciate that, Ron.
00:34:58 --> 00:34:58 Thank you.
00:34:58 --> 00:34:59 And you know,
00:34:59 --> 00:35:01 there's mechanical effects that we propose
00:35:02 --> 00:35:04 with manipulation and a person moving to
00:35:05 --> 00:35:06 end range,
00:35:06 --> 00:35:06 but
00:35:07 --> 00:35:07 you know,
00:35:07 --> 00:35:09 we're seeing more and more evidence of the
00:35:09 --> 00:35:12 neurophysiological potential effect and
00:35:12 --> 00:35:14 even the placebo effect.
00:35:14 --> 00:35:17 And that's if the person moves better and
00:35:17 --> 00:35:21 continues to move better and it turns out
00:35:21 --> 00:35:22 it's placebo, that's not a bad thing.
00:35:24 --> 00:35:27 But how that person is being approached is
00:35:27 --> 00:35:29 the difference maker in terms of whether
00:35:29 --> 00:35:33 that placebo may be achieved or occur
00:35:34 --> 00:35:36 And that's that they're confident in their
00:35:36 --> 00:35:36 clinician.
00:35:36 --> 00:35:38 They have a good working relationship.
00:35:39 --> 00:35:42 They have shared goals in terms of the
00:35:42 --> 00:35:43 patient's outcome.
00:35:44 --> 00:35:47 And then when that clinician puts hands on
00:35:48 --> 00:35:49 in a confident and skilled manner,
00:35:49 --> 00:35:51 they're there, right?
00:35:51 --> 00:35:53 They're there.
00:35:53 --> 00:35:55 And then if they see a within session
00:35:55 --> 00:35:57 change in a baseline,
00:35:59 --> 00:36:03 they're really going to be there and buy
00:36:03 --> 00:36:06 in, so to speak.
00:36:06 --> 00:36:07 The question is,
00:36:07 --> 00:36:08 can they treat themselves?
00:36:10 --> 00:36:13 Do they require us to put hands on?
00:36:13 --> 00:36:14 Many do.
00:36:14 --> 00:36:16 Maybe we can move them along more quickly
00:36:16 --> 00:36:17 if we do.
00:36:17 --> 00:36:19 It can be a combination of the two.
00:36:19 --> 00:36:20 But ultimately,
00:36:20 --> 00:36:22 we want people to be able to be
00:36:22 --> 00:36:25 empowered and self-treat because
00:36:26 --> 00:36:28 we spend billions and billions of dollars
00:36:28 --> 00:36:30 on musculoskeletal healthcare and we just
00:36:30 --> 00:36:31 can't afford it anymore.
00:36:32 --> 00:36:34 So we don't have enough evidence of this
00:36:34 --> 00:36:34 yet,
00:36:34 --> 00:36:37 but if the patients can become empowered
00:36:37 --> 00:36:37 to self-treat,
00:36:38 --> 00:36:40 maybe we can reduce recidivism and they
00:36:40 --> 00:36:41 don't need to come back.
00:36:41 --> 00:36:43 But if we don't give them that opportunity
00:36:44 --> 00:36:47 to become empowered or take a role in
00:36:47 --> 00:36:49 their own outcome,
00:36:51 --> 00:36:53 then they're gonna be dependent on us
00:36:54 --> 00:36:54 You know,
00:36:54 --> 00:36:56 and I've made that mistake in my career,
00:36:56 --> 00:36:58 putting hands on too soon or in a
00:36:58 --> 00:37:00 patient who may have an external locus of
00:37:00 --> 00:37:04 control and then becomes very difficult.
00:37:04 --> 00:37:06 Even if we have a good working
00:37:06 --> 00:37:07 relationship, you know,
00:37:09 --> 00:37:10 they become dependent on us.
00:37:10 --> 00:37:13 So I'd rather educate that patient on how
00:37:13 --> 00:37:15 they could self-treat than me be the
00:37:15 --> 00:37:17 person that is supposedly making them
00:37:17 --> 00:37:18 better.
00:37:18 --> 00:37:20 We want them to make themselves better.
00:37:20 --> 00:37:26 And that's why I believe so strongly in
00:37:26 --> 00:37:31 that testing of sustained and repeated
00:37:31 --> 00:37:33 movements to see if that patient can use
00:37:33 --> 00:37:35 that as part of their management.
00:37:36 --> 00:37:37 But then if we just test that and
00:37:37 --> 00:37:39 we don't test muscle balance,
00:37:39 --> 00:37:42 we don't test activation of deep spinal
00:37:42 --> 00:37:42 muscles,
00:37:42 --> 00:37:44 if we don't check for yellow flags,
00:37:44 --> 00:37:47 then we're going to miss out on something
00:37:48 --> 00:37:49 else that person needs.
00:37:49 --> 00:37:53 So it's just not about that.
00:37:53 --> 00:37:53 Yeah.
00:37:53 --> 00:37:53 Yeah.
00:37:53 --> 00:37:54 Rated movement.
00:37:55 --> 00:37:56 Yeah, it's got to be comprehensive, Ron.
00:37:57 --> 00:37:57 I love that.
00:37:57 --> 00:37:59 And I think both approaches certainly take
00:37:59 --> 00:38:00 that on.
00:38:00 --> 00:38:02 And as we're chatting,
00:38:02 --> 00:38:04 you just kind of keep adding to this
00:38:04 --> 00:38:07 bucket of this proverbial bucket that I
00:38:07 --> 00:38:08 have in my head that says,
00:38:09 --> 00:38:11 let's put all these things together that
00:38:11 --> 00:38:13 tie these approaches together.
00:38:13 --> 00:38:15 And obviously,
00:38:15 --> 00:38:16 self-efficacy is one of those.
00:38:18 --> 00:38:18 That's a...
00:38:19 --> 00:38:20 That's the end goal, right?
00:38:21 --> 00:38:22 It's you start with a therapeutic
00:38:22 --> 00:38:23 alliance.
00:38:23 --> 00:38:25 The name of the podcast is Hands On,
00:38:25 --> 00:38:27 Hands Off for a reason.
00:38:27 --> 00:38:28 So, you know,
00:38:28 --> 00:38:30 I think you're speaking to a lot of
00:38:31 --> 00:38:35 the similarities and commonalities in even
00:38:35 --> 00:38:36 the approach, right?
00:38:36 --> 00:38:38 The execution may look different,
00:38:38 --> 00:38:42 but the approach and the foundation is
00:38:42 --> 00:38:44 very similar as well as what we're trying
00:38:44 --> 00:38:46 to achieve with our patients.
00:38:46 --> 00:38:47 But the self-efficacy
00:38:47 --> 00:38:50 self-efficacy piece is one that I just
00:38:51 --> 00:38:52 want to underscore that you brought back
00:38:53 --> 00:38:54 into this conversation appropriately.
00:38:57 --> 00:38:58 Ron, I know you and I,
00:38:58 --> 00:38:59 we could probably go on and on and
00:38:59 --> 00:39:00 on and on,
00:39:00 --> 00:39:05 but I told you that I am interested
00:39:05 --> 00:39:05 in,
00:39:05 --> 00:39:07 because you've done a lot as a clinician,
00:39:07 --> 00:39:09 as a faculty member,
00:39:09 --> 00:39:12 in higher education leadership and just
00:39:14 --> 00:39:16 fellowship and residency and all the
00:39:16 --> 00:39:16 things.
00:39:16 --> 00:39:17 You've done all the things, Ron.
00:39:18 --> 00:39:20 And one of the things that selfishly I
00:39:20 --> 00:39:23 want to highlight is your mentorship of
00:39:23 --> 00:39:26 some really incredible clinicians,
00:39:26 --> 00:39:28 researchers, thought leaders, innovators,
00:39:28 --> 00:39:31 Corey Simon, Megan Donaldson, Eric Miller,
00:39:31 --> 00:39:35 who taught my last two students in the
00:39:35 --> 00:39:36 clinic at D'Youville.
00:39:36 --> 00:39:39 And so I feel like we're kind of
00:39:39 --> 00:39:41 coming full circle where
00:39:42 --> 00:39:43 a lot of the folks that you've poured
00:39:43 --> 00:39:44 into, Ron,
00:39:44 --> 00:39:47 are pouring into our profession and OMPT
00:39:48 --> 00:39:51 in even more variable ways.
00:39:51 --> 00:39:52 What is the secret?
00:39:52 --> 00:39:54 What is your philosophy on mentorship?
00:39:54 --> 00:39:55 Why?
00:39:55 --> 00:39:56 You're humble,
00:39:56 --> 00:39:58 so you will not appreciate me saying this
00:39:58 --> 00:39:59 this way,
00:39:59 --> 00:40:01 but why are you such a great mentor,
00:40:01 --> 00:40:02 Ron Shank?
00:40:03 --> 00:40:05 So I've had a lot of good mentors,
00:40:05 --> 00:40:07 great mentors, and great leaders.
00:40:08 --> 00:40:10 Interestingly, the other day,
00:40:10 --> 00:40:13 Megan Donaldson, who's our Aon president,
00:40:13 --> 00:40:15 as well as our program director at the
00:40:15 --> 00:40:17 Medical University of South Carolina,
00:40:17 --> 00:40:20 where I am now, put out a...
00:40:22 --> 00:40:24 something for us to read is faculty on
00:40:24 --> 00:40:25 teaching and leadership.
00:40:25 --> 00:40:27 And I've always believed that effective
00:40:28 --> 00:40:29 teaching or mentorship is really about
00:40:29 --> 00:40:30 leadership.
00:40:30 --> 00:40:31 So, you know,
00:40:31 --> 00:40:33 and if you think about somebody that was
00:40:33 --> 00:40:36 an effective leader or a coach that you've
00:40:36 --> 00:40:36 had,
00:40:37 --> 00:40:40 it's someone who you have a trust in
00:40:40 --> 00:40:42 each other, a trusting relationship.
00:40:43 --> 00:40:45 They have a belief that they're going to,
00:40:45 --> 00:40:47 we can be led or learned
00:40:48 --> 00:40:50 take you on a learning journal that you
00:40:50 --> 00:40:53 have respect and appreciation for what
00:40:53 --> 00:40:58 that student has done up to this point
00:40:58 --> 00:41:00 and that they're willing to learn more.
00:41:01 --> 00:41:02 Um, you know,
00:41:02 --> 00:41:04 and I was always amazed of these McKenzie
00:41:04 --> 00:41:07 diplomats who come in and, you know,
00:41:07 --> 00:41:08 now they've learned something to the
00:41:08 --> 00:41:09 highest level.
00:41:09 --> 00:41:10 They want to learn more.
00:41:10 --> 00:41:11 I mean, that's,
00:41:11 --> 00:41:13 that's quite a impressive compliment,
00:41:13 --> 00:41:15 but it's, um,
00:41:16 --> 00:41:17 you know,
00:41:17 --> 00:41:19 when you have that type of relationship
00:41:19 --> 00:41:20 with your students,
00:41:20 --> 00:41:23 or those who you're mentoring, you know,
00:41:23 --> 00:41:25 you end up supporting one another,
00:41:26 --> 00:41:27 and then just kind of guiding each other
00:41:28 --> 00:41:31 along the next step in their journey or,
00:41:32 --> 00:41:34 you know, in the mentors journey.
00:41:34 --> 00:41:37 So I think really,
00:41:38 --> 00:41:41 leadership is into effective teaching.
00:41:41 --> 00:41:42 And when
00:41:45 --> 00:41:47 When you can establish that rate,
00:41:47 --> 00:41:48 it's kind of like patient care.
00:41:48 --> 00:41:51 When there's a belief that you're going to
00:41:51 --> 00:41:53 be led in the right direction,
00:41:54 --> 00:41:59 then it just becomes a matter of keeping
00:41:59 --> 00:42:01 our minds open and learning from one
00:42:01 --> 00:42:01 another.
00:42:01 --> 00:42:06 So I think that those people who are
00:42:06 --> 00:42:11 good mentors or teachers tend to be good
00:42:11 --> 00:42:12 leaders as well.
00:42:13 --> 00:42:14 Yeah, I love that, Ron.
00:42:15 --> 00:42:16 I love that so much.
00:42:17 --> 00:42:18 The first thing you said was that you
00:42:18 --> 00:42:19 had great mentors.
00:42:19 --> 00:42:21 So, you know,
00:42:21 --> 00:42:25 great mentors breed great mentors who
00:42:25 --> 00:42:26 breed great mentors.
00:42:26 --> 00:42:29 And I think in, obviously,
00:42:29 --> 00:42:31 in the leadership of Megan, Corey, Eric,
00:42:31 --> 00:42:33 and others that you have mentored,
00:42:34 --> 00:42:37 there have been more leaders and this sort
00:42:37 --> 00:42:38 of generation of leaders,
00:42:38 --> 00:42:39 not just within AOMT,
00:42:39 --> 00:42:41 but in the profession.
00:42:41 --> 00:42:41 And
00:42:42 --> 00:42:43 I love the parallel to patient care.
00:42:43 --> 00:42:44 I think it is about trust.
00:42:44 --> 00:42:46 And something that you said that I really
00:42:46 --> 00:42:49 appreciate is that with your expertise and
00:42:49 --> 00:42:50 wealth of experience,
00:42:50 --> 00:42:53 you're still willing to learn from your
00:42:53 --> 00:42:54 mentees.
00:42:54 --> 00:42:55 And I love that.
00:42:55 --> 00:42:56 When I was in the clinic and I
00:42:56 --> 00:42:58 was taking students, it was selfish.
00:42:58 --> 00:42:59 I wanted to learn from them.
00:42:59 --> 00:43:01 I knew they were getting the latest and
00:43:01 --> 00:43:01 the greatest
00:43:02 --> 00:43:04 from whatever program they were coming to
00:43:04 --> 00:43:04 me from.
00:43:04 --> 00:43:06 And I wanted that knowledge.
00:43:06 --> 00:43:07 And so it was a little bit selfish,
00:43:08 --> 00:43:09 my approach to mentorship,
00:43:09 --> 00:43:11 but I love that you, you know,
00:43:11 --> 00:43:14 it's great to see the outcome of dedicated
00:43:14 --> 00:43:16 mentorship, not just clinical,
00:43:16 --> 00:43:18 but also professional development,
00:43:18 --> 00:43:20 and to see where all these great thought
00:43:20 --> 00:43:22 leaders are, thanks to, you know,
00:43:22 --> 00:43:24 some influence from you, Ron.
00:43:24 --> 00:43:25 So, and I know it goes both ways.
00:43:25 --> 00:43:26 Oh, thanks.
00:43:27 --> 00:43:28 Yeah, so Ron,
00:43:28 --> 00:43:29 what's next for you in this space?
00:43:29 --> 00:43:32 Maybe in mentorship or in leadership,
00:43:32 --> 00:43:34 if I could put you on the spot,
00:43:34 --> 00:43:35 what are you working on?
00:43:36 --> 00:43:37 Tell us more.
00:43:37 --> 00:43:38 Yep.
00:43:38 --> 00:43:40 So, you know, a few things.
00:43:40 --> 00:43:43 So we have a research task force that
00:43:43 --> 00:43:47 explores studies on directional
00:43:47 --> 00:43:47 preference.
00:43:48 --> 00:43:50 And, you know,
00:43:50 --> 00:43:53 we have quite a large and emerging or
00:43:53 --> 00:43:55 growing group that's looking at that.
00:43:56 --> 00:43:58 And some are McKenzie trained,
00:43:59 --> 00:44:00 some aren't necessarily.
00:44:00 --> 00:44:01 So, you know,
00:44:01 --> 00:44:03 we're open to people that are interested
00:44:03 --> 00:44:05 in kind of
00:44:05 --> 00:44:07 putting out ideas as we do,
00:44:07 --> 00:44:09 and then we go into breakout rooms.
00:44:10 --> 00:44:12 on particular projects.
00:44:12 --> 00:44:14 And so we meet quarterly.
00:44:14 --> 00:44:16 And that's been very fruitful, I think.
00:44:19 --> 00:44:22 And MUSC is very supportive of us doing
00:44:22 --> 00:44:23 clinical research.
00:44:24 --> 00:44:28 And having the ability and the freedom to
00:44:28 --> 00:44:31 balance both teaching and clinical work
00:44:31 --> 00:44:34 and clinical research is really critical,
00:44:34 --> 00:44:35 because if you take
00:44:36 --> 00:44:39 one element out, it's tough.
00:44:40 --> 00:44:41 It's tough.
00:44:41 --> 00:44:43 I think they all complement each other.
00:44:43 --> 00:44:45 And I was very fortunate to have worked
00:44:45 --> 00:44:47 for institutions that were always
00:44:47 --> 00:44:48 supportive of that.
00:44:48 --> 00:44:51 So continuing to do research,
00:44:51 --> 00:44:52 clinical research,
00:44:53 --> 00:44:53 once we
00:44:55 --> 00:44:57 complete our build out of this new
00:44:57 --> 00:44:58 program.
00:44:59 --> 00:44:59 You know,
00:44:59 --> 00:45:01 I have an office here that I see
00:45:01 --> 00:45:02 patients,
00:45:02 --> 00:45:04 so I want to get back into doing
00:45:04 --> 00:45:05 more of that.
00:45:06 --> 00:45:07 And of course, you know,
00:45:08 --> 00:45:09 work with our students.
00:45:09 --> 00:45:10 So, you know, Mo,
00:45:10 --> 00:45:13 how fun and exciting that is to see
00:45:13 --> 00:45:14 them, you know,
00:45:15 --> 00:45:17 begin to learn and begin that process.
00:45:19 --> 00:45:21 have them understand that this is just the
00:45:21 --> 00:45:21 starting point.
00:45:21 --> 00:45:24 DPP is just the starting point,
00:45:25 --> 00:45:27 and it's kind of what you do after
00:45:27 --> 00:45:29 you leave that makes the difference.
00:45:29 --> 00:45:33 What greater compliment to an instructor
00:45:33 --> 00:45:35 than to see the people you've taught do
00:45:35 --> 00:45:36 very well?
00:45:36 --> 00:45:39 And that makes it all really worthwhile.
00:45:40 --> 00:45:41 A thousand percent, Ron.
00:45:42 --> 00:45:42 Very well said.
00:45:42 --> 00:45:45 I have nothing to add and I will
00:45:46 --> 00:45:48 continue to be inspired by your work and
00:45:48 --> 00:45:50 your leadership and hopefully be,
00:45:51 --> 00:45:52 you know,
00:45:52 --> 00:45:55 a force of some good in this OMPT
00:45:55 --> 00:45:58 world and sort of bridging gaps where gaps
00:45:58 --> 00:46:01 exist and for the good of the profession
00:46:01 --> 00:46:02 and our academy.
00:46:02 --> 00:46:03 So it's really
00:46:03 --> 00:46:05 This has been such a rich conversation,
00:46:05 --> 00:46:05 Ron.
00:46:05 --> 00:46:07 I've never had one that wasn't with you.
00:46:07 --> 00:46:09 So thank you for sharing your insights,
00:46:10 --> 00:46:12 your history, your journey,
00:46:12 --> 00:46:13 your experience.
00:46:13 --> 00:46:15 And for those listening,
00:46:15 --> 00:46:18 please hit the subscribe button,
00:46:18 --> 00:46:20 stay tuned, share with your friends,
00:46:20 --> 00:46:22 your students, your colleagues,
00:46:22 --> 00:46:24 and we will see you next time.
00:46:25 --> 00:46:25 Thanks again, Ron.
00:46:26 --> 00:46:26 Thank you, Ma.
00:46:26 --> 00:46:27 Take care.