In this episode, we dive deep into shoulder pain management with world-renowned expert Jeremy Lewis. Jeremy discusses the evolving landscape of manual therapy, lifestyle modifications, and the future of shoulder rehabilitation. Explore his thought-provoking ideas on how musculoskeletal care should be more holistic and evidence-based. Learn why rotator cuff-related shoulder pain demands more than exercise and manual therapy, and why lifestyle factors like sleep, nutrition, and smoking can make or break a patient's recovery. Jeremy also touches on the exciting future of using virtual reality to manage shoulder problems, offering a glimpse into cutting-edge rehabilitation techniques.
Key Points Discussed:
- The shift in understanding shoulder pain: Moving away from structural explanations to holistic care.
- The role of manual therapy in shoulder pain management and its future in clinical practice.
- The impact of lifestyle factors (sleep, nutrition, smoking) on shoulder rehabilitation outcomes.
- How virtual reality is shaping the future of shoulder pain management and rehabilitation.
- Insights into the latest research on shoulder pain and its management.
Special Guest:
Jeremy Lewis, Professor of Musculoskeletal Research and Rehabilitation
00:00:03 --> 00:00:06 all right so well good
00:00:06 --> 00:00:07 afternoon I think it is
00:00:07 --> 00:00:09 jeremy in your time zone
00:00:09 --> 00:00:10 and it's uh eight thirty in
00:00:10 --> 00:00:12 the morning my time here so
00:00:12 --> 00:00:13 got a little bit of a time
00:00:13 --> 00:00:14 differential so I'll
00:00:14 --> 00:00:15 probably have different uh
00:00:16 --> 00:00:17 Hunger personalities and
00:00:17 --> 00:00:18 those kinds of things going
00:00:18 --> 00:00:19 on today with our show.
00:00:19 --> 00:00:22 But super excited to have
00:00:22 --> 00:00:25 you joining us at our AOMT
00:00:25 --> 00:00:26 conference this year and
00:00:26 --> 00:00:27 getting a chance to bring
00:00:27 --> 00:00:29 you over to the United States,
00:00:29 --> 00:00:31 bring you to sunny and
00:00:32 --> 00:00:33 hopefully not too humid and
00:00:33 --> 00:00:35 sticky Orlando, Florida.
00:00:36 --> 00:00:38 But I wanted to get an
00:00:38 --> 00:00:39 opportunity to get the
00:00:40 --> 00:00:40 attendees that will be
00:00:40 --> 00:00:41 showing up or maybe those
00:00:41 --> 00:00:42 that are considering coming
00:00:43 --> 00:00:44 to conference a chance to
00:00:44 --> 00:00:45 get to know you before you
00:00:45 --> 00:00:46 actually present our
00:00:46 --> 00:00:48 keynote and also our
00:00:48 --> 00:00:50 pre-conference course to
00:00:50 --> 00:00:52 our attendees by doing this show.
00:00:52 --> 00:00:53 So thank you very much for
00:00:53 --> 00:00:57 joining us today.
00:00:57 --> 00:00:58 It's my absolute pleasure
00:00:58 --> 00:01:00 and it's a great honor for me.
00:01:01 --> 00:01:02 Yeah, yeah, no, we're super excited.
00:01:02 --> 00:01:03 I know a lot of the people
00:01:03 --> 00:01:05 that I've talked to that
00:01:05 --> 00:01:06 are going to conference are
00:01:06 --> 00:01:07 really pumped to get to
00:01:07 --> 00:01:10 hear from you as well as
00:01:10 --> 00:01:11 the other keynote presenters.
00:01:12 --> 00:01:13 So, you know,
00:01:13 --> 00:01:13 I know a lot of people
00:01:13 --> 00:01:15 probably they know your work.
00:01:15 --> 00:01:16 They obviously know your
00:01:16 --> 00:01:17 work is probably in the
00:01:17 --> 00:01:18 shoulder and that sort of thing.
00:01:18 --> 00:01:20 But can you give our
00:01:20 --> 00:01:21 listeners a little bit
00:01:21 --> 00:01:22 about your journey that
00:01:22 --> 00:01:23 kind of led you to
00:01:24 --> 00:01:26 down your career path, if you will.
00:01:26 --> 00:01:28 I'm sure you've given this quite a bit,
00:01:29 --> 00:01:30 and you have a little bit
00:01:30 --> 00:01:31 of an elevator pitch,
00:01:31 --> 00:01:32 but just your journey that
00:01:32 --> 00:01:33 got you to this point.
00:01:36 --> 00:01:37 Well, each time I get asked to do this,
00:01:37 --> 00:01:38 I give a completely
00:01:38 --> 00:01:39 different story because I'm
00:01:39 --> 00:01:41 just trying to keep one
00:01:41 --> 00:01:42 step ahead of everybody else,
00:01:42 --> 00:01:44 but I'll try and be consistent.
00:01:45 --> 00:01:46 So I was originally born in New Zealand,
00:01:46 --> 00:01:47 grew up in New Zealand,
00:01:47 --> 00:01:48 had a wonderful childhood,
00:01:50 --> 00:01:52 moved to Australia as a teenager,
00:01:52 --> 00:01:53 struggled to try and work
00:01:53 --> 00:01:56 out what I wanted to do as a career,
00:01:56 --> 00:01:57 eventually settled on physio.
00:01:58 --> 00:01:59 Ten years after I finished
00:02:00 --> 00:02:01 undergraduate training,
00:02:01 --> 00:02:02 I did the one year
00:02:02 --> 00:02:04 manipulative manual therapy training.
00:02:04 --> 00:02:06 Jeff Malan was one of our teachers,
00:02:06 --> 00:02:07 so a great privilege of
00:02:08 --> 00:02:09 learning from him.
00:02:09 --> 00:02:10 And then a year after that,
00:02:11 --> 00:02:14 I did a one year sports
00:02:14 --> 00:02:15 physiotherapy course in
00:02:15 --> 00:02:18 Western Australia and
00:02:18 --> 00:02:19 twenty four years ago moved
00:02:19 --> 00:02:20 to the United Kingdom.
00:02:20 --> 00:02:22 The plan was to move here for a year.
00:02:22 --> 00:02:24 but really enjoyed living
00:02:24 --> 00:02:26 here and finished here
00:02:26 --> 00:02:31 another diploma in biomechanics.
00:02:31 --> 00:02:33 The scope of practice in the
00:02:33 --> 00:02:34 United Kingdom when I got
00:02:34 --> 00:02:38 here was rapidly changing.
00:02:38 --> 00:02:40 And soon after I got here, physios,
00:02:40 --> 00:02:42 physical therapists were allowed to
00:02:43 --> 00:02:43 refer patients for any
00:02:44 --> 00:02:45 imaging blood tests etc
00:02:45 --> 00:02:47 then we were allowed to
00:02:47 --> 00:02:49 train to do injections soft
00:02:49 --> 00:02:50 tissue and joint injections
00:02:51 --> 00:02:52 I did an extra year or so
00:02:52 --> 00:02:54 to become a to be able to
00:02:54 --> 00:02:55 use diagnostic ultrasound
00:02:55 --> 00:02:57 in clinical practice I
00:02:57 --> 00:02:58 don't use diagnostic
00:02:58 --> 00:02:59 ultrasound so much for
00:02:59 --> 00:03:01 diagnosis but I do use it
00:03:01 --> 00:03:02 for ultrasound guided
00:03:02 --> 00:03:03 injections for frozen
00:03:03 --> 00:03:05 shoulders which is clinical
00:03:05 --> 00:03:06 interest research interest
00:03:07 --> 00:03:10 And, uh, I believe it was,
00:03:10 --> 00:03:11 they changed the law again
00:03:11 --> 00:03:13 with an extra almost years training.
00:03:13 --> 00:03:14 We were allowed to prescribe
00:03:14 --> 00:03:15 any medicine that there was
00:03:15 --> 00:03:17 an evidence base for that
00:03:17 --> 00:03:18 could support clinical practice.
00:03:18 --> 00:03:20 So it's been a really
00:03:20 --> 00:03:21 interesting evolution.
00:03:21 --> 00:03:23 I still firmly believe that
00:03:24 --> 00:03:25 the most important, um,
00:03:27 --> 00:03:29 management that I can
00:03:29 --> 00:03:30 provide with patients with
00:03:31 --> 00:03:31 non-traumatic
00:03:32 --> 00:03:33 musculoskeletal shoulder
00:03:33 --> 00:03:36 problems is the traditional physiotherapy,
00:03:36 --> 00:03:37 physical therapy interventions.
00:03:37 --> 00:03:41 It certainly, from a risk point of view,
00:03:41 --> 00:03:43 a harms point of view, it's much safer,
00:03:44 --> 00:03:45 probably more effective
00:03:45 --> 00:03:49 than injection therapy and pharmacology.
00:03:49 --> 00:03:51 So I don't think we're in
00:03:51 --> 00:03:52 any way offering second
00:03:52 --> 00:03:53 best treatment with what we offer.
00:03:55 --> 00:03:56 So that's more or less what I do.
00:03:56 --> 00:03:58 I do two and a half days a week clinically,
00:03:58 --> 00:03:59 and I work two and a half
00:03:59 --> 00:04:00 days a week in research,
00:04:01 --> 00:04:02 doing my own research and
00:04:02 --> 00:04:04 supporting ten PhD students
00:04:04 --> 00:04:04 around the world.
00:04:05 --> 00:04:06 And I also have the
00:04:06 --> 00:04:08 privilege of teaching a shoulder course,
00:04:08 --> 00:04:09 which I've just come back
00:04:09 --> 00:04:12 from teaching in Korea, Hong Kong,
00:04:12 --> 00:04:14 Kuala Lumpur, and two courses in India.
00:04:14 --> 00:04:17 So please excuse the black under my eyes.
00:04:17 --> 00:04:20 It's jet lag and my voice is gone as well.
00:04:20 --> 00:04:21 So please excuse that.
00:04:22 --> 00:04:23 No, that is totally okay.
00:04:23 --> 00:04:24 I understood.
00:04:24 --> 00:04:25 Maybe I don't understand
00:04:25 --> 00:04:26 because I don't quite have
00:04:26 --> 00:04:27 that same level of a travel
00:04:27 --> 00:04:29 and teaching schedule for sure.
00:04:29 --> 00:04:30 But, you know,
00:04:30 --> 00:04:31 it's interesting that you...
00:04:31 --> 00:04:32 You're a lucky man.
00:04:35 --> 00:04:36 You know,
00:04:36 --> 00:04:38 fascinating background and
00:04:38 --> 00:04:39 fascinating history.
00:04:39 --> 00:04:40 It's interesting, too.
00:04:40 --> 00:04:41 I think we could probably
00:04:41 --> 00:04:42 have a lot of conversations,
00:04:42 --> 00:04:43 side conversation,
00:04:43 --> 00:04:45 just in terms of scope of practices,
00:04:45 --> 00:04:46 differences,
00:04:46 --> 00:04:47 and I'm sure that you've seen
00:04:47 --> 00:04:50 it in your travels throughout the world,
00:04:50 --> 00:04:52 you know, what certain physios can do.
00:04:53 --> 00:04:54 in certain countries.
00:04:54 --> 00:04:56 And that probably impacts a
00:04:56 --> 00:04:57 little bit of the way that
00:04:57 --> 00:04:58 you teach and manage.
00:04:58 --> 00:04:59 But I really appreciate that
00:04:59 --> 00:05:00 you mentioned that you
00:05:01 --> 00:05:02 firmly believe our
00:05:02 --> 00:05:04 traditional methods of physical therapy,
00:05:05 --> 00:05:05 you know,
00:05:05 --> 00:05:07 are really what matters the most.
00:05:07 --> 00:05:08 But it'd be fascinating to
00:05:08 --> 00:05:10 just even hear like at some point,
00:05:10 --> 00:05:12 not necessarily today, but, you know,
00:05:12 --> 00:05:13 just how that scope of
00:05:13 --> 00:05:14 practice looks in the UK,
00:05:14 --> 00:05:15 because I know the United
00:05:15 --> 00:05:17 States certainly is
00:05:18 --> 00:05:19 leaning into a lot of those
00:05:20 --> 00:05:21 sort of advanced practice
00:05:21 --> 00:05:23 skill sets within our own
00:05:23 --> 00:05:23 industry that it's
00:05:23 --> 00:05:26 obviously met with a lot of resistance,
00:05:26 --> 00:05:28 but that would be a fascinating topic.
00:05:28 --> 00:05:30 So I'm curious,
00:05:30 --> 00:05:31 and then I'm super excited
00:05:31 --> 00:05:32 also that you know,
00:05:32 --> 00:05:34 you you learn from Jeff Maitland,
00:05:35 --> 00:05:38 I know that that will ring, you know,
00:05:38 --> 00:05:40 true to a lot of our attendees.
00:05:40 --> 00:05:42 at AOMP conference.
00:05:43 --> 00:05:45 But more importantly, I was curious,
00:05:45 --> 00:05:47 how did you end up in the shoulder?
00:05:48 --> 00:05:50 I think everybody kind of has their ways.
00:05:50 --> 00:05:51 They may end up with low
00:05:51 --> 00:05:53 back as kind of their focus.
00:05:53 --> 00:05:54 Some people end up in the foot,
00:05:55 --> 00:05:56 in the neck.
00:05:57 --> 00:05:58 You ended up in the shoulder.
00:05:58 --> 00:05:59 How did you get there?
00:06:02 --> 00:06:06 It's sort of a bit like that movie,
00:06:06 --> 00:06:06 I don't know if you've seen it,
00:06:06 --> 00:06:12 the one with Gwyneth Paltrow,
00:06:13 --> 00:06:14 I forgot the name of it actually,
00:06:14 --> 00:06:15 but Sliding Doors,
00:06:15 --> 00:06:16 you might not have seen it.
00:06:16 --> 00:06:20 It's sort of, it's a movie where a person,
00:06:21 --> 00:06:22 half the movie is a person
00:06:22 --> 00:06:24 goes into the sliding door
00:06:24 --> 00:06:25 of an underground train in
00:06:25 --> 00:06:26 London and the other half
00:06:26 --> 00:06:28 is she doesn't meet the
00:06:28 --> 00:06:29 quite make the draw.
00:06:29 --> 00:06:31 So what happens in her life
00:06:31 --> 00:06:32 when you go down these two
00:06:32 --> 00:06:33 different opportunities
00:06:33 --> 00:06:36 separated by a few milliseconds, really?
00:06:38 --> 00:06:41 I wanted actually to
00:06:42 --> 00:06:43 specialize in an area.
00:06:44 --> 00:06:45 At the point in time when I
00:06:45 --> 00:06:47 was about to start my PhD,
00:06:47 --> 00:06:49 everybody was doing low back pain.
00:06:49 --> 00:06:51 Everybody was doing knee pain, hip pain.
00:06:51 --> 00:06:52 So I thought I'd go as far
00:06:52 --> 00:06:53 south as I could.
00:06:57 --> 00:06:59 and try and become as expert
00:06:59 --> 00:07:01 as I could managing feet problems.
00:07:03 --> 00:07:04 But I was really interested
00:07:05 --> 00:07:06 in the concept of posture
00:07:07 --> 00:07:07 and I was also very
00:07:07 --> 00:07:08 interested in the concept
00:07:08 --> 00:07:11 of subacromial impingement syndrome.
00:07:11 --> 00:07:12 So I decided my great
00:07:12 --> 00:07:14 contribution to the world
00:07:14 --> 00:07:15 would be to demonstrate how
00:07:15 --> 00:07:16 posture causes subacromial
00:07:16 --> 00:07:18 impingement and how when we
00:07:18 --> 00:07:19 improve posture,
00:07:19 --> 00:07:22 it reduces or alleviates the symptoms.
00:07:23 --> 00:07:25 and um three years later I'm
00:07:25 --> 00:07:29 uh probably my most
00:07:29 --> 00:07:30 confused person on the
00:07:30 --> 00:07:31 planet thinking that well
00:07:31 --> 00:07:32 there's absolutely no
00:07:32 --> 00:07:33 evidence for postural
00:07:33 --> 00:07:35 theory that we follow so
00:07:35 --> 00:07:36 strongly and there's no
00:07:36 --> 00:07:37 such condition as
00:07:37 --> 00:07:39 subacromial impingement
00:07:39 --> 00:07:40 syndrome and I think that
00:07:40 --> 00:07:42 uh subsequent our
00:07:42 --> 00:07:43 subsequent research and
00:07:44 --> 00:07:45 research and many others
00:07:45 --> 00:07:46 has has demonstrated that's
00:07:46 --> 00:07:48 the case that um the the
00:07:48 --> 00:07:49 postural beliefs we have in
00:07:50 --> 00:07:51 our profession um we're
00:07:51 --> 00:07:52 probably just disabling people
00:07:53 --> 00:07:55 by telling them how bad poor
00:07:55 --> 00:07:57 their posture is, their muscle imbalances,
00:07:57 --> 00:07:58 and, you know,
00:07:58 --> 00:07:58 asking them if they're
00:07:58 --> 00:08:01 related to Quasimodo.
00:08:01 --> 00:08:02 So, you know,
00:08:03 --> 00:08:06 so I think my PhD sort of
00:08:06 --> 00:08:07 blew that out of the water.
00:08:07 --> 00:08:09 And also it confused me
00:08:09 --> 00:08:11 knowing that this condition
00:08:11 --> 00:08:13 that everybody was saying
00:08:13 --> 00:08:13 is the most common
00:08:13 --> 00:08:14 condition of the shoulder,
00:08:14 --> 00:08:16 impingement syndrome,
00:08:16 --> 00:08:17 probably didn't exist.
00:08:17 --> 00:08:20 And I guess as a consequence of that,
00:08:21 --> 00:08:21 I tried to,
00:08:22 --> 00:08:23 think, well, okay, well,
00:08:23 --> 00:08:24 my first plan didn't work,
00:08:24 --> 00:08:26 but just stay with the
00:08:26 --> 00:08:27 shoulder and see what I can
00:08:27 --> 00:08:28 contribute with clinical
00:08:28 --> 00:08:30 knowledge and research knowledge.
00:08:30 --> 00:08:32 And that's where I got to.
00:08:33 --> 00:08:33 That's where I am.
00:08:35 --> 00:08:35 That's great.
00:08:35 --> 00:08:35 So,
00:08:37 --> 00:08:38 so the things like upper cross syndrome
00:08:38 --> 00:08:39 probably drive you nuts at
00:08:39 --> 00:08:40 this point now.
00:08:43 --> 00:08:45 I think what we're doing by
00:08:45 --> 00:08:47 perpetuating some of these
00:08:47 --> 00:08:49 clinical beliefs is just
00:08:49 --> 00:08:51 continuing to disable
00:08:51 --> 00:08:52 people who are seeking care
00:08:53 --> 00:08:54 and by telling them they've
00:08:54 --> 00:08:55 got impingement or telling
00:08:56 --> 00:08:56 them they've got
00:08:56 --> 00:08:58 subacromial pain syndrome,
00:08:58 --> 00:09:00 which is a meaningless, in my opinion,
00:09:00 --> 00:09:01 a meaningless diagnosis
00:09:01 --> 00:09:03 because then people ask, well,
00:09:04 --> 00:09:05 what what's the subacromion
00:09:05 --> 00:09:07 and then you talk about the
00:09:07 --> 00:09:08 structures in it and then
00:09:08 --> 00:09:09 you talk about well what
00:09:09 --> 00:09:11 could be causing harm or
00:09:11 --> 00:09:12 damage those structures I
00:09:12 --> 00:09:14 think that's another
00:09:14 --> 00:09:16 meaningless term we you
00:09:16 --> 00:09:18 give to patients and you're
00:09:18 --> 00:09:19 sort of asking or who's
00:09:19 --> 00:09:21 benefiting from labeling a
00:09:21 --> 00:09:23 term like that and to me it
00:09:23 --> 00:09:26 makes as as nonsensical as
00:09:26 --> 00:09:29 superhumeral pain syndrome so um
00:09:30 --> 00:09:31 So I think, you know,
00:09:31 --> 00:09:31 labeling people with
00:09:32 --> 00:09:33 pathoanatomical diagnosis
00:09:33 --> 00:09:36 is very harmful and telling
00:09:36 --> 00:09:37 people poor posture,
00:09:37 --> 00:09:38 and it makes it easy for us
00:09:38 --> 00:09:39 to explain symptoms.
00:09:39 --> 00:09:40 But the truth is,
00:09:40 --> 00:09:41 we've got really no basis
00:09:41 --> 00:09:44 for a lot of what we say in
00:09:45 --> 00:09:46 clinical practice.
00:09:46 --> 00:09:47 And I love medical, I love history,
00:09:47 --> 00:09:49 and I love medical history.
00:09:49 --> 00:09:51 And I've always tried to
00:09:51 --> 00:09:52 make an effort to go back to
00:09:53 --> 00:09:55 where some of these theories
00:09:55 --> 00:09:56 started from and how they
00:09:57 --> 00:09:59 snowballed or avalanched or
00:10:00 --> 00:10:01 how they perpetuated.
00:10:01 --> 00:10:04 And very often it's just, I guess,
00:10:04 --> 00:10:05 a couple of people had a
00:10:05 --> 00:10:07 couple of vodkas and had a thought
00:10:08 --> 00:10:10 or whatever the favorite tipple was,
00:10:10 --> 00:10:11 the drink was at that stage
00:10:11 --> 00:10:13 and came up with an idea
00:10:13 --> 00:10:14 and it just snowballed.
00:10:15 --> 00:10:15 That's probably what
00:10:15 --> 00:10:16 happened with postural
00:10:16 --> 00:10:18 theory sort of starting in Germany,
00:10:18 --> 00:10:19 a hundred and fifty years ago.
00:10:19 --> 00:10:22 It just sort of became existentially,
00:10:23 --> 00:10:23 that's the wrong word,
00:10:23 --> 00:10:24 but it became very
00:10:25 --> 00:10:29 increasingly a sort of myth
00:10:29 --> 00:10:30 build upon myth, build upon myth.
00:10:30 --> 00:10:31 And then it became fact.
00:10:31 --> 00:10:32 And I think that's the same
00:10:32 --> 00:10:36 for many medical, many
00:10:37 --> 00:10:37 conditions such as
00:10:37 --> 00:10:39 impingement syndrome as well.
00:10:39 --> 00:10:39 Because if you go back to
00:10:40 --> 00:10:40 the original paper in
00:10:40 --> 00:10:41 nineteen seventy two,
00:10:42 --> 00:10:43 Charles Near's original
00:10:43 --> 00:10:46 paper and you read it today, you'd say,
00:10:46 --> 00:10:47 well, hang on a second.
00:10:47 --> 00:10:49 This is just reading like a blog.
00:10:49 --> 00:10:50 This isn't a scientific paper.
00:10:51 --> 00:10:52 This is an opinion piece.
00:10:52 --> 00:10:54 This is what I've been doing.
00:10:54 --> 00:10:55 This is what I'm believing.
00:10:55 --> 00:10:56 This is what I'm suggesting.
00:10:57 --> 00:10:58 But I guess in the nineteen seventies,
00:10:58 --> 00:10:59 there was no such thing as
00:10:59 --> 00:11:01 a blog and it became a fact.
00:11:01 --> 00:11:02 But because of that blog,
00:11:02 --> 00:11:04 millions of people around
00:11:04 --> 00:11:05 the world and probably
00:11:05 --> 00:11:08 many thousands of people around the world,
00:11:08 --> 00:11:09 including in your country
00:11:09 --> 00:11:10 and in the United Kingdom
00:11:10 --> 00:11:11 and many others today,
00:11:12 --> 00:11:14 are having a subacromial decompression,
00:11:14 --> 00:11:14 which
00:11:15 --> 00:11:17 has clearly shown not to
00:11:17 --> 00:11:18 outperform placebo surgery
00:11:18 --> 00:11:19 and clearly shown with
00:11:20 --> 00:11:21 ten-year follow-ups not to
00:11:21 --> 00:11:24 outperform an exercise
00:11:25 --> 00:11:26 manual therapy approach.
00:11:27 --> 00:11:32 It's just adding expense to healthcare,
00:11:32 --> 00:11:34 reducing its sustainability,
00:11:34 --> 00:11:37 but it was started by basically a blog.
00:11:37 --> 00:11:39 And, yeah, so...
00:11:40 --> 00:11:41 And I think a lot of the
00:11:41 --> 00:11:42 elective surgery that
00:11:42 --> 00:11:43 happens on the shoulders,
00:11:43 --> 00:11:44 whether it's rotator cuff repairs,
00:11:45 --> 00:11:47 whether it's type two slap lesions,
00:11:47 --> 00:11:49 biceps tenodesis,
00:11:49 --> 00:11:52 so much of it is these
00:11:52 --> 00:11:53 elective surgeries that we
00:11:53 --> 00:11:55 think we're fixing problems
00:11:55 --> 00:11:58 with are clearly not
00:11:58 --> 00:11:59 outperforming placebos.
00:12:00 --> 00:12:02 And we have to ask ourselves,
00:12:04 --> 00:12:05 in whose best interest are
00:12:05 --> 00:12:07 these procedures being performed for?
00:12:08 --> 00:12:10 And, you know, follow the money sometimes.
00:12:11 --> 00:12:12 Yeah, you know,
00:12:12 --> 00:12:15 and I really appreciate all
00:12:15 --> 00:12:15 those thoughts.
00:12:15 --> 00:12:16 Actually, the history behind it,
00:12:16 --> 00:12:20 I'm going to have to go and look at that.
00:12:20 --> 00:12:22 Because obviously we
00:12:22 --> 00:12:24 resource that quite a bit.
00:12:24 --> 00:12:26 When I talk to PTs, you know,
00:12:26 --> 00:12:27 I think one of the things
00:12:27 --> 00:12:29 that always frustrates, you know,
00:12:30 --> 00:12:30 a physical therapist.
00:12:31 --> 00:12:32 So the example I give is.
00:12:33 --> 00:12:34 what do you do when a
00:12:34 --> 00:12:35 patient comes in and they say,
00:12:35 --> 00:12:37 I've got a herniated disc
00:12:37 --> 00:12:39 and it's causing my low back pain?
00:12:39 --> 00:12:40 Well, as a physical therapist,
00:12:40 --> 00:12:42 we're quick to jump in and say, well,
00:12:42 --> 00:12:44 it can't be your disc.
00:12:44 --> 00:12:45 There's so many people that
00:12:45 --> 00:12:46 are healthy that have healthy discs.
00:12:46 --> 00:12:47 There's people that are
00:12:47 --> 00:12:48 unhealthy that don't have healthy,
00:12:48 --> 00:12:49 so on and so forth.
00:12:49 --> 00:12:50 And so we jump onto that bandwagon.
00:12:50 --> 00:12:52 Yet, a few minutes later,
00:12:52 --> 00:12:53 we're quick to say
00:12:53 --> 00:12:54 something along the lines of, well,
00:12:54 --> 00:12:55 your posture is this.
00:12:55 --> 00:12:56 It's like,
00:12:57 --> 00:12:58 So almost like the physios
00:12:58 --> 00:13:01 version of a herniated disc, right?
00:13:01 --> 00:13:02 So like kind of talking
00:13:02 --> 00:13:04 about both sides of our mouths, which,
00:13:04 --> 00:13:04 you know,
00:13:04 --> 00:13:06 I certainly understand it's hard
00:13:06 --> 00:13:09 to get those, it's hard to, you know,
00:13:09 --> 00:13:11 untangle some of that mess
00:13:11 --> 00:13:13 that has been provided to
00:13:13 --> 00:13:15 us over the course of time.
00:13:15 --> 00:13:15 But yeah.
00:13:15 --> 00:13:17 Yeah,
00:13:17 --> 00:13:19 that's such an interesting reflection.
00:13:19 --> 00:13:21 You're a hundred percent right.
00:13:21 --> 00:13:23 You know, we, we,
00:13:24 --> 00:13:25 think that some of the
00:13:25 --> 00:13:27 medical diagnoses that are
00:13:27 --> 00:13:28 given are just so ridiculous,
00:13:28 --> 00:13:29 but then we just label
00:13:29 --> 00:13:30 people with other
00:13:30 --> 00:13:32 ridiculous diagnoses or
00:13:32 --> 00:13:33 explanations for symptoms.
00:13:33 --> 00:13:35 And I think one of the worst
00:13:35 --> 00:13:37 things we can do is just to
00:13:37 --> 00:13:38 confuse people seeking care
00:13:38 --> 00:13:42 more by denigrating somebody else's
00:13:43 --> 00:13:46 I'd never say to a patient, you know,
00:13:46 --> 00:13:46 it's ridiculous you've been
00:13:46 --> 00:13:48 given a diagnosis of impingement syndrome,
00:13:48 --> 00:13:50 or it's ridiculous that
00:13:50 --> 00:13:51 you've been told your
00:13:51 --> 00:13:53 symptoms are coming from your tear.
00:13:53 --> 00:13:55 This thing that's cruel to
00:13:55 --> 00:13:58 people seeking care, you know,
00:13:58 --> 00:14:01 that we all need to speak with one voice,
00:14:01 --> 00:14:02 but the one voice we speak
00:14:02 --> 00:14:05 with needs to be an honest voice.
00:14:05 --> 00:14:06 And I'm not sure that's
00:14:06 --> 00:14:07 happening in
00:14:08 --> 00:14:09 musculoskeletal practice
00:14:10 --> 00:14:10 around the world.
00:14:12 --> 00:14:12 Yeah,
00:14:12 --> 00:14:14 and I think there's a lot more we
00:14:14 --> 00:14:15 could be doing within our
00:14:15 --> 00:14:17 profession and between professions,
00:14:17 --> 00:14:18 reminding ourselves that
00:14:19 --> 00:14:20 the most important person
00:14:20 --> 00:14:21 in healthcare is not the
00:14:21 --> 00:14:23 physio or the doctor, it's the patient.
00:14:23 --> 00:14:26 And if we're not working to that ideal,
00:14:26 --> 00:14:27 that goal,
00:14:28 --> 00:14:29 it's questionable whether we're
00:14:29 --> 00:14:30 offering best healthcare.
00:14:32 --> 00:14:33 Yeah, no kidding, definitely.
00:14:34 --> 00:14:34 All right,
00:14:34 --> 00:14:36 so I want to take a little bit
00:14:36 --> 00:14:37 of a deviation here since
00:14:37 --> 00:14:41 we're getting to meet you in Orlando.
00:14:42 --> 00:14:44 So without giving away too much,
00:14:44 --> 00:14:45 because we don't want you
00:14:45 --> 00:14:46 to give away too much,
00:14:46 --> 00:14:48 we want people to come to the conference,
00:14:48 --> 00:14:50 but can you share a few
00:14:50 --> 00:14:51 takeaways that our audience
00:14:52 --> 00:14:54 will gain from hearing your keynote?
00:14:54 --> 00:14:59 Okay, well, I'm going to,
00:14:59 --> 00:15:00 if it's okay with you, Derek,
00:15:00 --> 00:15:01 actually work backwards.
00:15:01 --> 00:15:03 I'm giving a fifteen-minute lecture,
00:15:03 --> 00:15:03 I think,
00:15:04 --> 00:15:05 in the morning of the night
00:15:05 --> 00:15:06 after a pub crawl.
00:15:06 --> 00:15:07 So I guess it's going to be
00:15:07 --> 00:15:09 me and the sound engineer
00:15:10 --> 00:15:11 in the lecture hall.
00:15:11 --> 00:15:12 No, the physios come back.
00:15:13 --> 00:15:14 They bounce back really fast.
00:15:14 --> 00:15:15 You're going to be surprised.
00:15:15 --> 00:15:16 They're going to be a full audience.
00:15:18 --> 00:15:19 Yeah, OK.
00:15:19 --> 00:15:22 Do you want to bet ten dollars on this?
00:15:23 --> 00:15:23 Yes.
00:15:26 --> 00:15:27 Virtual handshake?
00:15:28 --> 00:15:28 All right.
00:15:29 --> 00:15:30 So anyway,
00:15:30 --> 00:15:32 so that lecture is going to be entitled,
00:15:33 --> 00:15:35 What Teaching in Iceland
00:15:35 --> 00:15:36 and Building a Shed Taught
00:15:36 --> 00:15:38 Me About Manual Therapy.
00:15:39 --> 00:15:40 And so that's the title of
00:15:41 --> 00:15:42 the short lecture,
00:15:43 --> 00:15:44 which I'm sure some people
00:15:44 --> 00:15:48 are going to find as
00:15:48 --> 00:15:50 somewhat as challenging as
00:15:50 --> 00:15:51 what I've been talking
00:15:51 --> 00:15:52 about with posture.
00:15:52 --> 00:15:54 I'm totally into touch therapy.
00:15:55 --> 00:15:57 I totally think as a profession,
00:15:57 --> 00:15:58 we should be doing
00:15:58 --> 00:16:00 manual therapy, touch therapy,
00:16:01 --> 00:16:02 touching therapies,
00:16:02 --> 00:16:03 but I think we maybe need
00:16:03 --> 00:16:05 to reframe it slightly,
00:16:05 --> 00:16:06 and I'm sure that's going
00:16:06 --> 00:16:08 to upset some people.
00:16:08 --> 00:16:09 I think there's ridiculous
00:16:09 --> 00:16:10 debates that are happening
00:16:10 --> 00:16:12 on social media about hands-on, hands-off,
00:16:12 --> 00:16:15 so irrelevant in terms of
00:16:15 --> 00:16:17 the important things we
00:16:17 --> 00:16:18 should be talking about
00:16:18 --> 00:16:19 delivering quality healthcare.
00:16:20 --> 00:16:21 We should absolutely be
00:16:21 --> 00:16:23 including touch therapy in our treatments,
00:16:23 --> 00:16:24 but maybe we should be
00:16:24 --> 00:16:26 thinking how we discuss them
00:16:26 --> 00:16:28 or explain them to patients
00:16:28 --> 00:16:29 and ourselves in different ways.
00:16:29 --> 00:16:32 So that's the second lecture.
00:16:32 --> 00:16:33 The keynote is going to be
00:16:35 --> 00:16:38 looking at what I would
00:16:38 --> 00:16:40 prefer to call my umbrella
00:16:40 --> 00:16:42 term for what people have
00:16:42 --> 00:16:44 called impingement syndrome,
00:16:44 --> 00:16:46 subacromial pain syndrome,
00:16:47 --> 00:16:48 partial full thickness tears
00:16:48 --> 00:16:49 of the rotator cuff.
00:16:49 --> 00:16:50 Because in truth,
00:16:50 --> 00:16:52 we do not know for the
00:16:52 --> 00:16:53 majority of people if the
00:16:53 --> 00:16:54 symptoms are coming from
00:16:54 --> 00:16:56 those pathoanatomical diagnoses.
00:16:56 --> 00:17:00 And I think they should be consigned to
00:17:01 --> 00:17:02 this is what we used to
00:17:02 --> 00:17:03 think and we need to come
00:17:03 --> 00:17:04 up with a
00:17:04 --> 00:17:06 non-pathoanatomical explanation
00:17:06 --> 00:17:08 for patient symptoms and
00:17:08 --> 00:17:09 I'm totally against the
00:17:09 --> 00:17:11 idea of calling it you've
00:17:11 --> 00:17:12 got simple shoulder pain or
00:17:12 --> 00:17:14 non-specific shoulder pain.
00:17:14 --> 00:17:16 I think that's derogatory for patients.
00:17:16 --> 00:17:20 People need, people who write about pain,
00:17:20 --> 00:17:21 people who are in pain
00:17:21 --> 00:17:22 write about the need for,
00:17:23 --> 00:17:24 who tell us that the worst
00:17:24 --> 00:17:26 pain is an unexplained pain
00:17:27 --> 00:17:30 and they also tell us that pain
00:17:30 --> 00:17:34 that if a treatment doesn't make,
00:17:35 --> 00:17:36 if the explanation for
00:17:36 --> 00:17:37 their symptoms isn't clear,
00:17:38 --> 00:17:39 then no treatment will make
00:17:39 --> 00:17:41 sense and they won't engage with it.
00:17:41 --> 00:17:43 So we need to provide, in my opinion,
00:17:43 --> 00:17:45 a non-pathoanatomical diagnosis.
00:17:47 --> 00:17:48 I've been promoting and
00:17:48 --> 00:17:49 pushing a term I came up
00:17:49 --> 00:17:53 with in twenty sixteen to
00:17:53 --> 00:17:54 replace all those other terms,
00:17:54 --> 00:17:56 rotator cuff related shoulder pain.
00:17:56 --> 00:17:57 So the keynotes about
00:17:57 --> 00:17:58 rotator cuff related shoulder pain.
00:17:59 --> 00:18:02 And I'm going to try and make a case that
00:18:04 --> 00:18:07 we need to be thinking way
00:18:07 --> 00:18:08 beyond a bit of exercise
00:18:08 --> 00:18:10 and manual therapy if we as
00:18:10 --> 00:18:12 a profession believe that a
00:18:12 --> 00:18:13 bit of exercise bit of
00:18:13 --> 00:18:15 manual therapy can make a
00:18:15 --> 00:18:17 difference to this
00:18:17 --> 00:18:19 condition in the presence
00:18:19 --> 00:18:20 of someone who's smoking
00:18:20 --> 00:18:21 not sleeping well not
00:18:21 --> 00:18:24 exercising well um and with
00:18:24 --> 00:18:26 poor nutrition where where
00:18:28 --> 00:18:29 fooling ourselves in a very
00:18:30 --> 00:18:31 large way we're being very
00:18:31 --> 00:18:33 naive and I'm going to try
00:18:33 --> 00:18:34 and make a case in the
00:18:34 --> 00:18:36 keynote that this could
00:18:36 --> 00:18:37 become a golden time for
00:18:37 --> 00:18:39 our profession because so
00:18:39 --> 00:18:40 much of the elective
00:18:40 --> 00:18:41 surgery that's occurring
00:18:42 --> 00:18:44 for trying to fix the pain
00:18:45 --> 00:18:46 are not fixes they're not
00:18:46 --> 00:18:47 fixing the pain at all
00:18:47 --> 00:18:48 they're not outperforming
00:18:48 --> 00:18:50 placebos or non-surgical
00:18:50 --> 00:18:52 intervention as I mentioned earlier
00:18:52 --> 00:18:54 But what I think we should be doing,
00:18:54 --> 00:18:54 and our competition
00:18:54 --> 00:18:56 shouldn't be with another profession.
00:18:56 --> 00:18:57 It should be within our own profession.
00:18:58 --> 00:19:00 How do we do a better job?
00:19:00 --> 00:19:02 And what I truly believe we
00:19:02 --> 00:19:02 need to be doing in our
00:19:03 --> 00:19:04 profession is stopping this
00:19:04 --> 00:19:05 ridiculous debate about hands on,
00:19:05 --> 00:19:06 hands off,
00:19:06 --> 00:19:08 and trying to work out how we
00:19:08 --> 00:19:09 become experts in assessing
00:19:10 --> 00:19:12 lifestyle factors and
00:19:12 --> 00:19:13 supporting people through,
00:19:14 --> 00:19:15 in a nonjudgmental way,
00:19:15 --> 00:19:16 supporting people through
00:19:16 --> 00:19:18 the process of behavioral change,
00:19:18 --> 00:19:20 which means we have got to
00:19:20 --> 00:19:22 put as much emphasis on
00:19:22 --> 00:19:24 assessing sleep quality,
00:19:25 --> 00:19:26 nutritional quality,
00:19:27 --> 00:19:29 general exercise participation,
00:19:29 --> 00:19:32 smoking behaviours, drinking behaviours,
00:19:32 --> 00:19:35 et cetera, as we do with anything else.
00:19:35 --> 00:19:38 And we need to think more
00:19:38 --> 00:19:39 holistically about the care
00:19:40 --> 00:19:40 we offer for all
00:19:40 --> 00:19:42 musculoskeletal conditions.
00:19:42 --> 00:19:43 We have to stop telling
00:19:43 --> 00:19:45 people we can fix them
00:19:45 --> 00:19:46 because the evidence would
00:19:46 --> 00:19:48 suggest that we can't and
00:19:48 --> 00:19:49 the orthopaedic surgeons can't.
00:19:50 --> 00:19:51 we need to just try and work
00:19:51 --> 00:19:54 out ways to restore people
00:19:54 --> 00:19:55 back to their valued
00:19:55 --> 00:19:58 activities and it's naive
00:19:58 --> 00:20:01 of us to think that a bit
00:20:01 --> 00:20:02 of exercise a bit of manual
00:20:02 --> 00:20:03 therapy can achieve that in
00:20:03 --> 00:20:04 the presence of other
00:20:05 --> 00:20:06 lifestyle factors so I'm
00:20:06 --> 00:20:07 going to talk about this at
00:20:07 --> 00:20:09 a cellular level how
00:20:09 --> 00:20:10 lifestyle factors can
00:20:10 --> 00:20:12 impact upon the health of
00:20:12 --> 00:20:17 tendon cells tenocytes um and um
00:20:18 --> 00:20:19 you know,
00:20:19 --> 00:20:20 it's not going to be only that
00:20:20 --> 00:20:21 that will send people to sleep,
00:20:21 --> 00:20:25 but we need to think more
00:20:25 --> 00:20:26 in terms of a Venn diagram
00:20:27 --> 00:20:29 than we can thinking that, you know,
00:20:29 --> 00:20:31 focusing in on what we tend
00:20:31 --> 00:20:32 to have focused in on for
00:20:32 --> 00:20:33 the last fifty or so years
00:20:35 --> 00:20:36 is probably naive.
00:20:36 --> 00:20:37 And maybe that's one of the
00:20:37 --> 00:20:39 reasons the outcomes that
00:20:39 --> 00:20:41 we're getting are less than desirable.
00:20:41 --> 00:20:42 So that's going to be my
00:20:42 --> 00:20:44 pitch in the keynote.
00:20:44 --> 00:20:45 But there'll be hopefully
00:20:45 --> 00:20:46 lots of good takeaway
00:20:46 --> 00:20:48 messages that people will value.
00:20:48 --> 00:20:50 And I hope it will also
00:20:50 --> 00:20:52 stimulate some robust
00:20:52 --> 00:20:53 conversation discussion.
00:20:54 --> 00:20:55 Be interesting to hear what people can
00:20:58 --> 00:20:59 how people react to that.
00:21:00 --> 00:21:02 No, I'm super excited for that.
00:21:02 --> 00:21:03 And I, you know,
00:21:04 --> 00:21:05 thank you a lot for putting
00:21:05 --> 00:21:06 something like that together.
00:21:06 --> 00:21:07 I think, you know,
00:21:07 --> 00:21:08 it resonates beyond
00:21:08 --> 00:21:09 obviously just the shoulder,
00:21:10 --> 00:21:11 but obviously it'll have
00:21:11 --> 00:21:13 the consequence with the shoulder.
00:21:13 --> 00:21:16 But, you know, I think that a lot of the,
00:21:17 --> 00:21:18 progression and movement is toward that.
00:21:18 --> 00:21:19 I think you're going to have
00:21:19 --> 00:21:20 an audience that'll be very
00:21:20 --> 00:21:23 engaged and interested in that as well.
00:21:24 --> 00:21:25 And I'm going to win ten dollars.
00:21:27 --> 00:21:27 You're going to have a full
00:21:27 --> 00:21:29 house in the morning.
00:21:31 --> 00:21:36 It depends who's most competitive.
00:21:36 --> 00:21:39 I might be prepared to pay a
00:21:39 --> 00:21:40 thousand dollars for people
00:21:40 --> 00:21:41 not to come just so that I
00:21:41 --> 00:21:42 don't lose face.
00:21:45 --> 00:21:46 All right.
00:21:46 --> 00:21:46 Well,
00:21:46 --> 00:21:48 I think that the topic title of
00:21:48 --> 00:21:49 itself is going to be interesting,
00:21:49 --> 00:21:52 especially, yeah.
00:21:52 --> 00:21:54 The people love those fifteen-minute talks,
00:21:54 --> 00:21:54 too.
00:21:54 --> 00:21:55 Those are fantastic.
00:21:56 --> 00:22:00 So the next question I have for you is,
00:22:00 --> 00:22:02 you know, and I think you actually,
00:22:02 --> 00:22:05 you kind of have said this already,
00:22:05 --> 00:22:05 so I don't even know if I
00:22:05 --> 00:22:06 want to ask a question,
00:22:06 --> 00:22:06 but I'll ask a question
00:22:06 --> 00:22:07 anyway because it may just
00:22:07 --> 00:22:08 generate a different thought.
00:22:10 --> 00:22:11 You know,
00:22:11 --> 00:22:12 you've already mentioned how
00:22:12 --> 00:22:13 management of shoulder pain
00:22:13 --> 00:22:14 has changed since you
00:22:14 --> 00:22:15 started and you've been
00:22:15 --> 00:22:17 kind of responsible for
00:22:18 --> 00:22:19 looking at some of those
00:22:19 --> 00:22:20 different ways about it.
00:22:20 --> 00:22:21 But, you know,
00:22:21 --> 00:22:25 how do what do you see in the next five,
00:22:25 --> 00:22:25 ten years?
00:22:25 --> 00:22:25 You kind of mentioned,
00:22:26 --> 00:22:27 I think it's I think I know
00:22:27 --> 00:22:27 where your answer is going
00:22:27 --> 00:22:29 to go a little bit with this.
00:22:29 --> 00:22:30 But, you know,
00:22:30 --> 00:22:33 in the management of shoulder pain itself,
00:22:33 --> 00:22:34 like how do you see it?
00:22:36 --> 00:22:37 I guess for lack of a better
00:22:37 --> 00:22:38 way of putting it,
00:22:39 --> 00:22:40 what keeps you excited
00:22:41 --> 00:22:43 about researching the
00:22:43 --> 00:22:45 shoulder going forward in the next five,
00:22:45 --> 00:22:47 ten plus years or whatever it might be?
00:22:50 --> 00:22:50 Right.
00:22:50 --> 00:22:53 I think if I realistically
00:22:53 --> 00:22:54 got ten years left.
00:22:54 --> 00:22:56 So the things that I would
00:22:56 --> 00:22:57 like to look at in the next
00:22:57 --> 00:23:00 ten years are I'm really
00:23:00 --> 00:23:01 interested in mechanisms.
00:23:01 --> 00:23:03 Why exercise therapy and
00:23:04 --> 00:23:05 maybe behavioral change,
00:23:05 --> 00:23:06 lifestyle change could
00:23:06 --> 00:23:08 influence symptoms.
00:23:09 --> 00:23:11 I think we have to move away from
00:23:13 --> 00:23:14 uh structural explanations
00:23:14 --> 00:23:15 we know that the surgery
00:23:15 --> 00:23:17 isn't repairing the tendon
00:23:17 --> 00:23:18 and even if it does that's
00:23:18 --> 00:23:19 not related to the reasons
00:23:19 --> 00:23:21 why people feel better so
00:23:21 --> 00:23:22 then we've got a whole lot
00:23:22 --> 00:23:23 of pain people coming and
00:23:23 --> 00:23:24 saying it must be just
00:23:24 --> 00:23:25 something that's going on
00:23:25 --> 00:23:26 in the brain but I think
00:23:26 --> 00:23:28 that's too far a leap
00:23:28 --> 00:23:29 forwards I think you know
00:23:29 --> 00:23:30 some of the evidence for
00:23:31 --> 00:23:32 some of the pain neuro
00:23:32 --> 00:23:34 educations pain beliefs is
00:23:34 --> 00:23:36 is on less stable grounds
00:23:36 --> 00:23:37 than some of the evidence
00:23:37 --> 00:23:37 for manual therapy
00:23:38 --> 00:23:39 What I'm really interested
00:23:40 --> 00:23:42 in is how exercise may
00:23:42 --> 00:23:45 change the biochemistry and
00:23:46 --> 00:23:47 may reduce some of the
00:23:48 --> 00:23:49 pro-inflammatory cytokines,
00:23:50 --> 00:23:51 the positively charged
00:23:51 --> 00:23:53 neuropeptides such as
00:23:53 --> 00:23:55 substance P may change
00:23:55 --> 00:23:57 their concentration in
00:23:57 --> 00:23:58 pain-sensitive structures
00:23:58 --> 00:23:59 in the shoulder.
00:23:59 --> 00:24:01 and seeing how is that the
00:24:01 --> 00:24:03 mechanism that white people
00:24:03 --> 00:24:04 many people come back and
00:24:04 --> 00:24:06 say I'm better not
00:24:06 --> 00:24:07 completely better but I'm
00:24:07 --> 00:24:09 better and it would also
00:24:09 --> 00:24:11 then make sense that when
00:24:11 --> 00:24:12 we add lifestyle factors to
00:24:12 --> 00:24:14 it do we even get a better
00:24:14 --> 00:24:17 uh restore restoration of
00:24:17 --> 00:24:20 homeostasis of the pain
00:24:20 --> 00:24:21 biochemistry around the
00:24:21 --> 00:24:25 tissues that may um uh that
00:24:25 --> 00:24:27 may help to explain why some people
00:24:29 --> 00:24:31 report improvement and maybe
00:24:31 --> 00:24:33 a lack of change in the
00:24:33 --> 00:24:34 biochemistry explains why
00:24:34 --> 00:24:35 others might not.
00:24:36 --> 00:24:37 So that's one thing.
00:24:37 --> 00:24:38 I'm also interested in how
00:24:38 --> 00:24:42 do we support people to
00:24:42 --> 00:24:44 participate in exercise
00:24:44 --> 00:24:46 programs and how do we mess
00:24:46 --> 00:24:47 with their brains in legal
00:24:47 --> 00:24:50 ways that they're not frightened to move?
00:24:50 --> 00:24:52 So I've got three PhD
00:24:52 --> 00:24:54 students at the moment who
00:24:54 --> 00:24:54 are looking at the role of
00:24:55 --> 00:24:55 virtual reality
00:24:56 --> 00:24:58 um in the management of
00:24:58 --> 00:25:00 shoulder problems and from
00:25:00 --> 00:25:02 my own clinical experience
00:25:03 --> 00:25:04 um of course you know
00:25:04 --> 00:25:05 there's a bias when a
00:25:05 --> 00:25:06 person talks about their
00:25:07 --> 00:25:08 clinical experience but um
00:25:09 --> 00:25:11 I'm so excited about the
00:25:11 --> 00:25:14 potential of this technology in terms of
00:25:16 --> 00:25:17 improving the adherence of
00:25:17 --> 00:25:19 people to an exercise program,
00:25:19 --> 00:25:20 helping people graduate
00:25:20 --> 00:25:21 through an exercise program,
00:25:21 --> 00:25:23 but also in a legal way,
00:25:23 --> 00:25:24 messing with their brain to
00:25:24 --> 00:25:26 maybe reduce the fear of movement.
00:25:27 --> 00:25:31 And we've had some spectacular failures,
00:25:31 --> 00:25:32 but we've also had some
00:25:32 --> 00:25:34 really spectacular positive
00:25:34 --> 00:25:35 changes in people who have
00:25:35 --> 00:25:37 not moved their shoulder for nine months,
00:25:37 --> 00:25:38 two years,
00:25:38 --> 00:25:41 that in a few minutes are
00:25:41 --> 00:25:42 moving normally and maintain that.
00:25:43 --> 00:25:46 well after the treatment and
00:25:47 --> 00:25:48 the initial treatment.
00:25:49 --> 00:25:50 And so I tend to divide my
00:25:50 --> 00:25:52 rehabilitation into three phases.
00:25:52 --> 00:25:53 The first phase is
00:25:53 --> 00:25:54 restoration of movement.
00:25:54 --> 00:25:56 Second phase is improvement
00:25:56 --> 00:25:57 of muscle performance.
00:25:57 --> 00:25:58 And the third phase is
00:25:58 --> 00:25:59 restoration of function.
00:26:00 --> 00:26:02 And so for me,
00:26:02 --> 00:26:05 virtual reality is a very exciting
00:26:08 --> 00:26:09 motor technology on the
00:26:09 --> 00:26:11 horizon it's here but it's
00:26:12 --> 00:26:13 going to become a bigger
00:26:13 --> 00:26:15 part of what we do I
00:26:15 --> 00:26:16 believe in assessment and
00:26:16 --> 00:26:18 management we just need
00:26:18 --> 00:26:19 more research on it so
00:26:19 --> 00:26:20 those those keep me excited
00:26:20 --> 00:26:22 I've got some research on
00:26:22 --> 00:26:23 frozen shoulders got some
00:26:23 --> 00:26:26 research on education and a
00:26:26 --> 00:26:27 bit of research on
00:26:27 --> 00:26:28 lifestyle so that will keep
00:26:28 --> 00:26:29 me occupied for the next ten years
00:26:30 --> 00:26:31 Yeah, well, good.
00:26:31 --> 00:26:32 I hope that you stick around
00:26:32 --> 00:26:33 for more than ten years
00:26:33 --> 00:26:33 then because we've got a
00:26:33 --> 00:26:34 lot of questions to answer.
00:26:35 --> 00:26:37 The mechanisms is very interesting.
00:26:37 --> 00:26:38 I think that that's coming
00:26:38 --> 00:26:41 back in terms of in play in
00:26:41 --> 00:26:43 regards to research as well.
00:26:43 --> 00:26:44 So that'll be interesting,
00:26:44 --> 00:26:45 especially when we don't
00:26:45 --> 00:26:47 know at this point.
00:26:51 --> 00:26:52 Yeah.
00:26:52 --> 00:26:53 So I have a,
00:26:53 --> 00:26:54 this question is actually very
00:26:54 --> 00:26:56 relevant because you just
00:26:56 --> 00:26:57 were a part of a
00:26:57 --> 00:26:58 publication that I think a
00:26:58 --> 00:27:00 lot of people are really interested in,
00:27:00 --> 00:27:01 in JOSBT.
00:27:01 --> 00:27:02 And that was the, you know,
00:27:03 --> 00:27:05 advice paper that just came out,
00:27:05 --> 00:27:07 I think ahead of publication.
00:27:08 --> 00:27:08 And so the,
00:27:09 --> 00:27:09 the question that I was going
00:27:09 --> 00:27:11 to ask you is, you know,
00:27:11 --> 00:27:12 for those that are, you know,
00:27:12 --> 00:27:13 either just entering
00:27:13 --> 00:27:15 physical therapy right now, you know,
00:27:16 --> 00:27:17 they're in PT school or
00:27:17 --> 00:27:18 maybe they're newly
00:27:18 --> 00:27:19 graduated and they're kind
00:27:19 --> 00:27:20 of thinking about what they want to do.
00:27:21 --> 00:27:23 you know, coming off that article there,
00:27:24 --> 00:27:25 what's some advice that you
00:27:25 --> 00:27:31 would give the new professional?
00:27:31 --> 00:27:31 Read the article.
00:27:32 --> 00:27:32 It's all there.
00:27:36 --> 00:27:36 Yeah.
00:27:36 --> 00:27:37 So it was a great team.
00:27:38 --> 00:27:39 Jared Powell,
00:27:39 --> 00:27:40 who's a PhD student in
00:27:40 --> 00:27:41 Australia coming to the end of his PhD,
00:27:43 --> 00:27:43 led on it.
00:27:43 --> 00:27:46 And it was co-authors were
00:27:46 --> 00:27:48 Chad Cook and Karen McCreish,
00:27:49 --> 00:27:51 who was another PhD student who's now,
00:27:52 --> 00:27:53 way surpassed me in her
00:27:53 --> 00:27:56 knowledge and her research skills,
00:27:56 --> 00:27:58 as Gerard will any minute now as well.
00:28:00 --> 00:28:02 So yes, it was a great team.
00:28:02 --> 00:28:05 And I think we had all
00:28:05 --> 00:28:07 slightly different ideas,
00:28:07 --> 00:28:09 but it came together in
00:28:09 --> 00:28:11 quite a hopefully useful
00:28:11 --> 00:28:13 way for new grads.
00:28:13 --> 00:28:16 And I think one of the big
00:28:16 --> 00:28:18 things that I've noticed
00:28:18 --> 00:28:19 that's changed is
00:28:21 --> 00:28:23 originally in my career, you'd go to the,
00:28:24 --> 00:28:25 after work on Friday,
00:28:25 --> 00:28:26 you'd go to the pub in
00:28:26 --> 00:28:28 Australia and you'd sit
00:28:28 --> 00:28:30 around all these manual therapy,
00:28:31 --> 00:28:32 physiotherapy experts and
00:28:32 --> 00:28:34 listen to their
00:28:34 --> 00:28:35 achievements of the week
00:28:35 --> 00:28:36 and you'd sort of say, well, my gosh,
00:28:37 --> 00:28:39 I'd like to be like them and, you know,
00:28:40 --> 00:28:40 I want to become the
00:28:40 --> 00:28:42 greatest fixer in the world,
00:28:43 --> 00:28:44 which I know a lot of
00:28:44 --> 00:28:47 people of my generation wanted to do.
00:28:47 --> 00:28:49 And so, you know, you apply for all these
00:28:49 --> 00:28:51 very difficult to get into
00:28:52 --> 00:28:53 postgraduate courses.
00:28:53 --> 00:28:54 And then you realise that
00:28:54 --> 00:28:56 maybe the reality doesn't
00:28:56 --> 00:28:59 live up to the expectation
00:28:59 --> 00:29:00 of those courses.
00:29:01 --> 00:29:03 And I think that's been replaced now,
00:29:03 --> 00:29:04 the Friday night pub, to a large extent,
00:29:05 --> 00:29:06 it's been replaced by social media.
00:29:07 --> 00:29:08 And, you know,
00:29:08 --> 00:29:11 you get these influencers in
00:29:11 --> 00:29:13 social media who are making
00:29:14 --> 00:29:15 ridiculous claims about
00:29:16 --> 00:29:17 what we should and shouldn't be doing.
00:29:18 --> 00:29:20 and to some extent bullying
00:29:20 --> 00:29:22 people and to some extent, you know,
00:29:23 --> 00:29:26 asking... And I think what
00:29:26 --> 00:29:27 we try to do in the paper
00:29:27 --> 00:29:28 is to try and balance that
00:29:28 --> 00:29:31 a little bit and hopefully give people,
00:29:31 --> 00:29:32 like we try to give patients,
00:29:32 --> 00:29:36 confidence to manage...
00:29:39 --> 00:29:41 ..to clinically reason, to problem-solve,
00:29:41 --> 00:29:42 to work things out for themselves.
00:29:42 --> 00:29:43 And I guess that was, for me,
00:29:43 --> 00:29:45 an important part of the paper and...
00:29:47 --> 00:29:48 you know,
00:29:48 --> 00:29:51 don't listen to people who are so
00:29:51 --> 00:29:54 adamant about the only way forwards is.
00:29:55 --> 00:29:57 And, you know,
00:29:57 --> 00:29:59 that was definitely part of the paper.
00:29:59 --> 00:30:00 But there's a lot more to it,
00:30:00 --> 00:30:01 and I strongly recommend
00:30:02 --> 00:30:03 that everyone get a hold of
00:30:03 --> 00:30:05 it and have a read of it
00:30:05 --> 00:30:07 and comment on it, what was good,
00:30:07 --> 00:30:08 what could have been better.
00:30:09 --> 00:30:10 Yeah, and the nice thing,
00:30:10 --> 00:30:11 we may even be able to link
00:30:11 --> 00:30:12 this in with this podcast,
00:30:12 --> 00:30:14 but it's open access at
00:30:14 --> 00:30:16 this point as well, too.
00:30:16 --> 00:30:17 So it should be able to be
00:30:17 --> 00:30:18 readable for everybody.
00:30:20 --> 00:30:21 I appreciate it.
00:30:21 --> 00:30:22 And obviously teaching in an
00:30:23 --> 00:30:25 entry-level PT program,
00:30:25 --> 00:30:27 it's important that we...
00:30:28 --> 00:30:29 retain and keep people
00:30:30 --> 00:30:31 excited about you know this
00:30:31 --> 00:30:33 profession you know I I see
00:30:33 --> 00:30:34 a lot of things on social
00:30:34 --> 00:30:36 media where like man it's
00:30:36 --> 00:30:37 like anything like even
00:30:37 --> 00:30:37 with my kids you know
00:30:37 --> 00:30:39 they're not um you know
00:30:39 --> 00:30:40 like they can be influenced
00:30:40 --> 00:30:42 by so much and a lot of it
00:30:42 --> 00:30:44 is not necessarily positive
00:30:44 --> 00:30:45 building or confidence
00:30:45 --> 00:30:46 building and some of my
00:30:46 --> 00:30:48 research area is actually looking at
00:30:49 --> 00:30:51 burnout in physical therapy.
00:30:51 --> 00:30:52 And I do think that that's
00:30:52 --> 00:30:54 part of the consequence of
00:30:54 --> 00:30:56 some of these things that we see.
00:30:56 --> 00:30:58 And certainly that what you
00:30:58 --> 00:30:58 mentioned there,
00:30:59 --> 00:31:00 the confidence going forward,
00:31:01 --> 00:31:02 I think that definitely
00:31:02 --> 00:31:05 helps people with regards to, you know,
00:31:05 --> 00:31:08 staying in this profession, being excited,
00:31:08 --> 00:31:08 hopefully about it.
00:31:11 --> 00:31:11 Yeah, I think that's,
00:31:12 --> 00:31:12 I'm aware of what you're doing.
00:31:12 --> 00:31:13 And I think that's,
00:31:13 --> 00:31:15 it's such a valuable contribution.
00:31:15 --> 00:31:17 And I wonder if, you know,
00:31:17 --> 00:31:18 if we also changed our
00:31:19 --> 00:31:21 belief system from an I can
00:31:21 --> 00:31:23 fix you model to I can work
00:31:23 --> 00:31:24 with you model to try and
00:31:25 --> 00:31:27 restore you to the greatest,
00:31:28 --> 00:31:29 highest level of function possible.
00:31:30 --> 00:31:32 And maybe we can stop
00:31:32 --> 00:31:33 burnout to some extent by
00:31:34 --> 00:31:36 by not going to work
00:31:36 --> 00:31:37 thinking I'm failing
00:31:37 --> 00:31:38 because I'm not fixing
00:31:38 --> 00:31:39 people the way that people
00:31:39 --> 00:31:42 on social media are claiming we can,
00:31:42 --> 00:31:43 or people in the past in
00:31:43 --> 00:31:45 pubs have claimed that they can.
00:31:46 --> 00:31:47 And maybe if we go back more
00:31:47 --> 00:31:48 to the nineteen fifties,
00:31:48 --> 00:31:49 which I think was one of
00:31:49 --> 00:31:50 the golden times of our profession,
00:31:51 --> 00:31:52 where if you think about
00:31:52 --> 00:31:53 your country in America,
00:31:53 --> 00:31:54 when there was the polio
00:31:54 --> 00:31:56 epidemic before Jonas Salk
00:31:56 --> 00:31:59 came up with the vaccine for polio,
00:31:59 --> 00:32:00 people in our profession
00:32:00 --> 00:32:03 were not trying to fix
00:32:03 --> 00:32:04 people with polio but
00:32:04 --> 00:32:05 trying to work out how can
00:32:05 --> 00:32:06 we restore them to the
00:32:07 --> 00:32:08 highest level of function
00:32:08 --> 00:32:10 possible and and obviously
00:32:11 --> 00:32:13 that needs to be exercised
00:32:13 --> 00:32:14 but like I said in the
00:32:14 --> 00:32:14 earlier part of this
00:32:15 --> 00:32:16 conversation it has to be
00:32:16 --> 00:32:17 through lifestyle factors
00:32:17 --> 00:32:20 as well and I wonder if we
00:32:20 --> 00:32:23 reduce burnout by um
00:32:24 --> 00:32:26 by actually changing our
00:32:26 --> 00:32:27 belief system and maybe
00:32:27 --> 00:32:29 making it more honest with
00:32:29 --> 00:32:31 moving away from the I can
00:32:31 --> 00:32:33 fix you to I can work with
00:32:33 --> 00:32:34 you in a non-judgmental way
00:32:34 --> 00:32:36 in a supportive way you
00:32:36 --> 00:32:37 know and we can just take
00:32:37 --> 00:32:38 this as far as you want
00:32:39 --> 00:32:40 um you know sort of like
00:32:40 --> 00:32:41 trying to help someone with
00:32:41 --> 00:32:42 depression or help someone
00:32:43 --> 00:32:44 with diabetes that there's
00:32:44 --> 00:32:45 so much we can do we can't
00:32:45 --> 00:32:47 fix these problems but we
00:32:47 --> 00:32:48 can reduce the long-term
00:32:48 --> 00:32:51 disability um you know it's
00:32:51 --> 00:32:52 it's interesting isn't it
00:32:52 --> 00:32:54 that so much not so many
00:32:54 --> 00:32:55 non-communicable disorders
00:32:55 --> 00:32:57 diabetes high blood
00:32:57 --> 00:32:59 pressure depression asthma
00:33:00 --> 00:33:01 no one goes in and says you
00:33:01 --> 00:33:02 know I want to be fixed of
00:33:02 --> 00:33:03 course we want to but no
00:33:03 --> 00:33:05 one's got a noble prize for
00:33:05 --> 00:33:06 medicine for that but what
00:33:06 --> 00:33:07 we can do is we can put together
00:33:08 --> 00:33:09 a package of care that
00:33:09 --> 00:33:11 involves educating why
00:33:11 --> 00:33:13 smoking is maybe not the great idea,
00:33:13 --> 00:33:14 why nutrition is important,
00:33:14 --> 00:33:17 why good sleep, hygiene,
00:33:17 --> 00:33:18 health is important,
00:33:18 --> 00:33:19 why a general exercise
00:33:19 --> 00:33:20 program is important.
00:33:21 --> 00:33:21 And by doing that,
00:33:21 --> 00:33:23 we can often reduce the disability,
00:33:23 --> 00:33:25 but when that patient's not fixed,
00:33:25 --> 00:33:27 but the disability is
00:33:27 --> 00:33:29 reduced and we can also
00:33:29 --> 00:33:30 work out ways to try and
00:33:30 --> 00:33:32 maintain that for as long as possible.
00:33:33 --> 00:33:35 help people problem solve if
00:33:35 --> 00:33:36 there's a flare up in blood
00:33:36 --> 00:33:37 sugars or there's a flare
00:33:37 --> 00:33:39 up in the depression,
00:33:39 --> 00:33:40 but we're always there if
00:33:40 --> 00:33:42 they can't help manage the flare up.
00:33:42 --> 00:33:42 And of course,
00:33:42 --> 00:33:43 all that can be supported by
00:33:43 --> 00:33:44 medicines as well.
00:33:45 --> 00:33:47 But I just wonder if we took
00:33:47 --> 00:33:48 that approach with our
00:33:49 --> 00:33:50 musculoskeletal practice,
00:33:51 --> 00:33:52 if we would be offering,
00:33:52 --> 00:33:53 we're definitely offering
00:33:53 --> 00:33:56 more honest care and maybe
00:33:56 --> 00:33:58 less burnout for people as well.
00:33:58 --> 00:33:59 And that's to me more important than
00:34:00 --> 00:34:01 a lot of the crazy debates
00:34:01 --> 00:34:02 that happen on social media
00:34:02 --> 00:34:04 at the moment that used to
00:34:04 --> 00:34:06 happen in the pubs, you know,
00:34:06 --> 00:34:07 back in the time when there
00:34:07 --> 00:34:10 was no social media in my life.
00:34:10 --> 00:34:11 Yeah, no, no, it's great.
00:34:12 --> 00:34:13 No, I appreciate it.
00:34:14 --> 00:34:16 So Jeremy, I want to respect your time.
00:34:16 --> 00:34:16 I want to respect our
00:34:16 --> 00:34:17 listeners' time because I
00:34:17 --> 00:34:18 think people's attentions
00:34:18 --> 00:34:19 are around thirty minutes
00:34:19 --> 00:34:20 or so and we're getting to
00:34:20 --> 00:34:21 about that point.
00:34:21 --> 00:34:22 And I'm going to leave a lot
00:34:23 --> 00:34:24 on the line because I want
00:34:24 --> 00:34:26 our listeners hopefully to
00:34:27 --> 00:34:30 come to Orlando, hear you speak,
00:34:30 --> 00:34:31 get a chance to meet you
00:34:33 --> 00:34:35 and see me win a ten dollar bet.
00:34:38 --> 00:34:38 All right.
00:34:39 --> 00:34:39 Well,
00:34:39 --> 00:34:41 I'm going to get out a crispy ten
00:34:41 --> 00:34:42 dollar bill and just in
00:34:42 --> 00:34:44 case I do lose because I'll stick to it.
00:34:44 --> 00:34:45 But we'll see.
00:34:45 --> 00:34:46 I'm pretty sure that it will
00:34:46 --> 00:34:47 be quite an empty hall the
00:34:48 --> 00:34:49 night after what is
00:34:49 --> 00:34:50 advertised as a pub crawl.
00:34:50 --> 00:34:53 I don't know.
00:34:53 --> 00:34:54 All right, Jeremy.
00:34:54 --> 00:34:54 Well,
00:34:54 --> 00:34:55 thank you very much for your time and
00:34:55 --> 00:34:56 have a great day.
00:34:57 --> 00:34:58 Thank you, Derek.
00:34:58 --> 00:34:59 It was a great pleasure.
00:34:59 --> 00:35:00 Looking forward to catching
00:35:00 --> 00:35:01 up in person next month.
00:35:01 --> 00:35:01 All right.
00:35:01 --> 00:35:03 We'll see you.