How Bright Is My Lightbulb

By Sheree Bright

There were some key messages at the AMT Virtual Conference 2020 for therapists who want to be progressive and keep on top of the way the industry is evolving.

Even in a virtual webinar format, it was still a highly engaging conference. Many of the presenters conveyed common themes, which are important principles for massage therapists:

• The importance of understanding a science-based approach; and 
• The power of language; understanding that what we say can positively or negatively impact the client’s perception of their pain or condition.

Here are a few of my lightbulb moments. 

Mary O’Keeffe: Diagnostic labels in musculoskeletal conditions – helpful or harmful?

The presentation by Mary O’Keeffe was fascinating and it was exciting to hear her research around pain science. Mary spoke about the biopsychosocial model of care, which is more and more commonly understood in massage. Find out more detailed information about the biopsychosocial model in this article.

Mary O’Keefe showed the brilliant research around specific diagnostic labels that are used clinically (such as non-specific back pain, episode, disc problem, degeneration, etc). Importantly, she explained what the research revealed in terms of the client’s perception of their labels or diagnosis. Some of the labels had more negative connotations and therefore impacted on the client and their beliefs around pain. According to the research, the term or label “episode of pain” appeared to be the most positively received by the research group, as it had the least alarming response. Perhaps, even though it is fairly generic, it is more beneficial to use this language with the client as it does not focus on, or refer to, any prior diagnosis.

In a clinical context, we have all heard it many times – the typical client who comes in with a worried expression, explaining they “have a scoliosis” (in a fearful voice). As we know, scoliosis is fairly common and in most cases not as concerning as the client obviously feels it is. This is an example of a label that is not necessarily helpful to the client.

Interestingly, many people in pain cannot recall a physical trigger. Stop and think about it for a second. It makes sense, as pathology tests don’t necessarily show the cause of pain. Mary also suggested a pain education approach, where the therapist focuses on listening to clients, taking time to understand their pain journey and trying something different – a new treatment approach they have not yet experienced. The massage therapist has the perfect amount of time and opportunity to get a holistic view of the client’s whole biopsychosocial picture and this depth of understanding cannot be underestimated.

Angie Clerc-Hawke: Role of Massage in Pain Revolution

The topic of pain science really takes on a life of its own and can send us down the metaphorical rabbit hole. The science might go over our heads, or round and round, or maybe the pain knowledge is just not getting out there.

Angie introduced the idea of being a “pain coach”. This could be a new way to enhance our role as a massage therapist and how we communicate with and manage our clients. It is a way to focus on active strategies for clients, encouraging them to become more proactive. The passive option is where the client just wants to be massaged (and fairly common). The challenge is getting them engaged and involved in their recovery and treatment plan. As massage therapists, we need to make sense of pain for each and every individual client. The client may be affected by a diagnosis hanging over their heads but we can reassure the client by aligning their personal pain experience with what their medical diagnosis tells them.

Another brilliant concept we learned was critical thinking to challenge our assumptions as an RMT. This should be every therapist’s mantra! Critical thinking in this context means:

• be prepared to question everything
• keep an open mind
• look for evidence; and
• dig out the research behind any theories before assuming they are correct.

In primary school these days they call it having a “growth mindset”. What we were taught 10 or 20 years ago was presumably current information at that time. But do we just accept the same old, same old? No. The answer is to keep exploring and you will grow as a practitioner.

Learn more about Pain Revolution here.

Daniel Wonnocott: Classic Vs Modern Approach To Treatment

Dan’s talk starts right at the beginning with the consultation process, where the therapist leads the client through a fact-finding mission, talking to the client and observing them. It is important to give the client the opportunity to tell you what’s going on for them. Let the client have their say and investigate. What the client can tell you may be more valuable than the assumptions you can make from observing their posture. “Find out where they have come from and where they want to go” i.e. goals and expectations of treatment. 

Focusing solely on posture is not always going to provide an accurate picture of what is going on. Posture is an adaptive behaviour. The client may be moving differently as a protective mechanism, depending on what is causing them pain.

Similarly, ROM testing can differ depending on the person you are treating, e.g. an elite athlete may have different ROM needs than the average person. Not many orthopaedic tests are actually proven to be effective or can be relied on to give a perfect, exact treatment formula. The goal for ROM is to improve the ROM for each individual client – rather than comparing them to others, it is establishing what is normal for them.

Again, we heard the clear message about use of language and how what we do and say can have an impact on our clients.

Dan suggests that we remove the emphasis on labels and what techniques we should use in a treatment approach. For example, DTM (deep tissue massage), TP (trigger point), DN (dry-needling), MFR (myofascial release), MET (muscle energy technique) etc. Starting to look at the inputs into the body and how the therapy method positively affects a change for the client.

Dan described in detail about the common pathways that we access and influence through massage: proprioceptive fibres or mechanotransduction (mechanical force) or nociceptive pathways (neurons, pathways of CNS) and the treatment effects. Most manual therapy techniques can activate the DNIC (descending noxious inhibitory control) process.

Did you miss Dan’s presentation at the 2020 AMT Virtual Conference or simply want to bathe in its awesomeness again? Please enjoy your free access:

Lightbulb Alert!

The art of applying manual therapy effectively is considering whether or not a deep tissue technique is really necessary for the client, who may already be under a high level of stress. Consider the client’s starting point of stress, then we add more stress (forceful massage techniques) and what is the result? We cannot expect a reduction in stress or a positive change in tissue. Stress ₊ pain = more stress (via the CNS). Therefore, clients presenting with persistent/chronic pain, it is really good to pull back on pressure. As therapists, how we treat the muscles is important from client to client, but the true effects of the treatment is reflected by how the nervous system responds.

There are a lot of theories around the popular fascia model. MFR technique is effective but the explanation around breaking tissue down is outdated and inaccurate as the physical force required to change the tissues is, in most cases, unable to be adequate. The better perspective is to observe how the whole body responds to the treatment and whether the treatment has a positive effect on movement capacity.

Alison Sim: Motivational Interviewing

Motivational Interviewing is the clever art of incorporating active listening approaches in a clinical setting and learning how this can be extremely beneficial with clients. Not only to build a rapport, this can be a great way to get the conversation started, explore a client’s treatment experiences and discover their health goals. All of which forms an important basis of data to help the therapist interpret how to treat their client mindfully and in a holistic sense.

A Great Conference to Help Us Stay Current and Stay Connected

As always, we are impressed by the quality, high calibre speakers sourced by AMT. Each and every presentation shows commitment to sharing research-based information that is relevant and exemplifies the profession moving forward in a positive direction.

Check out the full list of speakers here.

Your Chance to Watch the Conference

Want to watch all the sessions from the 2020 AMT Virtual Conference? Here’s your chance! CLICK HERE TO BUY YOUR COPY for only $99, which includes the Robert Libbey LAST workshop. Robert’s workshop can also be bought separately for $50 via the same link.

About the Author

Sheree Bright is a mother of two, RMT, yoga teacher and founder of a corporate massage business in Brisbane. Sheree opted for a career change and re-trained as a massage therapist in 2006. From a corporate background, she saw the light and willingly gave up her high heels in favour of more flexible hours. Sheree is currently venturing into part-time assessment marking for an RTO and enjoys teaching yoga as a sideline, while keeping her hands in massage. Her treatment philosophy is to offer her clients the best of both worlds, with a combination of remedial and relaxation techniques to help restore movement and balance in the body. She is a big advocate for self-care and likes to keep fit by doing a medley of activities such as yoga, Pilates, horse riding, swimming and striving to keep up with her children. Sheree also runs Bright Health Training with her husband, Aran.

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