Canadian Physiotherapy Pain Sciences Group

A PT friend of mine a long way away wrote to ask if I knew anyone in Victoria doing "soft, gentle" manual therapy. I knew he meant therapy that takes into account the patient, and the patient's pain perceptions, and is not just applied to their tissues as if said tissues were abstracted from the body and not connected to a nervous system, or as if the treatment of the tissues in abstracted isolation would in and of itself lead to a predictable and desireable outcome in terms of pain reduction for the patient.

Unfortunately, there is no category for such therapy. There is a category for "orthopaedic" manual therapy (pushing bones about), one for "acupuncture" (pushing needles into soft tissue, especially the sore spots, with the idea that tissue if aggravated will be stimulated to be less chronic, more acute, and finally "heal"), and various other categories for various definable conditions, age groups, or social classifications of behaviors, such as "sports"...

I settled, with a sigh, on two practitioners out of dozens listed, who had been brave enough to put themselves into a category listed as "complementary." I don't know them, or what sort of "complementary" PT they practice, but I took a chance because sometimes the unknown is less scary than the known. I also am listed as practicing in a "complementary" manner, along with "orthopaedic." To me, an "orthopaedic" listing is necessary, because it lets people know that you've studied the body in detail at least, and have acquired certain skill sets, even if you don't use them much. And "complementary" is my code-word for "willing and able to treat persistent pain problems in people."

It's a compromise.

My attempt to help my friend reminded me of why I was so interested a few years ago in helping set up a pain physiotherapy special interest group/CPA division in Canada. At the time I thought being able to present a new official category would gradually replace the one listed as "complementary", odious to many because it can mean non-orthopaedic hands-on techniques that include all sorts of anti- and pseudo-scientific hands-on theoretical constructs. Aha, I thought at the time. All these practitioners really need is access to updated pain science and neuroscience, and all will be well in PT land. The practitioners needn't necessarily change what they physically do with their hands, or how well they relate to their patients, but their thinking and understanding will take a big leap forward, and the sort of conversations they have and meanings they convey to their patients will become congruent with all that has been learned in the last decade or two. Eventually PT would be able to drop that compromising, dubious and embarrassing, even, "complementary" category in favor of the much preferable (to my mind, anyway..)"pain sciences" category.

Well, long story short, it seems the physiotherapy beaurocracy in Canada wasn't ready for such a move. Our application to become a division of CPA was rejected, tabled, postponed, moratorium-ed.

So, we decided to plow forth anyway and the Canadian Physiotherapy Pain Sciences Group was born instead. It is doing very well under the combined leadership of Neil (western Canada) and Dave (central Canada), both young with solid academic credentials and teaching experience; Deb, who is from my own era and who has revitalized her PT career by teaching pain seminars; myself, not doing much publically but always working behind the scenes, trying to help the profession get unstuck from the past.

November Workshop

I have to say, it went better than anticipated. At the last minute two more people let me know they wanted to come, which meant printing out more handouts and scrounging more chairs, and increasing the size of this class over the size of the last class by 150%, up to 5... plus the photographer made 6. Somehow they all squeezed into my treatment room.

And the best part, I was less stressed and less nervous and less exhausted afterward.

I think I might be getting the hang of this teaching thing. This time I had a white board ready, and some flip charts on which I'd prepared diagrams, a bit smoother flow. I still felt like I rambled around quite a bit, but no one was yawning that I could see.

The next day a few of us including the researcher friend went off to visit BodyWorlds, my second trip there. I lingered over the nerves pointing out each one by name to my participants. It was so much easier to grasp how they flow and penetrate layers when the layers are separated slightly, the way these exhibits are, how muscle structures spiral their way around bones like flower petals, and how the nerves slide through them like corset laces.

To top it off, the researcher friend tutored me in how to make power point slides for the next teaching adventure.

More teaching

I guess I must be fully recovered from the teaching episode in June, because I am about to do this once more, on Saturday next. The class size has increased by 50%, to three, and Eric, an ex-student from the first class, will be on hand to take pictures for an upcoming treament manual I'm writing. This time there is a name for the technique, discussed in a previous entry, Dermoneuromodulation. So things are looking up.

It's still a free class though. I can't bring myself to charge any money for this work. It's still in such a rough state.

Attending this round will be an old classmate, well, two in fact, who have taken an interest in this work that has defined itself through my two hands and mind and all the various beast brains that have stored themselves in my skull in this particular physical configuration, this particular intersection of life with space-time around it which I call me..

One of them became an academic, who is responsible for an entire PT program in a major university, and whose forte and personal interests happen to lie in research design. She and I have plans to begin a study in the new year.

I know it will be a few more years before anything comes about, but I have high hopes it will be published one day, that it will be a small seed that can grow into something substantial, something that can move PT from the doomed track it is currently on, or that I perceive it to be on, toward something more hopeful, not just for PT itself but for all the nervous systems of all the patients we treat.

It will be a single subject research design. My colleague will handle all the paperwork and analysis. All I have to do is treat the patients, who won't really be patients - they will be "subjects." She will measure their pain before and after, and again several months down the road.

This is all a dream come true. Despite that November and seasonal affective disorder is upon me once again, I still couldn't be more happy with the way life is turning out.