Episode 4: Adam Meakins and Chad Cook debate

[@HPSG2010]

Just a couple thoughts from a retired physio who fancies herself a human primate social groomer: 1. I find myself referring constantly to the philosophically-informed cog sci wisdom of John Vervaeke who distinguishes between propositional knowing and procedural knowing, the blurring/conflation of which I think creates a lot of the rifts within the physio profession. He also discusses perspectival and participatory knowing, which I think applies to the whole "patient-centered" direction we are (or should be) heading in as manual therapists within physiotherapy. 2. We are naught but fancy primates, so I think there will always be a place for (actual, physical) human primate social grooming, even though we have displaced so much of it into symbolic thought and strictly verbal interaction. Where pain is involved, and pain resolution sought, I like to think there are some very old parts of the brain that just can't be stimulated by anything other than physical touch, properly boundaried and contextualized. 3. Again, because we are primates, our bias seems to involve some sort of inherent deference toward hierarchy and tendency to elevate others and/or sort ourselves along gradients of fame based on perceived expertise. Like Chad I lived through the 80's and 90's and obesrved all the guru-based manual therapy enclaves, so I smiled as he discussed these. Happily, because of people like Adam, and thanks to pain science, these are being discredited, demolished, dismantled. 4. The only way I made any sense out of manual therapy was to sort it into styles that were either interactive and inclusive of all aspects (of being a human) and potential confounds (smart), or else operative and procedural and attempted to be specific and exclusive and "objective" (dumb). 5. Most of the online confusion within the profession seems to stem from our profession's attempt to "fit in" to different cultures and to different levels of the overall human health care hierarchy and its policing of itself. 6. The only way I could deal with all the endless apparent conflicts inherent within the profession was to step outside it, become a sole practitioner, set up my life such that all who sought my services could have one-on-one undivided attention (but no whale music or candle in the corner). I remained licensed (married to physiotherapy) but lived apart from it (not divorced but forever separated and not especially monogamous). Thank you for an interesting discussion guys. Maybe it will help resolve stuff someday. Maybe it won't.

[@shoulder_physio]

Thanks for your thoughts Diane. Fancy coming on the show for a chat?

[@TheHadesShade]

Now that you mention the fancy primates metafor, if I feel down, or my upper back hurts again from sitting too long behind my laptop watching/reading for my masters degree in manual therapy. I go and cuddle with my boyfriend on the couch, and then I feel better again.

[@anonanon257]

Another unsubstantiated pet theory is exactly what healthcare doesn't need. "Social grooming" is well-documented in nonhuman primates, yet strangely enough, these species evolved without the need of any "intervention", certainly never requiring a human touch or the cognitive baggage accompanying a "therapy". Homo sapians likewise managed to evolve over millenia, reaching this point without PT. Sorry, but this approach is just another attempt by PT to throw spagetti at the wall, hoping something sticks.

[@MartinGonzalez-ct6hd]

This discussion is a prime example of how debates should be held. Great job to both sides.

[@farazsethi467]

Well done guys for keeping it professional and not personal 👍👍💪💪

[@maclellanphysio]

Good to hear the professionalism of Chad 👍

[@CheburashkaGenovna]

This was a conversation extraordinaire! Loved every single second of it 🙂

[@sahand3083]

A good answer from Chad,When Adam compared the effectiveness of manual therapy with a weekend course of soft tissue massage.see at 1.18min

[@BearHumphries466]

The one downvote is from Brent BogBrush

[@garrettgriffin9613]

Excellent information. I’m currently learning MT and more general MSK management in my DPT training and having this perspective is invaluable. Big thanks to everyone involved!

[@benfrizzell4340]

This video should be included in every undergraduate physiotherapy course! Not just for the argument on manual therapy but also HOW to think as a therapist.

[@anonanon257]

Such conversations are avoided because they represent existential threat. The reason PT is in such a mess is because it is a cult, clutching and clinging to anything and everything that will reinforce the fragile collective egos of those who seek membership in a group they see as "elite".

[@air17]

Surprisingly calm and peaceful conversation (by Adam😜) and lots of/some common sense 👍

[@deepbackwardsquare]

A worthwhile exercise and clearly well planned and managed. Hats off to you Jared.

[@gocatbert]

Great conversation. Interesting to hear the different stresses on varied health system models, NHS is wait listed, hence the need to refer out vs US where there are PT clinics in every strip mall and how this influences the potential roll of the PT/Physio.

[@mdbalmeidaytube]

Outstanding! Congratularions Jared for this awesome, mature, elegant debate of so important theme of our modern way to think physical therapy (not only MT vs Exercices, but so many other core aspects of our profession) 🙌👏

[@shoulder_physio]

Thank you Marcelo!

[@MarmiteFerret]

Been looking forward to this. Should have called it on the giants of shoulders 😉

[@anonanon257]

PT poisoned by fandom. No wonder the profession lacks credibility. It's childish, ego-driven and insecure. Ripoff!

[@MarmiteFerret]

@@anonanon257 I agree physiotherapy is a dumpster fire but there are people trying to make it better

[@anonanon257]

PT is a dumpster fire and one symptom is the narcissistic egos that seek to fulfil their own agenda within the profession. In turn, the profession gives these egos free rein because the attention is sought after. The profession gives loud mouths a hall pass because overall, the profession is castrated of intellect and impotent. Meakins is a mini Trump with little of substance to offer. Just seeking the spotlight.

[@kt83948]

I really like what Chad said at around 39 mins...we hope to change people's lifestyles but are abysmal at doing so. I am just starting to learn about Motivational Interviewing and I hope it lends some power to my communication. But as we can all see from attempting intelligent conversations with polarized anti-vaxxers or vaccine resistant individuals (and many of them are thoughtful and intelligent) it is nearly impossible to get these people (or any person really) to read anything that contradicts what they think they already know. Trying to get people to change their lifestyles (which they probably do not value) is difficult. Very difficult. Their environment, closest circle of friends, and prevailing local governmental policies (and genetics) all have waaaay more predictive power of their eventual morbidity/mortality.

[@shoulder_physio]

I agree with you Kevin, Great insights

[@808mwong]

Primary care physical therapy. Big fan 🙌🏽

[@sahand3083]

All those differences and discussions reflecting the complexity of human being and the little evidence we have for our treatment as a physical or manual therapist.In my opinion a combination of those treatments and individual based approach will probably have a better outcome.There is still much to research.Thanx for your good debate

[@diannabarrett2681]

Very enjoyable and informative. Thank you!

[@rscranman2002]

Excellent interview! Thank you Chad, Adam, and Jared. I'm enjoying the courses on Medbridge that Chad Cook is lecturing....learning a lot!

[@TheHadesShade]

My university SOMT of the manual therapy master dergree recommended to watch this video before our course of manual treatment options of the thoracic and lumbar spine. They also added some SI joint manipulations, but I feel like that would only cause a manipulation of L5-S1 or above.

[@lizenbriek5032]

Physios as GP for musculoskeletal problems... I've been thinking about this for quite a long time. I just need a bigger location, and a lot of colleagues with the same mindset... Very nice interview, almost made me emotional. Giants indeed...

[@igotkiwi]

It would require more training, most PTs don't even do the basics well coming out of school IMO. Plus knowing about best practices for more invasive approaches (e.g., when to inject or not, when imaging is needed, etc.) and prognosis is not well taught in uni. In my opinion, it should be a 2 year post-master program to become an "MSK expert/first responder/GP", but I think this is the future too and I feel like my job has become so much better since I treat my practice more like this.

[@anonanon257]

What a joke. PT has a wicked inferiority complex, desperate for validation.

[@gregcastle1442]

Great thought provoking discussion all around, with so much relevance to our profession (the exception being Meakins triage model of physiotherapy)

[@vzeek4hj]

This was fantastic in so many ways!

[@ArielDC]

Wow ! I'm proud to be in the reference list. Awesome discussion :D

[@shoulder_physio]

fantastic paper - well done!

[@MARAMARAMARA83150]

On psychological intervention: there is an average of 50% pain reduction with treatment from effective CBT - David Burns, MD. I would venture to say that between Physical Therapy and cognitive therapy, pain reduction has extremely favorable chances.

[@kevinrust3588]

Such an amazing discussion. Both extremely well-educated professionals.

[@rangwalasphysiotherapycentre-p]

An enlighten discussion. Need more of these.

[@charliecolesportsmassage4224]

Chad mentioned briefly about the inaccuracy of Freyette's law. Is there any further reading one can do on this? Or other vids on youtube? Thanks! Great Podcast!

[@robertocostakrug7310]

Great podcast! And great cloning comment Jared!

[@shoulder_physio]

Thanks Roberto!

[@axelfricke2271]

Interesting Idea, that Physios can choose, If they want work with their hands and specific techniques. Because we mustn't forget, what does the Physios feel? It's not only about clinical outcome, but also about Humans having fun and a good Feeling by touching other Humans.

[@nickemery3101]

Thanks, really enjoyed this!

[@cjatwnty8301]

Chad was great. Meakins back tracking, but respect both for putting themselves out there.

[@marc-andresarrazin1523]

Very cool to see Adam in this context. Thanks Jarred for making this happen! But I think MT is 100% less detrimental than McDo!😀 Waiting for the next conversation...

[@hamishashton4039]

How about a similar one on acupuncture as this was way more reserved than "advertsised". Good healthy discussion though

[@Dragens2]

thank you guys. love you

[@teja_physio]

Great discussion. As a beginner MSK physio what education/workshops would you recommend rather than jumping into manual therapy certifications? Would you be able to recommend any particular training in CBT? Pain-psychology? Communication? Thank you.

[@arbillaexercisephysiology]

Anything by Laura Rathbone, Bronnie Lennox Thompson, The Knowledge Exchange (shameless self promotion), Russ Harris, Steven Hayes, Dynamic Principles and Motivational Interviewing courses. Hope that helps.

[@JerryHeschInstitute]

what are Adam means qualifications re manual therapy?

[@akashaarakash]

Can someone zoom in and tell the names of those 5 books placed on a table behind Adam Meakins? 😁

[@doudogg]

I would be interested to know if Adam would seek manual therapy after he's sustained an injury and been in severe acute pain. My thoughts are that acute injuries occur due to tissue failure from acute overload or repetetive microtrauma inducing overload. Exercise is required to protect that tissue from future overload and to deal with the loads required of it. However, Pain is amazing at inhibiting muscle function and overall function so manual therapy therefore shines in allowing for exercise based therapy by pain inhibition/modulation. Manual therapy should not be seen as a cure but it certainly helps with correcting movement, as well as gaining buy-in/trust from the patient to work through the required strengthening in the future :D

[@Dr_Footbrake]

he didn't when he hurt his back either last year or the year before

[@yahoo6972]

anything about ART? I see clients love it. Some of my colleagues who are performing this form of MT are very popular and get many referrals from MDs. Thanks in advance for an answer.

[@chuciulu5647]

Hi, I respect and very much agree with the fact that a lot of manual therapy "teachings" reffer to palpation or to specific applications but not all of them Have you heard about the maitland concept or more than that have you ever done the course, Adam? A quick example is that in the maitland concept palpation is something that sits at the bottom of the asessment and is used because it might give you some more relevance to the component that you suspect, you disagree with that? So then again maitland doesn't use palpation as an primary asessment tool, it might only give you more reason to think about a more specifically region or joint. Then if you agree with this, how can you say on the network that palpation is irrelevant or bullshit? Instead of saying this, show you are more open minded and teach the people that look up to you, how to use all the tools that are possible in which situation, because that might make a difference to a patient, and we all aware of the fact that all patients are different, so how can we make even the assumption that palpation might never be relevant, or other manual therapy things? Again maybe they are not the answer, but sometimes they might give better quality to the patient recovery, so another question comes, does it matter how you do it?

[@floriangirard2052]

16:55 "Fryettes's laws : what a crap laws that is"!!

[@rehabilitacioninke1779]

Chad (facts) v/s Meakins (opinions) great talk

[@coleethornton]

Sounds like you listened to a different video.

[@4ksandknives]

PAIVM - can be taught in about 30 minutes lol.... Other skills are more important as Meakins has stated. Need more work on soft skills and the clinical reasoning and anatomy, because it's woefully absent

[@floriangirard2052]

17:15 "I know 9 studies [which demonstrate no role of specific MT technique to get a specific outcome]". What are they, please ??

[@shoulder_physio]

Link above!

[@floriangirard2052]

@@shoulder_physio thks, but in the Infographic (well done btw), I can't see any of them, except the numbers I guess (eg "8,9,10")...

[@shoulder_physio]

@@floriangirard2052 did you get the reference list in the email too? It would be under non-specific effects of manual therapy

[@floriangirard2052]

@@shoulder_physio nope I didn't, just one with a subscription to the shoulder physio education

[@shoulder_physio]

@@floriangirard2052 if you send me an email i can send to you

[@sahand3083]

I just don't know why Adam or Chad say,that exercise is not beneficial for pain.Its proofed that exercises in many cases has some analgesic effects on pain.

[@giants_pride1292]

Really? I mean Adam is telling us on instagram on his private account and on thebetterclinicianproject exercise is beneficial for pain.

[@sahand3083]

@@giants_pride1292 Yes I was also surprised.They confirm each other,but it's scientifically proofed that exercise has analgesic effect.Its not about their opinion

[@shoulder_physio]

exercise is beneficial for pain, probably no more than other interventions though. The effect sizes are all low to moderate.

[@sahand3083]

@@shoulder_physio I agree with you.I like your podcasts.Its very objective and I learn a lot from your podcasts.Thank you Jared

[@TheSportsPhysio]

@@giants_pride1292 exercise is beneficial for pain, its just not that much any better than anything else. As I said we need to use exercise for pain. ore for its 2ndry benefits on functional and disability, not just pain!

[@anonanon257]

The big assumption here that neither speaker touches upon is why exactly does society need the profession of PT? Separate the professional designation from whatever good might be done using these (lower case) physical therapies and then begin the convo. You are both entering the discussion already accepting the existence and need for the PT profession. I question such an assumption as the quintessential issue here. People don't need PTs, period. People don't need to be told what to do, rather, PT needs people to tell what to do in order to bolster ego. PT has assumed that its place in society must exist because its proponents believe people need it. Yet that is marketing, not truth. If PT disappeared tomorrow, NOTHING BAD WOULD HAPPEN.

[@TheJtwilson]

Chad Cook is on the money and Meakins is only famous for his T-shirts , not for being a great practitioner of anything at all.

[@TheSportsPhysio]

Ha... someone clearly is a little triggered! Did I upset you by questioning something you believe in? And t-shirts available here thesportsphysio.teemill.com/collection/all-products/

[@rscranman2002]

It's obvious you didn't even listen to the interview. Jealous much?

[@cjatwnty8301]

Oh yeah. Tough when he is on his own but when challeneged, he just waters down and back pedals or says you are triggered and links you to his website or surpasses himself with smart allec emojis.

[@coleethornton]

@@cjatwnty8301 I think you missed the point. Adam referenced plenty of research. He also took steps beyond to say how what the research says has brought him to his current opinions. Chad did the same.

[@anonanon257]

@@TheSportsPhysio It would be different if what you had to say could end without invariably you having to make it about you, Adam. Your own projections as you accuse others of what you seem unable to own yourself as you get triggered invariably end with you claiming victimhood. You seem oblivious to your own issues, disavowing your feelings of frustration as if it is the fault of others who cause the real problems. Wow. PTs have a problem in lacking introspection and few it seems are capable of mature dialogue. You are a symptom, not the answer. Grow up.

[@anonanon257]

This term, "therapeutic touch" means what? Here is another example of absolute bullship. Who gets to claim such a term? According to who? So much intellectual vomit.