Latest / The STA Clinician Podcast / Ep.276 'A New Lens: Physioethology’ with guests Matt Low and Anna Maria Mazzieri

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Ep.276 'A New Lens: Physioethology’ with guests Matt Low and Anna Maria Mazzieri · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across health,
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Welcome to the STA Clinician Podcast, formerly known for the last five years,
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over five years now, as the Sports Therapy Association Podcast.
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My name is Matt Phillips, CorinnaVoncheckLive.com, and as always,
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this episode is being recorded live on the Sports Therapy Association YouTube
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channel and Facebook page at 8 o'clock UK time on a Tuesday.
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I'm just going to check. Now, people who have joined us live are able to leave
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comments on the screen. That's one of the many reasons for joining us live.
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I'm just going to check that people can see us. I believe they can.
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Sarah Jones is in the room first of
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all when you do leave comments and questions I can bring up the screen for
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example at the moment we are seeing Sarah going evening which is
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lovely thank you sir thanks for coming in Sir Glenn Murphy Sir
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Glenn Murphy is here as well says good evening all fantastic thank you for joining
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everybody sometimes I forget to thank you enough but I really appreciate you
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people who do join us live and if you've got questions from our wonderful guests
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this evening feel free to put them up on the screen and I will we will answer
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them together right then so a new month starts,
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but this month we're not having a specific focus topic.
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We did ponder about having a whole month dedicated to philosophy,
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but we decided that would be a little bit too much.
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Instead, we're going to serve you a small platter this episode, a few mousse-bouches.
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And there may be in the future, once you all kind of turn onto it and have got
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a palette for that, then we'll devote a whole month to it.
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Don't let the name deter you. It's actually about a topic that we've
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discussed very frequently over the last 275 weeks
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that being hands-on msk professions still
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rely too heavily on a mechanical human-centered view of the body that's what
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we're talking about which now i've put it that way i'm thinking a load of you
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are going oh yeah interesting we know about that so that's one of our goals
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for tonight to make you realize that we're not turning off philosophy we're
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actually making going to help you realize that it's something you're already
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doing and thinking about.
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That's the plan anyway. So using ideas from philosophy and psychoanalysis,
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Matt Lowe and fellow authors Roger Carey, Fiona Moffat and David Nichols propose
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in a recent paper, which we'll be talking about,
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that MSK conditions should focus less on fixing structural problems and more
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on supporting what bodies can do in context shaped by interactions with people,
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environments and non-human factors.
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So to discuss this and more, I shall now bring up author Matt Lowe,
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consultant and physiotherapist at University Hospitals Dorset NHS Foundation
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Trust, accompanied by the wonderful Anna-Maria Maccieri,
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Director of the SD School and PhD student at Health Sciences University.
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So without further ado, let's bring them up.
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Matt and Anna, that's a lovely way. Thank you very much just for the podcast
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listeners who can't see that. I had a wonderful way from that.
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It's wonderful. Anna-Maria, how are you?
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Good evening. Very well. Thank you. A bit of a croak going on there.
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Been talking a little bit too much this week. Yes. Yes. Sorry.
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Literally, I just finished clinic and it's been a very complex day.
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So I'm just... So it's actually this paper, it brings together why we need to
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change mindset around pain.
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Fantastic. I appreciate both of you giving up your time. We should say straight
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away that we were hoping to have Roger Carey with us, but sadly,
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because life gets in the way, as John Lennon said, he's not able to be with us here tonight.
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So sorry, he was on the advertising things out there, but he can't be with us.
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But we wish you well, Roger, and hope everything goes well with us. Oh, no.
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We do, don't we? Yeah, we love Roger. Definitely, didn't let us down at all.
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It's understandable. Things get a bit. No, no, no. Yes, indeed.
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So I always start off hoping that out of the listeners who are joining us live
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and also the actually 3,100 downloads we had last month. I'm hoping people don't
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know who either of you are.
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I doubt, I think everybody knows that, Mary Matt Cieri.
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But Matt, if we could start with you, I would really appreciate it.
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If you could give us, if a listeners aren't aware of the work you do and its
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relevance to the publication of this paper, maybe give us a short introduction
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about yourself and how you got involved in this paper.
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Thanks very much, Matt. And thanks very much for having me on the podcast.
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So yeah, my name is Matthew Lowe, as you know, and I was qualified as a physiotherapist 23 years ago.
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I did my master's program at Brighton University and I'm a manual therapist
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by background in that context.
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So it's really nice to be amongst other people who are manual therapy trained.
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But I think as we all, as the listeners here and everyone probably agrees with,
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it's more about your clinical reasoning skills than it was about manual therapy
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skills that we got taught.
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So, I'm a consultant physiotherapist by background at University Hospitals Dorset. What does that mean?
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It basically means I'm very fortunate and privileged to have a blend of clinical
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leadership responsibilities.
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Research and education and training contexts within my role.
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I'm a visiting associate at the Orthopaedic Research Institute at Bournemouth
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University, and I'm also a visiting fellow at Health Sciences University.
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My research is basically, because we're going to be talking about the research
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stuff, I'm also a PhD student at University of Nottingham.
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My research has covered areas from orthopedics, patient information,
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through to clinical reasoning and applying theory to practice.
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So if you had to say to me, what is my passion in the research area,
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it's applying theory to practice. So that's just a really brief intro.
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That's fantastic. Thanks so much. I didn't realize there was the connection
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there with Anna Maria, where you're studying the Health Sciences University.
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So I guess you guys are spending a bit of time together over there and that
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make the words as well then. We're in Plansley. We're in Plansley. Yeah.
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And that's a wonderful segue. Because Anne-Marie, you were with us. Thank you, Matt.
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You were with us in the pain month, which Nikki has actually said,
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I'll just bring up Nikki Mansfield comment, because I think it's very nice of
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you to say so, Nikki, and also just to repeat it.
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She says, I'm genuinely excited to see how on earth you're going to top the
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last two months, Matt. No pressure.
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The topics, guests, and hosting. Oh, thank you, Nikki. I needed that tonight.
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Happy, better than ever before.
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Seriously outstanding content. Thank you. That's so nice, Mansfield.
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It's very nice of you. We have had a great couple of months.
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And one of the stars of that month was you, Annemarie Maccieri,
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who joined us with Professor Dave Newell for one of our episodes on pain.
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But for people who aren't aware, a lot of people know you as a director of the
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ST School and one of the best educators in the industry for more evidence-informed
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soft tissue therapists.
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But you're also very much involved with a PhD at the moment,
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which we'd love to hear about.
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Yes, I'm really enjoying his PhD journey.
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I'm undertaking a PhD at the HSU.
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Here we're going to be talking about philosophy. And as a clinician doing a PhD,
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only now I realize how fundamental it is to clinical practice,
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the standing philosophy.
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In fact, you know, even in my PhD, even when people say, Anna, what is the title?
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It's just quite complex to just say a title.
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But even understanding the philosophy helped me to be less wrong,
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led me to eliminate a lot of noise around what I had when I started the PhD.
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So very interesting, yeah. My PhD, by the way,
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it's on the sense of self and body selfhood, the multi-sensory the coherence
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of the embodied selfhood through multi-sensory integration in people with chronic
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pain that they influence the touch the
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might have on such embodiment.
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So that's why I'm also very interested in maths and et al paper because some
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of it takes my bias, but I got some questions as well about it that I'm really
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quite looking forward to ask.
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Fantastic. Thank you very much. And it's really fascinating and interesting
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to follow your journey because you've always championed trying to put some evidence
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into soft tissue therapy and helping.
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I love the way you say be less wrong because that's such a healthy way of looking at it. It's wonderful.
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I think with human beings in general, what we're trying to do is be less wrong.
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So yes, it's been really interesting from a clinical perspective,
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how the work by Matt and Roger and Vienna and Dave, yeah, get a play of part
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for people who are actually using manual therapy in their careers and professions.
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So wonderful. Thank you very much for joining us. I guess we should start.
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We've mentioned philosophy.
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I haven't said enough the the name of
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the paper so the paper was physiothology so
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physiothology a post-humanist perspective
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on physiotherapy okay we'll make sure
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the link to that paper i think a few people have already said they've had a
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look at that and really enjoyed it in the comments we'll make sure that a link
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to that paper for those of you who haven't seen it is in the show notes and
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also a really nice video which kind of explains what the content is as well
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i can't remember the person who put that together but it was really nice really
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good kind of info video i guess we should start with tackling what physiothology means?
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And also, just to take the elephant out of the room before I get loads of emails,
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it's not just a perspective on physiotherapy, is it? You've used that word, but can it be applied to?
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Yeah, absolutely. So the only reason why I've chosen the term physiothology
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is physio is taken from the Greek term to describe nature.
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And ethology is obviously, as you guys know, is the science of animal behavior.
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But the philosophers that I applied this through,
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they extend the term of animal behavior and they apply it across a wider network.
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So basically, it's an ecological way of thinking about how we practice.
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And so you're absolutely right to pick up on this isn't just about physiotherapy.
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And we can dig into some of that detail a bit later.
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Sure. So that's essentially what physiothology is.
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It's applying, it's understanding nature and its widest context and how we interact with it.
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Now, there's more questions at the tip of your tongue, so I'm going to let you ask away.
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I just think for our listeners, I just want to pick a little bit more on that.
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You kind of glossed over, yeah, we called it physiotherapy and we might touch
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on that later, but were you ever tempted to call it something less specific
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than physiotherapy or is it because you're all physiotherapists? No.
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The last word, the perspective on physiotherapy, was there ever a thought?
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Oh, sorry. So yeah, sorry.
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Got you. So the reason is, is that I was applying, being a physiotherapist means
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that you have to have a perspective coming from somewhere.
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So I was explicit about that. I'm a physiotherapist, so I'm going to have my
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philosophical biases grounded in physiotherapy. I'm going to have my cognitive
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biases grounded in physiotherapy.
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I've got an entire social, cultural, and historical context grounded in physiotherapy.
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So I think being explicit about that and publishing it in a physiotherapy theory
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and practice journal just means that the readers know where this is starting from.
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It doesn't mean it's where it's going, but it's applying it in the context of physiotherapy.
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Fantastic. Very nice.
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It's just a lot of our listeners are not physiotherapists.
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We do get a lot who are and are our health professionals, but I just want everyone
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to realize if you listen to podcasts that it's not just about physiotherapy.
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Yeah, not at all. Anyway, so, Anne-Maria, the title, what does that mean to
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you and how does it link to things that you're studying at the moment and have
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already kind of experienced in clinic and stuff?
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Well, first of all, for the title, I have less of a problem because I collaborate
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so extensively with physiotherapists, osteopaths, chiropractors,
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and other professionals.
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And I am respected by them.
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I do not have a problem for a paper
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to be called or for a paper to be physiocentric because I go and read it.
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You know, I learned from osteopathy and I learned from physiotherapy.
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So I hope that people become less and less siloed or, you know,
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that they feel freer to actually, you know,
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even match themselves and recognize themselves into other professions.
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Because ultimately, at the basis of all, we are professions working with people in pain.
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And that brings us all together. then there might be some specificity in our profession.
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So, first of all, to me, we should feel much freer and much happier.
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In terms of, I absolutely, as I say, he's one of my top reads of certain since he came out.
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Why? Because to me, he gave a vocabulary which I didn't have,
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he allowed that it's not about the physiotherapies, it's about healthcare.
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It's about health, it's about care and it's about, like I said in a post,
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it's about the intrinsic responsibility that we have as people and our health
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and our care, but also as practitioners as our health.
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So from that perspective, he gave a vocabulary of the strong social and ecological.
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Responsibility we have, but also We spoke last time when we were on the podcast with Dave.
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I am looking more and more into inactivism and to me ethology is actually quite
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close to inactivism because as a person you enact,
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I keep using the word, but you are embedded,
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you enact, you are influenced by the environment,
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the ecology where you're on and that is so important because you change that
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behavior and you change the ecology or you change the environment and you change the behavior.
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So we are so intrinsically linked, but that link,
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and that's where to me, Matt Rogers et al's paper was absolutely fantastic that
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they bring the reader to think about their own responsibility as a therapist for a better,
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for a stronger social responsibility.
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When we see people, it's not just only us and the client or patient within those four rooms.
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We have a bigger responsibility.
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So, and that to me, the paper gave me a vocabulary that I didn't have. That's really nice.
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I like that. Yeah. I was just trying to. Thank you, Michael.
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That's… No, that was really cool. I was struggling to think how I put it,
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if someone asked me, but gave me a vocabulary.
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I think that's what's happening. I think Dave, who is actually here,
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Professor Dave Newell, has joined us. Thank you very much for joining us from
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Health Sciences University.
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Yeah, I think that's what the episode with him did as well, gave vocabulary
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to things which we've kind of…,
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Bumped around in our heads when we talk about bio, cycle, social,
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but then there's the issue of, hold on, we're separating bio from cycle from
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social, and then what about everything that's around?
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It's all kind of a little bit, but now it seems, thanks to that episode you
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did with the inactivism and everything, and now what we're looking at with this
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paper, we're starting to put a bit more meaning into words and be able to explain what's going on.
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This is why, Ma, philosophy, you can call this one philosophy,
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call it whatever, but Those are not discussions that needs to be had so separated
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from clinical practice.
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We just need very good people like Matt Lowe, Roger Carey, Fiona,
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or Professor Newell, that they have the ability to unpack them in a way that
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they're understood at different levels and they're understood by people that
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they might not think always or enjoy those.
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Actually, ultimately, they're so clinically relevant.
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That they need to be into training at different levels and they need to be in
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clinical practice because it changes the way you practice.
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People say, oh, but they're not clinically applicable. Of course they are.
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This is the base of your practice.
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Sorry, I got me excited about it. No, I love the passion. That's great.
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Matt, you've been listening now to Ana Maria commenting on what the paper meant
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for her. Is this one of your intentions? Is it's nice to hear this from a clinician?
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It's lovely to hear. It's lovely to hear because no matter what you write,
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a book or an article is always much more than the content that's read or the
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intentions of the reader.
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And for people to make such lovely comments and thought-provoking experiences
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that they've had is really nice. It's lovely to hear.
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I think I just want to extend what Anna Maria was talking about.
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I did quite a lot of work for a research project called Cause Health.
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I don't know if people are aware of that. And that,
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really brought home to me that we all have, whether or not we like it or not,
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have these deep entrenched philosophical biases. They're often socialized,
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certainly within professions.
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So that's why I think it's quite important to recognize and say that I'm a physiotherapist
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with my philosophical biases, which are associated with physiotherapy.
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I'll give you a clear example for that. Some of the legitimacy of physiotherapy
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has evolved from our relationship with medicine.
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So our relationship with medicine
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gave us legitimacy but we had to take on
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their theoretical and philosophical biases which meant
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that certain practices that might be seen as holistic would be somewhat sneered
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upon and or perhaps even just not seen as legitimate so and even now if you
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look at things like advanced practice if you look at the the ways in which physiotherapists
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practice where do advanced practitioners tend to practice?
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They tend to practice in medical clinics. And if we look at a biopsychosocial
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model, let's be honest, that resides very much in the biomedical domain or the
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biological domain at the very least.
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And what does that tend to mean? Well, that tends to mean that we break things
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into smaller component parts. If we understand the smaller component parts, then we know the whole.
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Now that's deeply problematic, certainly in complex systems.
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It doesn't allow for things like emergence, which we can talk about.
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But my point is, is that the kind of philosophical bias that we have,
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that changes what you do.
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Do you mind if I go on about this a little bit longer? Only because,
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so for example, if we look at the biopsychosocial, if I reside in the biological
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domain and I assume certain biomedical forms of understanding of the world,
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Then, which usually centers around reductionism, it's got its place.
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It certainly has helped us conquer a lot of communicable diseases, for example.
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But it means that I'm going to pay much more attention to the image or the scan.
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It means that I'm not as interested in the narrative or the story.
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I just really want to know the sequence of events that led you here today.
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Don't really have that much interest in the social cultural context or other
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matters associated with it as much.
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I'm going to bias things like imaging, scans, special tests,
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and my presumed kind of treatment direction may be more medical and surgical.
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That's an inherent philosophical bias that manifests in practice.
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If I think that health and disease resides much more as a psychological phenomena,
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stress, anxiety, and worry has physiological changes that changes allostatic load, for example,
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I'm going to deem much more important time and spend much more time focusing on narratives.
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I want to know people's stories. I want to know how they feel.
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Appointment times aren't going to be 15 minutes anymore. They're going to be 45 minutes or an hour.
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The environment is not going to be a clean cut plinth, which looks pristine.
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It's going to have a chaise lounge or plants in the background or a painting.
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So what I'm saying, and if I'm sociological, then it actually makes sense that
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I'm embedded in society, understanding communities.
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So how one sees health and disease philosophically does manifest in what we do and how we practice.
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That's great. Great breakdown. And Ria? Thanks so much that I was writing down.
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Absolutely. And this is what it's not about the practitioner.
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It's about the way we view health and social and well-being and the way because,
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and we spoke that last time.
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Let's talk about a moment, the biopsychosocial model. great because again he
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gave us another vocabulary so that we could go away we were all.
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Realizing that this biomedical model was not you know, didn't work and we didn't
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have the vocabulary again, ultimately because the philosophy doesn't match,
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doesn't align with a true holistic approach or a true holistic view,
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we are still reductionist we are
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still breaking down the bio the psycho
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and the social not only in implementation especially nhs where you know 10 minutes
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appointment how can you not you know be biomedically driven but also in our
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discussion within practitioners we are brain-centric or we are psychology-centric,
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or we are social-centric, and actually even in research,
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we keep within those silos. Instead of being...
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The organism, the person within the ecology is centered.
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And that's where the problem is. And, you know, when I was looking,
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for example, at the research on embodied selfhood and the sense of self.
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Again, theoretically, it's explained by most theorists really,
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let's call it holistic, let's call it as the whole organism.
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But then they take away the implementation when they do the research.
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They're actually going to break it down. The cognition only happens into the brain.
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Well, actually, if then the body becomes only the conduit for the brain to do
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its magic job, then you're still dividing.
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We're still back to the Cartesian dualism. And unless we understand that at the absolute core,
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we will treat the person just with only exercises or only the back pain without actually...
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Seeing that the back pain is a manifestation of different elements.
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Those elements originally might have had their own identity,
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but the moment in which they become back pain, then they become a new entity
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with a new, what do you call it, like with a new reality.
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Let's not go back to pre-back pain. Let's go to communicate together with the
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client to transformation, transformative health to something new.
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And so, you know, but also in the last and then I'm quiet.
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I love what Matt, what you said, Matt L, Matt Lowe.
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Well, I love what you always say, Matt P, but you know, now this,
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it's about, it cannot be 10 minutes anymore. The room has to be,
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the context has to be carefully created.
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This is what our skill set in holistic health, the woo-woo that people used to be woo-woo.
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I teach my students one of the treatments is room setup.
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What color will you have of the towels? Or make sure that the towels are always
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in the same position because that provides a sense of safety.
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Make sure that the light, make sure that, you know, they see the first of the
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two chairs, you know, slightly.
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All of that creates an environment.
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For health, a therapeutic environment, that together with, in my case,
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Touch, together with Therapeutic Alliance,
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all of that then creates this experience that instead of actually breaking down as treatment,
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it's not treatment, it's about the experience, probably when you will do all
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that. That's great. No, no, no. That's fantastic.
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It's really nice having you two together. I really appreciate the fact.
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I mean, obviously, it's sad what it's not here. It's not the same without Kerry.
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But it's nice having you two because you can bounce off each other with almost like the theory.
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Although, Matt, obviously, you're from a man of therapy background as well.
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But it's lovely having that, the theory, the paper with the practice of what you're doing in clinic.
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I wanted to go back, Matt. You mentioned, for example, you need the shade lounge.
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You need the painting. And you had some wonderful imagery there.
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I wonder if we could expand on that and show how, because in the paper,
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you talk about how things like light, noise, temperature, and objects in the
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room can make a difference. and we should be focusing on that.
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Things which, as Anna Maria points out, in holistic massage in particular,
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has already been focused on.
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We just didn't know what effect those, I mean, even now we'd call them contextual effects.
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But how do you suggest with the paper and how do these things,
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can you give an example of how these can affect the treatment and make a difference,
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more of a difference than maybe we assumed or imagined before?
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Yeah, absolutely. I think the challenge that I've got articulating some of my
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answers on a podcast is that some of the theoretical background,
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particularly in the work of Deleuze and Gattari, who I'm drawing from here,
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they're very suspicious of anything that's fixed, anything that's static,
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anything that's substance-based, and that has certain consequences.
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I'm not going to go into too much detail. Yeah.
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Ultimately, if we think of health as something which is ecological,
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which is multidimensional, but not just residing around humans,
26:56
we have to think about non-human factors or non-human elements or non-human entities.
27:01
And that we share much more with non-human elements, the obvious one being gut
27:06
microbiome, for example, but even an oxygen, we expire 16% of oxygen.
27:12
If we're in the same room, if we were all in the same room, you would be consuming
27:17
or breathing in air that I've consumed and oxygen that I've consumed,
27:22
the boundaries are much more porous than we think.
27:26
So the gap between me and the environment, even if we look at it from a kind
27:30
of material perspective, is very close.
27:35
And when we start to think ecologically, we have to,
27:39
in my, in how the paper tries to articulate it, in order to embrace this idea
27:44
as health being in the foreground and not something that's kind of a background
27:48
factor. I'll explain more about that.
27:51
So being a musculoskeletal practitioner, if I ground myself in my identity,
27:55
all I'm going to really have in the foreground is musculoskeletal.
27:59
Everything else becomes a risk factor or something that I need to refer on to.
28:05
Health is a general concept, sits in the background. So generally speaking,
28:10
what that means is that things that matter to health, like air pollution,
28:15
sunlight, vitamin D tend to, we know about it, but we tend to just kind of situate
28:20
it in the background a little bit.
28:22
We don't really think about it. Yet a lot of pain, for example,
28:25
is associated or could be associated with say vitamin D deficiency.
28:30
But anyway, that's another thing. So what I want to try and do is bring health
28:34
in the foreground and musculoskeletal is just one little bit in the.
28:43
Of understanding health and healthcare. So for example, if we just think about
28:48
bone mineral density, if we think about bone turnover,
28:53
I think it's something like four or eight months, I don't know exactly,
28:56
but my structure, my bone structure is not going to be the same in eight months' time.
29:01
So is there such thing as an identity?
29:04
If I start breathing in oxygen, expelling carbon dioxide, and we exchange those
29:09
gases, where's the difference between you and me? You can say it goes as far
29:12
as the skin, but surely it could be somewhat different.
29:16
Going to things like inactivism or affordances, the environment shapes the actions
29:22
that we do, what affordances we're possible.
29:26
So I know that sounds a little bit off. I'm going to get back on track.
29:30
My point is, is that if we see health as a concept in its vastness, which means health.
29:39
You know, everything from not just muscle density and power and proprioception
29:44
for sensory motor disturbance,
29:46
but from a broader perspective in terms of relations that we have with not just
29:53
our immediate background, but
29:57
with all of the impending things that are going to hit us down the line.
30:00
Things like climate change, things like political division, things like war,
30:07
things like famine, things like migration.
30:09
Those things impact health, whether or not we like it or not.
30:13
So it's not to suggest that immediately we should become activists or whatever like that.
30:17
But what I'm saying is that if all of that stuff needs to sit in the foreground
30:21
more, such that a plurality of different types of physical therapy can coexist,
30:28
You can still be a biomedical clinician, bear down on biomedical practices.
30:33
That's fine, as long as you acknowledge that that's what you're going to do.
30:36
Is that the future of healthcare?
30:38
Is the future of healthcare going to be a biomedical form of practice?
30:44
I think that healthcare practices could have the possibility of us all engaging
30:50
in a vast network of ways in which we engage with the concept of health in its wider scale.
30:56
And that's going to be situated in contextual, depending if you live in the
31:00
South of England, Nairobi, South
31:04
Africa, wherever, because it's going to affect you in different ways.
31:08
So put very briefly, health as a concept I think should sit very much in the foreground.
31:15
Imagine everything that you can think of that impacts on health.
31:20
Is almost like a lens by which we see future healthcare practices.
31:24
Musculoskeletal aspects are just a tiny little dot that sits behind that.
31:29
And that's one way to look at this paper, is to try to expand our perspective
31:33
of what physical therapy is.
31:36
Still done in a scientific way, still done in a legitimate way,
31:40
still drawing on from biological, psychological, social, ecological contexts,
31:45
but doing it in a radically different way than what we've done before.
31:49
And in this way, it rejects the body as machine, but it also de-centres the human.
31:54
And what does that mean? That's why I'm talking about this as a post-human project,
31:58
not because I want to get rid of the human, but to recognize that a human is
32:04
just one small part of the ecological landscape.
32:09
And if we de-center the human, we're more likely to recognize those non-human
32:13
elements that impact on health.
32:15
So it really forces us, and that's what I hope this paper does,
32:20
it really forces us to think differently about what we're doing in a future healthcare context.
32:28
Yeah, sorry, I wanted to say really quickly, now my brain is...
32:36
The only, let's call it a little bit my query, there was a little bit of tension.
32:43
So first of all, yes, I love that. And the fact that actually it's,
32:49
they come to us with musculoskeletal play, or with the way everything manifests, it's musculoskeletal.
32:56
So we need to validate that, validate the fact that they come to us.
33:00
So I love what you just said that actually, yes, still we can do what we do,
33:04
but with a broader look, with decentralized.
33:08
I love this idea of the human being not at the center, but as integral part
33:15
of everything else. So we need to look at everything else.
33:18
As a network of relations. Yeah, that's the relational part.
33:23
So the only thing that I was queried a little bit is about, So maybe because
33:28
embodiment is a concept that I quite like and it quite makes sense,
33:37
but I was a little bit concerned that we are not validating enough the position of the body as...
33:48
As an organism or where actually it actively influences the environment and
33:55
then it's influenced by the environment.
33:57
So to me, the idea that in embodiment that cognition also is at body level,
34:04
that to me is something quite important that I actually did in clinical practice
34:08
and I found that ethology takes that a little bit away and that was where my tension was.
34:16
That's very astute. And you're absolutely right, because it does.
34:19
It tries not to suggest that humans, because you have consciousness,
34:24
is any more important than any other entity in existence.
34:27
So you're right, there is a tension there. And it's because the direction,
34:34
and maybe it's a bit too forceful, does not prioritize humans because they have cognitive capacities.
34:41
There are non-human human organisms, which just because they don't have linguistic
34:47
skills doesn't mean that they don't have a share of space in the world of healthcare.
34:54
So I appreciate totally where you're coming from.
34:57
And I am very sympathetic actually to embodiment, to embodied cognition.
35:02
I think touch, for example, has a very real perceptual change or facilitates
35:10
perceptual change, which drives...
35:14
Not many many many
35:17
different types of change effects yeah affects
35:21
yeah the capacity to affect and affect it be
35:23
affected but huge all i'm saying is i'm pushing the border as far as i feel
35:29
i can and this is where the tension relies talking to a you know musculoskeletal
35:34
audience who there's a great comment in the in it so it's saying but i've pulled
35:38
my hamstring i'm not going to talk to thank you for discussing climate change.
35:43
And you're absolutely right, Gary. This is looking at a future healthcare context
35:48
under which physical therapists may play a part.
35:50
This is not by any way saying that what we're doing now is wrong or practicing it in this kind of way.
35:57
It's just saying that in a world where we've got, and I hope you don't mind
36:02
me discussing things like, you know, late stage capitalism, neoliberalism,
36:07
which has shaped the ways in which we could, Because I practice in the NHS,
36:11
it shapes the way that care is driven, okay?
36:15
It, it, it, there is a, there is going to be a growing need for healthcare practices
36:21
to get out to those who need it the most.
36:23
Those that don't have access to healthcare is going to increase.
36:28
That's going to happen. Now, if you put AI into this mix, there's a possibility,
36:33
well, we don't know where the future is going, but what we do know is it's going
36:37
to accelerate healthcare in healthcare advancement.
36:41
And I use the term in a neutral sense. I don't think it's necessarily going to get better.
36:46
Advances mean accelerate. It's going to accelerate change in the healthcare context.
36:51
And I'm just wondering what future physiotherapy or any physical therapy has when,
36:57
if you, for example, you just have to look at Cambridge, they've got a two million
37:01
pound investment or rather a procurement process to have AI as front of house,
37:08
physiotherapy services.
37:09
So I'm not saying that's positive or negative. What I'm saying is it's radically different.
37:14
And so therefore, if I'm going to be thinking of what health means in the broader
37:19
sense outside of musculoskeletal health, but things that we can influence as
37:24
musculoskeletal practitioners with our knowledge, skills, and experience,
37:28
it doesn't necessarily have to reside in the musculoskeletal system.
37:33
It can be in far bigger, broader
37:36
terms and and and this opens up the space
37:39
for a future physiotherapy the soft
37:43
tissue massage therapy because touch embodiment
37:46
all of that stuff's part of it but i just think what is the future going to
37:50
look like when things have accelerated and will accelerate in so in ways that
37:57
you know we can't really possibly imagine five years ago i wouldn't have thought
38:02
what's happening now would have been happening.
38:04
Yeah. A question. Let me allow, sorry, I mean, I just want to ask a question
38:07
because there's a few people and it's on my mind as well, like Nikki and that.
38:11
To cut, for people who are kind of thinking, okay, I'd feel sure what you're saying.
38:16
What i'm just kind of bringing a little bit back to like
38:19
what can we do now but if a
38:21
if a clinician is listening to this or the cliche is this what sort
38:24
of things do you think they should be doing
38:27
now or contemplating which will allow them to be part of this new kind of healthcare
38:33
system which does take into account more the environment the ecosystem and everything
38:37
which we're involved in what changes should we be making in clinic to be a part
38:41
yeah i i wouldn't necessarily that anybody should feel that they need to change anything.
38:46
What I'm saying is opening a possible door that people can enter into or not.
38:52
And let's imagine people do want to take that first step.
38:56
Then it might be, okay, well, the first easiest step might be,
38:59
as Anna Maria has talked about, is look at the environmental space.
39:02
Does it need to be inside?
39:04
In what way a therapeutic space is outside or different kind of situations or
39:09
contexts under which, you know, people practice, do we have to repeat the same
39:14
ways that we always have done?
39:15
Does a physical therapy need to be in a clinic room?
39:21
If we take the idea of the social determinants of health seriously,
39:25
what place does soft tissue massage therapy have in dealing with that?
39:31
It's not going to be sitting in a clinic room
39:35
it probably is going to be sitting in a deprived
39:38
area where you're looking at homing home
39:41
context shelters you can
39:44
use your analytical skills as a soft tissue
39:47
massage therapist to understand the effects that people have when they work
39:51
in these when they live in these environments right and you know you're probably
39:56
thinking oh gosh well hold on that doesn't quite make sense but you've got you've
40:00
got lots and lots of skills which can help people in ways that probably haven't been imagined before.
40:06
And that's what I'm trying to kind of open up.
40:09
Thank you. Because when we talk about the massage,
40:14
you know, let's call massage, any practitioner that provides massage,
40:19
when we discuss that with physiotherapists that they work on NHS,
40:23
we get challenged, oh, but NHS does not have time.
40:27
That is a luxury because they always have this idea of this image of massages lying on the couch,
40:33
the girl with the flower, are they lovely but
40:37
that is one perspective of
40:40
massage we are talking about touch you can like you say
40:42
when there is social determinants to health and
40:45
actually those are the people that sitting that cannot
40:48
they haven't got mobility you know working a tiny
40:51
little bit with the touch with the on the on the hand on the shoulder this is
40:57
where you can make a difference you you take you change change their environment
41:01
or change their experience of their environment you know so that we can think
41:06
of it in a very, very different way.
41:10
So thank you, Matt, for, again, you know, verbalizing something that irritates a lot of us.
41:16
No, no worries at all. And I know it's stretching things because we're used
41:20
to practicing in a certain type of way.
41:23
But, you know, there is such a thing as pink noise, for example.
41:27
If you were to, because Matt, you live close to the sea. there
41:30
is a therapeutic quality of watching the sun
41:33
and over this over this over the waves as it comes in now there is a certain
41:38
frequency of light waves which is described as pink noise which has a material
41:42
effect on our mood and it helps our well-being should we ignore that from from
41:48
therapeutic practices is that not a form of physical therapy.
41:52
So this is really, this is, that's a lovely example because you just said it and I felt relaxed.
41:57
So it's definitely something there, but I think that maybe is going to help
42:01
our listeners realize now, I suppose it's a lot of our listeners are soft tissue
42:05
therapists and particularly massage therapists, people in the hands on,
42:09
they're probably conscious about.
42:12
Actually I was saying that I'm thinking about a variety of students,
42:14
but a lot of our listeners anyway, are conscious of the ecosystem which their patient lives in.
42:20
And they're probably already suggesting try and go out for a walk,
42:23
literally smell the flowers and, you know, walk on the beach,
42:27
go and see, solve that problem you've got with your mother-in-law,
42:30
whatever it is, which is what we're kind of all talking about is looking beyond
42:33
just the achy knee, let's rub it.
42:35
So a listener who is already taking that on board, what we're doing really is
42:40
we're giving more weight maybe than even before to these other things in the
42:45
sense that how you can help that
42:46
patient within healthcare by putting more weight on these things. Yeah.
42:50
And the clinic could be there. It could be in the countryside or it could be in the beach.
42:55
Why does it have to be inside in the clinic room?
42:57
My point is, is that if we take the idea of the environment seriously and that
43:03
it has a restorative function, yeah, then why can't we practice in ways that
43:10
we haven't necessarily imagined before?
43:13
And, you know, like down by the seafront, right?
43:17
You know, and this is just one kind of layer away from where I'm trying to go, which is, you know,
43:28
pretty far out there somewhere when it comes to health and healthcare and thinking
43:32
of things and just, you know, applying the idea of health in the broadest context possible.
43:40
But even small things like that make a huge difference.
43:44
Having a community of patients, for example, of patients who lived in deprived areas,
43:51
we could invite them into a different environment where they're sheltered from
43:55
the stresses and strains of the situations that they encounter. That's therapeutic.
44:00
Then you can apply your soft tissue massage skills, your communication skills,
44:05
to understand their situation such that you might,
44:10
yes, of course, be able to deal with some of those things, but even applying
44:13
a therapeutic treatment modality in an environment where they feel safe in a literal sense,
44:20
not just the clinic room, which can be quite threatening for a lot of people,
44:24
actually in an environment totally separate to where they would normally be.
44:28
You're basically co-composing the environment.
44:33
You're working with all of the various entities that are possible to be changed.
44:37
Is this like, are we moving into the territory of OT though?
44:40
Isn't that what OT is kind of more about?
44:43
Going to the place where the person is or lives and looking at their environment?
44:46
It's part of it, but it's not occupational.
44:51
It's therapeutic, but it could be part of occupation.
44:55
The other thing is, is that occupational therapies, alongside again,
44:59
because of legitimacy, has kind of become biomedicalized in the sense that it's
45:03
become reduced. A lot of occupational therapists want to expand the current
45:07
dimension of where occupational therapy is going.
45:10
So if you're working in an orthopedics, occupational therapists will go out
45:14
to the person's house. They'll measure the height of the chair such that the
45:19
patient's less likely to dislocate their hip.
45:21
But it's become so narrow that actually the kind of perhaps ethos of occupational
45:27
therapy has been eroded over the long, long period of time.
45:29
And I know we're not talking here about occupational therapy.
45:32
I would say this is distinct from occupational therapy, but even if you were
45:35
to argue this is something that occupational therapy started with,
45:38
that's no longer the case.
45:41
A lot of our practitioners, we already do that when you were talking about the environment.
45:49
You know, often we advise, you know, go and do your gardening,
45:52
go and do the allotments as actually pure health-driven activities.
45:59
And it's very much person-centered.
46:02
Health care then is not the intervention anymore.
46:06
Health care becomes their environment. So they shape and they think they're involved.
46:12
This is why it's so important that we listen to the stories and we listen to
46:16
where they're embedded so that then, you know, for most of my clients,
46:21
it's not the rehab that I can manage to get on with them.
46:24
It's about actually using their own life or what they enjoy in life to expand
46:31
their capacity a little bit.
46:33
To have the relation with that particular environment, again the allotment,
46:38
that helps them to expand their capacity to reach their potential.
46:44
Because this is one of the things with ethology is a lot of the uncertainty
46:49
with ethology that the philosophy that actually is quite relative but,
46:56
You know, what brings the barriers is the uncertainty.
47:03
The barrier is made from the person and their own environment.
47:08
Because then you can grow into that environment. It's just always to be,
47:12
you know, isolated, to be restricted from it.
47:16
So, and yes, I'm sorry.
47:19
Yeah, but again, I think let's imagine another scenario. Because it's a really
47:24
good question you've opened up. how can we apply this?
47:27
So for example, if you're walking past, I don't know, a disused garden center
47:31
and you can speak to your local MP and say, can we do something with that?
47:36
Because the local council isn't doing anything.
47:38
And then you bring together communities across disparate areas and there might be a cafe,
47:44
there might be a clinic there, but there might be a 5k
47:47
run that you do at weekends there and you
47:50
integrate you have an opportunity to think about how
47:53
you can morph involve co-develop
47:57
change environmental contexts such that you could practice soft you know you
48:04
you practice in a person-centered way but you are you're having a greater influence
48:09
within the healthcare spectrum having a greater influence on there i want to
48:13
play devil's advocate okay just
48:15
I don't want to, but I feel I need to. What about though, there is going to be.
48:20
That market of people with first world problems who do want to get away from
48:23
the world and find peace and relaxation within four walls with a nice lighting
48:28
and that's how that's for their health that's what they need so you're not saying
48:31
forget about those people no but it's just if you want to,
48:34
actually make a i mean a lot of healthcare clinicians they want to make a difference
48:38
and they're not don't want to look after just these people it's it's branch
48:41
out a little bit more absolutely yeah this is looking at what i'm trying to
48:45
do is not get rid or throw the baby out of the bathwater,
48:48
which is perhaps how some people might view this paper.
48:50
That's not what I'm trying to do. What I'm saying is, is that how we practice
48:53
is probably about this big.
48:55
And we can still use our knowledge, skills, experience such that we see health
48:59
in its broadest context.
49:00
And it's almost like saying, go get it.
49:06
So there are some philosophical, there is lots of philosophical language.
49:10
We don't have to talk about teleology, purpose.
49:14
We don't have to think about essentialism. But all of those things kind of wrap
49:18
up with this, where I'm trying to go, which is that the three main concepts,
49:24
which I discuss in the paper, which is affect, which is the capacity to affect and be affected.
49:30
Relationality, which is how all entities enter into relations.
49:34
As they enter into relations, they change their capacities, both in terms of
49:38
the connections, which is the longitude, and the latitude, which is the powers,
49:41
which is the capacity to affect to be affected.
49:44
So my capacity to speak German has diminished over the period of times that
49:48
I have been distanced from speaking to Germans, being able to look at textbooks
49:53
of German, and so on and so forth.
49:56
So my encounters with German as a language will change my capacity,
50:01
will change my powers to act.
50:04
And so what we're trying to do here in a therapeutic context is see how we can think about those two.
50:11
So as I mentioned before, affect, relationality, but also think of the event,
50:18
which is how encounters can shape things that it's not just the one-to-one relationship.
50:25
It's the whole situation that sits around them.
50:27
And that sounds a little bit abstract. So if I give you an example,
50:31
if we look at a battle, you still describe the battle as an event.
50:36
So for example, what's going on awfully in Middle East at the moment is a battle,
50:40
but it's irreducible to the F-15s that have been shot down by friendly fire,
50:46
which is a state of affairs.
50:50
So the event is a descriptor of a kind of territory of what's going on.
50:56
And so that's how we kind of situate this philosophy.
50:59
What it what it does do is it it embraces
51:03
emergence which is just for the listeners emergence
51:06
is the philosophical idea where things
51:10
are more than their component parts and a concrete example is that for example
51:17
if you look at say if you've got fire you're sitting in front of a fire and
51:21
you throw oxygen on it what happens to the fire goes up if you throw hydrogen
51:27
onto the fire. What happens to the fire?
51:30
It goes up. I add hydrogen to oxygen. I combine them.
51:36
What happens when I throw that on the fire?
51:40
It diminishes its water and it closes it down. So adding things up does not
51:45
mean that you're going to get the result that you expected.
51:48
And when we think about clinical reasoning, there's a tendency to us think linearly
51:52
in terms of just adding things up or trying to subtract things.
51:56
And so having a philosophical system that embraces emergence,
52:01
relationality, and those kinds to concepts that I've been working with,
52:05
it means that we have much more of an idea of, or rather an idea of a direction
52:12
that we can practice and embrace uncertainty.
52:15
Because I think one of the issues with reductionism and the biomedical model
52:19
perhaps is that if we just knew more, then of course we would sort all these problems out.
52:25
Of course we would treat pain and we'd be better because we understand the smaller minutiae.
52:29
We can reduce the shoulder to its bones to its ligaments to its cellular matrix
52:36
to its allostatic load or whatever, all we need to do is just go further and
52:39
further and further down. And of course, the answer will come about.
52:43
Well, that's not the case. And what have we inherited that from?
52:46
We've inherited it from perhaps Greek philosophy, where fantastic philosophers,
52:51
and they've given us loads of great ways of thinking, but they've limited us in certain ways.
52:57
And that's around the idea of essentialism, where all entities have properties
53:01
in and of themselves, which then lends itself to, if we understand the properties,
53:06
then we'll understand the whole and so on. Anyway.
53:11
It's also the way it's easier for us to think.
53:16
No, I see that in clinical practice all the time.
53:19
I try to make people comfortable with the uncomfortable, comfortable with sometimes
53:23
not knowing and not needing that very precise diagnosis I want to go.
53:28
But actually, for the person in pain and Mantell, do you remember when we listened
53:34
to Jeremy Lewis, that Hilary Mantell said about her pain, the worst pain is
53:38
the one you don't know anything about.
53:40
It's don't you think that actually as humans we want
53:43
the certainty and so we are there in
53:46
the difficulties of as clinicians day to
53:49
day that to help the client to
53:52
feel safe with the certainty while actually deep
53:55
down we know oh actually there is no certainties so our intention all the time
54:00
is really really really difficult but the social the ecological change that
54:07
you we cannot make it If we all have the same common narrative,
54:15
aligned, because then we change societal beliefs.
54:18
We change how people behave, and that's social responsibility.
54:24
But now it's just too difficult because people understand this so neatly.
54:29
Yeah, yeah. This is a really good point because there is patient expectation
54:32
as well, which we could talk about for another five hours.
54:36
It's great conditions changing this kind
54:39
of idea and opening i think dave professor dave
54:42
newell from health sciences university has a nice point here
54:45
in the summary i'll just read it out for those who's in the podcast dave says
54:48
could we see matt's ideas as a lens through which we see the
54:51
health landscape there's different doors where before there were walls flat
54:54
ground where it looked like a hill the afford and space changes which is wonderfully
54:59
put isn't it and i can imagine clinicians listening to this adopting this and
55:04
thinking i'm going to put more weight in this and think about all this and maybe
55:07
go to the person's garden to work with them instead of bringing them into my sterile clinic.
55:12
How do you deal with patient expectation? Is that just a gentle process?
55:16
Yeah, no. And I'm not suggesting that anybody should change their practice.
55:20
So this is not my goal. My goal is to open up what is possible,
55:24
the space of possibilities.
55:27
And pose the question, if we keep doing what we're doing, our patients,
55:32
even if we look at it from a humanistic perspective, are we helping the patients
55:37
that probably need it the most?
55:39
And and in a non-human perspective
55:42
how can we as a as an
55:46
ecosystem work together such
55:49
that everything in terms of our life cycles all organisms both life and death
55:55
can support each other in a community in ways that we wouldn't have imagined
55:59
before because we tend to separate ourselves from our ecosystem regardless if
56:04
we kind of think of that or not we don't we think we think about life.
56:10
But but our death is the life yeah things work in cycles right and it's just
56:17
being part of just it's just recognizing this kind of whole sphere of understanding
56:22
what health is in a different way than what we currently do,
56:26
I learned so much from, I always mention it, my son all the time because he
56:32
did the anthropology and now he's medical anthropologist and his work was on plant medicine.
56:37
But the things I learned about how they view healthcare and actually how they
56:44
view our plant medicine or shamanism, Viewer care is not as person-centered,
56:52
but as world-centered.
56:53
So the liminal space, the plant medicine is there to create a liminal space
56:59
to actually then get them to better symbiosis with the environment.
57:06
So healthcare is about a symbiosis with where they live.
57:11
And for the viewers, you don't have to take it that far.
57:14
I'm giving you i'm giving i'm giving you like a
57:17
really big broad brushstroke and you might go you know
57:20
what actually there's something small that we can perhaps
57:23
do differently that changes the relationship
57:26
that we currently practice in such that it helps whichever direction you wish
57:31
to go as a as a as a as a soft tissue treatment therapist or an msk clinician
57:37
or whatever it's what it what it's trying to do is to go right i mean i'm pushing
57:42
this is where i'm trying to push physiotherapy,
57:44
only because that's my profession, I wouldn't want to speak on the behalf of other professions.
57:48
But I really think that the way that physiotherapy is going,
57:52
it's going in this kind of direction where, particularly in musculoskeletal
57:56
contexts, that we're not having the impact on our patients in the way that we think we are.
58:00
And there's plenty, right? There's plenty of different ways that we could be practicing.
58:05
And I think when I talk about the musculoskeletal community,
58:08
I include you guys in this, right?
58:09
We're running it together is let's provoke each other and see where this could go.
58:16
Okay, that's a good soundbite there. Did I spot there that rather than person-centered
58:21
care, we should be adopting a world-centered care? Did someone say that?
58:25
Does that encapsulate it a little bit? So there was a paper done by Barb Gibson,
58:29
which talks about decentering persons actually fulfills some of the,
58:35
well, in fact, most of the virtues of person-centered care.
58:37
In other words, considering a person, if you imagine a network of relations
58:41
with a patient at the middle,
58:43
if you de-center them and so they become part of the whole, let's call it the assemblage,
58:48
actually the qualities of person-centered care are probably increased because
58:53
you're recognizing all of the relationships without being blindsided by focusing on the person.
58:59
Even Vonnie's going to that himself. He developed it, didn't he,
59:02
and took it away from person-centered care into looking into politics and the bigger picture.
59:08
Didn't quite get the note so i'm not trying to diminish i'm not trying to diminish
59:10
person-centered care by the way but uh you know just thinking about the limitations
59:14
of our models this is how we started though i think and we're 903 now so i'm
59:19
conscious you guys probably have to go but,
59:21
this is how we started i think is is by looking at that massive
59:24
kind of big hole pitch in the distance then it's making more sense of the stuff
59:29
we've got at the moment is is connecting the dots a little bit better this is
59:32
what i get from what you're talking about and even though like you said guys
59:35
I'm not saying you need to just like start opening up your business in the garden
59:39
or go not yet but if you've got that,
59:42
kind of image in the distance somewhere then you can start making
59:45
tweets now like you say in the paper like the mapping and they're
59:48
taking into consideration and also yeah
59:51
challenging things like diagnosis we haven't had time to
59:54
talk about but just looking at the bigger picture which i think is is what the
59:57
take-home message is there i guess i'm not trying to get away from diagnosis
1:00:02
either i'm saying that's part of a particular lens but what is it limiting so
1:00:08
diagnosis are as limiting as they are enabling,
1:00:11
just think about what that is in the bigger context for your patient.
1:00:16
So a diagnosis can limit to you to a previous patient that had something similar,
1:00:20
or it could limit you to an algorithm, or it could limit you to just different
1:00:25
ways of thinking of how you might do a treatment regime, for example, or program.
1:00:30
And I think what it's limiting you as well as is what's enabling.
1:00:34
And that's what I leave it there.
1:00:36
That's good. That's good though. I think it was limiting as well as enabling.
1:00:39
Yeah, I like it. It's really cool. Wow, this should have been a two-hour session.
1:00:43
Okay, somebody in the audience did ask if people want to read this paper,
1:00:48
which is always a good sign. People want to read it.
1:00:49
It's still free access, is it? People can get it if they don't?
1:00:52
Oh, yeah, yeah, yeah, open access, open access.
1:00:55
And the other one I recommend is the Cause Health Rethinking Causality Complexity.
1:01:02
And that was one of the most amazing projects.
1:01:06
And I'm going to put a link for the book, but they have blogs.
1:01:11
It's fantastic, Mark. So, yeah.
1:01:13
So the Cause Health project, that's really, so if people feel uncomfortable
1:01:17
about me talking about de-centering patient care,
1:01:20
that is all about patient-centered care and it
1:01:22
resonates it's going to resonate far closer with you
1:01:25
it'll have a closer connection it talks about philosophical bias
1:01:28
it talks about the evidence-based paradox where the
1:01:31
systematic reviews of randomized control trials at the top are somewhat subverted
1:01:36
by clinical reasoning at the bottom because you have to apply clinical reasoning
1:01:39
in order to use the best of the available evidence so it basically looks at
1:01:44
all the things that might tick your biases in terms of understanding a balanced
1:01:48
perspective on evidence,
1:01:50
understanding clinical reasoning,
1:01:52
applying things in practice, and thinking of different ways and how you can do that.
1:01:56
So, have a look at Rethinking Causality Complexity for the Individual Patient.
1:02:01
It's open access, and it's part of the Cause Health team that's published in
1:02:05
2020 under editors Rani Lil Anyum, Sam Copeland, and Eleanor Rocker.
1:02:13
Fabulous And Roger, was Roger as well on it?
1:02:18
He wasn't an editor, he was one of the chapter contributors with me.
1:02:24
Fantastic right but at that time thank you so much so yeah
1:02:26
we've been talking about the paper physio physiothology a
1:02:30
post-humanist perspective on physiotherapy you can google that and
1:02:33
you'll find links to it as always we'll make sure it goes into the show notes
1:02:36
along with the video which i thought was really cool as well for breaking it down
1:02:38
a little bit and links to everything else we've mentioned it has
1:02:41
been i think you're going to need to do that i mean this is kind
1:02:44
of i'm hoping everyone's still here
1:02:47
watching us there's been some quite the moment
1:02:51
you said climate change that just kind of like opened up this massive
1:02:55
kind of sphere yeah but but there's yeah
1:02:58
you're gonna have to listen to this one back again and and
1:03:01
and look at the paper the papers breaks down these things wonderfully
1:03:04
and everything else so but i hope it has stimulated you
1:03:07
guys to i mean what is the i don't
1:03:10
want to keep going on but what do you hope i guess
1:03:12
a final question what do you hope listeners take away from what
1:03:15
we've talked about tonight i think
1:03:18
if what we've said resonates with
1:03:22
you in a certain way feel free to think
1:03:26
about transformation of what you do even if it's just a little bit even if it's
1:03:32
a small step challenge yourself to potentially think or practice differently
1:03:36
if you take that away from today i think that you know that's brilliant fantastic
1:03:41
that's good and maria what do you hope the listeners take away from today?
1:03:46
Well, actually, when we practice, we really need to think of this philosophy
1:03:54
and to actually make it clean, think of it as clinically applicable.
1:04:00
So even when we go and do our CPD activities, actually make a point to look
1:04:05
one paper a month or one paper every couple of months that it is,
1:04:09
or a book that it is philosophically based, and then really reflect on it.
1:04:14
Because actually you find what you align with and that will clarify.
1:04:19
Will help you so much on that decision making.
1:04:24
Fantastic. That's great. Imi, just to answer you, thanks for everybody who's
1:04:27
left comments tonight. Imi says, I've read the paper. What else can I read? In typical Imi fashion.
1:04:32
I need another book on my bedside table. I've only got 29 there. I haven't started yet.
1:04:36
But yeah, we'll make sure the links, Imi, don't worry. We'll make sure the links
1:04:38
to everything we've mentioned will be there.
1:04:40
And also, Professor David Newell has said, read the self-evidencing agent. Yes.
1:04:46
I would do. So we'll make sure a link to that goes inside there as well.
1:04:49
And he also says, thanks, guys. Fab chat.
1:04:51
Well, thank you, Professor Newell, if it suited you then
1:04:54
that's fine our job is done wonderful right thank
1:04:57
you everybody for joining us and just very briefly just to let you know what
1:05:01
we've got coming up next week so it's gonna be next tuesday we mentioned ai
1:05:05
there's a little bit of a segue there i don't think we're going backwards now
1:05:07
talking about ai oh i feel guilty now in fact no we won't announce it no not
1:05:11
at all i think it's brilliant it's so important it's so important for us to discuss this,
1:05:16
So, yeah, what we're going to have is the wonderful Tim Allardyce is going to
1:05:20
be in the studio, a firm favorite with lots of you who know Tim.
1:05:23
He's going to be talking about how artificial intelligence, AI,
1:05:26
is revolutionizing MSK rehabilitation.
1:05:29
So that's going to be next Tuesday on the Sports Therapy Association YouTube
1:05:32
channel and Facebook page, which both seem to have recorded wonderfully tonight without any issues.
1:05:36
So thank you, the powers that be, for allowing me to have a week off.
1:05:40
Thank you so much for who was involved in that.
1:05:43
But for now, then, yes, thank you so much to my guest for tonight,
1:05:47
Madlo. Thank you so much for coming in. Thank you very much for having me.
1:05:51
And thank you, Anna Maria Maccieri.
1:05:53
Thank you for allowing those chats to happen because they don't happen in many other forums.
1:06:00
And that's brilliant. Thank you, Matt. My pleasure. Absolutely wonderful.
1:06:05
If people have got questions, if people want to follow you, what's the best
1:06:07
place for people to follow you, Matt?
1:06:09
Where are you most prolific? Oh gosh, probably in LinkedIn now.
1:06:13
X or Twitter, it's kind of fallen quite heavily.
1:06:16
So probably the best place to have, I'm not as good at Facebook,
1:06:21
perhaps I should be better, but yeah, probably in my LinkedIn page.
1:06:25
So yeah, look me up there, quite easy to find me. It would be so nice to have
1:06:30
many more soft tissue therapists,
1:06:32
sports therapists and massage therapists on LinkedIn so that we have a community
1:06:36
there because at the moment it's very difficult to have those discussions within
1:06:40
our professions because they're not very present on LinkedIn.
1:06:44
So it would be nice to see more and more people on LinkedIn.
1:06:47
Yeah, LinkedIn, the place to be. And also people have joined us live.
1:06:51
I mean, you have got, you don't have to do anything. I hope you just enjoyed it.
1:06:54
But if you want to play a part of this, a part of the bigger picture,
1:06:57
then go forth and spread this information, share this episode.
1:07:00
And that's one of the best ways of helping healthcare at the moment is just
1:07:02
sharing episodes of the STA clinician podcast.
1:07:06
That's probably the best thing you can do at the moment. So,
1:07:08
because I think we put it in a nice, hopefully we put it in a nice gentle way.
1:07:12
I mean, something's not going to threaten you too much. We're not standing on a platform
1:07:15
somewhere shouting things out slagging everything that's happened in the
1:07:18
past off not at all we are here thanks to the people like
1:07:21
Carl Rogers all we're doing is just building on wonderful theorists in
1:07:24
the past and everybody and just kind of taking it to the next level which is
1:07:27
what it's supposed to be isn't it so thanks everyone for joining us I'll leave
1:07:30
you with that little task if you can share the episode that would be amazing
1:07:32
and if you are free if you listen to the podcast and you are free next Tuesday
1:07:36
at o'clock then feel free to join us either on the Sports Therapy Association
1:07:39
YouTube channel or on Facebook whichever you prefer until then as always take
1:07:44
care of yourselves and more importantly probably.