Confronting the Challenges of a Major Paradigm Shift

I’m not sure when it really happened. I guess these things don’t often happen with a sudden event, but with a gradual period of change when you look around and notice that things look different than they used to.  For me I think it began several years ago when I started running across some articles and video clips talking about new ways to conceptualize pain. I thought these things were interesting, but did not dig into it immediately. However, this is one instance when I credit social media with having a very profound and positive impact on stimulating thought and discussion that has radically influenced my outlook.

When I first got out of massage school in the late 80s I spent a great deal of time in the Emory University medical library in Atlanta, GA. At that point, one of the only ways to really immerse yourself in academic literature in the health sciences was to go to a university library where all these resources were stored. These were the secure ‘forts’ which were repositories of all this great information because there did not yet exist convenient or easy ways to disseminate this information to the public or others that weren’t near the physical location of a research library. Those were very exciting times for me because every time I went into the library I recognized what a treasure vault of information was there and I just wanted to dig into all of it.

What I really missed was the ability to have discussions with others about all the things I was learning and find places to ask questions because I wasn’t actually enrolled in any courses there. That has all changed now. The Internet has opened up access to an unbelievable amount of outstanding (and also crappy) academic literature. But more than that, it has allowed individuals all over the world to connect with each other and have conversations and debates about ideas and we can all benefit from these discussions even if we weren’t there when they first occurred. For all the disruptive, time-sucking, and mind-numbing things social media has done to us, I am grateful that it has given us the opportunity to create these communities of academic discussion so we can move our knowledge forward at a dramatically faster pace than we could in those old days.

But starting to drive really fast when you’re not quite ready for it can be very uncomfortable. This is what many people feel like when they encounter a major paradigm shift like we are currently seeing in the musculoskeletal healthcare professions that deal with chronic and acute pain conditions. This paradigm shift is so significant it has led to the emergence of an entire ‘specialty’ field which most people refer to as pain science.

One of the most common themes I’ve seen discussed in the pain science community is how individual practitioners experienced their exposure to some of these newer pain science concepts. Frequently, research findings may modify things we were initially taught. In many cases we are able to adjust course and look at things in a different light without it causing much tumult. For example, I, along with many of my contemporaries, was taught that massage helped remove lactic acid from the body after exercise. We spouted that information for years. At a later point research showed us that this simply was not true. It required an adjustment in the message we had been conveying about massage, but it wasn’t a difficult one to fit. It was like being in a minor earthquake where the ground just rolled a little bit under your feet and you stopped and thought…”wow that was kind of interesting.” (a real experience for me in San Francisco in 1984).

For many who encounter current pain science concepts, this paradigm shift causes a much bigger disruption. Think seriously shaking ground and big numbers on the Richter scale. Why does learning about pain cause such a big challenge to our whole way of looking at things? The answer reveals an interconnected web of physiological concepts. To unravel the findings of current pain research, we have to learn a good bit about biomechanics, neuroscience, physiology, psychology and many other areas. When the evidence pours in from all of these different streams there is strong indication that many of the things we were taught about how massage and manual therapy actually work may not be accurate. Now, most importantly, that doesn’t mean these treatments don’t work. It simply means they may not be doing what we thought they were doing, and that is actually very important.

When you are exposed to these ideas it may lead you to question a great deal about what you do and what you have learned. This can be very intimidating. For me personally, it has been a big challenge because I recognized that many things I have been teaching and writing about for many years may not be what I thought they were. However, we must be careful not to get swept away with the pendulum swing that is starting to go in a different direction. It isn’t necessary to throw out all of the valuable learning and clinical experience we have already built upon. But maybe we look at these things through a different set of glasses.

I went through a period of feeling very uncomfortable with how to reconcile all this new research with my current understanding of what massage and soft-tissue treatment was all about. The things I am reading and studying are still challenging many of my previously held beliefs and understandings. However, I now see all of these things in a much different light. I’m excited about looking at massage therapy in a new way, but also I am not willing to jettison the aspects of our work that change people’s lives and help them relieve their discomfort on a daily basis.

I think one of the biggest obstacles and challenges for those who are carrying the torch of the emerging pain science specialty is to understand how to introduce these ideas to those for whom this view is new. Too often I have seen and heard pain science enthusiasts speak to others with condescension and arrogance. As a teacher I clearly recognize how that produces an immediate degree of defensiveness in a student and that is a significant obstacle to learning. I heard a great quote from Til Luchau in a podcast when he referred to negative outcomes that occurred from ‘clumsy pain science education.’ I think there is a lot of that going around and it causes people to be resistant to the message and for the message to be distorted in the process.

Years ago during a period of intense self-reflection I realized that I had to make some professional choices because I was spreading myself too thin. I realized that my greatest passion and talents were as an educator and I made a promise to work extremely hard in raising the bar for massage education because that is what will shape the future of our field. So now I see this as a major task and undertaking ahead for me. I am an enthusiastic student of emerging pain science concepts as well as a staunch defender of the clinical value and benefits of massage therapy. My mission is to do everything I can to work toward highly effective methods of navigating this challenging paradigm shift so we can continue making massage therapy an even more beneficial means of addressing the extensive pain epidemic throughout the world.



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