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Massage Down Under

with Paula Nutting

Episode 118

Episode Transcript

Summary:

– Introduction to Paula Nutting (2:00)

– Paula’s background and transition into massage therapy (3:30)

– Changes in massage therapy training requirements (7:00)

– Integration with other healthcare professions (11:00)

– Overview of Chapman’s reflexes (14:00)

– Pressure and technique used in Chapman’s reflexes (16:30)

– Application of Chapman’s reflexes in different conditions (19:30)

– Challenges in understanding the efficacy of different techniques (23:00)

– Teaching massage therapy in different environments (27:00)

– Unique experiences teaching and learning massage in different countries (32:00)

– Outlook for massage therapy in Australia (39:00)

– Advice for new practitioners entering the field (42:00)

– Where to find more information about Paula Nutting (45:00)

Whitney Lowe:

And welcome to The Thinking Practitioner podcast, which is supported by ABMP, the Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package including individual liability insurance, free continuing education, and quick reference apps, online scheduling and payments with PocketSuite and much more. ABMP’s CE courses, podcasts, and Massage and bodywork Magazine always feature expert voices and new perspectives in the profession, including those from Til and myself and thinking Practitioner listeners can’t save on joining ABMP at abmp.com/thinking. This episode is also supported by the Academy of Clinical Massage, and if you are a massage therapist looking to elevate your practice and truly make a difference in your client’s lives. Our new in-depth orthopedic massage online courses are designed just for you. This training is fully online so you can benefit from the study wherever you are located. So please feel free to drop by our website at Academy of Clinical Massage to learn more. So, hello everyone. Til is off this week and I am delighted to be joined by my friend Paula Nutting from Australia. Paula, welcome to the Thinking Practitioner.

Paula Nutting:

Thank you. Thank you Whitney, and how lovely to actually say friends. That’s where I feel like we are. We’ve been in the industry a long time.

Whitney Lowe:

I was going to say, I was trying to remember how long it was and when we first met, but it’s fading off into the distance somewhere or not. Do you remember when we met?

Paula Nutting:

Yeah, it was one of the conferences down. I’m thinking it was in Melbourne that you were at, and that was probably about 12 years ago.

Whitney Lowe:

Yeah. Yeah. So wonderful. Paula, for our listeners that might not be familiar with you and your work, I would like you to take a few minutes to tell us about yourself, a little bit about your background and what you’re doing nowadays and what you’ve been up to for a bit there.

Paula Nutting:

Sure. Excellent. Thanks so much, Whitney. So originally was a registered nurse years and years ago, and then went into personal training and aerobics and then got excited about the massage industry. So moved across from one side of allopathic work to more of a complementary medicine model and I did my diploma and then had the opportunity to do the degree in health science musculoskeletal. So that was my course of journeying. And then I treat from my home clinic, always have had a home practice as well as teaching both online and face-to-face courses. And it’s mostly in, well musculoskeletal dysfunction, but it’s given anything from acute to subacute to chronic.

Whitney Lowe:

Yeah, wonderful. So I want to hear a little bit more about that in terms of your background in making that transition. I didn’t remember knowing that you had been a nurse before, so that’s an interesting part of that process. So what caught your eye, what brought your attention to the world of massage from what you were doing before?

Paula Nutting:

I worked in intensive care unit at one of the biggest hospitals in the Southern Hemisphere at Royal Brisbane, and I suddenly realized I was going in, only wanting to look after the people who were paralyzed, sedated, ventilated, all the machines, everything that went, “Bing, bing, bing.” And I completely lost my empathy. There was just nothing more in the tank. A girlfriend of mine said, “Hey, I’m going to go and do an eight-week massage course,” because in those days it was just a completely different system. We have a health training package that is nationally recognized in Australia, but prior to that you could just do anything and then put your shingle up.

So I found that it was really lovely to be able to integrate with people, touch and time because we have both of those that most other professions don’t have, and the fact that I actually allow space for good treatment, hands-on skills that we learned through this one guy. And then I went from there, I thought, “I’m going to actually have to do a proper diploma.” In those days, our diplomas, again was not the health training package. We had a lot more content in our packages then, but because when I completed the two-year diploma, I had background in allopathic and fitness and health as well as what I’ve done, and the head of faculty asked me if I’d teach some four units in the diploma, which I graciously accepted. And then we went from there. We started doing the health training package in musculoskeletal therapy and we were invited to do the degree while we were teaching. So that was a three year, normally a three year.

Whitney Lowe:

So what year roughly was this when you were doing this training and making that transition?

Paula Nutting:

I’m looking at my paperwork up here, 2000 and… When did I start? God, it seems to be… I’ve been trained for like 28 years. So I think the musculoskeletal course we completed in 2007.

Whitney Lowe:

Yeah. So has the training requirements for becoming a massage therapist changed significantly since the time when you were doing that?

Paula Nutting:

My hat, absolutely. And I would like to say it’s become excellent, but I think we’ve got too many hands in the pot and it’s actually softened it all. So there’s not the scope for schools to be able to teach what they want as much as what they think that the public health risk safety… Sorry, I’m just putting this phone on silent. I didn’t realize it was on. Yeah, so it’s blended down. The things that we learned were quite in depth. We did a lot of orthopedic testing when we went through, we did a lot of nerve flossing, not tethering. We did a lot of muscle energy techniques, myofascial release techniques.

Whitney Lowe:

So this was in your basic training programs that you had that level of… Wow.

Paula Nutting:

Yeah, sports injury management one and two where we were learning how to tape.

Whitney Lowe:

What was the length of that program? Was it in clock hours?

Paula Nutting:

Yeah. Because now they do them in clock hours or they do them, but back then it was four semesters, full time.

Whitney Lowe:

Okay, so you said about two years.

Paula Nutting:

Yeah. Do you remember the book Magee’s Orthopedic Assessment?

Whitney Lowe:

Of course, yeah. Yeah, the Bible on all that stuff.

Paula Nutting:

We had to learn that.

Whitney Lowe:

Wow, that’s heavy. That’s a bit of overkill. But yeah…

Paula Nutting:

He was totally overkill and we were being taught by physiotherapists and osteopaths primarily. So if you were lucky enough to have a teacher in the class that was an osteopath, they taught you extra tips and skills. If you are lucky enough to have a physiotherapist, they go, “Well, we would do this, but you can’t because it would be out of your scope, so you just refer them to me.”

Whitney Lowe:

Right. An interesting twist on there.

Paula Nutting:

But the musculoskeletal therapy, that degree only went for a certain length of time. That was probably two years, and then it’s been disbanded and it’s been fed into what we call our myotherapy advanced diploma. So it’s a nationally recognized course.

Whitney Lowe:

So, is it roughly the same number of hours or same length of the program now, or is it…

Paula Nutting:

No, no, that’s slightly less. There’s working in collaboration with one of our private health groups here in Australia, and they’re trying to set up an associate degree, which would be what we call AQF 7. So we have an Australian standard framework that we work through. So it’s really structured in Australia. It means that if you get taught in Perth, you go halfway through, you might do your college tutors in Perth, you can go anywhere else in Australia and your qualification will be accepted. It’s not like in America you have the chapters and one chapter isn’t transportable to another chapter.

Whitney Lowe:

Yeah, it’s this state by state licensure thing, and it is definitely not very portable. So we’re trying to work on that part of the process right now. But I’m curious too, because I know the training here in the US is significantly different than in some other places, and one of the big things that we grapple with here is because the basic training is a bit less than what it sounds like you’re talking about in the programs there. There’s this division over here between massage as a wellness service that might be done in a relaxation environments versus the more medical or clinical applications. But it sounds like there, the training that everybody’s going through a much more rigorous, medically oriented training program. Is that correct?

Paula Nutting:

Yeah, it is getting a little bit… It’s chunking away from either end. So we used to have a certificate four, which would be what we would call the wellness program. So that would be one year, and they would have the skills to do soft tissue work, take a good history like soap, but they wouldn’t be going into the in-depth where we do extra assessment, take active-passive resistive, some orthopedics and where that would feed into our therapeutic model versus our wellness model. Nowadays, they seem to be doing less of the orthopedic work. They seem to be doing less of the high-end stuff. So they’re adding a little bit where the people who would normally do a certificate four have to go through and they can complete their diploma in as little as 12 months, sadly.

Whitney Lowe:

Yeah. Well, how does the public… Is that a challenge for the public to recognize the differences in training that people have? Because that’s one of the things that we’ve grappled with a lot over here as we talk about split credentialing, how would people know the difference about the different levels of training? Has that been a challenge?

Paula Nutting:

Yeah, I think so. There’s a lot of, we have… Because I’m with Massage and Myotherapy Australia, the AAMT, we’ve always had a great structure where if someone rang me and said, “Listen, I’m after a massage therapist in Albion, now what are you looking for?” And I would normally put them up to the Australian Massage Directory so they can have a look online and people can put their qualifications in a space where they can look up. So it’s like a Google for massage.

Whitney Lowe:

Oh, nice. Yeah.

Paula Nutting:

So for me, mine’s got musculoskeletal therapy specializing in chronic… But you’ll know that there might be people that come in that would specialize lomi lomi or KaHuna or reflexology. To break it down to wellness I think we just go most of the wellness at places like the Marriott and the Siebel and the Hilton where you know that they’re day spa focused, most of those circus will not have anything more than the minimum standard. As you have over there, you all have to have continued professional education, some but they’ll be delving into the depths that we require. The higher the education, I need 50 credit points a year. If I had it by the 40, if I tapped out of four, I would need 30.

Whitney Lowe:

I see. Yeah. Yeah. So it’s scaled. It’s scaled down at the different levels there?

Paula Nutting:

Yeah.

Whitney Lowe:

Yeah. That’s interesting. Yeah. One of the other things I was curious about, how has it been for integration with the other parts of the healthcare system? Is massage covered at all for health insurance at all in Australia or how has that handled?

Paula Nutting:

Yeah, I’m glad you asked that, Whitney. Yes, because that could be a two-edged sword. We have the private health funds, we’ll give rebates for massage. We were trying to fight to get Medicare, so Medicare is where there’s up to… I think there’s 10 health professions that you get a Medicare card and you can tap it and the government will pay a portion. And we were trying to fight to get that for a while, and then we just decided it was in the too hard basket. We don’t have registration. Massage is not registered, but we’re trying to get a co-regulatory body within the associations.

We can’t kill people, so we’re not dangerous enough to be registered, which is nice not to be in that pot. The health funds are a big marketing play.  Because we go, “Look, come in, you get 25 or $35 back on your treatment,” which a lot of people love that. And at the end of the calendar year or the end of the financial year, all of a sudden you get booked up to your eyeballs because people are going, “Oh my God, I still got 450 bucks worth of…”

Whitney Lowe:

Oh wow.

Paula Nutting:

… “Massage to spend in my calendar year,” which is good.

Whitney Lowe:

That is nice. How is massage being perceived by other healthcare professionals, the physiotherapist community and that kind of stuff? Is there a fair amount of integration or is it still a lot of silos and not communicating a lot?

Paula Nutting:

Yeah, physiotherapy probably is the least most integrative for massage. There’s a big disconnect. The chiropractors and the naturopaths are probably the closest alignment because they’ll go, “Look, have a massage, then come in and I’ll do an adjustment or the massage will do well to maintain your body whilst we’re nurturing you with whatever herbs, medications that you need.” We do link well with osteopaths, and quite often there we’ll have hubs where you might have a couple of exercise physiologists, a couple of physios, a massage therapist, a chiropractor. Maybe if you’re attached to the hospital, you might have a nurse that’s involved with cardiac health. So it depends on where they are, but there’s quite a few in Australia popping up all over the place where they have everyone in one flagship. But I think we’d be the fighters between physio and massage because they see us as not having… Because there’s no evidence behind doing any touch or for the greater, especially the new physiotherapists. Physiotherapists in Australia currently come out with almost no touch education.

Whitney Lowe:

Oh, really?

Paula Nutting:

Yeah, almost none.

Whitney Lowe:

That seems odd to me because the perception that a lot of us have over here in the States is that a lot of the physiotherapists in Australia, we’re doing a lot more manual therapy type of thing. So that’s no longer the case or not accurate?

Paula Nutting:

They used to, loads and the older skill set, absolutely. They’re all hands-on, on the table loosening things off, then give you an exercise, might do some taping, might do some stretching. Nowadays, it seems to be all exercise only very few will do any manual glides, neuromuscular techniques, muscle energy techniques. Quite a few of them will do an extra course and into dry needling and do some myofascial dry needling and then they’ll give an exercise. So it’s great for us because we are getting more and more and more clients and patients into us because they’re going, “I’m not getting what I want. I’m not actually getting to massage and loosen the tissue.”

Whitney Lowe:

Yeah, interesting development. The way that this is growing, I’m always curious to hear from people in other areas how that is growing and changing in the degree of integration because I think there’s certainly a lot of movement away from a lot of hands-on and manual therapy in numerous professions, mainly because it takes a lot of time and doesn’t seem to be as cost-effective to be able to do that for many of these situations. But like you said, that’s one of the things that is good for the business of the manual therapists that are doing it because people still want that very badly and they want to have those services available.

Paula Nutting:

I was with my physiotherapist a week or so ago just doing some work on this cranky hip of mine, and she’s up on the table doing some inductive work, glides, loosening, mobilizing, and I’m listening to the guy across in the other room and he’s talking to his patient about, they come from Dolby, which is regional rural Australia, and they’ve been pigging or what are they doing and they’ve been fishing for Barra. And I said to her, “That work over there, he’s getting as much work, that integration that they’re having in the conversation whilst there’s touch, how do you measure that because that’s actually making effect in that treatment room.” He said 100% that it’s not just the hands-on, it’s that human interrelationship where there’s trust, nurturing, you’re getting an understanding of what’s happening with the tissue while you’re talking. What is happening to that person? It’s a great wellness model.

Whitney Lowe:

Yeah. I’m hopeful and curious to see where some of these models will expand and develop for education in our fields in the future. And I think we’ve got so much to learn from what the other professions have been through and also what each of us are growing into. So it will be curious to see where it does continue to grow for us. What’s that?

Paula Nutting:

How to teach it and assess it.

Whitney Lowe:

Yes. Yeah, indeed. Well, I want to get back to your path for a little bit and talk some more about some of the things that you’ve been doing because I know you’ve been teaching for a lot of years, been doing a lot of different types of things in your work, and one of the things I know you’ve focused a good deal of attention on is your courses in Chapman’s reflexes, and that is something that I know almost zero about, and so I wanted to hear a little bit about that.

So if you can give us some framework about, I remember first off reading and encountering the concepts of Chapman’s reflexes back in Leon Chaitow’s, one of his very first books, the blue Soft-Tissue Manipulation book. I think it’s out of print now, but that was like an early one for lots of us back in the 80s, and that’s when the first time I remember hearing about that. But I have not seen, heard or ever taken a course in this kind of stuff, and I was hoping maybe you can tell us a little bit about your work, your approach there and what that is about.

Paula Nutting:

Sure, I’d love to. So Frank Chapman was an osteopath in the 30s and 40s, and he specialized in visceral work. So Chapman’s reflexes are otherwise known as neurolymphatic points. So the neurolymphatic arc he was uncovering if there was congestion within the lymph system, it would affect the reflex arc of the nerve and by him stimulating it at the most distal point, so into that superficial fascial region, it would mobilize and get some more motility through the lymph and stimulate the neural arc and then the organ would improve its quality.

Whitney Lowe:

Can you tell me a little bit about what that pressure would be like? Is this small contact surface pressure work, like trigger point type of thing or moderate level pressure? What is it like?

Paula Nutting:

That’s part of that thing that Leon was talking about with the pressure and touch. Fred Mitchell talked about it because he was involved in it as well, and it’s moderate touch. So it’s actually if you’re putting fingers on your skin and then you are mobilizing the skin on top of the underlying surface, so you’re not sliding across the skin, you don’t do it with oil. It’s a non-oil-based. For Newton’s third law, every action has an equal and opposite reaction. It’s where you feel that first point of resistance and that’s when you start mobilizing. And there’s specific points that were actually marked out by George Goodheart who first discovered that the area that affected the stomach also stimulated the pectoral fibres of the clavicular head of the pectoralis muscle.

And that muscle became strong. So he then mapped pretty much most of the muscles that they use for touch for health. So touch for health can be either emotional or it can be the applied kinesiology side. So the applied kinesiology is the model I work from, from a defense pattern because everybody comes in with a level of defense, in my experience. Anyone who’s got pain is generally because whatever general position that their body has been in, we start adapting through fear. So we all see those shoulders rolled forward, chin tucked in, hips closed, and it then modifies our natural movement patterns.

We start seeing maybe the pathological resting position in the joints, not quite sitting where it should be. Maybe we are getting a little bit of compression in where the facets would normally move in a glide, whatever it looks like there’s changes in the body that creates some kind of pain response. So by working in the Chapman’s reflexes, I do a strength test for the muscles that are primarily defenses. So hip flexion, hip extension, trunk, lateral flexion, lower limbs, mobility of the thorax to get into extension versus closed down neck abdominals, whatever’s weak. I will then facilitate the specific arc, which is what I teach in the courses. So we might go a very simple way to work. It would be if the hip flexors are short and tight, so we all know that we get that stretch weakness. So they’re really strong in a seated position, but when we start moving them in the leg into an extension, the psoas iliacus rectus femoris don’t probably maintain a pelvis that’s really stable.

So we’re losing protection of the vital organs inside. We then have what I love the term, an amnesic gluteal extensors. They’re fighting with that antagonist inhibition and the pelvis becomes more unstable. So our hamstrings will naturally hold on, tighten up a little bit just to maintain a little bit of stability and control at the ischial tuberosities. So when I, quite often I teach this or I’ll do this as a trick or whatever, if I’m talking to somebody in a podcast or they try to do a toe touch, stand up and try to touch toes.

If there’s a reduction and anyone who’s listening to this, I would encourage you to try it. So you got to go down, gentle, see how far you can get down, whether you’re getting mid-shin to your toes, whatever. And then I want you to stimulate the neural arcs, which are going to be responsible for your hip flexion. And that is either side of the umbilicus, just one centimeter out or half an inch and about three fingers, and you just sink into the tissue to feel that bone. And just we are stimulating, we’re doing vigorous but not hard, so we’re actually stimulating the nerve end points. You’ve done that for 30 seconds, you don’t want to be doing it for much longer because it nullifies it and then drop down and do a hamstring length test again. See how far you can go down and touch toes.

It’s quite remarkable how much distance that some people will get. You can get up to six inches of improved range because you turn on the neural arc for the hip flexors, which means there’s length, which means the protection model’s not quite as aggressive, which means that the amnesic gluteals can then perform a little bit better quality in extension. So the hamstrings don’t need to be on to stabilize pelvis.

Whitney Lowe:

Yeah. So would you say that there’s particular patient populations or client populations that you would tend to do this type of work with? Or do you do this on a lot of people? Or what’s the kind of person that you would say that comes in like, “Oh yeah, this person’s going to probably respond well to this particular approach?”

Paula Nutting:

Anyone who has stress, lower back pain, neck, shoulder pain, chronic overuse, that’s a big one. So someone come in who does repetitive upper body work, exercise, people who do a lot of running, walking, swimmers, not so much. People have got good oxygenation. People who have got very good diaphragmatic work tend to be less of a problem than people who have got poor diaphragmatic control. Those people who are the slouchy forwards, they need strength. And in the olden days, I used to massage everything, loosen everything off to the point of overkill as we all do, when we start massaging, we all start really deep, we stick our thumbs and elbows in to try to kill people because bash that muscle. And then as you start to progress your knowledge, you go, “That’s not that smart.” So let’s gentle up, feel for the tissue, feel for response.

But I will never loosen a rhomboid. I refuse to come in and destabilize the scapula stabilizers anymore, not unless there’s real reason for it to happen, but I will open through the chest, I’ll strengthen the thoracic, I’ll actually strengthen the support for the thoracic flexes so that their natural resting length is longer. Then I’ll loosen off the pectoralis anterior latissimus dorsi, whatever that looks like. Definitely arms. We don’t do enough work on arms. I believe we should be always working biceps down through to fingers and then do some scapula stability. And then if they’ve still got a problem with the rhomboid, we might have a little tweak, but not that would be the last program or treatment that I would ever do.

Whitney Lowe:

Yeah, it seems so common that people come in and say like, “Oh, my upper back is just killing me,” and I’ll write that area right between my back. So you’re saying that that’s not where you’re going to target, you’re going to target elsewhere to get that addressed or settled through another pathway then essentially?

Paula Nutting:

Yeah, it’s the same as saying, “All right, so if you’re having a heart attack and you’ve got pain in your jaw and down your arm, am I going to be treating your jaw and your arm?” No. And the other thing, people come in and say, “My pain is in my right lower back, right in there.” And then I’ll find that they’ve actually got the weakness on the left-hand side, and they’ll like, “But that’s not where I’m feeling.” I’ll say, “That’s fine. I want you to imagine if you have got a broken… Just say you’ve got a broken right leg and you’re on a push-bike, which leg is going to do the work? The right one or the left one, that’s the healthy one?” Well, the left one, so which one’s going to take first? Which one is going to show overuse repetitive fatigue? It’s not the right.

Whitney Lowe:

Left side.

Paula Nutting:

And they normally go, “Okay, I get it.” Because all clients need an aha moment because I do their treatment. Otherwise, they won’t do home care if they don’t have a aha.

Whitney Lowe:

Yeah. I’m curious too about this particular type of work because of your description of it being significantly impacting the neurolymphatic systems and the recognizing that all these things are tied together to a great extent. We’ve got so many people with these chronic pain problems, the fibromyalgia type of conditions and other very persistent chronic pain things that don’t seem to have a really good explanation. Do you find these types of approaches helpful in addressing that kind of thing?

Paula Nutting:

I’d love to say yes, but it’s so hit-miss. Fibromyalgia is one of those conditions that has so many tentacles, doesn’t it? And I think that there’s a lot in here that we need to address for them. The ideology can be so different. People have always said, “Oh, can this help for Parkinson’s or can this help for multiple sclerosis?” I’m going, “Not that I can see that we’ll hold it in a…” It was weak the first time I tested the glutes. And then the second time, the glutes were amazing.

But I have had quite a few clients that have come to see me who have got Parkinson’s and we’ve woken up the arcs and getting them to stand up and walk around. The comments have been, “Feel much more stable, feel like everything is lighter, feeling like I’m more in myself.” So to me, I’m happy. If they can feel it, they’re less likely to be a fall risk, then God, do it. I’ve only even known it as neurolymphatic points. And Frank Chapman died quite young, so in honor of him, his business partner Charles Owens, coined them Chapman’s reflexes. So that’s why I hold the change.

Whitney Lowe:

Oh, interesting. Yeah.

Paula Nutting:

But the neurolymphatic points something that back then, but are they mechanoreceptors now or are they Ruffini? What are they now because back then those terms weren’t ever used? It’s hard to pinpoint. Is it one thing and does it matter?

Whitney Lowe:

Yeah, I think we’re really, so many of us are grappling with a lot of these things of recognizing that some of our former explanations are falling short of giving us a good understanding of the theoretical models that we may have adhered for many of us stronger than we should for a long time. But things work, we find certain types of things or ways of working that seem to get really good results. And I think that’s one of the things that I really want to encourage people to keep in mind is that it’s going to be a long time, probably before we have really good solid research to understand exactly why certain types of things work, and we’ll continue along the way to try to be improving our accuracy as best we can. But the reality is we’re probably going to change our minds a good bit along the way too, as more things come out.

Paula Nutting:

There’s a great quote by Leon Chaitow that I put in and it says, “Lack of proof efficacy is not the same as proof of lack of efficacy.” And it’s brilliant because it’s exactly right. How do we know what we’re doing is actually what we’re doing?

Whitney Lowe:

And we can understand, we can have certain ideas that this is what’s happening here, but then you talk to the practitioner next door who’s doing acupuncture or whatever, and they’ll tell you it’s a completely different thing that’s happening there. When you do this based on… It is the models the different lens of bias that we all happen to look for.

Paula Nutting:

Yeah, so true. So true. But we hating on something aren’t we?

Whitney Lowe:

Yeah, there was a study that came out a number of years ago, and I can’t remember exactly the title of it, but it was something to the effect of it was about back pain and it was looking at a comparison study of different treatment approaches, and it was something to the effect of low back pain. What you have is who you see. And they were essentially saying, “You go see a chiropractor and you’re going to have a subluxation. You go see an acupuncturist and you got a chi blockage and you see a massage therapist and you have trigger point problems.” And we all probably have a piece of the accurate picture there, but probably not the whole thing. And there could be numerous ways that things are happening there. So…

Paula Nutting:

It’s funny because when I was going through college and I used to, when I was teaching, I’d go, “The region that you are struggling to understand are the clients that are going to walk in through your door.” It always would happen. I’d go, “Oh, I’m terrible. I’m having real problems with working out shoulders.” And the next 10 people that come in, six of them would have shoulder pathologies and you’re like, “Thank you universe, whatever you’re doing.”

Whitney Lowe:

That’s right. Feeding us those things to learn. So I want to take on a little bit slightly different track here too, and pick your brain a little bit because I am also an education fanatic and looking at how things are taught and how we get a lot of the concepts across, knowing that for lots of us, we’ve experienced people who are magnificent practitioners who get wonderful things done, but also when you get into the classroom, they’re not always the best educators of transmitting that information to everybody. And so I’ve always tried to focus a lot of attention on learning how things work well in different environments. I’ve noticed that you are doing a fair amount of your teaching still, as always in the classroom, but you’re also doing some online teaching stuff as well. And I was curious to hear your experiences of trying to teach and get across some of those concepts in those two very different types of environments.

Paula Nutting:

And palpation work as we do, body work as we’re teaching body work. It’s tricky. I find that the one thing with online stuff is you do not want to do death by PDF or death by PowerPoint. So it’s got to be integrated and it’s got to be something that they are doing. So, kinesthetic. When I designed, I’ve always had the three online packages of silver, which is just for people who want to dab in the water to see what the Chapman’s reflexes are that neurolymphatic work is, do some of the quizzes because there’s five sections in those modules, just tap through those.

And then just an interest article. So then there’s two more that are more in more depth, and they both include having to provide online assessments. I’m watching them. It would be like, we are here and you’re providing a, “Hi, Paula, it’s Candice here, and I’ve got my friend Jessica and she’s on the table, and we’re going to go through the testing for the diaphragm and the stimulation…” So that I can actually see what they’re doing. And then I will always send a video back. “It was great. I saw that if you look at one minute 26, check that out again and watch what your client did with their arm. They did some internal rotation, which you probably didn’t see, but they were cheating. So we give always feedback.

Whitney Lowe:

Nice.

Paula Nutting:

And the courses are all… The quizzes are all mix and match, or they’ve got to move things from here to there. It’s not just a reading. They’ll highlight on an image and it will flick and the information will be behind it so they’re not sitting scrolling. When we hit our fabulous pandemic, I changed also to have either an evergreen or a live. So we’ve actually got the course that I videoed as a webinar, and then we come in and we go through it. So I’ll be here with you and whoever, many students, and we are going through each of the modules. And then we’ll go, “Okay, stop. If you’ve got someone in the clinic with you or here with you, you are going to do that treatment, the assessment, and then the facilitation while we’re all watching.” So it’s actually live, tricky to do live just because time zones are so horrendous.

Whitney Lowe:

I’ve certainly found that there are things that work better in the online environment and things that definitely work better in the classroom. And it’s a bit like comparing apples and oranges if things are done really well in each one of those environments, things that are just very, very difficult to duplicate in each one of those places about doing things that they both do well. I mean, I’ve got students in our online program all over the globe that would not be able to come and do an in-person course. And when we do the in-person courses, there are things that have come up with questions and discussions or quick little demonstrations that are very difficult to reproduce online. So everything seems to have it’s pros and cons, for sure.

Paula Nutting:

Yeah. I know that most therapists, when you talk to them, they want to engage in something that is manual just because… That’s why we’re who we are. We’re not accountants. We are drawn to body work. We are drawn to doing kinesthetic work. So somehow we’ve got to add that kinesthesia into the teaching to satisfy that emotional component.

Whitney Lowe:

So I also want to ask, you’ve done a pretty fair amount of globe-trotting, being around teaching in different countries in different places here. Are there any unique experiences or things that you learned about massage in different countries or different places that particularly stood out for you as you experienced the practitioners needs to in different locales?

Paula Nutting:

Yeah. Yeah. My first experience was going over to an AMTA conference in Cincinnati, I think. And it was just mind-blowing that there was so many variations of what educational… “No, we could teach it, but we can’t teach there. And that’s under beauty and that’s not health. And that’s…” I go, “What the… How the heck do people travel?” Clearly you don’t because it would be a pain in the jinger to be able to try to go from… And I think one of them was North Carolina and South Carolina have got two different things in your…

Whitney Lowe:

We have a lot of that mess.

Paula Nutting:

Horrible. And Leon Chaitow was actually teaching, there was another course I was in Winnipeg, and he was making comments about… He was showing some muscle energy technique work, and he made a comment that the Australians seem to have a broader knowledge. He said, “I’ve always found that the Aussie massage therapists are some of the best in the industry,” which is very lovely of him to say that. But I think it’s probably just because we all learn the same thing. We’ve all got the same length of time.

We’ve all got to cover off certain components within the… You have to get registered training organization, you have to follow the health training package. So there’s not a variety of everywhere. I am just trying to think, I’ve always picked up one or two skills from… I’ll be teaching a class, I might be doing something on muscle energy techniques for the lateral trunk, and then a therapist in there will go, “Well, do you want to see what I do?” Yeah, absolutely. And it’ll be just a variation, but everyone’s got great touch.

Whitney Lowe:

Yeah, that made me think when you were talking a moment ago, when we were talking about the difficulties of traveling between different areas, do you have an idea how many massage schools or training problems there are in Australia currently? What the number is that?

Paula Nutting:

Yeah, we’ve got training schools. There’s probably about… There’d be at least four in each of the major cities. That’s four times seven, and then there’ll be a few satellites as well. So I’d probably say there’d be over 50, well over 50 schools.

Whitney Lowe:

Yeah.

Paula Nutting:

You got to remember that the middle of Australia is nothing.

Whitney Lowe:

There’s not a lot there. Yeah. Yes. We’re talking about around that. Around the edges. Yeah. Right. Well, yeah, there inherently lies a big part of the problem for us because we currently have, I don’t think anybody really knows the numbers now, but the latest estimates that we’re hovering somewhere around 900 schools in the US right now. And that’s one of the reasons there’s such a patchwork of training because it’s just incredibly difficult to get any consistency among that many different training programs. And then, like you said, we have 50 different states and many of them have very different requirements and limitations. So it really does make the consistent standards of training challenging to try to access for sure.

Paula Nutting:

And that’s the registered training organization. So before we had our RTOs, we had loads more, loads and loads. Every corner would whack up a school because…

Whitney Lowe:

Oh, really? Yeah.

Paula Nutting:

They didn’t have to cover off government regulatory model. And now they go, “Hang on, that’s going to cost me a lot more time.” We get the auditing. There’s a lot happening where they just go, “Well, I couldn’t be bothered anymore.” Did lose a few really good schools. We had a great woman, Mette Sorensen, who teaches lomi lomi and KaHuna, and she had a brilliant course who had these gorgeous therapists who had most amazing techniques in both of those art forms. And she just stopped because she said, “I’m not going to compete with… I’m not going to have to rewrite my whole training for the government. Just not going to do that.”

Whitney Lowe:

Yeah, yeah. Was that in terms of… We had a huge bubble of schools here in the United States that seemed to have peak around 2007, 2008, somewhere around there. When we got up to close to 1600 schools, I think was the number at that time. It was just insane. Was it around that time that you were seeing the largest number? I’m curious if you had a similar practitioner bubble at that time.

Paula Nutting:

I think it was before 2005, because that’s when the health training packages first came in. So it would be 1980s up through to 2005. We had a lot of schools. Nowadays, it’s a coffee shop, every corner’s got a coffee shop on it. Come in and do an eight-week course from 6:00 to 9:00, eight weeks. You’re just doing it, off you go, have fun. So anyone could do it now. It’s totally different model.

Whitney Lowe:

Yeah. Yeah. So, well, it’ll be interesting to see. It’ll be a little bit of time probably before we see the impacts of what that’s going to be. But what do you see as the outlook for massage in Australia? Do you see it as going in a positive direction still with both access to good care by the public and good training for the practitioners?

Paula Nutting:

I think we’ve got stable training for the practitioners. I think the old day therapists of my ilk, once we die out, the skill sets will be much less because we just had those skills thrust upon us. They’ll still be safe, and they’ll still be lovely to come in and have a massage. They’ll still have people who are interested in doing their professional education that will include more knowledge and more skill sets. So there’s a lot of therapists now. They love doing the… They’ll do a certificate in dry needling. So we’ll stick needles into the client. I’ve got that within my degree, but I don’t choose to do dry needling. I find that I could get just as much effects with what I currently do, so I just don’t choose to. But there’s risk around sharps, et cetera, hazards, and I don’t want to add that into…

Whitney Lowe:

Yeah, we can’t puncture the skin here in the US as a massage therapists.

Paula Nutting:

You can throw them in like darts down here, and then you can jam those things in.

Whitney Lowe:

Yeah. Interesting. Yeah. If you had to give advice to a practitioner who’s entering the field now, what advice would you give to somebody for where it’s going in the future?

Paula Nutting:

Yeah, I think I would probably say, and it’s a really good question, I hadn’t thought about it, but try to, when you first start, treating, honour, the client that comes in. Allow them to come in with whatever baggage they’ve got without any… Don’t assess them aggressively or if they’re late. So, “Therefore I’m going to rush this treatment,” that kind of stuff. Feel free to give free treatment until you can build up a body of people that come into your room because we need to… Doing something for nothing is better than doing nothing and wanting to get… And when you’re touching people, touch them like you’re touching your mother.

Don’t touch them like they’re a footballer unless they’re a footballer. Just be mindful of your pressure because we’re creating inflammation to create repair, but there’s a level of tissue damage that we don’t want to cross. And when we start, we all work really deeply, and it’s just you’re wasting time in your skill sets by doing that. Start listening with your fingers. We used to do this, “Try this, boys and girls…” We just get a piece of paper and a hair and put it between the paper. You’ve probably done it as well. And you palpate until you can feel the hair. And two pieces of papers. If you feel the hair, you could put between that hair and your fingers and palpate, learn your palpation skills.

Whitney Lowe:

Yeah. Yeah. It is interesting. I do think there is a generalized trend across a lot of the soft tissue therapy approaches to less intensive type of work nowadays than was done not that long ago. I think we’ve found there’s not always so much benefit in trying to dig down, dig deep, and dig things out, that there’s other ways to get the responses that we’re really looking for from people, more so from the nervous system.

Paula Nutting:

And if you’re going to go deep because you need to go deep, go slow.

Whitney Lowe:

Yeah.

Paula Nutting:

That’s the key is time under tension here. So just if you’re sinking in, sink in, wait and then just the tissue will allow you, because the nervous system will calm down enough to take some of that tension off, and you’ll be able to get into those deeper areas and get off the psoas. Get off the psoas! 

Whitney Lowe:

Til and I did a whole episode about that, and that comes up frequently in different classes, and it starts some very vigorous debates amongst people. But I’m in that camp of, “We need to back off that a little bit.”

Paula Nutting:

Play with iliacus before you come digging in the iliopsoas. Iliopsoas is a stabilizer anyway, more than a hip flexor, really.

Whitney Lowe:

Yeah. Yeah. Interesting. Well, Paula, thank you so much for joining me today. Where can people find out more about you, your work and what you’re up to and everything? Where can they connect with you?

Paula Nutting:

Sure. Well, I’ve got my website, which is www… Just look up Paula Nutting because it’s actually called Your Musculoskeletal Specialist. So when I set up my website, I didn’t think about how long it takes to type in Your Musculoskeletal. So look just up Paula Nutting, and you’ll find it.

Whitney Lowe:

All right. And that is N-U-T-T-I-N-G. Correct?

Paula Nutting:

Yes.

Whitney Lowe:

Okay. For everybody.

Paula Nutting:

Also, you’ll find links to the courses. So Online, Live and our Evergreens. So the pre-records. There’s also my mentorship group, which is a monthly program where I help people get through whatever they need to do to move them forward, move their dial forward in whatever clinical practice. And then there’s free content in YouTube, so YouTube, Paula Nutting, and you’ll get stuff like DIY. So I used to set up for a lot of my patients and clients, and then some stuff for therapists to use. So just plenty stuff.

Whitney Lowe:

Wonderful. Yeah, lots of good resources. I would encourage everybody to go take a look at some of that stuff. So well always a delight to spend some time with you and hang out. So thank you so much for joining us here on our conversation this afternoon on The Thinking Practitioner. Paula, it’s delightful to have you.

Paula Nutting:

It’s always fun. Love it. And hopefully we’ll get a chance to see you in June when I’m over in your side of the pond.

Whitney Lowe:

That would be great indeed. That would be great. Yes. And do remember everyone that Books of Discovery has been a part of the massage therapy and bodywork world for over 25 years. Nearly 3000 schools around the globe teach with their textbooks, e-textbooks and digital resources. Books of Discovery likes to say learning adventures start here. And they find that same spirit here on the Thinking Practitioner Podcast, and they’re proud to support our work knowing that we share the mission to bring the massage and bodywork community thought-provoking and enlivening content that advances our profession. Instructors of Manual Therapy education programs can request complimentary copies of Books of Discovery textbooks to review for use in their programs. So please reach out at BooksOfDiscovery.com and listeners can explore their content collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics, and business mastery at BooksOfDiscovery.com, where Thinking Practitioner listeners can save 15% by entering “thinking” at checkout.

So thank you, again, to all of our listeners. You can stop by our sites for show notes, video transcripts, and any extras. You can find that over on my site at academyofclinicalmassage.com and also over on Til’s site at Advanced-Trainings.com. If you have comments, questions, or things you’d like to hear us talk about, just record a quick voice memo on your phone or send us an email over to [email protected] and look for us on social media. You can find me under my name, Whitney Lowe, and also Til under his, Til Luchau on social as well. And lastly, if you would please remember to rate us on Apple Podcasts as it does help other people find the show. And you can hear us on Spotify Podbean or wherever else you happen to listen. And please do share the word and tell a friend, and we’ll look forward to seeing you in the next episode. Thanks a lot.

 

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