Just a thought today about hands-on versus hands-off care.
I don’t invite anyone else to go down the path I chose … I’m just here to tell the story of what this path looks like for those interested.
I came into Osteo a firm believer that manipulation was what was needed to ‘correct’ what was wrong. That’s because of how my Osteo indoctrinated me.
The more I studied research, though, the more this idea started to fall apart … and I’m talking 1995-1996 here.
I was very fortunate to have ‘grown up’ in the Decade of the Brain, got the first book on psychonueroimmunology etc …
So, by the time I graduated as an Osteo, I was already sold on the idea that patient-generated ‘active correction’ was more powerful than ‘passive therapy’ … and it’s the direction I wanted to go …
… but I wasn’t there yet.
Over the course of 2000-2005 I did four key things that changed the way I practised.
1. I qualified in Mechanical Diagnosis and Therapy (aka McKenzie)
That’s because, at the time, it was the only therapy I could find with decent reliability for categorising … and it also happened to be what worked for my back pain /leg pain when manual therapy didn’t … MDT is almost all hands-off and patient generated movement.
2. I went to St Louis and certified with Prof Shirley Sahrmann on movement ‘diagnosis’ and movement ‘correction’ … again almost all hands-off and patient generated movement.
3. I hung out with David Butler and dove deep into pain sciences … and movement of the nervous system could also be hands-off and patient generated.
4. I dove into human behaviour change … because I was woefully unprepared and unskilled when it came to helping people make the small daily changes they needed to make that would also change their lives …
… and for this I went and studied with Prof Cialdini at ASU in the states on influence and persuasion …
… and also online with Prof BJ Fogg from Standford Behaviour Lab.
Now, the point of this walk down memory lane is not what you might think.
The reason I needed such an authoritative input into my mind was to help me shift out of a mindset of ‘hands-on care’.
As an Osteo, it was part of my ‘identity’ … and so stripping this back was a challenge as I had so many questions, doubts …
… and also the pressure to ‘perform’ for my patients and provide manual therapy because of their ‘expectations’.
And again, I repeat, I’m not suggesting you go down this path … because it’s certainly not for everyone … and it was an extreme decision of mine …
… but I decided to be an osteopath with virtually no manual therapy.
At the time, I scoured the AHPRA guidelines and NSW legislation and couldn’t find anything anywhere that said osteopathy = manual therapy, only that manual therapy was a tool osteopaths ‘use’ along with patient education and exercise.
As a clinic tutor, every now and then, I’d challenge my students to see if they could treat their patients without doing soft tissue massage, or manipulation …
… a few rose to the challenge, but manual therapy was so ingrained in their concept of what osteopathy is that I’d mostly get giggles and ‘Nic, you’re crazy’ kind of looks.
And that’s OK too … I get it.
But over time, I developed an approach and a patient base that was used to my approach. I would have patients referred to me because of my approach … they’d already received manual therapy from various practitioners … and still had their problem … and I got to try my approach with them.
Of course, since then … and from what I can tell … there has been a large uptake of pain science across all the manual therapy professions …
… and so here is my encouragement to anyone who’s thinking about how they might pivot during these times.
It’s perfectly OK to use hands-off interventions to help your patients. It’s not inferior … and for me, I think that sometimes it can be superior.
Imagine for a moment, if you couldn’t touch your patients … but they still desperately needed help?
What would you do?
How could you use your knowledge to devise a solution that produces results?
Imagine if you discovered that it was as effective as manual therapy?
If you happened to be curious to find out, now might be just the time to expand the width of your lane …
Eg. one person I’ll nominate for his experience on this is John Panuccio … I worked with John a while back while he was transitioning to more gym-based active rehab … getting patients onto the gym floor and off the therapy table.
Virus or no virus, all the other shit that happens to people is going to keep on happening … and the better you are able to help, the more value you can provide, the better off they’ll be and the better off you’ll be.
Dr Nic Lucas
BSc, MHSc, MPMed, PhD, ACTL
Founder & CEO, X10 Entrepreneur TM