Reimagining Pain Relief: Integrating Massage and Mental Health

I came out of school and it was probably five years into my career that I started really seeing a lot of the pain science stuff and getting interested in it. And I was just like so angry because all these people were staying stuff online that Basically challenging everything that I've learned and I was like, why would my teachers in school lie to me?

This is the Modern Pain Podcast with Mark Kargela. What's going on, everybody. Welcome back from the episode of the modern pain podcast. This week, we're talking to a friend and colleague Jamie Johnson. He's a massage therapist and firefighter. He's got a pretty cool background. He's not only just working as a massage therapist. He's works as a firefighter. And he's doing some cool things as a firefighter as well. He's got a psychological first aid certification recently, and now he's working with firefighters to help them deal with trauma. One, help recognize that early on. And then to help firefighters process that as they're working through things he's going to share in this episode, how that work is a psychological first aid. And his training has really helped him in his clinical practice and how the similarities you've seen as far as what he's trying to do with firefighters also really parallels what we tried to do with patients in the clinic. He's got a history of working with high level athletes. We'll talk a little bit about how some of the things he's seen with sports also can apply to the general population of folks who have chronic pain. We'll also talk a little bit about some of the struggles he had. I think we've all had when we're taught something in school and in our training. And then we get out into practice and we talk on social media and we see what research is being talked about. And people are basically telling us that what we were taught was wrong. And maybe not wrong, of course, but of course, what we now know is that what we're taught in school is greatly limited. And oftentimes, even though we're so far along in this pain revolution, It's still not really meeting the mark of what we should know in pain science and better help and understand folks in pain. So this episode, we're going to lastly, talk a little bit about community and how community was a huge part of his growth. Definitely has been a huge part of mine. And before we get into the content, I wanted to just let you all know that we will be having a modern Payne pro community. That's going to be starting. I'm extremely excited about it because it's going to be the opportunity to have a group of high level like-minded clinicians could be the early career clinician who is trying to figure it out and. Going through that existential crisis or maybe somebody who's an of. An experienced clinician who just wants to get around high level thinkers, high level clinicians who can help push their thinking forward, help push their clinical practice forward. We've all been there and in need of a community. And I'm tired of just feeling like I'm on an island. Where I don't have that San Diego pain summit. I can go to once a year. I want something I can go to daily, get on my phone, talk to my people, get the support I need within my practice right now. So if that's of interest to you, don't hesitate to reach out to me. You can also go on modern pain, care.com/community and jump on our waiting list. We'd love to have you in the community, but if you have any questions, definitely reach out. Enough of me talking onto the episode.

Welcome to the podcast, Jamie.

Thanks, man. Thanks for having me on. Appreciate it.

I got to know Jamie a little bit in person at the San Diego pain. Some, for those of you haven't been to the San Diego pain summit, not only is it a great mental stimulation, but there's great social stimulation over at the San Diego pain summit, I remember. Going in there from Phoenix, Arizona, it's like February. So I'm like all bundled up and frigid and and I go look and there's these Canadian dudes just chilling by the pool, having a good old time, just their swimming suit on. And I'm like, Oh, I used to be that person when I lived in the Northern most part of Michigan. We're pretty much parallel with a good chunk of Canada. But before we get into some of the discussions today, I want to introduce our guest Jamie Johnston. He's a. Somebody doing some great things in the massage therapy space, but also beyond that too, he's doing some great things working with folks who are dealing with personal trauma as practitioners, but also she's, he's worked with, obviously patients and different things like that. But Jimmy, do you mind introducing yourself to the audience? Just where you're at and what you're up to?

Sure. So massage therapist. I graduated massage therapy college in December of 2010. So I got certified in 2011. And I have a bit of a unique perspective with things because before I was a massage therapist, I was an industrial first aid attendant in a sawmill. And I started volunteering as a firefighter back in 2002. So I've been a first responder for so now most of my work, I spend treating patients but also work full time as a firefighter. So I have two careers and then throughout my psychotherapy career, obviously worked with just general clientele, but also have worked with really high level athletes between rugby Canada, hockey Canada some swim stuff and our local junior hockey team. The sports stuff is what got me into it. And then of course, later on getting interested in the pain science stuff and starting to teach courses and meeting people like yourself down in San Diego and having fun with that stuff.

Yeah. What's been the, I always am interested because I think we've all as practitioners beat massage therapy, chiropractic, physio and everything in between, we've all had that kind of existential crisis moment when we get slapped in the face with like pain science based on what, how we were trained in school and our training and then what we see in the real world with patients. And then When we're clutching onto some like dated theories. I know I have had to have many where I had to politely just let them go and move forward a little bit. I'm wondering if you could discuss a little bit of some of the challenges you've seen in yourself with some of that growth and maybe that existential challenges when pain science came into your world.

Yeah. I got really angry. I I came out of school and it was probably five years into my career that I started really seeing a lot of the pain science stuff and getting interested in it. And I was just like so angry because all these people were staying stuff online that Basically challenging everything that I've learned and I was like, why would my teachers in school lie to me? Why would they lie to me about? You know these techniques and how things work and everything like that when I paid thirty thousand dollars for this education And so I was really holding on to a lot of things and then when I finally let it go It's just it's almost like a calming peace falls over you because you're like it doesn't have to be that complicated we don't have to use these really outdated narratives and descriptions of things to people and it just, I think it really simplified my practice and it made me worry more about communicating with people and doing things with people as opposed to just. Treating them and having them lay on the table.

Yeah, that whole thought of doing things with people versus doing things to people, I think is a big transition. I think one that's still, folks, I work with students on a regular basis who are going through physio school and it's still like I do something to them. I got to fix them. I got to do all these things, to the patient, but that whole transition can be challenging. I'd love if you could talk a little bit about some of that, cause you're working now a little bit with. Yeah, practitioners will get back to probably some of the pain science and some of the massage therapy topics, but I'd love to hear what you're up to with some of the psychological almost rehab that you're doing with some of the practitioners and then how that relates to some of the things you may have seen in the clinic with patients.

Yeah. So yeah with being a firefighter, that's where I think I have a bit of that different viewpoint. Cause I'm so used to, to going to calls where people experience trauma and just getting them out of that trauma. And then on the flip side, then having people come into a clinic that are, been in a car accident or been through something major. Looking at all the trauma informed practice kind of stuff. I'm fortunate to be in a spot where the fire hall will send me on courses and things like that so I can learn more about mental health. So now I'm teaching psychological first aid. I've been a first aid instructor for years and teach a ton of those courses, but now getting into the mental health side of things. And I couldn't believe when I was doing the course, the whole time I was sitting there going that's exactly what we do as practitioners. That's exactly what we do as practitioners. Because one of the things that is cited is a thing called hobfalls five. And I'm not sure who hobfall is, even though I have found the research paper and read it, but they basically looked at studies and said, okay, after things like an earthquake or a house fire when people face major trauma, what are the things that they need and what are the things that they look for it? And they listed it out and they said the first thing is safety and then after that they need I'm trying to remember the order, it's connectedness, self efficacy and hope. I think that was all five. No, sorry. It was because I'm doing this by memory. It's safety, calm, connectedness, self efficacy, and hope are all the things that people are looking for. And I was sitting there, I'm like, every single person that comes into a clinical setting, those are the five things that should guide. Everything that we do with them, because, creating that safe space when they come to see you, making sure that, that your clinic is a really safe space for that person. And the more that I look at it, the more I'm like, Oh basically that creating that safety is all about patient centered care. And like you said, doing things with people and collaborating with people and making that a safe space. And then calm. And of course I'm sitting there, I'm like who doesn't get calm from getting a massage, right? That's one of the biggest things we do. But really when we think about whether it's physio, chiro, massage, like the more we can calm that nervous system down, create calm for that person. And then of course connectedness. So talk about that therapeutic relationship with people. That's the connectedness that we can have with them and then promoting self efficacy. So getting away from, just having that person getting passive treatment on the table, but. Talking more about movement and some exercise stuff and giving them, things that they can take home to create that self efficacy so that they're not reliant on you all the time. And then, of course, talking about hope and given those people like validating them and showing them that, hey, people get better after they've dealt with this. And, talking about being comfortable with uncertainty and realizing there's ups and downs through the rehab process, but the end goal is to get them back to where they were at before, so providing that hope for them. So the whole time through the course, I was just like, that's everything we should be doing.

Yeah, the whole trauma informed care thing just makes so much sense. We've talked with Matt Erb, who's somebody here in the physio space who's doing a lot with it. You probably come across some of his work who's trying to help us navigate that. He's doing it a lot with Mind Body Medicine Institute here with, I think, federal levels here with the U. S. government and things. But yeah it's such a huge hole. I'm wondering, coming from the fireman con or, firefighter, not just firemen, they're firewomen. Obviously, we know Jaletta, crushed it in her career when she was doing that. I'm wondering what you've seen. Is there like just that whole mental health divide of it's sometimes a little taboo and there's some cultures I know I've had friends and colleagues who work with special forces in the military here in the U S and that's, pain is a taboo topic and definitely don't get into my mental health. Cause you know I'm just a machine. I need to, crank and do what I need to do to support my team. I'm just wondering how you've seen that in, in your kind of culture there at the, in the firefighter culture.

It's changed a lot. 20 years ago, the You didn't talk about that kind of stuff. And, unfortunately, I don't know if it was due to injury or what it was, but one of my mentors when I was volunteering at Campbell River he committed suicide years ago. Things like that, but it's starting to get Smaller, I would say as far as like that, those kinds of reactions. But definitely we're much more open to talking about pain and those kinds of things. And I think I'm probably in a bit of a, one of those special spots again too, because everybody comes up to me and they're like, Hey man, my shoulder's bucking me. What do I do about this? And, I'll go in the gym with guys at work and be like, Hey, let's work through and do some stuff. So maybe it's that they're more often open to talking to me about it, but even at the higher levels, like at the chief level and things like that, they're, There's beginning to become way more of an understanding that, hey, we need to treat people differently and when I'm pushing to take courses like this, so that if we see somebody like one of our colleagues, that's, maybe we go to a call and then come back and maybe they're acting a little bit differently. It's how to recognize that, hey, we need to step in and help this person out. And much like we would with a patient on the table, right? But just being more open, having those conversations and creating discussion, I think, makes a massive difference.

Yeah, no, I think especially when you recognize it early, I'd be curious what you think too with the whole early recognition and being trained to recognize the signs of somebody, because obviously as a firefighter traumas, a daily sometimes experience for folks who are navigating some tough situations that folks are calling them into, what have you seen in it? It may be early cause I know you're somewhat early into this training. I know you've been doing it for a bit, but I'm just wondering What are your thoughts and maybe they talked about some of the research behind like this early recognition of trauma, we talk about the best way to treat chronic pain is treat it well. Acutely. Is that kind of what you've seen in the trauma situation as well?

As far as the psychological side, I haven't seen much research on that. But there's definitely more of a push now that, after, at least as firefighters, if we go to a call, that work. We're making sure to have a debrief after, and if somebody's having an issue, it's hey. leT's sit down and talk because definitely we don't, it's not one of those things where we want it to get out of hand and become that chronic thing. But then there's also definitely times where maybe somebody hasn't talked about it, it's become a chronic thing and then being able to recognize it and shift care for that person to counseling and, whatever other things that they might need. But definitely like the community support aspect of it is massive of, having those people around you to support you. Taking care of each other really.

Yeah, it's nice to with a community that recognizes the importance of the mental toll that comes along with the job. I think sometimes in healthcare, outside of just the firefighter culture, there's just this taboo and health. We have a healthcare system and I know. Canada has their challenges as well. Probably not as, quite as bad as the U. S. with the capitalist zest of our system. But it, we want to just pull it all down to the physical, we want to put you in that little mechanical MSK box and label it and fix it. And then there's obviously those people who are navigating maybe trauma alongside these injuries and different things that obviously have a negative impact on their recovery trajectory and all these things. What are, what have been some of the big aha moments or like transformational moments? Maybe you read something, maybe came across something online, but what were the one things that, I know you said you've been encountering folks online. I remember, I don't know if you were involved in Soma Simple when it was going on, but we

A little bit.

Yeah,

It was one of those ones that I got bad at.

yeah, that was one that I, Oh, initially it was a rough go. I don't even think, I don't know if it's even still on. I got to check to see if there's even an archive of it, but it's just, it was all gold. Cause it was everybody navigating the stuff. And I remember first coming across it. Cause it was just so in the face of my manual therapy training. And it was just like, I wanted to come back at these people and say that just like you man, so you're telling me everybody that's been. All these smart gray haired people that were telling me it's this way, that they were completely wrong, that I was just getting, so you almost feel pissed off and cheated a little bit. And then you realize some of the natures of science and some of the natures of education as well, of how long it takes for a research study to travel from the journal into the board examinations and in classrooms and all that stuff. But I'm wondering if you could share a little bit of some of those, what are the big things that really transformed your thinking or transformed your way of looking at things in your practice?

Honestly, I think going to San Diego was the biggest one, went down there with a couple of buddies convinced me to go down and it was meeting all those people that then you can leave and walk away and reach out to them and be like, Hey, I need a favor. Cause I'm not sure about this stuff. And everybody's here's a paper, here's a research paper, here's this, here's that. So I think having It's almost circling back to talking about community. And it's a matter of having that community of people around you that that made a huge difference for me. And then just getting into doing a bunch of the reading explain pain supercharged and some of those, that book sitting right there right now, cause I still pull it out once in a while to. To use it. And being able to put a lot of the things that I learned in that book and in other things into practice with people made such a massive difference. Going back to talking about trauma. I had a patient a few years ago who was actually taking CPR course with me. And then they were like, Oh, you're a firefighter. What's your side gig? I'm like, Oh, I'm a massage therapist. And the person goes, Oh what do you specialize in? I go, we're not allowed to say we specialize in anything, but I probably know more about pain than most people. And she looks and goes I've been in chronic pain for 30 years. Can I come and see you? And I'm like, sure. So first session was 25 or 35 minute conversation followed by 25 minutes of treatment. anD then as I'm leaving the room, just look down and I'm like, how do you feel? And she goes, For the first time in 30 years, I'm not in pain right now. And I was just like okay, I'm like, I don't have anybody after you. So if you need to take an hour to just lay here and enjoy that, I can do paperwork and stuff. So just take your time. And then the second time she came in, I was talking to her about DIMMS and SIMMS and things like that. And as she left, she turned around, looked at me and said, thanks for being one of my safety mechanisms. And I was just like, I almost started crying,

Yeah.

but it's the things of understanding how much more effective a conversation is as opposed to. Somebody just laying there and getting a treatment. It just, to me, it's just such a game changer realizing that the technique we use doesn't really matter. It's what we say and what we do and, that conversation and collaborating and getting that self efficacy in people and working towards that.

Yeah. It is so hard for practitioners. I know it was hard for me to let go that like I was, put the cape down of like swooping in as the hero and just, I'm going to find the, whatever dysfunction in the soft tissue or, joint dysfunction or whatever things that, the practitioners about buys to find it, I'm going to identify it and fix it with you. And. Nobody really unpacking some of the complexity of things. And I would agree, like when you can have a conversation where you start putting the pieces together with somebody and they have these aha moments. It's been the most rewarding care for me as well, where you get people where just the act of listening and, doing the similar treatments that you were doing before, but you're just reframing them as far as the narrative behind them and being in more of a. Supportive versus corrective mode of interaction that just, again, game changer, I would agree. It's been huge to see those folks make those trans transformations for sure.

Yeah. Yeah, it's crazy. And I think like part of my anger when I was going through it is because we I think as practitioners we end up identifying ourselves by the modality that we, it's, I'm a myofascial release therapist, or I'm a this therapist or that therapist or whatever it is. And you, when you start to lose that identity, it, it's angering. And I know you've had your letter on when she talks about like losing the identity of being a firefighter, like what a difference that made for her. So I think it just makes like such a massive difference when you can. Make the change like for those people who've made the change and maybe lost that identity But have come back to realize this is a way better way of doing things with people This is you know, I'm gonna have better outcomes. I'm gonna help take better care of people By getting away from that other stuff.

Yeah. I think the initial like visceral reaction of anger that, you're telling me I got to throw this stuff away and then you just push back and then you finally soften up a little bit, especially when patients and you start integrating some of this stuff and you see the changes and. Again, I think, there's probably a little bit of a sunken cost fallacy of all this time and effort and money, like you said, spent on, on gaining some of this training. And then, again, I think the misunderstood message sometimes it's you just got to throw it all away. And then everybody throws the baby with the bathwater argument, which I get, there should be, but can't agree with you more as far as the over identification with an intervention. And I think it's probably serving a little bit of a insecurity thing that most of us as humans probably have is we want to cling. To certainty, especially when we're navigating clinical waters where there is so much gray. So much uncertainty because we're treating people, man. They just, there's just so much variability in their lives and what they've experienced. And it's a lot easier to just put them into nice, neat categories of pathoanatomy and these different things. Gordon Waddell has a great quote about it where it'd be nice if that's the way it worked, but unfortunately we treat human beings and that ain't the way it's going to, be the best way to get folks out of chronic pain. I'm wondering what you've seen out there in the massage therapy world. Yeah, I know you're do some teaching and some coursework, obviously, expand it in other spaces as we speak, but what's been some of the big barriers that you've seen in your colleagues in that arena to make the jump. I know we've talked about it with physios and Kairos and different things. I'm just curious if it's probably similar, I'm guessing, but I'd love to hear your perspective on it.

Yeah, I think there's like a certain amount of just, oh, I don't need research, I already know what I do works, so they don't want to look at things. And I think that becomes part of that identity thing too, right? That and I think it's almost a community as well, because You know, if you go take, and I'm not picking on Myofascial Release here, it's just the first thing that comes to mind. You can take Myofascial Release one, two, three different levels where you're taking the course with the same people all the time. So that becomes a little bit of your community. So you don't want to look outside of that. And there's always the, it takes too long to read research. Research doesn't matter. That kind of stuff is I think the biggest things that I've seen. And I think there's a certain amount of where people look to instructors as these. Like massive people that you should follow and they're just treating they're just teaching another technique And I've had people reach out to me and be like, how dare you question John Barnes? And I'm like, why wouldn't I question John, right? So the, so yeah, I think it becomes a bit of that identity stuff, but I think one of the, one of the big things I see too is just scope of practice because it's so different in different places, like for us in British Columbia, where I live, our scope of practice is the same as physiotherapists. The only difference is they can diagnose and do electrical modalities and we can't. But other than that, I can pretty much do everything a physio does, exercise, be in the gym with people and that kind of stuff. And for me, I think getting back to that self efficacy thing is it's so important to do movement and exercise with people. Yet I talked to some of my colleagues out in the States and they're like, Oh, exercise is out of our scope. And I'm talking to them, I'm like, yeah, but as active range of motion and passive range of motion, they're like, no, we can do that. I'm like, then what's the difference. And they're like we just can't do exercise prescription. I'm like, okay, so don't just show them how to get up and off the ground. If their back is sore, show them if they want to get down and play with their kids, how they can do it effectively and do it. That even though they might be experiencing a bit of pain, that it's still safe to do it. And, just show them alternative ways and things like that. I was talking to a few people and it was like a light bulb went off. They're like. Oh yeah, we could do active brain propulsion it's, I'm like, it's just move it. Don't worry about teaching people how to do a deadlift. Just get people moving. So I think those are some of the bigger barriers for massage therapy, I think. No,

yeah, I, there's such a semantics and ridiculous kind of courting off of like humans is you can only do this, don't you dare have somebody move. No, we know, that's part of the. Human function is to be able to move. Yeah I think we need more folks and we'll be at whatever space massage therapy, PT Cairo and stuff that are pushing people to, more, adaptive ways of looking at movement, more adaptive ways of looking at exercise and those things. And yeah, granted, I can understand some. I'm not going to go perform surgery on anybody that's well beyond my scope. But I think there's some overlap that I think we should be willing to have as practitioners because, Oh I can't tell you to exercise and move. That makes zero sense to me whatsoever. But in the, it does not surprise me also that the U S is where you're talking to people, where it's been all the turf battles sometimes get ridiculous down here to where it becomes a detriment to the people we're trying to serve for

and it's strange, too, because even up here, it goes the regulations go province by province are different. So it's in, down there, state by state, it's different in every state. In, in one province, you might not be allowed to do, Exercise and in another one you can and so there's not enough cohesiveness. I don't think between everything to say that this is the standard we should all be at. Let's everybody trained to that. Yeah,

get involved in making these type of decisions. We won't go there because that one, I don't want, I don't want to get too many rating drops from getting political on things, but you've got a pretty big background with treating some high level athletes too. And I've always been curious cause the as I mentioned, I work with, colleagues and stuff who've treated special forces. I've also worked with other, excuse me, colleagues who've navigated, professional sports. Yeah. I still see the same human issues that exist with these high level folks. I think there's this belief that, that they don't deal with chronic pain. They don't deal with any of these psychosocial issues and things. What's been your thought, what's been your experience, I should say, with working with some of those populations as far as seeing those parallels, be it somebody with a 40 year, bedridden or, maybe not bedridden, but debilitated history of chronic pain versus a athlete. I see some of the same variables seem to exist from my experience. What have your experiences been?

it's just it's all still biopsychosocial framework. It's just different biopsychos and different socials, right? It's especially. Looking at the differences between team sport and individual sport, you take that, and that's part of the reason that a lot of the protocols on concussions changed, because it was, okay, just because I worked in hockey, I'll just say take that hockey player out of the dressing room, send them home to go sleep on the couch, and you've pulled them away from their entire support system, of their entire team, and now it's no, integrate them with the team as much as they can, they might not be able to be on the ice, but get them integrated as much as you can because as part of the, the social aspect is part of the healing process and what's going to help them get better. And it depends on the sport too. Like I've worked with rowing and rowers were not, at least the ones I worked with, I won't make the blanket statement that they're all this way. They weren't happy unless I was causing pain during treatment. And I'm like, this is so counterproductive to but their mindset is no, it needs to hurt. And they're not happy and then I'm looking at, okay, my, me being part of the psychosocial aspect. If I'm not making them happy doing that thing, then are they going to get better? I'm like, so let's do what they like and do what they enjoy. And of course, some of the things that you look at is like when they're being pulled away from the team or, a player gets injured and they're, because the age groups I worked with were like 18 to 20. It's oh is my scholarship going to be gone? Because I. Got injured. There's all these other factors that are coming into play with how much pain or disability or anything else that they're dealing with. So it's, I think it's all still bio psychosocial. It's just different psychosocials.

100 percent agree. I've been fortunate to talk with some folks who are, working with professional athletes and I agree. I just think it's different levels, but same issues arrives. They're people, all of them are people, it's not like all of a sudden they escaped some of the pressures, it's just different. Some people. Scholarships on the line being a professional athlete where, hey, big contracts online and, if they don't get better and or, feeling like they're letting down their team and there's just a lot that goes behind it. And I think whether you're working in a pain management setting or a professional athletic setting, I think you still should have a process to make sure you're checking in with people's psychosocial status, where there's, where's their head at along with this injury or this pain issue that they're having. Because I think you often will uncover some things that If you identify early and manage them I think you can have a great impact on the recovery trajectory versus just like defaulting towards I'm your car. I'm a mechanic. Let me just identify the faulty part and fix you type of process. Has that been what you're you've seen as well in your thought process?

Yeah, totally. And I've been fortunate to work with some really good people. I remember a couple years ago we were with Hockey Canada over in in Slovakia for a tournament. And one of the girls had, I think she had ruptured her ACL or MCL. Or PCL, sorry. And rehabbed it. So didn't get a surgery, went through rehab, the knee. So she's back to playing and we're back, we're over there and she slid into the boards and hurt the same knee. And as we're taking her off the ice, she's going, not again. And I'm sitting there and I'm getting the shin pad and everything off. The doctor does some tests and she looks and she goes, Hey, your knee feels exactly the same way it did in the summer. You didn't do any more damage to it. It just feels like that because you hit your knee into the boards. And I'm sitting there. I'm like, she's totally psychosocially there right now. This is amazing. And did the tests and two games later, she's back on the ice. But she just, her thought process was immediately. I'm going to have to do another year of rehab on this knee to get it back to normal. But there wasn't anything wrong with it. It was just, that fear avoidance almost because she, hits the knee and thinks, Oh, it's going to be the same thing again. So yeah, I think all the psychosocial is the same for her because it could be that person that thinks, Oh, I'm not going to be able to pay the mortgage now and go back to work. And in her case, it's, Oh, I'm not going to be able to play and go back to my school and I'll lose my scholarship.

Yeah, it's that PTSD thing, man, when people are faced with similar, the body. remembers last time that knee was dinged up. It was a derailed their playing career for a period of time. And they obviously don't want to go back there. Understandable, but I love it when you have somebody who's well versed on the reassurance and psychosocial and stuff, it would just be interesting if you could like. clOne that situation and have somebody who like, overly pathologized things and got them in, fear avoidance land. And, obviously, thankfully they, she didn't get that, but you, I would expect, a different trajectory if she was pulled back into the, we got to rescue you and avoid. Obviously,

You're done for the tournament, you can't play and whatever else, but and it's interesting too, because I think the, this type of language is making its way through healthcare now. Or at least I'm starting to see it because another friend of mine, who's a doctor, him and I were just having a chat about pain science stuff one day. And he said, he goes, Jamie said, if I do, if I get an x ray back on a patient and I see a growth, he's I won't call it a tumor. When I talk to them, I'll just say there's a growth because we don't know if it's a tumor yet. He's if I say tumor immediately, they're gonna think cancer. He's but we don't know if it is yet. So he's I've taken like a lot of those things, that language out when I'm dealing with patients because I don't want them to freak out when it's not necessarily that yet.

Yeah, no, and I'm sure you've seen patients and colleagues who have been given some information on films, MRIs and x rays, radiologists love to title things all sorts of, very fear inducing terms and degenerative this disease and degenerative that disease. And we all know that's, part of being a human, obviously in your case, obviously could be something very serious, no need to. To get somebody's mind there until testing has been done to do that. Yeah, exactly. So it's nice. And it's, and good to hear that folks are doing, I think we're, there's work to be done as with everything, but I think the more we can start giving people adaptive messages early on, I think we would save so much more money in healthcare downstream because a lot of that stuff, would freak any normal human out, and then that will derail a lot of things in their world.

And for lack of a better term, like it's going to save money in healthcare, but it's going to save more people in healthcare too,

Oh, 100%.

Those patients that need help and aren't being over pathologized and those things that get them back to doing what they want to do and Apologizing things and making things worse.

Yeah. Yeah. We've obviously, Joletta's story is a great one of getting pulled out of everything that, and that goes along with the work comp systems. I don't know how it is up in Canada, but a lot of times I know there's some good examples of where they're keeping people engaged in their workplace and their social setting and different things to where they're not just isolated, put on an island and you're on this isolation. Treatment where you have zero social support. Your integrity is getting questioned by this system of, that's always Trying to make sure you're legit claimant and not somebody who's trying to game the system and I get those thought processes, but man, it's hard to How do you expect someone to improve when they're so busy proving to you how bad things are? And it just becomes, this struggle. But have you seen some good, decent reforms up there in Canada as far as trying to, I know it sounds like they do some great stuff with obviously in the athletic arena with concussions and things like, which I completely agree is keeping those folks engaged. Have you seen that translate to other kinds of environments beyond just the sporting environment?

Yeah. Like the stuff that you were just talking about, like the gradual return to work programs and things like that. And I probably have a, like a bit more intimate knowledge about that just because I used to be a first aid attendant in a sawmill, right? I can remember cause we would have to deal with WCB all the time. And I remember somebody from WCB coming in and talking to me and they said, we've looked at studies where if people are off the job for more than 18 months, chances are they're never going back to that job. And it wasn't long after that, that I started to see more of the okay, bring people in for two hours a day, that gradual return to work of getting them back in the workplace and doing things like that. So there, I think that's good. And companies like WCB are now expanding the amount of care that they'll pay for as far as getting a massage or going to physio and those kinds of things. So I think those are expanding. And I think also just for looking at the fire hall, we've got like good light duty things where. Like one of my buddies hurt his knee last year and couldn't work as a full time firefighter. So they put him in dispatch and he just covered dispatch. So he didn't have to take time off work. He's still getting a paycheck. He's still with the group and still, gets that social aspect of being at work. So yeah, I think there's. I think there's a bunch of things along those lines that are getting better, for sure.

Yeah, definitely good signs of some positive movements on things. I'd love to hear your thoughts as we, as looking forward. I think, is there any areas where you think, and maybe it'd be massage therapy or, even bigger picture type things. Where do you think ideally, if you had the ability to navigate where we need to go again in healthcare, be it specifically massage therapy or in general, where anything that you're thinking based on your experience that you think we need to nudge towards a little bit more strongly.

Yeah I think the psychological side of things I got a friend that I went to college with. She went and got her diploma in counseling. And I just think if everybody had a diploma in counseling, and you could incorporate that into treatment, holy cow, what a difference we could make. But, unfortunately, there's also that bureaucracy where She's not allowed to offer counseling while she's doing a treatment, but she could see the same person for two hours and have a counseling session and a massage session, right? If we could incorporate those two things and so much of the mental health aspects get taken care of like throughout treatment and things like that, I think that'd be massive. So I think that's one thing. And I think we. As a, trying to think how to say it I think we almost need to take more care of each other as practitioners. And I always like, whenever I teach a first aid course, I always talk at the end and tell people, Hey, if you're ever in a situation, because I teach massage therapists and physios, like a ton of first aid courses every year. And I'm like, if you're ever in a situation where you have to do CPR on somebody, or you're at a traumatic scene, make sure that you talk to a mental health professional after. So that, cause we always preach about your physical safety, but we rarely ever talk about your mental health safety. I'm like, so make sure that you talk to somebody and if you need to phone me and talk to me, I'm happy to, I'm like, I'm not a mental health professional, but happy to have a conversation with you because when at work, if I go to a traumatic scene, I go back with a group of people, we sit down and have dinner together, we debrief on it, we chat about all the stuff if we need to, we get automatic referrals for counseling, but As healthcare practitioners, we don't get any of that, and I think I don't know about you, but I've had some patients come in who have said some absolutely horrific things on my table, and I don't mean like in an insulting way, like of trauma that they've been through. That I was just like, I don't know how you're still standing, like with what you've been through. But then what do I do with that information and how do I get taken care of? And I'd love to see, I'd love to see clinics, like if you're in a multidisciplinary clinic, that maybe you have a debrief every month or something in a community where healthcare professionals can talk to each other to debrief this kind of stuff. Because I don't know what it's like for physio, but I know like the burnout rate in massage, the average lifespan of a massage therapist is like seven years because the burnout rate is so bad. And I think that's a big contributor to that burnout, right?

Yeah, I don't think I, I'm not aware of the exact statistics on physio, but I know that there's been a massive uptick in discussions around burnout and things. And we got a lot of systemic issues as far as, overworked, highly productivity driven things and hard to even lend some caring. But I also agree you, I've also had some pretty horrific things said in, in our treatment rooms too, where you're like, Oh my God, I can't believe that's happened to you. Obviously validate that. I'm so sorry that you had to go through that. Are you working with somebody on that, to make sure they're plugged into the appropriate mental health things. And I also, just to go back to a little bit what you started with this. Coordinating off, to me I got a counseling degree and a massage service degree, you're going to make this bureaucratic ridiculousness where I have to literally schedule somebody and be that inefficient to where I can't intermingle the two together, I have to have two separate sessions. I don't I do know, because I, when politicians make decisions on what's best for people, it often doesn't go in the right way. And now I know there's some great politicians out there doing some good things. I just, it's frustrating with healthcare because a lot of the decisions that get made have zero to do. What's best for people in pain or in some of these traumatic situations and obviously as evidenced by some of the ridiculous hoops that your colleague had that attempt to jump through to Utilize her skill set the best way to serve a patient. So Yeah, there's just a ton of that Yeah, a hundred percent, it's, we got so many things we can offer. And I think to just the courting off of like professions too, I know if there was like a preponderance of pain psychologists out there, I would willfully and gladly step aside and pass the baton of Hey, yeah, go see. But in the U S I'm pretty sure it's similar in Canada. That is like finding a needle in a haystack type thing where. To get a good psychology, person that's really well versed in chronic pain, like a pain psychologist, oftentimes they're running, pain rehab programs and stuff. And it's not to take away from. Some psychologists who have, and even counselors and social workers that are stepping in to help fill that void a little bit. There's some great things going on there, but it's just such an underserved thing. And I think, this whole push for psychologically informed care and really making sure you're incorporating those things like you've greatly pointed out today of we need to have psychology on board because it dictates a lot more than what we used to think was we're feeling under our hands is that person's embodied experience, which is driven a lot by, psychological factors just as much as physical. How's that been in the push for the psychologically informed practice in the massagery? I know it varies and I know it varies definitely in our profession as well, but has that been something that's, you've seen some good signs on that moving forward?

Yeah, I think it is but there's still unfortunately the old guard that are just I think we're so I don't know if it's the Same in physio, but it's so much more I just need to learn another treatment to help this a new technique to help this person with pain rather than Taking courses that are teaching you how to listen and how to talk and that sort of thing so and then you see these people that are still just teaching techniques that all of a sudden Pain science is in the title of their thing, but they're not teaching any pain science. They're just teaching a new technique. So there's definitely still that aspect of it, but I think there is a lot more uptick for the bio psychosocial stuff and like for me doing psychological first aid and like my friend I was talking about that did the. Counseling diploma, we're putting a course together. We're just going to call it the fundamentals of trauma informed practice, where I'll do the psychological first aid stuff the first day. And then the next day, she's going to take it from the counselor's point of view of how do you do this as a massage therapist, where you're offering counseling. And there's a lot of interest in that. And I'm seeing a lot more like local people that are bringing up courses that are around the psychological side of things, as opposed to just the technique. So it's, I think it's making some headway.

Yeah, it's, just thinking back to what you said earlier in the discussion of like, how dare you criticize John Barnes? And I agree we've put these people on almost like a godlike pulpits of like worship. It's just they're people to like, granted, they've made some good theory, and they've had some good contributions, nothing to knock that it's just We need to not get and it's good to know that we got folks like yourself and your colleague who are putting some courses together. If folks wanted to get in touch with you as far as where could they find you, be a website or social media, if somebody's listening up here in BC and they're like, man, I need this psychologically informed stuff in my world, where would they find you?

Yeah my website, which is just the mtdc. com. So t h e m t d c. com. There's a contact form on there. Unfortunately for the psychological first aid, I can teach it online. So I can teach it by Zoom and somebody could take it online or we can do live courses kind of thing. Yeah, there's lots of access to it anyway. And it's, yeah, I just think it's super helpful just for you, like for a personal thing and for recognizing what your patients are going through.

Yeah, I could definitely see benefits of practitioners who are, struggling with some of the psychological and burden that, when you're hearing some of the challenging stories that our patients are bringing the treatment room, that stuff does, that stuff can impact you and not always the best way. And it's good to have a support system to. To lean on when you're having some of those struggles to navigate and process some of the stuff that you're hearing and in the treatment room. Man, I just wanted to thank you for your time today. I really appreciate you sharing your perspective. We'll link what Jamie has said about his website and things in the show notes. So you can all check that out and definitely highly recommend it, especially for the massage therapy space. But I would say physios, chiros, I know you. You work beyond just that, I think would have some benefit of getting in contact with you. So thanks again, man. Really appreciate it and hope you stay warm there up north.

yeah. Anytime, man. Let's do it again. It was a lot of fun. Thanks for having me on.

Absolutely. For those of you listening, we'd love to have you subscribe on whatever you're listening to your podcasts. And then if you're watching on YouTube, we'd love to have you subscribe to the podcast here on YouTube and we can better help some folks. Maybe there's some people out there who are struggling with some of the things they're hearing in their treatment rooms and they're having some trauma of the, the stories that they've had that are impacting them in a negative way. So if you could share this with somebody, we'd greatly appreciate it. And then hopefully they can get the help they need to better help some people in their practice. But. We'll leave it there this week. You guys have a good one. We'll talk to you next week.

This has been another episode of the Modern Pain Podcast with Dr. Mark Cargilla. Join us next time as we continue our journey to help change the story around pain. For more information on the show, visit modernpaincare. com. This podcast is for educational and informational purposes only. It is not a substitute for medical advice or treatment. Please consult a licensed professional for your specific medical needs. Changing the story around pain. This is the Modern Pain Podcast.