If there is an excuse for me to travel — to get me out of my southern California bubble — then going to conferences, such as the 2016 Manual Therapy Conference (MTC), would be one. I have only attended such conferences for manual therapists twice, and that was with the San Diego Pain Summit. But the RMTBC conference was something bigger and older than the pioneering SDPS, and the culture among most registered massage therapists was quite a mind-0pening experience.

Set inside the new Anvil Centre in New Westminster just north of the Fraser River, bright sunlight streamed through the glass-covered building into the main lobby which was used as a dining area. The auditorium seating reminded me of a TEDx Talk that I attended at UCSD in 2012 that allowed everyone a full and clear view of the speaker and visuals.

Besides the opportunity to travel in British Columbia for the first time, what also got me interested in attending are the speakers, especially the first keynote speaker Dr. Eyal Lederman, who is a practicing osteopath in London and manual therapy researcher. Dr. Lederman is well-known in our profession for his 2011 paper, San Diego Pain Summit which challenged and questioned the currently predominant biomechanical model to explaining pain.

While most of the stuff he discussed is similar to what is presented in his paper, the major theme he and a few other speakers emphasized that I find very important and relevant to what I do is patient-centered care. This includes how we frame our words and narratives when explaining the patients’ or clients’ problems, giving and holding space during their recovery, and adopting process model rather than the structural model.

The Process Model of recovery from acute pain to chronic pain. Illustration: Eyal Lederman

“In the last three decades, research findings have challenged the usefulness of the structural model in understanding the cause of many musculoskeletal and pain conditions. It has also been demonstrated that treatments based on a structural approach have limited clinical value,” Lederman explained in an online interview with M&F Magazine. “However, the therapeutic effectiveness of manual therapy can be dramatically improved when the focus is shifted towards a biopsychosocial model.”

“The biopsychosocial model is a topic which is close to my heart,” Lederman continued. “For the last 20 years, I have been researching this area and exploring how we can integrate this model into our manual therapy work. This led me to develop a model suitable for manual therapy called San Diego Pain Summit. In essence, this approach acknowledges that the body has inherent recovery capacity. In this Approach we identify three dominant recovery processes – repair, adaptation and alleviation of symptoms.

“Recovery from musculoskeletal and pain conditions is associated with one or several of these processes. As therapists, we can help these processes by creating optimum environments that support them. These environments contain a mixture of manual therapy, movement-related advice and behavioural and psychosocial support.”

Another interesting observation I had was that some RMTs posed some thought-provoking questions during the Q&A sessions and to individual presenters after the conference that few American massage therapists would probably ask. These topics I heard include how do we apply the biopsychosocial and process model to the clinical setting, the famous baby monkey study by Dr. Harry Harlow, and scope of practice for pelvic examinations.

​In fact, no RMT had asked me, “What kind of massage do you do?” That was quite refreshing!  In the last three decades research findings have challenged the usefulness of the structural model in understanding the cause of many musculoskeletal and pain conditions. It has also been demonstrated that treatments based on a structural approach have limited clinical value. However, the therapeutic effectiveness of manual therapy can be dramatically improved when the focus is shifted towards a biopsychosocial model.

Photo: Ken Leong

Besides the keynote speakers — Lederman, Dr. Sandy Hilton, Walt Fritz, and Dr. Ravensara Travillian — the MTC also had mini “breakout sessions” that included three 30-minute presentations. To me, this was a pretty novel concept, sort of like getting sushi samples at a buffet. One drawback I find in these sessions is that not every topic is of interest to everyone, and some of audience may have to sit through a presentation that they have little or no interest in before getting to the one that they like.

For example, I was very interested in Dr. Christopher Moyer’s talk on why manual therapy needs modern psychology and Brian Fulton’s take on the placebo effect. However, I was not that interested in Angela MacKenzie’s talk on fasica because I find very little relevance to the work that I do.

Also, unlike the San Diego Pain Summit, I find that some of the information presented don’t really have a coherent theme. Using the above example, Dr. Moyer asked MacKenzie, “Manipulation alters state of fascia, gel, and sol. Is this a definitive improvement or a theory?” after she presented a slide indicating that manual therapy can alter and “melt” fascia. Given the previous talks by Dr. Lederman and Dr. Hilton on applying the biopsychosocial model to manual therapy and patient-centered care, I don’t see how some of the presentations follow the theme of the keynotes by using outdated ideas and models. Also, attendees were not given a form to fill out to provide feedback of the speakers.

“The theme was manual therapy and the science and practice of it. We intentionally included juxtaposed the biomechanical model with the biopsychosocial model,” Bodhi Haraldsson replied when I asked him about the conflicting information presented at the break-out sessions.

“Angela and Vizniak were included to attract those that might not be interested in the BPS model and to stimulate discussion on the differences between the structural and the BPS models.

“To change minds and practice, it’s beneficial to speak the language of those we are trying to shift from the structural to the more nuanced BPS model” Haraldsson added.

On the brighter side, the MTC ran as smooth as a Disney cruise with almost no problems. Everything ran on time, breakfast and lunch were provided, and gallons of coffee were served to fuel some of our brains that were overloaded with so much information and ideas. There was a discussion panel at the end of the day that focused on a particular topic, such as pelvic health with Sandy Hilton, Paula Jaspar, and Sarah Bjorgan.

There were books, lotions and gels, and other products sold from vendors, but nobody pushed sales nor was I lulled buying anything. In an online interview with Brian Fulton, even his book, The Placebo Effect in Manual Therapy,  was sold out!

“I was really struck by the down-to-earth delivery and straightforward approaches used by many presenters at the conference,” Fulton remarked.  “I like pragmatic, uncomplicated approaches to bodywork. However, I also have a great interest in the (complicated) ‘human’ component of bodywork as well, so I was pleased to hear mention of the biopsychosocial model from almost every presenter. As an example, Dr. Lederman mentioned that he asks his patients about their activities of daily living (ADL).

“If they have difficulty performing a task, he uses the patient’s ADL goal guide his treatment. This is partly due to the specific nature of task training, but it is also eminently practical and sensible. Walt Fritz’s talk on implementing research into practice was similarly down-to-earth and practical, both in his treatment approach and in his presentation.

“I was pleased to hear him raise psychosocial issues many times during his talk as well. I was able to converse personally with Walt on several occasions over the weekend, and I have to say that he is so nice that it’s hard to believe he isn’t Canadian!”

One major takeaway I got from the MTC is Paula Jaspar’s “4 Big Questions” to Dr. Lederman about the BPS model and its application to manual therapy. Although Jaspar didn’t get a straight answer from Lederman, which she felt disappointed, it opened up several dialogues and sparked a debate on Facebook.

I highly agree with Jaspar’s opinion that manual therapists should focus on the bigger issues and perspectives rather than techniques. If there is going to be a “part two” of this conference, perhaps this would be good start — sort of like the cliffhanger in that TV show Sense8.

“I believe that the RMTBC conference is an important step towards embracing a biopsychosocial approach in manual therapy  — a shift that is essential for the future of manual therapy,” Lederman concluded.

Thank you Bodhi Haraldsson, Harriet Hall, and the rest of the team who put MTC 2016 together. I wish I had met all of you in person, even if it’s a brief and firm handshake. My experience with RMTs has leveled me up, and it was an honour. See you in two years!

 

Further Reading and Listening

a debate on Facebook

Manual Therapy Conference –  my final thoughts, by Anita Wilson, RMT