[00:00:00] Dr. Jess Reynolds: Welcome back to Aim and Practice podcast. I'm your host, Dr. Jess Reynolds. And on this podcast, we explore the world of integrative and complementary medicine and its application in real world clinical practice. Now, each episode, we dive deep into conversation with practitioners, authors, thought leaders, and innovators who are truly shaping the future of holistic healthcare.

Now, today's episode touches on a topic that I believe is of crucial importance for everyone. Any kind of practitioner, regardless of their modality or specialization. We're diving into the world of the placebo effect and patient communication, as well as the often overlooked aspect of what truly makes a treatment effective.

Now, our guest today, Troy Levine, is a massage therapist with 20 years of experience who brings a very unique and thought provoking perspective on these subjects. Now, Troy's approach challenges traditional views on treatment efficacy and emphasizes the importance of practitioner patient interactions in ways that can truly revolutionize how we think about and deliver our care.[00:01:00]

So in today's episode, you will learn the significance of understanding placebo effects All of its forms of therapy and patient care, how communication and expectation management can significantly impact treatment outcomes. The importance of individualized care and adapting techniques to each patient's needs and Troy's insights on the limits of manual therapy and the body's natural healing process.

Lastly, we'll talk about the role of practitioner humility and continuous learning in providing effective care and much more. So whether you are a massage therapist, an acupuncturist, chiropractor, or any other type of healthcare provider, the insights from this conversation have the potential to transform your practice.

So now let's jump into this awesome conversation with Troy.

Well, Troy, it's great seeing you. I'm looking forward to this chat. So we first connected at the Canadian Massage Therapy Conference a few months ago and pretty much immediately hit it off. And one of the things that I [00:02:00] found interesting is We both talk about very similar things, but we come at it from a slightly different language and perspective, right?

And the workshop that I took that you presented was essentially talking about the placebo, and I found your delivery and how you presented that information just phenomenal. So I'm curious, of course, tell us a little bit about you, and then we'll get into the question, which is essentially, why do you think it's important for practitioners to understand the idea of the placebo?

So welcome, and let's jump in.

[00:02:30] Troy Lavigne: Yeah, thanks. Yeah, I agree. We hit it off right away, like two peas in a pod and it was really fun. And, um, yeah, that was actually the first time I taught that class, uh, called I am placebo positive. And, uh, you know, think the reason I find that an interesting subject is the same reason why I want to talk about pain and the same reason I find.

Um, understanding research is valuable and the same reason I, uh, I have a [00:03:00] podcast myself and a lot of it's around neuroscience and I think it all comes together and I think for me it started, you know, when I was a massage, this is my 20th year doing massage therapy as an active therapist and I've gone through my highs and lows in the profession like everybody and for the first, You know, in 10 or 12 years, I really learned, I took what I learned in school as gospel, like most students who go to school.

I learned something from an institution who obviously spent time and money. On that knowledge and sharing it with me. I spent my money on that education and I learned it from somebody who I trusted, especially if you like your teacher. Right? And so I graduated and I thought, okay, what I do with my hands.

I can affect fascia trigger points behave this way. Stretching does this ice does that? Um, And, and I kind of just ran [00:04:00] with that for about 10 or 12 years with pretty good level of success. To be honest, I worked at a very high end gym in Boulder, Colorado. I worked for several professional teams from, you know, professional hockey in the NHL to soccer, to working, uh, you know, uh, Olympic level athletes to working world championships and not making traveling the globe with professional cycling teams, uh, working with the WTA, all, all these different So, I have all these reasons in my mind to think I have hit a level of success.

[00:04:30] Dr. Jess Reynolds: in 2012, 2012,

[00:04:32] Troy Lavigne: then in 2000, I think it was 2012 or 2000, no, it would have been 2013 or 14, I, I came across Paul Ingram's website, painscience. com,

[00:04:41] Dr. Jess Reynolds: came across

[00:04:42] Troy Lavigne: across his blog post on trigger points, which kind of tears them a new one, maybe four or five new ones. Yeah,

[00:04:51] Dr. Jess Reynolds: That's just his MO. Just pick something and tear it apart.

[00:04:55] Troy Lavigne: and the first thing I did was get angry as anybody who spent their time, [00:05:00] money and resources on an education would go. Of course, I'm upset. You just completely denied everything. I thought I knew, but the more I read it, the more I was like, he's really diligent and he's doing a good job in arguing his view and, and, you know, essentially saying this is not what we think it is. And so I had this big crisis of faith moment, which I actually did a podcast with Michael Hamm on crisis of faith, who's one of the former trustees of the Massage Therapy Foundation. Um, you know, I had this big crisis of faith where, oh my God, have I been lying to my clients? Have I been? Inaccurately describing and explaining what happens in the human body.

Um, it turns out, yes, I had been. But ignorance is bliss until you're no longer ignorant. And when I had that crisis of faith moment, I kind of came to this place and said, Okay, well, if what I learned in school is not accurate, but I'm still getting results, what is happening? And when I started [00:06:00] looking into that question, I started coming across a lot of really interesting research about just, you know, return to norms.

Thanks. I think that's something that a lot of manual therapists across the board frequently choose to ignore out of ignorance or out of, how to say, it's not that they're being malicious, it's that they just, they don't know any better. That's not necessarily, it's more that they think they're doing more than they're doing when the body is just healing of its own record. Uh, and I think there's a big portion to manual therapy. That falls under just return to mean and return to averages and the natural healing in the body.

Um, and so the more I started understanding that, the more I went, oh, wait a minute. I'm actually making this person feel comfortable, but the actual healing taking place is in my hands. It's not what I'm doing with my, my body or my physiological touch. It's, it's their body and I'm making them feel comfortable in the process of doing it.

And then I started looking into neuroscience and [00:07:00] cognitive behavioral therapy and just neuroplasticity and pain science and all these things. And

[00:07:05] Dr. Jess Reynolds: ultimately, the

[00:07:06] Troy Lavigne: it just ultimately led to this understanding of,

[00:07:09] Dr. Jess Reynolds: their, um, primary,

[00:07:10] Troy Lavigne: as therapists, our primary tool with our clients, as manual therapists, our primary tool with our clients is not our hands.

Which sounds so weird to say as a therapist of 20 years. Our primary tool is interaction.

[00:07:24] Dr. Jess Reynolds: need sensitive center

[00:07:26] Troy Lavigne: It's that simple. And, and I think that's a really hard thing for manual therapists to be willing to accept because when I was in school, I would say

[00:07:35] Dr. Jess Reynolds: tracking, my answer is the

[00:07:36] Troy Lavigne: maybe 10 percent was given to our interaction with client

[00:07:39] Dr. Jess Reynolds: is, you

[00:07:40] Troy Lavigne: when I'm 20 years later saying it is absolutely the most important thing in therapy, in manual therapy.

So that kind of led me to this idea of, you know, if, if interaction with clients becomes important, what are the components that make up interaction? And, you know, we go from. Pain education, PNE, pain [00:08:00] neuroeducation, you know, studies have shown that the more somebody understands about pain without touch, without change in exercise, without a change in lifestyle, the more somebody understands the mechanisms of pain they're likely to get 30 percent better.

[00:08:14] Dr. Jess Reynolds: So, reading books

[00:08:15] Troy Lavigne: So read a book on pain you will have a potentially a 30 percent improvement in your symptoms with no other change in lifestyle. That kind of became really relevant because as a therapist, most of the clients who see me are in pain. I don't do that much relaxation therapy, although I have created this new ASMR type of massage, but most of my treatment is therapeutic based.

For pain. Um, and then I started looking at things like laughter, like you can, you can decrease symptoms of pain by up to 20 percent just by laughing during the session

[00:08:41] Dr. Jess Reynolds: I don't have

[00:08:43] Troy Lavigne: again. I don't have to use my hands yet. So that's potentially 30 percent with P and E potentially another 20 percent with laughter throw in.

And when we come to placebo stuff, placebos can have a 14 to 20 percent effect on pain. So now we're at anywhere from 64 to 70%. I haven't even touched you with my hands. [00:09:00] At what point do I actually have to use my hands to get, you know, to get you out of pain? Um, not that hands are important. They absolutely, I touch every client who comes in but there's this component of touch is secondary to so much else Um, and it kind of leads to that initial question of one of the things that i'm really pushing now And that i'm trying to create classes around and this mentality is

[00:09:21] Dr. Jess Reynolds: room for, um, these, these

[00:09:22] Troy Lavigne: intervention influence is a component of a multitude and multidimensional component of care.

Um, where there's a percentage of what I look like if I'm male or female as a client or as a therapist, where the room is, what time of day it is, did they get a good night's sleep? Are they feeling strong? Are they feeling depressed? Are they feeling lethargic?

[00:09:42] Dr. Jess Reynolds: supposed to

[00:09:43] Troy Lavigne: How aggressive of a touch I am, you know, how motivated am I in my speech?

Am I happy as a therapist interacting with my client? Am I motivated to be in my clinic that day? Or am I thinking, man, I wish I was having a tequila right now. You know, like there's all these components to intervention that happen [00:10:00] within the first 30 seconds of interacting with a client. And I think those first 30 seconds to a minute become essential to good hands on treatment.

Um, and I'm trying to take my time and most of my career in the past 10 years now. Into finding out what makes those 30 seconds important and placebos is one of them by far. Absolutely. Absolutely. Placebos plays into it, but so does my smell. So does if I'm shaved or not. So does the clothing I'm wearing.

So does the lighting in my office. All these things that most people will say, yeah, if I walk into a room and I smell lavender and I hear the ocean and I see a diffuser and the bamboo on the wall, I'm going to relax. Sure.

[00:10:41] Dr. Jess Reynolds: They're the same.

[00:10:42] Troy Lavigne: And the same as if you walk in and you see medical charts and she's sporting equipment and you see athletes photos, you're going to think therapeutic, we just go, Oh, that's that's assumed that it's everybody should know that.

But I'm actually trying to find out what happens in the brain. That makes those things important because if I can [00:11:00] tailor them to the individual in front of me, I can get more positive results, at least that's my theory.

[00:11:07] Dr. Jess Reynolds: As you were describing that last part, I was thinking about Darren Brown. You ever watch any of Darren Brown's stuff? So for those listening, if you've never had any exposure to Darren Brown, he's I mean, you might call him a magician, a performer perhaps, but he is just His stuff is unbelievable. He's got a couple specials on Netflix, and essentially he uses a variety of hypnotherapy techniques, neurolinguistic programming, or NLP techniques, um, suggestion, and he essentially puts on, in my opinion, one of the greatest performances as far as, as I guess you could call it, a stage magician would do.

But what I, I've always found interesting about that is, This is a person who understands human behavior, cognitive science, as well as how communication and environment affects the way people think, enough that he can sell out a stadium of like, I don't know, people. A thousand people [00:12:00] at a pretty expensive price per ticket and quote, unquote, manipulate or persuade all of them simultaneously. So we know it's possible. We know it's possible to such an extent that it actually seems like magic, and yet that skill could be utilized unbelievably well in the world of any type of practice and modality. But the issue, which I've always found interesting because I've course studied hypnotherapy, is the issue is.

It seems a little bit, uh, fake. It seems like manipulation. It seems woo woo. Like, oh, hypnotherapy, we don't want to do that. That's nonsense. Because of the politics and the nonsense that happened during the development of hypnotherapy, right? So it's a bit unfortunate, but it's really exciting to hear that you're, you're really taking this seriously.

Because I think it should be taken seriously. It has such an unbelievably profound effect. So what kind of steps are you doing right now to, to sort of foster that?

[00:12:53] Troy Lavigne: Well, I think, I think there's a few things you said there that I think are worth addressing and a lot of it just has to do with even context [00:13:00] and phrasing, because this is something I address with all my clients, um, and, and that I teach in all my classes that I teach that I really encourage people to pay attention to, which is vernacular.

Our wording is incredibly powerful and it makes a difference. You know, I, I have two girls, a six year old and a 10 year old. And my 10 year old right now, every now and then, she wakes up grumpy. Sure, she's starting the process of puberty. You know, she's 10, but it's begun for her and things like this. And it's the same for myself.

It's the same for my wife. It's the same for my friends. It's the same for my clients. I say the same thing to every one of them if they come in and they're in a grumpy mood, or a tired mood, or a happy mood, or a manic mood. It doesn't matter what it is. I say, it's a choice. But it's only a choice if it's conscious.

[00:13:39] Dr. Jess Reynolds: don't know if

[00:13:43] Troy Lavigne: that fatigue as frustration or anger or depression, you're not tired. You're making a choice to pretend it's these other things. But if you consciously say, no, you know what? I'm actually in a good mood. I'm just tired. Well, then you can be happy and tired. There's nothing wrong with being tired, nothing wrong with being mad, nothing wrong with being [00:14:00] angry, depressed, whatever it is, but it's make it conscious.

And so I think when you said, you know, manipulate, it's for me, it's such a good word. People have similar to the word stress. People have this immediate connotation of this box of it's a negative thing. The sound of our voices to your listeners is stressful. It's just not so stressful as painful. So it's not perceived as a stress, but it's absolutely taking up brain space.

When we talk about the concept, um, which is allostasis, which is your ability for your brain to cope with and manage, uh, stressful influence without feeling overwhelmed, light, gravity, uh, interoception, the need to go pee, the need to feel hunger, the need to expand your lungs, these all consume brain space, conscious or unconscious, it depends on how important it becomes, you know, breathing unconsciously is easy until you go, Oh my God, I'm tired, I need to take a deeper breath, um, and so it's the same light, you know, light is not Painful to the eyes until you stare at a light bulb of the sun, and it's still stress.

It's just at what [00:15:00] point is it overwhelming and manipulation's the same way. Manipulation doesn't have to be negative. I can manipulate a client to get them to say, I'm motivated to do exercising and I'm gonna exercise pain free, and I'm gonna go ahead and do it two to three times a week. And if you can manipulate your clients into having a better lifestyle based on your client's needs, not based on the therapist needs, it's very much based on client goals.

If you can help manipulate them to get there as a success, hey, manipulate them. Now, if you manipulate them negatively, that's where it's bad. And it's similar with hypnosis, it's similar with placebos, it's similar with all versions of therapy. And I think you kind of get to the nuts and bolts of it there when you say that, because when you ask what the steps are, it has to do with intent.

Um, you know, if I sell you a treatment

[00:15:53] Dr. Jess Reynolds: think that if anybody's ever been in

[00:15:55] Troy Lavigne: isn't science based, which I'm not a fan of, I'm a very big fan of evidence based science and [00:16:00] most anybody who's listened to my podcast or who's taken classes from, you know, I'm a very big fan of research and I actually have a news, a blog that I write about news, uh, dissect meta analysis and reviews, things like that quite frequently, but one of the things that I think is really important is that, If I give you a treatment, a product, a book to read, something like that, and you get better, it's not a scam.

Even if it's founded on unresearched information, which is really a tricky scenario because it's very easy to ethically become power hungry, egotistical, and dominant with that. It's an incredibly slippery slope. And I'm not saying people should be doing it. I'm speaking of it from a philosophical standpoint of if I give you a product or a treatment or an exercise and you get better.

Is it a bad thing that I gave it to you, whether it's research or not? Now, if you don't get better, it is 100 percent a bad thing. It's a very clear cut answer. And yet when you [00:17:00] do get better, the answer is not clear cut anymore. And that to me is a really interesting thing when it comes to hypnosis, placebo, uh, you know, treatment that's not evidence based versus evidence based.

It becomes, you know, it becomes this tricky, tricky, uh, philosophical dilemma that we have in healthcare in general. And as complementary alternative medicine, CAM therapies, We are in a scenario, in a situation where we can actually toy with that line a little bit more than traditional medicine. You know, westernized medicine, doctors working in hospitals, doctors working in clinics, they don't have that option.

They have very clear, strict guidelines on what they are and are not allowed doing. And complementary alternative medicine has a lot of guidelines. But bizarrely enough, most of them fall into gray areas, um, especially province by province or for those in the U. S. State by state, you know, like in one state, one province you can needle and another one you can't as a massage therapist in Quebec.

I'm completely unregulated as a massage therapist. I have [00:18:00] no guidelines whatsoever. But where I'm also licensed in Colorado, I have very strict guidelines. So there's it's It becomes this gray area where in most other medical disciplines we don't have those gray areas. Um, and it gives us the opportunity to be playful in our therapy with potentially really positive outcomes.

But it also gives us this risk to become power hungry and get this God complex and not play it intelligently.

[00:18:25] Dr. Jess Reynolds: risk. Not that there's no risk. But

[00:18:27] Troy Lavigne: I think part of the reason for that gray area is that our interventions are much less risk. Not that there's no risk, but you know, if I go ahead and massage somebody's calf.

[00:18:35] Dr. Jess Reynolds: hefty money.

[00:18:37] Troy Lavigne: You know, it's not that they don't have a DVT, and it's not that it can't cause some version of damage, but it's less invasive than a scalpel.

So the risk is, the risk is so much smaller, so the gray areas exist more easily.

[00:18:50] Dr. Jess Reynolds: the risk is so much smaller than the grey area. [00:19:00] start to bring in principles of placebo effect, uh, or one chooses to bring in principles of hypnotherapy or NLP. Great. It's not unethical or in any way negative manipulation so long as you're educated in the process and you understand how to apply it ethically.

And another thing that I found very interesting about what you were discussing and how this can perhaps increase how easy it is to use more of this idea of placebo, which I would really love to dig in more into how it can be used as a practitioner in a moment. Well, one of the cool things that I learned to never, I just finished reading this book called The Expectation Effect, which is a phenomenal book.

It's essentially all about the placebo effect, but comes at it from a slightly different angle. What I found interesting is it turns out, and the data is quite clear on this at this point in time, the placebo effect turns out now to be, to be more effective if people know it's a placebo, and that's such a bizarre thing.

So before the placebo effect was effective, and a placebo is, you don't know [00:20:00] what you're taking, it's an inert substance, right, that has a therapeutic effect, and it's so strange to think that, again, the data is stating, with clarity, in the last 15 years or so, if somebody knows they're taking a placebo, then its efficacy goes up.

So what I find so fascinating about that is how we are aware of the fact that knowing the placebo effect exists and knowing that it is in effect really starts to amplify it.

[00:20:26] Troy Lavigne: Yeah, there's a little caveat to that, and you're not wrong. Open label placebos are, seem to be more effective, but the population that they're more effective in are individuals who are open to the idea that placebos are effective. So even an open label placebo. in an individual who is not open to the idea that placebos are effective.

It is still effective, but less so than if you are open to placebos and that open label placebo is not more effective on those individuals than a traditional placebo. There's something called [00:21:00] a cover over or an under hidden placebo as well, which is where you'll mask the placebo with a second treatment at the same time.

So let's say you're getting an injection. Or let's say you're getting an IV and they put a medication inside the IV and then they give you an inhaler at the same time. And you don't know that one of them is being provided, but you're being given an inhaler and the inhaler is the placebo. If you're still showing positive effects from the medication, let's say morphine or whatever it is, um, If you're not open to the idea of placebos, we actually see that those results are diminished, as opposed to somebody who is open to them, those effects are greater, and the open label placebo is very much that, and I think, I think you got to the, to the center of it when you said education is key, but it's not just education on the therapist part.

And I think that's something that a lot of therapists forget as well. I had a client come in yesterday, first session ever, um, we booked an hour and 15 minutes, 55 [00:22:00] minutes later we were still talking. We hadn't even started with the hands on treatment. Because I think education becomes essential. And it's not just therapist education.

My client needs to be educated on not only what I'm doing, but on why it's going to affect their brain, how it's going to affect their brain, and all the potential components around it. So yesterday, during those 55 minutes, you know, we spent 55 minutes in French talking about, Placebos and pain management and allostasis and hyperactive and the smoke detector theory

[00:22:28] Dr. Jess Reynolds: And the

[00:22:29] Troy Lavigne: and the HPA process and laughter and how it plays into it, and exercise therapy and the research behind all those things before we even get to the hands on care.

'cause I want them to understand it. And, and to go to the expectations that you, the book you were talking about, um, there, there is a difference as well with expectation versus what's called expectancy. And I dunno if that came up in the book, but expectation is a conscious component. I'm a placebo and expectancy is an unconscious component.

And the interesting thing with placebos is that you can actually [00:23:00] play on both. So the expectation is simple. They come in and how do you know what your client's expectations are? Communication. You ask them, what do you expect to get out of these sessions? What do you expect to get out of this first session?

The next sessions? How soon do you expect to be feeling better? You know, expectation is clearly communicated between the client and the therapist. There's no misunderstanding. Expectancy is the complete unknown component to what the client thinks will happen. They're driving to their session. They, they think, okay, I have an image in my mind of what a massage therapist is going to do to me.

I have a thought, unconscious thought in my mind of if massage should be effective or not, how much it should help me or not. They see your room for the first time. They see your building, you see your clinic, they hear the music. And all these unconscious processes take place in their mind where they instantly either say, you know, you eat with your eyes first concept.

And they instantly go. [00:24:00] I'm totally game for this. It's gonna be amazing, or I'm a little hesitant, or this is not my environment. This is not what I expected it to be, but one is conscious, and that's the expectation, and that's clear communication. Um, and then the other one is expectancy, and you can actually play on both.

A good example of that is at my office. I actually have three colored shirts, um, and when clients fill out their forms on why they're coming to see me. I will change my shirt depending on what they need from me. And, uh, an example would be clients coming in who are. Low energy, depressed, lethargic, things like that.

I'll probably change into a red shirt. Red shirt being a stimulant, exciting. Because for me, healthcare has never been about making somebody feel better. Bizarrely enough. Healthcare for me is about homeostasis. You know, if you come in and you're low, you should probably be picked up a little. If you come in and you're high, you should probably be brought down a little bit.

If you come in and you're in too much pain, we want to lower that pain. But if you come in and you can't feel [00:25:00] anything, we should probably bring it up where you can feel something. So. Therapy, you know, most health care is about homeostasis. That's kind of the foundation of health care. And I think we get lost in that, especially speaking as a massage therapist.

I don't know if it's always the same for you as an acupuncturist. I don't think it is from when I, from when we spoke in Calgary. Um, but as a massage therapist, the immediate assumption is that everybody needs to relax. I always hear that all people tell me I'm too tight and people ask me on session one number one.

Do I feel tight? I haven't explored your whole body yet. How do I know if you're tight that that shoulder might be tight? But that might also be the same level of tension through everything in your body In which case, no, you're not tight. That's your tone. That's who you are. And so I think homeostasis needs to be kept in our minds as the primary thing we're after.

So for me, I'll change my clothing based on my client's needs because it doesn't affect me. I'm comfortable with my clothes. I could care less what I wear. And so if they come in in there and, Really [00:26:00] hyperactive. I'll wear blue or turquoise clothing to bring them down as a suppressant. And if they're in a lot of pain, I'll wear yellow or white because those are the primary painkillers, um, amongst, uh, you know, in, in pharmacological placebo medicine.

They see that blue or white and yellow seem to be the pills that respond the most, the colors that respond the most to pain. So if somebody comes in a lot of pain, I'll wear a white and yellow shirt. Um, and those are the unconscious plays that I take. On placebo and intervention, and then the conscious ones would be, okay, your expectations are you're coming to see me.

You have low back pain when you walk out. Do you expect to feel 99 percent better or 5 percent better? Uh, do you expect to feel pain free in 1 session or in 6 sessions? Um, do you expect to have to have therapy be only tool for solution? Or do you expect exercise to be integrated into your solution? Um, and so there's the difference between the expectation component and the expectancy, and, and they both have a role in, in the client [00:27:00] recovery.

[00:27:01] Dr. Jess Reynolds: So one of the things you said, though, is, is communication, of course, is obviously a big part of this. And I'm curious, so you've got your sort of, like, nonverbal ways, but what about the verbal techniques? What do you use as far as your language and your communication style that really utilizes this idea of, of placebo in order to, to benefit your clients?

Yeah.

[00:27:20] Troy Lavigne: Yeah, I'm, I'm actually, I mean, I, when I went to school before massage therapy, I took, you know, part of, I was in special care counseling, which was helping people with special needs, and a lot of times that type of education is those people with special needs may not be verbal. Um, and so, let alone communicative in any way.

So we did tons of classes on nonverbal communication, and uh, communication styles and observational styles, and things like that. And that's obviously played an important role in helping me, but I'm not a fan of it being unconscious. Uh, the same reason I'm not a fan of my clients being unconscious. I don't let clients fall asleep on my table.

Very rarely do they. And if they do fall asleep on [00:28:00] my table, it's because they have specifically requested a session for rest recovery. But if they're coming in for anything else, communication becomes key. And for me, the biggest thing about communication is it has to be conscious. It can't be nonverbal.

It can't be unconscious. So if somebody's sitting there and I see them being in scene, they're moving around a lot, I don't just let it go unsaid. I will say I notice you're being very manic in your movements, or you're being very antsy, or you're very hyper. Do you need ten minutes to calm down? Do you need to go pee?

You know, what is it that we can do to get you to calm down? But if I see that they're having a hard time answering my questions, they can barely think, they've got brain fog going on, I might ask them, hey, do you have an underlying condition that's making it where it's hard for you to answer? I've got this one guy right now, he's a bodybuilder and he has Crohn's and he's on certain medication, and he admits it's giving him brain fog, so it'll take him Four minutes to answer a question that used to probably take him two minutes.

And so when it comes to these [00:29:00] communications, I just don't let it go unsaid. I think the most extreme example of that, which is actually something I did learn from a teacher at first year in massage school, was if a male client gets an erection on the massage table, what do you do? And most people, they'll just, you know, they get uncomfortable, they don't know how to handle it, whatnot.

And I remember the first thing I taught was, okay, you just take your hands off the body, you look at the client, you make sure they're awake, you look at them in the eyes and say, so, I noticed you have an erection. And that usually, like, cuts it pretty quickly and gets it out of the way. But it's also not leaving it unsaid.

It's clear communication. So when a client comes in the room, it's, they're sitting in front of me, they're telling me their problems. The other thing I'll do is, like, if they're saying I have back pain, Sure, that's great. Now I know you have back pain. Well, the back is a large area. Uh, there's two sides to it.

There's a lot of different tissue that attaches to the back. Um, is it, you know, passive, active? When does it hurt? How does it hurt? Um, people often think that the interview process or the intake process is, is just something to get [00:30:00] out of the way. And then they want to go on to their orthopedic assessments or their postural analysis or things like that.

The majority of my assessment is in the interview process and very little of it is done with the orthopedic stuff. Most of it is if they use the correct descriptive texts, I can probably figure out what the problem is. So if somebody comes in and they say, It hurts when I move and when I'm passive. Okay, well, that lets us know it's both soft tissue related and joint related.

But if they say it only hurts when someone moves me when I move, it's pain free, chances are it's passive doesn't guarantee it. You still have to do some tests later, but it already kind of like compartmentalizes it. But if they say it only hurts when I move, when somebody moves me, there's no pain. Well, that tells me active tissue, contractile tissue.

And then if they use descriptive text like it's sharp, burny, achy, numb. Okay, or sharp and burny and numb. That tells me, you know, tingly. Okay, well, maybe a nervous involved. If they say, Oh, it's a dull, achy tension that kind of is just present all day long. Well, that probably [00:31:00] tells me neuropathic pain. It probably tells me musculoskeletal pain, but not sharp emergency pain.

Um, you know, if they say like, Oh, I have, I have this pain. And after a couple of minutes of using it, it just like, if they describe their pain as the first 15 minutes increase in symptoms followed by 30 to 45 minutes of no symptoms followed by an increase in symptoms during activity, that tells me it's an overuse injury.

And that overuse injury means very one thing. Overuse equals fatigue. Fatigue equals rest. So there's all these components where in that interview process, communication, You can really have them get detailed in their communication style to say, okay, not only it hurts here. And when I do this for five minutes, it's it hurts here.

This is the type of pain. This is how intense it is. I took notes on it. This is when it happens. This is how frequently it happens. These are the things I do that help it go away. These are things that help it become worse. This is how long it's existed. You know, there's so much around it, let alone when they start talking about it, you know, does their body language change?

Do they get [00:32:00] pale? Do they go into a trauma response? Do they not want to talk about it? All these components as well that fall into the cognitive behavioral therapy. And so the communication becomes something where the more that's left unsaid, the less likely you as a therapist are to have information that you can use to your benefit.

And if a client comes in and, you know, to tie it into placebos, if a client comes in and they say, oh man, I use kinesio taping. So if I say, what color tape do you want me to say? No, I'll never blue. I hate blue. Well, I'll probably stop wearing a blue shirt. I have blue eyes. I can't help them too much with that, but I'll probably start changing some of the behavior that I have to make them more at ease, um, to create that trust relationship, things like that.

Um, and then the other thing with communication is for placebos, there's another component to placebos we haven't talked about called conditioning. Um, and a conditioned response is something that happens with or without our permission, but it's based off past experiences and exposure. And so conditioned responses could be [00:33:00] like, Oh, I've had massage.

For 15 years, and it's always been a positive experience. Well, when you come see me, you're more likely to have a positive experience because you have been conditioned to believe it will be a positive experience. Versus, I've always had massage, and every time I do, I'm in more pain and it hurts. You're less likely to be relaxed in my environment and get a positive outcome.

So with those conditioned responses, I will also lead them with the questions to make sure they understand That I'm conditioning them to get a specific response. And an example would be, after treatment with me, there's a chance that you will feel delayed onset muscle soreness, or DOMS, or MENKIN, however you know it, or just achy sensation from therapy, for about 2 3 days.

Anywhere from about, up to about 48 hours to 72 hours. Once that goes away, you'll feel good for 2 3 days. You'll love me. But in about four or five days, all your symptoms will come back, and it's not because you did something wrong. It's not because you hurt yourself again. It's not because you went [00:34:00] and moved something incorrectly.

It's because your brain is powerful, and you have this chronic habit of having pain. So now it's coming back because it's a dominant habit, and until we train it to have a new dominant habit, that habit wants to be persistent and stick around and then in session two, instead of having two to three days where you'll feel better, you'll have about three to five days where you feel better.

And on your third session, five to seven days. Thanks. And eventually two weeks and eventually three weeks and eventually you won't need treatment. And what I'm doing by telling them that is I'm setting them up for success. First of all, we know that historically that's what happens with deep manual therapy.

You know, we know that those are the body responses. So I'm not telling them anything they don't know, but I'm also telling them. And then if it happens, which is a key component, if it happens, They're more likely to go, Ooh, Troy was right. He said X, Y, Z happened, X, Y, Z happened. So I can trust him and what's going to happen next should also then happen.

And if the next thing that's supposed to happen is that I'm supposed to have fewer symptoms, I should have fewer symptoms. And the brain [00:35:00] actually really enjoys that predictive text and goes, Okay, I'm conditioned to think that'll happen. And then, you know, one of the things that happens with placebos is we actually do have this whole From a logical processing that takes place in the brain with endorphins and dopamine and beta and gamma and all these neurotransmitters that take place that are really out of our control and how they're how they're used and engaged, but they do get engaged.

When certain conditions are met and certain expectations are met, and a lot of those neurotransmitters have really, really good feel good responses, and a lot of them cut the HPA access of cortisol being used. And so, If we can create expectation and conditioning to allow those neurotransmitters to be met, hey, they're going to have feel good responses.

You know, they're going to have these sensations that go, that was enjoyable and I'm in less pain because of it. [00:36:00] And even if their pain levels don't change, at least their hope changes. And hope on its own, another example of, you know, intervention influence. Hope on its own is enough to reduce pain. So, it's one more of those components.

So, the conditioning and the expectation around, The said and unsaid components of placebo and manual therapy really create a neurotransmitter process, which is what I'm getting at, which is what I'm trying to get my clients to experience. I'm just using a blue shirt versus yellow shirt to get there, or I'm using language to get there.

But the ultimate goal is if I could skip all that and just make the brain do it, that's what I would do anyways.

[00:36:37] Dr. Jess Reynolds: I really, really appreciate that you used the inquiry portion of the session. When I teach orthopedic assessment, um, I, I spend Honestly, 80 percent of the time I'm teaching about inquiry and how to ask questions and what questions to ask in a shockingly small amount, teaching about, here's how you do these special tests for massage therapists, largely, and I believe, just to reiterate what [00:37:00] you said, the amount of information and knowledge that we can gain from a high quality inquiry.

Inquiry is just staggering. And another thought that came up as you're describing that is how my understanding of the placebo effect is, it's not just, it's not all in the head. There's a legitimate pharmacokinetic effect, meaning the effect of a placebo is If it is actually a placebo, and it's doing its job, is the same effect as the medical intervention, it just happens endogenously, essentially tapping into the body's capacity to produce all of the chemicals, neurotransmitters, and hormones.

That medication is either going to stimulate or mimic in one way or another. So I find that aspect really encouraging as well. Do you have anything to add or any additions or anything to that?

[00:37:46] Troy Lavigne: So on my podcast that I did with Luana Koloka, who's kind of the godmother of placebos on the planet, like she's like the voice on placebo stuff right now, um, she's a, she's from the University of Maryland, she's a PhD, [00:38:00] she's also a doctor there, and she did a study where they had open label placebos. and the hidden placebo that I was talking about earlier on clients who had had tumors removed for cancer.

Um, and what they found was that an open label placebo, meaning I'm telling you this is medicine and that it's a placebo and it's going to do nothing, replicated a endorphin response in the brain that was similar or equal to five milligrams of morphine. With no morphine injection taking place. That's amazing.

[00:38:40] Dr. Jess Reynolds: That's huge. That's huge.

[00:38:42] Troy Lavigne: That's huge. Now, it's not necessarily enough to get rid of your pain. It might dull it a little bit, but if dulling your pain is enough to get you to climb a flight of stairs, and that long term your arthritic knee pain is coming from quadriceps weakness. And climbing that flight of stairs, you've never been able to do it because it's too [00:39:00] painful, but now we dull that pain enough where when you climb the stairs over time, your quad can get large enough to handle it, and then your knee pain diminishes.

Hey, that might have been the percentage that was the most important percentage in your recovery. It may not. May not be at all, but it might've been the most important to me. That's one of the biggest, but a, another really fun story, which is one of the ones I used in the class that you were sitting in, which is probably my favorite placebo story of all time.

And it's the most mind blowing in my opinion, is, and for all the listeners falling right now, you can do this. Everybody can do this, and you'll get this, this, and I'm telling you right now, you'll have a placebo effect. So it's an open-label placebo. Nothing is changing, but it will have an effect on you.

Um, so if everybody closes their eyes. And you just put both your feet on the floor, and if you're not driving, close your eyes if you're driving, focus. Um, but what you're going to do is, your feet in your shoes, you're just going to tell me which of your feet, make a decision, and say out loud which of your feet is warmer than the other.

Take about 10 or 15 [00:40:00] seconds, focus on the humidity in the feet, focus on them in your shoes, your socks, barefoot, wherever they are, how they feel. Just think, okay. Which foot is warmer? And then once you have that decision, say foot. So most people will say a foot study came out. It was something like 98 percent of people will make a decision on right or left side.

And you know, if you told me it was your left side, I could sit there and say, Well, of course it's your left side. Your heart's on your left side. It's pumping blood there more easily. Yeah, yeah, yeah. If you say it's your right side, it could say that's colder because of this. We could give any number of reasons.

Dominant side, non dominant side, whatever it is. But the truth is, is they're the exact same temperature. Studies show that they're the exact same temperature. And here's the amazing part. They're the same temperature until you decide one of them is warmer. And after the decision is made, that foot will actually have an increase in temperature.

And they did this with really super sensitive, uh, thermometer, you know, receptors inside the soles and things like that. And they found that once the decision is made, [00:41:00] You actually have a change in temperature. So going back to what we talked about with communication, suddenly how we phrase things to our clients becomes really important because if I had phrased that is, are your feet the same temperature?

Most people will say, yes, they are, but if I phrase it, which of your feet is warmer than the other, you make a decision. So it gives me an opportunity as a therapist to use language to help my clients get better, and I do it all the time. They come in on session two or session three, and I don't say, how are you feeling today?

I say, how are you feeling in comparison to your first visit? Give me a comparative analysis, even if it's subjective, and you got to hope you do a good job because sometimes the answers come back and they say, I feel worse, in which case you need to change your technique. But if they come back and they say they're seeing an improvement, you don't have to actually work harder at your job.

They're already convincing themselves that. Therapy is an efficient tool for them, which means one, they're going to want to see you again. So that's good for your [00:42:00] business, but really what it is, it's good for them because they're now going to say I'm getting an improvement in my symptoms. And as I improve my symptoms, my quality of life is going to increase.

My joy is going to increase. I'm going to have less negative stressors. I'm going to have more of a positive outcome in my experience. And so that communication becomes key. Part of that communication also becomes making sure your clients stay awake. And this for me is probably the The hardest thing to get through with a lot of massage therapists is don't let your clients fall asleep on the table.

Now, I know for acupuncturists, it's probably similar. I know a lot, I mean, I receive acupuncture quite often, and they put the needles in, and I love it, and then they put the hot lamp over my feet, which is my favorite part of it, and then they walk out the door, and they let me rest for a little while, and what do I do?

I snore. I fall asleep so fast and so hard, and there's such a big part of me that wishes they'd just stay in the room with me. And keep talking to me, even if they're not moving, because the effects of conditioning and [00:43:00] expectation are conscious, not unconscious. So if I can sit there and massage someone and tell them, I'm massaging your glute medius, and this is why I'm doing it, and this should be your expectation, and don't let it become past a grimace, and let me know when that starts feeling good, and is your knee relaxed, then even if they just tell me stories about their life, but they're in tune with their body, then They're conscious to those expectations and those communications, and it's does this feel good versus not, um, you know, similar to what I said about the feet thing.

So those are the morphine one and the foot one for me are good examples. There are other really interesting examples. Another good one that is less about the neurophysiological component, but one that still plays into those. Unsaid components of how placebos playing to us is, um, people were put in front of three different versions of chocolate chips.

One had a 1 price tag. One had a 2 price tag and one had a 3 price tag. And they were said, eat the chocolate chips. Tell me which ones taste better. [00:44:00] And as most people will assume, you know, I'm talking about placebo. So you can understand that this is a trick question. But even when I did this in my class, I said this was a trick question.

It's an open late. I'm telling you right now, yeah. This, what I've written is fake. Most people still said the 3 chocolate chip tasted the best. They're all from the exact same bag. But to really make it an open label placebo, I had three different brands of chocolate chips out, you know, next to each other.

And I didn't say which one was which, but that way people are fooled visually to think, oh, there are three brands. And even though I'm saying no, they're all the same. Um, and yet people will are convinced that I'm lying to them. Um, and, and it's one of the interesting things with placebos when it comes to how the brain behaves because if I tell you it's a placebo and you get better, even though you got better, people feel cheated, which is really weird.

People feel like they can beat the placebo and there's a big hint to any listener following right now who thinks you can beat a placebo. You [00:45:00] can't. The only difference is how much it affects you. Whether it's 14 percent or 20%, but it's across the board. Placebos are effective whether you believe in them or not.

The difference is is how effective and if you believe in them more, they are more effective. So why not? Right? Like, why not use every tool in your toolkit? Um, but it's interesting that people feel cheated when they're told that it's a placebo before or after the responses. Um, even though the responses might be desirable to me, that that's such a because that doesn't happen in a lot of other areas of life.

You tell someone I'm going to help you get better and they get better and they go, Oh man, I feel cheated. It's really weird.

[00:45:38] Dr. Jess Reynolds: Yeah, yeah, I, um, to your point about. People staying awake while on the table and I, I find when I do acupuncture, it's essential. In fact, I almost exclusively now do hypnopuncture or acuhypnosis, however you want to combine it. And what I find so amazing is, well, what's in the practice that I have is we've got [00:46:00] points that have all these indications and it's like doesn't, it does not matter what somebody comes in with.

I can guarantee you there's an acupoint for that. Like it is just, it's silly. I kid you not, there's a point on the foot that is indicated for the sensation you experience when you don't like the sound of too many people talking. Like, literally for anything. So what I find really cool about, yeah, right?

Is, somebody could come in and they could have, uh, um, an issue and I could say, Okay, well, I'm gonna use this point for this, and I'll explain to them, I'm using these points for this, and this, and this, and this. And then, I'll sit down beside them, and I'll tell them, now what we're gonna do is we're gonna do a little bit of hypnotherapy.

And you're gonna be aware of it all. This is not, I'll explain in detail exactly what we're doing. Of course they would have agreed to it ahead of time. And then throughout that, I essentially just tell a story. I tell a story that is roughly an analogy of the point indications. So I do my best to amplify the effect of what they're expecting.

They're expecting acupuncture to be [00:47:00] some sort of weird, magical thing. They're expecting the outcomes based on what the points I said. And then when I tell them this story and use the hypnotherapy principles, everything kind of gets this little bit of a boost. But again, I'm very open, I'm very open with it, saying this is a story, this is an explanation that we can have, but ultimately, all of the healing that's occurring, that's you, that's you.

All I'm doing myself is just guiding and nudging you in the direction to eventually allow your body and your consciousness to do its own healing. So to the point, I think awareness is essential during a session. A course that we offer is called Relaxation in the Brain or Mindful Meditation Massage and it's the same thing but for massage therapists.

And there's essentially a script that plays in the background, you just press play and it's music and it's like a Yoga Nidra or an NSDR script where the massage therapist will be working on the foot and the script is bring your awareness and your consciousness to foot, feel your foot relaxing, so on and so forth.

So [00:48:00] by combining the use of communication and these very simple. Verbal techniques that we can use. I believe we have a massive effect or improved effect on what we're doing.

[00:48:12] Troy Lavigne: Yeah, I, I would agree. I think, I think it's important. There's a, there's a interesting thing that you had mentioned in there, which was to me,

when we're, when we're dealing with clients who, let's say, Don't like being cheated. Don't feel like don't like feeling cheated through massage or through placebo or through on evidence based, you know, like there's a lot of evidence on the benefits of acupuncture, but then there's in the western world.

They go. It's not evidence. We'd like, you know, things like that. There's a lot of evidence and a lot of these different subjects in the world like that. And one of the things that's interesting to me is that if a client is going to be guided through some version of treatment, um, There's a portion of that.

There's a portion of the population that will love that and latch onto it and go. This is exactly [00:49:00] what I needed because mentally it gives them an opportunity to escape. It gives them an opportunity to not be held responsible. It gives them an opportunity to really disconnect and be guided through the healing process.

And there's a percentage of the population that that's essential and key and important. But then there's another percent of the population who absolutely want to be in charge of their healing. They want to be engaged. They don't want to be guided. They want to be telling you what's going on. And I, and I think both are valuable and both are important and both involve obviously good expectation, conditioning, communication, things like that.

But I think there's a, there's a component where the client has, if, if the client wants to be unconscious, what I guess what I'm getting at is if the client wants to be unconscious on the table, or not necessarily unconscious, but disengaged, guided through it, they, for me, it still has to be a conscious statement.

They still have to say, this is what I'm after today. I don't have the mental fortitude, I don't have the brain space, I, [00:50:00] I need the disconnect where someone guides me through the process, as opposed to it just being offered, or just being given. Because that conscious component sets them up for, today this is what it looks like.

Next week, next month, Next session. It may not be the case. I may want and have a desire that's different. Um, and so for me, that becomes a key component. And it's the same with every session. I do, you know, most sessions look similar, but they still get the question. What are you after today on every session?

And I think that becomes a really important role in in health care is, you know, especially in more. I'm going to go ahead and say more complimentary alternative medicine health care. What is your role for today? Because the sessions aren't costing them 5, 000. They're not spending 28, 000 on a surgery.

They're not laid up for 3 or 4 weeks. They're not, you know, out of work. They're, they're coming in, they're spending most likely under 150 for most therapy. Um, and it's only going to [00:51:00] take about an hour to an hour and a half of their time. And because of that, um, their expectations week to week may change.

As opposed to spending five years waiting to go see a, you know, a, a neurologist about a specific, uh, pain that they're having. Uh, so I think those expectations need to be communicated on session one, but also every session have to be communicated on whether they want to be conscious, unconscious, guided, not guided, uh, what their role is in their therapy.

And you had mentioned also the

[00:51:28] Dr. Jess Reynolds: yeah, and on that note, sorry to interrupt. Go

[00:51:30] Troy Lavigne: no, no, go ahead.

[00:51:31] Dr. Jess Reynolds: I was, um, I completely agree that every session. One must check in in order to understand the expectations of that session, what they're looking for, what state they're in, all of these types of things. And, um, you know, there's all the techniques that we can use as practitioners, like matching and pacing and all these things to really meet our patients where they're at.

However, I also think that that needs to be nested within the greater expectations of the overall treatment plan, assuming you have one. We've all got those clients who just come [00:52:00] in for their check ins, for their tune ups, for their chill out sessions, Beautiful, love it. But the individuals who come in and they're like, listen, I have this problem, shoulder pain, step one, reframe shoulder pain into the real problem.

I have this problem. I can't go golfing because my shoulder hurts, right? Good. So they've got this overarching why that they're coming in for in order to go golfing. And the, the change occurs from week to week. Like I want a little bit more active, I want a little bit more of this. So essentially what I want to totally agree.

And we keep Each session within their session expectations and always touch in to the greater expectations as well and using our language in order to tie into that expectation ultimately means every session, no matter if it is a chill out session or a deeply, uh, bodywork therapeutic one, we're still always moving towards that, that larger expectation.

If that makes sense. I was a bit rambly there, but.

[00:52:55] Troy Lavigne: Absolutely. I think it makes sense. And I would agree as [00:53:00] well. And I want to go back to something you had said previously about, uh, the natural healing in the body, which, which I love because one of the, one of the things that the placebo research shows us is that the body does have the, you know, one of the things I said on my podcast once was, man, how wizard would it be if the body could heal itself?

Um, you know, how Gandalf like would that be? How cool. And the thing is, there is a component that can do it. There is a part of our body that has that potential, but I sometimes think one of the big cruxes, um, and and pitfalls in complimentary medication, especially, you know, I see it a lot in massage therapy, but I see it in acupuncture.

I see it in osteotherapy. I see it in chiropractic. I see it in most of the more complimentary medications where there's this component that says, well, if the body has the natural ability to heal itself, well, let's tap into that and heal the body. The body has limits. You know, I, at one point, I, if you move my arm into a certain angle, at one point, it's [00:54:00] hypermobile and eventually dislocates, like I have limits in what I can do.

Bones can bend, but they eventually break, and that it's a very fine percentage there between the bend and the break. Um, and I think, I think sometimes those limits are forgotten in complementary medicine. I think it's sometimes assumed that because we have these abilities that, Somehow magically we're going to tap into them with, uh, you know, not to call out any single thing, but like either a magical bracelet or, or a massage or a sound crystal or faith healing or needles or cupping.

And this is the tool, big T H E, you know, capital letters, the tool that's going to suddenly save the world. Or this modality is the one that's going to help every client I have. And I think it's a big pitfall that we have in, in conflagration medicine where they go, well, the body has the ability to heal itself.

Therefore we're going to tap into it. When in reality, aren't we tapping into it? You know, like, is the body just kind of doing it itself? And what you're really doing as a therapist is enhancing their experience [00:55:00] through the healing process. Like a herniated disc with or without treatment recovers in eight to 12 months.

So with or without treatment, eight to 12 months, the disc fully recovers on its own, barring re injury. Okay, so it's reabsorbed. Any symptoms that persist beyond that are probably more brain related and somewhat structure related but primarily brain related with the smoke detector theory. When the client comes in to get care, let's say a client has a herniated disc and they see us as therapists at week four.

four or five and you give them a treatment and at week six they come back and they go oh my god life saving session that was the best thing ever i came in last week i was in almost debilitating pain and now it's amazing well you know what's weird those people who come in at week five who don't get treatment at week six have the exact same response that week five to six for some reason four to six is really important in a herniated disc and most debilitating symptoms disappear Within that four [00:56:00] to six week, and then from six weeks to 12 weeks, they kind of get into this or six to 18 weeks.

They get into this dull aching phase. It's not across the board, but on average. And so when a, when a therapist sees a client for the first time, if they fall into that four to six week window, Um, you know, if you're good at marketing and you're unethical, hey man, promote it. You saved him. Hey, good for you.

But if you're even somewhat ethical and you know the science, most of my clients, I tell them, well, when did you have your injury? Okay, how many weeks out are you? Okay, well, I'm going to help you today. But honestly, all I'm helping with is your quality of life. This would have healed without treatment to this degree.

You would feel better with or without my care. But what I'm going to do is I'm going to help you feel safe in your recovery. Um, especially as it comes to exercise therapy, I'm going to help you feel safe to move. And I think a lot of the natural healing process in the body is overlooked in alternative medicine, and, and almost ignored, and somehow thinking that we have these magical powers to do more than we do.

Um, the body heals really well on its own, [00:57:00] and a lot of the things that Take care of that healing or are things like neuroplastic processes that don't really reflect what we're doing with our treatments But our treatments seem to create a safe environment for them to happen at a greater rate, which is fantastic So I don't want people to think that i'm i'm bad mouthing can therapies I'm a therapist for 20 years and I do it, you know, it's my primary source of income It's my primary job and I love it.

Um But I also think there's a component where we need to be honest with ourselves and our own limitations in order to help our clients. Um, and, and I think that's often overlooked, especially, you know, you watch social media nowadays and you see, wow, people are making some pretty outrageous claims on some of the stuff that can happen with manual therapy.

And, and I don't think it's another good example is the IT band. You know, the IT band is stretched the IT band. It takes 2, 500 PSI to stretch the IT band. That's a massive amount of force. I think that the analogy I heard once was that's the same. This equivalent to being drawn in quarter [00:58:00] by draft horses like that's not a good thing.

That would be an injury by all means. That would be a significant injury. And when they videoed the I T band being stretched, quote unquote, stretched under super slow mo cameras, they found that the I T band went from a solid state to a torn state. With no stretch in between. So can you stretch the I. T.

Band? You know, science time is kind of says no. So if if science is kind of showing us that we can't stretch the I. T. Band, maybe we should stop using wording like stretch the I. T. Band. It doesn't mean we can't have an effect on I. T. Band pain. Doesn't mean we can't have an effect on dynamics in the leg, but we maybe we just move away from the idea that it's stretching the IT band.

And I think that's one of those examples where we often feel like we have more power than we really do. Whereas the effect of what's going on in the brain, the placebos, the expectations, the conditioning, the laughter, the humor, the feel good sensations, the sense of safety, the sense of trust, all those things that come from the intake or the inquiry, those seem to be satisfied.[00:59:00]

With with that process and that as a therapist is where I have the potential for the greatest impact and then if if I have that Impact there then my hands they almost have to do little work to get the same results as opposed to having to do it all In my body

[00:59:17] Dr. Jess Reynolds: Yeah, yeah, I think, I think actually that's a really, um, like, we're getting close to an hour here, so we could probably talk about this for 10 hours, but what I really appreciate about what you just discussed is it, it kind of takes us full circle, right? We're kind of bringing back this idea of intervention influence and, and the balance between the fact that, you know, you, you still do touch your clients and you still are a manual therapist.

And what I'm hoping that, that people get after listening to this, it's, it's like, There's this tool that we all possess, and we use this tool whether we're aware of it or not, and it's everything from our communication style, to the clothes that we are wearing, to the shampoo that we use, literally, in order to create a scent in the room, to every little detail, from the picture that hangs on [01:00:00] the wall when the person walks in.

There are these, these, this cumulative effect of a million little things that all Inevitably influence the outcome. So what I'm hoping people understand is technique, it matters. I talk about this all the time, it matters. You know like myofascial release, it gets rid of adhesions. Those are things we know.

Don't want to get into the science of it, but you know. Like yes, the techniques matter. Your ability to perform a quality, effective treatment. But when we, when we consider the total outcome of a session, it matters, but perhaps more, depending on how you look at it, perhaps what matters more is every little step between them walking in the door and getting on the table, and even on the table, that has to do with their communication, that tends to have this outsized effect, because as you said, The body is pretty damn good at healing itself.

Our intervention could be these guide rails [01:01:00] that make sure during its process, the tissue is healing in the right direction, that they're healing with this minimal pain that we're reducing stress as they go through this healing process. So I think, I think that's, that's kind of unless a mistake and that seems to be sort of the theme that you're getting at here.

[01:01:14] Troy Lavigne: very much and I think for me the way I like to describe and that's very close to how I describe it I think for me, it's it's that you know for those first 12 or you know, 15 years of my practice I had really good results and I'd say I had really good results about 80 percent of my clients You And about 20 percent of my clients, I didn't get results.

I conveniently ignored those 20%. Like most therapists do. Oh, I'm a good therapist. I do a good job. This number of people, you know, if 8 out of 10 people get better. Hey, that's still a really good average, but I kind of said, Okay, well, I know how to help those 80%. I don't know how to help those 20%. And I'm really interested in that 20 percent because I would rather have 100 percent success rate.

You know, it's not about being perfect. It's about the pursuit of it. And so [01:02:00] when you look at intervention influence, you know, if we were to take a jar and fill it up with everything that helps a client get better. First thing is self motivation. Do they make it to the session? Yeah. Number one, did they book a session?

Did somebody book it for them? Second is, do they trust you? Do they not trust you? Do they understand the disorder? Do they understand the disease? Do they, are they seeking a multidisciplinary approach? There's all these components that make it better, but every one of them You know, it's like, which drop in the ocean makes the ocean full?

Well, they all do combined together. You can't, you know, taking one out, the ocean is still there, but if you get rid of them all of a sudden, the ocean's out there. So which is the most important one? They are all in which, which, you know, Jerry Seinfeld said, which breath is the most important breath? Well, the one I'm taking now until I take my next one, and then that's the most important breath.

And it's the same concept with manual therapy, you know, or all medicine. It's. What helps my client get better? If for client A, it's my elbow in their back, then hey, I'll stick my elbow in your back, if that's what [01:03:00] gets you better. But if for client B, it's me cradling their skull and them in tears on the table, and because I'm not a psychologist, not breaking, delving into the problem, but just holding the space for them to have that release.

I'll do that too. And if for client C, it's wearing a yellow shirt, I'll wear a yellow shirt. You know, if it's putting on corn, if it's putting on comedy, if it's putting on death metal, whatever it is that my client's going to need, and that was a C, not a P for any of your listeners there. If it takes, whatever it takes to get them feeling better is the most important thing.

That's why they're seeing me as a therapist. And so, As a therapist, I think, and I think it comes with time and experience in the profession, you eventually go, Oh, who I am and what I do actually matters less than my client getting better. There's a humbleness that comes from being in the profession long enough where you say, you know, when I was younger, it was about what I did that was important.

And now I kind of care less what [01:04:00] I do that gets my client better. I just want them to get better. And I think. That for me is the most important thing is that historically we have good tools with our hands and our orthopedic and our techniques and our modalities. We have good tools that help the 80%.

What are you doing to help the 20%? And I think that is where we are lacking as therapists, and I think if we can find that 20 percent we will start be taking more seriously in health care because we'll start having more consistent results. But to get to that 20 percent you have to be educated and you have to know how to use placebos you have to know how to use pain neuroeducation science, you have to know how to use hypnosis.

If you're allowed you have to know how to do soft and deep work you have to know how to do sports massage. and myofascial release. You don't have to know how to do lymphatic drainage and pediatric care. You have to know how to do all of these. You have to become very, very talented. And that only happens with experience.

It [01:05:00] only happens with time. But you have to get a pool of knowledge that is so large that you become a generalist. In order to help everybody. And I think, I think that's a beautiful, beautiful thing in healthcare and in manual therapy to become this person who can, can help with musculoskeletal dysfunction and disorder and pain.

How beautiful, but how, you know, that's a big responsibility too. How, how fearful and how scary all at the same time, but I think that 20 percent becomes really important. Technique matters, but sometimes technique is the least important thing. To a given client and you better have another tool at your disposal for that client.

[01:05:39] Dr. Jess Reynolds: And you know, you, you may have answered this in, in what you just said, but the question that I ask virtually everybody, it's the, the sort of, to tie a bow on the conversation is, in your opinion, what, what do you think is the most important thing that makes a practitioner, massage therapist, osteoache, it doesn't matter, a practitioner successful?

[01:05:58] Troy Lavigne: You know, I [01:06:00] was listening to your podcast the other day and I heard you say that I listened to a few of yours and I heard this at the end and I, and I remember thinking about it and I remember having a few possible answers, but I think, I think, I mean, there's so many possible answers. There's so many and I don't think it boils down to one.

I would say a really important one is being humble. You don't know everything. We don't know anything. The more we look into CPT, cognitive behavioral therapy, the more we realize we don't know very much about the brain. It is kind of this really big mystery. Um, the more we look into things like, you know, when I spoke with Luana Koloka on placebos, you know, she said her goal in understanding placebos more is to make clients and therapists more thoughtful in their interventions.

That to me is so beautiful, that is what a good way to think about not only placebo, but any version of intervention to be more [01:07:00] thoughtful, both as a client and as a therapist. And that's an important thing because most therapists think they have to be thoughtful, but they don't think their clients have to be very thoughtful.

But it comes back to that humbleness thing of if I'm a therapist and I'm thoughtful, but my client could give a shit, how effective is the treatment going to be? But if I say, you know what, I am actually the less, the least important person in the room. The client is paying me for my time. I might have the knowledge, but my client is absolutely the one having this experience.

If I'm humble enough to put my ego out of the way and put myself out of the way and say I don't know what will make you feel better. So I'm just going to stand back and wait for an opportunity to find out what makes you feel better. And maybe it's my hands. Maybe it's exercise. Maybe it's listening.

Maybe it's you telling me about your pain. Maybe it's about reliving that trauma. Maybe it's about you know, leaving early for a session because your kid's late. Who knows what's going to make them feel better. And if I, as a therapist, come in thinking, I have the solution. [01:08:00] I see you have a gate problem. So we're gonna go ahead and fix your screw home mechanism and change your arch and this and that.

If I come in with a plan, chances are you're the most important person in the room and your client is secondary to you. Um, and then the other thing is, if you're humble, you're gonna want to go learn more. If you're like, you know, I don't know everything and I really do need, you're going to go learn stuff.

You're going to go and you're going to learn stuff from people who absolutely disagree with you. Which is very much where I think you should go. You know, if your listeners are listening to you and they like you and they like what you're saying and they like this podcast Don't come take classes from us.

Sorry, Jess. Go take classes from somebody who absolutely disagrees with us because it'll make you think and it'll make you wonder, Am I doing it right? Am I doing a good job? So I think having the humbleness to say I don't really know my role and my or not my role because we know our role but my position and and what [01:09:00] is going to help the person.

What tool is going to help them and whether or not I will actually be effective. It it's freeing, it's liberating. It's really scary. But I think it might actually be one of the things that makes a clinician the most powerful clinician to say, you know, because I don't know what will help you, I'm going to wait for that opportunity to find out what helps you.

And I know there are some therapists who say having a plan is the most important thing and they're not wrong. My plan is I don't know what's going to happen. And, but that also comes with time and experience, you know, 20 years in, I've been exposed to enough tables on bodies, I've been exposed to enough classes where I feel safe in not having a plan and being flexible in the treatment room.

If I've been a therapist for one year, and the only thing I know is neuromuscular therapy, myofascial release, and Swedish and sports, you might be a little less comfortable in your plan. And that's completely understandable and acceptable. Give yourself time. Give yourself time. To feel like you help enough people [01:10:00] to not know what you're doing and then go, Okay, now I need to learn more.

There's nothing wrong with that. Um, but I think what makes people stay in the profession longer, I think what makes people want to stay motivated in the profession and have good practices really is the sense of I don't know what I'm doing today. I don't know what I'm doing for this given client. It may be different than last session and that humbleness that comes with it.

[01:10:22] Dr. Jess Reynolds: That's beautiful. I think it's brilliant answer. And I think I think that's a good place to wrap it up and tie a bow. So what I'll do is I'll put all your contact information, everything in in the show notes. And again, we could talk about this and a million other topics for eternity. So I hope we do get to do this again sometime.

And thank you so much.

[01:10:40] Troy Lavigne: Yeah, of course. No problem, man. I was glad, I'm glad you had me on.

[01:10:43] Dr. Jess Reynolds: Yeah, awesome.