I know enough about pain

TheKettleBellPhysioUncategorized0 Comments

I know enough about pain to know that I know very little. I’m writing this having just received Lorimer Mosely and David Butler’s new Explain Pain Supercharged. I haven’t got stuck into it yet, but couldn’t help but notice Figure 1 – The clinician’s iceberg of knowledge

I graduated from my Doctor of Physiotherapy program in 2012. Looking back, I would say with confidence that I understood essentially *nothing* about pain. Like the captain of the Titanic, I hadn’t even noticed there was an iceberg at that point. Given that the iceberg of ‘pain science’ had been floating around for a full decade before I graduated, that goes some way to explaining why there’s much chatter about Physiotherapy having a crisis of image and brand, and the frustrations that I and others have as new clinicians who see this iceberg and are trying to move away from low value healthcare. We know what happened to the Titanic.

Last year I was flicking through some old paperwork from Uni and found an article by Lorimer Moseley with some highlights on it, so something about the science of pain had obviously come up through my program. I have no recollection of it so it can’t have been important…. and no, it wasn’t because I was skipping classes and hungover.

Working in private practice 5 years ago as a new-grad I felt confident treating people with pain. I’d been a manual therapist for nearly a decade by then and had been teaching the stuff for just as long. I could perform a Stork Test with the best of them, deactivate trigger points and ‘myofascial release’ tight muscles with my eyes closed. I was confident, it was pretty straight forward, and I felt like I was helping people most of the time. I had no qualms sticking needles into people, poking them with tools, scraping them or sticking tape on them.

I recently heard the phrase I’m not young enough to think I know everything. That is so true! I’m 42 now and a little wiser than I used to be. In 1998 I was two years out of Uni, I’d traveled and lived overseas, and about to start my new career living in central London. Much like a lot of young men that age, I was cocky, a little arrogant, over-confident and thought I knew it all. Some would say that not much has changed, but they didn’t know me back then.

In 2004/5 I had a career change and since then I’ve completed a:

  • CertIV in Fitness
  • CertIV in Small Business Management & Life Coaching
  • CertIV in Training and Assessment
  • Diploma of Remedial Massage
  • Advanced Diploma of Myotherapy
  • Graduate Diploma of Manipulative Therapy
  • Degree in Exercise Science
  • Doctorate of Physiotherapy

….and a host of difference continuing education, professional development courses and Certificates – RKC, FMS, SFMA, Clinical Pilates etc.

It feels like I’ve been on a non-stop rollercoaster of education for the past 12 years, but it wasn’t until early 2014 that I started to take notice of the clinician’s iceberg of knowledge in relation to pain science. Since then it’s been a constant and sometimes overwhelming stream of information and education. It turns out that thing’s bigger than Ben Hur, yet still some can’t see it, or have seen it and ignore it like Captain Edward J. Smith did.

You’d think with all this education I’d feel like I was riding a wave of clinical excellence. That would be nice. It’s more a feeling of drowning underneath it wondering how to resurface for air. I have more doubts about what I believe to be true, more doubts about my competence as a clinician, and more scepticism than ever before!

Pretty much everything I once believed to be true, even some basic anatomy, has turned out to be wrong. I now work on the basis that whatever I believe to be true probably isn’t. On average, I’ve had a fundamental shift in thinking every 3-4yrs and I expect that will continue. 5 years out and I still feel like a novice and I expect I will continue to feel that way indefinitely.

I recently shared in a Facebook Live video here that ‘Leaner’ is my number 1 natural talent in the StrengthsFinder profile. I bloody love learning! I don’t recall ever struggling with cognitive dissonance, but now I find myself seeking it because then I know I’ve learnt something in the process and that excites me and feels like the air I need to breathe.

Todd Hargrove shared a couple of quotes on this blog from 2015.

“I think it’s much more interesting to live not knowing than to have answers which might be wrong.”

— Richard Feynman

“The truth will set you free, but first it will piss you off.”

–Joe Klaas

I know enough about pain to know that I know very little. I see the iceberg and I like the look of it. I feel like I’m navigating my way around it but if truth be told, I know that it’s far larger than I can imagine and *that* knowledge keeps me humbled by it. Like reaching the horizon, I’m confident that I will never truly understand how large it is, and that the larger it appears to be the less of it I will be able to see!

What’s fascinating is that I see other people watching it too, but they’re on different boats looking at it from a different angle and so what they see is different to me, and that’s ok because “treatment philosophy is a choice” Dr Scotty Butcher. The important thing is that they see it and they’re watching it. The passengers on those boats are far less likely to sink.

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