Colin Rust

New Episode! "Beyond Neural Tension: Exploring Neurodynamics with Michael Shacklock" In this conversation, Mark Kargela interviews Michael Shacklock about his journey and influences in the field of … Player links & show notes: modernpaincare.com/beyond-ne…

Manual therapy was going to be my way of feeling like I belonged in my profession and that I was good enough I came out of university, where I was exposed to an eclectic view of manual therapy where we learned Mulligan, Kaltenborn, Greenman/OMM/MET, McKenzie and others. I was drawn toward manual therapy. It was a skill that I thought allowed a clinician to solve complex patient issues through exceptional skills you gained in your hands. I spent the first 10 years of my career on a roller coaster with it. I would get letters and a dose of exposure to a group of clinicians firmly believing in whatever system I was learning and showering me with praise and confirmation bias These results would soon wane, and I felt back at square one I wanted to be great, and someone other clinicians referred their most challenging patients to This was likely rooted in the feeling most of you are familiar with. The one where you feel inadequate or not enough. The one that keeps you up thinking about patient encounters at two in the morning. I wanted to get rid of this feeling and feel like I belonged. That feeling at times grew very strong to the point I considered quitting the profession altogether more than once Fellowship was supposed to be the culmination of my manual therapy training to where I was to obtain Jedi status and truly be able to secure my belonging A major disappointment was seeing the complex patients I went into fellowship to figure out were also failing in the practices of my very accomplished mentors. Two courses changed the course of my career and felt like they were the beginning of taking the weight off my shoulders. They were a course on pain science and one on how manual therapy works. After fellowship Louis Gifford's Aches and Pains books also were huge for me. He recounted the same journey I felt like I was on. He practiced and was mentored by THEE Geoff Maitland and saw complex patients struggle with a traditional manual therapy approach. I wasn't alone! A massive A HA happened for me I was already enough and adequate. The problem was that I was playing a team sport by myself Manual therapy wasn't fixing anything but now was something that was an option to modulate pain not a must. Deep dives into pain science helped me understand the complexity of what can impact the pain experience. The complexity was located in the person in front of me and their story and was much more than millimeters of facet wiggle. The only way I could understand this complexity was to get better at shutting up and giving the narrative a space to be told and my purposefully curious attention to be questioned. I was asking about people's lives and not simply how their symptoms behaved or another question to interrogate their tissues. It was emotional at times for both me and the patients. You hear horrible journeys that some people have walked before our interaction with them that can't help but tug at our emotions. Opening a space for this narrative gave me the missing data from my encounters. I could take this data and see if I could co-create a narrative where I played a guide and the patient and their valued goals took the role of hero of the story. It has re-ignited my passion for what I do. I love the privilege I have of being able to become part of another person's narrative and to serve as a guide to help them get back to living a life toward their valued goals Patients I previously dreaded are now my favorite as it is now a challenge I greatly enjoy to find out what informs the presentation I see in front of me that earlier in my career would have had me calling the patient a difficult patient, a malingerer, an energy vampire, .... you get the point. I don't feel pressure to have THE answer. I am comfortable giving options that I discuss with my teammate (the patient) that we can decide on together. The morale of the story is that you are already enough. You don't need to continuously chase the next technique or treatment to "fix someone" I would argue a lot of our pain patients have the capacity to unlock a better and more fulfilling life inside them These things have often been buried by a system that invalidates, scares, over-medicalizes, and flat-out doesn't often listen. Learn how to receive and validate a narrative Learn how to take this narrative and make sense of pain with someone Position yourself as the guide by the side. Great things will happen.

How new grads approach pain • Tissue interrogation interview • Examine it to "find it and fix" - biomedical • Authorities/experts in their communication How pain care experts approach pain * Question tissues and narratives * Biopsychosocial exam * Guide by the side