The Rollercoaster of Professional Life

The first wave
Forty years of practice beckons – what a rollercoaster! When I emerged proudly with my degree in the late 70s, all packed with Maitland style manual therapy, I was convinced I could fix all and sundry and I often opened a clinical conversation with “what can I fix today.” ( I feel ill saying it now!) Anyway, it all worked well for a few years but then I noticed that “it” was not delivering the goods so well. Unbelievably some patients dared not get better. Things were feeling professionally grim, career changes were pondered, but then, proud and erect, fresh from New Zealand, Robin McKenzie rode into town, maybe even on a white horse!

The second wave
Wow – this was it! How silly was I to miss the disc and the novel notion of actually getting people to treat themselves and to give your thumbs a good rest. People started getting better again, my practice was full of lumbar rolls, the “Treat your Own” books and models of discs and I was on a roll too. This McKenzie approach worked wonders for a few years, but then the outcomes began to taper off, some patients wouldn’t improve, some wanted the old fashioned hands on that I had given away and a now familiar professional grimness emerged again.

The third wave
I heard about a year-long Maitland course in South Australia and I reasoned that there must be more to it than I’d first thought, so I signed up for the year. That was intense! I made it through a bit wounded but the old “I can fix anything returned” and I went into the outer suburbs of Adelaide to ply my trade, wriggling and cracking joints and doing the new teasing nerves stuff. People got better again! and complex problems seemed to dissolve. But would you believe it – it happened again – the clinical outcomes tailed off with what I now recognise as centrally sensitised states, overuse syndrome and complex regional pain syndrome.

The fourth wave
By now I was becoming a bit older and wiser and thinking deeper about things- so I thought –”stuff the others – I’ll work it out myself” And so I went off on the “neural tension” bandwagon – the idea of the physical health of the nervous system and mobilising nerves. I did some reading, had a few thoughts, stood on the shoulders of a few others and even wrote a couple of books. This was it I thought! Life will be easy from now on as we wriggled and glided and teased nerves from head to toe. Patients flocked in…… but the old diminishing outcomes emerged again, even for something I had helped to invent. Grim days – coffee was coming into fashion I pondered becoming a barista and I investigated what it would take to become a marriage celebrant.

The fifth miniwave
I was getting very wary now – the early work of Vladamir Janda was being updated and researched, particularly at the University of Queensland and once obscure bits of anatomy such as transversus abdominis, obturator internus and short neck flexors were now the new targets and the “with it” practitioners had ultrasound machine to view muscles. I went to the courses and gave it a go but my heart wasn’t in it. The outcomes were eluding me again. I tried the taping too but like a focus on a single muscle, it just didn’t make enough sense.

I drifted off into the world of pain and neuroscience and am still happily there. No magic, just a lot of hard work using neuroscience to fuel educational and imagery therapy and the good parts of the historic waves I’ve ridden. I thought I may have reached nirvana with the brain, but now I realise that neurones are only 10% of the brain and as the rest is immune cells, so there is long way to go.

Two thoughts:
I look around now at the course advertisements in the back of the journals and it seems the new roller coaster is driven by dry needling and someone called Pilates. No doubt some people are flying with it, and good on them, but not me – I am too war weary to get on the roller coaster again but I am sure there is something in it like there is in everything and if your professional paradigms are wide enough and trending towards biopsychosocial then there is a rational place for everything. The waves are not a loss if you can absorb them.

What bugs me is that it took so long to realise that it was I myself who was probably the main variable in outcomes – not the techniques. I am not saying that massaging patients with a wet salmon will help. However the interactional power needs better analysis and understanding and as Pat Wall would say ‘in the end, if the majority of the outcomes are based on placebo, do not fear, but work out what it was in the placebo which gave the outcome”.

To finish off, here’s a bit of Love Rollercoaster for you.

David Butler, Noigroup


What’s happening on NOIJAM?
Nudity and the clinical scientist – can there be therapy for pain by going nude?
Snoring in Afghanistan
Hunger pains in the US
‘Back infection’ mop up
Louis Pastuer
Here’s to whistleblowers and tiny testicles


Faculty travelling the world…

Brendan Haslam (AU)
USA: Inaugural presentations of Pain, Plasticity and Rehabilitation
Berkeley CA, 11-12 Jan 2014, with Steve Schmidt | Chicago IL, 25-26 Jan 2014
Michel Coppieters (AU)

South Africa: Presenting Mobilisation of the Nervous System – Cape Town 22-23 Nov | Durban 24-25 Nov | Pretoria 30th Nov -1 Dec
Netherlands, Arnhem: MOTNS on 18-19 January and N&N on 25-26 January
David Butler (AU)
USA: Presenting Explain Pain with Robert Johnson – Boston 8-9 Feb| Atlanta 15-16 Feb| Dallas 22-23 Feb
Tim Beames (UK)

Netherlands, Doorn: Presenting GMI on 17-18 January and Explain Pain on 7-8 February.
USA, Buffalo: Presenting Graded Motor Imagery on 22-23 March with US lead instructor Bob Johnson.
Denmark: Presenting MOTNS and GMI courses in 2014!
Irene Wicki (DE)
Poland, Warsaw: Presenting MOTNS on 28 Feb – 2 March

COURSES BY REGION… next six months
DENMARK 2014 With Tim Beames
Arhus: Mobilisation of the Nervous System, 3-4 May
Arhus: Graded Motor Imagery, 18-19 October

Warners Bay: Graded Motor Imagery, 16-17 Nov, David Butler
Melbourne: Graded Motor Imagery, 23-24 Nov, David Butler
Sydney: Explain Pain, 9-10 May, David Butler
Perth: EP, PPR, GMI courses – details to be confirmed.
With Sam Steinfeld and Laurie Urban
Montreal QB: Graded Motor Imagery (one-day), 24 January
Montreal QB: Mobilisation of the Nervous System, 25-26 January
Guelph ON: Neurodynamics and the Neuromatrix, 8-9 February
Toronto: Mobilisation of the Nervous System, 5-6 April
Fredericton NB: Graded Motor Imagery (one-day), 18 August
USA 2014 – a great year for guest lecturers…

David Butler presents in Explain Pain course in Boston, Atlanta and Dallas February 2014 (see him also at at the APTA CSM)
Tim Beames presenting the Graded Motor Imagery course in Buffalo on 22-23 March.

NOIUS Facebook page
EUROPE German speaking courses:
29-30 Nov, Schmerzen Verstehen, Zurzach DE, Martina Egan-Moog
16-18 Dec, Clinical Applications: Upper limb, thorax and neck, Hamburg DE, Harry Von Piekartz
21-23 Dec, Mobilisation des Nervensystems, Bad Zurzach CH, Hugo Stam
21-23 March, Mobilisation des Nervensystems, Saarbrucken DE, Irene Wicki
25-27 Apr, Mobilisation des Nervensystems, Zurzach CH, Hugo Stam
25-27 Apr, Mobilisation des Nervensystems, Hamburg DE, Irene Wicki
NETHERLANDS 2014 with guest lecturers:
Tim Beames (UK) in Doorn:
GMI on 17-18 January and Explain Pain on 7-8 February
Michel Coppieters (AU) in Arnhem
MOTNS on 18-19 January and N&N on 25-26 January
ITALY Mobilizzazione del Sistema Nervoso:
Belluno, 23-24 November, Ruggero Strobbe
Warsaw: Mobilisation of the Nervous System, 28 Feb – 2 March, Irene Wicki
Tim Beames
Lincoln: Explain Pain, 23-24 Nov
Bournemouth: Explain Pain, 30 Nov – 1 Dec
Netherlands, Doorn: Graded Motor Imagery, 17-18 Jan
Netherlands, Doorn : Explain Pain, 7-8 Feb
Tim also travels to the USA to present Graded Motor Imagery, Buffalo, 22-23 March.
Stephanie Poulton
London: Mobilisation of the Nervous System, 30 Nov – 1 Dec
Frimley: Mobilisation of the Nervous System, 25-26 Jan
Colchester: Mobilisation of the Nervous System, 1-2 Feb
Ben Davies
Dublin, Ireland: Mobilisation of the Nervous System, 23-24 Nov
Carlisle: Graded Motor Imagery, 30 Nov
Middlesbrough: Mobilisation of the Nervous System, 22-23 March
Stockport: Mobilisation of the Nervous System, 29-30 March
NOIUK Facebook page

18 Responses to “The Rollercoaster of Professional Life”

  1. Tianna Says:

    Thank you for these thoughts… is reassuring in the light of all of these courses and gimmicks that are offered (not only in our profession, but healthcare in general). Often wondering if I am not sufficient enough and I “need” these other “props” to make me look more appealing as a professional. When I know deeply that there must be something in the connection that we make with people and the knowledge and compassion that we share with them… that this is what assists in the outcomes. Thank you again.

  2. ianpstevensan Says:

    Brilliant synopsis …The great Dr/writer Iona Heath recently wrote a great piece on ‘doing nothing’- its fantastic. I wrote a piece on interacting with a patient relating to the last paragraph of your synopsis . This to me is where its at … was it Mick who said its the art and science of iatroplacebogenesis ?

  3. +David Butler on the Rollercoaster of Professional Life | Manuellterapeut Vegard Ølstørn Says:

    […] The Rollercoaster of Professional Life The first wave Forty years of practice beckons – what a rollercoaster! When I emerged proudly with my degree in the late 70s, all packed with Maitland style manual therapy, I was convinced I could … […]

  4. jeanromain Says:

    Thansk for sharing your story.

  5. mortenhoegh Says:

    Reblogged this on videnomsmerter and commented:
    David Butler er én af fysioterapien’s Grand Old Men. Jeg har valgt at videreformidle hans seneste blog-indlæg hvor han reflekterer over spændingsfeltet mellem teori og praksis.
    God læselyst!

  6. | noijam Says:

    […] the whole article on The Rollercoaster of Professional Life or comment […]

  7. June Trenholm Says:

    I’m estimating that I”m about 10 years behind you, David, in despondency. I’m still thinking that The Sensitized Nervous System added to the Mobilization of the Nervous System and Explain Pain just added to all that. All you have done seems to add to the explaination of why things like manual therapy and electrotherapy worked so well. Yes, there was always the roller coaster of “maybe if I knew a bit more…..” and the anticipation of finally “getting it”. Funny thing is, I still anticipate. Pilates, dry’s all good! I haven’t seen any evidence that undoes whatever I’ve seen other Physios get into. Yup, I’ve read it. What’s that? My rose coloured glasses are relfecting too much sunshine? Hey…Maybe that’s why I can’t complain about any of the approaches I’ve learned!

  8. The Cabbie Cortex | NOI Notes Says:

    […] Just another weblog « The Rollercoaster of Professional Life […]

  9. The Cabbie Cortex | noijam Says:

    […] Last month’s NOI Notes The Rollercoaster of Professional Life received so much feed-back. It was so lovely to hear from everyone, your feedback and treatment […]

  10. Hsieh-Hsing (Vincent) Wu Says:

    THank you, Dave!!

    This “What bugs me is that it took so long to realise that it was I myself who was probably the main variable in outcomes – not the techniques.” really resonates in my heart. I’ve been spending lots of money and time on finding the holy grail… in vain!! The revolution of pain neuroscience makes me realise that every patient is different and there are lots of factors contributing to what and how they feel. Incorporating pain neurobiology education in the clinic is a hard work, but with support from you and noigroup’s work, for me it is a sweet process with my clients. Thank you again!!

  11. The Professional rollercoaster and burnout | NOI Notes Says:

    […] responses which we all enjoy but there has never been a response like the one to the recent Rollercoaster of Professional Life. There were hundreds which included many first time responders and they are still coming in. The […]

  12. Trevor Chisman Says:

    Thank you for writing this. I think many therapy professionals have followed a similar sequence of learning and discovery. Moving through different protocols, systems and teachers, collecting ways of working and interacting that we find easy and effective and leaving behind those that don’t suit us. The next shiny new treatment model always offers to fill in the gaps in our understanding and outcomes but rarely delivers what is promised.

    As a massage therapist, I work in an industry where every therapist who becomes successful in their practice thinks it must be all down to the protocol they are using or the combination of techniques they incorporate. In recent years, this has lead to a growing selection of massage workshops and techniques named after said therapists and promising to offer the missing link in everyone else’s practice.

    Personally, I’ve come to believe it’s more about the whole experience for the patient/client and not the specific technique used. The tone of my voice, the smell in the room, the confidence I present, the reassurances and explanations I offer are just as important as the hands-on therapy I give.

  13. bellmo5 Says:

    Reblogged this on Training Log.

  14. The professional rollercoaster and burnout | noijam Says:

    […] responses which we all enjoy but there has never been a response like the one to the recent Rollercoaster of Professional Life. There were hundreds which included many first time responders and they are still coming in. The […]

  15. Annika Carlsson Says:

    Thearaphtic use of self.
    In Sweden there was recently a thesis /evaluation written on multimodal pain rehab courses. Patients were explaining that the most important factor was finding one person among the therapists who they could trust and whoncould give them energy to continue.

    But to be able to comunicate I guess you have to prove to the patient that you know what you are doing. Knowledge.

  16. Amanda Brennan Says:

    Thanks so much for this, being of a similar age and having attended similar courses, your story resonanted loudly with me.

    Having now moved into the area mental health and working as part of a good interdiciplinary team, I see that it is not just Physiotherapists that pass through such stages. My latest “it” is team work , I get excited about the new insights we find somewhere in the cross over between our professions, and feel releaved that the burdon nolonger feels mine alone to carry.
    Regards Amanda

  17. Routine therapy | noijam Says:

    […] the answer was yes. I suspect also from the huge response to David Butler’s noinote on the professional roller coaster that I might not be […]

  18. marijuana semi autofiorenti Says:

    eccellente palo . Stavo controllando continuamente costantemente questo blog e Sono impressionato!
    Molto info specificamente l’ultima parte 🙂 mi preoccupo per come Info molto .

    Stavo cercando cerchi certo Info per tempo molto lungo .

    Grazie e buona fortuna .

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