The Professional rollercoaster and burnout

NOI Notes always generate 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 Rollercoaster NOI Notes was an observation of the ups and downs of my professional life as I took on new ways, systems and gurus then discarded them, taking the good bits and finally belatedly realising that much of the outcome depended on features of me, not a system or technique. My rollercoaster is summarised below.


I want to summarise the responses and share some of the words of wisdom that came back. It occurs to me that the rollercoaster may well be linked to professional burnout – a problem in all professions and one where research is limited.

Most of us are on a rollercoaster
Most respondents said “hey that’s me too”. Even some recent grads were noting it too, but were pleased they weren’t alone. It makes me realise that this should be mentioned in undergraduate education. And I am glad the story made a few laugh! But when you do get sucked in by something and you realise it, it is probably healthy to laugh. Some thought I was at the end of the rollercoaster and retiring, thus the odd mini obituary (thanks for the nice words) but this is not true, I have a few potential waves still left in me!

Some younger respondents were relieved that there probably is no holy grail. And some too became aware of colleagues stuck on just one wave (eg “all they do is needle” or “they just go straight to iliopsoas”). A couple had found happy and fulfilling waves along the way with Feldenkrais. I think it helps to contemplate the waves – and as Mike says – “many thanks” and “I will remember this, the next time I become disheartened and want to be a plumber”.

Rollercoaster awareness and unpleasant memories
The notes did evoke unpleasant memories for some who recall visiting gurus as patients and being shouted at because they didn’t get better. I too recall lectures where you felt you could not question a particular guru. No wonder things cycle!

The notes got regular responder Cameron going – he asks “did any of my lecturers at university ever question a single assumption about any of these so called treatments?”. Being a lecturer back then, I guess, the answer is “probably not – sorry Cameron, we were sucked in”. Cam goes on to say “people are afraid of the truth – that the mind not only creates pain and injury and illness but it literally creates the whole world”, but that is a longer discussion we can have later on NOIjam.

Advice on flattening out the bump and limiting burnout
Positivity presented in the responses. As many respondents noted, as long as we are still curious, our jobs will be a pleasure. (Remember to evoke curiosity in your patients as well!). Nicole has a lovely line – it is the challenge of not always being right and thus having to think about and dive into the ever larger wealth of knowledge that helps.

Ernst comments that if rollercoaster recognition helps us sense our role and the power of the patient therapist relationship, new ways to treat should lead to reframing of patients’ behaviours and novel coping styles should emerge.

I enjoyed Allyssa’s rollercoaster – from transversus exercises to muscle energy to nutrition medicine to the visceral world and how just like in my experiences, each new approach initially appeared to be the answer. “Is it that I convey the placebo response to the patient because I am so newly overconfident after each course but after it is apparent it’s not the whole answer, they pick up on my doubts and the placebo is no longer transmitted.” Probably yes if placebo is taken as brainpower.

Craig has had a rollercoaster too but his physiotherapy practice has been helped by studying an MBA – leadership, ethics, marketing, motivation, teamwork, sales etc. Much like Allyson who has found support in Napoleon Hill’s “Think and Grow Rich” and Cameron in Jed McKenna’s “Theory of everything”. Professional improvement and burnout buttressing may not necessarily emerge from yet another rehab course.

The rollercoaster notes made some think quite laterally and deeply – Lezanne comments “it is clear my own wellbeing has an effect on patients” and coins the useful phrase “therapeutic use of self”. Deena brings up the issue that the rollercoaster context has changed and we now have to deal with pain systems increasingly bullied and tormented by policy makers. She asks whether bullying has any influence on pain (I don’t know but it probably does).

Perhaps Helen sums it all up by suggesting our job is essentially one of being a facilitator of change.

A final wave
I have been on my final wave for nearly 20 years now. A few people asked me what my next wave is. There is none. I am convinced that treatment foundations which combine modern neuroimmune science, education science, reasoning and evidence based movement enhancing strategies are the go – all what we teach at NOI.

Thanks again for such a response and messages of support. We have enjoyed them all here at NOI. These NOI Notes are also on NOIjam if you wish to comment.

David Butler, Noigroup


Adelaide March 21-22 Explain Pain David Butler
Melbourne April 4-6 Explain Pain 3 Day D. Butler, L.Moseley &
Prof Mark Jensen
Brisbane April 5-6 Mobilisation of the Nervous System Michel Coppieters
Sydney May 9-10 Explain Pain David Butler
Perth June 14-15 Explain Pain David Butler
Perth June 20-21 Pain, Plasticity & Rehabilitation Brendon Haslam & D.Butler
Montreal QB January 24 Graded Motor Imagery Sam Steinfeld
Montreal QB January 25-26 Mobilisation of the Nervous System Sam Steinfeld
Toronto April 5-6 Mobilisation of the Nervous System S.Steinfeld & L.Urban
Arnhem NL January 25-26 Neurodynamics & the Neuromatrix Michel Coppieters
Doorn NL Feb 7-8 Explain Pain Tim Beames
Warsaw PL Feb 28-Mar 2 Mobilisation of the Nervous System Irene Wicki
Saarbrücken DE March 21-23 Mobilisation des Nervensystems Irene Wicki
Frimley January 25-26 Mobilisation of the Nervous System Stephanie Poulton
Colchester February 1-2 Mobilisation of the Nervous System Stephanie Poulton
Oxford March 15-16 Explain Pain Stephanie Poulton
Middlesbrough March 22-23 Mobilisation of the Nervous System Ben Davies
London March 23-24 Mobilisation of the Nervous System Stephanie Poulton
Dublin IE March 29-30 Explain Pain Ben Davies
London April 5-6 Explain Pain Tim Beames
Crewe April 5-6 Explain Pain Ben Davies
Derby April 8-9 Mobilisation of the Nervous System Ben Davies
Las Vegas Feb 3 *FULL* Graded Motor Imagery David Butler
Boston February 8-9 Explain Pain D.Butler & R. Johnson
Philadelphia February 13 Graded Motor Imagery David Butler
Atlanta Feb 15-16 Explain Pain D.Butler & R. Johnson
Dallas Feb 22-23 Explain Pain D.Butler & R. Johnson
Buffalo March 22-23 Graded Motor Imagery T. Beames (UK) & R.Johnson
Doylestown April 5-6 Mobilisation of the Nervous System Robert Johnson

One Response to “The Professional rollercoaster and burnout”

  1. Carol Green Says:

    Having seen great changes in my profession over 20 years of practice with the move from clinical expertise ( the gurus) to emphasis on evidenced based practice ( which is often of limited clinical value) I am pleased that the swing back to evidenced based practice with the best of both worlds is becoming more common. I admit to a period of deep depression when doing a post grad diploma when became clear that many of the assessments I use are of no real value or need to be done in combinations for valid results (try that in a half hour session) and that our treatments ( evidenced based) have no validity. I seriously questioned what was the point in bothering with the whole process and if I should just focus on aiming for a big placebo effect ( yep, cynicism full throttle) However, unexpected clinical results with chronic pain clients that are repeatable has taught me that perhaps we have not asked the right questions yet with research, that clinical results ( case series) are invaluable for directing client treatment systems, that people are different (surprise, surprise) and subcategorising for patient treatment groups to match treatments is important. that when dealing with pain we are dealing holistically with multiple levels of pain processing and the interaction between the client and the therapist is important. Changing the processing at peripheral, spinal and cortical levels concurrently is more effective. Graded motor imagery, retraining movement, education for reducing anxiety and acupuncture for modifying peripheral drive delivered as a package has shown superior results in a clinical setting for me. I now look forward to the research to tell me why. This may take a while.

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