Ep 360 – Using Protocols? Re-evaluate Your Approach with Allison Denney

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[music] 

 

0:00:50.4 Darren Buford: I'm Darren Buford. 

 

0:00:51.5 Kristin Coverly: And I'm Kristin Coverly. 

 

0:00:53.1 DB: And welcome to the ABMP podcast, a podcast where we speak with a massage and bodywork profession. Our guest today is the rebel herself, Allison Denney, who is here in person in studio with us. Hello, Allison and Kristin. 

 

0:01:05.6 Allison Denney: Hello to you both. 

 

0:01:06.7 KC: Hello, we're so excited you're here. 

 

0:01:08.4 DB: For our listeners who don't know, Allison is a columnist for Massage and Bodywork Magazine and the host of the Rebel MT podcast on this very network, and a massage tutorial YouTube sensation. She also creates professional products for practitioners, including body butters with amazing names like Game Of Bones, Inflammation Highway, and Ruth Butter Ginsburg. For more information about Allison, visit rebelmassage.com. 

 

0:01:34.1 KC: Okay, listeners, so Allison has been here at the ABMP offices for the last few days. We're up to some very fun things that you will learn about down the road. And when we were preparing to record this podcast, I asked her, "Are there common questions, questions that people ask you often that might lead us to some fun topics for today's pod?" and here's what she said. 

 

0:01:55.1 AD: Here's what I said, Kristin. [chuckle] I said that there are lots of questions that come at me all the time that are very specific to different dysfunctions. "So Allison, what do I do if I have a client who has SI joint dysfunction? Or what happens if I've got a client who has got kyphosis or hyper-kyphosis, or somebody who's got a fused lumbar vertebrae? What do I do in these specific instances?" And it's always really hard for me to answer 'cause I'm kind of like, well, let me ask you nine million questions about your client first because I need to know all those things before I even begin to tell you how to start. 

 

0:02:30.5 AD: So the bigger picture answer I have, and the bigger picture topic that I wanna discuss is, how do we get to a place in our practice and in our career where we get these clients that come into our office and they have an issue that we maybe don't know enough about and we want to learn a protocol for, but we use our confidence and our critical thinking to figure it out and work through it and work with the client and get to a place of nice grounded confidence within our practice and in ourselves. 

 

0:03:03.0 AD: And I think that's the whole... There's so much to talk about within this. It's so deeply layered. We were talking about this a little bit before we pressed record. And there's so many things that we can talk about. But I think the biggest thing that I wanna hit on is kind of like, we are learners for all of our lives and it's okay to not know a thing. And then where we go from there is all the conversations that we have with our clients, with our colleagues, and all the things that we can constantly pick and learn and know and always keep evolving and how that just never ends. 

 

0:03:34.0 KC: Yeah. And I'm gonna jump in and put a question right out to the listeners. Think about your last session. Would you say it was protocol-based? Would you say that you do a different session with every client? Really, just do a little self-analysis as we start this conversation and think about if you're using protocols, why? Is it because you know that they work? Is it because you're a little bit afraid of trying something new? Is it because you're not sure? Are you afraid of what the client might say in the health history? Is it something that you're like, "Oh, I don't really wanna hear the answer to that question, so I'm just gonna maybe avoid it or ask it so quickly that they don't really have a chance to give me a deep, deep answer"? So really start to listen to this conversation as we're talking too from an honest place and say like, "Okay, where am I on the spectrum of, I don't know how to adapt, or I don't feel comfortable or confident adapting, to I feel ready to be present for any session?" And that doesn't mean you have to know everything, right, Allison?  

 

0:04:34.6 AD: Right. So I feel like I wanna dive in right now and my constant answer is there is no protocol. There is no protocol. And I think that's something I get super fired up about because not any two clients are the same. There is no two... There are no two people that are gonna walk in your door that have the same connective tissue meshing and the same health history background and the same injury, whole history, and who they are in their life, and how their nutrition is, and how their sleeping habits are. There's just... That's never, ever, ever gonna happen. So if you lean on a protocol over a dysfunction, you're limiting yourself. And that's the thing I get really... I really want most people to know above and beyond anything else. 

 

0:05:14.4 AD: I do think that one of the things that we talked about kind of like before we pressed record again is this idea that it's okay to lean on a protocol when you're just graduated. If you think about the fact that most of us get about 600 hours to 1,000 hours of schooling, and then we go out into this world where there is so much to know about anatomy and so much to know about dysfunction and injury and treatments and all of this stuff, it is completely understandable that we go down panic, downward spiral. 

 

0:05:47.6 DB: Yet Allison and Kristin, I just graduated from school and I've barely touched any bodies and I just wanna do that protocol. 

 

0:05:54.3 AD: Exactly. 

 

0:05:55.0 DB: I really feel like I need to do that, start somewhere. 

 

0:05:57.2 AD: Yes, exactly. And so the protocol is good for that. The protocol is good for the beginning when you don't know everything. And PS, and by the way, you're never gonna know everything. It's just not gonna happen. But the protocol is good to lean on in the beginning and just go through good transitions and making sure you're kind of checking different movements and different muscles. And I think that is solid, solid, solid, but... 

 

0:06:19.8 KC: Don't get stuck there. 

 

0:06:20.0 AD: Yeah, don't get stuck there, exactly. 

 

0:06:20.8 KC: Yeah. And now I think it's a great question back to you Allison is we're talking about, yes, that can be a comfortable transition. Don't get stuck there. Let yourself evolve because it'll be better for you as a practitioner, much better for your clients so you can address their specific needs. The question for you, Allison, is then how does someone build their confidence? How do they keep learning? What are your thoughts and suggestion for that?  

 

0:06:42.8 AD: For sure. I mean, that is another common question I get just in general of kind of like, "How do I get to a place where I know my stuff and I feel confident in my work?" and the answer is, quite literally, we never really get there. And so being in a space where we're constantly learning is the place where I find my most confident self. It is totally okay to be in a session and have somebody come in with a dysfunction that I am not that familiar with and say... Well, first of all, I want to emphasize the importance of knowing who your client is. So I will say very quickly, it's okay to say, "I don't know everything about this specific dysfunction. Let's talk about it." And then make sure that I'm following up with them and doing the research and doing the learning and taking the classes and continuing to add to my library and my tool of tricks. 

 

0:07:34.4 AD: But I also think that one of the things that's taught me to build confidence, and I'm sure you have a lot of experience with this, Kristin, is this idea of when a client comes into my office, who is my client? What is the health history that I'm taking from this client? So if they are telling me, let's say they had whiplash five years ago, and I say to them, "Okay, well, what's been working for you, or what has not felt good to you within the span of these five years?" And they kind of go, "I don't really know. I didn't do much." That's giving me so much information about who they are and I can work with that and go from there. 

 

0:08:14.6 AD: Maybe they are not very dropped into who they are and what they feel, or maybe they're not as kind of focused in or don't have a lot of time for their own wellness and they don't do all the necessary things and they're not really thinking about it as much and now it's gotten to a place that is downward spiraling. And that is really common. Or maybe they say, "I went to these five practitioners and I had this surgery and I had all these things done and this is not working and nothing's working," and then they're totally angry that nothing's working. And then of course, that's a whole personality right there. 

 

0:08:43.8 AD: Okay, so this person needs to be kind of like felt... Like they're taking care of their herd, they're safe, they're good, and we're just gonna go from there. So there's so much nuance there. 

 

0:08:50.8 KC: There is. And one thing I wanna pick from what you were just saying too, is that asking the client what's worked and what hasn't. So here's the thing, so oftentimes we get stuck in this idea that, "Well, I'm the practitioner. I should be the expert. I should know everything. And I am here to tell the client what will work for them." Here's the thing. If that client has been receiving body work of any kind over a period of time for something specific, there is value there in making sure that you're treating it as a relationship, that there are two people in this therapeutic relationship, and that client can absolutely tell you like, "Here are some techniques that really worked when I had pseudo-sciatica." And if you don't ask that question and don't then do the techniques that really worked, that is such a disservice to your client because if it's worked in the past, do it for them again, in addition to other things that you'll try because of your expertise and the way that you approach body work and the tools and tricks you have. But don't count out the value that the client brings to the conversation. So I'm gonna pivot this to... 

 

0:09:58.0 AD: I was just gonna do the same thing. 

 

0:09:58.1 KC: Yeah. 

 

0:10:00.1 AD: Okay. 

 

0:10:00.8 KC: To our expert resident client, Darren, how would you feel if a practitioner approached you in that way and said, "Tell me what's worked for you," bringing you into that conversation and treatment session planning? Is that good or bad? Thumbs up, thumbs down?  

 

0:10:13.9 DB: Yeah, totally thumbs up. I mean, I now feel like we're engaged in a professional relationship in which your curiosity is only gonna help me. Now, I think I've talked on previous podcasts that as practitioners, you need to prod quite a bit and ask quite a few questions because it's a good chance we may be intimidated or keeping some information from you that either we didn't put on the health history or forgot or intentionally didn't put on there 'cause it's embarrassing. And so those are really important things to hit on. But to be specific about what you're saying, like if you're asking me the question of what worked in the past, I can bring up two things that have occurred; one was... If you've ever read any of the editor's notes or listened to this podcast, you probably heard me talk about having golfers or tennis elbow multiple times. And if I had not been to you and you asked me that same question, I'd be like, well, Kristin, the injury first occurred in October 2015, and I was playing golf and I felt like a mini tear, but I didn't do anything about it, I was like, "Yeah, whatever, it'll get better over time." And then after that in the spring when it still was hurting, then I saw like PT, and I went through a whole PT routine and you know what, it didn't really work. 

 

0:11:27.2 DB: So I went to a different PT and I started the next thing again and it kinda got me a little bit better, but it wasn't totally great. And then somebody was like, "You should have PRP injections." And so I had PRP injections, and then it worked on one of the elbows, and then it started in the other elbow. So I can give you a full thing and then you'd probably just be taking notes like crazy. This is huge. I know you've done PT multiple times and I know you've done injections. What other massage have you done to complement this? Well, Kristin, I worked with so-and-so who did all this research and we worked together to do it, and it worked for a little bit, and then we didn't take it to the next level, or it didn't maintain. And then the other one, recently I did Rolfing too. And Rolfing was more general 'cause it's a 10-series process, and that one wasn't about addressing one specific thing. But I dove in. I was like, "Well, I think I got this broken right toe and this knee has been messing me around for a long time, and I've got this lower back thing over here and... Well, I had this frozen shoulder going on over here." 

 

0:12:25.0 DB: And just lay the... "What have you done about that?" And then I was able to spell that out. And then the Rolfer's like, "Got it," and then just starts putting it all together. And the cool thing was, with the two of you mentioned, then addressed all those things in the next 10 series. And now that's a longer protocol, but still heard exactly what I had to say. 

 

0:12:46.5 AD: Which is so huge. You were probably gonna say something about that?  

 

0:12:50.9 KC: Well, I was gonna say too, what I like about that is that you were saying, and this didn't work and this didn't work, and you know what, that is not always a bad thing. There's value in learning what didn't work and it brings me right back to Allison's point in the beginning, know your client. So now I know that you might be coming to my session with half of your brain thinking like, "This probably won't work." You know what I mean? So now I know who... Okay, so I might approach this session a little bit differently. I might use different language. I might communicate in a different way because, again, exactly what Allison said, there's value in everything that that client says, and now that I know your journey, I know how to approach it and how to talk about it and how to ask you questions afterwards that can give us both information, like what felt good, what didn't. Tell me in three days how you're feeling so we can kind of approach it in a very personal way to you. And again, that's what we're talking about, having enough confidence to personalize each session. Yes. 

 

0:13:45.3 AD: Yeah. I mean, I think that even as I was listening to you Darren, my head went to, okay, so you had all this stuff on the one elbow, you finally got the PRP and that seemed to help, and then it showed up on your other elbow. And my brain literally went to, "Okay, there's something wrong with your stroke. There's something wrong with your body mechanics." And I feel like that's the critical thinking that we need to be pulling in for everybody that we're looking at. And it's easy to get honed in on the one thing and think, "Oh my gosh, what are the muscles [0:14:15.6] ____ and what are the muscles that are in the golf swing?" and get completely lost. "Where was the tear? And what do I know about muscle injury, tear, recovery, blah, blah, blah." 

 

0:14:23.5 AD: I can downward spiral so fast with that and that's a really easy way to lose your confidence. Avoid that because that is a good downward spiral and that's what you don't want. So I feel like one of the best ways to increase your confidence is to do it yourself. And that sounds a little bit backwards. That sounds like there's no answer there, but ultimately, there's a lot of this idea of like, "Okay, I've graduated, I've started my practice, I'm starting to work on clients and I'm taking these CEs, but it's not like... I'm not... I'm still not feeling confident." 

 

0:15:00.9 AD: And at some point, that critical thinking element of like, "Okay, your injury, Darren, moved from one elbow to the other. What corrects those two elbows? What are all the muscles that connect those movements? And what's going on in-between? And how is he holding himself and how's... " And I'm not gonna necessarily, maybe, maybe not sit there with his golf swing and go out on the golf course and follow him around for a week and really dissect it, but I'm definitely gonna ask more questions that make my brain think more critically, and that is an uncomfortable space. I think the uncomfortable space is a hard place to go to. And when we start thinking critically, we often don't have answers, and then immediately go, "I'll just forget it. I can't do this. This is too hard. I'm not good enough." Whereas if we lean away from the protocol, which is the easy automated thing that we do and we start moving into the unknown and the uncomfortable and the not safe in my own body movements and techniques and ideas about anatomy and physiology, then we push ourselves. And when we push ourselves, we learn, and when we learn, we grow, and when we grow, we feel confident. That's kind of the bottomline after all these years of doing this, that's where I've come to with my own confidence. 

 

0:16:25.4 KC: Let's take a short break to hear a word from our sponsors. Anatomy Trains is excited to invite you to our latest in-person fascial dissection workshop, April 10th through 14th, 2023 in Boulder, Colorado. Join Anatomy Trains author, Tom Myers, and master dissector, Todd Garcia, on this voyage of discovery. Visit anatomytrains.com for more information. Let's get back to our conversation. 

 

0:16:58.2 DB: I'll say that the really good MTs that I worked with did do what you said. They go, "Show me your golf swing. Let me watch that." And then they would go, "What other activities do you do?" and I'd be like, "Well, I snowboard." They go, "Which one's your lead foot? Show me that." 

 

0:17:14.9 AD: Exactly. 

 

0:17:15.8 DB: And so you could just see their brains kind of figuring out this thing and it was at the beginning of the session, and then at the end of the session, they'd be like, "Now, did that help that specific area that we just talked about with regards to... We didn't do everything today, but does that feel better in that one thing?" And then one really important piece of information I didn't tell you guys was when I was going through this thing, like health history or whatever and kind of going through all the things I had done and that worked and didn't work, I would end my portion of the health history beginning the session and I'd say, "And I'm not gonna quit playing golf. So what are you gonna do?  

 

0:17:50.5 AD: Yes. I mean, oh my gosh, I just need... I need to dive in at this moment 'cause that is such a major point that gets lost in the health history. So if you're doing the health history and you're following the OPQRST, the... Do you remember what that... Just to review the... Oh my gosh. I'm gonna have to challenge myself here. Onset, palliative and provocative, what makes it feel better, what makes it worse? OP... Q is quality, R is... Is it reading? S is, what's the severity? And T is the time or the tempo of it, right? Woo-hoo! I did it. 

 

0:18:25.2 KC: Ding, ding, ding, ding, ding, ding, ding... 

 

0:18:25.3 AD: Okay. So that gives you a good, again, a good protocol. Lean into that when you're first learning this, but then start pushing through. And one of the best questions to ask a client is, "What is your goal? What is your goal?" So if they come in and they say, "So I've got... My right hip is higher than my left hip," and they're like, "but it's not a problem, I don't need to address it," don't address it. It's fine. It's not hurting them. It's not a problem. It doesn't need to be fixed. There's lots of like, "Oh, you have a knob, I need to break it apart and tear it apart." 

 

0:18:56.1 AD: Yes, maybe sometimes, but no, maybe sometimes not. If the goal is, "I'm not gonna stop playing golf," that's the goal. Let's work with the client. How old are they? How are they doing this? What's going on with their mechanics? What else do they do in their life? How do they take care of their body? Look at the whole nine yards and work with them to get to that goal. That is the best thing you can do. 

 

0:19:17.7 KC: And the goal doesn't have to always be like, "Oh, I just want this pain to go away," or whatever it is that's very body-focused. It's, "What activity," what we call the ADLs, activity of daily living, "do you want to return to, or be able to do more smoothly or with more ease?" And that's where you talk about playing golf, or reaching into the cabinet, or being able to blow-dry my hair. When I had frozen shoulder, I couldn't do anything, right? And so I would have given $1 million to be able to reach behind my back when I had frozen shoulder. 

 

0:19:48.0 AD: [0:19:48.0] ____ right arm. 

 

[overlapping conversation] 

 

0:19:49.1 KC: [0:19:49.1] ____ my right shoulder, please take it. Yeah. So it's like talking to them about life and not just, "You are a physical body and we will be working on your musculature and soft tissue." It's like, "Here's your life, and let me help you live your life in a more beautiful, smoother, less painful way." 

 

0:20:09.4 AD: Yeah, yeah, yeah, yeah. Yeah. Even if you're playing golf and it doesn't hurt as much, that's a win. 

 

0:20:13.8 DB: 100%. 

 

0:20:14.4 AD: That's a win. 

 

0:20:14.6 DB: Totally agree. Let me ask you something, 'cause I'm kind of curious. I think one of the things we're talking about here, we're talking about being open to communication, you're a life-long learner, but how does the ability to make mistakes, how do you allow that to yourself? 'Cause this seems like a positive thing that the protocol is like, A, B, C, D, E, I follow protocol, massage is done versus like, "Well, what if we did this?" This is such a mind shift. 

 

0:20:45.5 AD: It is such a mind shift, and making mistakes is very different on a human being than it is on a machine. I can be building a, I don't know, a coffee machine and it doesn't make good coffee and that's a mistake that I can live with. I'm not like... Nobody's going away hurt. But if I hurt somebody, that's a big red flag. That's the big fear. And I don't wanna make a mistake on somebody that's gonna cause any kind of, obviously long-term pain or any kind of a result that is creating more pain. 

 

0:21:15.3 AD: And that is scary. But the two ways to come to terms with that is have a really honest conversation with your client in the beginning and say to them, "Okay, you've got golfer's elbow. I don't have a lot of experience with it, but I know enough and I'm gonna work with what I know, and we're gonna stay in communication the whole time. And I'm gonna start... As I start working with you, I want you to tell me, I want to give you such incredible permission to tell me that this does not feel good, or this is not working, and then if I feel like we're gonna stick with it a little bit, let's try, or I'm gonna start to move and shift to something else, then let's do that." And then at the end of the session, you revisit that conversation and you say things like, "How did that work? Let's do this together. We are a team. And if we make mistakes, then I want us to figure this out together. Mistakes are a good thing, and I don't want that to be a bad thing for you in this session, so let's use it to our advantage." 

 

0:22:10.3 KC: Yes. And having a relationship where you are talking about multiple sessions. So you're saying "In this session, we're gonna try this and we're gonna see how it goes and we're gonna re-evaluate, and then we're gonna try maybe something different in the next... " So looking at it as a multi-session relationship and not just like, "I'm gonna just only do one thing in this one session and that's all the opportunity we have to work together." 

 

0:22:29.7 AD: Yeah. 

 

0:22:30.3 DB: If I was gonna put on my full capitalism hat, I would totally go, "That sounds like money." [laughter] Right? I'd be like... 

 

0:22:39.4 KC: And it does. 

 

0:22:40.0 DB: "Golfer's elbow not gonna heal immediately? Hm, we've got six months of work together." 

 

[laughter] 

 

0:22:47.2 AD: Right. And that's a good way to look at it for sure. But I also think that if you do come forward in the beginning and you say, "This is a holistic practice. I'm not injecting you with something that's gonna make you walk away and be able to play golf this afternoon. It's not gonna happen. I'm working with your whole human being. I'm working with your muscle tissue and your soft tissue, and your nervous system, and your endocrine system and your lymphatic system. I'm working with all of these systems. And holistic health takes time." And then start talking about multiple sessions and what to look for, what to hope for, what to reach for, what the goals are within certain timeframes. And yes, the capital hat comes back on. [laughter] 

 

0:23:25.2 DB: Yeah, maybe one of the best things you could say. So let's say that was the first session and you've done an amazing health history and we're asking tons of questions, but at some point we're gonna start the session. We're gonna work together and we're gonna work through that together. But say I come back for the next session, the second session, you know one of the greatest things you could say? "I did some research... " 

 

0:23:42.9 AD: For real. 

 

0:23:44.8 KC: Of course. 

 

0:23:45.2 DB: All-in. 

 

0:23:45.7 KC: For real. 

 

0:23:46.3 DB: All-in. 

 

0:23:46.7 AD: Of course, we did. Yes. 

 

0:23:48.2 KC: For real. 

 

0:23:48.4 DB: All-in at that point, right?  

 

0:23:49.3 AD: Because, side note, and I think this is another important thing that every massage therapist and anybody in any medicine, healthcare, anything needs to keep in their back pocket at all times. What we know about the human body is constantly evolving. What we thought we knew 10 years ago, 20 years ago is totally different. What we completely based research things on has shifted. And the way that we think now about muscle health is very different. The way that we approach different kind of chronic conditions has shifted massively. And so to be able to say something like you just said, Darren, where like, "I did some research, and you know what's really funny? I thought this protocol was something that we have leaned on in the past and it turns out this new research is showing that trigger point therapy is now different, ICE is now different, [0:24:38.5] ____ he is now different," whatever it is, and playing with that and just be like, "Let's figure out what works for you. This is what I've learned. Let's figure out what works for you and let's keep in touch about it." 

 

0:24:48.2 KC: And I'll add to that that not only "I did some research," but also, how about you send the research to the client because they may be super curious and wanna learn more about their own body as well? So not just keeping it to yourself saying, "Yeah, I did some research. I sent you that email yesterday. And that's what we're gonna build on today. Let's do it together." 

 

0:25:05.5 DB: 100%. I think one of the things that often happens is, at the end of the session, if you've wrapped up and we've talked about what worked and what didn't work, and many times it can be assigned with some exercises or some things to do... 

 

0:25:18.4 KC: Homework. 

 

0:25:19.3 DB: Homework. Any kind of research, anything that we're super dialed and together, I'm committed now to you, and now I'm not gonna go seek other MTs because I found my person. Right?  

 

0:25:30.1 AD: Yeah. And I think that blends into the point that we were talking about earlier before we started recording again, which is so much more about the fact that I wanna be with a practitioner who loves what they do. I just do. And if this doctor or this massage therapist or yoga practitioner or Pilates instructor or whatever it is, is bored with what they're doing, I am out. But if they're totally geared into me and sending me research and sending me information and staying in communication with me, they obviously love what they do and that's somebody I wanna be with. That is somebody I wanna be partnered with and I wanna be like arm-in-arm and I'm doing this together. That kind of passion is huge. I'm gonna add this on as maybe an ending point. I don't know. I could talk about this forever. But I do feel like the bigger sense of having a session that doesn't go well and letting that ruin your confidence and letting that eat you up on the inside is something that happens to all of us. There is no doubt that you're gonna have a bad session. There's no doubt that you're gonna have a client that's not happy. It just happens. It's a numbers game and that's gonna happen to you. 

 

0:26:38.2 KC: It does. 

 

0:26:38.6 AD: So when it happens, the key to getting through that is gonna sound woo-woo, but you gotta love yourself. You have to love yourself. Because if you do, then you can not take it as a hit to the armor, and then that armor is not working anymore. You can just kind of let it go as this is part of the process and use it to your advantage and learn, which is a massive part, a massive element to developing an internal sense of confidence that's gonna ride you through all of it. 

 

0:27:10.7 DB: I wanna thank our guest today, Allison Denney. For more information about Allison and all the good work she's doing, visit rebelmassage.com. Thanks, Allison, and thanks, Kristin. 

 

0:27:19.8 AD: Thanks for having me. 

 

0:27:20.9 KC: Thank you, Allison, for another incredible podcast conversation. We could talk to you for hours. We were thrilled to be able to have this conversation with you and we are so grateful. 

 

0:27:30.4 AD: That was so fun. Thanks. 

 

[music] 

 

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