Jared Powell:
Welcome to the shoulder physio podcast, a podcast dedicated to exploring meaningful topics in musculoskeletal healthcare. I'm your host, Jared Powell, before we begin, the primary purpose of this podcast is to educate and inform the views expressed in this podcast by myself and any guests are information only do not constitute professional advice and general in nature. If you act on the basis of any podcast episode, you should obtain specific advice from a qualified health professional before proceeding
Jared Powell:
Today's guest is Bronnie Thompson. Bronnie is an occupational therapist from New Zealand. Bronnie is a thought provoking writer covering an array of topics. But in this conversation, we talk predominantly about her wonderful paper titled living well with pain, a classical grounded theory. This might sound contradictory at first. Listen, how can you live well with pain pain after all is defined as an unpleasant experience, surely this precludes it from any positive association, Bronnie begs to differ and articulately communicates why this conversation was originally recall ordered in September, 2020 for my YouTube show on the shoulders of giants. Before we get into the nitty gritty of the conversation and for your information for the first time in two years, I am running my one day shoulder workshop in Sydney and Melbourne in may and June, 2022. Tickets are limited to 30 participants. The course offers a complete distillation of the evidence base for shoulder pain management, equipping you with up to date, knowledge, techniques, and clinical reasoning skills that are clinically actionable. If this is something you are interested in, check the show notes for more information without any further delay. I bring to you my conversation with Bronnie Thompson. Okay. Here we are with Bronnie Dr. Bronnie Thompson, I should say I don't, I don't know if that's the terminology you like to go by.
Bronnie Thompson:
Sometimes I have a PhD, so that's, you know, normally I don't do use "PhD".
Jared Powell:
Beautiful. So we are gonna chat about all sorts of different things. Bronnie is somebody who I always read all, everything she publishes just about. I'm certainly always reading her blog as well, and always presenting a challenging point and a full provoking point in regards to pain, especially. And, and for me, I, I know your work as it sort of relates to your fabulous paper of living well with chronic pain. And that's where I first started to, to read all of your stuff. And it's really informed my practice quite a lot and forced me to look at my own biases, which is which we often don't wanna do, but we need to do so. Thanks for that. We involved with, with the deep academic and research stuff. I just wanna know a little bit about you Bronnie and, and a bit of your background. Cause I know you're an occupational therapist, I'm a physio, so a little bit different, but I hope there's some overlapping qualities that we share. And also a bit of a brief history about you and, and how you ended up in the position you are.
Bronnie Thompson:
So who am I? Ah, I'm a 56 year old woman in New Zealand. And I currently work as mainly academic. So I mainly teach a little bit of research when I can do that. And a little bit of clinical work, probably not nearly enough really, but but that's the way things are at the moment. And, and I have worked in pain management since probably, oh, the late eighties, I suppose. So my background's occupational therapy and then I've also got a master's in psychology. And then I went on to do my PhD looking at people who live well with pain. And so my I kind of orientation partly personally because I live with fibromyalgia, but also cause of the people that I've worked with is, is practical. How can we help people live the lives that they want to live? That's really where I'm coming from outside of that, I do all sorts of weird and wacky things. Like I fish, I look for trout and I kayak in our wonderful high country lake and I have a zany labradoodle who is a she's large and she's very enthusiastic. You may hear her doing things. We'll see, we'll see what happens with that. And what else do I do? I silversmith. So that's my, my key way of, of not thinking words. Cool. I listen to classic rock and jazz and I hammer silver. It's awesome.
Jared Powell:
Love it. That's that's cool. That's that's some interesting hobbies that you, that you have. How did you get? So fishing's a classic New Zealand pastime, isn't it?
Bronnie Thompson:
It's well wonderful. So, so post PhD my partner and I were looking at, what can we do that gets us both out into our wonderful nature that, so he's as fit is a rat and he likes to climb up Hills. And I don't, I like the flat and I like my rivers. And so we just side, what can we do together where we're both outside and enjoying that, but we're not trying to catch up with one another. And so we decided to learn how to fish and we both, cause we both used to dive it scuba. I got concussed and now I throw up when I'm not good. It's just really a really horrible, so don't do that. So we decide, we learn how to fish and so we do and it's just, oh, it's awesome. It's just wonderful.
Jared Powell:
It's Bronnie. It's boring.
Bronnie Thompson:
No, it's not the catching. It's the standing there being mindful in this beautiful setting with the water flowing by. If it's raining, I don't care. I, I don't wanna be there, but if it's a beautiful day or you're paddling around this pristine lake and then you just every now and then it's like the gamblers high, all of a sudden you get hug on the line and it's all on. Oh, that's wonderful. And then we, then we release them. Mm we don't don't eat them.
Jared Powell:
Yeah. The, the, the scenery you've got over there in New Zealand is
Bronnie Thompson:
Stunning.
Jared Powell:
It's second to none. I think. Are you, are you in the south of the north Holland?
Bronnie Thompson:
Yeah. Yeah. Yeah. So what you can see behind me is on the, oh, on one of our rivers, there's a, there's a flat area and we go out towards the coast and the beach is on just about hundred meters from the end of that. And that's one of the beaches that we just spend most of our time in. It's got a place called nappy nap, which is people from not from New Zealand will laugh, I think, nappy, nappy, but it's it's a beautiful beach. It's just lovely. So yeah, we've got the whole of the south island to play with. Cause he's no tourists.
Jared Powell:
True. That's
Bronnie Thompson:
Awesome. It's nice actually.
Jared Powell:
Yeah. One of the perks to a global pandemic.
Bronnie Thompson:
Yeah. One of the few, we're not many let's take what right,
Jared Powell:
Exactly. Okay. So describe a normal week Bronnie. So what, what, what occupies you in a week from a work perspective?
Bronnie Thompson:
So I work seven, 10, so three and a half days in academia. And I also, so on a Monday I'll, I'll write my blog and that's not related to my academic work. That's my way of processing thing that are happening in the pain management world. And I guess working through ideas in my head and conveying them because I think as I construct a paper I'm actually creating my I'm constructing my opinion and synthesizing and hopefully, hopefully getting things that are in journals out to where they're accessible. Cause that, that irks me. So that was my spare time. And then I usually I work from home a lot because I share an office and trying to do stats or read complex texts, or I do any analysis or write when you've got conversations going on in the environment's really difficult. So so under lockdown it really didn't change my lifestyle very much.
Bronnie Thompson:
So Tuesdays is, is a reading half day Wednesdays. I usually go into the office and spend my day doing the admin work. So I'm the academic coordinator for our postgrad program and pain and management. And so that means student admissions just a, you know, university administration. We've got to remember, this is a medieval institution. It has been around since forever. So bureaucracy originated in the university. I swear, we're very good at it. And then I, I teach on Thursday evening. So all of our teachings is online. And so I'm doing a lot of that. I teach postgrads and I teach fifth year medical students and I do some ad hoc teaching and nursing postgrad nursing, and other course just as, as needed or as requested. But most of my teaching is postgrad, which is an absolute delight. We have the most broad range of health professionals, all Geekly interested in pain. What more could a woman asked for inquiring? I mean, I try to spend my Fridays doing meetings and writing and trying to read stuff. You know, I thought when I went into academic work, I had this vision of sitting in a cafe reading papers and proclaiming, well, you don't, it just doesn't work. So that was what you do during the PhD and it doesn't happen anymore. It's, life's a lot different.
Jared Powell:
Yeah, I can imagine. Yeah. So that's, that's cool. So you kind of, you, you, you set aside that Monday for the blog as a sort of creative enterprise to,
Bronnie Thompson:
Yeah. It's kind of creative. It's, it's partly, I need sort of brain space where I don't have obligations just to process what I've been reading and the discourse that's happening on social media. Cause those social media doesn't represent all clinicians one way where voices can be heard and know you may not actually spend time with practicing clinicians. So it's not always easy to understand what it's like. And I do a little bit of clinical work, but but it's quite contained. And what I'm hearing on social media are the actual debates and discussions and the reality of how difficult it is to critically praise material, that's spread around and to think about how do I do this? In my context, research environments are so different from actual clinical practice. So that's what I do in that time. Just mud, my way through thinking through that sort of stuff. And then when I'm not doing that, I I've got a client I see regularly. And so I'll go and spend some time with her and I'll, I'll do some silversmithing just to get my head clear of the pressure of what we do in our, in our teaching, which is so word dent, but there's so many words and thoughts and concepts that we try to process that I like that space, not to think weird.
Jared Powell:
Yeah. So yeah, no I'm with you. So, so important. It's can, it can be all consuming and often go to bed sometimes thinking about silly things to do with work when you just wanna wanna switch off. So it's important to have that, that release isn't it?
Bronnie Thompson:
Absolutely.
Jared Powell:
Yep. Okay. So what about, OK, so another, this is one of my favorite questions. So what TV series or book are you reading or watching at the moment? And tell me a little bit about it.
Bronnie Thompson:
So I don't watch much TV at all or Netflix or anything. And that's because I live with an outdoorsy man who likes to watch hunting programs. You know, I can't have two, two things going on at once. So I read junk science fiction and fantasy absolute trash, but the book that I've been reading, I have to get her name out cause its actually really important. She's fantastic. Fiction is I guess what you could call it. Okay. You mean just where is it Kindle? I'll find it.
Jared Powell:
No you're right.
Bronnie Thompson:
Should be able to find it. Cause I just sent myself a, a notice about a quote from, from this woman. I'll have to do it a different way. Sorry, just hold on a sec. Cause she write beautifully. Yeah. She is so here we go. Becky chambers and the series that I've been reading is called wayfarers and it's really a futurist depiction of what happens when humans can't live on the planet and create a self-sustaining life for board vessels. That's supposed to be on their way to going somewhere, but they got somewhere and then not everybody left to go onto planet. Instead of thinking about how systems don't remain static, people don't remain static and we try to preserve history as a record of what's in and that can sometimes lock us into trying to emulate that same, same, but actually it doesn't work.
Bronnie Thompson:
So it's a talk about entropy and human attitudes towards well parallels are towards people who ares a type of assumptions that different people have about aliens in her case. But also the, the way that values can be expressed differently. But ultimately they're really the same. So what I like about her writing is how intelligently written it is because I've read some really trashy science fiction and it is awful. Bring back Ian banks bring back the, the best writers, you know, let's get them back because they because there is a lot of pulp fiction out there and the real true science fiction writers make us think differently. They pro pro us in a wonderful way. Just pass aside our usual preconceptions and say, I wonder what would happen if I like that opportunity?
Jared Powell:
It's it. That's, I'm reading it. I'm fascinated by like early 20th century physics some somehow. And
Bronnie Thompson:
I won ask
Jared Powell:
Why there's there's an author. HG Wells. Yes. Pretty famous. Obviously he, he predicted the atomic bomb like 50 years before it even happened, even before we knew we could split the a yeah. So this is, this is the fascinating part about science fiction writers. They're so like preemptive and intelligent. It's amazing.
Bronnie Thompson:
Like the Jetsons, the Jetson had videos, Hey, what are we doing? That's right. We're using video. And it was thought that was just the way it is. And to imagine the possibilities, I think is something useful for us, it can be dystopian. This is how it's going be if all things fail or it can be really positive and make us anticipate that we could do things differently, which I think is really a good thing for us as humans, we've got imagination, we should use them
Jared Powell:
Bloody hope. Yeah. A hundred percent. And that's, that's probably that's so, so you've got the rigid academic work and then you can let your mind wander with some of this reading. It's a good combination.
Bronnie Thompson:
Well, academic work and inquiry and research is a creative process. And I think that we forget that and sometimes we even forget that our clinical practice is a creative process. And I think what I find really healthy about say silversmithing is that I'm looking at this of silver and I can springboard off ideas that I've had from completely different things and express that in a piece of silver. So it helps me and, and in clinic, that's what we are doing as well. We've got this person who presents in one way and we are thinking creatively about how can I help create some change or support some change or disturb this system that might be stuck so that change can happen. And that's that's a creative process when we get into formulas, then I think we lose that responsibility that we need humans. Aren't very straightforward. Really?
Jared Powell:
What do you mean? We can't just give a recipe approach to, and they're all gonna get better
Bronnie Thompson:
Three times 10. Come on. That I'm not, I'm not starting yet.
Jared Powell:
It
Bronnie Thompson:
Could happen.
Jared Powell:
OK. So, so we know, we know you are now you're a 56 year old, New Zealand woman. Who's silver Smith read science fiction novels, occupational therapist by background. Yep. And so what I suggested at the start of this or what I, what I said at the start was that I first came across your work with this living well with chronic pain. That it's a fantastic title actually as well. And cause it's kind of, it's, it's, it's jolting from the start because the concept of living well with chronic pain, it seems like Anon, it seems conflicting. How, how can you live well with pain? So that, that really got my attention. And then, and then it was a, it was a really well thought out paper as well. So, so congrats on that. Could you tell us a bit about it? How can you, how possibly can you live well with pain? The definition of pain is that it is unpleasant and it infringes and impinges upon our life. How, how can that, how can we resolve that to live well with it or, or sort of persist with
Bronnie Thompson:
It? It's so the back story to this, to why I chose to do this as a PhD, this is my PhD. Research was that I live with a man who has ankle spondylitis. And I have my fibro and so, and we think we live really well. And with Bo and he bond, he had a period of time when it was really out of control, really high levels of inflammation and really couldn't move well to the point of said this in a number of presentations where we, we had to use a rolling a sliding sheet to roll over at night because it grabs them in hiss and he couldn't cough and he couldn't take deep breaths and he couldn't roll over. And yet he's worked all the way through he at the time was a high country, firefighter, and a time he likes to go hunting, tramping, carrying a whack and grape pack on his back.
Bronnie Thompson:
He's never, he's, he's always been fit. You know, his favorite thing is to climb up the top of a hill and look out. And so I couldn't reconcile that with the stories that I continually hear. I at that time I was working clinically at a chronic pain service where people were saying, this is just eating up my life. I'm not who, who I was. You know, I, I dunno who I am anymore. And I couldn't reconcile how, how there is this disparity, how is it that some people like my partner I can carry on and you could, as you could explore this by trying to compare people. So we'll have people who cope well and people who don't cope well, and let's have a look at the differences between them when you do that, you are making some big assumptions about what might be important.
Bronnie Thompson:
And if you have a look for literature on people who cope well, there is very little there, especially at the time I started looking at this, which was about early two thousands. When I started thinking around this area and there were very few papers published. And so I didn't know, there were assumptions that if that somebody who's coping well might be the inverse of somebody who's not coping well. So all the things that somebody who's not coping, you know, the things that we know contribute to poor coping, maybe they'll be the thing, the opposite of that will be applicable. And these people, and I thought, okay, that's a huge lot of assumption to make, and I'm not sure about that. So I thought I'm a bit of a philosophy of science nerd. And I really like the, that. And when we're, when we're doing research, we often kind of think about a hypothesis just suddenly pops in fully formed, and then we go test it.
Bronnie Thompson:
But what that process of science making forgets and, and, and leaves out is that preliminary process. How do we know, how do we generate that interesting hypothesis? And yes, you can look for gaps in the literature, but if you haven't got a literature and there was for people with who live well with pain, then how do you come up with a, a hypothesis to test? So I thought, well, let's do some observations. Let's look for, we can call an empirical regularity. So we know that there are about 15%, 15 to 20% of people who have, who actually say I'm living really well. They have low distress, low interference, but they have moderate to severe pain. And this comes from a paper that I read. I think it's from 2016 and might be a little bit older than that from Carman, who a measure of, of chronic pain that looked at these three constructs and found that yes, there are these, these people that, that are out there and we dunno much about them.
Bronnie Thompson:
So I looked at that and thought, why don't we start talking to these people? And grounded theory is one way of being able to not just, but to step back from that and to start to categorize processes that people engage in as they do, as they become this person that lives well and generate a theory that can then be tested. So I chose to do that. It was fun. It was exciting. And I still the process because all our clinical work is done with people who say, I'm not managing this. I need help. I had the joy of talking to people who said, well, actually listen to what I'm doing. And by the way, I got pain. So what, what seemed to happen was that the whole overall process says, how can I be mean really reifying, my sense of who I am, because when pain happens, it's described quite often in qualitative literature as a, a disruption, to a biographical sense of self, the person that I am, the things that I assume I can do fall over.
Bronnie Thompson:
I'm no longer able to sleep. I can't go fishing cuz my shoulder hurts or I can't go walking or I can't work. Or if I work, I'm not the kind of worker I used to be. So there's a whole stack of losses. So what I found was that the overarching processes, how can I be there? And there are three bits to that, the first how can I make sense of this thing that's going on for me? What does it look like? What's the name for it? So I talked about naming it, naming it is as the process of getting a, a, a label or a diagnosis. And for all that, I'm not, I don't use diagnosis in the work that I do. A diagnosis has a function. And what it is is it's a shorthand way of saying this is what's wrong with me, that everybody else seems to understand. So if I say I've got fibromyalgia, you may have an understanding of really what that looks like. From some perspective, you don't get the whole picture, you just get this little bit, but to someone with pain, it means that this is something that we know exists. It's not a mystery anymore. It's a real thing. Somebody understands that it is a problem that acknowledgement a really important part.
Jared Powell:
It almost validation.
Bronnie Thompson:
Yeah, it is a validation. It's a this doesn't, you know, to be so scared of it, you can, it's a entity. And I was struck by the way that that sense of uncertainty until labels being is really freaking. It really freaks people out. So even if we construct label, like we construct it as a fibromyalgia is a really good word. For example, we can call it a whole bunch of stuff. This person's got widespread pain, we've chosen to call it fibromyalgia. But before that, it was known by a whole lot of other names. So it is a construct. And I think we need to remember that about diagnosis, that it's a social construct, something that make, and we impose order. And we assume that underneath that, that label is some kind of organizing principle. Actually, it's not actually that straightforward.
Jared Powell:
It's not a fundamental law of nature, is it?
Bronnie Thompson:
It's not. And we,
Jared Powell:
Anything else is a conflict.
Bronnie Thompson:
Yeah, we put it, we put it on there. And yet in social terms, the way interact with people, be able share a language that says, oh, I know what osteoarthritis is. Or I know what ankylosing SITIS is helps to give some expectations around what might need to be done, what my future might be that other people can understand. And for pain in particular seems to be really important because pain's invisible. So part of that first part of making sense is just get, get a name for it. The second part is to work out well, what does that mean in terms of what I can and can't do? What's the daily life impact. This is the bit that we don't do very well. We don't support people through very well. We tend to think that when someone comes to see us with their pain, that they already know what sets their pain off, what settles it down, that they already know how much they can and can't do.
Bronnie Thompson:
And in this first phase of living with pain, people are still testing out the boundaries. They at the end of this part of this process is the, is the sense that, so if's at this today. I can expect myself to do that. So it's predicting how much I can do if I don't up. And you know, if I don't have pain today, this means I can do this. And so it's a common sense, sense making of the impact of pain and throughout this period of making sense, there's people are only able to focus on what helps them exist in day to day life. But that process of existing is how do I get to sleep? How do I stay in my job? How do I keep things stable while I'm making sense? And sometimes as clinicians, we want to help the person make changes and we ask them, what do you want be able to do in the future?
Bronnie Thompson:
And sort of thinking, oh, on, I'm still making sense of this thing. I, what it's gonna be. So sometimes I think we can jump ahead. Mm. So then at some point in this period, there's a point where this group of people said, if, if this is the way it is, then I'm just gonna have to get on with it, which I've called deciding, cuz you know, really got easy, easy nav. And that was driven by two things. One that they had a relationship at some point during that making sense phase with somebody that I've called a trustworthy clinician, that person who did little, extra steps to say, you matter, I'm gonna individualize. I'm gonna look out for something for you as an individual. I might give you a to say, Hey, how did you go with that exercise? Or I might give out some, so a handout say was looking on the internet and oh, I found this and it reminded me of you.
Bronnie Thompson:
Something that to the person that they're not just, they're not the same everybody else. So it's not just person center care, actually stepping a little bit beyond that into taking their little extra individualizing step. And these, these clinicians were all so permissive and that they stood by the person to say, you, you go try some stuff out. I'll be here, I'll stand by. You I'll wave the flag and I'll be on your side. They didn't trying stuff out. And that person in con conjunction with the other part, which was, which was the desire to do something that mattered to people of call it occupational drive, cause I'm an OT and occupation is about all those things that people do in daily life that mattered to them. And we could call them value activities you want. But the, the things that being a parent, being a rugby player, being a fisherman, being a dancer, being an independent person, these things that drive us to engage in things that matter to us.
Bronnie Thompson:
So when you have a somebody who's prepared to stand by you and wave the flag and say, I'm here for you. And by the way, this little thing I found might help you. And you've got that drive to do what makes you feel like yourself? These people after they've made sense could move into the last phase, which is where I've called it flexibly, persisting, which is looking at this is the direction I wanna go in, but I might have to take some devious route to get there, but I'm gonna move in that direction anyway. And that was made up of engaging with doing again. So beginning to do stuff that didn't look exactly the same as the old way of doing it, but it still tapped into the meaning. So my rugby bloke wanted to still be involved with rugby. So for him, occupational engaging was going back to the rugby club and meeting up with his mate like, oh my goodness, that was helping to connect him back into that part of his self identity that mattered.
Bronnie Thompson:
And then in that process, it was through doing those things that mattered, that coping strategies were identified and used and developed. It's like they didn't develop the skills first. And then they did and looked for ways that they could get to do those things. And the way they wanted to that was about developing those strategies. And inside that strategy, I found some three really important groups. One was nonjudgmental awareness. So I noticed what my pain's doing on a day to day basis. It doesn't mean I'm gonna stop, but I take it into account. And I think sometimes the way that persistent pain management has been driven is almost like, pretend you don't have it, just put it over there and pretend and just carry on as if you're normal. Well, that's ridiculous. Pain is for me, it's all the time. And when I'm having a, a bit of a flare up and I have been the last few weeks, I do need to account for that.
Bronnie Thompson:
And what I expect from myself, I don't stop, but I do have to accommodate it. And so these people are saying, well, I just notice that, yeah, today's a bad pain day and I'll change my expectations. And I'll ACC or one woman was saying, well, look, what does it matter if I do my face to face work in the morning when I'm feeling better and do my sort of non-face to face discretional and relaxation stuff in the afternoon when I'm not feeling so good, I'm getting stuff done. I thought that was, that was, that was kind of to me, oh, can't do that because that's not what we were trained in. Pain management to do. We taught, we've always talked about pacing and not booming and busting. And here she was Mely booming and busting and finding it worked really well for her. So that was that sort of that noticing.
Bronnie Thompson:
And the second coping strategy that they all did, you was all about movement. It was all about exercise dam it, but it was not exercise because I wanna get strong cause I wanna something cause I wanna increase my cardiovascular capacity. It was cause it me space because I can, can do this walk to work and my mind gets some time to think I can jump on the on the bike and go cycle to and from work and I'm able to let go of stuff. So was used more as a mindfulness of opportunity almost, or a decompression opportunity, but also in New Zealand we have John famous rugby player, you know? Yeah. He is the spokesman for depression.org. He's been fabulous in terms of talking about his own experience with depression. One of the ads that he's been in said, I, I always do exercise because it just makes me feel better.
Bronnie Thompson:
And that exercise form doesn't, isn't as relevant as I'm moving and I feel better. And that's what these people were talking about. I'm moving and it feels better and that could be walking the dog. It could be swimming, it could be gardening. It could be whatever the really wanted to do that performed the function of I'm. I've got things I can spend my head head space in. And then the last group was a hodgepodge of whatever works. And by, by that, I mean, whatever works for that person. So people would pick up the most weird and wonderful things, including colored lights. I'll sit under my colored lights for half an hour. For one of my blokes, doesn't do anything as far as I know, but for him, it fitted for him. And I guess what I have discovered from the coping strategies that people describe, I've been expecting good coping people who think they they're living well would do the things that we expect from people who are doing pain management.
Bronnie Thompson:
They'd be pacing, they'd be exercising, they'd be planning. They'd be using positive self statements. They'd be using mindfulness by, well, not actually they'll use whatever fits and anytime something new comes out, these guys will evaluate, will that fit into my life. And then they'll pick up and use that if it fit, but not if it doesn't or they'll pick up a bit of it that fits. And then the last part of this sort of final flexibly persisting is that it, it's only really at this point that people are able to think of the future, then start as future planning thinking about. So now, now that I kinda got a handle on this, I could think about my trip to Australia or I can plan to go out on a Friday night because I know what I can expect and that's not present in people in that earlier phase.
Bronnie Thompson:
This wasn't set over a particular time. The people that I to had pain that ranged from a year to 30 years. So it was quite variable. It wasn't short term though. I don't think this process is a short term process. I think it takes time for people to figure out how can I express who I am, which involves letting go of previous expectations about what kind of a worker youre, for example what kind a mother you're going to be, or a Fisher person or a rugby player, and then to pick up new ways of expressing that. So it's quite a, yeah, it was an enlightening. Challenged me a lot.
Jared Powell:
Yeah. That's Ronnie, there's too many things to talk about. I've written,
Bronnie Thompson:
Sorry,
Jared Powell:
Scribbled. I scribbled all over your your research paper here. I wanna, I want, so that just, that brings up a quote that I think I read from your paper was, was that your body may change, but yourself remains. I think I got that from you or some or maybe Carol's paper, but anyway, it's a absolutely that sort of flawed me when I, when I read that and I'm trying, and you don't, you don't speak in quotes to your patients, but it's a very interesting way of trying to hit home or, or emphasize their identity. And perhaps you still can have that identity, even with these changes in your body,
Bronnie Thompson:
Even if you express it differently. I look at it. So if we think about I often work with blokes, I dunno why, but I end up doing it. And, and often they say, well, I want to be a really good dad. And what does being a good dad look like? Well, probably for most blokes, that'll be playing rough and tumble, going to sports, doing, doing that kind of stuff with, with their lad or S for most people with persistent pain that has to change and form. So how else can you express being a wonderful dad, loads and loads of different ways. And for people who have got stuck, that the only way I can be a good father is by playing and, and I can't do that. Then they lose that sense of I'm. They start to say, well, I'm not a good father, and yet we can help loosen that, that belief, that there's only one way to be a good dad and create this wonderfully rich example of the other ways that you can be that person that you want to be.
Bronnie Thompson:
And that's the creative part of being a clinician thinking. So like my racing car driver, who, you know, how can he be a really good racing car driver? He'd been a bit of a BLI when he was growing up with juvenile arthritis. He decided I need to get fit. If I wanna be a racing car driver, I'm going to get fit. So he goes to the gym and he's a guy who hated physi would, would try to avoid it and hide behind the bike heads. There is going to the gym for three hours, you know, that's pretty cool. Mm. So we can do things that matter if they're helping to build that sort of sense of who I am and even if, and increases pain. So I wanna sort of talk a little bit about that because, so I said, I worked, worked with motorcyclists and I dunno, a motorcyclist who hasn't told me that in a bit of a guilty shame faced way.
Bronnie Thompson:
Oh yeah. I went out on the bike. Oh, it was wonderful. But, but do I hurt? And then you say, was it worth it? And they say, yeah. So Mo I I'm an ex motorcyclist. And it's about that sense of being at one with the machine, taking through the, going through the curves and just absolutely loving it. And these guys have got this sense that if, but they shouldn't do it cause it'll increase their pain and that's cause people have said, you know, pain's the most important thing. If we can that a little bit it's to experience pain, if it's doing something that matters to you. And that's what these guys in this study was saying. Yeah. Going back to rugby for know, my participants really hurt. Yes. He started by just meeting up with the blokes of the club and then he started bringing the oranges at half time as people do.
Bronnie Thompson:
And then he started coaching and then he started being a line and then he started to go back into masters rugby. And that took a while, but it hurt, but I it's worth it. Cause it is about feeding his soul. You know, it makes him feel like himself again. And I sometimes think when we're looking at rehabilitation with people that we, we forget that they want a, they don't want have a recipe or a a of that they have, it's not what life is about. Life's more free flowing. And sometimes we think, well, you've gotta do your 30 minutes of exercise and do your three times 10 and maybe that doesn't fit. Maybe there are other ways to do that. That are more life like for this person. Yeah. It's hard for us.
Jared Powell:
Yeah. It is. It really is.
Bronnie Thompson:
Mm.
Jared Powell:
Can we, can I just go back to the, sort of the sense making aspect of the theory? Yeah. You mentioned that a diagnosis is important or a label or a name, which whichever way you wanna look at it. Yeah. How, how does that relate to a patho anatomical diagnosis that maybe challenged? So let's say sciatica and, and it's not, perhaps not correct their interpretation of it. And we wanna say nonspecific low back pain or something like that. So would you just allow that without challenging or having a discussion about the inaccuracy of the term perhaps, or would you say, look, this is serving a purpose. That person feels in control with that diagnosis. And then you sort of just go on and, and, and say, yeah, you've got Sarte, but it's not gonna infringe upon activities that you wanna do. How would you,
Bronnie Thompson:
Well, I think we've got, we've got terms that acquire meaning even if we've got a proper name for it, they, it will meaning over time. So I look at, at its utility very much more, it is confusing for patients to be given multiple names for essentially their, their personal experience. And working in chronic pain management. As I have, you'll see people with, you know, five or six different diagnostic labels for the same thing, and that's really confusing. So I think people like a label that is in common use, because it's what they're gonna say to their employer. It's what they're gonna say to him down the road. It's what they're gonna talk about to their mates and their, and their neighbors, as well as when they're gonna to see the next clinician. Hopefully they won't need to see too many, but, you know, they'll and I guess what I would look at is what's, what's the function. How well is this working for this person? Labels require good and not so good attributes. Fibromyalgia is a really good example of that, where it can be seen as a wishy washy basket case label. Everything gets thrown in there, or it can be seen as an identifier that maybe we don't really know what's going on here, but it's widespread pain. And we know from soci that when people collect under of fibromyalgia, there are good and not so elements of that as well. Some people say it's yay. I know it's dreadful.
Bronnie Thompson:
Oh, it's we have I'm symptoms. That word, it's the meaning that person takes from that word. So I like a nice convenient conversation with the person, a nice label that makes it easy for them to communicate what that means. And it's just useful to, for us, as clinicians to think about, if I give this person a new label, what, who is that satisfying? Is it satisfying me? Cause I like to have an algorithm. Is it a satisfying an insurer who might now pay for something or conversely, this person could lose their compensation and recover as a result? Or is it for some other purpose? If we are here to serve the people that we are treating, then we need to think about it from their perspective. So what sense do they make of being told there's another label for what you've got?
Bronnie Thompson:
So I try clinically. I don't use it. I try not to, I just say you've got pain and then we do a formulation, but, but the literature's pretty clear that people want to know what it's called. And Levinthal common sense model talks about this. He's a, got a lovely model of, of illness. And it's about what we think this title represents. The prognosis might be what the illness, beliefs are around this. If you've got a, you know, you know, it's gonna last about a week, you're probably not gonna die from it. Now with the same symptoms, cough, feeling ill, we might be worrying about what else that might means that we, the illness model that we've got of what it looks like to have a cold has got threatened and it's got chain it's changed. And that, that applies to back pain really well. You know, how many different words do we have for back pain? Loba might be the best one or you gotta touch a lump bagel.
Jared Powell:
Funny. It's just, it's so true. It's where, where, where I think a diagnosis or accuracy of diagnosis is important though, when it's, when it's this fundamentally mechanical diagnosis and the person interprets it to, to the letter, you know, so for example, subro on ping, which is a term that I hate somebody somebody's like, it's pinch, there's a bone rubbing on my tendon. Whenever I elevate my arm, I don't wanna elevate my arm. Exactly. Right. Look, there's a bone spur coming down. Yep. And so for me, that that's something that we have to change. Cause I think that interpretation sets us, sets that Condit to manage in a certain way, meaning you have to de impinge the shoulder, which, which is incorrect. So, so perhaps
Bronnie Thompson:
Usually in a way
Jared Powell:
Precisely or an injection or some form of other medical management. So I think when, when the way we speak about a condition sets it up to be managed in a very perhaps surgical or interventional manner a conversation maybe worthwhile.
Bronnie Thompson:
Yeah. I still think that that's about the way that the person interprets the hundred percent, but for clinicians, we, we buy into these terms big time. It, it does shape perhaps less so for occupational therapists because we are not dealing with the, I impairment. We are dealing with the function participation if we're looking at an ICF model, but we do, we are informed by that. So that shapes that diagnostic label shapes our expectations as it does to everybody, what, what do we think needs to be done? What do we think the prognosis might be? What are the things we must not do? And in the case of painful problem, we do have some problems there because how many names do we have for lateral elbow pain? Yeah. Yeah. And can we not just call it lateral elbow pain and be done with it? And I have, I have impingement in my shoulder. I know I've the, and it that, but you know, what does, what difference does it actually make from a practical sense?
Jared Powell:
Exactly. I think you've got shoulder pain.
Bronnie Thompson:
Yeah. I've got shoulder pain.
Jared Powell:
Yeah.
Bronnie Thompson:
Don't, don't prune the Eria and when go, just take a little quietly.
Jared Powell:
Yeah, yeah. A hundred percent. And that, so for me, I, I sort of work in a tertiary referral center for, for shoulder pain issues and the amount of biomechanical jargon that these people have been told. I
Bronnie Thompson:
Usually believe
Jared Powell:
That within an inch of the li like, it's just, it's, there's so many barriers to unpacking that and you need to be careful. And I don't want to take away that whole person's understanding of their condition and one fell swoop, you know, so, but, but I think we need to, when I say we us as sort of nonsurgical or non-medical people, allied health people need to discuss, and I do this regularly with GP is and orthopedic surgeons and sports physicians and all of these lovely people. Yeah. We need to have some form of consensus with how we're, what we're calling conditions and how, how we manage it. I just dunno if we're gonna get there. Exactly. There's far too many
Bronnie Thompson:
Vested, many different voices around it, depending on the slice that they taking through the problem. And ultimately the person themselves is gonna make some sense out all this mess that they've been told. And I guess that's why I quite like the guiding through, what do you think this means? What's your yeah. About what's happening and how do you know this and how you challenge that or that, can we try some experiments to see whether your assumptions about what's going on based on what you've been told by all of these people you've seen, does that do those assumptions hold and that's, that's where our clinical practice starts to become most useful, where we on a journey of discovery together, if a discovery and you know, psychology does this with mental illness. Very often we can do the same with pain. So you've got an impingement. So I wonder what that means if you try this. Exactly.
Jared Powell:
You know? Yeah. So we're getting, that's beautiful. Cause that's, that's kind of like cognitive behavioral therapy, cognitive functional therapy, Sullivan the off, and that's exactly that they have a cognition or a belief in a certain issue. And then we're like, well, let's give it a go. We what's the worst.
Bronnie Thompson:
That enough. Yeah. And I like that journey of discovery together. Cause actually I D know what will happen and that's for, for us both. Cause we can do play for approach to doing a movement that in a context, cause context matters that involves yeah. The playfulness takes that stress away from, I've got to do these exercises. So I get better instead I'm discovering, oh, what can I try with this? And I think that's and our clinical work, otherwise we start trying to take over the and prescribe and get frustrated when it doesn't work. And often it doesn't.
Jared Powell:
Yeah. I know that all too well. Yeah. All right. So the last, the last topic that I really wanna talk about is you've been vocal recently on this topic of exercise and I'm, I use INCOM with perhaps you have another alternative. So what, so exercise has exploded recently. I think in terms of it's a to, for everything, it resolves everything from chronic disease to mental health conditions, to pain, to everything. It's a poly pill, which may, which may not be wrong. It certainly can affect multisystems in a positive manner, but whether we just need to use it like a blunt tool, a blunt instrument for everybody. Well, we do,
Bronnie Thompson:
I think
Jared Powell:
Exactly exercise the world health organization says this amount of exercise per week. So, so I guess just tell me why you have a bit of a grip with this concept of exercise and, and how can we maybe think about it from a more nuanced manner?
Bronnie Thompson:
So when I say exercise to patients, particularly people who are struggling with their pain, the kind of you have two reactions. One is the gym person who yay. I'm gonna get back and do some stuff. The others, the frightened rabbit will frightened plasm in the headlights look like where the physio terrorists has terrorized them into doing stuff that they're not ready for, or that has been boring or that they've been prescribed, never reviewed. And then as soon as that program finishes, they drop like a hot potato. What is the point? If we're really about helping people live a good life movement is inherent to human beings. We've got to do it. We're not made to sit still ever. And, and here in my sitting still, but as you can tell, I don't sit very still, right? I read all the ton that's me. But so what we, I think what we need to recognize is that in an evolutionary terms, we were never designed to sit still, but neither were we designed to go lift heavy weights in a gym.
Bronnie Thompson:
We were never designed to do that. We were designed to have lots of variety to, in fact, we are, are the Swiss army night of, of animals. We're not very good at anything, particularly we're really good at everything. We have lots of options. And when we think about movement, I think we've wanted to put it into one frame and movement looks like this. When I look at the pre history people, pre-written history people and a variety of things that people do in tribal culture. It's physical, you dig, you pound, you grind, you, you shape you. You have to create these things. And that's all done in daily life. And we tend not to do that as much. Cause we is sitting behind, especially clerical workers, academics, whatever, sitting behind a computer. So we're not getting enough movement variety in our lives. Anyway, health movement, variety and intensity are bias.
Bronnie Thompson:
Important. Gotta have enough intensity to keep your tissues healthy. That's that's a given, but we don't know what the best way of doing that is for somebody. And what I object to is some young fit person, assuming that this person in front of them, me pick on me, wants to, and needs to do it in the way that they find meaningful. So this young buck might really love to go running and expect that I, who absolutely loathe running will do it. Cause it feels good to them. And there's this like mystified. Look, if I say, actually I don't really like doing that. What I like doing is carrying my fishing rod and going for a long walk along my back, which involves Boulder hopping, lots of balance. Usually it fall involves getting into the water and walking against the current. Now that is exercise.
Bronnie Thompson:
And I'll do that one day and I'll do something else another day I'll garden, I'll the I'll do my housework and all of these things. They're optimistic ways of viewing the way that humans can move. Then we're not restricted to the ideals that we expect from people. And the advert that they used in, in New Zealand was 30 minutes to push play and like that. So, okay. 30 minutes is probably not enough, but if we wanna start, we wanna start somewhere. And what about using physical play as a way of getting people into, into actually enjoying this process and it's meaningful. So you can do play by throwing a Frise around, you do play by jumping in a kayak. We going fishing. You can do play by I dunno, picking a ball around for the dog. So many options. Let's not just get stuck into three sets of 10. You knows awful.
Jared Powell:
Yeah. Is there's fun. We've gotta be more intelligent.
Bronnie Thompson:
Yeah. And I, I mean, I, dance and dance to me is, is essential. As I dunno, other people find running dance is also a form of movement, but I, you know, we don't expect in if we look at tribal groups, we don't see them doing the same thing every day. They have variety and we expect people to have this gym program that they follow every day. Instead of saying today, I, I can have this choice from five different activities, all that involve this rich diversity of movement and context. And that's important for adaptation, for variability, flexibility, for strength. We need all of that. Mm. And sticking to proper form, doing CEPS curls. I mean, come on.
Jared Powell:
Yeah. No, Mo moving variability is, is everything. Like if, if, if the, if a, if a biological system is comfortable moving in all sorts of directions, if all sorts of load and sorts of intensities, but with all sorts of context. Yeah. I think that is the most advantageous from an evolutionary perspective of an organism to live. And
Bronnie Thompson:
That's nearly what we are trying to do for people. And what we, what we're doing is, is movement. People is we've got somebody who's not moving very much cause of pain. So we start small. But if we only introduce them to stuff that is very constrained, and then they go off into the wild after we've repertoire movement, do they have for themselves later? Cause our bodies are constantly changing. We're aging, we've got different things that are happening to us in different environments that we're in. If we don't teach people that they can use anything in their world to create a movement opportunity. And we're missing out on this most incredible opportunity to, to help our whole community get better, to be more able to, to more resilient. So, so that's why I'm anti not exercise, except that the words got baggage. The word often means like for me, physi, where I was the last person chosen, fit all the ball sports in the team because I have got horrible hand. I, I can't catch a ball terrible and I don't enjoy running at all. And you know, I played hockey and I, I broke my thumb before my piano exam. That was just, you know, how to put someone off playing what actually could be a fun sport. And I don't like team sports. I like doing stuff. So, so can't, we do it,
Jared Powell:
Have
Bronnie Thompson:
Some fun
Jared Powell:
Around totally. So there's just more, there's more options and it's not. And exercise the word itself is denotes a more rigid kind of like, which is sort of indoctrinated within us culturally, isn't it? In terms of how we grow up physical education, you run laps, you jump, you, you know, blah, blah, blah, blah, blah. Which is what you're speaking to there's is more, we've gotta be more adaptable in our prescription of movement.
Bronnie Thompson:
Yeah. Bearing
Jared Powell:
Your mind, the individual.
Bronnie Thompson:
Yeah. We think, what does this person allow? What will they be motivated to do? Cause motivation is about how important it's to you, how confident you're you can do it. And if you don't, it's very important. It doesn't fit for you. Doesn't feel like it's you, you are not gonna do it. Even if you could, neither will you do it if it doesn't, if you're not very confident. And for me walking into the, into a gym full of sweety, blokes and light crap is like with loud music is like the, the worst thing I could possib me do, I just don't wanna go there. Yeah. Put me out fishing.
Jared Powell:
I agree. I think we've reached a consensus. Yay. I think so. That's I think we'll leave it there. Thank you so much. That's been, it's just so much to get through and I'll link to people, some papers that you've written and also your blog as well. Where can others people find out about you? Are you on social? Are you on Twitter? Are you on
Bronnie Thompson:
Instagram? On Twitter? Yeah. you'll need to look under a DMS free, which is not the easiest handle. That was way back in the day. I've been on Twitter for a long time. Okay. Probably since it's inception, I think I'm on LinkedIn and I'm also on Facebook and people are welcome to connect. I'm nearing my limit on how many people I can connect with. So followings, probably easier the blog health skills, but otherwise I'm, I'm sort of around all over the place. Usually can't afford me.
Jared Powell:
No, we don't want to. I think you're, you're, you're really a needed voice, especially in this time when there's a lot of like polarizing and, and deliberately provocative and quite tur conversations sometimes on social media, I think you're a nice, I don't wanna say gentle voice, but you're really like I don't, I dunno what the word is, but you are, you're, you're always quite diplomatic in, in how you talk. So I think that's really, yeah,
Bronnie Thompson:
It's not what people call me. Well, you can see that I'm quite outspoken about when I think about, because cause we are often very dictated to, and we adopt that and this social practice of calling one another out, serves to polarize and actually there's good that we can adapt from both, including dare I say at hands on, you know, we can use these things. It's just, we, the focus of person that we want to try and help it's who we're there for, not for ourselves.
Jared Powell:
Let's not talk about hands on. That's a, we'll have to, we'll have to reconvene this conversation.
Bronnie Thompson:
Well, I'm doing happy and
Jared Powell:
Let's do it. I'm happy to share that because I, I am Switzerland when it comes to that conversation. I'm I'm neutral. So that could be interesting.
Bronnie Thompson:
I'm I'm neither really, I, I don't, I don't really care. I've just had this big clear up and I've had a wonderful experience with massage with a really good massage therapist. I didn't change very much, but I tell you what I felt. Yeah, and that's not doing anything magic. And she said that as a Rachel a who's one of my students and also on social media, I just think sometimes we discount it. Cause the evidence says, and it can be misused, but then so can exercise sort of everything that we do we've it's moderation.
Jared Powell:
No, no, that is so that's fundamentally, I agree with that in every possible sense of it. Whatever makes that person feel a bit better, as long as it doesn't breed dependency, you know, and you're not delivering them, these messages, like you're putting stuff in back into place and blah, blah,
Bronnie Thompson:
Blah. Yeah. Yeah. And you're not jabbing people's needles. Yeah. That I'm not keen on that's cause I just don't like needles, but
Jared Powell:
Exactly. Yeah. Yeah. Anyway. All right. Let's let's leave it there. Thank you so much for your time, bro. And catch up soon.
Bronnie Thompson:
Okay. Catch up. Bye.
Jared Powell:
Thank you for listening to this episode of the shoulder physio podcast with Bronnie Thompson. If you want more information about today's episode, check out our show notes at www dot shoulder, physio.com. If you like what you heard today, don't forget to follow and subscribe on your podcast player of choice and leave a rating or review. It really helps a show reach more people. Thanks for listen. I'll chat to you. Soon. The shoulder physio podcast would like to acknowledge that this episode was recorded from the lands of the Uganda people. I also acknowledge the traditional custodians of the lands on which each of you are living, learning and working from every day. I pay my respects to elders past, present and emerging and celebrate the diversity of Aboriginal and Torres Strait Islander peoples and their ongoing cultures and connections to the lands and waters of Australia.
