The Postural Structural Biomechanical (PSB) Model – It’s Time To Let It Go!

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[Reposted from The Physio Detective]

A different kind of blog post today. Today, I am going to tell you a bit of a story of change, one where I had to confront the difficult reality that what I knew and did was not complete and was not helping my patients for the reasons I thought it was. I had to confront my belief in the Postural / Structural / Biomechanical Model and let it go!

It’s a difficult to story to tell so I have enlisted the help of Queen Elsa to help me tell it.

Part 1 – Life Before The Change

The snow glows white on the mountain tonight
Not a footprint to be seen
A kingdom of isolation
And it looks like I’m the queen

I used to be part of a very large community of physical therapists and other health and fitness professionals – in fact, most of the world think the way I used to. This is where posture was important, where making sure you had the right alignment was crucial, where activation of muscles in certain sequences was essential, and where if you weren’t stacked the right way, your biomechanics would lead to pain and injury and brokenness and suffering. My whole theoretical model was based on these beliefs and I taught them to many others (I am sorry for doing that!) – it is important to acknowledge that I was doing the best I thought I could to help these people and have spent an ungodly amount of money in the pursuit of educating myself and others.

Like Elsa, I was there but still an outsider. I knew things weren’t complete. I had a complex answer for everything but I knew a whole bunch of factors were also playing a part:

  • Why was that physio with very little skill and knowledge able to help patients and the experienced physio losing patients?
  • Why was I able to help someone when I barely did anything?
  • Was I helping people just because they like me?
  • Why was that patient not getting better when all the things I found to be important all improved?
  • Why is it when I applied the WRONG technique, the patient still got better “objectively” and subjectively?
  • Why is it that I couldn’t feel what others were feeling on a course and yet I still helped people they couldn’t help?
  • Why is it that a random “correction” was able to help someone just as much as a specific one?
  • Why was it that the kind of day my patient had affected how well I could improve them?

I had so many questions but I enjoyed being secure in the knowledge that I was making a difference and helping people.

But the one day at the end of 2013, Greg Lehman engages me in a conversation on Twitter about Thoracic Rings. This thing went on for days. but the key moment came when I asked him “does that mean I didn’t help all those thousands of people?” to which he replied something along the lines of  “I didn’t say you didn’t help those people, I think it was for different reasons”…at least, that’s how I remember it.

From that moment on, I realised I could let go of these techniques and models because they didn’t define who I was. I realised I had let these things be my identity – that’s why whenever someone attacked the models or techniques I used, it felt so personal…it was as if they were attacking me personally!

But I suddenly felt very isolated. I was free to question the models and techniques I had learned but now that meant I wasn’t “one of them”…and I didn’t know enough to be a part of the new crowd. I did try. I went onto a forum where a lot of them inhabited and asked questions but then was directed to read about 200 comments on a topic. Who has time for that?! It’s not that I am lazy, it’s just that I am busy! Where was the support, the short-cuts, the encouragement? It seemed like it was a rite of passage – we had to suffer to get here so you’ll have to suffer to get here. I think that’s stupid. It’s a massive obstacle to change!

Part 2 – Decision Time and The Change

The wind is howling like this swirling storm inside
Couldn’t keep it in, heaven knows I’ve tried
Don’t let them in, don’t let them see
Be the good girl you always have to be
Conceal, don’t feel, don’t let them know
Well, now they knowLet it go, let it go
Can’t hold it back anymore
Let it go, let it go
Turn away and slam the door
I don’t care what they’re going to say
Let the storm rage on
The cold never bothered me anyway

I had tried to be as good a physiotherapist as I could be. I had spent a lot of money doing courses and a post-graduate degree and specialisation training. My intentions and my heart have always been in the right place – helping people is what I feel called to do. I struggled through undergraduate school with my narcolepsy (I daresay it affected my high school as well!) and even now I struggle with being passive too long. I worked hard to be the good physio – to learn my theory and anatomy and be good at what I was taught.

But now, that world was being cut down…what could I trust anymore? The only thing that I was able to hold on to was that I was able to help people…that didn’t change.

The way I saw it, there were 3 options:

  1. To stay the same as I had been – to double down, give the middle finger to all who attacked me and just rely on my results as the main justification for what I did. But for those that know me, you know I like to be right…and knowing that what I believed in was not right would eat away at me…this was not an option.
  2. To dive deep into this other realm – I kinda do a lot of the things people proposed – I had these questions already and worked around them. I understood and had heard of the biopsychosocial model already. I understood the importance of the psychological and sociological contributing factors already and I was willing to learn more…but there was this air of superiority I didn’t like…there was not enough of an attitude of remembering where they had come from, not enough empathy and understanding, too much jadedness…
  3. So there was the third option – to go my own way…but that would mean being out in the cold. I would not be in either camp…but then, I was always a bit different…Different. This word had been a part of my whole life. I was different in so many ways. One very specific childhood memory I have is my mother exclaiming “why do you have to be so DIFFERENT!?” to which I replied “I JUST AM!”. My first Yellow Pages advertisement had the words “Feel The Difference”. Advice I gave to youngsters was to do things differently to others otherwise you’ll get the same results they get.

So I decided to let it go – slowly, of course! I decided to challenge my beliefs and think about my thinking. I chose the hardest way – to go my own way (it is not a unique way…just that I had to find it myself). I like being able to see what I did, I like being able to look back and say “ah, I used to do that”. I like being able to see the change over the years. And it took YEARS to change and I expect it to take until I die to keep evolving how I practice.

But there was a sense of freedom. No longer was I a fraud for not being as good as others in feeling the small things that others could. As a natural contrarian, I relished in being able to break the rules and still help people get better. I had taken up CrossFit and I fell in love with it because it pushed so many boundaries and broke all the rules and I loved it for that.

It was time to start letting go of all my old beliefs that did not stand up to the challenge of being examined…

Part 3 – The Process Of Change

 It’s funny how some distance makes everything seem smallAnd the fears that once controlled me can’t get to me at all
It’s time to see what I can do
To test the limits and break through
No right, no wrong, no rules for me
I’m free

Let it go, let it go
I am one with the wind and sky
Let it go, let it go
You’ll never see me cry
Here I stand and here I stay
Let the storm rage on

So I started to challenge what I did. Everything that I felt was essential to helping someone got examined. I began to seek out information that challenged my biases and beliefs.

What did it mean if I could help someone without doing THIS or needing THAT to be right first?

If this test is positive, does it REALLY mean THAT?

I began to study about logical fallacies and cognitive biases…this is an ongoing study because there are A LOT of them!

I tested the limits and I broke through so many of the old obstacles and beliefs. I reduced what I did to three simple words – DO SOMETHING DIFFERENT.

I mean, that’s all we really do anyway! We see what the person is currently doing and how it is associated with pain and we ask them to do things in a different way that is not associated with pain. We make fancy stories up around this but ultimately we are just doing things differently.

So on this rock, I rebuilt what I did. Different. Be Different. Do Something Different.

I had already developed quite a number of techniques to help CrossFitters I saw who were suffering from trying to do what others had told them was the right thing to do…I just showed them how to do it differently. Now a new language had to emerge.

Now I had to take this forward. Part of why I sold the practice was so I can focus more on developing the education side of my business. This is where I wanted to go next.

Part 4 – Encouraging Others To Change

My power flurries through the air into the ground
My soul is spiraling in frozen fractals all around
And one thought crystallizes like an icy blast
I’m never going back, the past is in the pastLet it go, let it go
And I’ll rise like the break of dawn
Let it go, let it go
That perfect girl is gone
Here I stand in the light of day
Let the storm rage onThe cold never bothered me anyway

Back in 2013, I started running local seminars in CrossFit gyms for mobility and helping people improve and prevent their pain. This was before the conversation I had with Greg Lehman. Over time, these seminars developed into general seminars about improving technique, and helping people with musculoskeletal pain, and seminars focusing on women’s health problems. I also started a podcast with Lori Forner which I eventually called “The Pelvic Health Podcast”. Lori continues the good work on that podcast – I was there for 51 episodes.

Then, I got asked by Sandy Hilton and Sarah Haag to present a course on How To Treat CrossFitters. It is a biopsychosocial approach to helping CrossFit Athletes. That same summer of 2016, Tracy Sher asked me to present a course on The Female Athlete and Susan Clinton asked me to run one on Moving Beyond Motor Control. All were 2 day seminars and focused on providing an evidence-based approach to helping people with musculoskeletal, sports, and women’s health problems.Since then, I have revised the most popular course – The Female Athlete – into 4 evolutions…and soon to be a 5th!

This last bit of the song Let It Go is my favourite. I have been through the pain of change and I know I will continue to learn and change until I die. But this last section of the song is where I encourage those that come to my seminars to leave behind the old Postural / Structural / Biomechanical Model…

And one thought crystallizes like an icy blast
I’m never going back, the past is in the past

My hope is that from my seminars, from their interaction with others who are also promoting similar changes to our profession, I hope that each participant can say “I’m never going back [to the old postural/structural/biomechanical models], the past is in the past!”

Let it go, let it go
And I’ll rise like the break of dawn
Let it go, let it go
That perfect girl is gone

If you let the old beliefs go, it will be a new dawn on your career. Let go of the fear, the beliefs that contradict each other, the burdening of patients to “get it right!”.

But not only that, embrace not knowing. You don’t have to be “perfect” – that person is gone! Embrace uncertainty. We don’t know why what we do works! We do know it is a combination of so many things, and those things aren’t perfect posture, correct alignment and proper biomechanics!

Here I stand in the light of day
Let the storm rage on
The cold never bothered me anyway

Stand up and be proud to be a part of the new dawn, the age of the biopsychosocial model. Be a part of what seems to be the best way to help our clients holistically. Let the storm of anger and defensiveness from others rage on around you.

But be warned. You will feel like you are out in the cold. You will be shunned, ridiculed, gossiped about. I have had friends lose their jobs over this type of thing. It is not an easy road but it is the right road. The cold never bothered me anyway but it might for you…

Part 5 – What Are You Going To Do?

…so know that you won’t be alone! I am here and feel free to look to me and others like me for support. Change won’t happen overnight. You won’t get judgement from me. I won’t call you names. I will acknowledge just how hard what you are trying to do is. And I will do my best to support you.I’ll simply ask you “what is the next logical step for you?” In what way are you going to let it go, just a little bit? In what way will you take that step away from the old beliefs and move towards a more biopsychosocial approach? What one belief will you address this week?

What one patient will you review and reconsider this week?Maybe you would like help in changing – I have a masterclass program that attempts to shrink the 3 years it took for me to change into 3 months – click here to learn more!

Let me know how you are going and if you ever doubt what you are doing, listen to Elsa’s song and remember that you are not alone 

Antony Lo

Antony Lo

Founder of myPTeducation. I am a physiotherapist from Australia that works at the junction of Musculoskeletal, Sports, and Pelvic Health treatment, rehabilitation, and performance enhancement. Over the past 15 years, I have been on a mission to EMPOWER, ENCOURAGE and EDUCATE health and fitness professionals all over the world and myPTeducation was founded upon this philosophy.

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