Episode 214 - Colin Davies (re-airing Episode 14), part 2: STOP Treating Your Patients

 Colin Davies PT, Dip MDT

Colin Davies PT, Dip MDT

Mr Colin Davies is a licensed physiotherapist specializing in the assessment and treatment of common muscle and joint problems. After graduating in 1971, he became a clinical associate of Robin McKenzie, the founder of the McKenzie Method of musculoskeletal assessment and treatment.

He has been a member of the teaching faculty of the McKenzie Institute since 1984 and as such, has presented over 300 courses for the McKenzie Institute in 15 different countries. In addition to his teaching role he is also an examiner for the McKenzie Institute Diploma Program.  He was appointed to the Board of Trustees of the McKenzie Institute in 2008.

He has been in Private Practice since 1979 and currently lives in Vancouver, Canada.

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In episode 214 it’s part 2 of my interview of Mr. Colin Davies, the re-airing of episode 14. We talk about memorable patient experiences, effective patient education analogies, resources, studies and more. And, following, some fresh, new content from a recent conversation I had with Colin with more great Robin McKenzie stories and how he stays so interested and excited about patient care after 40+ years. This week on MCF!

Show Notes

Patient memories

In the early 90’s with Dr. Charles Aprill, Colin was involved in a study comparing McKenzie assessment with the effects of discography and see if they could come to similar conclusions. They had a lot of complex patients in the study with multiple yellow flags, but they were still able to make accurate predictions using the assessment. The lesson that Colin learned during this process was that we need to stop treating patients and start understanding them. 

His advice to all MDT clinicians is, “Don't treat your patients, just assess them and you will have answers in due time”. 

 

Education and Analogies

When explaining derangement to patients which is basically an obstruction, Colin uses the analogy of a splinter in the hand. He gives 2 takeaway points to the patient with the splinter: one, that you have to squeeze in the right direction to get it out and two, when you squeeze it is going to hurt a little bit but once it is out you will feel better. 

It is important to help patients get over their fear that the pain with movement is not harming them.

Another analogy that he uses with patients with various psychosocial features and feel pain much more than usual is about a regenerating cut nerve. When the nerve is regenerating, it is hypersensitive and the perception of high levels of pain is a mistake on part of the nervous system and not the patient itself. He uses the example of a “burglar alarm” which is set too sensitive and instead of a person a mouse is running on it and setting it off.  

 

Best Professional Advice

Apart from everything that Robin has taught him, Colin talks about a book by A. C. Grayling, The Meaning of Life. The message is about perseverance, that the key to it is to understand that there is a natural graph line. When you start a new endeavor, it is easy in the beginning, then you encounter difficulties on the way. If you persevere through those difficult times, you will rise each time. To be successful, talent is important but not as much as perseverance.  

 

Resources

Colin is pretty isolated in Vancouver in terms of McKenzie practitioners but he reaches out to colleagues including Jose’ Liberato in Brazil, Mark Miller in USA and Richard Rosedale. 

 

Research Studies

Albert 2012 study that concluded that centralization was seen in patients even with ruptured discs.

Gillard 1979 study which showed the importance of movement and tension on tendon content and strength. 

Sir Ashley Cooper’s book (1930) which has sections of unrecognized fractures and dislocations that showed illustrations of healing without any medical attentions. Some of the illustrations are present in the MDT extremity book. 

Barry Wike 1966 article that explains the factors causing pain. Robin was very influenced by it and from it came the analogy of bent finger. 

 

Habits to be Successful

Colin states that he has been in clinical practice over 40 years and even today he gets excited to see patients, and while teaching courses. The seeds that Robin sowed are still growing and even today Colin is working on improving himself. 

 

Public Health Initiative

Colin feels that the MDT system has an enormous public health potential. The McKenzie Institute has a committee now and are looking for candidates who have university training in public health. The goal is to have a widespread reach and empower people to improve their health. 

At the recent San Francisco conference, the McKenzie faculty was educated more about the initiative and they looked at videos on various public health issues like use of seat-belt, stop smoking and the likes that have been successful. The different branches have been given the task of developing campaigns that will work in their respective countries. 

Initial goal is to reach the public and then the next step is to target the public health officials and policymakers to help bring about this change. We as physiotherapists should be focusing on improving quality of life and encouraging movement and exercise. Colin’s biggest wishes are that as a profession physiotherapy should move away from passive care and become front line health care providers for chronic illness and diseases. 

 

Remaining the Assessor

What has kept Colin going back to using the system is its elegance and the beauty of the assessment process (history and physical examination). Colin compares it to a sculptor working on a huge piece of stone. As you keep chipping away at it something emerges; similarly as you keep assessing and using repeated movements, things about the patient’s problem are revealed. 

Even understanding that the problem is non-mechanical is equally important as it helps avoid unnecessary testing and treatment. 

 

Avoiding Burnout

Colin states that he remains excited even after 47 years of practice just because of MDT. It has been ever growing and the recent advent of MDT in extremities keeps him on his toes and motivated. Making substantial gains and improvements in patients and helping them return to activities that matter to them most also provides motivation to keep going. Educating patients and allying their fears and giving them hope, especially to the older patients gives him a boost and satisfaction. Keeping a mindset of wanting to keep improving also helps him and some of his MDT colleagues from feeling jaded. 

 

Helpful Links

Albert 2012 study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326129/

Gillard 1979 study: https://www.tandfonline.com/doi/abs/10.3109/03008207909152351