017 - Diane Jacobs Brings You Into The 21st Century

Welcome to the 21st Century Physiopodcast, helping you bring your practice into the 21st century, with the latest technology news, research reviews, and easy to implement practice tips. Now, here's your host, Stephen King. Welcome to the 21st Century Physiopodcast. We've got a really exciting episode in store today. We've got Diane Jacobs all the way from Canada, probably the beauty technologies within connected people all around the world these days. So someone probably on the totally opposite side of the world to where I am now, and someone with a remarkable extended career over a long period of time. So I'm really looking forward to some of the great things that you've got to share with you today. So welcome, Diane. Thank you, Stephen. So Diane, for the listeners who don't know who you are, do you want to give them a brief introduction about yourself and your journey throughout your physical therapy career? Well, I'm a Canadian. I live in Saskatchewan, Canada, which is just pretty much in the middle of the prairies, the big flat part in the middle. About one hour north of the U.S. border with Canada. I like to call it the deep south of Saskatchewan. And I studied in Saskatchewan a long time ago, graduated in 1970, with the class of 1970. Probably before you were even bored, I guess. I feel like before I was born, correct? So in the year 2020, I will have been a therapist for 50 years. That's a lot. Yeah, I don't know where the time went, but anyway. So, and I still practice. I still have a solo practice. It's a one-woman shop, and it's in an extremely favorable situation. I'm kind of under the wing of another physiotherapy clinic and the woman who owns that clinic and she allows me to have my own practice inside of her clinic. All I need is one room. And it's sort of a semi-retirement practice. So I only work in the afternoon. It's quite wonderful, actually, and plus a travel and teach. So I have some leisure time these days. You can't even put a busy still live all the sands of it. I am, yeah, quite busy. So 50 years, that's a long time in the profession. As long as probably anyone going around in the profession, you know, what's the difference you see from back in 1970 when you started to modern practice today? There's some massive changes, I imagine. I think, yeah, there have been big changes. When I graduated, you know, way back. It was all about having been taught how to be a physiotherapist in order to work in a hospital. That was all there was to it. So, you know, I wasn't completely thrilled about that. I graduated and have my license to touch people and had a job in the hospital teaching people to crutch walk. And that kind of thing. Stroke rehab, that was another big area. Respiratory care. Physiotherapists used to do all of that before respiratory therapists came along and then they took over that whole thing. But the work in a hospital was like full of having to deal with lots of other people that were also working in the hospital. It was less, like there was, I mean, the patient care aspect was a big chunk, but then there were all this other, you know, lots of other people to deal with. And I, as an introvert, I found that really tiring. And I really did want to become a man with therapists. That was kind of what I thought I would learn in physiotherapy school, but it would quite turn out that way. So after about 13, 12 to 13 years of being a hospital, a, kind of around 1980, 283, there was a big tsunami of orthopedic manual therapy that suddenly hit Canada and it became such that if you didn't study these workshops or go to these workshops and learn all the minutia about joints and ligaments and so on, you would kind of considered not a very good physiotherapist anymore. It was like, hmm, because we had up to then just been these people who coached and applauded and crazed and cheered on people to do their own thing without any hands on really or minimal. Just enough to keep them from falling down and being an insurance issue. So anyway, so I was interested, but at the same time, kind of swamped by all of the theory of orthopedic manual therapy, which seemed to boil down to pain came from joints and you had to learn how to move joints around passively. And now in the, looked at it, then a whole lot of time went by and it was like, oh no, no, that's not so important as we once thought. Once pain science came along, thank goodness. We could kind of go back to being manual therapists who worked with pain and not had to worry too much about joint movement or any of that stuff. So yay, hooray. And going back to 1983 when manual therapy finally kind of took over Canadian physiotherapy, I took a different track. I looked at it for a while, but wasn't thrilled and took a different track. I moved to British Columbia where kind of the mecca of manual therapy in Canada was at the time, but only so that I could be closer to a school, which was just over the border in the US that was run by a doctor of osteopathy. And in the US, these are medically trained doctors who also do manual therapy and in his case teach it as well. And I liked that kind of way of working, the slower way, the more careful kind of like palpating for changes as opposed to trying to palpate for joints. So it was slower kind of soft tissue work and I was much more adept at doing that stuff than trying to figure out which joint was moving, which way or whatever. Anyway, so yeah, I learned all sorts of cool stuff there. Went down several dozen times probably to take workshops there from Vancouver. And so from about 1985 to about 2000 and 2003, that was the span of time that I studied with this guy. And the around the year 2000, there was a big shift for me, which was David Butler came to town, came to Vancouver. And he started talking about nerves now. And it was kind of like this giant light bulb came on. I thought, oh my gosh, that's what we've been working with all this time, even doing all the superficial kind of skin stretching stuff. It's been about the nerves. And that started me on this trajectory, which I'm still on, which is that any kind of manual therapy, it doesn't matter what kind of manual therapy you're doing. It's about the nerves. Hello. And it's about making sure they're happy and they're not crabby. And so there was a missing piece. Okay, so the osteopathic stuff had been very helpful in helping me learn to use my little hands on people. But I didn't understand how the nerves got into the skin from the depths of the body. So I had to go and beg and plead at the University of British Columbia to have them allow me to do a dissection so that I could understand how cutaneous nerves disseminated to the skin and that just wasn't anything in the literature. Now that except of 15 papers, which the Physiotherapy Association, the librarian, they're kindly dug up for me, but they were in German or French and they're mostly bi-plastic surgeons and they mostly were about the cutaneous nerves of the face and breasts. I mean, that's what plastic surgeons kind of are busy doing most of the time. I think that's their bread and butter. Anyway, so there's not there was nothing about the rest of the body and the dissection totally changed my appreciation for cutaneous nerves. It was like another light bulb when I wanted. So ever since then, I've been like, come on, let's talk about nerves, but let's talk about how cutaneous nerves are just as important as any other deeper motor nerve might be. In fact, probably more so in terms of pain and central sensitization and all these other things. So yeah, that's kind of it for me. I'm just a manor of girl. So from those dissections that you're doing, what was some of the big takeaways? All one of those light bulb moments that you thought, oh, okay, that makes a bit more sense now. Oh, that the skin isn't organ for one thing, you know, it's not just this thing. layer of of a ceramic wrap around the body. And no, it's thick. It's really thick, like super thick brown people. And the specimen that I was allowed to dissect, I just did monome. And this was an older male who died of something. I don't know what. But I was, and he was not a very fat person, a nice lean guy, older, old guy. And but the skin organ on it, it is arm. It was this thick on the forearm, and it was both that thick on the upper arm. So it's like a super thick cordon. So it's three-dimensional. And it slides around, but it's tethered to the deeper, fascial layer with skin ligaments. That kind of allow movement, but don't let you have too much movement. Yeah. And through the skin ligaments, some of them which are tubular, the nerves project outward to the surface of the skin. From there, they ramify massively in every connect. And so what are we doing in manual therapy? What are we actually doing? How is it working? How do you explain it to your patients and clients? Well, the skin is sensitive, and neurons are highly excitable. They're the most excitable tissue in quote marks of the body. And so you can shut your eyes, and you can feel a butterfly land on your arm. So if your mind is prepared and you're expecting it otherwise, if you're distracted, you might miss it. So preparation of person is kind of important, right? Kind of set them up for what's going to happen. And so that was a big thing I learned. And the whole thing about-- I mean, the skin is just ignored completely in manual therapy. It's crazy, right? But it's like the highway to the brain. The dorsal column-- dorsal column columns in the spinal cord are conveying all this information at this really rapid, I think 430 kilometers an hour or something. And just like single neurons that go away from spanadises between your big toe and your brain, I mean, hello. It's like, that's going to be fast. Get the information in there through the skin. I do think that manual therapy of any kind-- and I don't care what kind you're doing-- it's that's how it works. I've been pretty sure. I don't see how I can work any other way. In a conscious awake alive person who has sensibility and not in coma, not unconscious in order to have an operation is. We are not operating on people. We are interacting with nervous systems. And so where does that fit into a 21st century physio paradigm? I guess there's a lot of talk. A lot of social media these days is very anti-manual therapy. What is manual therapy fitting today in practice? I think I don't think that people are as anti-manual therapy as they are anti the really outdated explanatory models for manual therapy. I don't think anybody in our profession would ever claim to never put their hands on people or try to help them that way. It's a touching profession. So I do think a lot of people are against the really outdated explanatory models. And they are trying to take that ship and put it up right and say, no, we've got to get realistic rational. And we have to promote self-efficacy and independence in the patients. And what do you think this understanding is taken so long to come into profession? Obviously you're talking about it with David Butler's producer, his fucking nine easily 2,000s. And I'm still going through-- so he's got therapy and going through some of the courses. I still isn't integrated into there. I know. I know. I guess it takes a long time. I don't know. But I mean, pain sites took a long time to get going too. It was a great deal of fear over the 1965 Melzac and Wolt paper about gay control theory. They had that splash from that and push back. The anesthetists and the anesthesiologists kind of figure that was cool though. They knew something about sending modulation at that point. But the rest of the medical profession was a little upset because it overturned 400 years of biomedical model and all of that. So, you know, and not so many 50 years ago, no, 60s. How long ago is that now? Oh, 16. 1965, we're talking. That would have been more than 50 years ago now, 54 years. So it's actually 50 years. Does this seem like that one from the perspective of an old physio? Anyway. But yeah, I mean, it seems like it has been purged and taken off. But, you know, I mean, it still has like water. It still hasn't leaked into every facet of every hands on a profession out there yet. There's still a lot of room for improvement, definitely. I do think so. And so where do you think, obviously, there's been some big changes, you know, like that over the last 50 to 60 years. What do you think the big changes going to be over the next 10 to 15 years in the profession? And I'm sure it's-- what I would love, what my fancy is, is that physiotherapy becomes more therapy and less physiol. And not ever leaving away hands-on, I mean. But rather developing the-- incorporating from other fields of life about how the therapeutic relationship is kind of the critical piece here. Hello. Making that central. Painting sites in the therapeutic relationship. Taking those two things and making a new profession or kind of evolving our profession with those two things as fundamental core trainings or something. And, you know, way less-- I'm glad the electotherapy thing has kind of died off. You know, there's not really much about anymore. Yet, every single school still has all this shortwave dyothermia and stuff, stuff to their cupboard, you know, that they drag out. And because they still have to teach it even though it's irrelevant. But I'm ultrasound. All that stuff, right? Oh, if I had back all the hours that I spent learning the wiring back around the whole-- [LAUGHS] --the machine back in school. But anyway-- No, I can definitely relate to that. Yeah, oh, yeah. I think Dave and Laura are in one room, sort of teach us the latest pain signs. And then you walk straight out of that class into the air, the third class. It's insane, right? Anyway, yeah, there needs to be a renovation for something of the profession. And bring it into the century. And yes, you still need to have the anatomy classes and the pathology classes and all of that. But there needs to be kind of a bigger frame around the profession such that the ingredients of the profession are not taught as standalone. Things are kind of like this frame. It means that, yes, you have access to this information. But it is not what physiotherapy is, right? Physiotherapy itself should be all about the interaction between a patient and a therapist. And I don't know. Some people are even saying, let's get rid of the word patient, you know? And I kind of like-- I think that would be a good idea. Some days I think it would be a really good idea. Other days I think, that doesn't really matter. But I don't want to necessarily go to just only the word client, because that would make us back to being mischievous or something. But I don't know. Maybe we need a completely new word that is neither patient nor client. Interesting. You bring up the word massage therapist. So I guess they apply similar techniques to physiotherapy as osteopaths and cariprofactors. What do you say the difference is between all the professions and what physiotherapists do compared to? I think the massage therapist are the oldest one of all of the hands-on professions. In fact, physiotherapy and massage therapies be all one thing until it split apart. And physiotherapists decided that they were more interested in the joints and cracking them and stuff like that. And there always had been a few kind of like manipulative therapists in the profession all along. I think that stems from the British Army trained physios from centuries ago, still kind of like embedded in-- for Australian Canada, at least-- embedded in the profession in few, few numbers. But then suddenly the numbers-- exponentially increased of people that were interested in doing that to people. I've never been a fan of manipulative therapy as you could probably tell. It just seems too operative. But anyway, be that as it may. So as far as massage therapy goes, I always have thought that I probably would have been a happier individual that I been able to study massage rather than physiotherapy. But in my life at the time that I was ready to launch myself into adulthood, physiotherapy was the only school that was accessible to me where I lived. Now there are massage therapy schools around, but not them. And so what do you think you would have been happier? Because of the gestalt kind of massage therapy. Okay, so these are the massage therapy profession. It's got big hills to climb to. But generally speaking, the people who are in the profession are sensitive individuals who do care about their clientele and are wanting to do their best and they're very touchy and they're very human primate social grimming. I call it. I call what I do that too. As in that we are mammals and mammals hang out and handle each other and cuddle and do think it's a social event. It's a psychosocial bond building effort that mammals do and that, well actually any two vertebrate species. It doesn't really matter who's in it, but I teach workshops about how you're going to vertebrate. You're going to get cuddly up with the cats, particularly irresistible cats will hang out with anybody. Including lizards and reptiles and lardinos, what else. So really there is nothing in our intrinsic hardwiring that is against contact, physical contact. It's there culturally and you know we have it beat out of us for the most part, big bound reason. And then you have to have your license to touch people in order to be able to do it. But anyway, massage therapists are instinctively ready to go forth and touch people and it's like it's a calling. And there's a lot of people in massage therapy really interesting people who've left other careers where they made gobs more money and had gobs more responsibility and had you know heads of corporations and any all kinds of and academic people who finally got tired of the rat race and became a massage therapist because it is a peaceful way to make a living and it's less stressful. It's healthier on your own nervous system. Yep definitely. And so when when you come back to this enjoyment factor, you've been doing this now for almost 50 years. How do you keep that you know, enjoyment? What's your tips for young therapists out there? Because I often see I get a lot of emails myself, you know, people are two, three, four years out. I get to this point and then this laugh of I'm not sure if this is me. I might go back and you know study a county and go and do you know business or go and do another go and do a PhD. They sort of lose that interest in it is that loving feeling. They do. And you know what I think that's fine. If they don't want to do it, then they shouldn't be doing it. Just like people who don't want to be parents should not have children. You know, it's like okay when people start themselves out and it's fine if they make a mistake and pick the wrong thing to do first, you know, right up the gate and then change their mind later. It's okay. Maybe they'll be a fabulous, you know, real estate agent or whatever else they decide to do with themselves. It's okay. Yeah. And Angie, as you said, the first, you know, 12, 13, 14 years of your profession was probably not doing, you know, what you'd intended to do, what you thought physiotherapy was going to be. How'd you get through that period? Oh, I quit a lot. I did. I did try on other careers, you know, and I did go back to university quite a bit and study other things and I studied art. I studied sociology. I even studied pre-mad. Oh, wow. But I decided that was probably not a good idea and just be back in hospital again. Anyway, but physiotherapy always took me back again. And, you know, so it's been a lifelong, I would start to miss it after being away from it for a year or whatever. And I always, it was always easy to get a job. There was always like a desperate need for somebody to narrow to teach people at a crutch work, you know? Yeah. That's correct. So, so who's been the biggest influence in your career over time? I get the impression that David Butler obviously had a big, you know, impression. Well, he kind of was a pivotal force. Yeah. And I remember in that class, I was 1998 and I sat there and he looked at me and he said, you're thinking, aren't you? And I said, yeah, he says, you really are always thinking, aren't you? He didn't know me. I was the first time I'd ever come to his class, but he had begged me as somebody who sat there thinking and really what I was doing was sitting there coping with all the cognitive dissonance that I was experiencing and being simultaneously fascinated and overwhelmed and excited. And just all three things at once. Would it have been a few myths being busted in that class? I imagine. I hope so. Yeah. So what are the biggest, you know, if we go back to some of those myths I guess around physiotherapy? What are some big ones that you've seen change over the last 10 years that have, you know, things that have helped you get there just how it grew, which now we sort of realise that that's not the case. I have been overjoyed at several things, but the one that stands out the most is all the emphasis in Canada anyway that was put on palpation accuracy. And it turned out it was just a big myth and it turned out that no one had the right to stand there and say just somebody else that they couldn't palpate and that they, you know, assuming that they themselves could and that the other person was doing it wrong or whatever. Like all that stuff has been shot to dust and I loved it. Oh and the studies came out that there was no inter-rater reliability, you know, stuff. It was like great. I knew that. Anyway, so that and the the whole emphasis on, you know, if someone has comes in and they have pain that must be coming from some tissue. Like, I just loved when that one went away. I mean it hasn't gone away entirely, but it's going away and that's a good trend. And do you have anything? Oh, sorry. I was going to say also I had the opportunity and pleasure of doing, I'm sitting in a workshop taught by Peter O'Sullivan a couple years ago at San Diego Pain Summit, which is coming up next week. Wow. Anyway, and I loved it because here's the guy who I assume used to be quite transversive, Dominus kind of guy, right? And there he was and he had to like believe his own data and backtrack from being super enthusiastic about whatever transversive Dominus was supposed to be about. And he had to backtrack and believe his own data that said it had nothing to do with anything. And that now he's like, yeah, well, you know, don't brace. I love when stuff like that happens. It's kind of like going back to the old days when we were coaching and and attending and encouraging and helping, you know, without demanding. I think that's definitely what the proficiency, I think, more that sort of coach elements and you know, forming that team is into that therapy, you go on to someone and doing the best, you know, over in our case, I really love that philosophy there. So what do you think to someone needs to, what sort of skills do you think someone needs to be a good physiotherapist in the 21st century? Well, they have to be a decent human being. Be willing to be open to change be flexible enough that when these kind of new and quite irresistible and irrefutable new ideas come along that you'd be able to switch horses midstream and go the new way that the way that, you know, science kind of is hurting us, that you be able to be capable of determining your behavior and your and your interactions with patients and people who come see you based on scientific pleasability, not necessarily that you have to, you know, it's has to have evidence or this. No, but just it has to be coherent, rational, scientifically plausible and then take your way and be a decent human being. Pretty good tip I think it's probably good place to start. It's a starting place. So how do you - Oh, and jumpy on the FADS 3 career. As you mentioned, you've been through the electrocute. - Oh, I jumped on you. - Yeah, I jumped on you. - Oh, yeah. I learned my lesson. - Yeah, so it's just a learning thing over your career. You just-- - I think you just learn to sort better. - Yeah. - Okay, very good. - And yes, and smell the, you know, smell it in and out. So that's probably not a great idea, 'cause it doesn't fit with all this other stuff that I do think is real. - Nice and tough. So we haven't touched on yet. Dermani Neuro Modulation and your courses. What is it? And what's your teaching your courses? - Oh, I had, I came up with the name with some help. I was on a discussion forum for years and years called Summer Simple. And people there helped me find a name for the different concepts that all seem to fit together. And it's just about touching people in a kind way. And in a non-nose-exceptive fashion and in a non-nose-yboic way. So there's two things. There's a nonverbal part of the treatment and then there's the verbal part. But in Dermanur modulation and so kind of one thing. So it's, if you're talking, it doesn't matter what kind of manual therapy you do, right? If you're talking about skin and nerves and brain and spine cord and person that is embedded in all of that, then you're talking about Dermanur modulating. And the other technical aspects don't really matter. - And so you've got some courses running, can you try it in the next few months? - Couple. - What do people expect to get when they come to one of your courses? - Well, they're gonna get a whole whack of neuroscience and the emphasis is gonna be on the sensory nervous system, not the motor-operate system because really that secondary, in my opinion, in a manual therapy context, it's secondary to the sensory nervous system. You do want to persuade somebody's sensory nervous system to like you as a therapist. Anyway, you can through your contact verbally, psychosocially and physically. So the foundational kind of mechanisms I have completely adopted the neurodynamic kind of like explanatory model. So that's embedded in everything I'm teaching, except there's not a lot of emphasis in the classic neurodynamic model for congenious nerves. So I just added that in. Hey, whenever you're moving skin around, you're pulling on these ketaneous nerves and you're actually mobilizing them. And it's gonna affect their circulatory, the neurovascular thing, they're all kind of in-point like that anyway. So you're going to be mechanically stimulating all of that stuff that's mechanosensitive. And that's kind of, if you wanna think about it purely, operationally, that would work. But there's so much other stuff to it. There's the whole predictive brain processing model that I, so I teach a little bit of, I throw in some anneal synth video, you know? With his conceptual hallucination. Throw that in. And a little bit of the history of paid science that a neuromatrix model for sure by Nell Zach. And the idea of physiotherapist or manual therapy being a way of providing a predictive brain with some X afference, okay? An environmental stimulus so that it can then make new prediction. And talk about that way. Talk a lot about descending modulation and spinal cord and how really the brain, big fluffy brain at one end of the spinal cord is there to inhibit the spinal cord in every which way or the reflexes of the spinal cord, which will take off if allowed to, but if you can get the brain persuaded to come back online and inhibit the spinal cord, then that will inhibit the nosy subterval aspects of existence and persistent pain. A lot of that anyway. Oh, and I also teach that there's no point in trying to use manual therapy for kinds of pain for which manual therapy is of complete, not useful for it. So the kind of pain that it is useful for, which lucky for us, manual therapists out in the world all in our plenty full numbers, is the kind of the neurogenic kind of pain that is confined to a region of the body changes with position or rest. It's mechanically sensitive. And that kind of pain no matter if it's been in you for a year or 10 years or 20 years, it can be affected by manual therapy and improve and resolve even. So I do keep it confined to that. It's kind of pain you man with it, manual therapy is good for. Don't try to use it on these other kinds of pain because it won't work. Yeah. And so try to take a good history and figure out what you're doing. It's always a good process done. Yeah, and follow up. Okay, so follow up kind of movement therapy for home. Teach all about that too. And sort of the, it's a process of clinically reasoning your way through a problem with somebody. So somebody comes in and they have a particular pain in somewhere in their arm or leg or whatever, or back, whatever. And so finding out about their habits, what they do, when they're resting especially, because when a body is resting, it has mass, there's gravity affecting it, there's air pressure, 32 pounds per square inch, still affecting it. So some portion of the 72 kilometers of peripheral nervous system is going to be affected by how people not only use the bodies, but how they don't use their bodies. So I call it the default resting position problem. And there will be people that have their habits and they always maybe cross one leg, but never the other or they sit leaning on one elbow, but never the other, right? So they indulge themselves in asymmetric behavior. It doesn't matter if the body is asymmetric, it doesn't really matter at all. It matters that they use gravity and air pressure and all these other things symmetrically. So behavior, changing it up, sleeping on both sides, not just one side all the time, 'cause just because you don't want some of these breath on your face or whatever, you know? So learning to adapt, cook yourself on both sides like a pancake so that you're not burnt on one side and raw on the other kind of thing. It's an awesome analogy, how often? - Yeah, so that has to, especially from about here now, people are pretty unconscious of how they use their bodies. So sitting positions, sleeping positions, territorialism, this is a big one for humans. Having their own one corner of the couch that they always sit on and that's their spot. I'm like, "Children in the big bank theory, "I don't know if you get that TV show in Australia, "but it's plenty different." You do, okay, so Sheldon has his spot on the couch, okay? - We don't, why don't that also lie to Dananda? - That's good. I didn't know if it was just an earthquake at all. But anyway, so we all do that. We all have our spot on the couch that we hang out in and then the TV set is somewhere over there so we're always turning our head one way. You know, getting the furniture reorganized so that you can see the TV from any angle. And avoiding pain rather than trying to fix it later, just avoid it in the first place by adapting yourself consciously to your own body and organizing it in space in a comfortable position in various positions, not just always the same one. - So there's been a great episode. And lots of great tips through a diet. So before we leave, I want to get your, after 50 years, almost 50 years of experience, I want to get your top three tips for physiotherapists today to help them bring themselves into the 21st century. - Oh my gosh, well, the internet has already come along. So that's been a huge boon to physiotherapists. Just get on there, read. Hello, we all know how to read. So let's do some more reading. And not just use Facebook for friends and family. No, get into it, get into the groups, get learning from each other. And some a simple, for example, you know, a kind of an old fashioned discussion group by now 'cause it's now 20 years later. But it was so helpful for me to, so internet is a big one. another tip would be let go of old outdated. ideas. And Niel says, you know, conceptual hallucinations are such that if you are constantly, you know, and serve like positive feedback loops, the way of thinking is going to reinforce your way of thinking. But if you can step back and think, okay, what if I thought about it this other way or from this other angle, basically critical thinking. That's a big one. And third one, I don't know, keep going, you know, keep going. The more you just keep going, the longer you'll be able to keep going for. In case of the point, I think that's good advice and something I'll definitely continue to work on there too. So where do people find out more about you, Dian? How do they find out more about your courses? Oh, I have a website is called durmoneramodulation.com. And I have all of the upcoming workshops all listed on there. It's just a way for me to keep track of myself, really. But other people are certainly welcome to look up stuff if they want it to there in order to, if they want to join in a workshop. And also, there's a directory. It's pretty kind of like totally by volunteer. If somebody wants to be listed as having taken a durmoneramodulating workshop, they could be listed on in this directory. Doesn't matter what profession you're from. I do want to point out, well, we're on the topic of the website is that the term durmoneramodulation or durmoneramodulating, I placed it with creative comments, which means anybody can use it. I don't know what I want to, you don't have to pay a fee or anything like that. It's like anybody can use it if they choose to and want to for whatever they're teaching hands on kind of work. And that way, nobody can build a modality empire out of it, including me. Okay. I'm letting it go off into the planet, I'm going to refer it once it's travel. And people can teach it if they want to. They don't need my permission to teach durmoneramodulating if they want to teach it. That's fine. Lions are talking about the nervous system. We're good. Yeah. Yeah. Stay true to those philosophies. Now, I think it's been a great episode. Diane's been an absolute pleasure having you on. I really hope, I'll look forward to hopefully catch you up with you when you come around the couple of courses here in Australia in a few months. But thank you very much for your time today. It's been a pleasure for me to look at you, Steven. Thanks, Dan. That's another 21st century physio podcast, proudly brought to you by Matt, innovators and world leaders in movement assessment technologies that bring your practice into the 21st century for more great information and tips to bring your practice into the 21st century. Head over to www.podcast.physio. Lastly, if you love the podcast, we'd love for you to subscribe, rate and give a review on iTunes. It's very much appreciated. See you on the next