Linda Shacklock: Reflection on 30 years as a physio

Essay by Linda Shacklock.

More often than not, when you choose a career you won’t know how that choice will play out. Milestones provide us with the opportunity to pause and reflect. Through a clear and open-minded perspective, we can take an honest look back on the path that has led us to where we are today.

However, more fundamental than where we are is our character. What is most relevant in retrospect is seeing how it has shaped who we are today.

30 years in a profession is a long time. If you only read the opening few paragraphs of this post, then know that I am grateful. Some experiences have had a large impact on me, and others have left a smaller impression. Big and small, I am who I am because of the sum of all my experiences. The good, bad and everything in between. For all those who have had a role in my journey, I thank you for your part in the formation of who I am.

After graduating from university we think we have an idea of what direction we are heading. Yet often our younger brains tend towards assumptions based upon limited knowledge and life experience.

I knew from about the age of 12 that I wanted to be a physiotherapist. Why? I can’t tell you exactly. My conviction to seek out a career in physiotherapy was based on helping people; using touch and compassion to try to help alleviate their pain and suffering.

As a profession, physiotherapy has evolved a great deal over my 30 years immersed within it. At the outset of my university studies in the late 1980s, we were taught about cause and effect. Something happens to a person; they get injured or present with pain in a certain area. It was then our job to come in and fix that thing. 

Sounds straightforward, right? It can be, but the answer is rarely that simple. 

Life doesn’t travel in straight lines. If it did, we would be able to predict the future and avoid all setbacks. That’s why I look at life from a perspective that acknowledges its chaotic and intertwined nature. With every passing year, I see things more and more through a lens that accommodates the messy, swirly, entanglements of past experiences, present circumstances, and future hopes.

Physiotherapy: mind and body 

As a young physiotherapist, I soon came to understand that this way of thinking wasn’t really the norm back then.  

The concept and intricacies of pain weren’t as well understood as they are today. There was no room for my questioning of how emotion or stress can impact a person’s experience of pain. 

The physical was separated from the psychological and they didn’t cross over. Our studies in psychology were isolated from our studies in anatomy, physiology, and a whole variety of more specific physiotherapy subjects. It was in this era that patients were told by their doctors that their pain was entirely physical in nature. If they couldn’t pinpoint that or prove it via some kind of test or scan, then it was in the patients’ head. 

People were so afraid of being labelled in such a way that it impeded their recovery and healing. They spent their lives frustrated in ramped-up pain and suffering as they continuously searched for answers that affirmed their experience. 

This antiquated approach resulted in emotional factors being dismissed out of hand. Those experiencing genuine suffering and pain were pigeonholed. 

Thankfully today, we now know far more about the role emotion and stress play in how we experience pain and the sensations in our everyday lives.

Unfortunately, the remnants of these old theories are still present to some extent today. One aspect of my work is to sensitively coach my patients on the entanglement of mind and body.

Yes, what you are feeling is in your head. 

Yes, it is also in your body. 

These are not separate things; they are intricately intertwined. 

The often-difficult concept that we must grasp is to embrace and harness your brain’s involvement in pain processing. Your brain has a remarkable ability to create thought and action which we can utilise to guide and help you towards leading the best quality of life you can.  That is in my view the goal of seeking refuge from pain.

So as a young physiotherapist professional 30 years ago, I had to try and make sense of how to help people.

I had my university degree from UniSA, for which I am most grateful for. However, this did not automatically make me a good physiotherapist. It gave me a licence for physically therapeutic treatment, and was the springboard for a life of learning. 

Every patient I have treated has brought me deeper gratitude and new lessons for me to learn. Many of these were successes and some were less successful. But it is without a doubt that all these experiences of navigating the path out of pain alongside my patients are what have made me the person and physiotherapist I am today.

No successful healing journey is without some degree of pain, sacrifice, change of habits and priorities, and expanding our thinking both internally and externally. 

It is a privilege to be a part of someone’s healing journey, bearing witness to a person placing trust in you with parts of themselves that are raw, scary, and even unknown to themselves.

Lending a hand

My hands are part of how I communicate. In my profession, I am fortunate I can use my hands to support every patient who comes to me for help. 

That might be as part of a hands-on treatment approach, to fine tune dry needling or cupping techniques. It might be to assist someone in learning an exercise or how to tune in to their breathing or body to identify muscle-holding patterns when they are stressed or focused. 

My hands and treatment are often referenced by my patients, with many often being surprised at how strong I am for someone so small. I have been given humorous names such as “Queen of Pain” and “Thumbs of Steel”.

I don’t aim to cause a person pain, but often we must undergo a degree of discomfort to effect the changes that we wish to make together. There may not be an alternate route that will create the outcome we desire. How we go about treatment we decide together so that you remain in control.

I am not the same person I was 30 years ago. None of us are. Every experience throughout the course of our lives contributes to who we are. What we are yet to experience will further add depth to who we are yet to become.

The same is true of every patient we treat.

We cannot expect good results if we do not strive to understand their background and present state. Their hormones and internal chemistry. The context of their work, social life, education, family, history, faith, and upbringing. Their sleep habits, stressors, psychological tendencies, and anxieties. These are only a fraction of the extensive list of factors that are imperative to understand our patients.

The anatomical model of care must be juxtaposed with a foundational acknowledgment that we are all uniquely complex beings. We are all human beings that cannot be segregated into pieces, unrelated to the whole.

First and foremost, my patients are people. They are people who often seek help from me at moments that are some of the worst in their lives.

I may not be the first health professional—let alone physiotherapist—that they have come to seek help from whilst they do battle with the pain or injuries at the frontlines of their lives. There is often hope and expectation of miraculous outcomes in a short space of time for issues that are complex and have been present or building for months, years, or even decades.

Managing expectations, whilst sincerely forming a relationship, listening, and communicating in a way that still provides hope within a realistic span of time and providing a framework of treatment and education that allows flexibility and fluidity to change is the key to a successful outcome. 

What have I learnt along the way? 

The most important things that I have learned in 30 years of proximity to my patient’s pain are:

1. Don’t judge people based on your own experiences, values, or predispositions.
2. Don’t cut people off because they didn’t do the homework you set. They may not do it at all or in the time and manner that you expected (probably 95+% of patients don’t). Remember it’s not about you at all, it’s about what fits best with where they are at today.
3. Be humble, present and listen to what is being communicated to you. 
4. Equally being attuned to any nonverbal communication and how this might be a stumbling block to progress.
5. Let them know you genuinely care and are here to support them as individual people, they don’t have to do this alone.
6. It takes as long as it takes. There is no such thing as a linear healing journey. Heartfelt and clear communication and acceptance of this by you both will lead to the best possible outcomes.
7. Accept that there will be failures and backward steps. This is not an impediment to future growth. Be present for the emotions that this can bring.
8. Celebrate the successes out loud, no matter how small they are.
9. Meet people where they are at and not where you are at. It is not a race, and we all must take a different journey. 
10. Never invalidate someone’s experiences. You might not have the same experience, but we can offer empathy and understanding of why they may feel the way they do.

My journey does not end here at this 30-year marker on the road. As l look forward, I do not know where my journey will take me or for how long the next road I travel will be. I do however know that I will continue to be of service along the way to those that require what I can offer. 

In gratitude and love,

Linda Shacklock

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