Matt
David is an APA Titled Pain Physiotherapist based in Newcastle, New South Wales, who has worked in the field of vocationally oriented injury and pain management for more than 30 years. David is currently a registrar in the specialist training program with the Australian College of Physiotherapists. David is the managing director of Workplace Physiotherapy and a co-director of Innovative Pain Management. Working within a diverse into the disciplinary team a pain specialist, psychiatrist, pain psychologist, occupational therapist, other APA Titled Pain Physiotherapists, exercise physiologists, nurses and pharmacists.

David has additionally undertaken an independent physiotherapy consultant role with SIRA, New South Wales, over the last 25 years, involving assessment and collaborative formulation of management strategies for injured workers receiving treatment through allied health peers. More recently, David has been involved in advanced practice research projects through the University of Sydney and Queensland, has presented both nationally and internationally on the role of the physiotherapist in the management of patients with persistent pain. And with such an accolade, Dave, what else do you have time for?

Dave
I'm a part time farmer, Matt. So we want to throw that in there.

Soph
Important part of the bio.

Dave
As a pain physio, my happy place is sitting on a ride-on mower and mowing the grass.

Matt
Oh, right.

Soph
So good. So, Dave, I know, we know each other reasonably well but, I'm really interested, obviously, you've had such an illustrious career. You've worn a lot of hats over your time. I'm interested in maybe coming back a little bit to the start of your journey, if that's okay, and maybe just sharing a little bit about what actually drew you to the profession in the first place.

Dave
Probably like many physios, Soph, I had that sportiness in my background. As a kid, loved playing sport and genuinely that probably is what attracted me to physio in the first place. And at that time when I was thinking of careers, was at the time where physios were just starting to get a real platform and real recognition for the roles they provided. And I was really, really lucky. My father had this connection to the original Australian team cricket physio. And I got this great opportunity to go and do a little bit of work experience with him. And really, that was the carrot that got me into physio. And certainly my life has changed. You know, there's no sport in any of that working list now. But it was very much the carrot in front of me to go, what a great life and what a great working career this could be.

Matt
Because there's no sport now, did you try and pursue that avenue for a little bit, or do a few other things?

Dave
Yeah, I did, Matt, and actually I absolutely loved the sport I did. I mean, again, at the time when I was dipping my toe in the water for sports physio, it was very much, you know, an unprofessional career status to go into. And there were emerging roles for sports physios, but quite early on in the piece. And it was interesting because really probably where my career direction changed was that, I loved treating Mr. and Mrs Smith, you know, coming in with their problems. To me, they were the genuine people. I really was drawn to physio and ultimately the people I wanted to treat and wanted to help were the people that I felt genuinely wanted and really respected what I could provide for them. And to me, again, that was the thing that made me steer away from the sport side and start heading down that, more that vocational direction that I went down.

Soph
Absolutely. And so we had a little bit about what you're kind of doing at the moment and your journey over this time as well, but could you share with us a little bit more about what your current role in clinical setting kind of looks like? You know, what's your day to day in the clinic look like in terms of maybe the sort of patients that you see or the presentations that you come across and yeah, what's the day in the life look like for you?

Dave
Yeah. So it's pretty mixed, Soph. In a typical day there is, several different focuses. So even if we talk about today. So first thing I did this morning was, see a patient with, now, he would be ten weeks post motor vehicle accident, that is actually going into the University of Queensland research trial that I'm part of. And that's one of these advanced scope roles where they're looking, and in this particular trial, we're looking at the role of psychosocially informed physio treatment in the early stages of acute motor vehicle accidents and looking at how that can influence outcomes.

So that was patient one. You know, patient two was, well, that role two today was then doing an independent physio review where I had a really productive chat to a physio, and we, you know, spoke about what we could be doing to assist this person with their recovery and looking at maybe what some of the barriers were that were existing at present, and then trying to formulate a bit of a plan moving forward with how that person was going to then, ideally, probably improve and start to recover on a faster trajectory. Then there are some normal patients, you know, there's an acute patient, there's a person with persistent pain. Then we had a great CME tonight just before I clocked on with you where we were talking in our multidis team about actually managing ADHD and with the patients that we've seen.

I have a very cherished life, and really appreciate the opportunities that physio has now provided me with giving me a really varied scope with my day-to-day role. Really, it still gets me up out of bed every day and really encourages me to want to learn and to want to be the best physio I can be.

Matt
So Dave, you see quite a variety of clientele. Is there a difference in your approach, in your management, for people that you see who have persistent pain versus those who don't present with persistent pain?

Dave
In lots of ways, no, Matt. What I would probably try and go into every new assessment with a person is really trying to understand them and their story. And really, what’s brought them to that assessment. So probably the only variation is that, you know, with the acute patient the story is going to be less, generally. There's going to be less time and probably less story, but still there's probably lots of important information leading up to that particular event that could be really helpful with managing the person as well. But you’re really searching for that same information that ideally you're trying to capture, which is, really trying to get a sense of, what brings them to that appointment? What are they hoping to get out of the initial assessment in the management that you're going to provide with them and really tapping into them as an individual of what are probably some of those key factors that are going to be relevant to them. So realistically, whether they're acute or whether they’re chronic, it's probably not that different.

Soph
It's interesting you say that because I think that's sort of something that has come up in a few of our other interviews as well, that the models and the ways of understanding and considering pain actually translate across both the acute and chronic setting. It's just that the discrete, I guess, contributions within each, you know, at different stages might be different, but that's also very different depending on the person as well and lots of other factors.

So, you know, if we're taking that complex view of pain, it actually frees us up to, I guess, get a more person-centred view of someone's presentation regardless of what stage they're at. I think what jumped out at me when hearing you talk about your day, your typical day before, is that, with some of the work that you're doing with these clinical trials, but also in your caseload as well, it seems like you have a reasonable degree of sort of exposure to people who might be earlier on in their presentation, and, you know, maybe where we do actually have a bit of opportunity to intervene early and to, you know, maybe stop people going down the path of chronicity, not just with the clinical trial, but also, I guess, with the interactions that maybe you’re having with people as an independent physio consultant as well. How has that been for you in terms of communicating that and having conversations with other providers about, you know, they don't necessarily need to be working in a chronic pain space to actually be thinking about some of these things. And how do we bring that in earlier.

Dave
Yeah, I agree, Soph. I think it comes up with every interaction we have with the patient. There’s things I think often as physios we intuitively pick up with patients, you know, we know that something isn't quite right. And maybe sometimes with acute patients it might not necessarily be that their recovery trajectory is looking the way that we expect it to be. But the way I look at that is probably there are great opportunities to be delving in that little bit deeper and looking at that person of what may be going on that might be impacting what we see.

I think generally as physios, we're really observing and looking at behaviour and what comes as a consequence of behaviour. So we're really good at picking up those cues. I think where we could do as a profession continue to upskill is almost looking at maybe what are some of the things sitting underneath those behaviours?

So often when I'm chatting to physios they’re gold at being able to identify what they're seeing from a behavioural perspective. So whether that's, you know, maybe being boom-busting or endurance coping or avoiding, or a lot of protective behaviours, great at picking those things up. But to me, I think often where we can make a huge impact as physios is then diving that little bit deeper and looking at what might be the cognition sitting underneath those behaviours, what might be the emotive responses coming as a consequence.

And I think often when we have those discussions, particularly when I really like to have positive discussions with practitioners, it's really trying to cue them into what might be going on there that might be then resulting in the behaviour we see, and then encouraging them to really have those conversations with the practitioner to be trying to start to get a sense, I'm sorry, with the patient, to be trying to get that sense of what might be those other factors that we then need to start exploring a bit more and delving into and really having the focus of their treatment more on, maybe what we're seeing from that side that's then driving the barrier to their recovery.

Matt
Part of your role is working as a consultant with SIRA. Do you ever find that you have to justify a lot of, I guess working with the persistent-pain clientele of why they need certain things at a different to, you know, this person needs 50 of this exercise and that will improve?

Dave
Yeah, so Matt, if I'm hearing you right, you're asking about whether there’s an importance with identifying maybe the individualisation of care, why a particular person needs...

Matt
Yeah, yeah.

Dave
Yeah, I think so. I think one of the great things we've now seen, probably in the evolution of our profession in the last ten years, is the development of lots of clinical frameworks, and I think they're really brilliant with really giving the broader population, so this would be insurers and case managers and maybe rehab providers and even employees, giving them a better understanding of what good care looks like. The thing that I think probably they miss a little bit is then the individualisation of that care.

So what good care might look like to a particular person might be that that's it. They need to do a good strengthening, program to build up capacity. And for another person, it may be the reason they're not, or they're unable to undertake a task is because they've got a huge level of fear associated with it. So for that person, what their treatment's going to look like from a fear-based or a fear-driving behaviour response is probably very different to a person that's actually more got a genuine weakness response.

So really for those two people that what they care is going to look like is quite different. And whilst it all falls within the realms of those clinical guidelines, it's really important to be pushing and driving individualised care and really care that's targeted at addressing what those barriers are to that person recovering further, and in my field it’s obviously getting them back to work.

Soph
II think it's interesting to hear you say that, and even coming back to some of the things that you were touching on before, I think increasingly we're seeing this push towards psych-informed care in physio and sort of really upskilling as a profession, like you said, maybe not just observing the behaviours, but starting to understand how we can both recognise and sit with some of the, I guess, some of the more emotional aspects of someone's experience and getting comfortable with exploring experiences of distress, for example, and how people might be thinking and coping with their pain from maybe a slightly broader sense than as a profession we’re maybe historically attuned to.

I'm interested because you've obviously been in the game for a little while. What's your take on how that has kind of evolved over time? And, like, your observations of how the psychologically informed practice side of things has kind of changed over time, and how that sort of then come into some of the pain management side of things over time?

Dave
We're definitely in this transition phase, I think, at the moment, Soph. Like, we've got some great research that's been published in recent years that shows the value in psychosocially informed management practices and incorporating that well into the physio world. Yep, if I was to generalise this, I’d say, we understand the importance of it. We understand the benefit of capturing information at the moment. And that might be through psychosocial screening questionnaires and other things. I think we're yet in that position, probably as a broader profession, to be really walking the walk. So we've got the good talk happening, but it's the walk is the next thing.

And there's some great moves, you know. I think the StressModex trial was a fantastic trial to show some really simple strategies can make a huge difference to outcomes. The CFT trial has shown, you know, with more skilled and more complex patients the value of psychosocially informed management practices as well. So the great thing, I look at those is almost we're at other ends of the spectrum, the really acute whiplash management, we can see how beneficial and how effective that is. And with some real more chronic-y presentations, we're equally seeing the benefits.

So, I think we're on a great journey at the moment as a profession. I think there's greater opportunities for physios to now be understanding how to use this information. I had one of my early mentors, who was a great challenger to me. You know, I came in, I knew everything. I was the young physio, I could sort everything out. And one of the things he really did for me was not only got me reflecting on the people that didn't respond well, which makes sense, you know, they're the ones we need to learn from and understand, and, you know, how are we going to manage that person better the next time that same similar person presents.

But equally, how do we reflect on the responders? Because often the responders there’s this bias to what we think is actually making the difference. So, you know, it was a great mentor was really challenging me to go do you really know what you're changing with this person? And how do you know that? And could it be something else?

So I think what that did is it gave me an early opportunity to start to question, well, how my physio was actually working. I knew my physio was working. I knew I was getting good outcomes, but actually through what means it was working. And I think probably this movement we're on at the moment is really allowing us as a profession more deeply reflect and deeply question what are we actually achieving with patients when they're improving and when they're recovering? And I think what that does is it enlightens us to become more accurate with our clinical reasoning to be actually be identifying the things that we think we're actually changing and then can go and target those more effectively.

Soph
Absolutely. I think that point you make of being really open to that reflexive practice and really questioning our assumptions with what we're doing and not just does something work, but why is it working? And is there maybe a different way of thinking or understanding this than maybe where I might initially jump to? And I think being able to challenge our own biases and stay open to evolving models and understandings is going to be always so critical for not just physio, but I think health professionals generally, it's how we can kind of move forward. And yeah, really fascinating to kind of get that insight as to, you know, how you've seen this change over time.

I think I would agree with you that I think we're very good at acknowledging that the psychologically informed practice side of things is something that we need to be kind of moving towards and embracing and the role of these factors. But I think, I mean, this is an area of interest for me. And I think a lot of the conversations I've had with people has been that there's still this feeling of, maybe not quite having the degree of training or support to yet know how to actually navigate that in practice. Like, you know, we might identify that it's there. But then as a professional, what tools do we have to kind of then manage those situations? And how can we kind of work with people alongside that? So, I think it’d be a very exciting area to see move forward, I think.

Dave
If there's one thing I think I can reflect on well is that trying to surround yourself with non-physio mentors can be an incredibly valuable thing and that might be people from the medical world. But equally I think people from the psychological world, it’s probably the psychological mentors that I've been fortunate to work alongside have been great with providing that really challenging and sometimes really provocative discussions. It encouraged you to actually be uncomfortable in the abstract, which is a lot of what we see within our physio practice.

Matt
Yeah, right. I was just reflecting, actually, on our history, Dave. And it's nice to hear that, you know, you've had mentors and I guess before some things were established, you had some key people. Because I was wondering how you grew yourself when there were no courses, because I did the level one pain course and you happened to be the physio presenting that and I could tell you were actually, like, wow, this guy really knows what he's talking about. How does he have all the confidence to, you know, talk about psychologically informed care? But I guess the question in that is, you perhaps paved the way for a lot of those courses to happen. How do you seek out that kind of mentor? Do you just rock up to a psychologist and say, can you mentor me? Or what does that look like?

Dave
I think there's times we probably do need to be that direct. It's probably one of the lucky things I've had in my working life, Matt, is that I've worked in a lot of multidis settings. So, you know, I worked in a multidisc setting in the early 90s when it really it was the emergence of multidis in those days. We ran pain programs that you look at now and you just you shudder at the content but it was a learning opportunity for us all. You know, we were all new. We were green. We knew that there was something beyond musculoskeletal. And even though musculoskeletal is really important and still has a really key factor with people's recoveries, you know, I was starting to see gaps in my practice. Why wasn't that person getting better? Why were a bunch of people improving, without me almost needing to do anything? But then there was this cohort that, with me doing everything I thought that was right and targeting all the musculoskeletal impairments, it still wasn't the connection to getting them better. You know, to me, it was a bit of a combination of being open with, I knew I didn't have all the answers. But then also, yeah, I was really lucky with being able to have people alongside me that were from different backgrounds. And that was great, just to get a sense of how they looked at patients and how they might manage a person differently to what I would with my physio brain. So yeah, I’ve been really lucky, Matt.

But I think probably what I've also learned over my career is that, you hold these people in incredibly high esteem. Some of these mentors, and you think, how can I even go and ask them a really dumb question? But I think what I've learned over time is that most people, no matter who they are, you know, are incredibly humble, and incredibly giving with their time. And, you know, that they know that maybe what comes across from you is a dumb question is coming from a place of curiosity and wanting to learn. And I think certainly my experience has been that most people are incredibly giving. It's really more of a hurdle from your side of actually having the guts to get up and go and say, oh, there’s that person at that conference, I want to go and ask them this question. I think once you get over that, so many doors open for you. And I think that's probably the thing that I've learned through my career.

Soph
I think, too, it's also, like, people are, you know, this is an area of passion for people, right? I mean, I don't want to generalise and make the assumption that, you know, everyone is happy to give their time away and, you know, to do that. But as a general rule, I think generally my experience mirrors yours, Dave, in that I think everyone has always been very enthusiastic and generous with their time and even, you know, for some of those basic questions, just the fact that somebody is interested, you know, I mean, not to put myself at the level of mentor or that level necessarily, but I even think back to experiences where I've had younger physios ask me stuff about certain topics, and I've just been like, oh, I love this, let's talk about it.

So, you know, and I think that that is something that generally as a profession like we’re generally, most of us are here because we love what we do. And so, you know, regardless of degree of experience, generally speaking, everyone just seems to be pretty keen to connect and sort of share knowledge and work together in whatever way, shape or form that takes. So yeah, it's just amazing to hear that you had such great mentors and hopefully to anyone listening to this, you know, if you're in a position where maybe you're thinking you need to seek out people, you know, don't be afraid to take that step.

I guess, Dave, thinking about the specific sort of situation of your setting, particularly in the workers’ compensation space, because I think, like, at this point, you know, most people generally have a bit of an understanding of pain management principles, and I guess, the complexity of pain and the ways in which we might start to think about the biopsychosocial and, you know, most physios now are at least, you know, aware of this and are starting to bring it into their practice to a degree. I'm interested though, within your role within workers’ compensation and particularly working with that sort of group of people who are often in quite a, I would say, sort of unique situation, contextually with some of the complexities around their injuries and I guess, some of the factors that might be at play. I'm interested in what you've observed, or maybe some of the particular challenges or sort of things that you might have to kind of navigate around or support people differently in that particular setting within the workers’ compensation area.

Dave
For the average person, when they fall into workers’ comp, which for most people they do, it's not planned. You know, there's never this this expectation that it's going to happen to most people. So, those who fall into workers’ comp, all of a sudden they're exposed to these different people, who haven’t had to often deal with in their lives, let alone, there’s suddenly, their position, and we talk about context, their position in their workplace, can be changed quite dramatically. So to me, I think, probably some of the keys are really giving the person permission to feel like they're in control from the start.

Often when I see things not going well, it's that the person doesn't quite know their position. You know, what they're able to do, what they're not able to do. And that drives this, you know, almost loss of empowerment, that we see with people. So to me, it's giving them permission to be central, and everything we know about the research says that you've got to have that person central to their recovery and to really owning that return-to-work process that they need to be involved with. I think then also really empowering them to actually be that central figure. So not only giving them permission, but then obviously driving the empowerment side as well, which can be as simple as, when you’re going to your doctor, get your medical certificate, share that with everyone. So everyone knows what's going on there. Let your physio know when you're going to see the doctor so the physio can be providing updated information.

I think as the physio, we play an incredibly pivotal role in managing that person. We spend more time with that person than probably anyone else does through that return-to-work process. We get to know them as a person. And often what comes with that, even if we're not necessarily searching for it, is we find a lot out about that person. So what makes them tick, what's really valuable to them. But part of that is often you get this sense of this change to this person. So all of a sudden, if they're not doing their role, you know, suddenly there's a, you know, there can be this loss of self-worth. There can be the stigma that forms with people often in compensation schemes. You know, they can be poorly understood by their people around the work.

So to me, I think some of those key features is really encouraging them to feel like they’re owning. And it can be very challenging for lots of people because it's not a situation they've asked for. Often it's happened through unfortunate circumstances, but they've fallen into this place where they've almost got a choice of, you know, do you be the passenger or do you be the driver of the bus? And if you can be the driver of the bus, surround yourself with some really good people that are going to help steer you in that right direction with your recovery. So I think they’re probably the key things is, really having them front and centre. But really as a practitioner, making sure that we don't think of work as, you know, it can often be the elephant in the room where we talk about the recovery, we talk about how they're responding, but we're hesitant to talk about work. And I think for these people, often it's the work factors that are the driving factors that can inhibit a really positive recovery.

Soph
It's tricky isn't it. And it's easy to see how, you know, just the nature of it being a compensation claim kind of adds these layers of potential complexity and, like, I'm sure there would be people out there and I've certainly seen people, not so much now, but earlier on who might have a claim and recover well because their workplace is really supportive and their insurer is good and it goes smoothly without a hitch. But I think there's also a lot of cases where that maybe isn't so much the case and there can be these unique sort of tensions and challenges, I think.

There's always this interesting kind of perspective on where we sort of sit within that sometimes. And I'm interested to pick your brain a bit on it, Dave, around, in that position that you sort of described, where maybe we're spending a lot of time with people and maybe we get insights into some of the challenges or tensions that someone might be experiencing within that sort of context. Maybe it's issues with their workplace, maybe it's potentially difficulties with or conflict potentially with their insurer, for example, there can be lots of things going on.

Where do you see physio’s role in terms of almost coming into that sort of advocacy space for the person, because, you know, obviously we've got to be careful that we're not sort of, I don't know, it's a very fine line to walk, I appreciate, and it's tricky to not necessarily get too involved in some of the stuff necessarily get too involved in some of the stuff that's less relating to our scope and more to do with those back-end sort of claim processes. But yeah, I guess, what's your take on where we can kind of see in supporting some of those processes to reduce some of the barriers and conflict points that might exist for someone?

Dave
I think as long as we're coming from a position of having a solution and being focused on that solution, I see no reason why we can't be that advocate. Again, we're capturing a lot of information that no other people have, and I think if that's used to then drive solutions to what ideally are probably the barriers to that person recovering and getting back to work, that's where I think we've got a really valuable role. I think if we're more coming up to identify problems but really aren't offering the solutions, and ideally it's a nice collaborative, solution-forming process with the injured worker as well, where, you know, we're hearing things, ideally we're empowering them to do the problem solving, but assisting them and giving them the support to come up with those solutions. Where I see physio goes great with return-to-work is where we’re seen to be really providing that information that's driving good recovery and good outcomes, where we're being seen as that conduit with, you know, let's get the rehab provider and the employer in the room with the physio and it's all chat about what that recovery is going to look like. And really guiding that, I think we've got great opportunities there. So probably that it comes back to if we can be, being that conduit to a solution, then I think, I see no problems with that. I think we’re really assisting with the problem solving rather than almost creating extra problems ourselves.

Matt
I guess the theme I'm getting from you, Dave, is you don't really necessarily make a big distinction between presentations. You’re just seeing the person in front of you and trying to individualise care towards them. And that happens to also look at their cognitions and their behaviours and ideas, regardless of the acute or chronic setting. It sounds like, I guess, the psychologically informed care is just part of your tool belt more than, ah, okay, you come here with chronic pain, let me pull this stuff out just for you, kind of thing. It's all kind of integrated within your practice and how you operate.

Dave
Yeah, yeah, it is. And it's interesting you put it that way, Matt, because it's probably when you're on the inside, you're not actually noticing that that's what you're doing. But no, no, I totally agree. And to me it's, I think, we've moved on from this world of, you know, where my undergraduate training in for many, many years of my postgraduate work, it was you know, identifying musculoskeletal impairments. They’re the solution to getting that person recovering. And for a large proportion of people, they are and they're still really, really valid. But when we're looking at ideally what can probably improve that person even faster, it's then looking at what are some of those soft skills that maybe we can use as physio and apply that might be really relevant to that person. So yes, they might have a muscle weakness that we need to strengthen up. Yes, they may have a restriction of mobility that we can be using our wonderful physio skills to be doing. But if at the same time, you know, there is some other protective behaviour that's discouraging that flowing of activity that we need them to utilise to get back to work, it's really tapping into that and looking at, okay, that's more of an issue, really the focus needs to be on that.

So the barriers could be anything, they could be biological, they could be psychological, they could be social, they could be lifestyle. Or they could be a whole bunch. The key thing as a physio is really to be identifying what you think are the most modifiable factors that you're going to be able to change that's going to allow that person to recover and get back to work, as quickly and as durably as ideally what we want them to.

Soph
It's about finding which which lever to pull for each person.

Dave
And for some there'll be low-hanging fruit, for others, it'll be a bit higher up and it takes a bit more work to get to, but equally as valuable.

Soph
Absolutely. This has really been fantastic, Dave, thank you so much for actually sharing your experiences and your knowledge. It's really lovely to be able to chat and to pick your brain a bit about your experiences with this, and I'm sure that anyone listening would agree with this on that. I'm really interested, you know, as we're sort of finishing up, if you think about maybe some of the things that we've spoken about, if people listening were to take away, you know, maybe just one sort of main insight from our conversation or maybe one bit of advice that you'd like people to walk away with after listening to this, what would you want that to be?

Dave
Can I have two things, Soph?

Soph
I'll allow it.

Dave
Bit of negotiation here. I think to me, give people time at that initial assessment. And probably what I mean by that is I think time well spent at that initial assessment is often going to have a huge payback with treatments down the track. If you really have the opportunity to really get that bit of storytelling out from the patient, you really get a good sense of what they think are the most important factors that may be assisting them with recovery, or maybe getting in the way of their recovery, is really, really crucial. And often those couple of minutes just asking some really open-ended questions, whilst it may take you down a pathway you weren't prepared to go for consult one, it's really going to open up opportunities for more targeted management down the track. So, you know, to me having that great opportunity to do that on day one, it's going to come back in spades with further treatments.

So that's part one, part two is, there's never this perfect trajectory with anyone's recovery. You know, it's a matter of continuing to check in and what may be really relevant and really important on day one might be different at day 14 or day 21. So continuing to sort of have that openness to your treatment and continuing to seek what are the ongoing barriers to recovery, if that's what we're looking at, hopefully then continues to inform where you need to be going with your further practice.

Soph
Two amazing bits of advice for the price of one. Thank you.

Matt
Thanks so much to you, Dave, for sharing your wisdom and your time. And we do also want to thank the listeners, who have tuned in to Physios on the Mic. And we hope to catch you next time on Pain in Practice.