The Magic is in the Mud
Why the messy parts of clinical care can make the biggest impact
From the outside, clinical care looks clean - protocols, sets and reps nested inside neatly structured plans. But anyone who works with real life humans knows that the most important parts of care don’t live in the tidy spaces.
They live in the mud.
The Mud: Where the Real Work Happens
“Mud” is everything that doesn’t fit into a treatment algorithm:
Beliefs about pain
Fear of movement
Outdated stories from doctors of MRI reports
Expectations shaped by Google, Instagram, friends or past providers
Sleep, stress, recovery, identity
This is the stuff that feels messy, emotional, nonlinear, and hard to quantify. But it’s also the stuff that drives how we feel in our bodies and influences our behaviors.
Ignoring the mud doesn’t make it disappear. It just slows progress.
I’m borrowing the ‘no mud, no lotus’ ideas from a legend in the mindfulness world, Thich Nhat Hanh. Highly recommend this book and its timeless wisdom for transforming suffering by sitting with the messy parts of life.
The Lotus: What Grows From the Mess
There’s a reason the lotus only grows in murky water: the mud is nutrient-rich. It’s messy and uncomfortable, but it’s where growth happens.
Clinical “lotus moments” emerge from the same places:
When someone realizes that their back isn’t fragile
When they move through a feared movement/exercise and don’t die (i.e. nothing bad happens)
When they understand load, not damage, is driving symptoms
When a lifestyle shift unlocks better recovery
When a patient moves from looking for a quick fix for their pain to looking for ways to build capacity
Those breakthroughs don’t happen from the perfect stretch. They happen from conversation, reframing, and exploring uncertainty.
Soft Skills, Hard Outcomes
The ‘soft skills’ in the clinical encounter don’t get celebrated enough, but they often make the biggest difference:
Listening instead of lecturing
Validating instead of dismissing
Asking what someone believes instead of telling them what to think
Leading with curiosity rather than feeding someone’s fear
These skills lower threat, increase confidence, and make the “clean” parts of care actually work.
What it Looks Like in Practice
Working in the mud isn’t random. It’s purposeful exploration.
It can looks like:
Asking a patient what they think is happening instead of telling them
Exploring fears rather than dismissing them
Noticing the lifestyle patterns that amplify symptoms
Helping someone understand load rather than fear movement
Challenging a belief gently instead of lecturing
Letting a patient process frustration without rushing to solutions
Being comfortable saying “I don’t know, but we’ll figure it out together”
Working in the mud requires curiosity, patience, and humility. But if you stay with it, the lotus emerges.
No Mud, No Lotus
If you avoid the messy parts, you miss the moments that matter most. But if you step into the mud with someone, including their fears, stories, doubts, and complexity - you might just unlock real, lasting change.
