Chronic Pain Isn’t What You Think It Is

WEBVTT

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You're listening to the PT Pinecast,

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where smart people in healthcare come to

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make noise.

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Here's your host, Jimmy McKay.

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All right, kicking things off today.

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I do want to say before we start,

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thanks to Sarah Health,

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the remote care platform helping clinics

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boost revenue without having to add staff.

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Sarah automates daily patient check-ins

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like RTM that meets RTM requirements and

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supports better work through between

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visits.

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Find them online at sarahhealth.com.

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That's S-A-R-A health.com.

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The Sarahs of the world do get very

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picky.

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Like I'm Sarah with an A, Sarah.

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without an A, this is Sarah,

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without an A, sorry, hsarahhealth.com.

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Today's episode, PT clinic owner,

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professor, PhD candidate, entrepreneur,

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podcast host, surfer, mom,

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and somehow finds time to bake bread from

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scratch.

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Those are a lot of things,

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like Swiss army knife vibes is what I

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get from her.

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Her work sits at the intersection of pain

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science, clinical care,

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and then the messy reality of humans being

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human-y, as I say.

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She believes that chronic pain is not just

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a louder version of acute pain.

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We've said this before in different

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contexts, like,

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You know, kids just aren't small adults.

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They're different.

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So is pain.

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It's a nervous system story shaped by lots

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of things, stress, sleep, beliefs, trauma,

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safety, connection, the world.

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So let's get this pain conversation,

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which is always fascinating for me for

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some reason.

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Let's get in today's guests, Megan Steele.

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Megan, in the flesh from the West Coast,

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from the Westest of coasts.

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The Westest of West Coast.

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Thank you for that lovely intro.

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I'm happy to be here.

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So let's start with what I sort of

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like framed or highlighted or put in bold

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with my words.

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Chronic pain is not just a louder,

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longer version of acute pain.

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What do PTs or what does healthcare miss

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when they actually do treat it like a

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longer, louder version of acute pain?

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That's a great question.

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I think we miss the point.

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We miss the plot when we're sort of

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treating it as a louder, longer,

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stiffer version of acute pain.

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when we're thinking about acute pain,

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we're thinking about tissue damage and

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nociception.

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And for some of us,

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it's been a little while since PT school

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and those words are kind of coming back

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to us.

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Oh yeah, nociception.

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And I teach a class called orthopedic

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pathology to the first year physical

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therapy students.

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And we talk a lot about tissue healing

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times, right?

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Six to eight weeks on average for soft

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tissue, eight to ten for bone.

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And then

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What happens when people are outside of

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that window?

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We're not thinking about and hopefully

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we're not looking for a tissue source.

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Excuse me.

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So when someone's had pain for longer and

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I think.

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One of the great questions that I like

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to tell people to ask a clinician before

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you decide whether or not I want to

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work with this person,

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if you're someone that suffers from

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chronic pain,

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is how do you treat people differently

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when they've had pain?

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for three years versus three weeks.

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Because if you're telling me, well,

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it's a stiffer joint.

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I push harder.

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We have to do more exercises,

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those types of things.

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I'm going to say, thanks.

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I'll see you later.

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But if you're saying to me, well,

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someone with chronic pain,

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I'm thinking more about threat detection

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than about tissue damage.

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I'm all in.

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I'm interested.

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You seem to know what you're talking

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about.

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Let's continue this discussion.

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It's funny, before we hit record,

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you mentioned Rachel's softness.

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She's come on the show numerous times over

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the last couple of years, mutual friend,

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and she frames some things pretty well,

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which is.

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Pain or no different things in different

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contexts elicit different

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You know,

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she was just on Dax Shepard's podcast and

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I saw this great clip and she's like,

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you know,

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someone biting you in the middle of an

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interaction with a partner that you want

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and are attracted to is very different

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than just being bit by a random stranger

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or a dog.

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So looking at it outside of a

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biopsychosocial context.

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uh way seems to miss the point and

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if we only treat things one way we're

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only going to get one result so when

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a chronic pain patient walks into a clinic

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what would you suggest to students

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clinicians anybody listening what should

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the person be listening for before they

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ever test range of motion or strength what

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are like the i call them eyebrow tests

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what are the things that sort of make

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you go hmm okay

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That's a great question.

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And there's a variation of options there.

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But I oftentimes think about,

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you know what normal is, right?

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You've had orthopedic pathology,

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you've had physiology,

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you've had biomechanics,

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you know what that is.

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And so things that are outside of that,

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when people say things like,

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when my stress level is higher,

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I have a lot more pain.

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When I haven't eaten well,

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I have a lot more pain.

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When I know I have to go and

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give a presentation, I have more pain.

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And not everybody has that awareness,

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but sometimes also people will say to you,

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there's no rhyme or reason to it.

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I cannot discern a pattern to it.

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Sometimes I'll just be sitting still and I

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have this pain.

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that's not a normal physiological

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reaction, right?

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That's not a biomechanical,

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when we think about our biomedical model,

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someone sitting still not moving that

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painful joint should not have pain if

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we're just thinking about strictly

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biomedical model.

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But when you broaden your lens and you

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say, oh, well,

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there are a lot more things like context,

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like my psychological state,

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like the amount of sleep I got that

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affect my body and my physical experience,

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then your treatment targets expand as

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well.

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You said the most important question is

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not where is the pain coming from,

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but what is this person perceiving as a

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threat?

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I mean,

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I feel like that just summed up what

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you just said there.

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So what does that look like in practice

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or how do you teach people to take

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that from hearing me say that really cool

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quote?

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That was your quote, by the way.

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That's the smart thing.

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Want to be a good podcast host?

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Steal the great quotes.

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Makes you sound prolific.

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But what does that look like in practice?

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That's a great tip.

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How does that look in practice?

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Yeah, and that's quite challenging.

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So I also teach students in the third

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year, pain science.

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And sometimes they come back and they say,

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oh my gosh,

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because they've been out on their

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clinicals, right?

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And they're like, oh,

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this is what I needed.

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Why didn't we have this in first year?

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And, you know, thank you so much.

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And I say, well, this is the gray,

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right?

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In first year,

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you needed it to be black and white.

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because there's such a volume of

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information.

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It's like a fire hose of information

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coming at you with anatomy, physiology,

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biomechanics, pathology, et cetera.

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You need it to be black and white

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in the first year.

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And it's not until you've been out in

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the clinic and you've seen, gosh,

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not everything is like the textbook that

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you can say, oh shoot,

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there's actually some gray here.

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There's some nuance.

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And so the first thing that we do,

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one of the first things that we do

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in pain science is shut up shut your

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mouth they say it takes eight minutes for

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someone to tell their story wow do you

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know how soon we as clinicians tend to

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interrupt someone uh i think this has been

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if it's the thing i'm thinking it's like

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forty two seconds or something crazy less

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than that maybe

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Yeah, somewhere around thirty seconds.

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Yeah.

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Right.

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And it makes sense.

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We want to show that we know what

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we're talking about.

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We want to show that we're the expert.

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We've seen this before.

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We understand we're going to be the one

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that's going to be able to help you.

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And I'm not opposed to that.

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I think that's really important after

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you've let someone tell their story.

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And so, you know, people say,

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you know, like you,

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you handle these tough cases.

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You see people that have seen six other

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practitioners.

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What do you do differently?

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I'm not magic.

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I don't have some kind of a special

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intuitive psychic skill.

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I know how to shut the fuck up.

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Sorry.

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I don't know if we're allowed to say

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that.

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Um, okay.

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So I'd say that's probably my biggest, um,

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superpower, if you will.

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And if you've seen me on Instagram,

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you might be surprised that I know how

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to stop talking for periods of time.

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I used to use this as a cheat

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code.

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Back when I used to work for radio

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stations and I had to interview someone,

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it was not a healthcare thing,

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but I realized this might be the only

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time that person's ever been in a radio

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station.

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So I need to understand that.

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This is normal for me, not for them.

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Like this is their day.

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Like this is fun.

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This is weird.

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But also like, what is this?

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I don't understand this.

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So I made it a point to get

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with my receptionist and say, hey,

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whenever there's an interview,

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never send them back.

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I come and get everybody.

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I would meet them at the front door

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and I would immediately start to try any

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way to read that person.

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Are they a little sheepish?

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Are they nervous?

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I'd look for their eyes darting around,

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look for body language.

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And if I sensed a little coldness,

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I would give them the complete tour of

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the entire radio station.

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And my goal was to get them to

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warm up.

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But hearing what you just said,

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I'd never heard.

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I've heard the second statistic that we

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interrupt people at thirty two seconds or

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something like that.

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I've never heard the other one,

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which is it takes eight minutes to tell

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their story because my goal

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when I turned the microphone on,

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there they are,

00:10:00.222 --> 00:10:01.864
was to get to the good part.

00:10:02.423 --> 00:10:03.664
So maybe I needed to get,

00:10:03.684 --> 00:10:04.345
I sort of knew,

00:10:04.384 --> 00:10:05.285
and we sort of know,

00:10:05.666 --> 00:10:06.966
I need to get the first seven and

00:10:06.985 --> 00:10:08.147
a half minutes out of the way.

00:10:08.706 --> 00:10:10.868
So when I turn to you, you're warm,

00:10:10.908 --> 00:10:11.408
you're hot.

00:10:12.349 --> 00:10:14.110
And you can step, you're mid stride.

00:10:14.590 --> 00:10:16.451
So if I ever sensed that,

00:10:16.610 --> 00:10:19.231
I would do that.

00:10:19.292 --> 00:10:21.453
That's a skill, I think, in healthcare,

00:10:21.494 --> 00:10:22.653
which is shutting up.

00:10:22.714 --> 00:10:24.914
It sounds dumb, but it's not.

00:10:25.235 --> 00:10:26.296
Shutting up is a skill.

00:10:26.826 --> 00:10:27.447
It's a skill.

00:10:27.567 --> 00:10:29.207
And then I think the number two most

00:10:29.248 --> 00:10:32.009
important skill is what you just talked

00:10:32.029 --> 00:10:34.592
about is how can I connect with this

00:10:34.673 --> 00:10:35.212
person?

00:10:36.214 --> 00:10:38.816
How can I recognize where they are and

00:10:38.836 --> 00:10:40.376
then connect with them?

00:10:40.618 --> 00:10:41.899
Which, you know,

00:10:42.119 --> 00:10:44.880
I have a friend that graduated from some

00:10:44.921 --> 00:10:46.201
of the top schools in the country.

00:10:46.241 --> 00:10:47.503
She went to Duke and then she went

00:10:47.523 --> 00:10:49.365
to Columbia and she said,

00:10:49.465 --> 00:10:51.005
I know all my biomechanics.

00:10:51.066 --> 00:10:53.107
I know all my neuro, I know everything,

00:10:53.187 --> 00:10:54.668
but they never taught us how to talk

00:10:54.708 --> 00:10:55.190
to people.

00:10:56.701 --> 00:10:57.100
Who knew?

00:10:57.120 --> 00:10:58.142
Shocking, right?

00:10:58.282 --> 00:10:59.442
Who knew?

00:10:59.462 --> 00:11:00.023
Shocking.

00:11:00.082 --> 00:11:01.144
And there's a great, I love,

00:11:01.224 --> 00:11:02.605
I show in my classes,

00:11:02.625 --> 00:11:03.764
there's a great pie chart.

00:11:03.784 --> 00:11:05.567
It comes from the psychological research,

00:11:05.586 --> 00:11:07.727
but they found that it translates well to

00:11:07.768 --> 00:11:08.589
physical therapy.

00:11:09.188 --> 00:11:10.909
And it's like the percentages of the

00:11:10.970 --> 00:11:13.171
things that help people to get better.

00:11:13.191 --> 00:11:15.232
These are the things that have been shown

00:11:15.293 --> 00:11:17.474
to improve outcomes.

00:11:18.355 --> 00:11:20.755
And therapeutic alliance,

00:11:21.437 --> 00:11:23.038
thirty five percent.

00:11:23.077 --> 00:11:23.138
Wow.

00:11:24.140 --> 00:11:25.881
What people come in with, forty percent.

00:11:25.961 --> 00:11:27.143
You can't do anything about that.

00:11:27.442 --> 00:11:27.623
Right.

00:11:27.643 --> 00:11:29.605
That's their history, their beliefs,

00:11:29.644 --> 00:11:31.405
their biases, their expectations.

00:11:31.645 --> 00:11:32.706
Excuse me, not expectations.

00:11:33.647 --> 00:11:37.250
So thirty five percent is the relationship

00:11:37.269 --> 00:11:40.672
that you ideally will make with them.

00:11:41.172 --> 00:11:42.173
And so I tell my students,

00:11:42.192 --> 00:11:43.793
your goal on day one,

00:11:44.193 --> 00:11:47.535
your primary goal on day one is to

00:11:47.635 --> 00:11:48.596
get a day two.

00:11:50.854 --> 00:11:52.075
You don't need to figure it out all

00:11:52.154 --> 00:11:52.696
on day one.

00:11:52.735 --> 00:11:54.418
If somebody's had pain for twenty years,

00:11:54.538 --> 00:11:56.620
it's very unlikely that you will figure it

00:11:56.639 --> 00:11:57.600
out on day one.

00:11:58.142 --> 00:12:00.163
You need to connect with this person

00:12:00.264 --> 00:12:06.009
enough so that they will come back and

00:12:06.529 --> 00:12:09.732
then feel comfortable enough with you to

00:12:09.773 --> 00:12:12.375
share what's really going on with them.

00:12:12.395 --> 00:12:12.475
Yeah.

00:12:14.679 --> 00:12:17.182
And I think those are skills that we

00:12:17.202 --> 00:12:19.544
don't emphasize enough in PT school.

00:12:19.904 --> 00:12:25.791
And I think that ideally needs to change.

00:12:25.831 --> 00:12:26.451
Yeah.

00:12:26.552 --> 00:12:28.274
And we've talked about that before.

00:12:30.028 --> 00:12:32.049
I've used an example and people laugh when

00:12:32.090 --> 00:12:33.691
I give it in a presentation because I

00:12:33.730 --> 00:12:35.131
also like when you give when you're

00:12:35.152 --> 00:12:36.373
talking one on one with someone,

00:12:36.393 --> 00:12:38.214
it's different than when you're talking to

00:12:38.234 --> 00:12:39.014
a room full of people.

00:12:39.315 --> 00:12:40.056
Right.

00:12:40.115 --> 00:12:42.277
We're more apt to laugh and there's group

00:12:42.317 --> 00:12:42.917
and yada yada.

00:12:43.238 --> 00:12:46.940
So I'll parallel marketing or patient

00:12:46.980 --> 00:12:49.961
relationships to an actual traditional

00:12:49.981 --> 00:12:51.903
relationship, like stereotypical.

00:12:52.364 --> 00:12:54.024
And I'll say, well, of course,

00:12:54.044 --> 00:12:55.304
the goal of the pickup line is to

00:12:55.345 --> 00:12:55.905
get married.

00:12:56.669 --> 00:12:57.510
And everyone laughs.

00:12:57.530 --> 00:12:58.471
And they're like, of course.

00:12:58.491 --> 00:12:59.452
I'm like, oh, I'm not married.

00:12:59.472 --> 00:13:00.835
That's why I must be doing it wrong.

00:13:01.075 --> 00:13:02.196
Like the goal of pickup line is to

00:13:02.216 --> 00:13:02.876
get a laugh.

00:13:03.477 --> 00:13:04.799
The goal of a laugh is to build

00:13:04.840 --> 00:13:06.922
rapport, to get coffee.

00:13:06.981 --> 00:13:08.323
The goal of one coffee is to get

00:13:08.443 --> 00:13:10.385
dinner and then dinner is to get whatever.

00:13:10.666 --> 00:13:11.647
And it builds from there.

00:13:12.644 --> 00:13:14.046
And then I'll say, you know,

00:13:14.125 --> 00:13:15.347
I'll parallel the marketing.

00:13:15.368 --> 00:13:17.328
I go, well, the one post,

00:13:17.369 --> 00:13:18.490
the goal is to get them to buy

00:13:18.551 --> 00:13:18.971
something.

00:13:19.490 --> 00:13:20.192
And they're like, yeah.

00:13:20.231 --> 00:13:20.552
And I go,

00:13:20.613 --> 00:13:22.033
do you see how ridiculous that is?

00:13:22.053 --> 00:13:24.216
Sometimes you see how ridiculous you're

00:13:24.235 --> 00:13:25.456
making that giant leap.

00:13:25.476 --> 00:13:27.538
But this giant leap is ridiculous in the

00:13:27.558 --> 00:13:28.559
relationship context.

00:13:29.000 --> 00:13:30.981
But it's the same with with therapeutic

00:13:31.001 --> 00:13:31.482
alliance.

00:13:31.503 --> 00:13:32.943
It's like, hey, I'm your PT.

00:13:32.964 --> 00:13:33.784
Just trust me.

00:13:33.804 --> 00:13:35.306
Do you know who says just trust me?

00:13:35.706 --> 00:13:36.628
Used car salesman.

00:13:37.268 --> 00:13:38.509
Anybody who's saying trust me,

00:13:38.749 --> 00:13:40.850
demanding your trust, right,

00:13:41.551 --> 00:13:42.792
immediate red flag.

00:13:43.232 --> 00:13:44.033
And if this person,

00:13:44.052 --> 00:13:45.033
because I've heard it before too,

00:13:45.053 --> 00:13:45.914
which you just alluded to,

00:13:47.216 --> 00:13:48.777
has probably seen multiple providers,

00:13:48.956 --> 00:13:50.378
if it's long-term chronic pain,

00:13:51.019 --> 00:13:52.179
they've tried a lot of different things.

00:13:53.456 --> 00:13:55.697
They might be exhausted from trying things

00:13:55.817 --> 00:13:57.759
because they're not just dealing with pain

00:13:57.778 --> 00:13:58.740
while they're sitting in front of you.

00:13:59.139 --> 00:14:01.182
That's their all the time or a lot

00:14:01.201 --> 00:14:01.741
of their time.

00:14:01.942 --> 00:14:03.524
This is mentally, physically,

00:14:03.563 --> 00:14:04.644
emotionally exhausting.

00:14:05.304 --> 00:14:07.046
And it's going to take a little bit.

00:14:07.066 --> 00:14:08.126
Right.

00:14:08.527 --> 00:14:09.087
Exactly.

00:14:09.248 --> 00:14:10.229
And also, you know,

00:14:10.288 --> 00:14:11.490
they've had people who have

00:14:12.822 --> 00:14:15.383
maybe dismiss them or maybe kind of like

00:14:15.482 --> 00:14:16.003
first thing.

00:14:16.082 --> 00:14:18.004
Oh, I know exactly what this is.

00:14:18.063 --> 00:14:20.024
You got seconds in trust me.

00:14:20.144 --> 00:14:21.225
I know I've been here.

00:14:21.345 --> 00:14:22.145
I'm the expert.

00:14:22.206 --> 00:14:23.485
I'm the preacher from the pulpit.

00:14:23.546 --> 00:14:25.106
Who's going to be the person who's going

00:14:25.126 --> 00:14:27.168
to solve this problem for you because that

00:14:27.347 --> 00:14:28.388
feeds my ego.

00:14:28.488 --> 00:14:28.908
Right.

00:14:28.947 --> 00:14:30.849
Cause I'm the best.

00:14:31.668 --> 00:14:32.009
Um,

00:14:32.149 --> 00:14:35.630
and so it's really refreshing to people

00:14:35.671 --> 00:14:37.932
who have been in those situations to hear,

00:14:39.052 --> 00:14:39.511
tell me,

00:14:40.413 --> 00:14:41.432
we got all the time you need.

00:14:42.241 --> 00:14:46.426
no rush and for people to say i

00:14:46.466 --> 00:14:49.788
feel seen i feel heard i feel safe

00:14:49.828 --> 00:14:55.995
here that's just like oh the best yeah

00:14:56.034 --> 00:14:57.475
well you you mentioned instagram

00:14:58.375 --> 00:14:59.456
Do you like doing that?

00:15:01.336 --> 00:15:03.456
So it sounds like you laughed,

00:15:03.496 --> 00:15:04.476
but it's a funny question.

00:15:04.496 --> 00:15:06.298
But I've talked to a lot of people

00:15:06.317 --> 00:15:07.077
in health care, obviously.

00:15:07.097 --> 00:15:08.018
It's sort of what I do.

00:15:08.658 --> 00:15:10.418
And people with large followings are

00:15:10.458 --> 00:15:12.019
trying to get a following, right?

00:15:13.879 --> 00:15:14.558
And some people,

00:15:14.578 --> 00:15:15.720
when I ask that simple question,

00:15:15.759 --> 00:15:16.700
do you like doing that?

00:15:17.159 --> 00:15:18.700
A lot of them, after a little while,

00:15:19.200 --> 00:15:20.640
will say, honestly, no.

00:15:21.240 --> 00:15:22.160
Or I love it.

00:15:22.541 --> 00:15:24.142
I mean, I don't mind doing it.

00:15:24.241 --> 00:15:24.881
But I got to be honest,

00:15:24.922 --> 00:15:25.961
as a guy who talks a lot,

00:15:26.869 --> 00:15:28.889
I go in waves where I might do

00:15:29.070 --> 00:15:31.530
a lot like for months and then all

00:15:31.551 --> 00:15:33.270
of a sudden I don't wanna look,

00:15:33.291 --> 00:15:34.631
I don't even wanna open the app or

00:15:34.751 --> 00:15:36.871
any of the apps and people I've gotten

00:15:36.912 --> 00:15:38.192
messages, are you okay?

00:15:38.572 --> 00:15:39.753
And I'm like doing great.

00:15:40.254 --> 00:15:42.734
But I used to tell this to broadcasters,

00:15:42.815 --> 00:15:45.014
if all you do is consume stuff here

00:15:45.034 --> 00:15:45.936
at the radio station,

00:15:46.015 --> 00:15:47.076
what are you gonna talk about?

00:15:47.176 --> 00:15:48.395
I need you out at a coffee shop

00:15:48.456 --> 00:15:51.256
or a concert or getting your oil changed

00:15:51.476 --> 00:15:52.238
to come in

00:15:53.138 --> 00:15:55.220
and comment on life which is essentially

00:15:55.259 --> 00:15:57.841
what you're doing so so so I'll ask

00:15:57.861 --> 00:16:01.283
that question do you like doing it um

00:16:01.605 --> 00:16:04.206
yes and no and I think there I

00:16:04.246 --> 00:16:06.148
do go in waves and when you talk

00:16:06.187 --> 00:16:07.908
about kind of like oh these are all

00:16:07.948 --> 00:16:10.530
the things that she does I think I

00:16:10.551 --> 00:16:12.653
should put an asterisk there and say like

00:16:12.773 --> 00:16:15.375
not all at the same time right and

00:16:15.414 --> 00:16:18.717
so it seasons right you know like I

00:16:18.817 --> 00:16:19.158
I can't

00:16:19.498 --> 00:16:20.859
tell you how long it's been since I've

00:16:20.879 --> 00:16:22.240
been out in the water,

00:16:22.500 --> 00:16:25.464
but it's because I've been trying to swing

00:16:25.484 --> 00:16:29.386
at this academic goal that I have that

00:16:29.486 --> 00:16:30.508
is really taking up a lot of my

00:16:30.528 --> 00:16:30.729
time.

00:16:33.317 --> 00:16:33.636
You know,

00:16:33.677 --> 00:16:35.337
and I think we should also mention that

00:16:35.778 --> 00:16:38.739
I totally biffed it when you first invited

00:16:38.778 --> 00:16:42.900
me onto this podcast because you sent me

00:16:42.921 --> 00:16:44.701
a DM and I was like, yeah, sure.

00:16:45.701 --> 00:16:46.802
Send me an email or something.

00:16:46.842 --> 00:16:47.302
I can't remember.

00:16:47.322 --> 00:16:48.702
I was like really busy right now or

00:16:49.063 --> 00:16:49.583
something.

00:16:49.644 --> 00:16:52.345
And then like, I don't know.

00:16:53.586 --> 00:16:55.067
what i'm doing i don't know who the

00:16:55.087 --> 00:16:56.929
big dogs are i consider you a big

00:16:56.950 --> 00:17:00.613
dog congratulations i don't think i think

00:17:00.773 --> 00:17:02.494
most people because i talk to a lot

00:17:02.514 --> 00:17:04.596
of people in this context when they know

00:17:04.635 --> 00:17:05.676
they're recording and there's a little

00:17:05.717 --> 00:17:07.218
clock you know tell a little red light

00:17:07.597 --> 00:17:11.340
and then after and most people are more

00:17:11.381 --> 00:17:13.663
the same than they are different in a

00:17:13.722 --> 00:17:15.664
lot of ways in terms of like some

00:17:15.684 --> 00:17:18.166
of these big names are like i don't

00:17:18.186 --> 00:17:19.048
know how i got here

00:17:20.068 --> 00:17:21.630
don't know what i'm doing what am i

00:17:21.650 --> 00:17:24.071
doing next i don't know in fact the

00:17:24.172 --> 00:17:26.453
more interesting people say that the

00:17:26.493 --> 00:17:27.914
people who are like i know exactly what

00:17:27.934 --> 00:17:29.676
i'm doing everything's up and to the right

00:17:29.936 --> 00:17:33.078
here's the plan those people they're wrong

00:17:33.138 --> 00:17:35.760
most of the time it's like it's dunning

00:17:35.780 --> 00:17:38.063
kruger a little bit where like the

00:17:38.143 --> 00:17:40.365
smartest people um and the most

00:17:40.464 --> 00:17:42.026
interesting people when i ask them to talk

00:17:42.046 --> 00:17:43.086
are typically like why would you want to

00:17:43.106 --> 00:17:44.008
talk to me i don't have anything to

00:17:44.048 --> 00:17:45.028
say i'm like i don't know you just

00:17:45.048 --> 00:17:46.490
wrote three books or you do these amazing

00:17:46.529 --> 00:17:48.151
things um

00:17:48.451 --> 00:17:49.872
So I think we're all doing a little

00:17:49.912 --> 00:17:50.732
bit of that.

00:17:50.813 --> 00:17:51.772
Oh, well, that makes me feel better.

00:17:51.813 --> 00:17:52.314
Thank you.

00:17:52.394 --> 00:17:52.614
Yeah.

00:17:52.794 --> 00:17:54.694
I think if you lined me up with,

00:17:54.714 --> 00:17:56.976
I don't know, twenty other PTs and said,

00:17:57.016 --> 00:17:58.698
who's most likely to succeed on social

00:17:58.718 --> 00:17:59.097
media?

00:17:59.157 --> 00:17:59.317
Like,

00:17:59.397 --> 00:18:02.380
I would not be in the top ten

00:18:02.500 --> 00:18:03.019
of that one.

00:18:03.119 --> 00:18:06.301
But I've had some success.

00:18:06.541 --> 00:18:09.144
And I think a big part of that

00:18:09.203 --> 00:18:10.904
I credit to someone we both know named

00:18:10.924 --> 00:18:11.484
Shantae.

00:18:12.486 --> 00:18:16.148
who i stole at cpta one year and

00:18:16.209 --> 00:18:17.829
i tried to just like pump her for

00:18:17.869 --> 00:18:20.853
free advice as one does you know um

00:18:20.992 --> 00:18:22.794
and she was like looking at my instagram

00:18:22.814 --> 00:18:24.536
which was very like buttoned up and i

00:18:24.556 --> 00:18:26.277
was like these are the facts and this

00:18:26.317 --> 00:18:28.259
is my research study that i'm showing you

00:18:28.318 --> 00:18:30.540
and she was like so what i'm seeing

00:18:30.580 --> 00:18:33.803
right here is not exactly what i'm seeing

00:18:33.823 --> 00:18:34.663
right here and i'm like

00:18:35.195 --> 00:18:36.256
I'm not gonna tell people that I

00:18:36.376 --> 00:18:38.136
skateboard on the weekends.

00:18:38.257 --> 00:18:39.498
Why not?

00:18:39.577 --> 00:18:41.038
And that's exactly what she said.

00:18:41.078 --> 00:18:41.979
She was like,

00:18:42.019 --> 00:18:44.920
you can be a human being and people

00:18:44.960 --> 00:18:46.221
will be interested in you.

00:18:47.353 --> 00:18:49.653
And you can still give quality

00:18:49.673 --> 00:18:50.473
information.

00:18:51.174 --> 00:18:52.434
And so, yeah,

00:18:52.454 --> 00:18:53.915
that's kind of what I did ultimately.

00:18:54.036 --> 00:18:55.915
So the pain science course that I teach

00:18:55.955 --> 00:18:58.277
in third year is only part of the

00:18:58.317 --> 00:19:01.338
semester and that's funding reasons and

00:19:01.818 --> 00:19:04.000
academia reasons that are above my pay

00:19:04.039 --> 00:19:05.900
grade.

00:19:05.920 --> 00:19:08.060
I've asked many times, the students ask,

00:19:08.621 --> 00:19:09.902
can we expand this course?

00:19:09.961 --> 00:19:10.721
We want more.

00:19:11.583 --> 00:19:12.423
And it's always been a no,

00:19:12.442 --> 00:19:13.742
because otherwise we'd have to charge them

00:19:13.803 --> 00:19:15.163
more and they're already paying an arm and

00:19:15.183 --> 00:19:15.344
a leg.

00:19:16.214 --> 00:19:16.795
So I said, okay,

00:19:16.815 --> 00:19:17.935
I'm going to meet them where they are.

00:19:17.996 --> 00:19:18.135
Well,

00:19:18.175 --> 00:19:19.356
not really where they are because they're

00:19:19.376 --> 00:19:20.857
really on TikTok, but that scares me.

00:19:21.198 --> 00:19:22.318
So I said,

00:19:22.378 --> 00:19:24.619
I'll go to social media and I'm going

00:19:24.640 --> 00:19:27.501
to make a pain science Instagram for them.

00:19:28.301 --> 00:19:31.644
And the weird thing happened is other PTs

00:19:31.884 --> 00:19:33.724
who didn't have pain science in their PT

00:19:33.765 --> 00:19:35.125
program said, Hey,

00:19:35.205 --> 00:19:36.606
we didn't get this information.

00:19:37.587 --> 00:19:37.847
And then.

00:19:38.854 --> 00:19:40.474
people who suffer from pain,

00:19:40.494 --> 00:19:42.477
who are not clinicians, said, hey,

00:19:42.497 --> 00:19:43.517
we didn't get this information.

00:19:43.557 --> 00:19:45.598
Nurse practitioners, MDs, DOs,

00:19:45.659 --> 00:19:47.039
people are like,

00:19:47.921 --> 00:19:49.521
why don't we have this information?

00:19:49.561 --> 00:19:50.122
Where was this?

00:19:50.823 --> 00:19:52.023
Right, exactly.

00:19:52.163 --> 00:19:53.223
And so, I mean,

00:19:53.243 --> 00:19:57.386
there are efforts from AOPT to integrate

00:19:57.426 --> 00:20:01.509
pain science into all of the DPT programs

00:20:01.529 --> 00:20:02.790
and the entry-level programs,

00:20:02.871 --> 00:20:05.492
but it's hard work and it's slow and

00:20:05.532 --> 00:20:07.134
it takes time and...

00:20:09.146 --> 00:20:09.768
You know,

00:20:09.788 --> 00:20:11.329
there are a lot of moving parts in

00:20:11.369 --> 00:20:11.790
that.

00:20:12.431 --> 00:20:14.734
And so this was kind of my way

00:20:14.775 --> 00:20:16.836
to say, let's just get it done.

00:20:17.637 --> 00:20:18.839
Do you like doing it more now that

00:20:18.880 --> 00:20:20.021
you sort of feel like yourself?

00:20:20.041 --> 00:20:22.484
Does it feel less like work yet?

00:20:23.071 --> 00:20:23.971
Oh yeah, definitely.

00:20:24.133 --> 00:20:25.292
And I, you know,

00:20:25.413 --> 00:20:28.094
try to show you the sides of like

00:20:28.294 --> 00:20:30.996
my husband asking me for free PT advice

00:20:31.016 --> 00:20:31.855
and I'm like, oh yeah,

00:20:31.875 --> 00:20:33.136
why don't you work on my website?

00:20:33.636 --> 00:20:35.156
You know, so it's like,

00:20:35.238 --> 00:20:37.117
you get to be a little bit more

00:20:37.137 --> 00:20:38.558
of yourself.

00:20:39.138 --> 00:20:40.319
That brings people in.

00:20:41.440 --> 00:20:42.161
Totally.

00:20:42.280 --> 00:20:45.461
And every PT, yeah, every PT is like,

00:20:45.642 --> 00:20:47.682
same, I do not treat my family,

00:20:47.903 --> 00:20:48.723
you know?

00:20:50.163 --> 00:20:50.542
Yeah,

00:20:50.623 --> 00:20:52.084
just kind of a universal truth of our

00:20:52.104 --> 00:20:52.963
profession, I think.

00:20:52.983 --> 00:20:53.144
Sure.

00:20:53.503 --> 00:20:54.624
They're not going to listen anyway.

00:20:55.865 --> 00:20:56.325
Exactly.

00:20:56.545 --> 00:20:57.664
They don't do their home program,

00:20:57.684 --> 00:21:02.247
and you're like, where's my cocaine?

00:21:02.267 --> 00:21:04.027
So what do health care providers get wrong

00:21:04.207 --> 00:21:06.488
when they use pain neuroscience education

00:21:06.528 --> 00:21:07.768
with chronic pain patients?

00:21:07.907 --> 00:21:10.949
So let's say that they're like, OK, great.

00:21:12.109 --> 00:21:13.349
I'm understanding what she's saying.

00:21:13.710 --> 00:21:16.530
What are a couple of the hurdles that

00:21:16.550 --> 00:21:18.692
maybe they trip over in the beginning that

00:21:18.711 --> 00:21:19.652
are common that you see?

00:21:20.737 --> 00:21:21.157
Yeah,

00:21:21.218 --> 00:21:24.540
so what I see in students who have

00:21:24.601 --> 00:21:26.844
pain science education in their PT

00:21:26.884 --> 00:21:30.448
programs is they're doing more pain

00:21:30.468 --> 00:21:32.609
explaining than

00:21:33.826 --> 00:21:35.146
treating someone differently.

00:21:35.507 --> 00:21:37.708
So it feels a lot like, okay,

00:21:38.347 --> 00:21:39.508
pain neuroscience education,

00:21:39.607 --> 00:21:40.749
this is the thing that we have to

00:21:40.788 --> 00:21:41.048
do.

00:21:41.209 --> 00:21:42.829
So I'm going to do everything else that

00:21:42.869 --> 00:21:43.809
I've done the same.

00:21:44.250 --> 00:21:45.951
And then I'm going to talk at this

00:21:46.010 --> 00:21:48.231
person for fifteen minutes while they're

00:21:48.251 --> 00:21:50.053
doing their exercises or while I'm doing

00:21:50.093 --> 00:21:50.992
manual therapy.

00:21:51.573 --> 00:21:53.374
And that's not effective.

00:21:53.913 --> 00:21:56.576
And so I love that Laura Mermosley wrote,

00:21:56.736 --> 00:21:56.996
you know,

00:21:57.036 --> 00:21:59.777
in twenty fifteen pain science education,

00:21:59.836 --> 00:22:01.917
fifteen years on, where are we now?

00:22:02.018 --> 00:22:02.298
You know,

00:22:03.000 --> 00:22:05.222
Pain prevalence in the general population

00:22:05.282 --> 00:22:06.904
was at twenty percent when he wrote it.

00:22:07.125 --> 00:22:08.606
It's at twenty percent now.

00:22:08.987 --> 00:22:10.828
It's not the panacea that we all thought

00:22:10.848 --> 00:22:11.890
it was going to be.

00:22:12.210 --> 00:22:13.211
You're never, ever,

00:22:13.290 --> 00:22:15.834
ever going to talk someone out of pain.

00:22:16.555 --> 00:22:18.155
And that's where I have a hard time

00:22:18.296 --> 00:22:20.357
with some of the psychological

00:22:20.397 --> 00:22:22.200
interventions that, you know,

00:22:22.681 --> 00:22:23.781
are hands off.

00:22:24.574 --> 00:22:28.155
or not movement related because it's very

00:22:28.215 --> 00:22:29.757
unlikely that you're gonna talk someone

00:22:29.777 --> 00:22:32.479
out of pain because when you're talking to

00:22:32.519 --> 00:22:32.739
them,

00:22:33.400 --> 00:22:34.941
you're talking to their cognitive brain,

00:22:35.000 --> 00:22:35.980
their thinking brain.

00:22:36.481 --> 00:22:38.343
And that's not where chronic pain lives.

00:22:38.403 --> 00:22:40.263
Chronic pain lives in the subconscious

00:22:40.364 --> 00:22:42.184
below conscious awareness.

00:22:42.645 --> 00:22:44.987
And so I think we as physical therapists

00:22:45.627 --> 00:22:49.809
are the perfect practitioners to be able

00:22:49.849 --> 00:22:51.791
to have an impact on people's chronic

00:22:51.811 --> 00:22:51.991
pain.

00:22:52.474 --> 00:22:54.161
Why, what sets us up uniquely?

00:22:55.365 --> 00:22:57.286
we have an understanding of the physiology

00:22:58.125 --> 00:23:00.386
we can use manual therapy which talk

00:23:00.406 --> 00:23:03.209
therapists are not allowed to do and we

00:23:03.229 --> 00:23:06.190
understand movement and so i can use my

00:23:06.210 --> 00:23:08.171
manual therapy to access someone's

00:23:08.191 --> 00:23:11.333
subconscious and i can also use certain

00:23:11.353 --> 00:23:13.473
types of movement to access someone's

00:23:13.493 --> 00:23:16.214
subconscious so that their nervous system

00:23:16.275 --> 00:23:18.675
and their brain gets the message of safety

00:23:19.336 --> 00:23:22.157
and then we can make changes i'm not

00:23:22.198 --> 00:23:23.877
going to talk you out of pain and

00:23:23.917 --> 00:23:24.679
i'm not going to

00:23:25.318 --> 00:23:27.839
force that joint into, I mean,

00:23:27.859 --> 00:23:29.361
I could probably temporarily,

00:23:30.381 --> 00:23:32.382
but you're not gonna like me very much.

00:23:32.721 --> 00:23:35.182
And it's very unlikely that that's gonna

00:23:35.284 --> 00:23:37.644
stick long-term unless your nervous system

00:23:37.664 --> 00:23:40.125
says, I can accommodate this.

00:23:40.365 --> 00:23:41.645
I can take this in right now.

00:23:43.326 --> 00:23:44.728
Other things come into play, right?

00:23:44.807 --> 00:23:46.969
Stress, sleep, trauma, relationships,

00:23:47.009 --> 00:23:49.049
past experiences, safety.

00:23:49.789 --> 00:23:52.671
They all change how patients experience

00:23:53.412 --> 00:23:53.751
pain.

00:23:55.325 --> 00:23:57.608
Talk about, I just gave a list,

00:23:57.709 --> 00:23:58.971
and those are just things,

00:23:58.990 --> 00:23:59.451
that's more than,

00:24:00.032 --> 00:24:01.714
they all fit in biopsychosocial,

00:24:01.775 --> 00:24:05.320
but how do they actually change how a

00:24:05.340 --> 00:24:07.023
patient experiences pain?

00:24:08.536 --> 00:24:11.857
So things like, we'll just take trauma,

00:24:11.877 --> 00:24:12.577
for example.

00:24:12.758 --> 00:24:14.659
So we'll say we're talking about like a

00:24:14.719 --> 00:24:15.720
big T trauma,

00:24:15.779 --> 00:24:18.681
like a one specific incident, for example,

00:24:18.721 --> 00:24:19.961
like a car accident.

00:24:20.781 --> 00:24:23.643
So our nervous systems are designed to

00:24:23.682 --> 00:24:24.624
protect us.

00:24:25.163 --> 00:24:27.285
And if we think also about pain as

00:24:27.325 --> 00:24:29.026
our body's protective mechanism,

00:24:30.406 --> 00:24:32.628
then we can think about it as what

00:24:32.669 --> 00:24:34.790
is my body trying to protect me from

00:24:34.871 --> 00:24:35.372
here?

00:24:35.991 --> 00:24:37.953
And so over the course of our lives,

00:24:38.034 --> 00:24:39.875
we learn about pain.

00:24:39.955 --> 00:24:41.837
We learn about pain from our caregivers,

00:24:41.877 --> 00:24:43.519
from our experiences,

00:24:43.960 --> 00:24:45.981
from observing others.

00:24:46.102 --> 00:24:47.364
There's a lot of ways that we learn

00:24:47.384 --> 00:24:49.685
about pain and most of it is not

00:24:49.726 --> 00:24:50.266
conscious.

00:24:50.326 --> 00:24:51.406
Nobody sat you down and said,

00:24:52.208 --> 00:24:56.310
So snakes, here's the thing, right?

00:24:56.530 --> 00:24:58.051
Snakes comes to mind because I just saw

00:24:58.071 --> 00:25:00.053
a video of my daughter last week at

00:25:00.093 --> 00:25:01.733
preschool holding a snake.

00:25:03.075 --> 00:25:04.796
Did not come up in conversation once.

00:25:04.816 --> 00:25:05.696
I was like, how was school?

00:25:05.836 --> 00:25:06.237
Fine.

00:25:07.337 --> 00:25:08.858
Cut to her holding a snake.

00:25:08.898 --> 00:25:10.640
Did not mention that you held a snake

00:25:10.660 --> 00:25:11.319
today.

00:25:11.400 --> 00:25:11.579
Yeah.

00:25:11.819 --> 00:25:12.060
Nope.

00:25:12.101 --> 00:25:12.560
Didn't come up.

00:25:13.996 --> 00:25:16.817
So our nervous systems learn over time

00:25:16.957 --> 00:25:20.076
associatively, most often subconsciously.

00:25:20.537 --> 00:25:22.218
So that Pavlov, Bell,

00:25:22.678 --> 00:25:24.178
the dogs start salivating.

00:25:24.758 --> 00:25:26.419
Same for us with pain.

00:25:26.798 --> 00:25:29.219
I learn that driving in my car on

00:25:29.259 --> 00:25:30.960
a certain freeway at a certain time of

00:25:31.000 --> 00:25:33.220
day is a threat.

00:25:33.920 --> 00:25:35.039
So my nervous system says,

00:25:35.160 --> 00:25:36.340
I'm going to help protect you.

00:25:36.480 --> 00:25:37.701
I'm going to sound the alarm.

00:25:38.260 --> 00:25:39.560
And the alarm can be pain.

00:25:39.621 --> 00:25:40.842
The alarm can be what you just

00:25:40.882 --> 00:25:42.342
demonstrated, muscle tension.

00:25:42.942 --> 00:25:44.722
The alarm can be changes in movement

00:25:44.762 --> 00:25:47.304
patterns.

00:25:47.463 --> 00:25:49.164
There are a number of different ways that

00:25:49.204 --> 00:25:50.766
our body protects us.

00:25:51.205 --> 00:25:53.067
And if we think about pain in that

00:25:53.126 --> 00:25:55.729
way with our chronic pain patients,

00:25:56.169 --> 00:25:57.730
we're really treating them very

00:25:57.750 --> 00:25:59.851
differently from people in acute pain.

00:26:00.785 --> 00:26:02.526
Yeah, I'm thinking of people, too.

00:26:02.605 --> 00:26:03.926
There are certain people when they call,

00:26:04.627 --> 00:26:06.950
just their name on my phone makes me

00:26:06.990 --> 00:26:09.912
go like I can feel my body change.

00:26:10.092 --> 00:26:11.393
Like I now have to deal with this

00:26:11.432 --> 00:26:13.714
person or do I ignore this person?

00:26:14.535 --> 00:26:15.596
So you don't have to go far.

00:26:15.615 --> 00:26:16.375
You don't have to give me too many

00:26:16.416 --> 00:26:17.778
analogies for me to picture this.

00:26:18.438 --> 00:26:19.298
That's absolutely right.

00:26:19.358 --> 00:26:21.000
And I think about a patient that I

00:26:21.059 --> 00:26:22.941
saw very early on in my career.

00:26:24.664 --> 00:26:29.248
who had a spouse at the time who

00:26:29.288 --> 00:26:31.028
was physically abusive.

00:26:31.628 --> 00:26:33.950
And they had since divorced,

00:26:33.990 --> 00:26:35.310
but they had kids together.

00:26:35.371 --> 00:26:37.791
And so she was somebody that came in

00:26:37.832 --> 00:26:40.594
and said, my pain is so variable.

00:26:40.673 --> 00:26:42.295
There's no rhyme or reason to it.

00:26:42.315 --> 00:26:43.796
There's no pattern.

00:26:44.296 --> 00:26:45.277
And over time,

00:26:45.396 --> 00:26:47.098
by getting to know her and understanding

00:26:47.138 --> 00:26:49.641
what was really going on with her,

00:26:50.241 --> 00:26:52.483
we found out that any time that she

00:26:52.523 --> 00:26:54.165
has to interact with this person,

00:26:54.625 --> 00:26:56.228
her pain level shoots up.

00:26:56.748 --> 00:26:58.930
And so the kids were going through these

00:26:58.950 --> 00:27:01.053
life events and having to get together and

00:27:01.093 --> 00:27:03.054
have dinners and graduations and things

00:27:03.074 --> 00:27:03.474
like that.

00:27:03.515 --> 00:27:05.596
And any time I know that this person

00:27:05.676 --> 00:27:06.758
is going to be at one of those

00:27:06.798 --> 00:27:08.559
events, pain.

00:27:10.563 --> 00:27:11.584
I was talking to a friend who's a

00:27:11.624 --> 00:27:13.944
psychologist and it was after my mom

00:27:13.964 --> 00:27:14.484
passed away.

00:27:14.684 --> 00:27:15.546
And he's like, how are you doing?

00:27:15.705 --> 00:27:17.067
And I said, I don't know.

00:27:17.146 --> 00:27:18.606
Every once in a while I get upset

00:27:18.646 --> 00:27:19.268
for no reason.

00:27:19.688 --> 00:27:21.388
And he paused because that's what

00:27:21.509 --> 00:27:23.430
psychologists are very good at, the pause.

00:27:23.490 --> 00:27:24.651
And he goes, your mom died.

00:27:24.711 --> 00:27:25.191
That's a reason.

00:27:26.531 --> 00:27:27.551
And I remember thinking like, oh,

00:27:27.652 --> 00:27:28.071
I hadn't.

00:27:28.952 --> 00:27:29.972
Yeah, that's the reason.

00:27:30.073 --> 00:27:31.354
But like, why am I on a Tuesday?

00:27:31.374 --> 00:27:32.035
He goes, I don't know.

00:27:32.154 --> 00:27:33.015
Maybe you thought about your mom.

00:27:33.035 --> 00:27:33.955
Maybe you looked at something.

00:27:33.976 --> 00:27:35.155
Maybe you saw something she gave you.

00:27:35.476 --> 00:27:36.457
He's like, I don't know, man.

00:27:36.497 --> 00:27:38.417
But he's like, the reason is she died.

00:27:39.590 --> 00:27:42.432
the trigger might have been a memory,

00:27:42.452 --> 00:27:42.833
a song.

00:27:42.853 --> 00:27:45.054
He's like, it kind of doesn't matter.

00:27:45.273 --> 00:27:45.713
But he's like,

00:27:45.834 --> 00:27:46.974
I need you to understand that there was

00:27:46.994 --> 00:27:49.135
a reason because that was the thing that

00:27:49.195 --> 00:27:49.496
I said.

00:27:49.517 --> 00:27:50.257
Well, for no reason.

00:27:50.297 --> 00:27:51.317
I just break down for no reason.

00:27:51.337 --> 00:27:51.498
He goes,

00:27:51.678 --> 00:27:52.597
there's a giant reason your mom died.

00:27:52.917 --> 00:27:55.420
And the way he paused and said it

00:27:56.099 --> 00:27:58.721
made me have the connection and go, oh.

00:27:59.622 --> 00:28:00.742
I don't need to explain this.

00:28:00.803 --> 00:28:01.643
There's a reason.

00:28:01.962 --> 00:28:02.643
That's cool.

00:28:03.042 --> 00:28:04.084
And now when it happens to me,

00:28:04.144 --> 00:28:05.904
I quite, this happened two,

00:28:05.944 --> 00:28:06.444
three years ago.

00:28:06.865 --> 00:28:08.346
I still think of that conversation with my

00:28:08.405 --> 00:28:09.786
friend and I go, oh, there's a reason.

00:28:10.446 --> 00:28:11.406
I sort of don't need to know what

00:28:11.426 --> 00:28:12.686
it is or I can try to figure

00:28:12.727 --> 00:28:14.188
it out if I don't want this to

00:28:14.248 --> 00:28:14.667
happen.

00:28:14.748 --> 00:28:16.628
But also like there is a reason.

00:28:16.689 --> 00:28:17.950
So I don't have to feel because I

00:28:17.970 --> 00:28:20.750
felt bad about feeling bad.

00:28:20.851 --> 00:28:21.790
And that's not pain,

00:28:21.810 --> 00:28:22.811
but I could see like where there's a

00:28:22.872 --> 00:28:23.271
parallel.

00:28:23.911 --> 00:28:24.672
Oh, absolutely.

00:28:24.951 --> 00:28:25.451
Yeah.

00:28:26.093 --> 00:28:27.134
And, you know,

00:28:27.693 --> 00:28:29.015
it's great that you have this friend.

00:28:29.075 --> 00:28:31.017
And I think he's a great example of

00:28:31.237 --> 00:28:32.518
knowing how to shut the F up.

00:28:32.637 --> 00:28:32.858
Right.

00:28:33.558 --> 00:28:34.680
Like we could all take a note on

00:28:34.700 --> 00:28:35.101
that.

00:28:35.980 --> 00:28:38.804
And it's the same for pain.

00:28:38.844 --> 00:28:41.105
And it's great that you have this friend

00:28:41.145 --> 00:28:43.067
and you have this experience so you could

00:28:43.248 --> 00:28:44.307
see that connection.

00:28:45.288 --> 00:28:48.530
And it's hard for some people to get

00:28:48.590 --> 00:28:48.951
there.

00:28:49.112 --> 00:28:49.392
Right.

00:28:49.491 --> 00:28:52.473
We've been told that you have a brain

00:28:52.913 --> 00:28:53.974
and a nervous system,

00:28:53.994 --> 00:28:54.914
a central nervous system,

00:28:54.954 --> 00:28:55.855
and then you have your body.

00:28:56.076 --> 00:28:56.355
Right.

00:28:56.415 --> 00:28:58.798
And these things don't really impact each

00:28:58.817 --> 00:29:00.979
other and they don't connect for years and

00:29:01.019 --> 00:29:02.240
years and years and decades.

00:29:02.279 --> 00:29:02.500
Right.

00:29:02.519 --> 00:29:04.121
We think about the Descartes model,

00:29:04.181 --> 00:29:05.461
which is kind of just like.

00:29:05.981 --> 00:29:08.364
the precursor to the biomedical model,

00:29:08.384 --> 00:29:09.806
which we've been kind of following for two

00:29:09.826 --> 00:29:10.546
hundred years.

00:29:11.067 --> 00:29:13.088
But biopsychosocial has been around since

00:29:13.108 --> 00:29:15.651
the seventies, nineteen seventies.

00:29:16.392 --> 00:29:19.134
And so we've known about it and they've

00:29:19.173 --> 00:29:21.596
actually done studies about what makes it

00:29:21.635 --> 00:29:24.858
hard for clinicians to implement this,

00:29:25.039 --> 00:29:26.280
even though we know we should be

00:29:26.320 --> 00:29:28.442
practicing in a biopsychosocial framework.

00:29:29.727 --> 00:29:32.628
Part of it is they don't feel comfortable

00:29:33.368 --> 00:29:35.150
understanding it, talking about it.

00:29:35.630 --> 00:29:36.330
And therefore,

00:29:36.391 --> 00:29:38.051
then I'm not going to try to explain

00:29:38.092 --> 00:29:39.711
it to someone else who, you know,

00:29:39.751 --> 00:29:41.192
might be a little bit skeptical.

00:29:41.733 --> 00:29:44.214
And so I think that's an important piece

00:29:44.295 --> 00:29:46.036
of our education as physical therapists

00:29:46.056 --> 00:29:47.737
that we need to have,

00:29:47.797 --> 00:29:50.077
because when we get training on this as

00:29:50.097 --> 00:29:50.878
physical therapists,

00:29:50.898 --> 00:29:53.180
there's also research on this that we are

00:29:53.519 --> 00:29:55.101
excellent at implementing it.

00:29:56.965 --> 00:29:58.487
And so some people say to me like,

00:29:58.527 --> 00:29:58.666
well,

00:29:58.686 --> 00:30:00.288
how do I get there with my patient?

00:30:00.328 --> 00:30:02.589
How do I, if you know, it's,

00:30:02.769 --> 00:30:04.070
it's very easy for someone,

00:30:04.131 --> 00:30:05.952
especially someone who's had a history of

00:30:05.992 --> 00:30:08.414
being told it's all in your head.

00:30:09.194 --> 00:30:10.236
This isn't real.

00:30:10.276 --> 00:30:11.297
There's nothing on the scans.

00:30:11.356 --> 00:30:14.138
Everything's coming back clean for them to

00:30:14.219 --> 00:30:14.739
hear.

00:30:15.400 --> 00:30:17.181
There's a mental emotional component to

00:30:17.201 --> 00:30:18.682
this and it's still real.

00:30:18.821 --> 00:30:20.583
It's still not in your head.

00:30:20.624 --> 00:30:23.105
And that's also a skill that we practice

00:30:23.605 --> 00:30:25.166
in pain science because

00:30:26.740 --> 00:30:28.863
you have to know how to explain it

00:30:28.883 --> 00:30:29.383
to someone.

00:30:29.482 --> 00:30:31.744
You have to know how they can get

00:30:31.825 --> 00:30:32.645
on board with it.

00:30:32.705 --> 00:30:34.086
And some people will come into me and

00:30:34.106 --> 00:30:36.368
they'll say, you know, I've tried this,

00:30:36.409 --> 00:30:37.230
that, and the other,

00:30:37.490 --> 00:30:39.852
and I'm here for whatever, right?

00:30:40.011 --> 00:30:43.615
Like whatever you got, I'm bought in,

00:30:43.734 --> 00:30:44.635
I'm here for it.

00:30:44.695 --> 00:30:45.997
And there are other people that say,

00:30:46.897 --> 00:30:47.958
I don't understand that.

00:30:48.038 --> 00:30:49.179
I'm not interested in that.

00:30:49.319 --> 00:30:50.601
I would like physical therapy.

00:30:51.617 --> 00:30:52.419
And that's okay.

00:30:52.499 --> 00:30:54.039
I'm going to meet you where you are

00:30:54.460 --> 00:30:56.842
at some point during our relationship

00:30:56.882 --> 00:30:57.442
together.

00:30:57.603 --> 00:30:59.963
I might say to you, Hey, you know,

00:31:01.345 --> 00:31:02.506
we've gotten to this point.

00:31:02.586 --> 00:31:03.846
It seems like we've made a certain amount

00:31:03.866 --> 00:31:06.328
of progress and there might be some other

00:31:06.368 --> 00:31:07.670
components to this.

00:31:07.789 --> 00:31:10.531
Would you be open to talking about them?

00:31:10.972 --> 00:31:12.673
So I talk a lot about motivational

00:31:12.733 --> 00:31:14.134
interviewing with my students.

00:31:14.515 --> 00:31:17.076
I talk a lot about shared decision-making

00:31:17.416 --> 00:31:19.199
because there's no amount of me

00:31:20.247 --> 00:31:23.328
forcing education information on you

00:31:23.429 --> 00:31:24.990
that's going to change your mind.

00:31:25.030 --> 00:31:27.112
Right.

00:31:27.152 --> 00:31:28.794
So here's something I always wondered,

00:31:28.933 --> 00:31:30.734
and you mentioned twenty fifteen sort of

00:31:30.755 --> 00:31:32.977
being that look back and names like

00:31:33.017 --> 00:31:36.440
Lorimer Mosley and a lot of pain

00:31:36.480 --> 00:31:37.200
researchers,

00:31:37.380 --> 00:31:39.301
a lot of PTs who sort of embrace

00:31:39.701 --> 00:31:40.282
this.

00:31:40.303 --> 00:31:41.663
I always wondered this.

00:31:42.904 --> 00:31:44.786
How do you explain to students or to

00:31:44.826 --> 00:31:46.627
clinicians in your own clinic or anybody

00:31:47.772 --> 00:31:49.773
how to ask deeper questions without

00:31:50.314 --> 00:31:51.375
feeling like,

00:31:51.734 --> 00:31:53.295
because I graduated in twenty fifteen.

00:31:54.155 --> 00:31:56.136
So I was launched into the world.

00:31:56.317 --> 00:31:57.317
Sorry, I graduated twenty sixteen.

00:31:57.336 --> 00:31:58.518
So I sort of launched into the world

00:31:58.538 --> 00:31:59.038
a year later.

00:31:59.718 --> 00:32:01.058
How do you ask people to ask or

00:32:01.358 --> 00:32:02.900
teach a team to ask deeper questions

00:32:03.220 --> 00:32:04.941
without feeling like they're pretending or

00:32:04.980 --> 00:32:07.241
trying to be a psychologist?

00:32:07.261 --> 00:32:09.241
So that part came in where I was

00:32:09.261 --> 00:32:09.423
like,

00:32:09.502 --> 00:32:11.282
I don't want to pretend I'm doing

00:32:11.323 --> 00:32:12.403
something that I'm not trained to do,

00:32:12.443 --> 00:32:13.284
but this is important.

00:32:16.226 --> 00:32:16.586
I think

00:32:18.095 --> 00:32:20.195
Opening the door is a big piece of

00:32:20.256 --> 00:32:24.377
it and helping someone to recognize that

00:32:24.759 --> 00:32:29.300
our pain is influenced by our thoughts,

00:32:29.361 --> 00:32:30.622
feelings, emotions.

00:32:31.162 --> 00:32:34.243
All pain is processed through areas of our

00:32:34.284 --> 00:32:37.986
brain that process memory and emotion.

00:32:39.184 --> 00:32:42.266
And so every pain has a memory and

00:32:42.286 --> 00:32:43.846
emotion associated with it.

00:32:44.586 --> 00:32:46.586
And sometimes giving people that

00:32:46.606 --> 00:32:49.287
information and then shutting up is

00:32:49.346 --> 00:32:49.887
enough.

00:32:51.528 --> 00:32:55.429
I recently started a podcast with a friend

00:32:55.469 --> 00:32:59.109
who is a twenty six year pain survivor.

00:32:59.150 --> 00:33:01.650
She's had nine shoulder surgeries on the

00:33:01.690 --> 00:33:02.471
same shoulder,

00:33:02.490 --> 00:33:05.371
and it was a result of a traumatic

00:33:05.671 --> 00:33:08.392
accident that she had and

00:33:09.618 --> 00:33:11.359
Her doctor looked at everything.

00:33:11.400 --> 00:33:13.580
I think it was her maybe fourth surgeon

00:33:14.362 --> 00:33:15.021
who said,

00:33:15.521 --> 00:33:17.503
is there anything else you'd like to tell

00:33:17.544 --> 00:33:21.526
me about this?

00:33:21.726 --> 00:33:23.886
And just that, you know,

00:33:23.987 --> 00:33:25.788
when you see somebody start to kind of

00:33:25.887 --> 00:33:26.409
well up,

00:33:27.405 --> 00:33:30.047
tears you start to see the chin quiver

00:33:30.548 --> 00:33:32.588
those are kind of your cues to say

00:33:33.148 --> 00:33:36.410
is there anything else about that that you

00:33:36.430 --> 00:33:38.211
think might be relevant here or you think

00:33:38.250 --> 00:33:40.573
might be important you know there's some

00:33:40.633 --> 00:33:40.913
really

00:33:42.098 --> 00:33:43.840
great research or a growing body of

00:33:43.901 --> 00:33:47.124
evidence that shows us that we're not just

00:33:47.163 --> 00:33:49.625
our physical bodies and things that have

00:33:49.665 --> 00:33:51.367
happened in the past tend to have a

00:33:51.407 --> 00:33:54.471
big impact on our perception of physical

00:33:54.510 --> 00:33:57.512
sensations so you know do you think

00:33:57.554 --> 00:33:58.894
there's anything else that might be

00:34:00.672 --> 00:34:01.593
relevant here.

00:34:03.094 --> 00:34:04.595
You don't have to be a psychologist.

00:34:04.615 --> 00:34:06.355
And I don't train people to try to

00:34:06.415 --> 00:34:08.117
be a fake psychologist.

00:34:08.157 --> 00:34:10.679
That's not in anyone's best interest.

00:34:10.759 --> 00:34:13.141
But when physical therapists use

00:34:14.262 --> 00:34:15.702
psychological techniques,

00:34:16.023 --> 00:34:17.023
they have success.

00:34:17.103 --> 00:34:18.445
And if you think about it,

00:34:18.485 --> 00:34:21.806
you probably have used many of these in

00:34:21.847 --> 00:34:22.847
your treatments already.

00:34:23.856 --> 00:34:25.577
You know, cognitive behavioral therapy,

00:34:25.597 --> 00:34:28.099
you get people to reframe something.

00:34:29.000 --> 00:34:30.380
Acceptance commitment therapy,

00:34:30.521 --> 00:34:33.282
you get them to understand this is your

00:34:33.322 --> 00:34:34.382
reality right now.

00:34:34.422 --> 00:34:36.043
This is where we're starting from.

00:34:36.483 --> 00:34:37.784
This is going to be a little bit

00:34:37.844 --> 00:34:38.465
uncomfortable.

00:34:38.485 --> 00:34:39.965
This is going to be challenging.

00:34:41.326 --> 00:34:42.706
There are a lot of different ways.

00:34:42.867 --> 00:34:45.208
Some of the things that I teach have

00:34:45.268 --> 00:34:47.867
some EMDR basis where we're doing

00:34:47.947 --> 00:34:51.849
bilateral movements or bilateral manual

00:34:51.889 --> 00:34:52.650
treatments.

00:34:53.329 --> 00:34:55.170
So we can use these psychologically

00:34:55.190 --> 00:34:57.831
informed practices without being

00:34:58.311 --> 00:35:01.112
psychologists and be very effective.

00:35:02.742 --> 00:35:04.143
What would you suggest someone read?

00:35:04.222 --> 00:35:06.385
I like to ask people who read and

00:35:06.505 --> 00:35:07.166
speak a lot,

00:35:07.286 --> 00:35:09.088
like where they go for the well and

00:35:09.128 --> 00:35:10.528
who sort of said it really well that

00:35:10.548 --> 00:35:11.369
really impacted you.

00:35:11.429 --> 00:35:12.731
So specifically about pain,

00:35:12.771 --> 00:35:13.992
what lands with you or what do you

00:35:14.032 --> 00:35:14.472
like a lot?

00:35:16.201 --> 00:35:18.762
Yeah, I like, of course,

00:35:18.902 --> 00:35:20.202
The Body Keeps the Score.

00:35:21.402 --> 00:35:22.342
Vander Kolk,

00:35:22.481 --> 00:35:26.043
Peter Levine is certainly a great resource

00:35:26.083 --> 00:35:26.503
there.

00:35:27.483 --> 00:35:29.543
There's also a great book called What

00:35:29.603 --> 00:35:30.603
Happened to You?

00:35:31.463 --> 00:35:33.344
That is by Bruce.

00:35:35.125 --> 00:35:35.664
I'll think of it.

00:35:37.326 --> 00:35:40.606
And he is a psychologist who's worked with

00:35:40.646 --> 00:35:42.766
a lot of children with trauma.

00:35:43.976 --> 00:35:46.380
And he talks a lot about the associative

00:35:46.661 --> 00:35:48.344
learning that happens there.

00:35:48.425 --> 00:35:50.367
So he had a kid that was in

00:35:51.028 --> 00:35:54.255
foster care and there was one particular

00:35:57.096 --> 00:35:59.637
caregiver or teacher that this kid really

00:35:59.717 --> 00:36:01.237
had a problem with and he got really

00:36:01.277 --> 00:36:02.757
aggressive with him and they couldn't

00:36:02.818 --> 00:36:04.038
understand why.

00:36:04.918 --> 00:36:06.639
And the reason he was in foster care

00:36:06.679 --> 00:36:08.659
was because of an abusive parent.

00:36:09.420 --> 00:36:11.701
And when they brought this parent in,

00:36:12.181 --> 00:36:13.661
they had a conversation with the teacher,

00:36:13.742 --> 00:36:15.681
they talked about strategies and things

00:36:15.702 --> 00:36:16.202
like that.

00:36:16.742 --> 00:36:18.003
And it wasn't until they brought this

00:36:18.063 --> 00:36:21.204
parent in and they realized they both wore

00:36:21.423 --> 00:36:22.985
Old Spice cologne.

00:36:24.949 --> 00:36:27.090
And that was this kid's trigger to say,

00:36:28.329 --> 00:36:29.831
you are not a safe person to me.

00:36:30.311 --> 00:36:32.291
And if you think about smell, you know,

00:36:32.331 --> 00:36:33.612
it's so subconscious,

00:36:33.632 --> 00:36:34.871
you don't even need your conscious

00:36:34.911 --> 00:36:35.371
processing.

00:36:35.391 --> 00:36:37.393
It happens almost immediately.

00:36:37.413 --> 00:36:37.932
Yeah.

00:36:38.672 --> 00:36:43.014
Um, also one of the,

00:36:43.175 --> 00:36:44.855
one of the strongest senses tied to

00:36:44.914 --> 00:36:45.255
memory.

00:36:45.396 --> 00:36:46.876
I learned that from a sitcom in the

00:36:46.916 --> 00:36:47.376
nineties.

00:36:48.115 --> 00:36:48.956
That's exactly right.

00:36:49.637 --> 00:36:50.617
That's exactly right.

00:36:51.438 --> 00:36:52.858
And Bruce Perry is his name.

00:36:53.822 --> 00:36:54.663
What happened to you?

00:36:54.983 --> 00:36:57.244
He's written a couple other books as well

00:36:57.284 --> 00:36:57.744
that are great.

00:36:59.543 --> 00:37:02.565
Yeah, and really pain is a memory.

00:37:02.684 --> 00:37:04.125
Chronic pain is a memory.

00:37:05.246 --> 00:37:06.746
And so again,

00:37:06.766 --> 00:37:08.146
when we think about it as a threat

00:37:08.166 --> 00:37:10.567
detection, we think about it as a memory.

00:37:12.047 --> 00:37:13.748
Then we're thinking about treatment in a

00:37:13.807 --> 00:37:16.447
very different way than within traditional

00:37:16.487 --> 00:37:17.668
physical therapy where I just,

00:37:17.889 --> 00:37:19.048
you've got to get stronger.

00:37:19.168 --> 00:37:20.648
You've got to get more mobile.

00:37:20.949 --> 00:37:22.409
You've got to get X, Y, Z.

00:37:24.574 --> 00:37:24.753
All right,

00:37:24.773 --> 00:37:25.735
we have a tradition on the show.

00:37:26.375 --> 00:37:28.237
It is called the parting shot.

00:37:28.257 --> 00:37:31.518
This is the parting shot.

00:37:32.059 --> 00:37:33.440
One last mic drop moment.

00:37:34.141 --> 00:37:34.960
No pressure.

00:37:35.380 --> 00:37:37.503
Just your legacy on the line.

00:37:37.563 --> 00:37:42.445
I want to thank Empower EMR for supporting

00:37:42.465 --> 00:37:42.706
the show.

00:37:42.726 --> 00:37:44.086
If your clinic is stuck on an EMR

00:37:44.106 --> 00:37:44.768
that slows you down,

00:37:44.788 --> 00:37:46.188
Empower gives you cleaner workflows,

00:37:46.228 --> 00:37:48.429
faster documentation and support that

00:37:48.550 --> 00:37:49.471
actually shows up.

00:37:49.550 --> 00:37:52.213
Find them online at EmpowerEMR.com.

00:37:52.233 --> 00:37:52.652
And U.S.

00:37:52.693 --> 00:37:53.434
Physical Therapy.

00:37:55.385 --> 00:37:57.465
A nationwide network of clinics focused on

00:37:57.505 --> 00:37:58.385
developing clinicians,

00:37:58.445 --> 00:37:59.525
supporting career growth,

00:37:59.865 --> 00:38:01.967
and helping PTs build sustainable futures

00:38:02.067 --> 00:38:02.686
in the profession.

00:38:02.726 --> 00:38:05.327
Find them online at usph.com.

00:38:05.387 --> 00:38:07.108
So here's your parting shot question,

00:38:07.527 --> 00:38:08.509
Megan.

00:38:08.748 --> 00:38:10.849
If healthcare providers could change one

00:38:11.349 --> 00:38:14.230
belief about chronic pain over the next

00:38:15.190 --> 00:38:15.909
five years,

00:38:16.289 --> 00:38:18.090
what belief would you make the biggest

00:38:18.130 --> 00:38:19.751
difference for patients?

00:38:19.791 --> 00:38:21.552
What would your priority for a belief

00:38:21.592 --> 00:38:22.132
change be?

00:38:24.277 --> 00:38:26.521
my priority for a belief change would be

00:38:26.581 --> 00:38:29.184
that patients are not just their physical

00:38:29.224 --> 00:38:34.829
bodies physical therapy is personal and

00:38:34.889 --> 00:38:38.454
when we provide whole person care and

00:38:38.534 --> 00:38:42.498
create a connection with our patients we

00:38:42.577 --> 00:38:45.661
can really make change with chronic pain

00:38:47.496 --> 00:38:49.922
connect with Megan on Instagram.

00:38:49.942 --> 00:38:51.585
I'll put the link in the bio,

00:38:51.626 --> 00:38:52.367
as they always say,

00:38:52.407 --> 00:38:53.730
or the show notes will do that.

00:38:53.769 --> 00:38:55.373
But thanks for doing this.

00:38:55.434 --> 00:38:55.934
I appreciate it.

00:38:56.597 --> 00:38:56.916
Yeah.

00:38:56.936 --> 00:38:58.019
Thank you so much for having me.

00:39:00.338 --> 00:39:01.400
That's it for this one,

00:39:01.679 --> 00:39:03.362
but we're just getting warmed up.

00:39:03.822 --> 00:39:05.744
Smash follow, send it to a friend,

00:39:05.943 --> 00:39:07.606
or crank up the next episode.

00:39:08.146 --> 00:39:09.067
Want to go deeper?

00:39:09.487 --> 00:39:13.532
Hit us at pgpinecast.com or find us on

00:39:13.592 --> 00:39:16.114
YouTube and socials at pgpinecast.

00:39:16.554 --> 00:39:18.836
And legally, none of this was advice.

00:39:18.936 --> 00:39:20.657
It's for entertainment purposes only.

00:39:20.697 --> 00:39:21.239
Bulls**t!

00:39:22.320 --> 00:39:22.900
See, Keith?

00:39:23.121 --> 00:39:24.181
We read the script.

00:39:24.481 --> 00:39:25.123
Happy now?