WEBVTT 00:00:00.189 --> 00:00:02.232 magic afterwards. 00:00:03.033 --> 00:00:04.956 Adrian, welcome to the AM podcast. 00:00:04.996 --> 00:00:05.658 Thanks for coming on. 00:00:06.339 --> 00:00:07.219 Thanks for having me, Jimmy. 00:00:07.240 --> 00:00:08.082 I appreciate being here. 00:00:08.894 --> 00:00:09.794 This is the teaser. 00:00:09.894 --> 00:00:11.394 This is the thing before the thing, 00:00:11.635 --> 00:00:12.936 because the AOMT conference 00:00:12.996 --> 00:00:14.377 is coming up in just a couple of months. 00:00:14.397 --> 00:00:16.358 You guys are doing this, uh, St. 00:00:16.417 --> 00:00:18.379 Louis, Missouri in October, 00:00:18.419 --> 00:00:19.839 which is a great time to be in St. 00:00:19.879 --> 00:00:20.179 Louis. 00:00:20.739 --> 00:00:22.400 AOMT.org is where people can 00:00:22.440 --> 00:00:23.501 find more information. 00:00:23.841 --> 00:00:25.222 You're speaking there this year. 00:00:25.742 --> 00:00:25.983 What do you, 00:00:26.202 --> 00:00:27.504 what do you think about that conference? 00:00:27.544 --> 00:00:28.204 How does that feel? 00:00:28.224 --> 00:00:29.164 What do you, what do you, 00:00:29.204 --> 00:00:30.204 what do you look forward to 00:00:30.225 --> 00:00:30.986 in an event like that? 00:00:31.626 --> 00:00:33.627 Yeah, the AOMT conference is, um, you know, 00:00:33.646 --> 00:00:34.307 it's really interesting. 00:00:34.368 --> 00:00:35.787 I'm actually a manual therapist, 00:00:35.807 --> 00:00:36.749 so this is a background. 00:00:37.686 --> 00:00:38.726 that is actually my stomping 00:00:38.767 --> 00:00:40.127 grounds and then you move 00:00:40.146 --> 00:00:41.207 heavy into the pain world 00:00:41.847 --> 00:00:42.868 and it's always good to go 00:00:42.887 --> 00:00:44.009 back to your roots I have 00:00:44.088 --> 00:00:45.029 always loved it I like 00:00:45.088 --> 00:00:46.088 learning from them I like 00:00:46.128 --> 00:00:48.170 learning at these events 00:00:48.630 --> 00:00:49.470 but then also now bringing 00:00:49.490 --> 00:00:50.451 the pain stuff with us and 00:00:50.470 --> 00:00:51.670 coming hey guys annual 00:00:51.691 --> 00:00:52.692 therapist moving into the 00:00:52.712 --> 00:00:54.552 pain world um you know this 00:00:54.593 --> 00:00:55.412 is maybe how we should look 00:00:55.432 --> 00:00:57.173 at things so I i love it um 00:00:57.213 --> 00:00:58.073 I think I'm going to be 00:00:58.113 --> 00:00:59.274 honest sometimes I have a 00:00:59.293 --> 00:01:00.814 love-hate relationship because um 00:01:01.283 --> 00:01:02.103 Sometimes we're stuck in 00:01:02.124 --> 00:01:03.246 this old manual model, 00:01:03.305 --> 00:01:03.987 and I think people know 00:01:04.007 --> 00:01:04.628 what I'm talking about. 00:01:05.067 --> 00:01:05.688 And on the flip side, 00:01:05.709 --> 00:01:07.251 we got this painting that is cool. 00:01:07.311 --> 00:01:09.414 It's altruistic, but you got to apply it, 00:01:09.453 --> 00:01:10.335 which I think this is the 00:01:10.376 --> 00:01:11.316 perfect venue for it. 00:01:11.751 --> 00:01:13.132 where they combine both of 00:01:13.173 --> 00:01:13.834 those two worlds. 00:01:13.873 --> 00:01:14.213 So, yeah. 00:01:14.414 --> 00:01:14.674 Okay. 00:01:15.135 --> 00:01:17.156 Well, it sounds a little revolutionary, 00:01:17.177 --> 00:01:18.197 and that's my first question. 00:01:18.216 --> 00:01:20.198 You use this phrase, pain revolution. 00:01:20.840 --> 00:01:23.201 Help describe that and help 00:01:23.242 --> 00:01:24.563 people understand it so 00:01:24.742 --> 00:01:25.963 they can either make their 00:01:26.004 --> 00:01:27.305 own sign and march with you 00:01:27.364 --> 00:01:28.965 on this pain revolution and 00:01:29.006 --> 00:01:30.287 its significance really in 00:01:30.628 --> 00:01:31.888 orthopedic physical therapy. 00:01:33.129 --> 00:01:33.930 How and why should people 00:01:33.971 --> 00:01:34.971 join in on this revolution? 00:01:35.751 --> 00:01:36.472 Well, it's happening, 00:01:36.593 --> 00:01:38.334 regardless if people join or not. 00:01:38.353 --> 00:01:39.075 That's the easy part. 00:01:39.688 --> 00:01:41.609 In the early 1990s, 00:01:41.650 --> 00:01:43.010 when I got into this whole 00:01:43.051 --> 00:01:45.393 world of pain science, people kept saying, 00:01:45.412 --> 00:01:46.274 there's a pain revolution, 00:01:46.313 --> 00:01:46.933 pain revolution. 00:01:46.974 --> 00:01:48.596 I kept looking, well, where is this? 00:01:48.656 --> 00:01:51.278 And it was four guys doing something cool. 00:01:52.638 --> 00:01:54.141 But what's happened now is, Jimmy, 00:01:54.381 --> 00:01:55.421 this stuff has now reached 00:01:55.701 --> 00:01:59.204 a scale that is, the tide is coming. 00:01:59.245 --> 00:02:00.165 There's nothing you can do about it. 00:02:00.546 --> 00:02:01.447 It's in PT schools. 00:02:01.486 --> 00:02:02.287 It's in OT schools. 00:02:02.328 --> 00:02:03.147 It's in medical schools. 00:02:03.168 --> 00:02:03.868 There's textbooks. 00:02:04.209 --> 00:02:05.329 It's at every presentation. 00:02:05.390 --> 00:02:07.231 The joke of AOND is actually, 00:02:07.762 --> 00:02:08.842 The tweet that went out a 00:02:08.882 --> 00:02:09.681 few years ago and said, 00:02:09.723 --> 00:02:10.643 I showed up at the AONT 00:02:10.703 --> 00:02:12.182 conference only to have a 00:02:12.242 --> 00:02:13.383 pain conference breakout. 00:02:14.204 --> 00:02:15.903 It is now so embedded in 00:02:16.104 --> 00:02:17.343 everything that it doesn't matter. 00:02:17.364 --> 00:02:18.224 It's going to happen anyway. 00:02:18.604 --> 00:02:20.205 So the revolution is really 00:02:20.844 --> 00:02:23.126 to take what you were taught, your basics, 00:02:23.145 --> 00:02:23.846 your foundations, 00:02:23.885 --> 00:02:25.466 which I still think is phenomenal, 00:02:25.806 --> 00:02:26.606 but then pushing the 00:02:26.787 --> 00:02:27.806 envelope and taking on the 00:02:27.866 --> 00:02:28.866 new concepts of pain 00:02:28.887 --> 00:02:30.867 science is really what it is. 00:02:31.027 --> 00:02:31.707 It's happening. 00:02:32.207 --> 00:02:33.769 So in this case, what's the easiest way? 00:02:33.829 --> 00:02:35.489 Come to AONT, come take the conference. 00:02:35.953 --> 00:02:36.913 Take these sessions that are 00:02:36.932 --> 00:02:37.614 a little bit on the fringe 00:02:37.674 --> 00:02:40.134 of pain science versus just orthopedics, 00:02:40.215 --> 00:02:40.435 right? 00:02:40.514 --> 00:02:41.555 And then I think that is how 00:02:41.574 --> 00:02:42.596 people start getting into it. 00:02:43.896 --> 00:02:44.097 All right, 00:02:44.116 --> 00:02:46.016 this next one goes more specific. 00:02:46.177 --> 00:02:47.397 We throw this term around, 00:02:47.937 --> 00:02:49.079 nociplastic pain. 00:02:50.058 --> 00:02:50.939 How do you explain it to 00:02:50.960 --> 00:02:52.139 someone who wants to learn more? 00:02:52.159 --> 00:02:53.540 Maybe someone who showed up 00:02:53.561 --> 00:02:54.681 to the AOMS conference at a 00:02:54.721 --> 00:02:55.861 pain conference broke out. 00:02:56.521 --> 00:02:57.562 How do you describe it and 00:02:57.663 --> 00:02:59.582 why is it clinically challenging? 00:02:59.663 --> 00:03:00.544 Maybe that's why people 00:03:00.584 --> 00:03:02.205 avoid it or don't understand it. 00:03:02.685 --> 00:03:02.944 Yeah. 00:03:03.651 --> 00:03:04.832 Well, the first thing we do in medicine, 00:03:04.872 --> 00:03:05.813 if we don't understand something, 00:03:05.834 --> 00:03:06.614 we change the name. 00:03:06.713 --> 00:03:08.996 So this phenomenon has been 00:03:09.036 --> 00:03:09.616 called central 00:03:09.637 --> 00:03:10.576 sensitization for the 00:03:10.657 --> 00:03:11.858 longest time I've been around. 00:03:12.658 --> 00:03:14.340 And in the last few years, the scientists, 00:03:14.360 --> 00:03:15.260 the academics have changed 00:03:15.281 --> 00:03:16.421 it to nociplastic pain. 00:03:16.461 --> 00:03:17.643 Long story short, 00:03:18.203 --> 00:03:18.984 it's where the central 00:03:19.024 --> 00:03:19.965 nervous system actually 00:03:20.004 --> 00:03:21.545 starts driving your pain experience. 00:03:21.566 --> 00:03:22.366 So we have normal, 00:03:22.406 --> 00:03:23.987 healthy information coming 00:03:24.168 --> 00:03:25.188 into the central nervous 00:03:25.209 --> 00:03:26.969 system that then amplifies this. 00:03:27.491 --> 00:03:28.673 So now things like light 00:03:28.752 --> 00:03:29.894 touch becomes uncomfortable, 00:03:29.954 --> 00:03:31.014 which we call allodynia. 00:03:31.354 --> 00:03:32.435 We get hyperalgesia. 00:03:32.936 --> 00:03:34.056 And for the manual therapist, 00:03:34.097 --> 00:03:35.456 it becomes tricky because I 00:03:35.477 --> 00:03:37.479 was taught way back dozens 00:03:37.498 --> 00:03:38.438 and dozens of years ago 00:03:38.960 --> 00:03:39.939 that when I palpate and 00:03:39.980 --> 00:03:41.401 poke in areas and people say, ooh, 00:03:41.421 --> 00:03:43.043 it's painful there, the problem is there. 00:03:43.582 --> 00:03:45.104 But in these patients, unfortunately, 00:03:45.123 --> 00:03:45.723 no matter where you poke, 00:03:45.743 --> 00:03:46.664 it's sensitive because the 00:03:46.745 --> 00:03:48.006 system amplifies it. 00:03:48.621 --> 00:03:50.042 So your tests that you use, 00:03:50.062 --> 00:03:51.082 your treatments that you 00:03:51.282 --> 00:03:52.924 use becomes a little bit less reliable. 00:03:53.484 --> 00:03:54.164 In the old days, 00:03:54.305 --> 00:03:55.425 if I would poke at an area 00:03:55.466 --> 00:03:56.366 and it was a joint, 00:03:56.567 --> 00:03:57.706 then that's the problem. 00:03:58.147 --> 00:04:00.088 But now those tests are not that reliable. 00:04:00.109 --> 00:04:01.750 So we had to change the way we test you. 00:04:01.770 --> 00:04:02.871 We've got to change the way 00:04:02.890 --> 00:04:03.872 we treat you and approach 00:04:03.912 --> 00:04:04.532 you accordingly. 00:04:04.592 --> 00:04:06.894 So it is challenging. 00:04:07.014 --> 00:04:08.594 And it's about one in five patients, 00:04:08.634 --> 00:04:09.496 what the data tells us, 00:04:09.515 --> 00:04:10.776 walk into private practice 00:04:10.856 --> 00:04:12.457 or outpatient therapy has 00:04:12.518 --> 00:04:13.617 central sensitization or 00:04:13.638 --> 00:04:14.558 nociplastic pain. 00:04:15.199 --> 00:04:17.040 And they are just challenging. 00:04:17.553 --> 00:04:18.415 The easy thing is, Jimmy, 00:04:18.454 --> 00:04:19.375 I'll just say this. 00:04:20.016 --> 00:04:20.937 Every therapist I've ever 00:04:20.976 --> 00:04:22.077 talked to can sing this song. 00:04:22.197 --> 00:04:22.778 Where do they hurt? 00:04:23.238 --> 00:04:23.598 Everywhere. 00:04:23.899 --> 00:04:24.560 What makes them better? 00:04:25.060 --> 00:04:25.341 Nothing. 00:04:25.420 --> 00:04:26.040 What makes them worse? 00:04:26.360 --> 00:04:26.701 Everything. 00:04:27.862 --> 00:04:29.103 I'm not trying to be funny about it. 00:04:29.163 --> 00:04:29.944 I don't make fun of it. 00:04:30.004 --> 00:04:31.305 I spend my life dedicating. 00:04:31.466 --> 00:04:33.307 But there's this commonality 00:04:33.346 --> 00:04:34.127 in the clinic we see. 00:04:34.148 --> 00:04:35.408 These patients are challenging. 00:04:35.809 --> 00:04:36.850 We don't know what to do with them. 00:04:36.870 --> 00:04:38.512 We're not trained well to work with them. 00:04:38.872 --> 00:04:39.593 And that is why it's 00:04:39.632 --> 00:04:40.673 important for us to take it 00:04:40.692 --> 00:04:41.374 to that next level. 00:04:43.697 --> 00:04:44.858 Do you see the people that 00:04:45.017 --> 00:04:46.137 attend a conference like 00:04:46.177 --> 00:04:47.178 the AOMT conference, 00:04:47.319 --> 00:04:49.100 they're searching for 00:04:49.199 --> 00:04:50.461 answers to things like this 00:04:50.500 --> 00:04:51.120 because they're so 00:04:51.321 --> 00:04:52.562 frustrated by not being 00:04:52.622 --> 00:04:54.223 able to help those patients 00:04:54.242 --> 00:04:55.002 when they come across them 00:04:55.023 --> 00:04:55.562 in their clinics? 00:04:56.783 --> 00:04:58.185 Yeah, I'd probably say some of them. 00:04:58.264 --> 00:04:59.605 I mean, that is how I got there. 00:04:59.644 --> 00:05:00.446 People always ask me, 00:05:00.485 --> 00:05:01.726 how did you get into pain science? 00:05:01.766 --> 00:05:02.466 Well, I failed. 00:05:03.146 --> 00:05:04.187 The tools I had, 00:05:04.228 --> 00:05:05.048 and I was trained by some 00:05:05.067 --> 00:05:05.928 of the best people on this 00:05:06.009 --> 00:05:06.809 planet with the biggest 00:05:06.848 --> 00:05:08.230 names that people would hang on to. 00:05:09.290 --> 00:05:10.372 And I couldn't help them. 00:05:10.451 --> 00:05:12.192 And so we went to this payment side, 00:05:12.213 --> 00:05:13.494 which made it filled in a 00:05:13.514 --> 00:05:14.134 lot of the gaps. 00:05:14.634 --> 00:05:16.014 So I would argue that at AOMT, 00:05:16.035 --> 00:05:17.295 we're going to get people 00:05:17.315 --> 00:05:18.997 that have maybe tried their tools, 00:05:19.036 --> 00:05:21.177 they trade, and they've got to a limit. 00:05:21.218 --> 00:05:22.178 I don't know what to do now. 00:05:23.218 --> 00:05:23.819 That's good for you. 00:05:24.620 --> 00:05:25.961 AOMT is also very progressive. 00:05:26.021 --> 00:05:27.401 These people that attend 00:05:27.482 --> 00:05:28.663 AOMT are the tip of the spear. 00:05:28.682 --> 00:05:29.603 They're the best of the best. 00:05:30.043 --> 00:05:31.124 They are people that read. 00:05:31.144 --> 00:05:32.225 They read our articles. 00:05:33.355 --> 00:05:34.797 Trust me, they show up and they'll ask me, 00:05:34.857 --> 00:05:37.278 hey, you remember that paper on line 27, 00:05:37.278 --> 00:05:38.098 paragraph three? 00:05:38.959 --> 00:05:40.740 I'm like, whoa, dude, I wrote the paper. 00:05:40.761 --> 00:05:41.641 I don't even remember. 00:05:42.062 --> 00:05:43.223 So I think it's a little bit of both. 00:05:43.283 --> 00:05:44.283 I think there is the, 00:05:44.663 --> 00:05:45.463 I don't know what to do. 00:05:45.684 --> 00:05:46.625 Adrian, please help me. 00:05:47.004 --> 00:05:47.846 But there's also the, hey, 00:05:47.906 --> 00:05:48.826 I'm really into this. 00:05:48.867 --> 00:05:49.586 This makes sense. 00:05:49.627 --> 00:05:51.168 And I want to take this to the next level. 00:05:51.187 --> 00:05:52.829 So it's a little bit of both. 00:05:53.750 --> 00:05:54.089 Yeah, 00:05:54.110 --> 00:05:55.711 I think it's one of those two 00:05:55.730 --> 00:05:56.911 directions why people would 00:05:56.932 --> 00:05:58.192 do this specifically here. 00:05:58.817 --> 00:05:59.036 Yeah. 00:05:59.137 --> 00:06:00.057 Let's talk about a different 00:06:00.076 --> 00:06:00.918 phrase that I'm not even 00:06:00.958 --> 00:06:03.197 sure I came across when I 00:06:03.237 --> 00:06:04.158 was in PT school. 00:06:04.759 --> 00:06:05.358 Help me understand the 00:06:05.399 --> 00:06:06.738 concept of high impact 00:06:06.819 --> 00:06:08.540 chronic pain and how it's 00:06:08.600 --> 00:06:10.220 emerged really in clinical practice. 00:06:10.461 --> 00:06:12.021 What is this when this term comes up? 00:06:12.100 --> 00:06:12.920 Or is this another word 00:06:12.961 --> 00:06:14.442 that's just been given a new term? 00:06:15.341 --> 00:06:15.502 No, 00:06:15.521 --> 00:06:17.723 this is actually a subset of chronic 00:06:17.762 --> 00:06:18.002 pain. 00:06:18.023 --> 00:06:19.043 So, you know, 00:06:19.362 --> 00:06:20.423 it's not as if chronic pain 00:06:20.463 --> 00:06:21.084 is bad enough. 00:06:21.663 --> 00:06:22.983 There's a subgroup within 00:06:23.043 --> 00:06:24.865 chronic pain that's even worse. 00:06:24.884 --> 00:06:24.925 It 00:06:25.740 --> 00:06:26.802 And again, I'm not making fun of it. 00:06:26.822 --> 00:06:28.625 They just if you read the research, 00:06:28.685 --> 00:06:30.208 it just says there's a group of people. 00:06:30.228 --> 00:06:31.730 If you look at one in four 00:06:31.769 --> 00:06:32.711 people in this world suffer 00:06:32.730 --> 00:06:33.713 from persistent pain on 00:06:33.733 --> 00:06:34.613 some regular basis. 00:06:35.055 --> 00:06:36.677 And within that subset, 00:06:37.036 --> 00:06:38.379 there is a smaller subset 00:06:38.399 --> 00:06:40.242 that this is really impacting them. 00:06:40.680 --> 00:06:41.641 And there's criteria in 00:06:41.661 --> 00:06:42.581 terms of how it impacts 00:06:42.622 --> 00:06:43.562 their function and their 00:06:43.603 --> 00:06:45.305 ability to literally get 00:06:45.345 --> 00:06:46.064 along in their life. 00:06:46.185 --> 00:06:48.086 And so we need to do even more for them. 00:06:48.708 --> 00:06:49.788 And so if you go search for 00:06:50.189 --> 00:06:51.531 high impact chronic pain on the internet, 00:06:51.571 --> 00:06:52.250 you're gonna find it in 00:06:52.290 --> 00:06:53.833 complex conditions like 00:06:54.452 --> 00:06:55.374 chronic low back pain and 00:06:55.394 --> 00:06:57.355 fibromyalgia and knee osteoarthritis. 00:06:57.857 --> 00:06:59.197 And so it's just people that 00:06:59.218 --> 00:07:01.779 are really affected even more so. 00:07:03.252 --> 00:07:04.632 I don't particularly care for it. 00:07:04.672 --> 00:07:05.653 I'll be honest with people. 00:07:05.932 --> 00:07:08.713 I think, you know, I'm a clinician. 00:07:08.853 --> 00:07:09.973 I've always been a clinician. 00:07:10.033 --> 00:07:11.473 I think of the clinical idea. 00:07:12.033 --> 00:07:12.894 And I just hate the idea of 00:07:12.934 --> 00:07:13.853 going to a patient and saying, you know, 00:07:13.874 --> 00:07:14.593 it's not bad enough that 00:07:14.634 --> 00:07:15.413 you have chronic pain. 00:07:15.454 --> 00:07:16.535 You have the worst chronic 00:07:16.555 --> 00:07:17.595 pain we've got called 00:07:17.615 --> 00:07:18.475 high-impact chronic pain. 00:07:18.514 --> 00:07:19.995 Now, I'm not making fun of it. 00:07:20.035 --> 00:07:21.156 The scientists that do the work, 00:07:21.235 --> 00:07:22.036 I know who they are. 00:07:22.055 --> 00:07:23.235 I know that they do amazing things. 00:07:23.295 --> 00:07:24.036 I think the world of them. 00:07:24.055 --> 00:07:24.755 I read their stuff. 00:07:26.416 --> 00:07:28.036 We have not even got chronic pain right. 00:07:29.312 --> 00:07:30.331 And now we're saying, hey, 00:07:30.552 --> 00:07:32.293 you guys are not getting this right, 00:07:32.312 --> 00:07:33.833 but you've got to do even more for this. 00:07:33.853 --> 00:07:36.713 I think it's a little, it's tricky, 00:07:37.834 --> 00:07:39.254 but I understand why they're doing it. 00:07:39.293 --> 00:07:40.293 There's a subgroup of people 00:07:40.314 --> 00:07:41.553 that need even more. 00:07:42.153 --> 00:07:42.913 And that is why they're 00:07:42.934 --> 00:07:43.875 identified according. 00:07:43.975 --> 00:07:45.555 And I may be missing the whole point, 00:07:45.574 --> 00:07:47.055 but I've read as much as I can in it. 00:07:47.995 --> 00:07:49.115 I'm just a little concerned 00:07:49.136 --> 00:07:50.295 because in the clinic side, 00:07:50.336 --> 00:07:51.435 a patient will walk in and say, no, 00:07:51.475 --> 00:07:52.336 I don't have chronic pain. 00:07:52.716 --> 00:07:54.055 I have high impact chronic pain. 00:07:54.096 --> 00:07:55.177 And that's just another setup. 00:07:55.497 --> 00:07:56.456 It's like I got a very rare 00:07:56.536 --> 00:07:57.516 case of frozen shoulder. 00:07:59.041 --> 00:08:01.642 You know, it's unfortunately, 00:08:01.663 --> 00:08:03.463 I think for the patient side, 00:08:03.584 --> 00:08:05.485 it's a cry for more help. 00:08:05.584 --> 00:08:06.925 Hey, you guys aren't listening. 00:08:06.966 --> 00:08:07.466 I need help. 00:08:07.906 --> 00:08:08.826 So I'm just I'm always 00:08:08.887 --> 00:08:09.947 worried about these labels 00:08:09.987 --> 00:08:10.687 we add on to it. 00:08:10.747 --> 00:08:11.708 But that was going to be my 00:08:11.747 --> 00:08:12.627 follow up was do you think 00:08:12.668 --> 00:08:13.509 throwing an additional 00:08:13.548 --> 00:08:16.009 label on that helps or harms? 00:08:16.850 --> 00:08:17.550 I think it harms. 00:08:17.630 --> 00:08:18.391 I don't think it doesn't 00:08:18.430 --> 00:08:19.271 change one bit for a 00:08:19.312 --> 00:08:20.891 clinician in this country. 00:08:21.012 --> 00:08:22.132 If a patient walk in the clinic, 00:08:22.952 --> 00:08:23.774 Jimmy walks in the clinic. 00:08:23.814 --> 00:08:25.074 Hey, Jimmy, what brings you here? 00:08:25.134 --> 00:08:25.875 I get chronic pain. 00:08:26.375 --> 00:08:28.096 I know what I can and cannot do with you. 00:08:29.255 --> 00:08:30.416 An hour later, Jenny walks in. 00:08:30.437 --> 00:08:31.336 Hey, Jenny, what brings you here? 00:08:31.377 --> 00:08:32.457 I've got high-impact chronic pain. 00:08:32.798 --> 00:08:33.798 Nothing's changed for me, 00:08:34.798 --> 00:08:35.519 except for the fact that 00:08:35.538 --> 00:08:36.859 I'm probably thinking like, oh, crap, 00:08:36.879 --> 00:08:37.799 this is even worse. 00:08:37.820 --> 00:08:38.419 It's going to be even a 00:08:38.440 --> 00:08:39.260 worse day in the clinic. 00:08:39.721 --> 00:08:40.341 It doesn't change. 00:08:40.360 --> 00:08:42.042 I still have the tools that 00:08:42.062 --> 00:08:44.043 I have in front of me. 00:08:44.482 --> 00:08:46.524 On a national scale, at a higher scale, 00:08:47.024 --> 00:08:48.303 you can talk about multidisciplinary, 00:08:48.345 --> 00:08:49.024 interdisciplinary, 00:08:49.225 --> 00:08:50.264 but we're not even there yet. 00:08:50.325 --> 00:08:51.686 So I apologize to the people 00:08:51.725 --> 00:08:52.865 that are listening that's 00:08:52.885 --> 00:08:53.746 probably involved in the 00:08:53.787 --> 00:08:54.486 gathering or whatever, 00:08:54.527 --> 00:08:56.868 but I'm a little concerned 00:08:56.927 --> 00:08:58.609 where we go with labeling, unfortunately. 00:08:59.836 --> 00:09:02.258 It can get counterproductive 00:09:03.339 --> 00:09:05.061 in certain situations. 00:09:05.542 --> 00:09:06.221 If I was a patient, 00:09:06.283 --> 00:09:07.224 I'd be catastrophizing. 00:09:07.303 --> 00:09:08.804 It's not bad enough that I 00:09:08.825 --> 00:09:09.586 get chronic pain. 00:09:09.625 --> 00:09:11.368 I get worse than when there is, right? 00:09:12.219 --> 00:09:13.600 It's like, wait a minute, it's not that. 00:09:13.840 --> 00:09:14.000 I mean, 00:09:14.039 --> 00:09:15.020 it's a lot bigger than three years. 00:09:15.201 --> 00:09:16.322 So you said a second ago, hey, 00:09:16.721 --> 00:09:17.562 if Jimmy walks in with 00:09:17.602 --> 00:09:19.224 chronic pain or high impact chronic pain, 00:09:19.244 --> 00:09:20.085 you still have the same 00:09:20.225 --> 00:09:21.865 tools available to you to 00:09:21.946 --> 00:09:22.746 treat that person. 00:09:23.246 --> 00:09:24.548 So let's go to let's go to 00:09:24.607 --> 00:09:26.729 tools and tools or skills and techniques. 00:09:26.749 --> 00:09:28.870 So you said at the outset of 00:09:28.910 --> 00:09:29.630 this conversation, 00:09:29.671 --> 00:09:32.033 you're a manual therapist to, you know, 00:09:32.293 --> 00:09:34.134 found this this study of pain. 00:09:34.274 --> 00:09:35.735 What specific pain science 00:09:35.775 --> 00:09:36.917 skills and techniques? 00:09:37.576 --> 00:09:38.577 Do you think manual 00:09:38.618 --> 00:09:40.099 therapists should develop 00:09:40.119 --> 00:09:42.039 to better manage complex 00:09:42.120 --> 00:09:42.980 cases like some of them 00:09:43.019 --> 00:09:43.681 we're talking about? 00:09:44.160 --> 00:09:46.601 How much time we got, Jimmy? 00:09:46.761 --> 00:09:49.583 Yeah, that's a good question. 00:09:49.783 --> 00:09:52.005 I think a good start would 00:09:52.025 --> 00:09:53.385 be to understand pain, 00:09:54.326 --> 00:09:55.868 to really understand the biology of pain. 00:09:55.888 --> 00:09:56.548 The biggest thing, 00:09:56.587 --> 00:09:57.469 the hardest thing in pain 00:09:57.489 --> 00:09:59.289 science right now is pain phenotyping. 00:09:59.750 --> 00:10:00.370 The fact that there are 00:10:00.409 --> 00:10:01.270 different kinds of pain. 00:10:01.291 --> 00:10:02.951 You already mentioned nociplastic pain. 00:10:03.561 --> 00:10:05.701 When patients come in, pain isn't pain. 00:10:05.761 --> 00:10:06.601 There is pain that's driven 00:10:06.642 --> 00:10:08.342 by nociceptive input, 00:10:08.363 --> 00:10:09.703 which is nociceptive-driven pain, 00:10:09.724 --> 00:10:11.804 which is kind of our bread and butter. 00:10:12.485 --> 00:10:13.745 It's sprains, strains, and stuff. 00:10:14.065 --> 00:10:14.846 Man, we're good at this. 00:10:14.946 --> 00:10:16.365 We are so stinking good at this. 00:10:16.907 --> 00:10:17.927 Peripheral neuropathic pain, 00:10:17.947 --> 00:10:19.048 which is your radiculopathies, 00:10:19.087 --> 00:10:19.927 carpal tunnel, whatever. 00:10:19.988 --> 00:10:21.528 If you understand neurodynamics, 00:10:21.889 --> 00:10:23.009 nerve movement and stuff, 00:10:23.028 --> 00:10:24.110 you'll be okay with that one. 00:10:24.129 --> 00:10:25.549 And then we get nociplastic. 00:10:25.570 --> 00:10:27.350 So for a manual therapist to understand, 00:10:27.370 --> 00:10:28.172 there are really three 00:10:28.231 --> 00:10:29.251 buckets that people show up. 00:10:30.053 --> 00:10:31.354 And for this bucket, we do this. 00:10:31.394 --> 00:10:32.434 For this bucket, we do that. 00:10:32.475 --> 00:10:33.434 For this bucket, we do that. 00:10:33.495 --> 00:10:34.975 In terms of examination and treatment, 00:10:35.355 --> 00:10:36.174 we've done a lot of this 00:10:36.255 --> 00:10:37.375 actually at AONT before. 00:10:37.416 --> 00:10:38.375 This will continue on. 00:10:38.416 --> 00:10:39.235 It's a lot of this stuff 00:10:39.255 --> 00:10:40.756 being put out there. 00:10:40.777 --> 00:10:43.017 But we have to match the examinations, 00:10:43.096 --> 00:10:44.738 the vigor, the intensity, 00:10:45.118 --> 00:10:46.118 the duration of our 00:10:46.158 --> 00:10:47.298 examinations based on which 00:10:47.357 --> 00:10:48.158 bucket they sit in. 00:10:48.597 --> 00:10:49.778 The treatments must shift 00:10:49.818 --> 00:10:51.499 from nociceptive is going 00:10:51.519 --> 00:10:52.578 to be very traditionally 00:10:52.658 --> 00:10:53.440 orthopedic-based. 00:10:53.480 --> 00:10:55.320 Jimmy, lay down, crack your back, 00:10:55.340 --> 00:10:56.980 you sit up and go, oh, jeez, thanks, 00:10:57.019 --> 00:10:57.640 Aidan, I'm good. 00:10:57.941 --> 00:10:59.100 I'm going to go home, right? 00:10:59.990 --> 00:11:01.131 Whereas that technique does 00:11:01.192 --> 00:11:02.131 not work in the last 00:11:02.491 --> 00:11:03.893 patient group with nociplastic. 00:11:04.192 --> 00:11:05.253 You manipulate them and they 00:11:05.452 --> 00:11:07.894 flare and it takes a week 00:11:07.913 --> 00:11:09.235 to calm that system down. 00:11:09.414 --> 00:11:10.695 Or they say, oh, that was good. 00:11:10.735 --> 00:11:11.595 Can you do my neck now? 00:11:11.875 --> 00:11:12.995 And they become addicted to your hand. 00:11:13.015 --> 00:11:15.277 So we have to match the treatments, 00:11:15.336 --> 00:11:16.756 especially in manual therapy, 00:11:17.437 --> 00:11:19.457 because we can often flare them. 00:11:19.738 --> 00:11:21.479 We can make them addicted to our hands. 00:11:21.818 --> 00:11:23.340 So it's a beautiful balance, 00:11:23.360 --> 00:11:24.559 but you must know what kind 00:11:24.580 --> 00:11:25.461 of pain you're dealing with. 00:11:25.980 --> 00:11:26.120 Yeah. 00:11:26.860 --> 00:11:27.740 Talking about balance, 00:11:27.961 --> 00:11:28.841 we're talking about pain. 00:11:29.947 --> 00:11:31.727 on a podcast about a 00:11:31.788 --> 00:11:33.788 conference from AOMT with manual therapy. 00:11:34.288 --> 00:11:36.250 So should it be pain 00:11:36.909 --> 00:11:38.311 neuroscience education and 00:11:38.390 --> 00:11:39.750 manual therapy education, 00:11:39.850 --> 00:11:42.172 or should these things be combined? 00:11:42.552 --> 00:11:43.932 Should you not be able to separate them? 00:11:45.474 --> 00:11:46.553 I think they go hand in hand, 00:11:46.573 --> 00:11:47.534 and that is exactly one of 00:11:47.554 --> 00:11:48.434 the sessions we're doing, 00:11:48.514 --> 00:11:49.975 blending the two. 00:11:50.115 --> 00:11:50.355 You know, 00:11:50.475 --> 00:11:52.136 I was in another podcast a little 00:11:52.157 --> 00:11:52.596 while back, 00:11:52.897 --> 00:11:54.096 and somebody asked me a question, 00:11:54.116 --> 00:11:55.538 and I don't know why, but it slipped out. 00:11:55.557 --> 00:11:56.217 Somebody asked me, 00:11:56.238 --> 00:11:57.458 how come you're so good at pain? 00:11:58.139 --> 00:11:59.461 And I don't think I'm that good at pain, 00:11:59.480 --> 00:12:00.081 by the way, Jimmy, 00:12:00.121 --> 00:12:01.062 but it just slipped out, I said, 00:12:01.081 --> 00:12:02.342 because I'm a good manual therapist. 00:12:03.124 --> 00:12:04.105 And the host said, well, wait a minute, 00:12:04.125 --> 00:12:04.725 what does that mean? 00:12:04.764 --> 00:12:04.985 I said, 00:12:05.024 --> 00:12:06.886 because manual therapy gave me my 00:12:06.966 --> 00:12:08.908 basic skill set of reasoning, 00:12:09.369 --> 00:12:10.589 thorough evaluation, 00:12:11.750 --> 00:12:12.990 building a connection with my patient, 00:12:13.471 --> 00:12:15.133 all necessary things I need. 00:12:15.673 --> 00:12:16.894 And then the pain science 00:12:16.913 --> 00:12:18.534 takes me to that next level 00:12:18.556 --> 00:12:19.615 to take the complex patient. 00:12:20.057 --> 00:12:20.897 Here's the reality. 00:12:21.817 --> 00:12:23.379 If you only do one of these two, 00:12:23.399 --> 00:12:23.960 you're limited. 00:12:24.059 --> 00:12:25.620 Because if you only do manual therapy, 00:12:25.640 --> 00:12:27.081 you don't care about pain science, 00:12:27.437 --> 00:12:29.219 what people think, their fear, 00:12:29.259 --> 00:12:30.240 their catastrophization, 00:12:30.259 --> 00:12:31.301 you're not gonna make it better. 00:12:31.321 --> 00:12:33.283 And I would go the other side because, 00:12:33.322 --> 00:12:33.562 Jimmy, 00:12:33.623 --> 00:12:34.703 I live in the other world where I 00:12:34.724 --> 00:12:36.065 go to pain conferences where people don't, 00:12:36.085 --> 00:12:36.885 you don't touch people 00:12:36.926 --> 00:12:38.067 because if you touch them, 00:12:38.086 --> 00:12:39.126 they become addicted, whatever. 00:12:39.508 --> 00:12:40.889 Some of the most incredible 00:12:41.780 --> 00:12:42.802 Changes we see in human 00:12:42.841 --> 00:12:43.402 beings that come to 00:12:43.442 --> 00:12:44.844 rehabilitation is with our hands. 00:12:45.423 --> 00:12:46.644 They want pain relief. 00:12:46.725 --> 00:12:47.625 Manipulation, 00:12:48.046 --> 00:12:48.886 if you look at the effect 00:12:48.927 --> 00:12:50.148 sizes with manipulation, 00:12:50.168 --> 00:12:52.429 high velocity thrust to reduce pain, 00:12:52.970 --> 00:12:54.912 that's actually quite significant. 00:12:55.871 --> 00:12:57.134 I'm a physical therapist, and you know, 00:12:57.173 --> 00:12:57.833 last time I checked, 00:12:57.854 --> 00:12:59.154 we don't have a ton of 00:12:59.235 --> 00:13:00.515 tools to take your pain 00:13:00.917 --> 00:13:02.618 from a nine to a seven in one visit. 00:13:02.717 --> 00:13:04.700 Manipulation does, dry needling does. 00:13:04.980 --> 00:13:06.221 There are techniques that can do it. 00:13:06.260 --> 00:13:07.302 And so if you walk into my 00:13:07.341 --> 00:13:09.123 clinic and you're really hurting, 00:13:09.163 --> 00:13:09.923 I need you to do something 00:13:09.943 --> 00:13:11.105 to get you from here to here. 00:13:11.851 --> 00:13:12.812 And then you go, oh, man, 00:13:12.832 --> 00:13:13.452 that feels better. 00:13:13.552 --> 00:13:15.214 Now you're more open to listening to, 00:13:15.614 --> 00:13:16.774 let's talk about exercise 00:13:16.835 --> 00:13:18.875 and sleep and nutrition and this stuff. 00:13:19.255 --> 00:13:20.557 So I think they go hand in hand. 00:13:20.616 --> 00:13:21.136 On the one side, 00:13:21.177 --> 00:13:22.197 I need to reduce your pain. 00:13:22.738 --> 00:13:24.739 And manual therapy gives me that part. 00:13:24.759 --> 00:13:27.379 But also it gives me the basic skill set. 00:13:28.120 --> 00:13:29.400 I've said this for the longest time. 00:13:29.441 --> 00:13:30.601 You have no business 00:13:30.682 --> 00:13:31.501 teaching somebody about 00:13:31.542 --> 00:13:33.123 pain unless you've made 00:13:33.163 --> 00:13:34.943 sure they're safe and you 00:13:34.984 --> 00:13:35.985 do your due diligence. 00:13:36.404 --> 00:13:37.205 And the only way you can do 00:13:37.225 --> 00:13:38.586 it is by being a good manual therapist. 00:13:38.625 --> 00:13:40.346 Go through all my reflexes, my strength. 00:13:40.643 --> 00:13:42.384 sensation to make sure Jimmy is safe, 00:13:42.724 --> 00:13:44.403 he should be, and not see the doctor. 00:13:44.884 --> 00:13:45.624 You have no business. 00:13:45.644 --> 00:13:47.085 So you have to have both. 00:13:47.485 --> 00:13:49.666 And it's unbelievable that people go, 00:13:49.686 --> 00:13:50.826 this one or that one. 00:13:51.446 --> 00:13:52.385 I don't see how we cannot 00:13:52.426 --> 00:13:53.807 have these two cohabitate. 00:13:54.787 --> 00:13:55.807 We talked about communication, 00:13:55.826 --> 00:13:56.687 or you brought it up in 00:13:56.768 --> 00:13:57.548 several different ways. 00:13:57.628 --> 00:13:58.768 And I'm a person who loves 00:13:58.807 --> 00:14:00.048 communication and where it comes in, 00:14:00.089 --> 00:14:01.369 especially in a patient interaction. 00:14:02.129 --> 00:14:04.370 How can or how should 00:14:05.404 --> 00:14:06.505 therapists effectively 00:14:06.546 --> 00:14:07.706 communicate pain science 00:14:07.826 --> 00:14:08.986 concepts to their patients 00:14:09.067 --> 00:14:10.888 to help improve treatment outcomes. 00:14:10.927 --> 00:14:12.889 We talked earlier about maybe there's a, 00:14:13.068 --> 00:14:14.028 there's a line where it's 00:14:14.089 --> 00:14:14.929 too much or maybe putting 00:14:14.970 --> 00:14:15.710 too many words on it. 00:14:15.750 --> 00:14:17.770 So, you know, when someone asks, 00:14:18.030 --> 00:14:19.111 how do I communicate this? 00:14:19.231 --> 00:14:21.893 How, how much, when, where all those W's. 00:14:23.388 --> 00:14:27.510 the answer is yes I mean you 00:14:27.530 --> 00:14:29.172 know christmas we're 00:14:29.192 --> 00:14:30.393 talking about there's 80 00:14:30.393 --> 00:14:31.133 million americans in 00:14:31.173 --> 00:14:32.693 chronic pain and we need 80 00:14:32.693 --> 00:14:33.514 million different ways to 00:14:33.534 --> 00:14:34.154 do it because they're all 00:14:34.174 --> 00:14:36.135 individual beings right um 00:14:36.236 --> 00:14:37.517 in the most basic way to 00:14:37.697 --> 00:14:38.658 teach people about pain 00:14:38.677 --> 00:14:39.778 there's two ways jimmy one 00:14:39.839 --> 00:14:41.500 is a technique I literally 00:14:41.539 --> 00:14:42.360 say jimmy listen you're 00:14:42.380 --> 00:14:43.620 doing great I'm so proud of 00:14:43.660 --> 00:14:44.682 you we're making good 00:14:44.701 --> 00:14:45.763 progress but today I need 00:14:45.783 --> 00:14:46.964 to teach you something very 00:14:47.004 --> 00:14:48.144 important so I sit you down 00:14:48.163 --> 00:14:49.504 and we're having a very 00:14:49.565 --> 00:14:50.806 deliberate conversation I 00:14:50.885 --> 00:14:52.067 need to explain to you why 00:14:52.533 --> 00:14:53.975 When it's cold, you feel your neck. 00:14:54.274 --> 00:14:55.035 Nobody's ever done it, 00:14:55.096 --> 00:14:56.236 so let me do that today. 00:14:56.937 --> 00:14:57.618 That's one type. 00:14:57.658 --> 00:14:58.717 And we call that often pain 00:14:58.758 --> 00:14:59.958 neuroscience education. 00:15:00.038 --> 00:15:01.440 I sit down, it's almost like a technique. 00:15:01.500 --> 00:15:02.301 I'm doing this thing, 00:15:02.321 --> 00:15:03.601 and we have data to prove 00:15:03.621 --> 00:15:04.582 that your fear goes down, 00:15:04.623 --> 00:15:05.943 your catastrophization goes down. 00:15:05.984 --> 00:15:07.063 So it works. 00:15:07.104 --> 00:15:08.345 I mean, I can actually bill you for it. 00:15:09.245 --> 00:15:10.126 The other way of doing it, 00:15:10.167 --> 00:15:11.147 which I find very intriguing, 00:15:11.226 --> 00:15:11.927 and this is kind of where 00:15:11.947 --> 00:15:12.668 the research is going, 00:15:12.708 --> 00:15:13.629 is called pain neuroscience 00:15:13.788 --> 00:15:14.690 communication. 00:15:15.450 --> 00:15:17.231 And that is people that we train, 00:15:17.272 --> 00:15:18.052 and we've been tracking the 00:15:18.091 --> 00:15:19.033 data in our research, 00:15:19.072 --> 00:15:21.575 that if we train people in pain science, 00:15:22.178 --> 00:15:23.679 They change the way they talk to people. 00:15:23.720 --> 00:15:25.881 They're softer spoken, less provocative. 00:15:26.302 --> 00:15:28.342 They stay away from words that harm. 00:15:28.844 --> 00:15:30.424 They use more calming, 00:15:30.465 --> 00:15:31.885 relaxing reassurance kind of. 00:15:32.346 --> 00:15:33.586 It's almost like you take a 00:15:33.647 --> 00:15:34.927 shaker and you shake it 00:15:34.947 --> 00:15:35.927 through the clinic a little bit. 00:15:35.967 --> 00:15:37.208 It's like you sprinkle this 00:15:37.249 --> 00:15:37.870 little bit of things. 00:15:37.909 --> 00:15:39.291 So we call that pain 00:15:39.311 --> 00:15:40.650 neuroscience communication. 00:15:40.711 --> 00:15:42.011 And we're tracking some data 00:15:42.052 --> 00:15:43.173 in some of our research there. 00:15:43.633 --> 00:15:44.333 So I think it's both. 00:15:45.440 --> 00:15:47.181 I have heard people say, you know, Adrian, 00:15:47.301 --> 00:15:48.581 I've learned this pain stuff from you. 00:15:50.022 --> 00:15:52.263 And I find myself, I'm softer spoken. 00:15:53.143 --> 00:15:54.984 I slow myself down and make 00:15:55.063 --> 00:15:56.625 sure there's reassurance. 00:15:57.044 --> 00:15:58.706 There's all the things that we care about. 00:15:58.745 --> 00:15:59.625 So it's a little bit of both. 00:16:00.486 --> 00:16:02.567 But I think at its basic core, Jimmy, 00:16:02.648 --> 00:16:03.988 it is reducing words at harm. 00:16:04.768 --> 00:16:06.109 Therapy has the most harmful 00:16:06.149 --> 00:16:07.350 words known to man. 00:16:07.590 --> 00:16:09.330 Torn, ripped, ruptured, bulged, herniated. 00:16:09.750 --> 00:16:10.791 Take them out of our vocabulary. 00:16:11.482 --> 00:16:13.004 use softer spoken words that 00:16:13.124 --> 00:16:13.683 still explain. 00:16:13.764 --> 00:16:14.825 I know this is gonna be a 00:16:14.865 --> 00:16:16.125 little blasphemy at AON, 00:16:16.184 --> 00:16:17.785 but they have shown us that 00:16:17.846 --> 00:16:19.527 words like sprain and strain, 00:16:19.706 --> 00:16:20.907 as benign as they are, 00:16:21.006 --> 00:16:22.408 they're actually benign. 00:16:23.908 --> 00:16:25.629 The top of the top manual 00:16:25.649 --> 00:16:26.349 therapists will say, well, 00:16:26.369 --> 00:16:27.549 that doesn't really tell people, 00:16:27.570 --> 00:16:29.030 but the patient study show 00:16:29.051 --> 00:16:30.250 us that if I tell you a 00:16:30.331 --> 00:16:31.392 sprain or a strain, 00:16:31.611 --> 00:16:34.072 it doesn't evoke fear and 00:16:34.113 --> 00:16:35.133 you understand what's happening. 00:16:35.173 --> 00:16:38.615 So we can soften, explain, calm down, 00:16:38.654 --> 00:16:39.154 reassure, 00:16:39.601 --> 00:16:40.701 That's why I love being a therapist. 00:16:40.701 --> 00:16:42.602 99% of what I deal with is 00:16:42.663 --> 00:16:45.725 not life-threatening. 00:16:46.205 --> 00:16:45.725 99.99999%. 00:16:46.565 --> 00:16:47.885 So for me to walk up to Jimmy and say, 00:16:47.905 --> 00:16:48.865 Jimmy, you're going to be okay. 00:16:49.326 --> 00:16:50.726 I know you're at your ACL, dude, 00:16:50.767 --> 00:16:51.746 but guess what? 00:16:51.787 --> 00:16:52.567 I've seen a hundred people 00:16:52.607 --> 00:16:53.827 like you just last year. 00:16:53.847 --> 00:16:54.589 Are you going to be okay? 00:16:54.609 --> 00:16:55.708 See the guy on the bike there? 00:16:55.989 --> 00:16:57.389 It was just like you a month ago. 00:16:57.450 --> 00:16:57.990 Now look at him. 00:16:58.330 --> 00:16:58.970 What am I doing? 00:16:59.009 --> 00:16:59.791 I'm calming, 00:16:59.811 --> 00:17:01.552 taking away your fear or anxiety. 00:17:01.912 --> 00:17:03.052 So it's a little bit of those. 00:17:03.111 --> 00:17:04.613 It's reducing the words at harm. 00:17:06.262 --> 00:17:07.604 giving information that is 00:17:07.683 --> 00:17:09.125 understandable and reducing 00:17:09.204 --> 00:17:10.506 fear and catastrophization. 00:17:10.526 --> 00:17:13.328 And it's not necessarily deliberate. 00:17:13.388 --> 00:17:16.131 It is just, we change the way we practice. 00:17:16.730 --> 00:17:17.412 You said that people that 00:17:17.432 --> 00:17:19.513 study pain neuroscience communication, 00:17:19.673 --> 00:17:21.355 they begin speaking softer. 00:17:22.635 --> 00:17:23.517 Why do you think that is? 00:17:23.596 --> 00:17:24.337 I want to take a guess and 00:17:24.357 --> 00:17:25.298 you tell me if I'm right or wrong. 00:17:26.278 --> 00:17:28.161 Do you think now that they sort of, 00:17:28.580 --> 00:17:29.602 because now you're studying 00:17:29.701 --> 00:17:30.782 people and not a condition, 00:17:30.803 --> 00:17:32.523 do you think there's increased empathy? 00:17:32.984 --> 00:17:34.786 And now that they understand a little more, 00:17:34.826 --> 00:17:35.807 they're a little softer? 00:17:36.468 --> 00:17:37.268 Yeah, we have shown it. 00:17:37.669 --> 00:17:39.009 We have tested health care providers, 00:17:39.069 --> 00:17:40.490 measured their empathy and compassion, 00:17:41.070 --> 00:17:41.871 and then we teach them. 00:17:41.911 --> 00:17:42.330 And afterwards, 00:17:42.351 --> 00:17:43.432 the compassion and empathy 00:17:43.491 --> 00:17:44.452 changes drastically. 00:17:44.492 --> 00:17:46.534 We just completed a study on 00:17:46.594 --> 00:17:47.614 medical residents and did 00:17:47.634 --> 00:17:48.615 the same thing to show they 00:17:48.634 --> 00:17:49.895 turn extremely empathetic 00:17:50.316 --> 00:17:51.717 compassion towards people in pain, 00:17:51.757 --> 00:17:53.258 which isn't that just the coolest thing? 00:17:53.678 --> 00:17:53.958 So, yes, 00:17:53.998 --> 00:17:55.358 we're focusing on the human being 00:17:55.398 --> 00:17:56.599 versus the condition, right? 00:17:57.099 --> 00:17:58.441 But yeah, 00:17:58.500 --> 00:17:59.540 it's just to understand what 00:17:59.580 --> 00:18:00.221 they're going through. 00:18:01.275 --> 00:18:02.756 These poor people are struggling. 00:18:02.776 --> 00:18:03.557 They've been everywhere. 00:18:03.596 --> 00:18:04.458 Nobody can help them. 00:18:05.557 --> 00:18:07.460 You know, the thing about chronic pain, 00:18:07.480 --> 00:18:09.381 though, Jimmy, is the bar is so low. 00:18:10.162 --> 00:18:11.623 The good news is the bar is so low. 00:18:11.923 --> 00:18:13.243 Meaning what? 00:18:13.305 --> 00:18:15.506 Meaning that they had been so underserved. 00:18:15.546 --> 00:18:16.666 Nobody's done anything for them. 00:18:17.127 --> 00:18:18.528 But that's the good news, too. 00:18:18.969 --> 00:18:20.269 And I tell residents all the time, 00:18:20.309 --> 00:18:20.809 if you don't know what to 00:18:20.829 --> 00:18:22.191 do with a patient, just be there. 00:18:23.031 --> 00:18:23.732 Just be there. 00:18:23.752 --> 00:18:25.213 Say, you know, how are you doing today? 00:18:25.453 --> 00:18:27.095 Now, what can I do in this 30, 00:18:27.095 --> 00:18:27.895 40 minutes I got with you 00:18:27.915 --> 00:18:29.317 to make your day better today? 00:18:30.077 --> 00:18:30.258 And now... 00:18:31.141 --> 00:18:31.882 hear me correct, 00:18:31.961 --> 00:18:33.303 and specifically for Aiont, 00:18:33.903 --> 00:18:35.263 you've got to be good at what you do. 00:18:35.604 --> 00:18:37.744 It annoys the life out of a therapist. 00:18:37.865 --> 00:18:38.705 So Adrian's just saying we 00:18:38.726 --> 00:18:40.247 just need to be happy and whatever. 00:18:40.307 --> 00:18:41.327 No, be good. 00:18:41.448 --> 00:18:43.028 Otherwise, you're useless. 00:18:43.848 --> 00:18:45.611 Your skills must match what you're doing, 00:18:45.631 --> 00:18:47.791 not only the cognitive side, 00:18:47.811 --> 00:18:48.732 but the physical side. 00:18:48.873 --> 00:18:50.394 I mean, seriously, you have to be good. 00:18:50.693 --> 00:18:51.934 Patients know when you're good. 00:18:52.295 --> 00:18:53.715 And that's why I love Aiont. 00:18:53.796 --> 00:18:54.696 I love manual therapists 00:18:54.717 --> 00:18:56.218 because you've got this side covered. 00:18:56.258 --> 00:18:57.518 You're excellent at what you 00:18:57.538 --> 00:18:58.259 do with your hands. 00:18:58.871 --> 00:19:00.550 But now bringing the soft skill set, 00:19:00.590 --> 00:19:01.892 that is what's really, really good. 00:19:02.352 --> 00:19:04.051 A few years ago at Aon in Reno, 00:19:04.112 --> 00:19:04.972 Bill Boysenold, 00:19:06.553 --> 00:19:08.053 who was formed at UW Madison, 00:19:08.512 --> 00:19:10.034 made this beautiful statement, Jimmy, 00:19:10.054 --> 00:19:10.554 where he said, 00:19:11.213 --> 00:19:13.394 these things like compassion, empathy, 00:19:13.494 --> 00:19:14.515 respect, listening, 00:19:14.795 --> 00:19:16.496 they're not soft skills, 00:19:16.536 --> 00:19:17.816 they're essential skills. 00:19:18.195 --> 00:19:19.215 I like that better. 00:19:19.476 --> 00:19:20.236 Yes, me too. 00:19:20.256 --> 00:19:22.096 And it was an instant, I was like, dang, 00:19:22.136 --> 00:19:23.317 that is really, really good. 00:19:23.636 --> 00:19:24.397 They're essential, 00:19:24.617 --> 00:19:26.038 especially for this population. 00:19:26.784 --> 00:19:27.586 Bill said it way better. 00:19:27.665 --> 00:19:29.009 I did a presentation on the 00:19:29.048 --> 00:19:30.332 importance of soft skills, 00:19:30.393 --> 00:19:31.595 my background in journalism 00:19:31.615 --> 00:19:32.958 and communications before 00:19:32.979 --> 00:19:34.020 becoming a physical therapist. 00:19:34.321 --> 00:19:35.002 And the title was, 00:19:35.243 --> 00:19:36.907 why are these soft skills so damn hard? 00:19:37.778 --> 00:19:38.038 Yes. 00:19:38.659 --> 00:19:39.759 Because some people will say, well, 00:19:39.980 --> 00:19:41.240 why are they so difficult to do? 00:19:41.661 --> 00:19:42.942 And you want to talk about 00:19:43.001 --> 00:19:44.541 words by calling them soft skills. 00:19:44.602 --> 00:19:46.663 Do you decrease or increase the value? 00:19:46.763 --> 00:19:47.604 Some people say, well, 00:19:47.624 --> 00:19:48.564 I decrease the value and it 00:19:48.624 --> 00:19:49.325 should be simple. 00:19:49.605 --> 00:19:49.944 So why? 00:19:50.125 --> 00:19:50.726 So I've done it. 00:19:51.425 --> 00:19:51.566 Right. 00:19:51.586 --> 00:19:52.707 The goal of communications 00:19:53.086 --> 00:19:54.527 is just to have communicated. 00:19:54.547 --> 00:19:55.347 No, no, no, no, no, no. 00:19:55.627 --> 00:19:56.669 The goal of communication is 00:19:56.709 --> 00:19:58.108 to achieve understanding. 00:19:58.269 --> 00:19:58.449 Right. 00:19:59.029 --> 00:20:00.750 So the fastest lesson that 00:20:00.770 --> 00:20:01.550 I've ever learned is 00:20:02.270 --> 00:20:03.051 children and puppies. 00:20:04.165 --> 00:20:05.208 If you're not communicating 00:20:05.248 --> 00:20:06.328 right to children and puppies, 00:20:06.409 --> 00:20:07.509 you will get no result. 00:20:07.891 --> 00:20:08.570 But you'll say, 00:20:08.651 --> 00:20:09.833 I just yelled louder and I 00:20:09.893 --> 00:20:11.273 said it more and they didn't do it. 00:20:11.314 --> 00:20:12.095 They didn't understand. 00:20:12.474 --> 00:20:12.655 Right. 00:20:12.695 --> 00:20:14.577 Because your soft skills 00:20:14.637 --> 00:20:15.499 were not on there. 00:20:16.279 --> 00:20:17.320 We're not working because 00:20:17.361 --> 00:20:18.342 the goal was to achieve 00:20:18.382 --> 00:20:20.443 understanding not to have communicated. 00:20:21.045 --> 00:20:21.585 Correct. 00:20:21.726 --> 00:20:22.385 Oh, beautiful. 00:20:22.465 --> 00:20:22.626 Yeah. 00:20:22.646 --> 00:20:23.748 I have to remember that one. 00:20:25.380 --> 00:20:26.861 What should someone look forward to? 00:20:27.201 --> 00:20:28.461 You have a couple of presentations, 00:20:28.560 --> 00:20:29.061 one's virtual, 00:20:29.142 --> 00:20:31.282 one's in person at your presentations. 00:20:31.343 --> 00:20:32.022 Essentially, Adrian, 00:20:32.063 --> 00:20:33.763 I'm giving you first dibs 00:20:34.624 --> 00:20:35.983 to put butts in seats for 00:20:36.003 --> 00:20:36.704 your presentation. 00:20:36.744 --> 00:20:37.744 What are people going to 00:20:37.765 --> 00:20:38.786 look forward to in St. 00:20:38.826 --> 00:20:39.046 Louis? 00:20:40.086 --> 00:20:42.207 Yeah, so we have these two parts. 00:20:42.227 --> 00:20:43.366 We have two sessions. 00:20:43.386 --> 00:20:45.087 One is on blaming pain 00:20:45.107 --> 00:20:46.608 science and manual therapy, 00:20:46.628 --> 00:20:47.328 which we just talked about. 00:20:48.154 --> 00:20:50.217 What we, myself and Dr. Louie Punta Dura, 00:20:50.237 --> 00:20:50.916 my buddy Louie, 00:20:51.257 --> 00:20:51.798 and I are going to do 00:20:51.817 --> 00:20:53.479 together is basically show the two sides, 00:20:53.558 --> 00:20:54.519 why it's important to do 00:20:54.538 --> 00:20:56.240 manual therapy and why it's 00:20:56.260 --> 00:20:57.020 important to pain science, 00:20:57.040 --> 00:20:57.942 but then more important how 00:20:57.981 --> 00:20:59.482 these two work beautifully together. 00:20:59.643 --> 00:21:01.443 We believe they're not mutually exclusive. 00:21:02.003 --> 00:21:02.744 And we're going to share 00:21:02.825 --> 00:21:04.705 that data to show how you can basically, 00:21:04.726 --> 00:21:05.527 for lack of a better term, 00:21:05.886 --> 00:21:06.948 take one patient and start 00:21:06.968 --> 00:21:07.988 the manual way and end up 00:21:08.028 --> 00:21:09.288 in pain science. 00:21:09.648 --> 00:21:10.170 The other patient, 00:21:10.190 --> 00:21:11.230 you start with pain science 00:21:11.269 --> 00:21:12.391 and end up with manual therapy. 00:21:12.570 --> 00:21:13.511 They're not exclusive. 00:21:14.070 --> 00:21:14.750 And you can use them 00:21:14.810 --> 00:21:16.211 interchangeably for different reasons. 00:21:16.231 --> 00:21:17.653 We can talk about the words we use. 00:21:18.613 --> 00:21:19.433 I think one of my favorite 00:21:19.453 --> 00:21:20.534 quotes my buddy Louie 00:21:20.554 --> 00:21:21.314 always talks about is, 00:21:21.433 --> 00:21:22.714 I still do the same manual 00:21:22.755 --> 00:21:23.674 techniques I've always done, 00:21:24.076 --> 00:21:25.476 but I explain them different. 00:21:25.957 --> 00:21:26.916 We don't fix things. 00:21:26.977 --> 00:21:27.896 Things don't go out of place. 00:21:27.916 --> 00:21:29.258 We don't put things back in place. 00:21:29.577 --> 00:21:30.798 We're just getting some nice movement. 00:21:30.818 --> 00:21:32.179 We're getting things to move a little bit, 00:21:32.419 --> 00:21:33.259 get some blood flow, 00:21:33.380 --> 00:21:34.661 oxygen to calm the system. 00:21:35.000 --> 00:21:35.961 So we change the words, 00:21:36.000 --> 00:21:36.922 but it's the same stuff. 00:21:37.422 --> 00:21:38.162 The other one we're doing is 00:21:38.221 --> 00:21:39.103 on whiplash injuries. 00:21:39.343 --> 00:21:39.722 There's just... 00:21:40.692 --> 00:21:42.534 Of all the musculoskeletal conditions, 00:21:42.574 --> 00:21:43.374 that's the one that goes 00:21:43.394 --> 00:21:44.693 the most into chronic pain, 00:21:44.773 --> 00:21:45.713 about 40% of people. 00:21:46.295 --> 00:21:47.295 And some of the amazing 00:21:47.355 --> 00:21:48.194 research from Michelle 00:21:48.214 --> 00:21:49.234 Sterling's work in 00:21:49.295 --> 00:21:50.836 Australia has looked at 00:21:50.895 --> 00:21:52.776 therapists doing early intervention, 00:21:53.576 --> 00:21:54.896 psychologically informed care, 00:21:54.936 --> 00:21:56.096 like reassurance, 00:21:56.517 --> 00:21:57.336 all those things in the 00:21:57.356 --> 00:21:58.718 emergency room early on 00:21:59.178 --> 00:22:00.498 that actually calms the 00:22:00.577 --> 00:22:01.597 system beautifully, 00:22:01.637 --> 00:22:02.959 then allows them to move 00:22:03.479 --> 00:22:04.739 and be treated with hands-on. 00:22:05.199 --> 00:22:05.920 So those are the two 00:22:06.000 --> 00:22:07.420 sessions we're doing at AONT. 00:22:08.423 --> 00:22:08.703 Perfect. 00:22:08.723 --> 00:22:08.903 All right. 00:22:08.943 --> 00:22:10.365 Last thing we do on the podcast, 00:22:11.125 --> 00:22:11.786 let's wow them. 00:22:11.806 --> 00:22:12.625 What's words of wisdom? 00:22:12.645 --> 00:22:13.446 What's the last thing you'd 00:22:13.467 --> 00:22:14.467 want to leave with the audience? 00:22:14.507 --> 00:22:16.367 Is there any idea, sentiment, quote, 00:22:16.468 --> 00:22:17.107 mic drop moment? 00:22:17.127 --> 00:22:18.429 What do you got? 00:22:19.048 --> 00:22:19.569 Yeah, 00:22:19.650 --> 00:22:21.109 I should have thought about that one. 00:22:21.190 --> 00:22:22.151 I think what it's becoming 00:22:22.191 --> 00:22:23.352 very favorite in the pain 00:22:23.372 --> 00:22:24.211 world for me is the fact 00:22:24.251 --> 00:22:24.932 that pain that is 00:22:25.011 --> 00:22:26.673 understood is not to be feared. 00:22:27.693 --> 00:22:28.713 The more we teach our 00:22:28.773 --> 00:22:30.134 patients what's happening to them, 00:22:30.275 --> 00:22:32.016 the more they calm down and 00:22:32.155 --> 00:22:33.737 fear drives pain powerfully. 00:22:33.757 --> 00:22:35.077 So if they understand their pain, 00:22:35.117 --> 00:22:35.938 they're not afraid of it. 00:22:36.464 --> 00:22:38.166 they will move and in this 00:22:38.227 --> 00:22:39.407 conference be touched and 00:22:39.468 --> 00:22:41.088 go I'm okay I'm not being 00:22:41.128 --> 00:22:42.509 hurt I'm just sensitive and 00:22:42.549 --> 00:22:43.411 I think that's a critical 00:22:43.490 --> 00:22:45.271 element well said uh 00:22:45.291 --> 00:22:46.594 looking forward to st louis 00:22:46.693 --> 00:22:47.394 looking forward to your 00:22:47.433 --> 00:22:48.275 talks and appreciate the 00:22:48.295 --> 00:22:48.955 time giving us a little 00:22:48.996 --> 00:22:50.636 tease ahead to am's event 00:22:51.718 --> 00:22:52.638 thanks jimmy appreciate it 00:22:53.358 --> 00:22:54.359 that's it that's all we need