WEBVTT 00:00:00.029 --> 00:00:02.015 You're listening to the PT Pinecast, 00:00:02.095 --> 00:00:04.121 where smart people in healthcare come to 00:00:04.160 --> 00:00:05.003 make noise. 00:00:05.365 --> 00:00:06.809 Here's your host, Jimmy McKay. 00:00:09.804 --> 00:00:10.884 All right, kicking things off today. 00:00:10.945 --> 00:00:12.005 I do want to say before we start, 00:00:12.025 --> 00:00:13.465 thanks to Sarah Health, 00:00:13.605 --> 00:00:15.547 the remote care platform helping clinics 00:00:15.586 --> 00:00:17.388 boost revenue without having to add staff. 00:00:17.728 --> 00:00:19.649 Sarah automates daily patient check-ins 00:00:19.890 --> 00:00:22.530 like RTM that meets RTM requirements and 00:00:22.571 --> 00:00:24.832 supports better work through between 00:00:24.873 --> 00:00:25.373 visits. 00:00:25.832 --> 00:00:27.653 Find them online at sarahhealth.com. 00:00:27.673 --> 00:00:30.216 That's S-A-R-A health.com. 00:00:30.335 --> 00:00:31.817 The Sarahs of the world do get very 00:00:31.856 --> 00:00:32.156 picky. 00:00:32.197 --> 00:00:33.917 Like I'm Sarah with an A, Sarah. 00:00:34.158 --> 00:00:35.259 without an A, this is Sarah, 00:00:35.459 --> 00:00:39.542 without an A, sorry, hsarahhealth.com. 00:00:39.561 --> 00:00:41.764 Today's episode, PT clinic owner, 00:00:41.944 --> 00:00:44.365 professor, PhD candidate, entrepreneur, 00:00:44.646 --> 00:00:46.607 podcast host, surfer, mom, 00:00:47.798 --> 00:00:50.600 and somehow finds time to bake bread from 00:00:50.619 --> 00:00:50.920 scratch. 00:00:51.039 --> 00:00:51.880 Those are a lot of things, 00:00:52.020 --> 00:00:54.581 like Swiss army knife vibes is what I 00:00:54.600 --> 00:00:55.121 get from her. 00:00:55.920 --> 00:00:57.722 Her work sits at the intersection of pain 00:00:57.762 --> 00:00:58.781 science, clinical care, 00:00:59.121 --> 00:01:01.783 and then the messy reality of humans being 00:01:01.843 --> 00:01:02.902 human-y, as I say. 00:01:03.423 --> 00:01:05.703 She believes that chronic pain is not just 00:01:05.843 --> 00:01:08.245 a louder version of acute pain. 00:01:09.444 --> 00:01:10.484 We've said this before in different 00:01:10.504 --> 00:01:11.465 contexts, like, 00:01:13.563 --> 00:01:16.206 You know, kids just aren't small adults. 00:01:16.506 --> 00:01:17.046 They're different. 00:01:17.445 --> 00:01:17.965 So is pain. 00:01:18.326 --> 00:01:21.168 It's a nervous system story shaped by lots 00:01:21.207 --> 00:01:23.108 of things, stress, sleep, beliefs, trauma, 00:01:23.188 --> 00:01:24.810 safety, connection, the world. 00:01:25.191 --> 00:01:27.072 So let's get this pain conversation, 00:01:27.091 --> 00:01:28.552 which is always fascinating for me for 00:01:28.572 --> 00:01:29.033 some reason. 00:01:29.832 --> 00:01:31.933 Let's get in today's guests, Megan Steele. 00:01:32.013 --> 00:01:33.855 Megan, in the flesh from the West Coast, 00:01:33.875 --> 00:01:35.917 from the Westest of coasts. 00:01:35.956 --> 00:01:37.197 The Westest of West Coast. 00:01:37.436 --> 00:01:39.138 Thank you for that lovely intro. 00:01:39.177 --> 00:01:40.078 I'm happy to be here. 00:01:41.161 --> 00:01:42.322 So let's start with what I sort of 00:01:42.341 --> 00:01:44.543 like framed or highlighted or put in bold 00:01:44.563 --> 00:01:45.203 with my words. 00:01:45.484 --> 00:01:47.305 Chronic pain is not just a louder, 00:01:47.947 --> 00:01:50.368 longer version of acute pain. 00:01:50.828 --> 00:01:53.772 What do PTs or what does healthcare miss 00:01:54.152 --> 00:01:55.852 when they actually do treat it like a 00:01:55.953 --> 00:01:57.754 longer, louder version of acute pain? 00:01:59.605 --> 00:02:00.445 That's a great question. 00:02:00.566 --> 00:02:02.628 I think we miss the point. 00:02:02.668 --> 00:02:04.430 We miss the plot when we're sort of 00:02:04.590 --> 00:02:07.394 treating it as a louder, longer, 00:02:07.894 --> 00:02:10.877 stiffer version of acute pain. 00:02:11.433 --> 00:02:12.935 when we're thinking about acute pain, 00:02:12.955 --> 00:02:14.775 we're thinking about tissue damage and 00:02:14.816 --> 00:02:15.836 nociception. 00:02:16.415 --> 00:02:17.176 And for some of us, 00:02:17.236 --> 00:02:19.538 it's been a little while since PT school 00:02:19.578 --> 00:02:20.978 and those words are kind of coming back 00:02:20.997 --> 00:02:21.418 to us. 00:02:21.518 --> 00:02:22.838 Oh yeah, nociception. 00:02:23.498 --> 00:02:26.300 And I teach a class called orthopedic 00:02:26.341 --> 00:02:28.521 pathology to the first year physical 00:02:28.562 --> 00:02:29.361 therapy students. 00:02:29.401 --> 00:02:31.362 And we talk a lot about tissue healing 00:02:31.402 --> 00:02:32.323 times, right? 00:02:32.383 --> 00:02:34.843 Six to eight weeks on average for soft 00:02:34.864 --> 00:02:36.664 tissue, eight to ten for bone. 00:02:37.465 --> 00:02:38.026 And then 00:02:39.048 --> 00:02:41.210 What happens when people are outside of 00:02:41.250 --> 00:02:42.569 that window? 00:02:43.191 --> 00:02:44.991 We're not thinking about and hopefully 00:02:45.032 --> 00:02:48.093 we're not looking for a tissue source. 00:02:49.655 --> 00:02:50.175 Excuse me. 00:02:50.776 --> 00:02:53.798 So when someone's had pain for longer and 00:02:54.098 --> 00:02:54.419 I think. 00:02:55.919 --> 00:02:57.661 One of the great questions that I like 00:02:57.860 --> 00:03:01.584 to tell people to ask a clinician before 00:03:01.604 --> 00:03:03.525 you decide whether or not I want to 00:03:03.544 --> 00:03:04.224 work with this person, 00:03:04.264 --> 00:03:05.225 if you're someone that suffers from 00:03:05.246 --> 00:03:05.725 chronic pain, 00:03:05.765 --> 00:03:07.146 is how do you treat people differently 00:03:07.187 --> 00:03:07.987 when they've had pain? 00:03:08.479 --> 00:03:10.680 for three years versus three weeks. 00:03:11.180 --> 00:03:13.139 Because if you're telling me, well, 00:03:13.159 --> 00:03:14.020 it's a stiffer joint. 00:03:14.080 --> 00:03:15.001 I push harder. 00:03:15.100 --> 00:03:17.301 We have to do more exercises, 00:03:17.901 --> 00:03:18.701 those types of things. 00:03:18.762 --> 00:03:20.302 I'm going to say, thanks. 00:03:20.462 --> 00:03:21.263 I'll see you later. 00:03:21.782 --> 00:03:23.644 But if you're saying to me, well, 00:03:23.663 --> 00:03:25.243 someone with chronic pain, 00:03:25.343 --> 00:03:27.625 I'm thinking more about threat detection 00:03:28.044 --> 00:03:29.465 than about tissue damage. 00:03:30.045 --> 00:03:30.725 I'm all in. 00:03:30.806 --> 00:03:31.566 I'm interested. 00:03:31.626 --> 00:03:32.806 You seem to know what you're talking 00:03:32.825 --> 00:03:33.146 about. 00:03:33.227 --> 00:03:34.546 Let's continue this discussion. 00:03:36.887 --> 00:03:38.247 It's funny, before we hit record, 00:03:38.266 --> 00:03:39.768 you mentioned Rachel's softness. 00:03:39.788 --> 00:03:41.247 She's come on the show numerous times over 00:03:41.268 --> 00:03:43.348 the last couple of years, mutual friend, 00:03:43.788 --> 00:03:45.849 and she frames some things pretty well, 00:03:45.949 --> 00:03:48.310 which is. 00:03:48.330 --> 00:03:51.770 Pain or no different things in different 00:03:51.811 --> 00:03:53.292 contexts elicit different 00:03:55.271 --> 00:03:55.512 You know, 00:03:55.572 --> 00:03:58.975 she was just on Dax Shepard's podcast and 00:03:58.996 --> 00:04:00.437 I saw this great clip and she's like, 00:04:00.878 --> 00:04:01.179 you know, 00:04:01.539 --> 00:04:03.241 someone biting you in the middle of an 00:04:03.461 --> 00:04:05.664 interaction with a partner that you want 00:04:05.884 --> 00:04:07.407 and are attracted to is very different 00:04:07.426 --> 00:04:09.849 than just being bit by a random stranger 00:04:09.969 --> 00:04:10.469 or a dog. 00:04:10.890 --> 00:04:12.652 So looking at it outside of a 00:04:12.712 --> 00:04:13.935 biopsychosocial context. 00:04:14.474 --> 00:04:17.315 uh way seems to miss the point and 00:04:17.355 --> 00:04:19.036 if we only treat things one way we're 00:04:19.117 --> 00:04:22.278 only going to get one result so when 00:04:22.298 --> 00:04:24.639 a chronic pain patient walks into a clinic 00:04:25.999 --> 00:04:27.699 what would you suggest to students 00:04:27.720 --> 00:04:29.379 clinicians anybody listening what should 00:04:29.420 --> 00:04:32.581 the person be listening for before they 00:04:32.661 --> 00:04:35.903 ever test range of motion or strength what 00:04:35.923 --> 00:04:37.603 are like the i call them eyebrow tests 00:04:37.622 --> 00:04:38.564 what are the things that sort of make 00:04:38.584 --> 00:04:40.024 you go hmm okay 00:04:42.588 --> 00:04:43.389 That's a great question. 00:04:43.449 --> 00:04:47.411 And there's a variation of options there. 00:04:47.492 --> 00:04:49.274 But I oftentimes think about, 00:04:49.793 --> 00:04:52.776 you know what normal is, right? 00:04:52.817 --> 00:04:54.437 You've had orthopedic pathology, 00:04:54.478 --> 00:04:55.658 you've had physiology, 00:04:55.699 --> 00:04:57.019 you've had biomechanics, 00:04:57.519 --> 00:04:58.641 you know what that is. 00:04:58.901 --> 00:05:01.483 And so things that are outside of that, 00:05:01.884 --> 00:05:03.444 when people say things like, 00:05:03.865 --> 00:05:05.747 when my stress level is higher, 00:05:05.987 --> 00:05:07.209 I have a lot more pain. 00:05:07.348 --> 00:05:08.649 When I haven't eaten well, 00:05:08.790 --> 00:05:09.831 I have a lot more pain. 00:05:10.413 --> 00:05:11.754 When I know I have to go and 00:05:11.793 --> 00:05:14.036 give a presentation, I have more pain. 00:05:14.396 --> 00:05:16.557 And not everybody has that awareness, 00:05:17.117 --> 00:05:19.040 but sometimes also people will say to you, 00:05:19.060 --> 00:05:20.841 there's no rhyme or reason to it. 00:05:21.401 --> 00:05:23.322 I cannot discern a pattern to it. 00:05:23.343 --> 00:05:25.584 Sometimes I'll just be sitting still and I 00:05:25.625 --> 00:05:26.446 have this pain. 00:05:27.423 --> 00:05:29.446 that's not a normal physiological 00:05:29.505 --> 00:05:30.706 reaction, right? 00:05:30.766 --> 00:05:32.528 That's not a biomechanical, 00:05:32.850 --> 00:05:34.752 when we think about our biomedical model, 00:05:35.312 --> 00:05:37.214 someone sitting still not moving that 00:05:37.254 --> 00:05:40.338 painful joint should not have pain if 00:05:40.358 --> 00:05:41.560 we're just thinking about strictly 00:05:41.620 --> 00:05:42.482 biomedical model. 00:05:43.375 --> 00:05:45.377 But when you broaden your lens and you 00:05:45.416 --> 00:05:46.117 say, oh, well, 00:05:46.137 --> 00:05:49.197 there are a lot more things like context, 00:05:49.577 --> 00:05:51.399 like my psychological state, 00:05:51.439 --> 00:05:53.860 like the amount of sleep I got that 00:05:53.879 --> 00:05:56.920 affect my body and my physical experience, 00:05:57.281 --> 00:06:00.242 then your treatment targets expand as 00:06:00.281 --> 00:06:00.521 well. 00:06:03.021 --> 00:06:04.502 You said the most important question is 00:06:04.562 --> 00:06:06.944 not where is the pain coming from, 00:06:07.064 --> 00:06:09.266 but what is this person perceiving as a 00:06:09.346 --> 00:06:09.665 threat? 00:06:09.745 --> 00:06:09.886 I mean, 00:06:09.906 --> 00:06:10.987 I feel like that just summed up what 00:06:11.007 --> 00:06:11.627 you just said there. 00:06:11.947 --> 00:06:13.249 So what does that look like in practice 00:06:13.288 --> 00:06:15.050 or how do you teach people to take 00:06:15.071 --> 00:06:17.872 that from hearing me say that really cool 00:06:17.913 --> 00:06:18.273 quote? 00:06:18.432 --> 00:06:19.413 That was your quote, by the way. 00:06:19.473 --> 00:06:20.975 That's the smart thing. 00:06:21.175 --> 00:06:22.255 Want to be a good podcast host? 00:06:22.697 --> 00:06:23.557 Steal the great quotes. 00:06:23.596 --> 00:06:24.437 Makes you sound prolific. 00:06:24.697 --> 00:06:25.978 But what does that look like in practice? 00:06:25.999 --> 00:06:26.600 That's a great tip. 00:06:27.641 --> 00:06:28.583 How does that look in practice? 00:06:28.663 --> 00:06:30.684 Yeah, and that's quite challenging. 00:06:30.744 --> 00:06:33.326 So I also teach students in the third 00:06:33.365 --> 00:06:35.007 year, pain science. 00:06:35.526 --> 00:06:37.348 And sometimes they come back and they say, 00:06:37.528 --> 00:06:38.149 oh my gosh, 00:06:38.488 --> 00:06:39.329 because they've been out on their 00:06:39.350 --> 00:06:40.129 clinicals, right? 00:06:40.310 --> 00:06:41.151 And they're like, oh, 00:06:42.170 --> 00:06:43.451 this is what I needed. 00:06:43.512 --> 00:06:45.653 Why didn't we have this in first year? 00:06:45.834 --> 00:06:47.415 And, you know, thank you so much. 00:06:47.855 --> 00:06:52.577 And I say, well, this is the gray, 00:06:52.937 --> 00:06:53.237 right? 00:06:53.418 --> 00:06:53.918 In first year, 00:06:53.939 --> 00:06:55.360 you needed it to be black and white. 00:06:55.815 --> 00:06:57.357 because there's such a volume of 00:06:57.416 --> 00:06:58.017 information. 00:06:58.077 --> 00:06:59.918 It's like a fire hose of information 00:06:59.978 --> 00:07:02.622 coming at you with anatomy, physiology, 00:07:03.081 --> 00:07:05.884 biomechanics, pathology, et cetera. 00:07:05.903 --> 00:07:07.024 You need it to be black and white 00:07:07.064 --> 00:07:07.846 in the first year. 00:07:07.906 --> 00:07:09.266 And it's not until you've been out in 00:07:09.307 --> 00:07:10.908 the clinic and you've seen, gosh, 00:07:10.927 --> 00:07:13.509 not everything is like the textbook that 00:07:13.550 --> 00:07:15.531 you can say, oh shoot, 00:07:15.591 --> 00:07:16.793 there's actually some gray here. 00:07:16.833 --> 00:07:17.994 There's some nuance. 00:07:18.654 --> 00:07:20.995 And so the first thing that we do, 00:07:21.317 --> 00:07:22.418 one of the first things that we do 00:07:23.627 --> 00:07:29.812 in pain science is shut up shut your 00:07:29.853 --> 00:07:33.295 mouth they say it takes eight minutes for 00:07:33.336 --> 00:07:35.978 someone to tell their story wow do you 00:07:35.999 --> 00:07:38.821 know how soon we as clinicians tend to 00:07:38.860 --> 00:07:42.464 interrupt someone uh i think this has been 00:07:42.704 --> 00:07:43.886 if it's the thing i'm thinking it's like 00:07:43.946 --> 00:07:46.127 forty two seconds or something crazy less 00:07:46.148 --> 00:07:46.588 than that maybe 00:07:47.050 --> 00:07:48.632 Yeah, somewhere around thirty seconds. 00:07:48.672 --> 00:07:48.971 Yeah. 00:07:49.052 --> 00:07:49.372 Right. 00:07:49.932 --> 00:07:51.014 And it makes sense. 00:07:51.033 --> 00:07:52.675 We want to show that we know what 00:07:52.694 --> 00:07:53.555 we're talking about. 00:07:53.615 --> 00:07:55.137 We want to show that we're the expert. 00:07:55.177 --> 00:07:56.517 We've seen this before. 00:07:56.598 --> 00:07:58.259 We understand we're going to be the one 00:07:58.278 --> 00:07:59.639 that's going to be able to help you. 00:08:02.322 --> 00:08:03.543 And I'm not opposed to that. 00:08:03.642 --> 00:08:06.464 I think that's really important after 00:08:06.944 --> 00:08:09.086 you've let someone tell their story. 00:08:09.726 --> 00:08:11.449 And so, you know, people say, 00:08:14.172 --> 00:08:15.052 you know, like you, 00:08:15.072 --> 00:08:16.293 you handle these tough cases. 00:08:16.333 --> 00:08:18.434 You see people that have seen six other 00:08:18.473 --> 00:08:19.254 practitioners. 00:08:19.394 --> 00:08:20.596 What do you do differently? 00:08:20.815 --> 00:08:21.737 I'm not magic. 00:08:21.956 --> 00:08:23.577 I don't have some kind of a special 00:08:23.658 --> 00:08:25.819 intuitive psychic skill. 00:08:26.480 --> 00:08:27.781 I know how to shut the fuck up. 00:08:27.821 --> 00:08:28.161 Sorry. 00:08:29.982 --> 00:08:30.942 I don't know if we're allowed to say 00:08:30.963 --> 00:08:31.182 that. 00:08:31.202 --> 00:08:33.684 Um, okay. 00:08:33.705 --> 00:08:37.047 So I'd say that's probably my biggest, um, 00:08:37.486 --> 00:08:38.807 superpower, if you will. 00:08:40.068 --> 00:08:41.049 And if you've seen me on Instagram, 00:08:41.110 --> 00:08:43.312 you might be surprised that I know how 00:08:43.351 --> 00:08:46.754 to stop talking for periods of time. 00:08:47.094 --> 00:08:48.215 I used to use this as a cheat 00:08:48.235 --> 00:08:49.775 code. 00:08:50.397 --> 00:08:51.717 Back when I used to work for radio 00:08:51.738 --> 00:08:53.298 stations and I had to interview someone, 00:08:54.440 --> 00:08:57.162 it was not a healthcare thing, 00:08:57.621 --> 00:08:59.303 but I realized this might be the only 00:08:59.323 --> 00:09:00.664 time that person's ever been in a radio 00:09:00.684 --> 00:09:01.004 station. 00:09:01.384 --> 00:09:02.346 So I need to understand that. 00:09:02.686 --> 00:09:04.668 This is normal for me, not for them. 00:09:05.339 --> 00:09:06.279 Like this is their day. 00:09:06.419 --> 00:09:07.120 Like this is fun. 00:09:07.140 --> 00:09:07.761 This is weird. 00:09:07.782 --> 00:09:08.802 But also like, what is this? 00:09:08.883 --> 00:09:10.546 I don't understand this. 00:09:10.806 --> 00:09:13.809 So I made it a point to get 00:09:13.870 --> 00:09:16.513 with my receptionist and say, hey, 00:09:16.673 --> 00:09:17.693 whenever there's an interview, 00:09:18.294 --> 00:09:19.096 never send them back. 00:09:19.456 --> 00:09:20.317 I come and get everybody. 00:09:22.077 --> 00:09:23.580 I would meet them at the front door 00:09:23.860 --> 00:09:25.761 and I would immediately start to try any 00:09:25.802 --> 00:09:27.104 way to read that person. 00:09:27.804 --> 00:09:29.527 Are they a little sheepish? 00:09:29.647 --> 00:09:30.327 Are they nervous? 00:09:30.447 --> 00:09:31.809 I'd look for their eyes darting around, 00:09:31.830 --> 00:09:32.890 look for body language. 00:09:33.272 --> 00:09:37.277 And if I sensed a little coldness, 00:09:37.297 --> 00:09:38.839 I would give them the complete tour of 00:09:38.859 --> 00:09:39.879 the entire radio station. 00:09:41.054 --> 00:09:42.696 And my goal was to get them to 00:09:42.735 --> 00:09:43.157 warm up. 00:09:43.697 --> 00:09:45.458 But hearing what you just said, 00:09:45.578 --> 00:09:46.219 I'd never heard. 00:09:46.419 --> 00:09:48.321 I've heard the second statistic that we 00:09:48.360 --> 00:09:50.602 interrupt people at thirty two seconds or 00:09:50.623 --> 00:09:51.183 something like that. 00:09:51.583 --> 00:09:52.565 I've never heard the other one, 00:09:52.605 --> 00:09:54.186 which is it takes eight minutes to tell 00:09:54.206 --> 00:09:55.988 their story because my goal 00:09:57.741 --> 00:09:59.143 when I turned the microphone on, 00:09:59.202 --> 00:09:59.982 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?