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A PT, OT, and Chiro Talk About Pain & Nervous System Regulation · Fit As A Fiddle

• 0:00
  SPEAKER_01: You need other people in to really address different aspects of what's going on.
• 0:04
  SPEAKER_01: And I think every client is different.
• 0:06
  SPEAKER_01: I think of it like an algorithm, right?
• 0:08
  SPEAKER_01: I can make pretty good arguments that most people could benefit from chiropractic physical therapy, biofeedback, nervous system regulation, but everyone's algorithm, individual algorithm, is going to be different in terms of what's most effective for them, what works with their time and conditions.
• 0:23
  SPEAKER_02: Hello, everyone.
• 0:24
  SPEAKER_02: I'm your host, Dr.
• 0:25
  SPEAKER_02: Sneha Ghazi, a physical therapist, course creator, and mom.
• 0:29
  SPEAKER_02: I own Sneha Physical Therapy, a private practice in New York City, and created the course Master Your Public Floor to help you transform the way you think about and move your body.
• 0:40
  SPEAKER_02: Use discount code FIT20 for a special 20% discount exclusively from my listeners at the link in all show notes.
• 0:48
  SPEAKER_02: Each episode brings phenomenal guests in the health and wellness space who share inspiring tips and tangible advice.
• 0:55
  SPEAKER_02: All things health and wellness starts right here.
• 1:00
  SPEAKER_02: Hello everyone, and welcome to this week's episode on Fit as a Fittable.
• 1:05
  SPEAKER_02: We have a little roundtable kind of discussion today with two guests on the show, which is always fun to have.
• 1:11
  SPEAKER_02: We have Dr.
• 1:12
  SPEAKER_02: Rob Shire and Dr.
• 1:13
  SPEAKER_02: Taylor Ray joining us today.
• 1:16
  SPEAKER_02: Dr.
• 1:16
  SPEAKER_02: Shire is a chiropractor.
• 1:18
  SPEAKER_02: Dr.
• 1:18
  SPEAKER_02: Ray is an occupational therapist who also has a lot of other specialty work that she does.
• 1:23
  SPEAKER_02: And we work with each other to collaborate on patients and patient care.
• 1:29
  SPEAKER_02: We are all working in New York City.
• 1:31
  SPEAKER_02: As listeners already know, I am an orthopedic and pelvic health PT.
• 1:36
  SPEAKER_02: So our goal today is to really talk about, in kind of like a Venn diagram format, how our professions intersect, but also have this very individual touch, which is why we have different professional practices, different scope of practices, different practice acts.
• 1:54
  SPEAKER_02: And I want listeners to get a good understanding of that because I think it kind of gets lost in the shuffle, specifically with our three professions: PT, OT, Kairos.
• 2:03
  SPEAKER_02: We a lot of people can either get confused or misunderstand or just not understand, period.
• 2:11
  SPEAKER_02: And so we just want to shed a little bit of light from our own ways and also in a little network of people who genuinely actually work together and support each other's work as well.
• 2:23
  SPEAKER_02: So, with that said, welcome onto the show, Dr.
• 2:26
  SPEAKER_02: Ray and Dr.
• 2:27
  SPEAKER_02: Shire.
• 2:28
  SPEAKER_02: Could you guys go ahead and introduce yourselves, what brought you to the profession, and what you do on a day-to-day basis?
• 2:35
  SPEAKER_02: Well, stop, start with Dr.
• 2:36
  SPEAKER_02: Ray here.
• 2:37
  SPEAKER_01: Thank you so much.
• 2:38
  SPEAKER_01: Yeah.
• 2:39
  SPEAKER_01: So, like you said, I'm an occupational therapist.
• 2:41
  SPEAKER_01: Um, my specialty really is in nervous system regulation and HRV biofeedback.
• 2:47
  SPEAKER_01: And I think that really what brought me into approaching, using my OT life license in this way was just how the nervous system's approach allows me to really address people's capacity for participation in daily life.
• 2:59
  SPEAKER_01: And I think that's overall, there's always this running joke amongst even just occupational therapists that somebody asks you, what is OT?
• 3:06
  SPEAKER_01: We don't really know how to answer.
• 3:07
  SPEAKER_01: But if you zoom out and really look at it, our overall goal is helping patients and clients participate in life as fully and as meaningfully as possible and all the important roles, rituals, routines.
• 3:18
  SPEAKER_01: Um, and what I really like about my line of work is the ability to actually use those meaningful roles, routines, occupations, if you will, as part of like the intervention also, because I believe that's what brings people towards healing.
• 3:31
  SPEAKER_02: I love that.
• 3:32
  SPEAKER_02: Amazing.
• 3:33
  SPEAKER_02: Dr.
• 3:33
  SPEAKER_02: Shire, would you like to jump in on your work and what you do on a day-to-day basis?
• 3:38
  SPEAKER_00: Thank you for having us, uh, Dr.
• 3:41
  SPEAKER_00: This is a truly an honor and a privilege.
• 3:43
  SPEAKER_00: Dr.
• 3:43
  SPEAKER_00: Ray and I work together at the True Whole Care Um Center.
• 3:47
  SPEAKER_00: I I've been a chiropractor for 26 years.
• 3:50
  SPEAKER_00: I got into the perinatal work uh early on in my career when I was still in chiropractic school.
• 3:55
  SPEAKER_00: So I I've I just love this work.
• 3:57
  SPEAKER_00: It's my favorite part of the work.
• 3:59
  SPEAKER_00: But as Dr.
• 3:59
  SPEAKER_00: Ray said, nerve system integration, I think this is a great launching point because as chiropractors, we are adjusting the spine and the structure of the of the body to relieve nerve interference, to relieve nerve pressure where there where it occurs.
• 4:13
  SPEAKER_00: Uh, whether it's the low back, the neck, the mid back, uh, the big toe, um, you know, that that's really what we're looking for.
• 4:19
  SPEAKER_00: And helping to really, like Dr.
• 4:21
  SPEAKER_00: Ray said, balance out your nerve system.
• 4:23
  SPEAKER_00: And I think we come uh approach from it from different angles, but also overlap and help patients to cover those different aspects so that, like she said, they can fully participate in life in a pain-free way and get the most out of it.
• 4:40
  SPEAKER_02: I love that.
• 4:40
  SPEAKER_02: And I think that so as a physical therapist, we all, all three of us, have the exact same end goal for our patients, which is that we want our patients to have symptom management, to be able to participate in life the way that they want to.
• 5:01
  SPEAKER_02: So is it dancing at your daughter's wedding?
• 5:04
  SPEAKER_02: Is it getting out of bed?
• 5:05
  SPEAKER_02: Is it walking your dog?
• 5:06
  SPEAKER_02: Is it running a tri a half marathon or a full marathon?
• 5:09
  SPEAKER_02: Is it being able to travel the world?
• 5:11
  SPEAKER_02: Whatever it is, what are your limitations?
• 5:14
  SPEAKER_02: And there are many reasons for those limitations, right?
• 5:17
  SPEAKER_02: Because we know, all of us know, that we have to approach patients with a biopsychosocial kind of an approach, right?
• 5:24
  SPEAKER_02: We don't just understand or know that there's a very specific tissue damage or segmental problem that is the sole driving factor of the reason why they can't travel the world, for example.
• 5:38
  SPEAKER_02: And so with that knowledge, we know that our end goal is the same.
• 5:41
  SPEAKER_02: And then we all know that we need to take up the patient in a holistic approach, understanding so much of what's going on with them, and then using our individual tool sets and our toolbox, which is why we went to different kinds of schools to support patients in different kinds of ways, because people also respond to care in different ways.
• 6:02
  SPEAKER_02: Um, so with that framework in mind, Dr.
• 6:06
  SPEAKER_02: Shire, could you kind of talk about the world of chiropractic care and kind of the your specifics?
• 6:15
  SPEAKER_02: So you don't have to talk about, I guess, what everybody would think, but what do you think in your um learning, in your practice with your patients, with the 20 plus years of experience that you've had, what is the role of chiropractic care that you provide for your patients to support them with the tools that you are licensed to provide?
• 6:35
  SPEAKER_00: So I take a very um holistic as to use that word again, uh perspective.
• 6:41
  SPEAKER_00: So when a patient comes in, a pregnant mom comes in, depending on, let's just take, for example, if it's a musculoskeletal complaint, like a lower back issue.
• 6:48
  SPEAKER_00: Um, I'm gonna look to see where they're out of balance, where's their range of motion, where are their muscles guarding, where are they, where are they weak, right?
• 6:55
  SPEAKER_00: Uh and look to see what is the exact area from a physical standpoint of where they're being blocked and how a chiropractic adjustment can release and free that up so that the body can then work on healing.
• 7:09
  SPEAKER_00: Simultaneously to all that, I'm listening to what they're saying.
• 7:13
  SPEAKER_00: I'm listening to what their body language and what their body movement is telling me because that can reveal a lot that will maybe be outside of what chiropractic can achieve.
• 7:23
  SPEAKER_00: And that's where my little brain goes off and says, Oh, you know what?
• 7:27
  SPEAKER_00: There's some nerve system regulation that might need to happen that Dr.
• 7:31
  SPEAKER_00: Ray would be better able to address, right, with her skill set.
• 7:35
  SPEAKER_00: Or maybe somebody they've got some muscular or pelvic floor imbalance that is not my area of specialties that you, Dr.
• 7:42
  SPEAKER_00: Sneha, would be able to address.
• 7:43
  SPEAKER_00: So I'm always looking when patients come in, is where can I help affect the greatest amount of change?
• 7:50
  SPEAKER_00: But where can they also be served outside of that to achieve the best results possible?
• 7:55
  SPEAKER_02: I love that.
• 7:56
  SPEAKER_02: Dr.
• 7:57
  SPEAKER_02: Ray, any thoughts added on your profession?
• 8:00
  SPEAKER_01: Yeah, I mean, I think that when, you know, to balance off of what you said, when we talk about like nervous system regulation and what is like the unique approach that I'm looking at, one of the things that I do almost with every single plate of care is HRV biofeedback training, which is actually training the stress states or the stress response.
• 8:18
  SPEAKER_01: I I liken it to physical therapy for the nervous system.
• 8:21
  SPEAKER_01: You learn to shift different stress states, get recover back to baseline, um, and to shift your regulation state when you're experiencing different things.
• 8:29
  SPEAKER_01: So let's just say that we have a client with chronic pain and they're doing their PT, they're getting their adjustments, but and they're building strength, they're feeling stronger.
• 8:38
  SPEAKER_01: But every time they go down to, you know, pick something up, they freeze, they get nervous, they their body starts to panic or they tweak a little bit and then they say, Oh my goodness, did I just hurt myself again?
• 8:48
  SPEAKER_01: Even though they know they've been coached, they know they've worked with the therapist to that they're not that right, that that's not what's happening, that not what it means.
• 8:57
  SPEAKER_01: What we do is literally teach you, I what I like to do with HRV biofeedback training is teach somebody how to change their regulation state while they're experiencing these.
• 9:06
  SPEAKER_01: And that's kind of how we look at what's your what are you doing throughout the day?
• 9:11
  SPEAKER_01: How is it showing up in your daily patterns and routines?
• 9:14
  SPEAKER_01: You do all of this, you feel great, but every time you go to pick something up from the floor, or every time you turn this way, you get this stress response.
• 9:21
  SPEAKER_01: Let's train that and let that feed into the loop also.
• 9:24
  SPEAKER_01: I'm not sure if I staying on topic there.
• 9:26
  SPEAKER_01: Yeah, yeah.
• 9:26
  SPEAKER_02: Yeah, no, absolutely.
• 9:28
  SPEAKER_02: Um I I love this because one of the things that we work on with as physical therapists is that like fear avoidance behavior and understanding.
• 9:39
  SPEAKER_02: So I don't administer um the same technique that Dr.
• 9:42
  SPEAKER_02: Ray administers, just so for listeners to know.
• 9:44
  SPEAKER_02: But in the the way that we um kind of touch on this topic is explaining to patients just through patient education the actual tissue damage versus uh the nervous system response and how pain is absolutely true, real and felt by your body, but it does not always indicate tissue damage.
• 10:08
  SPEAKER_02: It does not always indicate that there's an actual physiological problem, but you are physiologically experiencing that, and how those two things can still be true.
• 10:19
  SPEAKER_02: I also tell them there are times where pain is true, tissue damage.
• 10:24
  SPEAKER_02: You can see that's in the form of actually getting bumped really hard and developing edema or swelling.
• 10:30
  SPEAKER_02: And truly, there's an inflammatory response and all of these things are happening.
• 10:34
  SPEAKER_02: But when it comes to, especially with chronic pain, that's not acute pain, oftentimes it is a heightened dysregulation, like a nervous system where there's dysregulation that's happening.
• 10:44
  SPEAKER_02: So, what is that term dysregulation, right?
• 10:47
  SPEAKER_02: So I'd love for you both in your own ways and your own practices, how do you talk to your patients about dysregulation without making it seem like they're dysfunctional?
• 10:57
  SPEAKER_02: Like there's it without making it seem like there's something wrong with their brain that is like attacking them or anything like that.
• 11:05
  SPEAKER_02: But how do you guys in your separate professions and what's your language that you use to explain this to patients in a way that is understandable and not attacking or accusatory?
• 11:16
  SPEAKER_01: Yeah, that's a really good question.
• 11:17
  SPEAKER_01: I think that when it comes to regulation versus dysregulation, the first thing is that it's almost exactly what you just said.
• 11:24
  SPEAKER_01: Your brain and body are absolutely not against you.
• 11:26
  SPEAKER_01: They are 1000% on your side, meaning anything that's happening, any type of quote unquote dysregulatory responses are all designed with some type of protective mechanism in place.
• 11:38
  SPEAKER_01: Um, I think that's like an important starting ground with it also.
• 11:41
  SPEAKER_01: Furthermore, dysregulation or regulation, this is another thing that I talk about.
• 11:46
  SPEAKER_01: To be regulated is not synonymous with being calm, right?
• 11:50
  SPEAKER_01: And I think that the concept of regulation from a nervous system perspective is to still be anchored to yourself, to still have access to certain tools and strategies, to still have some type of grounding in what's going on while your body kind of sorts it out.
• 12:05
  SPEAKER_01: So regul I can be in pain and regulated, right?
• 12:10
  SPEAKER_01: I can be in pain and dysregulated.
• 12:12
  SPEAKER_01: The concept is more so it's about staying grounded with yourself, having access to tools that you need to use and not feeling lost in the sauce sometimes is what I kind of say.
• 12:23
  SPEAKER_00: Yeah, I think it's um it's it's um a lot of times patients don't even know, right?
• 12:30
  SPEAKER_00: They they don't they have no idea what is the difference between regulation and dysregulation when a nervous system is is operating the way it's supposed to versus not.
• 12:39
  SPEAKER_00: They just know that they're showing up in pain or something's not working in their life.
• 12:43
  SPEAKER_00: So it becomes our job as the as the health professionals to be able to uh identify it, point it out, and then come up with a strategy to then help them to be able to regulate it, right?
• 12:54
  SPEAKER_00: So through the chiropractic adjustment, through physical therapy, through biofeedback, we're accessing, uh helping to access and uh bridge the gap for their nervous system to find that state back to balance, take them out of that, whether it's a fight or flight response, right?
• 13:09
  SPEAKER_00: That's been chronically embedded into their nervous system from past traumas or just repeated patterns.
• 13:15
  SPEAKER_00: Um, and and bringing that to their awareness, which, like I said, many of them are not even aware of.
• 13:20
  SPEAKER_00: I just had a patient come in the other day um who's been dealing with some chronic back pain for some time.
• 13:26
  SPEAKER_00: He's had an MRI.
• 13:27
  SPEAKER_00: It's clear, it shows nothing.
• 13:29
  SPEAKER_00: He exercises, he meditates, he eats right, he does all the things that any of us would recommend our patients to do.
• 13:35
  SPEAKER_00: And I said to him at the end of the day, because he said something in his in his um history that caught my ear that was related to a family member that he, his son, to be specific, that was like not quite, you know, regulated to use that to piggyback on that word.
• 13:51
  SPEAKER_00: And after everything that I did for him physically, I said to him, you know, listen, I I there's nothing really I can do for you.
• 13:57
  SPEAKER_00: You there's there's some other steps that you need to take to be help you to get uh this to help this um get back into place.
• 14:04
  SPEAKER_00: And it's not gonna be through chiropractic.
• 14:06
  SPEAKER_00: There's other avenues.
• 14:07
  SPEAKER_00: So that's kind of um the idea, I feel like.
• 14:10
  SPEAKER_00: I yeah.
• 14:11
  SPEAKER_01: And just to piggyback off of what you said or you what you sparked in my brain also as we're talking about that is the goal of regulation, right, is for you to carry that outside of the office too, right?
• 14:20
  SPEAKER_01: When I'm working with clients also, and when any of us are, right?
• 14:23
  SPEAKER_01: Sure, I'm thrilled if you feel relaxed during a biofeedback session, if you feel regulated and good.
• 14:29
  SPEAKER_01: But when you step a pinky toe outside into the real world, right, all of your ingrained habits, patterns, and routines come back into place.
• 14:36
  SPEAKER_01: That's where we want regulation to continue and carry in.
• 14:39
  SPEAKER_01: And that's where I think like making sure that we're bringing it, we're addressing it from multiple areas of the pizza pie and we're bringing it into the real world.
• 14:46
  SPEAKER_01: That's where ultimately I think the change actually happens.
• 14:49
  SPEAKER_02: Yeah.
• 14:50
  SPEAKER_02: I what comes to mind when you guys are talking about this is uh when I talk to patients about almost being an observer of their pain and stepping out of being in the weeds of it.
• 15:03
  SPEAKER_02: And that changes your experience of how you feel it, right?
• 15:08
  SPEAKER_02: It's a concept that's also in the world of meditation and mindfulness, where you don't what what you're experiencing right now, that you're almost able to like jump out and have like a bird's eye view and observe yourself and what you're doing, and actually show empathy and kindness for that situation for you and love yourself despite going through those experiences and those that pain.
• 15:35
  SPEAKER_02: And I'm gonna just touch on this as a mom of a toddler, because I have to do this a lot in the mom world that we talk about, and like, you know, you don't know, you have a dysregulated toddler, they're they're figuring out the world.
• 15:47
  SPEAKER_02: It's like the first time their brain is experiencing all blah blah blah blah.
• 15:50
  SPEAKER_02: So, anyways, you're in the middle of a tantrum and a non-tantrum situation where you have to figure everything out.
• 15:58
  SPEAKER_02: And one of the techniques that I'm using for my own, like right now for my daughter, is stepping out of being in that fight.
• 16:06
  SPEAKER_02: I call it I'm fighting with her.
• 16:08
  SPEAKER_02: When I step out of fighting with her and I go, We we're gonna have perspective here.
• 16:13
  SPEAKER_02: We're gonna talk about is this thing really important?
• 16:16
  SPEAKER_02: Is our like, do we have to make it specific that the red sock goes on before it, blah, blah, blah, blah.
• 16:23
  SPEAKER_02: Like, what is going on here that's causing all the issues?
• 16:26
  SPEAKER_02: And then figure out how to step into her shoes.
• 16:29
  SPEAKER_02: As clinicians, what we do to bring empathy, right?
• 16:32
  SPEAKER_02: We step into their shoes, we understand their perspective, but you can do that for yourself too, right?
• 16:37
  SPEAKER_02: You can step out of your pain experiences, you can step out of quote unquote the dysregulation of the physical body or the mental mind, and then step out of it and experience it in a different way.
• 16:49
  SPEAKER_02: And that actually, I think has been so helpful for people.
• 16:52
  SPEAKER_02: And I know that you both kind of work with this in your own world to help patients understand that their pain, their dysfunctional issues, whatever it is that they're going through, doesn't define them.
• 17:05
  SPEAKER_02: It's not all of who they are.
• 17:07
  SPEAKER_02: And it's really hard because sometimes it can become your identity.
• 17:11
  SPEAKER_02: It's the hi, my name is Sneha and I have a headache, or hi, my name is Joe and I have back pain.
• 17:18
  SPEAKER_02: It becomes a personality, becomes something that you walk around with as professionals.
• 17:24
  SPEAKER_02: We serve that, but then we also have this like very minute way of not um pigeonholing somebody into making it their personality.
• 17:33
  SPEAKER_02: And now I'm curious, what do you guys think?
• 17:36
  SPEAKER_02: What do you guys do to help people?
• 17:40
  SPEAKER_02: It's not really a distraction strategy, but how do you guys help people get out of being stuck in the weeds of the problems?
• 17:49
  SPEAKER_00: So I'm gonna I'm gonna go first because I you'll be able to, I know you're gonna take this uh to the next place.
• 17:54
  SPEAKER_00: But I um, you know, identifying those patterns, right?
• 17:58
  SPEAKER_00: Um, I'd introduce the concept of neuroplasticity, right?
• 18:02
  SPEAKER_00: The idea that the nerve system's pliable, it's changeable, that you want to learn to play the piano or or you know, learn a new language, you can do that.
• 18:09
  SPEAKER_00: It's one, it's one step at a time.
• 18:11
  SPEAKER_00: So, but first is to recognize that's the issue.
• 18:14
  SPEAKER_00: So just taking that concept of people, which many people are not even acutely aware of, or that they have that control or that ability, um, is a is a really refreshing first step because whether we're talking about retraining the nerve system physically, standing at your desk instead of sitting all day, or holding your phone up instead of looking down at it all day, right?
• 18:35
  SPEAKER_00: This is the beginnings of recreating new patterns for them, at least in a physical sense.
• 18:41
  SPEAKER_00: And then when they get to a doctor A, they get into a whole other aspect of understanding their nerve system, right?
• 18:48
  SPEAKER_01: Yeah, no, absolutely.
• 18:49
  SPEAKER_01: And I think that, you know, part of it is also from is bringing occupation back into it.
• 18:53
  SPEAKER_01: What are the things that are really important to you, the things that you like to do, right?
• 18:56
  SPEAKER_01: The things outside of that identification, hi on Taylor and I have chronic pain.
• 19:00
  SPEAKER_01: I also like, I love music.
• 19:01
  SPEAKER_01: I like going to concerts, I like doing all of these things.
• 19:04
  SPEAKER_01: And if we can bring that into finding ways to make that accessible, manageable, we use that to also like, you know, I'm thinking of a specific case where we were talking about how excruciating the pain is, which it is, but how it's really different when this person is listening to live music for a second or actually got to play, got into a game with their kids and forgot about it for a second.
• 19:28
  SPEAKER_01: And it's this difference of like I don't have that be your identity and your soul experience.
• 19:32
  SPEAKER_01: It's like suffering and experiencing sometimes is how we like break it down also.
• 19:36
  SPEAKER_01: And I think that showing people to your point, empowering them with the concept that we all had access to neuroplasticity, right?
• 19:44
  SPEAKER_01: Is I think empowering nonetheless and helps people see themselves as more than that identity.
• 19:49
  SPEAKER_01: That identity becomes also a shell too.
• 19:51
  SPEAKER_01: There's this protective mechanism also of being like, my name is Taylor, I'm in chronic pain, and not and being protected by that also when you think about being open to the possibility of improving, feeling better, getting better, that you can do some mindfulness, breath training, HRV and improve it.
• 20:08
  SPEAKER_01: I think that can sometimes pump people out into a little bit of vulnerability that has to be managed well as well.
• 20:15
  SPEAKER_00: And I just want to jump in one more thing because um I think it's also important uh to bring to people's awareness, talking about the identity, but but also to bring to people's awareness the self-responsibility, right?
• 20:26
  SPEAKER_00: The self the empowerment that people have.
• 20:28
  SPEAKER_00: A lot of times people show up in our offices and they're like, I'm in pain.
• 20:32
  SPEAKER_00: I've got XYZ.
• 20:34
  SPEAKER_00: I don't want XYZ, and I want you to fix it or get rid of it.
• 20:37
  SPEAKER_00: And you're like, whoa, wait a minute.
• 20:39
  SPEAKER_00: Like, you know, you know, we're gonna do that, but I'm gonna we're gonna reframe this a little bit to empower you with tools and knowledge to be able to manage this on your own.
• 20:50
  SPEAKER_00: Because at the end of the day, right, no one's coming to save us.
• 20:53
  SPEAKER_00: It's it's it's on our own.
• 20:54
  SPEAKER_00: We can see guidance, we can see help, we can see outside interventions.
• 20:57
  SPEAKER_00: But at the end of the day, once you learn a biofeedback technique or a you know, a physical therapy exercise or a whatever, the patient has to go and do it, right?
• 21:06
  SPEAKER_00: That's one of the biggest for me frustrations over all these years of practice is how many times do we give patients something that is going to be beneficial for them to resolve their issue and they don't do it?
• 21:18
  SPEAKER_00: Yeah, right.
• 21:18
  SPEAKER_00: We're empowering you to take this unknowledge and information, give you tools to be able to help yourself.
• 21:24
  SPEAKER_00: And maybe they take it, right?
• 21:26
  SPEAKER_00: Some of them take it and run and they come back and they get results because most of the time they do, or they don't.
• 21:31
  SPEAKER_00: And you don't know why?
• 21:32
  SPEAKER_00: Why, you know, did you do oh, I didn't do my exercises, I didn't do my, you know, training.
• 21:36
  SPEAKER_00: Okay, well, you know, I can't do it for you.
• 21:38
  SPEAKER_01: Absolutely.
• 21:39
  SPEAKER_01: And I think just what I'm also thinking as you're saying that is that's another reason why I am so passionate about the use of HRV or biofeedback in general, because it, you know, that that making like you shifting stress states or practicing regulation techniques visible before you can feel it, right?
• 21:56
  SPEAKER_01: We're dealing with people who have been in chronic pain, you're in pain for a long period.
• 22:00
  SPEAKER_01: Of time that is dysregulating by nature, you're maybe you're not going to notice how, oh, wait, did I feel better?
• 22:05
  SPEAKER_01: Because you're still protective.
• 22:06
  SPEAKER_01: Getting, letting you see, look at how, you know, chaotic this signal is and look at how you just shifted that, right?
• 22:12
  SPEAKER_01: It makes it real.
• 22:14
  SPEAKER_01: It makes them, it's, they were like, oh, I just did that.
• 22:16
  SPEAKER_01: I actually do know how to do this.
• 22:18
  SPEAKER_01: Some of these things, these exercises, these techniques that, you know, mop box, all these different breath techniques and stuff that is research back.
• 22:25
  SPEAKER_01: Clinically, we know that these things work.
• 22:27
  SPEAKER_01: It's so much harder to just wave that off when you are visually seeing that you're able to influence your physiology through using these techniques.
• 22:35
  SPEAKER_01: And I found that to be really like helpful.
• 22:37
  SPEAKER_01: Even when working with therapists, it's helped solidify and ground people and make tangible some of these strategies that otherwise they don't relate to as much.
• 22:46
  SPEAKER_02: Yeah.
• 22:46
  SPEAKER_02: I think, yeah, in the in the PT world, especially in the pelvic floor world, we we have different methods of uh providing biofeedback too.
• 22:54
  SPEAKER_02: And obviously the most obvious is like see, feel, touch, your own body and see that's buttoning.
• 23:00
  SPEAKER_02: Um, but then we use like also sensors and different things that connect to monitors and then show people what they're doing.
• 23:06
  SPEAKER_02: And I've found that um, especially when it comes to like sensory or tooled biofeedback that shows up on a monitor, it's the people who like the calculatory kind of backs like I know that I'm making progress.
• 23:21
  SPEAKER_02: And it can be so rewarding for some patients.
• 23:23
  SPEAKER_02: For some patients, it just stresses them out even more because there's like, so wait my god, why is that number not going up?
• 23:28
  SPEAKER_02: I'm doing all the things you just told me to.
• 23:30
  SPEAKER_02: I'm trying so hard and it's not moving.
• 23:32
  SPEAKER_02: That little dial is not moving.
• 23:33
  SPEAKER_02: But for some people, they find it really beneficial to be like, okay, now I understand what to do.
• 23:40
  SPEAKER_02: And now I understand that thing that you keep telling me that's not working, but that's not it.
• 23:44
  SPEAKER_02: And they finally understand because they're using their own body, their own mind, their own vision, their own touch to um factor that in, which I think that's the whole point of these tools, right?
• 23:55
  SPEAKER_02: Because we have these different ways of helping these different people.
• 24:01
  SPEAKER_02: They don't all come the same textbook version of this, you know, the same presentation with the same background, with the same physiology.
• 24:11
  SPEAKER_02: They come in, you know, like we said before, the biosychosocial approach, they come in with totally different expectations of what they're getting out of treatment sessions.
• 24:20
  SPEAKER_02: They're coming in with totally different expectations of what pain is.
• 24:23
  SPEAKER_02: They come with very different expectations of what their body is capable of doing and what it's meant to do and what they think that they can tolerate.
• 24:31
  SPEAKER_02: And so I think that like the the part that I want to jump into now, which is the exciting part of this conversation, is why it's so important to have this multidisciplinary team, to work with patients of all kinds, because we can't treat everybody the same way, right?
• 24:49
  SPEAKER_02: And so I'd love for you guys to kind of touch on your experiences, your background with that.
• 24:55
  SPEAKER_02: Um, what I mean, if you can even branch out further than our professions with other professions that you collaborate with.
• 25:02
  SPEAKER_02: But why do you guys think that that's important?
• 25:04
  SPEAKER_02: Why is it important for listeners to know that there's other options for them?
• 25:08
  SPEAKER_02: Sometimes PT is not the right thing in that moment.
• 25:11
  SPEAKER_02: Sometimes they got to do something else first.
• 25:13
  SPEAKER_02: Sometimes maybe before the chiropractic adjustment, they have to do X first.
• 25:17
  SPEAKER_02: Or maybe the chiropractic adjustment is what's gonna get them to be able to do that next piece and have that, you know, whatever release work that they need to in order to get them over the hump, right?
• 25:28
  SPEAKER_02: Maybe they have to work on their biofeedback, their heart rate, because their nervous system is so heightened before they they can even try to do a forward bend with me in the clinic, right?
• 25:39
  SPEAKER_02: So just curious what you guys think.
• 25:41
  SPEAKER_02: And again, you can jump out of our professions too, and just talk, speak to the importance of collaborative care.
• 25:49
  SPEAKER_00: So uh so again, uh and here we are in true whole care, uh, which is where Dr.
• 25:53
  SPEAKER_00: Taylor and I are working.
• 25:55
  SPEAKER_00: And it's it's such a wonderful place because we have all of these um uh providers and different opportunities under under one roof, right?
• 26:02
  SPEAKER_00: So it's really it's really quite amazing.
• 26:05
  SPEAKER_00: And understanding that everybody um responds differently to different um um different modalities, different people, different, you know, uh um energies, right?
• 26:16
  SPEAKER_00: And like you said, Snaya at the beginning, it's you know, at the at the right time, it might be a different sequencing, right?
• 26:22
  SPEAKER_00: Um, I might have a difficult time, you know, getting access to making a breakthrough with a patient, getting them to adjust it until their nerve system is unable to relax, or with a pregnant mom whose pelvic floor is like, you know, just all wound up and and and there's a you know maybe some stored trauma in there, we're not gonna be able to get her back to release until those muscles are to release.
• 26:44
  SPEAKER_00: And I can't do that.
• 26:46
  SPEAKER_00: I've got to refer that out to somebody else.
• 26:48
  SPEAKER_00: And that's where the beauty of collaborating with trusted professionals who are qualified and good at what they do for me is very, very rewarding because I love how the three of us and other providers you know can work together with the patient.
• 27:03
  SPEAKER_00: And then when they get the results, you know, it's just it's uh that's I think where the magic is.
• 27:09
  SPEAKER_00: And having that open mindset, right?
• 27:11
  SPEAKER_00: That's not mine's not the only way.
• 27:13
  SPEAKER_00: Yours isn't the only way.
• 27:14
  SPEAKER_00: It takes there's many colors uh of the palate, uh many roads to get to that place.
• 27:20
  SPEAKER_00: And we, I think, as providers, need to be attuned and open uh and percepted to those other possibilities to again serve the best interests of the patient.
• 27:29
  SPEAKER_01: Yeah, I mean, absolutely.
• 27:30
  SPEAKER_01: I mean, yeah, I piggyback off of what both of you guys say.
• 27:33
  SPEAKER_01: I think that from a clinician standpoint, diversity and thought and experience and specialty and all of that just enhances patient care, right?
• 27:42
  SPEAKER_01: Hands down, having all the different perspectives pop in.
• 27:45
  SPEAKER_01: And that's one of the best things about working here and being able to say to Dr.
• 27:48
  SPEAKER_01: Sher, hey, blah, blah, blah, this is what's going on.
• 27:50
  SPEAKER_01: He's like, you know, I try, and it's like, oh, okay, I can we can work with that.
• 27:54
  SPEAKER_01: I wouldn't have thought of that or looked at it that way or been able to reinforce anything that way.
• 27:59
  SPEAKER_01: So I think that that it makes me a better clinician collaborating with other providers and other specialties and also having like being able to actually to die to uh what's the word I'm looking for?
• 28:11
  SPEAKER_01: I'm not diefer.
• 28:12
  SPEAKER_00: Refer?
• 28:13
  SPEAKER_01: Yeah.
• 28:14
  SPEAKER_01: Give it, but say, you know what, you should talk to Sneha about that because she's gonna be way more equipped to handle that, right?
• 28:20
  SPEAKER_01: It also lets me focus where I need to focus and actually be in the lane that I need to be in so that I can do my job, knowing that it's a piece, it's a piece, it's a pizza pie, right?
• 28:30
  SPEAKER_01: So it's not just my job that's gonna get it there, but I have to be able to do that.
• 28:33
  SPEAKER_01: I think OTs in general, right?
• 28:35
  SPEAKER_01: We have a very vast scope of practice, but you have to, but we can't you can't adjust all of, I mean, we're not the most skilled in addressing all of that, but you need other people in to really address different aspects of what's going on.
• 28:48
  SPEAKER_01: And I think every client is different.
• 28:50
  SPEAKER_01: I think of it like an algorithm, right?
• 28:52
  SPEAKER_01: I can make pretty good arguments that most people could benefit from chiropractic physical therapy, biofeedback, nervous system regulation.
• 28:59
  SPEAKER_01: But everyone's algorithm, individual algorithm, it's gonna be different in terms of what's most effective for them, what works with their time and conditions.
• 29:06
  SPEAKER_01: So yeah.
• 29:07
  SPEAKER_00: What their what their mind is open to.
• 29:09
  SPEAKER_00: You know, I could talk about biofeedback and they'll be like, you know, no, I can't, you know, I can't, I'm not, I'm I can't do that.
• 29:14
  SPEAKER_00: Okay, you know, now maybe not is the right time, but you know.
• 29:17
  SPEAKER_01: And yeah, and like to your point, some people for biofeedback, it's actually very anxiety inducing, and they'll do better with no feedback, guidance through mindfulness meditation technique.
• 29:26
  SPEAKER_01: So it's just, yeah, it's about determining everybody's algorithm, I would say.
• 29:30
  SPEAKER_02: Yeah.
• 29:30
  SPEAKER_02: And for for providers listening, I just want to kind of synthesize this as a kind of invitation to explore this more, right?
• 29:40
  SPEAKER_02: Because I think too often we get stuck into our ways of doing things.
• 29:46
  SPEAKER_02: And uh, I can tell you the number of times that I've heard people in different professions being like, oh, they don't do a great job, or like, oh, that's kind of like whatever.
• 29:55
  SPEAKER_02: Um, but I don't think that helps our patients.
• 29:57
  SPEAKER_02: And because the middle of the Venn diagram is help our patients, and if somebody doesn't agree with that, you're not doing the right job as a provider.
• 30:05
  SPEAKER_02: So that's that's the first thing.
• 30:07
  SPEAKER_02: But I really do think that largely, almost every single one of us wants to help our patients and wants to improve the quality of their life.
• 30:17
  SPEAKER_02: We do it in different ways, but one improve the quality of their life.
• 30:19
  SPEAKER_02: And if that's the true goal, then we need to keep this open mind of communicating and understanding that it's not actually just about what you provide, which is awesome, but it's where the patient is coming from.
• 30:33
  SPEAKER_02: And if you are going to take a patient-centered approach, which is another word, I believe, in that Venn diagram, that we have to be in this collaborative care, be open to the collaborative care, and honestly understand other people's scope of practices too.
• 30:48
  SPEAKER_02: Like one thing that I had to really do, and I really should keep doing it because sometimes I'll forget, is when somebody asks me the difference between an OT and a PT, and I'm like, hold up, let me open the handbook and explain to you the very specific.
• 31:04
  SPEAKER_02: I mean, I could sit kind of say it, but I'm like, I'm not sure if that everything I said is 100% accurate because I didn't go to OT school.
• 31:12
  SPEAKER_02: I can tell you exactly what PTs do.
• 31:15
  SPEAKER_02: And also that differs from state to state, that's a whole different thing.
• 31:17
  SPEAKER_02: Yeah.
• 31:18
  SPEAKER_02: But still, I think it's important that we understand other people's um practice acts, scope of practices, and help people and patients in this interdisciplinary way.
• 31:30
  SPEAKER_02: And then for patients that are listening, I think this is an invitation to in your own, because so many patients are becoming their own experts in their bodies in a positive way, I believe.
• 31:43
  SPEAKER_02: I think that sometimes it can, there's always exceptions to this, but I really do think that so many more patients are taking charge of their health and not just being like, I am just going to let this go in the air and somebody figure this out for me.
• 31:56
  SPEAKER_02: I really do think that people are learning about their health conditions, learning about strategies that can help.
• 32:01
  SPEAKER_02: I think there's more information spread, and we talk about why the technology and social media and all that stuff, and in some ways for the better.
• 32:08
  SPEAKER_02: And so this is an invitation to um if you feel like, oh, that thing might, that thing doesn't work for me, wherever that block is, to just open up to other possibilities, especially if you're physically stuck.
• 32:20
  SPEAKER_02: Because if you're going to a really good provider, I promise that you are their number one priority.
• 32:26
  SPEAKER_02: Your well-being and the you getting better is their number one priority because it helps you, but it also helps them too.
• 32:34
  SPEAKER_02: If they can't help patients, they're not going to be practicing too.
• 32:37
  SPEAKER_02: So it is in your best interest, in their best interest, and a mutual best interest for providers to provide quality care and for patients to be open to various kinds of treatments.
• 32:49
  SPEAKER_02: Not that they need to jump from one place to another, but just be open to understanding what different professions do and how those different professions can really help them.
• 32:58
  SPEAKER_02: Because I really do think that we're jumping into an age of people not only taking charge of their health, but like going beyond.
• 33:05
  SPEAKER_02: Like we don't have to be subject to XYZ conditions.
• 33:10
  SPEAKER_02: And, you know, we have more information now.
• 33:11
  SPEAKER_02: And I think that people know that and understand that.
• 33:14
  SPEAKER_02: So I thank you guys for all the work that you do and the information that you put, the heart and soul that you guys have for the work that you do and providing patient care.
• 33:23
  SPEAKER_02: And I'd love for if you guys had any last words, anything else to add to our conversation, please jump in and um, you know, give your final thoughts.
• 33:32
  SPEAKER_00: I just once again uh thank you uh for the work that you do, but for inviting us onto your podcast.
• 33:38
  SPEAKER_00: Uh education is empowerment, doctor means teacher and Latin.
• 33:42
  SPEAKER_00: I think we would all take that pretty seriously.
• 33:45
  SPEAKER_00: And uh yeah, the more people we can reach uh and help heal, it helps to heal the planet.
• 33:50
  SPEAKER_01: Yeah, ditto.
• 33:51
  SPEAKER_01: Yeah, I mean, like I thank you so much also.
• 33:54
  SPEAKER_01: And I just also appreciative for the opportunity for collaboration within profession and stuff like that, too, and what he said.
• 34:01
  SPEAKER_02: Amazing.
• 34:02
  SPEAKER_02: Um, could one of you uh also tell listeners where they can find your guys' practice and uh contact information?
• 34:08
  SPEAKER_02: I'll also drop it in the show links, but in the show notes, but please also share what's the best way for people to reach you.
• 34:15
  SPEAKER_00: Uh so we're both at True Whole Care, which is trueholcare.com.
• 34:19
  SPEAKER_00: Um, I'm also at drrobertshire.com.
• 34:22
  SPEAKER_01: Uh yeah, and drsailoray.com.
• 34:25
  SPEAKER_02: Amazing.
• 34:26
  SPEAKER_02: So I'll drop that in the show notes for listeners.
• 34:29
  SPEAKER_02: These are wonderful practitioners, especially if you're in the greater New York area.
• 34:33
  SPEAKER_02: If you want to get an evaluation, just understand a little bit more of your body.
• 34:37
  SPEAKER_02: They're here to educate for your for and for your if you're the key coming to learn, which you probably are because you're listening to this podcast right now.
• 34:45
  SPEAKER_02: I encourage everyone to make use of their services and um get to know what they do as a profession, too.
• 34:52
  SPEAKER_02: Thank you both for being here.
• 34:53
  SPEAKER_02: Thank you so much.
• 34:55
  SPEAKER_02: Thank you all for tuning in and investing in yourself and your well-being.
• 34:59
  SPEAKER_02: If you listened to the show today and gained anything out of it, share it far and wide.
• 35:04
  SPEAKER_02: It means a world when you rate and review the show.
• 35:08
  SPEAKER_02: Don't forget to use your exclusive 20% discount code FIT20 when you sign up for our signature course Master Your Public Floor linked in the show notes.
• 35:18
  SPEAKER_02: See you again next week with an exciting new guest and topic!