Latest / Wellness by Designs - Practitioner Podcast / Making Sense of Pain: A Deep Dive into Treating Chronic Pain with Jesse Soopaya

Transcript

Making Sense of Pain: A Deep Dive into Treating Chronic Pain with Jesse Soopaya · Wellness by Designs - Practitioner Podcast

• 0:21
  Speaker 1: This is Wellmuss by Designs and I'm your host, andrew Whitfield Cook.
• 0:24
  Speaker 1: Welcome back to Wellmuss by Designs.
• 0:40
  Speaker 2: Andrew, I'm well.
• 0:41
  Speaker 2: Thanks for having me again.
• 1:02
  Speaker 1: Yes, I'm Andrew Whitfield Cook.
• 1:05
  Speaker 1: Hello Matt, I'm Andrew Whitfield.
• 1:17
  Speaker 1: They're in pain, so let's start off there.
• 1:22
  Speaker 1: What do you do for pain?
• 1:28
  Speaker 2: Yeah, so you're absolutely right.
• 1:30
  Speaker 2: Most people do come and see me in the practice here because they are in pain.
• 1:34
  Speaker 2: And, yeah, pain is, it's such a big, broad, complex phenomenon in the body.
• 1:43
  Speaker 2: So the first thing that I do is really try and figure out where it's coming from, what structure, what tissue is involved, and I usually try and sort of map out the root causes through just a really good questionnaire, subjective interview, and try and just find where exactly is this source of this pain coming from.
• 2:07
  Speaker 2: Is it from a somatic structure, so muscle, periosteum, ligament, tendon, skin, or is it something deeper?
• 2:17
  Speaker 2: Is it visceral?
• 2:17
  Speaker 2: Or are we looking at something that's more sensitization, central nervous system related overload, sort of chronic pain syndrome, those kind of things?
• 2:27
  Speaker 2: So, looking at all of those, I guess for common reflex arcs in the nervous system.
• 2:35
  Speaker 2: So we know that there's the ability for somatic structures to refer to other somatic structures through a reflex arc.
• 2:42
  Speaker 2: So, for example, you might have the patellar tendon reflex.
• 2:47
  Speaker 2: You tap the patellar tendon and that causes the extensors.
• 2:51
  Speaker 2: That's a reflex in the body and pain is very much like that.
• 2:56
  Speaker 2: So our experience of pain is essentially nociception, sensation coming from structures going through up into the spinal cord, where it's then either going up towards the nervous system or getting overloaded at that spinal segment, referred somewhere else.
• 3:16
  Speaker 2: So it's for me it's just trying to figure out okay, is this from an external somatic structure or is it more of a visceral structure, or is this something that is related to a person's I guess, overall nervous system state?
• 3:33
  Speaker 2: And that's kind of where I start.
• 3:36
  Speaker 2: But I really like using, I guess, this whole idea of finding the cause of the pain from when it first started, so often, looking at either symptom recognition and trying out things with manual therapy.
• 3:51
  Speaker 2: Starting off.
• 3:52
  Speaker 2: There, I find that a lot of people's issues can just get rectified with some really good soft tissue therapy or manual therapy and that can help to kind of yes or no, it's coming from a muscle or a tendon, you know, or a joint, etc.
• 4:08
  Speaker 2: That's causing most of the discomfort.
• 4:11
  Speaker 2: And then obviously exercises as well, like stretches and strengthening exercises, yeah, breathing exercises and things like that.
• 4:20
  Speaker 2: And then as an adjunct to that and I guess this is where I find that sort of whole complementary, more integrative approach I look at their lifestyle.
• 4:31
  Speaker 2: So what are they doing in terms of their exercise habits, their sleep, even just basic eating habits?
• 4:37
  Speaker 2: You know things like that as well can have an impact and cause pain in the body, and even something simple is overall stress levels.
• 4:45
  Speaker 2: What is their, I guess, balance of their energy energy out versus energy in?
• 4:50
  Speaker 2: Are they sort of disrespecting that equilibrium?
• 4:54
  Speaker 2: Are they in homeostasis?
• 4:55
  Speaker 2: And then, yeah, looking at ways to support them, and definitely nutraceuticals, vitamins, is a big, big part of helping to bring someone back into that balance or just to give them that support, that nutritional support, to get them through what they're going through.
• 5:13
  Speaker 2: So, yeah, I really really like using things like Ashwagandha, curcumin, magnesium, collagen.
• 5:22
  Speaker 2: Those are sort of the main ones that I typically recommend and suggest people use.
• 5:29
  Speaker 1: Yeah, yeah, jesse, I've got to take my hat off for you.
• 5:33
  Speaker 1: I love the way that you said that it's to support them while they're going through this.
• 5:38
  Speaker 1: It's not this I put them on magnesium and they're on it for the rest of their life.
• 5:42
  Speaker 1: So it's this real, responsible use of supplements to help people through a difficult period in their lives while correcting an imbalance, with the hope that they won't need those supplements in the future.
• 5:55
  Speaker 2: So I really take my hat off for you, mate.
• 5:58
  Speaker 1: Yeah.
• 5:59
  Speaker 2: Thanks for that.
• 5:59
  Speaker 2: Yeah, look, it's definitely something that I've become more attuned to, even myself included, over the years.
• 6:07
  Speaker 2: Now, these supplements are there to supplement a well balanced lifestyle diet, and the body responds well to these things, but ultimately, you should be getting these from your day to day life.
• 6:20
  Speaker 2: Your body should be accessing that through basic nutrition, and so oftentimes I really encourage people depending on their presentation, what they're at is to get some nutritional support, whether that be through a clinical nutritionist or a naturopath or going to see their GP or someone who they can get some really, really good education from on how to basically get the nutrients in the vitamins they need to support their body to heal.
• 6:48
  Speaker 2: So that's definitely something where, especially people who are very, very low health literacy, I'll pretty much always handball them to someone who can help them in that regard.
• 7:00
  Speaker 1: So, yeah, Can I just ask, though when we're talking about the difference between visceral and musculoskeletal pain, it might seem obvious because they're different tissues, but do you find that you have to rely on certain hints that the patient might give you the symptomatology where the pain is, how it's presenting?
• 7:23
  Speaker 1: Is there any hints that you can give us that might help to differentiate those two types of pain?
• 7:29
  Speaker 2: Definitely yeah.
• 7:30
  Speaker 2: So in my experience it's really important to understand the aggravating factors and if it's a mechanical movement that's causing that irritation, then you can be pretty certain that it's probably coming from some structures relating to that movement of that joint.
• 7:48
  Speaker 2: If it's something that's related to something that's non-mechanical let's say the pain lady presents with lower back pain and she's premenstrual and that's a recurring pattern and you pick that up in your questioning and that's something that you can go right Perhaps this is actually referring pain into the lower back, where the organ itself is referring nociception into the spinal cord segment.
• 8:19
  Speaker 2: That's also innovating the lower back muscles.
• 8:21
  Speaker 2: So the pain might be in the lower back, but it's actually emanating from internal organs and that's a pain that's often described as being deeper and a lot more throbbing and I often hear complaints of it feels very strong and it's almost quite hard to palpate, in that sense, whereas they can't quite find the spot.
• 8:47
  Speaker 2: Yeah, and there's also.
• 8:49
  Speaker 2: There's also pain that comes from the nervous system itself.
• 8:55
  Speaker 2: So we know that when you're looking at someone, especially when the symptoms have been quite chronic, that pain is an impulse from the brain to alert you of danger and perceived threat.
• 9:10
  Speaker 2: And the more that that impulse gets sent from the body, whether that be the viscera or the muscle, the somatic structures, that pathway, that impulse pathway, that neural pathway, it becomes facilitated and that facilitation means it's easier to trigger it.
• 9:27
  Speaker 2: So, therefore, people with long standing symptoms, who don't have a good understanding of what's going on they can have, they can get that experience of pain much easier and that so pain gets pain Correct.
• 9:45
  Speaker 2: Yes, Right.
• 9:48
  Speaker 1: So this is is that along the lines of complex regional pain syndrome, that sort of thing, or are we talking about something different?
• 9:57
  Speaker 2: Yeah, exactly, it honestly depends on where you live and what healthcare professionally you see.
• 10:02
  Speaker 2: But all of those sort of symptoms complex regional pain syndrome, fibro myalgia, those sorts of things they all sort of fall into that same bracket.
• 10:15
  Speaker 2: So I guess what I'm looking at with those diagnoses and trying to really find what's going on with someone, you're looking at things like that.
• 10:25
  Speaker 2: The pain is exceeding the normal time for tissue healing.
• 10:28
  Speaker 2: So, for example, we know that ligamentous structures roughly take about 90 days to heal in a normal, healthy person.
• 10:39
  Speaker 2: And so if this prolonged pain that's going beyond the normal time for a muscle war, a bone to heal, fracture to heal, you know that there's an element of sensitization in their nervous system and that's something that's really commonly overlooked by the person themselves but also other healthcare professionals and they, you know, super confused about what the hell is going on.
• 11:03
  Speaker 2: But I've even seen it where the pain can spread to the opposite side, to the side of to bursitis on a shoulder, goes on and on and on, and then that can actually overload the C5 nerve root, the dorsal horn, and then that, yeah, and then that transfers to the other side because it's a protective mechanism in the nervous system where the body is actually trying to alert you of.
• 11:27
  Speaker 2: It's got nowhere else to go those impulses.
• 11:30
  Speaker 2: So, and then that's when that spreading of pain in a sort of I guess unexplained way can lead to that whole complexity and the regional nature of overall everything hurts.
• 11:45
  Speaker 1: It's almost like the body's trying to tell you to stop Seek help.
• 11:50
  Speaker 1: You know that's right.
• 11:52
  Speaker 2: Yeah, exactly, exactly, and that's exactly what that is.
• 11:56
  Speaker 1: Yeah, Well, yeah, Isn't it interesting that we think of just pain very often as this bad thing we'd like to.
• 12:03
  Speaker 1: We'd like it to go away.
• 12:05
  Speaker 1: Can you get rid of it for me, please?
• 12:06
  Speaker 1: Rather than this pain is telling you something, it's a message.
• 12:10
  Speaker 1: Yeah, that's like we need to address the message Interesting Exactly, so it's a survival, survival, survival instinct, survival mechanism.
• 12:20
  Speaker 1: Yeah, I could talk to you all day, jesse, seriously, but we've got to move on to conditions, because that's what we promised our audience.
• 12:28
  Speaker 1: Yes, so let's move on to conditions what like presentation, how you might treat them if you'd use any supplements that you might find of merit, and how you know long term effects, how you get people off supplements, what their prognosis is.
• 12:45
  Speaker 1: So you know, let's talk about something common lower back pain, right, very common.
• 12:52
  Speaker 2: Yeah, sure, presentation first, yeah, yeah.
• 12:55
  Speaker 2: So I think, with lower back pain, again looking at the causes, but let's, I find quite frequently there is always an element of tightness in the back and the surrounding tissues and structures, and a lot of that tightness obviously is coming from the myofascial system.
• 13:14
  Speaker 2: So the fascia being that real elastic, sinewy substance that covers all of our organs, muscles, tissues, and one thing we do know is that elasticity in fascia is really important and muscles and that ability to have a relaxed musculoskeletal system largely comes from magnesium.
• 13:37
  Speaker 2: So often, especially for someone whose symptoms match up with a lifestyle that's contributing to tightness through sedentary behaviors or certain overuse example, throwing in some magnesium into their treatment protocol, I find is really really helpful and it just gives them that sort of ability to relax, sleep better.
• 14:00
  Speaker 2: People often report feeling much less tense overall Because, as you said before, pain begets pain and tightness in the back, whether that be in the muscles or stiff joint.
• 14:13
  Speaker 2: That can ultimately lead to upstate, whether there's trigger points in those muscles, and those trigger points can cause lack of blood flow, which is ischemia, and then that can also lead to anoxia, which is low oxygen level.
• 14:28
  Speaker 2: So, when you're looking at it, yes, massaging is very, very good and stretching is very good, but ultimately we want to help support people even more when they're not in the treatment room those other 23 hours of the day, and so I really love using magnesium for those sorts of things.
• 14:50
  Speaker 1: Yeah, it's really interesting speaking with David Cowick about his integrative dentist, about his use of magnesium with even temporal mandibular joint pain and also those patients that might you know.
• 15:04
  Speaker 1: They have their very tense they tend to be the more tense people and they don't relax their jaw and they end up with jaw pain after a procedure.
• 15:11
  Speaker 1: So he gets them onto magnesium and he finds that over a month or so or two that their jaw relaxes from.
• 15:18
  Speaker 1: That'll be more than one month, but from one treatment thing to the next six months, yeah, yeah, their jaw relax and they're much more amenable to that sort of wide jaw procedural sort of exploration sort of stuff.
• 15:34
  Speaker 2: Yeah, it's a very calming mineral.
• 15:37
  Speaker 1: Yeah, can I just ask?
• 15:38
  Speaker 1: So when we're talking about joints, lower back pain you know, let's say there's some deterioration of the cartilage on the facets in the lumbar joints, lumbar vertebrae, so try to differentiate between nerve pain and then also, because you get a pain, you want to isolate that, you want to stop it from moving, from giving you pain.
• 16:06
  Speaker 1: So you tend to put the muscles into spasm to support it.
• 16:11
  Speaker 1: You know it's not core stuff.
• 16:17
  Speaker 2: Protective spasm yeah yeah.
• 16:20
  Speaker 1: So so do you find that you have to sort of work back like an onion to say, okay, let's work on the muscles, but we still have to sometime address that.
• 16:29
  Speaker 1: You know?
• 16:30
  Speaker 1: Facet joint issue or correct.
• 16:32
  Speaker 1: How do you work?
• 16:33
  Speaker 2: Absolutely.
• 16:34
  Speaker 2: Yeah, that's obviously the facets are quite internal and the nerves are even more inside the vertebrae, so it's deeper.
• 16:42
  Speaker 2: But you definitely work outside in and the brain will prioritize, the nervous system will prioritize the impulse.
• 16:50
  Speaker 2: That's the strongest as well.
• 16:52
  Speaker 2: So the person might be experiencing nerve pain, for example.
• 16:56
  Speaker 2: That's the strongest impulse because the nerves getting compressed from a disc bulge or degeneration and other things that can be causing it.
• 17:06
  Speaker 2: But you can also put that person in a comfortable position, release them, relax the muscles and then they find that they're actually overall sensitivity and the impulses that are going up to the spinal cord are reduced.
• 17:19
  Speaker 2: So therefore that actually calms them down, which then helps calm their pain down a little bit.
• 17:25
  Speaker 2: So then you can actually get a better idea of, okay, what is the predominant thing happening here?
• 17:31
  Speaker 2: Is it, you know, just your arthritis?
• 17:34
  Speaker 2: Is it just tightness in the back, or is it actually you've got some nerve pain?
• 17:38
  Speaker 2: So, whatever symptoms are sort of persistent, through the treatment helps in the different.
• 17:46
  Speaker 1: You know, what's pinging in my mind here is how many patients I see on very high dose you know, gaba, penton or something like that, how do I phrase this?
• 18:05
  Speaker 1: Even on higher doses, their pain is not well managed and so they're looking for other issues.
• 18:12
  Speaker 1: Often they're a pill, or sometimes an additional cannabis or something like that.
• 18:19
  Speaker 1: Their pain is not imagined, their pain is not trivial, but they find it really hard to get somebody to believe them in the orthodox arena about the severity of their pain, and it would be so interesting for them to, rather than going down the tablet intervention or pharmaceutical intervention, to get a physical therapy intervention to relax the spasm, so they're not having to rely on these medicines so much.
• 18:52
  Speaker 2: Absolutely.
• 18:52
  Speaker 2: Yeah.
• 18:53
  Speaker 2: I've actually had a few patients myself that have come on very high medications, such as Gavipentin, and have been able to quite successfully wean off them with therapy relaxation therapies Predominantly.
• 19:08
  Speaker 2: I find work really well with those kind of more chronic high levels of pain presentations Okay.
• 19:16
  Speaker 1: Yeah.
• 19:16
  Speaker 1: So in with that muscle spasm do you tend to just say, you know, use a little bit of magnesium and some manual therapies and stretching, or do you tend to sort of go in with anti-inflammatory type nutrition?
• 19:30
  Speaker 2: So yeah, so anti-inflammatory, I guess, don't come into the picture unless the pain pattern is inflammatory.
• 19:39
  Speaker 2: So they present with typical.
• 19:42
  Speaker 2: When I wake up in the morning it's feeling a lot more sore, or after inactivity it's a lot more sore when the inflammation accumulates or in an early stage acute ankle sprain or even just an acute injury in general, any sort of muscles tears or disbolges.
• 20:00
  Speaker 2: It's really good to start to bring in those anti-inflammatory nutrients.
• 20:06
  Speaker 2: So one of the most powerful things that I use for anti-inflammatory related pain is curcumin.
• 20:11
  Speaker 2: So the extract anti-inflammatory extract of turmeric yeah, I find that to be really, really beneficial in alleviating inflammatory related pain and those sort of early stage musculoskeletal strains and sprains, as well as those more arthritic complaints as well.
• 20:30
  Speaker 2: I find that to, and there's there's really really good evidence now that curcumin does help with inflammation, suppressing it and not for chair risks.
• 20:40
  Speaker 1: Yeah, absolutely.
• 20:41
  Speaker 1: You know, what I love about curcumin is that we're not just talking about like an NSAID that does one thing really well and really strongly.
• 20:48
  Speaker 1: Instead, there's a beautiful diagram and I think it's from I think it's from Boston Uni, and it shows the different aspects of inflammation that curcumin works on.
• 21:01
  Speaker 2: Yeah, I think I've seen it.
• 21:02
  Speaker 2: Yeah, it's incredible.
• 21:04
  Speaker 2: Yeah, yeah, it's such a miraculous.
• 21:09
  Speaker 1: I think that's one of these paradigm things that we need to.
• 21:11
  Speaker 1: Anybody who's looking at integrative medicine has got to appreciate that we're not talking about drugs.
• 21:16
  Speaker 1: We're talking about things that it might seem wishy-washy to somebody who's used to a very regimented dialogue.
• 21:24
  Speaker 1: You know things that turn on and off and inhibit and block and things rather than instead the natural medicine vernacular of supporting nourishing.
• 21:34
  Speaker 1: You know that sort of it might seem ambiguous but indeed that's what nature does.
• 21:42
  Speaker 2: Absolutely, Absolutely.
• 21:43
  Speaker 2: And that's the beauty of using these, I guess, natural ingredients is they're natural and they're so powerful and, especially when they're extracted and well-made and well-formulated, you can use them with really, really good effect.
• 21:56
  Speaker 2: And yeah, I find that curcumin is just such an amazing ingredient that just helps relax not only that inflammation, but it's also an antioxidant.
• 22:07
  Speaker 2: You know, and there's so much research out there now showing that you know, irritable bowel syndrome and it helps with the gut as well.
• 22:15
  Speaker 2: So I think looking at those sorts of ingredients as a first line approach when it comes to helping and supporting people through health challenges is really a no-brainer in my opinion.
• 22:29
  Speaker 2: Why wouldn't you opt for those natural ingredients first?
• 22:34
  Speaker 1: Yeah, okay, so lower back pain.
• 22:37
  Speaker 1: Maybe we can finish off just there.
• 22:41
  Speaker 1: So do you tend to then move on, move through onto supporting, you know, cartilage degeneration with things like collagen, or do you tend to use them all at once or like, how do you stratify the use of them?
• 22:57
  Speaker 2: Yeah, I definitely try and start off with one thing at a time, especially when someone's new to the idea of using vitamins and supplements and I don't tend to recommend a lot of vitamins or herbs I'm really quite simple and if it does get sort of beyond the scope of what I know, I'll happily refer them to someone who needs who can help them in a lot more thorough way.
• 23:22
  Speaker 2: And so, yeah, I generally start with one thing at a time.
• 23:25
  Speaker 2: Take this, see how you go, let's support you with that, and getting their feedback as well really, really helps.
• 23:33
  Speaker 2: I think that's such a good scientific method is where you just test it out, feel it, see how they experience it, and then they come back and report.
• 23:43
  Speaker 2: But yeah, collagen is, I think for me it's more of a food almost rather than a supplement.
• 23:52
  Speaker 2: I think it's such a powerful food source for people in general.
• 23:59
  Speaker 2: This is a protein source and amino acid source, but it definitely helps with arthritis I've witnessed that in my practice and joint pain.
• 24:08
  Speaker 2: We know that it stimulates those chondrocyte productions and yeah, that's what we really after.
• 24:15
  Speaker 2: And even in the conditions like osteoporosis, I'll recommend it for people who aren't already taking it because of the ability to stimulate osteoblasts.
• 24:26
  Speaker 1: Yeah, I take your point about food and things like that.
• 24:29
  Speaker 1: Isn't it such a pity that we don't eat like now?
• 24:32
  Speaker 1: What's her name?
• 24:33
  Speaker 1: Nigella.
• 24:33
  Speaker 1: Nigella the cook yeah, nigella.
• 24:37
  Speaker 2: Bites, nigella Bites, nigella Bites.
• 24:44
  Speaker 1: She's British cook and she's voluptuous and very sensuous and she's very cheeky in the way that she talks to the camera and stuff like that.
• 24:52
  Speaker 1: And she always says that when she goes to a dinner party or friends place she'll pinch like the chicken carcass.
• 24:58
  Speaker 1: We'll say you dumbled that because I'm taking it home, and isn't it a pity that we've lost this way of cooking?
• 25:04
  Speaker 1: In the old days grandma would always chuck in the chicken carcass and we'd be having the marrow and the collagen from those meats and bones and things.
• 25:14
  Speaker 1: We'd reuse them.
• 25:15
  Speaker 1: Nowadays it's all fast and clean and all.
• 25:21
  Speaker 2: It's such a shame.
• 25:22
  Speaker 2: Yeah, I think you said it, it's that lack of time.
• 25:25
  Speaker 2: I think everyone's really just gotten a lot more time poor and yeah, I think if you did have more time, people probably would realize, hey, this is actually really tasty and really nourishing and full of good stuff.
• 25:40
  Speaker 2: So, yeah, I love it.
• 25:42
  Speaker 2: I think it's one of the top ingredients that I recommend for people and I think it works really well as an adjunct to treatment Any kind of connective tissue disorder.
• 25:56
  Speaker 2: It's such a powerful thing to be taking regularly.
• 26:02
  Speaker 1: Okay, so we've said lower back pain.
• 26:04
  Speaker 1: If you're talking about connective tissue, let's talk about ITB or TFL.
• 26:09
  Speaker 1: So Tensei Fasialate.
• 26:13
  Speaker 2: Yes, yeah.
• 26:15
  Speaker 1: Take us through this, because this hurts.
• 26:17
  Speaker 1: To treat it Like yeah, yeah, yeah definitely.
• 26:23
  Speaker 2: Well, look it's.
• 26:25
  Speaker 2: The ITB itself is fascia.
• 26:28
  Speaker 2: So it starts from the TFL, the Tensei Fascialate at the front of your hip bone.
• 26:36
  Speaker 2: So if you sort of place your thumbs on the outer front area of your pelvis, you'll feel a very, very small sort of meaty region.
• 26:46
  Speaker 2: That's your TFL and that is kind of the anchor, the starting point of where that ITB wraps around the outside of the lateral thigh down to the outside of the knee and it's very, very dense and strong fascia and we know that a lot of it has to do with that sort of three dimensional matrix and it's important.
• 27:07
  Speaker 2: So we spoke about last time hydration, making sure that we're getting enough liquid in our body to be able to hydrate so that you have that elasticity.
• 27:18
  Speaker 2: And in terms of treatment, it's really looking at their biomechanics or looking at their gait, their walking, how their body is functioning, and why is it that that structure is getting overloaded?
• 27:30
  Speaker 2: And often I'll see weaknesses all throughout that kinetic chain, lower limb, right from the foot up to the rib cage.
• 27:38
  Speaker 2: And yeah, in my neuromuscular training I've been taught how to examine the person's sort of the foot up and look at the relationship of the segments to each other, not just the segment and isolation, so being able to look at things almost from an engineering perspective of why is that lateral area getting so much torque and how can it's having to become so tense?
• 28:09
  Speaker 2: What's not supporting above and below so that's what I look at first is really like their ankle mobility, hip mobility, their stability, neuromuscular stability in their foot and the ability to stabilize through the pelvis.
• 28:25
  Speaker 2: Often I find it's the opposing side that's the problem.
• 28:29
  Speaker 2: So they might have ITB syndrome on the left side, but that's because that left side is overworking due to a weak right side.
• 28:38
  Speaker 1: Ah OK.
• 28:40
  Speaker 2: Yeah so it's interesting.
• 28:42
  Speaker 2: Yeah, so often, just by correcting the dysfunctions on the opposite side you can actually take some of that imbalance away and quite quickly make a meaningful change.
• 28:53
  Speaker 2: Yeah.
• 28:56
  Speaker 1: OK, and so treatment wise, is it mainly, you know, manual therapies and training people to look at the other side and support and look at what's happening with the feet, possibly the knees?
• 29:07
  Speaker 1: Is that really the mainstay of therapy?
• 29:11
  Speaker 1: Do you use any nutraceuticals there, or is it just like this stuff hurts?
• 29:16
  Speaker 1: Get ready for it.
• 29:19
  Speaker 1: Yeah, yeah, yeah.
• 29:22
  Speaker 2: Not as a first line intervention, I find with those sort of more fascial issues it's it's largely due to the imbalances in their body, their movement system, the mechanical system, yeah, so if it's not responding to treatment, then I might look at introducing some magnesium or some collagen to support and looking at other things that might potentially be causing it.
• 29:50
  Speaker 2: But if it was just in isolation, it's pretty straightforward and you can.
• 29:55
  Speaker 2: You can nine times out of 10, you can knock it out with just the manual therapy and the exercise and the modifications to their training.
• 30:04
  Speaker 2: Yeah, it's definitely an area that's it hurts because it's it's so tight that that hypotonicity just goes on and on and on, not addressed, and that just compounds and what, what leads to the, the amount of sensitivity in there.
• 30:22
  Speaker 1: But it's really interesting that you know the main style of therapy is to make it hurt more.
• 30:25
  Speaker 1: It's like counterintuitive, I tell you.
• 30:30
  Speaker 1: I just yeah, it's.
• 30:35
  Speaker 1: Jesse, sorry, you go, you go.
• 30:39
  Speaker 2: Yeah, I was just going to say that it's it's.
• 30:41
  Speaker 2: It depends on the person.
• 30:43
  Speaker 2: Some people have a very good tolerance for manual therapy and they actually find that they they can differentiate between a positive sort of sensation that's doing them good versus a negative one.
• 30:55
  Speaker 2: And I find the people who are able to tolerate some deep tissue, soft tissue manual therapy get better quicker because there's less reaction and there's less, I guess, withdrawal from the treatment itself, even though they might know they'll think it might be good for them.
• 31:14
  Speaker 2: So some everyone's, I guess sensory system is very different and that's where I think it's very important to find someone who's quite skilled in their craft and experience in manual therapy so that they can apply the right amount of pressure.
• 31:31
  Speaker 2: And you know, because you don't want to too strong a stimulus and you don't want to weak a stimulus, when it comes to applying pressure and therapy you want to be right in that sweet spot and that most people are pretty good.
• 31:44
  Speaker 2: But you do find the occasional person who is very, very sensitive and that's tricky to work around.
• 31:50
  Speaker 1: Yeah, Right, ok, so let's move to the far end of the body.
• 31:55
  Speaker 1: Sore necks, huge, and even migraines as well.
• 32:00
  Speaker 1: Can we, can we talk about those?
• 32:02
  Speaker 1: Migraines is something that interests me greatly.
• 32:04
  Speaker 1: You know, I've seen the sort of theory of migraines evolve over a period of time.
• 32:09
  Speaker 1: Where are we at to now?
• 32:10
  Speaker 1: Yeah, where are we at.
• 32:19
  Speaker 2: My experience with migraines is they they vary greatly and the research is is pretty clear, and I say pretty substantially consistent in terms of categorizing them into the different types of migraines.
• 32:35
  Speaker 2: But often when people come in saying I've got a migraine, I find that it's not a migraine that they've got, it's actually more of a tension type headache or a subarco genotype headache.
• 32:47
  Speaker 2: That's referring.
• 32:48
  Speaker 2: Yeah.
• 32:49
  Speaker 2: So I don't see a lot of migraines in my practice.
• 32:53
  Speaker 2: I think migraines are very debilitating.
• 32:55
  Speaker 2: When someone's got a migraine they usually just don't do anything.
• 32:58
  Speaker 2: Yeah, yeah.
• 32:59
  Speaker 2: So I think that the few migraines that I have seen, presentations that I have seen, it's pretty.
• 33:07
  Speaker 2: It's more of something that's been Been building and brewing for a long time.
• 33:12
  Speaker 2: Or might be hormonal, or it could be related to stress or you know, nutritional, chemical imbalance or something like that, or food intolerance, or you know they've just had it for so long.
• 33:23
  Speaker 2: It's not something that necessarily is going to get better in just physiotherapy alone.
• 33:30
  Speaker 2: So that's where referrals are really important.
• 33:33
  Speaker 2: But I think looking at someone's neck pain, headaches, migraine, that sort of region in general, the biggest thing is just to firstly calm the person down, to bring them into that parasympathetic state, and that is my go to in terms of just using, you know, relaxation therapies and calming herbs like ashwagandha to get them into a state of more homeostatic equilibrium.
• 34:00
  Speaker 2: And I find that that works really well because obviously, the neck is such as you said before, it's such a emotionally connected area to our limbic system.
• 34:09
  Speaker 2: So when we feel stressed, we tighten through those deep stabilizing muscles that we're not even aware of because they're so, I guess, deep and they're not very big, and then they get so tight and then they become very, very problematic and then that pain refers into areas.
• 34:27
  Speaker 2: Yeah, so I look, I look quite closely at the person, I guess overall presentation, most of the time I find that it is postural or structural in the sense.
• 34:40
  Speaker 2: That sense, and, yeah, I really really like the whole sort of idea of bringing a person into that relaxed state when they come in for a session with their suffering from a migraine, headache or neck pain, because it's it's such a threat.
• 34:56
  Speaker 2: It's such a threat when you have someone who's got pain in that region because it's so debilitating and they're so aware of it, so close to their center of consciousness.
• 35:05
  Speaker 2: I think that's something that I find is just priority number one.
• 35:09
  Speaker 2: Someone walks in the door is just get them.
• 35:12
  Speaker 2: Let's get them relaxed.
• 35:16
  Speaker 1: Go from there?
• 35:16
  Speaker 1: And are we?
• 35:17
  Speaker 1: Are we still at the stage where, you know, migraine was considered to be a biophysics sort of condition?
• 35:23
  Speaker 1: I thought forgive me if this is incorrect Am I correct in saying that migraine is now being considered almost like an autoimmune condition?
• 35:38
  Speaker 1: Is that right?
• 35:40
  Speaker 2: Yeah, you can say that, yeah, definitely.
• 35:44
  Speaker 1: So what's happening there?
• 35:48
  Speaker 2: Well, it depends on the person.
• 35:50
  Speaker 2: But when we look at the causes of the migraines, as I said before, the autonomic nervous system, the glands, the functioning of all of our sort of endocrine system, circulatory system, the stomach, the intestines they can all be causes of migraines, and hormonal system as well.
• 36:15
  Speaker 2: So that's why I think people are now looking at it from more of that sort of autonomic malfunctioning, having to realize okay, it's really tied into that system and so we have to treat it as from that perspective rather than just looking at it more superficially.
• 36:36
  Speaker 1: You know what?
• 36:37
  Speaker 1: You just made me realize something.
• 36:38
  Speaker 1: For years, decades, we've been thinking, we've been talking about biologically active amines you know the tyromines and histamines and things like that and yet we eat those.
• 36:50
  Speaker 1: They're not just in the brain, we eat them and we talk about avoiding these foods because they're biologically active, but we never think about that that food has to communicate with the brain.
• 37:02
  Speaker 1: It's I've only just realized it.
• 37:08
  Speaker 1: How stupid of me.
• 37:09
  Speaker 1: Like, seriously, I just sometimes I whack myself over a piece of over my head with a piece of four-bit food because I'm just like I'm stunned by how ignorant I've been.
• 37:23
  Speaker 2: It's so simple though.
• 37:25
  Speaker 1: Okay, I'm going to explore that.
• 37:27
  Speaker 1: Yeah, thank you.
• 37:28
  Speaker 1: Okay, so what about things like other therapies?
• 37:34
  Speaker 1: We've spoken about a few nutraceuticals.
• 37:37
  Speaker 1: We've spoken about curcumin, magnesium, collagen, fish oils and also what about other therapies Like, for instance, um, okay, so, keying into the emotional state of the person.
• 37:54
  Speaker 1: Music, music, music therapy, sound, yeah, yeah.
• 38:01
  Speaker 2: Yeah, yeah.
• 38:03
  Speaker 2: So they they're really good relaxation tools.
• 38:06
  Speaker 2: They are some of the most powerful ways to calm someone down and bring a person into a Paris and Bethesda state where they can heal, and I think it's really, really underappreciated.
• 38:19
  Speaker 2: I certainly wasn't exposed to it in my undergraduate or postgraduate training.
• 38:26
  Speaker 2: It's only further on that I've been able to really understand and educate myself in the benefits of music, sound and vibrational therapy and having played music a lot of my life and really appreciating the effect that vibration and sound has on the body in my practice, I think has really given me such a powerful tool to help people to relax.
• 38:54
  Speaker 2: You know, somebody must have a trouble doing that, especially when we're in pain.
• 38:58
  Speaker 2: Our nervous system is sensitized.
• 39:00
  Speaker 2: So any kind of input, external input, is really really powerful and, yeah, I definitely use it as a way to help people manage their stress physical stress, emotional stress and it's it's so such a nice compliment to that's the therapy, the session to adding some sound therapy At the end.
• 39:22
  Speaker 2: I find that it's just leaves people in a state of just total calm and I often find that that they're able to get so much more out of the session because it takes them into that state of parasympathetic rest and digest just a little bit more, and that's really ultimately what they're here to learn how to do and how to what, to what they need to experience.
• 39:48
  Speaker 2: And so, yeah, I use sound a lot.
• 39:52
  Speaker 1: Yeah, Just a last question, and that is we touched on it just before about the tyramine histamine sort of implications with pain in migraine.
• 40:04
  Speaker 1: But what about the importance of digestion in limb pain, For instance?
• 40:10
  Speaker 1: How important is that?
• 40:12
  Speaker 1: How much do you work on digestion?
• 40:17
  Speaker 2: Yeah, digestion itself.
• 40:20
  Speaker 2: I I don't go deep into fixing a person's digestion.
• 40:26
  Speaker 2: I more look at whether their digestion is causing their pain.
• 40:29
  Speaker 2: So, for example, we know that T five to T nine or even T 12, innovates the abdominal region, the abdominal organs.
• 40:37
  Speaker 2: Sorry, if someone's experiencing pain in their thoracic spine, the mid back or their abdominal region and that pain could be coming from a reaction to gluten, let's say that they're just not even aware of and it's only triggered from time to time.
• 40:55
  Speaker 2: But they perceive it as being.
• 40:57
  Speaker 2: You know, I did something to my, my back or my ribs are hurting.
• 41:02
  Speaker 2: Or you know I've got this pain in my abdomen and it's, it's, it's there, I can feel it, what muscle by torn.
• 41:08
  Speaker 2: But it's really, when you take a good examination, you realize it's actually coming from your organ, from your stomach or from, you know, the colon, and you can palpate that and feel that.
• 41:19
  Speaker 2: And so making people aware of that it's really important, because that's that's viscera, somato reflex arc, where the viscera is actually sending impulses to the spinal cord and then it's then overloading and going into the corresponding structures, somatic structures.
• 41:38
  Speaker 2: So, yeah, yeah, giving giving abdominal massages, hate packs, relaxation therapies, or even again, just handle into someone who can educate them a bit more about what they're actually putting into their bodies and how their digestion works.
• 41:53
  Speaker 1: Yeah, Jesse I, I, I struggle with thinking that the rest of your cohort would have thought like you.
• 42:04
  Speaker 1: Why what you're like?
• 42:06
  Speaker 1: You are unique.
• 42:07
  Speaker 1: Why are you so different?
• 42:08
  Speaker 1: Who taught you?
• 42:12
  Speaker 2: Well, I think I think it's you.
• 42:14
  Speaker 2: You kind of just look at things slowly over time and you realize you pick up patterns of what's actually occurring to you and a lot of this stuff is just straight out of the anatomy and physiology textbooks.
• 42:28
  Speaker 2: You know, we, we're all taught it.
• 42:31
  Speaker 2: But I think it's just being very conscious of what it is that you're seeing and what it is that you've learned and putting those two things together.
• 42:39
  Speaker 2: Yeah, I've, I've been lucky that my education has been quite, quite good from the get go.
• 42:45
  Speaker 2: You know, my mom was a teacher and educator and she actually taught me a lot of my early childhood education.
• 42:53
  Speaker 2: I was taught by her, so she was my teacher and I was very close with her and she actually taught me a lot about how to learn and I think that's that continued through university and then beyond that, I've always been looking at those extra additional courses or certificates or trainings that sort of piqued my interests and everything that I do is really just from my own passion and interest.
• 43:20
  Speaker 2: I'm not doing it because I feel like I have to.
• 43:23
  Speaker 2: It's it's really I'm curious and I think that curiosity has helped me put some an interesting sort of mix of knowledge together.
• 43:34
  Speaker 1: Hell yeah, Jesse, I've got to say I know that you wouldn't, probably wouldn't like this thought, but we really need to clone you.
• 43:41
  Speaker 1: I'm amazed at your unique approach and how holistic you are.
• 43:49
  Speaker 1: But you, you bring it back to extremely good training.
• 43:52
  Speaker 1: But I love what you say.
• 43:53
  Speaker 1: You were taught by somebody who taught you how to think.
• 43:56
  Speaker 1: You weren't just given something, you explored.
• 44:01
  Speaker 1: I really seriously, I take my hat off to you.
• 44:05
  Speaker 1: You're quite a unique man, a unique therapist, and I think your patients who are under your care are extremely lucky.
• 44:11
  Speaker 1: I wish there were more of you.
• 44:11
  Speaker 1: Well done and thanks so much for joining us today and giving us a little sneak inside that mind of yours.
• 44:19
  Speaker 1: It's quite incredible.
• 44:21
  Speaker 2: Thanks so much, andrew.
• 44:22
  Speaker 1: I appreciate it, thank you, thanks for having me Absolutely wonderful chatting to you and thank you everyone for joining us today.
• 44:30
  Speaker 1: Remember you can catch up on all the show notes and the other podcasts on the Designs for Health website.
• 44:36
  Speaker 1: I'm Andrew Whitfield Cook.
• 44:38
  Speaker 1: I'm gobsmacked.
• 44:39
  Speaker 1: You can see.
• 44:40
  Speaker 1: This is Wellness by Designs.