Latest / The Driven Athlete / CONTROVERSIAL Topic- Pain Science | Ep 39

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CONTROVERSIAL Topic- Pain Science | Ep 39 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up?
• 0:12
  Speaker 1: Y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:14
  Speaker 1: Driven Athlete Podcast.
• 0:16
  Speaker 1: Welcome back.
• 0:16
  Speaker 1: Appreciate y'all coming in to listen.
• 0:18
  Speaker 1: We've got a controversial topic today Pain science and the pain experience.
• 0:23
  Speaker 1: Okay, pain Because it's interpreted.
• 0:25
  Speaker 1: Uh, it's interpreted different ways, right, and different cultures interpreted different ways, and different people, different walks of life, different stages of life interpreted different ways.
• 0:34
  Speaker 1: But, uh, I want to start this off real controversial, Okay, and thought provoking.
• 0:38
  Speaker 1: A quote by Lil Wayne, the rapper Okay, pain is an opinion, which is totally true, all right, pain, ultimately, is an output.
• 0:52
  Speaker 1: Pain is not an input.
• 0:53
  Speaker 1: Okay, a person's body parts are not alive, right, they're inanimate.
• 1:00
  Speaker 1: Right, the only actual aware and conscious organ in our body is our brain, right?
• 1:08
  Speaker 1: So if somebody's battling pain in their knee, their ankle, their back, their neck, those body parts don't tell you they're hurting, they just send signals and those signals are sent and received and assessed, synthesized, broken down and then a judgment is made and then, therefore, pain is generated and produced by the brain.
• 1:33
  Speaker 1: So pain is 100% generated by the brain.
• 1:39
  Speaker 1: It's produced by the brain.
• 1:41
  Speaker 1: Body parts and nerves don't tell you they're hurting.
• 1:44
  Speaker 1: They send signals, totally, and they're very good at sending signals.
• 1:48
  Speaker 1: We know that.
• 1:49
  Speaker 1: Okay, there's a, there's a deep, intricate, uh connections at matrix between all your body parts and nerves and your central nervous system, through your spinal cord, the brainstem, the brain totally, um.
• 2:03
  Speaker 1: But to be clear, pain is an output and your body parts don't tell you they're hurting, and it's just interesting.
• 2:10
  Speaker 1: And once those signals and everything is assessed and assimilated and synthesized, then the judgment's made and it's like, yep, this is causing pain, right, and that we would call that the pain experience, versus just, the better term is pain experience, not just pain, because it's like a lot of things come with it together and we're going to deep dive into this, okay.
• 2:30
  Speaker 1: So it's just interesting, okay, and we're going to dive into some psychology stuff.
• 2:36
  Speaker 1: That's not my thing, I'm not smart enough for that.
• 2:37
  Speaker 1: All right, I'm a sports physical therapist, biomechanics and pain is what I do, right.
• 2:42
  Speaker 1: But we can't neglect that there is a psychological and emotional component with pain and we can't separate the mind from the body.
• 2:50
  Speaker 1: All right, we can't separate the mind from the body, so we can't separate nerves from all of our other body parts, like our muscles, tendons, bones, ligaments, visceral organs, all those things.
• 3:01
  Speaker 1: Totally, nerves are definitely connected and we can't neglect that.
• 3:03
  Speaker 1: And they're also connected to your central nervous system very intricately and delicately and we can't separate the mind from the body.
• 3:10
  Speaker 1: Ultimately, all right, and this is a—but what I was going to say is those signals that are being relayed and sent from your sensory organs, which are your nerves.
• 3:21
  Speaker 1: They're just signals.
• 3:22
  Speaker 1: They're danger signals or other positive signals.
• 3:23
  Speaker 1: They're just signals.
• 3:24
  Speaker 1: They're danger signals or other positive signals, but they're just signaling.
• 3:26
  Speaker 1: And those signalings are then sent and assessed and interpreted in the brain.
• 3:31
  Speaker 1: All right, and imagine if somebody was in pain for a long time.
• 3:35
  Speaker 1: Okay, this is where it gets deeper and a little more controversial.
• 3:38
  Speaker 1: But or just thought, thought provoking If someone's in chronic pain and they've been in pain for a long years, right, past three months is when you would consider something chronic versus subacute and acute.
• 3:49
  Speaker 1: Acute pain is like when something happens right away in your pain and if it continues to linger past 10 to 12 weeks or three months, then it usually jumps into a category called chronic pain, right, or persistent pain right.
• 4:02
  Speaker 1: We'll call it chronic pain.
• 4:03
  Speaker 1: So acute pain is at the very early stages, subacute pain is when it's still lingering, and then chronic pain is when it crosses over three months and beyond.
• 4:11
  Speaker 1: And for scientists and physicians and surgeons and stuff physical therapists, chiros, like all the healthcare practitioners when somebody's in pain for longer than that it questions like how that doesn't make any sense.
• 4:33
  Speaker 1: As in tissues and joints and damaged tissues heal really well, like the body's really good at healing itself, right, everything heals usually within six to eight weeks.
• 4:41
  Speaker 1: So from a soft tissue standpoint muscle tears, ligamentous injuries, joint capsule injuries, musculotendinous junction strains, spraining an ankle, all those things right, tissues heal in six to eight weeks.
• 4:54
  Speaker 1: That's the turnover rate.
• 4:55
  Speaker 1: Somebody's regularly healthy, right?
• 4:58
  Speaker 1: Not like an autoimmune thing that's blocking systemic healing processes, all right.
• 5:02
  Speaker 1: Bones usually take 10 to 12 weeks to heal, all right.
• 5:06
  Speaker 1: So like if someone has a fracture.
• 5:07
  Speaker 1: That's why usually people are in a cast for six to eight weeks and then they're out and they can gradually perform activity, physical therapy, stuff to get heat.
• 5:15
  Speaker 1: That facilitates healing process.
• 5:16
  Speaker 1: But bones usually union and heal and ossify in 10 to 12 weeks.
• 5:20
  Speaker 1: It's only 12 weeks, that's three months.
• 5:22
  Speaker 1: So if somebody is battling pain longer than that, 10 to 12 weeks, it's only 12 weeks, that's three months.
• 5:27
  Speaker 1: So if somebody is battling pain longer than that let's say 10 years, five years, even just a year, six months it's like everything's healed at this point Then why are they still battling pain?
• 5:34
  Speaker 1: We can't neglect those nerves also.
• 5:37
  Speaker 1: All right, we're going to deep dive into that.
• 5:39
  Speaker 1: All right, so this is a controversial thing we talk about with our patients.
• 5:41
  Speaker 1: For sure, it's a very tactful and delicate dance of a conversation.
• 5:46
  Speaker 1: So if somebody is battling pain for six months to a year to five years and it's not going away and it's worse, this is usually how the conversation goes with us.
• 5:56
  Speaker 1: All right, so, and we just are here to help people, right, we're not here to change someone's emotional states or psych.
• 6:02
  Speaker 1: We're not psychologists and we stay in our lane totally.
• 6:05
  Speaker 1: But we can't neglect that, we can't separate the mind from the body and also that nerves are involved.
• 6:11
  Speaker 1: So here's what the conversation usually goes like.
• 6:13
  Speaker 1: All right, so, mrs Jones, whatever, right, you have neck pain.
• 6:16
  Speaker 1: That's been going on for a long time.
• 6:17
  Speaker 1: Right, we got muscles, you got ligaments, you got tendons, you got joints, bones, all those things in your neck, for sure, or your low back, whatever.
• 6:29
  Speaker 1: But we can neglect.
• 6:30
  Speaker 1: We also have nerves.
• 6:31
  Speaker 1: And nerves innervate and are very sensitive and they detect danger signals and they're very good at that, right.
• 6:39
  Speaker 1: And nerves, of anything, take the longest to heal.
• 6:42
  Speaker 1: So muscles, bone, tendons, ligaments, all those things they take time to heal, for sure.
• 6:49
  Speaker 1: Nerves also take a long time to heal and if anything, actually they take the longest to heal.
• 6:54
  Speaker 1: So, considering that they're very sensitive, they're very resentful, they hold grudges, they have a great memory, and when a person is in pain for a long time, those nerves, connections and receptors aren't functioning as appropriately as they did in the past and nor are they regulated or deregulated as appropriately as they were in the past and they get used to sending signals.
• 7:17
  Speaker 1: So we would call that like hypervigilance, right?
• 7:20
  Speaker 1: So if nerves are very hypervigilant, they're ready to send signals whenever.
• 7:23
  Speaker 1: So they're all on high alert, like a car radio on full blast, and they're ready to send signals and the receptors of those signals are ready to receive signals.
• 7:32
  Speaker 1: They're ready to catch anything they need to to protect.
• 7:34
  Speaker 1: So there's a lot of hypervigilance that can go on over time.
• 7:37
  Speaker 1: So those nerves don't function as appropriately as they did in the past and they send signals and they're ready to send signals at a high intensity level like a car radio on full blast, for a long time too.
• 7:47
  Speaker 1: So they're ready to send Degner signals real threats or perceived threats.
• 7:53
  Speaker 1: Okay, and even just perceived tissue damage, right, if it's maybe not actual tissue damage present, they're still ready to send signals with perceived tissue damage or injury.
• 8:08
  Speaker 1: So, like the car radio on full blast, all we got to do is just turn the car radio volume down.
• 8:11
  Speaker 1: Let's just turn the volume down, and the best way to do that is movement and blood flow.
• 8:16
  Speaker 1: The key is non-painful, non-aggravating, non-irritating, non-threatening movement to help deliver blood flow to your muscles, ligaments, joints, bones, all those things, but also to your nerves, because nerves need blood flow just like anything else.
• 8:29
  Speaker 1: They need nutrients and oxygen, just like every other tissue does in your body, and they need to heal.
• 8:33
  Speaker 1: They just take the longest to heal.
• 8:35
  Speaker 1: The movement and blood flow also helps to acclimate nerves to movement again, so we can shift their awareness and perspective of movement being a threat, but maybe more as a benefit, because ultimately they will heal.
• 8:47
  Speaker 1: It just takes time right.
• 8:48
  Speaker 1: Blood flow and movement in a non-painful, irritating way helps deliver nutrients, oxygen, helps acclimate nerves to movement again and get accustomed to movement again, and it deregulates their hypervigilance and turn the car radio volume down over a long enough time horizon, and I'm going to do everything I can to help.
• 9:04
  Speaker 1: That's usually what the conversation looks like.
• 9:06
  Speaker 1: All right, exit conversation that's usually what happens.
• 9:09
  Speaker 1: Then we can show some exercises that are appropriate and we're course correct as necessary.
• 9:12
  Speaker 1: But anyway, that's usually the conversation.
• 9:14
  Speaker 1: We just try to help educate and shed light that, hey, we also have nerves that generate signaling and can allow for chronic, persistent pain to occur.
• 9:21
  Speaker 1: Right, and we can't neglect that.
• 9:24
  Speaker 1: We also can't neglect that there is a psychological component.
• 9:27
  Speaker 1: Right, and we can't separate the mind from the body.
• 9:29
  Speaker 1: No matter how hard we try, we can't separate the mind from the body, and that also plays a role too, right?
• 9:34
  Speaker 1: So I'm going to do everything I can to help and get things feeling better.
• 9:37
  Speaker 1: Okay, we're going to be on the same team.
• 9:38
  Speaker 1: That's usually what the conversation looks like.
• 9:42
  Speaker 1: So, the psychological component if we're going to deep dive, we don't include these next topics in our conversation top uh points.
• 9:49
  Speaker 1: This is just because I think this is interesting.
• 9:51
  Speaker 1: I think it's an interesting physiology of the human body and the pain experience in general, and I'm just appreciative and glad that I've been exposed to these kind of things from mentors and other wise people smarter than me, right, and I've simply tried to uh deep dive into some of the research and things to help people and then also uh take it for my own personal experiences and my family and stuff.
• 10:10
  Speaker 1: But anyway, I'm just glad I have these awareness and exposure to these knowledge stuff that researchers have found.
• 10:15
  Speaker 1: So this is what we don't include in our conversations.
• 10:18
  Speaker 1: I just think it's interesting.
• 10:19
  Speaker 1: But ultimately our perspective and beliefs shape our world.
• 10:22
  Speaker 1: That's it Perspectives and beliefs shape our world and how we perceive, the lens in which we view the world and the frame in which we perceive things.
• 10:29
  Speaker 1: And that then dictates our experience, perception of things as they come to us, and it frames our experiences, our interpretations of those experiences, and then after that, what action steps and how we handle those experiences right, how emotionally do we manage and handle those experiences that come present to us?
• 10:48
  Speaker 1: And then what action steps do we do next?
• 10:49
  Speaker 1: How do we treat people around us based on those experiences, and how we manage our emotions based on that stuff.
• 10:54
  Speaker 1: So our perspectives and beliefs shape our world.
• 10:57
  Speaker 1: We can't that's, that's like we can't neglect that.
• 10:59
  Speaker 1: Um, so from what I've heard of mentors and stuff and other experts.
• 11:03
  Speaker 1: This is not my field, right.
• 11:04
  Speaker 1: I'm not a psychologist, um, I just think this stuff's interesting, right, so join me in this conversation, discussion, if you like.
• 11:09
  Speaker 1: But some experts and mentors would suggest that those perspectives and beliefs would shape the way we interpret experiences.
• 11:18
  Speaker 1: Ultimately, all root back from our childhood of of experiences we've had in those fragile, malleable times in our life when we're extremely able to be influenced.
• 11:29
  Speaker 1: We're super easily influenced as a child, right, we're not exactly emotionally resilient as kids.
• 11:34
  Speaker 1: That's why everything seems to be so traumatic, right, we wouldn't, otherwise it wouldn't make sense, right?
• 11:40
  Speaker 1: Like we're young, undeveloped, emotionally, not exactly resilient, mature individuals until we're, like what?
• 11:47
  Speaker 1: Late twenties.
• 11:48
  Speaker 1: So everything that happens would be emotionally traumatic as a kid, right, so it's everything's.
• 11:52
  Speaker 1: Just imagine if some of the things that were traumatic as a kid for you, if someone, when you're a grown, coherent, intelligent adult, happened, it wouldn't be that big of a deal, right, but it was a big deal when you're a kid makes total sense.
• 12:03
  Speaker 1: Be that big of a deal, right, but it was a big deal when you're a kid Makes total sense.
• 12:06
  Speaker 1: So all the way back, rooting from childhood, that these mentors suggest that ultimately, from those childhood experiences shape our perspective and beliefs into adolescence and then early adulthood and into adulthood.
• 12:18
  Speaker 1: So, with that being said, that can influence maybe how, as adults, we experience pain and our familiarity with it, our nervousness with it and our fear associated with pain and our experience All right.
• 12:32
  Speaker 1: So, to be clear though, pain is real, right, we're not saying it's real for every time, for every person.
• 12:36
  Speaker 1: I'm not saying everybody's making it up.
• 12:38
  Speaker 1: I guess it's a real thing, right?
• 12:39
  Speaker 1: Very similar of like, hey, on a scale of zero to 10, how much pain are you in right now?
• 12:42
  Speaker 1: And somebody says an eight.
• 12:43
  Speaker 1: Nobody has the right or ability to be like no, you know what you look like.
• 12:47
  Speaker 1: You're at a four out of 10 pain, not eight out of 10.
• 12:49
  Speaker 1: If I had to look at you the same way, somebody be like how happy are you?
• 12:57
  Speaker 1: I'm like an eight out of 10.
• 12:58
  Speaker 1: Happiness, I think you're not.
• 13:00
  Speaker 1: You're like a six out of 10?
• 13:01
  Speaker 1: .
• 13:01
  Speaker 1: So it's a very similar thing Happiness, pain, like what level zero to 10 are you at?
• 13:06
  Speaker 1: It is real for everybody, right?
• 13:08
  Speaker 1: So it is a real experience.
• 13:11
  Speaker 1: It can, whether that pain experience is present, whether there's actual tissue damage present or no tissue damage present.
• 13:19
  Speaker 1: It's just interesting, I'm just throwing it out there, all right.
• 13:22
  Speaker 1: So perceived damage or real damage, pain can still be present, physical damage in your tissues.
• 13:29
  Speaker 1: And this is where it gets controversial, because perceived pain from perceived tissue damage or injury, perceived injury, is still a real pain experience, whether or not actual tissue damage is present or body injury is present, whether or not actual tissue damage is present or body injury is present.
• 13:44
  Speaker 1: So it's just interesting to think about, all right.
• 13:46
  Speaker 1: So chronic pain on that boat is a whole separate animal within this pain science realm.
• 13:51
  Speaker 1: And once a pain experience continues, persists past three months, we consider it a chronic and somebody that's in chronic, longstanding pain, a thought that goes across.
• 14:01
  Speaker 1: That we find right and researchers find they think there must still be something wrong.
• 14:06
  Speaker 1: If I'm still in pain, there must still be something wrong in my body with injury and tissue damage.
• 14:11
  Speaker 1: Right, something's not healed.
• 14:13
  Speaker 1: There's something still lingering that's not healed yet.
• 14:15
  Speaker 1: But we just discussed, though in the science, cell turnover rate and collagen fiber healing times is actually six to eight weeks, right, for soft tissue, and then osseous bone structures heal in 10 to 12 weeks, right, I'm talking about like someone is somewhat normally healthy, right, they don't have an autoimmune like a rheumatoid dysfunction or some other systemic pathology that would limit their healing potential.
• 14:36
  Speaker 1: People usually heal in six to eight weeks for soft tissue and 10 to 12 for osseous bone structures.
• 14:42
  Speaker 1: So if someone's in pain for five years that's still lingering.
• 14:45
  Speaker 1: Their thought is well, there still must be something still damaged, right, like, something's still wrong.
• 14:54
  Speaker 1: There has to be.
• 14:54
  Speaker 1: But the things heal within six to eight weeks or 12, maybe at the max.
• 14:56
  Speaker 1: So pain's been going for five years.
• 14:57
  Speaker 1: Then what happened?
• 14:58
  Speaker 1: The remaining four and a half years of time after things got healed?
• 15:02
  Speaker 1: Why is pain persisting?
• 15:03
  Speaker 1: The only answer and what the researchers are finding not me, I'm just relaying information the neural structures are still hypervigilant and ready to send danger signals.
• 15:12
  Speaker 1: When they're used to sending signals, they're still ready at a hypervigilant, elevated, regulated state of sending danger signals and those danger signals are received by heightened vigilant receptors to receive those danger signals and then those signals are interpreted, assessed and assimilated and then a judgment is made, an output of pain from the brain.
• 15:33
  Speaker 1: So it's just interesting we don't have these conversations with patients because there's no benefit.
• 15:38
  Speaker 1: That's not the route we go to help people.
• 15:42
  Speaker 1: But as just a interested person in physiology and science.
• 15:46
  Speaker 1: Like I think it's just interesting, right, that's what I'm sharing with y'all.
• 15:49
  Speaker 1: But, um, that's that has to be the answer, right, cause there's no damage.
• 15:54
  Speaker 1: Very often people will get an MRI and imaging and stuff which we're going to get in a second right.
• 15:58
  Speaker 1: Imaging is very important and helpful, total and decision-making, but when something's been persisting for five years and they get a fifth MRI and it's like something still hasn't been wrong and they've already had three surgeries or whatever, right, which is unfortunate.
• 16:14
  Speaker 1: I don't hate surgery, it's not always necessary, I'm just saying.
• 16:17
  Speaker 1: But MRIs finding slight abnormalities in their spine or their shoulder, rotator cuff or their neck, whatever their low back, and it's like, oh, I see it, there it is, there's a small abnormality, right, but it's not like glaring.
• 16:33
  Speaker 1: And then it has surgeons stumped as in, like you shouldn't be in as much pain as what you're describing.
• 16:38
  Speaker 1: This doesn't look like you would expect on the image and what the pain output is right.
• 16:42
  Speaker 1: So, with that being said, then our approach and talking points and direction of treatment is going to be different than our approach in a different situation, right?
• 16:53
  Speaker 1: So with the pain science kind of step of direction and understanding, it just dictates maybe our direction of treatment and approach to help people.
• 17:00
  Speaker 1: Right, because we want to help people improve quality of life totally, and it's going to be different with different people and our talking points are going to be different.
• 17:06
  Speaker 1: So, anyway, people get really hung up on their imaging abnormalities where structure of the image and structural abnormalities in a person's spine or shoulder or joints or whatever doesn't correlate to physical symptoms.
• 17:18
  Speaker 1: So the structural abnormalities don't seem to correlate to physical symptoms.
• 17:23
  Speaker 1: As an example, there's plenty of people that have an image that comes back not great, like it looks bad.
• 17:29
  Speaker 1: On their back, their spine.
• 17:31
  Speaker 1: They have arthritic changes, degenerative changes, foraminal space narrowing, stenosis changes, ligamentum flavamum inflammation, herniated discs pursing posteriorly to the fecal sac and impinging on a nerve root at multiple levels and herniated, sequestered discs right, like looks bad and the doc says you should be in more pain than you are.
• 17:50
  Speaker 1: I don't, I would never say that, but like that's a message I hear a lot.
• 17:54
  Speaker 1: It's like your back looks like an 80 year old's back.
• 17:56
  Speaker 1: You should be in more pain than what you're describing.
• 17:57
  Speaker 1: This is remarkable, right, and then they leave feeling worse than they went in.
• 18:05
  Speaker 1: But anyway, those type of people, right, they have like mild back pain and they get an image and that's what it comes back as I'm like well, I feel, I feel okay, though I don't have any radiating pain down my leg, I don't have any shooting pain, I feel just stiff, you know, just soreness occasionally, right.
• 18:16
  Speaker 1: And then you have people who have a pretty good looking image, maybe a mild bulge, but like nothing glaring, and they have severe pain rating down their leg and it's like lingers and it nags and it's like unrelenting and it hurts really bad, and they have radiating referred pain or sadica pain, radiculopathy pain, nerve pain down their leg and they're in severe back pain with spasms and stuff.
• 18:37
  Speaker 1: But their image looks pretty good.
• 18:39
  Speaker 1: So you have somebody with like a really bad looking image and they're in moderate, mild pain.
• 18:44
  Speaker 1: I like, I feel fine.
• 18:46
  Speaker 1: And they have somebody with a really good looking image and they have severe pain.
• 18:49
  Speaker 1: So there's a disconnect between, like the image and the structure and someone's pain and their symptoms.
• 18:54
  Speaker 1: So then, with that being said, is the actual structure the actual pain generator?
• 19:00
  Speaker 1: Research might suggest no, I'm just saying right, it can be totally like tissue damage happens and it hurts, right For sure, and the pain experience is real for everybody.
• 19:09
  Speaker 1: But what I'm saying is is if the structure and the disconnect between imaging and their symptoms and their pain prognosis and their functionality level and their direction of improvements isn't correlated to their structure and their imaging and their MRI and stuff, then should the structure be the focus of treatment or should something else be?
• 19:29
  Speaker 1: Or maybe a different approach and a different perspective on, maybe, how to fix someone's, improve someone's pain right and functionality?
• 19:36
  Speaker 1: Maybe the structure isn't the sole focus?
• 19:38
  Speaker 1: If it was, then why not just get a disectomy debridement and spine laminectomy surgery for everybody?
• 19:45
  Speaker 1: If at some point 80% of people have back pain when they grow up and be an adult, then why aren't 80% of people just getting disectomies?
• 19:53
  Speaker 1: Problem solved, just fix the structure.
• 19:55
  Speaker 1: The research has suggested that's not really the case, right, because there's plenty of people that get surgery and they feel worse when they come out or they pain on the other side of their leg or their back or whatever.
• 20:06
  Speaker 1: Right?
• 20:06
  Speaker 1: I don't hate surgery.
• 20:08
  Speaker 1: I think it's totally necessary sometimes.
• 20:09
  Speaker 1: I think it's also important to realize and recognize that the structure and the herniated disc or the arthritic changes that are noticed in foraminal narrowing of the space nerve impingement evidence on an image might not actually be the pain generator.
• 20:25
  Speaker 1: So is the structure, the focus to fix pain.
• 20:28
  Speaker 1: I'm just saying potentially not, and that's what the research suggests.
• 20:31
  Speaker 1: Probably not, but anyway.
• 20:33
  Speaker 1: So to further that point, all right, I've got some studies here.
• 20:39
  Speaker 1: New England Journal of Medicine study they found a high prevalence of abnormalities in the lumbar spine on an MRI exam of people without back pain.
• 20:44
  Speaker 1: Without back pain, they found a high prevalence of abnormalities in the lumbar spine.
• 20:45
  Speaker 1: On an MRI exam of people without back pain.
• 20:46
  Speaker 1: Without back pain, they found a bunch of abnormalities.
• 20:49
  Speaker 1: Only 36% of those examined had a normal disc at all levels.
• 20:55
  Speaker 1: That means that I mean, what is that?
• 20:58
  Speaker 1: 64% of people had abnormalities.
• 21:01
  Speaker 1: Only 36% had normal disc levels, had abnormalities.
• 21:10
  Speaker 1: Only 36% had normal disc levels and about half of them had a bulge at least at one interval-deeple disc and a quarter had at least one disc protrusion.
• 21:14
  Speaker 1: That's not really that.
• 21:15
  Speaker 1: I mean, that's a lot what I'm saying, but that's not a lot of people that had pain associated with it.
• 21:19
  Speaker 1: So 64% of people had abnormalities of a disc, herniation or something going on.
• 21:23
  Speaker 1: Interval-deeple disc issues, narrowing of space, whatever right, but not that many actually had symptoms.
• 21:29
  Speaker 1: Just interesting Systematic review of 2,100 patients without hip pain on an MRI 2,100% of people, no hip pain.
• 21:41
  Speaker 1: They found 37% of those people had a cam deformity, 67% had a pincer deformity and 68% had labrum deformity.
• 21:50
  Speaker 1: This is interesting.
• 21:51
  Speaker 1: A cam impingement or cam deformity is a femoral overgrowth of the bone structure, like hip impingement, femoral acetabular impingement, fai, femoral acetabular impingement.
• 22:03
  Speaker 1: So the femur can overgrow and then cause an impingement mechanism at the hip joint.
• 22:08
  Speaker 1: The pelvic structure or your acetabulum can also have an overgrowth and that can cause an impingement mechanism in your hip joint.
• 22:14
  Speaker 1: So what they're describing is 37% of people had femoral overgrowth that you would think would cause impingement, but none of these people had pain in this study.
• 22:23
  Speaker 1: 67% of people had a pincer deformity or overgrowth of the acetabulum or the pelvic bone attachment.
• 22:30
  Speaker 1: 67% of people had this overgrowth that would suggest impingement in their hip, but nobody had hip pain in this study.
• 22:37
  Speaker 1: And then 68% of people had labral involvement or labral deformity, but nobody had pain.
• 22:43
  Speaker 1: It's just interesting the symptoms don't correlate with the actual structural deformity.
• 22:48
  Speaker 1: So is the structure of the problem?
• 22:50
  Speaker 1: Again, probably not.
• 22:51
  Speaker 1: Systematic review again 1,100 people of a lumbar spine MRI ages between 20 and 70 years old.
• 22:59
  Speaker 1: 87% of those people had bulges.
• 23:03
  Speaker 1: I'm sure a lot of them had in the later stages of life, like the upper end of those age which we'll get into in a second 87% of people had evidence of disc bulges of people across the board from 20 to 70.
• 23:15
  Speaker 1: But do you see?
• 23:15
  Speaker 1: 87% of people rolling around and hobbled over in back pain?
• 23:20
  Speaker 1: No, another systematic review of 3100 patients on an an MRI 3,100 people on MRI of a lumbar spine 37% of 20-year-olds had evidence of disc degeneration already.
• 23:34
  Speaker 1: 96% of people at the age of 80 had evidence of disc degeneration, 37% at 20 years old.
• 23:43
  Speaker 1: That's kind of old.
• 23:44
  Speaker 1: You would expect a lot, but you don't see like 37% of 20-year-olds hobbling around in back pain with referred nerve pain down their leg.
• 23:52
  Speaker 1: I'm just saying there's a disconnect between structure findings on an image and the abnormalities of their spine structure and actual symptoms.
• 24:00
  Speaker 1: All right, okay.
• 24:03
  Speaker 1: Another study 70% of people over the age of 43 have some kind of abnormalities found on an MRI their lumbar spine.
• 24:10
  Speaker 1: 70% of people over the age of 43 have some kind of abnormality.
• 24:13
  Speaker 1: But you don't see 70% of people at 43 or above hobbled over in back pain or getting disectomies and surgery and stuff.
• 24:21
  Speaker 1: Like I have severe back pain, right, I mean, pain comes and goes Totally.
• 24:25
  Speaker 1: It can go away and we're going to be on the second too.
• 24:27
  Speaker 1: But that just again furthers the argument that structural abnormalities don't correlate and dictate pain symptoms or functionality or prognosis forward.
• 24:37
  Speaker 1: I'm just saying so.
• 24:39
  Speaker 1: With that being said, is the structure, the focus Right?
• 24:42
  Speaker 1: Just saying so.
• 24:43
  Speaker 1: It's interesting.
• 24:44
  Speaker 1: I had this conversation with patients, the nerve hypervigilance discussion of like we can't neglect, there's nerves in there too and they can send signals.
• 24:51
  Speaker 1: We've got to turn the car radio volume down, that's it right.
• 24:53
  Speaker 1: And also, by the way, to bring hope and make you feel better.
• 24:56
  Speaker 1: Like 70% of people over the age of 43 have some kind of disc or lumbar spine abnormality or cervical spine abnormality right, but not all of them have pain.
• 25:05
  Speaker 1: So maybe the structure isn't really the problem, right?
• 25:07
  Speaker 1: I'm just saying so we can work around stuff appropriately and get you back to feeling better.
• 25:11
  Speaker 1: And after 20 minutes of a conversation the patient will be like okay, cool, yeah, so, but what about my herniated disc?
• 25:17
  Speaker 1: I have a herniated disc.
• 25:18
  Speaker 1: You see it in my eye.
• 25:19
  Speaker 1: I'm like oh my gosh, did you not just listen to the 20-minute conversation we just had?
• 25:21
  Speaker 1: Everybody has herniated discs.
• 25:23
  Speaker 1: It's not that big of a deal, right?
• 25:24
  Speaker 1: It doesn't have to be, unless you want it to be or, if you don't want it to be Controversial statement.
• 25:29
  Speaker 1: I'm just saying I don't want to say that to the patients, but what I'm saying is everybody has herniated discs.
• 25:35
  Speaker 1: Did you not just listen to the 20-minute conversation we just had?
• 25:47
  Speaker 1: Trying to minimize the structural abnormalities that might free people out, right?
• 25:49
  Speaker 1: I don't hate MRIs, right or imaging, but it can be really helpful.
• 25:50
  Speaker 1: It can also set the stage for people to ruminate and hang their hat on imaging that they find of like.
• 25:54
  Speaker 1: But I have two herniated discs.
• 25:56
  Speaker 1: Like yes, we know Everybody does right I'm sure I do too, I played football and volleyball in high college Like it doesn't dictate or correlate symptoms, anyway, all right.
• 26:06
  Speaker 1: So, as mentioned earlier in this discussion, when somebody is experiencing pain for a long time, the intricate nerves and connections don't function as appropriately as they had in the past and they're used to sending signals around.
• 26:16
  Speaker 1: Just high alert hypervigilant, ready to send signals to protect from danger real or perceived danger.
• 26:22
  Speaker 1: Danger might not actually be present, but signals are still being sent, and then an output of pain is presented and that experience of pain is occurring.
• 26:31
  Speaker 1: Right, so it can still be real pain.
• 26:33
  Speaker 1: You just got to identify where is it coming from.
• 26:36
  Speaker 1: So, like I said, the best way to intervene like, how do we fix it?
• 26:39
  Speaker 1: How do we intervene?
• 26:40
  Speaker 1: What approach do we do?
• 26:41
  Speaker 1: Non-irritating movement and blood flow?
• 26:43
  Speaker 1: Because, just like any other structure in the human body, the nerves need blood flow, they need to re-acclimate to movement, and the best way to deliver this capacity to heal and perceive movement as less of a threat and more as a benefit, get them more resilient and acclimated to movement again is by moving and grooving around in a non-painful, aggressive way.
• 27:02
  Speaker 1: How about just some exercises, right, like just things that don't cause more pain Not just pain, but heightened more pain, because people are always in the past.
• 27:12
  Speaker 1: I would catch myself because I'd be like I would do the exercise we taught this whole pain.
• 27:16
  Speaker 1: Talk, work with patients, be like I want to get you feeling better, right?
• 27:19
  Speaker 1: I'll say, hey, is this causing pain?
• 27:22
  Speaker 1: And the response is I was like hey, does this causing pain?
• 27:27
  Speaker 1: And the response is I'm always in pain.
• 27:28
  Speaker 1: So, yes, and I'm like oh, what I should have asked is you came in with a six out of 10 pain.
• 27:31
  Speaker 1: We're doing these things right now.
• 27:33
  Speaker 1: Is this making it more than a six out of 10 pain?
• 27:36
  Speaker 1: Well, no, it's the same.
• 27:37
  Speaker 1: Okay, perfect, so we're not making it worse.
• 27:39
  Speaker 1: Success, a mission accomplished, let's keep going as long as it's not making things worse, because you came in at a baseline, at six out of 10 pain and this isn't making it worse, we're good, we're not making things worse, we're not irritating or aggravating things more.
• 27:54
  Speaker 1: That's the question we had to ask and usually, depending on where they're at, they're like well, okay, I was like ah, gotcha, but anyway, so that's the question we had to ask.
• 28:07
  Speaker 1: So, with all that being said, we have to acclimate nerves to movement again, perceive movement less as a threat and more as a benefit and over time, the car radial volume will decrease and the regulation and hypervigilance will improve and re-regulate if a person wants it to.
• 28:22
  Speaker 1: I'm just saying I'm going to say something controversial.
• 28:26
  Speaker 1: Not everyone wants to get better and I didn't realize this until later in my career and I had mentors kind of describe this to me.
• 28:33
  Speaker 1: The radial volume of nerve hypervigilance and receptor hypervigilance and output intensity, that volume can decrease and it should decrease if the patient wants to.
• 28:47
  Speaker 1: That's a decision.
• 28:49
  Speaker 1: That's a decision they have to make.
• 28:52
  Speaker 1: Do they want to get better?
• 28:53
  Speaker 1: Not everybody wants to get better.
• 28:55
  Speaker 1: I'm not going to ask somebody do you really want to get better?
• 28:57
  Speaker 1: That's not something we ask.
• 29:00
  Speaker 1: We'll approach things maybe differently.
• 29:02
  Speaker 1: It's not my job.
• 29:03
  Speaker 1: I'm not a mental health expert.
• 29:04
  Speaker 1: All I'm saying is is, like, not everyone wants to get better, and I have interesting stories about this that I've experienced with patients where I had mind bomb epiphanies about like, oh this makes total sense, oh my gosh.
• 29:17
  Speaker 1: But if a person fully accepts that pain doesn't have to stay here forever.
• 29:21
  Speaker 1: Pain doesn't have to have to linger forever.
• 29:23
  Speaker 1: It can get better if you want it to.
• 29:25
  Speaker 1: Just a matter of making that decision, if you can fully accept that reality.
• 29:28
  Speaker 1: From a physical, physiological standpoint, the key is avoiding super irritating things over time and movements.
• 29:34
  Speaker 1: That will heighten the sensitivity and heighten the hypervigilance of those innervated areas and neural pathways which can be a slow process and seem like we're not really doing anything.
• 29:43
  Speaker 1: It just takes time and trust the process and we'd be here to help you, right, totally, I'm here to help, I'm on your team.
• 29:50
  Speaker 1: So interesting story, right, because this isn't my scope of practice with, like, the psychological component, and we can't neglect that with a pain experience, right, which is an output from the brain, as discussed, we can't separate the mind from the body.
• 30:07
  Speaker 1: Physical pain doesn't only just come from physical structures and nerves.
• 30:11
  Speaker 1: There's another source.
• 30:13
  Speaker 1: There's an emotional component to pain and there's a psychological component to pain that we can't neglect.
• 30:18
  Speaker 1: We can't neglect.
• 30:19
  Speaker 1: There is a psychological component to pain.
• 30:21
  Speaker 1: There is a psychological component to pain and to further this argument more, imagine if somebody, just in general, is that fear and nervousness and a lack they have an ankle sprain.
• 30:46
  Speaker 1: Imagine if, like an MMA fighter or UFC guy, gets punched in the face or gets his ankle rolled in a grappling grip right and he rolls his ankle.
• 30:54
  Speaker 1: He's not writhing in pain, he's used to it, it's familiarity, right.
• 30:59
  Speaker 1: The same tissue damage occurs to somebody that's never had that happen before, but the person has never happened before.
• 31:04
  Speaker 1: They're in severe writhing pain.
• 31:06
  Speaker 1: There's a fear associated, a lack of familiarity and nervousness associated with pain and an experience that happens like, oh my gosh, did I just like ruin my ankle for my life?
• 31:15
  Speaker 1: Imagine if you've rolled your ankle 15 times.
• 31:17
  Speaker 1: By the fifth time you're like oh yeah, I mean it'd be swollen for a little while but I'll get better right, it'll be fine.
• 31:23
  Speaker 1: That happens and a perfect example is UFC fighters.
• 31:27
  Speaker 1: There was a fight I was watching where it was two vets getting after it.
• 31:31
  Speaker 1: They're expert fighters.
• 31:33
  Speaker 1: I was just watching on TV and this dude had this guy in an arm lock and broke his arm on camera.
• 31:41
  Speaker 1: And you saw it snap right and it was just dangling arm on camera.
• 31:46
  Speaker 1: And you saw it snap right and it was just dangling.
• 31:47
  Speaker 1: And the guy that has his arm broken sat up and looked at it and then shook with his other hand, shook the other guy's hand and said, hey, good fight, you know, and his arm's dangling, he's just been used to it.
• 31:57
  Speaker 1: Imagine if somebody wouldn't be used to it and there's not as much fear associated with an injury, right, they'd be freaking out, they'd be writhing in pain and be like, oh my God, like, right, it's totally normal and expected, right, I'd be freaked out of my arm broke and never had that happen before.
• 32:11
  Speaker 1: But someone who's a vet, who's had injuries like that happened before, there's not as much fear at all, and he's used to that kind of pain or that kind of injury and familiar with like, I'll just get an, you know, just get a surgery and get it fixed to be fine, right, it'll be in pain for a little while, it'll be swollen, but I'm not going to die, right.
• 32:30
  Speaker 1: So, with that argument, we can't neglect the emotional component and intensification of pain when other emotions are present and a lack of familiarity.
• 32:38
  Speaker 1: So, that being said, psychosomatic pain and emotional-based pain is real, right, it causes real physical symptoms.
• 32:47
  Speaker 1: But what's the source of this pain?
• 32:49
  Speaker 1: It's an emotional source, it's a psychological, psychosomatic source and that, over time, can totally change and manifest physical changes that would be evident on blood work, immune system, uh, blood work, um, and uh other physical symptoms, right, like arm pain, back pain, knee pain, leg pain, neck pain, shoulder pain, all that stuff.
• 33:13
  Speaker 1: And this is where it gets really tricky and controversial and difficult, right, and this is where I lose people.
• 33:19
  Speaker 1: Um, if they're, if they want to have this conversation I don't have this conversation with most people at all, right, I just think it's interesting, right, and if you want to have on board this discussion, let's dive in, right, but anyway, so, considering that emotional pain and physical pain output areas are located in the same region of the brain, with the same circuitry, so the brain doesn't actually differentiate physical pain from emotional pain.
• 33:43
  Speaker 1: It's the same area and the same circuitry and the same output area, so it's the same.
• 33:49
  Speaker 1: It doesn't know the difference, it's just interesting, so it feels the same right?
• 33:54
  Speaker 1: So if you link physical pain with some emotional influence attached to it that allows things to linger for a long time and not get better, that leaves objective healthcare professionals stumbled, stumped right and all they do is like I just want to help, right, how can I?
• 34:13
  Speaker 1: Let's look at the image.
• 34:15
  Speaker 1: Let's look at your joint, like how, what's wrong?
• 34:17
  Speaker 1: Why are you having pain still?
• 34:18
  Speaker 1: Let's look at this MRI Well, you do have a mild bolt.
• 34:21
  Speaker 1: We fixed it with a herniated disc, disectomy and a disc replacement or a foramotomy and a laminectomy.
• 34:30
  Speaker 1: That doesn't make sense why you're still in so much pain.
• 34:32
  Speaker 1: Maybe I missed this area?
• 34:33
  Speaker 1: Let's look at it.
• 34:35
  Speaker 1: So a person that doesn't have this kind of a thought, awareness, consciousness of like this pain, experience, talk or thoughts, physiology they're like, yeah, there must be something wrong in there still.
• 34:45
  Speaker 1: So, from a surgeon standpoint, they're like, okay, how do we fix it?
• 34:48
  Speaker 1: We got to go in there and do surgery again, right, or maybe an injection or just pain meds, right, just saying there might be another source that's contributing and heightening and intensifying this lingering pain.
• 34:59
  Speaker 1: That's not my job, not my role, not my lane.
• 35:02
  Speaker 1: I just this is interesting to me I, that's not my job, not my role, not my lane.
• 35:05
  Speaker 1: I just this is interesting to me.
• 35:06
  Speaker 1: I'm just bringing it up as a conversation point.
• 35:07
  Speaker 1: So, with that being said, um, uh, these topics of discussions, I think it's just interesting and I'm glad I have my own, uh, awareness of this stuff.
• 35:16
  Speaker 1: So physical pain that roots from a emotional or psychological component can still manifest physical changes and cause real pain experiences and also manifest hard objective physical changes like systemic dysfunction, immune dysfunction, blood work tests that come back abnormal of, like your white blood cell counts way down right, or your platelets are way down right, or these hormonal regulation lab values are way off, like your testosterone is way down.
• 35:47
  Speaker 1: What does that come from?
• 35:49
  Speaker 1: It can definitely be a gland problem.
• 35:53
  Speaker 1: But let's say, somebody otherwise was normally healthy, eight yearsimmune disorder and all of a sudden nothing's changed but their testosterone was dropped.
• 36:09
  Speaker 1: Physical manifestation and blood work values can change from emotional and psychological sources and that's a fact, right, like it is what it is.
• 36:18
  Speaker 1: Can we accept the reality of that?
• 36:20
  Speaker 1: And if that's the case, then what's the route to fix the problem?
• 36:23
  Speaker 1: Would a physical, structural, surgical intervention fix that?
• 36:36
  Speaker 1: No, and it's not my job either, but if that's the case, like, and if it's an emotional, psychological source, then we got to fix the emotional, psychological issue.
• 36:40
  Speaker 1: And that would be like a mental health professional right, that's not me and number one would you just be accepting and realizing like, oh snap, I am stressed, you know, whatever, whatever's the case, I'm not going to get into that, that's not my thing, but anyway, it can totally be a huge link to abnormal, manifest, objective findings, physically and physical pain.
• 37:00
  Speaker 1: And at this point this is where people are left in limbo, where they don't have any closure of an answer of like.
• 37:06
  Speaker 1: Then what's my diagnosis?
• 37:07
  Speaker 1: What's the problem?
• 37:09
  Speaker 1: What's my diagnosis?
• 37:11
  Speaker 1: Right, I have these hormonal values that are abnormal and outside the norm range and I have these immune system lab values are out of normal range and I have these other values that are abnormal range and my back hurts and my foot hurts and my shoulder hurts and my neck hurts.
• 37:29
  Speaker 1: I'm just saying that's where people left in limbo and they're like I don't have any closure.
• 37:34
  Speaker 1: What's the diagnosis here?
• 37:35
  Speaker 1: What is my problem?
• 37:36
  Speaker 1: How can I fix it?
• 37:38
  Speaker 1: And then, from a healthcare objective standpoint, that's where docs who want to help totally and they're super smart or physical therapists who want to help and we're I think I'm smart.
• 37:51
  Speaker 1: I want to be smart in my field.
• 37:52
  Speaker 1: That's where we're like what can we do to help?
• 37:55
  Speaker 1: Well, you're lacking these hormonal values.
• 37:57
  Speaker 1: Here's a medicine that helps fix that and regulates it.
• 38:00
  Speaker 1: You're lacking these hormonal values.
• 38:02
  Speaker 1: Here's another medicine.
• 38:02
  Speaker 1: You're lacking these immune system cell values and they're low or high or whatever.
• 38:08
  Speaker 1: Here's a medicine that can fix that.
• 38:10
  Speaker 1: Is that really going to be a long-term solution or actually addressing the source of the problem?
• 38:16
  Speaker 1: Maybe not.
• 38:17
  Speaker 1: So anyway, with that being said, I've seen a plethora of patients in this boat.
• 38:22
  Speaker 1: It's not my job to dive into the psychological or emotional aspects.
• 38:26
  Speaker 1: It's not what I do and I wouldn't go into that.
• 38:28
  Speaker 1: But we think that maybe that's contributing, you know, and that could be contributing to what's creating these physical abnormalities, and nobody has an answer right.
• 38:40
  Speaker 1: But is somebody willing to accept that pain can come from an emotional, psychological source and then, after that, then take action steps.
• 38:51
  Speaker 1: What concrete actions can be done?
• 38:55
  Speaker 1: So I've heard some experts suggest and this is like the biopsychosocial model of healthcare, biology, psychological and social biopsychosocial approach versus a pathoanatomical pathology of your anatomy.
• 39:09
  Speaker 1: There's an issue with the structure, like where's the source of pain or dysfunction, right?
• 39:14
  Speaker 1: So I've heard some experts suggest social support, family dynamics, perspective and beliefs that shape the world which started being shaped from childhood, childhood trauma, where mental health experts would want to dive in.
• 39:28
  Speaker 1: That's where they would approach and start what's your family dynamics, your social support structure look like, right.
• 39:34
  Speaker 1: They would start asking questions like what's your relationship with your dad?
• 39:36
  Speaker 1: What does it have to do with my back pain?
• 39:38
  Speaker 1: Just saying, um, childhood like, and so other expert would say that, like I'm just as I'm not me this is what another person said.
• 39:48
  Speaker 1: Expert would say that like I'm, not me this is what another person said.
• 39:51
  Speaker 1: But I don't disagree fully.
• 39:52
  Speaker 1: I don't know.
• 39:52
  Speaker 1: All pain eventually can root back to some kind of childhood trauma or childhood dysfunction.
• 40:01
  Speaker 1: Current family dynamics, current family support, current social support and current perspective and beliefs can also affect and intensify and enable lingering, chronic pain, and one of those all could be spouse resentment, right?
• 40:18
  Speaker 1: I heard another expert suggest that 71% of someone's perceived happiness is directly correlated to their relationship with their spouse.
• 40:25
  Speaker 1: So family dynamics and their spouse marriage dynamics, right?
• 40:30
  Speaker 1: Um, it's just.
• 40:30
  Speaker 1: It's just interesting to me.
• 40:32
  Speaker 1: I just be like, oh, okay, I take for what it is.
• 40:33
  Speaker 1: I'm not trying to, I'm not going to dive into this with people.
• 40:36
  Speaker 1: But, like, it's just something to consider from my end and the approach and perspective belief that I have and the frame and lens of pain that, um, I have my own life and my and people and my patients right Just dictates my approach to stuff.
• 40:48
  Speaker 1: But, anyway, spousal resentment can also be a huge part of that family dynamic that can enable and allow lingering chronic physical symptoms as it relates to mental, psychosomatic, emotional and psychological-based pain.
• 41:02
  Speaker 1: So if the puzzle pieces aren't fitting in the right way and something doesn't smell right, that's just something that experts would suggest to dive into.
• 41:12
  Speaker 1: I'm just saying Continuing this conversation.
• 41:17
  Speaker 1: I got six pages of summary stuff I wanted to dive into with this, but it's just shedding a different light on, maybe what the root cause of chronic pain, because here's a story that I've heard before that is just very interesting, right, like I've had a patient say this and I've had multiple patients along the same lines.
• 41:38
  Speaker 1: Guy comes in.
• 41:40
  Speaker 1: This was a while back.
• 41:40
  Speaker 1: This is I was back in Houston, but he was like you know, I'm here because my doc told me to be, but my back pain started in 1996.
• 41:49
  Speaker 1: At this time it was like 2016 or something.
• 41:53
  Speaker 1: This is like 30 years, 20 years prior, 20 years of back pain.
• 41:57
  Speaker 1: He's like, yep, my pain started in 1996 when I helped my dad or my brother move out of his house and I was lifting a table upstairs and after that my back hurt and it hasn't stopped hurting since then.
• 42:11
  Speaker 1: Um, so I'm like in my head in my early days I'm like thinking very biomechanics, like okay, maybe your thoracic spine isn't moving.
• 42:19
  Speaker 1: Well, what's your hip range of motion?
• 42:20
  Speaker 1: What about glute stability in your core?
• 42:22
  Speaker 1: And like we can work all these things, a manual therapy.
• 42:24
  Speaker 1: What if I mobilize this and then we strengthen this and then we work on this balance and dynamic stability and that will help your core, make your back feel better.
• 42:32
  Speaker 1: And they weren't getting better and they would come back the next day or like next week and I'd be like all right, how do you feel?
• 42:37
  Speaker 1: Did you do your exercises?
• 42:38
  Speaker 1: Did you do this?
• 42:38
  Speaker 1: He's like, yeah, I did all of them.
• 42:39
  Speaker 1: That hurts worse.
• 42:40
  Speaker 1: And I'm like, oh man, we got to change direction.
• 42:43
  Speaker 1: Maybe I was wrong.
• 42:44
  Speaker 1: Let me call my mentor on biomechanics and like do this and maybe this, and maybe I should do this instead, and these exercises and this manual therapy and this soft tissue work, whatever, maybe this is the structure that's making issues and my, and came back again.
• 42:57
  Speaker 1: He's like it hurts, it's not getting better, and I'm like we always get people better, like what?
• 43:01
  Speaker 1: I don't understand, how is this not helping?
• 43:03
  Speaker 1: You know, anyway, I'm bringing us one of my mentors and they're like, yeah, did you have the pain?
• 43:08
  Speaker 1: Talk with them.
• 43:09
  Speaker 1: And I'm like no, I didn't, I didn't even consider it, like it wasn't even the thing.
• 43:14
  Speaker 1: Yet, you know, I mean like pain science, right, I'm not going to get into his family dynamics, it's not my thing, but like as in, hey, we know that nerves contribute to signaling if danger and physical tissue damage is present or not.
• 43:26
  Speaker 1: Um, and we just got to get like a high, like a car radio on full blast.
• 43:30
  Speaker 1: We got to decrease the intensification of that car volume, right, the radio volume, and just decrease pain or to decrease the neural hypervigilance and ready to send signals, right, and then have those nerves be aware that movement could be a benefit, not threatening, and the best way to do that is just move it in blood flow, right.
• 43:49
  Speaker 1: Anyway, I was just like mind blown.
• 43:51
  Speaker 1: I was like, oh, of course had another guy that he was probably in his early sixties, maybe late fifties I want to say late fifties and he had been battling chronic back pain.
• 44:00
  Speaker 1: Right, same situation, same timeframe.
• 44:03
  Speaker 1: He's like, yeah, my pain began, and you know, 10 years ago doing this and I was lifting these items at my job and since then it hasn't gotten better.
• 44:11
  Speaker 1: I'm like, oh man, ok, well, let's work on this and these mobilizations, and maybe your back is contributing this way, and then maybe your hips what about your ankles?
• 44:19
  Speaker 1: We can look at your ankles for squats, and then your core stability and glutes and whatever.
• 44:23
  Speaker 1: And we were doing all these things.
• 44:24
  Speaker 1: And we were doing all these things and he's like, yeah, I feel all right.
• 44:26
  Speaker 1: I was like, okay, great, we're not worse.
• 44:27
  Speaker 1: He's like, no, perfect, okay, do your homework, do this, this and this.
• 44:30
  Speaker 1: I'll see you next week.
• 44:30
  Speaker 1: He comes back.
• 44:32
  Speaker 1: And I was like all right, so how'd it go?
• 44:33
  Speaker 1: How do you feel?
• 44:34
  Speaker 1: And he's like, yeah, I feel worse.
• 44:50
  Speaker 1: I was like did you do exercises?
• 44:51
  Speaker 1: He's like, okay, yep, and I'll do your homework and I'll come back next week.
• 44:51
  Speaker 1: Came back and I was like all right, how you feel?
• 44:52
  Speaker 1: Like I wanted.
• 44:52
  Speaker 1: I was brainstorming, I was researching all these articles.
• 44:53
  Speaker 1: I'm like what I can do to help?
• 44:53
  Speaker 1: And he's like yeah, it still hurts, doesn't feel better, actually, might feel worse.
• 44:56
  Speaker 1: And I'm like what?
• 44:57
  Speaker 1: I was like maybe you got to work on better.
• 44:59
  Speaker 1: And I was like what?
• 45:00
  Speaker 1: Like you can't like there's no reason why?
• 45:02
  Speaker 1: He's like I'm not going to get better.
• 45:03
  Speaker 1: And I was like, oh, I was like why, you know?
• 45:22
  Speaker 1: And he's like I've been in pain for long enough and I'm not going to get better.
• 45:24
  Speaker 1: Um, and he, I was like would you like?
• 45:26
  Speaker 1: And I was like ask, then I've dropped it.
• 45:30
  Speaker 1: Later that day I was asking him questions.
• 45:31
  Speaker 1: I was like so how?
• 45:31
  Speaker 1: Like later in the session, how was your weekend, though?
• 45:31
  Speaker 1: Like hanging out with your wife or whatever like your kids?
• 45:32
  Speaker 1: He's like, yeah, I just did some yard work and I was lifting these bricks.
• 45:34
  Speaker 1: And I'm like you're doing yard work and lifting bricks.
• 45:37
  Speaker 1: I was like, but you're never going to get better.
• 45:39
  Speaker 1: And he's like, yeah, and I was like, oh, you got your back pain originally from working on the job and there's a litigation involved and you have to submit disability insurance evidence and proof this week and if he gets approved, he gets life disability checks.
• 45:57
  Speaker 1: And I was like, oh my gosh, not everybody wants to get better.
• 46:01
  Speaker 1: This individual was willing to just be subjectively, report he's in pain and not be functional and not do things that he wants to do.
• 46:09
  Speaker 1: There was a financial incentive involved and I was like, oh my gosh, totally true.
• 46:13
  Speaker 1: So, anyway, I was like, not everybody wants to get better.
• 46:17
  Speaker 1: On the same note, there's other people another patient story that I've come across with that some people just don't want to get better.
• 46:24
  Speaker 1: Some people just don't want to get better, right, um, there had they.
• 46:31
  Speaker 1: I didn't know, I wasn't diving into this stuff, but this patient, who was a high level, uh, in the law space Okay, this was a couple of years ago too and, um, she had been battling neck pain and arm pain and mid back pain for like years and it's been getting worse, right, and it's not getting better.
• 46:50
  Speaker 1: Imaging came back with some mild abnormalities, but nothing alarming, like mild arthritic changes, right, that's not warranted to cause.
• 46:57
  Speaker 1: Like severe back pain and radiating arm pain, right, it's like this doesn't make sense.
• 47:01
  Speaker 1: Why is this pain so severe and intense?
• 47:05
  Speaker 1: But anyway, after talking and I was mentioning nerves and, like you know, nerves can be sensitive to and we just got to get nerves to feel better and they acclimate the movement and blood flow can help, and we just got to deregulate the radio volume and we'll do everything I can to help settle things down, because it can't neglect that and there's also nerves in there that can generate pain, not just like muscles and tissues and herniated discs and your joints or whatever, anyway.
• 47:26
  Speaker 1: So we were talking more and she was just her phone was ringing mid-session and she was answering her phone and she was like yelling at her family or like some of her kids, and then her husband wasn't really helping in the situation and she had been mentioning how she's, you know, has all these doc visits and stuff.
• 47:43
  Speaker 1: And I was like, oh my gosh, this makes total sense too.
• 47:46
  Speaker 1: If she's always in pain, she's the center of her family's attention and she can be taken to all these doc visits.
• 47:53
  Speaker 1: Um, and her husband is toting, you know, up like always just pampering all the time, like it's just a lot of support, right Cause he wants to her to feel better and he feels bad, and then her doesn't have a great relationship with her, her, uh, daughters, her two daughters, and like her one son or something like that.
• 48:10
  Speaker 1: And like I was like, oh my gosh, this makes total sense too.
• 48:13
  Speaker 1: I'm not diving into that, I'm just my own brain in my own head.
• 48:17
  Speaker 1: This is a while back, right, but, like another patient, our therapist told me very similar situations and I'm like I don't think they want to get better because if they do, that family support is removed and maybe they would be falling back and drifting into quicksand of irrelevance of their family, of their social support, whatever that maybe when they were growing up as kids, which then again she was described like we have conversations like they just open up about stuff this individual was describing like not the best childhood growing up either and they were emotionally abused I don't want to say physically abused, I don't really know the story, but there was a lot of turmoil in their childhood.
• 48:54
  Speaker 1: So there's like that in the background of their that shapes perspectives and beliefs and then current family dynamics and there's a lot going on with their kids and her husband and I was like, oh, not everybody wants to get better.
• 49:08
  Speaker 1: It's just interesting, right.
• 49:09
  Speaker 1: So it's just something to think.
• 49:11
  Speaker 1: I just think it's interesting and it's not my realm to dive into the mental health and emotional, psychological sources of pain.
• 49:18
  Speaker 1: Um, but they are real.
• 49:20
  Speaker 1: And then eventually it causes, it can cause and manifest physical symptoms and physical abnormalities and lab values as an example, right, it's just something to consider.
• 49:29
  Speaker 1: I think it's really interesting.
• 49:30
  Speaker 1: So, um, with all that being said, like um, it's not my job nor expertise to dive into that stuff, but people do open up and express feelings and their family dynamics and past experiences and things.
• 49:43
  Speaker 1: That's interesting and I respect it totally in full confidence, like I would never abuse that.
• 49:47
  Speaker 1: But it's just something interesting that my approach will change and then talking points will change and my approach to helping them get better might change.
• 49:55
  Speaker 1: But I also can't take it on myself to get really frustrated, because I used to, as I'm like why aren't you getting better?
• 49:59
  Speaker 1: I'm doing everything I can, I'm diving into the research, I'm calling mentors, I'm looking at articles, I'm reviewing my previous notes, I'm doing this manual therapy and course correcting and trying these exercises and nothing's helping and you're not getting better.
• 50:09
  Speaker 1: I'm getting very frustrated, Like why can't I help?
• 50:12
  Speaker 1: Right, but now I'm like, oh my gosh, not everybody.
• 50:16
  Speaker 1: I'm going to do everything I can to help, but not everybody wants to get better and there is a different source of pain that can generate physical symptoms, and I'm aware of that now and I want to help everybody totally, but a little less self-defeating and frustration of myself, knowing that the pain experience sometimes is out of the physical biomechanics, symptoms and control, right, um, and it's not my job to dive into the ladder Um, but anyway.
• 50:46
  Speaker 1: So we're doing everything we can to help so um to the ladder Um, but anyway.
• 50:48
  Speaker 1: So we're doing everything we can to help so um, it just changes the approach and how we do stuff, right, um, and a different light in which we can perceive, um and believe the way that pain comes and goes and it doesn't.
• 51:04
  Speaker 1: You don't have.
• 51:04
  Speaker 1: A person doesn't have to be in pain forever unless they decide to.
• 51:09
  Speaker 1: Not everybody has, and I understand not everybody has the capacity or the awareness to make that executive decision, because there's emotional and cognitive issues that can affect someone's awareness, like they're not a high functioning cognitive individual, right it's.
• 51:29
  Speaker 1: Uh, if there's disability involved, right, cognitive disability.
• 51:32
  Speaker 1: But if somebody otherwise is not having cognitive disability, um, they don't have to be in pain forever unless they decide to.
• 51:43
  Speaker 1: The first step is just accepting how pain actually really works.
• 51:45
  Speaker 1: Step is just accepting how pain actually really works.
• 51:51
  Speaker 1: And if they got better, would that remove some incentives?
• 51:53
  Speaker 1: I don't know, financial support, emotional support, resentment, I'm not really sure.
• 51:57
  Speaker 1: It's not my realm.
• 51:58
  Speaker 1: I'm not going to dive into that, that's not what I do.
• 52:00
  Speaker 1: But if they did get better, would that remove those incentives and comfort?
• 52:04
  Speaker 1: I don't know.
• 52:05
  Speaker 1: So it's not my job and I can't control that stuff.
• 52:08
  Speaker 1: I'm going to do everything I can, but that's up to them and all we can do and I can do and our you know people that want to help in healthcare is share insights from a neuromusculoskeletal standpoint to try to add benefit to people's lives and hopefully add improve their quality of life.
• 52:26
  Speaker 1: So that is what pain science is and the pain science approach and I think it's just really interesting and these discussions.
• 52:35
  Speaker 1: I really enjoy and diving into this stuff and if y'all have any thoughts or questions or insights on this discussion, I'm always open to suggestions, comments concerns, conflicting opinions.
• 52:47
  Speaker 1: I know this is slightly controversial, but I'm open to conversation, right, so don't hesitate to reach out.
• 52:55
  Speaker 1: And if you have any questions and pain that you feel like you've been battling that you want to help with, we would love to chat and at least share some insights or put some mental effort towards helping you.
• 53:05
  Speaker 1: And the best way to reach us is either our phone number at 561-899-8725 or our email, our administrative email team at athleterccom, and check us on Instagram Check out other podcasts.
• 53:18
  Speaker 1: Feel free to share this one To anybody.
• 53:21
  Speaker 1: You know we're always open to helping more people and expanding our reach, so we'd love to hear from you guys, and we'll catch you all next time.