Ep 57: Understanding Chronic Pain: Why You Hurt & How to Heal with Andrea Moore, DPT

Chronic pain can feel isolating, frustrating, and exhausting — especially when no one can see what you’re going through.  In this episode of The Starting Gate, we sit down with physical therapist Andrea Moore, an expert in helping people who feel stuck in long-term pain. Whether your pain began with an old injury that never fully resolved, or you’ve lived with pain for years without a clear diagnosis, Andrea explains why this happens — and what you can do about it.

We break down the science of chronic pain, including peripheral and central sensitization, how stress and past experiences shape pain, and why two people with the same injury can have completely different outcomes.

Andrea shares realistic strategies, from mind-body practices to movement, nutrition, and finding the right provider. Most importantly, she wants listeners to know that even if you’ve tried “everything,” there are ways to improve your pain and reclaim your quality of life. 

Find Andrea Moore, DPT: 

At Move + Smart Physical Therapy

Dr. Andrea Moore

Listen to more from Andrea on her podcast Unweaving Chronic Pain

thestartinggatepodcast.com

Email us with questions and topics you want us to cover at
contact@thestartinggatepodcast.com

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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Ep 57: Understanding Chronic Pain: Why You Hurt & How to Heal with Andrea Moore, DPT

​[00:00:00] 

Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz Two internal medicine doctors who spent years practicing traditional [00:01:00] primary care. Over time, we realized something was missing from modern healthcare, a real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome back to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. today we're talking about chronic pain, and this is something that is estimated to affect about one in five adults in the U.S.. So over 50 million people here in our country living every day with pain that never goes away, it's really not just the pain itself.

Having that pain every day affects how you move, how you get through your day, how you sleep, your mood, your relationships with your friends and family, and your coworkers, and really every part of your life and the lives of those around you can be affected. People with chronic pain really are left feeling misunderstood.

They're left feeling stuck, [00:02:00] and oftentimes the usual treatments we use don't bring any relief. So today we're talking about an approach that really can make a difference, and that's the role of physical therapy in helping people with chronic pain. 

And when most people hear physical therapy, they're thinking of a sports injury or rehab after a fall or having a specific surgery.

it's definitely helpful in all those scenarios, but it can be extremely helpful in dealing with chronic pain conditions that are difficult to manage. So today we brought on a guest who is a specialist in this area. We have Andrea Moore. She has a doctorate of physical therapy and works at Move + Smart Physical Therapy here in Lexington.

And she specializes in helping patients with persistent pain from anything from , chronic abdominal pain, headaches, neuropathy, or lingering pain that occurs after an injury. We're gonna explore how she approaches these complex cases and what progress can look like, why this kind of work is challenging, but [00:03:00] also extremely rewarding in healthcare.

Andrea, can you please tell our listeners a little bit about how you got here? 

 It is such a long story that it would take up this whole podcast, so I'll summarize one. It is such a pleasure to be here. Thank you so much for having me. And I got here not knowing this is , where I was gonna be at all.

I started as just general orthopedic physical therapist and I was lucky enough to work in a really holistic clinic , we had the whole hour one-on-one with patients and by nature of that we saw a lot of people who were not successful at other physical therapy clinics and had chronic pain.

And it turned out we really didn't learn much about chronic pain in physical therapy school. there was a lot of attitude of, they just need to learn to live with it. There's not much you can do. You just kinda have to do a lot of maintenance. And I also had chronic pain and did not like this as an answer.

I was like, this [00:04:00] sucks. Yeah, I wanna learn more. So I ended up doing a residency in orthopedics where we did a lot of chronic pain work. And then I went on to just specialize, like most of my continuing education was in chronic pain. I also am a nutritional therapy practitioner. And then I fell into more of your mind, body, somatic, trauma informed type of care.

 along the way, I myself had a really bad car accident. So I was out of work for almost six months with more chronic pain on top of the other chronic pain that I had, and really got to know firsthand what it's like to have that invisible injury where I was unscathed on the outside, but inside felt.

Pretty cruddy and having people look at me and are like, you look fine. This is just a case of the Mondays. Because of that, I just got really determined to figure out how I can not only help myself, but really help my patients along the way. And so tons and tons of my own personal research, continuing education has led me to where I am [00:05:00] today.

That's, that is amazing. It's, yeah. 

 Can you tell us, what kind of chronic pain do you even see? 

It is such a wide range, and I think that is the biggest thing with chronic pain. It's almost oh, I want to build a house. And it's okay, what type of house are you gonna build?

Before we even looking at what the details are and how you build it, right? There's so many different things and chronic pain is so complex. So I tend to see most often people who have failed other physical therapy and either they had a previous injury that just never got better or was, good enough or got better and then it has come back, 20 years later they're like, yeah, I injured my back in high school and it just never quite got better and now it has re flared up and no one seems to know what to do about it.

But I also see a lot of chronic pain that just happened that has no diagnosis. Maybe someone slapped a label of fibromyalgia on it but a lot of chronic pain with [00:06:00] no clear indication of what caused it. I tend to see a lot of women. With this and by nature of my practice 'cause I work in person at Move + Smart here in Lexington and I also have a virtual practice where I do see clients around the world.

And so by nature of that, I tend to see a lot of people who have actually gone through a lot of other chronic pain programs, like online things, seen all the top docs in chronic pain and they are still not better. So I see a lot, and that tends to be a certain personality type, tends to be women who tend to be a little more perfectionistic.

You're more type A, you're a go person. They were holding it all together for everyone until they just couldn't anymore. So it's that. And then the other person I would see who has a lot of trauma, past trauma would be the main types. 

when you are approaching a patient with chronic pain, 'cause I think you're alluding to some of this is.

Really you need to take a more holistic approach instead of just looking for that injury and attacking that. [00:07:00] So what are some things that you take into consideration when someone comes in with chronic pain that has just been so hard to manage and maybe the first time a patient's even asked about it?

I literally take everything into account that I can. Often, sometimes the little details are what's most important , I see one or two types of people. Somebody who has relayed their stories so many times because they've seen so many providers. And I actually find those people are often harder to get the important details out of.

'cause it's become this very rehearsed, here's what I have to say in order to get care and or they're speaking in really clinical terms and what I need to know is what they're experiencing. And so ultimately that is really what is most important. What is their experience? How is it affecting their life, their goals, their vision for themselves, , that is the base thing that I want to know.

And from there we take the next little step. And it's gonna look very different if they had a clear injury. Let's say someone sprained their ankle and they're like, man, this happened a [00:08:00] year ago or 18 months ago. This should be better by now. I'm gonna approach that person very differently than the person who is I've just been in pain for 18 years and I have no idea why.

And I have, sought every treatment and no one can do anything about it. There's very different approaches. 'cause with the first one, I am probably gonna do much more of a physical exam. We're going to really look at what's going on, but they likely have something that's called more peripheral sensitization of the area versus someone who's been in pain, likely has much more central sensitization.

And while they're related, it is important to know what you are looking at and what you are dealing with. Can 

you break that down a little bit more? Yeah. For our listeners about the difference in those two just for an understanding of the central versus peripheral. 

Absolutely. And I wanna even back up to be like.

What is chronic pain? Yeah. It's like a super complex definition of chronic pain is any pain that basically lasts more than three to six months. There we go. Done. Great. Okay, great. Super. Great. So it can be literally anything, not helpful [00:09:00] at all usually to have that definition.

But just to see the broadening of it is that it is just defining that you have had pain for a period of time. It is not the reason why you have pain. . It always has a component of a sensitization of the nervous system in it. So when you get an injury, let's say you're the common example is you're running across the street, you step on a nail and you're like, oh my gosh, ow.

You stop. What is happening in that moment is the nerves in your foot are sending a signal up to your brain, like an alarm system, like a danger. Hey, pay attention, something's going on. The thing is that there are no actual pain receptors at your foot or anywhere in your body.

We simply have a danger signal and the brain's receiving that, and it's in this like split second is making a decision of what to do. Now in that moment, if there's no, you're in the middle of the street, there's no cars coming, you might stop and be like, oh my gosh, there's a nail on my foot. But if in that exact [00:10:00] moment there is a car that is coming at you.

You probably will not even register that you stepped on the nail, or it might feel just like almost nothing you will get across the street. And that is because your brain can actually modulate what you are experiencing based on everything around you. So the way I like to look at it is when your brain is experiencing more safety than threat, then you won't usually have pain.

When your brain is sensing more threat than safety, you will be in pain or that signal ascent. Now the thing that becomes really tricky is what is your brain perceiving as threat? And so a nail in your foot. It's a threat that makes sense. It's a rusty nail. We need to, make sure you're up to date on your tetanus shots.

You need to make sure you're not gonna bleed everywhere. It's like we want that threat signal because without it, we actually could get in a pretty dangerous situation if you didn't take care of those things. And so that threat system is often [00:11:00] for people who are in chronic pain. They're like, oh, I hate that.

But it's we really need it. We're humans. We often do not pay attention to our whole body. If we aren't hurting, we might not realize we're leaving a trail of blood everywhere. Sorry to be graphic, but Right. It's like we like that we have that. The problem is, in chronic pain is often what happens is the threat system gets outta whack, for lack of a better way to say it.

So what should happen is as everything's healing, as you're attending to an injury, for instance, that threat system starts to come down and it just naturally comes down based on the injury, based on the care, based on your experience. Within a couple days of something like that, it should get better.

If you stub your toe within 15 minutes, it's getting better. Once you've assessed the situation and realize your toe hasn't fallen off, we're like, we're good, right? It's like you feel that come down really quickly. But in chronic pain. What happens is threat system is not coming down. The nerves in your foot for this, in this instance, are continuing to send threat signals to the brain.

Even in the absence of what we feel [00:12:00] is a threat, there is no threat there. The nail is gone. We're like, this shouldn't be here anymore, but the brain is like something's going on and that can be either because of peripheral sensitization, which is there are literally a sensitized nerves in the foot. So at the nerve endings, our body can actually put more receptors and they very rapidly, within 12 to 24 hours, it can be like, whoa, something happened.

We're gonna just throw on a hundred thousand extra receptors so we really know and can monitor the area. And so you're gonna get this really increased sensitivity of the area. That's where it's like you just barely put any pressure and it's ow. Versus, without the injury, you can put pressure on your foot and it doesn't hurt.

And that's 'cause that increased sensitization that's happening peripherally, which just simply means like in your limbs, at the outer version of your body or that sensitization can happen centrally. And that's much more brain nervous system based, where our brain is perceiving a fear of what could happen.

So let's say the person who had the nail in their foot they're a marathon runner, [00:13:00] that's their livelihood. They love it. All of a sudden that injury is a much bigger threat than somebody who maybe has an office job who is like, yeah, whatever. It's fine if I don't need, I'm fine to not walk for a little bit for the marathon runner.

That actually could just activate a lot of other brain systems that are like, this is bad, this is really bad that this happened. And if we don't have a way to modulate that, bring that down. That's where we can lead. That's one of the reasons, one of the many reasons that can lead to this sensitization.

So that's the difference between the central and the peripheral. There's actually, I'm gonna add one more thing. There's really cool research that shows that in professional, they, I dunno why they chose professional violinists, but they did. But they were looking at the differences hand to hand of like how much pain could they basically tolerate.

And in medical studies it's often just cold. Like how much, how, like how long can you leave your hand in a cold ice bath? And on the left hand, if you were familiar with the violin, which is the moneymaker hand, if you play the violin their tolerance was much less because the body's we gotta protect this hand.

This is my [00:14:00] livelihood. So it's like they could not hold their hand. In as much cold for as long as they could, their right hand. So it's literally on the same person. You can see a difference in the sides based on how your body is like wanting to protect that area. That's fascinating, isn't it? It's so cool.

So can you take us a step farther and say, okay, let's say somebody sprained their ankle, just a normal person, that's it, right? Regularly active person, but . Sports is not their livelihood. So they sprain their ankle, they have pain, they've sent more receptors, their body's monitoring it.

One person goes on to heal in a few weeks and then one person has long lasting pain. What's the difference between those two things that happen? Yeah, 

great question. There can be a lot of things that lead to that. Usually it is often either the peripheral or the . Central sensitization, and that can be based on that person's just current level of stress can play a huge role.

Let's say they're also going through a divorce or there's things are really stressful at their job. There's a lot of [00:15:00] factors like that show just those things increase the likelihood of that central sensitization. They've had previous injuries in that area before. If they had a mom who also sprained her ankle and she had a, let's say it was really bad and they saw their mom deteriorate for that, so just this past experience.

Or they had a friend who's oh my gosh, yeah, when I sprained my ankle, like I could never walk again and then I gained 50 pounds and then I got divorced, right? It's like you can like literally just hear a story that can put your brain more on guard. All of those things can play a role.

And one thing I wanted to add is that sensitization that doesn't come back down is actually shown to happen in almost 25% of people, which is a really high number. It's like an unheard of number. And, most things of, when we're looking at diagnoses, yes, it's you're not alone in this.

For this to happen. It's, and it's so under looked at and under known about, but it is a massive number of people who are at risk for the sensitization. I'd [00:16:00] imagine that since this research done, it's probably only gotten higher because these numbers are pre COVID, pre, world burning anyway, so we'll move on from that.

Okay.

All the world stressors that we experienced. Exactly. Exactly. I 

think probably people hide it sometimes too. Yes. Just because they don't wanna be labeled as chronic pain or to be thought of as someone that was seeking medications and so maybe some people don't even mention it, even though they're dealing with it.

That 

was me. I didn't, honestly, I didn't even know I had chronic pain for a long time because I just had it since I was a kid and I just literally thought everyone walked through the world like that and I thought I was just a baby about it. Like I just. Thought everyone's joints hurt all the time and that I was just the only one who complained about it because that's how it was dealt with my family, was like, stop complaining.

They're just growing pains. I'm like, I'm 18, but okay. So yeah, I think it just based on what is around you, it's can really impact the way the body then [00:17:00] interprets the signals that they're getting and the medical care that you've had and how somebody's responded when you've tried to talk about it before.

If you haven't had this really loving, attentive, empathetic care yeah. It's gonna make you much less likely to even wanna say anything about it. 

So when you have a patient that falls in this bucket, how do you start to work on that as a physical therapist? Yeah. 'Cause it, some of this seems like it is much about our processing and many of our behaviors more so than even something.

Physical. 

Yes. And so one of the big things, especially, I mean I do this virtually as well, it's obviously a little different virtually 'cause I'm not actually physically examining them. So I am making sure when I, I have my doctorate in physical therapy and so I can ask the right questions to make sure if I am seeing any yellow or red flags, I might be sending them to, Hey, I need you to screen for this.

I remember I had one woman who I did a consult with and I was like, I'm not a thyroid expert at all. What she was describing. I was like, please go [00:18:00] see a holistic specialist. , I never even saw her as a client, but she emailed me back and she was like, yeah, thank you so much.

I got on meds and I feel way better. And I was like, yeah, right? I'm not gonna take someone on as a client or talk about all these behavioral things when it's no, you just, need people like yourselves to, to look at you. So I am always screening for that, actively constantly because that is always something that I think needs to be considered. And I would like to say for people who are listening and or who, anyone who's listening to a podcast is probably more likely to be in the online space and seeing a lot of online things. And I will say the world of chronic pain online has gotten a little scary for me.

'cause there's a lot of people who are doing it who do not have a professional background. I've 

seen them 

and I'm like blown away. They're, yeah. And I think for the right person who has been adequately screened, , it's fine. But I have again, seen enough people where I'm like, you actually have a physical thing that needs to be looked at.

And you've been doing all this like mental behavioral health which I love that stuff. But if you can just [00:19:00] do some exercises and make your pain go away, that's also much easier and better. It's way easier to deal as a physical therapist who deals with both the mental health side of things and the physical side of things.

When it's physical, I, it's a little simpler. As the end of the day, it's a little simpler, it's a little faster. It's a, it's easier. So let's make sure that is, yeah, the case, like getting adequately screened by a professional who knows what to look for, knows what to rule out, knows how to look at both the mind and the body.

There's a lot of people, unfortunately online who are mind body therapists who have just neglected the body. And that's just the reality that I feel like needs to be addressed. But, so how do I start? . How much do we need to be looking at mind and body a lot of that's based on who they are.

How much have they been looked at? If there's somebody who's coming to me and they're like, I've done all the, all these online courses, and a lot of things are more, more head-based. I'm gonna probably do a lot more of a physical exam. Let's look at how they're moving, things like that. If they've done tons of physical therapy, I'm [00:20:00] looking at their movement patterns and there's just not much that looks like it.

It's all things that have been addressed and they haven't been successful with. I'll probably go much more mind based, and if it's somebody who's starting fresh or the first person in, sometimes we just have to pick a spot and often that spot's gonna be a thing that feels most doable for the person and that their body feels aligned with because I am not someone who comes in and is here's what we need to do on your body.

So much is based on a partnership. I am talking to the person, I'm getting an idea of how they feel about certain things. I need to make sure they are on board. A lot of times we are learning how to listen to their body's wisdom on where to go next, because a lot of times there might be 10 different factors.

I know we need to look at. And the order matters, but that order might be very much dependent on what the body is comfortable facing first, not what I deem as necessary first, it is what they, their body is telling me. And so a lot [00:21:00] is listening to them and learning, helping them interpret what their body is saying.

And we go by always by what their body is telling me. So 

for our listeners that may have dealt with chronic pain and have really just gone down the avenue of physical therapy in the traditional sense, what kind of things would they expect to do with you? Because I think that's was like, okay, if I'm going there and she says we're working on my mind, but she's a physical, like what actually would someone.

Experience or just even giving an example of someone's dealing with a type of pain that can help people reduce their pain looking at that central sensitization. 

Absolutely. And so I will say as a physical therapist, I do have a lot of additional training that is much more into the mindset side of pain.

Oh yes, you have lots of training so a lot of times I am going, I'm teaching somebody how to start to listen to their own body. A lot of times we are up in our heads, we're living in fear, we're living [00:22:00] in, this anxiety about, oh my God, am I ever gonna get better? And. Sometimes these people are told, oh, just stop worrying about it so much.

Oh, you should just go do some meditation, which are all, have vague truths to it. Yes. But it's for anybody who has ever tried to meditate and their body's Nope. Then we are looking at that. We're finding other avenues in, because a lot of times there's a lot of fear of even going into the body because they, there's such a disconnection between that and so one of the first things I am determining with somebody is what is your ability to drop into your body and connect with it For somebody who's their ability to drop in, connect, they actually feel really comfortable there.

Then we might be doing much more. Maybe traditional mindfulness based techniques, but we are using it from a very specific way to talk to the body that I guide people through. So I'm often starting them with a guided process where I'm just facilitating their ability to speak to their body, and then I'm teaching them along the way [00:23:00] how to go and do it themselves.

So that might be one thing that we might start the session with something like that. And then from there we might move into some movement. So maybe if there's fear around certain movement patterns, I'm getting them set up in a way that the body. It can work around those fear patterns at first.

So let's say somebody has a fear of bending forward, they have back pain, things like that. We might get them on the ground and do the similar motion, but in a way the body almost isn't familiar with, so it doesn't have the protective patterning around it and helping them start to gain trust in that motion in a very active way and very guided way.

Maybe I'm helping them through it. I might be giving them cues if we're seeing, different muscles activate, we might be just working on their breath pattern is a huge one. all different kinds of things. There's really no, I have zero protocols. There is no one set way I work with someone, but that's one thing.

And then for somebody who has a lot of fear of dropping into their bodies, a [00:24:00] lot of it is building up that trust to even start to connect with their bodies. Because if we're staying out of our bodies, we're staying up in our heads is really. It's almost impossible to treat chronic 

pain. Can you explain to our listeners what is an example of not being able to drop into their body?

Like how can, if they're sitting there as was that me or not? It's a 

great question. I will if you don't mind, I'll guide you through one. Let's it yeah. Little. I, tiny one, I wanna see this. So I'll have people just take up taking a breath. And anyone, if you are driving, obviously do not do this while you're driving.

I know. Do the disclaimer, do this. You can follow along. Just don't close your eyes, obviously, and be aware. So just taking that moment to just feel your feet on the ground. Feel yourself supported by your chair, just letting yourself be held by gravity and just noticing your breath at whatever [00:25:00] pace it wants to breathe.

You. You don't need to force it to do anything. And even just noticing how your mind will continue to think thoughts, 'cause that's what brains do. It's your heart continues to beat

and through it all, your breath continues to breathe you. If it feels supportive, you can place one hand on your heart or a hand on your belly just to make contact or just hands on your thighs. If your eyes aren't closed and it feels good to close them, you can do that. Or just kinda let them soften at something ahead.

And then just take a moment to notice. Where do you feel in relation to your body right now?

 For some people they might feel I'm just, I'm just in my body. Others might be like, I feel almost like off to the right or a little above it, [00:26:00] or really far above it or off to the left. How are you guys feeling? If anyone wants to answer that? I feel center. Yeah. Yeah. I feel slightly to the left. I love it.

Yeah, and so just that answer right there will tell me a lot, right? It tells me that, Sarah, you're able to just, you're like centered. You're in their body, kitty, you're a little off to the left, so it's like you're you're able to connect in, but you're not quite all the way in. There's no right answer.

And this can change totally based on the day. And so everyone can open their eyes. Now. I know we, we, this would, we probably go on a little bit longer, but it's, that's a really great way to get a sense. 'cause some people are like, oh, I'm up here. And it's so funny because people, 99 out of a hundred times, like people just be able to answer and they're like.

I don't even know what that means. Like I don't know why I could, like you said, off to the left, you're like, huh, okay. often people can get a sense and if people are like, I have no idea, then that, that tells me there's definitely a [00:27:00] disconnection. It's like they don't even know where they are.

Yeah. I like live above my head a lot. This is where I got into this work, right? Like most of the time my answer is I'm a little bit up. Some people were like, I'm up in the sky. So all of that will just tell me their ability to, especially when I'm guiding them through something that starts to set a scene for centered and grounded in.

It just lets me know, okay, is this person able to come in? And there's no right or wrong, it's just where are you right now? 

That 

is so fascinating. Yeah. 

And I'll say if you're listening to this and you're like, this seems like fufu Dfu that would've been me a couple years ago, honestly. Oh, yeah, I get it.

Oh yeah I would've definitely said this a few years ago, people talking about, and then I will say. I've done some work on mindfulness, which is very helpful. And then I came to your practice and saw two of your colleagues for knee pain, which then they told me had nothing to do with my knees basically.

And they forced me [00:28:00] to do all these things forced, we're gonna make you a believer, kitty. I love it. And I told them like the reason that this physical therapy you guys are having me do is so difficult is because I have to focus on it so much. And in general, I would much rather just hammer out some squats, not think about it.

Turn some blair, some music. I actually have to not even have music or a podcast or anything on when I'm doing the exercises that they've given me because. I have to focus on it so much. Yeah. 'cause it's not easy for me to just feel like what they were telling me I needed to feel, but being able to make that connection has been what's been able to help me get better.

And now I can have this sense of understanding where I am but if you're someone that just never has taken the time to do that, you wanna just move your body and Blair some music, it does make a difference. Yes. It makes a, to be able to, a huge difference. Understand, I'm 

with you on the, like the woo woo and the fru, whatever, and I try to make it really practical for people [00:29:00] because there is so much research behind it. Like you can get, it's funny because there are some people who teach it from a very medical perspective. It's almost to me it's almost a little sterile. And I do, I can be a little bit more like woo woo, I guess about it.

And I'll shift it based on the person too and their what their preference is. But then there's some people who are Yeah I've. Also been like, okay, this is too woowoo for me for some of it. And so it's like you have to find what works for you. And again, in, in session I'm gauging and I'm seeing how the person's responding to things.

But I will say I have taken tons of like very, medical men through this. And it's amazing their ability, when you're guided to someone's helping you through the process of how you're like, oh, okay, this is a little different. And I promise I'm not gonna force anybody to meditate and be like, you need to be quiet for 10 minutes.

Here's the thing, if you can sit down and clear your mind for 10 minutes, you don't need to meditate. Go do it. That's good. Good If you enjoy it. But it's like you're not the person that, the practice. We'll get the benefit from it. Yeah. Yeah. I mean you'll get benefits from it [00:30:00] obviously, but like it's.

The meditation. Mindfulness is really hard. The people who are like, it's too hard for me. That's not for me, are likely the people one that was me. That is still me. It's still challenging for me. I literally teach this for a living. That is why I teach this for a living. 'cause it constantly, that's not why, but it's like it constantly reminds me to do this for myself.

But it is because we live in a world that is so go. No one teaches us how to do this. And it's almost that we live in a world where it's been like laughed at or frowned upon or made fun of when really it's like, what? Why? Why is connecting with your body a bad thing? Why have we labeled that as something that has is wrong?

No, I completely agree with that and is something that I feel like in my previous practice, I feel guilty that I didn't help patients in this way because there, there are many medical conditions that truly have a mind body connection and. It's not top of the guidelines to actually work on [00:31:00] that. And sometimes, patients are frustrated, you feel frustrated 'cause you have nothing to offer them.

And really some of what you're talking about in managing these types of pain, that's what they needed totally. And, and so it comes with a, I always get guilt when I'm like, oh, I wish I had known this, but I'm so happy that I now feel like I have the knowledge of how powerful working on your mind body connection can be for many different conditions and helping people heal.

Absolutely. And I would say that there's not a single condition where it's not a part of it because even in a condition that has very medical reason, you need, very specific. I not a medical professor, not what I'm just thinking you need to go to kidney dialysis. It's like there's, you are gonna MINDBODY or way out of that.

Right? Right. However, the mind body piece is really important because how you are even just, thinking about the fact that you have to go to these treatments, that it takes up a significant portion of your life, how it affects your life, [00:32:00] all of that makes a huge difference in how the rest of your body is even handling everything, right?

If you're going to these and you feel everything is falling apart and this is awful and it's not fair, and all of which, have truth behind them, let's leave room for all those emotions. But if they're just festering in a way where we don't have this ability to talk about it and process it.

It's gonna lead to issues, it's also gonna lead to issues. If you're like, I'm just gonna slap on a smile on my face and pretend everything's fine, because I should think positive about everything. And I was told never to say anything negative because that can make bad things happen. And then all that stuff is just staying deep down inside like that also causes problems.

So it's like we need to have a space to let or emotions move through. And in order to do that, we have to know that we have emotions and we have to have capacity to feel them and to know how to move them through in a healthy way. Not in a way that is oh, this is what I'm supposed to do or how I'm supposed to feel.

It's no, [00:33:00] this is how I feel. Let me give space to move through this. And when we can do that, it helps us take care of ourselves a whole lot better for whatever condition we have. 

So let's say you've got somebody that has had, chronic back pain or chronic neck pain or something for. 20 years and they've tried a million things.

It has maybe helped a little bit, but then they still have pain and they're ready to be all in on, on all of this. And how do you set up the appropriate expectation for things might improve and how much can they expect it to improve? And how do you set that up for them? 

It's probably one of the hardest parts, honestly, in that I don't know that I can adequately get a gauge a lot of times on how someone is going to respond and improve.

And at the speed, I like to pretend that I know and I will make it, an educated guess. But often people really surprise me in that some people get better way faster than I was expecting. And [00:34:00] some people unfortunately are, they get better slower than I was expecting. And so one. That is one of the biggest things I set up.

If they've had pain for 20 years, I tell people, you're not getting out of it overnight. We're not getting out of it in three sessions. That being said, one of the biggest things I tell people is that we are constant in constant communication with your body and how their body is responding. No, I do not expect them to get better right away.

However, I do expect them to feel, oh, this feels like the right path. This is, yeah, okay, I'm still in pain, but this is different. This is touching into something, and people know that really quickly. I would say within two or three sessions, often people are like, okay, I, some people might already be like, okay, it's, maybe I've gotten like 10% relief.

Some people might get actually quite a bit of relief quickly and then it comes back. People really vary a lot based on that. [00:35:00] And it depends if they're in, like they're in pain all the time versus it's with a certain motion, right? There's just so many factors that feel like, I have to talk about this so vaguely.

'cause there's yeah. So much nuance. But a lot of times we are constant, I am constantly reevaluating the path we're moving on because if someone is like, Hey, I did this, I got better, it immediately got worse and we just are stuck in this bouncing, we're stuck then. Like I will change it pretty rapidly within a section or two of where we're going and where we're coming at it.

Because you really should be this really, maybe it is slow or it feels slow often. It's not slow in reference to the 20 years though. Yeah. I don't know. Is getting better in six months slow if you've been in pain for 20 years? Like not really, but it can feel really slow. I do find that a lot of times it's almost this exponential process that happens where it's starts out really slow.

And things build up you almost put these building blocks in place. So I talk about that a lot with people. It's yes, we are building a [00:36:00] foundation, let's say, for somebody who has a lot of trauma in their background, and they don't have the ability to connect into their body. Therefore there's no even processing that can happen of the trauma.

It's like we first have to build the connection to even be with our body before we could even look at the trauma, before we can even move some of these emotions through before we might even be able to do some, physical things that can help. So it's yeah, it makes sense that we wouldn't see.

Progress yet because we're still building this foundation.

But a lot of times I do have a gauge of yeah, I'm not surprised. You're not like feeling a difference right now. 'cause we haven't gotten there yet, but we have to do this thing first. We'll get there and then a lot of times they'll like exponentially take off or things will like. Much more rapidly improve once that foundation is in place.

So I think a lot of it is just an understanding and again, being on board with that's a fold sometimes. That might be the entire session. Just talking through that and figuring out a way to, yeah, be at [00:37:00] peace with that. Because when we are fighting that, when we are resisting that, that's where people start jumping around from treatment to treatment.

They never really letting anything take root. And that's where they find themselves right back in the exact same position five years later. And they haven't gotten any better when they just kind of stayed the course. They would be a completely, gonna be a completely different spot. 

Yeah. That's a prominent example.

I know Kitty and I are always big believers in expectation setting. And it literally can change people's outcomes just from that very first conversation that you have with the patient. Because if you don't tell them how much time it's gonna take and it's not better in a week. Yeah, they think it failed and it's wasn't supposed to be better in a week.

And that is part of we're both at Moose Smart and my own practice. Like I work, we work in packages. Like I don't work with someone visit to visit because of that. And so someone is committing to a process and depending on, I might start them with a three month package or a six month package or [00:38:00] things like that.

And that, I think helps, is a huge thing that helps set the expectation is like they're committing to a process and a time period and it's like then we can reassess, see how things are. Yeah. 

And you have alluded to this, but can you explain what does it mean to be a trauma informed practitioner? 

Yeah, it's a great question.

There are actual certifications out there. There's a lot of extra training that go involved and lots of healthcare 

professionals can become trauma informed.

Unfortunately, we're in a place where there's a lot of medical trauma that is. Happening, and this was something that I think I was lucky enough to be aware of before I even went to physical therapy school.

I did a project on obesity and I interviewed a lot of people and their experiences with medical professionals and the stories I heard were absolutely horrific. The one that has like still stepped just cry, thinking about it, stuck with me to this day is like someone literally had a doctor tell them that if they sewed their mouth shut, then maybe they wouldn't be obese.

That would be an example of not being [00:39:00] trauma informed, like it's just the things that sometimes people are told. I think professionals, and obviously that's a really extreme example, but I think professionals don't realize the impact that it can have on someone's nervous system. And ultimately everyone's nervous system is different.

I have said things as a trauma-informed , therapist that has set my client off 'cause I didn't realize that was a trigger . But knowing how to then catch that in the moment, how to see that someone's, heart rate has gone up, how they have gone into a fight or flight.

Like I just, lost them there, they got disconnected. Being able to pick up on those patterns and then talk them through it to then repair that to speak in a way that is creating a lot more safety for their nervous system. Those are all be examples of some trauma informed therapy. And then, and there's a difference between a trauma informed professional who can like, speak in a certain matter, make [00:40:00] sure that they're when they're explaining things, it's in a way that is creating a lot more safety about the plan, about the diagnoses, and then somebody who does actually work with trauma.

So those would be two different things. 

Can you tell me how you would help with something like diabetic neuropathy where your nerves hurt from your blood sugar being out of control or even chemotherapy induced neuropathy or something like that? 

Yeah. 

How can that help? 

Great question. I feel since you said diabetic first, I'm like I'm a nutritional therapist as well, so it might be looking at.

Behavioral pieces as well. And a lot of times, again, I know it's my bias, we're gonna go back into it. A lot of times how people eat is very much dependent on how they are feeling about themselves, the stress in their lives, things like that. So most people know what to eat or what not to eat. Like people know for the most part, and somebody's coming to me with diabetic neuropathy, they've probably gotten all kinds of education.

The thing is are they doing [00:41:00] it right? And what is the gap between knowing and doing? , That is like my favorite place to work is when someone knows what to do but they can't do it and then they feel shame and guilt and all kinds of things for not doing it. So I know I'm not quite answering your question.

I'll get there, but might be working on that of let's actually look like it's, are there still factors in your life that are contributing to this or could be actively worsening it? And let's see how we can look at that in a really compassionate way. Because. Often, there are a lot of things you can do for nutritional therapy that are not talking about 

food, 

and that still leads to people with much better nutritional outcomes.

That could be a whole different podcast, so Oh, 

might 

need 

to be, yeah, 

be a fun one. Yeah. So there's that piece too, just for the diabetic piece, right? It's are there actual factors that are happening or even peripheral neuropathy, are there actual factors that could be actively worsening it and likes, let's make sure those are under control, whether with me or another professional.

Let's not ignore those. The actual neuropathy itself you can [00:42:00] do a lot of sensation based things to help, again, improve almost the nerve like feedback to the system. So a lot of times what happens is people, they get in the really cushy shoes when they try to like picture their feet they're really.

Not right sized. Either they're really little or they're like huge or they like, they just don't have a good image of it. So if you, and I know I'm gonna reference something that a lot of people might be like, what is that? But you can Google it. The homunculus where you guys are familiar, where it's like the brain's map of the body.

It's like it gets very blurred with things like neuropathy. So we can actually do a lot of things that help unblur that to a certain extent. Obviously if there is nerve damage, we can't necessarily reverse that or that takes. If there is some healing of it take, it's just really, it's really slow.

We just know that, 'cause that's the, how nerves heal. They just heal slowly. I can't remember. It's what is it? Do you remember? It's like the rate of one millimeter for six months or like a, I can't, it's crazy. I might be, but it's just the reality is that, so that's a lot of [00:43:00] expectations setting for things like that.

And then a lot of it is how are you feeling about having neuropathy? Because again, if people are like, I hate it, I hate my feet, I just wanna cut them off. Like I wanna disown them, it will only worsen it because all that does is it tells the brain there's something wrong. My feet themselves are a threat.

And that can really lead to that peripheral sensitization, the central sensitization. And so now you're just layering on different, almost like nerve feedback issues because of how we are just thinking about what's going on with our body. 

It's 

so 

interesting. 

It is. I definitely never, I feel like I've just blown away over here.

Speech never referred anyone to physical therapy for their diabetic neuropathy. And it was so impactful for so many people. Having neuropathy, not being able to understand where their feet are. And then that leads to fear of walking around, fear of getting out of the house because [00:44:00] they're worried they're gonna fall.

And then that leads to social isolation and. Then there's just so many repercussions of that one issue. 

Exactly. 

And never once did I think to send anyone to physical therapy or did I, I didn't. Or did I know that it could potentially help. 

And I think that's the big thing though, is let's the reality sometimes, again, depending on the progression of the neuropathy, it's like maybe we're not actually, maybe at the end of the day if we're measuring the neuropathy itself, maybe that actually doesn't even change.

But what we can change is all of those repercussions from happening, like 100% like that. And that you can see where that completely is life changing. And that might be through balance training, through having them more, confidently be able to navigate the world with that absence of, feeling where their feet are, there are like insoles.

There's all kinds of things and that we can do to help that. But it's all mainly to mitigate the repercussions. And that is to me, way more important than. Anything else? 

So now you brought that up. So oftentimes when people were complaining about the [00:45:00] balance aspect of that, I would send them to physical therapy for balance training.

But if a person is sending a patient for balance pt, are they getting this part of it too where they're learning how to connect with their fee? Is that part of it for the usual? 

 It depends on the physical therapist. Honestly, I don't know that I can accurately answer that. Yeah. So might be, I think it's gonna be might or it might not be so dependent.

And I think that is where people, anyone who's listening and they've been to pt, I think a lot of people. Have a sense, and I think some, sometimes you need to give it a couple sessions. I would not base this off of one session unless there's like a gut instinct that's really, telling you something here.

But it is, I think we know, okay, this, it feels like this physical therapist is really listening to me. it's like I am getting a sense that maybe they might not even talking about it, but it's helping you just do that as a person. Sometimes just doing certain exercises can be enough for somebody to regain that connection without it even being explicitly stated [00:46:00] or just the way the physical therapist is instructing, it's for some people it doesn't necessarily need to be this overt thing. It really depends on the person and what's going on in Yeah. The person's brain. So it's are, do you feel like you're getting that, what I will say with some balance training. I would say not great balance training is like when they're sticking you on a lot of foam pads and bo suits and things that are way too hard for you and you're, if you're having to support yourself and you're holding on for dear life while you're doing your balance training and it's like bringing on more fear and anxiety, that would be a problem because balance training really should be very much graded to where can you find, where are you, like off balance, but have the capacity and the capability to like correct for that.

Now that we're getting really specific into balanced training right now, but I do see a lot of balance training gone wrong. I was lucky enough to have one of my clinicals in a balanced training thing where we talked about peripheral neuropathy and we had a lot of inner ear things like that as a student.

So I got a lot of really good balance training knowledge beyond what we learned in PT school. But I will say [00:47:00] if, yeah, it's if you feel like, Hey, I. I just feel terrified every time I'm getting balance training. Something's probably not quite right or if you're gripping on for dear life while doing balance training, that's not balance training.

I wanted to put one extra side note in is like the kind of Hoka shoes, the big thick cushion shoes are all the rage right now. I tell everyone who has a pair, I'm like, don't throw them out. If you have plantar fasciitis or you just have that day where you're on your, like sometimes it is nice to walk in clouds, but those are.

Atrocious for balance training or neuropathy or people who struggle with that thing because it just like your body has no idea where your feet are, there is no sense of like where your feet are to the ground. Obviously, if you don't like that is get individually assessed, to figure out the right shoes.

But I cannot tell you how many people I take out of shoes like that because we just have a lot of things in our daily life, unfortunately, that are fed to us, that really just disconnect us from our bodies and make all these issues worse, worse, [00:48:00] which is so frustrating. 

I would like to talk about the highest chronic pain that exists across the US and that's back pain.

 Where I see this go wrong for so long is when people develop chronic back pain, they stop moving and then all these things start to pile up, like all the conditions, and it could have just started from that first injury. So if we have listeners that are experiencing chronic back pain, and maybe it's even been more recent, what is some advice that you have for those patients?

Because I just feel like they're never guided in the right direction. 

Yeah. Unfortunately a lot of the direction, it's kinda like the old school thing was like bedrest and hopefully at least now we're out of that. But there might still be some people who were told that when they were young, it's in their head and that is one of the worst things that you can do.

If you quote unquote throw your back out and you need to take a day off, like that's fine, right? We're not being like, oh, go lift heavy [00:49:00] things when your back's in a lot of pain. But total rest or being really cautious about making sure my back is stiff and when I bend over it doesn't bend and I don't rotate it.

Over time, that is going to lead to a lot more issues. All the muscles will just tighten up and tense up and the pain will become a lot worse. So I have seen people with chronic back pain who literally all I do is show them safe ways to start moving it. And they there are some, like I talk about the complexity of chronic pain and I have a lot of people who, we're talking long term, there's tons of complexity and there's some people where I'm like.

Let's do some really gentle cat cows. And let me, I wanna add, I have now I have evaluated them at this point, I have determined medically that there is nothing that is dangerous for them to move. This is a really important piece because there could be some places where, you know, if that hasn't been cleared and people are really anxious about injuring themselves further, they're not really necessarily gonna be able to do this.

So it's get [00:50:00] medically cleared to be safe to move by a trained physical therapist. And then it's I might be like, let's do some cat cows. Let's do some really gentle stretches. And I'm talking them through, I'm letting them know what's happening, how this is actually nurturing their discs and how we're bringing all this nice blood flow, right?

Like I'm talking them through this whole process and making it really safe. And like literally two sessions later, they're like, I feel like a million bucks, right? Like I've had pain for 20 years, I didn't know I was allowed to bend at my back. And they do. And it feels, 

yeah, like just your comment, it could be about how powerful, just the fear in trying to Yeah.

Remove the fear. that can make such a big difference. 'cause that's what happens to so many patients that have back pain. Or they had that episode, they threw their back out and they're like, I can't ever have that happen again. Fear is no 

joke. Yeah. But 

then we stop moving and everything escalates.

And escalates. And the new pain another spot, i've just seen that spiral so many times. Oh 

yeah. Yes. And I think sometimes, they go to places and it's oh, just don't be scared of it. And it's [00:51:00] that's not enough for people. If you have a fear, it's really, I have found with these fears and anxieties, the more specific I can get with someone about what really is the fear about, and talk them through it.

It is probably one of the most helpful things, but it's like you have to get really specific. I'm not just don't be scared to do this movement. , I'm being vague on the podcast 'cause I don't have a specific person in front of me. But it's really important when someone's, some people's fears are really different.

I'd be like, oh, I'm terrified that if I bend, I'm gonna herniate a disc. I can talk them through what's happening. We can make sure , we're looking at all of that versus somebody who their fear is breaking their back versus, oh, I'm just scared of the pain itself can be a huge one.

It's like the conversation's really different and so it's like that is something that I'm taking the time. To really walk them through those fears. It's not just don't be scared 'cause that's not really fair to say. A lot of people don't have the medical knowledge. They don't understand what's going on at their back.

And then [00:52:00] I think a lot of people feel ashamed about the fact that they don't get it. But I'm like, why would you get it? Why would you know no one has taught you? I can't tell you how many times I say this, probably like 30 times a day. I'm like, no one taught you this. You shouldn't know this. It's, it's impossible. Like why would you have known this? It's okay that you didn't know. Let's now you know though, now we can talk about it. Now we can discuss it. We can really dig down into those fears and those anxiety. That's one of my favorite things to do with people. 'cause I don't know, it's fun.

So being scared of moving or injuring yourself further, I'm sure is a common one you hear. Do you hear any other, just misconceptions that patients have around chronic pain or how it can get better? 

There are so many. I would say a lot of it is oh, I was told there's nothing I could do. There's nothing I can do.

And I actually have had some people who like, maybe they're coming to see me for their shoulder, and it's in talking they have back pain. They're like, Nope, nope. And they're like, there's a lot of resistance to even looking at it, doing it. So a lot of times it's we don't go there. We work on the shoulder.

[00:53:00] Hopefully, eventually I can warm them up and gain their trust to start to break down that resistance to looking at it. But I do find that's a common one that people hold. Obviously I don't see those people a ton because they aren't gonna make, they don't come to see you, pt. Yeah. One, there's always something you can do.

And I would say, just going back to the neuropathy is a great example that maybe you're right, maybe for the specific injury you had, we can't change the injury itself. There are certain things where it's yeah, like we can't, somebody who lost a foot, right? It's we can't, right?

There's prosthetics, but it's like you're not getting your foot back. I know it's an extreme example, but it's a good one of no, I can't grow you a new foot. I'm not gonna change that. However. There are so many things we can do to make your life better with that. And so one, don't underestimate that piece of it.

 So I'd say that's one mis misconception. I would say. The other misconception that, again, I see a lot more in my virtual practice because of the online space is this, it's, oh, they've learned that hey, the pain is modulated by the brain. That the brain is actually what dictates the pain that we have, which is [00:54:00] true, but then they have taken that to mean that I just have to think about my pain different and.

Yes, there are components of that, but I have seen a lot of people take that and then beat themselves up for how they think about their pain and they've basically just shamed themselves that, oh, I, wow, I'm in pain because I thought something bad about myself today. Or I thought something bad about my pain and it's like my fault 'cause I'm scared of it.

And it's that's not helpful either. I've seen people like really get into some pretty bad places because of some of these mind body spaces that are like basically saying it's all in your head, but in a much fancier way and a much more roundabout way that leaves people really stuck. So it's like one, there could be something physical going on and so movement and physical therapy and looking at some mechanics and some muscle strength can be playing a huge role in that.

It's just not, it's not all about how you think about it. Yeah. But also how you think about your pain is [00:55:00] much more complex when you're bringing in trauma and the nervous system and things like that. That's just a, again, a much bigger topic, but I'd say those are maybe some of the two biggest ones.

I know because of something. It's Kitty and I, we love talking about nutrition and so I would love to hear just in a short tidbit, 'cause I know this could be its own shown show is impact of focusing on nutrition and helping chronic pain.

 I would say really depends on the person. I, being a nutritional therapist, and actually for a lot of my pre car accident, pain, nutrition played a huge role in my aches and pains. And it still does, but I will say when I dealt with more the mind body piece, nutrition became less important.

That being said, I very much eat healthy overall. And I have found it's like I started very heavily in nutrition, after I became a nutritional therapist, and I have found [00:56:00] that it wasn't as important as I originally thought for a lot of people, but. It is such an important factor of just an overall wellness health standpoint.

The only reason I say it's not as important is for the, again, I'm very biased in who I see and most the people who I'm seeing have a lot of like history of eating disorders, history of just body image issues and a lot that is emotionally wrapped up into , eating, I'm gonna put quote unquote healthy like diet culture, things like that where eating healthy almost has become the threat.

And so it's like a really warped sense. So it takes time to undo that, but eventually, yes. It, so it just depends on if I focus on it or not for somebody. But yeah, when we are not feeding our body real food, when we are eating a lot of processed food, we're not getting enough protein when we aren't.

When we're eating, eating too much sugar, which is gonna [00:57:00] inflame the body, or just eating other inflammatory foods or eating foods that we're sensitive to or we have gut issues, all of that's gonna impact our body. Again, it's just what order do we look at it in? And for somebody who's oh my gosh, I had no idea nutrition could be impacting that, and they're like, oh, that feels like a really exciting place to look down.

It's start there then. It's like where I just tend to see a lot of people who have just been like, again, brushed off by doctors where it's you just need to eat healthier. And, it hasn't gone well with them, but for people who are ready to take that on, it's, it can make a huge impact.

Like for me, gluten really impacted my joints. When I took gluten outta my diet, I was like, wow, amazing. My joints don't hurt all the time. And now I can introduce it in smaller ways and I'm fine. Whereas before I couldn't even do that. But yeah, I had somebody once who, same thing, it was like she had all this knee pain and we ended up talking about nutrition and she took gluten and dairy out and she's my knee feels fine and this feels super doable. I feel like even better now. So she was good to go. Like it really, again, depends on the person 

that, that is one. In the [00:58:00] lifestyle medicine practice may not be why someone came to see me, but as we're working on their nutrition, they're like, Hey, by the way. I'm having a lot less pain. Do you think it's what I'm, why, you know from what I've changed eating and I'm like, yes, I do.

Yes. 

Yes. Absolutely. 

Oh my gosh. It's 'cause I don't think that we realize how inflammatory our foods can be when we're eating a lot of fast foods, ultra processed foods. And it is not helping us out when it comes to pain. 

Yeah. And a lot of like nervous system things. If you're like downing, and again, I'm looking at myself here, downing like six cups of coffee a day.

I just love coffee. Like I know it. I just love the taste of it. Like I don't even drink it for the caffeine. But now I have a, my, one of my calf coffee alternatives 'cause I'm like, I just need a hot beverage and I'm happy it doesn't have to have the caffeine, but it's there was a point and I didn't even realize how much more I was drinking.

And I was like, why am I having so much anxiety? And I'm like trying to do all of like my own techniques. And I was like, oh, I'm just drinking a lot of coffee. And so I just stopped drinking coffee and I was like, wow. Look at that. This is way easier than doing all the [00:59:00] other things that I was doing to try to address my anxiety.

Let me just buy myself this coffee. I'll turn, I use Tino if anyone wants to know big fan of them. I dunno if you've heard of it. But it was like, I literally just switched to that and I was like, wow, that was way easier than sitting there and trying to do all this deep inner work. None of that was gonna solve the anxiety from drinking way too much coffee.

So there might be nutrition, things like that, that are just, can be pretty like low hanging fruit that Yes, absolutely. I 

would think just thinking of our lifestyle medicine pillars, as Sarah and I always wanna do, but I would think prioritizing sleep during this time when you're working on mind body connection and reestablishing your nervous system would be particularly important.

Huge. 

And I would say a lot of people with chronic pain have a lot of sleep issues. And again, sleep can be this really emotionally wrapped thing where it's like. I want to sleep, but I can't. They struggle with a lot of insomnia. But the nice thing is I would say for a lot of people, as we are delving into this work, the more you are able to connect with your body, usually sleep improves as a [01:00:00] byproduct or a lot of the things that we're doing for bringing down the nervous system will also help with sleep.

Yes, sleep is huge. 

So I'm trying to think about, just if we have a primary care doctor listening out there, because this is a really frustrating patient to have in the clinic and not. Because of anything with the patient. It's just as a doctor and you have a patient come in asking for your help, you really want to help them and it is much easier, like when we can give someone a pill that will fix the issue that they have.

But when someone has tried a million things and it's not helping and they're coming back to see you again to tell you, okay, I tried this other person you wanted me to see and it didn't help. How can a primary care doctor, obviously if they're here in Lexington, they now know about you, but if there's somewhere else, how can they find a physical therapist that is doing this type of work for this type of patient that they want to help but feel.[01:01:00] 

They can't for sure. 

One, I do see people virtually, so there's that. And I always, I'll have a link to 

that in the show notes. Yes. 

And I'm even happy to consult with the doctors themselves. 'cause I do think I think yeah, if you're someone who's been referring somebody to a lot of people, you almost wanna be like, wait, should I even make this referral?

Because it can be a lot for somebody to have to bounce from person to person. Yeah. And 

expensive. And expensive. That's expensive. Yes. Yeah. And you and doctors don't want to like make their patients have all these expensive either. 

Yeah. 

Exactly. And I also just wanna take a moment to just have so much compassion for the physician who is listening, who's in that scenario.

Because one, the fact that you're sitting here listening to this shows how much you care and just how amazing you are. And that is just rare in itself. . But it's a great question in terms of how to find somebody. I don't know that there's any great database, unfortunately. I almost wish I yeah, knew of some, something a little bit more.

I think the time [01:02:00] piece is so important. , This work is not. suitable to really short sessions or pt that's, in a gym that's full of people like your kinda typical outpatient ortho pt where the the pt, seeing four people at once, you're like on a public table.

This is not a conducive space to speaking about anxiety and fear for a lot of people. And so it's just being like, okay, that type of environment might be great for your athlete who's just rehabbing, an ACL or something like that. Like perfect, they they thrive in those, but it's probably not right for your chronic pain patient.

 And so I would say looking at websites, looking if they, talk about mind body care, if they talk about being trauma informed, looking at their different certifications or even CEUs that they have, just kinda looking at the language on their page I think can be a huge piece. I don't know that I have a much better answer than that.

And so your patient themselves has to be playing a really active role in finding that aligned care as well.

Like it's just not all on you either. [01:03:00] Yeah. That 

is something that I have found a huge value after leaving traditional practice is actually meeting people in the community that does different types of work, understanding what they do. And I'll say like the whole experience of a patient getting the connected with the right person is huge.

And that's something I wish Medicine did more of is actual professionals knowing each other because you really do help a patient much more when you can match 'em to the right fit. 

Totally. 

And then I guess same for a patient. If there's a patient listening and they're thinking, I need to find someone like this.

Mm-hmm. They can either come see you, or maybe that's what they need to look for on the website. 

Yeah. 

Also. 

I would just search around a lot of times. Again, the time piece is huge. If you can find somebody who does like an hour one-on-one type of care, I think is really important.

Especially if you feel like, yeah. Would not wanna be sitting here talking about this in an open gym. So [01:04:00] yeah, and I would just call sometimes, depending on the provider and their schedule and how their practices structured, they might offer, a free, 15 minute call. Like, I know, we talk to people and it's just like a quick consultation and even just hearing someone's voice, talking with 'em for five minutes can give you like a really good.

Feel for okay, yeah, I think this person, they're worth talking to two more. So just not being afraid to call the office and try to see if you can get the PT or the provider actually on the phone , can be really helpful. That's good advice. Yeah. 

 Are there any other takeaways that you would want our listeners to have from this show?

I think the biggest thing is just knowing that there is always something that can be done. If you feel like your life is being negatively impacted by chronic pain even if it feels like you've tried it all, sometimes it might be surprising what you do. Sometimes it's letting go and not trying so hard is a huge one.

But we have to learn how to do that if we're more perfectionistic [01:05:00] and or somebody who is a fixer again me. So that's why I'm really good at doing it with people because I see it. But just knowing that. If you feel like your life is not what you feel like it could be, then you're allowed to want more, to want better for yourself and to find the person who's gonna guide you through that, that you don't need to give up 

powerful message for patients that are dealing with chronic pain.

'cause that is not what they usually get to hear. Yeah, it's not. 

 you've given us so much good stuff to think about today and we're going to take a different look, but also maybe one that's not the normal path next week, and talk with a physician who , has specialized in sports medicine and integrative medicine, and really look at what are the different ways we can tackle more acute injuries and things and help this recovery so that people can be less likely to end up with chronic pain in the future.

So join us next [01:06:00] week and we'll dive into this a little bit more. Bye. See you next time.