Episode 43: Mechanical vs Biopsychosocial Aspects of Pain


In this episode, you will learn:

  • About mechanical vs biopsychosocial aspects of pain
  • How fear and pain play together and how he sees that in his practice
  • Various subconscious expressions of pain
  • The difference in mindset between the person who identifies with chronic pain and the person who has just experienced pain for years

Episode 43: Mechanical vs Biopsychosocial Aspects of Pain

Announcer 0:08
Welcome to the Pain Changer Podcast, where you will learn insider tips and tricks to help you improve your pain levels without the nearly daily trip to the doctor, or heavy pain medications. When you change your mind, you will change your experience with pain. Every week, the Pain Changer Podcast will teach you new ways to tune into your body in order to change your mind. If you had to scrape yourself off the bed like your undercooked pancake on an ungreased pan this morning. You’re in the right place. Now, here’s your host Katie Wrigley.

Katie Wrigley 0:38
Welcome back to the Pain Changer Podcast. This is episode 43. And I’m your host Katie Wrigley. I’m really excited to bring today’s episode to you. You’ve heard of a lot of different modalities and techniques to help you experience relief from your pain within the show. You’ve heard about the benefits of using comedy and perhaps you felt those benefits if the show has made you laugh at all. You’ve even learned about various foods and programming that can make your pain worse. But what about different aspects of pain? What can you learn when you look at pain through the mechanical and bio psychosocial aspects of pain? Stay tuned the answers are coming up right after this. Joining me today is David Jeter, Dave founded acceleration physical therapy in Spokane, Washington in 2007. And specializes in orthopedic manual physical therapy. He loves to get outside with all the varieties of activities in the Pacific Northwest. Physical Therapy offers Dave a way to make an impact on a patient’s life by improving mobility and dynamic stability. Movement is life. I agree, welcome to the Pain Changer Podcast Dave.

David Jeter 1:47
Thanks so much for having me.

Katie Wrigley 1:48
So happy to have you here. Would you be willing to go into a little bit about what piqued your interest in physical therapy initially?

David Jeter 1:56
Well, like most physical therapists, I injured myself when I was in high school, and had several surgeries on my knees. And I had always enjoyed the idea of the medical community and really enjoyed my time in physical therapy, you know, as a patient and and went to school at Eastern Washington University and became a physical therapist. And there I suppose the rest is history. That was about 20, 21 years ago, 22 years ago now. So yeah.

Katie Wrigley 2:30
Very cool, yeah. And I find that’s true for a lot of people in the wellness space, we tend to get in here for our own experience, because someone just set such a model of an example of who we want to be that we’re like, yeah, I want to do that, too. So

David Jeter 2:45
Well, you know, physical therapy is unique in the healthcare realm, because we get to see people a couple of days a week, most of the time, for an extended period of time. And so we get to know our patients, we get to know what their families are like, we get to know what their function is, like, what they are, what they’re aspiring to do. And when you can help somebody move from not being able to do something to being able to do something that feels really good. I mean, there’s nothing better than having a patient who is successful in physical therapy, there’s no better feeling than that. And that’s always the high that a physical therapist is looking for, over and over again. And, you know, when when we start talking about chronic pain, that that’s used to be very, very challenging, very quick, but when you can take someone who has significant chronic pain, and you can change their life, that is again, that’s that’s even even more because you can take, you can take a student athlete with post surgery, and take them through all of the things that you’re supposed to do post surgically and they’re mostly going to do fine, and they’re most likely going to get back to all the things they want to do. And it’s, it’s not really all that interesting. But if you can take someone who’s been in pain for 20 years, and you can change a bunch of different aspects of their pain and improve their life in a significant way, that’s that can be really powerful.

Katie Wrigley 4:22
I can imagine that makes a lot of sense. And there was one year in my past or as I was somewhere around disability, I think it was during pre I had seven PT orders in one year. My physical therapist knew me really well, which is your point. And you know, we talked about it in the show, having your practitioners know you is a really important part of the support in the care with pain. So if you are not in physical therapy right now, you may want to look into it as you’re listening to this episode and see if you may be able to get some relief. So Dave, what has working in physical therapy taught you about the nature of pain?

David Jeter 5:02
Wow, that’s, that’s a big? That’s a long question. That’s a question. That was, honestly, it’s a professional journey for me too. You know, when I, when I came out of school, and became a manual therapist, I went through courses in the North American Institute of manual therapy. And we talked about things in a very mechanical way. You know, we talk about levers and pulleys, and joints move this way. And muscles do these things and nerves do these things. And, we talk about how to resolve the mechanics of the situation, which is incredibly important. I don’t want to discount the fact that people have to move properly, to feel good from an orthopedic standpoint. But as I have, as I’ve gone on, and on and on, in my practice, you can just see, you can see so much more about how people are feeling about pain, really is a determining factor in how well they’re going to do in treatment. And it’s not even about and patients get very sensitive about it, when you start talking about pain, and you have to, you have to be, I have to be personally, I have to be very careful about how I talk about pain, because I never want people to feel like I’m saying, it’s all in your head, right? I’m never I’m never trying to say it’s all in your head. But at the same time, pain is a manifestation of your brain. Yeah, pain is an opinion of your brain’s threat level to this situation. And so, yes, all pain is in your brain, because that’s where every sense is, and we can kind of get into that a little bit. But when you start thinking about pain as a sense, like taste, then you can really explore what pain actually means in the context of musculoskeletal dysfunction? So, yeah,

Katie Wrigley 7:18
and that’s been, please continue.

David Jeter 7:21
No, I was just gonna say, it’s been a big journey from looking at people for as much as muscles and bones and joints and pulleys and levers, and then now really looking at people and saying, Okay, there’s a spectrum of, of mechanical, a truly mechanical, where I mean, I see some people where I do a little thing to them, and it starts moving, and then it never hurts again, right? That’s, I would call that a purely mechanical problem. And then I then I see people who have a huge bio psychosocial component to this, to this pain, and they have a lot of trauma related to a whole host host of psychological things going on, which are outside of my scope, of course, but they are relevant to their their pain experience, as well. So, looking at people, and then recognizing that runner that’s coming into me for knee pain, who looks very, very mechanical, also has a component of bio psychosocial pain that that fear of am I going to be able to train for this thing? It is a kind of comeback, when you know, aren’t I going to be able to get through that sixth mile, you know, in some of the some of the those ideas where it isn’t just an either or thing, everyone is on that spectrum of mechanical to biopsychosocial. And we have to respect that. And we have to treat that person as yes, you have pulleys and levers and joints. But you also have a brain that’s attached to this body and a body that’s attached to this brain. And they’re interacting in a way that we have to use the correct language. We have to talk about things in ways where a lot of times we’re dialing back the temperature of the threat level.

Katie Wrigley 9:14
Yes. That makes a lot of sense. You’ve said a lot of really impactful statements there. And the overall takeaway I hope for anyone listening is all of those elements that you just listed that are what make pain a complex thing. We’re talking about chronic conditions. These are all the things that are feeding into it, the elements of trauma, the bio psychosocial aspects, as you talked about the mechanical, structural things and then it all goes back into the neuroplasticity in the brain. And so have you really you know, and I actually had done in previous episode one of my first was that it was called pai is in your head. And to me that’s really empowering because that means that you can actually influence your pain. When you figure out what those things are, you can change your brain’s perception of that pain so that it doesn’t feel like the threat like you said, you’re lowering the temperature of the threat, so to speak, and really like downgrading that nervous system that way. And so the idea that pain is in our head, it used to piss me off because I couldn’t figure out how to heal myself. And then once I figured it out, I’m like, whoa, this is great. But it takes some time to get there. So have you noticed anything, you’ve said something very interesting about how they feel about the pain is a big indicator in their prognosis? Really, I think I’m really dumbing down what you said there. But have you noticed any traits or factors with people who are able to shift out of their 20,30 years of chronic pain versus those that just have not been able to make much of a bunch of a shift yet, and this is zero judgment, everybody is on their journey, going their pace, a lot of what influences us and I would love to hear what you think of this Dave, what the doctor tells you your prognosis is, is a massive influence on the mindset I’ve seen. So I’m really curious.

David Jeter 11:14
So I’m gonna give you a specific example, because I think this will make sense. I see a lot of post surgical rehabilitation, the patients, so people who’ve had shoulder surgery, and if you’ve had a rotator cuff repair in your shoulder, then you’ve had a muscle sewn down to the bone. So there is a timeframe where you have to be in that sling. And you can’t move your arm actively, and you can’t move it in this different way. And you’re not allowed to do this. And you’re not allowed to do that. And everyone’s sort of putting the fear of God into you to say like, if you do this wrong, you’re going to totally ruin the repair and your shoulder is going to be terrible again. So you have to do all of this stuff right. Which, part of that is true, you know, part of that mechanically is true, but also sets the patient up to just have this fear mindset, like from the beginning. So when I see that patient, three weeks after their surgery, most of what I’m doing is getting them to recognize that what happened in their shoulder was trauma from a surgical standpoint, but it’s healing right now. And if we do all the things that we’re supposed to do, over the next three to four weeks, in terms of getting things moving, and allowing things to heal, the person is going to do really well. And then when I move their shoulder around, and it’s very sore, I can tell them, hey, this is exactly what I’m looking forward to, what I see today, you only have half of the range of motion that you’re that you normally would have, that a normal shoulder has. But half the range of motion is exactly what I want to see today. And when you catch it in those terms, and you tell people, okay, this hurts like heck it’s supposed to because you got stabbed several times. And that turned inside your shoulder and grinded and all of the different things that happened during surgery. Yeah, but but you’re but it looks exactly how I expect it to look at this point. And my expectation is that it’s going to get better over the next three to four weeks as we work together, you’re going to go back to the doctor, you’re going to get the sling taken away, and then we’re going to progress with the rest of the rehab. When I can get a person into that mindset and like and buy into the idea that everything that’s going on is normal that person does really, really well. When people have this idea that I am abnormal, there’s something wrong inside my shoulder, there is something that is not right. And it has to be taken care of, I need another MRI I need, you know, like, and then it’s sort of like this Mobius strip that’s just goes around and around in their brain and they and that that fear and anxiety kind of ramp up to the point where it just becomes worse and worse and worse. And they refuse to move it and then we just kind of go down this rabbit hole of terribleness. Whether or not there’s actually something mechanically wrong with that without surgery. But let me let me kind of just bring it back just a little bit because I want to I want to talk a little bit about mechanical versus bio psychosocial, because I think if we if we talk about this, that’ll that will lead into some some other really interesting things or can at least when I think of mechanical, I just I really think about resolving how joints and soft tissues are moving and then progressively loading those areas to tolerate activities of daily living. So if something doesn’t move that is supposed to move. As physical therapists, we need to get it moving. And if something is supposed to be tolerating different loads, we need to progressively slowly load that tissue until it can tolerate those loads. And then as your low tolerance increases, then your ability to do activities without pain increases. That I mean, that’s a very simple sort of thing. When I think about the biopsychosocial side of things, we, you know, treat that side of things. There’s kind of components. First of all, we’re tapping into this oxytocin vagal nerve stimulus to counter the cortisol build up, that is this anxiety and fight or flight. So we talk a lot, I talk a lot about fight or flight. And this buildup of cortisol and vasopressin, and then how we’re going to tap into the vagal nuclei and oxytocin with breathing exercises, and that sort of thing, to get everything to calm down, to get that central nervous system to recognize that the threat level is not as high as we had thought it was, and we can all just kind of like dial things back. But I think that’s what most, I think that’s kind of where I had stopped in the past, right, talking about what pain is talking about maybe trying to calm down the central nervous system. And it was just all this idea of calming, calming, calming, calming. And I think where I have made a little bit of a growth in my own professional career is now like the second step of neuroplasticity to to get the person’s brain to recognize that movement is safe, that loading is okay. And progressive loading over time is the way that we get our bodies to tolerate the activities that we want to do. And we get, you know, and I also want to be very clear about this. Like, clearly, I didn’t make any of this up. I’ve I’ve I’ve never had I don’t know that I’ve ever had an original idea in my lifetime. But, you know, Adrienne Lowe and Lorimer Moseley, and Dr. Hanscom are, those are just three of the names of some of the professionals who are the giants in chronic pain, which I’m assuming that you’ve heard of, I use the Curable app a lot. I don’t know if you’ve ever heard of Curable, you know, doing some diaphragmatic breathing, expressive writing? And just like just that basic pain science of what is pain? And how do we understand that pain is not damage? And how do we get people to understand that if something is sensitive, it’s okay that it’s sensitive and it’s in, it’s okay to respect that. But at the same time, that sensitivity is not necessarily damaging you in a way where we need to necessarily stop doing things.

Katie Wrigley 17:52
Right. That makes a lot of sense. And thank you for all of that. You said again, you said quite a few things in there that really resonated with me, the the fear coming out of surgery, I’ve directly run into that with my knee replacement was the last major surgery I had, hopefully the last one in my life because it the surgery itself was picture perfect, but my pain wasn’t managed well. So in your brain never unlearn the pain level and the fear that attaches to that of Oh, no, I’m going to feel that again. And you do everything in your power to not feel it, including illogically stopping movement, because the subconscious is there to protect us, right. And so if that movement made us hurt, then we’re just not gonna move. Because the subconscious doesn’t give a crap, whether it’s logical or not. This is all about keeping you safe and alive. So if movement hurts, you don’t move. It doesn’t matter, that is actually the worst thing you can do. That’s the message from the subconscious. It’s not always the most reliable little bugger, it’s just doing a lot. And so that’s the shortcut it takes. But you can get stuck in that fear. And I’ve seen that that is one of the worst things that you can feel coming out of a surgery, especially when you’re trying to do a major rehab. I love your approach of assuring people that, you know, because there’s something that happens in your head when you see your arm and you’re doing everything you can and you can only move it halfway up from what you could before part of you is like what is wrong with me. So the assurance of what you do, to say, hey, look at you, this is exactly where you should be today. Now you’ve got to baseline for progress, and then maybe there’s some work for them to let go of what they could do before the surgery but it’s like, Hey, you’re gonna get back there again.

David Jeter 19:43
Well, I’m talking about language too. You know, when I talk about to patients, especially the shoulders. I always tell them, I don’t want you to think about stretching out a tight shoulder. I want you to think about lapsing into a normal range of motion. If we not, you know, if we took most patients and we knocked them out again, and we could take that arm or we could move it however we wanted to, because everything inside that shoulder can go to its normal range of motion that just doesn’t go because it’s because it’s sensitive at that at that early stage of the game, and it’s okay that it doesn’t move to that spot to the normal range of motion. But if we can get people to recognize, okay, if I relax, if I allow the shoulder to move, it will go into a normal range of motion, and the more that they relaxed, the more that they allow that shoulder to move, the better it feels to move into that range of motion, and they can kind of build on it the other way around. That’s the interesting part about that bio psychosocial pain feedback loop where you have your anxiety producing cortisol, and I like to think of cortisol as the spiciness in the soup, you know, if your body is just this bag of blood and hormones and whatnot, and cortisol is this spiciness that is creating irritation of the central nervous system. And then in that, that spiciness increases the pain experience and the pain experience is increasing your anxiety and the anxiety is producing more cortisol. And so it’s just this feedback loop feedback feedback loop. Right. And then you have your oxytocin where you know, you do some 478 breathing and you can produce some oxytocin and that cream can go in the soup and dial it back. And then your nervous system says, Oh, hey, this, this is not so bad. And which feels better, your pain experience is better, your oxytocin levels up, you know, so it’s just feedback the opposite direction. And so, giving people when I explain it in those terms, and attach it in those terms, patients really like it because all of a sudden, they start to have a little bit more control over their own system. And they can say, okay, I can feel my body, I can feel this anxiety coming on, I can feel my pain experience is, is out of control, what can I do about this, I can now set in motion, the opposite feedback loop, I can, I can dial this whole thing back. And I think that’s really, it’s a nice and powerful thing.

Katie Wrigley 22:15
It is. And it’s amazing, you know, and you you see this over and over again of what we look for, we find and so if you’re finding reasons to look for more pain, to be more afraid, there’s a limitless options out there, if you want to stay scared, if you want to stay in pain, and in the current Curable app, it has one of those exercises, it’s to think the opposite of however it feels so if the feeling feels sharp, you think about softness, and you’re conjuring up the opposite of what you’re actually dealing with. And the same thing when we look at healing. Like one of the questions I like to ask people in the language tells you a lot, the language tells me so whether someone’s actually ready to work with me right now or not, there are certain things that I have learned to hone in on at this point, that tell me someone’s readiness for the stuff that I do. You know, so that’s a great point with the language in there, that’s really going to tell you a lot. And the times, yeah, please,

David Jeter 23:12
No, I was just gonna say they were like, when the person is ready, that is such an interesting concept. And I think that is such a vital concept. Because you know, we see so many people with all these different chronic pain issues and that have just never had anybody talk to them about what pain is or any kind of actual chronic pain treatment that is even remotely decent. And, and there and a lot of times they are so stuck on this mechanical thing, like I know that I have degenerative disc disease, and I have no I have no space between my discs in my low back. And it will always hurt because of that mechanical thing. And even though most of what is in that image is totally irrelevant to whether or not they have pain or not. It’s like, are they ready to have an open mind? Are they, are they ready to think about this in a totally different way? Are they ready to shift their paradigm in a way that is probably a little scary? And, definitely different and also challenging to understand. I mean, to , to, to, to even scratch the surface of understanding what chronic pain actually is or just pain is, it takes a tremendous amount of energy to even just activate your brain in a way where you’re willing to think about it in that way.

Katie Wrigley 24:43
Oh, yeah. Yeah, I mean, I’ve been immersed in understanding pain for five years now. And I feel like I’ve barely scratched the surface. But then on the other hand, you know, I also consider that I’m, you know, pretty skilled in understanding all the aspects of pain. The fear thing in there and I’m curious what you think about this, because what I’ve what I’ve seen, fear and stress tend to be some of the biggest factors in someone’s experience of pain and worrying about the next pain spike, stressing about the condition, stressing about what the doctors told you going back for more imaging, Oh, you look worse this year. Like all of that stuff. So what do you see as far as how fears play?

David Jeter 25:26
I, well, I don’t do a great job, I’m gonna tell you right now, I do not do a great job of getting people to manage their stress better. Like that is not my forte, as a physical therapist. And I personally don’t do that, well, I just know that about myself. But I have I have some some secret tricks, you know, as a physical therapist, because, you know, when somebody comes in, for instance, with neck pain, there is a very good chance, if not 100% chance, that they have some things that are not moving well in their neck, you know, they have a couple of joints that just don’t move very well. And, in my experience, if I can, if I can get that person to move just a little bit better. And I can show them and they are willing to even accept that they are moving better, I can do that neurologic trick, I can do a mobilization on their first rib, or their upper cervical spine or their or whatever I want to move and resolve a little bit of a movement dysfunction problem, that gives them a little bit better motion, that reduces their pain temporarily. And they and then all of a sudden, I’m in because now I have changed that pain, because of this mechanical thing. And so because I kind of go to chronic pain through the mechanical side door, I don’t think that you can, I don’t think that you can treat chronic pain with that by just doing mechanical, I did that for a long time. And then I failed miserably at it for a really long time. Or the people I was successful with were, I had talked them into mechanical so much that they believed my mechanical story so much that they didn’t care about anything else. And they and they, that became their story that was successful. And they changed their neuroplasticity through a mechanical viewpoint or lens. But if I can get them to move a little bit better, then we can start talking about how to calm the nervous system down. That’s that’s sort of my that’s my my tact and and as we get that nervous system to calm down, okay, now we’re going to start loading. And now we’re going to start talking about neuroplasticity, and the different neurotransmitters that we facilitate, I don’t know, it sounds like you are trying to facilitate some neurotransmitters in some of your work as well. I’m interested to know what that looks like.

Katie Wrigley 28:12
So when I work with clients, I’m actually using this ball if people can’t see this, this is audio only. But it’s all over the place it is called a cognitive movement ball. So it’s activating the brain. So you’re actually activating both hemispheres of the brain. It’s purposely designed to do that. So you’re getting extra activity already, you’re starting to move the ball and various cross body movements and moving the eyes in different ways that gives you access to memories that are playing into this. So we are dealing with neurotransmitters we’re talking directly to neurology. Language is super important that I’m actually asking exactly how they feel. And I’m repeating that back to them. Because that is how their neurology interprets it. It doesn’t matter if it makes sense to me or not. And the other perk of that is I stay out of their story by repeating it to them because if I get into the story, then I’m in the story with them and I can’t take it apart because the story is just the conscious mind. It’s not coming from the subconscious. The subconscious is where all the goodness lies where we can start to change this shift. The neuroplasticity is able to shift that perception of pain. So that’s more of the way that I look at it. So there’s a lot of permanent changes that happen in there and actually help spark the body’s innate healing ability. And there’s really cool sets that I can do with physical therapists, like you were saying with that mobilization, if there is some other element, that bio psychosocial, that is keeping that shoulder from moving, I can actually move the ball on the opposite side, get them out of whatever is trapped in there, start freeing that the eyes are gonna be telling me a lot and you’re gonna get a lot more range of motion in a session. And so this has been a really complementary modality to go with physical therapy to go with functional medicine to go with chiropractic and you’d like there’s a lot of different uses in there where I’ve seen that and where I’ve been able to help as well. So it’s so I’m really focused on the neurology part of it because like you said, you said you’re not great at handling stress. But then at the end of that share, you were saying that you were actually calming down the nervous system, which in my mind is stress reduction right there. If you calm the nervous system, you have eliminated the stress, you just haven’t called it stress, but you’re doing the exact same thing. So I would say that you’re actually doing it quite well, in your practice to a point you didn’t even realize you’re doing it?

David Jeter 30:31
Well, I would say, you know, I think there’s a lot of practitioners especially like in a psychology room that would deal much better with, you know, the perseveration of thought processes of, you know, stress in people’s lives in terms of old trauma, you know, psychological trauma, I mean, like those kinds of like work stress and family stress and all of the other kinds of stresses. And I don’t I guess what I’m saying is that, I don’t, I don’t do well talking about that, in the sense that, maybe I’ll have somebody do some expressive writing and say, okay, I want you to try to get some of this out on paper, and you can, you can get that out there. But then, but then once it’s out there, I kind of like get one now you need to go talk to that person over there, right? Oh, just because I don’t know what to do with any of what you just said to me about any of that stress. So

Katie Wrigley 31:28
Makes sense. I wouldn’t expect that from a physical therapist, your wheelhouse is the body and dealing with what you see there and helping to calm it down. From a physical perspective, the manifestations of stress, someone else can deal with the psychological manifestations of stress. Like there’s a reason we have lots of different medical positions out there that can all complement one to one another, and work together for you the one body experiencing all of this at the same time.

David Jeter 31:55
Yeah, yeah, for sure.

Katie Wrigley 31:58
This has been a really interesting conversation. I really appreciate you coming on. Is there anything else that you want to make sure that you add as far as someone’s experience of pain? Or what else that you’ve seen through your years of experience? Is there like one key piece that really stands out, maybe having something that it looked like it was impossible, where I don’t like to use much, except if it’s saying making the impossible possible that I’m all about it. But was there one that looked like a seemingly impossible situation where the person made a miraculous recovery or miraculous shift? To really get back to like, what are those cases you’re talking about that are so rewarding, so it has been suffering for 20 years, and after working with you, they were able to have a much higher quality of life and a much lower level of pain.

David Jeter 32:50
Um, you know, I can’t, I guess I can’t think of anything specifically, you know, one specific patient off the top of my head, but you can kind of see it with patients. When, if you can get that, if you can get the nervous system to calm down a little bit. And you can get that pain level down a little bit, maybe with some manual treatments, or whatever. And you can get that person to move a little bit better. And, and they feel less threat level and they start understanding pain, then I think the thing that I’ve been doing lately, and I think the thing that has been the most successful lately is really kind of turning that into a neuroplastic change of progressive loading where you, you’re you, you then are starting to give exercises that the person looks at the exercise and they say, I can’t do that. Yeah, I don’t, I can’t do that. Like you’re asking me to do something that I can’t do. And you say, Okay, well, let’s, let’s just see how it goes on. Let’s just try it. Let’s see it. If it’s too much, then we’ll, we’ll change it. And they try it. They say okay, well, well, I guess that wasn’t that bad. And they’re surprised, right? And that surprised me at that moment where they didn’t think they could do something, now their brain has to deal with the fact that they can do that thing. That is huge. And I think that we as physical therapists need to really build on that sort of moment where, where the person says, I can’t I can’t do that. And then we kind of push them a little bit you know, we’re good at pushing people and they are successful at it. We have to figure out we you know, that’s that’s the part of physical therapy that’s so challenging is what can this person actually do today? Like, Yeah, can I actually have them do today that will push them in the wrong direction that will push them in the right direction where they will be successful, but it’ll be an it’ll be an exercise where their brain is surprised that it can tolerate it. And, and they have to they have to now neuroplastically changed their whole paradigm like well, I didn’t think I could do that. But I can do that. And now we’re, we’re, we have to figure out what is the next step and build on that and build on that and build on that. And, and the next thing you know, people have to deal with the fact that okay, now I can do this activity. It isn’t just this weird exercise that David makes me do. Now I have to think about the fact that now I can lift my laundry up, and I can carry it up the stairs. And that doesn’t spiral me out of control into this pain sensation.

Announcer 35:33
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David Jeter 36:17
I want to speak to one other thing that’s a little bit random as well. And I think this is a really, really, really challenging thing with patients with chronic pain is the idea of memory. Right? Just like when someone comes in, and they tell me their story about where they’re at and how they’re doing and what, what they’ve done and all of those things, okay, I write it all down and we write you know, we do these things. And then we do this treatment, we do this treatment for, say six weeks or so. And then I said okay, now it’s time to do a progress note. And I ask them, okay, tell me how you’re doing. And, most of the time, especially with patients who are in the chronic pain room, I will say, My pain is no different. My pain is exactly the same. And, and I look at them, and I say but I see that you’re vastly different, I know that you’re vastly different, you can go up and down stairs, you know, I mean, for your total knee, your knee bends and straightens way better, it’s way stronger, you can go up and down stairs, you can walk for a half an hour. Now instead of the household distances that you could do on day one, people are programmed. They’re not programmed to recognize those changes. They’re not practically programmed for the brain to understand to be able to remember where they were, and actually see that progress. And so they don’t, it’s like their brain isn’t taking credit for the fact that they actually are better. And I think that’s a massive piece of physical therapy too if we have to communicate to patients that, okay, this is where you were, and this is where you are, those things are not the same. And you need to recognize that those are not the same thing.

Katie Wrigley 37:54
Absolutely. I love that you brought that up, because that was something that I experienced myself. So I had permanently broken through my state of pain, but then there was still the practice of being out of pain until my brain learned it. And I remember one day specifically I was sitting in my recliner, and I was so pissed because I’m sitting there going this cognomovement bullshit like I have been doing this for months. And my back doesn’t feel any better. And I paused in that moment I went, okay, how true is that, that nothing’s better, because I had just put away a whole bunch of Christmas decorations. I just cleaned my house in two hours. And it used to take me two days because I had to stop because my back couldn’t handle the pressure of mopping and vacuuming. And I had done a bunch of other stuff that I couldn’t do before. And so I said that I’m like, oh, okay, so it’s not actually bullshit. And I have improved and my brain just hasn’t caught up. That’s really weird. But then it circles back to the subconscious. And what I’d said before that the whole idea, the whole purpose of the subconscious mind is to keep you safe and alive. That’s its job. And so until it trusts and you need those external factors to help you gain that trust, like you saying, Hey, you started here. Now you can do this, even if it doesn’t feel different yet. It is different, it is going to feel different for you at some point. And so one of the things that I tell people it’s like and I’m not telling you this to really depress you, but one of the last things that you’re going to notice about your pain state is your actual pain state. Yes, your energy is getting Yeah, as a lagging indicator. It is that your mood goes up, your energy goes up, life seems so much easier. And it takes months to realize that you’re not in pain unless you a) realize to start looking for that from the start, then people can measure their progress much better when you let them know this is going to be one of the last. The thing you want the most is going to be the thing you see the last. I’m sorry, but that’s just the way that our mind and body works together. But your mind continues to play tricks on you and I think part of that again, it’s it’s keeping you safe, and that pain was there to protect you. It’s a message from your body. There’s a lot of different elements and like you said, but it’s there to protect you, it’s not going to let go of that signal 100% until it’s sure that it can. And that’s going to take repetition to do that. And being in this new identity, like you said, of the person who’s able to do all this stuff, and they may not have liked doing laundry. So now they have to do it again. They may have been getting out with the laundry, there could be some resistance in there. And that’s, you know, an honest conversation with ourselves. Like, I found stuff, I was not at all proud of that I was getting out of being in pain. I’m like, Ooh, I’m gonna have to let that go if I want to stop hurting. But it’s tough. You gotta be ready for it. Yeah, yeah. So but thank you for giving that example because you’re right, pain is the lagging indicator in your progress. And it’s, it’s the thing that everybody wants the most. And it’s the thing that you’re gonna get the last,

David Jeter 40:51
I spend so much of my day, getting people to feel their body move. And it is always incredibly surprising to me, how few people can feel just just feel that if they turn their head one way versus when they turn their head the other way, it just doesn’t move the same. When they go in one direction. And then people go, I don’t know, maybe, maybe not. It’s like, well, no, I need you to feel that, like you have to feel that your body does or doesn’t move in all these different directions from a physical therapist standpoint, from a mechanical standpoint. Because if you don’t feel that now, you’re certainly not going to feel a difference in the future. And you’re not going to believe that you’re better in the future if you can’t feel that now.

Katie Wrigley 41:35
Right? Exactly. That body awareness, you know, and that’s one of the things I love about this work is I am so body aware now, like as you’re sitting here, I’m like, Oh, the left side of my back starting to bug me again. I wonder what’s going on over there? Like, I know, it’s emotional, because I got a lot going on. So I’m like, okay, this just bugged me last week so I’m gonna bust out my ball later, figure out what’s there and get it back under control again, could I have done that two years ago? No, I would have sat there letting my back keep getting worse and worse, and wouldn’t have been able to tell you much of anything that was going on. But that when when someone can start to listen to their body, and it sounds like you’re actually teaching them how to pay attention when they move their neck when they move their spine when they’re moving their arms or legs, whatever, starting to notice and tune into those mechanical differences or similarities depending on what they’re seeing there and start to learn what their body is telling them. That’s, that’s been one of the biggest factors to me and staying out of pain is that body awareness and tuning into it. When one of my guests had shared this great quote and wanted to share it with you, if you don’t listen, when your body whispers you’re going to have to listen when your body screams. Yeah, I like that. It’s so much easier to quiet the whispers than it is the screams. And so that’s just the habit that I’m in now is like, okay, you’re whispering I’m just gonna, I know you’re going to scream at you, you rendered me disabled before I don’t like your scream. So we’re going to listen while you’re whispering. And every time it works, it’s incredible. So yeah, and thank you for the work that you’re doing out there in the world, David, or Dave, rather, where can people find you to connect?

David Jeter 43:16
I’m at acceleration physical therapy in Spokane, Washington. That’s where I have my practice. You can go to accelerationpt.com. And check out our website. I mean, for just some general information. Or if you have a question for me, I, I get all that. All those questions to me, to my email, and I’m happy to talk with people about what’s going on with them. But you know, I don’t have a you know, I don’t have a book or, or any of the or any of the things. But yeah, if you need some help, and you’re in the Spokane area, then come by.

Katie Wrigley 43:58
Yeah, absolutely. So you heard from Dave, so accelerationpt. We’ll make sure that those links are in the show notes. And I don’t have a book either. Don’t worry about it. Yeah. You’ll write one if you feel like it you won’t if you don’t. You’ve added a lot of great perspective on pain and the complexity and different things that people can start to do to turn into their bodies and start to change their experience. So look for physical therapists like Dave, someone who’s going to help you find what your baseline is, help you normalize it, help encourage you, after the doctor scared the crap out of you and told you all these things you can’t do. Listen to your physical therapist for what you can do, a good physical therapist like Dave, because it’s going to open up your world. And when you start opening up your world and your mind to possibility, you’re gonna have a lot more hope you’re gonna have a lot more success in your healing when you can start to see your progress. So thank you again, Dave, for joining me today.

David Jeter 44:55
It’s been a pleasure.

Katie Wrigley 44:57
And thank you, as always my listener, for joining me today as well. I hope you’ll come back again next week for a special Valentine’s Day episode. Spiritual leader and yoga therapist Rika Carson will be joining me to talk about your sacred sexuality and your connection to everything. I cannot wait to hear the link she’s seeing with pain and sexuality within her work. Join me again next week to hear everything she has to say. We are a brand new podcast. We appreciate every review we get, especially the five stars. Please help us share this podcast and spread the word that you can accept the diagnosis without accepting the prognosis. You can do this by subscribing and leaving your own five star review to let us know what you like and what you want to hear more of. Thank you so much for listening today. And as always, remember that chronic doesn’t have to mean permanent

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