The Hidden ADHD & Hypermobility Connection: What Your Body's Trying To Tell You

0:00Pain is basically a fear response. It's there to stop you moving, stop you doing something, because a perception that you've formed is that something is going to be harmful to you. If I was standing behind your shoulder right now and we were sitting in the woods in Oxfordshire, right, and I tickled your arm, you'd sort of go like that and you'd look at it. If we're in the Amazon, that's meaning, that's context. So why have you taken a sensory stimulus and changed it in your brain without even realizing. So therefore, can you change your response to pain? Can you increase your pain threshold?

0:36Welcome to The Hidden 20%, our neurodiversity charity on a mission to rewrite the future for people who think differently. Together with you and an eclectic range of brilliant guests, we can break the cycle of silence by smashing outdated stereotypes, exposing the myths and sharing the most up-to-date truths about what it really means to be just different, not deficient. The best way you can help is really simple. Subscribe so you never miss an episode and if you can, donate to our charity through the link below. Enough preamble, I'm Ben, your host. Let's get into today's episode. Today I'm chatting with Nick Potter, consultant, osteopath, author of The Meaning of Pain and a pioneer in linking body, brain and pain.

1:25From Formula One to finance Nick's helped people perform under pressure while treating chronic pain and fatigue. Now his focus is on how hypermobility connects to ADHD and anxiety and why our bodies often tell the story that our brains can't. With decades of clinical practice and his own lived experience of spinal injury Nick's here to cut through the myths around pain stress and neurodivergence, sharing practical tools we can all use. He's also going to assess me for hypermobility. Let's get into it.

2:06Nick, thanks for your time. Pleasure. Tell me why you are interested in pain. As an osteopath, it's probably most of what walks through my door every day. And what is an osteopath? Well, very good question. Again, the osteopaths, the physios, the chiropractors, and everybody gets confused with it. And to be fair, the profession is emerging slightly because as we learn more on what doesn't work, etc. It's a system of diagnosis. It's neuroorthopedics. So it's how does your body do what it does relating to how the brain functions, etc. So we're very interested in the embodied brain, which is why I think now as a profession, it's more exciting than ever.

2:40And what do you mean by an embodied brain? Well, your brain without your body is a lump of blancmange. Okay. It's infinitely capable of huge amounts of things. It's multiply convoluted into a tight box because it got really big when we were evolving. But it can't form models of the world unless you are sentient or you can feel. And where is most of your feeling? In your body, right? So it's your touch, your feeling, your vibration. Where am I in space? And again, it's one of the things that actually, for example, when people take LSD, etc., toad and all these other things, you see hallucinogenics.

3:09What they're experiencing is a disembodied consciousness. Okay. It's the sudden awareness that there is an existence of a consciousness without being anchored to the world. Okay, physically. That's why they say it frees you from your ego. Okay. The ego is in fact the representation of the surface of your body relative to the outside world, transposed onto the surface of your brain. We call it the somatosensory cortex. So it gets quite complicated. Okay, we're going straight in. But it's vitally important because without knowing where you are in the world and orientate yourself in the world, life's no good.

3:42and then in some people experience that as dissociation, which is common in neurodiverse patients. There's such a mismatch between how they are sensing internal state, their physiology and their chemistry, to relative to the outside world. Okay. Okay, which is really there to take me out most of the time. And so why do people come to see you? Now it's really chronic pain. Okay. So maybe we should start there. Yeah. Pain is basically a fear response. Okay. Okay. It's there to stop you moving, stop you doing something, because a perception that you've formed is that something is going to be harmful to you.

4:15Can you give me an example? Hold on one sec. We're going to divide it into two parts because it is, without going down a whole series of rabbit holes, there is a thing called nociception. Big word. It just means your perception of pain. Now, that's based in your bodily system mostly, and that is actually touch, vibration, temperature. Okay? Loosely broken into those things. And you're feeling those all the time. You're aware of it or sitting in the chair. You know that you're there relative to me, right? So it's all feeding back into your brain. And your brain's doing 99.6 % of what it's doing, and you have no idea what's going on.

4:46That's why we don't know ourselves as well as we think we do. But you know that you're a being relative to me because you can feel the world separate, and you know that I'm over here. So it's all relative. You rely on your sensory system to tell you that. There are no pain nerves. Okay, this is the big one. There are no pain nerves or fibers anywhere in the body. It is a fallacy. So what is a nerve, therefore? So when I, if I take a pen and I rest it on your skin, those receptors for touch are going ping. And so there's nothing initially. They're going ping, ping, ping, ping, ping. And that's mediated up to the spinal cord.

5:22And there's a little mini brain in the spinal cord called the dorsal root gang. It's a little bud that's just inside. And most of it is just reflexic. So it's just saying, hi, something's touching me. Now, if I keep pressing a bit harder, it's going ping, ping, ping, ping, ping, ping. Okay. And the body knows through experiential life, et cetera, that if he keeps going with that, it's going to pierce my skin, which is dangerous to me, infection, irritation, harm, breakage, whatever. So it's building up a perception of that. All that is, is just a number of beaks. It's a pinging system, right? Once it reaches a high enough pinging system, which correlates with harm, you're going to pull your finger away.

5:55So that's a reflexive response, but it's still a fear response. So finger on the hot plate, getting hotter, getting hotter, got to get, oh, okay, that's all it is. It's just a reflexive. And that actually happens mainly at the spinal cord level. So it doesn't even bother the brain. Okay. Then there's a point at which if somebody keeps holding it there, okay, and I can't pull away, that's transferred straight up to the boss, which is, right, what does this mean? It's going to burn me. What are my options? I've got to beat this guy to get my finger off it. So it's like torture, right? How do I stop this guy doing this?

6:24Yes. So this is where reference, context, et cetera, all becomes manifest. And that's transferred up to the brain. And in fact, it's mainly manifested through the fear systems. And the reason we know this is because if you do horrible things to medical students, as we often do in scanners, things called fMRI scanners, you give them pain or you create fear. In fact, that also hurt, so emotional hurt. Exactly the same centers in the brain light up. And that was a major discovery. Emotional pain and physical pain. Yeah, well, you hurt, don't you? Your wife leaves you, it hurts. It's a different kind of hurt.

6:54It's an emotional hurt. The same imagery. It's the same kind of concept, which is, what does this mean to me? My narrative's changed. My wife's cheating on me. you know, I thought I had a happy marriage. You can look at it in those senses as the death of a neurological system. My neurological system was I've had this matrix around meaning of being married, my wife loves sex, et cetera. We've got married because we're committed to each other, et cetera. And then she betrayed me. So that narrative has just been obliterated. So you feel that has hurt. Why do some people have quote unquote, a high pain tolerance?

7:24For lots of reasons. It's contextual. So for example, there's two famous stories about pain. One was a chap who was a builder who managed to get on the floor he put his foot through a six inch nail went straight through his boot he's screaming howling they have to cut the boot or they get him to hospital and they realize that actually when they take it off he hasn't gone through his foot it's gone straight between his toes but his perception was and because everybody else is going ah we got right from a look you know and so he's feeling pain because his perception is it is but when he gets it off it's like oh that's a bit weird and then he feels a bit embarrassed right and we place two-thirds of our brain processing is on visual information okay that's a lot of processing yes okay so we're very big on visual imagery and And we use it for lots of reasons.

8:00And this actually comes into the neurodiversity world as well. So we use it for tracking the world. And then if I'm looking at you, anything that comes into my peripheral vision that's radically different, novelty, it's actually black and white. We don't know that, but it comes in at black and white. Or if it moves, things like posture, believe it or not. They've done studies into PCOS. So people who have good posture are potentially threatening. So you have an involuntary mechanism to look towards it. That's called Sokolov's orienting reflex. He should have got the Nobel Prize for it, but didn't.

8:26But it was a radical discovery. because it's actually involuntary. So anything in your environment that you perceive to be dangerous, you will orientate towards, because in our ancient days, it probably would take you out. And so how does this correlate then to how much pain we can endure? So some of it can be childhood. So if you look at parenting, for example, I remember taking my kids to the park. If your child falls over, you're that classic, right? They look down and they've probably grazed their hands, and they look down and there's that stunning moment. And you can see them, right? What you're witnessing there is processing.

8:59It's like a joke. When you deliver the punchline, there's always a little gap. What you're listening to in that gap is processing. Is it funny? Okay. Ha ha. Response. So the child falls over. So there's a pause. And then those little receptors, because you've had tearing of the skin, it might not be major, but it's that burning sensation, is the brain suddenly going, wow, assessment says, yeah, damage done. They look and then look at how much they scream if they see blood. Blood's really bad. Because mum told me last time, mum said so. I said, oh my God, darling. Right? So it's very parentally orientated.

9:27So if you rush to your child and overdo it, oh my God, my poor darling, my darling, those children will grow up with a low pain threshold. Interesting. Because the fear that she's attached to the injury is inappropriately high. So equally, if I'm an unavailable parent, I'm an unfeeling parent, et cetera, and I look over and I don't go to the child at all, that is not validating the child. Yes. Okay? So they're having to get up themselves and assess themselves. And they kind of go, well, I am actually bleeding that. It's quite stressful. but it's okay and i'm really but i haven't had the validation of my mother or father okay so in a sense the perfect option is go over assess them if it's not bleeding it's not then actually don't make too much of it and then distract them oh look at the doggy okay right that's kind of the perfect time so you validate them they go okay fine my mom says i'm safe and they attribute a relative amount of fear response to that appropriate to the stimulus that you've had and that's what they learn through the child that's why parenting is so important you do affect how your children responds to the world.

10:26So therefore, can you change your response to pain? Can you increase your pain threshold? Yeah. Look at the SAS, right? You go into the SAS, you're told to go and take 70 kilos and run 30K. Okay. And you get to 25 and you're screaming, your brain's saying, your body can't do this, I can't. And there's actually a thing called the central governor model, which is that actually your brain will start trying to tell you to stop way before you actually needed this contingency and that's what army training is about which is that actually i thought and then the sergeant major gets you up says walk another bloody okay wait a minute you told me you couldn't do that so you adjust that okay that can also become dysfunctional because those guys will lose an arm and not cry you know that it becomes a dysfunctional state yes they become uninterested in themselves so that you can go too far with it but that that's what training is about it's the same with same if you go for a run you know next week you know that was hurt but you kind of you know it was good it was good kind of hurt i've suffered and that's where the dopamine comes in because you go into a state of sufferance to then slip flip into oh but i feel great and now everything's seen i'm getting a rush of endorphins it's all good so there's this constant yin and yang between being in a state of suffering effectively which is need to then gratifying it what are the biggest myths nick you see around pain today one of them is the pain fiber thing it's still taught in medical schools and they'll go what about delta fibers they'll go no they're still just actually a slow firing sensory fiber that tends to be only established once a pain making is there but it's not causing the pain it's the brain making the decision that it's perception that something has happened to you is harmful and therefore you've got to stop and that's where what i deal with is the chronic pain so we've done nociception which is just reception summation which is how serious is it and my position is it and it's really reflexic but then you've got to say to yourself well how come we know the skin's healed why are they still getting pain that's the problem and that's what we call chronic pain we don't like the word chronic because people tend to think it means really bad it just means it's been there for more than three months it's just a cut off okay because basically if you break a bone six weeks it's healed yeah okay and it might be a bit stiff but it's basically healed so why at 13 weeks are they still saying you know doc it's like stiff i can't move it and that's because what hasn't corrected in the brain is that for some reason their perception is that it's healed so chronic is not this is going to continue.

12:42No. Chronic is looking back. Chronic is just a really irritating word and it's interesting when you do word clouds with patients they really hate it because most of them think it means chronic means like well bad. Yeah. It doesn't. Chronic just means chronos time. It just means it's hit a time point at which in the medical world we've said well that's healed so now it's chronic. It doesn't really help at all. Okay. And in my view most chronic pain is because the acute pain wasn't treated properly. Okay. Okay. But then I'll give you a scenario which gives you context. So imagine a young lady walking down Bassassi High Street.

13:10It's October. She smells burning leaves. It's raining. She's walking down. She's only a few meters from her house and suddenly Mugga comes out of nowhere, right? This man grabs her. He tries to get a watch. She fights a little bit. Then she hits the floor and she breaks her wrist. He gets away with the watch. It's all quite traumatic. She's got a broken wrist, but she goes to the hospital. She gets a start. It gets fixed. But suddenly she keeps saying, you know, it's weird. The pain comes back. This could be two years later. You know, I've still got pain in my arm. I still got it. And what's quite interesting is that her brain at that moment has taken completely unconsciously a flash photography of that moment.

13:43It's saying it will remember the smell of the leaves. It will remember the slipperiness of the grass. At a multi-sensory level, it was go and just take a moment and store it. But it's stored with a fear response. Yes. Right? And what we know is that in chronic pain, what tends to happen is when the input at that time has entered into the emotional circuits, and that's where it tends to get lost. So for example, I fell out of a second story window when I was 20. I'm now 42. And I herniated some discs and didn't look after myself. I definitely have chronic pain in my thoracic that was where I took the brunt of the fall.

14:25That you talking now reminds me of... You're right back there. Yeah. You can probably describe the balcony where you were. Yeah, yeah. So yeah, it's stored. So I've made you remember it. Yeah. And it's a traumatic moment. Yeah. Okay. So if I'd been monitoring your pulse rate, I'd probably see an increase in your pulse rate and your blood pressure. Okay. Right. You're in that moment. Yes. Because you haven't really processed it. Just going back to the woman, she could be walking down the street six years later, no pain. And she smells an aftershave on somebody in the tube. Happens to be the aftershave that the mugger was wearing.

14:57And that pain will come flooding back. because every pain experience is a matrix of multi-sensory input, including how I was feeling at the time. I was on my period. So she could go and be premenstrual and suddenly the pain comes back, right? Because that little increase in the fluctuation in her hormones exactly correlated with one node of that experience. And we call it a neural matrix. I was like a wall, they were geniuses, but it's been developed since. But that's the way it is. And that's what PTSD is. And this is why we see it in soldiers. I work with veterans. and they've had a leg off.

15:30And apart from all of the phantom limb pain, what actually happened was they're given a very specific training. You go out every day in Helmand Province. You don't veer off this. You do this. You follow these strict guidelines and you won't die. Okay? So they built up this. I'm in control. I'm safe. And then somebody blows their leg off. Right? And they wake up. They get better, blah, blah, blah. But they're still reliving the flashbacks that really bother them. So this is the body keeps the score idea. This is the body keeps the score. So you keep reliving that moment because if you don't, and it happens again.

16:01So you've deconstructed my narrative, which is I was told if I do all of the above and I've got my plates on my back and front and these guys won't get me and then some little put something under my foot and it blew my leg off. That's changed my whole narrative, which is I thought I was safe and I'm not now. Okay. I need to relive that because I need to work out all the permutations and parallels of how it won't happen again. Yes. Yes. So light your balcony. I thought I was safe and the balcony broke. Yeah. So the narrative was destroyed and I was badly injured. What about phantom pain? What is that?

16:34We're still slightly working it out. It's a disruption of what we call the somatosensory cortex, which is a representation of your lower leg on the surface of your brain. It doesn't know once it's healed, etc., that the leg isn't still there. So you still have a representative. So wild. So in a sense, it's trapped in that moment. Yes. Right? Yes. The leg's gone. That was a flash moment and it's reliving that all the time. and that's why we can use a very clever procedure so we call it essential motor imagery is you can take a guy who's and you'll say to me how does your left hand this phantom limb feel it's twisted and contorted and broken so we put their other hand into a mirror box so what they're looking at is the direct mirror image of their right hand and they say put your hand into the position that you feel left hand and you do that and of course they're watching the mirror image said now look at your left hand which isn't there and just unravel it and they kind of go like that And so they're perceiving that that's what they're doing.

17:27Yeah. And the pain goes away. Wow. Because you just change the neural matrix. You just give them another pattern. And then that pathway is changed. And very often, it's not always completely changed, but it's unbelievable how quickly they get better. But what's also interesting is I've got a couple of guys who've now become elite sprinters. Because these are tough guys. These are Marines, right? And they've had their whole life taken away from them because they're physical people. And they get back into it. It's fantastic. We put them on special programs. But what's interesting is when they have their fake leg on or their blade, What's quite interesting is I've tested this.

17:56They can actually now project the fake leg onto the brain. Wow. So I can say, shut your eyes. Tell me when you think it's going to touch the wall. So you do it with their real leg and they go now, and then it's a little bit there. Good. Okay. They do exactly the same with the left leg. And they can do it. Because what they've done is they've created an image. It's an avatar, if you like, of the fake leg onto their somatic sensory corset. And what you'd see if you could go in there like CSI and you could look in is that there is a strip and there's a thing called the homunculus. He's a funny little bloke.

18:24And he's got these enormous lips and everything that's really sensitive, a much larger part of the brain has, is dedicated to. And if you could do this in the leg, what you'd now see is there might be a little black spot where the old representation leg, and now there's a parallel one. So what we learned is that you don't lose the old habit. You just build a new one. It's like smoking. Yes. You come off smoking, you're building a new habit. We know that the old one doesn't. It's like jumping onto another track. But then somebody upsets you. Oh, it's fag. Right? So the emotional element of that no just got you back onto that track.

18:54I mean, this is the wonder of the neuroplasticity of the brain, isn't it? Yeah, that's what it is. It's neuroplasticity, yeah. Nick, what is homunculus? It's a little map of the surface of the body. And they show you in medical book textbooks as a little man. But he's got these ridiculous lips, because if you think about it, these are terribly sensitive. So you've got to have more pixels per square centimetre on the brain. So it's a larger section of the brain. Got it. That's why. So he looks a bit weird. So your genitals, the soles of your feet, your fingertips, they're all overrepresented. but it's basically a map of how the surface of your body is represented on your brain.

19:26And it happens in a particular part of the cortex called the somatocentery cortex. So everything on our surface of the body is represented there. And that's very important because then we know what's right, what's wrong, and where we are in our bodies. And now can you explain that to me as someone who's very literal? Yes. When I know there's not a little man that exists. Okay. So I've got to produce a surface representation of you. So it's just a diagram. Okay. That's why he's a little man. But that has got to be traced over the surface of my brain. So every time I touch here, a little light goes on in here.

19:59Okay. Okay. Every time I feel vibration, a little vibration thing goes in. It all sits just on this very superficial cortex. Like a constellation on top of my head. And it is the ego. It is the representation of the surface of your body as a limiter of the homeostatic system of yours. So when he talked about the id and the ego, what you've got is these drives of need, which is to gratify a chemical system that needs sustenance and support, limited by its consciousness of the outside world. Got it. Okay. And that has to be represented. Otherwise, you don't know where those relative two things sit.

20:33Why are you so interested in pain? What led you to your career? My own pain. I'm hypermobile, so we actually feel more pain and we get more pain for reasons. I had a rugby accident. I broke my own back. I was involved, unfortunately, in an accident where I broke my sternum and 10 ribs and I fractured two vertebra and was in agony, et cetera. But I was kind of stuck with my back and it wouldn't get in. It was actually a wonderful old, he was 97 when he saw his last patient. He was another old osteopath I saw. He was also blind, had amazing palpatory skills, but he put me back on track with very early versions of this.

21:05I mean, he was way ahead, they were way ahead of their time. And he said, you're locked into a stress response, your perception of that it's broken because they've shown you an x-ray and the x-ray was crushed and nasty. You know, don't forget when you give people imaging, right, they're seeing inside themselves. If I could, I wouldn't show patients the images. I tell them, but once you see a bulging disc, they can get obsessed with, has it gone back, doc? Has it gone? Are you better? Yes. Well, it doesn't matter. Well, why doesn't it matter? You said it was the problem. That's why imaging is very unreliable.

21:28I've got 14 discs out in my back. I don't have any pain. That's the other thing is that imaging is very unreliable. You don't have any pain? No. I've got a slightly irritated knee because I lost my ACL a couple of months ago, but yeah, I mean, that's fine. Even that doesn't hurt. It just feels a bit unstable. Okay. But I think also in my rugby career, what you did work out that even when you hurt yourself quite badly, everything gets better. It heals. And that's what sportsmen do. They kind of just get, yeah, okay, I have had a radical fracture of this, but they'll fix it, you know, and then it'll go away and I'll get on.

21:56Yeah. It's kind of transcendence. But another contextual idea is if I was standing behind your shoulder right now and we were sitting in the woods in Oxfordshire, right, and I tickled your arm, you'd sort of go like that and you'd just look at it. If we were in the Amazon, you'd go like that. Yes. Right? That's meaning. That's context. So why have you taken a sensory stimulus and changed it in your brain without even realising? And if I kept doing it, because it could be a snake next time. But this is where your pain being the response to fear is so contextual and so environmentally led. Another example, I had a very wealthy patient.

22:27She was eight, nine months pregnant and slightly older is later. So she was more high risk. And stupidly, she got on a plane, her private plane, and she went to America because then normally aircraft wouldn't let you fly at that minute. And she rang me and said, oh my God, I've done my back. I'm in so much pain and I said oh right where is it oh it's kind of in my lumbar area and it's kind of it's like coming on now I went so it's coming on and going away again yeah you're in labour you're just having a back delivery and she was calm she was saying it's uncomfortable yeah if you have a baby that's back to back they often feel the pain in their back not their tummy and it comes as this sort of deep crunching spasm in the back but it's wave-like and that's why I realised she hasn't because he'd done nothing to injure her back right so the moment I told her she was in labour and the meaning which is, I'm now stuck in America.

23:13I can't get on a plane. This has ruined all my plans, right? Okay, so, oh my God, you mean, oh my God, you mean, oh my God, oh God, oh my God, Joey, Joey, I'm in labor. And suddenly, the pain hadn't changed, but the context had. Yeah. The meaning, that's what my book I wrote in 2018, I called it the meaning of pain. Pain is about meaning, perspective, and where I am with it and what's causing the pain. What do you think society believes about pain today? I don't think society generally sees anything different too, because biopharma isn't our friend. I saw an advertisement for an anti-inflammatory the other day.

23:45And what's so interesting is they know that this knowledge is coming out. Now that's a threat to them, right? They want you on drugs. Look at the Oxycontin crisis, right? So if suddenly Nurofen says, actually, what I could do is work out this and I can do a stretch or whatever, I don't need the anti-inflammatory. That's a lot of loss of income to them. So they're now, I've seen it in their advertising, they're now saying, oh yeah, I had this headache and I was told it was all in my head, but then I took a Nurofen. So they're kind of coming out. That's not what we said. We never said it was in your head.

24:13What we said, it was a tension headache due to tension in your neck, et cetera. If you actually stretched it off, you wouldn't get the headache in the first place. Okay, but they're clever because that's why on the radio, I used to say with people who are really locked into chronic pain, I'd be very careful about what I said. I'd say, can I ask you to accept that it's not in your mind, it's not in your head, but it is in your brain. Because mind and head are very loaded neurolinguistically. It means you're making it up, you're malingering, you're a bit neurotic. You know, and this happens to girls all the time because they get told, oh, I think it's in your head, you know.

24:40But then when you say it's in your brain, they go, okay, I'll play with that. It's in your nervous system because that's where everything happens, isn't it? Then you kind of anchor them and then you can take them down the pathway. What's hypochondria there for? Hypochondria is health anxiety. So everything that happens to me that is adverse, strange or different is going to be cancer. Okay. There's also valitudinarianism. And it's really interesting. It's a subtle difference, which is the, it's a great word, but it simply means that, hypochondriac isn't there all the time. Everything, oh my God.

25:06whatever oh you know valetudinarism is when something happens they immediately jump to it's the very worst thing okay i.e that's so a little cough is it's a tumor yes so they are they've got real symptoms yes but it's just a cough okay they will jump to it's leprosy okay just for our listeners tell me about whiplash so i used to work for 17 years in a neurosurgical unit and one of the reasons i got the silly name nick the neck was because spikul spines were my thing because everybody else hated them. I loved them because they're very complicated. They're about orientating. So I studied that very hard.

25:38And one of the things I sort of unearthed was a thing called the upper cervical syndrome, which was where they lock up the upper bit of their neck. And it was very commonly part of whiplash. But it was fixable. You know, you could see them quite quickly. So they'd have these car accidents. They'd be hit, et cetera. But seven years down the line, they're still getting pain. They're saying, I'm getting dizzy. And some of them had a genuine little lock up in the neck, but you know, it should get better with some treatment. But they were still there. And of course, then you realize they were in litigation.

26:01What does that mean? they were actually suing somebody for the car crash. And the problem is once you're in that, there's two things that goes on. One is I've got to maintain the symptoms, otherwise I won't get the hand out. I won't get the payout. And I actually heard neurologists say, by the way, you don't want to get better too quickly, otherwise you won't get, you know, now you've gone down this line. And that would take sometimes two to seven years to get that litigation. Then they became the problem. You know, they'd retract and they really believed it. But one of the things I noticed years ago working abroad in India, et cetera, was that where there's no legal system, there's no whiplash.

26:32Okay, they'd get a stiff neck and they'd feel it in there, but it would free up and they'd get better. Might have a bit of a headache, etc. But there's not this incapacitating ideology around paying. Like some of them wouldn't go to work, they'd be off work. What about RSI? RSI was the same. We saw all these people. Everyone coming, oh, it's my keyboard. And I'm afraid the moment the insurance companies stopped paying out, I don't see it anymore. So you don't see RSI. I see upper cervical problems that are for other reasons, but I've never, I just don't see whiplash. You don't see whiplash. You don't see RSI.

27:00I don't see RSI. Anything else? They get tight forearms from doing it, but they've got good ergonomics and they stretch a bit, whatever. But the moment there was this wrap around, this kind of hysteria around, oh my God, it's this chronic condition, I'm going to be stuck, etc. They will just go into that hole. And there are certain personalities that are more likely to do it. Just as you know, in the OxyContin crisis, you could tell the people who would get hooked on the opiates because it took caring away. Opiates were a really interesting thing. They don't treat pain. They work on the amygdala, which is the limbic system, which is your mood and emotional system.

27:29So they actually just stop you caring. So if you give morphine to an amputee who's just lost his leg, they literally go, oh, that's that. And he says, is the pain better? They go, no, I just don't seem to give a shit. So they haven't reduced the pain. They've just dissociated from it, the meaning of it, what it is. So when you see a guy who's just lost, he's looking down at his bloody leg, right? He's lost his head, it's shattered. It's like, ah! It's a massive fear response. And then it's like, Christ, and it's like me. If I injure a finger, that's catastrophic to me because I use my hands all day.

27:56If I'm a violinist, catastrophe. You break a finger, you put a splint on it, you don't even think twice about it. Yes. The only difference between us is it's the meaning of what the injury is. So it's changing. I'm not saying it doesn't hurt. No. It's just it won't be as high because it isn't carrying this load of fear and emotion around. Well, if I can't work, I can't earn money, I can't earn money, my kids don't eat any. The financial crisis. Yeah. And as I said to somebody in stress terms, the modern version of us being on the planes of not that we're being chased by a saber-toothed tiger, but that we saw him in the hedgerow last week, so I've got to be careful, I've got to be there, is financial debt.

28:30Your mortgage is the biggest stress you have. And so anything that affects that or not being able to maintain a financial status where I can look after my kids or in single parent families, it's hard because it's not somebody's doing a crap job, they're just doing half a job and they can't earn the same money as two of you. And that puts your livelihood and your safety at risk. And that's a constant, that's constantly in the background. That's why people tense all the time. Is there anything else in that whiplash RSI camp pain-wise? Migraine's an interesting one. Not because it's litigious and etc.

29:01But again, it's a pain pathway. It's not really a headache. It's no different to chronic backache. Okay. It's sensitization of a neural pathway. And you can profile those patients quite significantly. Now, that doesn't mean they're neurotic. It doesn't mean they're blameworthy. But it means that they're not seeing the headache. They're seeing it as a pathological process, which in its own right is stressful. Okay. Okay. Another nice example. The way the brain works is to try and get a handle on the well, build a model of it. and not surprise itself, because surprise is things that might take you away.

29:32It's what we call surprisal. And I had a guy today, actually, it was interesting, who one of the major stresses to him that was stopping him getting better was that he hadn't had a diagnosis. And this is what I get with the hypermobility ADHD POTS guys, right? They come in, some of them cry of joy and say, finally, somebody has told me why I'm like I am. Because what people don't realise is no diagnosis is worse than a bad one. Yes. Right? I had a good lady the other day, I sadly had to tell her she had a tumour in her spine. And she said, oh, right. okay, wow, you know, okay, great. Well, at least I know what it is, was her immediate response.

30:03I'm like, wow, that's an interesting response. So having cancer is better than not knowing. Yeah, because you've got a handle on it. Yeah. And it's in all your linguistics, right? I can get a handle on it physically and I can get a handle on it mentally. Yeah. Now I know what I need to do. Yes. I'm on that journey and path. Thank you so much. And you sort of think to yourself, I've just given her the worst news possible, but actually she's relieved. Yeah. Because it's the not, you know how people's when they're waiting for tests, they say, oh my God, it's just the waiting. Yeah. It's just agony.

30:26And it's going, yeah, because you haven't got, you can't grasp. It's entropy to the brain. Let's get into hypermobility. Why have you been working on trying to unravel this connection between hypermobility and ADHD? Going back to when I was in primary care, there were a subset of patients I could see who just weren't getting better and that other people weren't fixing and actually were getting over-manipulated, hurt. You know, things weren't working for them and they kept coming back. And so I said, what's different about this group? and then you go off down that alleyway. And that's, so it's taken 20 years, but we've got way back when a place called the Hale Clinic down in London, which was quite full of quite clever people.

31:03Professor Botteco walks in and he's got his kid and he's the big, big breathing man. And he's got this genius idea and these kids are getting better and nobody's heard about it. And all the other respiratory guys say, oh, he's a flake. He's a weirdo from Russia, you know. But I could see these guys, they all had asthma and they're getting better. So I said, can I do your training? And I did. And at the time it was seen as charlatanry and now his system's taught all over the world and adaptations of it, you know, and was never properly recognized for it. John Sano, I could see what he was doing when his book came out about back pain and chronic pain and I just rang him up and said, can I come and train?

31:34And he went, yeah, no problem, you know. And so I did a couple of weeks with him but you could learn the system quite quickly but it was hearing from the horse's mouth. You can't read it from him but you've got to hear him and all these little things he said. And he often said, if you can't find the pain, find the rage. Why are they angry all the time? Why are they burying it? Right? where they're tense. And that's what I began to write. You could say that there was nothing pathologically wrong with these people. Why are they still in pain? And that's where you get this intricate relationship between a psychoneuroemotional system, which ends up as a stress response, which is a fear response, which also then manifests as inflammation because the outcome of stress is inflammation.

32:13Yes. And so many people have known this, right? I mean, Maudsley, the founder of the Maudsley Hospital, the great man in 1840, his wonderful line said, the sorrow that has no vent in fears will in other organs weep. It was genius. You know, you could see that they would go into what we now call conversion disorder. They'd put it into their bodies. Because it was easier to rub something, right, than deal with the hurt of something that's just too horrible. It's what I call rummaging in their basement. You know, why do we talk about basements? It's where we store the old stuff. We don't really want to get rid of it, but we know we've got to keep.

32:42But it's in amongst the spiders and the dampness. We don't want to go down there. And that's what he realized. And Hans Seeley, 1937, I mean, he was formative in me, even in my training. I was reading a lot from him. He came up with a thing called the general adaptive syndrome, which was simply that he had noticed when he would assess patients that people who were chronically long-term, sort of mid-level of stress, the same things always happened. Their adrenal gland increased, cortisol. Their thymus gland and their lymphatic system, which was your immune system, shrunk. And they got chronic irritation of their mucosal membranes, which is basically the gut, right?

33:17It's lined with mucosa and they got inflamed. Well, look at all the autoimmune conditions we see now. I do think that a lot of those are at the heart of them. And there are people who've dug down into that, is that they look back and say, well, why is this person in a constant state of stress? Now, that could be work. It could be childhood, that they've never come out of that. And that's where the psychotherapy can help. Let's just talk a little bit about Dr. Pateko. Can we just dive into his work a bit? Yeah. So I used to come out of my room, and it was rather irritating, because there were actually kids marching up and down, holding their noses, doing these, and all puffing.

33:46I was thinking, what the hell's going on? Could you get out of the way? Anyway, so I asked who he was, and we got talking one day, went for coffee, and realized he was a genius. And what he basically said was that the two things you have to get hold of is the pattern of breathing. So get back into the belly, do not use the chest, slow it all down, the 5-7 thing. What's the 5-7 thing? The 5-7 is breathe in for 5, out for 7. That's my stat go-to for people with breathing. So anybody who's stressed and tense, 5-7 is going to sort you out. 5-in, through the nose. Through the belly, hand on high, hand on below, breathe into the belly.

34:17Because again, a lot of people are holding their stomachs all the time it's like wearing a corset so you breathe in let it all go breathe into it for five and then nose only seven seconds so the out breath breathe out through the nose I would as well for reasons five in through the nose down to your belly it slows it down so you've got increased amounts of oxygen overtake so it slows gaseous exchange also if you're breathing out the parasympathetic bit of breathing which is the out which is the relaxatory is dominant whereas you've been sympathetic and amazingly it seems to be a biblical number in medicine I find five on the fifth breath religiously I will find the patients here and it's their stomach the vagus nerve switch is on that's IBS so they suddenly they all come back and say yeah you're right my IBS has got so much better IBS isn't a condition it's a state but we're told to take a deep breath yeah not exhale not exhale a longer breath but when you think about a sigh and then you go yeah yeah it's longer yeah but exaggerate that okay and make sure it's from a nose only during the day.

35:19One more thing, what he did, he invented a thing called the controlled pause. That is because when you are used to breathing badly with a low carbon dioxide level, your receptors in your neck or the carotid baroceptors, they get used to that. So if you ask people, for example, to tape their mouth at night, they will actually, can't do it way too quick. So start with the 5-7. Also ask them as far as possible to breathe only through their nose during the day. Much more difficult than you think if you're not talking. Sure. Also, when they're eating, don't talk. That's why the Japanese do it. They don't talk.

35:50I do, yeah. Because you air gulp, and that's why they often get bloated stomachs. And you can see it on an x-ray. You can see the air in their stomachs. Because they're having a chat, lovely, darling, sweet, and boom, they're swallowing air. And that's why they often feel bloated and distended. And then, of course, they often say, I'm belchy too. Yeah. And then, of course, that contributes to them being windy, etc. And then you shut down the bowel blower. One more thing, hypermobility also comes with slow gut motility. So by definition, they pass their poo slower. Okay. That's important. And then add in the IBS.

36:18They're the ones who get constipated, constantly bloated, feel uncomfortable. And they begin to feel that even just a normal level of fullness is bloatedness. So if you do the breathing, you switch on the bowel. So it may be that you will poo less per day, but you'll start pooing. Yeah. Interesting. Let's talk about hypermobility. What's the history? Let's walk through this. Where did this term come from? Well, again, back in Fulham, we got in the late 90s, we were seeing it and it was there. We just noticed that when people were lying on our beds at any minute, they were just floppy, right? And they were just a bit gawky.

36:51They were just a bit awkward in the movement. Given homage to him, I mean, John Cleese, perfect example, right? Ministry of Silly Walks, couldn't have existed without his neurodiversity and his hypermobility, right? He's doing his big leg thing, right? So, I mean, to me, he just embodies both of them and out of it came genius, right? It was also bonkers, right? He just multiplies them, he's pretty mad. So hypermobility is effectively a collagen disorder. I don't like disorder and disease. It's just a variance. It's how much collagen you've got in your body. And collagen is very important because it's a stiffening agent.

37:20It provides stiffness. And again, going to osteopathic principles, the spine does not hold you up. It's a misnomer to call it a column. It's just a segmented group of bones with multi-axial joints called discs to house the spinal cord that then goes down and torques to your body. You have this intricate system of muscles, and they're very important. So it's just like a circus tent. okay if you have some of them tighten too much or too loosely it's the tip the center's going to tip and that's kind of what posture is whatever and the brain is constantly working to balance all of those muscle systems so when you talk about stillness that is the perfect zen moment of perfect singularity of all muscles working on a point at the same time yeah so think about when people get older when those systems break down they get doddery right they start wobbling what the brain's redoing is rebuilding that model of the world and against gravity are you born hypermobile yes it's genetic yeah it is genetic it's it's very autosomal dominance that means if one of your parents usually mum is hypermobile that's why this is so predictive we can help people even before they're born right so if they're hypermobile we can predict with great certainty that they will have a number of issues so boys our brains are designed much more orientating around movement.

38:32So we get flagged up because of the irritation at the back and he's constantly distracted, can't keep still, you know. And it's like, oh, will you go up? The girls mask it. So they're not driven by movement as much. So they'll mask it to GCSE, et cetera, whatever. But so Jess Eccles, I'm sure you know of, fabulous psychiatrist who's done more in this field. She just said, well, why don't I take all my ADHD patients, which is my domain anyway, and just do a Baton score, which is a hypermigical score. And she went, wow, four fifths of them, four fifths of them are. And I did it with an educational psychologist.

38:59I said, could you just take 20 of your patients and just do a Bain and score. She rang me back two weeks. I said, Jesus, Nick, they all are. I said, yeah. So this is the ADHDers being hypermobile, over-indexes, or hypermobility over-indexes. So in a sense, that bit of ADN-ness per se, I reckon, is genetic because the hypermobility is genetic and it produces a neurotype from the body type through poor integration of postural reflexes. But that's really important because kids when they're developing, I mean, Jean-Claude Piaget, all these great neurodevelopmental guys, they really studied this stuff properly and empirically.

39:31They showed that play, which is basically movement, orientated, structured movement, narratives, I'll play doctor, you play wifey, it's all a narrative, it's all physical, right? Is the integration of your body in pursuit of a goal or an outcome, right? So it's, I'm going to go out this door in a minute. I've already got that in my head somewhere back there. And then, so I'll set that narrative and then I do it. But in hypermobility, if these kids are a bit gawky, you know, they're clumsy, we are clumsy. So it's not necessarily dyspraxia. They can hit a tennis ball, absolutely fine. But it's about attention.

40:02As long as I'm tracking the ball onto it, I can match where I've got to be. But what I will do is if I'm not attending it, I might reach for the glass down there to get my spectacles and I will hit the glass on the way because I'll just take my eyes off because I'm talking to you. So it's an attention issue. But it's because I can't match where I think my hand is to where it actually is. Got it. Now, if you can't orientate yourself in the world, go back to roaming the plains. if I can't guarantee that I'm not going to trip up over the tree stump in front of me because I'm running away from somebody, I trip, I'm toast.

40:32So as a baseline state, that's what we call increased surprisal. The model of the world that I've got and my position in it is inaccurate. Okay, it's what we call prediction error. How quickly can you assess me for hypermobility? In about 30 seconds. Let's do it. If you're lying on a bed in a clinic, 30 seconds. I'm going to do it here. Let's do it. Okay, so it's a nine-point score. Okay. Okay, so you're going to go for it. You're going to go for the big one. because I looked like you are. You do it so weird. You know how neurotypes all recognise each other? You can tell because they all sit there like this.

41:02Oh, so you think you're already thinking. I would be surprised if you're not. Wow, well, I didn't. Yeah, I thought. Can you tuck that foot round the back of that? No, not. You can. Believe me, most people won't even get close. So Nick's asking me to try and tuck for people listening. Nick's asking me to try and tuck my... Cross your leg and tuck it. Cross my leg and tuck it behind my other leg, which... That's not part of the test, but it is. First one is hyperextending fingers. So if your hand's flat you can get to 90 degrees or above. Okay, tick. You can do that so that's two points. Next is actually thumbs.

41:34Thumbs to wrist. Yep, thumbs to wrist. You don't have to really even touch but it's got to get within about an inch. You're pretty close. So that's tick, tick. Next one is hyperextending elbows. So if your arms go down to about 5 or 10 degrees beyond normal extension I think I'm failing there. You're failing there. But then you would do knees. Yep. So you stand up. Okay. So you've got to be load-bearing and then try and lock your knees back. See what I call chicken legs, okay? And that means that you can lock your legs back further than most people can physiologically because of looseness in the ligaments.

42:02Tick, tick. Then the last one is touching your toes easily. So actually even when you're stiff and sore in the morning after a hangover, you can still do it. There you go, okay? So that is the score. Another one I would add, which is an interesting one, is stretchy skin. So I tend to go to the neck here, which is reliable, and also the back of the hand. Now obviously very elderly people will have stretcher skin, but if you're a young chap like you, you'll still be able to stretch it more than you'd normally expect, but it will go back. But that's important for other reasons. We haven't validated that.

42:29There is a test for it, but I think I would add it in because I think it is important in the mix. So I am hypermobile. You are officially hypermobile because if you're five out of nine or above when you're seven, congratulations. I really did not think I was hypermobile. Yeah, I know. That's what I'm sure. And you see, the other thing is, because they're tense, this is why I assess everyone's breathing because like you've just sighed. So when they come in, I had a guy this morning, he was like that. And he said, I'm not hypermobile. I said, right, four breaths, five, seven, do it. Big out of breath, now do it.

42:59And then we saw him and said, now you are. Because he let go of himself. So anybody can do this test? Yeah, yeah. You can go on videos. I mean, it's all there. It's just called The Baten School. The Baten School. B-E-I-G-H-T-O-E. It's not B-A-Y. So I could do this with my children? Yeah. We don't really do it until about seven because all kids are very flexible because they're just not fully formed. but rarely seven plus. The other ones is classically toddlers who really, really pronate their feet, who are kind of almost walking on the insides of their ankles rather than just a bit flat-footed.

43:29I would raise things. And also then they're the ones who, as soon as they're walking, they do also very much hyperextend their knees and they tend to have what we call valga. They sort of, they're walking really on the insides of their feet. I would have a high level of suspicion, but we're not officially doing it. I'd really diagnose it till seven. But the answer is, flag it up at school. I would have all teachers trained to do a bait in school. And you do it to every child, so nobody's built that up. But then the ones that clearly meet it, you say to the patient, look, he is hypermobile. This is highly correlated with these problems in the future.

43:58And we'd love to help him. Not like, you know, he's flagged up as a problem. Just look, and there are some really good things. And one of them is you need to do exercise. We have literally eradicated exercise from schools. And it's an appalling testament to governments that they now are not allowed to move. There used to be playgrounds. They sold them off for development. And interestingly, if I see a subset of my patients who've actually been to public school, so private school. What's interesting is that they are hypermobile, but they're much more toned and firm because they do so much more sport from an early age.

44:27So by loading the fascia particularly, it thickens. You can't change the collagen, but you can change the thickness of your tissues. It's an adaptive, making your bones thickening. And what you find is that although you can do the mobility score when they're lying there, they don't get the pots because their cardiovascular system is better tuned. So as a good little sub-study, those kids are better off because what they've done is they've learned to orientate. So they've done lots of sport, lots of practice. What is POTS? POTS is postural orthostatic tachycardia. It's basically dizziness when you stand up.

44:56Okay. So if you're lying down, so in the morning, my lovely Alison Price colleague, she's a wonderful neurologist at Oxford, she came up with a lovely idea because she gets POTS and I think a lot of her patients do. When you're lying in bed, you're completely relaxed. Your body goes loose. Hypermobile people have low blood pressure. That's another sign actually I'd make it a third. You see, they'll go, oh, that's really interesting. you know I've got low blood pressure. Yeah, because your blood vessels are slacker because there's less collagen in them, less stiff. So when you lie down and relax everything in the morning, what happens is you've got really low blood pressure.

45:27When you suddenly sit up through a clever mechanism, as gravity sumps onto the blood in your venous system, the pulse rate should suddenly pick up to regulate that. In us, they don't. It doesn't as quickly. So there's a delay because it has to have a maximum stretch before it suddenly goes, oh, right. But that little delay means you feel dizzy because you haven't got enough blood going to your brain. And that's very worrying. Oh my God, am I going to faint? Once you understand, it's irritating but normal. Particularly if I'm in the heat, and if I'm in the sun, I will light up, and then I'll just pause, and then I go.

46:02So I'm not bothered by it. So get up more slowly? 100%. It will be worse in the heat. So a lot of patients out there will be listening and say, yeah, I'm hypermobile. Oh my God, that's really interesting. Yeah, in the heat, I'm much worse. Basically, pretty much anything over 25 degrees, most hypermobile people will most of the time feel unwell okay I do I hate the heat there you go because you're you're trying to open up all your blood vessels to lose heat yes so you lose your central core blood pressure so you're constantly in fluctuation so you need to drink more you need to have more salt because you're trying to maintain your internal homeostatic state and the body's going Jesus you know I'm going to do this so what am I actually going to do I'm going to make him feel unwell I'm going to give him a fear response sit down lie down I just you know the patient said to me yesterday she said I just sit down.

46:45Okay. So you just opt out. Yeah, no, that's not good enough. And what's the national average for hypermobility and how does that differ? We think it's between 20 and 40 % of the population. It's more common in girls. Okay. So, and that's why it's also more common that we pick up the correlation between the ADD and the hypermobility. But they're the ones that get missed because they're masked. What are the challenges with being hypermobile? The low blood pressure. I mean, luckily, generally, we tend to have much less arthritis. Okay. but because the brain is in a hypervigilant state then you're using a lot of neural energy you're burning off this Ferrari brain again right because you're trying to take many more flashes of the world a bit like with the pain thing right we're sampling the world about 4 bits per second ADD is about 16 bits per second so you really are using a lot of fuel but what people don't realise there is a body budget you can't ask for more the brain can't so that was a major discovery so you get about 1800 calories a day just to run your body yes operating in a 60 watt light bulb equivalent right That's quite a lot of energy.

47:44It's coming, right? Yeah, yeah. So you're burning that and you've got to find the food or whatever. But there's also that we think probably the hypothalamus at the base of the brain is the little god man who sits there like the sort of, you know, running the decks and he's saying, right, you know, that needs a bit more water. That needs a bit more salt. That needs a bit more calcium. It's justing all that all the time. And then when it's running out, it says, oh, boss, right? We need more, which is affect, thirst, gratify, goes back again, food, sex, right? We know what horniness is, which is difficult to describe.

48:11It's just imminent need to gratify something. So that's how it talks to us. They're impulses, right? They're impulses. They're affects, feelings. Yeah, impulses would be the drive to do it. So they're feelings that come up from somewhere, which is an imminent need to do something. And then, of course, we've got the social, what we call the social affects, which is despondency, rejection, sadness, etc. And again, most of those will come with a motor outcome. So we're very physical. Our brains were designed to move, not to think. The problem is society has gone towards valuing cognition so highly, because quite frankly, that's where the jobs are.

48:45STEM subjects make more money. If you're terribly clever and if you're conscientious, you're going to do well in the world. There's no surprise. So there's a lot of onus on that. So if you have a body that needs to move and that just thinking is all that anyone's interested in, there's a dichotomy there. I know you've convened a group of specialists, a working group, specifically around hypermobility and ADHD. Can you tell me why you did that? Because particularly in the NHS, in the training ground here, we have an unbelievable rich bed of talent. So I could see all these brilliant people. When I saw Jess Eccles' work, I thought, you know, again, like I did with John Sarkis, can I come and see you?

49:26Can I come and visit? Well, we're NHS, you're private, whatever. Okay, but can I come and visit? And we got talking, and there's a guy called Chris Muller-Pollard, who's a wonderful psychiatrist who specialised in ADHD. And I got talking to Chris, and I said, look, I can see this. Am I technically qualified to be a psychologist? No. Did I do psychiatry and psychology in my training? Yes, as a baseline, a bit like a GP. But I'm not an idiot. And I can see these things are heavily linked. And that also goes with my traits, right? I can see the connectedness of things. But these patients are sitting in the intersection between the specialties.

49:55They're falling through the sieve. Nobody's picking them up. And 90 % of the actual treatment is just education. This is why you are like you are. These are the hacks you can do. Some of you may need to use a stimulant because you just cannot find center at all. But actually you can probably self-regulate. Because again, you tend to find ADHD gets worse the more internally dysregulated they are, right? So if you bring them into the exercise, you get them not to fear it and realize that, yeah, it's going to be miserable for three to six weeks and then you're going to kind of, your body's going to gel, it'll adapt.

50:26And then you're going to come out and explain all that, predict it for them. And they go, oh, I know that's okay. So if they suddenly feel, oh my God, that was bad for me, I'm not going to do it. No, no, no, that's just called post-exercise soreness. suck it up, take a nirofen, but get on with it, you know, and keep going. And then suddenly the cardiovascular system rejigs itself. Their core gets better. They're not dumping blood into their abdomen. And suddenly everything just comes to get, it's like going back to this continuity. Everything's all just a bit wobbly. If you do that to a brain that's wobbly, right?

50:52I can't find anything. I can't find center cognitively and I can't find center in my body. And so what are you trying to achieve by getting siloed specialisms, talking and working together, what are you trying to do for ADHD, hypervigilant people? To bring a conjoined file of knowledge that works. These conditions are where actually randomized controlled studies, traditional research really falls apart. I liken it to climate change, right? You can't do half the climate change that you wanted to do studies because you can't control for anything. So you can't measure evaporation from the sea and then say, well, just forget about clouds because clouds have an effect, you see?

51:31So it's a multi-system integrated system. You can't do it. Each cell is a soup of chemical reactions. You can't just take one out and say, it's useful to study that, unless you see it in relationship to all the other cells. So every time you put a drug in, every other reaction in the cell is affected. So this is why this idea of constant need for evidence, though I'm an empirically trained scientist myself, is flawed. Because by the time you've measured one thing, so it's completely useless to you because you're not seeing it how it interacts. So what are the, as now someone who is still processing the fact that I might, that I'm hypermobile.

52:05Yeah, because I came here going, I don't know a lot about hypermobility, but I'm sure it's not. What's also important is, you know, you said earlier, you had to be careful about slumping down in the chair, right? That's because you're not comfortable. Yeah. Because we distort easier. Yeah. What do I and people listening, whether assess for hypermobility or not, what are the three things I need to be aware of? You need to make exercise part of your life. and it's not just going for a run. Hit workouts, resistance workouts and things that involve coordination. So climbing's fantastic, martial arts, primal movement exercise, which has become popular, etc.

52:39Yoga, no, unless it's power yoga. If you're doing Hatha, you don't need any more stretching. Stretching is not your friend because it will destabilize you more. Very interesting. A lot of patients might say, oh, you know, my back's always worse after it. I said, yeah, because you've just taken away the one thing holding you together. Wow. I was part of a cult in Thailand that was all based around Hatha and Tantric yoga and for nearly a year. And that was, yeah, very bendy. I mean, not cardiovascular, not actual lots of movement. It was about getting into different positions and holding them. And in fact, when you actually say to them, what do you like about yoga?

53:17It's the breathing. Yeah, pranayama. As you say to them, just do the 5-7, right? And that will just calm. Because as soon as you ramp up again, And you can tell you're holding your breath, you're sighing, you're yawning. You know you've got, your brain's gone back. That's what we teach the traders. I said, if you sigh, yawn or breath hold, that means your brain is going into a stress state. You just don't know it. It's prodromal. So control it. It's like a lie detector test, right? We measure your physiological parameters. You could be telling me the best lie of your life, but the body will always resist the lie because it's very energetically expensive to tell a lie because you have to keep telling others lies.

53:49So it doesn't like it. It's busy. The brain will tell you, no, it's not a good idea. Yeah, yeah. So exercise, another one? Breathing. Because when you get the disparity between the blood pressure, the pulse rate and breathing rate, it's actually called in medicine respiratory sinus arrhythmia. It's the relationship between three perfect things and they have to be aligned. So you know how people, you see all these aura rings around, these HIV. I'm wearing a heart monitor now. Well, there you go. It's useless to you unless you align it with your breathing. So you can only ever get your HIV, certain around through sleep and exercise.

54:20because why it's there is because of our chest cages. When you take a breath in, the pressure in your lungs has to drop to allow air to go in. But the problem is the pressure on the heart drops too. So the heart will go and then faint. So the pulse rate slightly goes up. So we actually listened for it. But I was at a doctor's meeting and I said, hands up honestly, all of you who know what a respiratory sign, they all went on. He said, how often do you listen for it in clinic? And then none of them put their hand up. And yet it's the fundamental relationship that keeps life alive and us able to walk around in the world against gravity.

54:53And all you do is you listen to the heart and you hear, as you breathe in, you hear, as you breathe out, and that sounds like simple, but it's not. The brain is doing lots of things to make that happen. The problem for us is because of our low blood pressure, our pulse rate always has to be a little bit higher and also we tend to hold our breath in. We hold the top of our breath. The breathing pattern disorder is a, like I don't breathe a lot. No, I know it's just, Yeah. You saw a lot too. I do, do I? You don't perceive it. You do a lot. That's how you offset the carbon dioxide. It's a problem of carbon dioxide.

55:30It's not a problem of oxygen. Okay, tell me about that. So when you breathe in, the sympathetic nervous system kicks in. When you breathe out, the parasympathetic. So what you tend to do is to go into the upper breath. Yes. Because that's the sympathetics. But that's also contracture of blood vessels, etc. So it's you trying to maintain your blood, your status quo. but it also means you're in a stress state. Now the problem with being in a stress state in terms of your blood chemistry is that if you puff off too much carbon dioxide, think of a panic attack, we tend to give them a bag to breathe into, right?

55:58Because they're puffing off too much carbon dioxide, their blood chemistry is going alkaline, we call it respiratory alkalosis, and that's a crisis state for the brain. And the more they go into it, the more irrational they become. So by definition, if you're even mildly hyperventilating, you're actually irrational. You lose 24 to 44 % of your cognitive ability the more stressed you become. you actually become stupider. Wow. Because you go back, your brain said, don't think, Ron. Don't even consider your options because that's a delay and a delay is death. And that's because of our breathing. It's because of the blood chemistry relationship to blood pressure.

56:29So this is why, you've got to know your physiology. I used to love physiology, but you've got to be able to interpolate all of those different elements and say, why is she doing this now? Why is she doing that now? Oh, let's give her more salt and see what happens next week. And they go, oh, it's amazing. Because that adjusts the blood pressure. It makes your blood pressure look better. So we're the one group, actually, who, unless you've got high blood pressure for other reasons, but basically should have more salt on their food. It's good because I love salt. Yeah, and you crave it. So do I.

56:54We know it. Because you do. You have a craving for it. So your body's saying, a bit of salt. You don't know that. It's actually saying, yeah, get it, because I desperately need it. Yeah, because my body actually needs it. Body's asking for my blood chemistry is all a bit off. So exercise, breathing, salt. Sleep. Because if you've got the hypervigilance and your ADD, you're not going to sleep well. So observe all of the same things that you tell ADD people. So do not expose yourself to blue light at night. Do not doom scroll. Sure. Okay. And also if you're more anxious generally, you're going to go down the route of being more open to negativeness.

57:23That's why the doom scrolling is so bad because you're reinforcing why you're crap. Yes. Okay. And the more you look for why I'm also perfect, you'll just find more crapness. It's just destructive. If hypermobility is based around a collagen deficit. Yes. Does eating collagen change it? Yeah. Unfortunately. Because it's genetic. Your body's not producing it at a DNA level. And it won't. No. So all this eating collagen is a complete waste of time. Actually. It's a great industry. I should be putting it forward. I'd make a fortune. But actually, because collagen is a big protein, so your body will break it down.

57:59So it will just go in as amino acids. So if you want to have amino acids, fine, but it won't make more collagen. Okay. And does hypermobility get worse with age? My slight headache patients that I will see is usually female because they're more likely to come in. 18 to 25. never done exercise fearful of it, don't like it, failed at it feel uncomfortable with it, makes me sweat, don't like it so I just get agitated or whatever and then as a result probably eat too much sugar because again the dopamine, blah blah blah and so I've now got an overweight, very soft patient in a lot of pain who will also get stress fractures I mean it affects their bones technically you won't see it on a bone density scan but hypermobile people are more likely to get stress fractures because the collagen that binds the bone the glue is weaker Yeah, I've heard you talk about the marshmallow and the chewing gum.

58:47Can you just give us that analogy? So that's more about how we're processing. So we now know, thanks to two very clever ladies who discovered something called piezo-receptors. They're little tiny propeller-shaped receptors that sit in your soft tissues, and all they're there to do is measure movement. And they've got a nerve on the back, and it goes and says, Oi, mate, this is moving. Brain takes an over-the-wall view and says, If I'm falling left, how do I correct? I just fire the muscles on the right, and I correct. And then the more agile you get, that's a subtle balance. But that's all thanks to these little receptors going, oi, oi, oi, oi, right?

59:16So the problem for us is, if you've got marshmallow tissues instead of chewing gum, those are bedded in a matrix that's much more squidgy. Unfortunately, squidgyness means you have to have a greater movement in the tissue for them to be registered. Right? So if you put your hands on your fingers, you can feel that movement. If I put cotton wool around it, I'd have to do much more movement for me to go, oh, it's moving left around. So that's transferred back. but that's why things happen a little later. So my eyes are telling me, oh, I am actually fully left, but my ankle hasn't picked that up yet.

59:48Okay. And that's why the classic question you ask hypermobile, did you always tend to twist your ankles a lot at school all the time? There's a thing that happens consistently in the hypermobile, but also in the stressed and tense. And it's, there's a wonderful guy called Janda who was actually in Australia. I was lucky. I went to work in the Australian Olympics and I worked down there. But Janda described a thing called Janda's upper cross and I use it all the time. and what he showed was, was that people, he thought it was mainly due to posture and leaning forward at the time, particularly relating to the neck.

1:00:18And there was an upper cross and a lower cross. So one was pelvic and one was shoulder girdle and neck. And the upper cross is where you get a reversal of the muscles that stabilize you. And basically there are two systems. There's one that's fatigable and that's like your bicep. If you keep doing that, it gets painful. And then they tar and you have to have a rest. That's the big movement. But then you've got to have muscles that just hold you up against gravity. And why they're clever is the little fascicles in the things they share the brain's very clever it says johnny's getting tired michael pick up johnny's getting tired michael and they just keep sharing they're deep and they're next to the spine multifidus etc and then you've got the ones that move the heads but the ones that just hold you there and grade movement are very important and what we discovered was that some patients would switch how they stabilized so they were using fatigable muscles instead of non-fatigable that's why they're in pain okay and that's exactly what you have because they're using different the muscles that shouldn't be there.

1:01:10But I said, and I don't think Janda really got to the possibilities, people with Jandas up across, 90 % of them have it because they hyperventilate and they have breathing pattern disorder because they... Yeah. So that's why you have forward head posture. Yeah. That's why the physio is giving the chicken exercise is a disaster. Planks, worst exercise ever designed by man ever and everybody's doing it, right? Why would you want when we sit in flexion all day, right? And when we want to stand up, could you go, like this, madness. Don't get it. And if you've got bad, core all you do is use your hip flexors so it doesn't develop the core what about cracking the knuckles do we see that in hypermobility people more than more than normal population yeah yes we do yeah because it's also in a sense its own form of tick so it becomes a habit right they do it all the time sure now what will happen is when they pop it the the joint will kind of reset itself and in the end so they can do it again they can't do it more than once in a row It's like if you crack a neck.

1:02:06Yes. It's the same thing. Yes. You can't do it probably for up to an hour later. Yes. Okay, because it's a sort of neurobiological process. Yep. But it gives them release. They feel freer. And then it becomes a habit because it's also grounding. It's just like nail biting or jigging your foot. But if hypermobility, I guess, is centered around joints, then... Well, it's easier to do. Yeah. You see a stiffer person, you have to like... And it probably might hurt. It's like, oh, God, that hurt. Whereas us, we just get... And it's gone. Yes. So then it's kind of release for free and easy. So what do we do?

1:02:34it gives us dopamine and we keep doing it and then it also grounds us because that's why you'll see people crack the knuckles generally when they're getting agitated or stressed like they jig their foot it's the same thing yeah and I do it with my thoracic so I know that I can yeah you go like that and you turn and pop and turn and pop yeah without relief what you really need is to deal with the ones above and below that aren't moving you just keep doing the ones that are yeah what do GPs know about hypermobility? not much okay there is now a sort of working pack that they're working Jess has actually produced one which is sort of education we really give GPs a hard time.

1:03:05I've worked with them. They're amazing people. Okay. And they get it. They just got seven minutes to assess you. You can't do that. You can't do an ADD patient. You've got to know about their history, their childhood. What could have traumatized them? Why have they ended up where they are now? That's a story. You can't do it in seven minutes. I'm sort of interested by the fact that we don't really want to look at hypermobility until at least seven years old. Yeah, you can probably see. I mean, look, I could see early signs of autism in six-month-olds. Okay. Because what I saw very quickly, I always check this, by the way.

1:03:37I go to my very eminent colleagues, like I had a PTA issue, and I said, John, I've noticed these kids who I think are autistic, they don't point. And that hadn't been, that was back in 2004. And he said, that's a really good way because they can't, pointing is an expression of desire, so they're making that integrated process. Children didn't go, ah, ah, ah, they just didn't do it. And that, nine times out of ten, and they went on to have autistic traits. Yeah, interesting. So I think you can see it in the neural development. Yes. But I think also, the other thing with hypermobility, which is really important, is understanding neurodevelopment, which is not taught well here.

1:04:12Crawling is massively important. Massive. And interestingly, I was also trained during the cot death era. Okay. And it was all very tragic. But I think we miscorrelated a whole load of contributory, one of which was tummy sleeping. They said, don't let them get hot. Don't sit right. So babies want to sleep on the tummy, and it's part of the thing. They hug up and they sit in there. And then the reason is, as they lift their head to turn it to breathe, they strengthen their neck muscles. Then the upper body opens up. So then they go up into a two-point gait. Then they realize if I woggle my legs, I can actually get somewhere.

1:04:41I can orientate myself in the world. Oh, I can grab that and sensory. They're constantly twitching. It's like also swaddling babies. Why would you ever do that? Why would you wrap them up? You're just limiting their development. So they need to be on their tummies. We stop that. So what we found was they weren't developing the extension phase. they were always keeping their, what we call their flexion postures. And you see it, people sitting at desk all day, they stand up and they walk a little bit like a six-month child with a belly, you know, like a sort of orangutan walk, because they've just lost all that, they've gone back into that.

1:05:11What is good exercise for hypermobile people? Things that get you extending and standing up and stretching. Okay. So movement stuff. So I'm not anti-all yoga, but sort of the Iyengas and the way you're posturally holding, fantastic. I like bar core, for example. If you could do a kind of mix of those, I mean, I'm actually working on that moment is to produce a class that actually kind of integrates all of those good things. What would you like to see happen next where hypermobility is concerned? I've done it once in two private prep schools. We did a thing called Move to Think. And what it was, and I realized they got rid of PE classes.

1:05:44So are these schools really more performing? They're just working harder. So what we did is we got rid of prayers in the morning. And we replaced it with an interesting group of gross motor movements. So kind of yogic. So they were a bit like Tai Chi. We had to have silence. They had to go quiet. because they all come in raged up, mum and dad are late, we're all coming, ah, wah, wah, wah, calm them down. They do the breathing and then they go down to what we call fine motor skill tracking. So they're focused, so it's a multi-complex movement they have to concentrate on. And the teachers said within a week these kids were calm, all of them, and particularly the ADD kids.

1:06:15And we also allowed them to go out and do various bits of exercise so that they could go off and they could just go and just go and move. You know, 40 minutes is way too long for a child. They cannot operate at an optimum level. And if you make the education supremely boring, which is what it is. There's no passion in it. You know, we all remember Mr. Chips, don't we? Remember, we all remember those teachers who just grabbed us in history. Instead of teaching us dates, they were there with us with the Spartans on the plains and ripping heads off and killing each other. And it's like, yeah, I remember that.

1:06:40You know, all of that. So I would go into education system, send in an occupational therapist into each year, the beginning of the year, and they just go through the whole year and do a bait in the school. And if any of them consistently flag up, then you say to the parents, look, no big deal. This is just quite likely because it highly correlates with dyscalculia, dyslexia, et cetera. all the disses. And not saying that we can eradicate them, but we can dramatically improve them. Because at the heart of all cognitive function is movement, not the other way. We were designed to move, not to think.

1:07:09Remember that, right? So all my traders, in the 80s, they'd be out there in the trading floor, screaming at each other in the pit, right? It was adversarial. And whether they were losing or winning, they were just manifesting. Now they sit at a computer, lose 20 million quid and go, you know, and internally they're in rage, you know. But they're not moving. Very occasionally they will throw something across the room. they'll throw a keyboard across the room. They just can't manage it anymore. That's not healthy. No. Summarizing a lot of what you said, the irony that I'm taking out is there is this thing called hypermobility, which sort of simplistically means moving more.

1:07:42Yeah. And the irony is that we're not moving more. We're moving less. And the way to help... Movement for us is a recheck. Yeah. When you just cross your leg, my brain, without realizing, my brain's just going, where am I? Okay. Because we're slipping a bit, yeah? Yeah. judging you because your bum's feeling sore, right? Because your soft tissues are moving over your bones and they're uncomfortable, right? Because everything's just a bit squidgy, right? The stiffness in there. So you move and it's more comfortable. That's okay. And it should be calm. Yeah. Okay, I'm calmer. But if your body's constantly wanting to move, right?

1:08:11Well, so is your brain because you're saying move, not concentrate. Yes. Map the world and move. Where can hypermobility go in terms of serious, bad, damaging, dangerous? Well, like neurodiversity, there's a spectrum. And there are some more unpleasant conditions, one called Marfan syndrome and Ehlers-Danlos, which again is still in that kind of bedding in settling of how many different types are there, et cetera. I mean, I can tell somebody's Ehlers-Danlos again. And again, they just have this incredibly soft skin. You can see it. They look plump, just marshmallows. And again, they're really struggling and they're doing it.

1:08:46And of course, if you're uncomfortable, right, you're not going to attend. So even when you're explaining to them, they're really kind of, they're losing you. And they start moving. So as soon as they start moving, I'll make it more dynamic. I'll say, let's examine you now. And we'll get them moving. And then we'll just carry on explaining. So you read them and you play with it. And it's a bit like magic. You know, you're just constantly going with it. But they suffer because they really are very unrigid. Marfin. Yeah. Marfins is tall, spiky people. So they tend to be very long. I'm definitely a bit Marfin.

1:09:12I've got gorilla arms, 38-inch sleeves, you know, should be walking my knuckles. But they have high palates, they have various things. So that's a slightly different subtype. Okay. But they tend to be kind of tall, spiky, long. They have a particular fechias, as we call it, a particular distribution in their face. And then Ehlers. And then Ehlers-Danlos is softness. You know, they're kind of normal looking people, but they will get their finger to the back of their thumb. Okay. You know, and then go round this way. And so where do contortions... The other one is getting your thumb across there.

1:09:40Most people can't go across the side, but they'll go way past onto this. Yeah. Where do contortionists sit within this thing? Oh, hypermobile. And of course, then they're beasted further by their mums. They're stretched, whatever, so they can get through a tennis racket. but actually and dancers I mean I look after a lot of ballets oh I mean almost all my ballet ballet dancers are hypermobile that's why they move they find dancing they're creative it comes with high trait openness so we're creative we see goodness in the world we're nice people we're empathic I give you a magic wand yeah what do you do with it right gosh first time he's been silent on an answer I know you stumped me a magic wand I would wave a magic wand of innovation in medicine okay Can I have it as a jewel wand?

1:10:22I would have the innovation in medicine and I would have a healthy, a magic inhibition of biopharma who are now doing bad things. I never used to say that, but they're just, it's this constant medicalization of problems rather than just actually teaching people that they can do things to save their lives and do things better. What percentage of your work with your clients is physical versus education? Now it will be a 70-30 split. It'll be kind of a psychoneurological orthopedic conversation of explanation. And you've got to adapt to the patient. Because some people to accept they're hypermobile or that there is a kind of psychological element to it is really hard.

1:11:05And you've got to do that without making out they're malingering or that they're mad or whatever. And actually on that point, I've got some of you who have been out of work for a year, chronic pain, blah, blah, and they're doing brilliantly, but they just won't quite go back to work. And it's not because they're shirking. it's because there's shame because for somebody to go back to work and say it ended up it was all in my head is really hard so I give them the out I say no no you just tell them it was a nervous system disorder okay okay and then I go oh wow okay so it was something proper yeah move on wow so it's the shame of saying it wasn't a broken leg yes it wasn't a paralyzed foot yes it wasn't it was because of serious that I really don't want to deeply personally I don't want to explain and and you can't see it you can't see it and say yeah no I'm amazing I've met this guy he's told me it's quite an unusual problem and it's a nervous system disorder it's quite complex and they go oh fine okay and then they move on yeah done so last question we have our green badges we are a charity people can buy badges from our website and it's great to see because it's starting to become this very simple symbol that hasn't got lots of words on it I like it I've got a very proud of mine I'll be wearing it all day yeah good support for neurodiversity whether you're neurodivergent or not.

1:12:19You have one on. This is your second one. Who would you like to give this to? It's a really good question. I think, having talked about him, I think John Cleese. Okay. I think, because he gave me a lot of joy. I enjoyed Fawlty Towers. It's probably generational. It's probably not funny anymore. And actually, when you hear him being interviewed, he's very wise about the world. And I think Python, some of it wasn't funny at all, but there were some genius moments. He's clearly hypermobile. He might even be marfanoid if you look at him. But the silly walks, the ministry of silly walks is, I still think, one of the best sketches.

1:12:48And he couldn't do that if he wasn't hypermobile. I think he is probably one of the definitions of bendy body, bendy brain. Exactly. And I think he's also been, as we know, he's been on a terrific journey, psychoneurologically. He had tough because we didn't diagnose it then. Yeah. And they were different. They came down from the footlights of Cambridge and they were all a bit wacky and crazy, but there was a genius there. So I'd probably give it to him as a really good representation of what we're talking about, but also for a poor generation who didn't get understood. That's a great one. It's my mother's hero, so she'll be very happy.

1:13:20Thanks, Nick. Like, you've got a brilliant brain. And... I genuinely, it's just I love people. I can't see anything more interesting than people. What is more interesting than people? Yeah. Well, thank you for assessing me as well. That is... My absolute pleasure. I hope it hasn't been too much of a curveball. No, well, it has, but yeah, in a... Maybe you could learn to do the Ministry of Silly Walks. It'd be good. Come on doing it. you know don't tempt the guys in the control room for the dead parrot sketch yeah it's one of my favourite no absolute pleasure thank you for having me and this is honestly it's great work you're doing because this is what people need and we need to be talking to everybody and sharing it so thank you for your work thank you

1:14:05that's it for today's episode of the hidden 20 % but just before you go a favour the hidden 20 % is a charity and we do this to bring you the truth, the latest research and the real stories that matter. So if this episode spoke to you, then please hit subscribe. And if you can, donate via the link below. Finally, a big shout out to you all for listening and our brilliant team who make this all happen. Phoebe, Charlie, Kristen, James, John and the guys at TYX Studios. We'll see you next time.

1:14:46Thank you.