Why Your Body Gets Stuck in Pain & How Movement Heals Faster - With Dr. Tom Walters

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28:47The lemonade salt is incredible, especially if you're doing anything where you're sweating a lot, that lemonade salt, it's different. So again, head over there, check them out. Drinklmnt.com forward slash model. And now back to the show. So let's, this is a great segue. Let's talk about the biopsychosocial model of pain, because again, specifically, let's use this sprained ankle example. Again, six months later, there's no recognizable tissue damage, but they've had this experience. Maybe when that sprained ankle happened, it really messed with their sense of identity and safety. And maybe they had a lot going on in their life.

29:29and again this is six months later everything's going great but there's this pathway that's been created that when it happened it enabled them to just shut things down they had they were forced to shut down and now maybe something's going on in their life and they have this pain pathway that's been kind of established and inflamed at one time and now it's activated again seemingly out of nowhere yeah the biopsychosocial model is so great because that's really where we transition from that old biomedical model, like all about the physical body to this more comprehensive model that really looks at the whole person.

30:02So you've got the bio, which are the tissues, and then you've got psychosocial because we know that your psychology, your thoughts, beliefs, and emotions really tie into your pain experience. And then your social support is huge, like social support, having a social network of supportive people is another big aspect and just overall health, but also your pain system. And so yeah, that person, like maybe they had an ankle sprain and it healed and they still from time to time, um, it flares up and they don't have a real good reason for explaining. It's like, it doesn't have a good mechanical explanation.

30:34It just kind of flares up out of the blue, which you see this in some people. I mean, there are chronic pain conditions after injuries, traumatic injuries like this. Some people after surgery will develop these chronic pain conditions. And so you're, you're really looking at, um, that whole kind of biopsychosocial model and you're thinking about, well, what's causing, like you said, you've got this new pathway that's, that's, that you, you know, there's a pathway that sends those messages up from your ankle and then your brain sends these, this pain output back down. So it's this two-way kind of loop.

31:07And so once a loop like that, you know, we have loops like that all over our body that just happen normally, right? It's a part of, it's a normal part of survival. Like you want to have these pain loops, but sometimes the pain loop, if you fire it a lot, it can become easier to fire it. We'll often say there's this saying that neurons that fire together wire together. And so if you fire a particular neural loop a lot, it takes a lower level stimulus to fire it again. And so just like you said, maybe that person, when they first injured their ankle, maybe they had a bunch of stress, like maybe it was a stressful period in their life, stressful work, maybe the relationship with their partner, like whatever it was, or maybe they had a bunch of fear come in, like maybe they were a basketball player and you need your ankle to function at 100 % to do your job or you, there's so many bad things that could happen.

32:00So fear could be one. So then all of these things can come in that can tell your nervous system, this is really scary and bad and we really need to protect this area. So then it's even easier to fire that pain loop again. And so that's where people can kind of sometimes get stuck into these pain loops. I often think, I keep going back to mental health, but it's kind of like people have had panic attacks. Like you can imagine, say you're scared of flying and you get panic attacks and you fly. Some, so oftentimes people can recall a specific time when they had their first panic attack. And like, it's like, once they, once that thing starts and they have that kind of panic attack wiring there, they'll often be kind of scared of it.

32:40They're scared of flying. And then sometimes if they just even think about flying, they fire that thing and can have a panic attack again. So chronic pain is a lot like that. You can have people with back pain who can literally just, there's actually studies on this where people with chronic back pain, one of the first things you do if they're really, really sensitive and flared up is that you just have them think about things that would make their back hurt because that fires a lot of the same neurons. They're not even moving. They're just thinking about doing a movement that would hurt. And that's like the first step.

33:07That would sound like spooky, right? That you can just think of a thing and it changes what your nervous system is doing, but it's so obvious. It's so obvious. And we've had so many scientists over the years saying how the brain can't distinguish between what is real and what is perceived, you know, your thoughts about a thing. And so we're instantly changing our chemistry in sometimes very significant ways based on our perception of things, not to mention what's happening with our, you know, sympathetic nervous system and this kind of fight or flight and that whole cascade of things that can happen with cortisol and adrenaline and all this stuff.

33:44And it's remembering that our bodies and our brain's primary function is survival, right? It's wired up to keep us safe and constantly perceiving what is going to be harmful for us and creating systems for us to withdraw and to hide out if need be, you know, based on a perception. And so what's really important to understand also is that, you know, you mentioning the tie in with mental health. If we're talking about pain, the same parts of the brain are responding to psychological threats as physical pain. Right. So we got the same parts of the brain that are lighting up based on maybe it's, you know, guilt or sadness.

34:33and we see the same kind of parts of the brain lighting up when we get a physical injury as well and so like just to think of how these things can tie together is just i'm i'm i'm kind of disappointed that it's taken us this long to really normalize this conversation but then again you know we had a certain era and again not to say that this was on purpose it kind of was a little bit stacklers and all that. But it's really been geared towards, and there was this war on pain, right? And geared towards, you know, these kinds of invasive treatments, or even, you know, in the case of the opioid epidemic, very dangerous drugs to try to treat these symptoms, which again, doesn't actually resolve 99 % of the time what the actual problem is.

35:18And what people found was that, you know, this opioid isn't just, for example, helping with this physical injury, it's helping with my emotional pain as well. And that can be really the sticking point for addiction. Totally. And I think the kind of cool things about a cool thing about like the opioid kind of conversation is I don't think a lot of people realize that your brain literally makes opioids, you know, and when you start taking those exogenously from the outside, your brain stops making something. And you see people where when they're on the opioids, their pain, maybe it helps it for a little while, but then they often become more sensitive over time as their nervous system stops producing those molecules.

35:53So it is a really dangerous situation. I think what you said there was so great, like the sympathetic and parasympathetic nervous systems. I just think there's so many people who pain can be confusing and hard to navigate when you don't know all this information. That's why podcasts like this are so great, because I think if people can go in and think even just at a base level, like, okay, I just got injured. It's really obvious. And now I have pain, like I sprained my ankle. You know, there are things like that that are way more straightforward. You can kind of tie it to something you got in a car accident or you were dead lifting in the gym and now your back hurts or you know i mean you can find things like you have those kind of really more straightforward mechanical pains they still have all the other factors from the biopsychosocial model but they lean more towards the fish the tissue part and then you can kind of think about these other types of pains that don't have that clear-cut kind of mechanical pattern where sometimes the best thing is thinking more about sympathetic and parasympathic nervous system because your pain system is all about survival and your, your nervous system is going to want to output more pain if it thinks you're in danger or you're threatened.

36:55So sometimes the best thing honestly is like just trying to tap into parasympathetic, like just chill, like try to chill, like do some meditation, like do box breathing, like go for a walk. Like sometimes those are way better than like some specific physical therapy exercise I'm going to give someone. So it really is at a base level. You just, you hope that everyone will listen to this and understand that pain involves so many of these other lifestyle factors that you can start working on right now. Like just try to help your nervous system calm down. And I think in the Western world, everyone's so ramped up.

37:30Like everybody's just on high alert. You drive down the freeway and it is obvious how many people are in sympathetic states. So it just, I think it's a good reminder for everyone, like at a very action first step, just try to find some strategies that for everyone, And even if you don't have chronic pain, just try to get yourself, try to encourage some of that parasympathetic kind of, we call it rest and digest. You know, it's when you're resting and digesting, like try to just kind of find some opportunities to chill and tell your nervous system it's okay. Yeah. And this is another point that you've been teaching about as well.

38:00This missing link between recovery and self-efficacy. Because you just mentioned you can give somebody these therapy exercises or do manual manipulations. But sometimes just going for that walk can be incredibly healing for them. And so you're really advocating for your patients to really understand their condition so that they can be a co-participant or even a driver of their healing. Yeah, you want it to be a collaboration for sure. You know, you don't want the worst is when people I've literally had patients say this to me and then it requires a bunch of education. But they come in and I'll start telling them about what's going on and they'll say, I don't care, just fix me.

38:36And I was like the last like you is so important in rehab and when you're treating pain to take an active approach. You know, you have to participate in it as the person suffering from the pain. You might get temporary relief from somebody working on you. You go get a massage or the chiropractor adjusts you or a physical therapist does some kind of hands on work. Those interventions can be helpful. But if you look at the research, they tend to be temporary. And the pain usually comes back. Like if the person doesn't incorporate some active things on their own. And so you, that self, self-efficacy is basically teaching people in a way so that they feel empowered, that they can manage their own condition, right?

39:17Like you, you don't want the person to feel like they have to be dependent on your interventions as a practitioner. Like if you, this was one of the reasons I actually got started on social media in the beginning is that I was so frustrated when patients would come to me and they were told by their practitioners that they would only get better if they kept coming back at certain intervals. That was so frustrating to me because it's not what the research supports. And you're just locking the person into dependency. I mean, I think about when I had that social anxiety, imagine if I had gone to a psychologist, it was like, you can only get better by seeing me and you have to come here once a week.

39:49And that's your only hope. Like that would be, that would just deflate you. You know, if you felt like you had no control, what if that happens if that person was on vacation or something, you know, like, totally. So, and it's just not what the research supports. So people get better when they feel like it's a collaboration and they feel like they have some hope and they feel empowered and they have things they can do on their own outside of the treatment session. So for a lot of pain conditions, it is movement based things. It's, you know, exercise, movement. It could be the aerobic exercise.

40:21It could be just working on your sleep hygiene. It could be trying to clean up your diet. It could be meeting with another practitioner. Like maybe you meet with a counselor or a psychologist and work on mental health kind of struggles that are maybe a part of your pain experience. But there, I think maybe the hope, maybe the part that gives people some hope in all this discussion is that most of the things that lead to long term resolution and pain are things you can do on your own. Well, this is a good, this is a good point to start talking about actually getting better. so if you could let's talk about using graded movement to rewire pain and to heal better and if you could i want to talk about again progressive exposure but let's use a certain example so maybe let's say somebody had a prior disc injury but you know they recovered and they're doing their thing this is a couple years later maybe they have an onset of some sciatic pain but maybe it's only bothering them maybe just when they sit or maybe just when they uh stand up from sitting they get a little something but they don't have pain when they are we'll say doing isometric exercises or um you know doing exercise in the pool whatever the case might be but yet they're afraid to do those things would this be a case where we would introduce those uh inputs if they're, if they feel safe doing them, if they feel, if they're not causing pain, or do you just completely avoid?

41:58Yeah, no, you wouldn't, you definitely wouldn't completely avoid. And I think that's a way area where we've shifted, you know, and how we think about managing pain, someone like that, you know, you would, you're kind of looking at like, if the person has some goals of participating in some kind of exercise, like they want to do some exercise in the pool or they want to, um, maybe there's somebody with, they've had that past disc herniation and maybe they like cycling. Like, okay, so say this, this could tie together. So say they like cycling and they also sit at a desk. And you said it kind of gets triggered when they sit at a desk.

42:31Both of those are flexion positions, right? You're, their symptoms are being exacerbated by being in a prolonged seated position, which we know from a biomechanical standpoint, if you're looking at that way, it puts the spine in flexion, it puts their hip in flexion. maybe it has nothing to do with their biomechanics. That's the thing, right? Like it could be that you'll hear some people where they say my back pain only comes on at work when I'm sitting, but not when I sit on the couch at home and I'm watching shows. So then you have to start thinking about the biopsychosocial stress, all those other factors.

42:59So you can't neglect those. You're always thinking about them, but say you, it comes down to, it seems like it's really related to their position and, um, you know, their spine kind of being in that position for long periods. you for sure, like if you find things that trigger them, say they're like, okay, I really like cycling and they want to do that. But when I do it for a certain amount of time or this intensity, it triggers my back pain again. And you know, they didn't have some injury that you couldn't, you could do an MRI on them and there wouldn't be some new physical injury. It'd be very unlikely because they didn't have a trauma or like most physical injuries require high force.

43:34Like you have to fall or get hit or something happens. So, you know, in that case, you're really thinking more about their nervous system, thinking there's a threat and deciding it's appropriate to output pain. So you're trying to figure out how can I expose them to this stressor, but in graded doses so that we can allow their system to tolerate it better. You're trying to make the system less sensitive. So that's kind of the idea. It's that dimmer switch again. You're kind of trying to turn the dimmer switch down. So you might take that person and maybe you just have them, maybe one of the easiest things initially is you have them say they want to get into cycling, maybe they try that activity, but it's just in small time doses.

44:13Like they, a lot of times people don't know how long they can tolerate something. So you're just like, okay, let's just start with five minutes and see how that goes. And then you ramp up your time. Um, you could ramp up the intensity of it in different ways. Like maybe they're riding on flat surfaces and then they go to Hills, something like that. You also could look at it from kind of a biomechanical standpoint. A lot of people with low back injuries are flexion sensitive where it tends to bother them when their back is rounded. So sitting, bending forward to like do a deadlift, something like that.

44:42And so if they get it when they're sitting at work, probably one of the first things I would try to tell people to do is like have little movement snacks and get up and just move around. You know, that's such a huge part initially with a lot of people is just introducing more movement to their day. But then after that, you might try to expose their system to flexion in different ways. Like you might look at, okay, well, their spine has to tolerate flexion when they're sitting for long periods. Maybe I need to introduce some flexion to their hip joints. We know they need some flexion in their hip to be able to sit.

45:13Maybe they've got a restriction there, or I could work on improving mobility in their hip. And maybe that takes some stress off their spine. And that's kind of more of a biomechanical explanation, but you can start introducing, you could kind of take a movement. Like if you have a movement you're sensitive to, you could break it down into component parts at each joint and figure out like, are there things I could do at this joint that kind of expose me to a piece of that movement? And that allows my system to gradually be exposed to it and desensitize over time, if that makes sense. Yeah. So just to kind of just summarize it a tiny bit.

45:49So of course, finding spaces to do the things that we are in. And I love that you started off with knowing what our goal is, where we are pain-free. And I would imagine, again, if there's like little bits of pain, it's okay as long as there isn't like something that's like a big alarm system goes off. And I think that that's that grace period too of understanding your body, knowing your condition, you know, yourself being educated about it. And knowing whether like this is okay, I'm okay. and it's just my brain is firing this signal, but I'm safe. And just easing into that a little bit as well.

46:28Is that? That's so true. I love everything you said there. There's so much self-awareness that goes into this. You know, you're kind of, you're monitoring all those different aspects and just like you said, when people are going through treating pain, very rarely does pain just kind of keep getting better in like a linear fashion. People have flare-ups. We call them flare-ups all the time. Like you just have setbacks. It happens all the time when you're treating pain, especially if you're treating chronic pain, you know, it just, and it can be unpredictable sometimes, but I think that mantra you laid out there of I'm safe.

46:59This is okay. It's just, you know, my nervous system is feeling a bit threatened, very unlikely that there's any damage in my body. I just need to respect it. It might just mean you back off for a little bit for a day and let it kind of simmer back down. And then you just get back on and you go back to that kind of process of gradually exposing the system to those stressors. And I think you also have to give yourself some grace too. If you wake up one day and you didn't sleep well and you're noticing you have more pain, well, that might not be the day to try and test the system more. Like you just, it's okay to like have days where, now it doesn't mean you're just totally bedridden and you don't move.

47:34You try to still find some ways to keep moving. So we know that's really helpful for the pain system, but maybe you aren't doing those really specific things that are more likely to be provocative and kind of trigger your symptoms. You're not trying to push that barrier. You might just be like, oh, okay, maybe today I didn't sleep as well. I feel a little bit more just flared up in general. I'm just going to find something that I can do that tends to feel good to me. It might be like, I often have patients wear aquatic, kind of exercise, like gentle aquatic exercise, like walking in the pool, just going for a walk outside.

48:02Oftentimes things like that are, you know, really helpful to people for just kind of keeping the system moving, but not in a way that, you know, kind of pushes up against that barrier and re-triggers the whole system again. You know, you mentioned flexion in relationship to the sciatic pain or back pain in general. And you were showing my team actually when I came in today a nerve flossing technique. Can you talk about that a little bit? Yeah, that's such a useful one for a lot of people, whether they have chronic back pain, have sciatica, have a new flare up of back pain, or you get back pain from sitting a lot.

48:38But yeah, we were talking about, he was mentioning that when he bends his neck forward, he gets this kind of tension that goes down his spine kind of in below his shoulder blades, kind of in that thoracic region, the mid back. And the crazy thing about the nervous system is all this continuous network. And there's a lot of cool studies where we take cadavers, people who have died and donate their bodies to science. And you can, there's studies where we put pins in the different nerves. And you can see that when you move the person's body, our nerves actually have to kind of slide. and so like if you imagine the sciatic nerve you know it's coming out of your low back all these nerve roots come out of your low back they go down kind of through the buttock region between the hamstrings to the back of the knee and then they branch and so you can move the person's body in a certain way you can kind of alternate between moving their leg and ankle to moving their head and neck and you can work on that nerve mobility and so we call it flossing because it's kind of like flossing your teeth where you're sliding the floss back and forth and I think a lot of people hear this and they think it's really woo woo, but it really is based on cadaver studies.

49:39And you see it really help desensitize a lot of people. It could be people who have like straightforward nerve pain, like they have sciatica. It could also be people who just have general pain, like low back pain. And you can do these, you can implement these nerve glides, these nerve mobilizations, and it will help to desensitize their pain. It basically, it kind of goes back to blood flow, like we talked about before. They've shown in carpal tunnel studies that when people do nerve mobilizations for their median nerve, which goes to their carpal tunnel, it improves blood delivery to the median nerve.

50:07And so that's one of the, you know, physiologically, that's one of the ways that can help desensitize pain. So we've got these nerve mobilizations for all the major peripheral nerves that go into our arms and legs. And I cover this a lot online because they help a lot of people reduce pain. You do have to be careful with them because it's a nerve. And if you make a nerve angry, it can suck. So you do have to be careful with it, but they're, they're really cool techniques. They're kind of cool exercises that not a lot of people know about. Can you describe it? We'll put up a video for everybody's watching the video version.

50:37We'll put up a video of you demonstrating this. Can you just describe the nerve flossing in this context? Because again, flexion, again, that's something that you would probably try to want to avoid or your body's going to have this kind of alarm go off. Yep. And it's so great for this because we were talking about how can you expose your system to flexion, but kind of be working on it. And so the one we were looking at is a good one for this. It's called the slump position. And so basically, if you're you have to be sitting, so like you could do the sitting at your desk, maybe driving if you're safe.

51:05But what you do is you're sitting and you kind of slouch forward. So the person would round their spine and kind of round their shoulders kind of like that slouch position we are told not to do, but you're going to slouch forward. And then you would straighten one leg, so you'd straighten your knee, extend your knee. And then what you can do to kind of feel tension on your nervous system, because some people don't know what nerve tension feels like what you can do first is you kind of pull your ankle back into dorsiflexion and you put your head down at the same time, like chin to chest. And when you do that, your spine's rounded, you're bringing your chin to your chest and you pull your ankle back.

51:37You'll feel a lot of times people will say they feel like what they think is like a hamstring stretch, but the way you can see that it's nerve is if you keep your head down and then point your ankle, if your hamstring stretch goes away, your hamstrings don't attach to your ankle. So if that sensation changes, the only thing you're doing is changing neural tension. You know, if my hamstrings attached to my ankle, then of course that would change how my hamstrings feel. But that's a kind of a cool way for people to see what a nerve feels like versus a muscle. And then what you do is to mobilize the nerve, you alternate between putting tension on the upper end of the nerve and then the bottom end of the nerve.

52:10So what we do is we take people, if they're in that position, they've got their knee straight, they're slouching forward. When they pull their ankle back into dorsiflexion, they'll look up. They lift their chin up. So what that does is it puts the nerve on tension at the ankle, but it puts it on slack at the neck so that's helping to pull it towards the foot and then you alternate so you point your ankle and then put your chin down your chest that pulls the nerve proximally back up towards the up towards the neck and so then you just have people alternate back and forth like that and that's called a nerve flossing mobilization you're just basically you're trying to think about tugging the nerve towards the foot and then back up towards the neck and that sliding movement can help with mobility the nerve but also can help with bringing blood flow into the nerve.

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55:15Head over to paleovalley.com forward slash model right now for 15 % off. That's P-A-L-E-O-V-A-L-L-E-Y.com forward slash model for 15 % off store wide. And now back to the show. So just to recap as well with the graded movements to rewire pain and heal better, we talked about basically stepwise loading to help to reduce sensitivity, right? So that's one of the things we're getting our brain, because this is the thing, again, just to reiterate this point, your brain is deciding to deliver that pain. It's a decision, you know? And again, it's wildly unconscious, but it's trying to protect us. And so it's just helping as we can stepwise to reduce sensitivity, to let our brains know that it's okay.

56:06You can trust me. I know I did some stuff, but you could trust me. That's where mobility exercises are so huge. Cause you can just do simple low load mobility exercises. That's the best thing to start with for anyone with pain is just easy. Like we were even talking about that, that kind of back pain example, like the cat cow exercise. You can just do like a little cat cow. If you've had an ankle sprain, you can just kind of do like an ankle pump and just move it back and forth. Like it doesn't have to be, you don't want like a high load, stressful thing right away. You're just trying to find simple, easy mobility exercises.

56:33And that not only does it help with blood flow and mobility, but it also helps tell your nervous system, this is okay. Like I'm moving this again. It's okay. Yeah. And then we build the tissue capacity over time, just adding in a little bit at a time. So I want to take a step back really quickly because with this bio psychosocial model, that social piece, this can lead into an awareness of our pain symptoms, or you used this term earlier, pain recipe, that could be, again, we might not even have like a mechanical or tissue damage, but still have an experience of pain due to, and we've got a lot of data on this now, these ACEs, right?

57:15and adverse childhood experiences, for example, and being far more prone to, and this isn't just what we would call like a tissue damage from a physical therapy perspective, but this could be fibromyalgia, this could be migraines, this could be irritable bowel syndrome, but this could also be like a, what we would see a physical therapist for types of pain as well, back pain, neck pain, you know uh shoulder pain whatever the case might be and it's instigated by things in our social dynamics what how again how is that possible yeah it's so true i mean like you said a lot of times people won't think about those as necessarily um physical therapy some of them won't necessarily think about them as conditions you go to physical therapy for hopefully this changes over time because i think physical therapists who are caught up on this information really can act as sort of pain coaches and there's a huge part of therapy in physical therapy you know right like it's such a huge part like that collaboration rapport you build people just listening to them helping validate their symptoms build self-efficacy give them hope i think that's a huge part of treating pain and you know if you talk to pain psychologists emotional pain and physical pain are processed in a lot of the same regions in the brain just like you and i are talking about like they really are kind of similar in a lot of ways and a lot of people have had trauma early in childhood or have PTSD from other events, like those individuals often are more prone to developing chronic pain conditions.

58:47And so within that biopsychosocial model, it is so important for people who, especially anyone who has pain, but especially people who have chronic pain, what we see is they over time become more isolated. And then you get into these downward spirals where you become, they socially withdraw, they become depressed. The depression amplifies the pain system. So, and they all kind of feed on each other. So there is a huge component when treating chronic pain where you're trying to help people kind of find social situations that they can integrate back into again. And this is where like sometimes pain communities can be really helpful, like chronic pain communities, whether it's online or in person, because then you can talk to other people who can empathize and kind of understand what's going on.

59:32And I think a lot of people with chronic pain feel like after a while that their healthcare practitioners and friends get kind of tired of them. They don't believe it's real, that there's some is really, maybe they're making it up for some gain. So it can be, you can see why they would naturally kind of withdraw. So, but that is such a big part of the healing process, right? Even when we think about like longevity studies, like how important, like socialization, having good social connections is so important. maybe you could argue it's one of the most important things for your overall health but i think in in the pain world you definitely see that people withdraw when they have chronic pain and that leads to poor mental health and more pain symptoms so we want to find ways to get them into communities where they can kind of integrate and feel safe and maybe that is like a pain community initially so um it's a huge piece there's a huge piece there's even studies showing that like people who have chronic pain laugh less.

1:00:27And so that could be a huge, I think that's a big part of socialization is just laughing with people. Like sometimes that, it just, I think it's another, it's another action that kind of tells your system that we aren't so threatened. Like if you can laugh a little bit, they've even got studies showing that if people just look at, have joke books and just read jokes and kind of, it lifts their spirit a little and their pain will be less. So, but I think that is a piece that kind of comes maybe with like the social piece and socialization. That's great. Thank you for sharing that. Again, we've got so many tools at our disposal, but because of that, and this is one of the things we kind of kicked off the episode talking about this pain avoidance cycle and just this kind of pain, depression, avoidance, like we can start to just create this very vicious cycle that we get trapped in and we can remove ourselves or even start to dim the light on all of the access and resources we do have.

1:01:25Because that can be another thing. When you talk about training in a pool, for example, you know, the environment that I was in, like I didn't have pool access, you know what I mean? But there's so many other things that I can do. And one of those things is just being able to just simply walk, you know, going for a walk, being in nature, there's parks that were, You know, driving distance away, very close proximity. Meditation is incredibly valuable, especially today with so many nervous systems, stimulants and insults going on, right? So having that tool at our disposal and practicing that and then community, especially.

1:02:01I mean, this is so, this is a vital part. This is one of the most powerful epigenetic controllers, right? And then giving our genes, our DNA, enriching experiences. Like we've got some really fascinating, we'll put the study up for everybody. My studies as of now, but this is also seen in humans as well. But basically being born with abnormalities with gene expression and kind of a hypersensitivity or disease state due to trauma experienced with the generation before with the parents. All right. And then the mice being born and having these mutations or alterations, let's put it like that, alterations, providing them enriching experiences helps not only that life experience for that mouse, but then the offspring of that mouse improves.

1:02:56It basically can change things within a lifetime. And so the person who shared this with me, by the way, is my really good friend. and she's a neuroscientist at NYU, Dr. Wendy Suzuki. And she's done a lot of research and done studies around aerobic exercise specifically, and healing and neurological health and all this good stuff. And so what are those enriching things you can do? So simply, we brought a big daddy earlier, like watching funny movies and things that maybe create a feeling of life is good and maybe nostalgia, but it's just trying to retrain your brain and your nervous system to know that you are okay.

1:03:32one of my favorite sentiments, and even I forget this, man, like is so transformative and powerful for me. But it was a statement from Albert Einstein that essentially the most important decision that we make is whether we live in a friendly or a hostile universe. It's the most important fundamental decision we make as a human being. He's a pretty smart guy, right? But just like remembering that, you know, like I live in a friendly universe. Life is for me, not against me. because it could seem when you're in pain, it's just like, it can absolutely seem the opposite. So just trying to find that bit of light and helping that to grow, grow the capacity, grow the exposure of it, stack conditions in your favor.

1:04:16Yeah, I love that. It's so true. Cause if you look at things from a, if you look at it as the universe sort of friendly versus what was the term you used? Hostile. Hostile. Like you're going to instantly, if you feel the things as hostile, you're going to feel defensive and threatened. And then your whole system, you're, you're, you're telling your system, we need to be on guard. And so just at a base level, that's such a great, for so many aspects of health, especially when you get into pain, that's such a great, if people can just, yeah, find some like enriching experiences, find that little bit of light, like you said, like find something that, or just try to practice.

1:04:54I think like, I know you talk about mindset a lot, but you can train your mindset. Like just when you wake up each day, like think about who's, who is the person that I want to show up as today. And can I look for like some light, some positive things? Like it's so easy. There's it's so, I think as humans, we survive by identifying, threatening, potentially harmful things. And so we focus on the negative and that's kind of how we got by. But you've also got to really be intentional about if you're not wired that way, I think we're all wired a little differently. And if you're someone who struggles with identifying the positives, you've got to maybe intentionally kind of just, you know, just have a practice where you think about identifying those.

1:05:36Because when you get into pain, it is so easy to get into that vicious cycle you talked about where it hurts. I don't want to be around other people or do anything. I'm depressed. And now it hurts more and everything seems negative. So you've got to find some ways where you can introduce kind of positive, uplifting things that give you some hope and get you excited about life that forget all these like specific physical therapy exercises, like at a base level, you've just got to try and do that for your system. And that's going to go a long way at a foundational level for helping you get out of pain.

1:06:12Yeah, this is when you know somebody's telling the truth, You know, because your expertise, which we're trained on, which we have books for programs is based on primarily these physical therapy exercises. And you're one of the most elevated elite people in your space. And for you to share, like you need this other stuff. So not even just as much, but even more in some aspects. but I also have these physical therapy exercises for you as well. And so for you, it's really, it's a both end world and providing people, because again, the tissue exposure, building capacity, helping to reduce the sensitivity, man, your book, by the way.

1:07:00So I went to a physical therapy session. I was taking somebody and I saw your book there. Like this is one of those things that's just popping up for a physical therapist all over the place as well as like a great kind of guided book for helping their patients. But this is something that we all have access to as well. So rehab science, you've recently actually broken it down for people because in the original book, which is beautiful, it's a beautiful book, there's the body parts are basically kind of separated into sections. And so for some people, like there's, there might be a lot of other stuff, but they just want to know about what about my back, back and spine.

1:07:37So now you have it broken up to where people can get the specific section of the book in another beautiful book, by the way, full color, all the things. So you have back and spine, you have shoulder, you have knee, you have ankle and foot, you have, and I just have a few of them sitting here, but you have basically all of the predominant places that people experience pain. What are the therapy exercises that can actually help you to feel better and to get back to doing the things that you love. Yeah, exactly. Yeah. It was like the big book is amazing for having a resource that gives you kind of the whole body.

1:08:10And like you said, a lot of practitioners find it to be really valuable in their practice. A lot of regular people have it too, but we definitely had people who were like, I just would like one book that's easy to carry. That's just knee programs or just ankle and foot. And so that was kind of the idea with creating these was to kind of take the trap, the body region chapters from the big book and just break them into smaller, more portable kind of books that are really the big book had a lot of pain and injury science. You know, the first 10 chapters were really all the science, a lot of what you and I have talked about today.

1:08:36These books, we kind of cut that out. It's just meant to just get to the protocols. So because a lot of times that's what people are looking for is they're looking for what are some exercises I can introduce right away on my own, because the truth is most physical therapy conditions can be managed on your own. If you give them time and you introduce mobility exercises and graded kind of resistance or strength exercises. Most conditions get better. You know, of course, it's not meant to replace somebody going to see someone. If you have something that doesn't get better or is getting worse. And the gold standard is seeing a practitioner who can actually evaluate you and prescribe specific, you know, exercises and interventions for your symptoms.

1:09:14But yeah, you can do so much on your own. So can you talk about some of these exercises? I've got the back and spine book opened up right here. So what's going on here? Yeah. So, um, and this, this is going to be probably in phase three. So the programs are broken into three phases and those exercises, there are resistance exercises. So phase three of every program focuses on resistance training. And so that one shows a lateral squat walk and a paloff press. And both of those are great. Um, you might kind of lump them into kind of core and trunk exercises, which are so important for a lot of people with low back pain.

1:09:47So lateral squat walk is one that challenges the glutes, especially the hip abductors, which helps support our pelvis and low back and then the pow off press is a kind of cool anti-rotation exercise where you've got a cable machine or a band and it's trying to rotate your spine so you're having to use those rotation muscles to kind of maintain your spine in neutral while doing a press movement so yeah it's kind of like it's like an isometric like people know planks a paloff press is kind of like a rotational isometric and so this isn't just about having a superficially strong or functional core.

1:10:20Yeah. Not all aesthetics. I mean, you're right with strengthening, you can work towards that. But yeah, it's more about, and I think I try not to use the term corrective when it comes to exercise. And you will hear that with a lot of people. I don't want people, exercises that are given physical therapy are not meant to correct something that's wrong with your body. It's really everything we've talked about here. It's about desensitizing the pain system and then gradually making the body more resilient. So we really, you know, most of the time when you go into physical therapy, physical therapists will take you through this kind of approach.

1:10:56And that's what I show in the book is starting out with kind of techniques that are for helping reduce pain, kind of dial that dimmer switch down a little bit. Then we work on restoring mobility and movement control. That's kind of phase two of a lot of programs. And then phase three is really the strength training where you're making the system more resilient. So even just at a base level, if people kind of think about that when they have pain or an injury, like calm the pain, restore mobility and control, and then build strength. If you just think about that as your base framework, that will take you a long ways for most injuries and pain issues.

1:11:27Amazing. So where can people get access to this new library of books? These are all with major bookstores. So usually Amazon and Barnes and Noble are the easiest. If people just search rehab science or search Tom Walters, they can go to my author page and you You can see all of these are now listed. You'll see each body region book and the main book, which is the big red one, so. I wanna ask you about one more thing before I let you go. You know, there's something, when we're thinking about, like you just mentioned, corrective exercises, you know, that term, which again, there's a context where that makes sense, but it's from corrective exercise to therapeutic exercise.

1:12:05And we don't have to be injured, by the way, or have be in pain to do a lot of these exercises. As a matter of fact, I would believe, again, just the name says it all, you know, with rehab science, it's also prehab as well. And so can you talk about the goal of rehab isn't to fix faulty movements, it's to build capacity, reduce sensitivity, the things that we've been talking about. Yeah, it's such a big one. And it's an area where we've shifted a lot. I mean, I was guilty 18 years ago when I started in PT, I thought a lot more about trying to correct people with specific because we were just very biomechanical in our way.

1:12:44We thought all pain and injury was kind of related to faulty biomechanics or faulty posture. And that stuff just hasn't stood up in the research over the last 20 years. So the problem with it is that people have to be careful because you go on social media, there are still lots of accounts out there that would lead you to believe that you have something wrong with your movement system, something faulty about your biomechanics. And then you need this specific exercise to fix that almost like you're a car, like your carburetor is bad. You got to go in and replace your carburetor. Like the body just isn't like that.

1:13:16The nervous system is just much more complex. It's, it really is, it really has shifted away from, because what happens is you see lots of people who have really what look like poor biomechanics who are some of the top performers in the world, right? Like one of the examples gets brought up all the time is if you look at some of the top marathoners we would have for a long time flat feet were kind of demonized like if you had flat feet overly pronated feet it's like oh that's really bad you've got to fix that you're gonna have all kinds of dysfunction there are some of the top marathoners in the world if you watch them run they pronate to where their arch goes all the way to the ground or they're just their their arch is flat all the time that's just how they live and they function at the top of their sport paralympic athletes think about how many biomechanical asymmetries and what would be kind of faults in Paralympic athletes there are and many of them have no pain Usain Bolt like you look at people who have like scoliosis and perform at the highest level so we've we really have to be careful with making people believe that we can look at their body and see something that's asymmetrical or doesn't fit in kind of the normal box and tell them that that's going to lead to dysfunction because it just isn't supported in the research.

1:14:24So really it's shifted more to, we just want to make your system more resilient. And if you have a deficit that limits you in life, like if you can't bend your knee all the way and you need to be able to squat down to do things in your job, well, then that impairment is something we should address because it actually impacts your daily life. But really a lot of rehab now has shifted towards therapeutic exercise where we're implementing exercises that are therapeutic for the person's unique situations, the symptoms they have or the impairments they have. And really at the end of that, almost every good rehab program will transition to string training because string training is really the best type of exercise for making your musculoskeletal system more resilient, right?

1:15:09Like we have all this research now showing the string training, not only does it make your muscles stronger, your tendons stronger, your ligaments get stronger, your bone density improves, the discs in your spine thicken. Like there's all these things that come from putting graded doses of resistance on your musculoskeletal system so it really is this shift and even when you're looking at pain incorporating movement helps to kind of tell your pain system that like this is okay and safe i always joke that i feel like everybody should have to do judo at some point in their life like i did judo in high school and i think other people throwing you and you enjoying it and thinking like oh this is just part of my sport i feel like it's actually it maybe it's kind of good for your nervous system because you're exposing it to something that's kind of threatening in a way but you're viewing it in a positive light and that helps to make your nervous system more resilient so that's my new plan with people in chronic pain as a judo program we're going to start graded doses of judo but yeah i think um yeah it really is and like you said those mobility exercise and especially strength exercises really have a prehab kind of side to them.

1:16:19Like a lot of people think physical therapy exercises are only for when you have pain or an injury. And then as soon as they're done with physical therapy, they stop doing them. And there are a lot of exercises that you could get rid of. Like if you have full mobility, you probably don't need to do a bunch of mobility exercises, but I would encourage everybody when you look at strengthening exercises to two to three times a week, try to have a program that goes through all of your major muscle groups. It's one of the best things. Just having a program that strengthens all the major muscle groups, try to do each muscle group if you can a couple times a week it will be one of the best things that you can implement for reducing musculoskeletal injury risk boom there it is man thank you so much for coming to hang out with us today um where's the best place for people to connect with you and just get more information all that good stuff yeah i'm primarily um it would be at rehab science on instagram and youtube people can always dm me i always say on instagram i try to always check those dms uh youtube has videos for kind of like the books for each body region.

1:17:16So there's a playlist for each body region. So you could go to the elbow playlist or the shoulder and you can find videos for common conditions. And then rehabscience.com is where people can find my books. I have an app that people can join if they want like video based and more direct kind of interactions with me. So amazing, man, thank you so much. And listen, this is a big part, again, as we started off talking about a big part of our reality. and you are working in a space that is more needed than ever. And thank you for reminding us that there are solutions, you know, because pain can be scary.

1:17:54It can be debilitating. It can be all consuming. And so helping people to really get back to being themselves and just having hope is such a invaluable thing today. And so I appreciate you so much for that, man. Well, thanks for having me back in, Sean. I appreciate you having a podcast like this because, you know, everything we covered today, it, I think it's thing, it's, it's, it's discussions like this that help people understand really how many factors can go into pain. And I think our system does a pretty good job of treating acute pains. But if you look at chronic pain, we know a lot about it.

1:18:31And it's still, it's just a global burden. You know, it's like one in five, 20 % of people live with chronic pain. So we know all these things we're talking about today can really help people. but I think people need to hear it a lot of times before they actually start implementing it. You know, it's like, there's a lot of information out there, but people have to hear it enough times before they're like, okay, I'm gonna actually try to do something about my stress levels or my sleep. I'm gonna try to go to bed earlier. Like, you know, it just, unfortunately, most people who have physical pain just think I'm just gonna go to physical therapy and do these exercises.

1:19:01And I think things are shifting, it's getting better, but it takes education like this and talking about it enough times for people to be like, okay, I'm gonna explore my mental health and see how this factors into my pain and my sleep and my nutrition. So appreciate you having me back and having discussions like this. Of course, yeah, it's my honor. By the way, really quick side note, pain psychologists, you know, this is an emerging field as well. And just seeing for me, not for everybody, but for a significant number of people, being able to, again, work with their mental health and having a resolution of their pain.

1:19:37Like this is real. And so as you started off this conversation, you have your own pain recipe. So your recipe is not your grandmama's recipe. You know, everybody's recipe is unique. And this is getting us to have some introspection, but also having our tactical things to do outside in the world and exercise and, you know, helping to make our tissues stronger, more resilient, building capacity. We got the whole gamut right here. Rehab science, Dr. Tom Walters, I appreciate you, man. Thanks, brother. Of course. the one and only Dr. Tom Walters, everybody. Thank you so much for tuning into this episode today.

1:20:12I hope that you got a lot of value out of this. If you did, you already know what to do. Share it with somebody that you care about. This conversation around pain is so vital. It's so important. Recently, pain has been advocated to be an additional vital sign for human health because it's such a pervasive part of our experience. But also now, today, it's a very pervasive part of our everyday experience with so many people living in chronic pain. And it is our mission to provide real science-backed solutions. Our bodies are incredibly intelligent. And being able to truly go within and to navigate that inner terrain and also to have the help and support and coaching and education out here in the outside world and pairing those together is so important.

1:21:09It's more important than it's ever been. But unfortunately, it's bass-ackwards right now where we have so much external focus where we're not really tuned in to what's going on with our bodies and we are more and more torn apart from that social support. And so we can proactively change that. And a big part of that is simply sharing conversations like this. And so whatever podcast app you're listening on, you can send this directly to somebody that you care about. Or take a screenshot of this episode, share it on social media, tag me, I'm at Sean Model. Tag Dr. Tom Walters as well, Rehab Science.

1:21:48And again, just keep this conversation going. Let people know that there are solutions. But we need to get educated about this stuff. And so again, I hope that you enjoyed this. We've got some incredible, incredible world-changing guests and powerful masterclasses headed your way very, very soon. So make sure to stay tuned. Take care, have an amazing day, and I'll talk with you soon.