Welcome to another engaging episode of the Hands On Hands Off podcast! In this special AAOMPT Conference preview, host Jimmy McKay sits down with renowned pain science expert Adriaan Louw to discuss his upcoming presentations and the latest advancements in pain education. Discover the groundbreaking techniques and insights that will be showcased at the conference and gain valuable knowledge to enhance your clinical practice.
Key Points Discussed:
- Overview of Adriaan Louw's presentations at the AAOMPT Conference.
- Key trends and advancements in pain education and management.
- Detailed discussion on innovative techniques and their practical applications.
- Case studies and real-world examples shared by Adriaan Louw.
- Predictions for the future of pain education and its impact on patient care.
Special Guests:
- Adriaan Louw, Pain Science Expert and AAOMPT Presenter
00:00:00 --> 00:00:02 magic afterwards.
00:00:03 --> 00:00:04 Adrian, welcome to the AM podcast.
00:00:04 --> 00:00:05 Thanks for coming on.
00:00:06 --> 00:00:07 Thanks for having me, Jimmy.
00:00:07 --> 00:00:08 I appreciate being here.
00:00:08 --> 00:00:09 This is the teaser.
00:00:09 --> 00:00:11 This is the thing before the thing,
00:00:11 --> 00:00:12 because the AOMT conference
00:00:12 --> 00:00:14 is coming up in just a couple of months.
00:00:14 --> 00:00:16 You guys are doing this, uh, St.
00:00:16 --> 00:00:18 Louis, Missouri in October,
00:00:18 --> 00:00:19 which is a great time to be in St.
00:00:19 --> 00:00:20 Louis.
00:00:20 --> 00:00:22 AOMT.org is where people can
00:00:22 --> 00:00:23 find more information.
00:00:23 --> 00:00:25 You're speaking there this year.
00:00:25 --> 00:00:25 What do you,
00:00:26 --> 00:00:27 what do you think about that conference?
00:00:27 --> 00:00:28 How does that feel?
00:00:28 --> 00:00:29 What do you, what do you,
00:00:29 --> 00:00:30 what do you look forward to
00:00:30 --> 00:00:30 in an event like that?
00:00:31 --> 00:00:33 Yeah, the AOMT conference is, um, you know,
00:00:33 --> 00:00:34 it's really interesting.
00:00:34 --> 00:00:35 I'm actually a manual therapist,
00:00:35 --> 00:00:36 so this is a background.
00:00:37 --> 00:00:38 that is actually my stomping
00:00:38 --> 00:00:40 grounds and then you move
00:00:40 --> 00:00:41 heavy into the pain world
00:00:41 --> 00:00:42 and it's always good to go
00:00:42 --> 00:00:44 back to your roots I have
00:00:44 --> 00:00:45 always loved it I like
00:00:45 --> 00:00:46 learning from them I like
00:00:46 --> 00:00:48 learning at these events
00:00:48 --> 00:00:49 but then also now bringing
00:00:49 --> 00:00:50 the pain stuff with us and
00:00:50 --> 00:00:51 coming hey guys annual
00:00:51 --> 00:00:52 therapist moving into the
00:00:52 --> 00:00:54 pain world um you know this
00:00:54 --> 00:00:55 is maybe how we should look
00:00:55 --> 00:00:57 at things so I i love it um
00:00:57 --> 00:00:58 I think I'm going to be
00:00:58 --> 00:00:59 honest sometimes I have a
00:00:59 --> 00:01:00 love-hate relationship because um
00:01:01 --> 00:01:02 Sometimes we're stuck in
00:01:02 --> 00:01:03 this old manual model,
00:01:03 --> 00:01:03 and I think people know
00:01:04 --> 00:01:04 what I'm talking about.
00:01:05 --> 00:01:05 And on the flip side,
00:01:05 --> 00:01:07 we got this painting that is cool.
00:01:07 --> 00:01:09 It's altruistic, but you got to apply it,
00:01:09 --> 00:01:10 which I think this is the
00:01:10 --> 00:01:11 perfect venue for it.
00:01:11 --> 00:01:13 where they combine both of
00:01:13 --> 00:01:13 those two worlds.
00:01:13 --> 00:01:14 So, yeah.
00:01:14 --> 00:01:14 Okay.
00:01:15 --> 00:01:17 Well, it sounds a little revolutionary,
00:01:17 --> 00:01:18 and that's my first question.
00:01:18 --> 00:01:20 You use this phrase, pain revolution.
00:01:20 --> 00:01:23 Help describe that and help
00:01:23 --> 00:01:24 people understand it so
00:01:24 --> 00:01:25 they can either make their
00:01:26 --> 00:01:27 own sign and march with you
00:01:27 --> 00:01:28 on this pain revolution and
00:01:29 --> 00:01:30 its significance really in
00:01:30 --> 00:01:31 orthopedic physical therapy.
00:01:33 --> 00:01:33 How and why should people
00:01:33 --> 00:01:34 join in on this revolution?
00:01:35 --> 00:01:36 Well, it's happening,
00:01:36 --> 00:01:38 regardless if people join or not.
00:01:38 --> 00:01:39 That's the easy part.
00:01:39 --> 00:01:41 In the early 1990s,
00:01:41 --> 00:01:43 when I got into this whole
00:01:43 --> 00:01:45 world of pain science, people kept saying,
00:01:45 --> 00:01:46 there's a pain revolution,
00:01:46 --> 00:01:46 pain revolution.
00:01:46 --> 00:01:48 I kept looking, well, where is this?
00:01:48 --> 00:01:51 And it was four guys doing something cool.
00:01:52 --> 00:01:54 But what's happened now is, Jimmy,
00:01:54 --> 00:01:55 this stuff has now reached
00:01:55 --> 00:01:59 a scale that is, the tide is coming.
00:01:59 --> 00:02:00 There's nothing you can do about it.
00:02:00 --> 00:02:01 It's in PT schools.
00:02:01 --> 00:02:02 It's in OT schools.
00:02:02 --> 00:02:03 It's in medical schools.
00:02:03 --> 00:02:03 There's textbooks.
00:02:04 --> 00:02:05 It's at every presentation.
00:02:05 --> 00:02:07 The joke of AOND is actually,
00:02:07 --> 00:02:08 The tweet that went out a
00:02:08 --> 00:02:09 few years ago and said,
00:02:09 --> 00:02:10 I showed up at the AONT
00:02:10 --> 00:02:12 conference only to have a
00:02:12 --> 00:02:13 pain conference breakout.
00:02:14 --> 00:02:15 It is now so embedded in
00:02:16 --> 00:02:17 everything that it doesn't matter.
00:02:17 --> 00:02:18 It's going to happen anyway.
00:02:18 --> 00:02:20 So the revolution is really
00:02:20 --> 00:02:23 to take what you were taught, your basics,
00:02:23 --> 00:02:23 your foundations,
00:02:23 --> 00:02:25 which I still think is phenomenal,
00:02:25 --> 00:02:26 but then pushing the
00:02:26 --> 00:02:27 envelope and taking on the
00:02:27 --> 00:02:28 new concepts of pain
00:02:28 --> 00:02:30 science is really what it is.
00:02:31 --> 00:02:31 It's happening.
00:02:32 --> 00:02:33 So in this case, what's the easiest way?
00:02:33 --> 00:02:35 Come to AONT, come take the conference.
00:02:35 --> 00:02:36 Take these sessions that are
00:02:36 --> 00:02:37 a little bit on the fringe
00:02:37 --> 00:02:40 of pain science versus just orthopedics,
00:02:40 --> 00:02:40 right?
00:02:40 --> 00:02:41 And then I think that is how
00:02:41 --> 00:02:42 people start getting into it.
00:02:43 --> 00:02:44 All right,
00:02:44 --> 00:02:46 this next one goes more specific.
00:02:46 --> 00:02:47 We throw this term around,
00:02:47 --> 00:02:49 nociplastic pain.
00:02:50 --> 00:02:50 How do you explain it to
00:02:50 --> 00:02:52 someone who wants to learn more?
00:02:52 --> 00:02:53 Maybe someone who showed up
00:02:53 --> 00:02:54 to the AOMS conference at a
00:02:54 --> 00:02:55 pain conference broke out.
00:02:56 --> 00:02:57 How do you describe it and
00:02:57 --> 00:02:59 why is it clinically challenging?
00:02:59 --> 00:03:00 Maybe that's why people
00:03:00 --> 00:03:02 avoid it or don't understand it.
00:03:02 --> 00:03:02 Yeah.
00:03:03 --> 00:03:04 Well, the first thing we do in medicine,
00:03:04 --> 00:03:05 if we don't understand something,
00:03:05 --> 00:03:06 we change the name.
00:03:06 --> 00:03:08 So this phenomenon has been
00:03:09 --> 00:03:09 called central
00:03:09 --> 00:03:10 sensitization for the
00:03:10 --> 00:03:11 longest time I've been around.
00:03:12 --> 00:03:14 And in the last few years, the scientists,
00:03:14 --> 00:03:15 the academics have changed
00:03:15 --> 00:03:16 it to nociplastic pain.
00:03:16 --> 00:03:17 Long story short,
00:03:18 --> 00:03:18 it's where the central
00:03:19 --> 00:03:19 nervous system actually
00:03:20 --> 00:03:21 starts driving your pain experience.
00:03:21 --> 00:03:22 So we have normal,
00:03:22 --> 00:03:23 healthy information coming
00:03:24 --> 00:03:25 into the central nervous
00:03:25 --> 00:03:26 system that then amplifies this.
00:03:27 --> 00:03:28 So now things like light
00:03:28 --> 00:03:29 touch becomes uncomfortable,
00:03:29 --> 00:03:31 which we call allodynia.
00:03:31 --> 00:03:32 We get hyperalgesia.
00:03:32 --> 00:03:34 And for the manual therapist,
00:03:34 --> 00:03:35 it becomes tricky because I
00:03:35 --> 00:03:37 was taught way back dozens
00:03:37 --> 00:03:38 and dozens of years ago
00:03:38 --> 00:03:39 that when I palpate and
00:03:39 --> 00:03:41 poke in areas and people say, ooh,
00:03:41 --> 00:03:43 it's painful there, the problem is there.
00:03:43 --> 00:03:45 But in these patients, unfortunately,
00:03:45 --> 00:03:45 no matter where you poke,
00:03:45 --> 00:03:46 it's sensitive because the
00:03:46 --> 00:03:48 system amplifies it.
00:03:48 --> 00:03:50 So your tests that you use,
00:03:50 --> 00:03:51 your treatments that you
00:03:51 --> 00:03:52 use becomes a little bit less reliable.
00:03:53 --> 00:03:54 In the old days,
00:03:54 --> 00:03:55 if I would poke at an area
00:03:55 --> 00:03:56 and it was a joint,
00:03:56 --> 00:03:57 then that's the problem.
00:03:58 --> 00:04:00 But now those tests are not that reliable.
00:04:00 --> 00:04:01 So we had to change the way we test you.
00:04:01 --> 00:04:02 We've got to change the way
00:04:02 --> 00:04:03 we treat you and approach
00:04:03 --> 00:04:04 you accordingly.
00:04:04 --> 00:04:06 So it is challenging.
00:04:07 --> 00:04:08 And it's about one in five patients,
00:04:08 --> 00:04:09 what the data tells us,
00:04:09 --> 00:04:10 walk into private practice
00:04:10 --> 00:04:12 or outpatient therapy has
00:04:12 --> 00:04:13 central sensitization or
00:04:13 --> 00:04:14 nociplastic pain.
00:04:15 --> 00:04:17 And they are just challenging.
00:04:17 --> 00:04:18 The easy thing is, Jimmy,
00:04:18 --> 00:04:19 I'll just say this.
00:04:20 --> 00:04:20 Every therapist I've ever
00:04:20 --> 00:04:22 talked to can sing this song.
00:04:22 --> 00:04:22 Where do they hurt?
00:04:23 --> 00:04:23 Everywhere.
00:04:23 --> 00:04:24 What makes them better?
00:04:25 --> 00:04:25 Nothing.
00:04:25 --> 00:04:26 What makes them worse?
00:04:26 --> 00:04:26 Everything.
00:04:27 --> 00:04:29 I'm not trying to be funny about it.
00:04:29 --> 00:04:29 I don't make fun of it.
00:04:30 --> 00:04:31 I spend my life dedicating.
00:04:31 --> 00:04:33 But there's this commonality
00:04:33 --> 00:04:34 in the clinic we see.
00:04:34 --> 00:04:35 These patients are challenging.
00:04:35 --> 00:04:36 We don't know what to do with them.
00:04:36 --> 00:04:38 We're not trained well to work with them.
00:04:38 --> 00:04:39 And that is why it's
00:04:39 --> 00:04:40 important for us to take it
00:04:40 --> 00:04:41 to that next level.
00:04:43 --> 00:04:44 Do you see the people that
00:04:45 --> 00:04:46 attend a conference like
00:04:46 --> 00:04:47 the AOMT conference,
00:04:47 --> 00:04:49 they're searching for
00:04:49 --> 00:04:50 answers to things like this
00:04:50 --> 00:04:51 because they're so
00:04:51 --> 00:04:52 frustrated by not being
00:04:52 --> 00:04:54 able to help those patients
00:04:54 --> 00:04:55 when they come across them
00:04:55 --> 00:04:55 in their clinics?
00:04:56 --> 00:04:58 Yeah, I'd probably say some of them.
00:04:58 --> 00:04:59 I mean, that is how I got there.
00:04:59 --> 00:05:00 People always ask me,
00:05:00 --> 00:05:01 how did you get into pain science?
00:05:01 --> 00:05:02 Well, I failed.
00:05:03 --> 00:05:04 The tools I had,
00:05:04 --> 00:05:05 and I was trained by some
00:05:05 --> 00:05:05 of the best people on this
00:05:06 --> 00:05:06 planet with the biggest
00:05:06 --> 00:05:08 names that people would hang on to.
00:05:09 --> 00:05:10 And I couldn't help them.
00:05:10 --> 00:05:12 And so we went to this payment side,
00:05:12 --> 00:05:13 which made it filled in a
00:05:13 --> 00:05:14 lot of the gaps.
00:05:14 --> 00:05:16 So I would argue that at AOMT,
00:05:16 --> 00:05:17 we're going to get people
00:05:17 --> 00:05:18 that have maybe tried their tools,
00:05:19 --> 00:05:21 they trade, and they've got to a limit.
00:05:21 --> 00:05:22 I don't know what to do now.
00:05:23 --> 00:05:23 That's good for you.
00:05:24 --> 00:05:25 AOMT is also very progressive.
00:05:26 --> 00:05:27 These people that attend
00:05:27 --> 00:05:28 AOMT are the tip of the spear.
00:05:28 --> 00:05:29 They're the best of the best.
00:05:30 --> 00:05:31 They are people that read.
00:05:31 --> 00:05:32 They read our articles.
00:05:33 --> 00:05:34 Trust me, they show up and they'll ask me,
00:05:34 --> 00:05:37 hey, you remember that paper on line 27,
00:05:37 --> 00:05:38 paragraph three?
00:05:38 --> 00:05:40 I'm like, whoa, dude, I wrote the paper.
00:05:40 --> 00:05:41 I don't even remember.
00:05:42 --> 00:05:43 So I think it's a little bit of both.
00:05:43 --> 00:05:44 I think there is the,
00:05:44 --> 00:05:45 I don't know what to do.
00:05:45 --> 00:05:46 Adrian, please help me.
00:05:47 --> 00:05:47 But there's also the, hey,
00:05:47 --> 00:05:48 I'm really into this.
00:05:48 --> 00:05:49 This makes sense.
00:05:49 --> 00:05:51 And I want to take this to the next level.
00:05:51 --> 00:05:52 So it's a little bit of both.
00:05:53 --> 00:05:54 Yeah,
00:05:54 --> 00:05:55 I think it's one of those two
00:05:55 --> 00:05:56 directions why people would
00:05:56 --> 00:05:58 do this specifically here.
00:05:58 --> 00:05:59 Yeah.
00:05:59 --> 00:06:00 Let's talk about a different
00:06:00 --> 00:06:00 phrase that I'm not even
00:06:00 --> 00:06:03 sure I came across when I
00:06:03 --> 00:06:04 was in PT school.
00:06:04 --> 00:06:05 Help me understand the
00:06:05 --> 00:06:06 concept of high impact
00:06:06 --> 00:06:08 chronic pain and how it's
00:06:08 --> 00:06:10 emerged really in clinical practice.
00:06:10 --> 00:06:12 What is this when this term comes up?
00:06:12 --> 00:06:12 Or is this another word
00:06:12 --> 00:06:14 that's just been given a new term?
00:06:15 --> 00:06:15 No,
00:06:15 --> 00:06:17 this is actually a subset of chronic
00:06:17 --> 00:06:18 pain.
00:06:18 --> 00:06:19 So, you know,
00:06:19 --> 00:06:20 it's not as if chronic pain
00:06:20 --> 00:06:21 is bad enough.
00:06:21 --> 00:06:22 There's a subgroup within
00:06:23 --> 00:06:24 chronic pain that's even worse.
00:06:24 --> 00:06:24 It
00:06:25 --> 00:06:26 And again, I'm not making fun of it.
00:06:26 --> 00:06:28 They just if you read the research,
00:06:28 --> 00:06:30 it just says there's a group of people.
00:06:30 --> 00:06:31 If you look at one in four
00:06:31 --> 00:06:32 people in this world suffer
00:06:32 --> 00:06:33 from persistent pain on
00:06:33 --> 00:06:34 some regular basis.
00:06:35 --> 00:06:36 And within that subset,
00:06:37 --> 00:06:38 there is a smaller subset
00:06:38 --> 00:06:40 that this is really impacting them.
00:06:40 --> 00:06:41 And there's criteria in
00:06:41 --> 00:06:42 terms of how it impacts
00:06:42 --> 00:06:43 their function and their
00:06:43 --> 00:06:45 ability to literally get
00:06:45 --> 00:06:46 along in their life.
00:06:46 --> 00:06:48 And so we need to do even more for them.
00:06:48 --> 00:06:49 And so if you go search for
00:06:50 --> 00:06:51 high impact chronic pain on the internet,
00:06:51 --> 00:06:52 you're gonna find it in
00:06:52 --> 00:06:53 complex conditions like
00:06:54 --> 00:06:55 chronic low back pain and
00:06:55 --> 00:06:57 fibromyalgia and knee osteoarthritis.
00:06:57 --> 00:06:59 And so it's just people that
00:06:59 --> 00:07:01 are really affected even more so.
00:07:03 --> 00:07:04 I don't particularly care for it.
00:07:04 --> 00:07:05 I'll be honest with people.
00:07:05 --> 00:07:08 I think, you know, I'm a clinician.
00:07:08 --> 00:07:09 I've always been a clinician.
00:07:10 --> 00:07:11 I think of the clinical idea.
00:07:12 --> 00:07:12 And I just hate the idea of
00:07:12 --> 00:07:13 going to a patient and saying, you know,
00:07:13 --> 00:07:14 it's not bad enough that
00:07:14 --> 00:07:15 you have chronic pain.
00:07:15 --> 00:07:16 You have the worst chronic
00:07:16 --> 00:07:17 pain we've got called
00:07:17 --> 00:07:18 high-impact chronic pain.
00:07:18 --> 00:07:19 Now, I'm not making fun of it.
00:07:20 --> 00:07:21 The scientists that do the work,
00:07:21 --> 00:07:22 I know who they are.
00:07:22 --> 00:07:23 I know that they do amazing things.
00:07:23 --> 00:07:24 I think the world of them.
00:07:24 --> 00:07:24 I read their stuff.
00:07:26 --> 00:07:28 We have not even got chronic pain right.
00:07:29 --> 00:07:30 And now we're saying, hey,
00:07:30 --> 00:07:32 you guys are not getting this right,
00:07:32 --> 00:07:33 but you've got to do even more for this.
00:07:33 --> 00:07:36 I think it's a little, it's tricky,
00:07:37 --> 00:07:39 but I understand why they're doing it.
00:07:39 --> 00:07:40 There's a subgroup of people
00:07:40 --> 00:07:41 that need even more.
00:07:42 --> 00:07:42 And that is why they're
00:07:42 --> 00:07:43 identified according.
00:07:43 --> 00:07:45 And I may be missing the whole point,
00:07:45 --> 00:07:47 but I've read as much as I can in it.
00:07:47 --> 00:07:49 I'm just a little concerned
00:07:49 --> 00:07:50 because in the clinic side,
00:07:50 --> 00:07:51 a patient will walk in and say, no,
00:07:51 --> 00:07:52 I don't have chronic pain.
00:07:52 --> 00:07:54 I have high impact chronic pain.
00:07:54 --> 00:07:55 And that's just another setup.
00:07:55 --> 00:07:56 It's like I got a very rare
00:07:56 --> 00:07:57 case of frozen shoulder.
00:07:59 --> 00:08:01 You know, it's unfortunately,
00:08:01 --> 00:08:03 I think for the patient side,
00:08:03 --> 00:08:05 it's a cry for more help.
00:08:05 --> 00:08:06 Hey, you guys aren't listening.
00:08:06 --> 00:08:07 I need help.
00:08:07 --> 00:08:08 So I'm just I'm always
00:08:08 --> 00:08:09 worried about these labels
00:08:09 --> 00:08:10 we add on to it.
00:08:10 --> 00:08:11 But that was going to be my
00:08:11 --> 00:08:12 follow up was do you think
00:08:12 --> 00:08:13 throwing an additional
00:08:13 --> 00:08:16 label on that helps or harms?
00:08:16 --> 00:08:17 I think it harms.
00:08:17 --> 00:08:18 I don't think it doesn't
00:08:18 --> 00:08:19 change one bit for a
00:08:19 --> 00:08:20 clinician in this country.
00:08:21 --> 00:08:22 If a patient walk in the clinic,
00:08:22 --> 00:08:23 Jimmy walks in the clinic.
00:08:23 --> 00:08:25 Hey, Jimmy, what brings you here?
00:08:25 --> 00:08:25 I get chronic pain.
00:08:26 --> 00:08:28 I know what I can and cannot do with you.
00:08:29 --> 00:08:30 An hour later, Jenny walks in.
00:08:30 --> 00:08:31 Hey, Jenny, what brings you here?
00:08:31 --> 00:08:32 I've got high-impact chronic pain.
00:08:32 --> 00:08:33 Nothing's changed for me,
00:08:34 --> 00:08:35 except for the fact that
00:08:35 --> 00:08:36 I'm probably thinking like, oh, crap,
00:08:36 --> 00:08:37 this is even worse.
00:08:37 --> 00:08:38 It's going to be even a
00:08:38 --> 00:08:39 worse day in the clinic.
00:08:39 --> 00:08:40 It doesn't change.
00:08:40 --> 00:08:42 I still have the tools that
00:08:42 --> 00:08:44 I have in front of me.
00:08:44 --> 00:08:46 On a national scale, at a higher scale,
00:08:47 --> 00:08:48 you can talk about multidisciplinary,
00:08:48 --> 00:08:49 interdisciplinary,
00:08:49 --> 00:08:50 but we're not even there yet.
00:08:50 --> 00:08:51 So I apologize to the people
00:08:51 --> 00:08:52 that are listening that's
00:08:52 --> 00:08:53 probably involved in the
00:08:53 --> 00:08:54 gathering or whatever,
00:08:54 --> 00:08:56 but I'm a little concerned
00:08:56 --> 00:08:58 where we go with labeling, unfortunately.
00:08:59 --> 00:09:02 It can get counterproductive
00:09:03 --> 00:09:05 in certain situations.
00:09:05 --> 00:09:06 If I was a patient,
00:09:06 --> 00:09:07 I'd be catastrophizing.
00:09:07 --> 00:09:08 It's not bad enough that I
00:09:08 --> 00:09:09 get chronic pain.
00:09:09 --> 00:09:11 I get worse than when there is, right?
00:09:12 --> 00:09:13 It's like, wait a minute, it's not that.
00:09:13 --> 00:09:14 I mean,
00:09:14 --> 00:09:15 it's a lot bigger than three years.
00:09:15 --> 00:09:16 So you said a second ago, hey,
00:09:16 --> 00:09:17 if Jimmy walks in with
00:09:17 --> 00:09:19 chronic pain or high impact chronic pain,
00:09:19 --> 00:09:20 you still have the same
00:09:20 --> 00:09:21 tools available to you to
00:09:21 --> 00:09:22 treat that person.
00:09:23 --> 00:09:24 So let's go to let's go to
00:09:24 --> 00:09:26 tools and tools or skills and techniques.
00:09:26 --> 00:09:28 So you said at the outset of
00:09:28 --> 00:09:29 this conversation,
00:09:29 --> 00:09:32 you're a manual therapist to, you know,
00:09:32 --> 00:09:34 found this this study of pain.
00:09:34 --> 00:09:35 What specific pain science
00:09:35 --> 00:09:36 skills and techniques?
00:09:37 --> 00:09:38 Do you think manual
00:09:38 --> 00:09:40 therapists should develop
00:09:40 --> 00:09:42 to better manage complex
00:09:42 --> 00:09:42 cases like some of them
00:09:43 --> 00:09:43 we're talking about?
00:09:44 --> 00:09:46 How much time we got, Jimmy?
00:09:46 --> 00:09:49 Yeah, that's a good question.
00:09:49 --> 00:09:52 I think a good start would
00:09:52 --> 00:09:53 be to understand pain,
00:09:54 --> 00:09:55 to really understand the biology of pain.
00:09:55 --> 00:09:56 The biggest thing,
00:09:56 --> 00:09:57 the hardest thing in pain
00:09:57 --> 00:09:59 science right now is pain phenotyping.
00:09:59 --> 00:10:00 The fact that there are
00:10:00 --> 00:10:01 different kinds of pain.
00:10:01 --> 00:10:02 You already mentioned nociplastic pain.
00:10:03 --> 00:10:05 When patients come in, pain isn't pain.
00:10:05 --> 00:10:06 There is pain that's driven
00:10:06 --> 00:10:08 by nociceptive input,
00:10:08 --> 00:10:09 which is nociceptive-driven pain,
00:10:09 --> 00:10:11 which is kind of our bread and butter.
00:10:12 --> 00:10:13 It's sprains, strains, and stuff.
00:10:14 --> 00:10:14 Man, we're good at this.
00:10:14 --> 00:10:16 We are so stinking good at this.
00:10:16 --> 00:10:17 Peripheral neuropathic pain,
00:10:17 --> 00:10:19 which is your radiculopathies,
00:10:19 --> 00:10:19 carpal tunnel, whatever.
00:10:19 --> 00:10:21 If you understand neurodynamics,
00:10:21 --> 00:10:23 nerve movement and stuff,
00:10:23 --> 00:10:24 you'll be okay with that one.
00:10:24 --> 00:10:25 And then we get nociplastic.
00:10:25 --> 00:10:27 So for a manual therapist to understand,
00:10:27 --> 00:10:28 there are really three
00:10:28 --> 00:10:29 buckets that people show up.
00:10:30 --> 00:10:31 And for this bucket, we do this.
00:10:31 --> 00:10:32 For this bucket, we do that.
00:10:32 --> 00:10:33 For this bucket, we do that.
00:10:33 --> 00:10:34 In terms of examination and treatment,
00:10:35 --> 00:10:36 we've done a lot of this
00:10:36 --> 00:10:37 actually at AONT before.
00:10:37 --> 00:10:38 This will continue on.
00:10:38 --> 00:10:39 It's a lot of this stuff
00:10:39 --> 00:10:40 being put out there.
00:10:40 --> 00:10:43 But we have to match the examinations,
00:10:43 --> 00:10:44 the vigor, the intensity,
00:10:45 --> 00:10:46 the duration of our
00:10:46 --> 00:10:47 examinations based on which
00:10:47 --> 00:10:48 bucket they sit in.
00:10:48 --> 00:10:49 The treatments must shift
00:10:49 --> 00:10:51 from nociceptive is going
00:10:51 --> 00:10:52 to be very traditionally
00:10:52 --> 00:10:53 orthopedic-based.
00:10:53 --> 00:10:55 Jimmy, lay down, crack your back,
00:10:55 --> 00:10:56 you sit up and go, oh, jeez, thanks,
00:10:57 --> 00:10:57 Aidan, I'm good.
00:10:57 --> 00:10:59 I'm going to go home, right?
00:10:59 --> 00:11:01 Whereas that technique does
00:11:01 --> 00:11:02 not work in the last
00:11:02 --> 00:11:03 patient group with nociplastic.
00:11:04 --> 00:11:05 You manipulate them and they
00:11:05 --> 00:11:07 flare and it takes a week
00:11:07 --> 00:11:09 to calm that system down.
00:11:09 --> 00:11:10 Or they say, oh, that was good.
00:11:10 --> 00:11:11 Can you do my neck now?
00:11:11 --> 00:11:12 And they become addicted to your hand.
00:11:13 --> 00:11:15 So we have to match the treatments,
00:11:15 --> 00:11:16 especially in manual therapy,
00:11:17 --> 00:11:19 because we can often flare them.
00:11:19 --> 00:11:21 We can make them addicted to our hands.
00:11:21 --> 00:11:23 So it's a beautiful balance,
00:11:23 --> 00:11:24 but you must know what kind
00:11:24 --> 00:11:25 of pain you're dealing with.
00:11:25 --> 00:11:26 Yeah.
00:11:26 --> 00:11:27 Talking about balance,
00:11:27 --> 00:11:28 we're talking about pain.
00:11:29 --> 00:11:31 on a podcast about a
00:11:31 --> 00:11:33 conference from AOMT with manual therapy.
00:11:34 --> 00:11:36 So should it be pain
00:11:36 --> 00:11:38 neuroscience education and
00:11:38 --> 00:11:39 manual therapy education,
00:11:39 --> 00:11:42 or should these things be combined?
00:11:42 --> 00:11:43 Should you not be able to separate them?
00:11:45 --> 00:11:46 I think they go hand in hand,
00:11:46 --> 00:11:47 and that is exactly one of
00:11:47 --> 00:11:48 the sessions we're doing,
00:11:48 --> 00:11:49 blending the two.
00:11:50 --> 00:11:50 You know,
00:11:50 --> 00:11:52 I was in another podcast a little
00:11:52 --> 00:11:52 while back,
00:11:52 --> 00:11:54 and somebody asked me a question,
00:11:54 --> 00:11:55 and I don't know why, but it slipped out.
00:11:55 --> 00:11:56 Somebody asked me,
00:11:56 --> 00:11:57 how come you're so good at pain?
00:11:58 --> 00:11:59 And I don't think I'm that good at pain,
00:11:59 --> 00:12:00 by the way, Jimmy,
00:12:00 --> 00:12:01 but it just slipped out, I said,
00:12:01 --> 00:12:02 because I'm a good manual therapist.
00:12:03 --> 00:12:04 And the host said, well, wait a minute,
00:12:04 --> 00:12:04 what does that mean?
00:12:04 --> 00:12:04 I said,
00:12:05 --> 00:12:06 because manual therapy gave me my
00:12:06 --> 00:12:08 basic skill set of reasoning,
00:12:09 --> 00:12:10 thorough evaluation,
00:12:11 --> 00:12:12 building a connection with my patient,
00:12:13 --> 00:12:15 all necessary things I need.
00:12:15 --> 00:12:16 And then the pain science
00:12:16 --> 00:12:18 takes me to that next level
00:12:18 --> 00:12:19 to take the complex patient.
00:12:20 --> 00:12:20 Here's the reality.
00:12:21 --> 00:12:23 If you only do one of these two,
00:12:23 --> 00:12:23 you're limited.
00:12:24 --> 00:12:25 Because if you only do manual therapy,
00:12:25 --> 00:12:27 you don't care about pain science,
00:12:27 --> 00:12:29 what people think, their fear,
00:12:29 --> 00:12:30 their catastrophization,
00:12:30 --> 00:12:31 you're not gonna make it better.
00:12:31 --> 00:12:33 And I would go the other side because,
00:12:33 --> 00:12:33 Jimmy,
00:12:33 --> 00:12:34 I live in the other world where I
00:12:34 --> 00:12:36 go to pain conferences where people don't,
00:12:36 --> 00:12:36 you don't touch people
00:12:36 --> 00:12:38 because if you touch them,
00:12:38 --> 00:12:39 they become addicted, whatever.
00:12:39 --> 00:12:40 Some of the most incredible
00:12:41 --> 00:12:42 Changes we see in human
00:12:42 --> 00:12:43 beings that come to
00:12:43 --> 00:12:44 rehabilitation is with our hands.
00:12:45 --> 00:12:46 They want pain relief.
00:12:46 --> 00:12:47 Manipulation,
00:12:48 --> 00:12:48 if you look at the effect
00:12:48 --> 00:12:50 sizes with manipulation,
00:12:50 --> 00:12:52 high velocity thrust to reduce pain,
00:12:52 --> 00:12:54 that's actually quite significant.
00:12:55 --> 00:12:57 I'm a physical therapist, and you know,
00:12:57 --> 00:12:57 last time I checked,
00:12:57 --> 00:12:59 we don't have a ton of
00:12:59 --> 00:13:00 tools to take your pain
00:13:00 --> 00:13:02 from a nine to a seven in one visit.
00:13:02 --> 00:13:04 Manipulation does, dry needling does.
00:13:04 --> 00:13:06 There are techniques that can do it.
00:13:06 --> 00:13:07 And so if you walk into my
00:13:07 --> 00:13:09 clinic and you're really hurting,
00:13:09 --> 00:13:09 I need you to do something
00:13:09 --> 00:13:11 to get you from here to here.
00:13:11 --> 00:13:12 And then you go, oh, man,
00:13:12 --> 00:13:13 that feels better.
00:13:13 --> 00:13:15 Now you're more open to listening to,
00:13:15 --> 00:13:16 let's talk about exercise
00:13:16 --> 00:13:18 and sleep and nutrition and this stuff.
00:13:19 --> 00:13:20 So I think they go hand in hand.
00:13:20 --> 00:13:21 On the one side,
00:13:21 --> 00:13:22 I need to reduce your pain.
00:13:22 --> 00:13:24 And manual therapy gives me that part.
00:13:24 --> 00:13:27 But also it gives me the basic skill set.
00:13:28 --> 00:13:29 I've said this for the longest time.
00:13:29 --> 00:13:30 You have no business
00:13:30 --> 00:13:31 teaching somebody about
00:13:31 --> 00:13:33 pain unless you've made
00:13:33 --> 00:13:34 sure they're safe and you
00:13:34 --> 00:13:35 do your due diligence.
00:13:36 --> 00:13:37 And the only way you can do
00:13:37 --> 00:13:38 it is by being a good manual therapist.
00:13:38 --> 00:13:40 Go through all my reflexes, my strength.
00:13:40 --> 00:13:42 sensation to make sure Jimmy is safe,
00:13:42 --> 00:13:44 he should be, and not see the doctor.
00:13:44 --> 00:13:45 You have no business.
00:13:45 --> 00:13:47 So you have to have both.
00:13:47 --> 00:13:49 And it's unbelievable that people go,
00:13:49 --> 00:13:50 this one or that one.
00:13:51 --> 00:13:52 I don't see how we cannot
00:13:52 --> 00:13:53 have these two cohabitate.
00:13:54 --> 00:13:55 We talked about communication,
00:13:55 --> 00:13:56 or you brought it up in
00:13:56 --> 00:13:57 several different ways.
00:13:57 --> 00:13:58 And I'm a person who loves
00:13:58 --> 00:14:00 communication and where it comes in,
00:14:00 --> 00:14:01 especially in a patient interaction.
00:14:02 --> 00:14:04 How can or how should
00:14:05 --> 00:14:06 therapists effectively
00:14:06 --> 00:14:07 communicate pain science
00:14:07 --> 00:14:08 concepts to their patients
00:14:09 --> 00:14:10 to help improve treatment outcomes.
00:14:10 --> 00:14:12 We talked earlier about maybe there's a,
00:14:13 --> 00:14:14 there's a line where it's
00:14:14 --> 00:14:14 too much or maybe putting
00:14:14 --> 00:14:15 too many words on it.
00:14:15 --> 00:14:17 So, you know, when someone asks,
00:14:18 --> 00:14:19 how do I communicate this?
00:14:19 --> 00:14:21 How, how much, when, where all those W's.
00:14:23 --> 00:14:27 the answer is yes I mean you
00:14:27 --> 00:14:29 know christmas we're
00:14:29 --> 00:14:30 talking about there's 80
00:14:30 --> 00:14:31 million americans in
00:14:31 --> 00:14:32 chronic pain and we need 80
00:14:32 --> 00:14:33 million different ways to
00:14:33 --> 00:14:34 do it because they're all
00:14:34 --> 00:14:36 individual beings right um
00:14:36 --> 00:14:37 in the most basic way to
00:14:37 --> 00:14:38 teach people about pain
00:14:38 --> 00:14:39 there's two ways jimmy one
00:14:39 --> 00:14:41 is a technique I literally
00:14:41 --> 00:14:42 say jimmy listen you're
00:14:42 --> 00:14:43 doing great I'm so proud of
00:14:43 --> 00:14:44 you we're making good
00:14:44 --> 00:14:45 progress but today I need
00:14:45 --> 00:14:46 to teach you something very
00:14:47 --> 00:14:48 important so I sit you down
00:14:48 --> 00:14:49 and we're having a very
00:14:49 --> 00:14:50 deliberate conversation I
00:14:50 --> 00:14:52 need to explain to you why
00:14:52 --> 00:14:53 When it's cold, you feel your neck.
00:14:54 --> 00:14:55 Nobody's ever done it,
00:14:55 --> 00:14:56 so let me do that today.
00:14:56 --> 00:14:57 That's one type.
00:14:57 --> 00:14:58 And we call that often pain
00:14:58 --> 00:14:59 neuroscience education.
00:15:00 --> 00:15:01 I sit down, it's almost like a technique.
00:15:01 --> 00:15:02 I'm doing this thing,
00:15:02 --> 00:15:03 and we have data to prove
00:15:03 --> 00:15:04 that your fear goes down,
00:15:04 --> 00:15:05 your catastrophization goes down.
00:15:05 --> 00:15:07 So it works.
00:15:07 --> 00:15:08 I mean, I can actually bill you for it.
00:15:09 --> 00:15:10 The other way of doing it,
00:15:10 --> 00:15:11 which I find very intriguing,
00:15:11 --> 00:15:11 and this is kind of where
00:15:11 --> 00:15:12 the research is going,
00:15:12 --> 00:15:13 is called pain neuroscience
00:15:13 --> 00:15:14 communication.
00:15:15 --> 00:15:17 And that is people that we train,
00:15:17 --> 00:15:18 and we've been tracking the
00:15:18 --> 00:15:19 data in our research,
00:15:19 --> 00:15:21 that if we train people in pain science,
00:15:22 --> 00:15:23 They change the way they talk to people.
00:15:23 --> 00:15:25 They're softer spoken, less provocative.
00:15:26 --> 00:15:28 They stay away from words that harm.
00:15:28 --> 00:15:30 They use more calming,
00:15:30 --> 00:15:31 relaxing reassurance kind of.
00:15:32 --> 00:15:33 It's almost like you take a
00:15:33 --> 00:15:34 shaker and you shake it
00:15:34 --> 00:15:35 through the clinic a little bit.
00:15:35 --> 00:15:37 It's like you sprinkle this
00:15:37 --> 00:15:37 little bit of things.
00:15:37 --> 00:15:39 So we call that pain
00:15:39 --> 00:15:40 neuroscience communication.
00:15:40 --> 00:15:42 And we're tracking some data
00:15:42 --> 00:15:43 in some of our research there.
00:15:43 --> 00:15:44 So I think it's both.
00:15:45 --> 00:15:47 I have heard people say, you know, Adrian,
00:15:47 --> 00:15:48 I've learned this pain stuff from you.
00:15:50 --> 00:15:52 And I find myself, I'm softer spoken.
00:15:53 --> 00:15:54 I slow myself down and make
00:15:55 --> 00:15:56 sure there's reassurance.
00:15:57 --> 00:15:58 There's all the things that we care about.
00:15:58 --> 00:15:59 So it's a little bit of both.
00:16:00 --> 00:16:02 But I think at its basic core, Jimmy,
00:16:02 --> 00:16:03 it is reducing words at harm.
00:16:04 --> 00:16:06 Therapy has the most harmful
00:16:06 --> 00:16:07 words known to man.
00:16:07 --> 00:16:09 Torn, ripped, ruptured, bulged, herniated.
00:16:09 --> 00:16:10 Take them out of our vocabulary.
00:16:11 --> 00:16:13 use softer spoken words that
00:16:13 --> 00:16:13 still explain.
00:16:13 --> 00:16:14 I know this is gonna be a
00:16:14 --> 00:16:16 little blasphemy at AON,
00:16:16 --> 00:16:17 but they have shown us that
00:16:17 --> 00:16:19 words like sprain and strain,
00:16:19 --> 00:16:20 as benign as they are,
00:16:21 --> 00:16:22 they're actually benign.
00:16:23 --> 00:16:25 The top of the top manual
00:16:25 --> 00:16:26 therapists will say, well,
00:16:26 --> 00:16:27 that doesn't really tell people,
00:16:27 --> 00:16:29 but the patient study show
00:16:29 --> 00:16:30 us that if I tell you a
00:16:30 --> 00:16:31 sprain or a strain,
00:16:31 --> 00:16:34 it doesn't evoke fear and
00:16:34 --> 00:16:35 you understand what's happening.
00:16:35 --> 00:16:38 So we can soften, explain, calm down,
00:16:38 --> 00:16:39 reassure,
00:16:39 --> 00:16:40 That's why I love being a therapist.
00:16:40 --> 00:16:42 99% of what I deal with is
00:16:42 --> 00:16:45 not life-threatening.
00:16:46 --> 00:16:45 9999%.
00:16:46 --> 00:16:47 So for me to walk up to Jimmy and say,
00:16:47 --> 00:16:48 Jimmy, you're going to be okay.
00:16:49 --> 00:16:50 I know you're at your ACL, dude,
00:16:50 --> 00:16:51 but guess what?
00:16:51 --> 00:16:52 I've seen a hundred people
00:16:52 --> 00:16:53 like you just last year.
00:16:53 --> 00:16:54 Are you going to be okay?
00:16:54 --> 00:16:55 See the guy on the bike there?
00:16:55 --> 00:16:57 It was just like you a month ago.
00:16:57 --> 00:16:57 Now look at him.
00:16:58 --> 00:16:58 What am I doing?
00:16:59 --> 00:16:59 I'm calming,
00:16:59 --> 00:17:01 taking away your fear or anxiety.
00:17:01 --> 00:17:03 So it's a little bit of those.
00:17:03 --> 00:17:04 It's reducing the words at harm.
00:17:06 --> 00:17:07 giving information that is
00:17:07 --> 00:17:09 understandable and reducing
00:17:09 --> 00:17:10 fear and catastrophization.
00:17:10 --> 00:17:13 And it's not necessarily deliberate.
00:17:13 --> 00:17:16 It is just, we change the way we practice.
00:17:16 --> 00:17:17 You said that people that
00:17:17 --> 00:17:19 study pain neuroscience communication,
00:17:19 --> 00:17:21 they begin speaking softer.
00:17:22 --> 00:17:23 Why do you think that is?
00:17:23 --> 00:17:24 I want to take a guess and
00:17:24 --> 00:17:25 you tell me if I'm right or wrong.
00:17:26 --> 00:17:28 Do you think now that they sort of,
00:17:28 --> 00:17:29 because now you're studying
00:17:29 --> 00:17:30 people and not a condition,
00:17:30 --> 00:17:32 do you think there's increased empathy?
00:17:32 --> 00:17:34 And now that they understand a little more,
00:17:34 --> 00:17:35 they're a little softer?
00:17:36 --> 00:17:37 Yeah, we have shown it.
00:17:37 --> 00:17:39 We have tested health care providers,
00:17:39 --> 00:17:40 measured their empathy and compassion,
00:17:41 --> 00:17:41 and then we teach them.
00:17:41 --> 00:17:42 And afterwards,
00:17:42 --> 00:17:43 the compassion and empathy
00:17:43 --> 00:17:44 changes drastically.
00:17:44 --> 00:17:46 We just completed a study on
00:17:46 --> 00:17:47 medical residents and did
00:17:47 --> 00:17:48 the same thing to show they
00:17:48 --> 00:17:49 turn extremely empathetic
00:17:50 --> 00:17:51 compassion towards people in pain,
00:17:51 --> 00:17:53 which isn't that just the coolest thing?
00:17:53 --> 00:17:53 So, yes,
00:17:53 --> 00:17:55 we're focusing on the human being
00:17:55 --> 00:17:56 versus the condition, right?
00:17:57 --> 00:17:58 But yeah,
00:17:58 --> 00:17:59 it's just to understand what
00:17:59 --> 00:18:00 they're going through.
00:18:01 --> 00:18:02 These poor people are struggling.
00:18:02 --> 00:18:03 They've been everywhere.
00:18:03 --> 00:18:04 Nobody can help them.
00:18:05 --> 00:18:07 You know, the thing about chronic pain,
00:18:07 --> 00:18:09 though, Jimmy, is the bar is so low.
00:18:10 --> 00:18:11 The good news is the bar is so low.
00:18:11 --> 00:18:13 Meaning what?
00:18:13 --> 00:18:15 Meaning that they had been so underserved.
00:18:15 --> 00:18:16 Nobody's done anything for them.
00:18:17 --> 00:18:18 But that's the good news, too.
00:18:18 --> 00:18:20 And I tell residents all the time,
00:18:20 --> 00:18:20 if you don't know what to
00:18:20 --> 00:18:22 do with a patient, just be there.
00:18:23 --> 00:18:23 Just be there.
00:18:23 --> 00:18:25 Say, you know, how are you doing today?
00:18:25 --> 00:18:27 Now, what can I do in this 30,
00:18:27 --> 00:18:27 40 minutes I got with you
00:18:27 --> 00:18:29 to make your day better today?
00:18:30 --> 00:18:30 And now...
00:18:31 --> 00:18:31 hear me correct,
00:18:31 --> 00:18:33 and specifically for Aiont,
00:18:33 --> 00:18:35 you've got to be good at what you do.
00:18:35 --> 00:18:37 It annoys the life out of a therapist.
00:18:37 --> 00:18:38 So Adrian's just saying we
00:18:38 --> 00:18:40 just need to be happy and whatever.
00:18:40 --> 00:18:41 No, be good.
00:18:41 --> 00:18:43 Otherwise, you're useless.
00:18:43 --> 00:18:45 Your skills must match what you're doing,
00:18:45 --> 00:18:47 not only the cognitive side,
00:18:47 --> 00:18:48 but the physical side.
00:18:48 --> 00:18:50 I mean, seriously, you have to be good.
00:18:50 --> 00:18:51 Patients know when you're good.
00:18:52 --> 00:18:53 And that's why I love Aiont.
00:18:53 --> 00:18:54 I love manual therapists
00:18:54 --> 00:18:56 because you've got this side covered.
00:18:56 --> 00:18:57 You're excellent at what you
00:18:57 --> 00:18:58 do with your hands.
00:18:58 --> 00:19:00 But now bringing the soft skill set,
00:19:00 --> 00:19:01 that is what's really, really good.
00:19:02 --> 00:19:04 A few years ago at Aon in Reno,
00:19:04 --> 00:19:04 Bill Boysenold,
00:19:06 --> 00:19:08 who was formed at UW Madison,
00:19:08 --> 00:19:10 made this beautiful statement, Jimmy,
00:19:10 --> 00:19:10 where he said,
00:19:11 --> 00:19:13 these things like compassion, empathy,
00:19:13 --> 00:19:14 respect, listening,
00:19:14 --> 00:19:16 they're not soft skills,
00:19:16 --> 00:19:17 they're essential skills.
00:19:18 --> 00:19:19 I like that better.
00:19:19 --> 00:19:20 Yes, me too.
00:19:20 --> 00:19:22 And it was an instant, I was like, dang,
00:19:22 --> 00:19:23 that is really, really good.
00:19:23 --> 00:19:24 They're essential,
00:19:24 --> 00:19:26 especially for this population.
00:19:26 --> 00:19:27 Bill said it way better.
00:19:27 --> 00:19:29 I did a presentation on the
00:19:29 --> 00:19:30 importance of soft skills,
00:19:30 --> 00:19:31 my background in journalism
00:19:31 --> 00:19:32 and communications before
00:19:32 --> 00:19:34 becoming a physical therapist.
00:19:34 --> 00:19:35 And the title was,
00:19:35 --> 00:19:36 why are these soft skills so damn hard?
00:19:37 --> 00:19:38 Yes.
00:19:38 --> 00:19:39 Because some people will say, well,
00:19:39 --> 00:19:41 why are they so difficult to do?
00:19:41 --> 00:19:42 And you want to talk about
00:19:43 --> 00:19:44 words by calling them soft skills.
00:19:44 --> 00:19:46 Do you decrease or increase the value?
00:19:46 --> 00:19:47 Some people say, well,
00:19:47 --> 00:19:48 I decrease the value and it
00:19:48 --> 00:19:49 should be simple.
00:19:49 --> 00:19:49 So why?
00:19:50 --> 00:19:50 So I've done it.
00:19:51 --> 00:19:51 Right.
00:19:51 --> 00:19:52 The goal of communications
00:19:53 --> 00:19:54 is just to have communicated.
00:19:54 --> 00:19:55 No, no, no, no, no, no.
00:19:55 --> 00:19:56 The goal of communication is
00:19:56 --> 00:19:58 to achieve understanding.
00:19:58 --> 00:19:58 Right.
00:19:59 --> 00:20:00 So the fastest lesson that
00:20:00 --> 00:20:01 I've ever learned is
00:20:02 --> 00:20:03 children and puppies.
00:20:04 --> 00:20:05 If you're not communicating
00:20:05 --> 00:20:06 right to children and puppies,
00:20:06 --> 00:20:07 you will get no result.
00:20:07 --> 00:20:08 But you'll say,
00:20:08 --> 00:20:09 I just yelled louder and I
00:20:09 --> 00:20:11 said it more and they didn't do it.
00:20:11 --> 00:20:12 They didn't understand.
00:20:12 --> 00:20:12 Right.
00:20:12 --> 00:20:14 Because your soft skills
00:20:14 --> 00:20:15 were not on there.
00:20:16 --> 00:20:17 We're not working because
00:20:17 --> 00:20:18 the goal was to achieve
00:20:18 --> 00:20:20 understanding not to have communicated.
00:20:21 --> 00:20:21 Correct.
00:20:21 --> 00:20:22 Oh, beautiful.
00:20:22 --> 00:20:22 Yeah.
00:20:22 --> 00:20:23 I have to remember that one.
00:20:25 --> 00:20:26 What should someone look forward to?
00:20:27 --> 00:20:28 You have a couple of presentations,
00:20:28 --> 00:20:29 one's virtual,
00:20:29 --> 00:20:31 one's in person at your presentations.
00:20:31 --> 00:20:32 Essentially, Adrian,
00:20:32 --> 00:20:33 I'm giving you first dibs
00:20:34 --> 00:20:35 to put butts in seats for
00:20:36 --> 00:20:36 your presentation.
00:20:36 --> 00:20:37 What are people going to
00:20:37 --> 00:20:38 look forward to in St.
00:20:38 --> 00:20:39 Louis?
00:20:40 --> 00:20:42 Yeah, so we have these two parts.
00:20:42 --> 00:20:43 We have two sessions.
00:20:43 --> 00:20:45 One is on blaming pain
00:20:45 --> 00:20:46 science and manual therapy,
00:20:46 --> 00:20:47 which we just talked about.
00:20:48 --> 00:20:50 What we, myself and Dr. Louie Punta Dura,
00:20:50 --> 00:20:50 my buddy Louie,
00:20:51 --> 00:20:51 and I are going to do
00:20:51 --> 00:20:53 together is basically show the two sides,
00:20:53 --> 00:20:54 why it's important to do
00:20:54 --> 00:20:56 manual therapy and why it's
00:20:56 --> 00:20:57 important to pain science,
00:20:57 --> 00:20:57 but then more important how
00:20:57 --> 00:20:59 these two work beautifully together.
00:20:59 --> 00:21:01 We believe they're not mutually exclusive.
00:21:02 --> 00:21:02 And we're going to share
00:21:02 --> 00:21:04 that data to show how you can basically,
00:21:04 --> 00:21:05 for lack of a better term,
00:21:05 --> 00:21:06 take one patient and start
00:21:06 --> 00:21:07 the manual way and end up
00:21:08 --> 00:21:09 in pain science.
00:21:09 --> 00:21:10 The other patient,
00:21:10 --> 00:21:11 you start with pain science
00:21:11 --> 00:21:12 and end up with manual therapy.
00:21:12 --> 00:21:13 They're not exclusive.
00:21:14 --> 00:21:14 And you can use them
00:21:14 --> 00:21:16 interchangeably for different reasons.
00:21:16 --> 00:21:17 We can talk about the words we use.
00:21:18 --> 00:21:19 I think one of my favorite
00:21:19 --> 00:21:20 quotes my buddy Louie
00:21:20 --> 00:21:21 always talks about is,
00:21:21 --> 00:21:22 I still do the same manual
00:21:22 --> 00:21:23 techniques I've always done,
00:21:24 --> 00:21:25 but I explain them different.
00:21:25 --> 00:21:26 We don't fix things.
00:21:26 --> 00:21:27 Things don't go out of place.
00:21:27 --> 00:21:29 We don't put things back in place.
00:21:29 --> 00:21:30 We're just getting some nice movement.
00:21:30 --> 00:21:32 We're getting things to move a little bit,
00:21:32 --> 00:21:33 get some blood flow,
00:21:33 --> 00:21:34 oxygen to calm the system.
00:21:35 --> 00:21:35 So we change the words,
00:21:36 --> 00:21:36 but it's the same stuff.
00:21:37 --> 00:21:38 The other one we're doing is
00:21:38 --> 00:21:39 on whiplash injuries.
00:21:39 --> 00:21:39 There's just...
00:21:40 --> 00:21:42 Of all the musculoskeletal conditions,
00:21:42 --> 00:21:43 that's the one that goes
00:21:43 --> 00:21:44 the most into chronic pain,
00:21:44 --> 00:21:45 about 40% of people.
00:21:46 --> 00:21:47 And some of the amazing
00:21:47 --> 00:21:48 research from Michelle
00:21:48 --> 00:21:49 Sterling's work in
00:21:49 --> 00:21:50 Australia has looked at
00:21:50 --> 00:21:52 therapists doing early intervention,
00:21:53 --> 00:21:54 psychologically informed care,
00:21:54 --> 00:21:56 like reassurance,
00:21:56 --> 00:21:57 all those things in the
00:21:57 --> 00:21:58 emergency room early on
00:21:59 --> 00:22:00 that actually calms the
00:22:00 --> 00:22:01 system beautifully,
00:22:01 --> 00:22:02 then allows them to move
00:22:03 --> 00:22:04 and be treated with hands-on.
00:22:05 --> 00:22:05 So those are the two
00:22:06 --> 00:22:07 sessions we're doing at AONT.
00:22:08 --> 00:22:08 Perfect.
00:22:08 --> 00:22:08 All right.
00:22:08 --> 00:22:10 Last thing we do on the podcast,
00:22:11 --> 00:22:11 let's wow them.
00:22:11 --> 00:22:12 What's words of wisdom?
00:22:12 --> 00:22:13 What's the last thing you'd
00:22:13 --> 00:22:14 want to leave with the audience?
00:22:14 --> 00:22:16 Is there any idea, sentiment, quote,
00:22:16 --> 00:22:17 mic drop moment?
00:22:17 --> 00:22:18 What do you got?
00:22:19 --> 00:22:19 Yeah,
00:22:19 --> 00:22:21 I should have thought about that one.
00:22:21 --> 00:22:22 I think what it's becoming
00:22:22 --> 00:22:23 very favorite in the pain
00:22:23 --> 00:22:24 world for me is the fact
00:22:24 --> 00:22:24 that pain that is
00:22:25 --> 00:22:26 understood is not to be feared.
00:22:27 --> 00:22:28 The more we teach our
00:22:28 --> 00:22:30 patients what's happening to them,
00:22:30 --> 00:22:32 the more they calm down and
00:22:32 --> 00:22:33 fear drives pain powerfully.
00:22:33 --> 00:22:35 So if they understand their pain,
00:22:35 --> 00:22:35 they're not afraid of it.
00:22:36 --> 00:22:38 they will move and in this
00:22:38 --> 00:22:39 conference be touched and
00:22:39 --> 00:22:41 go I'm okay I'm not being
00:22:41 --> 00:22:42 hurt I'm just sensitive and
00:22:42 --> 00:22:43 I think that's a critical
00:22:43 --> 00:22:45 element well said uh
00:22:45 --> 00:22:46 looking forward to st louis
00:22:46 --> 00:22:47 looking forward to your
00:22:47 --> 00:22:48 talks and appreciate the
00:22:48 --> 00:22:48 time giving us a little
00:22:48 --> 00:22:50 tease ahead to am's event
00:22:51 --> 00:22:52 thanks jimmy appreciate it
00:22:53 --> 00:22:54 that's it that's all we need