From Fixer to Guide: Transforming Your Chronic Pain Treatment

[00:00:00] Position yourself as the coach can be a massive game changer in your ability to help someone overcome life altering pain issues.

[00:00:06] But how do we do this? What steps do we need to take?

[00:00:09] In this week's episode of The Modern Pain Podcast, I sat down with Matilda Kailer and we discussed this transition.

[00:00:15] Matilda is providing amazing education that is helping physios make this transition.

[00:00:19] We talked about the disconnect we have with some of the things we want to focus on as physios and the challenges people face in their lives.

[00:00:25] There was a problem that was just like it doesn't add up. How does this actually help the person?

[00:00:32] It's not their goal, it's my goal. It doesn't make sense that we should figure out how 2mm of stability around the pelvis is going to help you live your life better or make meaning for you.

[00:00:43] For me, it took Shelfing my ego and the need to be the fixer that got me off the Bernould train and really helped me better connect with and help people in pain.

[00:00:50] We spoke to the real expert in our encounters.

[00:00:53] But the person in front of you is actually the expert. So this mindset shift where we don't fix and we actually really listen with authentic interest and human connection,

[00:01:07] really just listen to the person in front of us and make them come in the driving seat and make them the main character.

[00:01:15] We discussed the issues people in pain face when they travel through a healthcare system that continues to focus on pathologizing them and have all these other systems that are getting air after air.

[00:01:24] And I mean, understandably a lot of the folks like him and enter our worlds are wrought with a thought they are so full of airs and so broken and so fragile and so frail because we have these systems that

[00:01:35] do nothing to tap into the resources of the person. They just if anything drain the resources because these people stop pursuing the resources they have because they feel like they're so defeated and broken.

[00:01:45] If you are struggling to make a transition from the fixer mentality to the guide or coach this episode is for you.

[00:01:51] One favorite I ask you that is if you get value out of this podcast, you consider writing a review or subscribing wherever you listen or watch the podcast.

[00:01:59] Now, onto the episode.

[00:02:00] This is the modern pain podcast with Mark Karjala.

[00:02:05] Matilda, welcome to the podcast.

[00:02:08] Thank you. Thank you very much.

[00:02:10] So you know I've crossed past a bit on social media like mine's obviously joining each other a little bit on social media.

[00:02:15] I've always enjoyed your content and sometimes it's not an English so I have to I've had to use the translate function a little bit on social but it's been great stuff and I've been fortunate to chat with you a little bit as you've been planning some big things over there in Denmark.

[00:02:28] But for those of the folks in the audience that don't know you would you mind introducing yourself a little bit about where you're at, what you're up to and maybe a little bit about your journey.

[00:02:36] First of all I've been listening to you podcast for a while and it's amazing I love to hear it and you're all the great guests you have in and so it's a very privileged to be here.

[00:02:45] So thank you. Well, my name is Matilda and I'm from Denmark and I've been a physio for like a little bit over 10 years and my journey well it started actually from contemporary dance.

[00:02:56] I was a dancer before was a physio and have this great experience that you can dance six to eight hours a day and the body is amazing and it can do all kinds of stuff.

[00:03:08] And I always have this experience with me that is just like it's amazing what the body can do but then of course like most people who do sports for the on a high level will I got an injury in my knee so I went to a physio right.

[00:03:22] I was at one point I was both amazed of what she could do and what she could figure out about my knee just by touching it and moving it that was just like wow can you do that.

[00:03:33] So I was amazed about all this figuring out how the body works and then but I was also like he didn't know idea how to make sports specific rehabilitation for dancer so I did all like the lunges and squats and things like that was very football kind of stuff.

[00:03:50] So actually my way into physio was that I wanted to be a dance physio so I went all the way through the sports physio world and very detail orientated and was a sports dance physio in Denmark for a while and only work with the ballet dancers and contemporary dancers and all they kind of stuff.

[00:04:10] But actually at the same time I also started on pain education and especially the musculoskeletal way I'm having diploma in musculoskeletal therapy.

[00:04:20] And the more I learned about pain, the more I kind of discovered it I need to learn about people.

[00:04:27] It was also because the pain even though the diagnosis was quite the same in two different people.

[00:04:34] The persons were different and what they wanted to do if there are dancers or was I don't know greater on 35 who was just going to go to the garden we needed different things and how I did packed the person was very different so even though the diagnosis was the same it was a very different.

[00:04:51] How can I help this person and the more I learned about more complex and crumming pain well than the psychologically informed physio and the communication skills and back then it was really like pain neuroscience education that was quite high at that point.

[00:05:08] And all this how can we educate and help them understand the pain more so my world shifted a bit from all the pain science to all the psychology so like for instance it was coaching that I mostly took my degree in and then asked cognitive behavioral therapy mindfulness compassion all these kind of because they all had this way of.

[00:05:37] Methods that was helping the person but the problem was I had the pain science in one hand and then I had all these psychologically.

[00:05:48] I had the informed methods and theories but none of them talked about.

[00:05:53] The person pain and it was just like they all talked about other kind of stuff and I was just like how can I mix these two how I need an education that mixes.

[00:06:04] All the things I know from here but all the cases all the examples they were not about pain and I was just like we need to get the pain science and this.

[00:06:12] I'm like logically informed methods and theories and questions into the pain world and that's actually where I am today and that's why I'm here and why we cross path because now we have.

[00:06:24] Trying to create a pain coach education in Denmark it's always interesting this similar journeys that people I take as far as people that have gotten into.

[00:06:34] Persistent pain is for recognizing a lot of the shortcomings maybe of our education that we have in physio and different things I'm wondering.

[00:06:43] Where like what have been the major shifts you mentioned them a bit as far as some of the things you.

[00:06:48] Especially when you had your physio who's more of a football based physio and then you wanted to be the dance physio where it's going to be athletics and it's going to be dance high level performers.

[00:07:00] What were the major shifts for you was there any particular moments or anything of where man this just doesn't work the way I thought it worked for what were those moments for you because I think we all had those.

[00:07:09] I think I'm just going to identify the pain and I'm like you said with your physio who was figuring things out in your name of course there's a time in place where we can do physical exam to identify some structural things but.

[00:07:19] I'm wondering what those kind of challenging moments were for you as you were coming up that where you were recognizing maybe the traditional way where you were trained in physio.

[00:07:27] Wasn't meeting the mark when it came to our patients in pain.

[00:07:31] When I think back when you talked to us it's like oh there was many I come from this dance world this belly and we just it was small movements like tiny movements that made the difference right we stood there like really.

[00:07:42] That's a fight about this and then there was all the at that time in Denmark it's called dynamics stability.

[00:07:49] So Paul Hott just stability and micro management you would say about the muscles and have been there like with a laser pointer figuring out how the pelvis is going to move like two millimeters in a sideline turn out and which is like.

[00:08:03] This doesn't make sense how is this millimeter stability training around pelvis and the core how is that even gonna relate to what you're going to do afterwards.

[00:08:18] So definitely there there was a problem which is like it doesn't add up how does this actually help the person.

[00:08:24] It's not there goal is my goal that it doesn't make sense that we should figure out how two millimeters of stability around the pelvis is going to help you live your life better or make meaning for you.

[00:08:36] That was definitely one of them and I think also we went through all this went from this by mechanical and point of view where.

[00:08:46] We've tried to figure out how can we make a specific diagnosis because when I thought as a young physiotherapist that if I made the specific diagnosis.

[00:08:57] Then I could give the specific intervention and the problem was the more we learned about all these tests and more and more information or research came out there was just like okay we can't make specific diagnosis and most of the time it's.

[00:09:14] None specific so what is the intervention so I was just like it got more and more complex about what is the right thing to do here and is the diagnosis important enough to make the intervention.

[00:09:27] So it was I thought it was really a complex time and I still think it is quite a complex time to be a physiotherapist but it's also very exciting time.

[00:09:37] I think it's a very exciting time to be a physiorect now because now the science tells us with restore trial with the walk back trial for perfect purpose all these kind of stuff makes it like the intervention is getting broader.

[00:09:52] And it's not necessarily more the mechanical stuff that's not that important that's a big decision I'm not going to go into that that's like bigger put kind of sin herself but.

[00:10:05] The intervention is getting broader and that's more personalized and that's so exciting I think it's really exciting how to we can do the intervention in collaboration with the patient.

[00:10:17] So you've informed me that your title of your handle is the pain guide and that's what it translates to from Danish to English and.

[00:10:26] It goes speaks to what the transition I think you know both agree we need to make as physios is serving as the guide not this hero of the story where we have to swoop in and become the person that finds the issue and fixes the issue where we hold that change as a badge of honor here as physios.

[00:10:45] I'm wondering if you can speak to a little bit of your kind of development as a coach and how you feel like that because you mentioned you've taking a lot of education is coaching is a coaching education.

[00:10:57] I'm wondering if you can speak to that as far as where that education is served you well when you've brought that to a physiotherapy kind of treatment strategy.

[00:11:06] The coaching is.

[00:11:08] I would say first of all it's a mindset and it's definitely the mindset shift from the expert kind of you to the more curlaboration and person sent it kind of you.

[00:11:20] So the mindset shift about believing that the person you sit in front is actually the expert in their lives they are the expert in their pain and they are actually the ones who know most about their pain.

[00:11:32] So this mindset shift about not us being the expert but we have of course the expertise and knowledge about pain and people and behavior change and the interventions that we recommend today.

[00:11:47] But the person in front of you is actually the expert so this mindset shift where we don't fix and we actually really listen with authentic interest and human connection.

[00:12:03] Really just listen to the person in front of us and make them come in the driving seat and make them the main character in this treatment land that's definitely a big shift.

[00:12:16] And then there is the second part which is the skill set in coaching we have this saying that coaching is the art of asking the right questions and to ask the right questions you need to listen.

[00:12:31] So the best coaches I know and the best coaches I've watched they actually don't talk very much.

[00:12:39] They actually really listen carefully and very interested and curious like there really curious about the person's story and how they experience it, how it's affecting their lives.

[00:12:52] And then they ask these almost beautiful questions like you just like, yeah blow your mind kind of questions where you just like you can see the person is making the reflections that make them shift about.

[00:13:06] Wow I haven't seen it that way or yeah I can see now so we actually help them on the journey and is this kind of yeah guide.

[00:13:15] That's why it's the name not the I'm not the expert it's very important for me, but I'm really the guy trying to listen carefully and then trying to ask questions and help them come to their own like epiphanys and yeah then I can do this or creativity just like oh maybe I could look at like this way.

[00:13:37] So really like help them on their journey so it's more like help them through a process with pain and then of course the third thing is the knowledge.

[00:13:48] So you need to have a knowledge about pain signs of course so really understand the complexity and the biosciing social view of it but also knowledge about psychology and human behavior.

[00:14:00] Because the thing you want to do is not just talk to the person you want to help them make a change in behavior and that is so important that you have this first of all mindset about them.

[00:14:14] In the driving seed then you have the skill set of asking questions that help them change behavior that serves them better in their life that is more meaningful to them then make them come closer to their meaningful goal.

[00:14:30] So yeah that's something something about coaching so it's not just talking it's not just rewriting, re conceptualizing the problem but it's also behavior change that's so and so important.

[00:14:42] I love how you speak to you because I think we've all had this struggle I know I definitely had it as I was trying to develop into this type of role in because I spent a lot of my encounters prior to really practicing in this manner.

[00:14:53] I was doing most of the talking and we have students in clink we just had a patient where a couple times a week we have students from a university who will come and we mentor them which unfortunately I love that part of.

[00:15:04] My job but they were like you barely talked at all like they talked like and because they were getting uncomfortable because they're thinking I got asked these questions I got to get through my.

[00:15:13] And again we still asked the right questions about red flag screening and all the things like that but they were surprised how much.

[00:15:19] The patient talked and how little I talked throughout that education did you find it hard I know for me personally.

[00:15:25] I felt it almost a little bit of a difficult transition and I don't know maybe it's an ego thing as we have as physios is it almost puts us in this consideration that maybe we're not the.

[00:15:36] I don't know want to say main event or maybe the hero but it's a red definition of our worth and the encounter to me it's a much greater worth in the encounter when you can take somebody.

[00:15:46] And coach them and help them find change within themselves and talk them through it but it's a difficult transition did you find yourself.

[00:15:52] Struggling to go from that like how we're trained in physio where we really lead the encounter and we're really asking all these questions and we know we have so many stories even these on the podcast where.

[00:16:04] Patient after patient we've interviewed it's had oftentimes they didn't feel like anybody listened or let them tell their story did you find that a difficult transition for you.

[00:16:12] Yes absolutely first of all because there's also this what is the physiotherapy don't do mental therapy.

[00:16:17] What is the physiotherapy don't prescribe exercises is you are your good physio if you don't do that because that's how we've school we're school to find the error and fix it that's how I was trained right.

[00:16:30] And it was just like had actually it's funny story I had this she wasn't student I was a student in the physio and she dropped out of physio and started on what's in the name calls psychometric.

[00:16:42] Therapist so it's like yeah and we talked afterwards when she did the shift and she was just like it's amazing physios all they do is look for errors that's all you do that's how we're trained we look for errors and when things were a little bit wrong everybody who's a physios do knows how to stand in the underwear would.

[00:16:58] And get mission right so we remember this that we needed to find the error and the time is kind of thing that would explain the problem.

[00:17:06] And then was all we did at the school and then she was just like in my on my education all we look for is resources.

[00:17:15] Where's all the resources in this person oh she's like it was so amazing for me to have this conversation because it was just like.

[00:17:22] And actually I think I did shift afterwards but it took me a couple of more years before I got there but now it's finding the resources in the person actually see the person.

[00:17:33] And believing they actually have the resources if they're allowed to unfold or explore their resources and that's how we can help them right.

[00:17:44] Believe in I believe you buddy is adaptable you have a biology like anybody else of course have this hope sometimes I think.

[00:17:54] A coach or guide someone who's holding the light until they are able or have the confidence to believe they can hold the the light for themselves right so we just help them have this knowledge about the body being adaptable and the plasticity of all the body on the mind.

[00:18:12] I think you spoke to the transition it's interesting the people we cross pass with to make that shift where you know and I love the discussion of air finding right and it seems our patients come in with list after list of all the errors.

[00:18:26] And not just physios too is there's a venture into the medical system there's all these things and there's a lot of our patients with.

[00:18:33] Chronic persistent pain they have chronic overlapping pain conditions my grains they have GI district dysfunction they have all these other systems that are getting error after error and I mean.

[00:18:43] Understandably a lot of the folks that come in enter our worlds are brought with the thought they are so full of errors and so broken and so fragile and so frail because we have these systems that.

[00:18:53] Do nothing to tap into the resources of the person they just if anything drain the resources because these people stop pursuing the resources they have because they feel like they're so defeated and broken and error and.

[00:19:05] I'm wondering if you can go over a little bit about what kind of a session of a pain coach like looks like.

[00:19:11] You discuss some of the nice things of like there's always these discussions of well you're only just talking to somebody you're not doing any you know this traditional physios stuff I think you've nicely pointed out that we still do those things it's just.

[00:19:23] We need to move past it and I did a post about a little bit of the criticism of us getting excited about the latest pass of way to short term modulate pain and then people say what you're saying it's never done I'm like no I'm not saying that.

[00:19:34] Say you can do it and then you've got great choose whichever one makes the patient feel better temporarily but now what are we doing to get the patient to make change that's meaningful in our life, but.

[00:19:44] Coming back to your the coaching sessions and one of you can discuss what it looks like to have a coaching session.

[00:19:50] With somebody who's dealing with some painful issues I think that the most important part if I'm meeting a person a new client have the luxury of making my own clinic so I have two hours for the first patient.

[00:20:02] And that's and I know that's a huge problem it's again and again that's the thing how can I do this I know I'm going there's so many clinicians who want to do this but they just like the system doesn't work for me.

[00:20:14] I have half an hour I have all these expectations I have to do all is how can I do this in a short time so.

[00:20:20] And I truly believe you can do a lot in very short time there's a very a lot you can do and learn about communication skills and learn about relationships and how to build a bond and how to.

[00:20:34] And maybe also what not to do in half a hour but most of all I think you need to listen to this story so I love Peter Sullivan's quote which is a tell me your story right just open it up just come on I got the time I got years I really want to and really have this.

[00:20:53] Curious mind really like I want to get to know you I want to understand you so I had this so yeah okay.

[00:21:02] So much I want to say mark it's so exciting okay well let's take one thing at a time so the initial assessment I had this I wasn't a webinar actually in Monday where they quoted that we should make a shift from.

[00:21:16] What's the matter with you to what matters to you and I think it's quite beautiful because it's just like.

[00:21:24] It's not about me figuring out what's wrong with you but it's about what matters to you what is the problem what is your story how did you get here and where do you want to go and actually before we figure out anything about what's wrong with you and of course there's the red flags and all like it's.

[00:21:41] Not for this podcast I think but of course there's a physical examination if there is something you need to explore to figure out.

[00:21:49] But right now I think we talk more about the coaching session right so.

[00:21:53] We need to figure out what's important to this person before we start making an intervention or before we start.

[00:22:00] Now I like shooting questions like this machine got kind of stuff I was on a clinic where did some teaching in in pink coaching and communication and I had this guy he was amazing.

[00:22:10] You knew all about this new modern pain science and he was so informed like he was really skilled in the knowledge said and then I put them together like two and two and make them have this more like this initial assessment about.

[00:22:24] Try not to figure out what's wrong but try to explore the pain like you want to explore it what is this and what does this and how about that like really exploring and what.

[00:22:37] And he was together with a girl with a woman who was about 45 and had some headaches and he and he his first question was well after he listened to a story was like okay so when you turn your head like this does it hurt.

[00:22:51] I was just like okay I was just like okay by mechanical kind of question okay fine I was listening right and then he did like this okay you said it was running where when you run do you does it hurt when like have these bumps in your.

[00:23:05] And then he asked about well how far you 45 right how far are you like in menopause or is that and all the he was trying to like finding the question he had all the knowledge.

[00:23:16] But he was still skilled communication wise in finding what was wrong and not necessarily sometimes I think it's so important to figure out.

[00:23:28] What is it you want to do before we figure out what's wrong what is it you cannot do right now that the pain.

[00:23:36] Stuck you from so we find the goal before we go into what's wrong because then we figure out what the goal is and then we can figure out what is standing in the way.

[00:23:47] Of doing that and that's different approach to how we go into to the first initial assessment so we really trying to figure out the goal the goal is.

[00:23:59] Absolutely one of the most important parts of the other coaching sessions are figuring out what is it that matters to you and how do you get there not just to figure out what the goal is.

[00:24:09] But also because when you get when you ask people about what their goal is what value it will give them if they achieve this goal and why is it important for you to get there we also connect with who they are a person.

[00:24:25] What their motivation is and we also it's often like if you ask somebody about their goal they tell you what's prohibiting them from doing it so so you it's actually the process of goal sitting it's much more important.

[00:24:40] Actually then the quite the result of the goal setting of course you want to you know exactly what the goal is but also the process about getting to know them figuring out what is it you want to do and what's stopping you from doing that because then you get all these like okay then I need to get this about pain signs okay maybe I need okay then I need to get so we get so much information about asking what people want to do afterwards.

[00:25:04] So that's if they only like trying to keep it short about the initial assessments that would be my absolutely mingle.

[00:25:13] You put in a words kind of something that I've been trying to encapsulate myself as far as like starting with what matters which.

[00:25:19] I think we have this tendency as physios to really try to break down the micro right to the like you mentioned with the Paul Hodges and Paul I think would be the first admit that's no longer maybe how he practices with that thing but.

[00:25:32] You know been tied to the core thing because he did some research that made us think back when obviously we are thinking is as moves since then but.

[00:25:39] I'm always thankful to those initial folks who bring out some things that of course research then challenges but.

[00:25:45] I think we have this tendency to break things down to the micro of like your gate patterns like you said the physio there was like what's happening in your running mechanics.

[00:26:12] What's.

[00:26:12] Where what are the things and it might get to the point where hey there's maybe some local.

[00:26:17] No see-ceptive issues in the neck that we might be able to do some local symptom modification things of course position as a guy as a supporting thing not some sort of.

[00:26:27] I think that's the best way to practice is with folks is to really and I don't think this is something that's unique to somebody who's got persistent pain either I think this is something where.

[00:26:42] People whether it's in acute ankle strain or it just known what makes you take as a person then you tailor your communication to really.

[00:26:49] Try to pull into that and push position what you're doing to let's get you back to the things that matter for you for some people will be the things that were used to it they want to get back to sports or they want to give back to things but.

[00:27:00] Some I think if we just don't ask and we just miss a huge opportunity to really one get.

[00:27:06] Of an establishment of a therapeutic alliance and rapport with somebody who really hears that you're listening.

[00:27:12] And you understand what are the things that are most important to them have you found this approach really because I know for me it's been like big game changer with like patients who.

[00:27:23] Give you the slack is maybe a early career clinician or maybe you don't have it figured out yet right and again I we're not trying to figure out like we have to have the answer in the thing that's going to do it but.

[00:27:33] I think people when you when they hear that you are listening that you are somebody that is on their side that really understands what makes them tick that they are willing to make a journey with you that might make some.

[00:27:46] And this steps here and there when you try things or you do things that may not always work as perfectly as we'd like it to have you found that really opening some doors where you can.

[00:27:56] Be creative in session but also have the room to maybe try some things that may or may not go well in session how's that been for you.

[00:28:03] First of all I absolutely agree that that it's the relation before the information or the physical assessment but it's not like I don't wanted to be I'm not advocating for just talking not at all.

[00:28:16] I think we as a physio has a central role in helping people pain and I think our hands is amazing and what we can guide people through movements we can when we make the physical examination it's also about reassurance so telling them what we do and telling them what we're figuring out and telling him.

[00:28:34] Maybe most importantly of all what we are not finding and that's quite important I think especially when we talk about this all this kind of era finding stuff right when we tell them all the things that we didn't find.

[00:28:47] And really helped them not well there's nothing wrong with you by by not that kind of steel style but really this I can see that you were worried about this let's check it out let's figuring it out and then talk them through it take them with you as you move their body and or move their joins and whatever it is and then concluding this okay we.

[00:29:10] I with all that I know and would all the testing we can know I'm not worried about your body parts for instance or you joined there's nothing here that's worries me but that's not the same as I can see that your pain is really.

[00:29:28] I'm proud of them for you and I would love to help you and we have all these kind of interventions and we want to get you through that so we don't go into sometimes I feel as a physiotherapist you know being there myself and I know a lot of the physios I work with they always they want to give that diagnosis right and we need the communication skills to.

[00:29:46] Be comfortable and confident in not giving.

[00:29:52] A specific diagnosis but still reassure the patient that we can help them and that's actually I think quite a big shift also to.

[00:30:02] I feel okay and have the skills to take the patients to well we can do all this and this and that's interventions that can help you with your pain and I'm.

[00:30:14] Let's figure it out and we know what more when we start the interventions what's working for you if we think of acting really clarifying values with somebody which I think is a huge exercise to get front and center early in our working with somebody so we can really understand what makes them tick what is the things that are meaningful to them.

[00:30:31] Because if we can position our care of those are the things that are meaningful for us to work on I think one patients are like yeah that's the me I want to be then I'm struggling with.

[00:30:41] And then we can identify what are the barriers to getting there and then we can sometimes move ourselves down to a little bit more of the.

[00:30:47] Traditional things like we're going to get people moving we might do some exercise again if you do some symptom modification stuff that supports is launching in the patients.

[00:30:55] We position it well and it's not becoming something that the patient thinks is.

[00:30:59] Some curative measure but it's something to help them support to move them to and I know that's how you work with your.

[00:31:05] The physios you train but also the patients you work with as well. Do you find that to be a pretty beat decent struggle for physios to move from that and you've already alluded to it a bit and you've really explained it very nicely, but how do you help a physio I guess would be a good question to to get comfortable.

[00:31:22] Get to know the person before they get to know their mechanics.

[00:31:26] I think actually the this the new data and then the new kind of signs that comes up actually speaks for itself.

[00:31:33] And it's or it's really helping us when I say us I mean you and me all the other ones who wants to work like this a little bit more, but we really have some data that helps us.

[00:31:45] Say that this is actually a more important approach than the biomechanical way.

[00:31:52] And most of all one of the things that we can see is like that the pain's self-efficacy is so important for the prognosis and I don't think that we can be the fixer.

[00:32:02] And then help somebody build their pain self-efficacy.

[00:32:05] I think we really need to put the person in the driving seat and not just in a taxi, right? They just sit in the back seat and we give them some treatment or something and they go again.

[00:32:15] We need to put them as an active participant in the treatment.

[00:32:22] And I'm sorry and I know that a lot of people in pain and especially moments people with pain for a long time, they want to participate so much.

[00:32:34] They really want to have so much more in their control things that they can do what can I do? How can I help this and not just go to a physio once a week go to and also the other the other Thursday and and they good appointments and just so much more.

[00:32:52] And so it's out of their control because they want things done on them. That's how the systems or the biomechanical way very black and white but what they really want is also to have this self-management feeling like I'm handling this, I got this.

[00:33:10] I know what to do and we need to help them build that confident. But to do that we also need to I sometimes talk about not just if we want to help patients with a self-efficacy, we actually need to start helping the clinician build that self-efficacy.

[00:33:29] So how can we help them be confident in asking these questions in getting to know the person and define their role as a physio as also a helper and behavioral change or helping the person not just the body.

[00:33:47] So there is a shift in this that makes I need to because a lot of the barriers for clinicians when I hear it is I'm not a psychologist.

[00:33:56] I don't know how to do this and actually I'm a little bit scared if I'm going to open up like Pandora's box and it's just like and I don't know how to handle it.

[00:34:05] But at the same time, I believe every physio has this very empathetic and empathetic is like helping me empathetic thank you.

[00:34:16] And I have this amethetic why they did they wanted to be a physio. They're really going to help the person right and they have them and I'm sure that every clinicians tried that they have opened up a person and they said and the person said nobody's ever listened to me like this people or they start trying or they get touched and move because we also touched their bodies we touched them as a person.

[00:34:40] And and I remember this I remember that I had this ability that's very big word it's not one I want to say this my language is against me but I have this natural way of people's opened up to me and I think a lot of physio has it when they talk to people open up.

[00:34:57] Because there are so few people that you actually can talk about their pain with. You have a physio who's so interested in your pain and it's just like okay I can talk about it and I can explain it and I can it's so you don't do it with your friends you don't do it with your family necessary but here there's a person who's really interested in your pain experience and that's very vulnerable actually and that we as a physio feel comfortable in holding that room where it's okay to talk about this and it's okay to talk about how to talk about it.

[00:35:27] It's impacting you and as a clinician feel confident in holding that room and not just a lot of physios also talked about I know how to open the night and then what I don't know what to do then.

[00:35:41] How can I help them with this then it's just like okay I'm sorry to hear that well physio career which is like it lag like the next level so how can I use what you just opened up so beautifully how can I help you.

[00:35:57] use that and help move forward to what you really want and feel confident in making that move and use this so important vulnerable information that you got from your client and help them use that in the.

[00:36:13] things they want to make or in what behavior they want to change or things like this right or in this reconceptionalizing of the problem of the paid in experience right so so building.

[00:36:27] I think it's sometimes is really just be comfortable in learning the questions sometimes it's very practical okay you get this script you have to learn it try to ask these questions see what happens up feel comfortable.

[00:36:39] asking a question that is potentially vulnerable and because you also need to be comfortable in doing that and not be afraid of what the answer is right.

[00:36:48] and then when you get more and more comfortable in asking questions and receiving the answers and learning how to how can I receive this without either going into it just I'm sorry but really how can I use the answers you give me and help you.

[00:37:06] use that further on your journey yeah so what else really let's go said in it yeah I totally agree with you that.

[00:37:15] sometimes we take it like to the first steps of this approach where we can ask sometimes the difficult question but are you ready to deal with what comes from the patient then are you going to be able to.

[00:37:25] take that information one validated and empathize with it that man I'm so sorry this happened to you I'm really sounds like a really tough journey for you.

[00:37:34] and then being able to then construct it like we talk about this co-constructed narrative that we put together with a patient that hopefully.

[00:37:41] and then we make sense of their story helps them make sense of their story obviously Peter or so and the CFT approach will talk about making sense of pain.

[00:37:49] but that's what we do read we try to construct a narrative that with the patient of like this is how I've heard your story.

[00:37:56] you mind if we talk about it and how maybe it impacts your story might impact your pain in different things and then moving that step further of okay let's do something and keeping these things in mind because I agree like a lot of physios.

[00:38:08] hear the information up heard that but let's go talk to the things I'm comfortable about let's look at your pelvic alignment and all these things.

[00:38:14] I'm wondering if you can speak to the difference what you see.

[00:38:17] between what you would consider like maybe a pain treatment and a pain coaching session do you see a delineation between those two and how might they differ because I think there's.

[00:38:25] maybe traditional pain treatments and then there's pain coaching and we'll maybe get into where you see pain coaching functioning as a role in the healthcare systems moving forward.

[00:38:33] I'm going to talk about a lot of people think that pain coaches is only chronic complex pain and I actually don't believe that.

[00:38:42] I think that it definitely has a role all over all kinds of treatments injuries or conditions because it's also like a communication skill right it's about the question sentence about the communication and the relation to the person and how to make it person sensitive so it's also like this mindset.

[00:38:59] but I think the pain treatment really is like focusing on the pain and the pain coaches coaching is focusing on the person or the human and that's that is like.

[00:39:12] micro macro kind of you if we call it that and it's and it's not necessarily that it's one or the other I don't think it's like a binary thing I think.

[00:39:22] it really depends on the person in front of you because sometimes you really need very focused micro that can be helpful sometimes right and sometimes the best thing you could do is not at all go that in that way.

[00:39:34] like I had a patient who as she was getting round and she was like I have 48 diagnosis.

[00:39:40] There's just like wow okay should I make a physical examination or trying to find a 49? No, I don't think so.

[00:39:46] Maybe you need something different right how it and it's just like when we do the pain coaching it's really about putting the patient in the driving seat and really make them what beside them on their journey.

[00:39:59] and I think like a coaching actually there was this well physiotherapy day here in September where it's about a little by pain and I and there was a webinar with the piano solivan and he was told and I asked about pain coaching because I'm asking everybody about pain coaching these days.

[00:40:15] I really believe that the pain coaching term is and I think that in a couple of years it's much more normal.

[00:40:23] And that's also when I talk to you and I really think that the best way to make something new is collaboration with the ones who work with it.

[00:40:32] So I asked him well what do you think about pain coaching and he was just like well pain coaching the it's also about more like a process space.

[00:40:42] I think a lot of people also talk about this process based approach instead of an intervention based approach.

[00:40:50] And I think that's really the coaching style also that we not necessarily see each other three times a week or something like that.

[00:40:57] Well, we take a good time to make like good basics a good foundation and figure out where you're going what's standing in your way and how can I help you with that.

[00:41:04] And then we follow them maybe over a longer time but not necessarily as often. So really put them and making the adjustments, making help them figure it out if they come to like a rough patch or flare up or what should we do here and really take these experience and help them.

[00:41:22] Okay, what should you do now? How can you so it really is this supportive self management that a lot of people talk about right.

[00:41:28] So so he really say it's about like the long run that you follow them that were a longer period but not us often as pain treatment that's me trying to much a little pain.

[00:41:38] Well, if I make very if I'm making very black and white right, but that's a good question.

[00:41:43] I want to respect your time until I've really enjoyed the conversation and with that said where do you see pain coaching in the future like where if we're tracking out 10 years and where would you like to see pain coaching or where do you see it functioning.

[00:41:57] It within maybe just a greater whole of working with people in pain.

[00:42:02] Right now I'm trying to make this pain coach, education and Denmark and this is the reason why I'm making it an education and not a week in course because I have been on so many weekend courses and most of the time I'm amazed and inspired but then I gone that on Monday and I was just like how do I put this into play? How do I do this?

[00:42:23] So I really want to educate people to feel comfortable in the communication skills and the asking questions and have this both the pain science that's we start to talk about and also the question skills and the communication skills to help people make behavior changes.

[00:42:42] So I really want to make for now it's like five months this education we start on we start with like an online platform where you get all the theoretical because you really need the knowledge also right so.

[00:42:55] So we start with all the theoretical so you get that on your own because that's just you just need the information but when we start on the education it is so practical.

[00:43:05] I'm actually quite pragmatic in my way of thinking because we need to I'm not right so I love to study and all this kind of nerdy kind of stuff but what I really needed was to.

[00:43:46] Be confident in doing it and getting feedback and actually be seen in all my.

[00:44:12] I want to move you from being.

[00:44:16] I want to be a little bit more focused on the practical stuff and life cases and feedback and also on yeah learning to do it in real life that's what I wanted to see you know differently.

[00:44:26] But if I talk about what I hope it will be in the future I really hope it's a title in itself.

[00:44:31] I really hope if I really like see the big mission yeah I actually hope that there's a pain coach connected to every physiophonic and let's say 10 years hopefully that it's not like it's something that should stand instead of a physio but.

[00:44:49] I believe that if a patient comes in I have this experience when I when I early in my career that I knew how to screen for psychoselfial factors but then I didn't know what to do that them.

[00:45:01] So I had how old the question is and I don't have to spotted ABC down there but I didn't know what to do with it so I could see it.

[00:45:08] But I didn't know how to work with it all I didn't have the time to it so I hope that there's a panko you never physiophysi clinic so when you there's a person coming in and you can see all the psychosophials factors that's involved in this it's not necessary that.

[00:45:25] He or she shouldn't be there but you know I think it would be very good for you to give you the best treatment here I would recommend that you have three hours with our panko and then the panko can work with all this what is wrong and redefining the problem work with the experience work with how you see the pain and also work with the for instance a psychosolcial factors and and then the physio is working for the rehabilitation for instance so it's more like a collaboration right.

[00:45:56] And and then I actually also hope that there's a pankoch in maybe not maybe actually I hope there's a pankoch in every company so when a person is out with a low back pain they don't sit around for six weeks and just wait at home but you like it should be as normal as seeing a pankoch.

[00:46:15] If you are in pain as it is normal to see for instance a stress coach when we have stress so we have this normal expectation of working with you as a person when you also in pain.

[00:46:27] So maybe there's a pankoch connected to your company so when you have low back pain.

[00:46:30] The company have unhealth insurance and you address here to a pankoch and then can help you what to do how to stay connected to the to the work, how can we help you train, transistor, transistor back to work again sorry about my language.

[00:46:45] I don't have all the words but how can we do that and maybe also there's a pankoch in the system so if you're out of job, if you're sick and you're out of job there's a pankoch that's connected to you so you can help you through this process.

[00:46:58] That's actually my big goal and I really hope that I already know that the pankoch title is used but it's not really, I really want to set the standard for it so it sells a really like an education and not just a week in course to be a pankoch.

[00:47:15] But it's really easy and you have learned it and it's not something you just know like a mindset or knowledge but you actually it's the skillset yeah that's definitely the dream.

[00:47:25] I couldn't agree more with the thoughts I think as physios and outies and chiropractors, I was passing there needs to be a degree of experiential learning with us this isn't something that on a Saturday in Sunday you're going to all of a sudden you need to have and especially if you have a group that can help you ask these difficult questions get uncomfortable.

[00:47:43] Understand how to function in that uncomfortable state that some of the things that we hear will bring us in that's just normal human stuff when we hear some of the tough emotional things that patients go through and some of things in their story but.

[00:47:55] When you as a physio can get amongst a like-minded group of people are again beyond just a physio and be able to say here's the questions ask we need you to ask him.

[00:48:05] Here's a group that's going to support you that's going to help you understand that yes you felt uncomfortable like we all did when we ask these questions but.

[00:48:13] We want you to function with those questions and be able to just not like I used to just like tuck tail and run from emotions and difficult feelings and anger and the things that are natural human things that people have under dealing with pain so I think your programs can be.

[00:48:26] An amazing resource for folks and those of your listeners will have it linked in the show notes so you can check it out because I do think.

[00:48:34] More of these programs where it isn't going to happen on a Saturday I don't mind we can courses but I'm probably recovering weekend course junkie where it was just like I have to have the next.

[00:48:44] Of course that's going to solve this thing for me I honestly think that we don't need more that I mean we have some great ones out there don't get me wrong but.

[00:48:51] We need to get in programs where you get supervision when you're asking these questions and having these conversations and how are you communicating.

[00:48:58] Because one what we think we're doing and what when somebody else watches us or when we get supervised may not line up I know for me there was some.

[00:49:07] I opening things when I had to have people listen to how I interviewed a patient and when how I had a follow up sessions with patients it's uncomfortable nobody likes to hear themselves on video or.

[00:49:17] On tape we have we've had students in the past taped themselves audio and.

[00:49:21] It's but to me man the room for growth in those situations exponentially more than what you're going to get on a Saturday and Sunday course when you have some folks who've probably made the mistakes you're making numerous times and can help you.

[00:49:34] Not make those mistakes in the future so make sure you check out Matilda's program and check out some of her stuff online too will link her social profiles in the show notes I wanted to thank you for your time today Matilda thank you for everything.

[00:49:46] You're doing and we wish you the best of luck in everything you're doing with your program.

[00:49:50] Thank you Mark it's been amazing to be here and I really hope that a lot of clinicians out there feel that this is actually something you can learn everybody can learn it so I really want to help clinicians make this new complex world of pain and be excited about what are you actually capable also as a human and in the communication skills because people really look for these communication skills right so.

[00:50:12] This is something everybody can learn so thank you thank you very much for having me and it's been a pleasure.

[00:50:17] So thank you everybody.

[00:50:19] The most rewarding character you will provide and if this guy who was the most emotions adverse person in a treatment room can get comfortable with difficult emotions you can do it too so definitely check out Matilda's stuff and we'll like you said link it in the show notes.

[00:50:33] We'll leave it there this week wherever you're listening to your podcast we love you subscribe maybe review share this episode if there's some folks who are figuring out how do I.

[00:50:41] Start dealing with some of the difficult conversations in my clinic and maybe position myself better as a coach versus a fixer because the fixer is a quick path to burnout I've been there we probably all been there so enjoy the rest of your week we will talk to you all next week.

[00:50:57] This has been another episode of the modern pain podcast with Dr. Mark Karchala.

[00:51:01] Join us next time as we continue our journey to help change the story around pain for more information on the show visit modernpanecare.com

[00:51:09] This podcast is for educational and informational purposes only it is not a substitute for medical advice or treatment.

[00:51:15] Please consult a licensed professional for your specific medical needs changing the story around pain this is the modern pain podcast.