Join us for a riveting journey through the landscape of trauma and healing, where Bethany Ranes Ph.D. and I navigate the mind's labyrinth following traumatic experiences. As a cognitive neuroscience research scientist with notable tenures at United Health Group and the US Army, Ranes lends her profound insights into the ways trauma shapes our physiological and psychological wellbeing. From the subtleties of microaggressions to the roar of chronic pain, our dialogue offers a fresh perspective on how small-scale stressors accumulated over time can manifest into significant psychological hurdles.
This episode paints a vivid tableau of the body's response to trauma, elucidating how evolutionary mechanisms and sensory cues influence our reactions to stress. The discussion spotlights the transformative potential of therapeutic touch, dissecting the dance between trauma responses during massage therapy and the human immune system. Delving into the art of creating a safe space for clients, we discuss the critical importance of empowerment and control in fostering a healing environment. Dr. Ranes's expertise demystifies the complex interplay of the body's alarm systems, offering practical strategies for managing trauma responses with mindfulness and kinesthetic awareness.
Concluding with a teaser of her "Firing and Wiring" blog series, we explore the interface of neuroscience and daily life, promising insights into how to navigate the brain's intricate circuits to enhance our daily experiences. Whether it's the psychological barriers to pain management or the soothing cadence of ASMR principles in massage therapy, our conversation encapsulates a treasure trove of wisdom that promises to empower listeners in their own journeys toward understanding and overcoming trauma.
Find out more about Dr. Bethany Ranes here: https://interoceptlabs.com/
Join us for a riveting journey through the landscape of trauma and healing, where Bethany Ranes Ph.D. and I navigate the mind's labyrinth following traumatic experiences. As a cognitive neuroscience research scientist with notable tenures at United Health Group and the US Army, Ranes lends her profound insights into the ways trauma shapes our physiological and psychological wellbeing. From the subtleties of microaggressions to the roar of chronic pain, our dialogue offers a fresh perspective on how small-scale stressors accumulated over time can manifest into significant psychological hurdles.
This episode paints a vivid tableau of the body's response to trauma, elucidating how evolutionary mechanisms and sensory cues influence our reactions to stress. The discussion spotlights the transformative potential of therapeutic touch, dissecting the dance between trauma responses during massage therapy and the human immune system. Delving into the art of creating a safe space for clients, we discuss the critical importance of empowerment and control in fostering a healing environment. Dr. Ranes's expertise demystifies the complex interplay of the body's alarm systems, offering practical strategies for managing trauma responses with mindfulness and kinesthetic awareness.
Concluding with a teaser of her "Firing and Wiring" blog series, we explore the interface of neuroscience and daily life, promising insights into how to navigate the brain's intricate circuits to enhance our daily experiences. Whether it's the psychological barriers to pain management or the soothing cadence of ASMR principles in massage therapy, our conversation encapsulates a treasure trove of wisdom that promises to empower listeners in their own journeys toward understanding and overcoming trauma.
Find out more about Dr. Bethany Ranes here: https://interoceptlabs.com/
Hello everybody and welcome again to another Sensory Approach to Manual Therapy podcast. Today I'm speaking with Dr Bethany Raines. Bethany is a research scientist, mainly in cognitive neuroscience. She was the lead scientist at the United Health Group. She is the principal investigator for the US Army, which I'd like to talk to you about a little bit there in your role, especially as it pertains to what we want to talk about today, which is mainly head injuries and psychological trauma and also physiological trauma. And you also spent time as a scientist with the Betty Ford Clinic for addiction, which also interests me because I actually taught a class last year that talked about pain, chronic pain, as an addiction process inside the brain, as a ritualistic addiction, and it actually got a lot of really negative feedback online really negative feedback online.
Speaker 1:People didn't. Yeah, people really didn't like that concept, even though I'd come across quite a few research papers and you know it was just like a two minute snippet that we'd put up as an advertisement with the Canadian Massage Conference and some people really took offense to it, and I was amazed that they took offense to it. So I'd like to talk to you about that, but it may not be today's podcast, so welcome.
Speaker 1:No problem. Do you want to introduce yourself to our listeners and let them know? A lot, of, a lot of the listeners here, you know they're, they're big fans of neuroscience and they pay attention to a lot of that stuff, which is what a lot of podcasts about. So we don't have to change our language or anything like that today. So welcome, and do you want to introduce yourself at all?
Speaker 2:Sure, yeah, I always joke that I'm everybody's friendly neighborhood neuroscientist A lot of my work has always been in the translational side of things.
Speaker 2:So while I have done some work as a lab rat in my life working predominantly with forensic populations, actually whenever I was doing more of my academic research what really interests me is taking the things that are coming out of the lab which some of them are just truly amazing and helping to both translate them so people just understand them, so they're more accessible, because everybody with a nervous system really should be able to have access to the newest neuroscience. It's important, you know, it's not something for niche academics or scientists, it's for all of us. It's like our owner's manual to our mind, and you know and I also do a lot of work in applied neuroscience, so I help companies and folks that have really cool ideas take what we're learning in neuroscience and actually make things out of it, which I love to do. So that way it's actually being used to help people kind of getting that gap between an idea and the application of the idea closed down as small as we possibly can.
Speaker 1:That's actually one of the reasons why I was really interested in having you on as a guest, because a lot of the people who I've had on before, who are neuroscientists or who speak about that as researchers, they're not necessarily clinicians and you're not a clinician, but you do have that applicable portion where it's not just the science, because the science that I just did a podcast last week which is coming out in my next series, which which is on placebos, which I know you and I spoke about the last time we talked and it's one of those things where it's research is great. It's really good to know something, but if it doesn't benefit somebody, then it's just knowledge, you know, with no impact, and the impact is really where it's valuable. And as a person who's really interested in neuroscience myself, as a lot of my listeners will be, we are clinicians primarily, and so the information is great, but I want to know what does that information make me do differently with my hands? What does that make me do differently as a clinician with my words and my vernacular and my environment? And so that's actually what I want to talk to you about really, because this is going to be the final one in the series that I'm doing on trauma.
Speaker 1:The first one was an athlete who experienced trauma, hilary Allen, and the second one was Brian, who I just spoke with a couple weeks ago and put up, and he's a clinician who does something called trauma-informed care and I actually asked a lot of my followers on Instagram how many were aware of trauma-informed care and I actually asked a lot of my followers on Instagram how many were aware of trauma-informed care and it was a surprising number who were not, and I was surprised by that. Yeah, there were quite a few who were unaware of what trauma-informed care was, and actually Wednesday I'm doing something with the IASP on why trauma informed care is important for chronic pain, and so I want to think it's your just just your a quick understanding from you on what, what trauma is, because it's kind of become a catch all and it's also kind of become something that some people dismiss and some people latch on to. So how would you look at talking about to clients what trauma is in your mind as a scientist? Sure.
Speaker 2:I could probably give a little context on this, in that as a scientist, as a person, I tend to have a very strong what we would call like an evolutionary bend. I like to think that everything that we have whether it's comfortable, uncomfortable, good or bad all came or comes from some kind of an adaptive sort of ground spring, and trauma, I think, is a really great example of that. So trauma is something that you know not to give. It can be a catch all, because the word trauma is it really just kind of means impact, right? Catch all because the word trauma is it really just kind of means impact, right? So take that as you will.
Speaker 2:You're impacted by things all the time and I think it's really gone through evolutions of. It's almost like fashion. What does trauma mean? Right now, and we've gone through well, trauma is like major traumatic events. You know it's something that causes PTSD. You know it's something that if you're talking about head injury, it's something that causes a serious issue like a concussion. But yeah, at the end of the day it's an impact and what we're seeing more and more in the research is that it doesn't have to be as big as we used to think. So over the years in my work lots of people have adopted this, this idea of big T trauma and little t trauma right, I mentioned it in my last podcast.
Speaker 1:Yes, and I said big T, little T and I told the listeners you're going to talk about it.
Speaker 2:So, yes, the last, you know, the last decade has been dominated by this idea of like the big T trauma. I mean, and it's really not even just the last decade been dominated by this idea of like the big T trauma. I mean, and it's really not even just the last decade, it goes all the way back. And we think of folks like vessel you know vessel Vander Kolk, who you know talked about how these large traumas in our lives will lead to more somatic issues, which I'll talk more about later. But you know this idea, it's always that it has to be some big thing. We talk a lot about adverse childhood events, right, the ACEs.
Speaker 1:And it seemed like the big T had to be something that was significant enough that to the outside population, to the person not experiencing the trauma, that they could logically look at it and go. I can understand or empathize why that would be considered traumatic and that seems like the old version and it seems like that's changing now. Because you talk about things like bullying, you talk about things like gender equality, you talk and think of, you just talk about the systemic racism that exists and these are things that you know using the word systemic racism, that's a big T. But then we look at how it behaves people on a daily basis where it's like tiny little things that are done all the time that are the systemic example of it.
Speaker 1:I had I had a guest on talking about burnout, benny Vaughn, who's an African-American massage therapist of great renown and a good friend and he was. He just opened up a multimillion dollar complex as the massage therapist when COVID started and and during Black Lives Matter and he's interracially married and he lives in rural Texas and he got his wife got pulled over by the police and he's talking about how he just sat there in the car with his hands on his lap. Him and I were talking, it brought me to tears in the podcast and he's just like yeah, no, I know, you know, you know what's going on. He was just like I know what's happening here. We didn't do anything wrong and it was just the way he. And it's like that's the little T with a big T consequence and it's just amazing how the two have kind of become so intermingled.
Speaker 2:They have. I wouldn't even want to any more discriminate between the two. I think that systemic racism is a perfect example of this. It's um, so these little traumas are what is frequently referred to as death by a thousand paper cuts, right, you know, one of the terms that you hear often, particularly in the area of systemic racism or any kind of systemic discrimination, really is microaggressions, and that's really kind of come to the forefront, particularly since the Black Lives Matter movement, but just in general, about our movement, but just in general, and it's the little things that you can't point to because they're ubiquitous and they're sort of like just they just creep and crawl everywhere at the cellular level. It's.
Speaker 2:You know, an example I sometimes will give, as, as a woman in a particularly you know, particularly male dominated area, I was once at a like it was a startup sort of round Robin we were seeing lots of pitches from lots of people about chronic pain. I was once at a like it was a startup sort of round robin we were seeing lots of pitches from lots of people about chronic pain. I was the only woman in the room and I was sitting on the inside of a horseshoe and I was like kind of sandwiched in and I was just sitting there and the pitch folks, the startups would move through us and one of the CEOs for the startup, who of course will remain nameless but got to ours and pointed at me and said sweetheart, can you give me a coffee before we get started? And it was just one of those little things that I bet lots of people wouldn't even notice. But he picked out that I was a woman in that room and just automatically assumed I was some kind of subservient role.
Speaker 1:Luckily. It definitely doesn't help that he started with the word sweetheart.
Speaker 2:Sweetheart oh honey sweetheart yeah.
Speaker 1:And right.
Speaker 2:So it's little, those little things right, because you're just like and I think they carry an extra burden of, well, it's just a little thing, and most people are like, well, this is such a little thing, you can just shrug it off, but they're happening so often, right, and that's a minor one compared to what people you know, I have the privilege of being a white woman and that one's terrible Right so you're talking to a white man in his mid forties.
Speaker 1:It's not like I've been like when I talk about, about systemic racism.
Speaker 1:We're like here in canada. We're dealing a lot with the indigenous cultures. You know, my father's actually indigenous and he's married to a full-blooded indigenous. And recently over these, um, you know, during during the pandemic, there were these school, uh, these mass graves that were found during something called the 60s school here in canada.
Speaker 1:And, being a being a white male in my mid 40s, I'm always like you know what, like it's hard to talk about this stuff because I'm the one I'm the one on usually the giving end of this, not on the receiving end, and yet it's important to talk about. But it's exactly like you said, like those micro traumas. The one I remember is bullying as a kid. You know, I was bullied as a child and it's an example where people like, oh, just toughen up, be harder, it builds character. That was the 80s mentality, which is 80s baby. But now we look at it and we go, no, those little moments of bullying add up over time and it's like death by a paper. You know a thousand cuts. Or you know it's like obesity or overweight or malnutrition through consistently and constantly, just always eating the same thing that you think is good or oh, it's, you know that extra donut's not going to be what kills me, but over the course of a lifetime that's 10,000 donuts, you know like.
Speaker 2:A hundred percent it's going to be. Yeah, exactly so. Your brain works very similarly and trauma is kind of this amazing process. Frankly, when it comes to your survival system, when you take a step back, you know I'll do sensitivity, that it can cause some very disruptive symptoms, but it is what has kept us alive. So what's happening is that you know you have a neuroscience base of listeners so I can go through this quickly but your brain doesn't react. It predicts, right, and it predicts based on sort of a model of everything you've experienced and that's what your memories are for. That's why we learn is to predict and be better next time.
Speaker 2:When a trauma happens, whether it's a big T, little t, anything that we associate with harm or potential harm or threat, is something that your brain takes extra special care right, and that's when your amygdala starts to get involved with things and it becomes now a survival issue. It becomes I have to avoid this, I have to fight this, I have to freeze around this in order to survive. And whether you know, back in the old and old and olden days, of course it was a bear. It was, you know, saber-toothed tiger, whatever you know, we needed to know what that growl was. We needed to know what these tracks are. We need to know what the smell is or what kind of caves to look out for.
Speaker 1:And these days, it's mostly social right. Most of our threats are psychosocial, but the exact same where we are, at least I mean what we are. That's true because we look at some of the stuff going on in the world right now in eastern europe. We look in the middle east, I mean yeah, look at a lot of places in africa still in the sudan and we're like, hey, it's for them, it's surviving at a very different level.
Speaker 2:Yeah, exactly which, exactly, which is why we yeah.
Speaker 1:Even here in Canada I think we took in during the Ukraine war we've taken in 80,000 refugees and you know there's been a lot of conversation about what's going to happen to the healthcare system in a couple of years when a lot of these children that we've taken in grow up with all these memories of being a refugee from a foreign country who can't go back necessarily, who lost love and family members, a lifestyle, identity, all these things like that. So I did a talk last year at the Canadian Massage Conference called the Evolution of Pain, and I've talked to some of my followers, some of my listeners, about evolution. We've talked about it a lot. So the idea of evolution to me I love that because a lot of people see pain, they see traumas, these negative things in our life, and they don't realize that, like pain, chronic pain is a great example. Um john's war act, who I did another podcast, who is an evolutionary biologist guy, talks about him and I talked about.
Speaker 1:Without pain, without that concept, we wouldn't be bipedal because when we tried to stand up over time, the fatigue and pain and chronic pain that came from having weak erectors and weak vertebral discs made it that they had to solidify, they had to get bigger, the muscles had to get stronger, so that pain led to an adaptive process. Now what you're saying is trauma is doing the same thing. Now, physiologically, I can understand some of the adaptations that pain will cause. What are some of the adaptations that we're getting, evolutionary wise, from the trauma response?
Speaker 2:So trauma response is largely taking sensory cues from the environment that you usually unconsciously associated with threat and using them to predict that threat. We really don't have a whole big tool belt when it comes to our threat response. As a human, you know species, so you're looking at what is frequently referred to as your fight, flight or freeze, and so you're seeing that sympathetic activation is the fancy shmancy thing.
Speaker 2:for that the scrabble word, as I like to say, but so what you generally will have is your, your, your brain takes in all of these cues, these sensory cues that in a healthy you know, non-threatening environment situation would be considered benign A smell of something, a taste of something, the way the sun reflects off of something, right, all of these little cues that people who have not experienced the trauma would never even think twice about. However, if you've been through the trauma, it's something that unconsciously will activate your fight or flight. It starts to unconsciously activate that sympathetic response and it can do so sort of quietly, um, and it can build up and you might not even realize, especially if you're, you know, somebody who tends to be go, go, go all the time. You don't have a whole lot of of sort of what we would call interoceptive mindfulness or this uh, uh, an attention to what's going on in your body all the time.
Speaker 1:Yeah, we might not notice it's big. Yeah, we call it kinesthetic awareness and it's the same thing. You don't have a good one, yeah.
Speaker 2:Yeah, and we do. We tend to turn that button down. We live in a kind of an anxious world, most of us, and so we've turned that volume down. So what will happen in this is it gets louder and louder. It needs your attention.
Speaker 1:That's the whole point of the system. So it'll get higher and higher is. Is that where, if we are having these trauma responses but we're not paying attention to them because we're not aware of them, we don't have good kinesthetic awareness, we're not being mindful whatever happens, we're distracted, let's you know. We sure we could say kinesthetic lack, awareness, dyskinesia, however, you know whatever scientific term we want to put to it. But we could also just say I'm busy with something I else I'm distracted or I'm ignoring you.
Speaker 1:Yeah, that, logically, is more important to me at the moment that I have to focus on. I'm making dinner and I don't want to fight at the moment, as an example, because the kids have to eat and we have to eat. But what happens when that happens? Is it similar to what's going on with most? Because I often equate trauma responses and pain responses to be similar because, around predictive texts, around predictive behavior, around long-term potentiation, around learning, they have very similar occurrences inside the brain. So with pain, if we don't pay attention to it, the signal just keeps getting more significant if it's still dangerous to us because it's saying you're not going to pay attention to me. Now I'm going to make it louder so you will eventually pay attention to me.
Speaker 1:With trauma responses, are we seeing the similar thing happen, where it starts out small and then, because we're not aware of what those symptoms are, we don't pay attention, we don't stop and gather ourself, and so eventually we see what's called a large trigger or a large response, where somebody blows up or they you know they in in French, we say in LV, and it has the word nerve in it, which I love which is essentially you're overwhelmed at that point and you know you throw your keys or you throw a fit or you quit randomly or whatever it is, and that's what's happening. It sounds like you're saying is that if we don't pay attention to those signals, the trauma is. Eventually the response is going to say no, you're going to pay attention. Do you want to pay attention now or when it's a lot bigger of a problem, kind of thing.
Speaker 2:Absolutely, and especially when you have, you know, a psychological trauma response, a lot of times the signals that are triggering it are all around you. It's pretty tough. It'll be a relationship that you are oftentimes seeing that person all the time and it's triggering you, or a behavior that you yourself might do that's triggering you, and a lot of those things can be very unconscious. So, yeah, they're happening, that thing is not going away, so your brain is going to get persistently more panicked about getting your attention.
Speaker 2:And pain is interesting because it is tied very much into this process in that it's part of this complex sort of immune response that you have sort of say, and it's part of a macroimmune response as opposed to your microimmune response where it's kind of like stop, drop and roll right. Pain makes you stop and it can very easily become associated with things where you start to feel it. You know whenever you need to just stop or get away from something that's causing that trauma response and you're just not responding to it. Pain also presents a unique challenge because we don't think of pain that way. When we think of pain, we think my body's broken. Oh my God, I've broken something, I've hurt something, and that won't be so much.
Speaker 1:That won't be so much the case with our listeners, because a lot of them have done a lot of the pain, study classes and sciences and we understand now that there's this big shift of perceived threat versus structural biomechanical damage and how we know the brain is very much engaged and the good news is that becoming that is becoming much more part of the common culture. It's, it's taken a long time. It is, you know, it is, and it's moving fast.
Speaker 2:I remember whenever I first started having this conversation with with executives like atalth and I would talk to rooms that had surgeons who were just like you sound insane, but it is really true and we're seeing it. I think it's gaining so much traction so fast because it's working. It makes a lot of sense and when people do know that, it's wonderful because then you can use your pain as it's being used by your brain. You're kind of in parallel now and you're like okay, when I feel this pain, something is going on. I need to take a beat, look around. What is causing this? What is triggering this?
Speaker 2:It can be hard to figure out what is triggering a trauma response. It's not always obvious or easy. A lot of times it's normalized. It's a benign signal, You've normalized it, but it's also causing you a trauma trigger response. So that can be tough and that's why you asked about trauma-informed care.
Speaker 2:That's essentially at the heart of that trauma-informed care piece is the idea that you've got something that might be both, on one hand, normalized and so normalized. It's automatic and kind of invisible to you, but it's also triggering this immune response in you. It's triggering a safety alert and it's really tough on your own or in a traditional, non kind of trauma informed care system to figure out what the heck is going on? Um, and you don't. What you don't want to do is to come about it in the wrong way and accidentally trigger it more or, like you know, keep that triggering going on in a therapeutic environment. So now that place is not safe for you either. You don't want to start to associate the things from your therapy setting as being part of the trauma response, and that's the risk that can happen if it's somebody that doesn't have that trauma-informed background.
Speaker 1:So you bring up two points that I want to talk about, one that we'll talk about later, but I want to try to remember, skip back to it which is it? Pain and trauma are part of the immune response, which, logically, I can wrap my brain around that concept really easily. But I also want to want to bring us into a little more of a nice little, tidy little bow present of how that would be, because historically, our immune response, we wouldn't consider trauma or pain to be part of it. We would say, you know, okay, cytokines, inflammatory white blood cells, you know we have osteocytes, all these things that are going on. That's your inflammatory response or your immune response. But it sounds like we're looking at something that might be pre-existent or part of the immune response, but that is before the chemical processing taking place. I want to get to that in a second.
Speaker 1:The first thing, though that sounded really interesting to me was and then I wanted to ask you about is when we talk about those triggers. Right, as massage therapists we have a scope of practice and the triggers we're not allowed delving into them, we're not allowed going in a. Why do you have this trauma response? Was it because of X, y Z. We don't do that. But what happens is, as a massage therapist, we are frequently treating someone and they have a trauma response and we don't know the trigger, we don't know what we've done and we don't even know if it was us. It may have been the music that came on, it may have been they were asleep and a memory popped in their brain. It may not have anything to do with us. However, there's a good chance that it has something to do with us because of where we're touching the body, which is kind of our hypothesis. So when they have that trauma response let's say tears, frustration, anger, whatever it is at that point it's obvious to both the clinician and the client okay, a trauma response is happening. We need to make sure that you feel safe. But before that trauma response happens, it sounds like that's the culmination of a multitude of responses that are ignored to get to that point. So those smaller responses that are often ignored because of either, let's say, lack of awareness, kinesthetic, whatever it is as a therapist we can probably pick some of those up think is more common that people don't associate with a trauma response.
Speaker 1:That Brian and I spoke about in my last podcast is when we're treating a client and they're not cold and clammy and they're not sweaty, and then we go to an area of their body and they get cold and clammy and sweaty. To me, I've often associated that as a early warning that something is going on. Or they're really quiet through the session and then suddenly they start getting really chatty. Or vice versa they're really chatty and all of a sudden they're really quiet through the session and then suddenly they start getting really chatty. Or vice versa they're really chatty and all of a sudden they go really quiet. Now sometimes they just fall asleep.
Speaker 1:But to me these are often signs, and a lot of therapists will say these things. Can you think of any other more subtle signs that, as therapists, we can pay attention to? To say, because the goal is not to avoid the response, I don't care, I don't care if somebody has a trauma response to my table, it might be good for them. I'm not looking to avoid it, but I'm also not looking to provoke it. I'm just looking to have the session come to fruition or whatever it is.
Speaker 2:The purpose of any trauma response, whether it's large or small. And I should say too, before I go too far down, this sometimes there's only large trauma responses if the traumatizing event was also very large. So you want to take that into account as well. So folks who have been in like a war-torn environment or have had a near-death experience, it's very possible that they're going to kind of go from zero to 60 because the intensity of that threat is so high that your brain just immediately goes to, you know, just red alert. So sometimes it's not a matter of it building up to that. But with these microaggressions, with the things where you're steeped in the smaller traumas all the time, it frequently looks kind of like a gradual turning up of the volume, but it can sometimes just be a big, loud one, often the result of what we will call one trial learning right, where you have something that's so scary you don't need that repeated, and so anyway, when that happens, whether you have you know these more subtle again, think of it as all being very tied into the immune response more broadly. And so this actually kind of fits in with the other question you were talking about.
Speaker 2:It's fascinating because you talk about cytokines and all those things. When you look at people who have PTSD, when you look at people who have a trauma history, you look at people who even have chronic pain. When you take a look at their blood samples, we see elevated cytokines, we see elevated issues of systemic inflammation. We see a persistent immune response. We see an elevated immune response to things in the brain and the you know kind of throughout the nervous system. You see something called microglial activation, which is sort of like the brain's white blood cell response Does that mean that you're?
Speaker 1:does that mean there's a? I mean this is a far-fetched thought and I don't know if research has been done on it, but does that also mean that long-term, you're seeing a higher ratio of like, let's say, rheumatoid arthritis, osteoarthritis, things like Hashimoto's disease, things that are inflammatory-based illnesses as well, or is the research not far enough around for that?
Speaker 2:There's certainly research on. What it mostly looks at is the correlations between a history of trauma, particularly in ACEs, and those conditions. One of my colleagues at United was an immunologist. We love having this discussion. His big dragon that he was trying to slay was rheumatoid arthritis, while I was working on chronic pain and we were constantly talking about the overlaps. But yes, autoimmune issues are frequently tied to trauma, just in the same way that chronic pain issues are, and it does not make the immune system any less real. That immune response is autonomic, just like the pain. So your brain is in charge of all of those things. You know your brain, it handles all of those autonomic responses. So subtle trauma responses will frequently mimic other sorts of immune responses. You talk about cold and clammy or feverish. I mean it's literally fever right.
Speaker 2:You know, things like just general touch is very, it's very powerful for us as humans, because we don't. It's not, it's not a sense that we have quite as much flooding in as we do some of our other senses. We see people all the time, we hear people all the time, we talk to people all the time, but we don't always touch people all the time. And the less frequently you are touched, and especially in a safe or sort of just routine way, the more likely it is that any kind of touch is going to register as somewhat threatening for you because it will be novel. Anything novel to the brain is threatening.
Speaker 1:So, if it's unusual, I teach a lot of my students in every class. I teach a full class that I'll actually be teaching quite a bit here lately, soon and hopefully coming to Minnesota next year, and one of the things we talk about is stop with the painful treatment Like yeah, there's so much research that shows that painful treatment is non effective.
Speaker 1:but no pain, no gain theory was popular in the 80s and it's been debunked time and time and time again. And yet the amount of times I'll receive a treatment or I hear people saying it that they've had treatment and they go no, I didn't. I couldn't handle it, it was too much pressure, it was painful, cause bruising and all these things that I'm like there's so little value in doing that Because it's like you said. You're now associating your therapy with a negative response. Yeah, and early on you might just go. Okay, danger, negative response, that's not trauma, but that's for someone who has a regulated system. The moment they have a dysregulated system, it's not. Oh, that was slightly uncomfortable. It's. That was threatening or it was non threatening, like there's no middle ground and I think that's forget what traumas.
Speaker 1:There's no volume control.
Speaker 2:It's an on or off thing, it's not a turn it up, turn it down kind of response of like just thinking about an ongoing average that you're constantly feeding in and so, as soon as you take, if you don't have a lot of data points, and then you have a particularly negative data point that you throw in there, well, now your average trends way over here to the negative. If you have lots and lots and lots and lots of data points and they're all fairly positive, one big negative thing isn't going to have as big of an effect. But if you don't have a lot of events and you have one bad one, it could be the exact same level of bad as this other person, but now yours is really going to set everything off and then from that point on, there's no anchor on the other end.
Speaker 2:There's no anchor on the other end and now that your normal expectation is threatening every time you go in after that, it will continue to reinforce the threatening because you're expecting the threat, that it will continue to reinforce the threatening.
Speaker 1:Because you're expecting the threat, are you?
Speaker 2:familiar with allostasis? Yes, yeah.
Speaker 1:So I teach that in my classes a lot, you know we give, and I give this to my clients in the clinic. They get a picture that I've drawn that has a glass on it and I say, with a percentage point, draw a line on that glass, tell me how full your life is. That glass is your life. And then they often ask questions. You know, okay, well, what's in there. I go. Everything, gravity going to the bathroom, your family, your job, your anger, everything unsaid, everything you've judged about yourself, everything you've judged about every other human, everything is in that glass. And the frequency of times where people put the glass at like 99.999% full, I go.
Speaker 1:So you're just living in this constant state of hypervigilance for fear that the next piece of information input that's going to come at you is going to be perceived as certain because you're going to be overwhelmed Like you have. No, you have no room for anything else in your life. And I think that's the thing that is hard for a lot of people to remember around trauma that if it's a small T trauma, it's almost like microdosing. You're getting such a small amount that you think, oh, this should be fine, and yet they have this. What we would. You know what somebody would call exaggerated response, but it's not an exaggerated response. It's a completely justified response to their experience on the planet.
Speaker 2:Yeah, yeah, and that's what? Yeah, exactly. So you know, and, as this applies as a clinician, you know thinking about this. So, when somebody is having these responses, all of them are seeking out the same end, and it's safety. Everything that you have as a trauma response, whether it's pain, whether it's sweaty palms, an elevated heartbeat or just like a general sense of like uh-oh every single thing in that is meant to be a tool for your body yourself to find safety, and it's even a popular is one of the earlier evidence or trauma-informed care curriculums was called seeking safety.
Speaker 2:But what you can do in these situations, that's helpful, no matter what. You don't want to ask them what triggered that or tell me more about that, but what you can do is reinforce that they are currently safe, everything's fine. How do you do that? Well, you check in with them. Everything's fine. How do you do that? Well, you check in with them. Is this pressure okay? Are you feeling okay? What can I do to make it more pleasurable or more pleasant or more comfortable? Are you all right? Is the temperature all right? What can?
Speaker 1:I do to help you, one of the ones that I learned very early on and it was actually in school which I was really thankful for my teacher it was Nate Butrin who taught me this, who's someone I don't know if any of my listeners from the you can take classes from him. He was a great teacher. I remember he said if they have a trauma response, if they have, like, let's say, you're working their SOAS and they've been the victim of sexual abuse, and you don't know that, and it's not on your intake form, because, honestly, why would it be? You're not a psychologist, it's not. You know. It's good to know if they've had trauma, but you don't necessarily need to know what the trauma is. And so you're working and the amount of times that this has happened in my career and I'm sure a lot of the therapists is, you know.
Speaker 1:They start crying on the table and most people's response is to take your hands off the body and go oh, my God, I'm so sorry and all that does is make the client go. What did I do wrong? As a client, I started crying, whereas as a therapist, what we can do instead is we don't take our hands off the body, we just stop moving. We look at them, we get their attention, make sure they're conscious and just say do you need me to stop? Is this something you want to continue to experience or is this something you want to move away from? And we go work on another area of your body and that gives them one a sense of power, which anybody who feels powerful feel safe. Another thing that I learned from Brian was you know, offer the opportunity for your clients to have the door open or closed during the session, which for massage therapy is a little different, because most of my sessions clients are closed, but that's not the case for a lot of massages. A lot of clients, people are undressed, fully, you know, and they're draped, but to say open door policy, that's a little different. In that example but it's also one that's interesting and one that he did that he recommended, that I've actually incorporated. That I really love.
Speaker 1:Whether somebody has trauma or not and I don't even ask the question is I try not to stand between their eyes and the door. So the way my room is set up, if I want to treat the left shoulder, I'm standing between them and the door. Though the way my room is set up, if I want to treat the left shoulder, I'm standing between them and the door. So if I am going to treat their left shoulder, what I have them do is I'll have them turn on the table. So now I'm not standing between the door to treat their shoulder. And it's one of the more interesting ones that I've that I've taken on unconsciously and I just and it hasn't really changed the session very much, but it's one of those things where they they can see the door. You know, just safety mechanisms.
Speaker 2:It's excellent. It's all you want to do is promote everything about the session as being a safe place. I like what you said about empowerment, because that's very true. When you're in control, you generally will have an overall sense of feeling safe. Because you're in control, you can do what you need to do. I would encourage people to don't ask about traumas, particularly specific traumas, but what is really helpful, what you could do, is just say is there anything about the session today that you're nervous about? What can you know anything are?
Speaker 2:you nervous about doing something wrong? Are you nervous about getting undressed? Are you nervous about the door being closed? Are you nervous about you know, not knowing what to do? Let them tell you. You know, I'm a little uncomfortable with this because you may not even know why, and when you try and ask somebody about traumas, a lot of people couldn't even tell you right.
Speaker 1:The trauma might be completely unrelated but it's happening and a lot of them will feel. A lot of people feel silly about their trauma. When they express what is a traumatic like, they'll go. I can't believe that is something I'm hanging on to, and I'm about to be 44 year old and I talk about being bullied. I I still have moments where if I see something physical that looks like bullying, as a 44 year old man, that's not happening to me. I still go into this phase of like total aggression, of like what the is going on and I and I get really angry and I have to stop and go.
Speaker 1:Wait a minute, this isn't happening to you, this is happening to another human has nothing to do with you, to start with. Secondly, and who are you to project your BS and baggage onto them? But it's amazing because I look at that now and I go come on, you know where your trauma comes from. I know where I was bullied and how. I know how to move beyond it. I feel like I'm able to meditate and be mindful, and yet those responses still happen. So a lot of people they might look at it and go. That's such a silly thing to be traumatic over, that's such a silly thing to have and yet. So they're not willing to claim, like, how important it is in their life and yet it's something that holds value. So that's where you know, asking them where that trauma comes from. Like a lot of people won't even admit that they have that trauma.
Speaker 2:No, if they, if they even know about it. There's so much shame around trauma. There's just an unwillingness to talk about it. It's important to also know and you kind of brought this up but you know, trauma occurs in a different part of the brain than the prefrontal cortex, which is our thinking brain, which is our conscious brain. The part that we really control is that prefrontal. All those things that you can do practicing mindfulness, metacognition, knowing, just knowing this is fine, I'm fine, I know I'm fine. Those things happen simultaneously with the trauma response. They don't cancel each other out. However, these can start to reduce. You know, when done correctly, they can bring down that activation over here. It's not like they're unrelated, but just because you know that you shouldn't feel scared does not mean that your trauma response is not going to activate.
Speaker 1:And just because you might be able to help it one day, it doesn't mean the next day, when you're more tired or you didn't get enough sleep or you're more excited because you're not paying attention, that you'll be able to have that same control response.
Speaker 2:Yeah, you're going to have a little less ammo in the prefrontal tank, and this is all about practice. So this is where what we're talking about what can really help make this prefrontal stuff more effective is pairing it with less cognitive things. So what's really great with a massage therapy session is that you know, as you mentioned, you have touch. Touch is powerful, and so when you have safe touch, that's going to reassure about a thousand times more powerfully than just thinking I should be safe. I don't know why I'm scared. I shouldn't be scared. So you know, these things of being able to create a sensory safe environment in the way that you're talking about, and a sensory practice, the power of your sensory data as it comes in raw is much more powerful than the cognitions that you create in order to try and control something.
Speaker 1:So you're able to give me the title for this podcast.
Speaker 2:Sensory data.
Speaker 1:That's a really good point. I mean, it's all a data game.
Speaker 2:Yeah, and so your your sensory data, like that's a really good point. I mean, it's all a data game, yeah, and so your, your sensory data are powerful. The only problem with sensory data is that we're constantly flooded with it all the time. So you, your, your brain has learned to be selective. That's what the prediction thing actually evolved to take care of in the first place is to figure out what's important and create you know, kind of create that so're you're controlling those sensory data.
Speaker 2:That's much more powerful than thoughts that can be generated, and so it's. It's really a valuable thing to to leverage.
Speaker 1:And I love that you bring up the predictive aspect, because I'm pretty sure you must be familiar with ASMR.
Speaker 2:Yes.
Speaker 1:Yeah, and so I actually did a really interesting podcast. I have an entire massage technique called ASMR. I'm teaching it later this year and and it's literally tactile stimulus to replicate ASMR sensations. Now, not everybody has ASMR but everybody can kind of get that spectrum of response where they get the free soul and the feel good responses. And I teach a section of my class on why is massage therapy effective. You know why does massage therapy work and there's a whole slew of material that I teach around that it's a two-day class but the first part of the class, when everybody's the most awake and the most listening, is I introduce people to ASMR and I say listen, the likelihood that most of the responses, the feel-good behavior that somebody walks away with from a massage. We can talk about structure and biomechanical behavior and we can talk about whether you can find a trigger point or not and the science really shows us we can't. We can talk about whether we're strong enough to stretch collagen, which again the science shows we're we're able to, but my God it would hurt, like the actual old mentality of what we're doing with our hands.
Speaker 1:Um, compared to how much of an overlap there is between ASMR and massage therapy is amazing and one of the biggest things is that with ASMR, prediction is key.
Speaker 1:Context and prediction If you can create context massage therapy, you know the context is kind of a given. You can highlight it more by having a therapeutic environment or a relaxing environment, music, lighting, all that kind of stuff. But context is a good given. But prediction is key, and so it's one of those things where, during a session, never letting a client fall asleep and telling them what you're going to do next, a lot of my students have a hard time adapting that into their practice. But what does that also do? It diminishes the likelihood of a trauma response Because the client can sit there and say, oh, they're going to go work on my glute yet next. That's where I had my surgery, that's where I had my sciatic nerve, that's where I had my evulsive muscle, whatever it is, but they're going to go touch it and that's why I came for treatment, so I'm ready for it, as opposed to, I was asleep and now I woke up with an elbow in my glute and so like there's so much prediction behind it.
Speaker 2:Well, and and you know we talk about the amygdala as being sort of like the fear center of the brain or the threat center what actually is the closest to truth is it's the unexpectedness detector. It's just that, for humans, non-predictability and threat are pretty synonymous. For us, when you can create that predictive model accurately for your patients, you're going to have something that's effective. And they get it, and it really does. They. They lean on that prediction. What you've done is you've literally done something that will deactivate amygdala activity, like pretty significantly. It'll reduce it because none of it's unexpected, none of it's new or scary or novel.
Speaker 1:So that's actually really interesting, because one of the things I teach in my class is we do this thing Instead of doing trigger point therapy. It's like an updated version of trigger point therapy, which I'm not sure if you're familiar with as a non-massage therapist. But essentially you find a spot, trigger point, and you can't find them, so you have to have the client find them. So I give my client an option. I say which of these along this muscle tissue is the most sensitive? And they tell me what's the most sensitive. And then when he treated it, I say, okay, I'm going to apply pressure or I'm going to pinch this area, and I want you, as the client, to tell me before this is a grimace. And we don't want to go beyond a grimace, because as soon as you go beyond a grimace you're into pain because you're in threat response perceived as threat. But if we stop before the threat, the brain kind of like a bra or underwear, the brain kind of just goes oh, wait a minute, wait a minute. Is this threatening?
Speaker 1:No, no, no it's not, and it takes that level of influence, which is quite high, you know it's still enough to almost cause the grimace, but it goes, I don't care about this anymore. And then as a clinician you don't change your pressure and the brain just kind of says I'm okay with this and eventually forgets about it. And as that continues, the symptoms diminish. And then I tell my client okay, when this pressure becomes very tolerable I'm going to have you tell me so I can go in again and you're going to stop me once more before it's a grimace. And by the fourth or fifth time we're doing this, we're at a level of pressure that is way beyond what could have been handled in the beginning without threat response. But it's giving them this predictive behavior, they're in control. But it's also giving them a prediction where they know their limits but they're able to predict the next thing to happen. And I had never thought about it in that way, where we're essentially bypassing the amygdala. I've never thought about it in that regard. That's really interesting to me.
Speaker 2:You're doing graduate exposure therapy, which is a phobia therapy, and so you're treating the sensitivity so when you have phobias, you do something called graduate exposure therapy.
Speaker 2:It's a very well-established therapy. The example you always give somebody is fear of spiders, arachnophobia, and you start with a picture of a spider, something that just generates a little like ick, but nothing that panics you. And for some people a picture of a spider will panic you. You got to move all the way down to a cute little itsy bitsy spider in a children's book and work your way through. You get to a point where you're comfortable that you sit in safety with that stimulus until your body calms down and you can practice breathing or whatever you need to do. But you get until you're normalized with it, it doesn't bother you anymore. And now we kick it up a little notch and we go up to like something until eventually you're like holding a tarantula in therapy or whatever. And so what you're doing is something I promote, often with any kind of a manual therapist.
Speaker 2:Sensitivity in the body is essentially a phobia. It's a fear of that touch. It's an activation of the threat response when that body is touched. What you just described is exposure therapy. It's an exposure therapy paradigm for that fear of touch. So what you're doing is you're going in and you're like helping them at a place where the threat response is not activated until it's normalized, and you're going a little further, and then a little further and at no point.
Speaker 2:Is the amygdala on edge? No, at no point. Are you scared, uncomfortable? You've gone too far if you're scared or uncomfortable. But you've created the situation and by the end of the day, all of a sudden you're looking down and, like this person's got a spider crawling on their head or whatever it may be. You are getting in there and able to help them.
Speaker 1:I'm really happy because of confirmation bias, like that's fantastic, like it makes me happy, right. I'm very frustrated.
Speaker 2:All for the heuristics.
Speaker 1:Now I have to go change my textbooks because now there's a title to what this is doing and I will definitely want to include that and I'll want to go and find references to research and reference it, because that's fantastic, but I had no idea that's what that would is, but that's fantastic and so that's how is that? Is that something that you were doing when you were working with the military on on like trauma responses around IEDs or around amputations or around loud noises like that?
Speaker 2:Um, that's a great jump. So there's really cool stuff going on. With the military. I was more involved with brain injury and return to duty, so my research was really around seeing. You know, I worked with a lot of PTs, ots, and we looked at folks who had just finished rehabilitation for a head injury and we knew that we needed to be. The normal return to duty criteria were not sufficient and we needed to make sure we had appropriate return to duty criteria to account for things that happened when you had a head injury cognitive changes and whatnot vestibular changes, balance, dizziness, nausea.
Speaker 2:However, one of the things that I think really cool that's come out of this that the military has been using is preemptively doing exposure therapy when somebody might have to go into a high trauma situation. It's you know so it's graduated exposure training as opposed to graduate exposure therapy, and what you're doing is you're getting somebody you know kind of gradually prepared for what might happen so that they don't have a trauma response when it happens. You're doing, again, very much like what you're describing You're creating a predictive model for them in a safe place that they can use in advance, so that they're not just dropped off in a new culture with a new language and new norms and new food and new smells. And on top of that, just danger, danger, danger.
Speaker 1:And so don't go and get trigger happy because you're supposed to be a peacekeeper. Exactly, and you're already at your limit of capabilities.
Speaker 2:Yeah, if you're going in, you're panicked, you're at a high, you're at red alert, your amygdala is firing like crazy, everything's going to look like a threat. And if your whole training as a military person this goes with law enforcement too right, if your whole training has been to just react automatically to threats by shooting or reacting in that way, You'll see threat everywhere You're going to have incidents right, yeah, you're going to see threat where there's no threat.
Speaker 2:So this is a new way to approach that predictive training model. Instead of just like threat, go right and anybody who's been in these situations will tell you I didn't think about it, it just happened Like I didn't even realize I was doing it. It just happened Because, like I didn't even realize I was doing it, it just happened because they've been trained for that to be their automatic response. This is creating a whole different kind of training. It's a much more complex, much more thoughtful approach to this, where you're keeping that person from feeling threatened in the first place so they can remain calm and they can keep that prefrontal stuff going. They're not just reacting on adrenaline. So you've got somebody who goes and they know exactly what to expect. They've been and there's things like that. Use VR for this, so you're fully immersed in, like a virtual version of where you're going to be. You practice what you need to do multiple times you there's. There's a lot going on. That, I think, is really fascinating.
Speaker 1:I think one of the more popular examples of that would have been on Chris Hemsworth's um six series documentary um, where he uh, I can't remember what it's called blanking on it, but limitless where he has to deal with heights and he goes into a VR environment where he's on the top of the building and then he actually has to go up on a height. And that's a really interesting example too, because a lot of my history as a professional athletes and Olympic athletes and things like that really I mean top of you know some of the best in the world literally in their sports. I mean, in fact, the lady who dealt the trauma. She was the number one ultra runner on the planet when I was seeing her and she had this traumatic experience. She fell down 150 foot scree field essentially. But what you're describing to me is something that's been in the athletic industry for a long time, but I don't think they ever would have equated it to gradient, gradiated exposure uh, training, because that's what it was, though that's what?
Speaker 1:training on a treadmill or on a bike in the heat, with dehydration, for a four-hour period, where your heart rate you know, doing all these high intensity but like essentially you're, you're replicating a race environment where, during the race environment, you can perform at your best and not and not be reactive. You can. You can be active in your thought process instead of reactive in your thought process, and I really like that. I think that's amazing, because I think that's also a really interesting way of introducing touch to people who have become so focused on experiencing their chronic pain and their trauma, so focused on living with their discomfort, that in their mind, they've come to a place of acceptance I will always have this pain, it will never get better. I won't change, and I don't want to take that away.
Speaker 1:There are humans who really do have a scenario, like I have a lady who I saw this morning. She's had a titanium replacement in her shoulder Eight years later. She can't lift her arm up above here. She can't even eat. She has to use her arm. Now we're getting to a place where she can like just this morning she was taking her shirt off. You know very difficultly. And yet we know there's a limit. We know at one point we will hit a wall with how much range of motion slash discomfort she can experience. We just don't know what it is. But for a lot of people they come to that place and it sounds like that exposure training in advance, like one of the things we say in physical therapy. You know, in a lot of rehab is okay, you can't run for 15 minutes, but you can probably walk fast for 30 seconds and then walk slow for 30 seconds and then with repetition we bring back a higher level of performance and it sounds like that's that would be considered gradiated exposure therapy as well in rehab.
Speaker 2:Yeah, I mean the entire context of training and rehab is essentially doing the microaggression trauma response in reverse. It's all of these little. Instead of death by a thousand paper cuts, it's life by a thousand tiny feelings.
Speaker 2:You know and a thousand feel good, just feel good response a thousand feel good moments you know, a thousand lifetime movies or something you know and it's like. And so when you talk one thing that I think is really important and with pain, one of my biggest issues with how chronic pain is treated in our conventional kind of environment right now, I ran into way too many people who were told right away upon getting an injury by a doctor that they'd be in pain for the rest of their lives. And I get nobody's trying. I accuse no one of malice, that is just the training that people are getting. But the power of an authority figure, particularly in a situation where you've probably just been in a car accident or a sports accident and you're scared and you're in an ER and you don't know where you are and you have this big authority figure. You're probably sitting or laying down while they're standing above you and they say you'll be in pain the rest of your life the power of that is unbelievable and undoing. That is incredibly difficult, but not impossible.
Speaker 1:Your listeners, that you're listening right now, they are all the people in doing that. I promise you, because every time I teach at a convention, every time I go to a conference, you know, as therapists, this is our biggest hubris is how do we not gain the God complex while being the ones to help people recover not only from their injuries but also from what they've been told by people who have degrees in education that far outweigh our own? And yet the clients come see us and they go. I've been told I have a herniation. Therefore I will have X, y, z discomfort for this period of time, for the rest of my life.
Speaker 1:And we, as clinicians, are somehow reversing this, and I'm not going to say I guess reversing is absolutely not the right word, but we're somehow encouraging these clients to feel better, getting results. And so the hubris is how do you not walk away going, hey, I'm top dog and what you're saying is wrong. But at the same time, how do you go up to them and say, hey, by the way, what you're saying we are seeing in the clinic is not happening. The words you say don't manifest with our clients. So because I'm a massage therapist who doesn't have a degree. I walk up to a doctor and say this stuff and, mind you, I've been fortunate in that my circle people have been very nice to me and they happen to listen to me, and I don't know why, and I'm grateful for it. But I know that there are also a lot of times where they'll go. Who are you and why are you talking to me? What are you saying? You're wrong Just because oh yeah, it's awkward.
Speaker 2:You know, one thing I want to say to you and to the listeners, because I feel like this is something not enough people realize Doctors have to learn a lot of things about a lot of things, and so when you sit down and look at pain and this is the United States, but I think Canada is very close the average, you know physician gets less training on pain than a veterinarian.
Speaker 1:So it's not an anatomy as well. I think they get. I think the average physical therapists and massage therapists will do 40 hours more of anatomy training than a medical general physician.
Speaker 2:Yes. So it's important to remember that, even though they are such a deep authority for us in our health, when it comes to pain, they simply just aren't able to get all that information because they have to learn so much else that you know for them is more urgent, right, yeah, so when a doctor tells you I know you'll be in pain, blah, blah, blah, blah blah, it's based on on one of their lowest, like you know, volume topics in med school. The other thing I want to point out is that you know we point to these things herniation, you know, spinal degeneration, you know all these kinds of issues. And well, no, no, I have this. My doctor told me that's what's causing my pain.
Speaker 2:I think it's important that people know New England Journal of Medicine. This was a long time ago now. I want to say maybe like 20 years ago. I'll have to see if I can find the links so you can put it in like show notes or something but they looked at people who had no back pain and they looked at people who did and they realized that people with no back pain had just about the same number of spinal abnormalities as people who did.
Speaker 1:All these maladies. As people who did all these things, we have always thought because correlation and causation right we never thought to look at healthy people. Yeah, I have a blog on my website, uh, that a lot of my listeners uh pay attention to, and my first blog post was a study came out in 2019 I think it was the meccar group, and they did a meta-analysis of 3111 subjects and they found, um, they did mris and x-rays and they gave it to a group of 60 clinicians and the clinicians came away with saying 86% of the people need some version of intervention surgery, injection, manual therapy, rehab, whatever it is. But the clinicians weren't aware that 100% of the subjects had no pain for six months.
Speaker 2:It was a criteria.
Speaker 1:And yeah, 86%. And so I think I think that's becoming more understood that structure and biomechanics have less. You know, they're more correlated than causality based. You know, similar to the idea that your postures because of your pain, or your pain equals your, your pain is because your posture, we're realizing it's. It's the inverse, it's your posture because of your pain. It's an adaptive process to cope with your discomfort.
Speaker 2:Yeah, yeah, I like to think of spinal abnormalities like wrinkles. They're a sign of aging. Are they imperfections? Yeah, are they kind of ugly to look at, on imaging, if you go real deep into it? Sure, is it not ideal? I guess not. Do they hurt? Of course not. They're a normal thing. That happens when you age.
Speaker 1:And that's actually something that's interesting, because there was a big push for a while there to move away from this idea that structure and biomechanics and the pain, neuroeducation became king and that was the most important thing, and I think now it's important that we're seeing there's this shift. Okay, well, let's not throw the baby out with the bathwater. A broken arm does hurt your structure there is a reason for pain.
Speaker 1:A herniated disc can be painful. It's just not correlated one for one. It's not. You have a herniated disc, you'll have pain. It's going to be painful. Yeah, it can be the origin of your symptoms, but once it's recovered, after eight months your symptoms should be gone. And if they persist, we now know it's. There's not that relationship, but I think a lot of people they try to throw the baby out with the bathwater. They're like biomechanics and structure sucks and I know I was guilty of that, but I think more and more. I'm really like no, there is a healthy balance, there's a mix Because the body is a healthy balance.
Speaker 2:Exactly, yeah, though there's most certainly and we have an entire process for structural pain no cisseption right. We've adapted as human beings to have nerves, that whose whole job is to create pain sensations in the brain whenever there's damage to the body. So there's no doubt. Yeah, I am by no means saying that there is not structural damage, but I think for way too long we've assumed that if there's pain there must be structural damage, and that is not true. The 86% number that you threw out is really fascinating too, because recent studies have shown that that's about the number of people with chronic pain conditions who have no structural issues, that the pain is top down.
Speaker 1:So it's funny that that's similar. The 86 was a mix of low back, shoulder, knee, like they had different areas of the body, but that was the overall.
Speaker 2:Yeah, I know that Howard Schubner's group just recently put out a study a couple months ago looking at this and I think it was. It could have been back and neck, I think it was back and neck, but they saw that I think it was like 85, 86% of people with back and neck pain when they took a look at it. It wasn't the structural issue that they thought was causing the pain actually had no logical basis. You know that it was actually. A lot of people will call it neuroplastic pain. I just call it top down, I think top down is simpler.
Speaker 1:It's just it's coming from the brain. Yeah, there's so many different names for it. We talk about downregulation, upregulation, dysregulated system, neuroplastic, nociplastic there's so many different terms for it. We just know that it's a version of integration between brain and body and that integration is variable for most humans, but that it is present in all humans kind of concept.
Speaker 2:Yeah, absolutely so very cool. Well, that's very interesting.
Speaker 1:I'm so grateful for the talk today. I really am.
Speaker 1:I definitely want to have you back on in the future as another guest. I know we've already talked about potentially having you on to talk about placebos, which is going to be in my next series, so you might be, I might be reaching out to you pretty soon to have you back on, and I am speaking with Minnesota to come out and teach there next year, and so when I do, I'll I'll reach out to you because I mean if, if it happens to be in the area where you are, I'll talk to you about why wizards are better than druids, and we'll, we'll just get into it.
Speaker 2:Bring your character sheet that sounds great, yeah, looking forward to it, and if any questions or anything I can help clarify that we talked about today, just let me know I'm happy to.
Speaker 1:Awesome, and is there anything that you would like you know any of our listeners? Do you want to send them anywhere to your website? Do you want to have them for your consultation? Is there anything that you're interested in having them reach out for?
Speaker 2:Just that's OK. You know, I just actually launched a blog series on neuroscience education for anybody who's interested on medium. So the series is called Firing and Wiring and it's just sort of weekly blog articles about just how the brain works and what that looks like in the real world, what you can do to take advantage of it. Um, it's not necessarily tied to chronic pain specifically although I have a feeling there will be lots of mentions of chronic pain over there over time. But I think it could be a helpful resource for folks who are just generally interested or curious or excited about how your brain works, and so I've tried to put it in some kind of enjoyable, bite-sized articles. Nothing's more than like a five minute read. I try to be mindful so I don't go on and on, but if anybody's interested, by all means check it out.
Speaker 2:I think it could be really interesting.
Speaker 1:And send me the link. I'll make sure to put it in the podcast description so people can find it. If they want to, that'd be great. And then I just, I just, yeah, I just want to say thanks. It's been a real joy today.
Speaker 2:Yes, thank you Likewise.