Sensory Approach to Manual Therapy
Sensory Approach to Manual Therapy
Why Pain Language Matters For Manual Therapists
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If you’ve ever helped a client feel better while secretly doubting the explanation you were taught, this conversation is for you. Pain researcher Mark Johnson joins me to interrogate the quiet “hidden curriculum” in modern health care: a WEIRD, tissue-centric worldview that can be lifesaving in acute injury but can also trap both clinicians and patients when pain lingers. We talk about why the biomedical model still matters, and why it can also reach a point where it stops being the best guide for what happens next.
We get specific about how pain is shaped by more than anatomy. Mark explains how metaphors and word choice can change physiology through threat and vigilance, why militaristic “battle” language can backfire, and how labels like “chronic” may act as a nocebo by making pain feel permanent and identity-defining. We also explore prediction, priors, and “past adversity influencing now,” not as a moral failing or “maladaptation,” but as adaptive systems responding to an environment that often mismatches our biology.
To hold the complexity without drowning in the biopsychosocial checklist, Mark introduces an integral AQAL lens: inner experience, outer physiology and behavior, shared systems and environments, and shared culture and meaning. From there we move toward salutogenesis and a practical “sense of coherence” built on comprehensibility, manageability, and meaningfulness. We finish with hands-on takeaways for manual therapists: soothing touch, careful reframing, and community-based support like health coaching that helps people rebuild a workable story around their lives.
If this reframes how you talk about pain in the room, subscribe, share the episode with a colleague, and leave a review so more clinicians can find it. What word or phrase about pain are you ready to stop using?
Welcome And Guest Introduction
SPEAKER_01Hello, everybody, and welcome to another episode of the Sensory Approach to Manual Therapy Podcast. Today, my guest is Mark Johnson. He's a professor of pain in Agesia at the Director Center of Pain Research at Leeds Beckett University in the UK. He has 30 years of experience. He's published over 300 some research articles, supervised PhD students, and his work spans clinical trials, experimental pain research, systematic reviews and pain education. For me, one of the reasons I wanted to bring him on today is that he's also one of the more adventurous philosophical thinkers in pain science, uh, which is very much why he's here today. So welcome, Mark. Thank you very much, Troy. It's great to be here. I'm looking forward to this. I came across one of your papers recently, and I have a research blog. Uh, and I I looked at your paper and I several of them and I put them together and I published out my own interpretation of that stuff. And it kind of brought me down this rabbit hole of reading some of your papers. And there's there's many of interest. But where I want to start with, because I have a I have a flow that I think might get us to where I'm trying to go today with how what you talk about, because you're not you're not a clinical pain person, you're a research one. Um, and my listeners are primarily clinical. And so bridging that gap is often a very complicated thing because what looks good on paper doesn't always apply in a clinic. And so I wanna I want to lead a conversation which I think might get there. The first one being what you call the hidden curriculum problem, which you've talked about. Um, and in some of my previous podcasts, my listeners, they've they've heard me talk about my crisis of faith, where when I started massage school and graduated, you know, I thought I was top dog. And and then I came across some of Paul Ingram's research, and I kind of went, whoa, I have been lying to my clients, not out of maliciousness, but out of ignorance, not aware that trigger points do what they think they do. You know, fascia doesn't behave the think we the way we think it does. And we definitely don't have the mechanical stimulus to create changes in the body the way we historically were taught. And yet my clinical outcomes are still present. I'm still getting results with my clients. They're still finding improvements. And so my crisis of faith really brought these two worlds together, which led me down the neuroscience pathway. Um, but for you,
The Hidden Curriculum Of WEIRD Medicine
SPEAKER_01you describe something similar. This this biomedical model and value seems to be almost overvalued. Do you want to talk a little bit about that?
SPEAKER_00Yeah, yeah. I'll I'll reframe it then. Um we we live in the normality of now. This is our normal. Um, we're born into it, we come out of the oblivion of before becoming consciously aware into a ready-made world. And it just happens for us as individuals to be in the ready-made world of for me, the 1970s and 1980s and and onwards. And I think that ready weird world is beautifully sort of conceptualized by Joseph Henrik's work. Uh, he he coins the phrase, we're in a weird world.
SPEAKER_01I I remember reading that article.
SPEAKER_00Yeah, yeah. I mean, it's a it's a fantastic perspective to understand our blindness firstly. So it's a westernized, educated, industrialized, rich, democratic mindset or worldview.
SPEAKER_01I I thought that was such an interesting way of looking at and defining it as weird, but it's so true. It's the colonialized, you know, my my father's indigenous, and here in Canada, we talk about it as the colonialization, you know, and it's it very much comes from that up-down vision of reality.
SPEAKER_00Absolutely, absolutely. And of course, when you're born into that normality, you're blind, you're blind to any other reality, except the realities of the past that have been written down in scripts and in literature. And what we tend to do when we revisit those scripts and literatures is to then place our normality into them. So I've written a little bit about medieval Europe and pain in medieval Europe, and of course, our perception of it in the comfortable world of weirdness that we have at the moment is well, it must have been dreadful to live in those times because of you know the conditions, the deprivation, the squalor that potentially you could be living in. Um, but of course, people in those conditions, that was their normality. So one of the things I'm really trying to do in the way I think about anything is to try and see it from other perspectives. I mean, I think, you know, my mission every day is to wake up and see if I can find something, some situation or some person who can shift my perspective of what I understand reality to be. Um, because what's given me meaning in life is to try and understand um what's going on. You know, that that that shift from I've I've got conscious awareness to that point at which I believe it'll stop. Um, I don't believe in an afterlife. So I'm trying to make an understanding of well, what is this all about? And of course, we get an opportunity every day to go back into that oblivion when we go to sleep. So on every day we re-wake and connect with the outside world, which is ready-made, and our sense of self, which has been.
SPEAKER_01Is this the part is this where you some of the papers where you talk about uh the emotional memory images where you go into that unconscious state, or is that separate?
SPEAKER_00Well, yeah, yeah. Well, it's part of a bigger picture um of well, memory, first of all, that declarative memory. I mean, where does that how does that happen? You know, I have a sense as I'm talking now in my mind's eye, I can quickly get some images, some visual images of my childhood. I've connected with a storyline that goes right the way back to the age of three, four, five years when I became Mark, the personhood of Mark. Um and uh so there's a whole load of things going on within our neuroscience, our physical material, energy world that is unique to me and manifesting in my inner world. So I guess I'm trying to fathom how my inner world exists in relation to the tissue world that we all are in at the moment in our weird mindset. So one of the things about weirdness that's really strong is that it's very tissue-centric. We've spent the last two, three centuries becoming more reductive and seeing that energy and that matter of the physical world in real, real depth, clarity, and granularity.
SPEAKER_01It's almost one of those downsides to evidence-based practice and evidence-based research and medicine. And I talk about this in some of my classes where I try to like find a happy medium between the evidence-based reality of the importance of that in healthcare and yet the patient-centered approach where they seem to be at odds. And it seems to be one of those things. The further we go down that evidence-based, it has to be justifiable and quantifiable and has to be the least amount of secondary negative, positive negative side effects with the most positive outcome. We seem to isolate our world more and more into the purely physiological and remove emotional, cognitive, and spiritual from it as an experience. And so I wonder if that's what you're like, when we say the hidden curriculum, are you are you explaining the weirdness almost as this experience of your teachers taught you the way they did based on their reality? And you accepted it as reality because you were part of their world, their weirdness. And that that's why you think of the human body and pain and science and philosophy and culture and sex and gender the way you do, and that had you grown up some other way, you would have had a different vision of reality.
SPEAKER_00Yes, to an extent. But I think in the modern world that we are contaminated, I don't want to use the word contaminating in a in a in a negative way, but but weirdness is spreading everywhere.
SPEAKER_01We're influencing everybody's weirdness.
SPEAKER_00Absolutely. You go into rural India, uh, and and and and and villagers are medicalized into our weird narrative of now. Um that is the way it is. Because that's our experience.
SPEAKER_01You go into your you go into Europe, UK, or North America, and we're seeing the easternized weirdness. You know, I work in acupuncture clinic, you know, like we're seeing the easternized philosophy weird and weirdened into our reality as well.
SPEAKER_00Absolutely, absolutely. And I think what we would what one of the things that I I sort of push a little bit is in our modern weird world, are we are we actually sucking out what makes a human a human in our quest for trying to understand what a human is? And one of the things I'm really, really pushing at the moment is we need to re-inject humanness back into humans. And the way we do that is through relationships with other humans, and that involves things like uh reconnecting people into communities, reconnecting people into creativity as opposed to pure scientific thinking, and reconnecting people into spirituality. I'm now I'm I'm I'm I'm an atheist, I'm not I'm not religiously spiritual, but I have a lot of spirituality. I I think of spirituality is more like a life force, is connecting with nature. Because one of the fascinating things I find is when I go in to talk to medics or I go into talk to physiotherapists, I say, okay, so what are you actually working on? What is your what is your material that you're working on? And they'll say, Well, it's people. Okay. So what makes a human being absolutely being? And they often then get stuck because they've not actually thought about it. And our curriculum doesn't go through it. And it's the first thing we should do in any primary school is to try and get our
Reductionism Versus Being Fully Human
SPEAKER_00young children to understand what they are in relation to the bigger picture of the planet Earth and the vast universe in which it sits. And this is just fundamental, yet it's neglected. And I'm just staggered by that.
SPEAKER_01It it seems almost like in our quest for understanding, you know, like when you you reverse engineer, you take something apart to understand how it was done. And in the process of taking it apart, you try to get down to a finite definition of this is this part and this is this part, and this is how they work together. And it makes it almost, I just published a book called Pain, the other four-letter word. And part of it is we talk about essentially, you know, the reason you're experiencing pain today versus yesterday isn't because you did that extra bench press. It's not because you ran that extra five minutes. It's the totality of everything in your life plus that five minutes. It's the totality of everything in your life plus that extra deadlift. And so just the deadlift on your own probably would not have caused you pain. But the fact that everything else behind that deadlift is already present, that was excessive at this point. And often my wife is going through perimenopause right now. And just the other day, she was she was going like, why am I so tired today? And she's listing off all these reasons why she shouldn't be tired. And I'm like, Yeah, but you're not listing off all the internal reasons of interoception, of biochemical changes, hormonal changes that we're not taking your blood draw right now and, you know, and quantifying. And so it becomes this you're not experiencing this because of the one thing you're thinking of. You're experiencing this because of everything conscious and unconscious, known and unknown, the temperature and the gravitational forces that it applies to the part of your brain that detects gravity. All of those are being stimulated at the same time, causing you to sit there and go, now I'm human. And it almost seems like in healthcare, like I as an educator as well as a clinician, and I'd like to think of myself slightly as a philosopher, I can understand the importance of bringing human nature back into science. But as an educator and researcher, my God, how horrible how horrible. Like it's so it seems almost like insurmountable as a concept to say, let's take every known variable, which are unknown by their definition, and apply them to our understanding of human nature and how we can then give you this version of intervention, and this will be the predictable outcome.
SPEAKER_00That's where I'm sitting at the moment, because I'm the book that's just gone into production is trying to trying to take that forward. Um, so there's a there's a there's a whole load of threads I can pull on that, Troy. It's fascinating. Um, one of the things about weird thinking um is that it is very much a reductive, analytical, objective evidence-based approach. Uh one of the things about our linguistic construction is that it's it's it's linear. So if you think of art, if you think of a picture, when you look at a picture, you see it holistically, it's got lots of little elements in, but if you try to describe it to somebody, you end up having to do it by taking little elements of it and putting them into a sequence, an ordered sequence. Um that's uh that causes blindness for us in in the way that we then try to conceptualize and talk about and explain to others an understanding of anything.
SPEAKER_01And you talked about you talked about that in one of your papers, where you talk about the importance of paying attention to, I think it was in the uh the pain framework where you talked about um the what is it, the past, uh sorry, let me remember where it is, the past adversity influencing now. And where you talk about how using you talk about this in several papers that you know, the changing of metaphors, the pain framework. But for me, the one that I find the most interesting that ties into the past adversary influencing now was the warmongering language, because I find those two go so hand in hand. I think those two, you know, they're they're two separate papers, but to me they could be one single concept. The the way we talk about pain is so confrontational when pain is truly the best, you know. Like I used to teach evolutionary biology, and one of the things we talk a lot about is hey, your spinal column is thick because of pain. Like you stood up against gravity for the first time and you went, oops, this hurts. And your bones densified over evolutionary time. And that's because of pain. So you might not like it, but it was really good for you. Because look what you can do now. And guess why you don't brachiate anymore? Pain and brachiation would be bad for you nowadays, because we don't have the structures to withstand it. And so, you know, you think about pain and heat. Oh my goodness, it saved you from burning yourself. So we don't like it, but but what a what
Metaphors That Shape Pain Experience
SPEAKER_01a positive experience in your growth as a human. And so the warmongering language, especially as it relates to, have you ever read Lisa Barrett Fellman's stuff on prediction theory?
unknownYeah.
SPEAKER_01So her stuff, I mean, that's when you talked about the pain framework with the past advice uh adversary influencing now. That for me was so spot on with the prediction. Like your past experiences predict your future outcomes very clearly. We see that.
SPEAKER_00Absolutely. Absolutely. And again, that's why I've tried to pull together recently, because this, I mean, again, there's there's lots of threads we can we can pull on this. Um, but what is that past adversity influence and now? Well, we we think of it as our in our world experience, but what is it in terms of being a human? Well, it's it's it's priors, it's neural circuitry, that's sort of you know, patterns and and connections that have been made. Um, and and and they get triggered. They get triggered by serious trauma or by just day-to-day adversity. And they're they're adapting all the time. So one of the things I really hate at the moment is the way that we frame, for example, chronic pain, is maladaptive physiology. No, it's not, it's adaptive physiology. Perhaps it's a maladapted environment because you've mentioned evolution. Well, we've got an evolutionary mismatch going on. We've got a paleolithic physiological body trying to adapt into a very rapidly changing external environment.
SPEAKER_01Our environment is evolving quicker than our ability to catch up to it, and therefore we experience discomfort because of the mismatch.
SPEAKER_00Absolutely. And what happens is that the the the way that we live also preys, and I don't mean this intentionally, but but the way that we live feeds our evolutionary comforts. So we don't like to move around. You know, it's good to conserve energy when you've got a low calorific environment to exist in, which was the Paleolithic era. Whereas now we've got a high calorific uh environment, and of course, we want to take as many calories in as we can, because evolutionary-wise, we're physiologically adapted to experience pleasure when we do that. We want to sit down and use motor vehicles and not move around because evolutionary-wise, you get comfort when you're sitting down and not doing anything more than you do if you're running a marathon. So just the way that the modern world is constructed sort of then preys on our evolutionary heritage, which causes then this longer term psycho, what I call psychophysiological dis-ease. So it's not disease. We're at unease with what we're embedded in our environment in the modern world.
SPEAKER_01There's the there's a big debate going on right now in manual therapy around the book, The Body Keeps Score. Um, which, you know, great book. And the big debate right now is people are getting very upset because they're saying, no, the body doesn't keep score. And I think they're almost taking it too literally in that, yes, the body does keep score, but it's not like the emotion is stored in your muscle. The emotion is still stored in the brain, but the brain's predicted response based on caloric efficiency and body budgeting is more likely to make that muscle create that response when certain triggers are influenced. Therefore, the body almost kind of keeps score, but it's because they separate the brain from the body. And I remember thinking one time when I thought I was like, when was the brain ever not part of the body? The brain is, you know, take the brain out of the body, you don't have much left going on, right? And so for me, it always seemed like the two, again, they seem like they're taking it so literally, not remembering that it's almost like a chain of events. We have this experience in our past that has rewired our understanding of reality, that creates a predictive behavior for threatened vigilance. And if it's repeated with repeated exposure, it becomes energy efficient to have a certain response to it, even if that response is maladaptive. Therefore, we get what we would consider a maladaptive response, but the body's doing exactly what it's trained to do. Respond with the most energy efficient behavior due to calories.
SPEAKER_00And maladaptive for what? I mean, that that's a critical question as well. It's not maladaptive for protecting the integrity of tissue, which is what all of this is about. Um so it's not the body that's maladapted, it's the environment. Exactly. Um and I think that's that's the critical thing. Um yeah, and and I think also our language, we just can't help it. But we we give and and this will be controversial, and I I am getting more um sort of uh courage to be saying this a bit more. But is paying.
SPEAKER_01The people who are gonna argue with you probably don't listen to this podcast. And by the time they do, it'll be a little while.
SPEAKER_00It'll be all right, yeah. But but I mean, I I think I think what I've started to realize, and it's using what I call the integral perspective, which we can come back to if you want, there is an inner world experience that's that's private to me. Um, and that inner world experience gives me thoughts, gives me sensations, gives me feelings and meanings. But I think in reality, uh those feelings and meanings are not part of the material or energy physical domain. And if that is the case, they cannot have uh intrinsic causal power. They cannot feed in. And this is a real, this really does tip people because uh if they do exist as an as a as a force, we would detect them and they would be in the physical domain.
SPEAKER_01Would would increased heart rate and increased brain activity not be the physical domain? We're just not measuring them frequently. Absolutely. So to consider them accountable?
SPEAKER_00Yeah, but we don't feel our heart rate most of the time. So I'm talking about the inner world. So when we look at when we look at trying to hold together the complexity of being a human, the the biosychosocial model was supposedly the one that does it, it doesn't do it. It's there's no human in it.
SPEAKER_01So it's talking about all quadrants, all life, because it's one of my last questions for you.
SPEAKER_00Great, agree. So one of the problems with the biospsychosocial is that individual practitioners have had to work around. Well, we've got these lists of risk factors, for example. Well, how do we bring this together to help an individual? And and I think, you know, I mean, it was a great step forward, the biosychosocial, and it was grounded in really good conceptual understanding of complexity and systems theory. However, you know, people uh we get lost in it. We don't know how to hold it all together. There's not a human in the middle.
SPEAKER_01So as a yeah, for me, the biggest one, the biopsychosocial, similar with patient-sided care, is if you work in a small environment, if you work or not small, if you work in an isolated environment where you have one of only a few or the only healthcare intervention person, suddenly the biopsychosocial model, you cannot encompass every component necessary to hold together the biopsychosocial. You can either be the bio and one other or two other, or you can be barely all of them, but you can't be good at all of them. Like it it it takes too much experience, time, and knowledge to master every component behind it. And so if you don't have a network of therapists to work with and medical practitioners, the biopsychosocial model becomes hard to imp uh implicate for the client and the patient because they just don't have enough resources.
SPEAKER_00Absolutely. And what ends up happening, I think, is that the individual patients walk away saying, oh, the docs give us some lifestyle advice, as if, you know. So what it does is it it drifts responsibility back to individuals. Whereas I'm very much about, well, actually, I think we need to drift the responsibility out to society because we're embedded in a society that's in the background, but the medical narrative brings that background and pushes it further away. It brings the tissue to the foreground.
SPEAKER_01I have a young client who's who's very fit. She's an athlete and she just got into police academy and she's very excited. And she got hurt for the first time in her life, a significant enough injury where she actually feels like her ability to run a half marathon is affected and things like this. And she's 21 years old. So she came in and she hasn't had a lot of experience with medical practitioners before. She hasn't had a lot of injuries. And so she asked me during the session, she said, What's the worst injury somebody could possibly have? And I was like, Well, the one you're living right now, that's obviously the worst because it affects you privately. But then I took a step back further and I answered differently. I answered that first, and then I step took a step back and I said, But philosophically, like globally, if I were to answer that question, I would say low back pain. Not because it's the most pain, but because it's socially acceptable to have low back pain. If I go outside and I tell someone my back hurts today, there's almost nobody in the planet who won't say, take Tylenol or ibuprofen. There's almost nobody in the world who won't say, go get a chiropractic session, go see a PT, go see a doctor, go see a massage therapist. There's almost nobody in the world who won't say, move more, do exercise therapy. And there's nobody who won't believe me, even if I have no physiological reason for my pain. There are very few people, and I'm beginning to get a small community of humans like this in the world around me who will sit there and say, No, you don't have low back pain. You don't have low back pain. What you have is an experience of predicted threat and vigilance that has caused your threshold and capacity to send off the HPA access as soon as your threat and vigilance diminishes, you are not and you have no tissue damage. We've seen your body is in healthy shape, you're lifting tons of weights. There's very few humans who will counter the thought process and say, I disagree with your statement about your back pain. Same with the headache. But if I walk outside and say, look, I have an I have my toe hurts because I have a nail in it and they physically look and there's no nail, nobody will believe me that my toe hurts. And so when she said, What's the worst type of pain that you could possibly
When Pain Does Not Pass
SPEAKER_01have? I really think it would be low back pain only because the societal acceptance and propaganda that we see through marketing and social media and pharmaceutical companies on how acceptable it is to have low back pain. It means that I'm willing to believe it far more than reality.
SPEAKER_00Yeah, I mean the social pain's a social construct. We learn, we learn the word pain, we learn how to express it. I often, you know, I ruminate on, well, if we didn't, if we didn't have uh a language, how would pain manifest in my body? It wouldn't exist, not in the way that we think. So I'd have discomfort, I would have, you know, I'd have behaviors, garden behaviors, escape behaviors, I'd have an internal tone of not liking it, but I wouldn't have a language on which to to to express it. Um and I do think that you know when when we look at damage-loaded language in particular, and then warmongering language around pain, well, we're socializing people into that experience. And the more granular that becomes in terms of the words that are used, if you look at something like the McGill pain questionnaire, if you sat and studied that and then went to the doctor and and explained, well, it's this and this and this, your experience of using those words really makes the pain your experience and potentially more granular in itself. So it there's this there's this messiness that's going on around that. And the other thing is that you know, the big the biggest issue is people need to feel validated, but both in legitimately in what they're telling people, but also that their pain is exists and is believable. Um, and the bottom line is you can't disprove anybody's pain because I'm not in your world. I cannot go into anybody else's inner world. So that validity of the person and the live uh validity of the pain is just it's a no-go area. If you say you're in pain, you're in pain. I can't, I can't print prove everything otherwise. Um and then, you know, what's the worst pain? Well, look, often I I say it's not about the pain. Pain's not the issue. If you want to get if you want to remove pain, it happens virtually every night when you go to sleep. We can put you into general anesthetic, you go, we can give you local anesthetics, but when you when you get your local anesthetics, you'll disembody you the rest of that area of the body. So pain we can manage. It's when pain does not pass. So the expectation is you have an incident and you expect it to pass the pain to pass the tissue to recover or whatever. That's the issue.
SPEAKER_01It's the stickiness that's now the stickiness, the stickiness is what I wrote about in the blog because that was one of the papers that first brought me to your attention, which is uh it wasn't the stickiness, but it was the way that I titled my blog called The Biomedical Model Has a Shelf Life. And I don't mean in that the biomedical model will expire in its functionality. I mean it has a window of effective treatment, and then it is no longer effective. That's a shelf life. And I think that window lies roughly in the three-month category, usually when pain shifts into the chronic state. Not always the case. Sometimes we see like a heriniated disc fully reabsorbs at eight to 12 months. So there the medical model sits a little longer, you know. But an ankle sprain, even a severe ankle sprain, three months longer, traditionally is quite improved, broken bones quite improved. And so for me, that shelf model, that shelf life really applies to the biomedical model, where at the three-month window, that stickiness, that stickiness is no longer your tissue is damaged and your nosuception is present and it's sending stimulus to the brain, and the brain is interpreting it and going, I feel danger, therefore, here is your pain response. Three months later, the tissue is healthy and recovered, and that's where we move into the central sensitization conceptualization and go, okay, now the brain is just stimulated because of past advice, uh past adversary influencing now effects. We see it in caloric efficiency, we see it in predictive mismatches, we see it in a lot of different things. And so when it comes to the shelf off of the biomedical model that we were just talking about, uh, where do you see, you know, how do we bring the biomedical understanding of healthcare into a modern understanding of pain science? Because that biomedical model is very much rooted in the 60s, pre-biopsychosocial, pre-AKAL, AQAL, which we'll talk about later. How do we bring it into that understanding of look, it applies when you've got a broken bone, but when the bone is healthy, it no longer applies, and yet we're
Nociception, Tissue, And Conceptual Precision
SPEAKER_01still cutting out scar tissue and giving unnecessary surgeries and medication.
SPEAKER_00So yeah, I mean, the let's get to basics. Uh there's no pain without tissue. And end of story. There's no pain without activity in no cceptive apparatus. By definition, it has to be no susceptive apparatus that's active, otherwise you're not experience pain. You'll experience some touch, heat, something else. That's fundamental. So it's always necessary to have no seceptive apparatus in the the tissue description of a pain.
SPEAKER_01Funny enough, that statement might have upset my listeners more than the other stuff you were saying earlier. Right. Because there's a bit of a debate right now about that, even though it shouldn't be a debate, but it is a bit of a debate.
SPEAKER_00So so there's the the what's what's been banded around at the moment is the idea that tissue damage you know can be completely uncoupled from pain. Well, let's get back down to basics again. What's tissue damage? It's basically the environment within the uh extracellular fluid and the intracellular fluid, you know, it's that it's that environment. And and tissue damage is a human construct, a linguistic human construct, as is health, to try and capture what that change is. Now it might be that you've got the presence of acidity, there might be mechanical deformation of cells. There's a whole raft of possibilities there. Um and that can be happening at any part in the system in the biological system. Um so so you know, I think what happens is again, our linguistic framing does constrain our ability to uh get the the nuance of this clearly, and then it also over-generalizes so that we, you know, and I've been guilty of doing it myself. I mean, I'm I'm really trying it much much more carefully to get conceptual precision in the way that I that I write and I talk. Um but but yes, you could have this tissue healing peripherally, um, yet there's something else driving within the system that activates, causes activity within what we might categorize as this noseceptive apparatus, because as soon as it emerges as pain, then it is no suceptive apparatus by definition. So even if you wanted to go backwards from pain, it still has to be noseceptive apparatus. Yeah, yeah, absolutely.
SPEAKER_01By our sensor gravitalization doesn't remove noseception.
SPEAKER_00No, no. And I think one of the things about the the way we we we talk about things, we we conflate in our experience and bodily tissue as if they're the same thing. And it's just because we've shortcut it a bit, because we've not really got the nuance of what's what's going on at a physiological and then an experiential level. That's because in our weird world, um, people have been given credit more and more in academe for becoming more and more subspecialized, which causes silos. So the world of the generalist is sort of poo-pooed in the modern world, you know, it's not it's it's almost like the opposite of trying to take into account the entire of the human being.
SPEAKER_01It's you you're really good at the arm, ignore the rest of the structure.
SPEAKER_00Absolutely. That that that's where where you get your your career progression. The more the more you're in depth and producing and becoming a world expert in one area, the more likely you're going to get career progression. So there's a whole load of insidious forces at at the at the macro level that drives.
SPEAKER_01Yeah, even those forces in their original intent were a value. Hey, become more specialized, you'll you'll do better, we'll pay you more, but have become almost so extreme that they have negative consequences to them. Um, I published a podcast a little while ago uh with a lady from the University of the West Indies on the 10,000 papers that were the drawn from the world recently, um where we she actually did a dissertation on that. And we talked about the same thing, you know, like the original idea behind research is you should get better. But what it's produced is research mills, where people not quite, you know, like it's just pumping out any piece of paper that has almost zero value or credit to it, just because it's to say I did a paper and I can put my name behind it kind of thing. So when we talk about the nuance, it almost seems like it's that conflict in general with the way our weird world works, in that, so like I'm in a, you know, I'm in Canada, so our healthcare is uh public similar to yours. Um, but even in a private system like what lives in the United States and things like that, it's there's this difficulty in that similar to the NHS, you guys don't have enough doctors. We don't have enough doctors, there's not enough doctors anywhere in the world. And so to be nuanced takes more than 15 minutes. To be nuanced takes more than just here's a pill, go away. Now, for let's say I I'm making these numbers up, I don't know if they're real, but let's say 75% of the population gets better with a 15-minute intervention. Is it not valuable then to stay there and just keep the non-nuanced world when we go the majority find improvement, even though these 25% over here are all suffering forever? And and and yes, they would benefit from nuance, but we just don't have a system that allows for that level of personal intervention.
SPEAKER_00Yeah, yeah. So again, there's there's a number of things coming out there. Uh, the nuance is really important to get an understanding of the basic uh processes that are going on of say being a human being. Um, but often that's not necessarily pragmatic in in assisting people to have meaningful existences. So there's a tension there. So when I was talking about perhaps your thoughts aren't actually driving your behavior as a deterministic viewpoint, or pain is not driving your behavior, it matters not one iota to a person living day-to-day. In fact, uh explaining that and giving them the reason why your thoughts are not doing it might derail them, probably would. And evolution is is very good at physiologically adapting our inner experiences to match survival out there in the uh in the real world. So it doesn't matter day-to-day, but it does matter in an understanding for us in academia, for example, to make sure that we we are not driving the direction of progress forward in the wrong way. So what tends to happen is a bit like a pendulum, it does overswing. So the biomedical pendulum has overswung when it comes to the stickiness of pain. Pain that does not pass. Because our Do you see it swinging back now with our current understanding of modern pain? Yeah, I mean, that's what I'm trying to do. But I I have to say that the biomedical model uh is at the core of it because it it it sits in tissue. And and and tissue has to be there for pain to to emerge.
SPEAKER_01That's kind of what yeah, it's kind of what we I talk about with a lot of my students when I teach classes. We can't remove the biomedical model. Don't throw the baby out with the bathwater.
SPEAKER_00No, no, absolutely.
SPEAKER_01Just just don't think it's the only thing that's important. Yeah, you know, it has more to it. Awesome.
SPEAKER_00And and I think, you know, when you look at professional identities, uh so I did this with the physio physiotherapy students the other day. Their professional identity is in the body, the mechanists, you know, and mechan mechanisms comes from the industrial revolution in terms of an analogy and a linguistic way of then describing, which becomes the way we think about the body. So we think of the body mechanistic, not as organic. And and and that might shift as we move into more digital and AI stuff. We might get different analogies and different ways of explaining linguistically that shifts our conceptual understanding. But I think that that's the that's the challenge. So I think you've got to start to identify where where are the right people located? So the docs are just brilliant in tissue, saving people's lives. You know, that's what they do, that's what they should do, and they should stay with that. But interesting, they have the big power within the system. Um, and and and that dominates. So to the extent, and I again I I I'm not being critical, but I am just going to raise it as something to be aware of. We've therapized everything. So we've got art therapy. I mean, art, just leave it, it's art, it doesn't need to be therapized. We've got artists. Music is music, dance is dance, therapy, and we now got lifestyle medicine. We've even medicalized lifestyle, and that is the weirdness of now. And it's not that we're doing this intentionally in some sort of conspiracy, it just is the way that the motion of the way we are as humans progresses.
SPEAKER_01I wonder I wonder if it's almost just the nature of understanding of evolution versus modern times and the advancement of technology, like we talked about earlier. You know, we can't adapt quickly enough, evolutionary-wise. It's gonna take us tens of thousands of years to catch up to the fact that we have screens in front of us. They've only been around 75 to 100 years, right? And so it's gonna take us so much longer. And so I wonder if like lifestyle coaching is simply a way of saying, look, go back to a bigger picture of what we are. You know, Pete uh Holmes has this great comedic bit where he says, you know, you think you're in the UK right now and you've got issues, zoom out. You're on a rock floating through infinite nothingness. Absolutely. You think you got a problem, zoom out and you'll see. Maybe it's a little bigger. So, like our problems when we think in terms, and it's one of the things I talk about in my book is when in terms of evolution, it might actually be doing us a disservice to consistently try to avoid pain. Not me, it's helping me, but my children and their children and their children. If we go far enough through evolution, at what point am I doing my descendants a disservice by not allowing myself to experience pain and treat and teaching the next generation that it's it's bad to suffer, that's it's hard to be resilient. At what point is the evolutionary turn gonna go, oh, well, then we don't know we no longer need these protective mechanisms in place?
SPEAKER_00Absolutely. People who don't experience pain don't live long. I mean, there is a genetic condition, it's called congenital insensitivity. They say insensitivity to pain. Well, you can't be insensitive to pain. Your nose deceptive system hasn't hasn't developed, so you're not you're not able to detect uh harmful um stimuli into the butt into the body. Um, but they their lives are not that they're pleasant, but they're not long. And they're you know their their physical condition can often be quite um limited because they're constantly be breaking bones, they can, you know, they lose digits and so pain is a fundamental aspect of life. If you want to know that you're alive, pain is one of the best ways of of feeling and being alive.
SPEAKER_01You you said something earlier about humans in evolution. You know, we we seek out, you know, it feels good to sit instead of walk because I'm not doing a marathon. One of the things I've always thought about when it comes to neuroscience evolution is the human body actually, we're not programmed to experience pleasure. We're programmed to survive. You know, the nervous system is not programmed for accuracy, it's programmed to react in an uncertain world. So there's no point of my experience that says, you know, eat this thing, it's going to taste good. It's more eat this thing, it's not poisonous and won't kill you and gives you calories. If it tastes good, hey, how cool is that? You know, added bonus. But we're not necessarily designed to sit there and go, oh, this feels good. We're designed to sit there and say, this doesn't feel dangerous. And it almost seems, you know, again, it's one of those things that nuance matters at one point. Because if it comes to me not moving enough, not lifting enough, you know, a lot of the research coming out of the pairing monopausal world right now is showing that uh women who lift 70% of their body weight stabilizes a lot of the hormonal changes due to the amount of stimulus and osteoporosis degeneration and things like this. But lifting 70%, I mean I'm 230 pounds. 70% of my body weight is a lot of weight for me to have to go in and do deadlifts with. It's definitely not pleasurable, but it almost seems to avoid other displeasure by feeling strong as I walk around in the world.
SPEAKER_00Yeah. Yeah, yeah, yeah. And it's interesting because I think we've also got a narrative in the modern world of, you know, well, every everything becomes reductive. So exercise, it's it's exercise prescription. It's not even physical activity, you know, it's not just movement. It has to be sort of taken into a medical narrative in some in some guises, um, not intentionally, you know, it's all in in in in in in good interest. Um yeah, yeah. I mean, uh,
Why The Word Chronic Backfires
SPEAKER_00I always say people do it because you enjoy it, you know, because you feel like it's you get you get a job.
SPEAKER_01I like splitting wood, so I split wood.
SPEAKER_00Yeah, yeah, yeah.
SPEAKER_01Absolutely. One of the things you talk about was um you so we've mentioned it several times today. We've we've already used the word chronic quite often. But I know you've you've talked about the word chronic in a really interesting way before, and you've correlated it to a nacebo with nocebo, which I which I thought was really interesting as a concept because it definitely goes back to the thing about like back pain is acceptable because society has accepted back pain. Using the term chronic seems, you know, it's almost like using the when you know nowadays everybody says, oh, they're trauma dumping or PTS, everybody has trauma, everybody has ADHD. It almost and it's not to trivialize those who are experiencing it, it's to make people who aren't experiencing it realize, are you using the correct terminology? And for chronic, I almost wonder if it's become too easy almost because of the medicalized system we have to say someone's living with chronic XYZ. That way they have access to care, they have access to medication, access to insurance, things like this. Yeah. Um, but might it not also be the reason they are continuing their condition?
SPEAKER_00Yeah, yeah, absolutely. So I I unpacked the in in in the book. Um I I unpack the word chronic. It's got a number of connotations that I think now are doing us a disservice and are causing harm. So I think language causes harm, quite simply. And I'll just take take your listeners through why it does. When I get an inner an inner thought, the way that I communicate, so we're we're communicating Troy our inner experiences to each other and our inner thoughts. We're doing that by sending what's in our inner world out into the real world. So it becomes movement in air molecules, which then becomes movement of a near drum and you and then it gets converted into your inner world. So language is is insidiously harmful because it becomes a physical thing, which is transduced into changes in your neural system and in your bodily processes. So the words we use can be as dangerous as any chemicals we swallow, you know, as pills. And I think that realization is really important. I I think of language as part of the settings in which we exist. And once you start thinking like that, then you start to realize, well, I wonder what these words mean. So so chronic, it it I mean, uh one one of the things that's really important is that we don't we don't nominalize something that's in motion. So so we're all in motion. There's no static moment in time. But when we say the word pain, we we nominalize it. It's I think pain's an event, it's an ongoing thing, it comes and goes and it's it's moving. Um but by using the word pain, we nominalize it in English so that it becomes a noun. And as soon as it becomes a noun, we start to treat it as if it's a thing. And as soon as it becomes a thing, we can be separate. There you go. And the hard part of the twisty verse in the mind is to try and understand that pain is an inner experience, it is a subjective entity, it is not an objective physical entity, but they coexist. One isn't causing the other, it's just a different perspective of the same uh event, and that's hard.
SPEAKER_01That's one of the one of the things I use in my book, but also with a lot of my clients, because I still see clients every day, I've got clients this evening, um is when they come in and they go, I'm in pain, and I look at them and their face is neutral and normal, and they're not wiggling in their seat and they're not moving and they're not grimacing. I go, okay, well, let's let's let's talk about that word. It's one of the things I do in my first session is if you're gonna use the word pain, which you are completely allowed using, you have to be experiencing one of two concepts. It has to be either one, a five out of ten on the pain scale, and two, or which would be the equivalent to a grimace. You're physically making a face. Or two, it needs to be described as sharp. So when people come in and say, Oh, I have this dull, achy pain, and they're not making a face, I go, Do you mean discomfort? And eventually over time, they start reframing it on their own and they go, you know, I ran today and it was tense and tight and stiff, but I wasn't in pain. And the moment they remove the word pain from their experience and they internalize it as discomfort or tension or tightness or stiffness and non-sharp, their threat levels drop, their HPA access doesn't kick in, their vigilance levels drop. And I go, look, you're doing more activity with less what you would describe pain and more discomfort. And that already changes your understanding of reality.
What Artists Reveal About Suffering
SPEAKER_01And it really shifts that understanding of it's something happening to me versus something that's happening within me.
SPEAKER_00Brilliant, brilliant. We did a we did a project uh which which really was quite profound for me, working with artists. So it was an artist-led project called Unmasking Pain, where we brought in.
SPEAKER_01I talked about that in the blog that I did, your paper on that as well.
SPEAKER_00I mean, it was just fascinating watching how the artists uh interconnected with with people living with pain versus how we would normally do it in clinical settings.
SPEAKER_01What I really liked about it was that it was non-clinical driven, which meant people talked about it differently because they weren't talking to a healthcare practitioner.
SPEAKER_00Yeah, absolutely. And what was interesting was the artists um they they let the participants lead. Um, so the word pain was not mentioned. Artists weren't going to prime anybody with the word pain. And what quickly became apparent was pain, yeah, was was was causing some suffering, but that wasn't the main thing. Because the context had shifted from the clinic. And if you go to the clinic and you've got a respiratory condition, you talk about breathing. If you go to the pain clinic, you talk about pain. So in the artist-led things, it was much bigger picture that was going on.
SPEAKER_01Pain's quality of life. It's I don't, I don't get a play, I don't get a play with my kids. So one of the things most of my listeners are massage therapists. I have quite a few in other disciplines, but most are massage therapists. And and I know massage therapy is different in North America than it is in the UK. I have a few listeners who've spoken to me how there are differences and that it's more medical, it's it's closer to physio and sports and in the UK. But it's one of those things where we get an hour with our clients, and oftentimes, again, it's this thing of it's society has primed people to believe this about massage therapy. And and it's not true by any means whatsoever, but but society is definitely primed it this way. They totally will tell us everything as though we're their psychologists. And we are not, we're massage therapists. We're not trained in psychology. A lot of us don't know how to handle this stuff. We have tons of continuity classes on how to protect yourselves from being trauma-dumped and stuff like that. But it is definitely one of those experiences because people come in and they don't go, I'm at a respiratory specialist. I'm not at the they come in and go, I'm here for everything I am. And that everything I am is usually my quality of life
AQAL And The Four Quadrants
SPEAKER_01is suffering and pain is part of it, but it's only a part of the reality of my quality, and that becomes important. Yeah.
SPEAKER_00Absolutely.
SPEAKER_01So I want to I won't sorry, I want to take that and move it in because what you're talking about to me, it reminds me of the all quadrants, all life experience. Right. Uh, because you've talked about the inner and the exterior a few times. Um, and I want to be respectful of the time we have. And this is a concept that I really want uh my listeners to hear about. If it's I've never heard about it before before I read it in your paper. Um, I've definitely seen um from uh both from what you read and then some of the other critiques that it's got a lot of criticism. It's definitely not a I would, it's not, it is very much a controversial concept, the all quadrants all life. So I know you've tried to narrow it down to remove some of that controversy and to get rid of a lot of the variables behind it. Um do what do you want to bring a little bit of that into this? Because you've mentioned it a few times in different words.
SPEAKER_00Yeah, yeah. So so we've got a three, a three-circle model by a psychosocial. It's accepted within academic, within medical circles, because it's gone through peer review processes and gone through the traditional conventional uh approach. Um, the the model, the it's called the AQA model, it's an integral model, all quadrants, all levels, um, is an attempt by a guy called Ken Wilbur, who is sort of a popular philosopher, um, sort of author of trying to bring everything together to construct something that holds together, a framework that holds together the complex reality of living as a human being. So it's experiential. And there's four quadrants, which I think are really good because at any moment as uh as as you exist as a human, there are four perspectives or four lenses you can look at your existence. So the perspective that we all experience, the only lens we really have is our inner world. That's an upper left quadrant. It's the inner world of what you might call your mind, but it's what I think of as the feelings and meanings that we have as an individual.
SPEAKER_01There's does it incorporate in interoception as well, or not so much?
SPEAKER_00Yes, yes, anything that's going on internally.
SPEAKER_01Even if it's physiological.
SPEAKER_00Yeah, yeah, but it's not the physiology. So it's just that inner experience, this phenomenology, if you want it to see a lived experience. So that's the upper left quadrant. The upper right quadrant is uh the exterior world of me. So try at the moment you can say I've got a body, you can see my tissue, you can see my behaviors, you can hear my words. So they're existing in the physical world, it's it's out there, but they belong to me. So it's my physiology, it's my tissue, it's my behavior. So they're the individual quadrants. But I'm also in a shared environment. I'm in the shared environment of our physical worlds. Um, so I share this house with other people. I also share an understanding of our systems, such as financial systems, medical systems, you know, rules and regulations. I share those. Um and that's the lower right quadrant. That's in the external world, we can all say them. But we also share our inner worlds together. So you and I are sharing our inner worlds. These shared meanings between people, we often call culture. And it's the values and morals of being part of a community of human beings.
SPEAKER_01If I say something like the term Brexit, we both have an understanding based on our personal experience, and it's all internalized based on cultural experiences.
SPEAKER_00Absolutely. And it may be an in-group thing for me and an out-of-group thing for you. And it's often when we talk about culture, we often talk about you know ethno-cultural perspectives and race and and and and things like that, but actually it's moral values that I think are really important. So they're the four perspectives of any moment in time. And it's just a really good way of bringing everything together because no moment in your existence disconnects from one of from any of those perspectives. They're all happening simultaneously. So you move from a three-circle biopsychosocial listing to four views of a particular moment in time, for example, pain. So, with pain, it would be my inner experience is pain, and I might have some thoughts that are associated with it. And that's the upper left quadrant. At the same time, my physiology is doing things. I might have behavioral things going on, like a grimace or some escape behavior. You will see that. You won't see my inner world, but you will see my uh exterior um representation of that inner world. Uh, I might move around the environment, so I might go to a pain clinic, I might go into a healthcare system that you can also go into as well. That's in the lower right quadrant that we share. Um, I might be in an environment that really promotes pain itself, a painogenic environment, or I might be in a really nice environment that's relaxed and it's it's it's soothing. So it's more what we call salutatic. And then my pain might be accepted and legitimized in my household, but not in my clinic. So there's a the the lower left quadrant is looking at, well, what's the culture around pain? Is it accepted? Somebody says they've got lower back pain. Will that be something that a clinician will accept and validate or not? So there's four.
SPEAKER_01Do you find that when those four worlds seem to be in accord, we seem to have a great understanding of health in our own experience? Or is it if even if discord is present, we still seem to have a state of generalized health?
SPEAKER_00So that's the key. With those four perspectives, you can now look at each of these individual perspectives and say, are they aligned or not?
Salutogenesis And Sense Of Coherence
SPEAKER_00So following on from those four quadrants, I've moved towards a salutatic uh perspective on how we look at pain, which salutegenesis is the growth of health. So we we live in a weird world of a pathogenic mindset.
SPEAKER_01And again, by weird world, you mean capital weird.
SPEAKER_00Yes. So from what we were talking about. Our westernized, educated, industrialized, rich, democratic mindsets are very much grounded in a pathogenic lens. We try to kill pathogens. This is where all the militaristic in warmongering language comes from. So we try to get fighting pain, battling through your pain, no pain, no gain. There you go. So that's a pathogenic mindset of how to manage things. And it works with pain to an extent. You know, if you if you remove some tissue, the pain might disappear in acute sentence.
SPEAKER_01And that would be the biomedical model for the first three months of intervention.
SPEAKER_00There you go. But as you transition then to this pain that should pass has now become stuck and does not pass, then I think that that model doesn't quite hold the power that it that it used to do. Um so a salutatic model, instead of just uh going at the tissue and trying to, you know, treat the pathology, is about growing health. So how do you grow as a human being? And at the core of it is what we call a sense of coherence. So is your world coherent as you live it in a day-to-day existence? And in coherence, it uh it really has three elements. Is it comprehensible? So is what's going on comprehensible? And you can apply this to pain. Is what the doc's telling me comprehensible? And does it match up with what the physio or the massage therapist is telling me or what my family are saying? So comprehensibility. With that comprehensibility, am I able then to manage through so that I'm not suffering? So there's a managing element, comprehensibility, management, and then the last one, which I think is the critical one, is what's going on around me in my life meaningful? So I can have pain and I do have pain, and I have pain a lot because I'm a cyclist, I crash and I got terrible saddle sores, different story. But I still have a meaningful existence. And that coherence, sense of coherence for a person, I think is at the core of how we then move through this stickiness period.
SPEAKER_01That's interesting. I I'm gonna have to reflect on that because one of the things that I talk about on how to enhance their experience. And I and I apply this to a lot of different concepts, pain being one of them, but I but you know, how I interact with my kids, how I interact with my partner and things like that is essentially the concept of allostatic load, where if I surpass my threshold, you know, we're gonna have three likely responses in the beginning when I as I approach my capacity. And that's gonna be brain fog, anxiety, and impatience. And those are three like subtle alarms that say, hey, you're getting close to your limit. But most humans, most of us just say, Well, I'm I'm hungry. I have brain fog, so I'm gonna have some coffee or chopper bar and I'll be fine. If I'm anxious, we'll just go when I'm when I'm done today or this project, I will be less anxious. Or most of us say, if I'm impatient, as soon as this person leaves my environment, I will be less impatient. As soon as I have time to concentrate on my work, I will be less impatient. And so we ignore those three like subtle warning signs that are internal because we have a hard time paying attention to the interoscept itself. And then the next warning sign is pain because the body says, Oh, you didn't want to pay attention to the first three signs. I've got one that you won't ignore. So suddenly you get a headache, suddenly your back starts hurting, suddenly, suddenly you're sitting at your computer too long and your neck starts hurting and your upper back hurts, and you go, Oh, it's my posture. When in reality, it's you've just overblown your capacity and threshold. My version of the cohesiveness version would be instead of saying, let's not get to that limit, it's when you get anxious, when you get impatient, when you get brain fog, you need to listen to those three warning signs and you need to take a break and you need to allow your system to calm down. And the moment you're calm, you need to go right back to that place of impatience, anxiety, and brain fog. And we we would call it resilience training. And the more frequently you can stay there without surpassing the limit, the more likely you are to be able to increase your capacity to handle more stressors with less adverse effects. Um, but it wouldn't be salugenic necessarily, because that seems soothing in nature. And this is the goal is to expand our which resilience training involves not necessarily soothing behavior sometimes. The goal is a soothing outcome. But in the process, you know, it's like riding your bike. I just did 100 miles on Friday on my trainer in my basement. Fantastic. We'll talk about cycling when we're done with the podcast because I recognize your hat. Um, and you know, to get to be able to do 100 miles in under four and a half hours took a lot of intense exercise that was non-soothing to do something that felt great in the process. Um, but that's that resilience training. How would that fall into the AQAL, the all-call, you know, all quadrants, all uh levels aspect of life to bring that cohesiveness together?
SPEAKER_00Yeah, I mean, I think I think with a sense of coherence, the the key is what we call general resistance resources. So where do you pull resources from each of those perspectives to then give you a coherent understanding of what's going on and also resources that can help you manage what's going on? Um and that's the beauty of the model. It it brings to the fore the upstream collective environment where we're not pulling resources from. So one of the things would be, you know, pulling things that give you meaning in your life, which is usually connected back into communities of things that you enjoy doing. Um and and and and shifting the language so it's not always a destructive, damage-loaded language. Um and and that in itself then just gives you the ability to curiously explore, which is one of the things I can hear you doing all the time, you know, with your with your clients. Um, because that you cannot change it for them. They have to start to get a transformation through curious exploration themselves. And and and often you you find people just have a light bulb moon and say, I've had enough of this.
SPEAKER_01Well, it's what it's a lot of a lot of we we in the massage therapy world, we have a joke, and it's like, you know, we will we always have that person at a party who says, Oh, my back hurts, and you give them your card and they don't come and see you. And and the next time you see them at the movie, they say the same thing, and I go, Oh, I get it. You're not in enough pain. The moment you're in enough pain, you'll give me a phone call. Right. And it's not just massage therapists, it's anybody who works in healthcare finds that. Is the moment you're in enough pain, you'll you'll find a reason to go get an intervention. And that curiosity moment is interesting. That's one I teach a lot in my classes, which is to tell people stop telling, stop giving exercises to your clients. Ask your clients to make up an exercise. You know, like there's this great, I mean, it's it's it's such a well-done ad from such a company that I'm not a big fan of, but Coca-Cola had this amazing ad for Christmas time where this grandfather can't bend and he starts going to see a doctor and he starts taking medicine. He bends his back a little by little and he gets physio, and then he's working out and he starts deadlifting, and then he's in the his garage and he's lifting a weight, and it goes through a whole year. And at the end of the year, he lifts his grandchild up to put a star on top of the tree. There you go. And it's like, get make your client make up the exercise. And chances are they're gonna make an exercise that they find curious, fun, feasible,
Practical Tools For Manual Therapists
SPEAKER_01and real, and and it makes it enjoyable for them. So I want I want to respect your time. So my last question would be you know, we we've talked about a lot of philosophical stuff. I feel like we could have a few more podcasts talking about the philosophy of all this kind of stuff. Wow, yeah. My last question would be uh as manual therapists, uh, you know, language reframing is already very valuable, and you've mentioned it several times, you know, removing warmongering language and things like this. What are some tricks that you would give to manual therapists who are working with clients? And you know, we we can use the word pain if we want, but you know, equally as present in people's experience is anxiety, stress, fatigue, depression, you know, and like when when we overdo our capacity in one of those terminologies, you know, the response inside the brain is almost the same. You know, one of them is painful, but the HPA axis engages just as much in anxiety as it does in pain. It's the manifestation is just a little different, but adrenaline is still the response, and cortisol spikes are still the response. So for you know, for therapists who are dealing with clients like this all day long, what are some like key tricks that you can say, look, this is great in philosophy, but how do we apply it to the person in front of me in my clinic?
SPEAKER_00Yeah. So my my my background is intense. Uh, you know, that's that's so transcutaneous electrical nerve stimulation, which electrically rubs pain away. From an evolutionary perspective, the first thing anybody does when they're in pain is to start to rub away. Around the area because it soothes. So for me, it's about soothing the body, calming it down. So I think in the modern world, we many of us are in a state of psychophysiological dis-ease, and the the best way, because it's got a great evolutionary heritage, you know, physiologically adapted to connect through touch with other humans. So if you asked me what was the one thing that you would say to the government to do in terms of interventions, I'd say give everybody a massage a few times a week, you know.
SPEAKER_01Oh, my listeners are gonna love you.
SPEAKER_00Well, absolutely. And I'm not I'm not saying that just because I'm hard on with you, Troy, but but it is what I believe. Uh it doesn't need to be electricity doing this. I mean, another human, giving the body a good rub, is absolutely brilliant. And and and instead of spending all the money on all the pills, why don't we just start doing that? And that's reconnecting also within social narratives, broader narratives, non-medalized narratives. You mentioned acupuncture earlier. I did a lot of worked a lot in Western um medicine acupuncture and also traditional Chinese acupuncture. They're the same thing physiologically, all it changes is the narrative. And actually, the traditional Chinese narrative is pretty good, it's metaphorical, and and the medical one actually is still metaphorical. So yeah, I would I would say give everybody a massage. And if if they said, well, what would you invest in in terms of personnel in the health service? Say health coaches, you mentioned life coaches earlier. We've got a service in the UK called Rethinking Pain, it's one of the first ever that's done this. It's a community-based support for people living with long-term pain. Um, and it's run by the voluntary community um sector, not by the healthcare sector. It's funded by the healthcare sector, but it's got governance by um clinicians, so there's a there's a governance, but it's basically health coaching that goes on there. They do pain education, do a bit of pain science education, but we have modules that involve uh things like movement, creativity, storytelling, faith in pain. Um, and it's for our diverse communities, predominantly a Pakistani community, which is uh the the main minority uh ethnic group in this particular community. So it would be health coaches, and you guys can do that because a health coach connects all of these different narratives into a cohesive story, co-produced with the individual.
SPEAKER_01The the story coming out is pretty common. I think in 2024, in uh the fall issue of Pain magazine, there was an editorial done by an osteopath in the University College of London, and it talked essentially about um you know researchers showing us that the number one thing for pain outside of PE seems to be interdisciplinary approaches. Like that's it. Even if the approaches are disagreeing with each other and non-cohesive, we still see greater results if they are interdisciplinary, which is pretty cool. And then another podcast they did with Pavel Goldstein talked about brain-to-brain coupling through touch. Um, and he was on as a guest because he did a great article. And it actually inspired an entire class that I teach called Touch is Communication. And it's essentially about using touch to stimulate C tactile afferent nerve pathways, which we know were measurably stimulated at 10 centimeters per second of movement under 10 grams of pressure. And it's that soothing touch that you're talking about. That's all it does. And there's a University of Essex, there's a great um professor there, PhD, uh, Julia Peoria, who uh has got a PhD in ASMR studies, and her and I talk about you know, the soothing effect that ASMR responses seem to have on the brain with dopamine, oxytocin, serotonin and endorphins is mind-boggling. And it just makes us say more and more that soothing touch seems to have more valuable.
SPEAKER_00And if you look, if you look at our evolutionary heritage, the great apes, they're bonded by grooming, just touch.
SPEAKER_01I think it's Dr. Brown who did a study on that.
SPEAKER_00Yeah, yeah, and then it's Robin Dunbar's work, is is is really good around that. But what we've done as we've we've evolved, we now use our language to groom. And this goes back to the importance of language.
SPEAKER_01So the six language is may break my bones, yeah. But words
Final Thoughts And Book Tease
SPEAKER_01never hurt me, is no longer true.
SPEAKER_00It's no longer true. Absolutely right. Absolutely true.
SPEAKER_01I love it.
SPEAKER_00Yeah, yeah.
SPEAKER_01Well, before we go, um, is there anything uh I know you've mentioned a book several times? Do you want to promote any of your own material you have an opportunity to?
SPEAKER_00No, it's coming, it's coming out in the new year, it's in production at the moment. I've tried to bring everything together in it, um, and uh probably made a complete mess of it and it's probably unreadable, but I'll give it a go.
SPEAKER_01Um I'll keep my eyes open for it for sure.
SPEAKER_00Yeah, yeah. But no, I've I've thoroughly enjoyed this. It's uh it's been great fun.
SPEAKER_01Yeah, awesome. Thanks so much, Mark.
SPEAKER_00No problem at all, Troy.