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Episode 15: Dealing with Pain Science featuring Janell Saville

Transcription:

Brett Scott 0:02
All right, everybody. Welcome back to another episode of the barbell therapy podcast. I’m your host, Dr. Brett Scott. Today we’re mixing things up a little bit here where I have one of my clients Janelle with me, who has recently become a life coach and had some questions for me about my experience with chronic pain as I do have it myself. And I’ve been dealing with this since I was about 20 years old. So about the past 10 years of my life. And as I am someone that also works with a lot of people with chronic pain, my thoughts about it there. And she just kind of approached me about it and asked, you know, if you could interview me ask some questions, and I figured putting my thoughts and experiences out on the podcast might be a good way to do it, or better use of my time and might benefit someone out there looking for help. So I figured we’d just put it out here in that way. So Janelle, go ahead and introduce yourself a little bit and what your experiences have been leading you up to becoming a life coach

Unknown Speaker 1:07
here. Yeah. So I love I love your entrepreneurial spirit in terms of getting the most value out of anything. So I have to appreciate work with you, Brett. But my background is I met Well, it’s actually health and wellness coach, but you probably one of the same. I would I guess I would say, but um,

Brett Scott 1:26
I’ve worked just to get a bad rep. So yeah, I mean, no,

Unknown Speaker 1:29
sorry. But it’s a life coach. I’ve done okay. But yeah, so I am I work full time corporate America, that’s my job. But I’ve always had an interest in health and wellness. I was I became a massage therapist, I did some additional training. And at some point I ran across pain science in it just very much intrigued me in terms of how all the different components of your life, whether it’s the actual physical injury or lack of and your brain and neuroscience, all that I’ve just been fascinated with over the past like 10 years, I would say. But last year, I actually decided I’m gonna make a change in my life. So I became a certified health and wellness coach with a goal of eventually coaching for pain for people with chronic pain. And I don’t I have a little bit here and there, but I don’t suffer like a terrible level. So I was like, Well, let me make sure I’m, you know, getting the right information that what I’m doing is appropriate. And I’m like, Who can I talk to? And then I’m like, oh, yeah, Brett, not only because you experienced that you’ve shared with me, but also that you work with people that have it. So it was just really serendipitous opportunity to chat with you. So thank you for your time.

Brett Scott 2:43
No problem. And I’ll let everyone know to Janelle is a badass national champion weightlifter, the Chinese here as well. So if she has a lot of pain that I don’t know about, she’s doing pretty well at managing it with the weight she puts up. So let’s go ahead. And so what did you want to start with Janelle of just kind of I know you want to talk a little bit about me and then, or my own experience, and then my experience of working with patients and my understanding of pain science. So where did you want to begin?

Unknown Speaker 3:15
I want to start with you. I want to I want everybody to get to know, Brett, a little bit more. So I want to understand, yeah, if you just want to give a brief, brief, brief, brief background in terms of what you’re dealing with when it started. That’d be great. And then maybe we can go into a little bit about what you’ve tried, what’s worked, what hasn’t some things that might be advice you would give to people, but we can start with just the backs give us the backs.

Brett Scott 3:42
Yeah, so my experience with chronic pain was I was in exercise physiology school, I was actually working at a PT clinic. And I just kind of had this shoulder pain start and was like, kind of nagging what I now know was like impingement syndrome, but it kept getting worse and worse and I was doing rehab and nothing was really working in like I had gone from you know, kind of doing this pretty heavy, heavy intense like bodybuilding routine, like I was a gym rat five, six days a week couldn’t stop me. And then all of a sudden was like I couldn’t lift overhead and then bench pressing started hurting. I went to PT I like knocked all my activity down. And it got a little better and then like one night I remember I like once a pull the sheets up over my head and I got worse again and back to pt and she was like, let’s get an MRI, maybe you tore a labrum or something. So we went did that. And no findings on the MRI besides the surgeon said it looked like the joint was very inflamed for some reason. So I wanted more time PT whatever. Then still dealing with that then. So that was my left shoulder and then all of a sudden my left hip started bothering me is kind of the same symptoms instead of overhead, lifting and squatting And then started treating me for that. So I’m a PT student, I’m an employee of this place. I’m getting treatment there for shoulder and hip. I mean, one day, I said to PTM, okay, my left hip isn’t bothering me today, but my right one is and she’s like, something’s wrong here. Like, this isn’t adding up, you’re 20 years old, you’re pretty healthy. Like you go to the gym every day. You know what you’re doing? Like, we need other tests. I’m like, maybe there’s something underlying here. So from there, I was sent to a rheumatologist and funny enough and this is why I’m such a big person that says to advocate for yourself is what their told them, You know what was going on. And I had noticed too, that all my joints had started cracking all the time. Like, I like sitting for five minutes, I would just like lean back and like a zipper up my spine. My shoulder was popping all the time. My hips were popping all the time. And this was completely new for me and I was like, something just doesn’t feel right here at all. I have a tendinitis everywhere. Something wasn’t right. And then I was having this and then I started having a searing SI joint pain. So I started seeing a chiropractor too, and he couldn’t seem to figure anything out and went to a rheumatologist. They basically had me bend over touch my toes reach side to side and said it doesn’t seem like anything’s wrong with you, but they sent me for blood work, came back for a follow up. It was they tested me up and down the river is you don’t have this you don’t have that blah, blah, blah. We missed this one thing and we put it in the wrong vial. So it didn’t test but I don’t think it’s that back and forth, back and forth. And then it’s like, okay, like, why am I in all this pain, don’t know. And then I was in pharmacology in school, trying to manage all this stuff. Like I couldn’t sit for like 10 minutes and hurt so bad. I had to stop going to the gym. It was just like walking hurt for prolonged periods couldn’t drive far. And then I was in school and we’re learning about some of these biologic drugs for like Enbrel, Humira, all those and I they brought up ankylosing spondylitis, which was this kind of increasing prevalence in the United States for men of the onset was around 18 to 30 years old. It was SI pain. It was hip pain, shoulder and back pain. All the symptoms, and the way it came on was me to a tee. I like looked at the screen was like, Holy crap, that’s me. I left class I call the rheumatologist office. I was like, hey, was the one thing we missed in that vial, HLA B 27, which is the antigen for it. And they said, Yeah, but like, how did you know I was like, I think I have it, we need to retest me for it. When again, they somehow messed it up again. But finally on my third time, I went back. I was like, Yep, you’re positive for HLA B 27, and ankylosing spondylitis. So for those of you that don’t know what Ankylosing Spondylitis is, it’s a inflammatory rheumatoid family disorder, which basically, we have this, this metabolite, I guess I could say, called tumor necrosis factor or TNF, which basically just creates a lot of inflammatory activity in the body. And so for those of us with ankylosing spondylitis, what it does is it increases the degeneration of the spine, just basically at a faster rate. Because of the inflammation that this necrotic factor creates, and the antigen and antibody response we have. And so it used to be called Bamboo spine. So slowly over time, my spine is supposed to be fusing. And I’m, you know, in 20 years from now, I’m supposed to be hunched over or, you know, wheelchair bound or what we don’t really know. You know, everyone there’s, there’s various levels of this and I think part of me thinks I’m just lucky to have a more mild case of it. However, I also have lived a very different lifestyle than most that have had this. So when I went there, and you know, in this is what I see all the time is a medical practitioner to is like, they don’t give you a lot of hope. There’s not a lot that can be done because a lot of medical practitioners just don’t have time. So when I went there, so I saw the rheumatologist for my follow up. And it was the most interesting part here is I had to see this rheumatologist and it was interesting before I even went to see her because the front desk woman who was very friendly, vetted me with the fact that The doctor is really weird. She’s like, almost autistic. Like, she doesn’t look at you. She won’t really look at you or acknowledge you. But she’s very smart. Like she’s found cancer in people before.

Unknown Speaker 10:09
I was like, that’s quite an intro. Yeah.

Brett Scott 10:13
So I went in and she wasn’t wrong, like, and so then, you know, she didn’t look at me the whole time. She just looked at her notepad didn’t want to make eye contact. Didn’t really educate me on like, what was happening, she basically told me, we’re going to put you on this medication. And you shouldn’t lift any more than your body weight off the floor anymore. You should really stop lifting weights, you should just stretch and do yoga. For me, that was like, nail my coffin shot. Right, right. I didn’t. Those weren’t things I was going to hear and wanted to take. Take something I wasn’t going to accept that answer.

Unknown Speaker 10:52
Yes. Do you mind if I interrupt you? Because I have a question. Yeah. So when you’re starting to get like this shoulder pain, this hip pain? And how long was it between that started and when you couldn’t even sit down in class? Like, how quickly did it happen?

Brett Scott 11:09
I’m probably about four or five months, I would say that’s really started with shoulder pain. And then it was like, all these things started happening. I was like, What the heck, but you know, they hurt and but no one sees that on the surface. I’m like, I’m this young. I’m this muscular looking kid with that’s been going to the gym and plays sports and does all these things, and hasn’t let these things like taken over yet. So no one really, like sees anything wrong. And then I’m told I’m overtraining. I’m just pushing it too hard. I’m not working out, right? Like, I have a 4.0 as an exercise physiology student, I work in a physical therapy clinic, I’m helping rehab people like, I know the difference between right and wrong. Like I’m not training too much. I wasn’t doing anything for a while.

Unknown Speaker 12:02
So and it’s almost like if you hadn’t had pushed and had been happened to be learning about that. Like, who knows when you could have connected the dots on your symptoms? Because you? Yeah, exactly. Like your external appearance is so different than what you were actually experiencing?

Brett Scott 12:25
Yeah. And if it wasn’t for that pharmacology class, it probably would have taken another few years to really figure out what was wrong, because the doctor just kind of overlooked it and said, It can’t be that even though it was the chiropractor kinda just said, let’s keep manipulating the PT, my PT. Luckily, like after, you know, things went to a third and fourth joint was like, okay, something’s up here.

Unknown Speaker 12:57
Because I’m sorry, I keep it hard for you. But I think, because that’s something I think people feel a lot, regardless of the cause of your pain is that you’re not either taken seriously or it’s attributed to some like, basic thing like, yeah, you’re working out too much, but you don’t feel heard. Maybe you didn’t feel heard like this is actually happening.

Brett Scott 13:20
Yeah. And, you know, I was basically told, like, just lay down and be a pancake and let this like, take over and I was like, No, do this. I was even I asked them. The rheumatologist was like, Well, what about nutrition? Like, can I do something from a nutritional standpoint? He’s like, No, that’s not going to help this. I was like, and once she said that, I was like, about, like, I need to find something else to do. And I’ve actually never been back to a rheumatologist since even though no one’s supposed to prescribe this drug except the rheumatologist I figured out a way. But it really just goes down to like, yeah, if I wasn’t in that class, I never would have found this out. And that’s the thing with ankylosing spondylitis. And a lot of, we see a huge increase now and all these auto immune factors, whether it be from our food, our environment and toxins in our worlds, there’s more and more of this stuff coming up. And we’re just not diagnosing it as well. And like, I was actually kind of at the word the prevalence of Ankylosing Spondylitis restart coming up and then all of a sudden was like, right after I got diagnosed, like all these drugs like Anberlin humera. And all those started coming out in literally like commercials on TV, and it sounds like a monster on the radio. Oh, I

Unknown Speaker 14:27
remember those. Yeah,

Brett Scott 14:29
yeah. But for a long time wasn’t any anything about it was kind of this rare disease. So those were kind of, you know, the things I was told to do that I wasn’t going to get to take for an answer.

Unknown Speaker 14:45
And it sounded like you may have already even tried some of that like, taking rest time and not working out as much and that didn’t help anyways, or didn’t even make it worse.

Brett Scott 14:56
Oh, yeah. It’s kind of in this is a thing with chronic pain. And to is we see, like, even now even though I’m better now and I am on, I’ve been lucky enough to find a medication that really works for me to manage my symptoms as well as I can. Yeah, there’s still like, I still recover slower than most people like, it’s always like, I just started I got really stiff, and it took me a long time to warm up and like, I could foam roll for hours and still feel a difference in like, even now, like, even now, like I competed a high level and weightlifting, not the highest, but like, I get banged up easier than most, because my joints don’t move as well. They’re stiff. However, that’s been weightlifting has been the biggest like blessing for me as far as it’s hard. Maybe I can’t keep up as well with everyone else. Because my spine naturally over time is going into a flexion base position where weightlifting has been always very upright and extension based. I did I had some hip issues last year, too. And I went to the doctors and like he basically told me my hips were 10 years ahead of schedule for age, and that I had like 40 year old hips with arthritis. And like I was I had limited joint joint space, and like early onset arthritis. However, if I don’t wait lift for if I take a week off or anything like my first session back hurts. And people can like you, you’ve probably seen it too. It’s like, I look stiff. I look like I’m probably in pain. And I am. But it’s like I know now, if I don’t just do it and get through it in a safe manner. Like, I’ll be better by the next session in the next session in the next session where if I yeah, just take a lot of time off. Like if I leave weightlifting for a prolonged period of time. It just hurts. So it’s like you’re you’re greasing the wheel with movement. And it forces me weightlifting as a whole has like forced me to do the mobility stuff because I’m motivated by the outcome of the goal. Like if I was just doing bodybuilding, like it’s like, you don’t need to stretch to bodybuilder you can be all balled up with muscle and not be able to move and be stiff. But that would just make me worse where weightlifting has really been a blessing to force me to do the things so that I can get the thing done that I want to do.

Unknown Speaker 17:24
What does that make you feel when somebody tells you Oh, you have the hips of a 4010 year old hips with arthritis? Like, is that even possible to know like what somebody’s hips look like when you’re 40 years old? Like it just seems like they put these images out there of what I say they may be like practitioners in some cases of like, they give you this grim visual of Oh, like you’re imagining like, Oh, my, my joints must be like, what is it crusty? And they’re like what’s happening? Like, and you as a physical therapist, you probably know better than the average person. But like, how is that helpful? Are What do you think they’re trying to do with sharing that kind of information with somebody?

Brett Scott 18:08
I kind of want to save this for like the second portion on pinning that on recovering people, and helping them get better. There’s something to be said for in the doctor. So I was very helpful, actually the orthopedic surgeon. But, you know, he just kind of told me like, hey, like you have, you know, I think it was 10 millimeters, like less joint space than like the typical 30 year olds hip. So you need to consider like, you know, what is it you’re getting out of the sport? And is this worth you pursuing? And if it isn’t, then fine, but just know, like, you know, you might get a hip replacement and you know, 10 years from now, which to me is fine.

Unknown Speaker 18:51
So he wasn’t saying that by you doing weightlifting that might actually make progress faster.

Brett Scott 18:56
Yes. Which I somewhat disagree with. But yeah, for a lot of people being told these things don’t normally help. And there’s nothing you can do about it. Yeah, yeah. So so there is there is some stuff we’ll go into there.

Unknown Speaker 19:13
But the Brett says, well, middle finger F that I’m gonna do this anyways. Yeah, and you know, ways to make it fit in your lifestyle.

Brett Scott 19:25
Yeah. And granted, it’s not I can’t program like some like I got like I would program some of my athletes or some of you guys, you know, so I do because if I do squat too much or anything like my hip does flare up, it will. So I also have FAI which is femoral acetabular impingement syndrome, we call it so basically, instead of a ball, a socket, I have an oval and a socket, so I don’t have as much hip rotation from probably from my early days. I started playing hockey when I was three and was on all kinds of teams. and stuff. So we see a lot of that and a lot of males, especially male hockey players. And so I have a bit less range anyways, so I’ll flare up but I think with the the Ankylosing Spondylitis on top of that, it does make it a little bit worse. Yeah. And so I I can deadlift more but if the squat less I’ll do more power variations, then I’ll go into like a full snatch, because it just will wear me down if I do too much, and I can’t recover.

Unknown Speaker 20:32
How much of your like mental energy time is spent on dealing with your your pain, whether it’s just pushing through it? Or thinking about it or planning about it? Do you spend a lot of time does that take up a lot of space in your life?

Brett Scott 20:47
Oh, that’s a really good question. Um, it’s definitely changed over time. You know, when I first when I first got diagnosed, it was really like, a kind of shattered me for a while it’d be like, you know, stretch, do yoga, stop lifting weights. nutrition isn’t going to help, like lifestyle factors aren’t going to help you, which we know do. Basically, no one said here, do this. And this will at least help. Like, I didn’t get that. But I was like, I love moving. I’m like, hyperactive all the time. And I just, I didn’t take that for an answer. But for you know, even now sometimes, too. You do worry, like, Am I making this worse? Is this gonna get worse? Like if I do this? If me squatting and I’m in pain, like, am I going to pay for this later? Am I Am I shredding my labrum is my joint, you know, changing on a daily basis, things like that. And so that’s very hard. And then there’s this, like, what does my future look like? Like that for me for a while, especially in the beginning, it’s like, this thing came on and progressed so fast, or like I went from like, squatting, dead lifting benching, like lifting six days a week without any issues, too. I can’t do bicep curls without searing SI joint pain. So that was, so yeah, that was really hard to be like, and the medication they put me on and they didn’t tell me the first time, the medication took three months to like, kick in and work. So I took it for like three weeks, I had horrible side effects for a while. And I was like, forget this, like, this is horrible. I went back and like, oh, no, that doctor that didn’t look at you forgot to educate you that this drug takes three months start working. I was like, oh, okay, well, let’s try it again. And luckily, after three months, it started to get better. And but even so, like, it’s slowly like, I still almost feel like I’m almost still getting better from it. 10 years later, but for a while, it’s like yeah, like, what am I? What am I going to look like a 30? What am I going to look like at 40? What am I going to be able to do with these ages? Is there anything I’m doing good or bad? Or, you know, how does everything affect you? And your long term health? And it’s like, do I try to do all these things to preserve myself eat this perfect, healthy lifestyle? I live? Live fast and hard and die young?

Unknown Speaker 23:22
You don’t you won’t know. You won’t know. You don’t know. Nobody can give you an answer. Like there’s no certainty. Wow, yeah.

Brett Scott 23:28
And so there’s still a lot to this, they don’t know. So and then coupled with put in the environment of physical therapy school, and physical therapy school is very behind the times to as far as understanding pain science or teaching it the way I think it should be taught, and just the narratives we use. So you go to school, so you go to physical therapy school, not you go to school to be calm, a good physical therapist, but PT school teaches you how to evaluate to cover your own ass, and teach you how to find everything that’s wrong. And so that’s still a big problem in all of, you know, modern medicine is we go to the doctor and a lot of people don’t like to go to the doctor because of the fear and anxiety they get when they they go in with one issue. And they come up with 50. So in PT school, where I’m still kind of recovering from this in a way. I’m not super mobile, I do have like hip joint pain, on and off again. You know, every day we go into lab and it’s like, oh, you’re trying to weight lift. Like you shouldn’t do that. Like you have this positive test and that positive test and this and like your hips don’t move right. And this doesn’t move right. And your best to like Ooh, yeah. And so there are

Unknown Speaker 24:54
a lot of like they’re judging you for doing that because you should know better or They just say you shouldn’t be doing that at all, like, just because of what’s going on.

Brett Scott 25:04
You know, I think it’s I don’t think it was like a judging me. But it’s like, some people are like, as a as a PT student, you don’t know. Because at this point, we haven’t explored pain science yet. We’re taught in schools till still teach in medical providers still still use the biomedical model of if we find this you have pain, which we now know like, that’s not true. So part of that was, yeah, it’s just like, as a student, we learned this and I was like, Okay, well, if if if x equals Z, you know, your y. And it’s like, yeah, we have these special tests, and we have you have all these positive findings. So therefore, like, you’re broken. And that’s what a lot of people still get in medicine is, you come in, yep, you have a positive MRI. That’s why you’re in pain. And it’s like, no, no, no, pain goes way deeper than that. But in school again, and every day, you’re coming in and told all these different things you have wrong with you. So we actually have a thing called PT student syndrome, where you think you have everything wrong with you, because it’s like, you know, you correlate a couple of the symptoms like my, my roommate, literally, at one point, thought he was having a heart attack. Like he went to the doctor, he went to the emergency room, they’re like, you have anxiety. It’s probably like pts. It’s PT, school anxiety. Yeah. But because you’re reading about it in the books, and then you’re like, Oh, that’s really bad. And like, all you know, it’s all the negatives of all the bad things that happen to these people. And then you’re told like, well, you have all these same things. It like really, probably mess with me mentally more than anything else. between that, and then it’s like, yeah, we’re active, healthy people trying to promote people to be better, but you’re gonna sit in the chair for 14 hours a day and study also doesn’t help.

Unknown Speaker 27:02
Yeah, already. Yeah, I already. Yeah. So you were in? Yeah. So you’re like this viral, virile young man, like working out data, you get this, like unknown symptoms coming on, you’re kind of fell through the cracks a little bit with your tests, and you had to kind of advocate for yourself to get this, so at least you got an answer on what’s going on. But then the responses will just be a pancake, don’t do anything. If you do, then maybe you’re gonna like, make this escalate quicker, and you know, cause you issues sooner than later. But we really don’t know. Here’s some medicine, but we don’t explain to you how it works. And so you’re just like, having to figure this all out? On your own? Yeah. Did you have any other kind of social support? That that people that you could relate to what was going on?

Brett Scott 27:54
Ah, no, you’re the only person that really kinda was like, backing me, was my physical therapist, actually. So she was my boss, but she was my PT, too. And she’s just like, she, she kind of saw it happening, because I had been working there at like, before, and through all this and was just like, something’s not right. And she was like, she even said, she’s like, I don’t buy that. Something’s not wrong with you. And like, we need to get you help. But other than that, like, even like, you know, cuz I didn’t stop going to the gym, like, I couldn’t do as much. But I tried to go and do something. And like, then it was like, even my parents, like, didn’t understand that. And that was really frustrating. Because it’s like, well, you know, why can’t you do this? Like, you’re going to the gym all the time. I was like, Yeah, I’m trying to be healthy. So that that was always tougher, like, you know, I didn’t want to stop participating. So like, I still played hockey, and I’d come come home and like, pay for it be limping around the next day, was like, Well, I can’t help your dad do the roof or whatever in this and that which, like, I get that, too. But yeah, it’s just like, there’s no one that has an understanding of like, or like, even like the people I worked out with, with the car, like, just like, you’re fine. It’s like, I’m not. So that’s definitely even even now. Like, when I work with my coach, it’s like, Hey, I can’t do this. You know, and I get it. Because sometimes I can do all these things fine. And I don’t look like I’m limited, but really, like, I still feel pain. I still feel stiffness. I know if I do more of this. It’s just it’s gonna snowball into something worse. So I need to stop. When I know I need to stop. So yeah, there’s definitely like, there’s not a lot of people that understand. Especially I think, in my case where I am someone that like there’s a lot of chronic pain, people that don’t do anything. Yeah. And then they’re a little more. That’s like, okay, like, yeah, this person has fibromyalgia, or chronic fatigue syndrome or chronic pain syndrome. And like, they might get a little more of a A soft love than the tough love I guess. Which isn’t always good either. So, but yeah, it’s your it’s rather a lonely process to go through especially like, you’re in a relationship or whatever. And like, you know, pain can affect your moves and what you’re doing and like you’re frustrated all the time. And people don’t understand it because they don’t feel it.

Unknown Speaker 30:22
Yeah, and you look fine. You look good. Yeah, you look great, right? I mean, really? It’s not like you have like, a arm in a sling or a cast on, it’s like this. Yeah. not visible to people. And then it’s like, Oh, am I just being weak about it? Or like a baby about things? Or is it you know, like, just yeah, I could see how that would be hard for you to gauge actually, where you should push or where you shouldn’t, and then also communicating to the people around you. Like what what’s great for you?

Brett Scott 30:58
Yep. What’s next?

Unknown Speaker 31:01
So what has worked for you like, you work you left you work out, you stay active, you know, warming up, but any, any other things that you found just, you know, if you wanted to give advice to somebody that is going through this, what would you tell them what would be helpful,

Brett Scott 31:17
um, the, by, from my own personal experience with out without my physical therapy background, so this is just, Brett not not Dr. Bs talking is for one, like, you always have to advocate for yourself. If you feel like something is wrong, like you need to speak up about it. And if you don’t feel listened to be louder, or find go find someone else that will listen to you. For one, always be active is my other piece of you know, so much in we see this all the time to have like, and we see it with different types of people and even different cultures. And you know, we’re, as a society, we’re living longer, but we’re not living any better, like our rates of disability just keep continuing to go up and up and up. And if we just look at, you know, just just basic management of your health of if we work out every day, like we have a huge decrease of the risk of further other possible diseases, metabolic disease and metabolic conditions like, you know, diabetes, cardiovascular disease, hypertension, all these things go down when we exercise where when we don’t exercise, we see an increased risk of all of them, and increased severity as well. So find whatever you can do, especially something you enjoy, and try to do that as best you can. Don’t fall for the the passive superficial fixes. So we see this all the time of it. And you see this a lot with like people that want to lose weight to but don’t want to live an active lifestyle, or just don’t appreciate an active lifestyle of like, there’s always the next big thing, the next fad diet or whatever, you see this with chronic pain to have. I’m gonna go to the pain clinic and they’re gonna prescribe me pills. I’m gonna go and this guy’s gonna give me a cortisone injection. And that’s going to, you know, bandaid me for a while. And then I’m going to try you know, this supplement, and then I’m gonna do this, this other thing where it’s like, what if we change your diet, we eliminate all the crap out of it. And we start working out. I don’t care how you work, I’ll just do something to move your body on a daily basis. Those are the two big things were like we see it culturally too. So we see people doing all these diets or aches and pains, even. Not chronic pain, but just chronic pain of one joint say it’s like, oh, well, the doctor Yeah, Misha, I don’t need to go to physical therapy. You probably should. Or you know, you didn’t get pain just because you you know, because you didn’t get a cortisone shot, something precipitated the pain coming on. And, and then we look at people that just kind of lay down to some of these things. And you see it with like, older individuals, especially in certain cultures and populations was like, no, like, Mom doesn’t do anything like, like Italian, Spanish. Some other I think Indians are quite like that to where it’s like, you know, as the the younger side of the family takes care of the older generations. And it’s like, we have the biggest trouble getting those people better because they just it’s like learned tissues in like, learned helplessness. It’s like someone else will do this for me. But like, really, if like you want to get out of pain or manage your pain better, you really need to take this on and do it for yourself. And that includes you actively participating in the process not looking for something passively.

Unknown Speaker 35:13
So yeah, like the app, being active, finding something to keep you active to give you that sounds like almost like a reason to get up and get out there and live your life, regardless of what’s going on.

Brett Scott 35:28
And so like, for me, that’s weightlifting, right. And that’s been the biggest thing, because it’s gonna try to flex me over, I’m trying to stay upright. And it’s really done that for me, and like, if I didn’t, if if I made a day where I don’t care about weightlifting anymore, I would stop trying. And I’m not gonna do that, because I, I’ve just become so passionate about the sport and doing it. Not having to do it. Well. I just I love the process of it. I love the challenge of it. So for me, it’s been that, that like, that’s what keeps me doing all the mobility and stuff I should be doing anyways, to not get stiff that I need to keep going with where I think everyone needs some type of way, whether it be you know, kids, grandkids, anything like that they have to have a why but behind why they exercise.

Unknown Speaker 36:18
Yeah, I mean that even just anybody even that doesn’t have chronic pain. I think you need to keep that yeah, in front of you. But then, because you were we talked a little bit about oh, pain, you know, the the model is really biomechanical or that might be still taught. And I think for you, that’s probably accurate. Like there’s physiological things happening in your body that’s causing you pain. But have you seen what’s your experience also with like, the other components of social the emotional mental pieces of pain? Do you see your pain go up or down depending on like your stress levels are or how you’re feeling? And also, are there ways that you can maybe I don’t want to say control but affect your pain levels? Outside of just physiological processes? Does that?

Brett Scott 37:15
Is this Dr. Brett now?

Unknown Speaker 37:18
No, this is back to regular Brett. Just I want to know about you personally.

Brett Scott 37:22
Okay, so for me personally, I seem to have certainly good days and bad days. Sometimes I don’t always know why. Sometimes I feel like I could eat good sleep good train really well have had like a D load week. And then I’ll go to work out on Saturday, which is like, you know, game day for us. And I could still feel like trash. Other times, I’ll have a really hard training week. Feel like trash all week? Go into Monday think it’s gonna be garbage? And then I feel great. Not always reason why don’t know. I definitely notice, you know, I found over time being a business owner and entrepreneur that you can’t out train stress. So the more things we put on ourselves, that’s one thing that definitely gets in the way of performance sometimes. And so like your with all I’ve done in the past year, like train has kind of taken a backseat, and I’m okay with that. That’s been my, I’ve realized, like my expectation to have a big day when like, I have 12,000 things going on in my office. And, you know, we’re putting out fires left and right, like, yeah, it’s not going to be the best time to try to be a Olympic gold medalist weightlifter, right, so. So for me, it’s just been it’s a mixed bag. And you know, there are different things like stressors will get in the way of different things. But for me, now, I’ve I’ve come to have such a have, from a clinical perspective, a fairly good understanding of pain, we still as researchers, and scientists, there’s still a whole lot we don’t know. But I understand enough of the basic concepts where pain doesn’t affect me as much anymore. So from my own personal standpoint, I can’t say that I was asked if this is the Dr. Brett, my my own learnings of pain. And this is what I do with patients too, is teach them about pain and how it affects us and what affects pain, that really can change your understanding of it, how you manage it, and what your long term outcomes gonna be like.

Unknown Speaker 39:38
Yeah, I think that’s a great transition then if you want to go put on the Dr. Brett hat, because I saw you put in the notes like the the locus of the control internal versus external. Did you want to touch on that in terms of how that how that affects, like how you would talk to somebody or what you would recommend.

Brett Scott 39:59
Yeah, So, going off of what I said, to transition to the next piece, so this is Dr. Bs now is one of the big things

Unknown Speaker 40:08
to be asked though this is good, I like that. Okay, yeah,

Brett Scott 40:12
that’s my MO. So what we see is, there’s basically two different types of people. And I read this in our kind of notes there two of, there’s people that will just take whatever is told to them and go with it, believe it as you know, full blown truth. And then there are other people that are like, No, this is not the option, this is not what I’m doing, I’m gonna be driven in the complete other direction of what I want. And so what I’ve seen as a clinician, and what I’ve seen with myself, too, is, is we have, and what we have to understand is we have to locus of control, right? So we have internal and external locus of control. An internal locus of control is one where it’s, you are the controller of your environment, and you are the one that’s responsible for the consequences of your behavior and the choices you have. external locus of control is when the consequences of your behaviors are outside of your control. Right? So what do we what different personality sets do we see there, we kind of see like a growth, a growth mindset with an internal versus a closed or fixed mindset, with the external. So we’ll see with an internal locus of control, someone that has a better set on that, as we’ll see people have better academic performance, they’ll have better interpersonal relationships, they’ll give greater efforts to learning be more open and to learning, they’re more likely to be humbled by like the learning experience, and being open to that. And they have lower rates of disease to where people that fall more towards this, and it’s a spectrum, right. So people that are more towards the external. It’s these conditions are designed as they are, it’s like, I can’t go to the gym because I have bad knees. Right? They have lower efforts to deal with their own health. I can’t go to the gym, because I have high blood pressure. I can’t do this, because I have this, there’s a lot of I can’t, I can’t, or I was told, I have bad knees. So I shouldn’t do this. And all it takes is tell him once sometimes, and they’re kind of, and it’s really hard to get some of these people back. And they really don’t have much of a level of dynamic variation of like, their mindset is their mindset, you can’t change it, there’s not much adjustment to be had there. So it’s this is the way it is, this is how he made the this is the kind of lay down on the ground. And this is just how my life is gonna be and let’s just be depressed about it. So we need to think about those things. And we see with this, and this is bringing the pain zones to is people that have that more of an internal locus of control, just in general in life, will have better success with managing chronic pain. Because they’re taking an active role in it, they’re not accepting No, for an answer, it’s like there’s got to be a better way, there’s got to be something, they’re always going to try something, they’re going to be open to different ideas. There’ll be open to different providers. Whether one provider is right or wrong, being open to it and finding the best one for you is the best versus I want to this person, they told me this, and I’m just gonna accept this and go home and take these pills forever and set my lazy boy. So there’s a lot there. And so that goes into what we do know about the biopsychosocial model. So as we stated like it as medical providers were traditionally trained, you know, whether it be physical therapists, chiropractors, surgeons, er, Doc’s primary care physicians, we practice the biomedical model of pain where you have a broken bone, a severed nerve.

You know, tendinitis, tendinitis, a torn labrum, you have to have pain. That’s why you have pain. We now know. So I got into pain science when I was when I started grad school, or I was halfway through grad school. And this is all my outside of time. Like I was just listening to podcasts and stuff all the time and reading and following some really interesting people in the field. And I was like, oh, there’s, there’s a lot more to this then, you know, and it was like some interesting facts started coming up where like, in the past 1015 years or so we started doing MRIs of people that didn’t have pain because before it was like, I have pain. I go to the doctor, I get an MRI. Yeah. So I got paid when someone said, oh, let’s start interviewing people that don’t have pain, go 50% of the people that have like disc herniations in their spine, don’t have any pain. Oh, 40% of people between the ages of 20 and 40 have debt, degenerative changes in their hip, and soft tissue injuries around the hip to with no pain. And 96% of 20 year olds have abnormal findings on MRI without any issues are like, well, 96% of are abnormal, what actually is normal? Right? Yeah, right. And then we have people like fibromyalgia, chronic pain syndrome, chronic fatigue syndrome, all these different things where you scan the body, head to toe, and there’s no sense of pain. And then then when you start doing all this pain studies, and we see that, oh, looks like there’s no, no center of the brain that is responsible fully for pain. The only thing we see, when we stimulate or give someone a noxious or painful stimulus to the, to the body, the only thing that lights up in the brain is the emotional center, all across the board. So pain, we know is related to emotion. And and then we started looking at the studies of perception. And those are really interesting, too. So now we start looking at and I’ll give some examples. So one I just read about, and in, listened to a talk on was this guy was working, and he stepped on a nail and the nail went all the way through his boot out the top. And he was in so much pain that the medics arrived, and he was like on the verge of passing out anyways, from the pain and like, like hyperventilating, everything, they had to sedate him, they gave him morphine, and then some other sedative to basically put them up there, get them to the hospital, the go to take the boot off, the nail had not even hit his foot, the nail went right between his toes. But his perception was so bad. Even though nothing physical had happened, his perception was so bad that he had passed out. They’ve also done some pretty cool studies with that involved with laser pointers. And they said this was like a study where they needed to put these lasers in these areas of the body where you know, they were safe. So they’re going to scan the body first. So then they have this dubious practitioner Come on, and scan the Biden’s uh, uh, you know, things starts beeping or whatever it’s like, yeah, we don’t know. And it’s like, but it’ll be fine. Right, so they do the scan. And they also had a revelation of blue laser. Now, they didn’t tell people anything about these lasers. But people had a perception of a cognitive association. So they scan the safe areas. And then they got to the part where the person suspected and didn’t trust the clinician enough, because that scanner had gone off. So when they go with the laser, these people felt a significant increase in pain. And the sensation was either hot or cold based on the red or the red or blue. But they were like gas station like laser pointers that had no, they had no thermal effect to them. Yeah, but their perception drove them into pain. They’ve done the same thing with like a hot plate on someone’s back, and they have someone else turn it up. And it’s not plugged in. There’s no hot plate, there’s no temperature, but you can perceive there to be one. Um, it even goes deeper than that. So then they said, okay, like this is all kind of conscious reaction type stuff. Let’s go subconscious. Right. So there was actually a study they did, where we took two groups of people and so we had a group on an actual drug and a group on a placebo. What they did is they just changed the side effects or, or changed the expectation of the side effects. So they told the group on the drug that I think had mild to moderate side effects of nausea, vomiting, diarrhea, and they said, mild to moderate side effects for you. For the group on the placebo. They said, you’re actually this drug is really good, but you’re gonna have moderate severe side effects of nausea, vomiting, diarrhea. Now, these are things we always thought were outside of our control. Turns out they’re not. So the control group that was on a sugar pill actually ended up with more severe side effects. Because they were told that they were going to have more severe side effects of things we didn’t think we could control which really throws a lot of things out there. And then they’ve even done some things with like performance and racing and just positive and negative outcomes of put people on a spin bike, and you put a smiley face on the screen in front of them versus a negative face, this group with a smiling face performed 10%. Better. So what we really see now is our communication with patients is so crucial to sending the right message to them. And letting them know what’s what’s possibly going on with them, but doing it in a in a beneficial and empowering manner versus XYZ. So yes, so. So the big thing we need to think about is we practicing the biopsychosocial model. So what we know now is just because you have an injury doesn’t mean you have pain, right. And so a couple other things to think about with this is as soon as you break a bone, but once you recast it, and you put it in a cast, the bone still broken, but it doesn’t usually hurt anymore. You could also you know, I do it all the time, like I work in a gym, smash your leg on a bar, you don’t, but you just like keep walking, you know, you go about your day. And then two days later, you look down at your quad and you’re like, oh my god, like, how did I get this bruise? I don’t even know. But then all of a sudden, it starts to hurt. Yeah, then you notice it, right? You know, and then we could get a headache. But no one ever thinks like, they have a headache. So their heads broken, it’s just you take some ibuprofen, and it goes away. But then, you know, we could have all kinds of other things. But then like, so broken bones don’t hurt, but like you get a little paper cut. And then you put some hand sanitizer on it. And then you’re really in pain. And so we know pain isn’t linear, it’s not correlated all the time. And that injury doesn’t always mean pain. Right? And so an injury is just some physiologic trauma. So you get hit, you break a bone, you sever a nerve, you have a wound, something like that it’s physical pain is just the experience the sensory emotional experience of pain, when our stress exceeds our ability to cope with that stress, typically. So we have this biopsychosocial model of, well, we have that bio part, right. So the biology is, yes, there’s trauma to the area, we have tearing up a tendon, we have these things. So those are contributing factors. And sometimes they can play a role. Right? But then we also have to look at, well, what from a psychosocial standpoint is, what are we telling this person? What have they been told? Do they have anxiety? What are their coping mechanisms? What are their own beliefs about this? Do they think they can get through this? And then looking at what is their environment look like? So What activities did they participate in? Do they want to? Are they trying to? Do they have a supportive network at home? You know, what things? Are they trying to do that maybe they can or can’t know? What is there? Unfortunately, soakage socioeconomic status, all these things play into how someone will manage pain. And so it’s pain is multifactorial now, and so much of what we get changes based on the expectations based on what we’re given. So, what we want. So this comes to basically, life is basically like a cup. And I tell patients this all the time is my analogy is a cup. So we have pain. And so we have these kind of this bio, Psycho and social aspects, right? In your life is the cup, and it’s like, well, what is happening? Is the cup overflowing? Is the cup leaking?

What are the ingredients that we’re putting into it? Right? And so from this broad perspective, like what can we change? And so like, right now I have a girl who I’m working with, are basically basically doing like health and wellness coaching instead of physical therapy. And it’s not what she expected. She came in, she’s had six knee surgeries. She’s had part of her temporal lobe and her hippocampus removed. So she has issues with like spatial learning, and some cognition and memory stuff. And she came in she’s like, I don’t know if this matters, but I’ve had these two procedures. It’s like, okay, yeah, those are important. But more importantly than that, she tore her ACL playing Hockey and doing all these things, but she’s had six knee surgeries, but then she had, I guess the surgeons like a family friend to the surgeon told her I regret the way I did my surgery. I don’t want to touch her knee anymore. Then she went to another surgeon who told her yeah, this knee is like messed up. I don’t want to touch this knee either. Wow. Yeah, she went to a physical therapist that basically told her like, suck it up. This is what you’re gonna have to deal with. And threw a few other pieces there too. Now, she came to me with this understanding that basically her knee was fucked, but she wanted to see if there was anything else she could do to potentially get better. She had to give up hockey she gave up a college hockey scholarship. She snowboards but it gets in the way all the time. There’s some so many other different pieces. But really, she had no understanding of why she had pain. What made it worse, what could make it better, anything like that. So I gave her like strength and conditioning things. Now. Now when she comes in the office, I tell her I’m like you ready for some life coaching today. Because what we’ve done since then, is we started with, well, what’s going in and out of a cup. So what we found out was she has a horrible work schedule and sleep schedule. So she typically, and her pain was waking her up every night to or so she thought her pain was waking her up. What we found out is she was drinking four black coffees by noon time to energy drinks by three o’clock and then pre workout in the afternoon. So our her nervous system is like all jacked up. So let’s remove those triggers. So we’ve cut that down by half. She also uses nicotine, that’s another thing that can jack up the nervous system and our heart rate and everything else. So we’re slowly trying to wean her off that we also looked at what is your workouts or your activity look like. So she had no set schedule to her snowboard. So we had her start. So she has like a fitness track. So we had to start tracking her mileage of when you get to a certain level of pain, we need to kind of call it a day there. Or we need to just if you know that like at the three hour mark, you get into more pain, then we need to cut it at three hours and come back the next day. We’ve worked on that we’ve worked on sleep hygiene of she would keep the TV on all night in the windows open. And so and then like blu ray blocking glasses and all these different things that we’ve worked on. And then just her mindset about pain, and that it’s okay to feel pain. But she really needed to get stronger, she didn’t have enough strength in her leg either. So biologically, we’re working on getting it stronger. However, so much of it has to do with and then oh, and then there was a surgeon that wanted to immediately realign her knee while she has no leg strength. So even if we immediately realign a knee, it doesn’t matter because she has no lateral strengthen her leg. She does like two sets of five and she’s smoked and her legs are shaking like she’s never walked before. And it’s like, well, this is why we need PT. But without doing all these other things for teaching her to understand her pain, and what can trigger it. There would have been no getting her better. And so she’s luckily doing much better now. But it came down to removing all the bad ingredients making the bigger and how do we make the cup bigger? Well, we train we’re going to find all the things you can do well enough that don’t hurt you. We’re going to build those up. Right make you stronger. Let the things get rid of some of the things that hurt but that calm down, calm shut down and build the backup.

Unknown Speaker 59:03
Yeah, yeah, I think that’s that’s a really nice use case about it’s not just like you said, Oh, this is your this is broken. Here’s why we’ll fix it really have to look at the whole picture to understand what’s going on. And these different layers maybe one of those wouldn’t made a difference but adding on the sleep the nicotine, the strength like those all together start to help but without looking at the big picture. You might be fighting a battle that you’re just never even gonna You don’t even have a chance at. Yes, you’re just replacing a knee and that’s it and you’re stuck.

Brett Scott 59:41
Yeah. It’s it’s funny because we had a conversation the other day where she was in like a chronic seven out of 10 pain every day. And now she’s at the point where she’s only having pain really two days a week. But she says it’s worse on those days. I was like well it’s kind of like dealing With chronic pain sometimes if we can get better, is really like. It’s like you start working in a new office. And there’s like this clanging that just happens in the background. And all the other employees are used to it by now. Right? But it’s like you’re it’s your first day here. And all you hear is this. You haven’t, you haven’t gotten used to it yet. Right? No one else thinks anything. But it drives you crazy. And then eventually you get used to it. But that’s what happens with chronic pain too, is like, we start making these decisions based on our pain. And they don’t, we don’t see them affect us as much. Now she’s now that she’s made better decisions of let’s stop at a certain time. Let’s remove some of these things. Let’s eat a little bit better. That was another one she like wasn’t eating nearly enough calories for her. So her body was just in distress. But we make now that she’s making better decisions. And she’s seeing the positive results of that, because she’s put herself in control of it. Now she’s taken ownership of it. Of like, yeah, you know, she’s like, Yeah, I’m a shithead. And like, I gotta stop being one. But now that she’s done that she’s like, the pain zone was worse on the other days. I’m like, well, it’s like you that noise went away. Right. And so now that it’s back, it sounds louder than ever. But we’ll just kind of get used to that again. Yeah. And, and it’s like now now it sounds like they’re sorry. I think now. Now, it sounds like they’re slamming the door down. But it’s really just not the

Unknown Speaker 1:01:28
same. Yeah, yeah. So um, what do you because I feel like my personal experience was, which is not like I wouldn’t say insane by any means. But I think it’s a nice window into that, because I do have a lot of pain science background, and they understand it. And I, when I first met you, I had this knee pain, right? I told you about and it was like, perfect. I could barely even squat like it was terrible, and had been going on for nine months. And

Brett Scott 1:01:58
I hit and I had to do box squats. I could

Unknown Speaker 1:02:00
barely do anything. But I realized that I might have done something to it. But that was right when COVID happened. I moved across the country to California to live in my sister in law’s house. I was super stressed at work, I wasn’t sleeping. I was like all of these I stopped working out I lost my social. All of this had come together. And I was I got to a point where I paid like a lot of money out of pocket because I was quite sure my knee was like, dangling off like it was about to explode. And I got an MRI. And he’s like, No, looks fine. And he and I went to the sports doctor and he couldn’t use like, it’s fine. And I’m like I can’t like it’s like, it’s like a night that was so bad. And then I’ve moved back here and like found, you know, your gym, I found a social network, I made changes in my work. I made a lot of changes. And it just Scott gone. Totally gone. Fine. And I didn’t do anything like that. Was it? Yeah. Yeah. Maybe some single leg, whatever those things are, I did a

Brett Scott 1:03:09
few squats really, really good. Yeah. But yeah, I mean, there’s so many things that come into this. And, you know, there’s, there’s so much to dealing with the chronic side of it, too. And like that, you know, maybe with some acute factors. And again, it’s like looking at the cup of what stresses were in there, like, were we sleeping were we eating where we weren’t where we eating? How stressed are we because what we can think about too, is, again, pain is a sensory experience, based on our tolerance or our ability to cope with the stress that we perceive. Right. And so part of what I educate my patients on too is we have this thing we call an action potential thresholds. So what an action potential threshold is, is it’s just a neuro transmission of acetylcholine. That signals for something to happen. So if I, you know, scratch myself here, I can feel that because I get a sense of it up that goes to my brain because I have time to focus on it right now. Maybe if I was out in the woods, and I was running from a bear, I’m not gonna feel this or worry about that right now. Which is why we can bump ourselves and not feel it, right. However if if I do this all day, right, and I just keep scratching like this doesn’t hurt right now. I feel it. But if I keep doing this all day, eventually the skin is gonna get red and raw, and eventually I’ll probably break through and I’ll either create, you know, a blister a callus a wound or cut open through skin. I don’t know. A rash. So many options. No I’ll feel that because the some of the stimulus is over time build up to be enough to cross through threshold to create a sensation of pain got. So we have inputs, whether they be threatening or non threatening their inputs, right, our body can perceive certain ones to be threatening to some to not be. That depends on our past to, however, so we have all these things that go back and forth, and then the some of them will shoot them over this line. Now, that line will move so stress, you know, work stress, lack of sleep, poor nutrition, mental emotional stress, relationships, whatever, can vary this line, right? So if all these things are negative, that brings our ability to to deal with that stress down. So pain will be perceived to be worse. Not that anything physically is wrong, it’s just that it might be worse. Same reason why someone with, you know, knee arthritis, they, they may feel fine in the morning, they may feel worse at night, because it’s all they focus on. Because they have other things going on during the day to keep them distracted from it. There could be biologic factors to have the way they position themselves, and I could be part of it that’s making it worse, but also like the anxiety of perseverating on it doesn’t usually help anyone, either. So these are all just things that they’re just there’s all these different fluctuations in in that and even inflammation itself doesn’t cause pain. Inflammation, however, increases our sensitivity to pain. So there’s some a lot of nuances to all that stuff, too. And then thinking of of pain, and what we’ve done in our previous experiences, too. There’s a good story. There’s a TED Talk by this researcher, Laura Moore Mosley on YouTube, it’s like 15 minutes and you can look up.

Unknown Speaker 1:07:07
I’ve met Larimer. I’m a fan. Oh, yeah.

Brett Scott 1:07:11
I don’t know that. That’s so you know, his his Australian Whitesnake story or brown stick whatever it was. Yeah. But that’s a great example of like he talks about. And for those of you that don’t know the story, he talks about, like running in the woods as a kid, and you could run all through the woods with his, with your brothers or whatever. And you could come out with cuts on it. Like you don’t know why, because you you weren’t focused on it. And all these signals didn’t, weren’t important enough for your brain to perceive as important. So they just never got there. Were one time he almost died because he was bit by a rattlesnake. I think it was a rattlesnake. And then he was talking about years later walking through the woods with his wife and, you know, get scratched. And in last time, this happened to him when he felt something like that he almost died. So he has all this pain because he, you know, just doesn’t, doesn’t, you know, his brain goes, well, last time you were here, we’re gonna put you in a significant amount of pain when it could just merely be a scratch. Right? So

Unknown Speaker 1:08:15
your brain is trying to protect you and, you know, keep you from danger. And that was a dangerous and sip signal. But he could have like the swelling and like even like the physical reaction. I mean, it’s it’s, it’s crazy. How, how much happens in this little noggin of ours, that you don’t even realize how much it controls what’s going on in the rest of your body? Yeah, yep. It’s almost. Yeah,

Brett Scott 1:08:42
that is Yeah, our brain is very good at capturing moments in memories of things subconsciously, and giving them to us. Yeah. And repeatedly, and that can go for movement too. So you know that that’s like a traumatic experience that he really had. But even you know, a lot of times like people have pain from deadlifting or they get hurt doing deadlifts. Are they subject to increased pain when they go back to deadlifting? Absolutely. And we have to desensitize them to deadlifting and teach them again that like deadlifting isn’t why they got hurt. Right. deadlifting was the increased physical stress that broke the camel’s back. Unless Unless we ended up you know, physically it was so it was a max out wrap and they broke a bone or something like that. But other than that, they you know, it’s just that was the, the increased stress that there was too much for them to cope with physically, mentally, emotionally, their body started to feel pain. When we get into herniations, that thing that’s that’s an injury that that’s something we need to medically manage. But if it was just you know, you have low back pain from deadlifting. Typically, it’s going to be, you know, they could be doing great with rehab, we go back to deadlifting. If we do too much too soon, even though they could handle it now, their perception is this is where I got hurt. This is what happened. It’s like no, no, all these other factors your, your environment. And so this is where some people were like too much on pain science of just just keep working out, like just load it and then push through, push through it like buy in, there’s like almost like biology doesn’t matter anymore. It’s like, no, it does, like if we have flexion sensitive low back pain. So, you know, if, if we don’t have a hamstring that can move well, and you don’t know how to move your leg Well, or flex your leg and get into a deadlift position. Well, if you don’t have good core endurance, right, we can end up with some of these things. So you sitting in a flexed posture all day, and we flex two to 3000 times a day. And then you’re deadlifting and we don’t have the technique for the level of stress. Will all these things culminate into, that’s all flexion based and now we threw more flexion at you. So yes, you got hurt. But it’s like if we fix the chair, in the environment, in the beliefs and everything, sometimes that in itself is enough to heal someone. And they can gradually go back to deadlift, and we just need to start with low exposure.

Unknown Speaker 1:11:15
Yeah, yeah. No, that’s this is great. I think, um, cuz I know, it’s been a long time. We’ve been talking. I appreciate your time, by the way. Um, one quick one question like that. I personally have, like people that, like, let’s say, I sprained my ankle, right. And it hurts acute injury. Is there anything that you there’s we actually have two questions? I’m sorry. One, is

Brett Scott 1:11:40
there anything like 20? more minutes? All right, we can keep

Unknown Speaker 1:11:43
going. So one, is there anything that you can do to help somebody from kind of going into that chronic pain? Like from transitioning, like, whether it’s education upfront, like, have you been able to kind of put that in action or have any strategies around? That?

Brett Scott 1:12:02
was your second question,

Unknown Speaker 1:12:03
my second question, same scenario, but like, because I see it all the time, especially you’re in sports, too, like, oh, I, I sprained my ankle like 20 years ago, and then every season they go back, and oh, another ankle hurts or whatever, I have this injury. Is it really an injury? Or is it just like a like that, that you’re just not sent? You’re not desensitized, or you’re sensitized to that, that movement or whatever is causing you to feel pain, even though you might not actually have an injury?

Brett Scott 1:12:35
Yeah, so so both are good questions. So for part one, how do you get or prevent an acute injury from become a chronic one, I think the biggest thing is load management. So do what you can. So one of our golden rules, especially with with chronic pain, it varies a little bit with chronic pain. But generally speaking, if someone has like low grade pain of you know, a joint or somebody they’ve been dealing with for a long time, the golden rule is basically we can work out in a zero to four and be fine, we’re not doing damage. So realistically, like if, if you sprained your ankle at soccer, right, those things take forever to heal. But you can be functional still. Right? And we see this too, in the literature is with disc herniations, ankle sprains, tendinopathies all kinds of different injuries is you can have pain. Or you can have you can injure something and have pain too. Right? So injury and pain, right? They’re different. So you can have them both. And we can see that the injury gets better and heals. But the pain still there. Right? We see that a lot with ankle sprains actually is people actually, the ankle heals faster than we think it does. And they’re still left with pain, because it’s like, well, we’ve been weight bearing on it for months now. And it’s just like, the bet but the brand says every time we walk for the past three months, we’ve had pain. So keep keep, keep picking it up, right? Yeah. Where you can also have the other side where the injury is still there, or we have imaging that shows like The injury didn’t change or didn’t really get much better. And their pain is gone. So they’ve learned to habituate and desensitize to whatever stimulus there may be. And so, one of the big things is, we want to let things calm down for a little bit, right? But then we want to start reintroducing loads and we want to low tolerance. So we want to work out zero to four pain we want to be the golden rule is really basically if you read a zero to two, you can keep doing what you’re doing. So Like with weight training, we’re in a certain zone and like maybe we start with one, it goes through a two, right? That’s okay, we can keep going. When it gets to a three, we might want to slow down, we can keep, we can keep continue the activity. But we might want to do less reps do maybe some less sets, maybe do a little bit less weight, reduce the volume. If we get to a four, we typically want to stop, like that’s the end of our session for today. Let’s, let’s go home call today. And let’s start fresh tomorrow. The other thing too, we need to consider is if we go into a session, and we have a two out of two out of 10 pain, right, we can work up to that four out of 10 pain. But I want to see that your pain goes back to its baseline of two, within 24 hours. If it’s a two, it goes to a four and it stays at a four for 24 or more hours, we did too much we need to back off, that’s too much. Because it’s just there’s there’s stress recovery and adaptation. So we need to just respect that what we call the SRA curve, to be able to continue to make positive process progress, right instead of like, like, if you’re managing a soccer team, everyone’s got ankle sprains. We can’t have the team doing this all year, we knew at least Yeah, bumps and bruises are gonna happen. But we can still kind of be on a steady incline. And that really comes down to loading it appropriately in this level where our pain just doesn’t go up over that, that baseline of you know, maybe a two out of four. Because the other thing too is like, if we don’t keep loading things we’ll get into like, learned non disuse. And then we’ll see atrophy and other issues come with like not loading an extremity or something. And we see that with like stroke patients, too, that just can’t. So we don’t want to see that. Because then, and then it’s just like we get into fear of when it behaviors where it’s like, almost if we get back to our activities as soon as we can sometimes depending on the situation. It’s like, okay, we can still do this. Or it’s like, oh, it’s been six months. I don’t know, people were very hesitant in avoiding of certain things. Yeah, yeah. But we still need to respect biology to like if you tore an ACL and we have a repair, we have staples, those need to heal. And there’s even evidence now, the better predictor of and I’m not a super, super up to date on exactly what the literature states, but I’m pretty sure if you’ve torn an ACL, you’ve had it repaired. your likelihood of re injury is greater based on your psychological readiness profile. versus the actual state of healing in the joint. Because so much of the ACL too, is like reaction time. Yeah. It’s, you know, pivoting, running, decelerating, accelerating. Part of that comes down to can the does the brain know how to do that again? Yeah. And if you don’t feel ready for it consciously or subconsciously, we can see like, I’m pretty sure they’ll see increased shear force through the joint, which could cause another tear. Wow. So it might not have to do with the tear, but just some type of re injury, or increased pain or just decreased performance?

Unknown Speaker 1:18:35
Yeah, well, yeah, like tripping. Yeah. Yeah, you gotta go check your references. But

Brett Scott 1:18:39
I have an I’ll have I have a guests that will have on for this.

Unknown Speaker 1:18:43
Oh, perfect. We can get the real story. I guess behind that. Yeah. It makes sense. Like, if you’re uncertain, or it still seems dangerous, makes sense. Yep. Well, thanks. I don’t have anything else. I mean, this is great. I could talk all day about this stuff. But um, I think this helps at least me understand kind of that journey from a personal level. So for thank you for sharing. Thank you for sharing that. And also, just like kind of what’s out there and what people are dealing with. It’s, it’s a lot, and that’s where that’s what I feel like. What I’m trying to do, I’m not trying to be a physical therapist or anything like that, of that, but I think it’s working together in terms of finding a healthier way to live reducing stress, nutrition, it just goes hand in hand. I mean, anybody can benefit from it, but even people that are dealing with pain seems like there’s a lot of opportunity there.

Brett Scott 1:19:41
I would say to the last thing for anyone that is listening to this that isn’t in in chronic pain is Trump’s excuse me, trying to find the positives and things and find providers that are also you know, they might be, there might be some practical skepticism but also positive in supporting you and your goals and whatever you want to do, understanding you. And that’s really like what we try to practice here too is like all of my sessions, I start with, like, I make it a point when I go into an evaluation, because we’re trying to find what’s wrong, and we’re provoking pain and doing these things. But before I started with anything, my mentor taught me like, the two big things I got from my mentor, were, never say no. So notice has a bad connotation to it. It’s been really, it was a really hard thing to break for a while. But it’s like if someone does something wrong with like, completely put them in the wrong state of mind. So how we communicate is huge in those realms, but never say no, and always start with a positive approach. So regardless of my findings, I’m always going to start with finding something this person does well, because we’ll use that to their strength and rehab, too. It’s like, yeah, you know, you have a disc herniation. And your right hip doesn’t really move well right now. But before I’ll even discuss that, it’s like, hey, you know, we we did this, that the other ends, like we found, like you have great flexibility through your thoracic spine, like you have a great toe touch. Your left hip moves really well. I wish I had some of that. But you know, our right one is, you know, we need some improvement on it, and we can get there. So finding someone that can do that, and help you in those ways versus tell you like, just give up. There’s a better way out there.

Unknown Speaker 1:21:28
Oh, gosh. Wow. Yeah. Well, we’re lucky to have you here and doing what you do. And I’m I’m excited. I know you’re gonna. You’re gonna kill it. You got big plans. I’m excited to see what you do.

Brett Scott 1:21:39
Yeah, well, thanks for coming on. This is pretty cool. This is the first time I’ve really been able to talk about my experience with pain. myself too, so feels kind of good. Yeah. So yeah, for everyone else. Janelle, where should everyone find you? And if they’re looking for any type of coaching from you, where can they find you? Yeah, the name of your business.

Unknown Speaker 1:22:03
It’s called sensibility sensibly well, so it sounds to me well that work is my website and then I’m sensibly underscore well and Instagram

Brett Scott 1:22:14
and she also well you don’t really to post any are lifting these this? She’s also a kick ass weightlifter. What’s your or there’s that private?

Unknown Speaker 1:22:23
No, I don’t put that on my business. But maybe you can more than welcome to follow me on authentic Janelle. Where I would post my my my stuff but yeah, I love lifting I’m with you. I’m I’m a fan for life. So

Brett Scott 1:22:39
yeah, we’re going to the Pan American Championships where maybe Janelle will take home

Unknown Speaker 1:22:44
a title I plan to I plan to so cool. Well, we’ll see you tomorrow, I suppose. At the gym. Thanks for that. Yeah,

Brett Scott 1:22:53
no problem. Take care of 

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