Episode 3 – Who are we and why do a podcast? Empowered Beyond Pain podcast


Professor Peter O’Sullivan, Dr JP Caneiro and Kevin Wernli introduce themselves, why they’re doing a podcast, and share conflicts of interest.

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Episode Show Notes:

17 year time-lag between research and clinical practice:



Ten scientific facts about low back pain:

Video’s of the facts presented by patients available here: 



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“To think that someone’s going down the road and getting care that’s 17 years out of date, that’s a scary thing for me and that’s one of the biggest drivers for creating a podcast thats free, people can easily access, it’s not behind a paywall, it’s not technical medical jargon and it helps to empower people” 


Welcome back to the Empowered Beyond pain podcast, proudly brought to you by Body Logic Physiotherapy. While we normally aim to make sense of science and bring evidence to your eardrums, this week’s episode will help you make sense of who we are and why we’re running a podcast. I sit down with professor Peter O’Sullivan and Dr JP Caneiro and we share personal experiences of pain, explain why we encourage you to ask: “is there more to pain than damage”, and we explicitly share our conflicts of interest. Pete and JP are two of the most humble people I know, and arguably are world leaders in the musculoskeletal pain field, frequently being invited to present at international conferences and forums, so we are very, very lucky to be able to learn from them each week! A quick heads up, this episode needs a language warning as Pete recites, word-for-word, what a surgeon told him about his wrist after he broke it in several places, and let me tell you, they weren’t empowering. As always, related infographics, references and the transcript can be found at www.bodylogic.physio/podcast, as well as video of this conversation. At the end of the episode we also get to share some exciting resources we’ve been working on in conjunction with people from around the world who have a lived experience of persistent pain, so stay tuned! We hope you enjoy this episode of empowered beyond pain, and remember to ask, is there more to pain than damage.



So welcome to episode 3 of podcast this episode we thought we would do a why are we doing a podcast but before we do that lots of these people that are listening might not actually have any idea who we are so I thought it’d be a good idea to introduce ourselves and then speak about why we’re doing a podcast we can do it we could introduce each other or we can do that yeah whatever so is I know he introduced themselves it won’t say what’s in there it won’t say the real story and I think you two are too humble to even start actually properly introducing yourselves so that’s a good idea would you like to start yes oh ok ok fara Brazilian speaks Portuguese primary language hair stylist yeah came to Australia a long time ago come on go with that 15 yeah it is basic degree and it is masses and biomechanics then came to Australia learn English learn English did his exams again to get registered in Australia all right yeah did dishwashing to catch a bit of English so he could learn English they needed his post-grad in sports physio at Curtin and then I started working clinically but also doing different research and then came on board with us here at body logic and kind of went on a pathway clinical pathway and their research part pathway with it was involved with a lot of research projects and then did his clinical specialisation and was boot board at that stage so I thought he do a PhD and particularly looking around a pain and pain related fear and now he’s doing a postdoc so he’s got these two roles where he’s postdoc fellowship finishing off some work around some work around back pain but also in the arthritis linked to a research program that were involved in and then is a director of body logic here which is wonderful so what is he great human being number one that confessed awesome Valley is the valleys family values friendship trustworthy humble super high working super clever bloody good clinician awesome researcher like what what is that it’s a full package huh yeah very lucky minute yeah is that a reasonable summary dude would you like to introduce pavement yes so Peter is is AQE so boy in New Zealand most queue is that I met so far they’re very nice people very easygoing clever down to where and that’s pretty much fun I see Pete and so Pete was a clinician at heart very very interested in you know providing the best care of people so he is interested in his patients not only that they get better but they enjoy the things that they want to do in life and he is very good at facilitating that process so about twenty years ago you came from New Zealand so training New Zealand I just got a school wait straight you can’t Australia interestingly enough with a similar intention of coming and doing post-grad here and he did his post-grad did very well and started working with some of the big names of physiotherapy in Australia and very quickly became a lecturer in the postgraduate program so very early on he was doing his clinical work and working University translating that that knowledge to other clinicians and then he embarked on a master’s degree that developed on to a PhD and that was a very fascinating clinical journey for him that paralleled or someone say ignited a shift in the way that our profession was working at the time and moving on from just hands-on work to more understanding motor control and how we could you know get people to change their behavior to improve their function and reduce their pain and so he had a seminal paper published in 97 around that work and that started a lot of questions of how humans behave basically and a lot of that work has been kind of developed in the colony from seeing patients trying to understand how they how they think how they work how they behave with their bodies and taking that to a lab to experiment with people in pain people without pain and seeing can we modify this can is that a relationship between what they’re doing and the Payette function so that basically reflects a very curious mind with the best interest at heart and so he’s working the clinic and in research is basically patient centered and that shows on all the work that he’s been doing and I think one of the key characteristics that I think of it is that he sees himself as an enabler not only of his patients but also of every single person that gets in touch with him so he tries to get the best out of people and he facilitates that it’s never about him it’s always about creating a path and you know you talk about their knowledge of building in a kind of a forest around you where you know you have lots of people working together as a team and we are stronger as a team and that reflects on you know yourself and and me as his PhD students and working here in the practice that’s what we see on a day to day basis that’s the people we know so he continues to himself and probably one of the one of the many but key moments that I’ve seen in public was back in 2000 in line in 2011 maybe at the APA conference where he stood up as a keynote speaker at the Australian pain visit Therapy Association conference and he basically said look this is how I used to think and my patients and a new research not only from our group where from across the world changed the way I think so from now on I would say that the words that are used here or inadequate and this is how I’m thinking so as a as a pretty strong point in the history of the profession and a lot of people felt very aggrieved by that because they’re going about that I thought my whole life and now I’m changing so that had that ability that flexibility is what is really cool and I remember doing one of my first research projects and you know I was coming you know the results that we have pathi sized what we’re gonna find and we didn’t find that and I was like we wanted and he’s gonna what are you talking about this is wonderful have we found what we thought we would not lend as much and that really stuck with me so every time I get our results I you know you have your hypothesis and you wanna feel clear whether you you know you found what I wanted yeah but that to me just demonstrates this flexibility this enablement and this interest in developing patients and researchers so similar to what you said when I when I came to Australia and I met Peter I knew his work or I tried to know his work with limited English that I had and that reflected a lot of how I thought and but then when I met him I met this incredible human being there was you know very welcoming and very warm and that facilitated a lot of the pathway for me and and we build a really strong friendship and we have very similar values and as Pete said we both value families are friends we care for our patients we want people around us to be as developed as they can we are now partnering partner in the business but our minds and hearts are centered at developing the best that we can for our patients and building up people that can best care for their patients as well and this is another example of that where you know you initiated this this process and we’re trying to convey this information to to others yeah so so while we’re on that I think it’s probably so I certainly agree with what’s been said I think enablers are really turn to use for you paid certainly that’s been true for my career under you so far and certainly for Jade beads but lots of other people as well but I thought maybe it would be helpful to contrast what you used to think and what you think now just so we’re explicitly sharing that with with our audience who most of them are people in pain that’s what we’re targeting so can you contrast what what the that used to look like yeah so you said on yep yep so look I am my basic training in New Zealand that was a long time ago so it wasn’t heavies making me feel really on the problem view was you know in terms of pain was it was linked to structure which is a very very common view still in society it’s like if you’re in playing something’s damaged something’s broken something needs to be fixed or there’s something wrong with your body that’s out of alignment or your postures this or that and I can remember in my first days in physiotherapy school and domain I know Oh Tiger Dunedin we had to strip down to our jocks and we had a posture photo taken and I was told that my posture it’s terrible – way back and you know there with all these faults with wrong with my body which I’m like I’d a had no idea they were all these things are on my body but it was like my first introduction to physiotherapy was that I was not you know I’ve had all these thoughts and I think fundamental to a lot of my training and you know that was all done in good faith yeah me wrong like they were just our beliefs and I think what struck me and my basic training was that it was so little knowledge around pain I can remember in my last year of my course thinking what have I done like actually all we’re doing is really telling people’s ideas because there’s very little science and evidence behind this and I had two thoughts either I’m either heading down a path of like going into a profession which is based on not a lot or here’s an amazing opportunity to build a platform knowledge from very little and luckily I took that part because I really really nearly took that path because I quite a medical school before I even graduated because I was like god I’ve got you know yeah because this is crazy and luckily I had a year with our deferred entry where I thought I just got a glimpse or something that kind of piqued my belief that something could be better within this space yeah so I’ve kind of meander away from what you asked but that was around this idea that the body is you know painters means you damage you need to fix it or you need to correct it there’s something at fault with the way that you’re moving so there was no sense at all over by social understanding a pain at that point in time and then I kind of came to Australia I’ve done ER or every workshop no man I could crack any joint on anyone’s body and quite well I think you know I’ve got the prize for the best cracker in a real artist you know still can do it but I realized it was just such a impotent tall when faced with people who are disabled in distress with pain was like a it was just a trick and as a human being I hated the fact that I could provide short-term pain related come back the same or for some people might have fled them up I had no idea why that was so I decided I either it was another cross where I was they didn’t get out of the country or comes to go somewhere else so I kind of toyed with which way to go and I was thinking research PhD there weren’t good opportunities in New Zealand but I was told someone who’d come to Perth so I applied and got in here that was a really critical moment of my career working with Bob LV who was extraordinary man great clinician but it also this really opened mind lovely wonderful communicator but also a mind that could rapidly adapt with knowledge it was just at that time of maxis when you guys don’t know who’s passed on who was a blanket terrified me yeah he used to torture me he was doing a lot of plain science work and he was really early in his thinking out of the blocks you know you like just twisting my brain around the role of pain science and Max and I used to like Tessa with each other and wrestle each other and I had the view that you know back pain was linked to instability we just had to stabilize these muscles in the back and it would all be good and he had a very different view around the whole the wrong the nervous system and and I think what we were saying was two sides of a coin I think mass saw the world through neurotransmitters and I saw the world through the lens of the person and I couldn’t quite marry those two worlds up I can see that way differently now so I would see aberrant movement as some biomechanical fault rather than a behavior where I would see the way summer moves is now a reflection of behavior and that may be a response to pain and foggy or fear or distress or fear learning or lots and lots of things so that’s kind of being this kind of a painful process of shift or change over time but I have to say that funnel in fundamentally as a person this view fits much better with my personality I was really never felt comfortable with these rigid kind of reductionistic ways of understanding pain because they never really made sense to me as an individual but also for my patients that never made sense where I colored by psychosocial view of pain most total sense to me as an individual through my own lived experience and through working with others then obviously fits with where the evidences yeah it’s a long route so to summarize that would you agree that perhaps you know we used to look at pain as being is very uni dimensional where we can find it on ask and it’s related into structure whereas now it’s kind of a bit more actually that’s one part of a bigger picture of yes of different things yeah you’ve got partly that but pain absolutely may be absolutely related structure I’m you know I fractured my shoulder couple years ago and god it was painful and I didn’t know it was fractured I hate you I didn’t show up and I secured I was skiing and I carried on skating for two weeks and it was really really really sore and I could not move my arm and then I go to skin a few weeks later and it was fractured yeah that’s a that’s a clear structural reason to be really really sore right and that’s what’s tricky about painting but I’ve also had severe planets but had nothing to do with structural damage there’s the same amount of pain I mean screaming headaches that is not because I bang my head so that’s the tricky thing about planning is you can have terrible pain that’s linked structural damage in terrible pain that’s linked to some wine up in the nervous system and then you can have life-threatening conditions that are associated with no pain at all and that’s the crazy and wonderful thing about pain is that you can have an absolute threat like I had a bunch of Pommery and blind no pain has been breath hmm and I felt no kind of I still I couldn’t breathe but it didn’t hurt probably the most life-threatening event I’ve ever had was something that had no pain and I’m he’s lots of other penguins that are not talking life or any at all that were terribly painful and and that’s kind of interesting because as a looped experience the thing that was most likely to knock me off didn’t feel anything no when the things that were most painfully distressing we’re not life-threatening at all so before we because I actually want to talk about some personal experiences we’ve pain because I think that shapes our beliefs and our trajectories or somewhat as well a second we haven’t introduced you I was gonna just okay I think it’s time for me to jump on the podium so you guys to share it if you want to I’m happy to kick it off because I think we we have an interesting meeting yeah we did so so you grew up in the hills up in Perth yep and then you did physio and you did your honors with Lillian did a pretty cool honest degree and the und Queensland and I ran a workshop in Queensland a few years ago and there was this young fellow there who was in the workshop asking a few great questions and then I needed to write the important you offered me the ride and in that right as we talked and you said you had an interest in research I asked you what it was and you were quite sure are we gonna do it and I said there might be an opportunity and so that kind of that little passing moment of the right Airport tilted your trajectory and he came back here and join our research team you know probably surprised at Peter can and our group at Curtin and then you’ve been working here clinically as well doing a simple project looking at the relationship between pain and inactivity limitation and movement mantra as well in posture so did you have any questions yeah so you know and I think I think the thing that struck me about you which is why I advocated for you for that project is I saw a creative brain an interested brain so like someone who was head head was creative and flexible and very interested in the question but also caring and and interested in the person and that not that those combinations of Assam was asking me the other day about what made a really good clinician and I said it’s someone who really deeply cares but it’s also someone who’s adaptable who can self reflect who can look back on an event and go oh my god I screwed up or that was didn’t work or what was it so that kind of soft learning process and and I could see a little bit on our sign there I could see a little bit of what you were like which reminded me of what I was like a much younger stage in my career of this mind that was just hungry to learn I mean and that that’s something I really value about the way you operate yeah and you’re fearless of that giving something a crack and you know happy to fall over and get up and give it a go again and that’s great yeah I reckon because that’s what learning is absolutely if you don’t learn to ski without falling over yeah cause I know and I think I can take thing as weather strike me in your cab is your initiative so you have a lot of initiative and you you know I’m thinking of the group and thinking about bringing other people with you in that in that journey as well and also when we see patients together or when talk about tough cases as Pete said you you’re happy to get feedback and you’re happy to to adapt and change and grow and I think that’s a great characteristic or you know developing as a clinician and as a person yeah thanks guys um I appreciate that but enough of the niceties where we’re here to talk about why we’re doing this podcast for the people that are listening but like I said before I think can we just quickly share some personal experiences with pain so you shared your this is one of the many fee you pay and I’ve got a long history as well but I’ll pick the most influential one for me is there anyone any more that you want to share in terms of experiences with pain yeah I finds interesting I reckon because the things that are most have the most significance of the things that are most threatening I reckon and I’ve had elites of different pain experiences probably one other one I could pick a number of these but one of the ones that struck me was I had a like a big fall and barely fractured my wrists and numbering years ago about 18 years ago and it was a it was a complex fracture of my joint so I would have punched the joint and split and fragmented and it was all sitting out here and I think new view as soon as I got up I had a deformed down that didn’t move and I was going that for my job and probably I was working a lot more with my hands back then that was a massive issue because I was like going that is not what a physio wants that was the first thing that went through my head it’s like that is not an injury if physio wants and so I know I’m having surgery with pins stuck through it and this serger the first thing the surgeon said to me was your wrist is hmm when I came out because I said obviously cancerous Karissa’s you getting up with a rocker honest it’s good that you’re embarking on an academic career because your clinical career is gone strong that was the that was what I was told I mean in a language like this and yes Herbert I believe that is an absolute that isn’t absolute robot so that was not an interpretation and and and my first gut reaction to that was I don’t know in that that I will not own that so I was also told to take three months off work and I had a way less than like two months or three months so I took a week off and I remember sitting at home with excruciating pain in my wrist and just having a week of feeling completely tortured of having this pain and having nothing to occupy my brain apart from these words that have been given to me and this experience that this part of my body that I used and trusted I rock climb a mountain eared and I men biked and I used my hands and could work with my hands to manipulate and feel tissue and touch people and this is a broken part of my body that was kind of cast in the wastebasket that was horrible so after a week it’s a big back talk about hey mom wrestling and pins coming out and I just worked with one hand and I realize I could do all my job with one hand and like and the patient’s bringing them in a second what’s what’s going on here like I’m coming to you thank you care if you’ve got one hand how does that work I give it like a 50% discount but I think even force me to work differently yeah oh my god I can do my job with it with one hand I don’t need to do all that stuff I was doing before so I’m like I’m gonna give that a crack so actually it was a great opportunity to say to me I’m not taking three months off being sick I’m gonna do my job I will adapt to do my job in one hand and then force me to kind of change a whole bunch of the ways I practice a bit like coronavirus and go on telling us it was a bit like that moment and then as soon as I got my pins out I had this emaciated iron I can’t remember look you know trying to move my wrist and it was just it was just horrible miserable and every time a motive crunched and grated and and I just had this I gave myself a picture of a healthy wrist when going on a picture a healthy joint and I just kept that wrist moving and I just kept on moving it and I went back to work and I started using my hands and I started doing things and I it was swollen chronically swollen it was crepitus and my wife was just going give you a tiny risk it break you know you just don’t stop moving it and I just kept up on doing that and they would ache every night I go to bed I’m just I can I have my hot packs and I was chronically inflamed or probably overdone it and then after two years all the pain went away and my wrist was fully mobile and I never hurt me since and that was only years ago what 16 om that was more 20 years ago and I mean in fact was a long time ago so 22 years ago so that was a really powerful moment for me of going the impact of negative health information can be absolutely devastating yeah but the power of the mind in of behavior can alter processes and the human body is extraordinary if you give it the right mindset and the right environment and that probably that experience has emboldened me to be courageous when I work with people with pain even when in the face of structural imperfection yeah I reckon yeah that’s cool JP hmm yeah it’s always a learning experience isn’t it yeah right yeah so I have I probably had two events one with trust traumatic I was I had a had an accident and I broke my leg I had a spiral T field fraction and similar to your wrist when I looked at it I knew it wasn’t complete because he was pointing the wrong direction and it was you know quite a distressing time and I had a surgery surgery was a success according to the surgeon and and after that that process was you know gradually going back to using the leg but at that time I was there was a lot of stuff happening in my life they were I was distressing and at that point having that break wasn’t was an ideal financially and other affairs and I remember getting some really bad news one day and actually I was sitting in your house in your couch with my leg out and got the news at night and in the morning or just had breakfast and then I had Reggie like back he’s a little tingling shooting pain Bernie and I remember sitting there and thinking there is nothing that I’ve done that could have caused this this was like a few weeks down the track this was not an infection this was nothing else the only thing that changed is that I got some really distressing years plus the whole context of this and I really stuck with me with such a significant body response and so felt in your body and I had every right to think if I was a complete 90 passion I have every right to think that the screw just broke or something went wrong on my leg is broke again or whatever and I was soon after starting to put some weight on it so that resolved because I you know I looked at that situation I’m going the stress is what’s distressing me and that’s my body responding to it I’m not gonna pay attention to it and that’s very soon resolved that discomfort then I rehabbed myself go back to walking was working went back to the gym and started doing a bit heavier than I should have and then I developed this leg pain did it have an incident I just was quickly build up my my Lord and I developed this this leg pain and that was around the time that I was doing my specialization and and that came and went for a little while but one of the key things around that time on reflection is that the way we were working in the practice was a very open minded way about pain which is kind of how we’re discussing here and I was getting various feedback feedbacks from across the country when I was treating patients I was being watched and observed and given feedback on the way I’ve treated and because there was a run sports there was a biomedical viewers way stronger and I was constantly being reminded of this structural problems that we have and this attention we need to give to pathology and if you do identify the pathology the pathway for management is easier and it’s clearer and you just it’s almost like following a recipe you know it’s a disc ethology you do this no compression you do that it’s a fracture u2x and at that time I remember having these this divided mind like half of my brain was going you know paying is a multi-sensory experience and every dimension it’s an expression of your health every factor influences and the other part of my brain was to structure it to back to disk and I can remember kind of falling into these protective habits and having this image in my back of this red-hot the injured pointy part in my back that I had no idea where he came from because I never his can and we had chats are a list and I had to make a decision at one point a guy I either trust this or I don’t and that was a very divisive moment there was nothing else that changed apart from just going being true to my understand your pain and behaving as such and the interesting thing is that during that process when you’re receiving feedback that is different what you receive in the place that you’re working and then you have an exam you have to make a decision on how you’re going to work and at that point I made a decision of going to this specialist exam which is a pretty rigorous process in Australia Darry yeah in practicing the way that I believe is the way especially should be practicing and with my true values of how I see pain and the management of thing and if that wasn’t enough to pass the exam I was comfortable with that process and those decisions were around the same time and when I made a decision I eradicated those behaviors I used my body constantly I went to the exam I did what I had to do and it was just a very interest interface between this old structural traditional biomedical training that I had being brought to attention when you had a felt experience in your body and I had the great advantage of heavy had training on the other hand on the other way of thinking about pain but also I’ve been talking to clinicians such as they who support that view now if you put yourselves in the shoes of a patient who jumped from one clinician to another and they have that information reinforced and they don’t have the knowledge of the power to go against that decision it’s a pretty tough place to be and that decision made a significant change in how I behaved in relation to my body in relation to protecting my body or using my body and and I think that’s in the clinical encounters that we have with patients understanding where they’re coming from and in a supportive manner trying to demonstrate to them a different way of thinking if the structure is actually not the problem it’s a it’s a delicate process but it’s a very rewarding and interesting process yeah and we have a really significant role in providing care for patients in that way yeah sorry I was just going to say probably the other situation that I had is that I when I was six years old I was diagnosed with Perthes which is a in avascular necrosis of the head of the femur and I remember seeing three top orthopaedic surgeons in in Brazil and the three of them said look like your childhood is is gone you can’t use the leg you should be lying in bed with pasta what kids usually do they kind of just paint the ceiling and change the color boots and peaches so you can see stuff like that for the next couple of years the other guy said we put a hip replacement and the third guy said just see how I go and before you forty you we replace your hip so there was really negative powerful information coming from the top of the tree of the medical you know pathway and I remember my parents sitting there walking out of those of those consults in going that cannot be true that cannot be true the body cannot be so fragile and we have to do something else and we my mom did some research we did she went after a lot of information and we took a different approach when we spoke to another doctor and he said look what is saying is what the journals are saying but look I reckon what you’re gonna do you’re gonna use common sense narrow your experiences in childhood so you can run your car we can play soccer basically I was a crappy Brazilian keep that with country and and then you have to gradually develop yourself and get yourself some strong muscles they said I’ll be lying to you if I say that you’re he said your hips gonna look crap but I don’t know how it’s gonna be in the future keep me posted and and that was a very supportive and not very common way of managing a situation like that and I went for my physio training and here was the head of the orthopedic of the hospital that I was doing a placement so we had conversations all the time and he wanted to know what I was doing and in part one of this it brings the social support because what I was asked to do as a 6 8 10 11 year-old not to run not to jump not to do all the stuff it’s pretty much impossible when you live in a street with five other boys doing all that stuff and my mom at the time she called all the parents of those kids and the kids and they said this is what he needs to do to have a healthy adolescence and adulthood you can help him or you can just allow him to do whatever he wants and I basically had these five friends with her friends to me up until tonight who basically told me what I couldn’t do so I was like nurtured by the social support helping me to do like you can do this you can do that and let’s try this now and that was really important because a problem that I had wasn’t put aside was validated wasn’t knowledge was supported and that was really important I only see people with pain where we can have support that is negative where they don’t let people do anything you know let me carry the shopping for you don’t lift anything heavy watch your back or it could be supportive in our way of core now I was there with him to consult he said you’ve got to be active you gotta sleep well so let’s go to bed and let’s keep well and let’s exercise so that is a really important thing so that negative health information and understanding that patients receive that and if they all that information or not is a really important thing that we know we have to do a thing yeah absolutely and those personal experiences they they help us within our consoles as well I think they’re hugely valuable kind of imagine it with one of my favorite memories growing up so I’ve fractured several parts of my body but one particular that comes to mind was playing football hurt my hand and I told my mom at the time and said you know I’ve got sore hand and she said yeah it’ll be all right no worries like it’ll get better don’t worry too much about it a couple of days went by and we still saw Todd mom again it’ll be a fine like just keep doing what you’re normally doing two weeks went by and my hand was still sore and it was a bit swollen a bit blue and and she’s are well let’s go to the doctor and an x-ray and there was two fractures there now my mum feels terrible for this and it’s not a reflection in any way on her but for me actually I’m quite glad that that’s the path that she took that she didn’t you know baby me didn’t protect me didn’t shelter me and and to me that shaped this whole narrative that there is more to pain than just damage which is kind of what I wanted to talk about we say this at the end of each of our episodes but but can you kind of summarize what what that means why do we say that look you were both part of a wonderful tool that we heard last night so no idea claims work it can which talked about people who had a knee replacement and it talked about these different pathways that people go down so you a great pathway or and not a good pathway and the vulnerability or if it’s it touches on your sling jpay around people who can have pain and kind of move on in their lives people who’ve got good social support people got high levels of so via single soft belief or self confidence they can adapt they can shift the way they think about a problem to adapt to it in a different way where the viability the vulnerability factors are really around poor social networks a negative mindset around the body getting stuck having no strategies like hitting roadblocks and not having no support to kind of get around those roadblocks and that could be health support or social support and own personal resources and that’s what good health kids so important because when you hit a roadblock and that’s what I say to my patients I have one today it’s just like I’m just being driven mad but this pay at the end he goes I feel so much better didn’t do anything to her we just talked through a strategy I said why do you feel better she goes I have a plan I had no plan I was stuck I now can see it I quit her way forward and it’s like we see these pathways or people just get stuck and there are so many pitfalls in the health system where the focus is on your damaged body part not about is it’s it’s a it’s a reductionist kind of- sickness mindset rather than a health mindset let’s say your body is like another discussion today about the brain’s like a pharmacy you can open up but you know the an OG z ism or you can create pain drugs you know like that’s all in your brain and in that capacity it’s kind of how you unpack that capacity so I think you’ve heard both of these scenarios where pain can be related to damage but there’s so much more to pain the damage and and that is about how you understand and how you respond to it how your supporter with it how you adapt to it how you manage it in your pathway forward and that’s what this podcast is about is to kind of share narratives of of hope for people it’s not in any way to say that structure is not right to pain because it very often is it’s but it’s just one bit of the puzzle and I think women it’s the only bit of the puzzle that’s a massive trap but the other thing is that the body is this amazing healing potential there’s some amazing ability to adapt this amazing ability kind of you know to respond to difficulties in a positive way if you have the support networks mindset strategies to go that path yeah corner it opens up a whole a whole new plethora of options to help get better right if you just think that paintings are damaged then you’ve got one option yeah you’ve got very limited options but actually understanding that that’s a part of your bigger picture yeah opens up the doors to say okay there’s lots of different things oh and help with this and I think what can struck me as well with Nadia’s presentation last night getting better is not paying for it and we often measure better by what’s your pain scale so I am pain every day is like tired of my life right if it it doesn’t bother me it doesn’t keep me awake at night it doesn’t stop me doing stuff it doesn’t in any way inhibit anything I do in my life that’s the measure of pain in my mind and that’s about the meaning of it the bothersome Norah the the impediment that it places on you and I think we can’t need to get away with this a measure of planners on a numerical rating scale is what kind is because you can have six out of content pain so I feel every weekend when I go mountain biking with you and it’s pleasurable right but it’s still painful but it’s got a different meaning yeah but you can have to add a pain to edit in pain that drives you mad if you don’t know I understand I won’t have a way of distracting yourself a little moving off right mmm-hmm yeah you talked about before that um you know potentially if you have some negative healthcare experiences that that can really push you down a tree oak tree yeah and I think for me that that kind of partly highlights one of the reasons that I wanted to to do this podcast was to so maybe you know there’s some healthcare practitioners out there that are whether they don’t know that I would provide the most up-to-date care based on research now you guys are lucky and we’re lucky in that we have our foot in both kind of cams we work in research would also be working clinical practice so we have that ability to try and transfer that and translate that to the real world it’s quite a scary study that showed that there’s a man a seventeen year lag for health or research to get from universities to the real world into practice and for me that’s just not really acceptable we need to be doing better to do think that someone’s going down the road to see a physio or any other doctor and getting care that’s 17 years that’s a scary thing for me yeah and that’s something that one of the biggest drivers for creating a podcast that’s free people can easily access it’s not behind a paywall it’s not you know a technical medical jargon and it helps to empower people so I was wondering when you guys would would love is there anything else you want to add to that too as to why we’ve decided to do a podcast and we’re doing this you know on time and it’s probably important to mention that we you know in terms of conflicts of interest when we’re not getting paid to do this so yeah could you talk about conflicts of interest and while we’re doing a podcast sure so as I said before I work in clinical practice for my income comes from seeing patients and I also am also a partner at quite a bunch of physiotherapy and that’s a it’s a clinic where we see patients and we provide a physical therapy service and the other part of my income is from working in academia as a research fellow at currently probably the only other thing that would have income from is when we are invited to present into clinical workshops what we get paid by either an institution that is providing service to their clinicians or a group of clinicians that want to have access to that information so there will be my conflicts of interest yeah when you say in terms of why we do this and you know there’s more to painting than tissue damage I saw our ladies that highly-intelligent 50-year old who has been dealing for over 25 years and she said look I asked her what so expectation of today would you like to get out of today and she said I don’t know I suggested to come here but I’ve seen 25 years I can guarantee you someone in more than 25 clinicians and I’ve done lots of scans my scan shows nothing so I get it it’s not in my structure my structure really hurts when I touch it it hurts it hurts my back I can show you every day same place so it’s not in my mind it’s in my body but the skin tells me they say you can’t explain your pain and she said how about my pain experience and she goes I don’t understand how I can experience something that this can kind of talk for and and that was quite a compelling question and there’s a lot there are a lot of patients out there that have the same difficulty in understanding and I we have a duty of care I think or we as you said we are lucky we have access to all this information something we produce something we have access to we on Twitter getting information left right a sensor we can we have access across a paywall through the university so we have a lot of knowledge that we can get our hands into I think we have a duty to translate that to patients and not only the patients that can afford and can come to to where we work to pay for a service but also for patients that are sitting at home and potentially in Brazil or New Zealand or elsewhere to listen to this and then go to their clinicians and go hey what do you think about this so this lady today she’s being stuck in a place where she’s following all these rules which are very common rules imposed by to us through our through our trained over the last 17 years probably and a lot of these rules they have been challenged and she is she’s really she has got a lot of self-efficacy she goes to secret information and she tries really hard and she is couldn’t get out of that out of that place you know she had a lot of other factors in her life such as stress such as putting on weight working a highly pressure job not having social social support have any significant events happening over the last couple of years when despite the fact she had pain for 25 years over the last couple of years is when that pain became really unbearable so all those factors is they reflect they can influence her pain experience and they’re way beyond her skin so in her case it was a very clear case where tissue damage wasn’t even part of the picture because she had a very good look at spine but it’s surprisingly good looking MRI for a 50 year old now you look at hang on a second so you look at that like this is not tissue damage and she said that herself but you go you know you haven’t been as active as you used to be you put on white you work in a high-pressure job you don’t feel as much stress but your body may feel it you know your sleep is altered and so there’s lots of factors that we know that can influence how how your body responds and you mentioned before about having options and I remember when I you know look at my training at the time in Brazil I did my master’s in biomechanics because I wanted to know more about the mechanics of the body so I could fix the impairments to facilitate people to get back doing what they wanted to do so my fundamental training was around pain equals tissue damage and I remember my lectures were around the name of the lectures were the name of the pathologists we’re going to study so when I came over here I came to get better and made no therapy because then I could actually you know twist the source of the problem and fix it and I came here and Australia was going in this shift where I was like you know hands on heavy but also motor control and and it was a really interesting time and you really challenged my beliefs at that time but I remember when I was formally presented this biopsychosocial view of pain although there was very challenging I’m great hang on a second so does that mean that my management now includes you know talking to people about this sleep optimization it talks about stress management he talks about being physically active so all of a sudden my toolbox just increased and I had all these factors which are many a modifiable and we can help people to interact with them and if we take painting on a picture and we put another health problems such as cardiovascular disease diabetes all these factors are present there so it sounds like the pain world is just taking a bit longer to catch up especially the beliefs around the community yeah sorry okay that’s a very roundabout question to you know that’s my answer to your question that’s good conflicts of interest yeah so um I obviously uh you know part of my job is Professor occurred in Union which is you know work with the amazing team of researchers and very very fortunate I kind of have one small cog in a kind of piece of wonderful machinery and then the other role here is clinical and then co-directed with Joe Peter what is logic I made a decision and it was a it was a very xx decision actually I can remember grappling with this probably around maybe twenty years ago of whether I would use my knowledge to create a educational business because I could see there was a lot of money you could make through education and I remember most because I came from New Zealand and there was the McKenzie system and I remember going to Robin Mackenzie’s workshops and I don’t want to take away from the contribution that he made because he was pretty impressive to him what he did and innovative although though all of the theories were not have not been but a lot of the concepts around self-management South care I hear it again but it was all kind of wrapped up and some kind of scary language and and very much around structural models of pain and I’m too you know to be fair I think in an element of the McKenzie approaches shifted but I can remember sitting in some of this workshops in him and he was brave guy he bought patients into his workshops but he’s a very strong person and and and I I was a young questioning fearless curious person who put my hand up way too many times locked down and and I can remember thinking that I didn’t I didn’t there was a sense of Guru ism when within our profession where this son of the pocket talks like a pyramid with a person at the top was the king and they just told all that others what to do and the others just followed and didn’t question and I’m really they’re fundamentally grated on me so I can remember a very clear time where I had that was this kind of like tipping point where I could have gone down this pathway I’ve gone you know I can make a lot of money out of education by educating physios and I’m going you know it doesn’t fit with me it’s not what I do want to do fundamentally you know knowledge is and I could see there was a trap where if I started creating a business around knowledge that would put me into a vise where I’m then constrained by business not having this open world on learning and so I made a deliberate decision at that time that I would not do that and that I will never do that in terms of you know a system that this is a system and a lot of people you know I know within the cognitive functional approach to managing pain a lot of people probably look at me as like I’ve got some business vested interest but apart from running the odd I gotta tell you Hector he’ll be filled with the last number of years when we’re not selling a product in a sense you can’t so what it’s a bit like sewing sign knowledge I think we can sell it but this idea of creating knowledge to be shared knowledge to be curious knowledge to create and ice acknowledges ongoing evolutionary not finite yeah so to constrain myself to a finite basis on what you sell as a product fun Milligan that makes sense to me which is why we’ve deliberately not gone out that pathway yeah so that’s a long answer division yeah to the divet to the next question but it is something like deliberately and think about and there were a lot of people pushing me to do it because they could see financial benefit for themselves I think and I really pissed a few people off by not going down that path but I have absolutely no regret that I didn’t do that because it’s allowed me to partner with a lot of other researchers who I don’t think would have come near me with a bargepole if they saw I had a financial interest in the answer rather than having a curious mind to explore a question and then allow their answer to kind of update my learning into evolve and change so I think it was a really really good decision a long time ago in terms of the podcast you know as Jackie said I’ve spent you know when I finish my PhD in 98 so I spent a lot of years so what’s that 20 salad 94 it’s a lot of years 26 years of doing research or publishing papers and and like you say every day I’m hearing people go why don’t no one taught me this yeah that heals many it looks like we’ve been we’ve spent so much time publishing stuff that is never never accessed by the public that is something that is fundamentally wrong this podcast can reach people and to give them a taste of what what actually knowledge looks like and how that can apply to them in the real world that’s gone because the other thing is it’s often behind paywalls and it’s not even readable so a lot of the stuff we write has to be written in a scientific language that their average person would be absolutely is incomprehensible there are lots of people so that’s a massive issue for us as scientists to say how do we make that knowledge applicable and understandable when I think it’s a beautiful part about working in clinical practice is we can have simple conversations with people to translate knowledge every day so I was thinking about your 17 years thing you know 17 years it translated nor is the practice what I kind of see clinical practice is like my it’s a bit like road testing your vehicle all the time when we’re constantly re trying new vehicles all the time so if you come here you you’re going you’re part of a like a an innovative Road testing clinic and if you’re brave enough to be part of it it will be honest with you in that journey but in in a sense it’s kind of like an iterative process of saying what’s working and allowing that patients to be really honest with us to say hey that didn’t work that was crap this didn’t make sense that’s how we can kind of learn as punch it yep yeah and and I guess the other thing is to one of the things we would like to as I said you know trying to tie these people in pain as well as clinicians that are helping people there are you pay is that would love to hear from them and have their input so this is not initially it’s us presenting what we think it’s it’s important and interesting and necessary but it would be great to get feedback from patients to get their answers their questions answered in a way that it makes sense to them because we get asked lots of questions every day and at times it seems like we’ve some of the questions may seem trivial and may seem like difficult to be answered but they’re so commonly asked to us them will be good to have a common narrative that we can pass that on and have patience any access to it yeah so we have set up an email for that so you know to in the spirit of getting questions from from the listeners if they do have question that questions they can email podcast at body logic physio and we’ve also put our feelers out through Twitter to pick up some frequently asked questions as well so that certainly is plans in the in the pipeline so I think we should wrap it up i that’s been a good episode this has been one that’s been a little bit more about us in our journey and I guess what we stand for and why we’re doing this sort of thing so yeah thanks for your time gents thanks guys appreciate it figure every way [Music]


So, there you have it, episode 3 of the Empowered Beyond Pain podcast. As you heard, we all have personal experiences with pain and our main mission with this podcast is to empower you to live beyond pain. In addition to the conflicts of interest mentioned, we wanted to be clear what “proudly brought to you by body logic physiotherapy” means. Put simply, podcasts aren’t free to run, and we don’t want to run advertisements as unfortunately, many businesses in health spread messages of vulnerability, fragility and fear, which while arguably a good business model, isn’t such a good healthcare model, plus, we believe education should be free and uninterrupted! So in order for us to do that, Body Logic Physiotherapy has kindly agreed to wear the costs associated with getting this evidence to your eardrums each week! As mentioned in the episode, if you’d like to ask questions or leave a voice message with the possibility of having your question featured on the podcast, send an email to ‘podcast@bodylogic.physio’.


Finally, a quick announcement: we’ve been involved with some resources that highlight 10 scientific facts about low back pain and have worked with many prominent global patient advocates to record and share their stories. Well, these got approved and released by BJSM and next week we will be discussing the behind the scenes of the popular: ‘Back to basics: 10 facts every person needs to know about low back pain’ paper lead by Professor Peter O’Sullivan and co-authored by JP Caneiro, Kevin Wernli and many other great international researchers. We just recorded that episode and it’s jam packed with great information. We discuss how the core isn’t as important as we thought it was for low back pain, why perhaps you  don’t have to lift with a straight back, and why imaging needs to be taken with a grain of salt in persistent low back pain… Fact you then, and remember to ask: is there more to pain than damage.