Episode 3

Episode 3 – Who Are We And Why Do A Podcast? Empowered Beyond Pain Podcast

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“To think that someone’s going down the road and getting the care that’s 17 years out of date, that’s a scary thing for me and that’s one of the biggest drivers for creating a podcast that’s free, people can easily access, it’s not behind a paywall,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

We explicitly share our conflicts of interest. Pete and JP are two of the most humble people I know, and arguably 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 the 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 lived and 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 our podcast. In 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 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 could introduce each other. I know if they introduced themselves he won’t say the real story .and I think you two are too humble to even properly introducing yourselves so that’s a good idea.

Would you like to start?

Yes, ok. So JP. Far out. Well, he’s Brazilian and speaks Portuguese as his primary language. He came to Australia a long time ago, 15 years ago. He got his basic degree in masses and biomechanics then came to Australia to learn English. He did his exams again to get registered in Australia all while dishwashing. He did his post-grad in sports physio at Curtin and then started working clinically, as well as doing different research. He then came on board with us here at Bodylogic and kind of went on a pathway clinical pathway and their research part pathway with it was involved with a lot of research projects. 

Then did his clinical specialisation and was a bit bored at that stage so he thought he would do a Ph.D., particularly looking around pain and pain-related fear. And now he’s doing a post-doc so he’s got these two roles – Where he’s post-doc fellowship and finishing off some work around back pain and some work around arthritis as well, linked to a research program we’re involved in. And as a director of Body Logic. Which is wonderful. So he’s a great human being number one.

He has awesome values. Family values. Friendship values. He’s trustworthy. Humble. Super hard working. Super clever. Bloody good clinician. Awesome researcher. Great dad. And husband. He’s the full package.

That’s a reasonable summary. 

Would you like to introduce Peter? 

So, Peter is a Kiwi boy, born in New Zealand. Most kiwis that I met so far, they’re very nice people, very easygoing, clever. Down to earth. That’s pretty much how I see Pete. Pete was always a clinician at heart. Very, very interested in, you know, providing the best care to people. So, he is interested in his patients. Not only to help them get better but what sort of things they enjoy and what they want to do in life. He is very good at facilitating that process.

So, about thirty years ago you came from New Zealand. So trained in New Zealand. He came to Australia, interestingly enough with a similar intention of coming and doing his post-grad here and he did his post-grad very well and started working with some of the big names of Physiotherapy in Australia. He very quickly became a lecturer in the postgraduate program. Very early on, he was doing his clinical work and working for the University translating that knowledge to other clinicians.

Then he embarked on a master’s degree that developed on to a Ph.D. That was a very fascinating clinical journey for him that paralleled or some would say ignited a shift in the way that our profession was working at the time. And moved on from just hands-on work to more understanding motor control. And how we could get people to change their behavior to improve their function and reduce their pain.

He had a seminal paper published in 97 around that work, and that started a lot of questions of how humans behave. And a lot of that work has been kind of developed in the clinic from seeing patients, trying to understand how they think and how they work. And how they behave with their bodies. And taking that to a lab to experiment with people in pain and people without pain. And seeing can we modify this.

And we can what the relationship is between what they’re doing, and their function. So, that basically reflects a very curious mind with the best interest at heart. So he’s working in the clinic and doing his research. But is patient-centered and that shows in all the work that he’s been doing. I think one of the key characteristics I think of with Pete, it’s 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. You talk about their knowledge of building in a kind of a florist around you. Where you know, you have lots of people working together as a team. And we are stronger as a team. That reflects on, you know, yourself and me as his Ph.D. 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 challenge himself and probably one of the many, but key moments, that I’ve seen in public was back in 2009, 2011 maybe. At the APA conference where he stood up as a keynote speaker at the Australian Pain Visit Therapy Association conference. And he said look this is how I used to think. And my patients and 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 are inadequate, and this is how I’m thinking.

So, 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. I was coming you know the results that we have predicted sized what we’re gonna find, but we didn’t find that. 

It wasn’t what we originally wanted. And he’s like what are you talking about? This is wonderful! We have found what we thought we would not have learned as much, so it’s great. That stuck with me so every time I get our results, you know you have your hypothesis, and you wanna feel clear, whether you know, you found what you wanted or not. 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 came to Australia and I met Peter I knew his work. Well, 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. He was, you know, very welcoming, and very warm. That facilitated a lot of the pathway for me and we built a really strong friendship. We have very similar values and as Pete said, we both value our families and our friends.

We care for our patients. We want people around us to be as developed as they can be. We are now partners in the business, but our minds and hearts are centered on 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 when you’ve initiated this process and we’re trying to convey this information to others. 

So, while we’re on that I think I certainly agree with what’s been said. I think enablers are really good terms to use for you Pete, certainly, that’s been true for my career under you so far and J.P’s. But lots of other people as well. 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 our audience. Who most of them are people in pain, that’s who we’re targeting. So, can you contrast what that used to look like?

So look so, in my basic training in New Zealand that was a long time ago, that was 30 years ago, so you’re making me feel old now. 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 pain, something’s damaged, something’s broken something needs to be fixed. Or there’s something wrong with your body. That it’s out of alignment or your postures is this or that.

I remember one of our first days in a physiotherapist school in 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. This was way back and you know, all these faults were wrong with my body apparently. I’m like, I’m 18. I had no idea there were all these things wrong with my body, but it was like my first introduction to physiotherapy that was, that I had all these faults.

I think fundamental to a lot of my training, and you know that was all done in good faith, yeah that things were wrong with me. Like they were just the beliefs at the time. I think what struck me with this basic training was that there was so little knowledge around pain. I can remember in the last year of my course thinking what have I done? Like actually all we’re doing is regurgitating people’s ideas because there’s very little science and evidence behind this.

I had two thoughts. Either I’m heading down a path of going into a profession that isn’t based on a lot. Or here’s an amazing opportunity to build a platform knowledge from very little. Luckily I took that path. After all, I nearly took that path because I applied for medical school before I even graduated. Luckily I had a year with our deferred entry where I thought I just got a glimpse of something that kind of piqued my belief that something could be better within this space.

I’ve kind of meandered away from what you asked, but that was around this idea that the body is you know, pain means you have damage. You need to fix it or you need to correct it if there’s something at fault with the way that you’re moving. There was no sense at all over or social understanding of pain then.

Then I kind of came to Australia. I’ve done ER and every workshop known to man. I could crack any joint on anyone’s body and quite well I think. I’ve got the prize for the best cracker. And I realised, you know, you can still do it. But I realized it was just such an impotent tool when faced with people who are disabled or in distress with pain. It really was just a trick and as a human being, I hated the fact that I could provide short-term pain relief for some people But it still came back the same or for some people, it freed them up. I had no idea why that was.

So, I decided I either try to go to another country or go somewhere. I kind of toyed with which way to go and I was thinking of research Ph.D. There weren’t good opportunities in New Zealand but I was talked to someone who’d come to Perth. So, I applied and got in here that was a critical moment of my career working with Bob Levey who was an extraordinary man. 

Great clinician, but it also really opened my mind to a lovely wonderful communicator. But also a mind that could rapidly adapt to knowledge. it was just at that time of Maxis, who you guys don’t know, who’s passed on. He terrified me, he used to torture me, he was doing a lot of pain science work. He was early in his thinking out of the box. You know, he was just twisting my brain around the role of pain and science.  

Max and I used to like tussle with each other and wrestle with each other. Because I had the view that you know, back pain was linked to instability. I thought we just had to stabilise these muscles in the back and it would all be good. He had a very different view of the whole nervous system. I think what we were saying was two sides of the same coin. I think he 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. I would see some movement as some biomechanical fault, rather than a behaviour. I would see the way someone moves is now a reflection of their behaviour. And that may be a response to pain and fear or distress. So, that’s kind of this painful process of shift or change over time. But I have to say fundamentally as a person this view fits much better with my personality. I never felt comfortable with these rigid kinds of reductionistic ways of understanding pain because they never really made sense to me as an individual.

Also, for my patients that never made sense either. Where I was coloured by a psychosocial view of pain – Which made sense to me as an individual through my own lived experience and through working with others. It fit with the evidence as well. So yeah, it’s a long route. To summarise, would you agree that perhaps we used to look at pain as being unidimensional? Where we can find it ask if it’s related to structure? Whereas now- it’s more actually that’s one part of a bigger picture.

Pain can be related to the body structure. I fractured my shoulder a couple of years ago and god it was painful! I didn’t know it was fractured. I was skiing and I carried on skiing for two weeks and it was really sore! I could not move my arm. And then I go it scanned and a few weeks later and it was fractured. So there is a clear structural reason to be really sore right and that’s what’s tricky about pain. I’ve also had severe pain though that had nothing to do with structural damage. But there’s still the same amount of pain.

So for example, screaming headaches. That is not because I bang my head. So that’s the tricky thing about it. You can have terrible pain that’s linked to structural damage. And you can have terrible pain that’s linked to some issues within the nervous system. 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. 

You can have an absolute threat like I had a bunch of Pommerylie. No pain, I just couldn’t breathe. But I felt no pain. It didn’t hurt. Probably the most life-threatening event I’ve ever had was something that had no pain. There are lots of other painfully distressing that are not life-threatening at all. Or there are times that things were terribly painful and that’s kind of interesting because as a looped experience. The thing that was most likely to knock me off, I didn’t feel anything. 

I actually want to talk about some personal experiences with pain because I think that shapes our beliefs and our trajectories somewhat. 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 had an interesting meeting.

So you grew up in the hills up in Perth and then you did physio and you did your honors, with your degree in Queensland and I ran a workshop in Queensland a few years ago. There was this young fellow there who was in the workshop asking a few great questions, which was you. Then you offered me a ride and in that ride as we talked. You said you had an interest in research. I asked you what it was and you were quite sure what you wanted to do. 

I said there might be an opportunity and so that kind of thing in a passing moment of a ride to the airport. That tilted your trajectory and you came back here and joined our research team as a primary supervisor. You’ve been working here clinically, as well as doing a simple project looking at the relationship between pain and inactivity limitation and movement mantra, as well as posture.

 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. And an interesting brain. So, like someone whose brain was creative and flexible and very interested in the question, but also caring and interested in the person. And they are not that common, those combinations. Someone was asking me the other day about what made a really good clinician. And I said it’s someone who deeply cares but it’s also someone 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 whatever it is. That kind of self-learning process. And I could see a little bit what you were like which reminded me what I was like at a much younger stage in my career. This similar mind that was just hungry to learn. That’s something I really value about the way you operate. And you’re fearless of giving something a crack and you know, you’re happy to fall over and get up and give it a go again.

That’s what learning is absolutely about. If you don’t learn to ski without falling over, you’ll never learn properly. So, you have a lot of initiative, and when I was thinking of the group and thinking about bringing other people in. With you on that journey it was easy. And also When we see patients together, or when talking about tough cases as Pete said. You’re happy to get feedback And you’re happy to adapt and change and grow and I think that’s a great characteristic. Especially as a clinician and as a person.

Thanks, guys I appreciate that. But enough of the niceties. We’re here to talk about why we’re doing this podcast for the people that are listening, but as I said before, I think can we just quickly share some personal experiences with pain ourselves. So, you’ve shared one of many stories about pain, and I’ve got a long history as well. Butt I’ll pick the most influential one for me. Is there any more that you want to share in terms of experiences with pain?

I find it interesting because the things that have the most significance are the most threatening ones I reckon. I’ve had many different pain experiences. Probably one other one I could pick out of a number of these, but one of the ones that struck me. I had a big fall and badly fractured my wrists several years ago. About 18 years ago I reckon! 

It was a complex fracture of my joint. I would have punched the joint and split and fragmented it. 

It was all sitting out here and I knew as soon as I got up I had a deformed arm that didn’t move. I had to move my arm for my job. I was working a lot more with my hands back then. That was a massive issue because this is definitely not what a physio wants. That was the first thing that went through my head. That is not an injury a physio wants. 

So ended up I’m having surgery with pins stuck through it. The first thing the surgeon said to me was “your wrist is fucked”. And he was saying that it’s great you’re embarking on an academic career because your clinical career is gone. That’s what I was told. That is an absolute quote, not an interpretation. My first gut reaction to that was no. I don’t own that. I will not own that. So, I was also told to take three months off work. And I had a way less available. 

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 had been given to me. And this experience that this part of my body that I used and trusted. I used to rock climb mountains and I biked and I used my hands all the time. And could work with my hands to manipulate and feel tissue and touch people in my job. And now this is a broken part of my body that was kind of cast in the wastebasket. That was horrible.

After a week and after the pins coming out. I went back to work. I just worked with one hand. I realised I could do all my job with one hand. It took the patient’s bringing them in a second and they were like what’s going on here? They were like if you’ve got one hand how does that work? And I would give them a 50% discount. But it forced me to work differently. And there was a moment when I was like oh my god I can do my job with it one hand. I don’t need to do all that stuff I was doing before.

It was a great opportunity to say – I’m not taking three months off being sick. I’m gonna do my job. I will adapt to do my job on one hand. This forced me to kind of change a whole bunch of the ways I practice, a bit like coronavirus. It was that moment and then as soon as I got my pins out I had this emaciated arm. I can’t remember trying to move my wrist, and it was just horrible and I was miserable and every time I moved my wrist it crunched and grated.

I just had to picture of a healthy wrist and a picture of a healthy joint. I just kept that wrist moving and I just kept on moving it. I went back to work and I started using my hands. And I started doing things but it was chronically swollen. My wife suggested just giving the wrist a break because I never stopped moving. But I just kept on doing that and moving it. But it would ache every night. when I went to bed. I would use hot packs but it was chronically inflamed or I’d probably overdone it.

Then after two years, all the pain went away and my wrist was fully mobile. It has never hurt me since and that was years ago, more like 20 22 years ago. So, that was a really powerful moment for me of experiencing the impact of negative health information. It can be devastating. But the power of the mind and behaviour can alter processes. And the human body is extraordinary if you give it the right mindset and the right environment.

That experience has emboldened me to be courageous when I work with people with pain. Even when in the face of structural imperfection. I reckon that’s pretty cool. It’s always a learning experience, isn’t it? 

I have had two major events one of which was traumatic. I had had an accident and I broke my leg. I had a spiral T field fracture and similar to your wrist, when I looked at it I knew it wasn’t good because it was pointing in the wrong direction. It was quite a distressing time. I had surgery and it was a success according to the surgeon. After that process, I was gradually going back to using the leg. But at the same time, there was a lot of stuff happening in my life that was distressing.

At that point having a break wasn’t ideal financially, and I had other things going on with my life. I remember getting some really bad news one day. I was sitting in your house on your couch with my leg out and got the news at night. In the morning I just had breakfast and then I had this like little tingling shooting pain. 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. There was nothing else I could think of. The only thing that changed is that I got some distressing news, plus the whole context of this. It stuck with me, with such a significant body response. And so felt in your body. I have every right to think that the screw just broke or something went wrong. Or my leg was broken again. Or whatever.

I was soon after starting to put some weight on it. And it started to resolve and then it was resolved. Because I looked at that situation, I’m thinking the stress of what happened is what’s distressing me. That’s my body responding to it. I’m not gonna pay attention to it. Very soon it was resolved. But that discomfort. Then I rehabbed myself. Got back into walking and it was working. 

I went back to the gym and started doing a bit heavier weights than I should have. And then I developed this leg pain. It wasn’t an incident, I just was quickly building up weights and I developed this leg pain. And that was around the time that I was doing my specialisation stuff. It 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 how we’re discussing it here. I was getting various feedback from across the country when I was treating patients. I was being watched and observed and given feedback on the way I treated. And because there was a run of sports, there was a biomedical view was way stronger. I was constantly being reminded of these structural problems that we have. 

With this attention, we need to give to pathology. If you do identify the pathology the pathway for management is easier. And it’s clearer. It’s almost like following a recipe you know – it’s disc ethology – you do this no compression – you do that it’s a fracture you do x etc. At that time I remember having this divided mind. Half of my brain was thinking pain is a multi-sensory experience and in every dimension, it’s an expression of your health. Every factor influences.

And the other part of my brain was to structure it back to disc. I can remember kind of falling into these protective habits and having this image in the back of my head. Of this red hot injured part in my back, that I had no idea where it came from because I never had a scan. We had chats and I had to decide at one point. I either trust this or I don’t. That was a very divisive moment in my life. 

There was nothing else that changed apart from being true to understanding your pain and behaving as such. The interesting thing is that during that process when you’re receiving feedback that is different to what you received in the past. Then you have an exam you have to decide on how you’re going to work. At that point, I decided to go to this specialist exam. Which is a pretty rigorous process in Australia. 

And then I started practicing the way that I believe is the right way. With my true values of how I see pain and the management of pain. If that wasn’t enough to pass the exam I was comfortable with that process. Those decisions were around the same time when I also decided to eradicate those behaviors I used on my body constantly. I went to the exam I did what I had to do and it was just a very interesting interface between this old structural traditional biomedical training. 

It had been brought to my attention when you felt an experience in your body. I had the great advantage of heavy training, but on the other hand, the other way of thinking about pain. But also I’ve been talking to clinicians who they support that view. 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 or the power to go against that decision. It’s a pretty tough place to be.

That decision made a significant change in how I behaved concerning my body. In relation to protecting my body or using my body and I think that’s in the clinical encounters that we have with patients understanding where they’re coming from. We’re trying in a supportive manner to demonstrate to them a different way of thinking. If the structure is actually not the problem, it’s a delicate process. But it’s a very rewarding and interesting process.

We have a significant role in providing care for patients in that way. I was just going to say probably the other situation that I had is that when I was six years old I was diagnosed with Perthes which is avascular necrosis of the head of the femur. I remember seeing three top orthopedic surgeons in Brazil. The three of them said look your childhood is gone. You can’t use the leg. You should be lying in bed with a plaster.

What kids usually do they kind of just paint the ceiling and change the colour, put some pictures there and see how you go for the next couple of years. The other guy said we put a hip replacement. The third guy said just to see how it goes. And before you’re forty we can replace your hip for you. So there was this negative powerful information coming from the top of the tree, the most experienced surgeons. 

I remember my parents sitting there walking out of those consults and they were going “That cannot be true. It just cannot be true. Surely, the body cannot be that fragile.” We have to do something else. My mom did some research, she looked into a lot of different information and we took a different approach. When we spoke to another doctor and he said ” This is what the journals are saying but I reckon what we are going to do is use common sense. We want to narrow your experiences in childhood so you can drive a car later in life or play soccer or whatever you want to do. 

You have to gradually develop yourself and get yourself some strong muscles they said. I’ll be lying to you if I say that your hips are not going to look crap. But I don’t know how it’s gonna be in the future. Keep me posted.

That was a very supportive and not very common way of managing a situation like that. I went for my physio training and there was the Head Of The Orthopedic Of The Hospital when I was doing a placement. We had conversations all the time and he wanted to know what I was doing. In part, this was what brought in the social support because what I was asked to do as a 6, 8, 10, 11-year-old was not to run. Not to jump. Not to do all the stuff you want to do as a kid. It’s pretty much impossible when you live in a street with five other boys doing all that stuff.

My mom at the time she called all the parents of those kids and the kids. And she 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. I had these five friends. And these are still friends to me up until now. They basically told me what I couldn’t do.  

I was nurtured by this social support helping me to do things. They’d be like you can do this, you can do that. Let’s try this now. That was important because a problem that I had wasn’t put aside. It was validated. The knowledge was supported and that was important.

I see a patient with pain where the support there is negative. Where they don’t let people do anything. They don’t let them carry the shopping. Or lift anything heavy. Always “watch your back” or support your core more. 

I was there with him to consult. They were like you’ve got to be active. You gotta sleep. 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 too. And if they all have that information, or not, is a really important thing. We know we have to do our thing. 

Those personal experiences help us with our consults. I think they’re hugely valuable. It kind of reminds me of what I went through as some of my memories growing up. So I’ve fractured several parts of my body but one particular that comes to mind. I was playing football and I hurt my hand. I told my mom at the time and said, you know, I’ve got a sore hand. She said, it’ll be all right, no worries. It’ll get better don’t worry too much about it.

A couple of days went by and my mom was staying that it’ll be 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 and a bit blue. And mum was well ok let’s go to the doctor’s. The x-ray showed there were two fractures. My poor 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 the path she took. That she didn’t you know, baby me, didn’t protect me. She didn’t shelter me and 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 you can kind of summarise what that all means. 

Why do we say that?

You were both part of a wonderful tool that we heard last night. When we talked about people that have had a knee replacement, and we talked about these different pathways that people go down. You either have a great pathway or and not such a good pathway. The vulnerability of it, it touches you in a way. 

Sometimes you’re around people who can have pain and still kind of move on in their lives. These people who’ve got good social support from people around them. They’ve got high levels of self-belief and self-confidence. They adapt and they can shift the way they think about a problem to adapt to it differently. 

Where the viability and the vulnerability factors are really around poor social networks, a negative mindset around the body getting stuck. There around having no strategies, like hitting roadblocks. And not having any support to kind of get around those roadblocks and that could be health support, or social support and none of their resources.

Good health is so important because, when you hit a roadblock, you need good health. This is what I say to my patients. I had one today, and she was like I’m just being driven mad. But at the end of the day he goes, I feel so much better as we talked through a strategy. I said why do you feel better? She goes I have a plan now. I had no plan before. I was stuck. I now can see that there is a way forward.

We see these pathways or when people just get stuck. There are so many pitfalls in the health system where the focus is on your damaged body part. It’s a reductionist kind of-sickness mindset rather than a health mindset. Let’s say your body is another discussion today. And the brain’s like a pharmacy you can open up. You know you can create pain drugs that are all in your brain. In that capacity, it’s kind of how you unpack that. I think you’ve heard both of these scenarios where pain can be related to damage but there’s so much more to pain than damage.

That is about how you understand and how you respond, and how you support the journey. It’s how you adapt to it, and how you manage it in your pathway forward. That’s what this podcast is about. To kind of share narratives of hope for people. It’s not in any way to say that structure is not right to pain. Because it very often. But it’s just one bit of the puzzle. I think with women it’s the only bit of the puzzle that’s a massive trap. 

But the other thing is that the body has this amazing healing potential. There’s some amazing ability to adapt and respond to difficulties positively. If you have the support network, the mindset, and strategies to go, that opens up a whole new plethora of options to help get better. If you just think that the pains too much and you’re too damaged then you’ve got that one option or very limited options. 

Understanding that pain is simply part of a bigger picture opens up the doors. There are lots of different things that can help with this. I think what struck me as the most with Nadia’s presentation last night, was getting better but not by measuring the amount of pain you’re in. We often measure whether we are getting better or not by your pain scale. So, if I am in pain every day. And I’m tired of my life. We might think we’re not getting better when we are. 

But if it doesn’t bother me, it doesn’t keep me awake at night. It doesn’t stop me doing stuff and it doesn’t in any way inhibit anything I do. Then that’s the measure of pain in my mind. And that’s about the meaning of it. I think we need to get away with this measure of pain on a numerical rating scale. Because you can have a six out of ten for pain. But I can still feel like ok every weekend when I go mountain biking. And it’s pleasurable right but it’s still painful so that brings up another different meaning with pain. The pain can drive you mad if you don’t understand it. 

Potentially if you have some negative healthcare experiences they can get you down. I think for me that kind of experience highlights one of the reasons that I wanted to do this podcast. It was to show there are some healthcare practitioners out there that might not provide the most up-to-date care based on research. We’re lucky that we have our foot in both research and working clinical practice. 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 seventeen year lag for health or research to get from universities to the real world into practice. That’s just not acceptable. We need to be doing better. To think that someone’s going down the road to see a physio or any other doctor and getting care that’s 17 years old, that’s a scary thing for me. That’s one of the biggest drivers for creating this podcast that’s free and people can easily access it – it’s not behind a paywall. It’s not technical medical jargon and it helps to empower people.

I was wondering is there anything else you want to add to that? We’ve decided to do this podcast. It’s probably important to mention that in terms of conflicts of interest; we’re not getting paid to do this. As I said before I work in clinical practice. My income comes from seeing patients and I also am a partner Bodylogic Physiotherapy. It’s a clinic where we see patients and we provide a physical therapy service.

The other part of my income is from working in academia as a Research Professor. The only other way to get income is when we are invited to present in clinical workshops. 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 can be conflicts of interest. 

Why do we do this? Well, there’s more to pain than tissue damage.. I recently saw a lady, a highly-intelligent 50-year-old who has been dealing with pain for over 25 years. I asked her what the expectation of our consult was. What would you like to get out of today? She said I don’t know. She said she’s seen over 25 clinicians and lots of scans. The scan shows nothing. She gets its not in her bone structure, but it still really hurts. When she touches it, it hurts her back. Every day it’s the same place so it’s not in her mind, it’s in her body. 

But she can’t explain her pain. She didn’t understand how she can experience something like this but have no explanation. That was quite a compelling question and there are lots of patients out there that have the same difficulty in that understanding. I think we are lucky we have access to all this information and we are producing it. Other people have access to other places that might not be quite as reliable. They might be going on Twitter getting information left right and centre that’s just not even correct. 

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 to come 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 they can go to their clinicians and go hey. What do you think about this?

So this lady I was talking about, she’s being stuck in a place where she’s following all these rules. These are very common rules imposed to us through our training over the last 17 years. Probably not a lot of these rules they have been challenged. She has got a lot of self-efficacy, she has sourced her own information and she tries hard to keep herself informed. 

But she still couldn’t get out of that place. She had a lot of other factors in her life such as stress, such as putting on weight, working a high-pressure job. She didn’t have social support. She did have significant events happening over the last couple of years. Despite the fact she had pain for 25 years, over the last couple of years is when that pain became unbearable. So all those factors that were current were reflecting and influencing her pain experience. 

It went way beyond her skin. It was a very clear case where tissue damage wasn’t even part of the picture, because she had a very good look at her spine, but it’s surprisingly in good shape for a 50-year-old. And you’re like hang on a second. So you look at that like if this is not tissue damage, she said that herself. But perhaps she hasn’t been as active as she used to be on and she’s put on weight and she’s working a high-pressure job. She might not feel as much stress but her body may feel it. Her sleep is altered.

So, there are lots of factors that we know can influence how your body responds. And you mentioned before about having options, and I remember when I was looking 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. And to facilitate people to get back doing what they wanted to do.

My fundamental training was that pain equals tissue damage. I remember my lectures were the name of the pathologists we’re going to study. When I came over here I came to get better. Because then I could you know, figure out the source of the problem and fix it. I came here and Australia was going in this shift where I was it was hands-on heavy. But also motor control, and it was a really interesting time. It challenged my beliefs at that time.

I remember when I was formally presented with this biopsychosocial view of pain, although it was very challenging. I was like hang on a second? so does that mean that my management now includes talking to people about this sleep optimisation. Talking about stress management. Talking about being physically active.

All of a sudden my toolbox just increased. I had all these factors many are modifiable. We can help people to interact with them. If we take painting on a picture and we put other health problems such as cardiovascular disease or diabetes. All of these factors are present. So, it sounds like the pain word is just taking a bit longer to catch up. Especially the beliefs around the community. 

Part of my job as a Professor occurred in unison where I was working with this amazing team of researchers and I was very fortunate. I was kind of one small piece in this kind of wonderful machinery. Then the other role here is clinical and then co-directed with Peter and this is Bodylogic. I made a decision and it was a very easy decision to make. I can remember grappling with this probably for maybe twenty years ago. Whether I would use my knowledge to create an educational business.  

I could see there was a lot of money you could make through education. I remember most because I came from New Zealand and there was the “McKenzie” system. 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 in what he did and very innovative. But though all of those theories, there were no concepts around self-management,

And it was all kind of wrapped up in this kind of scary language. And very much around structural models of pain. To be fair I think in an element of the McKenzie approaches shifted, but I can remember sitting in some of these workshops with him. And he was a brave guy, he bought patients into his workshops. But he’s a very strong person and I was a young questioning, fearless, curious person. Who put my hand up way too many times.

I got this sense within our profession where it was like a pyramid with a person at the top was the king, and they just told all that others what to do. The others just followed and didn’t question. That whole thing that was kind of like a tipping point where I could have gone down this pathway. I’ve thought I can make a lot of money out of education by educating physios. I’m going, you know, it doesn’t fit with me. 

It’s not what I do want to do fundamentally, knowledge is. I could see there was a trap where if I started creating a business around knowledge. But then I’m constrained by this business not having this open world of learning. I made a deliberate decision at that time that I would not do that. I will never do that in terms of you know a system.

This is a system and a lot of people think within the cognitive functional approach to managing pain. A lot of people probably look at me like I’ve got some vested business interest. But we’re not selling a product in a sense. But it’s this idea of creating knowledge to be shared. Knowledge to be curious about. Knowledge to create and acknowledges ongoing evolutionary updates. 

I think there were a lot of people pushing me to do it because they could see a financial benefit for themselves. I think I pissed off a few people 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 evolving and change.

I think it was a really good decision a long time ago. Since when I finished my Ph.D. in 98, I spent a lot of years like 26 years of doing research or publishing papers. Like you say, every day, I’m hearing people go why didn’t anyone teach me this? It looks like we’ve spent so much time publishing stuff that is never accessed by the public. That is fundamentally wrong.

I hope this podcast can reach people and give them a taste of what knowledge looks like and how that can apply to them in the real world. 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 to the average person it would be 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. I think it’s a beautiful part of working in clinical practice is where we can have simple conversations with people to translate knowledge every day. I was thinking about your 17 years thing you know 17 years behind.

I kind of see clinical practice 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’re part of an innovative road testing clinic. If you’re brave enough to be part of it, we will be honest with you on that journey. 

But in a sense, it’s kind of like an iterative process of saying what’s working. And allowing 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. I guess the other thing is one of the things we would like to try for these people in pain, as well as clinicians that are helping people.

We love to hear from them and have their input, so this is not initially what’s presenting to us or what we think is important and interesting and necessary. But it would be great to get feedback from patients to get their questions answered in a way that makes sense to them.  

We get asked lots of questions every day and at times it seems like we’ve some of the questions may seem trivial or may seem difficult to answer, but they’re so commonly asked to us. It will be good to have a common narrative that we can pass that on. And have our patients have access to it. 

So, we have set up an email for that. In the spirit of getting questions from the listeners, if you do have questions they can email the podcast at body logic physio. We’ve also put our feelers out through Twitter to pick up some frequently asked questions as well. There are certainly plans in the pipeline.

I think we should wrap it up now. 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 health businesses 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 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…Talk to you then, and remember to ask: is there more to pain than damage.