In Your Pants with Dr. Susie G - Moving better with less pain

Episode Date: April 7, 2020

Seeking treatment at the start can seem frustrating - maybe the exercises aren't working, maybe the hands-on manipulation is causing *more* pain, and you're thinking "this is supposed to make me feel better why is it not working?!" The goal of physical therapy is not only about instant relief, but about rediscovering how your movement allows you to move better and with less pain. The goal of any therapy is to get your life back and allow you to do the things you love without worrying about your pain alarms ringing. Neil Pearson joins me on In Your Pants, a physiotherapist and Clinical Assistant Professor at the University of British Columbia, and in this episode we bust misunderstandings about the conception of pain versus the lived experience. Check out the show notes on my website: www.drsusieg.com for a worksheet on pain that you can do at home!

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to another In Your Pants podcast. I'm so glad that you are able to join us today. On today's show, we are talking about contemplative and movement-based pain care. And to help me do this, I've got a very special guest. His name is Neil Pearson. I'll get to his wonderful bio in just a second, but I wanted to just share some of the key

points that we'll be talking about on the show today. We'll be talking about pain education and science and biology, what it is. This is a very big topic, and we're going to try to bring it into a very digestible and manageable way of explaining it, but not just to give you information, but also to help transform your experience because pain education and pain care should be about helping you to experience the possibility of pain changing in your world. So Anil and I discuss a lot of the factors associated with our lived experience with pain and some of the many different interconnected collections of processes that are involved with our pain experience.

So without further ado, let me formally introduce Neil before we get to the show. Neil Pearson is a physiotherapist and clinical assistant professor at University of British Columbia. He's a yoga teacher, a yoga therapist, and creator of the Pain Care Yoga Training Programs for health professionals and yoga therapists. Neil is founding chair of the Physiotherapy Pain Science Division in Canada. He's the recipient of the Canadian Pain Society's Excellence in Interprofessional Pain Education Award. He's faculty in yoga therapist training programs, and he's an author. Neil develops innovative resources, collaborates in research, and offers a yearly mentorship program for health professionals and yoga practitioners seeking

to enhance their therapeutic expertise. He's also the co-editor of Yoga and Science in Pain Care, Treating the Person in Pain, and Understand Pain, Live Well Again. So without further ado, I welcome Neil Pearson to the show. Welcome, Neil. Thank you so much for being in the In Your Pants podcast. I've never been in one of those before. You have pants, don't you? I do. I hadn't thought of that as an option, but yes, I do. Awesome. Well, thank you again. Welcome. So thank you so much for taking the time to be here. And let's just start right off the bat. I'm always curious as how you find yourself in yoga therapy, going from physiotherapy to yoga therapy. How did that all happened for you right well uh i guess i should say so i've been a physiotherapist physical

therapist since 1985 and uh really started to get much more interested in in uh chronic pain initially and then helping people with persistent pain problems and then when i started i guess the the yoga therapy piece really started when i started to work in a uh a pain management center pain management clinic and it was more of one of the cognitive behavioral therapies sort of focused clinics with lots of movement and and um education and uh breathing techniques and all those things and so at the time i was i just moved to vancouver and i was starting to uh practice yoga uh in classes and the more i was practicing yoga in the classes and the more i was working in this clinic the more i started to think there's some really amazing uh similarities and commonalities between

these two things. And so that really got me more curious about how we could start to take what we understand from the yoga philosophy and yoga practices and integrate it with what we understood from pain management, from the lived experience of pain, and also from the science that we were learning about how sort of how pain works. Yes, good segue into that as well. So you do really integrate the science of pain and that lived experience of pain in the meeting that someone has. Can you explain to our listeners, you know, what is pain education when we talk about pain education? What is it? And why is it such an effective and important aspect in pain care? Wow, that's such a big topic, the idea of pain education. So maybe we could reframe it as

in life we have lots of experiences of pain and we don't often take time to sit and think about what we actually think about pain and and sometimes when we do we start to realize that our thoughts about it don't really match up with our experiences and one of the simple examples would be something like a paper cut you know a paper cut it's a relatively small injury but it can give you a really really big pain doesn't always but it can and we never sort of sit back and think about, well, hang on a sec, what's that mean? Because our normal thought would be that pain tells us when we've been damaged and we have more pain when there's more damage. But if we sit and think about a paper cut, we of course start to realize that we haven't really considered maybe

it's more complex than that. So that actually could be the framework for all pain education or all trying to help other people understand pain, whether it's health people, healthcare professionals who haven't really thought about what they think about pain either or us when we are experiencing pain it is it really is the idea of there's a lot of misconceptions about pain misunderstandings and some people would say our kind of you know a bigger word would be our conceptualization of pain and the lived experience of pain and even our our beliefs about and our attitudes towards recovery when there's pain in their injury we haven't really sort of stepped step back and thought about that is we pretty much all know somebody who's been in a catastrophic

injury. And even though there's been all this horrible damage to the person's muscles and joints and bones, here you've got this person, his back pretty much doing life. And so maybe there's still some pain, but that's a massive injury and you would expect that that person would be wildly disabled by it if our thought was that the amount of pain that you have should be directly related to your tissue health right and so we have this idea is that you know if the tissue has been injured then we're always going to have pain or it's always going to get worse and but we all know people that that didn't work that way so back to pain education is how do we provide people with with knowledge and how do we provide people with an experience which i think is actually more

powerful. When we have an experience that's inconsistent with our previous beliefs about pain, then that allows us to sort of wonder, which is a little bit different. Because I think one of the troubles we have with pain education is sometimes a person would come up to a healthcare professional and say, well, of course, I've got all this back pain. They show me this big disc bulge on the MRI. And the person says, well, when was that done? Well, it was done a year ago. And of course, the healthcare professional now is thinking, well, because it was there a year ago, it might not need to be painful anymore. It doesn't always, lots of people have these things and it's not painful. But if I, as a healthcare professional, jumped into starting to tell you,

so you said, this is why it hurts. And I say, well, no, we know that people who have this don't have to have pain. Well, that's sort of hitting a belief sort of right in the head. Whereas if you think of it a different way, so you've got that experience, if I could show you a way to move, or if I could guide you with movement, or guide you with contemplative practice in a way that at the end of it, you were experiencing that you could move with less pain. So now you've had an experience that's inconsistent with what you believed. And so you might wonder about that. You know, has there been some sort of weirdness happening here? Is there some, you know, we started to almost think, is there some magic in this? right does this this person done something to me right but if i could get you to have that

experience repeatedly where you were doing something that would change this pain repeatedly over time it allows you in a very gentle way to start to reconsider that maybe your thoughts about this don't actually match up with actually human experience right and i think that's going along the lines of what we're talking about that pain is changeable so we're violating an as you call the expectancy violation, where it's contradictory, right? Where you expect one thing to happen, but you change the context, or maybe someone's guiding you in a different way, or even under the radar to do something very similar to an activity that might otherwise be very unthreatening. And like you're mentioning, kind of surprises the person in a very contemplative

way like, wait, how did that happen? And I think you're right where it's like we need to start to create more of those positive experiences to create new memory traces or a different type of learning for the current situation that one is finding themselves in. Right. I mean, the education, we have been really focusing on the cognitive education of sitting a client or patient down and explaining it to them. And I think that's useful. And if you look at what Laura Mimosley and David Butler have really championed is this idea of using metaphor and story. And the cool thing about story is it's an experience. So if I can tell you a really engaging story, you get wrapped up in the story and it becomes more of an experience than me

providing you with knowledge. And that allows, once again, this more gentle ability to consider that maybe my worldview or my view of pain isn't quite accurate. Yet I think that one of the things that we need to recognize from us on the healthcare person's side is that what we need to do is to recognize that we're giving people experiences sometime. So if I did manual therapy on your neck, and at the end of it you could move with more ease and have less pain,

well, this actually is a pain education moment for me to say, wow, that's amazing, your pain changed. right because it doesn't always change like that so your pain changed and and then to me i would always throw in one other thing is let's find all the other stuff that will do that too because it's one of our frameworks around pain is our idea that we're looking for the thing that changes pain right we really want that because it hurts and we want something to change it and one of the things we haven't recognized um that science really showing us but patients have been telling this for us this forever, and we really haven't been paying attention well enough, is the idea of

there's multiple mechanisms of physiology inside us that can actually change pain. There's not just one, right? And so when we find one thing that works, what we'd want to do is then look for other things that would have similar or maybe more or maybe less benefit and start to put them together. Yeah, that's wonderful. Yeah. I mean, I've heard patients say this, and it was only a couple years ago that it it you know it's stuck in the right way as a person saying something like you know when my hips sore i get in the bathtub and i feel better but when it's really sore that doesn't work i need to get the temperature just right and i need to put in epsom salts and i turn candles on and i put aromatherapy on and i listen to enya and now the pain gets better right that's

what the person was saying was what i do when the pain's really bad is i layer on top of each other all these different things that all give me some pain relief but i can put them all together and even get a better pain relief. And again, science is saying, and this is really important for people here, is science is saying that there are multiple mechanisms within us. And so we want to learn many of those. And if we sort of flip back around to the yoga part, or what happens in a pain management program, is people are being taught all these different techniques. Because I don't know what technique will work best for you right at what time in your recovery so what we do within yoga practice this is we try to go in many many doors the same as we we do within a more

medical based or psychology based pain management program and i think that's really important as you're saying that telling people that there isn't just one path there are maybe multiple paths and multiple layers and those that are helping you or coaching you to figuring out well what are what's the secret sauce for you the ingredients for your secret sauce essentially right and so that's that's kind of what i tell people too like i'm just giving you a flavor these are just appetizers i want you to try them because as you're saying and i totally agree that it is an x it needs to be an inner experience that shifts them in a different direction it's an internal experience. And what we're trying to do is find those moments or those opportunities,

those teaching opportunities, and for them to actually experience it. I say, you have to start to practice some of these ideas, make them your own, just really experiment with curiosity, compassion for oneself, right? Because it could be easily, one could be easily frustrated. And I think that's a good topic to maybe kind of go in about like self-compassion and love as you're exploring through these, you know, difficulties or challenges or struggles in your life and know that just because one thing didn't work for you, it doesn't mean that nothing's going to work for you. Right. And sometimes when we try, say, a contemplative practice or, you know, in the medical side, we call it self-care practice. So we'll use those interchangeably, like self-care

and contemplative practices. So sometimes when we try them and it doesn't make a change in what we want to start. So maybe we were hoping that we'd feel calmer when we did it, or we're hoping that it might have decreased the pain or that I'd be able to move better afterwards. So we have a goal around it and we do it once and we don't move towards our goal. Sometimes our experience is that this doesn't work or I can't do it. And at this point, it sort of wraps up in the compassion side of things, but it's also a little bit of just reframing for us when that this happens because when that happens, I'll say to the person, okay, so I've never thrown darts before. My goal is to get this dart in the center of that dartboard. It's the right distance

away, but that's what my goal is. And so I throw the dart at the dartboard and I don't even hit the board, let alone the center of it. So what should I conclude? Because when we practice a contemplative practice the first time and we don't get a change or we don't get near the goal, sometimes we conclude, I can't do it or this is impossible. But when you throw the dart at the chartboard, most people would conclude the idea is, well, I need to practice this more, right? And I think this is one of the, this, you know, this fits in with the compassion piece because we often are so critical of ourselves. And I think that's part of, so I'm not trying to, you know, color us or paint us in a certain way, but I think that when we've had ongoing pain,

we've tried to change things so many times. And when we've tried to change things so many times, we start to feel less competent and the when we start to feel less competent then sometimes we become less compassionate right and and you know even our language starts to get on at times right you know we talk about our bad foot or our stupid back and you know this this language whenever that happens uh you know for the the yoga therapy side of these we'll say to person you know you know it's you right right you're talking about you you're talking about a part of your body and and the best the best approach to this is to you know reconnect with it and and show it you know i know it sounds really woo woo but show yourself love show yourself compassion be nice to yourself

like you would be with your best friend who's beating themselves up like what would you do then so do that for yourself um it's not the solution and i think what a lot of people hear when we say things like that is oh you know you're just one more person just saying think positive thoughts and everything be peachy you say well well no actually it's back to the layering bit that when we do that that's a piece of the puzzle or it's a one of the ingredients in the secret sauce as you said right that's right right and and i love that because um you you mentioned something important that we try really hard to make something go away or try really hard for something good to stay and i think that kind of goes into the philosophy of impermanence and this

constant um concept of everything is always changing although it may not seem like it is for you know someone who's really feeling like they're stuck it may seem like things are constant or never changing or or that they're doomed um but things are changing um like the sun is always shining but if you're in your house and everything's boarded up and the blinds are are covering the windows you're never going to see the sun unless you start to you know let some light in essentially it's always there it's just how much of it are we willing to receive and i think that might be reframing or as you're saying like you know let's not be so afraid of it because there's a lot of fear around pain um yeah well you know sorry the one thing i was going to say is that i i think one

of the things that happens is that we start to feel as you're saying that pain is immutable that it's not changeable and so we can we can have someone talk to us about uh equanimity and impermanence and these things and that can help but once again i would go back to wouldn't it be amazing if we have an experience in which the pain changes and then have the the person who's working with us you know sort of have a dialogue or discussion with the idea that that you know look what's happening here is is that you know of course pain feels like it's unchangeable but here's an experience where it did and let's look for some more and because sometimes it's it's uh possible for us to partially reconceptualize so that we start to believe

that yes it's changeable but until we have the experience that it actually is changeable it really is more of an academic kind of idea or there are sometimes we do formal education classes where we'll have people with pain sit down and at the at the beginning at the end we do this true or false questionnaire and uh what you get some people at the end is is they'll they'll look at the question there and they'll say so do you want me to answer based on what you just told me or based on my experience and the first time this happened i was i was like my jaw was on the floor i didn't know what to say but what the person was saying is that they understood the information right and they understood that this was possible but they didn't believe it was happening in them

and you know it took me a while for me to figure that out as well what this person needs is an experience that would be consistent with what the new information they've learned because that's not their experience their experience is what's going on in me is something different it's something that's not changeable i've tried all these things nothing's working and and i think that's for you know if we go back to the pain education but also the contemplative practices is is they're more experiential even though both of them happen in you i mean this is sort of weird right when we try to talk about it if if you provide me with information then well i'm changing there's a you know there's a change happening to me but there's a different kind of change that happens when you

provide me with an experience right and and it gets really fascinating because sometimes people they have the experience but until the person understands why that could have happened it seems too woo-woo it doesn't feel so real and you can put them together that way but then sometimes we need to go the other way for some of us we need someone to explain to us that it's possible and this is what's happening and then to have an experience that confirms that right it's sort of odd that we need to uh go in different pathways and and i don't even think that it's it's it's not like it's it's for you you need the knowledge and then the experience afterwards I think it's actually for the concept.

So for you, sometimes you may need the knowledge first and sometimes you need the experience first. And that's part of the reason why I love what I get to do is because as a physical therapist, I can go in the more cognitive, knowledge-based door. And then the yoga and the yoga therapy has really opened up the door to go through the more of the contemplative or experiential side.

Yeah, oh my gosh, that's beautiful. and it sounds simple, but I think it's not easy, right? Especially for, I mean, healthcare providers and wellness professionals and for those experiencing that lived experience of pain, because we try to get that experience. And sometimes, you know, you do have to work through many layers as you say. So Neil, in your clinical experience, how do you frame what you do with the person in front of you like how do you set the stage to let them know that this is a process because it sounds like this is a process versus you know one and done yeah true uh so i'll get to the question i think but the bit of the process versus the the immediate change right

is that um even when i came into this i was thinking of pain management more like a light switch and um even when it was fascinating to look back because at first i got to the point okay it's not but then i didn't realize that my language was still more like the the light switch thing until a patient said to me one day is you know she said you know the thing that i've learned from the experiences you've given me is that pain management or pain care is it's a dimmer switch and she said and and we are talking about and she said she recognized that she started with that idea of looking for the thing that would turn it down or off but she had learned that that it was more like a dimmer switch and and she was a really really really sweet woman and we

actually started to have a dialogue because she started to tell me about some of the language that i was still using that uh matched better with a light switch than it did with a dimmer switch and so it was a really great learning experience because she just had that capacity that to help me of course that's where i learned most of the stuff that i learned is from listening to people in pain who have been gracious enough to let me sit at their feet and learn from them rather than just doing it the other way. But in terms of that's a process, where I am right now, it's a little bit more simple because people come to me

either to the yoga things that I do or when I am treating people in physical therapy, which over the last couple of years I've been doing so much teaching and development that I haven't been you know sort of rare that i see people one-on-one but anyway when people come to me in the other those those places there's sort of an expectation of what they're going to get to start with um so it's harder if you are a regular physical therapist or occupational therapist actually maybe people i think occupational therapists would do more on this than physical yes i agree um when people come to to a physical therapist you know what they're looking for is the

physical therapy treatments the thing that would actually help the person to move with more ease the the right exercise the kind of treatments to make them better um and in there um so i've just actually started to consult with this big canada-wide uh clinic group they got over 250 clinics and a lot of them are physical therapists who are working in more of the the acute subacute and so we're we're figuring out how do we bring this in and so what we're talking to them about is the idea of shifting language so that when a person comes in with your standard back pain, neck pain, shoulder pain, you can do all the stuff you normally do. And as a patient, you want to expect all the stuff you normally do. But around the pain, what we would hope is that the person

would also give you an idea that there are things that you as an individual could do to try to change this. But also that the language you'd be hearing is a language that suggests that when a physical therapist works say works on your neck there's some mobilizations or something on your neck and you can you have less pain and can move with more ease at the end but the person would be talking about how um this is this is showing that pain is changeable and that there are you know if i can do something to you to change this let's look for the things that you can do to get a similar kind of result so that there starts to become a conversation early on that pain's not just all about the tissue that um our our protective responses our nervous system our

immune system those things are are important and i mean when when i see if i see any friends who have you know stuff and you know i do the you know the typical physical therapy assessment and i tell them the stuff to do at the end of it it'll all sound like your normal physical therapy but at the end i'll say something like there's this breathing technique i have an audiophile of and i'm going to send it to you and i want you to listen to this and do it five times a day because i know if you do that you're actually going to change the chemistry of your body you'll change the inflammatory chemistry of your body and it will help healing i can't tell you if it'll help you get better faster but i know it helps healing and so when i'm teaching physical

therapists about doing that kind of thing i say i actually don't really care so much if the person does it because they're probably going to get better without it anyway because we do right we normally do get better without adding those things but if i say that to you at the beginning and you're not getting better like people normally get better and now i start talking about the fact that that pain doesn't just have to do with the the tissue and the tissue healing there's this other thing now you recognize that i'm just not making something up because my original idea didn't work right it's actually trust yeah breaks that trust yeah a little more mostly made such a beautiful comment you know for the first two months and 29 days all you do is talk about the

tissue and then the very next day now it's at three months and so it's now officially a chronic pain condition you start to talk about the nerve system how could the person believe you right right exactly yeah set the framework set the container you make sure it's safe obviously and that you're building trust and the rapport between the person in front of you who's bringing strengths and weaknesses and their fears and worries and all that and taking into consideration the entirety of the human being and as you mentioned their lived experience and validating their experience um yeah that's so important yeah and i think one of the other thing is is that to reframe the things that we as physical therapists do for patients as uh well actually what are we trying to get out of

it so if if a physical therapist was doing um one of the needling techniques like acupuncture or manual therapy. Now, there are times that we might want to do that or we might want to receive that because the pain is really horrible today and it'd be really nice if somebody just made it feel better. And so the goal right there is to actually give the person some ease, some escape. But a lot of times when you do this over time, right, when we're doing these kinds of treatments over time, the purpose of them is to help a person to move and or live with more ease. And this is another reframing that we're trying to do in this process is to say to people, so if you were my patient, you had neck pain, I would say, you know, I'm going to do this technique on your neck and let's

see what happens. And if it did give you less pain and more ease of movement, I would tell you that that's the purpose. The goal of this is to help you to move with more ease, right? So I'm going to help you do, I'm going to help you by doing this. And then you need to do this because it's your movement is actually going to make you better, better than just me. And so if the treatment that I'm doing for you is not allowing you to move or live with more ease, then we need to change the treatment. Because it's not just about giving you pain relief right now. That's great, right? But what we want is, over time, is that it allows you to get back to your life. Because you getting back to your life the you know the the the every aspect of you getting back to your life is going to help

you get better again and we haven't framed it well and and that's part of the the teaching people about the process and i go even further because i work with the the doctors of british columbia helping the family practice docs to integrate some of these things and what they do and one of the one of the things we do with them is say so if you're going to write a prescription for somebody you write it on your piece of paper and you're handing it to the person but you don't give it to them yet. And what you say to them is, this is to help you move better. And if this hasn't helped you move better by next week, we're going to change this. So you're going to come back and see me next week. And so it's a reframing it from rather than saying the point of this treatment is

to give you less pain. The point of this treatment is to help you get back to life. And if it's not doing that, we need to change it. And so that's part of the learning of the process. So as a person in pain, we need to recognize that the majority of times when we get hurt, we get better. The human body is so resilient, has such capacity to improve and get better. But there's sometimes when we need help, right? And sometimes the help we need is just the standard, just the thing that the doctor can do temporarily or the physical therapist, chiropractor, massage can do temporarily. so essentially you know we're not focused so much on the symptoms or the pain we're actually trying to shift the focus to to alleviating suffering or improving that person's quality

of life so that they can take actionable steps to live better move better be better in the world feel better about themselves and how they interact it's not just you know pain and the symptoms which a lot of us are so focused on just getting rid of and if it's not gone then it must not be successful. And I think that's what you're talking about, Neil, is shifting our framework around, well, how do we work with the person in pain? And instead of just pain, pain and throwing in the kitchen sink at symptoms, we can't compartmentalize pain or a person or even by symptoms. Well, I think somehow we need to hold some things that feel opposite. There are times that when we're in pain, it would be really,

really great if somebody could give us a hand with that pain. And then there are some times when we have pain when it's better to focus on recovering function and getting back to life, social engagement, work, all that stuff. And what we often see within the pain care world is one or the other. People go into a place and say, we're not going to focus on your pain here. We're just going to focus on helping you get back to life again which cannot feel very well very good sometimes and then on the other side is is the that lets us you know we're going to focus on the pain and sometimes that works but sometimes it creates the wrong focus because the the the purpose of decreasing the pain is to help the person get back to life so how do we do both

yes and and this is problematic for us when we when we have ongoing pain because at some point we start to get the spot of wondering like, where exactly is this going? You know, what is the outcome going to be here? And it's odd that people don't often, people, I mean, healthcare people don't often talk to us about this part. And that we don't know for the person, you know, when we have ongoing pain, we don't know and the healthcare professional really cannot tell us which path we're going to go down. And we may go down the path of really the pain mostly goes away and we get pretty much everything back. Or we could go down the path of getting to a spot where we can do so much better and the pain is still there, but it doesn't bother us anywhere near like it did

before. But then there's another path. And the other path is the path where the pain really hasn't changed very much, but we get our life back, you know, sort of despite the pain, which is such an odd thing, but we need to, as people in pain, we need to hold that that's a possibility because there are some people in pain who will tell us exactly that story that the the biggest thing that the health care or the yoga therapy world gave the person was the capacity to re-engage with life and yet the pain even you know all those things they tried the pain didn't change very much and and it's it's tough because the system seems to want to to decide which one are we going to work on. Either we're going to just ignore the pain and just go that way, or we're going to do

this other. And I would suggest that what we want to do is try to find the things that can help us find some escape and peace from the pain and also work on getting our function and our life back at the same time. And it's almost like we need to follow two paths at the same time. And this is this is frustrating because isn't medicine supposed to be certain and definitive? Yes. I need to know exactly how many hours, minutes,

seconds and days this is, you know, it's going to take. And yeah, we, yeah. Humans love concrete, like black and white answers.

And unfortunately pain is a phenomenon like many things in life and being human with its predicaments. but it's how do we work in the face of uncertainty how do we get comfortable with uncertainty I know payment children that's one of my favorite books by the way I'm plugging it in here but getting or get comfortable or comfortable with uncertainty payment children but anyway it's just it's just really interesting how once we kind of think in different ways and kind of shape our lives with with those philosophies um how things can change oh absolutely yeah yeah i think to come back to what you said was if the only thing we're trying to do is to change the pain and that's where we

run into trouble and i think we also get in trouble if the only thing we're trying to do is just recover function um we need to have more paths and again i think that's part of the reason that that yoga can really work for for people who want to engage in yoga it provides different paths within it now you've got the movement path you've got the contemplative path you've got the more meditative practices you've got the the self-love compassion you know practices that are that are aspects of of you know the broad view of yoga absolutely and being transparent i think you're talking about like as health care providers it might be very difficult you know because the person in front of you is looking to you for answers and it us as a provider should be okay

with that uncertainty as well of knowing, I don't know where things will go, but I'm here to support you. I'm not here to fix you. I'm here to support you on your journey. And I like to use my hands to support you, not to fix you. And that's one thing. I think one gemstone I learned from my yoga teacher training was like, you use your hands to support the person, not to change them, not to fix them, not to adjust them. You're there to be supportive and say, I accept you as you are and there's no need to to change your shape to be anything other than it is right although i as you said that i was thinking the one the one little shift would be a lot of times when i put my hands on people's bodies when they're doing a like the posture practice or move practice it's actually to

uh give them some biofeedback so they can adjust out right so you know the yoga stuff is more like moving further in and so many times people have gone so far that they can't breathe anymore their body's getting all tight and and when you you know put your hands on a person in a certain way sometimes that allows the person to become more aware of what they're doing in the moment and realize that you know really that this practice is about challenging ourselves but still doing it from a place of some ease or uh some place where you feel like you have some possibility of smiling in the midst of this yes i love that you said smiling because playfulness i've been doing a lot of research on my own about play and neuroplasticity in the brain and and a lot of the

research comes from animals but and there's actually a cool video if you guys look it up it's a polar bear playing with a husky have you ever seen that neil yeah i just saw that that's yeah it's so cool that like you would think that you know in the dead of winter in manitoba i think actually in Canada, someone videotaped a polar bear and a husky playing where you would think that that would be a snack for the polar bear who's starving, but they're waiting for the ice to freeze over again. And they just play and the most compassionate and just, it's just awesome. But anyway, we are also, we have a lot of play that I think gets lost as we become adults. And I think, you know, adding music, like you mentioned earlier in our conversation, adding those layers

and making the impossible to I'm possible and showing them that humor and having fun can actually change the way your brain is wired. We just have to tap in what works for that person. And what does play mean for that person? When was the last time they actually played? And there is no definitive definition of play. Just like joy, it's different.

But anything that brings playfulness and joy into that person's life will be supercharging their recovery at least their well-being. Oh, absolutely. There was a study probably 10, 12, maybe even longer years ago. It was a really small one, but they took a group of men who all had low back pain for more than a couple of years. And if I remember correctly, they did a whole bunch of questionnaires and in the midst of the questionnaires, they were looking at their pain and their mood and things like this and um then they gave them money to go see uh to be part of the study they were

going to go see a movie but they needed to take their best friend then they gave the money for the tickets and you know the popcorn and stuff um and then the next day they sorry it had to be a comedy movie right and then the next day they uh they got them to go through these questionnaires again and what they found was that the majority of people um doing that you know because you've got the the laughter right you've got the social engagement of a really good friend which all we all know the science behind those things but anyway the majority of people were better there was about 60 percent of people um said their mood was better than their pain was less and all that stuff but what the scientists did that i think was really really great is they looked at was anybody

worse and what they found was that there was about 20 percent of them were worse so so i think it was 60 were better 20 didn't change 20 were worse some numbers like that and the fascinating thing about the 20 is that they did a qualitative uh questioning with the with everybody and the people who were worse uh basically the the the response was don't tell me that all i need to do is laugh and smile and hang it with my friend and everything be fine so what the person felt was invalidated by this idea that that humor would be of of benefit or social engagement would be a benefit which of course isn't the isn't the uh the point that we're trying to make and i think but i bring it up because i think it's really interesting that there are some times we're not ready for it right

so yes it can help but we're are we're in a place where help me with my back help me with my back first and you know then maybe we can move on because a lot of times people start to get the sense that you're ignoring the problem right because we don't have the right framework around it um that that thought is you know help me with my body and once my body is getting better then let's add this stuff in and i think you know i say this more for the health care people and the yoga people who are listening is is uh you know note there sometimes you don't feel safe enough to try this yet now it's like uh the experience of you know there's probably been some time in your life when something's really upset you and someone who you love dearly is right beside you

and they're telling you it's okay you know to calm down and you're sort of pushing them away because you're not ready not ready it's it doesn't feel safe to do that yet and so we can run into this very same thing with with uh playfulness and humor uh at some times and and we just need to realize that that that's okay it'll work it'll work later once we've addressed other things it still gives some benefit right and neil how do you like for the health care providers and the wellness professionals how does one what's the best way to go about knowing when certain things are appropriate i know there isn't a protocol and that's not what i'm asking for but it is i'm just trying to maybe even make a point that it is difficult sometimes to you might you might you

you try something and it might not work, but don't be discouraged. It's a learning opportunity, a teaching opportunity to say, and to actually be honest and upfront with the person in front of you to say, okay, well, and please let me know if this doesn't work for you. Right on. Right? Like permission. Yeah. So my answer would be listen and build a therapeutic alliance, but then always recognize that it's still a human being in front of you and you only know them for a certain period of time. And so there's a really good chance that even the breathing techniques that we're seeing to work on lots of people, it's possible that that could increase anxiety in the person in front of you, or there could be something about it that could sort of turn on the pain tune in a way that you don't really expect.

and so what you just said about permission the the the people we're working with need to know that they have permission to pause anytime they want and let us know it's not getting them what they want to get i know that sounds really really loose but that is the point if i'm getting you to do if i'm as a health care professional showing you a technique for you to work on if it's not getting you what you want to get. We need to know that now. Actually, if that were to happen, if you were to say, you know, this isn't making me feel whatever. The question I would say is, so well, if you think about what just happened, does this technique seem to be one of those things that if you keep on practicing it, it would be worthwhile and will be helpful? Or does it seem

to be one of those things that it's just going to bug you and it's not going to be of any value right now. And once again, that's loose, right? But it's amazing that so many people actually can say, oh yeah, it feels like if I work on this, it's the right thing to do. And other people, the same person another time is like, no, that's not doing it. And that's part of, I think, the whole point of pain care in the end is that every human is so unique that I don't know how this particular technique that i'm asking you to do or guiding you through is going to land on you and it's not even just about you it's about right now in your life and in your recovery program process because it's possible that the very same thing in a couple months may give you a very very

different effect because things change and that's that is part of the trouble that i think we as people in pain experience that the healthcare people as we're starting to learn about this we we're not really thinking that way we're thinking you know i've learned these techniques that will work and i want to give them to them because they work and you know you're so focused on giving the person the technique that you're not reassessing quickly enough right um and uh so it's a it's just one of those things that's so important to to listen all the time right Because sometimes when we say to healthcare people, the most important therapeutic intervention you have is listening.

And a lot of times what the person hears is, during my initial assessment, I really need to listen to the person's story. It's like, well, yeah, but you also need to listen to the person all the way through everything, and not just listen to the person's words. To watch when you can see the person holding their breath, or their body getting tighter, their legs crossing, or their arms crossing or their eyes crossing you know rolling whatever it is right because you can when someone is saying something that makes no sense to us or feels wrong to us you know there

is nearly always body language and the longer we work in this area the more we start to notice that sooner right and you know when we're teaching yoga therapists to work one-on-one we're absolutely asking them to observe the person's breath, observe the person's body tension, observe the person's face, their voice, keep on watching that stuff because it's going to give you cues as to whether you're going down a door that's helpful or where the person is now having to guard themselves from whatever's happening. Absolutely. Oh my gosh. Well, speaking of, I see you have your book behind you on your shelf, but you co-edited a book, which I'll just put a shout out here right now yoga and science and pain care it's a wonderful book i actually

have a patient who's reading it as well right now so yeah yeah she's reading it so um it's a wonderful book um anything else that you're doing uh neil in the world right now what are some projects you're involved in or too many to say there are a lot of them well actually um so uh for quite a number of years i've been teaching a thing that's called pain care yoga so it's a it's an integration of yoga with pain science but it's really focused on yoga therapy more of a one on one and we've had a lot of people asking us for the last couple years you know what could we do around yoga teachers so we are in the process of creating a thing called pain care aware that will be a sort of two-step learning process step one will be i see online so we haven't exactly got

the right number figured out yet but it'll probably be around 15 hours of online education that yoga teachers could learn so that they would understand the basics of pain and the idea is to if we sort of framed it in the biggest the idea would be how as a yoga teacher do we continue to keep people safe without providing language that tells the person that they need to be too careful or that their body is fragile or easily broken and so we got to balance these things right and and so we're trying to give people an understanding of yoga teachers an understanding of you know this is what pain is and based on this this is how we want to guide people with movement in the class to keep them safe but also you know because there will be

people in your class who have pain when they're doing things how do you bring some of this language in in a way that that makes sense rather than you know some of the some of the languages is you know if it hurts you shouldn't do it right which of course is going to teach you the wrong stuff um but then of course there's a language that's um uh this idea of transcending pain that we need to get past it which is going to get you to just endure it and push through and actually potentially cause damage to your body if you do that sort of thing so we need to find the balance of that but anyway that's pain care where uh it's going to be launched uh really early in 2020 and uh i mean i just keep on working but there's a lot of work that i do with health care

professionals and with doctors and i'm really excited actually there's in the community in which i live um there's a a primary care group that's being developed that will have um doctor nurse practitioner uh psychologist or counselor physical therapist occupational therapist and so people will actually be able to go there and if they do need a team there will be a team there and so we're looking at how we could educate that group in terms of pain management so they all be talking the same language because there's a huge gap between you know a person has ongoing pain they see their family doctor or they see their physical therapist or the yoga therapist and they're usually seeing individuals and then beyond that the next step is really way down the

road it's the the medical interventions or it's the uh the multidisciplinary pain management center and so we're trying to figure out how do we uh this is one model of community-based pain care like team-based pain care because people need you know care in their community and and it's better if we look at the resources there so around the the province of british columbia there's a number of us through a patient advocacy group called pain bc that we're working on different uh uh processes like that i guess the one other thing i just want to say really fast is that the other thing i'm doing is next year i'm going down to australia and i'm going to ride in the pain revolution yay so the pain revolution for people who don't know if you want to look it

up just look up painrevolution.org so uh we will be riding bikes uh over 100 kilometers every day to rural and remote communities and when we get to the community we are going to be teaching the healthcare people about pain but also teaching the community people about pain and in each of those communities one of the people who uh when the healthcare people were raising money for them so they can actually go to the university of south australia to uh become much more of a leader in understanding about pain and pain topics and so we're it's really about increasing accessibility to good pain care but also about pain literacy uh both you know so knowledge within the community and with the health care people.

And so my plan is to go down there next March and do it and do the ride. And this will be fun because we're going to be riding all day and then doing education every evening, which will be really an amazing task. And then my plan is to bring it back to Canada and see how we can figure out how to do something similar. It would be different with something similar. Yes, that would be awesome. Much closer for me to participate in than Australia.

Well, it's nice riding in your land too, right? Yeah, it is. It's beautiful. It's totally beautiful. Yeah, and I haven't thought about that. Why don't we have like a U.S.? It should be, you know, international everywhere. Well, they've got the, as far as I understand,

they actually have the Australian government is backing them to a certain degree. I mean, it's, and in Canada, there's a national pain task force happening right now. And I know in the United States, it's the, oh my gosh, It's the Consortium of Integrated Pain Medicine or Pain Management. Over 177 agencies in the United States are together trying to figure out how do we address this because it's so huge. You know, there's the cost to society, but then there's the cost to us as individuals because, you know, pain changes everything.

And I don't know if most of your listeners really know the, I mean, if you've got pain you get it but if you don't have pain you may not recognize that that um the personal cost in terms of uh losing relationships and and work and your house and um you know even the the the risk of suicide goes way up when people have chronic pain and right and people don't really recognize that but we're getting the uh i guess my point is that we're actually getting people who have some capacity to help some government agencies are starting to actually pay attention to this and recognize it's something that needs to be it needs to be coordinated from a national perspective even though just like in in canada our ministries of health are provincial

like yours are in in states but without that overarching body to help coordinate things it's really hard to get it done well oh and we're just starting to unravel and collect our resources like you're saying neil like just start somewhere and spread the message one person at a time and it's so wonderful that we have these larger institutions and the government backing up a lot of these efforts to help shift the pain paradigm. So it's wonderful. Thank you for all the work that you do and that you continue to do and collaborate with. And I can't thank you enough for being on the show. Thank you so much. Are there any ways that the listeners can reach out to you or learn more about you and your practice sure so there's there's my main website is pain care you like the

letter u.com and so if you go there that's got more of my current things on if you're a person pain and you wanted to access some free stuff there's some free stuff on the paincareu.com website but there's another thing that i've created called uh first five steps and it's free so step one provides you with some understanding about pain step two a breathing practice step three is a body tension releasing practice and step four is a movement guidelines then it's totally free it doesn't ask you for your email address or doesn't take your ip none of that stuff nice so that's a different site though so to get to get that you go to lifeisnow.ca got it it looks like that it looks like life is snow but it's actually like it does look

because i'm in canada sometimes people think that it must be like the snow Oh, right. Life is snow, like a snow globe, you know. Lifeisnow.ca. Wonderful. And I'll link for the listeners in the show notes so they can easily access that. Thank you so much for making that accessible for everyone and really for the wonderful work that you're doing in collaboration with a lot of other individuals like myself and Lorimer and David Butler and Sandy Hildens here. And Shelley Prosko and Marlissa Sullivan and all these people. And we stand, and if I didn't mention you, I'm sorry, but we stand on the shoulders of giants. And I love that we're all kind of getting together to share this message. It's very powerful and hopes to really help people alleviate their suffering. So thank you so much, Neil.

I really appreciate you. Thanks for giving me the opportunity to share this. Wonderful. All right, listeners, thank you so much for being here. thank you so much for following and until next time and loving wellness for your pelvis this is dr suzy g signing off bye thanks for listening to today's episode be sure to head on over to drsuzyg.com where you can get more information show notes and related articles on today's topic also if you like what you're hearing head on over to itunes subscribe to the podcast

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