Pain Management from the Pros, Strategies & Solutions for Successful Treatment & Recovery with Dr. Kelly Starrett, Jill Miller & PJ Nestler | Part One

We decided to shake things up a little bit and do an extensive conversation about pain. Points of view on what type of relationship we should have with pain, how we can use pain to help us learn and grow and be better, and whether there are things out there and available modalities to help us get relief without having to take medication.

Contributing to the show is:
Dr. Kelly Starrett. Creator of the Ready State, and author of The Supple Leopard.
Jill Miller, creator of Tuneup Fitness and Yoga Tune Up. Her knowledge is so vast she has often been called the teacher’s teacher.
PJ Nestler Director of programming at Fitlab and XPT. He has trained professional athletes from multiple sports and is a movement specialist. PJ has passionate opinions about pain and how we connect with it.

Stay Tuned for Part 2 Later this week with:
Doug Goldstein is a board-certified and fellowship-trained orthopedic physical therapist. Doug helped me with a torn hip labrum with homework and exercises, so I did not need to get surgery.
Engineer Jim Ohneck creator of the epoch 980 laser that is proving to provide pain relief for people all around the world.

Listen to the episode here:

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Key Topics:

• Pain is Information [00:04:49]
• The Pain Rubric [00:08:59]
• Fascial Tissues as We Age [00:13:54]
• Pain Points and Theories [00:17:33]
• Fascial Tissues and Movement [00:21:31]
• The Benefits of Massage on Inflammation [00:22:45]
• The Five Ps of the Parasympathetic Nervous System [00:25:24]
• Extracorporeal Shock Wave Therapy [00:31:29]
• A Personal Story on Chronic Pain [00:33:24]
• Pain Misconceptions and Health System in the US [00:42:15]
• Pain Response [00:48:23]
• Changing the Mindset About Pain [01:00:25]
• Resources for Pain Education [01:09:18]

Pain Management from the Pros, Strategies & Solutions for Successful Treatment & Recovery with Dr. Kelly Starrett, Jill Miller & PJ Nestler | Part One

Welcome to the show. We did it a little bit differently because it’s a topic that impacts all of us, which is physical pain or discomfort. What I decided to do is recruit a bunch of people who work in similar and different aspects of either training or physical therapy, alternative modalities. Not only get their opinion about the role of pain, what pain means to them, and how it shows up for them but also dealing with patients and where they see maybe some productive approaches and things that help them get relief.

I’m always encouraging people, it’s like, “Let’s not quiet the pain down so much because we’ve got to honor it. It’s there to tell us something but it is hard to live with.” What are the things we can do that don’t involve medication and getting through it? Sometimes it’s using your body a lot. We have aches and pains. It’s great to know that you have these modalities, dry needling, or other forms of physical therapy that help you get that relief.

I will share with you all the guests that we have. I feel fortunate that these people took time out of their crazy lives to spend time on this topic. First of all, we have Dr. Kelly Starrett. He and his wife created The Ready State, formerly known as MobilityWOD. He’s written such books as Becoming a Supple Leopard. I’m excited. He has a crazy extensive book coming out and I’ll be sharing that with you. He is a Doctor of Physical Therapy. Kelly is one of the smartest and most practical. It’s his approach to self-care, recovery, and helping athletes recover. He’s one of my favorite people in the space and human beings.

I was lucky enough to get Jill Miller. She is the creator of Yoga Tune Up. For me, it doesn’t have anything to do with yoga but her understanding of anatomy is extensive. She’s been called the Teacher’s Teacher. She has a brand called Tune Up Fitness. I highly suggest her books because her whole thing of using movement and treatment and she has so much information. She’s got wonderful books like The Roll Model. She’s another one. These are people who lived this themselves. Kelly’s got an artificial knee. Jill’s had her own injuries and surgeries. It’s not somebody who’s never experienced pain.

The next guest I have is PJ Nestler. I’m fortunate, I get to work with PJ at XPT. He is the Director of Performance at FitLab and XPT. He’s a Human Performance Specialist. He’s passionate about the topic of pain. Sometimes our medical industry wants us to completely try to avoid or eliminate pain and most people in performance typically don’t agree with that. PJ chimed in and shared not only his feelings and the role that pain plays and the relationship we should try to have with it but also in ways in which he gets relief.

All of these people have worked with professional athletes. They’ve dealt in the physical therapy space so they’ve helped a lot of injured people. They have so much knowledge. I’m not a big hacker but when people know about certain things even if it’s the sauna. Jill and Kelly created a curriculum years ago called Treat While You Train. It’s people who understand, like, “I know you’re in a lot of discomfort but if you were pretty diligent about these few things, you might get more relief than you think.”

I was excited to talk about this. Both Laird and I are uncomfortable quite a bit. We’ve dealt with injury. I know that a lot of you out there, you’re sitting in chairs all day, you’re driving in your cars, you are training hard, and you are aging. It’s like, “How do we get everybody together and talk about pain? Let’s not be afraid of pain.” There’s stuff you can do out there to get relief in the short term and the long term. This might be a two-part series. I hope you enjoy these points of view.

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I’m Dr. Kelly Starrett, the Co-founder of The Ready State. I appreciate the opportunity to spend a second talking about what we think about pain when we’re working in athletic populations. There are a couple of things that we want to always reiterate whether you’ve heard it once or ten times, pain does not mean necessarily tissue damage, it doesn’t mean something is broken, or it doesn’t necessarily even mean you’re injured. We’d like to say and hammer on the spell that pain is a request for change.

In our athletic populations, we want people to begin to think about pain as another level of information like poor wattage and poor output, “I was slow on my run today. I couldn’t lift the weight I wanted to run.” All of those things are sort of bio outputs. They let me know bio-expressions. Pain is one more piece of that information and it can be useful to let me know if something is worthy of paying attention to.

What the brain is trying to do is it’s trying to get us to pay attention to something. One of the things we can do with that information though is to have some clear lines in the sand. One of the things that we want people to understand is that the resting state for the human being is pain-free. When that important signal pops up, and it can pop up for a lot of reasons, we shouldn’t panic and we should be curious about that. What’s going on with that?

There’s this top-down approach that we always know is going on. If I am stressed, if I feel unsafe, if I’m tired, and if I’m inflamed, my brain can become more easily sensitized and tends to care about what’s going on with my body a little bit more than if I’m well rested, feel loved, stoked, and I’m in a happy environment. It’s important to understand that they’re very much a set of behaviors that we can engage in that help us become a little bit more tolerant and modulate how our brain ends up perceiving what’s going on in the body. Sleep, for example, turns out to be one of those.

There’s a bottom-up approach too. Oftentimes, we can get a little bit twitchy or a little bit more easily sensitized or sensitive to pain based on things like our genetics, our previous experience, how our parents talked about pain, and how exposed we have been. If I dropped into the brains of some of my World Cup athletes, I would perish because they’re undergoing so much physical discomfort. What we realized is, of course, pain is personal. Ultimately, there are a lot of things we can do to try to modulate that.

[bctt tweet=”100% of pain comes from the brain.”]

Some of those guidelines are, “If my pain is so bad that I can’t go to work and I can’t do my job, that’s a medical emergency. I should go get help with that and escalate that up the chain.” If I can’t occupy my role on the team or occupy my role in the family, also, we consider that to be a medical emergency. Everything else, we think, “We should be able to take a crack at this. It’s an incident-level problem. It’s not an emergency problem.” If I have a mechanism of injury that something’s going on or I’ve got something that smells and feels like I have a fever or sickness, a red flag, once again, we’re going to get medical help.

Otherwise, we want people that begin to take a crack at fixing themselves and feeling better. That falls into a category of behaviors that we haven’t been honest about, frankly. People have been self-soothing with opiates, THC, bourbon, and food for a long time. Until they hand people a different set of narratives and a different set of tools, they’re going to keep reaching for the tools, ibuprofen, food, and red wine to make themselves feel better. That’s a reasonable proposition.

When someone has pain from the bottom up, we say, “There’s a lot we can do here.” Sometimes that’s common, simple, myofascial pain and a little bit of rolling or hitting it with something like a percussion gun can make it feel better. Suddenly, we realize we ended up with a whole bunch of seemingly disparate tools. I’m on the internet and I see cupping, KT Tape, and all of the scraping. How do I wrap my head around that?

A simple model that we came up with to help us understand and begin to categorize those things, especially since there are some things I can do from the tissue levels up to help my knees not hurt as much after that big run or my back after that big pickleball event. The first one is we want to see if we can desensitize it. We’re good in this culture and society. Probably humans have been desensitizing the pain for a long time using any substance on the other side. That could be a rub and that could be soft tissue mobilization. I could be addressing trigger points in there.

That desensitization means that I have some input and suddenly my brain says, “It’s not such a big deal.” That created a window of opportunity for me to go move and change the system somehow. I was getting that signal for a reason. It might have been an old injury. It might have been a tweak. It may have just been stiff. My brain is interpreting that way. Desensitization, oftentimes, we can hit something quickly and we feel good. The second thing we’d like to help people understand is we can decongest those tissues.

Oftentimes, if I have a little bit of swelling or stagnation, that phenomenon can also be sensitizing to the body. If I have a swollen knee, it’s more likely that my brain may interpret that knee as painful. When we can manage congestion through movement, walking, non-exercise activity, and then we can add other techniques in there like compression, jumping in Normatec boots, or jumping on something like an H-Wave or a non-neuromuscular electric Stim device, which allows us to create muscle contraction to pump out that congestion. Lo and behold, oftentimes, that’s enough to make me feel better. I became sensitized because I had tissues that had been congested. That is a sensitizing mechanism.

The next one is we say, “Can we reperfuse?” Oftentimes, we have tissues that are a little ischemic, muscles that are holding on, and hypertonic. We can have tissues like tendons and ligaments that sometimes don’t get great blood flows for whatever reason. Oftentimes, if we can increase blood flow to an area, that may be enough to change the local environment so things feel better. That could be a sauna, scraping, or cupping, and realizing that there’s a whole language around seeing if we can increase blood flow to the system.

The last thing that we often forget or fail to appreciate is that it’s easy to put some restoration of movement back in. I don’t mean any movement like if my knee hurts, I should squat more. What I’m saying is if you are finding out that you’ve got pain with a movement, and it’s usually always associated with a movement and the pain we’re talking about, I can ask the simple question, “Do I have access to my full native range?”

If I’m missing dorsiflexion or my quads are stiff and my leg doesn’t flex as much or my hamstrings are stiff and they’re limiting my hamstring range of the limb, it’s not always the tissues but by restoring our range of motion. For example, if I have shoulder pain but I can’t put my arm over my head, one of the things I can do is restore how effectively my arm goes over my head. Often, we’ve changed some aspects of the system where the brain stops caring about or it stops thinking it’s a threat.

The idea here is that we can work from both sides simultaneously. We have a lot of tools and tactics to make people, in an environmental situation or environmental construct, feel a lot better about being more tolerant. You can handle a lot more silliness in the system. If you’ve slept, if you’re eating micronutrients, if you’re hydrated, if you’re feeling loved and supported, and if you like your job, all of those things matter. There’s a human being in there.

On the other side, we can’t forget that there’s a lot of biology that can’t be explained away. They’re just a pain talk. It’s not just the placebo. We know if that we can impact what’s going on and how the tissue system functions, we can meet in the middle. Oftentimes, when we begin to tell people how much agency they have around feeling better and managing or taking a crack at things that even seemingly were chronic in nature, it’s shocking to realize how much control we have over feeling better.

Remember, pain is a request for change. Your pain doesn’t necessarily mean you’re injured or you’ve got tissue damage. It means that let’s become curious about what’s going on. Remember, the resting state of the human being is pain-free. Everyone has the right and the control to the best of their ability to self-soothe. Hopefully, that helps you understand how we talk about this in an athletic performance environment and with people who are trying to manage the pain themselves.

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This is Jill Miller, the Co-founder of Tune Up Fitness and author of The Roll Model and Body By Breath. When it comes to pain, one of the first things that I think of is I look at my young children and I think about how free they are in their bodies and how happy they are to move in all the ways that they do. Sometimes I think to myself, “They are never going to have this much freedom and pain-freeness in their bodies ever again.”

The research shows that, as we age, pain becomes a more frequent bedfellow in our lives. It’s not that there aren’t children who don’t live with chronic pain, there certainly are for the general population. Most kids are pretty free in their bodies and you see these restrictions that pain creates around movement and lifestyle. It impacts and shackles people as they age. A lot of this is due to the ever-changing nature of their fascial tissues. The F word that I like to lecture on and help people to embody knowledge is their fascial system.

Your fascial tissues when you’re young are in an extremely fluid-loving environment. As we age, we become more fibrotic and less fluid by volume. The lack of fluidity as we age plays a part in the motion lacking appropriate glide. Your fascial tissues surround every muscle cell that you have. From the muscle cell, it spans to the fascicles and then to fascicles binding together within myofascial units. Your fascial tissues are running from cell to skin from top to bottom and everywhere in between giving your body its form, shape, and volume.

Recent research has shown that your fascial tissues are also one of the greatest sensory reservoirs we have in our body. What I mean by that is new research in 2021 by Martin Grunewald amassed the number of sensory neurons that are located in fascial tissues. The number is 250 million. To give some perspective, your skin has 200 million and your eyes have somewhere about 150 million sensory neurons.

Our fascial tissues are our greatest sensory organs. A lot of that pain that we experience is generated in the connective tissues. 40% of these neurons are sympathetic. They’re governed by the autonomic nervous system and they’re constantly feeding your body information about location, about the movement of blood and fluids through these tissues. These tissues are also sensing temperature and they’re also sensing stretch.

There’s a lot of information coming from your fascial tissues. Many of the sensory nerve endings within the fascial tissues are still hard to define. They’re these free nerve endings and also nociceptive nerve endings, pain-sensing nerve endings that are relatively hard to trace but most likely are directing their inputs into our interoceptive sensibilities, our body’s sense of its own physiology.

That being said, the definition of pain tends to veer toward the biopsychosocial model of pain. Every generation grapples with theories of pain and the current one is this biopsychosocial theory, which attempts to explain that pain is an output from many different parts of the brain that relies on many subjective experiences from your body but also from your emotions, your interplay with your environment, your interplay with other people, and even your spiritual sense.

Pain perception doesn’t necessarily always correlate with actual tissue damage. Your brain is anticipating painful events. If you’ve had a run-in with your body or you’ve had an accident or injury, your brain may put you in a state of experiencing pain even though there’s not something that’s literally triggering you. There’s also our own decades-long buildup of pressures into our fascial system that can suddenly flip and our bodies can end up having syndromes that are problematic.

For example, fibromyalgia is one of those syndromes where we have this body-wide almost rumination of symptoms through different body parts. There doesn’t seem to be a clear classification of those. If you look at the different relationships within the body when you’re looking at a disease like fibromyalgia, many of these idiosyncratic pains are due to facial dysfunction. When we have frequent headaches, this could be the temporal fascia. The wrists are problematic, this is defined as carpal tunnel. Chest tightness in the fascia of the ribcage may be impacted.

Sometimes some of these body-wide syndromes, maybe it’s a dysfunction of the cells within the fascia itself. How does your fascia become dysregulated? How do your body parts become dysregulated and result in pain? If there has been an injury in the past that is persistent inflammation within that area isn’t resolving, when there’s inflammation in an area and it hurts to move, your body is more likely to be static.

You’re more likely to avoid moving that area or you’ll create movement scenarios where you’ll bypass that area in your movement. That stagnant area that is accumulating these inflammatory cytokines is not getting motion that’s telling the tissues within it to slide, to have pressure, and to be shifted. That lack of movement signals the cells within the fascial tissues known as fibroblasts to lay down more collagen. If no movement is needed, then we should stabilize this area.

The fibroblasts that live within that remodeled fascia start to lay down more collagen that stiffens the local tissue and almost creates a new skeleton within a sea of soft tissue. We have these areas of rigidity of fibrosis and collection of inflammation. This could happen within muscles. Frequently, this is also happening within organs that end up shutting down due to fibrosis and poor exchange of inflammatory regulation. It’s interesting that the fascia can become a part of this chronic persistent pain.

What’s the cure in that case? How do you reverse that? Movement has been shown to be the thing that helps to flip the switch on the negative proliferation of immune cells and those inflammatory cytokines. Movement introduces pro-anti-inflammatory mediators and helps to then reverse that cycle of inflammation. Once the body starts to move, then the fibroblasts can reduce the fibrosis and can also lay down collagen in the way the body was intended to move.

In my line of work with Tuna Up Fitness, I use Roll Model balls. These are, for the most part, squishy, pliable, and grippy balls that clients and students use to self-massage into areas that are, frankly, in chronic pain or nearby areas. The body starts to become more comfortable with the movement. The body attenuates itself to pressure. You can get movement into areas where non-movement is occurring. You can get movement into areas using pressure and using rolling directly into areas of inflammation to start to change that inflammation.

There was a study at Harvard done by a woman. She wounded the calves of mice. She severed the interior tibialis of their lower leg. She used this little percussive massage instrument. She applied a soft amount of latex onto the ends of these little tongs and this machine pressurized into the interior tibialis for five minutes. Once every three seconds, there was this squeeze applied to the little mice’s interior tibialis. They did this twice a day for five minutes.

What they found was that in the mice who had the massage treatment with a soft rubber latex application, the muscle cells healed faster and the muscle fiber type was stronger than those who did not have the massage. Also, the blood vessels that helped lead to healing healed faster. This application reduced the neutrophils, it reduced the abundant buildup of pro-inflammatory cytokines that were keeping congestion in the area.

This is one of the first studies to ever show the linkage between fascial massage and inflammation in the immune system. We’re on a precipice of understanding that massage can be extremely beneficial to areas that are inflamed and that are suffering due to long-held chronic pain and tightness that is creating fibrotic conditions and highly toxic conditions within the internal environment of the body.

One of the other things that I like to share about pain is that it is also helpful to put oneself into states where healing can occur. Healing tends to occur best in a parasympathetic environment. Most people know that if you’re under chronic stress and if you’re in unfriendly environments and if your interpersonal relationships are stressful and not harmonious, it’s going to be harder to heal. I like to describe what I call the five Ps of the parasympathetic nervous system as part of managing pain and setting up an environment for healing to occur.

[bctt tweet=”It is helpful to put oneself into states where healing can occur.”]

The first P stands for Perspective. Perspective is a top-down offering to yourself. By top-down, I mean a cognitive frame. It’s something that you say to yourself and that helps you to be a great host to the processes that you are intending for healing, repairing, and regeneration. For example, a great P would be a mindset like, “I am healing,” or, “I allow relaxation. All of me is welcome here.” These are all different Ps that don’t deny your experience but they welcome the felt experience and might even send you on a trajectory in a positive direction.

The second P for the parasympathetic nervous system for helping you to manage pain is Place. It’s difficult for all of us to find a sanctuary in which to heal and repair. Ideally, if you can help your environment to be un-triggering as possible, it’s helpful for your brain to be able to let go of worry. The third P for the parasympathetic nervous system dominance is Position. Our body is relaxed well when they’re on the ground. Get yourself into a position where gravity can support you. That might be in a bed.

There are probably some competing ideas out there that, with pain, we should try to force ourselves to move and push through. There is a time and a place for that. I’m also talking about how you set up a parasympathetic environment, which is also necessary for the resilience of healing with chronic pain. Getting down to the ground happens to reduce sympathetic stresses on your heart and your lungs. It alters what’s known as the baroreceptor reflex. That’s a little more complicated to share here.

When we recline or when we even put ourselves into a gentle slope where our pelvis is slightly higher than our heart and our head, it ends up slowing down the breath rate and it ends up slowing down the heart rate in a way that makes our vagus nerve dominate our parasympathetic nervous system’s response. It can be helpful in order to slow down, rest, and relax.

The fourth P for the parasympathetic nervous system is the Pace of Breath. The pace of breath implies that you want to create a breathing pattern where your exhale is longer than your inhale. There are inhalation practices that also induce the relaxation response, in particular, a double inhale followed by an exhale. In terms of the all-around pace of breathing, if you make your exhale a little bit longer than your inhale, that’s going to tend to relax the body.

Finally, the fifth P to induce parasympathetic nervous system dominance is Palpation. Palpation is something I mentioned earlier and we discussed it a little bit more thoroughly earlier in this pain discussion. Palpation means that you’re inducing pressure locally into areas that may be inflamed or adjacent areas or even other areas of your body that have been carrying the load while you’ve been bypassing and avoiding the pain.

If we can increase the feeling of pleasure throughout the body through palpation, massage, and also reducing inflammation, eventually, we will induce plasticity where the pain is no longer welcome here. We create more robustness in our entire nervous system, fascial system, and musculoskeletal system. Maybe pain has a holiday from our body or maybe we can vanquish it all together until the next round of pain decides to set upon us.

Ultimately, for the life of our body and the life and interest of positive plasticity to occur, we want to maintain movement in the global sense for our body and also in the tiny and micro-local sense in our body. We get that through healthy movement habits as well as small focal massage-based treatments that anybody can do to empower themselves to transform their pain into function, robustness, and a helpful health span.

One final thought that I’d love your readers to be aware of is that in addition to all these easy-to-do self-treatment strategies that I’m suggesting about rolling and the five Ps, there are also tech interventions that are astonishingly helpful for people with chronic pain, especially as it relates to fibrosis. I mentioned fibrosis a number of times. Fibrosis is hard to rectify with just massage. It’s the accumulation of too much collagen and too much sticky hyaluronan. Hyaluronan is one of the fluids that allow tissues to glide but when it accumulates, it can become more like a glue that sticks layers of tissues together and creates masses of non-moving tissue within the body.

There is a tech known as Extracorporeal Shockwave Therapy. Easier said is shockwave therapy which sends acoustic waves into soft tissues that don’t move well and that are long-standing and at substantial depths within the body, depths that a massage therapist’s finger cannot reach. Shockwave therapy targets these stiffened tissues.

They haven’t fully understood the mechanism behind why the treatment is effective but I’ll tell you a little bit of history. Shockwave therapy comes from the tech that is used to break up kidney stones within the body. They realized if they adjusted the wave that instead of breaking up kidney stones in the body, they can be accommodated into connective tissues in the body.

A recent study looked at the behavior of fibroblasts after shockwave treatment. What they saw is that four hours after shockwave treatment, the fibroblasts, the cells within the fascia, started to spread out hyaluronan. Twenty-four hours later, it was still making productive hyaluronan, which was going to allow these tissues to glide once again. Restoring glide in tissues that were congested, congealed, and non-moving. I want to give a big shout-out to that tech because it’s extremely promising for persistent pain, pain that hasn’t been responsive to physical therapy, manual therapy, or movement therapy.

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First of all, Gabby, thank you so much for inviting me to be here and be a part of this conversation on pain. This is a topic that’s very personal to me. I’m excited to be able to share some of the information that has completely changed my life. Hopefully, some people reading this will be able to empower them with the same life-changing information that it did for me.

I want to make a couple of things clear before I start that this discussion is about chronic pain. We’re not talking about acute pain. This isn’t the fall down and smacking your knee on the ground, the immediate pain that you feel. However, there is some relation to that. We’re talking about after smacking that knee and, over time, the pain in that knee continues. Years later, you’re still constantly dealing with this pain that you can’t get rid of. That’s the type of chronic pain we’re talking about here.

My goal is to empower people to understand pain, control pain, and hopefully eventually overcome their pain without limiting their abilities. Hopefully, we’re going to reframe the way a lot of people think about pain because it’s important. To give a little bit of context, I want to share a little bit of my pain story and why this is personal to me. I’ll also start by saying I’m not a physical therapist. You’ll learn throughout the story that I’ve worked with thousands of these people.

I am a trainer. I’m a performance coach. My background allowed me to be interested in this and understand physiology and psychology at a level that forced me to dive in when I was experiencing pain and dive into a lot of information that I’m going to share. I’ve been researching it extensively due to the fact that I was laid up on the couch for weeks at a time in some of the pain that I had suffered.

I suffered from low back pain. Starting in my early 20s, I had an injury where I felt sharp pains in my back doing a back squat. One day, I went too heavy. When I’m 21 years old, I’m pretty resilient. I rested for a few days and went back to my normal routine. Maybe a year later, I had another flare-up of back pain when I was kickboxing. Every one of these flare-ups continued to get significantly worse.

I’m still pretty young. I was told to see a chiropractor and go do some yoga. I did both of those things. The first diagnosis ever received from the chiropractor was that my hips are offset, my leg length was uneven, and I should come in and do chiropractic treatments three times a week for 8 to 10 weeks while getting rid of all the other activities that were exacerbating it.

I’m going to share a lot of the diagnoses I received here because I know that this will be common and there will be a lot of people who can connect to some of these diagnoses that I’ve heard throughout this process. I started doing yoga. I stopped doing jujitsu, kickboxing, and weightlifting for ten weeks. I went to the chiropractor and things got better. Over the next few years, I kept having these minor flare-ups, it’s similar. Back pain would flare up during kickboxing or some other activity. I’d stopped doing the activity for a while and it would eventually subside.

Six years later, I moved to California. I start training and I had a major flare-up, the first real big flare-up that knocked me off my feet. It took me off my feet for a few days. I was a performance coach at the time so this was impacting my job and my career. I went and saw a physical therapist and that PT told me that my glutes were not activating, my core was weak, and my hamstrings were too tight, “Come see me and do these physical therapy exercises three days a week, which included all your basic PT, band walks, glute bridges, and core strengthening stuff.” All the basic PT garbage.

I went through that process and it didn’t get better. It kept having this issue. I ended up, for the first time, seeing a spine specialist. I went to a general care practitioner who gave me some painkillers and muscle relaxers. I then got a referral to a spine specialist and got an MRI and an x-ray. That was the first time. This is 6 or 7 years into my pain issues where I got a diagnosis that I had a slight fracture to my L5 vertebrae.

In my head, I think I have this fractured spine. I was given more painkillers and muscle relaxers and I was told to stop kickboxing or doing any heavy weight lifting or exercises that were exacerbating the injury. I followed those instructions. I’m only 25 or 26 years old at the time. I was pretty bummed out that I’m going to be this limited from doing the activities that I like. I was frustrated, upset, and beaten down by that.

The next year, another major flare-up. I went to a new PT, a new analysis, and a new prescription. It’s the same thing. I went through this cycle of a new general care practitioner, more painkillers, more muscle relaxers, more diagnoses, go get another MRI, another x-ray, and a new spine specialist. The fracture was the same but it looked a little worse. This spine specialist wanted to do a spinal fusion surgery. I’m in my late 20s and they want to fuse my vertebrae together.

If you’re not familiar, that surgery costs about $65,000. It shows conflicting efficacy in reducing low back pain. It’s back and forth. Some people get better and some people don’t. It’s not effective overall. It permanently restricts your the movement of your spine which often leads to a whole bunch of other issues up and down the chain, particularly for young people.

I didn’t do that surgery. I went back to PT. I kept doing the treatments and kept doing movement and trying not to flare it up. Over the next five years, I continued to have more and more flare-ups. Less intense activities would create flare-ups. It went from heavy weightlifting to kickboxing to picking something up off the ground to normal training to sprinting. It was all different activities that would cause these flare-ups and they got so bad that it was taking me off my feet for weeks.

I was unable to sit down for months comfortably. I would have to kneel on pads at work while I worked at my desk. Driving in the car was excruciating. I was taking more painkillers and muscle relaxers than I care to ever think about. I was taking prescription doses of ibuprofen daily. I was taking Vicodin, hydrocodone, oxycontin, and anything I could get my hands on to take the pain away so that I could go to work and do my day-to-day activities. This was demoralizing and a challenging time for me.

In 2000, I had also seen another spine specialist who wanted me to get another different surgery. He told me that the spinal fusion would have been a bad idea a few years prior. This was a different surgery. The fractures had completely separated. Instead of just being a crack in the piece of my vertebrae, the pieces were often floating and they wanted to screw them back in. Luckily, I had a physical therapist I met who understands the pain and understands the principles that we’re going to talk a little bit about.

That was probably in 2016 when I started becoming re-educated on pain and started following his prescription. I’ll talk a lot about what that process was but to give a little bit more of the context, I worked with him for about 1.5 or 2 years. I had a few setbacks while we were working together. I still had some pain but we kept working. We kept changing the dose and we kept working through this process. 2017 was the last major flare-up that took me off my feet and then I was cleared. I was cleared of back pain.

From 2017 to 2021, I had no major flare-ups. I was back to all the activities I loved. I was kickboxing. I was lifting heavy weights. I was running, sprinting, and doing all the stuff I love to do. I did have one flare-up in May of 2021, which led to me diving deeper into this research and creating some of this to share with other people. I spent 7 or 8 days pretty much laid up and unable to move, which was pretty demoralizing.

It brought me to my knees and brought me to tears multiple times because I thought I had gotten past this. Fortunately, I was able to work on my psychology throughout this process and shift what happened. That flare-up, instead of two weeks of being unable to move and then unable to go back to activities for months at a time, was two weeks of being pretty immobile. I then quickly got back to all the things that I love to do and haven’t had any issues since.

[bctt tweet=”Pain is personal but there are a lot of things we can do to try and modulate that.”]

I want to share some of that process with everybody so that they understand. The reason I gave that context was to start to think about the things that I went through because I guarantee that any active people had some of those diagnoses. You’ve probably had some sort of pain, particularly low back pain and you’ve been diagnosed with a weak core, tight hamstrings, your limbs are uneven, or you’ve got some fracture.

You go get an x-ray or you get an MRI and they see something. Maybe it’s a disk slippage, a slight herniation, disk degeneration, a lot of that stuff when it comes to backs, or labrum, in your hip, or your shoulder. Those are common diagnoses that we hear about and not always are associated with pain. You’ve probably gone through the process like me.

Throughout that process, I probably saw 3 or 4 general care practitioners, 5 or 6 physical therapists, 2 chiropractors, a yoga teacher, 2 different spine specialists, and a sports medicine doctor. I saw many doctors and many specialists and had many different diagnoses and many different prescriptions for things to do. I tried every passive modality you can imagine, massage, stretching, acupuncture, cupping, and E-Stim. If it’s out there, I pretty much tried it.

I finally worked with this PT who changed my mind. I use the term mind often because it’s going to be a lot of what we talked about. When I worked with that PT, that’s what allowed me to shift this. I want to share some of those things with you as we talk about this. We have a misunderstanding of pain. Our common understanding of pain is this mechanical approach. We believe that when we have tissue damage, it creates pain. I say we, Americans in general.

Most of us think, “If my knee hurts, something in my knee must be mechanically off. Maybe there’s a slight tear to one of the ligaments. Maybe I smacked it on something or there’s a bone issue.” We believe that because we have pain, there must be some tissue issue there. Typically, we believe it’s linear. The more damage we have, the more pain. The more pain we’re in, we believe that there’s more damage.

However, this is widely disproven and it goes against all the current pain science but it’s still a popular belief among normal people. Unfortunately, it’s the adopted approach amongst most doctors and clinicians. That’s a big problem because we believe what those people say. This creates this vicious cycle of misunderstanding pain.

Americans, in general, have an increased tendency to medicalize pain. We spend so much money on pain. To give an example, the United States spends about $500 billion to $700 billion per year on pain treatment. To put that in context, we spend about $250 billion on cancer and about $300 billion on heart disease. The leading causes of death, we spend about half to a third as much as we spend on pain treatment.

Another crazy statistic is that the US accounts for about 4% of the world’s population and 80% of it is opioid use. We clearly, in the United States, have a strong disassociation with pain that’s different from the rest of the world and a need to medicalize and prescribe things for it. We often have excessive and unwarranted diagnostic imaging and the insurance model drives this. If you’ve been through anything, you know that you have pain, you go to your doctor, and your doctor gives you some medicine, usually a painkiller or muscle relaxer. Maybe he sends you out to a specialist.

In order to go to the specialist, you’re required to get an x-ray and then an MRI. You go through this mundane process that takes a ton of time. We use a lot of diagnostic imaging. The problem with that is when we get an image done, there are many abnormalities that we find in imaging that can be misdiagnosed as pathology, as something that’s creating the pain. If I go in and I say that my shoulder hurts, the people who get imaging done are people who are in pain.

You don’t go in and get a yearly MRI done on your shoulders to see if they’re healthy. You go in when you have shoulder pain. When you have shoulder pain, they do an MRI and they show you, “There’s a torn labrum in there. It must be the torn labrum that’s creating your shoulder pain. Let’s treat the torn labrum through surgery or some other thing because that’s what’s causing your pain.”

However, there’s so much research behind this stuff that has disproven that. There are so many studies that have been done where they take asymptomatic people, people who don’t have pain, and they do the same diagnostic tests, MRIs, and x-rays. What they find is a lot of these asymptomatic people have the same abnormalities without pain.

I’ll give a few examples of those abnormalities. Disk degeneration is a common thing that happens throughout our lives. If you take people in the age group of 20 to 29 years old, about 20% to 30% of them have disk degeneration. As you move up every ten years in those channels, the disk degeneration percentage gets higher and higher. For people who are over 80 years old, more than 90% of them have disk degeneration because it’s a part of aging. However, many of them do not have pain.

Another big meta-analysis looked at people who have labrum tears. They scoped people in their hips and they found that 68% of people had labrum tears in their hips but didn’t have pain. Two-thirds of the people with these tears in their hips didn’t even have pain from it. Another similar study is active adults, 45 to 60-year-old, 55% of them had labrum tears in the shoulder with no pain. Probably 50% of the people reading this podcast have a torn labrum in their shoulder and do not have pain. However, when I go in with shoulder pain and they see a torn labrum, they say that’s the cause of my pain.

There are many examples of this. I don’t want to spend too much time. I want you to remember that you are not your MRI, your x-ray, or your diagnostic imaging. That does not define you. I got that term from another PT whom I highly respect. I like it because people identify with the results of their x-ray and their MRI like I did with my back pain for so long. I was told that I had fractures in my spine. When people talked to me about my spine, I said, “I have a broken back,” and that’s how I identify it.

We talked a little bit about the misunderstanding of pain but now let’s talk about what it is. If we have it wrong and it’s not just this linear tissue damage equals pain, that model, if you take most people in the street, that’s what they would tell you pain is from. If that’s not it, then what is pain? A little bit of this knowledge should help you to challenge your own beliefs about pain and then move forward. We’ll give you a few tips that you can move forward with on this process.

Pain is a signal of danger. Your brain and your nervous system recognize a threat to the system and they give you a pain response so you’ll move away from that threat. It happens fast. You have sensors that come from your external body that goes up to the brainstem. They go up to your brain and then your brain will say, “I don’t know what this is. This might be dangerous.” It sends pain right back down.

When you put your hand on a hot stove, that’s exactly the process that happens. The signal goes up to the brain, it comes back down from the brain to your hand, and you say, “This hurts.” You move your hand away so you don’t burn your hand. That’s how that signal is created. However, the threat is a learned behavior. There are many studies where people don’t get that signal. They don’t recognize that their hand is burning. They don’t learn that behavior.

Another good example of this is to think about any of you who have kids. Have you ever had your kid who has fallen and hit their head or fallen and gotten a cut or something that happened and you immediately realize that there are two ways you can go with this response? If you overreact to that and you treat it as if the kid did something that they should be scared of, immediately, the child will start crying and will massively overreact to this pain response.

However, if you treat it as if it’s nothing, which has happened many times, and you run up to the kid, the kid looks at you, they cut their elbow, they look up at you, you run up and you go, “You’re okay.” You treat it as if it’s not a big deal. Many times, the response that that child has is different because it’s a learned response that they have to this sensation that they’re feeling.

They don’t know that it’s as much of a threat and therefore the actual pain that they feel is different. This is not just an emotional or psychological thing. The feelings that you have will be different based on the way that you think about them. 100% of pain comes from the brain. The brain is what sends those signals. That is where the pain is processed.

We’re talking about chronic pain. Many times, chronic pain is massive overprotection of the nervous system. Your biology is designed to keep you alive. If you’ve done something in the past that stimulated this response, then your brain becomes more sensitive to that next time to make you try to avoid it. If we keep training those neurons that produce pain, they get better at producing pain. This is why chronic pain often returns stronger even when you have different stimuli or less intense stimuli.

I gave the example of my back pain. My back pain was getting worse and worse with each flare-up even though the actual event, the signal that was happening, was way less intense. I was getting more pain with a less intense event each time because my body was getting more efficient at producing a pain response. The brain will learn from these significant threats to respond stronger next time. The brain learns, “This thing hurt me last time. It was serious. The next time I feel that, I need to protect you even more. When I protect you even more, you’re going to get a stronger pain response.”

A good way to think about this is I heard about this analogy once. Imagine that you are walking down the street and you see this person in a green hat and they walk up to you and they punched you in the face and then they walked away. You went weeks with nothing happening. You didn’t even know what happened.

You walk down the street and a different person with a green hat comes walking by and punch you in the face. Randomly, this keeps happening. Every time you see a person with a green hat, they punch you in the face. At a certain point, you walk around, you turn a corner, you see a person in a green hat, and you would flinch.

You have a flinch response as if this person is going to punch you in the face because your body is recognizing that threat before it happened because this is what has happened many times before. That is how the brain sees a pain activity or an event. These things that maybe shouldn’t cause you pain are now causing you pain because you’ve had this previous injury and you’ve learned the pain response to that event.

There are a lot of additional factors here. There’s previous traumas that can cause this. There’s the authoritative fallacy, the fallacy that we believe. Because doctors or clinicians have told us something and that we perceive their authority, therefore, we believe that what they say is true and that we should be in this amount of pain. It becomes this learned response from these people. You can get a nocebo effect. It’s like a placebo effect but you get a negative response to something because you’ve been told that this thing is going to hurt.

For example, I was told I have a broken back so the language that was used by my doctors and clinicians is this fear-mongering language that can create a stronger pain response. The center of the brain that modulate pain are closely linked to the portions of the brain that regulate emotion. Negative emotions like anger, fear, anxiety, depression, and chronic stress, all of those things can exacerbate the pain response. I don’t need to tell anybody here who’s been in chronic pain that when you’re under chronic stress or you’re feeling negative emotions, your pain comes back and gets worse.

Another big problem is passive solutions like surgery and medication. For most people, it seems like an easier solution. People don’t want to do consistent work. They want to take a pill or get surgery and they want the doctor to fix them versus them taking ownership to fix themselves. The last thing is as you remove a stressor for a certain amount of time, it’s likely to reduce pain.

The example that happened with me or the typical insurance-based physical therapy model is I rolled my ankle, something hurts, and I go to a PT, “Stop doing exercises and activities that are going to hurt this. We’ll spend the next 6 to 12 weeks doing these low-level activities that might strengthen it.” It’s not necessarily that the exercises themselves got it better. It could be that. However, a lot of times, it’s the fact that you didn’t do anything to induce the pain and the pain subsided.

When you go back to playing basketball, you have another ankle injury, and you can’t seem to figure out why this injury keeps coming back. It’s because that rehabilitation you were doing was not helping the problem. We have a lot of coping strategies. We tend to avoid activities because if we injured our ankle playing basketball a bunch of times and it was a serious traumatic event, we avoid playing basketball. That creates fear around that activity and that pain response.

We create this negative feedback loop that will create a heightened sensitivity. If you do return to that activity, you’ll be more timid about it and therefore more likely to have a pain response from something that you do. Our negative beliefs can dictate our outcomes. Whether we have positive or negative outcomes can be dictated by the beliefs we have ourselves. A whole bunch of other things like our postures, diet, sleep, and stress. We call that our stress cup, these are all the accumulated factors that can have an influence on the pain response.

[bctt tweet=”Pain is just a signal of danger.”]

The problem that happens with pain is a lot of those other things can get worse. Our anxiety can pick up. Maybe our relationship starts to suffer because we were angry about the pain. We lose activities that we love to do. Maybe we start to eat poorly because we’re not exercising as much. We’re not sleeping well because of the pain. This becomes this big, huge negative feedback loop where this stress cup is boiling over.

I’ll talk about what we can do about those things. I want to stop for a second. I’ve talked a lot here. Hopefully, this has been somewhat helpful for people to understand. If you’re interested in learning more, there’s a lot of good information out there and I highly recommend you go dig into it and start learning more about pain.

I learned a lot of this stuff from a guy named Lorimer Moseley, who is a researcher and a professor on all things pain. He’s a neuroscientist and also a physical therapist. He has a great TED talk if anybody’s interested in a short explanation of pain and the misunderstanding of pain called Why Things Hurt. It’s a great TED Talk, Why Things Hurt by Lorimer Moseley.

There’s another great website called ThisMightHurtFilm.com and they’ve got a bunch of good resources on there about unlearning pain. Another great thing they have is a directory where you can connect to doctors and physical therapists who understand the psycho-physiologic and psychosocial aspects of pain. They have this purely medicalized view of pain. Dive into those resources.

I’m going to give you guys a couple of things that you can do about it because that’s the big thing. What can we do about it today? The number one thing you can start doing today is to start changing your beliefs. Start working on changing your beliefs about pain. Start thinking about pain not as this major problem but as this over-protective alarm system that seeks threats.

As we start thinking about that, every time you have pain, you can have this curiosity, “Why am I having this heightened response? What threat is my body sensing?” Instead of having a fear response to pain. Pain creates fear and then that fear creates pain and it becomes this snowball effect that’s a negative cycle to get into. We’ve got to start rethinking how we think about pain.

Also, start changing your beliefs about your injury. Whatever injury you have, know that tissue damage is not directly related to the pain response. You are not your MRI. You are not your diagnosis. That is not your identity. Chronic pain, most of the time, can be changed. You do not have to live in chronic pain. You can beat your chronic pain as long as you start changing the way you think about pain and the way you think about and identify with whatever injury you’ve had.

“I do not have a broken back. I live with fractures in my spine but I am not broken.” That’s the language I had to change about my injury and then about yourself in general. You’re not in danger. You’re not broken. You are safe. Some of these are mantras because you being safe is the opposite of you being in danger. When you are sensing pain and when your nervous system is creating a pain response, it is telling you that you are in danger, “Whatever activity is dangerous to the system, therefore, I’m giving you this pain to get you to stop doing the thing.”

This is why back pain can also be debilitating because your spine is important to the system because all of your spinal cord that runs through there, your body knows it needs to protect that at all costs. When you have minor injuries or minor issues to the spine, sometimes you’ll get a massively heightened pain response to that because your body is trying to tell you, “Stop doing anything that you’re doing because we need to protect this to preserve life.”

Those are the first three things you can do. Change your beliefs about pain, about your injury, and about yourself. Change the language that you use to reinforce those beliefs, that’s number two. We have to start changing our language. As we try to change our beliefs, we have to change the language we use about ourselves, about our injury.

I like to do this with journaling and mantras. When I hurt my back the most recent time, I spent a lot of time laying down on the couch. When I wasn’t researching this information and writing up these topics to share with other people, I was writing in my journal mantras and words to affirm the way that I believed in myself. I was affirming that I am safe. I’m not broken. I am not in danger. I am safe. I use a lot of positive mantras to reinforce that belief and make sure I didn’t get stuck.

Even when somebody asked me what happened to my back, I couldn’t even move. I couldn’t get up off the couch. I couldn’t go to the bathroom. When somebody would ask me, I’d say, “I’ll be back in a couple of days. I’m having a little flare-up here. My nervous system is overreacting but I’m fine. I’m good. I’ll be fine by the weekend.” I use that language to convince myself that I’d be fine.

I do not use the language of, “I hurt my back. It’s broken. I’m laid up. It sucks. It’s the worst. I can’t do anything.” I had to try hard to avoid that negative language. That’s one of the things you have to use, remove the negative language and remove identifying from your injury or your pain and work on affirming yourself with positive language through journaling, mantras, or whatever you like to do, visualization. There are so many good techniques out there.

Another thing you can do to empower yourself is you have to focus on the items from your stress cup that you can control or change. I mentioned a few of those already, stress, sleep, diet, loss of activities, your relationships, your social life, anxiety, worry, fear, those negative emotions, and your postures that you’re in. Sometimes the pain will force us into these postures that are not good for us and then that creates more pain. Also, your general tissue health.

For each of those things, take control of the ones you can. You don’t need to have a poor diet because you’re in pain or you’re injured and you’re laying on the couch. The more of those you can take control of, the more we can reduce that overall stress cup and focus on self-care. Focus on your relationships, your nutrition, and any activities you can do and remove other stressors and focus on self-care.

Another thing I like to do is journal or reflect on what your tendencies are so you can create some awareness and then seek help if you’re having trouble. If you’re falling into this cycle of negative thoughts or emotions, take control of those things and seek help. Find somebody who can help you to get through those things.

Remember that compassion and empathy go a long way. Have compassion for yourself. Many times, we tend to beat ourselves up when we have pain, “My back flares up and now I’m stuck on the couch. I can’t do anything.” I start talking negatively to myself, “Why did I do that stupid thing? I’m such an idiot. I’m so weak. I can’t believe I had this pain again. I’m such a wuss.” You talk negatively yourself.

Think about if someone you love was experiencing this pain. How would you treat that person? Would you cater to them? Would you try to help them? Would you try to ease any of their stress? Treat yourself like someone you love and have some compassion and empathy for yourself. All of those negative things are not going to help. They’re only going to hinder the process.

Another big thing is to remember that movement is medicine. Motion is the path to healing. Avoidance is not good. Maybe you can’t move. I didn’t move much for the twelve days I was on the couch but I moved as much as I possibly could. I did everything I could to continue moving and to add motion without exacerbating the pain. Sometimes that meant fighting through a little bit of pain as long as the pain wasn’t getting extreme or moving much worse.

If I was in a 6 out of 10 pain and I could do some movement staying in a 6 or 7 without getting up to a 9, use that movement. The more you avoid activities, the more your brain is going to start to remember that the time you went to pick up the weight from that last deadlift was how you hurt your back. I lived that for nine years. I didn’t pick up a barbell for a deadlift because I would believe that I could not deadlift because I would hurt my back.

I had to retrain that out of my nervous system. The sooner you can get back to that deadlift, as soon as that pain goes down, go back in the gym and get under that bar and pick that bar up. It doesn’t mean you have to go crazy heavy but you need to train your body that you are safe. Teach your nervous system that you are safe. Another great thing that we can do is find movements that will create some inhibition of this pain. This is something that probably takes a little guidance from a clinician who understands pain and can do a little troubleshooting to figure this out.

Find a PT or a clinician who can help you. There’s a tool that you can find, it’s PPDAssociation.org/directory. This is the Psychophysiologic Disorders Association. It’s a directory of doctors and clinicians who have this mind-body model of pain. Psychophysiologic means the mind-body model of pain. This is a great resource to go and find clinicians who understand the psychosocial and psychophysiological aspects of pain.

We want to try to decrease some of these pain sensations and create a trainable window. My pain was a 6 out of 10 in my back. What I found was certain core activation and breathing drills allowed my pain to subside down to a 3 or 4. What I did is I went to the gym. I did my breathing and my core activation drills. My pain in my back subsided down to a 3 or 4. Now I have this trainable window where my pain has subsided enough that I can move.

My retraining was to go back to that bar and start doing deadlifts, not super heavy but enough to send a signal to the brain and the nervous system that in this movement, there is no threat. I’m okay to move here. There’s not a threat here. That’s what I’m trying to train. I’m not trying to strengthen my muscles. I am trying to train the brain and the nervous system that I can do this range of motion with this weight and move. I can pick up this load and there is no threat.

When you do that stuff, it’s good and progressive loading of the tissues. You want to use slow controlled tempos and fine movements that will help you to build strength back through the right ranges of motion so you can get back to the activities that you love to do without pain. If you’re exacerbating pain, then you need to find a different activity or a way to inhibit that pain so that you can train around it.

That is exactly what I did to rehabilitate my back. That’s what I started doing in 2016 and it picked up in 2017. Since 2017 and it’s now 2022, I’ve had one flare-up and the flare-up was severe for a short time. I worked on all of the things I could work on while I couldn’t do much movement. As soon as I could, I got back to the gym and I got back to the exercises that I love to do. I no longer have that limitation.

When I feel a little tweak in my low back, what I used to say is, “I need to be careful because a little tweak can easily lead to a major flare-up. I don’t want to be off my feet for three months. I’m going to not do anything that could create any issue.” Now, I retrain that language and I use a different language every single time.

There are a few key traits that you’re going to have to have. You’ve got to have patience when it comes to defeating pain and overcoming chronic pain. It’s a long and grueling process but you need to trust the process. Be kind to yourself, take it slow, and have patience because you will get through it. You may have setbacks so keep in mind that you have to have patience. You also have to have persistence. It’s not a straight line. You will hit setbacks as you go through. You have to keep moving forward and trust the process and keep moving forward.

Find people who support you and who can help you to keep trusting the process and have that persistence to keep moving forward and not get derailed when you have some setbacks because you will face setbacks. You have to have courage. If you’ve been suffering with chronic pain, you have courage. You need to summon some of that courage to dig deep, fight through the pain, find the discipline to stay the course, and keep persisting through because you will get to the other side. You will be able to return to activities without that pain because you are not limited by that pain.

Some final takeaways there. That was a lot of information. I hope that you left with something. Maybe it was a little bit of a new understanding of what pain is. Maybe it was a little bit of a practical application of what you can do. I gave you a few resources there that you should go check out. Lorimer Moseley, go check out his TED Talk called Why Things Hurt on YouTube. He’s got a website. He’s got a lot of stuff that is great to find out. He’s Australian. He’s a tall and skinny guy with a shaved head and an Australian accent. He’s super funny as well. He’s great to listen to. I highly recommend him.

Go check out This Might Hurt Film and check out some of their resources. They have a link to that directory directly on that website so you’ll find the directory. If you want to go straight to that directory, it is PPDAssociation.org/directory. I’m not associated or affiliated with any of those resources I just told you. They’re things that I have found helped me and some people that I’ve worked with overcome pain. I hope that you guys can find those to be helpful as well.

I’m hoping that you leave here with a sense of empowerment. Remember, don’t give in to believing your own BS and your own negativity. Don’t give in to believing that you are abnormal, you’re in danger, you’re broken, or any of this that you may have been told by a doctor or a physical therapist, or somebody in the past. Do not give in to believing that stuff because you are not abnormal, you’re not in danger, you’re not broken, and you can get through this. Don’t give up. Focus on the things that you can control and have the patience, persistence, and courage to keep moving forward.

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Thank you so much for reading this episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guests or even myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button and leave a rating and a comment. It not only helps me but also helps the show grow and reach new readers.

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Resources mentioned:

• The Ready State
• Becoming a Supple Leopard
• Tune Up Fitness
• The Roll Model
• XPT
• FitLab
• Treat While You Train
• Body By Breath
• Lorimer Moseley
• Why Things Hurt
• ThisMightHurtFilm.com
• @GabbyReece

 

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About Dr. Kelly Starrett, Jill Miller & PJ Nestler

Kelly Starrett, DPT is a coach, physical therapist, 2x New York Times bestselling author, and speaker. Along with his wife Juliet, Kelly is co-founder of The Ready State. The Ready State began as Mobility|WOD in 2008, and has gone on to revolutionize the field of performance therapy and self-care. Kelly received his Doctor of Physical Therapy degree in 2007 from Samuel Merritt College in Oakland, California. Kelly’s clients include professional athletes in the NFL, NBA, NHL, and MLB. He also works with Olympic gold-medalists, Tour de France cyclists, world- and national-record-holding Olympic lifting and power athletes, CrossFit Games medalists, ballet dancers, military personnel, and competitive age-division athletes.

 

Jill Miller is the co-founder of Tune Up Fitness Worldwide and creator of the self-care fitness formats Yoga Tune Up® and The Roll Model® Method. With more than 30 years of study in anatomy and movement, she is a pioneer in forging relevant links between the worlds of fitness, yoga, massage, athletics and pain management. She is known as the Teacher’s Teacher and has trained thousands of movement educators, clinicians, and manual therapists to incorporate her paradigm shifting self-care fitness programming into athletic and medical facility programs internationally. As the creator of some of the world’s best mobility tools, she has crafted original programs for 24 Hour Fitness, Equinox, YogaWorks, and numerous professional sports teams. She and her team of 500+ trainers help you to live better in your body with an emphasis on proprioception, mobility, breath mechanics and recovery.

Coach PJ Nestler, a human performance specialist with over a decade of experience preparing top athletes for competition. His life mission is to help athletes and coaches realize their true potential. With a passion for sports and a commitment to excellence, PJ has become a leader in sports performance training. He has trained dozens of athletes from the NFL, NHL and MLB and has worked extensively with over 100 fighters, including multiple Brazilian Jiu-Jitsu World Champions and Top 10 ranked UFC fighters. Through the application of his progressive training philosophy and unique approach to every situation, Coach PJ continues to raise the bar for fitness professionals. He has emerged as a sought-after expert in human performance and trainer education. We couldn’t be more thrilled to have him on the XPT team, as the new Director of Performance!