The Beyond Pain Podcast

Episode 61: Stop Chasing Your 20 Year-Old Self: Rehab, Identity & Chronic Pain

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the challenges clients face when comparing themselves to their younger selves during rehabilitation. 

They explore the impact of aging on physical capabilities, the importance of setting realistic goals, and how to navigate expectations in the rehabilitation process. 

The conversation emphasizes the significance of small wins and embracing one's current identity rather than striving to return to a past self.

Takeaways

  • Clients often compare themselves to their younger selves.
  • Aging brings physical changes that affect rehabilitation.
  • Setting realistic expectations is crucial for success.
  • Small wins can motivate clients in their journey.
  • Pain management strategies can include modifications like braces.
  • It's important to focus on who clients are now, not who they were.
  • Professional athletes have different training demands than average clients.
  • Rehabilitation should aim to enhance current capabilities.
  • Clients need to understand the potential outcomes of their choices.
  • Building a supportive relationship with clients fosters better outcomes.

Joe Gambino (00:44)
Welcome back into the Beyond Pain podcast. am one of your hosts, Joe Gambino, and I'm here with our other host, Joe LaVacca You can find us on Instagram at joegambino.dbt for myself at strength and motion underscore PT for Lavaca over there. You can find this podcast on Instagram, Beyond Pain podcast and on YouTube cups of Joe underscore PT. There is an application form down in the show notes. So if you would like to reach out, please do so. Welcome back, Joe boy.

Joe LaVacca (01:09)
It is good to be back my friend. Good to see you and we can tell the summer's here because the tank top is out. Guns are out. The sun is out. My thighs are always out so I'm always trying to show off the thighs. Upper body I think has always been a work in progress for me so I can't pull off the tank top like Mr Gambino over there with your nice broad shoulders and I think listeners are

Joe Gambino (01:15)
⁓ it's hot down here.

Yes.

Joe LaVacca (01:37)
on YouTube, we're getting an extra special treat today.

Joe Gambino (01:40)
Yes, that was the goal that was the goal this morning when I woke

up in our 90 90 It's gonna be 91 today. It's been we hit 96 has been it's been very hot down here. So

Joe LaVacca (01:50)
Yeah, did you get hit with that heat wave that the northeast got hit with too? I mean it was brutal.

Joe Gambino (01:54)
⁓ I

guess so. We have been in the 90s for quite at least a week now. So yeah.

Joe LaVacca (02:01)
Yeah, absolutely miserable. I am Adam Colorado

again, judging from the background. I'm always changing positions here in Colorado, I feel, it keeps, I think it also keeps the YouTube followers guessing. Different backgrounds all the time. Yeah, exactly. My bookshelf now, just a white wall, glaring sunlight. Who knows, who knows where I'm gonna be. ⁓

Joe Gambino (02:12)
People should just be like guessing what Joe's background going to be today. Is it going be Mexico? Is it going to be, you know, the new bookshelf?

Ha.

Joe LaVacca (02:28)
Yeah, I'm excited to chat about today's episode because it was inspired on the way into the clinic. So this is a live inspirational moment to moment episode, really like a lot of our episodes are. I feel like we get inspiration. We just start rolling with it. But today I figured we would talk a little bit about something that pops up fairly routinely. And I'm wondering why it took us all to talk about it until today. But.

When we have clients and they're talking to us about their pain or their injury, one of the little threads of information that routinely comes up is this comparison to who they were. And one client really recently, I may have shared just a brief tidbit on it. He was 71. He's had multiple spinal surgeries and fusions.

Joe Gambino (03:21)
Mm-hmm.

Joe LaVacca (03:24)
And really the biggest thing that we deduced that was holding him back in his assessment was the fact that he was just comparing himself to when he was 40 and active before he ever had any surgeries, any fusions, anything like that. So the opening question, what do you do when a client is comparing themselves to who they were and that's the biggest thing, maybe holding them back in their rehab process.

Joe Gambino (03:35)
Yes.

Yeah, that's a, that's a probably a very tough question. Um, I mean, in those cases, I mean, this person needs to, you know, how I would kind of educate in a sense is kind of bring them back to, where they are today and kind of where they are. And it's kind of bring them to the present in a sense. Uh, well, sure. You know, when you're 40, you're feeling X, Y, and Z and you're, you're doing great, but today we're struggling with back pain. You're also 30 years old, 30 years older. Um, you know, and things change and,

There's actually, I talked to people about this a lot, but also it was one of these kind of posts that went really almost viral on Instagram. think like, uh, it was, it was really about, um, after the age of 30, every decade of life afterwards, you have a decrease in strength and decrease in power. And there are changes that happen physically that are going to push on a decline. That's why you can't be a pro athlete, you know, unless you're a Tom Brady, right into your forties or LeBron James, right? Like.

Joe LaVacca (04:38)
Mm-hmm.

Well,

and even that had a cap.

Joe Gambino (04:52)
Yeah, you know, right? So at some point, right, you're past your prime, you're not going to be where you were and even 40, right? Like, I mean, that's, you know, I'm surprised he's not comparing himself to even younger in a sense, because your prime is going to probably be in your 20s and 30s. So bringing it back to all this this information and say, hey, you know, like, you can't compare yourself to their surfer, maybe like a pain perspective, you can, you know, maybe you want to feel that way again. But if you've had multiple surgeries, you have to also bring them back to that, you know, when talking about on podcasts.

when you've had injuries before and you have surgery that things are going to change for you, right? It's more likely that you're gonna have pain, where injuries can pop up. It just increases your risk for injury. I have a client now. She's one of the ones that we talked about in the ACL episode. And she's actually right now determining whether she's gonna go non-surgical or surgical. And we were just having a conversation about it. And she was like, well, I just wanna like guarantee

Right? Like at the end of the day, like I'm going to have no issues in the future. And I was like, well, you have to be okay with like, what are the outcomes? Right? Like I like to be like outcome driven, right? Like, so there are scenarios. If you go non-surgical, I don't have any experience with it, but there's three scenarios that can pop up, right? One, you can, you can not get back to your active lifestyle because we don't know. I don't know what the outcomes are. I've read one article about it and it shows positive. you fit certain criteria, there's one outcome where you're going to be doing.

pretty well and you know, might have some issues, but you know, you're back to doing everything you want. And then the other outcome is you feel great and you almost have never any issues. And the same thing, if do the surgery, you know, the outcome is probably going to be, you know, there's an outcome where it fails. There's an outcome where you're to still have some soreness and things like that, you know, that pop up, maybe some swelling down the line. She's like, wait, what? And I was like, yeah, like, you know, once you have an injury,

Joe LaVacca (06:34)
Yeah.

Joe Gambino (06:37)
you know, something is going to pop up that there's a good likelihood of it. So I think setting those expectations and and I may rethink things in a sense, which was a little shocked by me saying it. And I think that people need to be prepared for how things can change, because when things do pop up, they're going to be more prepared for those things. I know I got a little bit off of aging, but we kind of bring it back to aging. think letting them understand that changes happen when you have injuries, when you've had surgeries, these changes that happen as we get older. And this way,

No, sure. We can get you feeling younger. The whole point of training when we're in our thirties, forties, even before that, right, is to make sure that we're making sure these as we age, the changes are not as, as steep. We want to build up as much as possible. And if you didn't start earlier, we can still build you back up and help you move better, feel stronger, have more power, all of those things. It's never too late. But I think when you give somebody that, Hey, this is the potential.

now and in the future when it does happen, like, oh man, Joe told me this was going to happen. Like they'll feel better about it in the future. So I don't know that answers your question fully, but I would love to know how you navigate it.

Joe LaVacca (07:39)
you

Well, like

we always talk about, it's not about answering my question. I wanna hear your opinion and that's it. So I got Joe Gamino's opinion, that was great. I think it's always interesting when the aging comparison pops up. And I kinda handle it a few different ways, again, depending on how close I am to the client or maybe how close I've gotten to the client over time. But in the very beginning, and...

Joe Gambino (08:03)
Mm-hmm. Sure.

Joe LaVacca (08:07)
that comparison pops up. Let's just use my current client as an example. I kind of pause and I stop and I say, well, hey, I just want to confirm one thing. When is your birthday? And they give me the date. And I'm like, okay, so we are 71 years old. Is that correct? And they're like, yep. And I'm like, okay. And if I'm hearing you correctly, you would like to be 40 again.

and they sort of, and then I just pause, because I want to clarify that. And they go, yeah, I know that sounds kind of crazy. I'm like, well, it doesn't sound crazy. It just doesn't seem like it's a reasonable goal for you to be chasing. So I can't turn back time, but I can work with you right now. Then I say, do you like sports? And.

you know, sometimes they say yes, sometimes they say no, but regardless, I'll always say, well, do you know who LeBron James is? Do you know who Tom Brady is? And those are the easy yeses. So there are great comparisons to say, hey, look, these people were able to maintain such a high level of performance, but do you know how old they are? And then,

Joe Gambino (09:11)
Sure.

Joe LaVacca (09:24)
Typically it's, well yeah, think Tom Brady was 42 when he retired. LeBron James will be, I think, 41 or something like that when he retires. I'm like, okay, so you're seeing this kind of cap that even professional athletes who are able to sustain this as their job, they can't go past a certain point. Or they have to start to deviate. Tom has to start playing flag football.

Joe Gambino (09:31)
Mm-hmm.

Joe LaVacca (09:49)
LeBron has to start doing three on three half court tournaments if he's going to continue to optimize his play. So I said, what in your history or experience or interaction with other providers kind of leads you to believe that it's fair for you to compare yourself to them when you were a lawyer, a social worker, a dentist, an IT tech your entire life?

Joe Gambino (09:51)
Yes.

Joe LaVacca (10:16)
So the 40 hours a week you were put in for working and then managing your family, that was 40 hours a week they were training and lifting and exercising because that was their job. So when you and I are straight training three hours a week, five hours a week, just know you have so much further to go to compare yourself to an athlete and they still don't play past.

you know, the idea of 40 or 50 or things like that. So I'll throw in an analogy too every once in a while for them. like, you know, it's sort of like when you're in your kind of saving for your bank account. You know, when you and I are younger or when you and I are in our phase right now, we're building our businesses, we're building a brand, we're hustling, right? We're doing as much as we can right now. So then that way, when we're hopefully 60 and 70 or 80, I can just maintain.

you know, what I've built rather than trying to hustle throughout my entire existence. And I do think people can appreciate that a little bit. Like, yeah, okay, I understand what you're saying. I can see sort of the irrationality in what I am thinking or what I'm expecting. And then that kind of can open the door for a lot of people. However, I have had a few people who are like, yeah, I understand that, but I don't see any reason.

Joe Gambino (11:13)
Mm-hmm.

Joe LaVacca (11:41)
why I still can't do X, Y, or Z. And I'm like, well, that's fine, but then I don't think that I'm gonna be able to help you because I just think that your goals right now are not realistic and based on your previous history, and we've said this before too, by the time people probably find me and you, they've been through the wringer a little bit. They've seen quite a few providers and they're still searching for answers.

So to even kind of take that back is like, well, how has this process been going for you thus far chasing the fountain of youth? Has it been successful? Because it seems like you're sharing this story now for the eighth or ninth time. So when does it actually become a you problem versus when does it become a physical therapy or training, ⁓ you know, non-solution or something like that, right? So.

Joe Gambino (12:15)
Right.

Sure.

Hmm.

Joe LaVacca (12:34)
I'll pause there. don't know. What do you think about that?

Joe Gambino (12:36)
Yeah.

Um, I think it depends on, you know, here, you know, where we know how lofty or how big the goal, how far does it seem away. think a lot of people, know, when they're trying to think back like, you know, I wish I felt 40 gamma. We'll take you at the person. 70 is probably the last time that they felt good about their body and where they were. Right. So it's probably less of feeling the age and more of feeling like they can get back to doing things without restriction again. Right. And, and

You know, sure, maybe someone's really hooked on like a movement or like they need to get back to CrossFit or whatever it is, right? And you need to maybe in those cases, right? Need to dial back and say, Hey, maybe we should try X, Y, and Z first. Let's get some success here. And then we can, you know, let's let time dictate if we can get back to those things. But I think, you know, a lot of times what I sense from people when I'm talking to them, it's, it's less about, I need to be 40 again. It's more about like,

And I just want to be able to go out and like lift and not have pain or I want to go hit the links and, know, not need to take a Tylenol afterwards. Or if I want to go on a golf trip with my buddies, like I want to be able to play 36 and not be dead. Right. Or, have to have to bow out. So that that's kind of the more along the lines that from what, what I'm seeing. And I try to keep it there and ensure maybe you need to redirect and educate and create a more realistic expectations or what I like to do in those cases, like, you know, someone's like really like, this is a big lofty goal.

Joe LaVacca (13:38)
Yep.

Yeah.

Joe Gambino (14:03)
is say, why don't we make some short term, shorter goals? Like what can we accomplish in four months and keep them more fixated on that and then move the needle there and see how far we can get them. And then from there, hey, what can we do now in the next four to six months and so on and so forth. So I think also shorter term goals can make something more useful for somebody. So instead of this big lofty goal, that's what I might be struggling with that may be like, hey, I don't even know if we can get you here, but what happens if we.

backtrack this and start here and then take that one step at a time and see how far we can get you.

Joe LaVacca (14:33)
Yeah, you bring up a good point like with not having to take Advil or not having to do this. And I think that's where a bigger mismatch occurs for me. It's like, not only do you want to move backwards, where you're comparing yourself to a person who doesn't exist anymore, right?

You also want to do it without any modification. Or maybe people on social media or other providers have been like, well, no, you don't want to take medication. You don't want to be wearing a brace. You don't want to use a cane. And really over the last few years, I've really just been thinking, well, why the hell not? And I've had a couple of people come in more this week and they're like, well, yeah, I can run, but I have to kind of keep the ankle brace on when I run. And I really prefer not to do that. And I'm like, well, why?

Joe Gambino (15:06)
Mm.

Joe LaVacca (15:19)
And they're like, well, it's gonna make me weaker over time. I'm like, hold on, hold on. The brace that takes away your pain that allows you to do activity like running and training is going to make you weaker over time? Can you explain that for me? And they're like, well, actually, no, I can't when you put it that way. And I'm like, right, so if pain is your biggest barrier and you have a device or a medication that's safe that takes it away, then where is the harm?

in you using it safely, effectively, as per the dosage. Not that you would need to wear the brace to sleep. I understand how that could be a constraint. Not that you have to wear it around your house, but with the activity level that you're trying to seek, what is the sort negative outcome of using something like tape, a brace, taking an Advil before, taking an Advil after?

What are you willing to trade off in this process to get you back to where you want to be? And if it's not modifying the activity altogether, like three on three basketball or flag football or, you know, shooting, I'm not a golfer, you are. What's the gold tees or the furthest ones? What's the closest ones? Yeah, the black, okay.

Joe Gambino (16:27)
you

Usually the black. Black would be the

furthest and then reds would be the closest.

Joe LaVacca (16:40)
friends

would be like, so you want to play golf but you don't want to shoot off the red tee. So where can I help you in this process when you're having a goal that's not realistic and I want you to compare it to any other facet in your life. Okay, so you want to run like you were 40 or 20. Do you want to have the same bank account when you were 20 years old? Do you want to have the same friends? Do you not want to have kids? Do you not want to have your wife? Because if you want to go back to being 20 or 30,

that's the life you're choosing. And I think, you know, there's a lot more to your life right now than just golf, than just running, than just this. So maybe it is about re-prioritizing, you know, how important these other things are to you. How are you going to get back to things? What are you willing to trade off? And then, you know, if I did have that close of a relationship with them, reminding them.

that they're a goddamn dentist, a social worker. You know, like you're not a runner. You you like, you're a dentist who likes to run. You're a lawyer who likes to lift. You're not a lifter. Right? So, and if you wanted to reevaluate that sort of like identity, well then you got to give up everything else. Then you can't go to work tomorrow.

Joe Gambino (17:47)
Yep.

Yeah, identity is the perfect word for this. kind of brings us back to Mike Stella's episode where it's, you know, for I think a lot of people when you have this big turnover, especially with age, right? It's almost like you're admitting that you're getting older and not a lot of people want to do that, right? And they want to try to hold on to what they've been able to do as long as, as long as they can. So I think where we are, right? I mean, I think we always need to create expectations for people, like realistic expectations. I took something from you along.

Joe LaVacca (18:01)
yeah.

Joe Gambino (18:23)
time ago when we working at Perfect Stride, and I still use it to this day, when I have someone in chronic pain, when I'm talking to them, especially for the first time, it's like, you know, can never, nobody could ever promise you that you'll never have flare-ups or pain again, right? But it, you know, that's like an unrealistic, you know, probably the wrong thing for someone to promise you, right? And it's gonna lead to poor expectations and negative outcomes in the long run, right?

Um, so I use that to this day. And I think that, you know, yes, we need to set these expectations that sure, maybe you're not going to get here, but I also think that we need to. No, I look at it, right. As I try to be as, as optimistic and say, Hey, you know, here's the expectations, but let's get you as close to possible as, as, as we can, right? Let's just get into training. Let's do all the right things and let's see how close we can get you. And if you still need to modify, you know, I'm perfectly fine with someone wearing a brace. You know, I had someone I was working with here in the community with elbow pain. And in the beginning he had to wear.

those Those thing that goes around your forum for that puts a little pressure on it Yeah, and it worked wonders from so said listen do your push-up do your pull-ups? are the two primary things train Where where your brace? It allows you to do what you want to do Let's work on all the things that we need to do and now he's actually at a point where where he can he doesn't need it at all for for anything He still has some pain with some gripping in certain ways and when he's doing yard work, but like all this training feel feels good

so, and I wasn't sure where that would go. He's older. He has a very, very long list of injuries. he's doing very, very well better than I would have even expected from, from our, our first session together. I think we spent 30 minutes just talking about his injury history. Like that's how significant it's been. so then he's been doing great. Right. So, you know, I also don't want to be like, you know, when I'm having these conversations with people, I don't want to be like so out putting where they also aren't motivated in their journey. Right. So it's finding that balance of here's your expectations.

Joe LaVacca (19:58)
Yeah.

Joe Gambino (20:12)
Let's move into a journey. Let's, let's take one, one small step at a time. It's moving the right direction and see how far, how far we can take them. And I think each, like, I like small goals in that, in that regard, because it just allows us to push in a direction and Hey, we hit one milestone. Boom. It's positive for them. It's positive for, for us. Right. We feel good when we help people. That's why we're in it. Right, So going through that journey, small, small, small. And at the end of the day, I think if you can get somebody a lot of small wins, even if they couldn't get back to like this big, huge goal.

that they had or like, you know, going back to this old identity, I think they'll be happy at end of the day because they've seen all these small wins that have added up to a long part and maybe it allowed them to keep as much of their identity as possible. At the end of the day, I think that's probably going to be the one for that person versus the very specific I have to do X, Y, Z. There are definitely people who are type A, very, have to do this. And those are a little bit harder to navigate. again, I think, I think

going about it that way is, will be very helpful. Expectations, small goal setting and just, you know, I always big fan of just like, let's let time dictate what do you can and can I get back to you? Because I've also heard a lot of doctors who say, Hey, you should never do this again, based on the injury or the surgery we've had, right? And, um, you know, I also disagree with a lot of those things, unless it's very, very specific reason why, um, a lot of them, think it's, it holds people back more than it helps them. Not to say that you do that, but.

Joe LaVacca (21:23)
Yeah.

Yeah. And I really,

no, I know. Well, I've had a, I'm just thinking about like five people this week with a doctor conversation. Maybe that could be the next episode, but, but I think the, the goal expectation thing that you brought up is also really great and really important to talk about. And maybe part of it in the conversation of, you know, I want to get back to, where I was when I was 40, I want to be able to, you know, run 10 miles pain-free.

Joe Gambino (21:39)
Okay.

Joe LaVacca (22:04)
And right now my knee hurts so badly that I can't do that. Okay. So sometimes my clarifying question is, so just to make sure we're on the same page, if we got your knee paid down to a three and you were able to run eight to 10 miles, that wouldn't be acceptable for you. And they're like, no, no, no, my God, that would be great. I'm like, okay. What if we got your pain down to a four?

but maybe you had to spread out some of your workouts a little bit more, that's still not acceptable to you. You know, like, no, no, no, that would also be really great. And I'm like, great. So, right then and there, I just gave you two alternate goals that were not pain-free running for 10 miles like I was when I was 40. And that was where acceptable to you. And then that's a little bit eye-opening of like, okay, yeah, wow, so there are different definitions of success.

Joe Gambino (22:44)
Mm.

this.

Joe LaVacca (22:59)
in this process that I'm about to embark on that no one has ever redirected me on. And I do know now, or I can see perceptually, that there is a lot of room for improvement before I even get to this end goal. So I think that was a beautiful point, Joe. My last little, yeah.

Joe Gambino (23:16)
Yeah, I love those questions too. And just

wanna bring me back to those outcomes that we talked about with the person with the ACL, like this is, you if we had these three things that pop up, like, are you okay with all of them or any of them, right? you know, so, so yeah, I just wanna say, you know, those are great questions. I ask those questions all the time to figure out what is really a success for somebody. And then the sky's the limit, let's go as far as we can, but at least we know when the expectations are now set that.

Joe LaVacca (23:29)
Sure, yeah.

Joe Gambino (23:42)
This might be the cap, right? Let's start to get to here first and then we can get to the next one and the next one and the next one.

Joe LaVacca (23:49)
Right, right. Yeah, I think my closing remark would be, you know, rehab, strength and conditioning is not to bring you back to who you were, it's to make the most of who you are. And I think that's really where I've really focused my journey and my mindset with people. And that seems to have helped me. And it's really all about me. Joe, as we've talked about multiple times, if it's easier on me, it's easier on everybody else. But I think that's really where I try to bring people to that.

Joe Gambino (24:02)
Mm-hmm.

You

Joe LaVacca (24:15)
sort of realization or the way that I view rehab and strength and condition.

Joe Gambino (24:20)
Yeah, I like that because I think and you know, one takeaway for people on this, know, outside of like, you know, having good expectations and proper goal setting is just making sure that, oh my God, I lost my complete train of thought there, Joe. I don't even know what I was going to say. So it was, it was going to be, it was, you know, it was just going to be pure gold and I'm going to have to save them until it comes back into my brain, which will probably be at the top of next episode. Oh boy.

Joe LaVacca (24:37)
It was gonna be good though.

You

man,

Joe Gambino (24:48)
I was lack of sleep last night. They got me there.

Joe LaVacca (24:48)
all right, well, look, we were talking about little baby Joey. It sounds like he's fed and now maybe hopefully taking a nap or something. he'll be ready to rock and roll. So I know you will be and sharing all your infinite wisdom in the next episode. anything else you wanted to share for today?

Joe Gambino (24:58)
I might be at this point.

We'll just end this episode on a negative note from me.

Joe LaVacca (25:10)
Well, Joe, we love you anyway. I love you anyway. Listeners, we love you. And don't forget to come back next week for another exciting episode filled with lots of practical information and wisdom on the Beyond Padding podcast.