Episode 96: How to Know You’re Healing—Even When Pain Keeps Coming Back

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode, Joe Gambino and Joe LaVacca discuss managing pain flare-ups, understanding progress in recovery, and practical strategies for coping with chronic pain. 

They explore mindset shifts, the role of lifestyle factors, and how to recognize meaningful improvements despite ongoing symptoms.

Takeaways

• Pain flare-up management
• Progress markers in recovery
• Mindset and emotional resilience
• Lifestyle factors affecting pain
• Patient education and communication

Transcript

Joe Gambino (00:43)
Welcome back to the Beyond Pain podcast. am one of your hosts, Joe Gambino. I'm here with our other hosts, Joe LaVacca Find us on Instagram at joegambinodbt for myself, at shredthemotion.com, underscore PT for Lavaca over there. You can find this on Instagram as far as the podcast goes, Beyond Pain podcast. And if you want to watch along YouTube cups of Joe underscore PT. Welcome back, Joey Boy.

Joe LaVacca (01:04)
It is good to be back. I'm looking forward to chatting with you again. And I know that ⁓ we'll be bringing lots of that's our new motto actionable steps on the podcast. Yeah.

Joe Gambino (01:13)
actionable step. This episode I

have a question for you. May not have distinct checklist of action here for you, but not so much, but maybe it's more of mindset question around recovery. Okay, so we're switching theme here just slightly from last week.

Joe LaVacca (01:22)
Hmm. Trick question. Okay. Okay.

Okay.

Joe Gambino (01:35)
And so the question is actually posed by a client of mine as we were talking, and I'll frame you a little bit here, where she's doing better, a lot of upper back pain, tightness, discomfort, especially around like one particular spinal segment, like if you put pressure on it, been doing much better, can sit much longer, overall just symptoms are down, but still like pops up.

and still had, she just came over like off of like a week and a half flare up. And in our conversation, what we found out is even though this flare up was here, it recovered quicker than it typically has in the past for her. And she is able to still do more like sitting no longer bothers her and things like that, which was not like in the beginning, it was like 20 minutes of sitting would be like pain really starting to like radiate and spread from that one spot outwards. And so her question is, the hard part for her is that she doesn't know

if she's making progress because she's still having flare ups, she's still having some pain and she's so how are you approaching conversations like that? How are you letting them know or what can somebody think about when they're going through a journey and they still have flare ups and they still have pain to help them really realize that they're making progress and she doesn't understand like

Okay, like I see like some of these other things are happening and like I am okay. Yeah, I am getting better. But when these flare ups happen, it's like, man, like am I truly getting better? How are you approaching it?

Joe LaVacca (03:00)
Yeah.

Well, the first thing I would say is that it's always worth revisiting or confirming that we're both on the same page with what progress is. That's number one. And I think that when people come in on day one versus day 10 versus day a hundred, their perception of progress is probably changing, even if we're not having that direct conversation with them. And in day one,

Joe Gambino (03:20)
Mm.

Joe LaVacca (03:24)
It might be, I can't even sit without pain. And then now a month later, whatever she's sitting and she's fine without pain. But now it shifts to, well, but I can't even run without pain and I can't even live without pain and I can't even do this without pain. So clearly the progress mark marker for her is pain. Okay. Which is okay. That's fine. Like

Joe Gambino (03:45)
Mm-hmm.

Joe LaVacca (03:47)
Not a big deal. I'm not going to tell her she can't have a progress marker for pain. However, looking at it from a fact-based perspective, we're just kind of taking the big picture. You're able to do more activities over the last few weeks, even in the presence of pain. And you're seeing how your ceiling is shifting. So first of all, does she realize that? That sitting is a lot less demanding than say, walking. Walking is a lot less demanding than running.

running might be at or about the same as lifting, depending on what you're doing and your intensity. Maybe it's positional. Hey, we're seeing that you're getting pain every time you go to the gym when you squat or every time it's Wednesday and you have that big meeting at work. So I think always checking in with what progress means weekly, monthly. mean, it could be session to session with some folks, especially if their pain has gotten better. Like

If you've been dealing with pain for a really long time, one thing I've realized is that if you get a little bit of hope and you start to feel better, my next conversation with a lot of people is what can I do now? What should I be doing now? And it's like, well, hold on. It's only been five days. Like, I'm glad that you feel better, but I don't know if this is just how your pain would have ebbed and flowed anyway. So let's just stick to the plan. The second thing that I'd probably, visit with her is that flares are happening to you.

not to the spot in your back. So what else is going on in your life at the time the flares are happening? Is there work issues? Are there spousal issues? Are there nutritional issues? We spent a whole week last week talking about nutrition and what does that mean and what are opportunities around that? So when we're thinking of the flare, I know it's really easy to hone back in on that one spot on your back and be like, man, like this

tissue, this structure, this disc, this bone got really, really aggravated. But it could just be that your system got sensitized again. So regardless of what you were doing that day, how long you were sitting, how long you were running, this was going to happen because there's an opportunity potentially that we're missing or potentially that we talked about. And then maybe weren't giving enough priority to because

Our lists as clinicians, think change and shift as well, just as people's perceptions of their progress change. If I gave you three lifestyle recommendations, four exercises, a list on how to sleep better, and then two recommendations to talk to a therapist to help you with your spousal issues at home, where do you start? So it has to be agreed upon that, hey, we started here. Maybe it was with movement, maybe it was with breath, maybe it was stress management.

Cause we both thought that that was going to give you the most bang for your buck. However, we never said that the other things didn't matter. We just agreed to start here. So now that you have those systems in place and we look at our sort of like chessboard here, what's the next move that makes the most sense to you? And let's see if I can help you. If it's, you know, spousal stuff or nutrition stuff. Well, Hey, you know, given my history, you know, maybe I can help you with both. know enough to be dangerous with both, but if it's something really deep.

Joe Gambino (06:21)
Mm-hmm.

Sure.

Joe LaVacca (06:45)
then you need to go talk to someone or you need a coach or you need a dietitian, right? Maybe that's next step. So let's keep our program going. You're lifting, you're breathing, your mobilizations, your whatever running progression. And in the meantime, why don't next week, instead of you coming back to see me, just go see and talk to the therapist, see what they have to say, talk to the dietitian, see what they have to say. You're still doing our program though. We're not subtracting. We're trying to move pieces around to see, which is going to give you the most bang for your buck.

Joe Gambino (06:47)
Sure.

Yeah.

Joe LaVacca (07:12)
based on your goals. How did you go about handling that conversation?

Joe Gambino (07:17)
Well, I'm going to ask you one more question here before we talk about it, because I do like what you said, and I love the question around what progress means, and especially talking about it's more of a sensitized system versus a, you this particular structure is just bad, right? It's a bad boy, and it's causing you some issues.

Joe LaVacca (07:34)
Yeah, right, right.

Joe Gambino (07:37)
For this particular person, the pain seems to have no Rama reason when these flares happen, right? Like we aren't able to identify.

Joe LaVacca (07:42)
Hmm.

Joe Gambino (07:45)
this activity, this stressor, this change in her day, whatever it is. And I think that's part of what lends to when the pain does pick up like that. And it's more so during these flares, like she just had this week and a half of high level of pain, hard to bring it down, and it becomes mentally taxing in a sense, where the strips mood and energy. So it impacts life when these flares happen. So when we don't have

Joe LaVacca (07:50)
Mm-hmm.

Joe Gambino (08:12)
a real U2X and it drives this sensitization and it almost seems to happen for unperceived reasons. Does that change the questions and the way you go about it?

Joe LaVacca (08:14)
Mm-hmm.

Nah, it may be depend on how interested they are in possible explanations. And I think that from what I recall and reading about even nerve firing patterns is they're spontaneous. Right? I mean, the neurons in our brains are spontaneously making connections. Those connections are living entities. The thought pattern of,

Joe Gambino (08:29)
Mm, I like that.

Joe LaVacca (08:46)
where you live or where I live is a neuronal connection. Your pain is a neuronal connection. Your emotions, your sadness, your happiness, whatever, these are all connections that will make or break depending on the day or just because they are literally always seeking connection. So obviously we can't control the billions of neurons and firing patterns in our brain, but realize that they are trying to survive just like you and I, right? For them,

Their world is, the more connections and builds I can make, the more solidified I am, and the more likely I have a chance to be here. Your outer nerves will sometimes just shoot off chemicals and hormones too, for any number of reasons. mean, moving my elbow might've been enough to cause my shoulder pain because I needed nerve firing patterns to move my elbow. And that could have been enough for that day to just move me over a threshold, and now my shoulder hurts again.

And I think in those situations, the affirmations are really important. And I've had two clients recently where I've really encouraged them to either write this down on their phone, open up their CoachRx app and read it either out loud to themselves or over and over again. This is just a flare. I am safe. I have been here before and I know this will get better. This is a flare. I am safe.

Joe Gambino (10:01)
Hmm.

Joe LaVacca (10:07)
I have been here before and I know that this will get better. Exactly. Over and over and over again. And you have to believe it. Right. And the one thing that often helps people believe that, and I may have touched on this a few times and I bring it up often week to week with clients is the double standard. If you are husband, spouse, child,

Joe Gambino (10:09)
It's like the Simpsons back-to-back weeks Joey, just right on that chalkboard over and over again.

Joe LaVacca (10:34)
was going through the same thing, what would you tell them? Would you look at that sentence and is that something that you would speak to them? Yes. Okay. So if you would tell it to them, you have to believe it deep down, right? Or else why would you lie to your child, your spouse, your best friend, your mom, your dad? That doesn't seem like you. So if you would extend that information as truth, then you have to receive it yourself as truth.

And then there might be a quote unquote buyout, right? So you say this affirmation. Sometimes that might be the only thing you can do. You're in a meeting, you're in a work call. you're on the train, right? There's nothing that you can do. But when you are capable of doing anything that you enjoy, that's your buyout. It could be reading a book for three minutes. It could be listening to your favorite song. It could be going for a walk outside around the block.

It doesn't have to be something where you're like, okay, get down, do your hip circles, stretch your hip for three and a half minutes. remember the isometrics I taught you? remember that like breathing pattern I taught you, right? Sometimes those things will be accessible. But a lot of times without these connected patterns, we're gonna need something a little bit different, more that you can do any place, any time. And that could be just walking. That could be...

Joe Gambino (11:29)
Mm-hmm.

Joe LaVacca (11:49)
popping in your AirPods and putting on your favorite song. That could be listening to a podcast. That could be reading a book. Whatever the case is, find something that you enjoy and makes you realize that you can still have your identity and then keep repeating the mantra.

Joe Gambino (12:04)
Mm-hmm.

I like that. I think maybe not in this particular case, but I think there are cases that I've had where moving and shifting to the something you enjoy philosophy sometimes in like certain cases can be better than let's shift to the let's try these exercises and see what you can do with pain because sometimes pain is like is the problem in a sense and constantly like checking in with symptoms. I think sometimes can make things harder for

for some people and certain, especially in certain parts of their journey. So I really liked the idea of like, you, can you do something you can enjoy that can either distract you from what's going on or help you feel a little bit better in the meantime, that is, that is absent of how can I play around with the area or play around with movement and then pray at the end of it that I feel a little bit better. Right. And then I think also just like enjoyment in, you know, like sometimes pain can really put you down, like a really big rabbit hole of like,

Joe LaVacca (12:33)
Sure.

Joe Gambino (12:59)
despair and I think pulling in things that you really enjoy can help kind of play out of it as well. So I do like that a lot.

Joe LaVacca (13:05)
Yeah,

unless you like your hip stretches and your mobilizations and your hip circles and whatever, then yeah, go do them. But a lot of people are doing those things because they believe they have to, or they believe they should, or they believe like that's the only way to make themselves feel better. And I think that when we reinforce that message, we're reinforcing the idea that yeah, you're right. This is happening to your hip. This is the hip tissue. This is the hip capsule. This is the hip muscle. So you need to work the hip muscle.

Joe Gambino (13:08)
Yeah.

Yeah.

Joe LaVacca (13:33)
And when we accept that pains that broader approach, well now look at how many more options we have to help you cope with it in the moment.

Joe Gambino (13:41)
No, no, it's great point because I mean we both believe right like pain is not necessarily just I mean it can certainly be tissue specific right but it can also not be at the same time so very good I think this was a very

very useful conversation that will help a lot of people I think if they're struggling to understand if progress is happening from a pain continues to ling around throughout the process.

Joe LaVacca (14:05)
Yeah, that's a new motto, actionable steps every podcast. All right, man. Well, as always.

Joe Gambino (14:07)
That's it. Look at that. didn't think we were going to have actionable step, but here we go. We got a few. Get yourself a chalkboard, put it in

every room of your house and make sure a hundred times a day you write down your affirmations.

Joe LaVacca (14:21)
Yeah, look until you until you believe it until you get the blue until you get the tattoo on your forearm The chalkboard will have to do well, Joe. We love you listeners. We love you Thank you for listening again, and don't forget to come back next week for another exciting actionable episode of the Beyond Pain podcast