Episode 99: Why Treating Pain Isn't Enough: The Future of Persistent Pain Care with Benjamin Stevens

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain Podcast, hosts Joe Gambino and Joe LaVacca welcome Dr. Ben Stevens, a chiropractor and educator from Canada. Dr. Stevens shares his journey into chiropractic education, emphasizing the importance of communication skills developed through teaching. 

He discusses the mindset of evidence-based practice, highlighting the need for clinicians to adapt and evolve based on new research. The conversation also explores the significance of empowering patients to make lifestyle changes for better health outcomes, and the future of chiropractic care as it shifts towards behavior change and patient self-management. 

In this conversation, the speakers delve into the evolving role of therapists as case managers, emphasizing the importance of understanding patient expectations and the need for accountability without shame. 

They discuss the significance of social support in healing and the value of building long-term relationships with patients. The conversation also touches on redefining success in therapy, moving away from a transactional mindset to one that fosters community and connection.

Takeaways

• Dr. Ben Stevens shares his journey into chiropractic education.
• Teaching enhances communication skills crucial for patient treatment.
• Evidence-based practice is more about mindset than strict adherence to research.
• Empowering patients is key to effective pain management.
• Lifestyle changes can significantly impact patient outcomes.
• Chiropractors often rely on manual techniques, but there's a shift towards education.
• The importance of establishing authority in teaching and treatment.
• Patients need to feel empowered to make lifestyle changes.
• Communication is vital in both teaching clinicians and treating patients.
• The future of chiropractic may focus on behavior change and patient self-management. Exploring social work can be beneficial for therapists.
• Therapists often struggle with their own egos in patient care.
• Case management is a vital skill for therapists.
• Patients often need guidance beyond just physical treatment.
• Social support plays a crucial role in patient recovery.
• Long-term relationships with patients can enhance healing.
• Therapists should not rush to discharge patients.
• Many patients seek a guide rather than a quick fix.
• Understanding the whole person is essential in therapy.
• Therapists can create a community for ongoing support.

Transcript

Joe Gambino (00:00)
Welcome into the Beyond Pain Podcast. I am one of your hosts, Joe Gambino. I'm here with our other host, Joe LaVacca And today we have a special guest, Ben Stevens. He's a Chiro in Western Canada. He also runs the Canada's largest Con Ed company for chiropractors. And welcome into the show.

Joe LaVacca (00:09)
Yes, it is.

Dr Benjamin Stevens (00:18)
Thank you very much, Joe and Joe. It's good to be here.

Joe LaVacca (00:22)
We go back a long way, ⁓ Dr. Ben. We met better part of a decade ago, teaching for rock tape. So give us a little bit more background on yourself, your education, where you came up, why you live in Canada, why you decided never to move back to the United States or into the United States. yeah. Give give all the viewers a good shining example of Dr. Ben's personality over here.

Dr Benjamin Stevens (00:32)
Mm-hmm.

Well, first I think we need to know there's a shining example of Joe LaVacca personality and that my earliest memory of you is you singing karaoke in Mexico and I'm pretty sure it was Whitney Houston. I don't remember, but it was one of those where I remember thinking like, damn, he can do that. Cause it wasn't like, oh, he's doing a shitty job. Like everyone was in awe.

Joe LaVacca (00:55)
Ha ha.

Joe Gambino (01:06)
⁓ Joe's a big

karaoke guy. I've that's one of my earliest memories of Joe's well. Perfect stride is karaoke.

Joe LaVacca (01:12)
Yeah.

Dr Benjamin Stevens (01:15)
That's great.

Joe LaVacca (01:16)
And that was the

peak. That was the peak. It's it's been all downhill from there because I can't hit the same notes anymore. So now I'm like kind of into Hootie and the Blowfrish and Bruce Springsteen. I really had to, you know, bring it down a couple octaves.

Joe Gambino (01:18)
Ha ha ha.

Dr Benjamin Stevens (01:28)
Yeah, well, that's that's highly unfortunate because that was peak masculinity era. And that's why you have so many male friends now is because they all heard you singing Whitney Houston.

Joe LaVacca (01:35)
Fair. No one was threatened. No one was threatened by my

by me becoming the alpha male. So they were like, We gotta get more Joe in our life.

Dr Benjamin Stevens (01:42)
I

mean, yeah, when you were done, just, you know, I was bowing down when you came off the stage. I can never sing again now that I've seen that. But, I mean, it's even more fun because I don't drink and I was watching everyone else do this and I was going, man, maybe I do want to drink.

Joe LaVacca (01:49)
You tequila's a hell of a drug. Tequila's a hell of a drug. That's all that's all I'm gonna say about that.

Yeah. Yeah, wow. If

what an influence I've become. ⁓ I'm so good at karaoke, people are like, I'm thinking of drinking alcohol.

Dr Benjamin Stevens (02:03)
What was the question again?

Joe Gambino (02:08)
Ha

ha.

Dr Benjamin Stevens (02:10)
Water time.

Joe LaVacca (02:11)
my god.

Yeah. The question was just give us a little bit more background on you. how did you become to run the Canada's largest education company?

Joe Gambino (02:16)
Ha ha.

Dr Benjamin Stevens (02:22)
Yeah, okay, great. ⁓ Well, I mean, I was ⁓ like yourself, I was really unfortunate to be unfortunate. I was really fortunate to be involved in Rock Tape very close to when it was founded. And that's because the first medical director in Rock Tape, Steve Capobianco was one of my personal mentors when I was going through school. So I went to school at Palmer West in San Jose to become a chiropractor. He was there teaching some of the sports electives. And I just really got along with Steve like everybody does.

⁓ and kind of shadowed and probably annoyed him for the better part of, know, three, four years while I was there, I ended up going out to a whole bunch of different rock tape, events and just putting tape on people and learning from him. And then by the time I got back to Canada, ⁓ I graduated, moved back here, rock tape had just moved to Canada around the same time. And so Steve called me out of the blue one day and said, Hey, you're teaching rock tape courses. And I was, I went, huh?

And I was, I can't do that, you know, pure imposter syndrome, like everybody has out of school. I definitely had a certain amount of confidence just as a personality trait, but like in that world, I went, I don't know about this. he went, no, you're fine. So he flew up here. taught the first few courses together and that kind of got me my start into continuing ed. was off to the races within a year of graduating from school. And so that was kind of just a fortuitous way into it. And then match that with me.

I moved to a town where I knew zero people. Like I'm from the East Coast. I'm from New Brunswick, Northeast of Maine, tiny little town out there. And then I moved to British Columbia on the West Coast into a town kind of up in the mountains called Kelowna. And I knew no one and I moved here and I started a business and I didn't really have any kind of mentors or anyone telling me what to do. And so the way that I overcame that was just by going to every continuing ed course I possibly could.

because I wanted to be surrounded by as many smart people as I could. wanted to learn as much as I could, as much as I could. I just didn't want to feel like I was shitty at my job. And at the time, Somatic Senses, which is the company that I now own and operate, was doing a lot of courses all over Western Canada. And I showed up to every single one of them, like eight to 10 a year. And so after the first year, the guy that was running it at the time and founded it, one of my best friends, Michael Maxwell, ⁓ he essentially invited me to kind of come and join him and test out running the business for a year. And I went,

great because I just paid about $15,000 in the last year to take these courses. It'd be really good to get paid to do it. Wait, am I going to get paid? And you went, yeah, probably eventually. And I went, sure, I'm in. And so as a result, sometime in 2012 or 13, I kind of joined him and we were 50-50 in Sematic Census for the longest time. so Sematic Census as a business has been around since 2003 hosting seminars and it's been, you know, 500 to 700 seminars since then. And so I joined somewhere along the line and

did a lot of continuing ed since then.

And that's how we showed up here with me doing it all now.

Joe Gambino (05:13)
Yeah.

Nice. ⁓ that's that's ⁓ that's pretty cool. I'm ⁓ our next question we usually ask people is if you have like a personal journey of pain and how it's shaped how you've been a clinician, but I'm curious more so with your experience of like teaching, how has that impacted the way that you treat patients?

Dr Benjamin Stevens (05:35)
⁓ hugely. One of the primary reasons being that when you teach, communication is basically all you have. You don't get to do something to the people in the room when you are an educator. You only get to portray things through your words. And that's something that has been very distinctly valuable for me because over time, I don't think I knew that communication was, ⁓ you know, early. I didn't know that communication was the thing.

Like it's kind of, I gotta get a toolkit for this. I gotta get my soft tissue technique here and I have all these manipulation techniques over here and I got all these things that I can do to people. I was very much the kind of the operator at the start, despite the fact that I had mentors like Steve, you know, trying to nudge me in that direction. ⁓ It just made me work on being very intentional and very structured with the way that I communicate. It made me work on my presence in a room. It made me work on all these things that create a therapeutic alliance with the patient. I was just practicing it on other practitioners and I was practicing it in a

somewhat, I guess, high pressure situation where it's like you'd have a room full of, you know, 10 people up to 100 people, whatever it might be. I you had to figure out how to deliver that value and that connection rather quickly, ⁓ because especially in the continuing Ed world, people will get, they'll just get bored and they'll ignore you or they'll literally take a nap in the back of the room if you're not great at it. So ⁓ just very, very easy and direct correlation between how well I was communicating with a room full of practitioners and teaching complex information and

how it was doing that with the patients.

Joe LaVacca (07:03)
What do you think the biggest difference was in the communication tactics skills between educating clinicians and teaching clients in clinics?

Dr Benjamin Stevens (07:16)
Probably one of the biggest ones was authority. I think most patients need to know that you have the right amount of authority But there's a really important kind of trust component to that in continuing Ed There's like they need just enough trust that you kind of are a good person and that they know you and they know what you're saying is true But the authority piece is a significantly higher proportion when you're teaching and so there's a certain amount I hate to say it but there's a certain amount of kind of showmanship

when it comes to continuing ed where it's like you have to establish authority, you have to do it quickly and you have to be able to show ease while you're doing it. ⁓ And that's the kind of thing if you lean too heavily into authority in the treatment room, it's very poor bedside manner. You're actually doing the opposite of what you want with people. You're not connecting with them. You're not helping them in certain ways. And you know, in our world, ⁓ know, surgeons kind of get the bad rap for being the ones that do that. They talk down to people and most people just have very poor experiences. The more qualified a doctor

tends to be the poor and experience that a patient has. That translates really well to education because people kind of are there in awe of you and they wanna learn from you and they're trying to get as much as they can because they essentially wanna take a piece of your authority and bring it back to what they do. In the treatment room, if you go that far, it's alienating. And so a lot of it has to do with being able to kind of judge that line between how much authority and how much connection, how much friendliness, how much affection, all these different things. But they are kind of distinctly different.

It's, I think the commonality between them is being very intentional and structured with how you speak. And just things like the pacing and the postures and all those, like you can, you just need to be intentional about them, but too much authority in the treatment room just doesn't go well.

Joe LaVacca (08:54)
Yeah, that's an interesting thing. And the first time I ever taught, and really how even I became affiliated with Rocktape was through a PT out here named Rick Daigle. And very grateful for him. He kind of gave me my wings in a sense, trusted me, and sent me out on my first tour. I think it was in the Cleveland area, somewhere in the or somewhere in the Midwest. And my first class in front of people was 96 people. And

Dr Benjamin Stevens (09:22)
⁓ not

bad.

Joe LaVacca (09:24)
Short

of short of singing karaoke, you mentioned the showmanship thing. I was like, ⁓ how do I get 96 people to listen to me? I'm barely like two years out of school. And I remember, you know, kind of going through it. It was almost like, you know, you wake up in like an old school situation with like Will Ferrell. You're like, ⁓ what what just happened? I I blacked out for eight hours. I don't even know if I just said anything or if I just rambled. And a handful of people came up to me afterwards and I was like, God, here we go.

I'm gonna I'm gonna get laid into. And they were like, that was one of the best courses we've ever taken. And we've been clinicians for like over 20 years. And now it could be, and I will say this to everybody 93 people left and absolutely hated the course. But it was but but those but those three people coming up to me, ⁓ it it really did instill that confidence. Like you're saying of, hey, you know what? If you can be honest to a room of clinicians, if you can be genuine and tell them, Hey, look, this is how I would approach something.

Dr Benjamin Stevens (09:54)
Yeah

Joe LaVacca (10:22)
This is the knowledge base that I have to help you solve problems. Let's do this like kind of together. It does definitely work a lot better than me just implementing those same tactics in the clinic without establishing trust first. So I think that was a really good answer, Ben. Thanks for that. You mention a lot now on Instagram. You're you're really niching down into educating and growing somatic senses. And you mentioned

evidence-based kairos. Everyone knows chiropractic and PT and everything like that. But what makes a Cairo a PT evidence-based in your mind?

Dr Benjamin Stevens (11:00)
Got it. It's funny, I've had this question rattling around in my mind quite a bit because the easy and obvious answer would be that they consult with the evidence for answers to what they're doing. But the reality is ⁓ nowadays, medical knowledge doubles about every 70 days online. The mass amounts of research that are coming out. We can't really be purely evidence-based even if we wanted to be.

And so an evidence-based practitioner these days is, it's really primarily about a mentality. And a huge part of that mentality is just the humility to evolve. That's it. And that is when you are faced with new evidence or you give an evidence that what you were doing should evolve or change in some way, that you are willing and massively desire to do that. So it's not necessarily about do you, that's every technique you have, the perfect technique according to the research. It's not, is everything you're doing perfectly researched? Because for one thing, we can't keep up on the research perfectly.

And another thing, so much of what we do is so nuanced and unique to each patient that there's just no way there's research on it at all. And so the reality of the matter is like being evidence-based is very much a mindset that you're trying to consistently go out on a cadence and seeking new evidence to help you become better at your job. And you are willing to change whatever you do to serve the patient according to the evidence. So it's mostly a mindset.

I don't think there's almost anyone out there that's not in research full time that is like abreast of the research across the board. It can't be done. It's just even if you get, you know, AI bots serving it up to you on your phone with notifications, it literally just can't be done. So a lot of it is about mindset.

Joe Gambino (12:37)
That's interesting. I feel like, you know, I've never really heard someone talk about mindset being like the ability to like shift the way that you think based on new evidence and new things that come out. ⁓ usually it's like, yeah, you know, you do based on the research, you know, you're using your clinical judgment and the in your experience, stuff like that. so I think that's ⁓ I really like that because I I do feel like some people get really stuck in their ways. And I do think the best clinicians are the ones who can adapt to the new information that comes out. But my question to you is good. ⁓

Dr Benjamin Stevens (13:02)
I think evidence-based can be its own kind of dogma as well.

And that is something that like, kind of almost hate that I live in that world where I say that phrase so much because it can become its own thing where people are, you know, patting themselves on the back for it. And I mean, for me, like it's just because I'm in the world where I deal with other clinicians all day, every day, that it's kind of a phrase that I end up using. But your patient's not used to hearing that phrase, right? Like they don't necessarily care. Yeah, they don't, they don't care.

Joe Gambino (13:18)
Mm-hmm.

Yeah. Right. I was that's what I was gonna ask.

Dr Benjamin Stevens (13:30)
⁓ And for the most part, I don't even know if a lot of clinicians care. A lot of it is it's a way to it's almost, I mean, I hate to tell it say it this way, but it's like, it's almost a way to portray your values to the world of like what you think. It's like, here's my worldview. It's almost like here's my religion, so to speak. And so it's a weird kind of messy, messy word. But for me, like most people who are relatively evidence based, it does come down to a mindset and it comes down to a desire to actually better for your patients, not a desire to pat yourself on the back because you know that you're

Joe Gambino (13:34)
Mm-hmm.

Sure.

Dr Benjamin Stevens (13:58)
kind of working with the evidence, but a desire to be better for your patients. And if research comes out that shows that you could be doing something better, you should want to do that for your patients. Sorry, I'll stop rambling on that one. Evidence-based is a big one.

Joe Gambino (14:09)
No, you g you you literally answer

Joe LaVacca (14:10)
⁓

Joe Gambino (14:11)
the question I was about to ask and like you know, people use like evidence based on their website and like you know, they they portray it as marketing, but I don't think really the patients know too much. So that was really kind of where I was I was about to go anyway.

Joe LaVacca (14:11)
no. Yeah, no, no, no, that's why.

Dr Benjamin Stevens (14:24)
No, they don't. They assume you are relatively evidence based until they find out otherwise. And even then they don't know what the evidence is, so they probably don't know.

Joe LaVacca (14:24)
Yeah, I think I

Joe Gambino (14:28)
Sure.

Joe LaVacca (14:32)
Well, that's you you know you mentioned like even the most in-depth researchers can't be on top of all the research coming out. And one of the things I always, you know, kind of chuckle out on Instagram is when people are fighting each other online about a certain topic or a treatment or a technique, and they're like, Well, when you look at the evidence, I'm like, Well, what what evidence is that? I mean, there was four million articles like you said that just came out in the last like six months. Did you scour through all of them?

Joe Gambino (14:46)
Yeah.

Joe LaVacca (14:58)
I think for me right, exactly. I I think, you know, the reason why I read research or, you know, read these books and color code them so they look pretty for everyone that comes into my apartment, which is basically just me and my daughter. ⁓ is that it helps me, yeah, I hope so. She's type A, so I think she does. ⁓ is it just helps me with uncertainty. And I I read a long time ago that research isn't really necessarily to

Dr Benjamin Stevens (14:58)
Yeah, just to argue with me on Instagram.

She appreciated that.

Mm-hmm.

Joe LaVacca (15:28)
give us an answer. It's to guide us to a better question. And when now I see people come in, especially struggling with persistent pain, ⁓ a lot of them don't either have the affordances, the capability, or the opportunities to maybe do quote unquote, a lot of the things they keep hearing about, you know, pushing their VO2 max and strength training and, you know, getting eight hours of sleep. And it creates this feeling of I think being stuck.

Dr Benjamin Stevens (15:31)
Mm-hmm.

Joe LaVacca (15:56)
And I think that's why they maybe rel resort to so much passive therapy, because it's like, I can't, I can't, I can't. And then when you, you know, scour through some of these now, you know, suggestions that the research is proposing, it's like, well, hey, look, well, what about drinking more water? What about eating healthier? What about you know doing this? And they're like, Well, that can help me. That can help me with my pain. That can help me with this. I was like, Well, I don't know, but it might make you healthier, and in turn, that might make you feel better.

And maybe that makes you start walking or start doing this. So I think the research has just given me opportunities to present pathways to people and not feel like they are so hunkered down into one thing and really just instill empowerment. So I'm wondering like what you think about that, especially like again from the chiropractic field where stigma or traditionally chiropractors rely a lot more on manual-based techniques and therapies than maybe do PTs or trainers.

Joe Gambino (16:46)
There's nothing left, my loves. We have more right here though.

Dr Benjamin Stevens (16:55)
Yeah, while you were saying all this, I'm just kind of like, I'm cheerleading in the back of my head because a big part of what we need to be doing is empowering people to kind of make those changes. And a lot of those minor changes do add up to a big difference in how people feel and how they process pain and how much pain they experience. But none of us are trained in how to help someone else alter their lifestyle and how to help someone else alter their habits. None of us really have training in that. We're now just, think, on the cusp of a new era where practitioners

We all kind of know, most of us anyway, we know those are important. We actually know that lifestyle factors are one of the biggest predictors of whether or not we're gonna get great outcomes in what we do, but most of us don't have the training on how to guide someone through the process of altering that. We don't have ⁓ kind of a habit change or mentality change framework. We have a soft tissue change framework. We have a loading framework. We have a whatever it might be framework. And we do all this research, take all this continuing ed around how to kind of treat a body.

We don't actually take that much continuing out to read that many books on how to actually help a human change for themselves because that's so hard and it's very complex and there are professionals out there. That's what they do for a living. There are counselors that that's what they do for a living is try to help guide people towards changing on their own and even they're not having amazing success rates because I don't think we really know perfectly how to do that. So it is something that I think is extremely important and I think we're just at step one.

Step one is just recognizing that it's very important and recognizing that we don't necessarily as people like Kairos and physios and trainers have the perfect toolkit to actually help people do that. In my experience, I was actually probably, I'm not gonna say I was better at it, but when I was a personal trainer and when I was in strength and conditioning, there was a culture around training whereby it's understood that you have to do it, I can't do it to you. And so the clients that would come to see a trainer were almost pre-qualified to create habit change in their life.

a lot of the time. Some of them weren't, some of them were just like, they just needed someone to yell at them and tell them what to do. And they needed a sense of accountability to another human. But most people, when I was a trainer, they would come to you with the understanding that you were going to guide them, but they had to do all the work. There's a culture around physio and Cairo and massage and all these other things whereby that's really not the built-in assumption because of the last many decades of us being the operator and doing things to people. The assumption is actually that that's what's going to continue to happen.

And so I think we're not just fighting our lack of education, we're not just fighting our skillset, we're also fighting the cultural norm around what it is that we do to people. And so Cairo, I think, is probably further down that pathway than physio, but not as far down that pathway as massage. In that, Cairo has very typically been a lot of manual therapy, it's very typically been hands-on, and people like that, people like to be touched, people like to feel that connection. Cairo's have some of the... ⁓

some of the best bedside manner in my experience. A lot of them are some of the best at connecting with other human beings and doing it in a quick fashion. And a lot of the time they do it through touch and they do it through guidance and leadership. And they're really good at controlling that kind of narrative within a room. But with that being said, we're all really well practiced at doing that in the context of manual therapy being the highest value thing that we do. We're not well versed in the context of doing that with education or guidance or habit or lifestyle change being the highest value thing we do.

I don't think anyone's that well versed in that. And that's kind of the next frontier, right? It's the way for us to really figure out how to change the, sorry, to change the kind of health landscape out there and to really help a lot of people is to help them help themselves. But most of us, we don't really have the tools to do that.

Joe LaVacca (20:29)
Yeah, that's really insightful, especially with Joe, being you're you're all virtual, Joe. So, you know, f yeah, for you not having that toolkit of manual therapy, I mean, how have you been able to convince people that virtual treatment is just as valuable, or if not more valuable, and to kind of piggyback off of what Ben was saying.

Joe Gambino (20:36)
Pretty much, yeah.

Yeah, I think ⁓ going back to like what Ben was saying about like communication, I think that's been like the the biggest thing in the virtual environment, like your ability to like A like communicate authority and like how you perceived like you're gonna help somebody and show them that there's value. ⁓ but even just like in sessions, like I used to I don't know whatever made me do it in the past, but when I was at Perfect Stride and I would purposely try to

Coach somebody without ever showing them how to do it and see if like the words that came out of my mouth actually made sense to the person if they could do what I was asking them to do. ⁓ and I think that really helped a lot. ⁓ and I didn't even realize the effect that it would have on like the way that I talk to people. ⁓ but I feel like the way that you communicate really does help because honestly, to me, per like me, I don't know if the like the all clients perceive it the same way, is that there's really not that much different. I really just can't put my hands on you.

But like the way that I assess you, the way that we go through things, the way that we do exercises and coach it, doesn't really change. and the one thing I do like about this environment, and and maybe that that's what helps instill, is that we like doing this environment makes the the patient feel like they have more onus, like they're doing it more, not necessarily on their own, but there's like they have to do the work, right? Like I can't just be in here doing manual therapy and that stuff. So also to Ben's point.

so I think that's a really unique advantage to this environment. Plus you have more access to me, which I think is ⁓ is a fun selling point as well. I don't know if that answered the question, but a few things in there.

Joe LaVacca (22:23)
No, I think it no, I think it did. I think

and one of the questions that we had for Ben was, what do you think the future of chiropractic and PT or or training looks like? And if I'm hearing correctly, it is maybe leaning into more of these strategies that help people change behaviors and change lifestyles and be comfortable with those things because those those are maybe potentially more impactful. And I heard a podcast I I am

Joe Gambino (22:42)
Mm-hmm.

Yeah.

Joe LaVacca (22:52)
Bulking at who maybe has said this about the PT profession, but I wanted to maybe get your view on it, that PTs, the future for us, is really as maybe case managers for people who are in pain, where we can listen to your story, make sense of it, and then say, hey, you know what?

I think that you would really benefit from manual therapy. You do have some difficulty with passive mobility or passive constraints. Maybe there was a trauma or a surgery. And I know a great chiropractor. I know a great massage therapist. Hey, you know what? It seems like you're really deconditioned. You know, ⁓ I think training would be really valuable for you. Or, hey, it just seems like you're stuck. You know, have you thought about behavioral therapies or psychotherapy or

You know, exploring social work, you know, something along those lines. Do you see something like that being beneficial? ⁓ you know, yeah, either for PTs or or chiropractors? Because I never ever thought about myself as like someone who would be a case manager for people. But I I do see it now more and more if I'm reflecting on you know the advice that I'm giving to people and how I'm not forcing them, and we were talking about this off offline.

Joe Gambino (24:05)
Mm-hmm.

Joe LaVacca (24:10)
You know, forcing him into the sale of me, you know, stay here with me for twelve sessions and stay here with me for three months. I have all the answers. It's almost like, hey, well, have you considered this? So do you do you see a profession letting go like that? like I I because I think that's easier said than done.

Dr Benjamin Stevens (24:25)
Do I, yeah, I was

Joe Gambino (24:25)
Mm.

Dr Benjamin Stevens (24:29)
going to say, do I predict that it will happen? No. Do I think that it's something that we could afford to do more of? Yes. ⁓ Honestly, it's, we like to pretend that therapists are also these, you know, Autobots that we can just choose what's best and do it as well. And the reality is we're humans. We have things that we need to do for our own ego. We want to feel important. We want to feel like we helped the patient.

⁓ you know, early on in my career, if I couldn't help a patient and they went somewhere else and got better significantly quicker, I was let down, you know? In reality, if we were kind of just, you know, robot therapists, there'd be 100 % excitement for that patient and that's it. And later in my career, definitely that's significantly more what it is. ⁓ But I'm also just really good at not holding on to patients any longer than I need to by even one visit. ⁓ And so we all have these egos as well. We want to feel like we fixed someone.

We want to feel like we did the thing. We had the miracle cure. so becoming a case manager feels deflating as a phrase to a lot of people. But the reality is I think a lot of us, what we're doing is we're constantly like, you know, if the patient's kind of a garden, we're just like planting new things in it, kind of hoping that they're going to grow, hoping that they're going to work when you kind of, you know, actually enriching the soil is what needs to be done. And there's all these.

all these barriers to that being the thing that we really do and a lot of it being the expectation that the patient comes with, that they feel like they can't fix themselves a lot of the time. And I'm not trying to put the, you know, the responsibility fully on the patient here, but I do feel like a lot of people came to me feeling like I've tried everything already. And then I'm like, well, but you haven't tried all of the advice that I've given you. You've tried seeing a bunch of therapists. You haven't actually set a bedtime alarm. You set your alarm to get up. You don't set your alarm to go to bed.

Joe Gambino (26:01)
Mm-hmm.

Joe LaVacca (26:05)
Yeah, yeah.

Mm-hmm.

Dr Benjamin Stevens (26:14)
And I was like, it's really that simple. ⁓ If you want less pain, here's 10 things you could do. But again, like with me, I don't have that skill set. So as a case manager, I could probably manage cases to have less pain across the board, or to experience less pain across the board, to feel better, feel healthier across the board. But that's also not what people are coming to me for a lot of the time. I have to earn people's trust enough to do that. And a lot of the time, the way that I earn people's trust enough to do that is by fulfilling their expectations.

Joe Gambino (26:43)
Mm-hmm.

Dr Benjamin Stevens (26:44)
And by making sure that I'm having little ⁓ promises and then like making little promises and then fulfilling them over and over and over again. And so in an ideal world, you know, the, the patient, not an ideal world, but in a world that's simplistic, a patient comes in and they go, I will do whatever is required to feel better. And as therapists, we go, this is what you need to feel better. And we know it's a perfect match. They do a hundred percent of the things and they start feeling better. But the reality is

they don't always know exactly their experience of pain. We don't always know exactly how to guide them through it. We're going to tell them our best bet. They're going to be let down that you told them to go to bed earlier rather than putting your hands on them, or they're going to be let down that they have to do exercises five times a day that are a little inconvenient compared to you using shockwave on them. And so there's this kind of big mess, right? But I do think that being kind of a case manager is

Joe Gambino (27:24)
Yeah.

Dr Benjamin Stevens (27:35)
what a lot of the best people end up doing over time. Like it's not as if your hands are gonna get magically 10 times better over your career. They'll get a little bit better. And it's not as if your coaching and queuing is gonna get 10 times better over your career to the point where you're gonna get 10 times better outcomes. Maybe, but in all likelihood, as you're getting better through your career, it's you're getting better at all the soft skills, you're getting better at case management, you're getting better at thinking in the long term, and you're getting better at all of the stuff that we don't really have a distinct.

Joe Gambino (27:51)
Mm-hmm.

Dr Benjamin Stevens (28:03)
educational platform to teach us or kind of a structure to go about. We just figure it out as we go and that's really what makes people better with experience anyway, is they become better case managers. I just don't know if the patient's ever gonna want that to be what they seek when they seek a therapist's help.

Joe Gambino (28:15)
Mm-hmm.

Yeah. That's fair. I'm going to ask you a tough question here. And I don't know if you have the the answer for, but it's based off something that you were saying about ⁓ you know, someone has seen other other people, they haven't seen success, they come to you, and you, you know, you you mentioned maybe they haven't taken all of your advice yet. But for someone who's tried PT, Cairo, massage, a bunch of different things and haven't really seen the success that they've wanted, what would be, I guess, like your your advice for them?

Dr Benjamin Stevens (28:46)
for the patient. ⁓ For one, sometimes, and again, I'm just, I'm an accountability guy through and through, and I try to have, I try to be able to walk the line of accountability without shame and accountability without accusation, but I have had people go like, I've tried Cairo, and I go, who? Because I will know most people in my town. Okay, how many times did you see them and what did they do? And I want to explore that. And I'll find out they went to see that person two times.

Joe Gambino (28:47)
Yeah.

Dr Benjamin Stevens (29:15)
or three times, they never really gave the process a chance to actually get better. And I go, okay. And the same could be applied with basically anything, right? And they're just like, you know, I stopped working out because of X, Y, and Z. And I go, how long? And they go, it was by like February 10th. And I went, okay, you gave it five weeks at the start of the year. That's not how fitness works. And so for some people, my job is just to draw their attention to what they already know. And they kind of just didn't really want to admit anyway, where I'm just kind of going like, you are actually on the right track.

we just need time and we need maybe a little nuance, right? Because there are people that that's all they need is some, a little bit of nuance to what they already had. And then there's the people that, ⁓ that's just very not true. They're just like, I was in physio for a year and I know the physio they went to and I think they're fantastic. Cause they're like, man, I was at this Cairo all the time and they did, you know, they did all this, you know, active release technique and we did all these exercises and all these things, you know? And so for me, what I don't want to do in that situation is assume that the person that it has, that it's the kind of

Joe LaVacca (29:47)
Right.

Dr Benjamin Stevens (30:15)
patient's fault. Part of me goes like, okay, like we need to investigate this. Like maybe there is something that everyone else overlooks that I'm going to uncover. That happens sometimes, not usually. A lot of the time it's, ⁓ there's all these peripheral factors that are feeding into the issue that haven't been addressed. It's like there's all these things that we talked about that, know, just every practitioner planted something new in the soil, but no one kind of addressed the soil, so to speak.

And so they go, I've tried all these different solutions to my problem. And this is going to sound cliche, but no one really got to the, okay, well, why do you hurt all the time? You know, like this was not a big injury. Why is it still hurting two years later? And, know, find out that during the last two years that they've been going through a divorce or that there's spousal cancer or that they have a very, very high stress job or that they eat macaroni and cheese for dinner every night. ⁓ Because there's a lot of these things that I think

I've done a really poor job before of actually being overt with. I've always kind of assumed, and especially because I work with a very, very fit crowd a lot of the time. I've worked with people who are very high fitness. And the assumption is that those people kind of have all these boxes checked because visually it's easy to look at someone that's ripped and kind of go like, they're sleeping. they're eating well. they're exercising. All these things. Not necessarily the case a lot of the time. It could be that there is someone who has a pathological relationship to exercise.

It could be that it's someone who exercises as their therapy because they have this insane emotional turmoil in their life and their escape is the gym and the things that they can control is like a strict ketogenic diet and they do CrossFit seven days a week, twice on Saturdays. And that's why they look that way. But if you don't ask, you don't know. And they go like, I don't understand why it's still hurting. All these people tried all these things. And I go, man, you're working out eight days a week. Literally chop that down to four.

Go to bed earlier, don't look at your screens, drink more water. The list goes on and on and on. But a lot of the time, like in my experience, other practitioners just haven't asked the question. What they've done is they've taken whatever they're good at as a practitioner and gone, this might be the solution to your pain. And then they just look at the little kind of anatomy that hurts. Don't look at all the stuff that surrounds it. So it's, you know, I've got advice for the patient that's kind of been to everyone is I would say, look back over that and go have any of them asked about you as a human being asked about

asked about your emotional state, asked about all these health status things that could be helping, and have you done anything to address them? Because you might need a case manager, you might need guidance, you might not need a different technique or a different practitioner, you might need to address all these other things.

Joe LaVacca (32:57)
Yeah, that's ⁓ insightful. And I w one of the things that you you you made me think about when you keep referring to the soil. and and I think that you mentioned, you know, holding on to people or knowing when to let go. And that was our our kind of theory about the future. One of the things though, right now that I really try to consider since a patient called me out on it, and it was a little bit earlier on in strength emotion.

Joe Gambino (32:57)
Yeah.

Joe LaVacca (33:26)
And I was in this mindset of like, you know, I don't want people to be here, you know, a day longer than they have to. Right. I don't want to over treat. I don't want to over guide. I don't want to overcoach. I don't want to overdo this. And, you know, I kept handing her things to do and do on her own. And I was like, well, yeah. And then you can start doing these. And then, you know, you don't have to see me every week. You can go to like once a month. And then like, then it's just like peace out. And she was like, Joe, why are you trying to get rid of me? And I'm like,

Joe Gambino (33:31)
Mm-hmm.

Joe LaVacca (33:53)
I'm not trying to get rid of you.

Dr Benjamin Stevens (33:53)
I've had that experience.

Joe LaVacca (33:54)
Like, I'm not trying to get rid of you, but this is just like what I'm supposed to do. You know, I'm supposed to like only see you for four sessions and then like that's it. Then I'm supposed to like just let you go. And she's like, ⁓ do you know that I've been looking for years to find you, like a person like you in this field that listens, that cares, that guides me? And she's like, if it wasn't for you, I am not doing anything. So please.

Dr Benjamin Stevens (34:13)
Dude. Yeah.

Joe Gambino (34:15)
Mm-hmm.

Joe LaVacca (34:23)
Let me come as long as I like. I can afford it. This is valuable to me. This is important to me. And then I realized I was like, wow, the social support that now we can also offer for people, I think it's kind of swept under the rug. And, you know, t working with trainers like literally by my side all day long at the gym I'm at. I I really then took this valuable lesson from them. They have.

Joe Gambino (34:24)
Ha ha ha.

Dr Benjamin Stevens (34:40)
Mm-hmm.

Joe LaVacca (34:52)
They're seven, they're eight, they're nine, they're 10, they're 11, right? On Monday, Tuesday, Wednesday, Thursday, Friday. It's the same people, right? Because they've created this community of like, hey, I'm gonna guide you. And you, me, and Joe can sit here and say, well, you know, you know, exercise is a lifelong path, and you know, managing your emotions is a lifelong path, but you're only gonna do it with me for eight weeks, right? And then good luck, you know? and I hope that you've instilled you know, enough behavior change and all that stuff to just go and do it on your own. And

Dr Benjamin Stevens (35:13)
Yeah.

Joe LaVacca (35:21)
If I show you my client load right now, yeah, some you know, people go in and out, but I've worked worked with some people for three to five years, and they're in the same spot, right? And they come in and you know, now we're all strength training and whatever, and I write them programming and I change it up for them month to month. But what I realized was the longer we stayed together, their pain came back, right? The back pain would nag in six months, you know, their shoulders started not feeling great a year or two later again, right?

Joe Gambino (35:26)
Mm-hmm.

Joe LaVacca (35:49)
So all of those things that probably would have stopped them in their tracks, they would have gone back to the doctor, they would have gone back over here, they would have stopped working out, they would have maybe fallen into some bad habits. We were able to nip in the bud just because we had created that social community. Do you think that gets pushed enough? ⁓ especially for clinicians who are not quote unquote working on their own, you know, that idea of getting

Dr Benjamin Stevens (36:03)
Mm-hmm.

Joe Gambino (36:06)
Yeah.

Joe LaVacca (36:15)
People in and then getting people out, but is that the reason why maybe so many people are stuck and maybe not getting to where they want to be in your opinion? Or is it something bigger?

Dr Benjamin Stevens (36:25)
God, I have so many thoughts on this one specifically. I've had that exact experience. I knew I was gonna tear up at some point during this. I was tearing up the uterus. It very much reflected my own experience and it just made me, it made me feel for both you and the patient because one of the things that we almost all do as therapists is we fucking hack our relationships. It's so strange because for some reason, so many of us were so scared of becoming that person that just sees someone in perpetuity that we are so scared of being someone that

Joe Gambino (36:31)
Yeah.

Mm-hmm.

Dr Benjamin Stevens (36:55)
like we feel like we're taking advantage or we feel like we're doing it just for money and we really want to trust ourselves and we really want to be so ethical that we never bother actually checking our assumptions at the door. And we assume that that's what every single patient wants is they just want to get in, get better, get out, fuck you, never see you again. I don't want to be at physio. For some reason, that's what we assume, but so many people want their Sherpa. They want their guide. They want their person.

Joe LaVacca (37:13)
Yeah.

Joe Gambino (37:14)
Yeah.

Dr Benjamin Stevens (37:22)
Right? This happened to me this week. I haven't actually seen a patient in quite a while now because I'm spending so much time in education, but I made a video that went on Instagram and I got a text message from a patient that I haven't seen in seven years being like, are you back? And I was like, what? No, I'm not right now. I'm still doing this. And he goes, ⁓ okay. Cause I was going to book in with you seven years, but he still considers me his guy. Right? Because I established this trust. I established all these things.

Joe LaVacca (37:43)
Yeah.

Joe Gambino (37:45)
Mm-hmm.

Dr Benjamin Stevens (37:49)
And so I did the exact same thing for so long. I operated on this really false assumption that everybody wanted to kind of like a compacted treatment program that would be like, here's the package, the solution to your problem. Once your problem is solved, the package has been used up. End of story. And the reality is so many people, whether they're conscious of it or not, they want to find their guy. They want to find their girl. They want to find the place.

Joe Gambino (38:06)
Mm-hmm.

Dr Benjamin Stevens (38:14)
that they can take their problems or their problems feel seen. And there's so many other aspects to it. So when you were talking about the kind of being with people for the long term in the community, I'm just like, hell yeah, people want that in an ideal world. Everybody gets that. I think, you know, maybe half of people only are really the ones that want to get in, meet you, get out. And the next time they have a problem, they may or may not come back. They might go to something more convenient that's closer to them. But in my experience,

Joe Gambino (38:35)
Mm-hmm.

Joe LaVacca (38:36)
Yeah.

Dr Benjamin Stevens (38:43)
a majority of people, want to find their person. They want to find their guide. They want to find the one that is going to help them and they feel at home with. And I've done the exact same thing. I have kicked people out before they wanted to be kicked out and they've been insulted. And I'm going like, great. My job was to be like, you know, a Sherpa, to be a caretaker, to be a guide. And I insulted my patient by trying to get rid of them. And I just remember several times being like, God, you're a fucking idiot, Ben. Like,

Joe LaVacca (38:57)
Yeah.

Joe Gambino (39:02)
Ha ha ha

Dr Benjamin Stevens (39:10)
Why are you getting rid of people that want and need to be around you? Why are you doing this? And it's because again, I was stuck in this operator mindset of like, ⁓ the thing I'm doing to this person has run its course, therefore my value as a practitioner has run its course, and voila. And it's just so not true for the patient or for me.

Joe LaVacca (39:13)
Yeah.

Yeah.

Joe Gambino (39:31)
Mm-hmm. Yeah. And I think to layer on that. I think, especially cash-based, at least for physical therapy, it's like we our value prop is like you have to see us less than in person, right? Like that's like how like the math works out for people. And it's like we think that at least this is what I thought when I when I first started, like we do really significant work here, right? Like we can help you, and like if I can get you done in less sessions is showing my value, ⁓ and it's kind of proving my ego that I I'm I'm a good clinician, right?

and some of the best things that I think I've done, especially as I moved into virtual, is now it's just time based, right? It's not session based anymore. Right. So like I know, hey, like four months time, like based on what I've seen, like that's a good amount of time for us to like make changes, move that person to where they want to go. And then I give them the option, hey, do you wanna do you wanna stay on for longer or not? Right. ⁓ and I think that's really been helpful for both myself, like to not feel like I'm so much pressure that I have to get someone

Dr Benjamin Stevens (40:01)
Yep.

Joe LaVacca (40:03)
Yeah.

Joe Gambino (40:29)
done for sessions, but also for them 'cause they have time to navigate the hurdles that inevitably, you know, pop up in their care and stuff like that and guide them ⁓ longer than somewhat typical.

Dr Benjamin Stevens (40:40)
Yeah. I mean, and I've had patients who have come in on day one that have actually been ⁓ kind of annoyed with previous therapists for trying to fix them without really seeing their values. And that's something that has always been easy for me because when the patient comes in and tells you about it, you're kind of like click, it gets in. And so for a lot of people with me, that's been professional athletes. I've treated a lot of professional athletes. And like, I remember one of my, you know, my favorites, ended up becoming one of my really good friends in this town. He showed up on day one.

Joe Gambino (40:50)
Mm-hmm.

Dr Benjamin Stevens (41:08)
with a list of things that he wanted to get fixed. And it wasn't even all pain. A lot of it was performance based because I come from that background. And he would go like, when I do this, this happens. I have an asymmetry here, I have this. My coach wants me to work on that. And he hauls out a notebook and he's just like, what are we going to do? Kind of thing. And he ended up being that patient that if I told him to come in every single week year round, he would not. I didn't need that to fill my schedule by any means. It wasn't going to impact kind of my income or anything. But I remember being like, this is great.

He told me exactly who he was on day one and what he valued and he just laid it out for me, right? And those are the kind of patients that it's really easy because you kind of go, ⁓ they know what they want or they're just, they're open with it. But a lot of our patients, what we need to do is we need to, we need to kind of slowly pull it out of them. We need to help them realize who they are and what they want. And so many of us are so afraid to sell and we're so afraid to actually lead people.

that we're kind of like, putting the patient in charge all the time. And for certain people that can actually be stressful. That can actually be like, don't ask me to make all these decisions. Like you tell me, like, should I be here all the time? Like, am I going to benefit from seeing you as a part of my community? Am I going to benefit from that? What can I do that'll actually make me healthier? That'll actually make me happier? That will all these things. And it's like, I always shied away from all the bigger, longer term, more deep investment stuff from people.

Joe LaVacca (42:20)
Mm.

Dr Benjamin Stevens (42:31)
because again, my ego was wrapped up in it just like yours of we have this weird narrative as therapists where it's like we want to get people fixed and get them out the door. Right. And it's, it's still there in new grads, by the way, because I talked to a lot of new grads and they were like in the first two or three years of practice. is a very, very common phrase that I hear out of people. Cause I'm getting people into this kind of clinical mastermind that I've got going on. And a lot of them, like just even to do a discovery call, they feel kind of an intake of like, what's your dream practice look like? Like, how do you want to practice? And

very common answer is like, want to have a practice where I see people as little as possible and get them out the door. And that's almost always the younger practitioners that do that. The ones that have been doing it for 20 years, they don't tend to say those phrases anymore because I think they've realized that there's so much more value to who you are as a therapist than just doing something to someone fixing the problem, getting them out the door. People love their community. People love having their tribe. And as therapists, we can be that tribe.

for people. just haven't been thinking that way. We've been thinking that we're the operators, we fix people, we get them out the door. But, you know, I think most patients I know that have their tribe of therapists and people that they rely on, it actually lowers their kind of general anxiety and it helps them to kind of raise the bar and what they expect from themselves just life-wise and health-wise when they have people that they trust because it feels connected to them. And so later in my career, I felt really happy about being that person for a lot of people.

That was my ideal practice was being in a lot of people's tribe and being their cornerstone person that helped them. And I would, know, for better or worse, tons of them would have my cell phone number, tons of them would, you know, follow me on Instagram or Facebook and reach out to me there. And I actually really loved that because I didn't want to be kind of corporate of I'm the operator come to me when you have a problem that I can solve. It's like, I want it to be in their corner. And a lot of people really like that. I just, took me years to get to the point where I realized that that's what a lot of people want.

I don't even if that answered the question. I don't even know if it was a question. I'm just rambling.

Joe LaVacca (44:24)
No, it was good. Hey, man,

it was good. It was good. And you know what? I and I know and I want to be respectful of of your time and and and Joe's time. You've been so awesome. ⁓ your answers are so thoughtful and and well spoken. And I really appreciate that about you, Ben. But you dropped the mastermind. ⁓ tell everyone a little bit about where they can find you, how they can learn more from you, how they can work with you and all that stuff.

⁓ before we let you go and then hopefully have you on for like a part two, three, four, five, six.

Dr Benjamin Stevens (44:56)
Let's do it while I'll bring the full tiers next time. Just come with your sadder, come with your most heartfelt stories. I won't cry over sad, but I will cry over heartfelt every time. I'm a sucker for these things. ⁓ Yeah, mean, so Sematic Senses Education is the company that I run up in Canada. We do a lot of work in the States as well. We get a lot of things PACE approved for Kairos. So you can go to sematiccensus.com. You can find a lot of our courses there, online courses and in-person seminars. ⁓ Probably one of the easiest ways to get a hold of me is actually Instagram. If you just go to

Joe LaVacca (44:58)
Yeah.

Dr Benjamin Stevens (45:24)
It's just doctor.benjamin.stevens. It's a kind of a yellow background icon of this ugly mug. And so you'll see me online. I try for the life of me to respond to every message that I get there. It's very easy to find me. And a lot of the time that's where I go to talk about the stuff that is kind of up and coming, like the mastermind. So you can't Google this mastermind. You can't find it. I'm filling it one by one, having conversations with friends and the whole premise behind it is to give people essentially access to the most modern up-to-date toolkit.

taught by the people who are the best at teaching it kind of year round, which I'm very, very excited about as a clinician and I'm excited about it because all those people are my friends. yeah, somaticcensus.com or go find me on Instagram. You might find my personal account or my professional one. Feel free to reach out on either. One of them is just gonna be a bunch of, you know, probably me in the woods and surfing and random shit. And then the other one will be a bunch of strange professional content.

Joe LaVacca (46:18)
Excellent. Joe, any closing thoughts or things on your mind there, my friend? All right. Well, Ben, we love you. Joe, we love you. Listeners, we love you. Thank you for listening to another episode of the Beyond Paint Podcast. And don't forget to come back next week with even more insight and tears.

Joe Gambino (46:22)
Now.

Please.

Dr Benjamin Stevens (46:36)
More tears.

Joe Gambino (46:36)
Ha ha ha.