The Crackin' Backs Podcast

What If Your Chronic Pain Isn’t a Tissue Problem? Dr Steven Capobianco

• Dr. Terry Weyman and Dr. Spencer Baron

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What if chronic pain isn’t a tissue problem—but a brain map problem?

If you’ve ever thought, “My pain must be structural,” today’s episode flips that script. On the Crackin’ Backs Podcast we dive into why pain persists, how the nervous system and brain maps shape sensation, and how skilled manual therapy can update the body’s map instead of masking symptoms.

We’re joined by Dr. Steven Capobianco, co-founder of RockTape and one of the sharpest minds redefining pain, movement, and human performance through neuroscience-informed approaches to chronic pain and sensory-driven movement therapy.

In this episode, you’ll learn:


• Why pain isn’t always a tissue injury and what “back being out” really means
• How manual therapy becomes sensory input to update the nervous system
• What most people misunderstand about nervous system regulation
• The difference between outer maps and inner body maps
• How chronic pain makes the body feel unsafe—and what truly restores safety
• Why patients shouldn’t be passive on the table but active participants in their recovery
• When manual therapy empowers vs when it creates dependency

This episode is essential listening if you’re struggling with lingering pain, movement limitations, or feel like you’ve tried everything without getting answers. By the end, you’ll understand pain through a neuro-sensory lens, not just a structural one.


About Dr. Steven Capobianco

Dr. Steven “Capo” Capobianco, DC, MA, DACRB, CSCS, PES is a movement expert, sports chiropractor, and co-founder of RockTape—a globally recognized company blending neuroscience, movement education, and therapeutic techniques to enhance performance and reduce pain. He holds advanced degrees in kinesiology and chiropractic medicine, a Diplomate in Rehabilitation, and performance certifications from the NSCA and NASM. Dr. Capo lectures internationally, authored the Fascial Movement Taping manual, and teaches clinicians worldwide how to move clients out of pain and into performance.

Learn more about Dr. Capobianco and movement science:


RockTape official site: https://rocktape.com

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Dr. Terry Weyman:

All right, guys. Well, you know, today we're sitting down with Dr Steven Capo Blanco copy of I'm not even gonna try, because I always call you either cap out or Steve, we started off air. You can't offend me. So yeah, I'm not even gonna try. And Spencer will tell you I'm worse with logistics or linguistics.

Dr. Steven Capobianco:

Nice, thank you.

Dr. Terry Weyman:

I'm gonna try and go. I have to do with an Italian asset, Capo Bianco. Even better, that's how you do it. Capo bianco, he's a co founder of rock tape and one of the but you know what? He's one of the sharpest minds redefine how we touch, brain mapping, nervous system, shaping, pain, movement, human performance. The more I get to know this guy, the more I love this guy, and he is just one big brain with arms and and a body attached to it. So welcome to the show, Steve, and we're just going to call you capo.

Dr. Steven Capobianco:

Capo works. I appreciate the attempt, the attempt, and I appreciate the opportunity to kind of talk shop with you guys.

Dr. Terry Weyman:

You know, ever since we sat down at pro sport is just, you know, I just have been fascinated with you. And you know, my partner, Dr Aaron Schneider and Ira were just huge, big fans of you. So it's just an honor to sit down with you and the fact you took time. So thank you, bud. My pleasure. My pleasure. All right, you've been studying. To kick this off, you've been studying, we've been talking off air. You've been studying about chronic pain, and it's become like a passion for you. And for example, you know, you're discovering that pain is not only a tissue problem, it's also a brain problem. And when someone asks, My back is out, what do you usually think about that when they say stuff like that.

Dr. Steven Capobianco:

I loved how you you set the stage for it. You know, having a patient, which we've all had, and I continue to have, or they come in and say, my back is out. I have a bad back. I have a bum knee. You know, all the descriptors, and this is the important part, at least from my experience, and what I'm reading as it relates to chronic pain, it's, it's the narrative that we attach to the symptom that that actually adds fuel to the fire. And so if you're not paying attention to how people describe what they're experiencing, not, you know, obviously giving you a location saying I've got a bad back, or, you know, my back is out, but, you know, looking at those descriptors, so then you can dive deeper. And that's really what I've been doing as it relates to the last, let's say, 10 years of my 23 year career, is that I've been focusing on the nuance in between their description of whatever's going on. And that's, that's really where I've been diving into the literature. The literature is really getting fascinating because they're starting to ask those questions. They're starting to get into the weeds as it relates to something as messy as chronic pain.

Dr. Terry Weyman:

You know, on that note, you also are talking about, you're relooking at even the touch in our sensory spotlight, and how our when our hands contact somebody, can you kind of dive into a little bit about how you're looking at sensory and touch differently than we have in the past.

Dr. Steven Capobianco:

Well, you know, I think we can. The three of us can all agree that the way that we were trained when it comes to chiropractors is we're putting our hands on people, and we're manipulating X tissue that could be the soft tissue, if you're a soft tissue practitioner, the joint, of course. And so that, that was the mindset that I was given as a as a new practitioner. I was trained as a biomedical, you know, specialist, I was putting my hands on people to move tissue, and the shift as it relates to now performing the same therapies, the chiropractic adjustment to soft tissue manipulation, but it's just a different goal. And intent, probably intent probably intent is probably the better way of putting it, is that when I'm putting my hands on someone, I'm starting that communication from hand on body, not even thinking about what vector I'm going to put into the joint, or what level of muscle that I'm trying to influence, I'm starting off with, how am I communicating To this person's nervous system, and how does that influencing what they're experiencing? How do we take advantage of touch to make that connection to the patient?

Dr. Terry Weyman:

You know what Spencer and I were talking, I think he was even yesterday, about the new Docs coming out. And you know you talk about how when you touch somebody, that lights up parts of the brain, the system. Well, a lot of the new Docs coming out are using AI, and they're learning, and they're very good, maybe good diagnosticians, but are we losing that touch? And where do you see that going?

Dr. Steven Capobianco:

Yeah, they can't take that away from us. And I hear a lot of people, especially new Docs that are coming out, thinking that AI is going to take away what we can. Provide. I think that's going to be a challenge, because, yes, I have all the tools that we can manipulate or use the innovation that we're getting in respect to medical devices and tools to be able to create a touch stimulus. I'm even seeing these, these, these robot massage therapist. Have you guys seen those where it's a table that has connected arms that the the robot actually performs the the massage on you, which looks amazing, to be honest, but, but what it can't do, and what it can't replicate is, is the human connection between a therapist, the doctor, and the individual, right? So that, that part I'm really excited about. I'm actually excited for the new Docs that are coming out, because they're getting, you know, you know, new information, information that we didn't have when we were in in our formal education. And the new evidence is really saying that the touch stimulus is having a conversation with the brain. You know, when it comes to my content with rock tape, we're always talking about the tape is, is, is, is a megaphone to the brain. It's providing us a conversation to the brain that the brain has to now articulate and say, What does this mean? And then the response the output is going to be, hopefully, a reduction in pain and improvement in your movement. So touch is so much more nuanced than just pushing a muscle or moving a joint.

Dr. Terry Weyman:

You know, everybody's now searching for that nervous system regulation. You know, they're looking at breath work, they're looking at cold plunges and vagus nerve blocks. And what do you think people are most misunderstanding about the nervous system, especially when it comes to chronic pain.

Dr. Steven Capobianco:

Well, let's dive into it. It's I just think this the storytelling that can be had by better understanding how the nervous system governs what we experience and how we move, and how the brain is number one job, and I hope this has been communicated in with your, you know, your those others that you've been interviewing, is that the brain's job is to keep you alive. And the brain isn't as reactive as we used to think, meaning that stimulus and react. It's much smarter than that, and so it's predictive. And so the brain is a predictive machine looking to predict what's going to happen in the future, so it could appropriately devise a plan that makes sense, that keeps you alive, ultimately. So when it's predicting the future, it's predicting what is a threat versus what is safe, like, what direction do I need to move that's going to be away from the threat and towards safety? And that might seem odd to say, but ultimately, every step that we take is a decision that we have to make. Is this a safe step or not? If you're on the edge of a cliff and you're walking around, you're going to walk differently and be a lot more cognizant of the environment around you, because a step could be off the edge, versus me walking around in my home, where I know where every you know surface is, I could do that with my eyes closed and still walk efficiently, because the brain is again predicting what what is a threat and what is safe. What we're learning is that to be able to predict effectively, you need to be able to perceive, and so perceive, perception requires a good map. So we were talking about our devices just before the call. And when I navigate any city, and I travel quite a bit, I'm always relying on my GPS on my phone to be able to navigate whatever environment that I am. And so, like I always think about this, is that if I'm going down a street that I don't know and a right turn versus a left turn could be I'm going down a street that I can get mugged versus going down to a street where I can have a great dinner with friends. You know your nervous system is going to really pay attention which direction is most you know, most appropriate for you. The same thing happens in our body. We have multiple GPS maps. The ones that are most pertinent to to our discussion today for pain and movement is and I use the term exteroceptive map, which is basically our human homunculus if you guys are familiar with the turn, you remember our old neuroanatomy textbooks of the description of the body within that part of the brain called the somatosensory cortex, so that that is exteroception. And if our homuncular map, our exteroceptive map, is smudged or lacking clarity, your brain's not going to have a good idea of where we are in space. And so when your brain considers moving your bad back or your back that is out a threat, it's going to do what it exactly should do. It's going to protect you. So when you don't have a good map of your body. Right? Just like not having a map of whatever city that you're in, your brain is going to protect you. And so the best levers that your brain has to protect you is increase your pain. That's the number one lever that it has, because it's the best motivator. But it also will decrease your movement. It'll make you tighter. It'll make you weaker. You know, those are all things the brain can do to be able to protect you from what it deems to be a threat.

Dr. Spencer Baron:

Steve, you brought up homunculus. Now I also want to cater to the fact that some of our viewers are lay people. And you mentioned, no, no, I'm just, I have a question about that, homunculus versus interoception. But you know, the homunculus was created in like 1937 by by some neurosurgeons that would touch areas of the brain, and people would respond saying, Oh, I feel that in my, you know, tongue, or I'd feel that in my fingers. And they mapped it out to where, how portions of the body, or areas of the body would occupy portions of the brain. It was pretty cool. But again, that was from 1937 now, can you explain something? There's interoception you had mentioned about, there's somatoception. Can you explain those two? Yeah, and the differences, and you know what those maps look like, so people understand better.

Dr. Steven Capobianco:

Thank you for reminding me, Spencer, is that the let's start with first, with this homuncular map. And so, like, again, there are multiple maps, and I'd like to kind of break them out in more detail, but the homuncular map is really pertinent when it comes to touch right? Because it's a touch map. Ultimately, to your point, they've been able to map the entire body. And the homunculus Is this the name that Penfield, the neuroscientist, you know, gave this description of this basically, you know, little you that's what homunculus really means in a part of the brain. And what they've been able to do is map each region, so you know exactly where your shoulder is, in respect to your elbow, your your lower back, in respect to your hips and the mat. Clarity is critically important for your brain to figure out where am I in space, what's my posture, what should be next move according to what I know where my body is, and so that's the the exteroceptive or homuncular map. Now the ones that I've been diving in so much further it says I became aware of it about a decade ago as I started to work with more chronic pain patients and started to dive into the literature to say, What am I missing here? Because we all know that chronic pain is difficult to manage, and the traditional touch therapies, from adjustment to soft tissue care to foam rolling, tape, whatever you want to call it, may not be improving their symptoms. So we think that we're we're influencing the homuncular map, and we are, but it's not making a change. And so I started to say, what else am I missing? And so I found that there are multiple maps in the brain, and another map that I think is pertinent to this discussion as it relates to chronic pain is the interoceptive map. So if we take extra as our outer map, our touch map on the outside of our body, the interoceptive map is what you feel inside, and the interoceptive map is I can give you examples of your when you sense your heartbeat. That's an interoceptive feeling when you feel grumbling in your stomach because you're hungry. That's an interoceptive feeling when you have to go to the bathroom, your bladder expanding is an interoceptive feeling, but here and that means, means nothing to anyone that wants to know more about chronic pain. But interesting enough, pain is an interoceptive sensation, and so understanding interoception in more detail, at least for me, is giving me some extra levers that I could pull with my patients and clients, to say, Hey, your outer map, your body map, is, is clear that that is, that is, that's exactly what we wanted to achieve, but it didn't make a dent on your pain. So your threat is not coming from your outer map. Maybe it's coming from your inner map, your perception of the pain. So, you know, Terry, at the beginning, you talked about my back being out. Well, just the word being out. What do you think a naive brain would think of something like a joint that's stacked and it's now, it's you say the word out, and they, they interpret, the brain interprets the out as a threat. Now that amplifies the pain experience, because you put some meaning or a narrative, a negative narrative, to the description, right? So I'm glad we came back to this, but that's, that's interoception. In a nutshell. You know there, there's plenty of amazing researchers in this space, but the one that I would share, anyone that wants to dive in deeper, would be bud Craig, C R, A, I G, A, excuse me, C R, A, I G, and just one of the leading experts in where this map resides. So if the outer map resides in a part of the brain called the somatosensory cortex, s1 the insular map lives in a part of the brain that's much deeper and more primitive, called the insula. And the insula is it's so fascinating to me, so stop me if you just you think I'm going overboard. But the insula takes information from the body, including touch, and it enters the back of the insula, and it's basically, think of it as like a snapshot. It's a snapshot of what that experience is. So let's say my hand is on the person's lower back. They're interpreting this information, okay. Well, this hand is not some creepy dude. Hopefully they don't interpret me as a creepy dude, but not a creepy hand. But it's a it's a an expert, a therapeutic or a chiropractor that's been trained that that is here to help me the interpretation, or that snapshot from the beginning of this is touch now starts to gain some some ammunition, some meaning. So from the back of the insula to the front, that snapshot of my hand on the lower back starts with that feels like touch, feels like a nice touch. It doesn't hurt. And now, oh, it's a therapist that's that's putting this touch on me. This might be a good experience. Oh, that touch is warm. Warm to me means safety, like see what I'm getting at. So as that message goes through the insula, that where this interoceptive map lives, you can shape it with your thoughts. And so that was a game changer for me, is that I was saying, Okay, well, I can touch them, but if I if I can coach or cue the patient to start to change the narrative of what they're feeling, that we can actually change the experience. And that's what I've been doing the last, you know, trying to hone, at least for the last five or 10 years, is, how do I better create a therapeutic alliance with my patient, versus just having them be a blob of tissue on my table that I'm that I'm, you know, operating on

Dr. Spencer Baron:

you pretty much answered my my next question about if someone had pain for years and and they feel that their body is, I mean, they're hanging on to it. They remap their brain. They feel like it's an unsafe place to live. And if you and just to even to go over one particular example of how touch can help make them feel safe, like a patient comes into your office and they have, I don't want to just use low back pain. Let's say they have, oh my gosh, their elbow hurts. They have elbow pain. They've had it for years. What would you do? It would be different, yeah.

Dr. Steven Capobianco:

Well, let's, let's go back to those maps. So I I'm still performing, and this is what manual therapy is. Gotten a bad rap manual therapy, and I'm going to include a chiropractic adjustment into that is. It's basically been, been under attack for the last, you know, 10 years. And I'm sure you guys have seen it, where those that are saying, anyone that puts hands on people is, is, is, is creating reliance. It's not necessarily mechanically, making any change to the tissue. And so, like, I was like, Okay, well, I've been in practice 23 years. I feel that some of my manual therapies have been pretty effective, not to everyone, right? And this is my point, that I've evolved from being a manual traditional manual therapist, let's put an elbow into a psoas to one that's a little bit more nuanced, and I want to I want to share with you is how I've kind of evolved my manual therapy. I'm still putting hands on body and using tools to quote, unquote, manipulate the body, but I'm doing it with a different lens now, so the example of the elbow is a classic one, right? So like, especially with the pickleball movement that's going on, I'm sure you're seeing it in your area, Spencer and Terry it's everywhere. So I shouldn't even ask, it's everywhere. We're having a local HOA meeting in respect to the noise associated to pickleball. Have you guys been under that? Have you heard of that?

Dr. Spencer Baron:

Not yet, but we get it. We see a lot of calf injuries amongst the older folks,

Dr. Terry Weyman:

for sure. And it is, it can be noisy. So yes, I've heard even when they're in people's homes and there is no ha Hoa, it's causing friction between neighbors. And they started at the soon as the sun comes up, you know, like spends your time and and they start playing pickleball. And people are, I'm trying to sleep, and it's not quiet like tennis, you know, and tennis is not as quiet, but that, yeah, it's a lot louder,

Dr. Steven Capobianco:

yeah, well, I'm running into this now, but I. Deal with a lot of folks that have had, you know, elbow issues that become more chronic. So the let's say that they've gone through three or four other practitioners, from massage therapists to PTS to other Kairos, and they finally come to me, and you're like, I've had this for three years. It's not resolving. Immediately, I'm starting to think, Okay, I'm no better than the other three or four. I used to think that I was always, you know, cocky and better, but I'm no better. I'm but I, what I can do is potentially get open an opportunity to create some dialog. And I know that you've had Dr Joe Lavaca on here, and I learned, you know, Joe was part of my, you know, education team, and I loved how Joe would communicate what he does as it relates to chronic pain. So I've taken some things from him as well, but it's, it's all about starting to make that connection, and that connection starts with the words that we choose. You know, quite often I'm not as particular about the words that I'm that I'm saying. If I'm seeing someone that that is not in chronic pain, but when I have someone in chronic pain, my Nocebo terminology I'm very sensitive to. So if, if you're any of your followers, don't know what no SIBO is, it's the opposite of placebo. And so, like just saying things like, my back is out. I have a bum knee. I have, you know, bone on bone. Those can all be no cebic, meaning that they actually can cause pain, just like placebo can take away pain. So it's a psycho, psychosocial, you know, manipulation, just by using words. And so I start connection by building that relationship. But to answer your question more directly, Spencer, is that I immediately start with some type of hands on, or touch therapy. And my touch therapy ultimate goal is not necessarily to to break down scar tissue or adhesions. I don't believe that to be true. Like, like we were trained to think. Now I'm using the touch to be able to say, how do I improve the Wi Fi connection between that body part, your elbow, and your the maps in your brain? And if I can add to that, there is some nuance to the type of touch that will actually influence different brains. There's almost like a a coordinate that you could use to be able to talk to the extra receptor, or homuncular map, your your touch map. And then there's another coordinate that you could use to to talk to the insular map, the interoceptive map. So those two are, like my big two that I start with. I said, let's first identify the clarity of your map. Do you guys still use two point discrimination?

Unknown:

Sometimes? Yes, right. So

Dr. Steven Capobianco:

this is what I've got. You know, two point discrimination. For those that are not familiar, it's basically, you could do this with a with a, you know, just two pieces of what is the one I'm thinking of a paper clip, and you can kind of expand it and use it. But ultimately, what you're asking someone to do, if it's the elbow and I'm going to use myself on screen, but verbally, those that are maybe listening, I'm going to be using two point discrimination to see how clear their exteroceptive or homuncular map is. I'm not using it like we were trained as trying to find out what's the sensory dysfunction of X nerve or following a dermatome. I'm actually just saying in the area that you have pain, how clear is your outer map. And so you could use two point discrimination to say, tell me, with your eyes closed, of course, I'm asking the individual to tell me, is this one point or two points? And then we can measure that distance to be able to identify how clear someone's map

Dr. Terry Weyman:

is. I haven't seen that in years.

Dr. Steven Capobianco:

Terry, this is what blew me away, like, again, I've been in practice, you know, probably as long, if you know, maybe less than you guys, but I'm somewhere around the same realm. I asked this question every class that I teach, and everyone has put this tool away. It's in a drawer somewhere because they're like, I was using it for dermatomes, but it really didn't give me enough information to change what I was going to do this to me, if I'm going in to say I want to improve the clarity of your homuncular map, your touch map, how do I know if I'm making a significant change, other than seeing a change in their pain or their movement, which is important. But as you know, chronic pain takes time to be able to change the perception of pain. And if I can show someone that when we started, even in the same session, I might start at their 80 millimeters apart. Those two points of contact are demonstrating that that person doesn't have a very good map. You should always measure it to the asymptomatic side, just like we've all been trained to do, there is normative. Of data for every part of your body as well. So if you wanted to measure your lower back map compared to the mass, you can actually look at that and it ranges around 40 to 44 millimeters of separation that's considered, you know, normative, you know discrepancy. But when you come to chronic pain, that map becomes blurrier and blurrier, so your ability to sense two points becomes compromised. So job number one for me with my touch therapy, I want to communicate that level of touch so that's when you're taking advantage of a beta fibers, the fast traveling mechanoreceptors in your skin and fashion. So that's my first, first, first way. So I'm going to use tools, I'm going to use my hands, I'm going to use whatever I have that's novel enough to get the brain's attention, and then we're going to recheck. And like I said, you can make that change within one session. Does it last, probably not, but it's a it's a starting point where you can say to the patient or client, today, we did some good work. We we improve the clarity of your body map from 40 millimeters to to 30 millimeters. And they're like, but my pain is still high. And I was like, I get it, but we're making movements towards changing that by improving your overall map. So I give them a goal. Let's focus on making this as clear as possible. Let's shine that spotlight. So that's, that's the first way that I would start Spencer, is that I would start with clarifying their outer map. I'll stop there and see if you guys have any questions before I move to the inner map.

Dr. Spencer Baron:

No, that's beautiful, because I you know the fact that you're measuring a difference pre and post, and it proves to the patient that something's something's changing. So that's continue, that's continued. That was great.

Dr. Steven Capobianco:

Let's listen. Chronic Pain is messy. Humans are messy. So like, if we're not paying attention to the human that's presenting that that is clearly that they just don't know where their bodies in space. And you could do that. There's multiple other ways I should I should imply is that you could do movement screening and looking at how someone accomplishes a specific movement. Can give you some sense of, you know, are they confident or not in that movement. That's not a that's not a structural identification. I'm actually looking at how confident are they moving through that range of motion. Because if someone's moving through and they're very cautious, that's information that I'm going to take in respect to their map, not necessarily, you know, it's a it's scar tissue, or it's a joint restriction, I can go in and work on those, but I'm looking at how clear their map is according to their movement, and then using, you know, something as simple as two point discrimination, so that that is, that's the that's the body map or touch map component. And quite often, sorry, quick,

Dr. Spencer Baron:

quick quick question, in regards to that, are you able to also identify someone's chronic pain as well? You started to allude to it before. I think, you know we I read in some psychology magazine that people have a tendency to have a psychological overlay, which, you know, in regards to their pain, and it suddenly becomes their identity, or not, or it be chronic pain becomes their identity. And you have people come and go, yeah, like, and it's like, oh, nonchalant, yeah, my back's been hurting for years, or something like that. And then you find out that, what would life be like if it didn't hurt? You know, what? How do you identify, whether it's you know, you remap the brain, you know, and it's sensory input, versus someone who's psychologically owning it?

Dr. Steven Capobianco:

It perfect segue where you couldn't have done it better, at least for me to kind of tell the rest of the story, because honestly, the the one component that we've kind of, I started to, you know, to suggest is a good is a good way to to create an improvement in your touch map doesn't necessarily solve all the problems. If it's just that you you'll see, you'll see the improvements, and that person can start to sustain, you know, more changes durably. But those that say, Yeah, I'm seeing some change, but I'm not seeing enough. That's when you have to dive deeper. And when I say dive, I mean, we do need to dive inwards now. And so how I now shift my gears in respect to what I'm trying to influence? I'm not going to be using touch that's focusing on a beta fibers, you know, all the the fast traveling mechanical receptors that speak to the homuncular map. Now I'm going to be changing the dosage of how I'm touching them, the speed. I'm going to give you all of these metrics, because they're important. And is that my touch now changes. It becomes much lighter, and it's it's taking advantage of body temperature. What they're finding is that we can stimulate a certain set of receptors by by human touch. They really got most of this information from Mother Child interface of, why do we put a baby on mom's chest, bare chest, immediately after birth? Because they see that survival rates go up. It's not just a an immune function, which a lot of it is, it's the neurological connection immediately after birth. It's just blows me away of what I'm learning about primates and how they interact using touch and Mother child interactions have now given us the opportunity to learn as therapists that there's a certain form of touch that we can provide, which is actually been labeled as interoceptive touch. So interoceptive touch, if our goal is to now start to our start to communicate with a different part of the brain. We're going to be using, like I said, lighter touch, and they actually give you kind of a a level of touch. If you're going to rate pain from one to 10, you can rate pressure from one to 10 as well. So you're trying to stay within what a patient will perceive as one to three. So it almost seems insignificant when I get this type of treatment, because I've been conditioned to think that you need to literally strip out my psoas with your elbow. That's like a nine or 10 on that list, one to three. Most people would say this is not even giving me what I'm looking for. So you have to be make sure you're coaching them as you're doing this type of touch. So that's number one. Is pressure. Speed also matters. They call this caressing touch and again, taking from Mother, you know, Mother Child primates, when they groom each other, there's actually a speed that's been shown to be most effective to stimulate these receptors called C tactile fibers, the letter C tactile fibers. So C tactile fibers, we would have learned it when we got trained, and I should speak for myself as nociceptors, right? But these C tactile fibers have dual multi function, actually, and one of them is to receive caressing touch as a safety mechanism. Why do we feel better when our mom is rubbing our back? When we're not feeling well, because we're stimulating these seat tactile fibers, there's a sense of safety that's that's literally flooding your insula, and your insula says, safety, safety, safety, and then the nervous system calms down. Well, think about this with chronic pain, their threat, threat, threat. My back, when I bend back, that's pain. That's a threat. When I cough, I have to brace myself because that's a threat. When I sleep, I can't sleep on my left side, so I have to sleep on my right side. That's a threat. So if you can change their experience by using this type of safety, touch coupled with movement, eventually you can actually rewire the the insulas, snapshot picture of that everything is a threat to to to it now it's safe, so that, that's the part that I know I may not have articulated well, and I'm welcome any question, but interception is is a different form of touch coupled with cueing, and that's the that's the part that I'll kind of expand on, but I'll see if there's you guys have Any questions on what I've said so far?

Dr. Spencer Baron:

Yes, patient, we have a variety of patients. And if, if I did a touch that was between or some soft tissue or light skin work on skin that was between one and three, they would think, I'm not doing the job, because they talk trigger points and knots in the mother and you got to get in there, pulverize it. That's right. Say. What do you say to those folks?

Dr. Steven Capobianco:

Dude, it's, it's not easy, but, but again, think about what chronic people go through. It's not like if you're the first that they're seeing, then you might have a different strategy. And I could start to peel away at the onion, where to say, I want to meet you where you're at. And I get, again, I get this from, from Dr Lavaca, is that he's the master communicator, and he says, Well, Steve, if someone's coming in expecting you to strip out their psoas, strip out their psoas, because the expectations there, but at least you could say, we're going to do a pre and post if we don't get durable change from that. Hopefully that opens up an opportunity, a door that you can have a different conversation next time. And maybe it's weeks down the road, right? But I mean, now you say, All right, well, we're going to be kind of decreasing the amount of pressure now, and we're going to be doing this strategy. Here's what we're trying to do. And I use a whiteboard with all of my patients, and I draw shitty pictures. And. We laugh about it, and I'm trying to explain what I'm trying to do to their brain, and I make this phone line connection if I'm talking to an older dude, or Wi Fi connection to a younger population, but I want them to understand what I'm trying to do and and so that allows me to say, Okay, today is going to be a lot lighter, but this is what we're trying to do, let's check and see if we make a change. So give them some objective measurements that say, Man, that was pretty effective, and so it gets buy in. So the last lever that I pull is the interoceptive lever, because it's the trickiest. It's now it's tricky for the patient, mostly because they've been so disconnected from their body for so long. And the therapist I know, I wasn't trained to, you know Act, the act as the bartender or the, you know the therapist, you know the psycho psychological therapist. I'm a manual therapist. I do touch therapy, but I've learned over the last few years of how to do it, I think, seamlessly, but this more authentically is probably the best way to do it. Saying, Okay, I'm going to be touching you. This is lever three. Mind you, I went deep, you know, for a week. Let's say, for example, I went lighter, trying to improve someone's extra receptive or homuncular map. And let's say I'm on week three, and I want to do a one to three in pressure. They're already set up to understand what I'm trying to achieve. And so one to three now it makes a difference, because I've explained why it makes a difference what our goal is to to to communicate to this part of the brain. But this is the last part that I definitely want to share with you is, this is where you have to ask them to be an active participant. They're no longer just a piece of meat on the table. Now I'm saying, Okay, I'm touching you. Where am I touching you? And they're like, my back, all right? Is it your right side or your left side? This is lateralization. This has been researched and saying chronic pain back sufferers have difficulty identifying, you know, right or left. They have difficulty identifying pressure. So you're asking these questions, am I on the right side of your back? The left side of your back? Am I moving clockwise or counterclockwise? All of that helps to shine a spotlight on that part of their brain, their body, in that part of the brain, and then we go another step deeper, literally saying, okay, my hand is and I asked them to close their eyes. And you guys can even envision this, or who's listening to this is that my hand is a boat on top of water, and you are diving under the water, and you're a scuba diver, basically in the water, looking up at the bottom of the boat. Is my hand. And so I'm giving them, you know, pictures to visualize. And so they're they're closing their eyes, they're visualizing what I'm telling them to think about. And then I say, Okay, you're scuba diving in this water. Is it warm or is it cold? And then they're like, I guess it's warm, and there's no wrong answer. This is the beauty of this exercise. Now you're asking them to intercept, right? So which most people haven't done majority of their lives? So then you ask more queuing questions. Do you feel like you want to swim towards that boat or my hand or away from it, and that gives you an idea of their sense of threat. So you're not only asking them to verbalize it, but you're going to see how do they respond? I didn't look at a patient's eyes. I'm really ashamed of saying this, but probably 10 years of my career, most of my patients were face down or facing away from me. I never looked at someone's eyes. I couldn't tell you what their eye color was, or, you know, because I didn't focus on it. But the eyes are a great window into what you're feeling. So I start to pay attention to their pupils, and they can tell me a lot of information. If you're on high threat. They're dilated. If you're in safety mode, they're more constricted. So I'm looking for all these cues. I'm giving them ways of, kind of articulating what they're feeling inside. I ask them to say, what shape is your pain? Some people say, What a ridiculous question. But I'm asking them to just depart from just naming it, but to actually now describe it. Is it a beach ball, or is it a golf ball? Is it spiky, or is it smooth? And again, you guys might even be thinking that, Steve capital, you've lost your friggin mind, but I'm telling you that the research supports this idea of interoception that could be manipulated with touch, that light touch, soft touch, slow touch, but also by having someone mindfully pay attention. And that I'm using the term for the first time, it's basically mindfulness, but you're guiding them around the experience.

Dr. Spencer Baron:

Is, man, I know, right? I have, I have a question that, okay, interoception. I've been wanting to ask this earlier because you mentioned something about the Kinesiology tape, or, in your case, rock tape. And you know the fact that interoception gets sensory feedback from, you know, heart, lungs, kidneys, so on, but probably one of the biggest organs in the body is the skin, so it gets all that information. And for years and years, whenever I would use that tape on someone's injury, it was for the purpose of what I would now I look at it as I think, why did I describe it that way, as a band aid for the muscle, you know, or the ligament tendon, and it's only recently that I would love for you to describe why you would use tape, because I have a feeling I know what the answer is, but go ahead.

Dr. Steven Capobianco:

Well, I'll speak it just like I do it every day with, you know, with patients is like, it's a spotlight on the area. I'm shining a spotlight on a blind spot that you have within your brain. So, like, you can't see your knee. Your brain says, Well, why would I let you move that knee? So the tape is basically shining a spotlight on on the area to bring, bring it to its awareness.

Dr. Spencer Baron:

Have you always known that? Steve,

Dr. Steven Capobianco:

no, no, I was trained just like you. I initially learned kinesiology tape from Kenzo Kase himself. And Kenzo is the chiropractor, Japanese chiropractor, very strong accent, definitely 30 years ago when I learned it. And so I was trained as a as a biomedical, you know, you know, practitioner. I was moving muscles, I was taping ligaments, and all of that has been relatively debunked. And so we we have to kind of lean on what the research is telling us, and it's basically saying this in multiple ways that we're influencing the nervous system, and that includes an adjustment, soft tissue manipulation to a strip of tape.

Dr. Spencer Baron:

I have to say that the concept was was brought to my attention about five years ago when a patient who'd been a patient for like, 11 years now, she had a history of brain surgery and had other multiple surgeries, and always wished that she could be a ballroom dancer. And this is in her 50s, and I, you know, I'd been working on her, working on her, and made incremental improvements until I said, You know what? I'm going to use this, this tape, to provide sensory feedback to your brain, because and I put it, I remember putting on her, her right quad, and left it band, and she could not do it as she performed. She won, she won ballroom dancing competitions, and required that tape to be put on because it gave her a sensory perception that nothing else would right.

Dr. Steven Capobianco:

That's how, well one, that's how we teach it, because, you know, it's evolved, and so I know that we're running up against it, but, I mean, I've evolved even our description of how to use rock tape, because that's the brand that you know that I had involvement with but, but just in respect to how I would communicate it, it was more of a myofascial we're influencing the fascia and the muscle ligaments. Then we started to talk about how it's stimulating certain mechanoreceptors. Well, great. Where did that information go? It goes up to where your touch maps are. So we started communicating about extra reception or improving your touch map. Then we started learning more about how touch, including tape, can influence different systems as well, including the insula for the interoceptive map. What I'm sharing with you today is that it all comes down to dosage. If it's lighter, it's more likely going to be more influencing the insular, interoceptive. If it's faster or deeper, it's typically more touch map. So having this information definitely as a practitioner, gives us you know more direction of what we could be doing with our with our patients and clients, and then when it comes to the patient, those that are feeling that have chronic pain, and I'm a chronic pain sufferer. I played collision sports most of my life, and so I'm, I'm reaping the, you know, the effects of that now, but how I'm my the homework that I do is the same homework that I asked them to do. I was like, You need to take ownership of the narrative that you're giving yourself. We don't you know would you talk to, and this is almost like therapy that I'm providing others that I've received is that, would you talk to your best friend the same way that you're talking about your shitty back or your crappy shoulder or your bum foot? Like words matter? Then thoughts matter. And so I start to kind of become more comfortable with the conversation saying I'm putting a strip of tape on you. This tape is going to help improve your awareness of where that joint, that body part is, but I also want you to think about this tape as your safety net. I want you to think about this tape as your best friend that's going to be there whenever you need it to going back to your point of your ballroom dancer is that they start to attach meaning, positive meaning, to that strip of tape, especially if it's like a specific color that they like. I used to make fun of colors, saying, colors don't mean anything. Well, I've really taken that back. I said, Well, if someone is connected to a to this color versus versus this, which I always wear black, I probably would respond more favorably psychologically to this than I would this, right? So colors do matter in that case. But my point is, is that how we communicate this should change from the information that we get.

Dr. Spencer Baron:

You know, it's funny, because at Miami Dolphins, they denied using any kind of tape anywhere, because and they and, of course, we were given reams of different brands and companies and so on, and it was because players were using it as a cool look, as like pinstriping on a car and denied it all together. But you're right. It is. It definitely gives you some feedback of of safety, and provides a sense of image that gives you empowering and yes,

Dr. Steven Capobianco:

and so that, it was Peyton Manning that said, this is that when he was going through, and I think it was either his neck, I'm pretty sure it was his neck injury, where he was talking about his disconnection from his his team, his peers. So what he decided to do is that his rehab, as you know, Doc is that, is that you're going to be doing that in a in a rehab, you know, room, it was separate from the players. And so he actually brought most of that therapy into where all the players were, because he wanted that connection. But he would say, This is what he caught my attention. He talked about the strip of tape that he had on his neck post surgery. Was basically his social identifier. It allowed people to know that he is actively working training to get back with his team so he can support his team. So the tape became the kind of the identifier. I thought that was an interesting way of putting it, which I never really thought of until he brought it up.

Dr. Spencer Baron:

You there's a conversation about a threat inoculation. I think Mosley and Butler had brought up something like that. I know that's that's near and dear to you, but you've described a little bit of or you've described a lot of it, but threat inoculation, can you, you know, go over what you how that is interpreted by you?

Dr. Steven Capobianco:

That's my new and I can answer it pretty quickly, that that's my new definition of manual therapy. It's less to do with the mechanical effects that we think are occurring, and more that I'm using this to decrease the threat of the nervous system, multiple ways of testing for that, and and then, and then, using that kind of neurological window that I just opened up for to now, take that individual, if indicated, from passive to now moving. None of this stuff that I'm talking about generally is long term, meaning any type of manual therapy has been well documented that you'll get short term benefits, but they don't generally last very long, unless you attach it to some type of meaningful movement, so you have to load it. And so I'm a huge proponent of manual therapy, plus manual therapy, and you know, because you have to be doing other things. So threat inoculation is if I could use a, let's say, interoceptive touch, a very light touch to decrease your threat Awesome. Let's now get you off that table, and let's start having you move at whatever level is indicated for them. So that's what I mean by threat inoculation.

Dr. Spencer Baron:

You know, I don't think the the audience realizes how touch in certain areas of the body can be so powerful and so sensitive that you have to be masterful at realizing we were, you know, I was taught through, well, I took courses in neuro linguistic programming that if you know when a patient walks in and and they're upset, and you put your hand on their back to console them, you're reinforcing a sense of whatever they're coming in with. It's depressing or hurtful by like Pavlov's dogs. You put your hand on their back. You go, No, everything will be all right. We have to be so careful not to fire off triggers that are negative. So for what you're doing. Is, is much more science based and intentional that I don't want people to think that it's just so simple to do that

Dr. Steven Capobianco:

your term of intentional is, is probably the biggest part of this, this conversation, is that, yes, the intent has to be there. You have to communicate that intent to your point, is that someone comes in that's expecting deep tissue, and I'm giving them this type of slow caress, like touch that might not be interpreted. So you have to educate along with your touch. And so the intent is just telling them exactly what we collectively are looking to achieve, and so that just opens up the opportunity listen. People came to see me. I'm 235 pounds. They came to see me because they wanted deep and I would give them, like I said, what they wanted, but if we didn't get the outcome, I hope any practitioner would say, oh, okay, that didn't work. What else can we do? And I'm just sharing with you that I feel that this interoceptive, you know, component of the discussion definitely, when it comes to chronic pain, is something for both the pain the doctor and the patient to consider. Because again, I do homework every day. I will journal around what I'm feeling in respect to my pain before I just used to just ruminate about it, say, Damn, my friggin back is killing me. I wish it would go away. I wish I could just get away from it. It was always the enemy, and so part of my therapy is journaling it on paper. When I feel like crap, I rage on the page. I get it out. I tell the tape. Same thing to my patients. I was like, You need to get your narrative out of you and on paper, and it's a good starting point. So those that are willing to do that, they do great. That's a that's an interoceptive exercise. I asked them to mindfully move when you're eating breakfast. I want you to think about every move. That's an interoceptive lever that you can pull. Meditation is a big one. Sometimes kind of charge, because some people don't want to think that they're meditating. But meditation is another interoceptive, you know, homework that you can provide so that, that, to me, is the, is the next wave of therapy that we can provide those that are in chronic or persistent pain,

Dr. Terry Weyman:

you know, Steve, you talk about, you know, the brain and chronic and and you also talk about manual therapy. But there's a fine line of when it becomes when patients actually could become dependent on it, versus empowered. And how do you create this resilience of creating a patient who doesn't need you forever, because sometimes they get attached to their chronic pain, and now you don't want them to be attached to you. So how do you empower this patient?

Dr. Steven Capobianco:

Yeah, simply education, you know, explaining like again, you know, Spencer, you brought up the patient that just wanted tape on their body. I've had many athletes that once they see the benefit. That's basically their lucky pair of underwear that they wear forever. So you have to be able to you need to be able to explain what you're trying to achieve, what that duration of time should look like, and that we're moving towards this end goal, which is your ownership of your own body. And that's where movement comes in. Like, if I'm not attaching some type of movement as part of their their Manual Therapy. In this case, then I've missed the opportunity to make long term change. So it's ultimately education and then giving them ownership of their own movement.

Dr. Spencer Baron:

I refer to crutches as a crutch that you get rid of. You're not going to walk on crutches for the rest of your life. We're just using it to facilitate change, and that's how I oftentimes

Dr. Terry Weyman:

Well, said, Yeah, I think he didn't even, Courtney even mentioned, with everything, what's the orthotics? Yeah, but like with anything you ask, what's the end game? And I think we need to always start with patients going, here's what we're our plan is, but here's where our end goal is.

Dr. Steven Capobianco:

Couldn't say it better. That's exactly what it is. And so I'm a manual therapist. I don't shy away from it. I don't hide from it. There's plenty of evidence that says that it's effective, but most of it is short term. But that short term window is super important for someone that is in chronic pain, that I can make a change on the table in real time, and then ask them to move, because I have a window of time that is safe for them. Going back to Mosley and Butler Spencer, they talk about Sims and dims. Are you guys familiar that term? Those terms, their acronym, safety in me is Sim, and danger in me is dim and so he they basically talk about this model of whatever therapeutic intervention can take someone from thinking that there's danger in me, my bum knee, to safety in me, that small little window of time provides opportunity to make that change longer lasting. So I love the Sims dims concept as. Like my goal today is take away danger, and let's make you more safe, so then you can start to move more effectively and efficiently.

Dr. Spencer Baron:

Love it. If the last stuff, yeah, no, really, this is great stuff. In the last few minutes of our show, we go over rapid fire questions. I got five of them, and some of it has a lot to do with what you do, and some has nothing to do with what you do. So what are

Dr. Steven Capobianco:

the game what are the game rules? Like the

Dr. Spencer Baron:

game rules are, they're rapid fire, so I'm going to throw it out to you, and you got to give it in a brief answer. Gotcha, if one word is cool, maybe we can take a few more so we're ready. All right, you could teach Question number one, if you could teach every human being, one skill to reduce chronic pain, something that you could do daily. What would that be?

Dr. Steven Capobianco:

Physiological sigh. Look it up. Look it up. So if I'm staying rapid, physiological sigh, look it up, and you'll find a great thing that you could

Dr. Spencer Baron:

do every day, like a sigh, like s i g, can

Dr. Terry Weyman:

I dive in deeper. Yeah. Well, yeah. Now I want

Dr. Steven Capobianco:

physiological sigh. Some, some will call it the intentional sigh. This is how it's done. If you guys want to do it, along with me, great. It's an, it's a blow out your air on the count of 3123, normal breath in for three at the top of that quick sniff in, and then exhale seven seconds out. So if I repeat that, it's a normal inhalation through the nose three seconds at the top of that inhalation, you're going to sniff in, sometimes twice, and then it's a long exhalation out. So that physiological sigh has been demonstrated to decrease threat. Ultimately, if you're going to take it for like a global description, but a deep it takes a sympathetic system into parasympathetic, the fastest when it comes to breathing tactics. So if you have someone in chronic pain, they're always on sympathetic, because they're always trying to get away from the threat. So you're using this breath to bring it to more into parasympathetic. It's an easy thing to do. Love that I know.

Dr. Spencer Baron:

Yeah, question number two, what's one personal belief or habit you have that most people would never guess about you.

Dr. Steven Capobianco:

I like, I like classical music.

Dr. Terry Weyman:

Really, you have a favorite. I love this look. Did you see it like

Dr. Steven Capobianco:

you went the classical would be, I'm Italian, you know, born and raised and so it would be like Pavarotti. Pavarotti would be the top of my list. Let's start with that one. Nice, nice, so opera, classical music. But you know that that that genre,

Dr. Spencer Baron:

Vesti la Juba, all right, very good. Love that in one sentence, you've helped build a global education and product platform of rock tape. What's the biggest moment of doubt you had in building that? And how did you push through it,

Dr. Steven Capobianco:

resolving my anxiety to be right all the time?

Dr. Spencer Baron:

Oh, interesting. Okay, you were actually wrong at some point in your

Dr. Steven Capobianco:

life, of course, many, many times.

Dr. Spencer Baron:

Fantastic question number, what was that? Four? If you had to describe in one sentence why you get out of bed for for this kind of work, not the science, not the title, but the impact of people's lives, what would it be?

Dr. Steven Capobianco:

It's I actually have a tattooed on my arm. It's a phrase called ancora imparo. I share it at all of my slides. Ancora emparo, apparently was said by Michelangelo in his late 80s. And what it means in Latin, or translated from Latin, is still learning, so I get out of bed because I continue on to learn and Cora and para.

Dr. Spencer Baron:

Good one. That was great. All right, last question number five, Steve O, you've been at the forefront of evolving pain science and manual therapy, if you could rewrite that story The world tells about pain and movement. 10 years from now, what would it be?

Dr. Steven Capobianco:

Our bodies are resilient? I'd stop right there. I don't need to add to it. It's exactly what we're trying to do. Our bodies are resilient.

Dr. Spencer Baron:

Beautiful and true. That is great. Oh, this was a very good program today. Thanks. Dr Capo bianco, oh, man, that was great. Thanks, Steve, that was fun. Bye.

Dr. Steven Capobianco:

Dave, he's working in the background, went to the bathroom or fell asleep.

Dr. Terry Weyman:

That was awesome, buddy. Thank you.

Dr. Steven Capobianco:

Listen. I've done some of these in the past, and I know I go overboard and I probably just black more than is necessary. But again, I really honored to be on the platform and and listen, I'm a huge fan in the background, so consider me another follower.

Dr. Terry Weyman:

Oh, see, this is the but this is what we like the conversation. Is such it the way it I mean, we I love when people get on a roll, because that's what the juice comes out. You know, it's not that. It's not a interview. It sounds like that's just, it's just three buddies talking, and, God, you just let some juices flow. And it's funny, because I haven't used that, that prong. I know what the thing's called,

Dr. Steven Capobianco:

that prong thing, you point discrimination tool. That's it, all right,

Dr. Terry Weyman:

I haven't used that since I graduated, yes. So that's what I think spent. There's so many times Spencer, I get on the phone after a show, we're like, oh, he that person. Remind me this and, and so that's what I just appreciate about this show, and and, and the people that we've had on it is just it gets me fired up, because, like, the last couple days before you got on, I was talking to Spencer. I go, I'm kind of on a vacation right now. I go, I just kind of feel lost. I mean, I don't know how to relax, and so I I go to bed, I want I've been watching Olympics. I go to bed, I get up, I go ski, I watch the Olympics, and then I'm like, four days went by and I got nothing done, but I don't feel any more relaxed. You know, you would think you'd feel relaxed after doing nothing, but actually I feel more tense. So, you know it I need, sometimes you can need to get fired up with with something that

Dr. Steven Capobianco:

David we did, trying to call, I tried to text, Yeah, cuz the he's got to close it down, right? So then it gets recorded, yeah.

Dr. Spencer Baron:

Thank you for listening to today's episode of The Kraken backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at crackin backs podcast. Catch new episodes every Monday. See you next time you.