OTs In Pelvic Health

Why Pain Science Matters + How To Talk With Our Clients About It....Simply!

• Lindsey Vestal • Season 1 • Episode 28

Share episode


Ted Talks

Podcasts 

  • One Thing pain podcast with Mick Thacker
  • Pain Science and Sensibility with Sandy Hilton & Cory Blickenstaff
  • The Healing Pain podcast by Dr Joe Tatta

Books

Other Resources

 

 

____________________________________________________________________________________________
Pelvic OTPs United - Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:​

  • Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
    ​
  • Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!


Lindsey Vestal So today we're going to walk that fine line between being geeky but being really clear and simple with our language to help our clients understand pain and our new definition of what pain actually is in our body. Stay tuned as we dive into this together and do our best to be our best for our clients with understanding what pain is all about. 


Intro New and seasoned OTs are finding their calling in Pelvic health. After all, what's more ADL than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving OT in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired OTs, we are out of the box OTs, we are Pelvic health OTs. I'm your host Lindsey Vestal and welcome to the OTs and Pelvic health Podcast. 


Lindsey Vestal Pain is our brains. Natural alarm system pain is our brains attempt at simply trying to get our attention. We need to feel pain. Pain protects us. It keeps us alive. It is our alarm system. Letting us know that something has happened to our body. So when you feel pain, you react quickly. And that's exactly what is needed sometimes. And pain is just one way. One resource that our brain body can use to get our attention. For it to say, Hey, I need you to notice this. I need you to notice. Stop and take action. Some other ways that our body does. This is fatigue, hunger, thirst. Right? These are all outputs of the brain. So the classic definition of pain, the one that most of our clients consider is physical suffering or discomfort caused by illness or injury. So this means that when they get an injury, that injured body part sends a message up to the brain. And that's how we feel. Pain. Simple enough. So this means that our symptoms are the result of tissue pathology, which means that there should be an organic explanation for all of our symptoms. And it assumes a reasonably proportionate amount of pain related to tissue pathology. Okay. But those of us in Pelvic health are acutely aware that this definition of pain has many limitations. So, for example, it doesn't explain why pain can continue when tissue damage is no longer present. So I'm thinking of chronic pain. It also doesn't explain when clinical phenomena such as phantom pain happens. And I've come across research in more recent years that has showed that some types of pain I'm thinking here, like nausea, plastic pain, you know, the go along with things like fibromyalgia and irritable bowel syndrome may not be associated with tissue injury at all and actually is associated with nervous system dysfunction. So that working definition of pain that was around for a super long time is effective and successful in treating acute illnesses that have predictable outcomes, you know, like a treatment for bacterial infections that require antibiotics. And it's very helpful for health care practitioners who have to focus on one very specific part of a person's health. So over the years, we have begun to understand that pain is so much more nuanced and complex. It's not as simple as one plus one equals two. As much as we might like it to be. So we have now begun to understand that there are social, psychological and behavioral dimensions to pain and illness. And that pain is actually produced by the brain and not by the tissues. Say what? What did I just say? All right. That's the hook of this whole podcast. So that's the crux of what we're talking about. That pain is actually produced by the brain and not the tissues. All right. How the heck do we explain this to our clients? How do we understand this ourselves? Okay, here's the thing. Pain is real. Pain is produced by the brain in response to a perceived threat. And not all tissue injury produces pain. So although we may consider pain. Kind of as a measure of tissue damage, maybe even correlated with how much injury we've had. This is actually not the case at all. Instead, pain is actually more of a protective system that gives us a chance to change our behavior often before the damage actually occurs. So all pain, no matter how it feels sharp or dull, mild or intense, is always a construct of the brain. And shockingly enough, is uncorrelated with tissue damage. Now, if there is a good reason to believe that protection is needed, our brain actually manufactures the sensation of pain. Now, sometimes this pain is not useful. Sometimes our nervous system becomes overprotective, producing unnecessary or intense warning signals that can actually contribute to unhelpful, persistent pain. If you're a pelvic floor O.T. listening to this, you get this. You have seen these clients, right? So this is why we're talking about this today. This is so useful. And if you haven't seen a client like this, you will in your career multiple times. I'm sure of it. So our beautiful brains take in experience and they literally filter it through its own unique biological, psychological, even socio cultural variables. And then it produces a symptom that we might label as pain. Right? So the experience of that pain and even the severity or the intensity is going to be dependent on how the brain has filtered the objective situation. This is why people could, you know, two people could experience getting a tattoo. One person. It was the most agonizing experience they've ever had. For another, they might describe it it as pleasurable or an okay experience worth the cost, but no real strong opinion about it. Right. So this nuanced understanding and that's what I call this like it's a very nuanced understanding is huge. And it really can shape the way that we help our clients. So in order to help our client through an experience of pain, we don't want to just look at what you may have heard deemed as issues in the tissues. We also want to address the bio psychosocial variables. And this, my friends, this is why I'm so passionate about the O.T. model of care. This nuanced understanding is becoming a lot more accepted across the board to the point that the International Association of the Study of Pain, it's the I a ESP. They have recently revised the definition of pain. So this is the first time they've done this since ELO in 1979. So this is very significant and I don't know about you. Well overdue. This new definition of pain is this an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage? I love the addition of the word emotional in there, and I love the words actual or potential tissue damage. So because pain is a personalized experience, right? Very, very individual experience influenced by bio psycho and social factors, I really believe that the bio psychosocial approach to the management of pain is key. It is literally the most up to date and multifactorial approach that we have. I mean, with this new definition and the new research that has come out, we now understand and can take into consideration the cognitive and social factors that influence the pain experience. And we know that our treatment has to address these areas, too. When our treatment include these factors, considers these factors hands down, we have better treatment outcomes. My friends. I mean, I have seen this time and time again. I have I talked about this on a former podcast, the podcast where I went into sort of like my my Otti manifesto on my views on biomechanical versus the bio psychosocial approach. So check that out if you haven't already. I go into why. Why it is we actually get better treatment outcomes with this approach. And when we operate from this new and revised definition of pain, we can more accurately listen to our clients and experiences right with a much more nuanced understanding. We can respect our clients, experience so much more for the nuanced person that they are right. We now understand pain is an individual experience for each and every person in front of us. And this lights me up. This lights me up because it helps me lean even more into this idea that there is no cookie cutter approach in O.T., right? That we really listen to the client in front of us and reach into our vast and varied toolbox to help and empower. Now, as OTs, we know that we can't only address the pain, but also write also how the pain interferes with their daily activities, their quality of life, their relationships, their social interactions. And when we stop and take this stuff into account, we really develop that personalized, multidisciplinary, client centered pain management strategy. So how do I start this conversation with clients, Right, Because this can seem all very heady. It can seem like, yeah, okay, you're going down a very nerdy path right now, Lindsey. And I get it. But how do I translate this into my clients understanding so that they're not eye rolling and I can actually empower them with it? Okay. So I'm going to share with you how I do this. I will often broach this topic by bringing up vision, right? So so vision, the ability to see it's actually produced by the brain, right? So vision is produced by the brain. And we get information through our vision for our visionary system through sensory inputs, right. Our eyes do a fantastic job of capturing light from things around us and transforming it into information used by our brain. But our eyes don't actually see anything. That part is done by our visual cortex, which is in our brain. It's specifically in our occipital lobe. Right. So when I explained this, most of my clients start to make this connection between the brain and sensory inputs. So this is my way of starting the conversation between how our sensory input gives information for our brain to interpret right? And all around our body. There are no core sectors which are sensory neurons. And their whole job, their whole job is to do it to detect actual or potential tissue damaging events. Okay. So, so then a second neuron comes along, it takes the message, it travels up to the spinal cord, to the brain, and the brain makes sense of the message, just like our occipital lobe makes sense of our vision, our vision information by drawing information from current and past experiences and from a state of our mind. So our brain is very quickly saying, and this is when we're experiencing something from our noses receptors, right? Where are we? What are we doing? What can we see? What can we smell? What can we hear? Have we been here before? What happened last time? How did we solve it? Did we get hurt? Are we stressed? Are we frightened? Are we relaxed? And this is all individual and all contextual because of our beautiful, intelligent brain that is trying to protect us. Now the brain assesses how dangerous the situation is and decides, well, what should we do next? Right? And if it perceives the situation as potentially dangerous, it will produce pain to draw our full attention to it. Now, if there's the brain thinks there's no need for protection, it won't produce pain. So pain, you see, is not produced in the body or the tissues. It's produced in the brain. It's a danger message coming from the body, just like our visionary system. Right. So when we explain it like this, when we put it into context of something that is a little bit still complex, but a little bit more understandable, it can really start to plant moments for our clients. So when we explain it like this, when we put it in this context, it can it can start that cascade of moments. I have some super exciting news for you. O.T. Pioneers Intro to Pelvic floor therapy is opening for enrollment January 13th through the 17th, 2025. This is your chance to dive into a 100% online course. With lifetime access, you'll get five group mentoring calls with me and two free months inside our off social media private community Pelvic TPP's United. Plus, we're hosting an optional in-person lab in Cleveland on February 21st and 22nd. Please come join over 1500 other OTs who have already taken the leap. I can't wait to see you inside Oti Pioneers Enrollment January 13th through 17th 2025. We can remind our clients that our brain has our best interest at heart. I will often ask my client to recall a time in their life when, let's say they had an injury, but they didn't experience any pain from it, so maybe they had a bruise or a cut, right? Like, I can't tell you how many times I wake up and I see a bruise on my thigh or my leg. It's a pretty common occurrence for me, unfortunately. And I have literally no idea where I got that bruise from half the time. All right. So I explain that to my client. They usually recall something like this as well. And we start to make sense between injury doesn't always have to equal pain, and pain does not always have to equal injury. The next thing I'll do is I'll share with them a quiz by Lama Lorimer Moseley. I will link to this in the show notes, and it's a great way to begin addressing these concepts. So basically they have to answer true or false to a series of statements, and it's food for thought, for discussions and continuing in the education when you see them the next time. So I plant the seed. I give them a link to the quiz and they take it and we come back and we talk about it some more. So to give you an example of the quiz and remember, they're all true or false, the first 1 or 1 of the ones is something like, you know, pain only occurs when you're injured. True or false, the intensity of pain matches the severity of the injury. True or false? Chronic pain means the injury has not healed properly. True or false? The body tells the brain when it's in pain. True or false? The immune system has nothing to do with pain experience. True or false? The brain decides when you will experience pain. True or false? Stress makes your nerves fire. True or false? You can see that through these quizzes, through conversations. We're really trying to get to the place where our clients are realizing that pain is much more complex than simply the physical state and that there's so much evidence that says pain has to do a lot with protective mechanisms around neuroscience, immunology and so much more. In my opinion, it's really worthwhile to ask our clients, to ask themselves, Is there a story that I'm telling myself that's influencing what I'm feeling right now? Right? And then just stop and reflect on that. And maybe let's try this right now while you're listening to this podcast in your own body. Is there something that's bothering you right now? Some physical symptom. You know, do a quick body scan, see see if you can feel something. Personally, right now, I've got a little minor ache in my upper shoulder, my left upper shoulder. So I'm going to just stop for a second. I'm going to ask myself, is there a story that I'm telling myself right now about this discomfort that's may be influencing my experience? So because when we ask ourselves this question, it can open the story up to what else is going on in my life. And when I ask my clients to think about these kind of things, I have heard things like, well, actually I'm pretty stressed. I, I just got a new job. And I noticed that basically the week I started that new job, my back pain really picked up. Right. Something like that. And this is when the magic happens, because we're starting to link experience and stress with physical symptom. Right. The pain could be due to the emotions that they were experiencing and not the physical output. The experience may have been a sensitized nervous system, and it's actually influencing the pain. Right now, this is not always the case, but unless we stop and ask the question. We're not going to know. We're not going to know if there is a relationship. And one of the things that often come up related to this conversation when we're implying that pain could be more in the nervous system is the question. Well, does that mean, Lindsey, that you're saying pain isn't real? And I want to stop right now and say very loudly and very clearly, pain is always real. It's always real. You trust the client in front of you telling you that they are feeling pain. The new information we're discussing here in this podcast is that it may not be due to the physical input. It could be caused by emotional input. It's from the brain. And what the brain is experiencing has an effect. It has a ripple effect. A sensitized nervous system could be producing a pain response. And this is really important part of this. So in that very first visit, I want clients to know that I'm listening to them. OTs Recognize we all know listening is such a powerful therapeutic tool, really listening to people. So I want my client to know they're being heard and that their pain is real. I believe them. What? I'm adding them. What I'm adding to the conversation and getting them to consider perhaps for the first time is that the threat could be psychosocial and not purely physical. There is so much increasing evidence around this that says our social interactions are actually a pretty strong determinant of our health along with the psychosocial and tissue contributions. So I believe all of these factors need to be taken into account when considering our assessment and our treatment. And I have to say, you can see why OTs and our perspective bring so much to the table. We do this innately. We look at the whole person to deeply understand the experience they're having to treat it appropriately so that that alarm system can quiet and the pain is capable of change. For me, this actually starts with the intake at the Functional pelvis. So we have a very lengthy intake process that includes outcome measures and an intake form that starts with acknowledging, Hey, all right, this intake form, this intake form is a pretty lengthy thing. It actually says that right on the form. We take a whole person approach and we want to understand all of the various aspects of why you're here today. And I always encourage my students and my pioneer students to use a distress outcome measure because distress outcome measures are getting at that other aspect and it lets them know that you're looking at more, that you're looking at that whole person approach. And when we do this well often hear in sessions and response, like I get that I really think that you were the first person to dig under the covers and to try to understand everything that's going on in my situation. That is such a beautiful thing to hear. I also want to take a second to mention that this can mean that we may also refer out when we need to. So just because we're taking on a multidisciplinary approach doesn't mean that it's all on us, right? You've heard me say this more than once. If you attend my OT power hours on my Facebook group, I go live there every single week. Third is Thursdays, Thursdays at noon Eastern Standard Time. There are over 100 replays available for you. Go geek out for free. Find out how far down the rabbit hole you want to go into Pelvic health. So I say there all the time. It really takes a carefully selected, conscientious group of people to care for our clients. And that means not putting all of the pressure on ourselves to do it all. Now, first of all, we're there. Guide. They're the expert. And then we bring in additional referral parties if it's needed. Ideally, we're working with that referral party and the client feels that and knows that and they feel cared for because it's a community that has their back. And as coaches, we are uniquely positioned to do this. Physicians simply don't have enough time to look at the constructs and to educate the client on this and to build that rapport that it truly takes to evolve. In Pelvic health OTs offer a truly psychologically informed practice. And we look at that effect that it has on pain. This informs us on what we need to do next. The distressed inventories I'm going to link to them in the show. Notes are there are so many of them that I love and it helps so much to move the needle and to understand how it's informing what we need to do. I mean, humans are so multidimensional and pain is so much more of a human condition than it is a medical condition. So this means that we don't just treat tissues when there's so much more going on than just that bio piece. This is as simple as encouraging them to start moving in a novel way. Get that brain. Having novel experiences, which is so key in this. Taking the time to ask clients specifically around their story influences things like I don't know how they're having a bowel movement right now. This is hot and heavy on my mind. I didn't know I was going to bring up bowel movements in this topic, but or in this episode. But I'm updating my colorectal course right now. It's called O.T. Elevate the bio psychosocial approach to colorectal conditions. I go into pain science in this. I go into concepts around facilitator versus fixer. So I'm thinking about specifically how this relates to bowel movements right now. And so asking them about their stories, right? So their bowel movement history, maybe their birth experience, how they could be influencing their ability to contract or release their pelvic floor. Do they have shame around defecation? And I'm thinking about a client that I've had whose constipation actually stems from an experience that her grandmother had. So my client was easily 5 or 6 years old and her grandma was living with her. And right before dinner, her grandma was raised to the E.R. due to fecal impaction. Now, unfortunately, her grandmother ended up passing away a couple of days later, and it wasn't due to the fecal impaction. But my 5 or 6 year old client was unable to separate the incident. You know, she's now in her 50s. She was unable to separate the incident from those red flashing lights and that loud ambulance noise whisking her grandmother away and her grandma never came back. So this influenced her comfort and her perception of defecation and its safety. And she had this thought looping, which only came out by me asking these thoughtful questions that the same thing was going to happen to her. So many of our client stories may seem small in their memory, and they may not realize the impact that it has on their psychology today. So when we hold space for them as they process these experiences, it's not just that physical work that influences our client's abilities to fully eliminate or to do things that matter and pelvic health. So there are so many thought leaders in this area, and I encourage you to check out what they've got. Of course, I mentioned Laura mosley. There's David Butler. There's Neil Pearson. I'm going to link to some of their books in my shownotes. And so many resources that I have personally found to positively influence my understanding of pain science. They're all going to be in the show. My main message today is to encourage all of us OTs to be bold with our roots, to really step into what our framework is rooted in, which is the psychosocial approach, the bio psychosocial approach. This is absolutely what differentiates us as practitioners. We take this whole person approach and our clients, they intuitively feel it from the beginning. The intake process speaks, volumes are active, listening speaks volumes, and our task analysis speaks volumes. We know Pelvic health does not have a cookie cutter approach that focuses solely on tissues. It needs to be trauma informed, whole person informed. And what we innately as Oates know in the bio psychosocial framework. If you are interested in knowing more about my approach and this approach, get on my newsletter. I am going to be coming out in 2023 with a course that speaks directly to these topics. So get on my newsletter to be the first to find out when that course comes out. It's my honor to talk more and more about this with each and every single one of you. It is a topic near and dear to my heart. And let's keep the conversation going. 


Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their Pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast. 



People on this episode

Head Shot

Lindsey Vestal

Host