Breaking Free from Chronic Pain with Dr Clayton Dir Physical Therapist

Have you been told your pain will never get better? That surgery is your only option? That you just need to learn to live with it?

Dr. Clayton Durr, performance physical therapist who has worked with champion athletes across powerlifting, strongman, and CrossFit, joins the Gaslit Truth Podcast to challenge everything you've been told about chronic pain. Sharing eye-opening insights from his practice, Dr. Durr reveals how our own brains can create "anticipatory pain" even after tissues have healed—and how the medical system often fails to address this crucial disconnect.

Through powerful patient stories, Dr. Durr demonstrates how something as simple as validation and proper movement can eliminate pain that multiple doctors dismissed as permanent. He breaks down the problematic profit-driven algorithm most pain patients experience: doctor visit → X-ray → opioids → injections → surgery, noting that 50% of back surgeries show no improvement in outcomes. 

The conversation dives deep into dry needling, a game-changing technique often confused with acupuncture, that provides immediate relief by disrupting muscle spasms and giving patients a "therapeutic window" to begin proper healing. Dr. Durr explains why this approach, though highly effective, remains underutilized in a system that financially rewards surgeries and medications over lasting solutions.

Most importantly, this episode offers hope where the traditional medical system often fails to. As Dr. Durr emphasizes, "The pain may not be your fault, but it's your responsibility." By understanding how your body actually heals and finding providers who truly put patients first, you can break free from the narrative that your pain defines your future.

Ready to challenge what you've been told about your chronic pain? Listen now and discover why hope might be the most powerful pain management tool we have.

Chapters

• 0:42 Welcome to The Gaslit Truth Podcast
• 7:20 Understanding Chronic Pain Perceptions
• 13:24 Challenging Traditional Medical Approaches
• 24:23 Dry Needling vs Acupuncture Explained
• 35:06 Hope vs Degenerative Disease Narratives
• 44:14 Patient-First Healthcare Solutions

Transcript

Dr Teralyn Sell: 0:22

You have been gaslit into believing that you need meds, injections and surgery for your chronic pain. We are your whistleblowing shrinks, dr Tara Lynn and therapist Jen, and you are listening to the Gaslit Truth Podcast. Welcome aboard everyone. Today we have a special guest. I've been waiting a while for this one, actually.

Dr Teralyn Sell: 0:41

We've been trying to sort this one out for a few months now. So Dr Clayton Durr. Clayton Durr is a physical therapist, a doctor, a physical therapist. That's important to point out. He is a performance physical therapist who specializes in performance. He has worked with national and world champion athletes in powerlifting, strongman, crossfit and many other sports. That's really cool. He also has a focus in chronic pain and patients who have been dismissed by the medical system or gaslit and being told they are fine. He is the host of the podcast Heal Without Harm, where he discusses the pitfalls of the medical system and bringing on guests who are actively building a better system. Welcome to the show, dr Clayton.

Dr Clayton Dir: 1:28

Thank you so much, both of you, for having me. I've been following your content for quite some time and I'm catching myself watching being like hell. Yeah, yeah, I feel like we have similar paths, different genres maybe.

Dr Teralyn Sell: 1:40

For sure. I think there are so many different specialties that Jen and I are running into that are thinking very similarly now, so it's really cool when they kind of cross and meet together. So excited to have this conversation, particularly about chronic pain, because I don't think we've had that before, have we Jen? I don't think we've talked about chronic pain. No, it's a new one. Yes, it's a new one, and I know that a lot of our clients have a lot of chronic pain and they've been through the ringer in pain clinics and things like that. So I'm really stoked to listen to what you have to say about this, clayton.

Dr Clayton Dir: 2:19

For sure. No, and I'm excited to learn a little bit from y'all, because there's sometimes where patients will come in and I can tell that it's almost like a sensory processing disorder of some sort, or at least that's playing into it, where the tissue's doing fine but you're still feeling pain and I know I can help, but I know I'm not going to be like the root cause fixer and so trying to find someone to put them in front of, to finish that out or assist in that care is something that I'm still actively looking for.

Therapist Jennifer Schmitz: 2:46

That's intriguing.

Dr Clayton Dir: 2:47

That is really intriguing, yes, yeah.

Therapist Jennifer Schmitz: 2:50

So the tissues themselves heal and you can see that. And yet there is still this viewpoint that they take of pain and there is still a subjective statement that there's still pain levels there.

Dr Clayton Dir: 3:04

Have you guys learned about the homunculus of the brain? Does that sound familiar?

Therapist Jennifer Schmitz: 3:07

Does not, did you say, monkey?

Dr Clayton Dir: 3:09

Homunculus Very, very similar. There's a couple of shared letters in there. You don't have to validate.

Therapist Jennifer Schmitz: 3:15

Thank you, that's cute, oh, I like you, it's not quite genuine Idiot. Stop, it All right the.

Dr Clayton Dir: 3:21

All right. The brain has a map of the body, and if you just type in homunculus if you can figure out how to spell it into Google you'll see that different parts of the brain perceive sensation from different parts of the body. The hands and the feet take up a huge amount of surface area in the brain, because that's where we get most of our sensory from right. If I drew the letter four on your back with, like my fingernail, you may be able to recognize it, but if I drew it on your hand, you would know exactly what you're feeling.

Dr Clayton Dir: 3:45

And so the brain has its own perception of the body, and so sometimes it gets like this learned, almost like a learned behavior, Like if you touch my arm it's going to hurt, so please don't touch it, and then that tissue heals. But you still think if this arm gets touched it's going to hurt, and so we have to work through that. But sometimes I'm not the best person for that because I don't know how to navigate it or I don't have the same, maybe information you guys have in your brain or I don't know how to unfold it and have that conversation. But most of the time I just lean on exercise and weightlifting and be like, hey, we're just going to work through this and kind of through that process, you'll get more comfortable.

Therapist Jennifer Schmitz: 4:20

It reminds me a little bit of how traumatic memories are stored in trauma storage right, and how there may not be a threat and there is nothing there, like in front of you, and yet we still perceive there to be, that, there for us.

Dr Teralyn Sell: 4:35

Wait, I have a lived experience, a recent one, because my front tooth cap just came out right and so I had to go to I know right. Anyway, I had to, had to go to the dentist and she was working on it and it was so sensitive and she kept saying this is weird, because most people don't have this level of sensitivity whatever. And I'm thinking well, I do, but the thing is is that she would get close to it and it felt like a jolt of lightning was, and she was like I barely even touched your tooth. It was like this anticipatory, like you know, and I felt it, like I felt that pain where it really wasn't even there. It was like this and I kept saying to myself this is anticipatory pain, this is anticipatory pain Like don't do it, don't do it. So I feel like this is like a similar concept in real world, like you kind of anticipate that pain happening.

Therapist Jennifer Schmitz: 5:28

It's along the same line Well, you got to get your monkey checked. Then, terry, Get your monkey checked. This is seriously.

Dr Clayton Dir: 5:32

It's along the same lines on why amputees still have like phantom pain, because the brain still has the map of that limb, even though it's not there.

Therapist Jennifer Schmitz: 5:40

Okay, phantom limb pain. I know that. I remember that from Psych 101.

Dr Teralyn Sell: 6:00

Okay, phansom, limb pain I know that, I remember that from Psych 101 physical pain when you have physical pain heightened, you will have more emotional pain. When you have emotional pain heightened, you will have more physical pain. It's like this feedback loop system and I feel like some of that was anticipatory pain or historic pain that you expect to happen again, or the belief that it will never be gone so you have to live with it forever. So you know the head is connected to the body. Essentially is the moral of that?

Dr Clayton Dir: 6:31

Well, then you tell that patient like, oh, by the way, this tissue is fine, I don't know why you're still in pain. And then that's the end of the conversation. And then it's like, well, what am I supposed to do with this? And so I think even there was one gentleman actually who came in. This was within my first six months of getting out of school, uh, when I felt like I still had no idea what I was doing. He came in with shoulder pain and the story. I saw him in January but he started having pain in, I think, october. He got the flu shot and he's not saying that's what caused the pain, but that's when he started noticing it. At least it created some soreness. Never really went away. He got that, I believe, in October.

Dr Clayton Dir: 7:05

November came around about Thanksgiving. He went to a doctor. The doctor said oh, I think you. He went to two doctors, I don't remember which order he got the diagnosis in, but one of them said I think you tore something a little bit, but otherwise you'll be fine, it'll heal, kind of thing, somewhat like. Sent him off, went a couple of weeks, pain was still there, slash getting worse. Went to another doctor and they just said oh, you have tendonitis and kind of like, dismissed him again, not necessarily rudely, but like, sent him on, was like, oh, you'll be okay. It was christmas eve. His dad passed away and he remembers that between christmas eve and like new year's day he was moving a ton of stuff out of his dad's house and somebody goes isn't your shoulder hurting? Like you're moving these boxes without issue. He's like oh my gosh, I totally forgot that I was having shoulder pain. And within a day, like it was like 10 times worse than it was.

Dr Clayton Dir: 7:50

He came into my office. He was a classic, like blue collar type dude. He he lives on like a small farm. He's got, you know, the side beside, side by side uh, almost monster truck, golf cart looking things like. The dude is like very physically active. He was also a welder. Well, I saw him for 30 minutes, by the way, which is normally an hour eval. This is like very physically active. He was also a welder. Well, I saw him for 30 minutes, by the way, which is normally an hour eval. This is like a half hour free consult to see if we're a good fit.

Dr Clayton Dir: 8:10

And he was telling me the story and he's like yeah, I'm a welder and sometimes I'll have to be in really weird positions, like they'll be on the ladder, leaned over here, arm you know, finagled through this like small hole to weld a. He said I just don't know if I'm going to be able to keep doing my job. It hurts so bad to go to work. And I kept asking questions and then I think the thing that really rested on his heart was he had a four-year-old son. He's like I want to be his baseball coach. I want to take him through, you know, like baseball.

Dr Clayton Dir: 8:41

He's like, and I'm afraid that won't happen now. He's like my shoulder hurts. Know what's hurting you? Because you're passing all my tests Range of motion is good, strength is good, mobility is good. Me palpating on your tissues is good. Like I don't know what's going on right now, but come back later this week, let's do a full eval and let's start treating the shoulder.

Dr Clayton Dir: 8:56

Three days later he came in zero pain, like he had no pain left at all, and I said, okay, let's try to hurt you.

Dr Clayton Dir: 9:01

Essentially I was like let's like, do this strength test and like push it hard, let's play catch with a ball, but let's make it a four pound ball.

Dr Clayton Dir: 9:07

Like let's push these things to the limits. Never saw him again after that, never had pain again and I was like what the heck was this Like? Like physically did not touch him, had a conversation with him, essentially like validated what he was feeling, saying like I know they say this, but all my tests are showing this, let's go push your tissues to the limit and see what happens. And that unlocked like you were talking about the emotional side of things and the perspective or perception of pain, anticipation of pain, and then also getting like incorrectly validated, potentially from other doctors, like when you have a, an image that shows a tear, you're like, oh shit, like what do I do now? Like what am I losing now? Am I going to lose my job? Am I going to lose my ability to play with my kids? And then that like catastrophizes and goes from there, and so that was a really cool turning point. Thankfully, within my first year of practice, that really opened my eyes.

Therapist Jennifer Schmitz: 9:59

So okay. So does this lead, as we jump right into this then, does this lead into the the statement that you had made to us that surgery should never, most of the time, be the first option?

Dr Clayton Dir: 10:11

unless it's like if we don't do this in the next hour, you're going to lose the ability to walk, type of stuff, or like dramatic, you know, car accidents and stuff. Yes, the people who, like they don't really remember when their shoulder pain came on, or like the knee just started bothering them they started running six months ago and about three months in my, my knee started bothering me a little bit those are the people that end up oftentimes showing up in an ortho office and getting a surgery. Or they have back pain and you know, they end up getting a surgery. Those are the people that I'm I'm speaking to now. Where surgery is.

Dr Clayton Dir: 10:41

Often it's this classic algorithm right, I go to the doctor. They take an x-ray. They don't find anything. They prescribe opioids and muscle relaxers. That doesn't work. They say, okay, let's get you signed up for an injection. They get the injection. I would say it seems like 10 to 15% of the people that come into my office so a biased sample but that come into my office and get an injection. They report wow, this hurts so bad. I felt tingles down my leg. Like this made everything worse, like those are the reports that I get more often than rare, probably just more in the uncommon category. But if that doesn't work, then they say all right, let's sign you up for an ortho consult. And I think the ortho consult should be like let's investigate this and see what's going on from an orthopedic standpoint. Unfortunately, it's more of. Here's what your MRI shows. When do you want to have surgery?

Dr Teralyn Sell: 11:32

And it's almost like no in between. No, they go straight to surgery.

Dr Clayton Dir: 11:33

It's like you're consulting for surgery at that point, Exactly. So a lot of times PT is not recommended. I think it's becoming more recommended, thankfully, kind of, because insurance is actually somewhat requiring it. However, the way it is sold is the doctor goes. I mean you can try PT for six weeks, or you need to try it first, but then go ahead and sign up and it's just like cool.

Therapist Jennifer Schmitz: 11:53

Thanks, bro, Well and you know, I just went through this with my knee, and it was one of those things where I woke up and there it is Like I don't have some great awesome thing. That happened where I was like crossfitting and blew my left knee out when I was, you know, doing some. That was none of that good shit, right? So what's interesting, too, is there's this insurance, and you talk a lot about insurance too, so we dive right into this why insurance does not have your back in this case. Right, you shared this with us, right, like, you can tell us more about why you say that? But even when it comes to PT, there's limitations on it. Here is the parameters of how long you get PT, and then that's it. And so I often question that, too, where you get your six sessions of PT and you're done, and then patients are done. You're just, you're done.

Dr Clayton Dir: 12:42

Yeah, and a lot of times they're no better, um, or they're just a little better, right, right. And what's frustrating here's my thought that like goes into the conspiracy type of thing.

Dr Teralyn Sell: 12:52

But not even conspiracy, but it's like realistic at the same time.

Therapist Jennifer Schmitz: 12:55

This is very real.

Dr Clayton Dir: 12:56

It is. Who makes money from the insurance or from, like big pharma, who makes money off of PT? Like nobody, like not the physical therapist, that's right, of course no. In the nin like nobody like, not the physical therapist, that's of course no. In the 90s they made more money. In the 1990s, a bachelor's degree in physical therapy got you more money per patient than in 2025, where I had to do a seven-year degree and drop over 100k yes so because, because physical therapists now the majority of them are required to have a correct yeah, well, I had the bachelor's and were grandfathered in, or the master's Right.

Dr Teralyn Sell: 13:27

So that's kind of a newer-ish. I mean I'm old, but that's kind of newer and I would say I was even below normal, like most people.

Dr Clayton Dir: 13:33

I think the average there was I can't remember the website, but there was a website that helped PTs pay off debt. But they helped everybody, but primarily 150 to 170 in order of hundreds of thousands of dollars of debt for PT. And then we come out and we make 60 to 80. Like my brother graduated from engineering school at four years and they're making 80 K two years out of school and I'm like right.

Dr Clayton Dir: 13:58

I wish I would just be okay with sitting at a desk all day. That'd be nice. Not to dismiss them or discredit them, but like that's, that's a way better.

Dr Teralyn Sell: 14:12

We understand, we, uh, yes, we totally understand that. So I want to circle back to the statement that you said. Sometimes it's it's the way that it's sold. Um, that the intervention, the way that the intervention is sold is, is very important, and I think about this as you're talking. I was like, yeah, PT is kind of like mental health, kind of like the red haired stepchild of the medical model, if you will Like, because we're often the last sold to for, especially for pain patients. Well, you could go see a therapist what do you think? It's all in my head. And then suddenly that that patient doesn't want to see a therapist. They don't want that and they're resisting pretty much everything because they've been sold this idea and also the way other interventions are presented to them as being, well, you could try it, but right, Kind of like physical therapy.

Dr Clayton Dir: 15:03

Yeah, honestly, I, uh, I I'm a huge analogy and metaphor type person. Um, it's the way my brain works and I think it's the best way I can relate to people. And I was just listening to Simon Sinek, uh, a couple of days ago, and I love the way he talks on a lot of stuff, and there was things that he was saying that resonated a lot with me, and he talked about how, in 2020, everything got blown up. His business life was going down. He's like yet I had the best time of my life.

Dr Clayton Dir: 15:29

He's like the amount of problems that I had to solve and the challenges that were faced in front of me. Although it was a lot of negative, it was enjoyable and I liked the flow state that I was in and all that. And I think that's how it is for me. When it's like the more problems that show up from a high perspective on you know our type of conversations, trying to change public, uh perception and stuff like that or even just when someone comes in and I've had somebody sit in front of me and say how many times do I have to come here before I get my mri?

Dr Teralyn Sell: 15:55

oh yes, what do you think that's gonna?

Dr Clayton Dir: 15:57

give you, you know, and what I enjoy about that, though, is like okay, cool, the difficulty level in today's case is expert mode. This person thinks you are worthless and this is not going to be helpful at all, and I'm like, just sit back and like I'm going to sell you on this Now. Some people are just not going to be sold, but I enjoy that challenge now, where it used to intimidate the absolute hell out of me, where I will use their own reasoning to like, get them to be back on my side. Like, what do you think the MRI is going to give you? Well, it's going to tell me what tissue is wrong. Okay, so do you believe that tissue is the reason you're in pain? Well, sure that you know. It says my supraspinatus is slightly torn. Okay, let's test it.

Dr Clayton Dir: 16:31

I've got three tests to test and see if that tendon is problematic or weak or painful, and then we'll go from there tell you right now, because you can lift your arm. No, I don't think it's completely ruptured, and so you're going to get way better outcomes by going through PT and letting it heal. Do you want to be in a you know, in a sling for the next eight weeks? No, can you do your job like that? No, okay, cool, so stick with me, let's save you time. Money's get to this, you know. And then we go one step further, and in that session I will have a test that hurts, or tests they can't do right, a range of motion test, a strength test, something like that and then I will find the tissue that I think is wrong and I will dry needle it. Are you guys familiar at all with dry needling?

Dr Teralyn Sell: 17:16

So I've never had dry needling. I've heard of it. If you want to explain that a little bit, I think that would be an appropriate thing to do, for sure.

Dr Clayton Dir: 17:23

I'll circle back to it right after I finish this kind of like little storyline. So I will dry needle that muscle and let's say it was eight out of 10 pain once they got to like 90 degrees of lifting their arm. So they get up and they're pointing to the side and that hurts eight out of 10 pain. We dry needle the muscles that I found to be problem and we retest and you see their face go up to 90 degrees in that anticipatory pain that you're talking about. And then you see this like oh shit, and they're like who are you? I'm a magician. And they get like 160 degrees, like almost up to their ear, and they're like this hurts like three out of 10. Like what did you do? And it's like, oh, I got that muscle to essentially like calm down, I changed your pain perception and then it got you to move it. I you still get surgery now significantly with with that. So let's get after this, you know. And then there, and so that's what I've really with initial eval.

Dr Clayton Dir: 18:22

So, going back to the dry needling, I love how many great inventions or findings or complete accidents. And so they actually found dry needling by, they were doing a study and they're doing trigger point injections. So injections on trigger points are like knots in the muscle and they of course do like I don't know, double blind or whatever. Some people get injected, some don't. Well, the people that got injected sorry, the people that got a needle but no injection got better.

Dr Clayton Dir: 18:49

Because when you put a needle into a muscle that is in a trigger point or in spasm, if we want to think of it this way, like, imagine like 10 of these muscle fibers are stuck in cramping. They're just turned on, they can't turn off. That's where a lot of your pain is coming from and your dysfunction. And then we have to figure out why. But that dysfunction is stuck. If you just poke it with a needle, it disrupts that spasm.

Dr Clayton Dir: 19:10

Usually it is temporary. You'll get two to five days relief from the first session of dry needling. But when I put that needle in there you'll get this twitch and cramp, like sensation, and then it'll relax and you get what we call a therapeutic window, generally in the first sessions, of about two to five days of less pain with movement, less pain when using that muscle, stretching it, strengthening it, whatever it may be, and that's what I tell them. I said I can dry needle you every week, give you no other instructions and I'll practically be a chiropractor who pops your back. You just keep coming back. I'll keep you know, but if you want to solve this thing long term, take advantage of the time that I just gave you and go do the exercises I recommend to actually solve the problem in this muscle and make it not go back into spasm. That's how you stop seeing me.

Dr Teralyn Sell: 20:58

That's in your life again without pain, and so it gives them the power. But I'm helping them shortcut. I'm just enamored by this because I keep rolling through my brain on how many people dismiss PT. And by the way, I've dismissed PT. I have.

Dr Clayton Dir: 21:09

Honestly, to give you some credit, I dismiss a lot of PTs when I'm the third one they saw and they're like why is this so much different? And I'm like what exercises were you doing? And they hand me a 1980s print off. That's been 17 times. And it's like stretch your calves, stretch your quads, stretch your hamstrings, stretch your hips, do the pigeon stretch? And I'm like, yeah, none of those are going to help you. And they're like they don't. And I'm like how long does it take you? 28 minutes, like I would quit too. And so.

Dr Clayton Dir: 21:35

I'm trying to decide is it the? Orthos and surgeons giving us a bad name, or is it other physical therapists? And a lot of the times I would say some, not a lot of times, but it seems like half the time it's PTs and corporate medicine, whether they want to be there or not, where they have to see two or three people an hour, and so then they just default to like, well, let me just show up, hand the piece of paper, tell them, yeah, it's probably that tissue, and then not actually solve problems.

Therapist Jennifer Schmitz: 21:59

So it's not individualized is what you're saying.

Dr Clayton Dir: 22:04

Most people it's not no. So our clinic is cash-based. We're out of network and we see five to eight people a day per provider and my boss was the sixth person to join a mastermind and PTs like us, pts that run clinics like this. There's now over 200 people in that mastermind and they have a course where they walk people through a three month process on how to start a clinic like this and run it. They've now helped over a thousand clinics throughout the nation. So it's coming like things are happening right and so PTs are getting out of that like mill ran PT. It's coming around and so then it's like on TikTok.

Dr Clayton Dir: 22:42

One of the best ways I've found to help people is show them what I do. Kind of like you guys talk about what you do and then they're like hey, can you help me? I'm like I'm in Wichita, where are you? Boston? Cool, can't help you. And I actually went to this facebook group of 6 000 providers and I said can you guys please fill in this excel spreadsheet for me? And so I will go on there, find somebody in boston. I will kind of like verify their website and you can usually tell the difference between corporate medicine and like one of these guys and I'll say, hey, check out, you know, move better pt on north fourth avenue, whatever, and they'll be like great. And then month later you know'll see in that Facebook group, whoever sent me somebody in Boston, they said they saw somebody on TikTok. Thanks for the referral. That's been my attempt to try to get people to more PT and validating that like, yeah, I would have quit the PT that you tried the last three times as well.

Therapist Jennifer Schmitz: 23:31

Which would be the more traditional. As you say it right, the way that traditional PT can fail patients. This is kind of what you're talking about.

Dr Clayton Dir: 23:38

Exactly, yeah, they're not helping people, but it's because insurance still pays for it. Insurance still reimburses. If I put an ice pack on somebody's back, they'll give me $12.

Therapist Jennifer Schmitz: 23:50

Who shouldn't do this? Who can't do dried needling.

Dr Clayton Dir: 23:55

What kinds of patients?

Therapist Jennifer Schmitz: 23:55

can't do that, like who can't do dried needling. Oh, good question.

Dr Clayton Dir: 23:57

Can't do that. Yeah, there's not many contraindications. Pregnancy if you're going to be doing any sort of dry needling around the area, like if you're dry needling their calf and stuff, you should be fine. I would say that we still join the whole like don't do anything to this lady in the first trimester, cause you never know what could happen. But I've, I just straight up don't dry needle anybody who's pregnant. And plus we've got now a pelvic floor specialist who takes on those gals. If these people have a suppressed immune system, autoimmune disorders, things like that, we're going to be very cautious, potentially just not do it at all. Needlephobic they're scared of needles. I've got one gal actually coming in today that she still won't let me dry needle her.

Dr Teralyn Sell: 24:39

I'm like I promise you it will make your hip better, but we don't like.

Dr Clayton Dir: 24:41

I'm like gradual, informed nudging, uh type, but I don't want to make your ptst worse at the same. Yeah, exactly. And then, um, if there's active infection in the area, if they're on like blood thinners, will be a little bit more cautious. I mean honestly, like from a medical perspective, just like anything, any normal contraindication of poking a needle into their body are going to be the usual contraindications ultimately. But you can do some crazy stuff like I've we've dry needled, like the orbicularis oculi, like the muscles around the eye, for like oral or not oral, uh, ocular migraines and stuff.

Dr Clayton Dir: 25:08

I've done temporalis before. Um, I've not done this. But you can do tmj, uh, like your masseter and then your pterygoids up under the jaw for those types of things, so people who grind their teeth or have like popping and clicking when they open their jaw, stuff like that. You can do the abdominal muscles. I'm not certified to do it because it takes a lot of training, because you know your abs are pretty thin and then there's, like I don't know, all these special organs underneath, so you have to get certified in that. But you can drain pretty much any muscle.

Therapist Jennifer Schmitz: 25:35

Okay, and even for individuals who have had, like, major surgeries and there are, like there's been structural damage, that's been done. You know, you've had your hip replaced or your knee, your knee redone, or back surgery back surgery you slipped a disc and you know your L4 is is jacked up and 20 years ago you had to have that fixed.

Dr Clayton Dir: 25:54

Okay, I would say too, this is where it kind of goes back to the whole like um, parallel with like mental uh mental approaches and like PTSD and traumatic events. So needling the way I usually talk about it and teach it is more trigger point style dry needling, so this muscles and spasm, poke it, make it go out of spasm. There's many different approaches though, too, where if you poke a needle into an area, the body's going to see that as injury and start the inflammatory process, which is appropriate, right, yep. And so some people you just need to poke the area, like lateral elbow pain, um, sometimes some protocols say just put like five or seven needles in there, let them sit for a couple minutes and then pull them all out, um, and then it's going to like start this process, that your body's going to go heal it up, um. Then there's also dry needling that they think more into the fascial system, and so if you just type in like dry needling scar on any social media, you'll see someone with like a knee scar on the front of their knee, and this will always have to be once it's closed up, and the general protocol is 12 weeks post surgery. But they'll put the needles in and they'll wind them is what they call it. They'll twist it and it's kind of like pulling or like up some of that tissue to help that scar lay down even better and desensitize it and help the scar become nice and smooth instead of like super keloid and things like that.

Dr Clayton Dir: 27:03

Now, that's one that I don't do that much because I don't see those people in general. And then I've never really like put it into practice. I was taught but I never put it into practice so I don't have the reps for it. And then the last kind of option is homeostatic points. This is where it goes a little bit more voodoo-y kind of sounding, but anywhere there's a branch of nerves and so like your sciatic nerve goes down the back of your leg and behind the knee it splits, it goes into your tibial and fibular nerve we would call that area kind of like a little plexus, right where it branches out. And there's points there where if you put the needle somewhat close to it, you just push it in and then leave it. It'll desensitize the person's nervous system and kind of bring it down, just so that they're a little bit less fight or flight in the area, a little bit less protective so you can most of the time calm down the pain perception from there down or in that area.

Dr Teralyn Sell: 27:50

I wonder what the intersection is between PT and mental health. Like I sit and I think, like how can mental health professionals partner with PT? Because I know that there's. There can be like oh, go to a chiropractor. Like that's like the only you know thing that people talk about. But I've been thinking about this for quite a while, even before you came on the show, like what is the partnership between mental health care and PT?

Dr Clayton Dir: 28:19

Um, I think it would be crucial. Um, I think the hard part for me and putting it into practice is y'all are overran. Like if I want to get an appointment with y'all, it's like cool, I'll see you in nine months. At least that's the perspective. Um, that's what's hard is like you don't have like your people. It feels like don't have time to like set aside and like come talk to me Just because there's so many people asking for the services that you offer.

Dr Clayton Dir: 28:43

I've had a hard time communicating that way. And then the second thing is even if I do have you sold and you're like yeah, you need to go see Clayton for your knee pain and I think this will help break through some of the stuff you've got going on psychologically, uh, that's asking that patient to spend more time and money, and so then when you actually get to implementing it, the barrier seems like gosh, I just gotta go to all this therapy and out of the money to do all this. Uh, is is my other perception there. So I fully agree with you on paper. Right, it's very what's it called when you have a bunch of providers together, like working together?

Dr Clayton Dir: 29:13

uh team um kind of like that there's like no I don't know. It's more of a hospital type termed thing where it's like uh, multi-disciplinary act, that's interdisciplinary interdisciplinary team.

Dr Clayton Dir: 29:26

You're getting all the different perspectives where, like I told you, my patients sometimes that I can tell there's there's a little bit of emotionalness wrapped up into this. Um, I can help you the best I can. But there's somebody like y'all who probably have this very strategic approach and you're like, oh, we'll knock this out, we're going to do step one, step two, step three, and I'm over here like I'll give you a hug and tell you, like gosh, you know.

Dr Teralyn Sell: 29:48

Which helps. Calm down, calm down. You want a hug? Okay, calm down, calm down. You want a hug?

Therapist Jennifer Schmitz: 30:01

So can you do a quick? Uh, can you do a?

Dr Clayton Dir: 30:02

quick PBS special on the difference between dry needling and acupuncture. Yeah, for sure. Uh, the only thing that's similar is the needle. Uh, we buy the same needles and that's it. Um, when it comes to acupuncture, uh, I'll give you my understanding of it, but I don't have an education in it necessarily. To my my understanding, most of the time acupuncture only goes into the dermis, which is like the same level of skin that, like tattoos, go to right, Like you're puncturing the skin, getting a little bit in and you're leaving it. They're going to follow more of the Chinese or Eastern medicine approach, where they're looking at the flow of energy, the flow of chi. They're going to look at your meridians and they may be poking your ear to solve, like, your left hip problem. And it's been around for a long time and a lot of people will swear by it. So I'm sure there's some stuff to it. I just don't know what those studies look like. That's acupuncture, Dry needling again.

Dr Clayton Dir: 30:46

If I kind of keep in the window of that trigger point method and treating that way, we are putting the needle all the way into the muscle and we're trying to find the dysfunctional tissue. Ultimately, I don't put all of my like stock in is this tender to touch? I don't put it all in the stock of is this muscle dysfunctional? Like when you try to use it? I use three or four different things to kind of like cluster together. So, for example, if we use that rotator cuff uh, the super spinatus one, someone who comes in with shoulder pain, they can't lift overhead anything over like 90 degrees of arm lifting hurts If they put their elbow at the side and they try to like open up their arm, which is called external rotation. If that hurts, that's starting to tell me like okay, rotator cuff's probably involved. And then I go palpate those tissues and I say, is this tender, Is this tender? And they're like, yeah, you're pushing really hard. And then I like push their, their shoulder and they're like, oh, wow, that's way different. You know, the right one makes me want to punch you.

Dr Clayton Dir: 31:36

The one that's not hurt feels fine, and so, and usually I can feel like a tender top band of tissue. So you're rubbing over this muscle and there's like wow, did you install a metal cable into this thing? Like that's where we need to go. And so that's when I'll take the needle and I'll tap it in and I'll usually do what's called pistoning, which is where we kind of go in and out in different directions. We're trying to treat a large surface area without actually pulling the needle back out of the skin. Usually what I'll feel is I will see and or feel that muscle twitch and it's super cool. And if you just type in like dry kneeling twitch, you'll see it on social media Super satisfying and you will actually have the patient say wow, that's recreating my pain, Like I know you're poking me in the back of the shoulder blade, but I feel it in the front of my shoulder. I'm like cool, we're on the right path, this is what we're looking for. And you go, you take it out and you retest.

Therapist Jennifer Schmitz: 32:25

Usually, the whole process takes five minutes or less. I'm just. It's so hard to not personalize everything that you're saying right now, whether it's for myself and shit that I need to explore or for people that I love. When you came on before we started, I was telling you that I was just in a pain clinic with somebody very close to me, and that person has had a couple of major surgeries two on a knee and then one with a slipped disc. That happened many, many, many years ago. So there's this chronic back pain that exists as well, and I went with them because they wanted a holistic perspective on pain management.

Dr Clayton Dir: 33:04

They also do that a lot of the times with them.

Dr Teralyn Sell: 33:05

Yes, an advocate.

Therapist Jennifer Schmitz: 33:07

Yeah, and so it was, that's all. I was right. And so I went along and of course, I had a visceral reaction going into the pain clinic because of all the damage that has happened in my traumas from just white coats in my life, which that's a new thing for me Side story on that, anyways. And I'm sitting there and listening and the individual said to this person that I love so much, this is chronic, it will never heal, it will never get better. And sat there listening and I'm like, yes, I know there are structural injuries that exist here. We've had two surgeries on knee in the last year and a half. We had a major back surgery many, many, many years ago, 20 years ago. Right, that exists there. You've been managed on opiates for over 20 years. That's the treatment intervention. Right, is the opiates. And I'm sitting here listening to this what.

Dr Clayton Dir: 34:04

So which is a great maker.

Therapist Jennifer Schmitz: 34:06

Right.

Therapist Jennifer Schmitz: 34:07

Oh, I'm sitting here like I kept telling this person so much that I love I'd be so careful not to say who it is right Because he'd be so pissed at me. I'm like revolving door, revolving door, forever consumer, forever consumer, right. I'm sitting here like saying all these things and I'm just listening and that the verbiage that's given is this will forever be, this is degenerative, this will not get better. We can do all these interventions that are going to kind of make it a little bit, you know like make your pain a little less, yeah, um, but this is for your forever sentence, death sentence. And I'm just sitting here and I'm like fuck this.

Therapist Jennifer Schmitz: 34:39

Like from from what perspective? Oh, from from what perspective? Oh, I know from what perspective. This comes from a very narrow minded, money-making Western medicine perspective. Would you say that to somebody and I'm listening to you here, talk about these options, which dry needling was not an option, given the holistic options. There were some given, so I was like, okay, that's great, and one of them was acupuncture. But that statement to patients this won't get better, it's degenerative, you will have this forever.

Dr Teralyn Sell: 35:07

Well, I want to say, hope is also an option. It's just on right.

Therapist Jennifer Schmitz: 35:11

And it just turned me off so much, and so I don't know what your thoughts are on that. But there's this verbiage that we say and that's pain clinic. This is a pain clinic, doc.

Dr Clayton Dir: 35:19

Right, right well, I mean, like you don't go to mcdonald's expecting to get sushi right, like what else did? You expect from a place like that.

Dr Clayton Dir: 35:27

I'm not saying that to you but like no, you're right, you're right, keep going with the analogy you're on and I think that's why it's important that I just shared a post yesterday I don't even know who it's from. It said we need more doctors on social media, and it talks about because there's not only bad information on socials, but when you actually go into the medical world, that's what you get like every single time, like you can. Where are you? Where you guys located at like? Where was this experience? At what state?

Therapist Jennifer Schmitz: 35:52

I'm in wisconsin.

Dr Clayton Dir: 35:53

It was here in wisconsin yeah, I'm in kansas and we have the exact same thing. Like you know what I mean. It's. It's so predictable, um, and exactly what you're going to get, and so, and what else kills me too, when you talk about hope and stuff. I just shared a post and it got a little bit more traction than I had anticipated. Nothing, bonkers. But I said like here's the advice I would give as five years in practice, if I wasn't afraid of hurting your feelings. And then the caption said the pain may not be your fault, but it's your responsibility and you're the only one that can change it. Responsibility, and you're the only one that can change it.

Therapist Jennifer Schmitz: 36:21

And change requires change. Yes.

Dr Clayton Dir: 36:22

Yeah, the medical system does such a good job of saying it's not your fault, poor you. You're stuck like this, it's just going to happen. And it's like no, no, like come into my clinic, let me look at things and let me assess you and then let me show you what you can do. Like one of my favorite things to do is, as you make someone's pain, go down, walk out into the gym and say, have you ever deadlifted before? And they're like no, doesn't that hurt your back? I'm like well, let's see what happens.

Dr Clayton Dir: 36:46

And I hand them a kettlebell and say you got a deadlifting 400 pounds. And I say pick this up and set it down. They pick it up and they'll have 50% good form. Let's say they set it down and I say how much weight do you think that is 20, 30 pounds, that was 70 pounds. What Are you serious? It's like yes, you can deadlift 70 pounds, you did it relatively easy and did you have pain? And if the answer is no, I'm like cool, we're going to do this more to strengthen these muscles.

Dr Clayton Dir: 37:11

If the answer is yes, then I start critiquing their form. And it's also crazy how much tilt type of thing. And they're like well, that doesn't hurt and that felt a little bit easier. It's like do you see how changeable this is? And then I then, unfortunately, then it's like okay, now I have to untie all the shit essentially that this pain doctor just told this person and people don't understand the weight of that person's opinion, that person's statement right, when you have a license on the wall and 90 patients in the waiting room, they think you know what you're talking about. And I mean, it's not wrong, they know their stuff. But it creates such limiting beliefs in the patient and that's what pisses me off and that's what makes me so frustrated, because it's all of that that I have to go and work and like continuously tell them like no, like please disregard what they say. Like show me your MRI, you know. Like, show me your x-ray and let me talk you through what this actually means. Cause, degenerative disc disease.

Dr Clayton Dir: 38:07

Oh man, so you're saying this is just going to keep breaking down? And then they picture it. Then they catastrophize it. Pain gets worse. They say, oh my gosh, I, I, I shouldn't move this. And then there you go into the spiral no-transcript.

Dr Teralyn Sell: 38:50

The lack of hope in, in that idea that you can't do something is profound and it eats up the problem. Yes, it does. Yes it does, because the the lack of doing something means her muscles aren't moving and they're they're. Basically, you know the muscles are going down and decreasing and you know. So now she can't do certain things that she should have been able to do before and so, but that's because the doctors are telling her you can't. So if you just blindly listen.

Dr Teralyn Sell: 39:23

Conversely, there's this woman that I saw on TikTok I think it was a while ago and she had and I know this isn't back, but she had a hip replacement and she was doing yoga, like a lot of yoga, and I showed this to my mom because my mom's had knees and hips and all these things. She's like the bionic woman, that's what my kid calls her. But anyway, I said look, I said I know that you're not going to be like this woman, but she's had a lot of things happen to her too and had a lot of surgeries, and she still does things. But of course, looking at that model is like I could never do that and I'm like I, I understand, but you can do something right and instead of nothing and I do find this a lot in the elderly population is that once they have a surgery, they become sedentary because they're afraid of, you know, wrecking it, wrecking the surgery or whatever, because they've been given the fear from the surgeon or from whoever, that you can't get better or you're going to hurt yourself worse.

Dr Clayton Dir: 40:29

Yes, and that's where the hope and the messaging that we have needs to change, yeah, the narrative that we give as providers or that the providers as a whole.

Dr Teralyn Sell: 40:40

Yeah, because Jen and I talk about this all the time, regaining a sense of your personal agency, of like change. You are the change agent. Nobody is going to change this for you. And what message are you going to start believing about yourself before you decide to engage in that change? Are you going to believe this is hopeless? Are you going to believe that you can do something? And what?

Dr Clayton Dir: 40:59

what kills me with, like, the two stories that you can do something, and what kills me with the two stories that you guys just told was about your parents, right?

Dr Teralyn Sell: 41:05

No, jen, it was not Jen's. No, we can't out that Huh.

Therapist Jennifer Schmitz: 41:12

Okay. He already knows.

Dr Clayton Dir: 41:15

Older individuals in our life there you go, I had a four-year-old lady in here yesterday who trains with a personal trainer three times a week, does water aerobics two to five times a week, does Pilates a couple of times. And I also treat her and I was said first of all I said good job, by the way, because most people your age they just kind of quit and you made sure not to stop moving. I said that's the reason you're still here. This girl can still palm the floor Like she moves really well.

Dr Clayton Dir: 41:40

But her and I kind of went on this tangent and I said what pisses me off so much is people your age, I think, are preyed on significantly. Because when an 84-year-old lady comes in and they say they have knee pain, you are someone who probably has a decent amount of money just because you either have retirements or you have like social security, you have something where you've built up funds over your life, so you probably have money. You expect to be unhealthy because you're 84, like yeah, it's probably wearing down, I probably am not healthy, whatever. And you're very, very unfortunately like you just believe whatever the doctor says and to none of this is like that person's fault. But when you start to see like this pool of people that you're like, oh yeah, we could probably get money on this person pretty easy.

Dr Clayton Dir: 42:21

And you say like, okay, your knee is wearing down, you probably just need a total knee. They say okay, and it's like that's a multiple thousands, if not tens of thousands, of dollars surgery. And the best part, if you look at it just from the surgeon perspective, doesn't matter how long it lasts. This person may die in two years, completely unrelated, because you don't have to worry about longevity. And then when they get, you know when they come out of it they may have some pain. So now they're going to buy this, and now they're going to buy this. And if you know anything about sales, the best way to make money is upselling right like we bought this product. What if we just tack this on?

Dr Clayton Dir: 42:49

yeah and next thing, you know, they're two years in and they've started, you know, three different pharmaceutical medications. They're still in pt, they're still doing this and it's just like all right, here's the beginning of the end. And it just pisses me off because when people are in pain and they go to an ortho, they're like, okay, we can make the pain go with surgery. And it's like 50% of back surgeries aren't any better at all.

Dr Teralyn Sell: 43:10

No, and then you find yourself in another back surgery Exactly After that. I find that if you have one back surgery, you're going to have three more Probably the next one within two years. Yeah.

Dr Clayton Dir: 43:20

And it's like cool, this didn't work. What if we do it? What if we do it again? What if we do more of it?

Therapist Jennifer Schmitz: 43:24

Okay, so all right. So, as as we, as we get near the end here, I want to wrap this into something you wrote for us before the show. You, you said you, we need to get better healthcare and that it's growing. But as a patient, you need to be put first. As the clients, you need to find a provider that's going to put you first. Is this part of the thing that people should be assessing? When you say put you first, how does a patient know if they're being put first? Oh, good question. How do they know that?

Dr Clayton Dir: 43:56

One. I think it's whether or not the provider's actually listening. I'm pretty sure I don't remember the stat, but I think it's like 17 seconds before the average primary care provider interrupts them. The average time spent with a patient in primary care is 2.7 minutes, and so, even if that person has a heart of gold, the provider like.

Dr Clayton Dir: 44:15

When you're in a system like that, it's very hard to stay positive. I mean, there's a reason that our clinic built a system differently. I would say that when clients come in, they fill out their paperwork. I usually write up the questions that I'll have based on their paperwork, and then I got this from a continuing ed course. They call them asterisk signs, so signs that, like the person says, I can't do this because of my pain, I can't get in and out of the car, put on my jacket, throw a ball with my kid. They have something and it's like cool.

Dr Clayton Dir: 44:46

Every time you come in, I will ask about this, because it doesn't matter what I say or what I think is getting better. If you can't feel tangible change throughout this process, then I'm not doing my job. If you're not getting closer to the goals you walked in with and are asking about, then I'm not putting you first right? And the thing is is too many times I've seen people who go to the ortho they say look, here's your knee, let's go and do surgery. It's like did we even talk about this? Are there other options? Like, does my opinion matter? What if I don't want to do surgery? What are my options? And most of the time they just don't know and so no, this is the only option, and so that's a good question. I actually don't know how, like I don't know a perfect way.

Dr Teralyn Sell: 45:20

I think you did, I think you did and um, I. I want to just add in there it's there aren't any other options that I can do is really what that surgeon is saying, that I know of Um and so I, but I. I don't think that that's what they say. They just say there aren't any other options. But I wish they would just say that I know of that I'm capable of doing. I wish there was more just transparency and knowledge and more I don't know truth.

Dr Clayton Dir: 45:51

Yeah, yeah, just admitting what you don't know and saying how I help people right when you're a hammer. Everything looks like a nail. That surgeon is probably going to suggest surgery.

Therapist Jennifer Schmitz: 46:00

Yes, we've heard that on this show before A million times.

Dr Teralyn Sell: 46:04

But it's true, it's very true, yeah, so I think we. Is there anything else that you want people to know about the power of PT that they might not know?

Dr Clayton Dir: 46:17

I would say, your perceptions of PT. If they're poor, it's probably a bad PT, not a bad profession, and you need to find someone who's going to like sit with you and help you, Just like. As I know, the conversation around therapy in regards to like mental therapy is if you don't vibe with the person, go find someone you vibe with. I mean, that's the end of it. And unfortunately, healthcare change can only come at the pace that people demand it, and so if you're not going to support a provider like me or providers like you guys, then you guys can't grow.

Dr Clayton Dir: 46:45

And so it's kind of like, if you're going to advocate for better healthcare, you have to put your dollars there, you have to show up in those people's offices, and someone like myself I don't use any healthcare dollars Like I go once a year to make sure like my blood's not, you know, horrible or something, and so I don't I don't even have power to do it, cause like I don't need much right now. But when you go sit with these people that you're, you guys are talking about in those offices, like don't give them your money, like don't go to that office, like take your bad experience and give that person a bad review appropriately. I'm not saying like destroy them, but like make sure that you're incentivizing the good providers to keep doing what they're doing. Help those providers provide so that the dollars can start coming out of the crappy system and start building up the better system. That's what I'm looking for and that's what this podcast is probably all about as well.

Dr Teralyn Sell: 47:31

Yes, I love that idea. That is a fantastic way to put it, because I agree with that 100%. And, by the way, most of my healthcare dollars don't go to the system either.

Therapist Jennifer Schmitz: 47:42

I know I'm having an issue because I keep firing all my doctors. So, I'm running, I'm like, yep, we're out of that realm now because, I fired pretty much everybody so, and that's good. Ok, like people fire me too, I'm like hey right, all right. Shop around Like for sure. Oh, all right. Well, we've reached the end of the show. Everybody, dr Clayton Durr rhymes with gurr. Thank you for being on the show, clayton. It's been great to have you.

Dr Clayton Dir: 48:08

Thank you so much for having me. This was a blast. We should do it all the time, every week. We'll do it every week. If you need a tri-co-host, let me know.

Therapist Jennifer Schmitz: 48:16

Oh sure you guys. You are listening to the Gaslit Truth Podcast. You can find us anywhere that you listen to podcasts. Please make sure that you give us a rating only five stars. We had someone who gave us four stars very recently and told us it's because we talk too much. So guess what? Don't listen to the show and you can find us on any of the social medias. And if you want to send us your Gaslit Truth stories, please do so at thegaslittruthpodcast at g.