Missing Ingredient in Rehab: Learning to Trust Your Body

What if doing everything right still doesn’t make you feel whole again?

In this episode, Dr. Fred Bagares, board-certified Sports & Spine physician and founder of MSK Direct, explores why so many patients “pass” their rehab programs yet still don’t feel like themselves. From a teenage athlete afraid to trust her ankle again to a commercial pilot living with chronic back pain, these stories reveal a deeper truth: healing isn’t about finishing a protocol — it’s about rebuilding trust in your body and confidence in your movement.

You’ll learn why traditional rehab often misses the psychological side of recovery, how fear alters your nervous system’s response to pain, and what real progress looks like beyond pain scores.

Whether you’re recovering from surgery, managing chronic pain, or helping others heal, this episode reframes rehabilitation as a partnership, not a prescription — and a process of moving forward, not just going back.

🎯 Key Takeaways

• Why “passing the test” doesn’t mean you’re ready
• How fear and trust shape recovery outcomes
• What true progress looks like in real life
• The difference between discomfort and danger

🔗 For clarity guides, treatment options, or to explore personalized recovery plans, visit MSKDirectVB.com or FredBagares.com.

Transcript

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Maria came to see me six months ago after rotator cuff surgery. She had finished physical therapy. She did everything. They told her pass all the tests, but something was still wrong. I'm doing everything. They told me. She said, but I'm still not there. Where's there? I don't know. I guess I thought they would tell me that moment with Maria crystallized something. I'd seen something for years. We've turned rehabilitation into a checklist, a series of exercises, a number of visits, but we never asked the most important question. What does quote unquote, better actually mean to you? Not to the protocol, not to the insurance company. But to you, because here's what I've learned, treating musculoskeletal conditions for over a decade, rehabilitation isn't about chasing pain. It's about teaching your body and your brain to trust movement again. And you can't do that with a photocopied exercise sheet and 12 sessions. This is what we're gonna explore today. I'm Dr. Fred Biris, and this is The Talking Rehab Podcast. Quick favor, before we dive in. If this podcast has changed how you think about your body or your recovery, hit that subscribe button. It's free. It takes two seconds, and it's how we keep bringing you these conversations every week. No fluff. Just real talk about what actually works. Thanks for being here. Now let's get into it. Early in my career, I cleared Sarah a 16-year-old midfielder to return to soccer after her third ankle sprain. She had passed every functional test objectively. She was ready when I told her she could play, she looked terrified. What if it happens again? I started giving her the standard reassurance. Your ankle is stable. You've built the strength back. The ligaments have healed. These were all true. Then she said something that stopped me. How do I know I can trust it? We'd rehabbed her tissue, but we hadn't rehabbed her confidence, We helped strengthen her perineal muscles, but we hadn't taught her the difference between pain. That means danger and discomfort. That means adaptation. Think about that. She had perfect dorsiflexion, range of motion, great single leg balance, but she was terrified to cut left on a soccer field because her body was screaming, don't trust me. And you know what? Her body was right to scream. Because nobody had taught her how to listen. This is where most rehab fails. We treat tissue and forget the nervous system. We fix the structure and ignore the psychology. We get you through a protocol and call it success. Even when you're afraid to move, your brain is part of the injury. Your fear is part of the dysfunction, and if we don't address that, then you'll never fully recover, no matter how strong your glutes get. James is a commercial pilot. When he came to me, he'd been dealing with chronic low back pain for at least three years. He did physical therapy twice, tried chiropractic care. He also had some spine injections. Some things helped temporarily, but nothing really stuck. Standard Rehab had treated his chronic low back pain. But James isn't a diagnostic code. He's a human who sits in a cockpit for eight hour flights to Europe. When we sat down, I didn't start with his back. I started with his life. What do you do? What matters? What does a good day look like to you? Turns out his pain wasn't just about his back. It was about chronically shortened hip flexors from prolonged sitting compromise rotational core stability, a complete inability to find comfortable positions at 35,000 feet. We needed strategies he could actually use in the cockpit. We also needed him to understand what his pain was signaling and also what it wasn't. We needed to address his peripheral nerve sensitization, his tendinopathy and his movement compensations, shockwave therapy, magnetic peripheral nerve stimulation, specific rotational core work, not generic planks, and ongoing coaching about how to interpret his symptoms as he gradually returned to full flight schedules. That's not fancy medicine. That's just treating James instead of treating a diagnosis. But here's what drives me crazy. We have the imaging to see your torn meniscus, but imaging can't show me that you're terrified of reinjury. It can't show me that you've been compensating for six months, and now your hip hurts too. It can't show me that you've stopped playing with your grandkids because you're afraid of hurting yourself. Beyond the obvious means asking why is this happening to you, why now, and why this pattern, a cookie cutter protocol, can't answer those questions. Here's the thing, rehabilitation doesn't happen quickly. It's certainly not over. Just one or two visits. It happens when someone who knows your history, your patterns, your goals is there to help you interpret what's happening, not just at the beginning, but six months later when your shoulder starts acting up again and you're not sure if you should be worried. A patient once told me, I don't need a doctor who sees me for 15 minutes and never thinks about me again. I need a coach, someone who knows my game. That kind of stuck with me because That's exactly right. Think about athletes. They don't just train. They have coaches. People who watch their form, adjust their programming, pushes them when they're ready, pulls them back when they're not. Someone who knows when they're sandbagging and when they're actually at their limit. My patients deserve that too. Whether you're training for a marathon or just trying to carry groceries without wincing tissues need load to heal. Tendons need tension and bones need stress, but too much too soon you will reinjure yourself too little and you will never fully recover. There's definitely a sweet spot where tissue is challenged but not overwhelmed. Finding the zone requires constant communication and reassessment. Not a six week timeline, someone copied from a textbook. Your rotator cuff isn't healing on someone else's schedule. Your biology, your age, your goals, they are all different. And here's what nobody tells you. Recovery isn't linear. You'll have good days and setbacks. You'll have moments where you feel great and then wake up sore for no apparent reason. You'll need someone who can help you distinguish between, this is normal for adaptation and we need to back off. That is true guidance. This is what makes rehab actually work long term instead of just getting you through a protocol. So let me ask you something. How are you measuring progress? If your answer is just the pain score, you're missing the entire picture. Progress might mean you walked further yesterday, which is longer than you could last month. It might mean you slept through the night without your shoulder waking you up. It might mean that you played with your grandkids without fear or you went to work without needing medication. Just the function. These are the true victories. So what does better mean to you? Less pain or more life? Sometimes the hardest part of healing is unlearning. Unlearning the way we used to move the compensatory patterns We've built, the way we rush through recovery because we're desperate to get back to normal. Okay, but here's the truth. Rehab isn't about getting back to who you were before the injury. It's about becoming someone who moves with confidence. Again, someone who trusts their body and knows the difference between discomfort and danger. It's also about coming back better than where you left off. This takes time and patience, and it also requires a partnership with someone who sees you as a person, not just a protocol. Your body is giving you feedback constantly, pain, stiffness, that feeling of something's not quite right. Most of us learn to ignore it, push through it, or panic. What if you learn to listen instead to interpret what it's telling you to know when to push and when to back off. This is the goal of rehabilitation learning. It's the wisdom about your own system and it's what we should be teaching you. Rehabilitation isn't a destination, it's a process of relearning trust, not perfection, but overall progress. Not fixing what broke, like you're a machine with a bad part. Teaching your body to adapt, strengthen, and move with confidence again. Can you do something today you couldn't do last month? Can you move with less fear? Can you imagine a future where this injury is just part of your story? But not the defining chapter. If you're tired of being treated like a diagnostic code instead of a person, visit msk direct vb.com and book your clarity consult. We'll sit down, define what success means for you specifically and create a treatment plan built around your life, your goals, and your body. Or you can head to fred begar.com for resources and tools to help you think differently about your overall recovery. As I've said before, you deserve to be treated more than just a checklist. You deserve someone who actually knows who you are and your game. Thanks for listening to The Talking Rehab podcast. I am Dr. Fred Biris, and remember that recovery isn't about going back. It's about moving forward. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.