Thrive Despite Chronic Pain

If chronic pain, inflammation and stress are holding you back, listen in on this episode of Awaken Your Wise Woman, as host Elizabeth Cush welcomes chronic pain specialist and coach Dr. Tawny Kross for a discussion on healing body and soul.

“When your limbic system is overactive…, you want to be able to show your system how to find safety.” 
 — Tawny Kross

Living with chronic pain can be a challenge for anyone, but if you’re a highly sensitive person, you feel things even more intensely. Pain can be debilitating—and both frustrating and emotionally draining when you can’t seem to find relief. The good news is, you don’t have to suffer. In this episode of Awaken Your Wise Woman, host Elizabeth “Biz” Cush, LCPC, a licensed professional therapist, founder of Progression Counseling in Maryland and Delaware, and a mid-life women’s coach, welcomes physical therapist Dr. Tawny Kross, founder of Ready, Set, Rewire (RSR), a program designed to take women with chronic stress, pain and inflammation out of survival mode so they can thrive and live an active lifestyle they love. Listen in on their discussion of the nervous system, the body and how a holistic view might help you manage pain. 

You can find the full show notes and resources mentioned here.

Transcript

SPEAKERS

Tawny Kross, Elizabeth Cush

Elizabeth Cush  00:02

Hi Tawny, and welcome to The Awaken Your wise woman podcast. Thank you for having me here. Oh, it's so nice to have you here. I'm excited to jump into the conversation, but our listeners might not know who you are, so if you could just, you know, share a little bit about yourself, that would be great, 

Tawny Kross  00:20

sure. So I am Dr Tawny Kross. I prefer being called Tawny. I am a physical therapist by trade, and I've been working for, gosh, 12 years now at the Durham VA, where I live near and I have had a long history working with veterans with chronic pain. And so my practice grew kind of understanding and learning a lot about the complexity of the nervous system, the body, and what exactly is going on with pain. Because when I came out of PT school, I felt very like, Oh, I know how to solve pain. And I was very much like, No, I don't know anything.

Elizabeth Cush  01:01

Wow,

Tawny Kross  01:02

yeah, like, that's how, that's how I ended up doing what I do.

Elizabeth Cush  01:07

So sort of not stumbled upon it, but it sort of came into your world, versus like you being a chronic pain sufferer, and then learn, you know, trying to help others, which sometimes that, that that's a path too, but, yeah, 

Tawny Kross  01:30

yeah, yeah, but just having clients that suddenly you have to learn how to help them manage the chronic pain, absolutely, one of the things

that I see a lot is, like the statistics show that one out of four, one out of five, people have chronic pain. And when you're working with veterans, just because of the complexity of what they've gone through in their life, trauma, stress, all that things you were you're more looking at like 80, 90% of the population. So if you're only looking at it from a purely physical, mechanical angle, it can be very, very daunting and frustrating to see like these people are just aren't getting better.

Elizabeth Cush  01:57

I bet, I bet, and I know I have clients that have chronic issues, but chronic pain in particular, and it can be so well debilitating is one word, but just so emotionally draining and upsetting and frustrating And really, really hard. 

Tawny Kross  02:21

Yeah, absolutely. And I imagine especially so, because you work with women who are so sensitive, which actually is part of the predisposition to having chronic pain.

Elizabeth Cush  02:34

Really Is that true? I didn't know that. I mean, I've wondered that, because just being more sensitive in general. Not, not to say that it's their fault that they suffer more, but, but yeah, just that they're the awareness around the chronic pain feels like might make it feel worse. 

Tawny Kross  02:55

Yeah, absolutely. Well, it's, I want to say, actually, the research behind it is women, for sure, a lot more than men. Yeah, and then there's also they consider like hormones that are involved as well. But I also see it as a sensitivity factor as well, because if your nervous system is primed to be more reactive to not just your own like emotions, your thoughts, the environment around you, and you're more sensitive to others as well. It's kind of this huge cumulative stacking effect. It's a gift to be able to be that sensitive. And it can also come with almost too much sensitivity when it comes to not like actually being too sensitive, like your system is just so 

Elizabeth Kush  03:40

Oh, so primed active, yeah, right, right. I was thinking about, you know, just like, as a highly sensitive person myself, like the the amount of just as a kid, like the physical sensory overload would be really hard. Like, if I had a, you know, a sweater that was scratchy, like I was almost like I couldn't tolerate it, right? Like it was so disruptive to my, you know, regulation. So just thinking about somebody, a woman who has who is highly sensitive and having chronic pain, just being so, you know, it could be easily overwhelming if that pain just was constant and never going away. 

Tawny Cross  04:30

I mean, for anybody, but yeah, in particular, yeah for sure. And you bring up a really good example, because in a very extreme case that that's something called, what we say is allodynia in the medical world, meaning that if you, let's say, put on a shirt, your your skin reacts to the cotton as if you were, like, I don't know, being stabbed by a knife, right? So, like ordinary things become much more loud, much more extreme, and it can be really frustrating because you're just trying to put on a shirt, right, right? Just trying. To get by just trying to live.

Elizabeth Cush  04:57

So for you, I know you, you really work towards not just the the medical piece you know. You really want to help your clients, the people you're working with, just manage the chronic pain in a way that's a much more holistic, or whatever, you know, using all the tools that we have potentially,

Tawny Cross  05:26

yes, for sure, because, like truly, we are such a little wonderful ecosystem, right? And I think that when we begin, when we become too one sided, whether we're looking too much in the physical, or too much in the mind, or too much in the nutrition, or too much whatever we're actually missing the greater picture of the fact that we're actually this entire whole person, we have whole systems, and we have lives that are not usually accounted for or shared with the doctors that we see, right? So like, you know if, if you're someone who goes to the doctor for shoulder pain, and the doctor is only focusing their shoulder meanwhile, they're not asking you about, Okay, what's your life like? Like, how, how? How are things going lately? And those are some factors, even though they don't seem directly related to the shoulder pain, can be actually a factor to consider, then you're missing a lot of the parts that can be helpful in treated treatment.

Elizabeth Cush  06:23

Yeah, well, I was just talking to a couple weeks ago. I don't even know how you pronounce, but how you I mean she, she teaches and also practices functional medicine. So I was going to say a functional medicine, a functional doctor, functional medicine. Doctor, whatever. And she was talking about the the, you know, the three pieces they look at, or she looks at and like the story was really as important as the other pieces. Because one, we carry the story right, whatever we're holding around, whether it's how we got the chronic pain or how we feel about it?

Tawny Cross  07:07

Yeah, absolutely. And like, doctors don't really ask you that, right there. No, let's just do this one thing, right? And I think it's it worthwhile bringing up, especially for your listeners. I when, when you get health care, whether it's for pain or for anything else, there are two experts in the room. There's the doctor, who's like the specialist of whoever, and there's you. You're the only expert on you and your entire life, and the only person that can actually truly understand and feel what you're feeling. And we want to be able to make sure that you're bringing that expertise to the table.

Elizabeth Cush  07:37

Yeah. Yeah, yeah. Well, and do you find, I know, I did a course in mindfulness based stress reduction, and that like the idea that, you know, if we can kind of disengage from the sort of the meaning around the chronic pain, that it can really help manage it and help reduce stress. Do you find that to be true too? I mean, so not like over identifying with it or know what the right words are?

Tawny Cross  08:11

Yeah, no, I think those words are perfect. I would say that's definitely true, and it is so, so hard, because almost none of us go through life with this space of just being an observation. We have judgments, whether they're good judgments or not so good judgments on something. We have very strong, emotional things that are tied into what we think and feel. And if it comes to pain, it's usually, you know, very stressful. So what's happening with your nervous system is you're activating your emotional centers when it comes to pain, and if you follow like the pathways on what chronic pain looks like, like? What happens to your nervous system over time, the centers that light up are actually the same pathways for emotional pain. So, oh, wow, stress, anxiety, those things can become actually what manifest even as as physical pain, still very real. There's no such thing as fake pain. It's all real manifested in the body pain. But these pathways become so very, very tied. So when your limbic system, which is part of that emotional center is very active, and you probably know this, but I'm just explaining for the people,

Elizabeth Cush  09:25

yeah, yeah, yeah, no, it's good, yeah. The more explanation is better, yes.

Tawny Cross  09:29

When your limbic system is overactive, that fight, flight freeze area, you want to be able to show your system how to find safety, and that comes with tapping into the front part of your brain, the prefrontal cortex, and the mindfulness training can be a wonderful part of that, and that is, I wouldn't say it's devoid of emotion, but it certainly is more like slower thinking, logic planning, and it's definitely a the spot in your brain that. Turns on when you're able to be safe. Because if you're you know, not safe, you probably wouldn't think, Oh, I'm being chased by a bear and I need to do homework at the same time. Those, those two things don't coexist at once. So when you're in that phase of thinking so mindfulness, you're able to actually switch away from the limbic system activation and then slow your system down and your body can find more safety.

Elizabeth Cush  10:24

Yeah, yeah, yeah, that feels important. So what like, in your opinion, like, are there things that need to shift in terms of, sort of, the medical community and around treating chronic pain. Because honestly, I I'm not sure, although it makes sense, if, like, I'm not sure any of my clients have been referred to a physical therapist for chronic pain. I mean, I guess it depends on the pain. I guess that's true. But if it's like, I don't know, fibromyalgia or something. Are we going? Are we getting referred to physical therapy for that, or is that typically, like, medical doctor and here's your pain medicine? 

Tawny Cross  11:13

And  so that's a really great question. I want to say yes and I want to say no, and the reason why I say yes is because we absolutely like pain is actually the main reason people come CPT, whether it's back pain to fibromyalgia. So to some extent it depends on the doctor that you see. The doctor has to be like, oh, this person like, would benefit from movement, because there's a heavy, heavy volume of evidence for fibromyalgia and exercise from it, for instance, makes sense, and so they'll send you the PT if they believe that this is something that would be beneficial for that patient. But that being said, pain care has changed a lot over the course of the past, I want to say even, like, 10 years or so, so when I was trained in physical therapy, for instance, we still had much of a a structural focus, like, give you this exercise, give you this stretch. And so when you go out into the community and you get referred for PT, thankfully, by some doctor that believes in like movement as medicine, you might actually enter into a space where you have a PT that's practicing in a very traditional, conventional way. Mm, hmm, means that you're just looking more at, like, movement mechanics and like, strengthen this or stretch that. But if you're working with a therapist that has more of the latest pain science in their background, they have a little bit more understanding, at the very least of like, what's happening with the nervous system in terms of chronic pain, then you're going to see some therapists that will either be mindful of, like, the emotional pieces, even if they're not necessarily able to dress on it. It kind of depends on, like, how, how much expertise that provider has, sure on the extreme end of things, extreme meaning, like you're in my world, and you're looking at medicine in a very integrative and holistic fashion. You're going to see a PT that would look at nutrition, that would look at the nervous system, that would look at your life, that would look at pain science, that would look at movement and all those other things combined.

Elizabeth Cush  13:16

Mm, and are there ways to find those you know, someone like, you like as are there like, I'm looking for this training to make sure I'm getting that kind of PT I want to get.

Tawny Cross  13:27

Yeah, I would say, if I had to look up some PT is just from, like, Google or something, if I looked up pain neuroscience education, just so that I know that the PT understands what that is. I would pair their name with pain, neuroscience education, and see if I could find at the very least that they understood pain.

Elizabeth Cush  13:48

Got it. That makes sense. That makes sense. And do you find that you know when you are working with your clients like, what are some of the I don't want to use the word success, but, you know, improvements that they're seeing with the, you know, working with you

Tawny Cross  14:10

sure, one of the biggest things is, I, I actually, and I'm sure people hate this because, like, they're looking for pain to change, like, right away, but Pain is, like, the long term thing that we're looking for. So if you're running a marathon, you're not going to want to be like, every step going, Hey, are we there yet?

Elizabeth Cush  14:30

That would be bad. Yeah, that would be a that would be a long journey,

Tawny Cross  14:38

but it would be more around, like, is movement starting to feel more expansive? Like, are you going away from just gentle recovery movements where you're just like, oh, maybe I shouldn't do that, or maybe I shouldn't do that, and you're starting to expand what you can do. So that is a huge piece of growth. So for example, I've had people who there's just, I can barely. Walk, and then they're now like, okay, now I think I want to attempt running, or I want to attempt, like, strengthening. So when they're starting to feel more comfortable with their body and they know and it can recognize that not every signal they're getting means something is horribly, horribly wrong, that would be a huge piece of growth. There's also emotional regulate, regulation pieces too, that I start to see they're maybe they're less anxious, and sometimes it's just about pain in the beginning, but that also has some carry over to their lives. They start to notice, like, I communicate better with my my family, like I'm not so afraid of, like sharing with them, like, what, what I've been burdened by. Or, you know, so there's, there's, oh my gosh. It's always lovely to see, like the relationships that change, like the sense of freedom that that person feels to be able to not just physically move more, but feel like they can be more themselves. Yeah, there's a lot too, too, yeah, transformation that's 

Elizabeth Cush  15:57

Oh yeah. Well, I would think just sort of returning to like, being able to trust your body would be a huge, huge step,

Tawny Cross  16:07

yeah, for sure, I mean, and I think I mean, you speak this, speak about this a lot in in your own work, it's just like understanding the body, like, what is the body trying to tell you? And it's very, very similar with pain care, because pain, ultimately, even though, you know we've been trained and taught that it's something scary and maybe it means something's broken or wrong, pain ultimately, is your body's best and loud signal, and it's trying to tell you something. And to some extent, absolutely, of course, sometimes there's going to be some physical things that it's trying to talk to you about. And it can also be like, hey, maybe you're teasing your boundaries too much with like this. And it will, it will put a hard foot down and say no, because it's, it's, it's so good at getting our attention.

Elizabeth Cush  16:58

Yeah, I agree. I do. I think that, but we're so good at ignoring our body signals, I feel like that isn't something that we're taught. Like to really tune in and pay attention and trust that your body knows what it's doing. Yeah, there's

Tawny Cross  17:21

just there's, I feel like it needs to be taught way at the beginning of our lives, like when you're in in grade school, or when, yeah, and especially because if you have kids like you're and you're modeling these things with your kids, your kids also benefit from you practicing these skill sets of understanding the body, listening to the body, and what the body is actually trying to communicate. It's not trying to hurt you or harm you. Trying to hurt you or harm you.

Elizabeth Cush  17:44

It's trying to help. Mm, hmm. And do you find I I'm just when you were just saying, like your body communicating with you, like, I've worked with clients in the past where they were so hyper focused or so sensitive to their body signals that just even the smallest, I don't know, pain or twitch or sensation, let's say, brought them into this spiral of like, I have cancer or I'm dying, or this is way bigger than just I had a little muscle spasm or something like that. Have you found that with some of your any of the people you've worked with?

Tawny Cross  18:30

Yeah, for sure. I think it's a good chunk more so and it and it really comes from not being able to understand what your body's communicating the first place, right? If you've never learned, and maybe your your body's just saying, hey, whoa, this is like a stretch that's pulling the muscle in just this way your body's feeling pulling. And then your system goes, Wait, wait, is that actually okay? And then it actually amplifies that signal to be experienced as pain, right? It does happen a lot. I've actually had even one client. They were, I think they were trying to straighten out their knee just a fraction, and they just started sobbing, because it hurts so much. They're like, Oh, no, something must be wrong that I was trying to straighten out the knee five millimeters, and it's, it's awful,

Elizabeth Cush  19:24

wow, wow. Yeah, I feel so much for people in that position, because then you would just, I would imagine you would just withdraw and stop trying to move at all, because it just felt so scary. 

Tawny Cross  19:38

Yeah, for sure, I mean, and I think that's, that is a common struggle space, and for those people that are in that space, The fascinating part from that just by starting to work on mindfulness, things like body scanning, mm hmm, where you're just. In the body to be able to better understand, like, Oh, what are some of the little things that I'm noticing, like my heart rate, or like my breath, and then imagine movement. It's also something that's super worth exploring. Sometimes I have people start to, like, have reactions just imagining the movement. And I'm like, Okay, this is a good space to start. We don't watch a movie just yet because you're so triggered by even imagining movement. 

Elizabeth Cush  20:24

Wow, start here well and picking up on that though, like, I have found that when I'm learning something new, well, like, I don't run anymore, but when I did like, I would imagine other people running, like, what their bodies looked like, and so then trying that for myself to say, like, Does this feel comfortable? Do I like this? You know, running at this pace, or with doing these things with my arms, or whatever, that it helped me. I don't know better run in a way that was supportive for me, which is funny to think about, like the imagination process works like that.

Tawny Cross  21:02

No, I actually there's so much fun science around this. Like, one common thing that people see, that I think they really latch on to, is when you watch the Olympics, and let's say you see an Olympic swimmer with their like, headphones on, and then they look like they're kind of like, you know, jamming a waste to something most of them are actually trying to imagine that finishing touch to show that the visualization part correlates with like higher like top three finishers.

Elizabeth Cush  21:35

Wow, interesting.

Tawny Cross  21:36

The other thing I always like to bring into is like your physical maps. And when I say physical maps, like your brain runs through maps of movement. So right now, I'm doing this weird circle, circle hand thing with my near my head, the maps that are activating from me doing this movement are the same ones that are activating from just imagining doing that, which is pretty cool. And that's so cool, physiology actually changes, even if you're just imagining it. 

Elizabeth Cush  22:09

Wow, that's amazing. Yeah, it's super cool. Yeah, love science. So cool. So if you had words of wisdom for any listeners who might be struggling with chronic pain, like, what? What would you offer to them? 

Tawny Cross  22:30

Yeah, number one thing I think is important is to just practice, even if you may not believe it today, just practice thinking, okay, it hurts and it's not the same thing as brokenness or something being harmed, just having that as like, because most people will be like, Oh, is it my herniated disc? Is it my blah, blah, blah, blah, blah, when in reality, it might just be your nervous system is feeling triggered by something, and it could be something emotional, nutritional, not necessarily physical. And the second thing would be taking the time to, I don't know if this is the best way to say it, like, quote, slow your roll, unquote, because we're so fast at thinking and reacting. And if we just took the time, even 30 seconds, to just check in, like, what am I noticing right now? And can I slow myself down and maybe maybe ask myself, like, what would be supportive for me right now, what would be helpful, rather than being immediately into a state of reaction now that's that might be a simple thing. It's also something that comes with practice.

Elizabeth Cush  23:35

Oh, definitely, definitely, definitely, yeah, well, it's like practicing, sort of more mindful living, or whatever mindful practices, just to be able to integrate that sort of slowing down, the pause, the noticing to be like, instead of that reactive like, go, yeah, 

Tawny Cross  24:00

Yeah, just maybe as an example that might help is I have had, I had this one client that I was working with, and she was talking about, no, interestingly enough, we were focusing on food because she was having a lot of sugar cravings. And I asked her, I was like, Okay, I don't need you to do anything differently. I just want you to pause and assess the situation, and then come back to me a couple weeks later and tell me what you notice. And she's like, Okay, I think it's just because I have sugar cravings, but alright. And then she came back to me two weeks later. She goes every time I went to the pantry to grab something was after I had a fight with my son.

Elizabeth Cush  24:35

Oh, wow, yeah.

Tawny Cross  24:39

And obviously, like sugar can be something that is calming in some senses. That's why people comfort eat, but that's what the pause allows you to do. It allows you to recognize what is threatening my nervous system and what do I actually need to support it? And for her, she actually started addressing her relationship with her son, and that actually helped her.

Elizabeth Cush  25:00

Oh, I bet, I bet, I bet, I bet, yeah. Well, just yeah, that whole interconnectedness of Yeah, what? How quickly our our brains and our bodies can go to whatever that yeah, if it's a craving, or, I don't know, a negative thought or whatever it is, if we can just kind of be like, Alright, what's going on? Yeah, yeah, yeah. What's happening inside? Well, and to notice, like, I think often, some of my, you know, when clients first come to see me, and in my therapy practice, it's usually for anxiety and stress. And it's like, well, can we kind of walk it back, like you're telling me, like you woke up anxious today, but let's, let's, where do we start? Like, what did you wake up that way? And if you did, what were your dreams, or what happened last night before you went to bed? Like, can we kind of step take those steps backwards to see you know where it's building.

Tawny Cross  26:02

But yeah, yeah, for sure. I mean, those are such important questions. Because yeah, if we can get at least even a snippet of more of the bird's eye view, or 24 to 40 hours zooming out, rather than being focused on just the body signal, yes, it would meet. It would open up the world for understanding how to actually navigate through, yeah,

Elizabeth Cush  26:25

yeah, because I think too, with, like, any sort of trauma and like, chronic pain, to me, you know, can be traumatizing too. We get you can be so, like, hyper focused on that pain versus, yeah, that wider view of, like, what else is going on. 

Tawny Cross  26:42

Yeah, that's a phrase. Let's see if I can broaden my vision.

Elizabeth Cush  26:44

Yeah, yeah. Well, it's true. Like, I tell that to clients, like, if they're feeling really stuck, like, look around, like, Look see where you are, lift your head up, sit up straight. Even that can help kind of change perspective.

Tawny Cross  27:00

And, yeah, yeah. And I think that, I guess in a metaphorical way of looking at things, like, when we're in fight or flight, we tend to zero in on Yes. And you can almost say we have, like this tunnel vision. It goes like, everything shrinks down, if you have the ability to even think about expanding that helps your nervous system feel safe in some shape or form, to be like, Oh, okay, like, maybe we don't have to. This is not a danger, right?

Elizabeth Cush  27:32

Exactly, exactly. Yeah, I love it. Love. Love the way the brain works and how we can help work it, help it work better or whatever more, not to our advantage. Alright, well, so nice chatting with you, tawny, if people want to know more about you and find you how, how would they do that?

Tawny Cross  27:55

I am very active on Instagram, and if you want to direct message me and say biz Cush, love to know how I got connected with you. Perfect. I'd be happy to send you over any free resources you can just say something like freebie, and I'll check out what things might be most helpful for

Elizabeth Cush  28:13

you. Awesome. That's fabulous. Well, thank you. Thank you. Thank you. I appreciate your taking the time to come on the podcast. And yeah, I yeah, thanks so much.