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138. Mind-Body Approach to Pain and Mobility/Revolutionize Your Recovery with Dr. Helen Porat

• Dr. Adrienne Youdim

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Dr. Helen Porat is a former competitive gymnast and all-star cheerleader turned coach and Doctor of Physical Therapy. With over a decade of experience, she specializes in healing the body through assessment of the nervous system, movement, and manual therapy. Dr. Porat empowers her patients to make their bodies more resilient and less vulnerable to injuries.

Dr. Helen Porat joins Dr. Adrienne Youdim to discuss her unconventional approach to physical therapy and the mind-body connection in healing pain.

They explore the importance of breathwork, maintaining good posture, and using movement to regulate the nervous system.

Dr. Porat emphasizes the power of education and understanding the body's ability to heal. She also addresses the impact of emotions on physical pain and the role of habits in coping with stress. The conversation highlights the need for self-compassion and the benefits of starting small when incorporating movement into daily life.

What you will learn from this episode:

  • Understanding the mind-body connection is crucial in healing physical pain and stress.
  • Breathwork can be a powerful tool for stress relief and regulating the nervous system.
  • Maintaining good posture can improve breathing, mood, and overall well-being.
  • Movement snacks, and short bursts of physical activity throughout the day, can help prevent postural fatigue and promote spine hygiene

"I think that education is really important, understanding that the body, no matter how long you've been feeling like this [the pain], does have an incredible ability to heal." - Dr. Helen Porat

Ways to Connect with Dr. Helen Porat:


Ways to Connect with Dr. Adrienne Youdim:

Ways that Dr. Adrienne Youdim Can Support You

  1. Join the Monthly Free Mind-Body Workshops: Participate in engaging mind-body practices designed to help manage your stress response. Register here.
  2. Sign Up for the Newsletter: Stay updated with valuable insights and resources by subscribing to the newsletter. Sign up here.
  3. Freebie alert. Register for our monthly free MindBody Workshop and receive a downloadable guide on emotional labeling to help you manage your emotions effectively.


Connect with Dr. Adrienne Youdim

TRANSCRIPT Mind body approach to pain and mobility/revolutionize your recovery with Dr. Helen Porat

THE HIGHLIGHTS OF HER PHYSICAL THERAPY PRACTICE AND HER UNCONVENTIONAL WAYS OF DOING IT

Dr. Adrienne Youdim 

So Helen, I'm so happy to have you.


Dr. Helen Porat 

I am so excited to be here. I'm watching you in action.


Dr. Adrienne Youdim 

Helen and I have this, I was going to say sorted past, but there's actually nothing sorted about it other than the fact that I went to college with your hubs. How is he?


Dr. Helen Porat 

He's doing well, thank goodness. I know we need to get him on. We'll have a full doctor party here.


Dr. Adrienne Youdim 

I love how things happen full circle.


Dr. Helen Porat 

Yes.


Dr. Adrienne Youdim 

I'm really intrigued by your approach to physical therapy, and before we get into why and how you practice the way you do, can you just describe for the listeners your philosophy behind physical therapy, the mind, the body, how you practice and what your mission is?


Dr. Helen Porat 

Yeah, absolutely. So I'm Dr. Dr. Helen Porat, and I've been a physical therapist for 14 years now. I've been lucky enough that from the moment that I graduated, I was in a clinic that really gave me the opportunity to work hands-on with my patients. So I really made an effort as a new, freshly green grad to find a clinic that I wasn't going to be seeing patients every 15 minutes. And so that really gave me an opportunity to use some of the manual skills that I had learned at the university that I went to, which is a manual therapy-based graduate program. So manual, just meaning that it's really what it sounds like, it's hands-on. So doing myofascial techniques and joint mobilizations and adding that in with what you would normally think of as physical therapy with rehabbing muscles and all of that.


And so that really gave me an opportunity to see patients for a long time and get to know my patients. And then it gave doctors in my area an opportunity to send me what they called, they're complicated patients. So from a very freshy grad, I was seeing the quote unquote non-textbook complicated patient. That is where it started. And 14 years later, I have a solo practice here in Dana Point, California where I block out an hour for each of my patients. I've been able to extend that with a lovely world of social media no longer confined to what I said, oh, I could always control what's in these four walls that no longer was a truth that I could hold up to the last couple of years. So I've been able to extend that information and education on my platform.


Dr. Adrienne Youdim

What I love about what you do is that it's so unconventional to my mind. I mean, when I think for physical therapy, I think manual, I think massage and joint manipulations and things of that sort, but you really approach physical therapy in a very emotional, spiritual, mental way. And I'd love for you to talk about how you meld those two aspects. We talk a lot about health bites about mind and body, how in conventional medicine we tend to separate the two and how in reality these two things are really so intertwined.


Dr. Helen Porat

It really is. And I think that we are seeing a paradigm. I mean, I'm sure that you're seeing it with your practice and it definitely takes a while to integrate that into a real life clinic life. But I think that we are seeing the shift because when I first started out with being super professional and really, I wouldn't say purposely separating, but really sticking to the fact, sticking to the information that I had at hand about the nerve pathway and that sort of thing. But I soon came to realize that there really was no separation. I did feel like it was out of my scope of practice initially, right? And so being that post-graduate, I didn't want to go out of my scope of physical therapy practice. So it set me on this mission to continue to educate myself about neuroscience, about pain mechanisms, and really thankful to so many pioneers in the neuroscience world that have explored pain, that do understand that pain is part of your body, understand the pain pathways.


So for me, not that I needed that, but it was very reaffirming and important for me to understand that within my scope of practice, I'm still really able to keep that full body approach and not separate the two because we can't separate, you know, our past experiences and the nervous system as you know, I would find out over a decade later of doing this. So, yeah. So that was really important and that definitely set me, yeah, as you can imagine down the rabbit hole of different courses. And, again finding, like the NOI group based out of Australia, who does this with patients who have phantom limb pain, who have unexplainable sensitive nervous systems. So really adding the science, but then also because I get to work with my patients closely and get to know them and love them just that intuitive understanding that, you know, we really can't separate the emotions and the physical pain.


GOING BEYOND THE PHYSICAL PAIN AND DIVING DEEP INTO THE SUBCONSCIOUS LEVEL TO FIND CURE AND HEALING

Dr. Adrienne Youdim 

So talk a little bit about how you work that in. How does that materialize in your practice? And you know, I'm asking because, so pain is so common, right? Pain syndromes or unexplained pain where someone will go to the physician with a symptom, and we can even broaden it to unexplained symptoms, not just pain, right? That they are concerned about, maybe it's palpitations, maybe it's vertigo, maybe weird kind of feelings, numbness and tingling in the fingers or the extremities. And they do what we call the million-dollar workup. Blood tests are done, specialists are seen, MRIs are done, and a lot of times much to the person's dismay, there is no diagnosis, which certainly is frustrating, right? You want to know that there's a reason, there's a cause and therefore a solution. But we're finding that even if we don't have this organic etiology or cause there can be a solution that is more intuitive. And so I would love for you to address that person who comes to you with back pain, but even broaden it, that person who comes with a palpitations that their doctor has not been able to figure out the cause of, but that maybe in your work you can address the root.


Dr. Helen Porat 

Yeah. So let's just start with taking some mechanical pain. Like why if someone would come to a physical therapist, because most people aren't coming to PTs unless, that word of mouth or understanding, but just that straight back pain, that reoccurring back pain, that's been frustrating. Like you said, they've gotten an MRI, they may have experienced, like a bout of pain medication, anti-inflammatory, epidural injections, physical therapy, and it's this reoccurring back pain. And so whenever we have any kind of pain, the most important thing is to understand why you're in pain. Is it truly a muscle spasm, a muscle weakness issue? All of the things that we're trained to screen and address and create plans of care around in physical therapy, right? So like your typical physical therapy plan of care, let's strengthen that core.


Let's restore some range of motion. But either way, just having that kind of explanation to a patient emotion's out of it. Because we come in with a lot of emotional pain associated with the physical pain because we don't know what's happening. And it's stopped us from doing not only what we love, but just our daily function, maybe getting to work. There's nothing, a fast track to feeling old, like having a stiff back that you have no idea what's wrong and then it's scary. So then that fear around the pain, well, if I move, am I going to make it worse? It's spasm so I must be injuring something more. So my job as my patient's physical therapist is to really have them understand the mechanics, understand what's safe, what's not safe, which usually is not so many things.


Usually most things are safe when we understand how to move our body and what your body is doing as a natural mechanism. So that's number one. Just truly from that mechanical standpoint, without getting too much into my wild realm of emotional and what happened during that time of your life. I just came back from the clinic and just saw a patient that two months ago had to put their dog down and he and his wife have had an array of physical manifestations from that. So, that's where I really get to know my patients. But that's just from the mechanical point. Now when we start talking about this, it could be the same patient or different patient that is now experiencing palpitations, vertigo, probably what you see more in your world where they're not absorbing nutrients, they're having digestion issues.


Now we're talking about that dysregulation that I see in so many people's nervous system. And that is going to be a patient that is not going to respond the way that they'd like to, to all of these good things that they're trying to do for their body. And so you see that patient that, what did you call it, the million-dollar workup, I mean, totally right? Like getting the lab test done. And usually things as you know, are not going to really show up on lab tests. Like usually things have to get pretty bad to show up on a lab test and they're not going to get that. So I always, I'm sure you educate your patients. That's a good thing. Because when you go to a doctor, when you go to my husband, they have a certain skill set and you're fortunate if you don't need that skill set as your intervention of choice, right? If you do, then that's great, but most of the time you need to realize, because there is that frustration, there's the emotional side of going to a physician that doesn't know what to do for you. And I think that that also needs to shift because as a patient, we want to be fixed. And, I think that we're starting to understand this idea that we have to kind of go into our internal regulating systems before we can expect any of these skilled practitioners to quote unquote fix us.


Dr. Adrienne Youdim 

So what does that look like? What does regulating your own nervous system, what does that look like for somebody?


Dr. Helen Porat 

Yeah, so I think that in my program that I've created, there are a few phases. So disclaimer, if you follow my platform, I love breathwork. I have been working on the diaphragm since I graduated PT school. And thenI'm going to bring this back to a comment that I remember you telling me when I first went back to teaching at the university. But I was an adjunct faculty at the university that I graduated from and for that course I taught about the diaphragm. Now at the time, 14 years ago, even graduating students of physical therapy were like, why do we need to know about the diaphragm? We're in a very different world now. In 2023, we know all about the diaphragm and breath work and that parasympathetic nervous system.


So disclaimer, I'm very passionate about the diaphragm. I use it as a tool to get the nervous system regulated, um, that comes into the second phase of my program. But the first phase is building awareness around it, right? Because similar to that back pain patient, we have to understand why these very scary symptoms are happening to our body. Why it feels like we're falling apart, why it feels like no matter what we try, we continue to get worse. And there's nothing scarier than having heart palpitations when you lay down to go to sleep and you try to rest your head and now your doctor's telling you sleep is important, but you feel like you're having a heart attack. So understanding that this isn't, that there's something deeply wrong with you, but that it's really a signal to start looking at those regulating.


So bringing awareness, bringing education to some things that have been working at an unconscious level. So we call that kind of neural awareness. And then we go right into one of the greatest tools which is that breath work, right? Because we can access a big flow into that parasympathetic nervous system by activating the diaphragm. And so with all of the mechanical postural changes that we have in our high tech life, it's not conducive to breathing well and add stress to that. These micro stressors that we have, that really is going to inhibit the diaphragms function. So really getting full function, full optimal breathing pattern is a huge way to kind of reinforce regulation in our nervous system. And I almost call it like getting rid of the stress in our tissues. And that does come from science because we studied all the science behind it. So before that just used to sound like a bunch of fluff but we actually understand that there's chemistry happening at a cellular level that changes when we can tap into that system.


Dr. Adrienne Youdim

Well, before I dig into that a little bit further, I do want to just also acknowledge that we talk a lot about these alternate sources of symptoms that don't have an organic ideology. We talk about a lot of that on this podcast and just to kind of say there are, we shouldn't dismiss anything, right? And there are, palpitations is something very serious. And so I don't ever want to give off the impression, especially as the physician, that we shouldn't evaluate those symptoms through rigor and medical means. Because there could be an arrhythmia, there could be an underlying infection that's causing palpitations or fast heart rate. So that having been said that that should be addressed, there are then these very simple, I would say, simple doesn't mean that it's easy for us to do them or that we do them simply, but simple measures to help regulate the nervous system and to address the stressors that sometimes present as these symptoms that then we can't find, again cause for.


Dr. Helen Porat

You're absolutely right. I mean, these are patients that we're screening, we are always looking, I mean, those are what, yellow red flags that we have to look at before intervention. So absolutely, we've screened, these are patients that have already been through what I call like the medical merry-go-round. They've already sought different types of diagnosis and they're still having this a lot of them are getting diagnosed with dysautonomia. We're seeing a lot of, like, just even in this last year, a lot of long COVID patients that they felt that really big shift in their body after that in their nervous system and they're having changes in their hormones, weight gain, and again, with the palpitations and that sort of thing. So we definitely see a lot of those arrows pointing to the nervous system and addressing the nervous system in order to get back to, kind of a balanced state homeostasis. Yeah.


WHAT YOU NEED TO KNOW ABOUT BREATHWORK AND HOW IT'S EMPLOYED TO HELP PATIENTS BRING DOWN TENSION

Dr. Adrienne Youdim

So tell me, in terms of breathing before we get to the mechanical, including posture, which I'd love to get your input on, but tell me in terms of the breathing, how do you guide your patients? What do you advise them to do? What are some kind of strategies that you employ?


Dr. Helen Porat

I would say that the first thing that anybody should do right now if they're listening is to just note how you breathe, right? So just sitting there, do you have the ability to breathe through your nose? Do you tend to be somebody that mouth breathes more often? And then when you do try to attempt breathing through your nose, which is the best way to create enough resistance to get the diaphragm to contract, can you get a full inhale in and or does it kind of take some effort and then you have to finish with a mouth breath or some chest breathing. So just bringing awareness would be the first step. And then the second step would be, addressing position, addressing some tightness that they may have, and then bringing awareness that I would say, and of course, this is where I'm getting some practitioner bias, that most of us are breathing through our neck and chest muscles.


And so this is, it's that chicken or the egg. Do we breathe that way because we have tightness in the neck or do we have tightness in the neck because we breathe that way, right? We're breathing 20,000 times a day. And I can tell you from screening many people, including those, about to graduate physical therapists, that it's very hard to find what I call the perfect specimen who just knows how to breathe well. Because usually unless you're looking at babies like, when you observe a baby, you see their belly lift and rise and no tension. But as you get older, some of those postural changes and imbalances and stress we see that that changes. So yeah, I would just have everybody, try to take a deep breath in through your nose, see if you can hold it for a few seconds and then see if you can slowly release it through your nose as well.


And advice that I give to all of my patients or anyone that cares to listen to me that when you're not talking or eating while you're chewing to try to keep your mouth closed and to try to press your tongue up against your palate so you're not like pointing your tongue at the front of your teeth, but you're trying to have that tongue gently pressed up against the palate and then you're trying to breathe in through your nose as often as you can. And so this is just like that first step, right? This is still in that awareness phase where we're just bringing awareness to something that we already do without thinking about. And we become detectives, we start to say, oh, can I do that? What does it feel like? Do I feel anxious when I think about keeping my mouth closed for too long? So we start getting curious about that activity,


Dr. Adrienne Youdim

Okay. And what's interesting is that it doesn't take, I mean, even if we have a certain pattern of breathing, that is not necessarily perfection. It doesn't, which is all of us, to your point. It doesn't take a long time of intentional breathing to help regulate the nervous system. And I have mentioned a few podcasts ago that I started bringing these breathing practices into the office. And I'm amazed by how somehow it always ends up being six minutes of guidance. I don't know, maybe that's my internal tape. But when it's six minutes of doing this work with patients, they open their eyes and they're like, wow, in terms of being able to notice the places of tension in the body, soothe those areas of tension, and then through their breathing, really bring down their heart rate, bring down that sense of pressure as the blood pressure comes down, right? Really bringing down that physical sign of stress.


Dr. Helen Porat 

And then really connecting to your body, right? Like, how busy are we all? I can only imagine how busy you are with all the things you do. And I mean, just taking that moment to connect and there's so many things happening again at a mechanical level, at a chemical level, when you tap into that breath, all of the changes that you make to heart rate and digestion and just like reconnecting and as you become a better detective, about better practicing this, you're going tobe able to start understanding what your body needs, right? So then that's where you really start connecting and kind of awakening, as I call it.


HOW MAINTAINING GOOD POSTURE LEADS TO PROPER BREATHING

Dr. Adrienne Youdim 

Talk to me a little bit about, um, posture and how poor posture may impact your physical state, your emotional state, and what are maybe some points that people can keep in mind. I always remember my mom kind of running her fingers up the top of my spine to kinda remind me to sit up straight. So that's what comes to mind for me.


Dr. Helen Porat

Absolutely. And so, before I really got into nervous system regulation, and I can say that still now, spine is my passion and spine hygiene, just because it's something that needs to become more approachable, right? Like as approachable as brushing your teeth, we should be able to care for our spines because usually by the time that our spine gives us some attention, we're very scared of it. Like we had initially talked about. Some general, good posture tips, starting with number one before we even talk about what a good posture is, is setting a timer. So this is what I call movement snacks. You can implement this really just as a habit, trying not to sit for more than an hour at a time. And this doesn't mean that you're taking long extensive breaks and you're getting the yoga mat out.


That's a plus that a lot of my patients who already have back problems do in order to prevent problems from occurring towards the end of the day. But just as a regular spine hygiene practice, setting a timer, you stand up, you move around, and then you sit back down. So movement snacks, whenever you can, trying to keep your body in motion, trying to get out of this inevitable forward flexion sitting position. The next step to that is just, what I call kind of restoring a neutral spine. Now I don't treat off of position, I don't care about position, but this idea of trying to get our head stacked over our shoulders, stacked over our pelvis, and the reason why is because we end up kind of having this banana back with the head forward and the pelvis forward and we lose our core, we lose all of that good real estate for breathing.


And then of course we have that forward neck tension. Those are just some general tips that just kind of bring a little bit of awareness. One of the greatest tips that I could leave anybody with without having seen them as while you are driving in the car, seeing if you can put the base of your head on the headrest of your car, and then once you get there, try to change your rear view mirror. And then this is going to serve as an immediate visual cue that when you start kind of getting into that banana back , start getting into that forward posture, you're going to see the cars disappear behind you and it's going to give you a little visual cue to zip it up, back up and kind of get your head in that good position. So a lot of the things that I try to do is, again, just as you would care for your teeth or anything else, just trying to prevent the aches, trying to prevent postural fatigue from occurring with our high tech lives. Right.


Dr. Adrienne Youdim

And it's funny because the awareness piece is so critical. I mean, we were just talking about this. I imagine my mom's finger up my spine. And yet when you gave me that visual of the car, I heard a couple little cracks in my back. But she tells me that even though in my mind I thought I was sitting up straight, I in fact wasn't, and goodness, how long was I not sitting up straight that I actually heard the crackling.


Dr. Helen Porat

Exactly. And then just to bring it back to your point, when we are in this position, we are in a better position for breathing as well. So this really is a more optimal position to get full function out of your diaphragm, that main breathing muscle. And so you're really reinforcing a good habit. And I can tell you that if you are in that forward posture, you're probably in what, so there's that two symptoms, the stress sympathetic, nervous system as you know, and the parasympathetic. And so when you are in that forward posture, you tend to have to open your mouth to breathe in order to accomplish intake of oxygen. And so you really aren't in a state of almost like chronic hyperventilation. And so you really are changing the chemistry in your body by just being in that posture. So the two really do go really well together. And again, just bringing that little bit of awareness and trying to implement some of those practices that, like you said, doesn't take all that much, it doesn't take fancy equipment or anything besides just kinda...


Dr. Adrienne Youdim 

Not sexy as I say, I know like sometimes people, they want something sexy and it's not sexy, but it's effective.


Dr. Helen Porat 

Exactly. Absolutely. Yeah.


Dr. Adrienne Youdim

Can you describe what happens when people do this change in posture? Like what's happening chemically? Because I can even say that within a few seconds of sitting upright, I feel more alert. I feel like my mood is almost uplifted, even though my mood was uplifted to be with you to begin with.


Dr. Helen Porat 

You get that endorphin? Yeah. A few things happen here just from the positional posture standpoint, we know this is science-based. This isn't just how we feel that even changing the position of your face can change your mood. They did this with, again, not very exciting, not very sexy. They did this with a pencil test. They had somebody stick a pencil in it, create a smile, and then they had them do another face, and then they did a bunch of measures for parasympathetic activity and that sort of thing. And they found the one that was with a smile ends up feeling better. The same thing goes with our posture when we do at a neural level. We are tapping into that same chemistry. So all of those happy endorphins, what I say, like the body math working in our favor, and again, you're reinforcing more of a parasympathetic state when you're actively using your diaphragm. It is happening. It's not just, it does reflect in our attitude, more confidence. These are all fun studies that you can dive into.


Dr. Adrienne Youdim 

So what else do you recommend? So far I'm gleaming, aware of your breath. And some minute shifts in our breathing that include employing the nasal pathways so that you trigger the diaphragm breathing more from the bottom or the belly and not limiting it to the chest or the top. We also talked about taking breaks, just being able, reminding yourself that when your apple watch, if you have one, gives you a little ping, you don't just shush it, but you actually respond by breathing or even getting up and moving around, getting out of your desks. That's a really important posture. What are other ways in which you have people simply utilize awareness in their body to maybe address underlying stress and or physical stress or pain?


UNCOMPLICATING WHAT HAS BEEN COMPLICATED FOR SO LONG

Dr. Helen Porat 

Yeah, and I think that, you realize this because you're working with patients every day, is that you know, what we just talked about is something that people that already feel kind of good are going to be able to do easily. But when you're not feeling so good, it's really hard to stand up straight. It's really overwhelming to think about those things. So just being really gentle, and I know that you talk about this a lot, but also just being really compassionate with yourself as you're making these changes, right? I think I've seen some of your work about just that frustration, taking the guilt out of it, taking the shame out of it. Like, oh my gosh, now, Helen talked about this banana back and I'm such a banana back. So just making gentle shifts in the way that we talk to our body as you're trying to make improvements.


And then just realizing that if you are somebody that has been in a lot of pain or that just hasn't been feeling that well, that this is just like really a signal and that it can be really frustrating to go through that whole medical cascade. So I think that education is really important, understanding that the body, no matter how long you've been feeling like this, does have an incredible ability to heal. And so when you start regulating the body by implementing some of these simple practices that we just started discussing, you really start creating an environment at a cellular level at an emotional level to be able to start healing some of those things. So yeah, just to really give hope. I think that that's one of the things that I really enjoy out of my practice is that, just trying to uncomplicate what seems to have been so complicated for so long, if that makes sense.


Dr. Adrienne Youdim

Yeah. And as you were talking I was thinking about placebo versus nocebo effect and for everybody, knows the placebo effect, which is said very simply something that, well, I'm going to say it as like the physicians would say it, something that doesn't really work, works, right? And so that's actually been our approach to the placebo effect, which is that it's something that shouldn't be capitalized, but actually should be taken out of the mix because it doesn't really work. But the whole point is that there is, we can capitalize on placebo, which is making something that isn't necessarily fixing actually help you. And we can also be aware of nocebo, which is kind of what you were implying, which is when you have that negative thought or you speak to yourself in a certain way, or you set the tone of this isn't going to work, or I'm doing the wrong thing, that actually can have a demonstrable and concrete negative impact, which is real, even though it's not caused by something concrete, it has a concrete effect,


Dr. Helen Porat

Right. And so if we think about the primary purpose for our stress response, it's to protect. And so what has been found with research is that stronger feelings that are anger, frustration, guilt, shame, all these really strong feelings, alert the protective mechanism. So it actually sends stress responses when we use that kind of, when we imprint those deep feelings. Whereas if you're happy, if you're feeling calm, if you're feeling that, that's not going to get that indicator on high alert, right? That's how , start desensitizing a sensitive nervous system, again, by creating safety. And this isn't just like floofy out there, like really creating safety through education, through understanding how emotions can dial up or dial down, our nervous system sensitivity. So we implement all of these things and till it starts to become a whole picture, and until it starts to become a practice, till it starts to become, oh, we're having beliefs about ourselves and I'm going to choose not to give that one power because I have skills that I can use.



Oh, Dr. Adrian and Helen told me about this breath. You know what? I'm just going to try that. Right? So we start, a lot of it is creating safety around fears. And some of these fears, what we call the dangers in me, are hard to find. Some of these could be going to the doctor and maybe having an outdated practitioner, maybe giving you some bad advice or maybe not believing you that you were hurting. So then we create safety around that. We create new experiences so that your protective system isn't on high alert. So it's really interesting how we can just start to learn about the nervous system, all the things that we can do kind of what I say, like ramp up or bring down the heat. Yeah.


Dr. Adrienne Youdim 

And you mentioned COVID and I think a lot of the symptoms that people are having post-COVID, whether it is because of having had COVID actually and having these, long COVID symptoms or it is a response to the high level of stress that people experience. Sometimes these symptoms are one and the same. And so how can you tease out, and does it even matter that it's because you had COVID and it's long COVID, or you may or may not have had it? And it's just a response to COVID, meaning a response to what we experienced collectively in the pandemic, symptoms like racing heart, brain fog, sleepiness, bodily fatigue, insomnia. These are symptoms that people are complaining of quite commonly now. And the million-dollar work up does not give them an answer. They did have maybe COVID, so maybe it's a long COVID, right? But maybe it's just what our systems have been?


Dr. Helen Porat 

Absolutely. I mean, it's like here we are a few years later and we really are, and I'm sure that you are in your practice seeing this shift in what patients are experiencing. And I think that it is this chronic state of fight or flight that maybe not right away you see it, but now we're seeing the adrenals and that's actually something that can be tested, right? Like that, like a lot just, it starts where you really are seeing that people are now feeling the effects of what was a huge stress episode, where we talk about fear and we talk about that protective mechanism. There was a lot of fear, there was a lot of anxiety, there was a lot of anger, and now we are seeing the effects of that for sure.


BRINGING AWARENESS TO BAD HABITS THAT CAME ABOUT AS COPING MECHANISMS AND GENTLY STARTING TO TURN THIS AROUND TO BUILD BETTER ONES

Dr. Adrienne Youdim 

Yeah. And so the point would just be that really these are practices and principles that everybody should consider because everyone to some degree has had, has been impacted. Even those of us who feel like we were in place of privilege and didn't have the same degree of impact as others, everyone to some degree has been impacted. And so therefore everyone to some degree would benefit from these practices.


Dr. Helen Porat 

I think. So. And then I would just, again, I really like to get curious and like detective work about our own habits. It's like, what are habits that you picked up? Were you kind of going more for that anesthesia effect like drinking, numbing, netflixing, scrolling? And so all of these are signs of like, oh, not just because we got lazy and we started drinking wine every night, but like, these are coping, these are numbing mechanisms. And so again, bringing awareness to that and seeing where you can make a shift, let's awaken some of those parts. And it's not always pretty. Like you've seen me talk about, like that's hard work to do, but just bringing awareness and starting to be honest with ourselves as we kind of move forward as to where we can build better habits. For sure.


Dr. Adrienne Youdim 

We talked a little bit before we started about shame and what role that plays. And I think about that all the time when we think about labeling, when we talk about numbing, numbing to me makes me think of addiction. And then addiction to me makes me think, well, there's a backlash sometimes because not everybody characterizes themselves as addicted to, but I think it's important to just note that this idea or concept or strategy of soothing is very human. And whether we label it as something or not, to your example, the alcohol for example, there were statistics that 17% of women during the pandemic flipped into a kind of excessive use or alcohol use disorder. Whether we use those terms or not, we can be curious about the things that we have picked up in excess that don't necessarily serve us, whether that is something like alcohol or whether it's something like just Netflix that is impacting our sleep.


Dr. Helen Porat 

Absolutely. And again, I think that when we can do that in a way as being an observer, it's really hard to just be an observer without judgment. But when we can successfully be an observer of our own habits, of our own self-talk, really without judgment, right? And so now we're taking some of the shame, we're taking some of the, I'm doing this because I'm right. Some of these like false facts that we can make up and we just say, oh, I'm like, education, right? Is so huge. So that's why I love anybody that will listen to learn about their nervous system. This is stress. You're doing this because stress doesn't look like how you think it looks, right? We all are under some kind of chronic micro stress because we live in a technological world. We're trying to do it all.


And so just making friends with that and having self-compassion of, oh, I picked this up. This is a stress habit. Okay, let's see if I can replace it with some other tools that I have. So yeah, I love that just kind of taking some of the guilt, some of the shame, some of the labeling out of it. Because really that's where you're going to find success and that's where you're going to find your body's going to respond better from a nervous system standpoint, because you're going tobe tapping more into that parasympathetic nervous system that we're liking and that's going to actually get rid of the stress to give you success for it.


Dr. Adrienne Youdim 

Not just, as I said, it's not just the nicer thing to do, but it's the more effective thing to do, right?


Dr. Helen Porat 

Yeah. Like, the more effective, just cause it's science, right? This is just from a scientific successful standpoint. Yeah.


Dr. Adrienne Youdim 

We have just a few more moments, but I want to just shift quickly a little bit to your other background, which is that you were an athlete and so that is part of your past. And, I want you to just talk a little bit about exercise and movement. One of the things that I often say is, I wish that exercise and weight loss could get a divorce because oftentimes they're tied, one does not lead to another, and then we throw the towel in on moving our bodies because it's not necessarily changing the numbers on the scale. We also know that, by and large, we are sedentary people. We don't really move, and then exercise or movement becomes intimidating. So can you speak to that huge demographic of us who are not moving regularly? How can we make this more approachable? How can we make movement more accessible? What kind of guidance can you offer?


FIGHTING OFF A SEDENTARY LIFESTYLE BY USING JUST YOUR BODYWEIGHT WITHOUT NEED FOR HEAVY WEIGHT TRAINING

Dr. Helen Porat

Really just starting anywhere, starting with the movement snacks, right? Getting a body in motion that stays in motion. So starting with the movement snacks, setting a timer, no pressure, not even asking you to do anything different besides the actual moving from your desk, standing up, moving around, getting a glass of water sitting back down. And then the other one, and I do this with my chronic pain patients that really their nervous system can't handle a lot of movement because they're in so much pain. So we start with five-minute walks, timing. I don't care if you feel good, I don't care if you want to do 10 minutes, we start at five minutes. And then from there we figure out how their body responds and we work till 10 minutes. And so walking is a great place to start. Our body likes it. Our nerves like blood flow.


Remember, our nerves are like little hungry vampires that need blood flow. They're only going to call to your attention when they haven't gotten it. So walking is great for that. It's also great for our nervous system like we talked about. That would be a great start. Another thing that I would say is that exercise doesn't look like the way that Instagram makes exercise look like. We now know with studies that you don't need to do heavy weight training to build muscle mass. Realizing that for men and women, but especially for women, we have got to build strength as we age. If we want to talk about blood glucose regulation, we are now understanding the role that muscle plays in so many other systems. So really coming from that standpoint that you can start doing self-body weight. I always recommend Pilates, Mat Pilates. It doesn't even have to be the one with bells and whistles as a great place to start. I have women of all ages doing Mat Pilates. So that one's great. And you know, there's some pretty affordable ways to do that online. With these apps as cheap as $20 a month. So yeah, just realizing that you don't have to be doing heavy strength training. You can still be having huge benefits from your body by just moving and starting to build strength. Yeah, absolutely.


Dr. Adrienne Youdim 

This is just stamina building, for so many people who have gone out of the habit of exercise. I love when people reiterate the notion or the truth, rather, that five minutes of walking really is effective in starting to make those changes that people are looking for. In fact, there was a study that showed that seven minutes of movement a day, prolonged life. Seven. Yeah, amazing. It's tremendous. Right?


Dr. Helen Porat 

Amazing. And you know, it's like, it's really one of those things that it builds off of each other and there's going tobe days that feel harder than others, but if you can make a commitment to yourself of just starting with five minutes, I think we can all work on that. And when you do start feeling the effects of feeling good, it's like anything else, you're going to want to do more. Your body's and your brain is going to start taking you in the direction that's going to seek the right thing for you, right? Because we crave it when we start feeling good. And so you go back for more. For sure.


Dr. Adrienne Youdim 

And that just makes me think of the motivation as well, where it comes from. It doesn't come from being inactive, it doesn't fall upon you, right? Like fairy does. Motivation comes from doing the thing. And so I think that's also a good point. Once you do it, you start craving it, but not before you start doing it. Right. A little bit of a leap of faith.


Dr. Helen Porat 

Absolutely.


Dr. Adrienne Youdim 

So I think there are going tobe people out there who are going to want to reach out to you whether or not they've been dealing with chronic pain and are looking for a pathway out of that. Or there are people who really are seeking to be more mobile and more active, but just haven't done it for so long and want a compassionate way to get their foot in the door. Where can people find you?


Dr. Helen Porat 

You know, Instagram, I try to be pretty active on Instagram, so they can definitely find me there @brainbodypt, or I think it's @brainbodydpt. I'll send it to you. And yeah, that would be the greatest place to reach me at. Obviously I have my solo practice here in Dana Point, California. But I've been really loving my online practice. So I have a 12 week group program that takes you through three phases to regulate your nervous system, to get a fully functional breath pattern and to activate your core, to reinforce that regulated system. So really great for all of my mamas, I don't care if you're 10 years postpartum or 15 years postpartum, really working all four parts of your deep core at that last phase. So I've been loving doing that and definitely, yeah, just message me anytime. Thank you.


Dr. Adrienne Youdim 

Yeah, I'm looking at it right now. It's brainbodydpt, and we'll put that in the show notes so people can go there. And I do love your content. It really is intriguing the way you bring together these various concepts seamlessly into your practice. So thank you so much Helen for spending time with me today. This has been a lovely conversation.


Dr. Helen Porat 

Thank you so much for having me. I enjoyed talking to you.


Dr. Adrienne Youdim

It's my pleasure.




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Adrienne Youdim MD

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