Pain science with Greg Lehman: the cup, tenderness and movement

So you're poking everything to find what you call a restriction or an adhesion. And I think what we did is we just pathologized normal, like normal tissue tenderness and normal tissue tightness and normal tissue. And if you poke anyone, you'll find 30 different spots that are sore. And this person might never have complained of pain. And now you've said, oh, my gosh, look, you're so tender there. It's so sore. It's so tight. So what are you doing to people? You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery.

And now your host, Dr. Sebastian Gonzales. Hey, guys, it's Dr. Sebastian Joss, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is going to be part four of a five-part series that we've already done three of for the Pro Cairo Online CE online education. Okay. There is online education tools that I was a big part of making. All right. I may not be a part of the content creation in this, but me, Ben Ramos, and Philip Snow all put it together because we believe there's a big need. There's a big need, a void of quality online curriculum, really, for us to advance our learning because we can't go to workshops all the time.

Not a lot of them offer CEs. And so the first week, I interviewed Ben Ramos, and then we went to Philip Snow, and then James Valkersel, and this time it's Greg Lehman. And so Greg is going to speak some about the biopsychosocial methodology of working with patients as well as some pain science. And so I like to think of it as the thing that I got from really interviewing and talking to Greg is that he's so calm and chill and he communicates really well. All right. And although there are sparks, there are mechanical sparks that create people's problems, there's also fuel which drives it. And so we talked about the cup analogy in our conversation, which he does cover in the curriculum as well.

And so listen to this. Gather everything you can. Know that it's an experience. Listen to it and feel the experience if you're a patient. And just maybe we can all improve overall with our communication style. So if you've not been to this podcast before, just know that there are tons of great things back in the archives. If you've not been back there already, you're missing the boat. I mean, we're up until like 150-ish right now. I'm not sure which number this one is exactly. But I've interviewed a ton of great people. So please go back there and pick which ones that interest you. I have a lot of people who listen to literally all of them.

All right. And I've learned a lot over the last two years of doing this podcast as well. And so please follow me, follow along with me in this journey. And I think you'll learn a bunch. Now, if you are not familiar with the format, I like to share a little bit about myself just so you guys can get familiar with who I am as your host. Because if I'm taking you on this journey, I hope that you're going to like me. And so we'll do that in a little bit of a short format right here. And then we'll get straight into Greg's interview. So I don't know what the first thing you guys really remember when you're alive, actually.

And I think I remember mine. And I think it was the traumatic experience that I really remember. And so when I was growing up, we had this house that actually my parents do still live in. And it was just configurated a little bit differently. And so down the hallway, there was actually, there was kind of like a fake plant planter. I remember there was like styrofoam in it. And then you'd stick all these little like ivy kind of coming out. So there was ivy all down the hallway. And so it had a little boxed up box, kind of like a planter did. And under the bottom, there was nothing. So you could go under it if you wanted to.

And it's probably about like two feet high. And so I don't remember much before that. But I do remember at one point running under that thing and I hit my head. And I think it's because I grew. And so kind of I think that's the first thing I ever remember in life was just hitting my head on a planter. And so what is the first thing you remember? Anyways, that was just a little bit about me. A quick story today. And so let's get right into the content. All right, everyone. Welcome on Greg Lyman. Greg, how's it going? It's awesome. You? I'm good. I actually, I know we've been back and forth on this for a little bit to try to get this nailed.

You're a busy dude. Ah, just some weekends here and there. Well, I'm glad I nabbed you now because we have the, so that online curriculum we put together, I was doing a series of all the presenters. You're fourth on the list and we still have one more, but it's going to release really quickly here. So we had to fill that void. Fourth place. Not bad. Fourth. Fourth, yeah. You were almost at the podium. I dismissed the medal. I dismissed the podium, yeah. Okay, maybe there'll be a positive drug test and I'll get it seven years from now. You're right. Actually, so do those people actually get the actual medal?

Really? I think Kara Goucher, like she's a runner, American runner, and Shailene Flanagan, I'm pretty sure both them. There's a Canadian cross-country skier, Becky Scott, they did it, yeah. Do you still get the Wheaties endorsement though? No, that's what's horrible. Like it costs them a lot of money. I mean, sometimes they do a little mini ceremony, but the opportunity cost is, well, it's gone. Yeah. It's horrible. Well, maybe that they make the talk about it later, they can go on The View and Oprah and everything, then they can still make something from it. Yeah, maybe, but if they're going to get an Oprah, then they're already making money.

So, for all the listeners who aren't familiar with your work and who you are, can you tell everybody a little bit about yourself and how you kind of came to think how you do about patient management? Yeah, so I'm a clinician in Toronto. I'm a physio and a chiro, and I guess technically a strength and conditioning coach, but I don't work with teams anymore, just individuals. But a long time ago, I did work, when I did my master's in spine biomechanics, I did work with the basketball team and hockey teams after that. So, my clinical approach has been always biomechanically oriented. I mean, that was my master's and my undergrad and the stuff that I loved.

But even when I was quite young, I knew that there was psychosocial aspects to pain and injury. And I was always taught pretty young to question a lot. I mean, my brain mindset is to question things. That's just what I always do. So, it fits well with my practice style. But I had a lot of good mentors who helped me avoid a lot of the difficulties that many clinicians go through, where they spend a lot of time learning things and then realize none of that matters. Yeah. People love the growing pains a little bit, huh? Yeah. And I think I avoided a lot of them because I had just good influence. And I read from a vast, like a wide body of literature.

So, I was pretty lucky to avoid that stuff. I made mistakes, but not massive ones. I do hear that mic rustling that we talked about a little. Oh, sorry. Yeah, let me know. Okay. I think we just have to do a clip and like put it to your hairline so it dangles by your face. I think I had my hand up on my headset moving the mic. Yeah, I think you leaned back and it was a shirt rustle. Yeah, I won't move. So, can you, oh, keep going. I didn't mean to interrupt you. No, no, that's it. But we'll get into, we can get into more. Okay. And now I'm in practice still. I just, I left like the big practices I was in working with others and medical doctors and stuff.

And I just have a tiny boutique. Someone, a patient was in yesterday and we have to walk through my garage to get to the clinic. And they're like, it's rustic. I'm like, okay, that's it. That's going on my website, my rustic boutique. She had to walk past my garbage bins. Yeah, well, it's the. And then I just travel and teach. Yeah. So, how many days are you working in clinic now? I'm just curious. Or in your spot. Like, it'd be like a morning here, an afternoon there, like an evening here. It's pretty flexible. Right now it says Tuesday and Wednesdays, which is what I always wanted to do was be in part-time practice.

But I got too skewed when I was young and I was in full, well, you know, you're in full-time practice for 10 years. And you're like, what happened to my research goals and teaching goals? So, now I finally, I'm a little skewed toward teaching now, like too much. So, I'm going to start teaching less and see more patients again. Yeah. I personally kind of run into the route where it's like, I mean, like you said, it's hard to dig into literature. But it's, I feel like more of my questioning presents itself when a patient's in front of me. And so, they kind of like go hand in hand for me anyways.

Oh, yeah. Absolutely. Mm-hmm. So. I mean, it's always humbling. It's humbling to be a clinician and that should drive your reading or the courses that you take. You know, the problems that we all have. So, it's important to keep seeing patients just to remember you still suck sometimes. Yeah. Yeah, right. I remember there's one person I had that I swear I knew what the route I was going. And I think I had every exercise toy out on the floor kind of like a dog that had just unloaded the bend and still didn't find what I needed with them. You know, I want to ask you actually with, I listened to your, I listened to a lot of the podcasts you did, but as well the curriculum that you did on our forum.

And your communication style is very soothed, very calming, very good. And I would, I feel like it's, it's, I feel like it'd be really good for patient care. I mean, it's, it's, you know, threatening with the words. It's very, so did you, did you, were you always kind of like that or was there a certain style that you kind of started migrating towards? Uh, I, I've always, I've always wished I could be a little more arrogant, like with my patient style. I've always been, like, you know, when people just say things with such certainty, I, I, like, I feel like I know a lot and I've read a lot, but that in turn makes me, you know, a little naturally self-reflective.

And I, and so I've always passed it on to my patients and I think they appreciate that honesty, but I'm sure there's a subset of people who just want to be told, and I don't know who they are until later. Like, this is exactly how it works. We're going to do this, no questions asked, and you're going to be fantastic. That, that sort of like arrogant confidence. And I, I think that works for some people, but it was never, never my style. Mine was always more reflective and getting them involved and figuring out things we could do together. Yeah. And do they ever, um, so when they, do they ever stop you at the end and they're like, Hey, so what would you do in my situation?

Or they kind of want a little bit more of that direction or they always. Oh yeah. So I have no problem giving a strong, like, and I still give strong opinions with confidence. I just, I am, I always like the idea of giving people that there's other options, but if, if they ask that specifically, I certainly lay out what I would recommend, you know, what it will take. But I do like the idea of, uh, when you give a treatment plan to someone and propose it, I do like the idea of saying that there's other options as well, because that's empowering. Like, it doesn't mean like there's so ruin, there's only one way to fix this, which is totally unfair.

Um, and, and it also opens you up where sometimes things don't work. And, and so your patient two or three months down the line, nothing's improving. You're like, this is, that's okay. There's other things that we can do. Maybe I can help you with them or I can set you up to see someone else to help you. Yeah. So having that, like, I don't know if that's like, uh, just being like modest or just being like aware of how there's lots of ways to treat things. So I'm not sure how to define that. Yeah. No, I think that's, I think I had a patient or actually in the day that they just liked, um, like there was honestly something that we, I don't think I would be able to help her with.

And I just tell her like, like, I don't want to lie to you about it. I don't want to overpromise, but at the same time, I need disinformation to see if you're going to be my ballpark or not. And if I can't help you, I'll, I'll, I would love to quarterback you and help you along the way. But she was really refreshed to hear that someone didn't have all the answers and they're willing to, to delegate out anyways. Yeah. So, uh, when, um, the, the thing I wanted to ask you personally for myself was that I, I know that there's, I have interns that come in in the office here and it's, uh, I feel like a lot of them coming out of school.

They have an idea of something needs to be the problem in somebody, um, cause we learn anatomy and all that type of jazz. And, and I feel like, you know, the, the pain science and biopsychosocial effect, it kind of like dips into the other realm. How do you marry the two together? Um, personally, uh, and how would you explain maybe to an intern? Yeah, I, what I like to do is to acknowledge that there's a lot of interacting variables when it comes to pain. So, uh, I rarely, I'm trying to think if I've ever discounted the role of the body or nociception, like probably never, you know, so I like to, you know, I use the cup analogy, which is in the book and which is, um, and, and of course in the course, which is, you know, pain is when our cup overflows.

And what's in the, and this of course is a model, it's probably not accurate, but you know, what's in the cup is all of these potential contributors or mediators or causes of pain, uh, or stressors in your life. And so pain occurs when your cup overflows. So treatment is either building the cup up or decreasing what's in the cup. And so when I talk with patients, I'm like, so you have this, this shoulder pain, you have a scan, the tendon, as the doc notes as tendonitis or something. And we'd be like, that can be part of it. So that can be a tendinosis. It doesn't have to be everything. So we, we put that in the cup and then how you expand on that with the biopsychosocial is like, well, what are the other factors?

That are influencing your sensitivity related to that tendinosis. Because what's cool is three months from now, we can do rehab. You can be completely out of pain and doing fantastic. And you still have that tendinosis. So, you know, you, you coped with it. So there's lots of different ways where we can build you up. So I think a lot of treatment and your students are right. They're kind of taught, we got to fix things, right? We got to find something to fix and then get rid of it. And I don't think we really do that. I think that's like the least thing that ever happens. I think treatment is more about building up a resilience and tolerance and coping with these things we often think we have to fix.

Sorry, that includes the biopsychosocial mediators or pain. That includes rumination, catastrophizing, low self-efficacy, depression, anxiety. Those things are hard or impossible to fix. So we just acknowledge that they're variables. And then we build up other coping strategies for them. I feel at least patients are very, like a lot of them are very keen to, well, this occurs when I'm stressed out. So I don't think it's a foreign idea to them. Like, I know that, like, again, work, I feel like I've been conditioned to, I came from a soft tissue background. And so we just do soft tissue, anything, you know, like make the person better, fix a problem.

And I feel like there was a lot more to that. And also the confidence, I think, in approaching somebody with at least a solution, I think it was helpful as well because they want to feel like they're in good hands. Mm-hmm. Yeah. I mean, I don't think there's anything wrong with manual therapy. But I think it often works for a few different reasons. Like, one, I think they're special about short-term fixes, that they actually really do help people for a few days. And since a lot of pain is just going to not be serious after a few weeks, that few days of help really is a real change in whatever the person's feeling.

And then there's the other argument with long-term persistent pain. Maybe it's just something that you do because the person expects it, and then you get to add on all of the other good stuff. Mm-hmm. And I found that's what I was doing a lot in my practice, the short-term fixes for non-serious things, and then, like, the rubbing with my mouth theory where, like, I'm doing manual therapy, but it's the shit we're talking about. Yeah. Has there actually ever been anything where you thought, I really, really don't want to do this, but the patient's asking for it, I'm going to do that, and then talk about it?

Oh, yeah. Yeah, yeah, yeah. And I've also not done it and had, like, really tough talks about why we didn't do the manual therapy. And it's usually when, like, you think that their belief that they need manual therapy, that's what's somehow driving their sensitivity. And if you keep contributing to that belief, then they're not going to get out of pain. But if you think that belief, oh, just do this for me, it's no big deal, I really want you to. And you're like, oh, you don't need it, but sure, it's not going to harm you. And you don't have some belief that's ruining them. That's, like, I have no research on that.

That's just a total judgment call. Yeah. I did pick that one thing up from the presentation you gave, is that their belief system could be detrimental or favorable or didn't really have an effect. Is that something of that nature? Yeah. We always talk about, like, we've got to correct these false cognitions that people have. And I would say, you're going to have a shit ton of false beliefs, and they're not always harmful. And you can't go having an argument with every single person you run across. It's just not worth it. So you've got to, like, make, and I don't know how. I mean, I have a slight idea how, but it's not validated.

I don't know anyone doing that research. Like, when you make that decision that that false belief is getting in the way of recovery, that's, yeah. But we make these clinical decision-makers all the time. That's when you have more of the conversation, is when you feel like that belief system is hindering their recovery. Yeah. Like, so usually, like, one rule of thumb is they have some. So let's say you think that it would be really helpful for this person to start spending more time with their friends and going out and rock climbing or exercising, whatever they love to do, but they have a belief that, you know, activity is harmful and they need to rest and recover and they can't do any.

Like, pain means a stop as soon as they start to feel discomfort, right? Those would be a few false beliefs getting in the way of, like, healthy behaviors, right? That would be, you know, the biggest rule that I would have. That's an easier one. I'm just thinking right now that back in the day, like, when, you know, like, when you, like, before we started treating these things, I guess it's probably 500 plus years ago. Oh, probably more than that. Did people just kind of get hurt and just stop doing things or is this like a new, like, because I had, I had a patient that came in one time that he, uh, he had, he had some back pain and he was talking about how he's like, I don't think I'm going to go hang out with my friends and I'm like, why not?

And he's like, cause my back hurts. And I'm like, well, what's that got to do with it? You know, stand, you know, um, did that, when did that start? Like, I don't know if you have an answer to that, but I, I feel like it's like a, maybe it's a natural thing. People, people are kind of installed in people. Yeah, there is a big argument that we've created a lot of the suffering disability associated with normal pain, this type of back pain that we all get. And what, what we've done over the past hundred years is, is made people worry about it a bit too much and then withdraw because you wouldn't have the option.

And I would assume, depending on your status and society, just to withdraw and stop working, doing the things that are healthy. So I believe there's like some Australian or New Zealand, like, uh, research on how, um, back pain in some cultures, like before medical intervention was common, but, but suffering and disability was low. And then when the medical interventionists come in and try to decrease that low back pain, they actually increase the suffering and disability. Oh, cause you're like proving that it's there kind of thing. Yeah. And they try to intervene in it. And then when you intervene and you keep talking about it, you make a bigger deal about it.

And I don't want to minimize that. There are some people with just ridiculously debilitating back pain. And there's probably been these people throughout history with severe neuropathic pain or something like that from a radiculopathy. That's just very hard to treat, but it's the other things where we turn like normal pain, you know, that's still horrible, but we turn it into something just disabling. And I think that's the majority of them, I would imagine. That's, that's the idea. Like, yeah, if you look into workplaces, when they go in and I used to be sort of an ergonomist, you know, we go and teach people how to lift and do all these interventions.

And these things in general don't seem to have a strong effect on low back pain. And there's always these cases where it backfires, where you go and teach people about low back pain. And then suddenly the reports of low back pain spike. Yeah, yeah, right. Yeah, that's not uncommon. Like when I was in occupational biomechanics 20 years ago, we would hear these stories. Yeah, that's funny. I think, yeah, you got to choose your words wisely in that, right? Yes, unintended consequences. Well, that's, that's interesting. Yeah, I think, is there, do you think following that route then, is there, is it just that we're making it known and we're doing provocative tests and documenting?

Or is it the, I know, like some sides, there's the med legal, there's the workers comp, there's the, I guess you got to be a victim to be paid in some of these things, you know? I'll stay away from that one. I think that's super complicated where people have to prove that they're really in pain and sore. That's a problem. There's, it's not their fault, but there's competing interests. And I understand what people go through there. But I think at an individual level, especially as a manual therapist, which I am and certainly was more, we, we, well, what do you do? Like, I used to do active release technique.

So you're poking everything to find what you call a restriction or an adhesion. And I think what we did is we just pathologized normal, like normal tissue tenderness and normal tissue tightness and normal tissue. And, and if you poke anyone, you'll find 30 different spots that are sore. And this person might never have complained of pain. And now you've said, oh my gosh, look at, look, you're so tender there. It's so sore. It's so tight. So what are you doing to people? And I think there's a subset of people that we've messed up. I don't think it's a massive amount of the disability that's out there, but I think there's a subset that we've, we've, we've created with our, uh, our assessments like this.

Do you, do you think in those, um, say in a form like that, when you are poking and prodding and you're eliciting like a normal response, it might seem pathological to the person. Can you, is there a, maybe communication styles you can use to say, oh, well, like, you know, like I've heard some people come in and saying, oh, someone told me that I have the tightest upper trap I've ever seen. I know. Is there a way to kind of calm that out of the patient? Yeah. Diagnosis, human, right? That's the, that's it. Uh, you know, like I always tell people, go poke your friends, uh, like a 1970s swinger party, but like, uh, uh, just start, or if they got kids like, uh, at a year and a half, all of my little girls would be sore when you poked them in the traps and a five, they're telling you to fuck off.

My kids are precocious. Language skills are excellent. Uh, actually they don't swear. They think it's dirty. It's funny when you swear as a grownup, your kids, they, they don't want to do it because it's not cool because their old man is swearing. Anyways, uh, except the five year old, but anyways, uh, uh, so the, if you start poking anyone, they'll report that they're, they're tender. So, you know, if you're working with a runner and their, their calf is tender on the inside of the, of the tibia, push on the other side and you'll find that they're sore in the same spot. You know, not always the same, but you gotta, you gotta normalize this if someone's really worried about it.

So some people get super hypervigilant. We want to like, we want to validate. Yeah, it's real pain, but no, this, you shouldn't expect it to be 100% gone because that's just not going to happen. And then if you have that expectation, then you're always going to feel messed up. I would imagine goal setting then at that point is like, like there's, there's still some discomfort there. It's normal, but can you do what you want to do? And are you happy? Yeah. It's the same with low back pain, right? Like you can have people have those big flare ups and, uh, you know, they're just disabled for a few days and they're like, well, how do I prevent this?

And I would say it's probably unlikely that we'll prevent, you know, you having recurrences of low back pain, but what we can work on is taking you from the 10 out of 10 that you feel down to the three out of 10. So you're going to have a flare up because everyone does. Everyone has episodes of low back pain, but now you're going to have normal low back pain, quote unquote, where you're just not ruined for that week. And that's that, and that goes back to that cup analogy where we have this tissue sensitivity that we all get, but how do we like keep it out of simmering pot rather than it boiling over?

I imagine it as a solo cup for some reason. Yeah. I just threw the pot in there. I'm mixing my metaphors now. It was never boiling, but it's, that's that enough, like this idea. It's like, you know, vinegar and baking soda, right? You can have vinegar in there, but sometimes you add that little bit of baking soda and poof, you know, it's, it's multiplicative. That's a word rather than additive, additive, whatever it multiplies rather than just adds chain reaction. Yeah. We don't want those chain reactions. We want to just be able to have a little bit of pain and not have the whole system freak out.

That's a huge success for me when I'm working with patients with persistent pain. I think that's awesome that people can do stuff with pain, but without it being disabling and demoralizing and, you know, they're ruined for days. I remember I had this one gentleman that came in that he had, uh, he, he had had, uh, chronic ongoing pain for about 30, 30 years. I think I wasn't really able to help him. Um, but after working with him for a little bit, he was, he always came in and he was so happy, like always happy, like the cheeriest dude. And finally I asked him like, I'm like, you're, you're in pain all the time.

Like, can I ask like how you're so happy with this? And he's, and he's just like, I don't know, it's just not in me to be like a downer or something. Yeah. And so it was, I was interesting that he could, that, that he was like that when other people are very different when they're in the same type of situation. Yeah. Was he disabled or was he suffering? No, he was working. Well, he was working. I'm sure he was suffering to some degree. Yeah. It's, it's actually, that's a really, I find patients like that really tough because in some ways they're, they're successes. Right. And it's why you see a lot of pain researchers who say, uh, we should accept that there will be some people who will have some pain all the time.

It's not fair to say that we're all going to be 100% pain free. And so someone like that, like that, I would have trouble with a patient like that cause he's still doing great. Do you know what I mean? I'd almost say I'd almost part of the treatment would be like acknowledging how fantastic he is. You still get better, but you know, get also give himself a break if they're hard on themselves. Like you're doing really well, you know, that's kind of setting goalposts, changing the goalposts a little bit different there, which might just be us excusing our failures, but, uh, you know, it's okay to give someone a pat on the back.

Interesting. Yeah. I didn't think of it that way when I'm going through it. I, uh, I was happy that he, so he committed to some care. I had him for a little bit of time. Um, and so I kind of took that as like his acknowledgement that he could do a little bit better, but, um, yeah, interesting. I'll, if next time I get one like that. They're tough because a lot of my treatment is, is, is resuming meaningful activities and doing the things that people love. And sometimes you have those patients who are doing all of that stuff and then you're like, Oh, this is going to be hard. And they, and they actually have really good beliefs about their back and they don't really feel like they're damaged and weak and frail.

Their back just hurts. Right. And that was, those are tougher ones. And that, and that's why I still get excited with the biopsychosocial because you're like, okay, what are all of the other potential contributors here? And what are all of the things we can work on? And, and for like the listener, like a really simple question that people can ask, and I'm going to create like a, I don't know, something on this, I don't know, maybe on Instagram is like the, a good question to ask is how can you be healthier? Right. And it acknowledges that health is everything in our life. It acknowledges, we don't really know how pain interacts with everything in our life, in our life.

So how can we make like the best person, you know, possible? And then maybe, you know, that can contribute to less pain, right? Because it's such a, such a complicated thing. When you've worked on all the other little specific nitty gritty things, you know, but working on that as well at the same time. It seems like you just take like the, the overall like elephant in the room. It's like, I don't drink any water. I think I'll drink some water. And so just an easy way to get help, to get healthier and to see what the effect is. Yeah, it could be that it could be like, if you look at the definition of health, which I don't know well, you know, it's, it's, health is biopsychosocial, right?

It's, there's the social component of health, you know, there's a spiritual, which I don't know anything about, but you know, there's meditation, there's all these things that I don't, I don't work on with my patients with mindfulness, acceptance, breathing. And so to me, I'm like, I'm not a complete therapist. I know that, but, but I will recommend that people try those with somebody else. Like, what are all the things in your life that can make you healthier? You know, hobbies, social activities, exercise, sleeping more, diet. Okay, let's work on all these. Number one, it's just good in general.

Number two, it can help your pain potentially. Does anyone ever pick something that is like blatantly not like within the category that you would, you would not necessarily think, but they're like, you know what? I need to smoke more. And you're like, oh. Oh, I didn't know you're going to go that way. I mean, smoke what? You know what? Well, I've had, it's gone the other way. I've had people say, I know you're going to tell me to stop smoking, but I'm not going to. And I'm like, okay, fine. Don't worry about it. It's just, that's putting way too much stress on you. If you think that you have to be out of low back pain by, you know, quitting smoking and you know, you can't quit smoking, then I don't think I'm helping you if I tell you you have to quit smoking.

So I'd be like, all right, smoking is one thing in your cup. How can you get healthier otherwise? Because they know, like, this is not an education thing. Everyone that smokes, most people know that it's not helpful, but they're not willing to stop. And I'm not a smoking cessation expert. So I'm like, okay, if you're not willing to do that, that's fine. I accept that. You know, you should. So we'll talk later if you are ready or I'll help you talk to someone else. But what are the other things we can work on? I've had, I've had, I had a couple that's, and we, I had two patients who did that in a row because they were married or getting married.

So that's not unusual. And so again, that's awesome. There's one thing, not awesome, but sometimes there's things we can't change. So what can we work on that we can change? And the biopsychosocial gives us options. There's a lot of options. Totally. The, uh, I, I, I imagine there was a, I'm just thinking about like it was smoking. So some people will say like, you know, I'm trying to find a girlfriend or boyfriend and, but smoking is a complete deal breaker. And so if, if the other person smokes or that person smokes and they really want to find a husband or wife, maybe that's a secondary goal.

Then you can use that as. It's want to motivate change. Yeah. My, well, my wife used to, she was a smoking cessation expert. She worked for, at the military and she was a health promoter. And she, so she did all of these programs and she's like, it's ridiculously hard. Yeah. She's not sure how many people she ever helped. Billboards don't. There's a billboard by my house. It doesn't work. Oh yeah, exactly. Yeah. So they're, they didn't do public health campaigns for that type of health promotion. That was all like individual medication and then these sessions, but you had to do the counseling sessions that she did in order for you to get the medication.

Oh, she was the gateway. Yeah. And a lot of people, well, I just, I am here to talk to you just cause I have to, to get the drugs. That's okay. Um, another thing I think that, um, I, I heard you speak about on a different podcast. I thought it was a good conversation point was, um, demonization of movement or, um, how, like I always see the body is really capable of doing some amazing things. But then, you know, when you say like, oh, there's a perfect way to squat, there's a perfect way to do this. And, uh, uh, I feel like we kind of corral people into those thoughts. Um, and, um, I guess it was winter, when is a certain movement, maybe, uh, something you want to take away?

And then, uh, when is it nothing that you're concerned about? Like when you imagine somebody, it's almost like when we ask perfect or what's optimal, it's, you have to always then say optimal for what, you know, is it, is it for performance, uh, you know, and then, uh, is it for strength or power? So is it just to, you know, produce more force while they're squatting or do you want to squat in a weird way? Because it reflects their goal task demand. Like if, if you're a break dancer or something or a hockey goalie and you go into lots of valgus, then it makes sense to me to train valgus squatting.

But if your goal is just to squat and squat heavy and get, get strong, then it would make sense that valgus for the most part may not be the right movement pattern for you. Although there'll be some people when they dip into valgus at the bottom of the squat, it totally is the right thing for them. So you got to say optimal for what? Um, but if it's for pain to me, I'm, I'm like, this is where I'm truly a movement optimist. For the vast majority of people, I think like the kinesiopathological model, which is there's a right way for people to move. And if you don't move that way, you're going to have pain or it'll exacerbate pain.

If, when I look at the kinesiopathological model, it's just a temporary avoidance strategy. You find shit that hurts and how someone moves, and then you teach them another way to move that doesn't hurt. Right. So I think there's totally a role there, but I would take it a step four. A step further and say, this is just temporary. You can go back to your other pattern of movement, especially if it's successful for your other goals, like performance or, uh, however, whatever your goal of doing the movement is. Yeah. So I, I don't say just if it hurts, just keep moving the same way. I do believe in, in teaching people different ways to move.

Although the research doesn't really even support that. I can't believe that, but it supports it in the short term, just not after a year or six months. I know I had a lady recently that came in that she was a runner. And so she had, uh, she had, she, well, we'll say, we'll say walk run. So she, she ran like a, there was like a 12 minute pace. They do walk run strategies and so on. And it, and it hurt her knee. And so, uh, in the office, I, I did a whole workup and exam. I really didn't find anything. Her knee wasn't going to explode. There wasn't really anything super relevant. And so I was like, go ahead and run.

Let's just see it. So you did. And so she, she's like, yep, this hurts my knee. And I said, go faster. And she's like, oh, it feels better. And she's like, but I don't run at this pace. And I said, can you for a little bit? And, um, she was, she was kind of, she didn't quite understand why I'm like, well, you can walk if you want. Like it didn't hurt to walk, but, um, I'm like, why don't you just scale like 13 or 30 seconds off of your, whatever pace it is. And even either one of them hurt, you can pick above or below. It doesn't matter to me, but I feel like her, her, uh, her pace at that point was, was creating their symptoms to, to keep going.

Um, but she was, uh, she was a little bit reluctant to, to change what her habits were because she was in a group that ran that same pace. Oh, it's tough. Yeah. So it was just, uh, just, just, uh, just a thought when you were, when you're talking about that, you, you have, um, you have people when they're running, um, you ever do something like that or something similar? I mean, I used to teach a running course and I, I still work on gate modifications with people and I use it purely as symptom or stress modification where I'm just shifting stress around. And I'm, I'm, I firmly believe there isn't one right way to run, right?

You have lots of different options and speed is one thing you can change. And it is pretty amazing when people feel better when they run faster. And so if you don't think there's one right foot strike, then it's, if their knees hurts, you can change it to a four foot strike. Although do that super slow, uh, or you can take shorter strides and more steps, or sometimes you have people who are taking super short steps and they might have a cadence of 210, which is pretty high. So you decrease the cadence. So you just get to play around with processing as like Louie Gifford would say. So, and that's, that's the same idea with, with any other movement.

We have all of these different options if you're a movement optimist and then you can have people move differently because it feels better for a bit. Easy peasy. Well, good. Is that, when that would fall into the category of, would that be, uh, her belief was harmful to her recovery or is that a different thing? Uh, you know what? She sounds like an endurance coper. You, you gave her a strategy of like how to run differently to feel better, but there is some other driver like her, she wants to run with her friends that was making her persist into pain when she just needed to back off a little bit.

So she's like an accidental endurance coper that was socially driven. I'm going to DX that. What's the ICD-10 on that? Yeah, exactly. Somebody else might be like an accidental endurance coper. Like say they run on their forefoot and their Achilles are killing, are killing them because they don't have the skills for whatever reason to like shorten their step and do a midfoot heel strike or something like that. Or, or they run on their forefoot because they read a book that they were supposed to run on their forefoot. So both of them are accidental endurance copers. One, because they don't have the skills.

The other, because they, they were told that they have to run on their forefoot. So that's, sorry, go on. So, so with that one then, so the, the management of those is probably the, I imagine the first one, the community-based one, you tell her, you tell her like, go ahead and hang out with your friends after or speed up and slow down and wait for them. Or, or, or in the other one might be, how would you, how would you mitigate that, that one that told, was told to run that way? Uh, I, I, I mean, with someone like a runner like that, I would mess around with their number of steps per minute. Right.

And then, and then the last thing is like, uh, you know, really challenge her what, what she thinks is going on, that she feels better when she's running faster. That's kind of interesting, right? That her, her knee can handle more load, at least per step. I think the cumulative load is less when you run faster like that on the knee. It depends on the part of the knee. Um, uh, so I would give her all of those options. Okay. Right. I can't wait. This comes back. Well, that's, what's fun. You're like, Hey, these are the four things we can do. Right. And we can do all of them. You know, you can do parts of all of these, right?

Maybe once a week you run with your friends and do the speed up once a week. You don't, you wait for your friends after. And the third time per week, maybe you can just run that pace with your friends. And because you've given yourself a break the other two days, you can do your regular thing. And then we're going to do some exercises to build you up anyway. It's like having an eating cheat day. Sure. Well, right on. Um, is there anything else that you want to cover on this? I didn't, I didn't want to keep you too long. Oh, I didn't want to cover anything. And is there anything that you think I could ask better?

No, it's fine. Well, right on. Um, where, where's your workshops going to be, uh, uh, as of this is going to to be, this is going to release in early July of 2019. Um, oh, you know, I have a, I'm in the States a lot. That's what we call the America, the States when you're from Canada. I don't know if you guys do that. Uh, don't bomb us if I offended you. Uh, uh, I'm going to be in like Portland and Syracuse and Washington all in the September, October, November, uh, Washington, uh, uh, state. Yeah. Like Seattle. It's funny. You got to say that Washington state versus DC. Yeah. Cause I am in Washington DC in July, but, uh, as well.

Okay. I think that's it for the United States of America. We definitely don't say that. We can say the red, white, and blue. I think, yeah, we say America. America. Yeah. We just, you cut it off. Um, I think we, Canada is, uh, so we, do we, I think we say great white North, right? Or do you, is there more North than Canada that's great white North for you? Finland? They're high up there. I mean, we all meet up. We all meet up at the top, but I think, yeah, I think Russia is trying to take some of our land up there. They're actually moving. They're moving over. Yeah. Really? They're like, they, that there's a, that's why there's military up there.

There's no conflict. It's just, we have, we have cities up there just to establish an Arctic like base. Yeah, we have NORAD up there, but it's Santa. By Santa Claus? It's because, because there's, it's probably energy and resource rich. Does someone own the country? Every country wants a little piece of, yeah, the Arctic is all, all, um, you know, um, it's attributed to someone. I didn't know that. The word is. Yeah. And so that's why, and every now and then I think there's like people saying, no, no, it's ours. And Russia says, no, it's ours. And we say, well, that's when you take the flag and just put it there.

And then if no one disturbs it, it's yours, I think. Yeah. Sarah Palin did. She's, she could see Russia from her house. That's right. That was a, is that a, uh, uh, there's, there's an area in Alaska that you can see it only certain seasons, I think. Oh, that's so cool. Yeah. Um, how can everyone reach you? Uh, Twitter is the best. That's where I give most of my clinical musings, which is just Greg Lehman, uh, Instagram. I'm doing a little bit more. That's mostly my, my gymnastics. It's my gymnastics diary of old man tumbling. So if anyone's old out there, you want to start gymnastics, you got to use that hashtag.

Just old man tumbling brigade. Just fun. I just did a giant swing. What's a giant swing? You know, on a high bar when you spin all the way around. Oh, when you're fully extended. Yeah. Well, I bent my knees. So my form wasn't very good. Oh, so it was a subpar giant swing or is a, it was a tall kneeling tight giant swing. Well, no, it's fully above par because I didn't smack my face into the bar. So it's not subpar. It just wasn't optimal. Oh, so the rotation was okay. Oh, so you're moving off an optimist on. Yeah. I went all the way around. And last time I went, last night I went around three times in a row.

It's awesome. I think you have, you have more centripetal force or centripetal force when you're more tucked versus extended in that, I think. Right. So it's interesting seeing the video. Like I, I drive my knees up to get over and you should, you should be straight. And it's actually feels easier when you're straight, but I drive my knees to make it over for sure. You're just freaking out. You're not really thinking. When you're over the top, it's kind of like, so when you're in like a ride at the carnival, do you feel your shirt move and start to go over your face and you can't see anymore? Or are you going over quicker than that?

You're going so fast. That doesn't happen. The only time that can happen a little bit is on your backswing before you've done your first giant where you're almost right up in a full handstand. That's the slowest. And then you're like, okay, it's going to happen. And then you get over so fast. You're like, oh, I made it over. That's cool. All right. I'll make sure to take a look at that then. Oh, yeah. So fun. Champoline flips. Yeah. We're right on. I think, thanks so much for being on. This was, uh, this was great. I learned something. Oh, good. Thank you. All right. Thanks so much, Greg, for being on.

That was amazing. That was, uh, I learned stuff. I always learn stuff doing this stuff. So, uh, thank you so much for giving me a little bit of tools to work with, with the patients that I have. So, um, if you guys did not catch wind of that, by the way, uh, Greg is going to be in the States. The, apparently the, what do you call it? The, uh, the, uh, United, not United States. He called it the States. So, uh, he's going to be in the States. So, uh, check him out. I will put a link in the show notes to his website and where he's going to be and so on. Reach out to him on Twitter. Uh, he does put a lot of content out on there.

So, uh, he's, uh, he's going to intrigue you and challenge your thinking. Lastly, if you have not already gone on it before, um, if your birthday is coming up, which is a great, uh, ticking time bomb, you should go to Pro Chiro Online CE because that's where all this content is going to be. It is, uh, again, I know it's a CE program and I know you get 12 hours for it and ethics is in there and all that jazz. And sometimes when we're going through and looking for these on, these online things, it's really because there's nothing else that, that we think we should go to. Honestly, I've, I've said this many times before.

If you take the curriculum and you are wondering about if you can improve your skills with flexion intolerant backs, with, um, discogenic symptoms, with patient management, that whole module is based upon back stuff. And I'm telling you, it'll level up your game. Like no joke, like the workshop that I did, I showed some of the stuff that I learned in that course and, and every person walked away with, with the gem and it changed the way they practice. They're more confident. They can manage people better. And so there's, there's a lot of bonuses in there. And so the, although it is a CE thing, in my opinion, it's not a CE thing.

If you are getting out of school, you should be buying that. Okay. You can buy in little parts. If you like, if you'd like to buy Greg's part, you can just only do Greg's. That's fine too. We believe in the teaser course and each one has a 10 minute section in the beginning, which is completely free. And so you can test run it and just see what you like. By the way, if you're looking for a little snippet snippets here and there too, I do post some on Instagram. So, um, I just want to make sure everyone is aware of that. Again, I'm not a big hard seller. All right. I think, you know, from all these podcasts and I've done, I mean, I haven't made a single penny off of doing any of these podcasts.

Um, but there are products and services that I believe in, in educational, educational workshops I believe in. This is one of them. Do it. Like we created it because it was needed. All right. You need it. If you don't like it, just say something. All right. No big deal. On that same note, uh, I did bring up the concept last time where the possibility that I was going to have another offloading musculoskeletal and neurological symptom workshop. And I thought I would redress that again today because it is still a possibility. And so, uh, just to be clear. So this is July 3rd, July 3rd. Guess what tomorrow is?

The 4th of July. And if you're listening to this late, you're out of luck. Sorry. I'm going to be hard pressed on this thing because, uh, there's early bird discounts. All right. If you go to, uh, if you, if you pay me for the workshop and reserve your seat before midnight, July 4th, July 4th, the best day of the whole damn year, uh, then you get the early bird discount. And the early bird discount is $500. All right. Uh, if it's after that, you're going to pay the whole price. And I'll be honest with you again, I don't want you to pay full price at all. I don't want you to pay more. I want you to pay 500, but I know how things work with people.

Unless you give them a deadline, they tend to not do it. And so I want to make sure that the people who want to come are serious and the ones who want to reserve their seats and learn more about how to reduce symptoms in, in a more calculated way rather than just passive care. Um, I want to make sure they're able to come. And so here's the rough details on it. Again, uh, at this point of recording, I don't know what the date is because I'm recording this thing in mid June. And so, uh, or at least this part of the podcast here. And so, uh, uh, if you're interested in the exact date, it's going to be closer to probably August 24th or September 7th.

It's going to be a single day seminar. Um, there's no CEs involved. That way I can just accelerate the process. We can come and go as we please. We're going to have a good old barbecue and drinking beer or wine. Or cheese or, um, but for the people who don't drink, we're going to have spin drifts there, right? You're not obligated to press. It's not going to be a rager. It's just chill, right? And so we're going to have some tomahawk steaks and everything. Last time I grilled three tomahawk steaks, we had a handful of people back at the place and we laughed so hard. Uh, I haven't laughed that hard in a long time.

So if you're interested in doing this and you are interested in having a better, doing a better job with your hip patients, the ones with hip impingement or what you think possibly a low grade labral tear. If you're low back patients or your morale to parasitical ones, the hip flexor, uh, conditions, uh, or people with running populations, runner's knee, hamstring strains, foot issues, kind of heel pain or, uh, plantar fasciitis. I'm going to be covering a lot of these things in regards to running populations or just, I would say, let's say weekend warriors or athletic professionals, not professional athletes, like the real people you see.

I'm going to show you how I go through many of these people, many, many of these types of cases without even really using any manual therapy. Okay. I do, I do use manual therapy, but I think we have a really great window of opportunity in the very beginning to work with people in a very empowering way. You show them how to reduce their symptoms based upon positions, postures, loads, uh, management of loading, uh, and as a medicated dose, if you give them one thing to do only, uh, for about 10, uh, 10 minutes a week and they do it in office with you, actually the medicated dose is much better if they do it throughout the week and they're able to, they're able to decrease their symptoms.

And so it's been very empowering for the patient and they feel like, dude, I, I'm in control of this thing. Right. And so they're going to get, we're going to get them loaded. We're going to get them strong. They're going to be resilient and they're going to get back to their sport. They're traveling on the running. And actually a lot of people that I've worked with, they actually run a little bit quicker afterwards. Right. Cause we reintegrate them back as a sprinter at least first and we start to scale their mileage appropriately. And so if you're interested in this, in this type of thing, and you really want to level up on your, on your corrective exercise to a load, to return to sport for your weekend warrior types of people, this is going to be great.

I'll drop clinical pearls and whatnot, but I'm not going to go over how to do manual therapy and so on. But I will show you lots of clinical pearls of how I successfully can do this with patients in my office. So, uh, if you're interested in this, the deadline again is tomorrow, which is July 4th at midnight. If you miss it, I will be hard pressed to collect a little bit more. All the details are going to be in Instagram. You can go to at performance HB, uh, or if you want to just email me, seb at p2 sports care.com. And again, the rough story on this is, I, I don't know if I wanted to, I didn't know if I want to do this again because I didn't know if I want to deal with the, uh, accreditation process.

And I, uh, it was just cumbersome and it was long. I spent months writing this curriculum and there's about 400 slides to cover. And I, uh, but, but the long story short, I had such fun doing it. Like everybody, like the response I got, people, people go walked away with really good things and their ability to, uh, or they were actually going to, uh, I think better CE classes after that are not mine. The mine's like a Pandora's box or like a charcuterie platter of it. It's like they're testing cheese and they realize what they like. And so please go, uh, and do that. And I think that we're all going to improve as a profession.

I learned stuff last time from an attendee, right? I learned I was doing an arm bar subpar. I could do an arm bar a little bit better for my shoulder cases. So please reach out to me on that. Uh, minimum people is eight, uh, and I want to know by July 4th, if we're going to do it. Um, also to students, if you didn't hear the last podcast, uh, just know there, there is a student version of this. All right. Uh, the SEU students have, have reached out to me to, uh, get a bunch of them in 14 is cap, uh, for, uh, a six hour workshop. And I, I love giving stuff away. I've had people shadow, uh, many, many times, but they just don't walk away with a full comprehension of how to use this in clinical practice.

And so they, they wanted more and they asked me, I didn't propose. They asked for more. And so, uh, currently I do have a student who is, uh, helping me admin this kind of stuff because it was originally his idea. Uh, I will put a link to his on the show notes. It's Kyle Hemsley, uh, or at this point, if he's not helping out with it because he's already come, uh, or say he doesn't want any part of it anymore. Um, just reach out to me and we'll see if it can link you up with that, with that group of students who's, who's already doing it. And so you guys are going to walk out, um, like with learning how to use your corrective exercise in a medicated dose.

It's going to be amazing. Um, I, I wish, I wish this upon you if you're a student, especially six terming up. Okay. All right. So as always, leave people better than how you found them and a plea for your date and date and angle scale. Uh, and I'll see you guys next week.