♪Bob and Brad, ♪
♪the two most famous ♪
♪ physical therapists on the internet. ♪
- Hi folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We're the most famous physical therapist on the internet.
In our opinion of course, Bob.
- Today Brad, we are joined,
this is a great honor by the way.
- Yeah it is.
- That we were able to pull this guy in.
We're joined by Dr. Adrian Lowe.
Lowe is, high low?
- High, low.
(laughs)
- And he's a, I'm going to let him tell his background,
but he's basically a pain expert,
is what we want to refer to him.
- Exactly.
- So, thank you very much for coming.
- No problem.
Happy to be here,
this is amazing to meet you guys, we're done.
(laughs)
- You'll find out it's not as amazing as you think
but if you could give us a brief background.
- Yeah, I'm from South Africa with a funny accent.
I was trained as a physical therapist,
came to America, land of opportunity.
I started treating patients with traditional therapy,
and for some reasons started seeing more complicated people
and the stuff that worked yesterday doesn't work anymore.
And then I needed to find something else.
I found this incredible thing called pain,
well it's called pain neuroscience to be to be true,
and it just took me on this incredible journey,
the more I learned about pain,
the more intriguing it became.
And challenging patients became less challenging.
It doesn't make it easy, not even close, but here I am.
And then decided I like it so much, lets study it.
- Where did you get your PhD from?
- In South Africa.
- Yeah, yeah.
Did the research here in America,
but run through university in South Africa.
- Dr. Lowe, he studied under some
of the most famous physical therapists,
the real famous, some of the most intelligent probably,
physical therapists in the world.
- Right.
- And you all know their names,
but just to be assured that that's true.
- And look at the literature he's published.
- Alright, when you got to give a look at the books,
it makes us think that we haven't been doing enough
with our life here, but that's a little bit
of offering of some of his books.
And we'll mention some of his other books here too.
In fact, this one,
where's the one "Why do we hurt?"
Is that one over there?
- That one's probably over there.
- "Why do you hurt?"
- Do you want me to?
- It's over there.
- Yeah.
- Don't don't get me right well, yeah.
We're well organized.
- Oh yeah, that's kind of the topic
of this this particular video today.
Why do I hurt?
So this is one of our more popular books
- yeah it is.
- So well I thought what we do is we want
to give it you know this is about all about our subscribers,
so we want to make sure that it's you know,
we're doing them benefit.
So let's take if you could,
give maybe the kind of a case study
or an average patient that you're that you see
and how you go about treating them basically.
Starting-
- Yeah, no, that's fine.
You know what,
there's there's a story of the year commonly
in every clinic you guys have heard too, right.
I mean no disrespect
but people in chronic pain when they come to us,
you know, there's a classic story, where do you hurt?
And we hear everywhere?
What makes you better?
Nothing?
What makes you worse?
Everything right?
And I'm like, No, no, this is this is a challenge we face.
That little song, as I call it.
There's not a country that will we cannot sing
that it's a global problem.
And so when people come to us, they've been everywhere.
They don't know what to do.
And the problem is also,
we don't understand pain well enough.
And so one of the fundamental things we ask patients often,
you know, I will ask him,
what do you think is going on with you?
That's my number one question.
Whenever I talk to students, I say I love that question,
because it tells me what they're thinking.
And the patient can answer me from here to there.
They can say, well,
didn't you read my report of a bulging disc?
So they just told me what they're thinking.
And I can talk about that intelligently.
Because you and I and Brad,
we all know what the current literature says.
But then on the flip side, I can say I have no idea.
That's why I'm here which is so neat,
because it is an open script, right?
- Sure.
- And and you know, after the evaluation,
getting to know the patient,
I'll often asked them as anybody explained to you
why you're hurt, and it still shocks me that 99% say,
nobody's ever explained to me.
So in this case,
what basically works is we've taken
the most advanced science on the planet that we know of
and we put them in stories.
Human beings learn through stories, metaphysics-
- Exactly, I agree 100%.
Can you remember what you taught
about history in third grade?
- Wow, if it's in story form probably so.
- Yeah, exactly.
We don't remember facts.
- Right.
- But do you remember the story
of the tortoise and the hare?
- Oh, sure.
- Yes, exactly.
- So what we've done is we've taken
the most advanced neuroscience and put it in stories,
simple, easy stories,
we then tell the patient the story,
which I'll tell you one in a minute.
And what we have found out
from some amazing research is people's lives are better
for it.
They understand what's going on.
They know what they can do.
And so the most-
- By purely by, by the education itself?
- By the education,
but what's important is we need
to understand you're not going
to explain pain out of people.
Pain is complex.
It's very real and people have to,
but what it makes 'em calm down,
they have less fear.
They're more likely to move
and what makes them better is movement.
I think there's a there's a misconception these books
and everything is we don't explain pain out of people,
we just make him understand that pain,
which makes him less fearful, which makes him move.
- Which relates to the back to the point
that you made when it first come in.
You ask him what is causing your pain?
They don't know.
- Yeah.
- And so by not knowing they're more stressed out.
- Absolutely.
- It's a part of the anxiety that goes along with it,
that I you know, what is it is something very serious,
which is you think it is-
- Correct.
and it may not be doesn't equate with injury.
- Or I think, you know,
I can something I personally can relate
to is I have a condition
called spondylolisthesis.
- He's got it right.
- What a brainer.
- With a name like that a diagnosis like
that the average person really doesn't know what-
- It's really frightening.
- It's very frightening inside.
- Yes it is.
- I'm not gonna be able to, you know, run again-
- My life is over.
- Yeah, I'm just gonna have to be still.
And so when I do videos on it I let them know
what I'm doing or what I come from?
So hopefully that to get that brick wall
that diagnosis out of the way and I think that happens,
like just even simple arthritis,
someone will come and say, I've got arthritis in my muscles.
You know, you can't get arthritis in your muscles,
it's in the joint.
And I try to explain that.
So this is going to be helpful for me to, hopefully, really-
- Can you mention the, I'm sorry to cut you off Brad but-
- Yeah.
- Could you mention the study
that they talked about the brain scan showing before
and after?
- Yeah, yeah, we have done some studies.
And they're a little bit technical.
But when you scan somebody's brain during something painful,
they move that back, the brain lights up,
it uses more sugar, more oxygen,
and that's what those blobs are.
And when we found that as we teach you about pain,
the brain really dampens down very similar if not more
than what we can do with medicine right now,
which is really powerful.
And that then reduces that threat value in the brain goes,
I must be okay.
The guy the funny accent explained it to me.
- Sure.
And it's important that as a moving part,
but you know, Brad, you mentioned arthritis.
I live in Iowa and I asked my farmers,
every day John Deere overalls, John Deere hat,
you know what do you think's going on with your back?
I got arthritis.
What they basically told me is because I'm old, I must hurt.
Yes, they tighten together.
And we know it's not true.
Because if I've righteous in back pain was the same thing,
then only old people should hurt.
Then why do 50% of school kids have back pain?
It is not the same thing.
- Sure.
- And so when we show somebody that as you get older,
there's more arthritis
or as we call it wrinkles on the inside, right?
You know, wrinkles on the inside.
But back pain, you're therapists we know peak
at age 35, 45, 50.
I show it to patients, I draw it for them, they go.
Wow.
So just because I'm getting old doesn't mean I have to hurt.
- Exactly.
- Let's get on the bike.
We can change movement,
but we cannot change aging, but aging and pains.
Two different things.
We have a lot of research show
that people that are older hurt
because they're not moving not because they're old.
That it is it's a fallacy and so,
so an example would be again, like I said,
we've talked to people explained
and they may turn to me and say but why do I hurt
and that's kind of what we get to right.
So we use an analogy the analogy we use
is a sensitive alarm system you
got you ever house your house?
You guys are so popular it's probably gated community.
(laughs)
Right?
- The man double wide trailer
at least doubles he's got the double.
- So we tell people right at your house is an alarm right
and so we use an analogy everybody's familiar with an alarm
so I would simply sit
with people and ask him if you step on a nail,
do you want to know about it?
So what do you guys think if you step on a nail,
- Absolutely you want to know about it?
- Why?
- Because it could get infected because right-
- Exactly, right.
- What if it's rusty.
- Exactly, a rusted nail especially so guess what?
I've never had somebody say no.
Why?
Because our patients are smarter than we think.
They'll say no.
Now I asked him why he said well, I didn't get an infection.
So how do you know there's an nail in your foot?
Well, you don't have eyeballs the bottom of your foot right?
So we have an alarm system.
A body's nervous system works like an alarm system.
That's the metaphor,
and people understand an alarm system step on a nail.
The alarm system ramps up in the foot,
fires a message to the spinal cord
to the brain saying ding, ding, ding,
there's a nail in the foot and all I do is I tend
to the patients It doesn't make sense.
And again most people so that makes total sense.
Now the you know what the real patient says,
what does this have to do with my back?
- Sure.
And then you sit there and go Yes.
Why they asked the right question.
- Sure.
Well Frank, guess what?
You were in the backyard raking the leaves.
You felt a pop in your back?
What happened?
The alarm went off.
I don't know if you went to the emergency room.
Nobody goes to the emergency room saying I feel great.
So something trips your alarm
and I'm not thinking fun,
but it's kind of that wow, okay, this makes sense.
And they say what should happen is we pull the nail out.
The alarm system comes down right?
You guys have stepped on a nail or thumbtack.
- Sure.
When you pull it out the alarm just go away.
- Well it start to calm down.
- It lingers.
lingers a little bit right.
But what happens is Frank
if we pull the nail out the alarms just calms down,
we put in we put a bandage on,
we get a tetanus shot and life is good.
By the way, we learned something today.
Don't walk barefoot around nails pain isn't a bad thing.
Without pain, we'd be dead right?
It teaches us sharp is bad.
- People who cannot feel pain are in trouble.
- They're in serious trouble look at our diabetic patients.
- Right, right.
We have to watch-
- They have to watch their feet, take care
- Absolutely, so the, the crux of the matter,
all of us have an alarm system,
it ramps up and says ding, ding ding,
you stepped in a nail ding, ding ding you
have you hurt your back, you have spondylolysis.
You hurt your leg, you just broke your leg, right?
It tells us go get some help.
We take care of the problem.
We have surgery, we get some help we get some therapy,
and the alarm goes on.
And hey, we're good.
You have had that happen to you.
You have all of us have, right?
Even Mike the guy behind the camera.
It happens to all of us, what a beautiful system.
But here's the problem in about one
in four people something trips,
the alarm didn't go get some help,
go see Brad, right, go get some help.
But then we do something but the alarm never calms down.
That's what we call a sense of alarm system.
Now we got fancy medical terms for it but doesn't matter.
Your alarm system stayed sensitive.
And you know what, in all the years we've done this
in all our research in the thousands of patients we've seen,
I've only had three questions.
How do you know this doctor drives a Jaguar,
what do you drive?
You don't need a therapist and I understand that.
- Sure.
- And by the way, this story says very simply,
they really want to be validated.
How do you know this?
Number two, they want to know why did it stay up?
My neighbor had the same thing, but she's fine.
- Yeah.
Why a I different?
- And then the last thing is, what do I do about it?
And that's number one,
by the way, and if they ever asked you,
what do we do about it?
That's the right question.
How do we dampen this system down,
so very simply, how do you know what we can see
it by a test?
You can barely move the arm can barely touch your back.
You told me you used to could as we call it,
before your pain you could run five miles
now I can barely walk a half a mile.
You used to be able to sit for an hour
and I can sit for five minutes your tolerances are awful.
And many patients get that aha moment.
Why did say up there we talk about all the stresses
and stuff in life.
So I will tell them for example,
if you have pain in
and you go see three physical therapists,
two doctors, two chiropractors
or podiatrists or whatever,
it's not getting better would your alarm calm down.
Never had a patient say yes,
they're smarter than that, they say no it'll stay up.
Yeah, exactly!
- It might even go higher,
because every time they meet someone
that can't help them, it wasn't in their minds.
I really got something.
- Exactly, absolutely.
And then you get failed treatments
with this and for a little bit, and then,
by the way, now there's rumors about layoff at the office.
And because I missed a lot of time,
because I go see Brad and Bob,
I'm gonna be the first one that is going
to is all of this runs to keep the system elevated.
And then finally, what do we do turn it down?
And this is the coolest part.
There are so many things.
So we have now figured there's about 22 things you
and I and Brad do everyday in therapy
that actually turns the brain's own medicine
on we're talking about exercise.
We're talking about palates,
we talked about relaxation,
we're talking about mindfulness,
we're talking about sleep hygiene, nutrition,
you guys have talked about nutrition,
I've watched your videos,
there's so many cool things we can do non pharmacological.
I mean, I think every listener you all
of us in America now aware that drugs are good,
but there's some some of them
that are very bad things doing for people.
So can we get the healthy side going
and that's kind of the idea, simple story.
This is our highest rank stories of patients go,
Wow, I got it.
So what you're telling me
is that the reason I'm still hurting is not
because the ankle is still bad
or that we were moving people away from their tissues.
But remember, all we can do is it's only
because we've done due diligence
and examine somebody very carefully.
- To make sure the tissues are healed.
- Exactly!
And so a lot of people have blamed us
and say, oh, all you do is talk to people about pain.
90% of our patients literally cry after the examination.
And I'll ask them what's going on?
They say that's the most thorough medical exam I've
had in 10 years.
One of my students have figured out
the thing that makes this work is when people feel
they they've been listened
to in the validating and they trust you.
- Sure.
And so, you know, I think for the clinicians listening
even today, it's creating that I'm here,
how can I make your life better is
that connection and it's a,
it's let's teach a little bit of what's going on.
And we've just found
that if we teach people this, their lives are better for it.
- I think Dr. Lowe, what he's referring
to here is what happens when someone comes in
and with those type of symptoms quite often.
The typical layperson or the typical clinician
is gonna go this is a headcase.
You know what I mean?
There ain't no and that's nothing worse.
- Oh, yeah, the trick I know I did.
- And and but they do you know they do
and a lot of physicians,
they're just like I'm trying to get this person out
of my office as fast as possible
and they don't really have an explanation for them
and they just send 'em out the door.
- I don't want to interrupt.
- No, that's fine.
- I just had a patient this week
total knee replacement you know,
now they want to do it in one day.
So he went in total knee replacement overnight
and they discharged him the next day.
They gave him exercises but only two or three
and he was feeling it hurts I don't know what I'm doing
and it's swelling up and he was very anxious,
he was feeling he was pushed through the system.
He didn't know what was going on
and I did I spend you know about an hour
and 15 minutes with him and by the time he left
I told him you exercise and do I said
this looks like a normal mean you're ready
your motion looks good.
He was so relieved.
He left and we're going to see him three times a week
to get his range better and decrease as things improve.
- Yeah.
- I mean, just the psychological aspect of it.
I didn't do anything to his knee
except I move it a little bit.
Look that was walking me sure he's safe.
- I just did more than you think you did.
We can prove that.
Yeah, I have to do this.
I'm sorry.
You guys have a major following.
But all pain is real.
We have never scanned fake pain.
- Oh I agree.
- I would highly recommend
if you're a patient listening to this,
and if somebody ever accuses you of
that fire that healthcare provider,
they do not deserve to see you
and for the healthcare providers.
Just because somebody tells you something
that it doesn't make sense doesn't mean it's
on really just means we haven't studied it yet.
- That's exactly right.
- And so I will just tell you,
the longer I've done this, I'm getting older and older.
I really revel when somebody walks in.
And so you know, I've been everywhere everything.
Who are you?
Who are you as a person?
How can I make your life better,
and there's so many things we can do,
even just listening to our patients.
Most powerful words ever studied in medicine?
You're gonna be okay.
Now, how cool is that?
And again, it's so sad
I was doing I was doing a class last week
for physician assistants,
and in their practice that they're not allowed
to tell people you're gonna be okay
because it gives them false hope.
Oh, I hope you give me false.
- Oh, yeah, right.
- Be that guy.
Like Brad said, I'm going to be okay.
- I'm going to be the optimist.
- I'm going to be okay.
But I think this is so neat.
As words matter, our patients matter.
All pain is real with never scan fake pain,
you know, stuff like pain that spreads in the body.
We now know why it happens.
The thing that drove me nuts when patients came in here,
what brings what makes your pain worse when it's cold out?
I had no idea what to do with them.
I didn't know which muscle that was.
Which joint is that?
But now I know there are some really amazing receptors
in the human body
that tells us hey, it's getting cold in Minnesota,
put on a sweater.
And if they become a little over abundant,
we get sensitive to cold.
Wow!
And we have found out if I tell that to Grandma,
she's going to go I'm gonna be okay.
How cool is that?
And so I you know, one of the reasons I wanted
to be here is because I need people in pain
to understand we're here we're here to help.
And if somebody is not helping you fire them.
They don't deserve you, this is your pain.
As my mentor David Butler told me years ago,
tell patients that you own your pain
and not somebody else you make the best decisions
and so I hope the healthcare providers today
if there's one thing you can do, it's cheap.
It's free by the way, listen, this listen, be there.
I have no problem telling a patient no,
that's I don't know what to do with this today,
but let me think about it.
But tell me your story.
Get to know them.
There's so much about reassurance.
Reassurance is analgesic?
- Sure.
Anyway, we've studied this-
- I'm getting tingling up and down my spine,
but I'm seriously I want to give him a standing ovation.
I'll go outta camera to do so.
But that is just awesome.
I think that's just awesome advice.
I think we're gonna cut this video off at this point.
We're gonna be doing two more.
So if you're watching this one,
look for the next one,
because we'll try to continue some
of the discussion at that point.
- Now as far as the information we covered here.
- Yeah.
- I one of the books kind of review this
or is this kind of on-
- I think why do I hurt book, covers?
- Yeah Why do I hurt book is the most common one
that most people that talks about how pain works-
- And for therapists and clinicians,
I, you might consider this book
integrating manual therapy and pain neuroscience.
But in addition, there are classes that are given credit.
- So one of our jobs is we want
to train the next generation,
we want to train the most compassionate,
empathetic, well trained people on the planet.
So seminars all over we teach-
- Evidence in motion.
- Evidence in motion, if they just look us up.
And so that's what we're doing Google Evidence in Motion
and I'm sure your name will come up.
- It somewhere on there, yeah.
(laughs)
- Well, thank you again, doctor for coming.
Very much.
We'll have another one.
Check us out.
(electronic bounce)