♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our own opinion of course, Bob.
- Once again it is our extreme pleasure
to have with us today Dr. Adrian Louw.
Dr. Adrian Louw is a pain expert,
and I'm gonna let you talk
as to what your qualifications are,
what makes your that.
- Brad?
- This is a real treat for us.
- Yeah, this is a treat.
- I mean this is like going to
one of the world's leading experts.
- Right. (laughing)
- You're very modest but you'll find out
if you're listening.
- Just listen, you'll find out.
- You'll be on the edge of your seat.
- So Dr. Louw if you could maybe just
give us a little on your background.
- Yeah, like I said, I'm a physical therapist,
trained as a physical therapist
and got very interested with the pain
and decided to study it.
And then I was very fortunate to be surrounded
by some of the smartest pain people on the planet,
and they were very kind to me.
Just started studying, doing PhD work,
and now doing an enormous amount of,
we've got about 23 studies right now ongoing.
- Oh fantastic, wow.
- Big research team and just trying to
get the world a better place.
- Wow, that is so awesome.
- So you got your PhD.
- Yeah.
- And he's from South Africa.
- Right, and he's written all these books,
we got 15 or 14 books that he authored.
- On pain.
- And what are you gonna do is,
you wanna check these books out
because if you have a specific problem
it probably is in one of these books.
So if you're having trouble with back pain
or if you have pelvic pain or fibromyalgia,
check out the book links below
and we'll get into those specifically.
If you're a therapist,
you may wanna check out this book,
"Integrating Manual Therapy and Pain Neuroscience".
There are also classes they put on,
and it's gonna in evidenceinmotion.com
if you check that out.
Sorry to interrupt you, so. - No worries.
- Carry on.
- So I guess, again, we're talking here,
we're gonna kind of talk about example of
some of the education that you give.
Why don't you talk about why the education is important.
- We have just found out,
several years ago we interviewed people with pain.
What do you want from us?
And the clear message is they want more information.
The current, even though people get internet,
and all those information currently isn't,
it's not clear.
It doesn't explain things really well, so we--
- I think it's even scarier on the net.
- It is actually scary, yeah,
there's recently studies that showed 90%
of the information on the internet about back pain
isn't bad, it is disastrously bad.
- Oh wow.
- 'Cause it drives fear and all those things.
And so we went to study pain,
what is pain, how pain really works.
And we found out people are better for it
when they learn about pain
but from a neuroscience perspective.
And what I mean is if they understand the
underlying biology.
Now, the problem is,
I cannot just sit with you like a textbook
and say, "this is how pain works."
It doesn't make sense.
So we've taken this and put 'em in stories.
We learn through stories.
Everybody listening right now probably cannot remember
what they were taught about history in fifth grade.
We could lie, right?
Say Lincoln, we can say Hitler,
we could say anything of those.
But we remember stories like "The Tortoise and the Hare",
right?
Stories, through the history of mankind,
we transferred knowledge through stories.
And so we took this information, put them in stories,
and it works, it makes peoples' lives better.
To be honest, one of the coolest things we're working on,
we built a middle school pain neuroscience program
that's now in nine middle school, nine states.
- No kidding?
- In the United States.
So we're teaching kids about pain
and we're tracking them now through school
and they experience less pain,
they take less medicine when they hurt,
all the things we want them to do.
- Which I imagine decreases stress, too.
- Absolutely.
They have less fear, all those things,
so we're tracking them
and bottom line is if people know more about their pain
and know how it works,
our lives are better for it.
And for us as therapists it means they'll move,
and movement is the biggest pain killer on the planet.
Bar none.
- Absolutely.
- The old motion is lotion. - Motion is lotion.
(laughing)
- And you had mentioned in the other video
some of the other things that can help decrease pain too.
In addition to education.
- There's a bunch of stuff we have now looked at.
I mean if you look at things like sleep hygiene.
Sleep calms the nervous system down.
There's different types of nutrition,
mindfulness, relaxation, goal setting.
Different forms of exercise.
I may call it manual therapy,
some people call it yoga, Pilates, et cetera.
Movement, all those different movement styles.
There's so many different things that can
calm the nervous system non-pharmacologically,
'cause that's a safer alternative
for what we're doing right now.
- Oh go ahead, Brad.
- You'll see people that are on pain medications
with a primary goal of reducing that?
Is that something you deal with on a regular basis?
- Absolutely.
And as we always say,
you cannot take the pain medicine away.
If I was a patient listening right now I'd say,
"Don't take my medicine, I don't know what else to do."
We should think about it as a scale,
if we build this side so powerful
and my physician can take the medicine down,
they don't freak out.
And what we have now built,
especially in the VA,
what I'm showing you right now,
there's 22 things we're doing
as part of, in many VAs right now,
as part of their anti-opioid initiative.
If you build this side up
the brain turns on its own chemistry.
Your brain right now has the most powerful medicine known,
on the planet, between your ears.
When you hurt yourself,
our brain has this incredible capacity to shut that down.
We're sitting here right now,
farmer in Nowhere, Minnesota today is putting up a fence.
Auger pulls his arm and cuts his arm off
in the middle of the field,
the brain turns open the faucet, the tap,
and produces these fancy chemicals,
endorphins, (mumbles), serotonin,
where the guy feels nothing.
Puts a tourniquet on him,
he drives 20 miles to the emergency room,
he probably stops for a coffee.
We've heard these stories, right?
(laughing)
And then he shows up
at the emergency room - With a nail in the head.
- Then we ask him, "What's your pain rating?"
"I'm good, I'll wait."
How cool is that?
When we hear our soldiers coming back
and they've been shot, they're not aware of it,
our brain has incredible chemistry.
When you're in pain, the brain dries that up
to make you more sensitive.
So we almost have to ask today
how do we take a dry brain, less chemical,
and make it wet again?
All that happy chemicals.
And that's that stuff you guys do and I do,
all that 22 things.
Let's turn the brain on so we can take the medicine,
over time, away, and (mumbles).
- So you're saying the brain physically can produce
pain--
- Medicine.
- You guys runners?
- Yes.
- We talked about running and dogs,
and we talk about it in a great way.
A six mile run produces 10 milligrams of morphine
in the human brain.
- No wonder I'm so high after.
- You're a druggie, (laughing).
- So think about it.
If you break your arm today
and you go to the emergency room,
they're gonna give you two or three milligrams of morphine
to set your arm.
You get two to three times more than that
by just going on a run.
That's why this is that runner's high.
And this is so much our brain produces to dampen the system,
but it dries up when we're in pain
because the brain's worried about us.
So we have to enhance that again.
- So would you say, of the 22 things,
the first thing, and a cornerstone of it,
is education.
- There's four.
We've tested. - Four, okay.
- And trust me, we didn't sit one night
with my buddies going, with a couple of beers going,
yep, yep, no, yep, yep, no.
This is statistical modeling,
there are four things you gotta get right.
You gotta know why you hurt.
The most dangerous brain we have
is one that doesn't know what's going on
because we all make up our own reality.
And I mean no disrespect here today,
but all of us have been,
all of us have found something on our body
and like, ooh, what's that bump?
And two minutes later you're thinking worst case scenario.
So the brain must know what's going on.
- It's taking those leaps.
- Yes, number one, check.
Number two, you gotta move.
Motion is lotion, as you guys always preach.
Motion is lotion.
When we pump blood and oxygen through the human body,
the nervous system calms down.
And I know our patients right now are watching this going,
"I know he's gonna go there.
"We gotta run marathons, climb Mt Kilimanjaro,"
no no no.
A nice brisk walk
and very simply is you gotta get your heart rate up
a little bit,
pump some blood through your body.
How cool is that?
Buy a leash, take your dog for a walk.
How cool is that?
And then number three is sleep.
It is one of the biggest cornerstones we have.
The minute somebody can get meaningful sleep,
but it isn't as simple as just, say, go sleep.
We gotta change your biology,
we gotta get your system to dampen down.
We gotta get healthy sleep habits.
And then number four,
you gotta have a reason to get out of bed, that's goals.
There's gotta be a reason to get out of bed.
And unfortunately our system right now
does not incentivize people to go back to work
or to go back to activity,
and we gotta find that thing.
And that's where we talk to our patients
about deep beliefs and thoughts and goals,
and if those four things are right,
we've tested it,
people had meaningful shift in their life.
- It's funny, I just read the book "Why We Sleep".
- Yes yes yes, absolutely, Bradley Walker.
- I was telling Brad, yeah exactly,
and it's a fantastic book.
- It's mind-blowing.
- But it scares the heck of you
if you don't get enough sleep.
I mean I've changed my life now
making sure I'm gonna get enough sleep.
I mean we go to bed earlier, we--
- I would tell you,
if you can get a person of chromic pain to sleep,
you're halfway there.
But it isn't that simple.
- It's not simple. - Your system has to
dampen a a bit.
But mind-blowingly, it's amazing.
- So we thought we'd start the education process, maybe,
with a story.
And you use a lion because you're from
South Africa. - South Africa,
yeah, that's right.
- We might use a barking dog,
or a Pujo.
How 'bout, you probably don't know the movie Cujo?
- No.
- No, I don't.
He made it up, didn't he?
- A Stephen King movie,
Cujo is this huge dog that starts attacking a family,
and it's kind of like the one example of a bad dog.
- I think he made it up.
- We'll go with the lion.
- Look it up.
Okay, we're gonna use lion.
- So one of the ways we often,
as I said, we tell stories to patients,
it resonates with them.
And so what we find with people in chronic pain,
for example,
they have problems, they're fatigued.
I have so many patients come and say,
"I don't know what's going on.
"Since I developed pain I'm so tired.
"2:00 in the afternoons, I'm wiped out."
Or they say things like, "I cannot sleep at night."
Either they cannot fall asleep or they're so exhausted,
even though they sleep,
and so we understand the underlying biology,
there are stress chemicals running through our body.
But sitting with them and just saying,
"Let me tell you how stress works,"
is a little too academic.
So we tell a story.
And you guys are gonna be my,
okay, you guys are gonna be my fifth graders.
- Okay.
- There's a TV show, "Are You Smarter Than A Fifth Grader?",
so don't let me down, don't let me down.
- We're gonna be perfect.
- All right.
If a lion jumped in this room right now,
right, a big, roaring African lion,
what would you do?
- I'm gonna try to-- - Run.
- I'm gonna try to maybe, I dunno,
I'm gonna run or fight or flight.
- Yeah, and most people are familiar with fight and flight,
right?
So we would run and so,
you'd probably shove me in front of a lion,
this is a classic.
- That's right, we don't have to run fast,
we just have to run faster than you.
- Than the last guy, that's me, yeah.
So we would say to the patients,
if a lion jumps in the room, what would you do?
And they'd say I'd scream, I'd run, whatever,
fair enough.
But then we run through scenarios.
If a lion jumps a room,
are you gonna take a nap?
I've never had a patient say yes,
they say, "No, I'd be awake."
exactly.
The lion jumps the room,
are you gonna mobilize all your energy,
or are you gonna store some for the winter?
"No, I'm gonna mobilize."
They're smart, right?
If the lion jumps the room, which muscles do we need?
The big ones or the small ones?
It's the big ones, - The big ones.
- So I can punch the lion,
shove Adrian in front of the lion, right?
They understand this.
If a lion jumps the room
are you worried about the food in your stomach?
No, we shunt blood away from it.
Everybody understands the system.
The local zookeeper at Winona, Minnesota,
I don't know if you have a zoo here,
comes and takes the lion out of the room
and you sit back in your seat and go, "Whew,
"that's the third lion attack in Winona this week,
"this better stop," right?
We have this fight and flight.
The system rems, calms, rems, calms.
What does this have to do with someone in pain?
Pain is a stressor.
Pain is a normal thing, all of us experience pain,
but living in pain is not normal.
I think we need to understand,
if you wake up in the morning
and from the moment you wake up you experience pain,
that assumes you slept.
And that lion's in your life not for a day,
not for a week, not for a month, not for a year,
but for 20 years.
Your system shunts but never comes back.
That's why, when you wake up in the morning, guess what?
You burn through fuel by 2:00 and you're wiped out.
And again, it seems simple, but patients go,
"Wow, that makes sense."
- And that's why you might have a irritable stomach
for 20 years.
Because it's not adjusting like it should.
- So the bowel and bladder is a little bit suspect,
we don't sleep at night
because the lion could be in the room,
all these things change.
So they understand, that's why I run out of fuel.
When you lay in that room at night in bed
you can't go to sleep because where's the lion?
So you don't fall asleep.
By the way, since you're in sleep,
you don't go do the deeper restorative phases you need--
- Exactly, which is REM.
- So you never really rest.
And so these things,
I'm sure people are looking at this going,
"This is silly, but it makes sense."
- I wanna know how to get rid of the lion.
(laughing)
- Well there's ways of getting rid of the lion, right?
But the point is simply we, then the question comes,
and this is actually coming back to you, Brad,
is then we ask somebody,
"What would you do if a beautiful small
little baby lion cub walked in this room?"
And the classic answer is (groans), right?
So we need to take this lion and let's identify the lion.
What is the lion?
We have different explanations for our pain,
treatments aren't working,
I'm not sleeping,
and what about my job, my kids, my family?
You make this monster list.
And we just start attacking each one of these.
Okay so what's sleep?
Now we're gonna go to the sleep program
and we work through a sleep hygiene.
Good. Check.
Let's talk about this.
And we slowly start making this lion smaller and smaller
and smaller,
so when we do wake up and that lion you go (groans).
(groaning)
- Notice what we're doing here.
It's not everything nothing, but we can slowly shift it.
All is we often say, and I mean no disrespect,
but we gotta turn the Titanic around.
It's a big turn.
We're not gonna turn it overn--,
it's not like a quick little boat,
but we're gonna turn this turn.
And the minute we start turning with
better movement, better sleep,
better nutrition, all these things,
the boat can turn.
Takes a little time, but it can do it.
- It's funny, I just,
I used this example last night.
I was talking to a family member,
I won't mention who it was,
but she has been under a fair amount of stress
and the stress has been calming down,
and she thought she had irritable bowel syndrome.
And I said, "How's your stomach doing?"
And she's like, "Well it's been doing better."
And I go, "You know, I think it may be stress related."
I gave the example of the lion,
how your digestive system slows down
when the lion's in the room,
and she goes,
'cause she kept thinking it was something serious,
something really bad, and she goes,
"That just is so calming to me knowing that,
"that that alone can be so helpful."
And I said, "That is true,"
and that's what they have found.
- And we need to understand,
obviously we do due diligence by screening, right?
I have a practice like you guys,
patients walk off the street,
we go through a very thorough medical screening
before we jump to this.
I don't want people to think all we do
is sit and tell stories.
- Excellent point,
because something could come in
and it could be something serious.
- Absolutely.
So we do screen carefully,
but once we've covered the bases, we will go this route.
And again, if things don't change, we examine again.
So we do due diligence,
but again,
the more people understand the better off they are,
like, "Oh, that makes sense,"
and we can see the changes.
- And if you have the example of the person coming in
that has seen 20 clinicians,
they probably have been screened already for serious things.
- Fair enough, fair enough.
- And they have not found anything that could be a problem,
so the screening has almost already been done.
- Correct.
- To a large extent.
You know I think a great starting point, again,
if you have a specific pain issue,
check out the books below.
These books are great, they're terrific,
I mean you've touched on just a small part of,
with the stories there's a lot of other examples in there,
a lot of other stories.
And I think this is a great way to start
getting to a life without pain.
Or at least manage pain.
- Yeah, I agree.
I'm, I wanna hear more about gettin' rid of this lion.
(laughing)
With the books, you know,
I know we talked about diet a year ago,
and I'm like, diet, blah blah,
I don't wanna deal with it.
I'll just quit eatin' less.
And then I start reading some books on my own,
and once I start reading
and seeing that my mind can decipher things better,
and ya know.
- And the sleep book that we mentioned, too,
I think it's just fascinating.
- Right.
And it's such a, so much better to educate yourself,
become better as opposed to going to the doctor
and getting, coming out with some pain meds
and not really feeling any better than you were before
and not understanding it, right.
So I just think education is so powerful.
- Now we had a video the night before on,
another one from Dr. Louw,
and we'll have one in the future, too,
on fibromyalgia,
so stay tuned to the channel.
Check us out.
- All right, thank you.
- Thank you.