Welcome back to the Healing Pain Podcast with Dr. Ben Cormack
A good therapist should always point their patients towards a scientific direction from what an evidence based practice may have shown them. Which is why Dr. Ben Cormack, a specialist in the combination of pain science and exercise, believes that exercise is the best way to heal chronic pain naturally. Dr. Cormack knows that there are no specifics in exercise that will show that this yoga discipline will heal this, or this Pilates technique will heal that. The great thing about evidence based practice is that it doesn’t go in one direction and instead helps both the doctor and the patient see the bigger picture and make that vision into something tangible. Dr. Cormack explains more about peripheral sensitivity and how movement exercise helps patients deal with chronic pain.
The beginning of the year makes me think of my resolutions and other people’s resolutions. When you think of that, there are always two things that come to mind. People want to, one, change their diet and two, they want to start an exercise program. For me as a physical therapist, exercise and movement is probably the top intervention that I use with patients. Depending on the person and their condition and their diagnosis, arguably exercise is probably the number one or number two way to help people heal from chronic pain. If you are someone who has chronic pain, chances are you know that exercise can help you but you’re not sure where to begin. If you are starting an exercise program, oftentimes you’re saying, “This is good but now I’m starting to feel a little fatigued. The exercise program that I chose for myself that was recommended is causing me pain and I’m just about ready to throw the towel.” I have brought a really amazing expert guest. His name is Ben Cormack. He is a musculoskeletal physiotherapist who specializes in the combination of pain science and exercise together. He not only treats patients at his clinic in the UK, but he also teaches practitioners all around the globe.
Evidence Based Practice: Promoting Cognitive Efficiency For PTs with Dr. Ben Cormack
Ben, welcome to the Healing Pain Podcast.
Thank you for inviting me on.
It’s great to be here with you. All of us, even those of us that are physical therapists are looking at our exercise program right now and we’re saying, “What can we tweak? What can we change? Should I be doing this? Should I be doing that?” Let’s start really simple and basic because we have practitioners as well as people seeking relief. Why should someone with chronic pain begin an exercise program?
You hit the nail on the head if we look at a lot of the evidence and the data that we have surrounding pain. Exercise does seem to be something that looks like pretty beneficial. One thing that we have to remember about persistent pain and even acute pain, I don’t think there’s any singular thing that’s proven to be a magic bullet. I think that’s really important. Sometimes we conform potentially some expectations that are beyond maybe the reality. It’s important to start by saying that exercise looks like it can be very, very beneficial. I don’t think it’s a magic bullet and I don’t think there is going to be a magic bullet with persistent pain certainly. We need to look at a number of different avenues. One of the big reasons I think that exercise can be powerful is because exercise hopefully and movement and activity, we don’t always need to frame it as exercise, that can sometimes be negative. Sometimes it’s about the activities that people love, that they enjoy, that have meaning for them, etc.
My aim with working with people is to try and create what I describe as a positive charge. What a positive charge means is that people can focus on things that are positive to them, that are meaningful. I think sometimes the cycle of persistent pain is very negative and people stop activity, they stop exercise, they stop the things that they enjoy, they stop doing things that make them happy. Stopping these things becomes a real negative signifier. Often getting people and bringing them back to doing things that they love, to doing things that make them feel like they have a positive aspect in their life, to make them feel like they can, they are back to somewhere where they were before is really, really powerful. It’s something that people can get in there and do it themselves and help themselves with as well, which is another powerful aspect.
It’s so interesting to think of as practitioners when you look at the fields of physical therapy, when you look at the fields of personal training, yoga, Pilates there are definitely camps and methods that’s, “This type of yoga will heal your back pain and this type of exercise approach is good for,” you can pick the diagnosis. It really creates sometimes confusion for patients as well as practitioners. Patients come to us and they say, “I have fibromyalgia. What is the best type of exercise for me?” As a physiotherapist especially, you should be able to start the conversation with someone. How do we enter into that conversation with patients and start to gear them toward what exercise or what type of movement strategy might be best for them?
What’s very powerful here is to use the evidence based that we have and that’s part of being a good therapist is being able to understand, read the evidence based and have scientific direction. What’s really wonderful about the evidence based is actually it points towards the fact that there are no specific, “This exercise fixes this problem.” Anyone who tells you that is not reading the research. What we need to understand is that if it helps, if it works for you, then that’s positive. Let’s take back pain for an example. They have studied big lifts versus Pilates. They have studied walking versus strength exercises. They have studied the bike versus Pilates. They have studied everything you can think of versus everything else and nothing specifically says, “This is the best.”
What I take from that and what we have to remember by evidenced-based practice is often it doesn’t direct us in a really singular direction. Often, it helps us understand the wider picture. When it comes to exercise and back pain or fibromyalgia or any of these other things, if you enjoy it, if you do it and if it makes you feel good, then it’s probably positive. We also have to remember that these things can be slightly trial and error. You can do something that you think is going to be positive and you might have a negative effect or you might have a short-term negative effect, but may be a longer term positive effect. It comes back to that magic bullet thing, “This is the exercise, go away and do it, you will get better.” That’s probably the wrong message. The right message should be, “Start off small. Find the right dosage. Do things that you’re going to do regularly. Listen to your body. Be optimistic, be positive.” If we think about the variables or the context, that’s probably far more powerful than going and doing the right exercise. We have to think about all the things around the exercise rather than, “This is the best.” You read it in these crappy magazines or newspapers, “Yoga fixes your back, Pilates does X plus Y.” Some people get on well with it, some people don’t. It really doesn’t matter. If you enjoy it, if it has a positive effect on your body, then it’s likely to be positive.
As physios, we probably have pushed this idea of one type of exercise and one type of exercise routine will be best for a certain condition because back in the early 2000s and late ‘90s, we started looking at this fancy algorithm of back pain if it’s discogenic or if it has a directional preference, we try to create this fancy algorithm. Now we’re finally saying it’s really, really difficult to create an algorithm per diagnosis so to speak because it’s really difficult to diagnose exactly what the generator of pain is in someone’s back with so many different types of structures.
There are two factors here, if we are looking at trying to identify a specific structure that we can blame for causing pain. What we firstly have to understand is we can’t really do it. If you think about discogenic pain, we have some data that might suggest repeated extensions and centralization might give me an indication it’s discogenic. The data are about actually being able to identify back pain coming from a specific structure is awful. There just isn’t the data there. That’s why most of the guidelines and triage stuff now is suggesting that 90% is non-specific simply because we can’t find the right bit that’s causing the pain. It just doesn’t work like that.
The biggest predictors of pain seem to be things like people’s predicted expectation of recovery. If you expect to get better, it’s much more of a predictive factor than whether we actually can identify if it’s coming from a specific area of your body. That’s really important information. The other thing that we haven’t quite worked out is if we do group these people together and subgroup them into, is it discogenic, is it facet, X or Y or Z, actually if that improves outcomes. The question is, can you do it? The data doesn’t seem to be there. Does it do any better than not doing it? The data doesn’t seem to be there. Why mess about? Why not focus on these positive aspects? This is a real big problem that we have. We often focus on risk factors, diagnoses, negative stuff. Actually, it’s about positive stuff. It’s about understanding people. It’s about helping understand what makes people tick a little bit more? What they think, what they feel, what they enjoy and actually creating a nurturing environment for getting people back to doing that rather than some diagnostic process. Certainly within back pain for example, that just doesn’t seem to be supported by the evidence based that we have whatsoever.
I think the point of expectation is so important for both practitioners and patients to really start to understand what that really means and how it affects their pain. I want to start to move into some of the science behind pain and let’s move up the nervous system. Can you explain what peripheral sensitivity is and how movement exercise helps address that in someone who has chronic pain?
I wouldn’t regard myself as a huge expert within this kind of field, but certainly if we look at peripheral sensitization, it’s just simply the upregulation of what we have peripherally. Nociceptors, ion channels, terminal endings and all that kind of stuff that I think is important, but I don’t always know if it’s really important. One of the reasons being behind peripheral sensitization is it’s very, very difficult clinically to actually know whether something is peripherally sensitized, centrally sensitized. Is it happening at the dorsal horn? Is it happening at the terminal ending? Is it happening at the dorsal root ganglion? Who knows? What we have to understand about movement is if we move differently, then it might be that we have a different effect on nociception. If we have an upregulation of nociception peripherally, what’s going on at the terminal ending whether that’s more ion channels so we can get more sodium in and all these other fancy terms that we talk about that confuse patients.
One of the really important things is if we move differently, do we have a different effect on nociceptors that are activated? Do we have different effects in just the way that things work? Now, part of the problem here is I don’t actually know if I can really hand on heart and say, “I know.” I don’t really know how exercise affects pain. I don’t really know if what I have done has created an effect on peripheral sensitization whether it’s what’s happening within the brain, whether it’s what’s happening within the brainstem, whether it’s what’s happening in spinal interneurons, whether they’re facilitatory or whether they’re inhibitory and all these other factors. I just don’t know. Certainly, I think sometimes we can help people break a loop with movement. What I mean by that is if they’re moving in a similar way, are they creating patterns of sensitization wherever in the nervous system that’s coming from? If I look even higher and look at the brain and look at certainly, maybe concepts of pain memories, neurotags, that kind of thing, it might be that doing things differently creates a different signal which creates a different interpretation, which creates a different output. Could I hand on heart tell you that I know what’s going on? Absolutely not and anyone who told you that is lying because they don’t. Certainly, I think if we help people do things differently and have different inputs, do we hopefully get different outputs? I think that’s the most important thing to think.
The science can be very, very confusing especially for patients. It’s confusing for all of us even if you have some fancy letters at the end of your name. It is important to start to talk about it because it does open people’s minds up and they start thinking, “Maybe there is a way I can start to influence that it’s more than just the range of motion, let’s say, of my joints and my flexibilities.”
We have to understand that pain is hugely multi-level, multi-area. We know that we have what’s going on with the brain, with the brainstem, with the spinal cord, with the dorsal horn. We know we’ve got central sensitization. We know we’ve got peripheral sensitization. Sometimes we potentially think we know more than we do. Human beings are this big black box and we do stuff to them and they operate differently or think differently or feel differently. The actual internal workings are for me a little bit of a stab in the dark. Importantly, I don’t know if that’s where we need to focus. I went through a period of my career where I was very into neuroscience and getting down and dirty with the technical aspects. More and more I come outside and I say, “All this stuff is really fascinating. It’s really interesting. What’s most important and what I’m most interested in is how does this person feel? How do they think? How do they behave? How can I help facilitate and change that?” It’s important to understand if you’re lecturing or discussing with people. The mechanism to me becomes less important as long as I can have a positive effect.
When you work with new clinicians, new practitioners, where do you find they are confused or start to get tripped up in the beginning when they start to integrate this into their practice? There’s a lot of information that you can really start to look at and start to analyze and then you have to take that and obviously, bring it back to the clinic and use it with your patient. Where do you see practitioners getting tripped up?
What we sometimes do is we replace anatomy and biology and whatever else biomechanics and all these other things that we’ve learned, we tend to replace them with neuroscience. What I’m doing is rather than telling people about bones and about muscles and about tendons and about ligaments, I’m telling them about complex parts of the neuroanatomy or neurobiology or neurophysiology, which is cool. Does the person I’m talking to understand it? Do they care? We have to understand that as well. Sometimes, I think we replace one thing with another thing. Whereas really what we should be doing is listening to the person, listening to their story, listening to what they think and what they feel. Then if I do need to talk to people about things like pain and pain science, I’ll start off with very broad analogies. One of my favorites I say, “Pain is a good thing. It’s like red wine, sometimes you can have too much of a good thing.” We might start off with a very broad analogy to help people understand that pain is a positive. That sometimes we can have too much of a positive thing. Essentially, you wouldn’t want to live without pain. That would be a pretty rubbish existence. We know that people have congenital pain defects and don’t live very long.
Pain essentially is a positive thing. It’s here to help us. It’s here to stop us hurting ourselves. It’s here to make us live longer. It’s a survival protection mechanism. Sometimes it might be that I don’t need to go beyond that and other times, it might be you are opposite a Harvard professor who wants to know everything. I think it’s important you tailor the information to the person. I think one of the big mistakes that not just new practitioners or old or anyone, a mistake people make sometimes when they are exposed to new information is they want to get it all out. They think it’s going to be suddenly a magic answer. This is what I’m going to say about exercise. It’s isn’t a magic answer. Nothing is a magic answer. We need to remain critical and reflective.
The biggest thing is getting everyone’s desire to get this new information out and throw it out there and bombard people with nerves and alarms and whatever else. I would suggest the judicious use of information. First of all, I would like to be interested and caring and informative and collaborative before I have to tell people about all the anatomy and all those things. If you have to go there, then I need the cognitive variability to be able to go there. If I don’t need to go there, it could actually be counterproductive and I think that’s a mistake. It becomes a knowledge-bombing or a verbal vomit over people of pain science and suddenly they walked out as confused as they walked in. You don’t have to tell people the history of pain and the inner machinations. What we need to use is the information judiciously and think about not giving information but the facilitation of outcome. How can I facilitate an outcome which is an increase in activity or a different thought process rather than thinking about the input, which is nerves and ion channels and that kind of stuff? Does that make sense?
It does. I think we all have so much information in our heads especially new therapists that becomes this dump of information when a patient comes in. As a practitioner, there are very few physical therapists that I have met that are not extremely altruistic in nature and they really just want to help the person in front of them. However to do that, at times it takes patience on your own part. Patients come to us with sometimes decade’s worth of pain. Even if you have four PhDs and whatever it is that you study, there’s a time element that can be difficult for us to contract with patients. I still think it lends itself to think about and really discuss. Even if there is no specific code or formula, a general practitioner has to have some kind of framework in their own head that they work with when they’re dealing with a patient who has pain.
We all need a framework and it enables us to be able to operate. It gives us an element of cognitive efficiency. Sometimes that framework can tip over into the concept of algorithms and protocols, which is over efficiency potentially. We need to think about that as well. Sometimes frameworks are good but we also need to have a framework that allows us to incorporate other people. Let’s say diagnostic stuff is a great example. We’re sitting there, someone is speaking to us and they’re telling us all this stuff and our training told us to have this hypothetical deductive reasoning. I’m trying to work out from what they are telling me some form of diagnosis. That’s my reasoning. That’s my framework. Actually sometimes that stops us from hearing people. We’ve got in a dialogue saying, “What is it? What’s the problem? I want to find out.” Actually, that stops us from sitting there and truly listening to someone. We have to find this middle ground where we have a framework but we allow this framework to work for all of us. This is probably fluid. I’m not saying I’ve got it sorted here. I’m not saying I’ve got the answer but something I’ve definitely been working on is having a framework but maybe allowing that to be sometimes less of a framework depending on the presentation.
Sometimes when you’ve seen a lot of patients again and again and again, it’s very rigid. I’m just doing that same thing. You come in, “What’s the history? What’s the nature? What’s all this stuff?” For some patients, I don’t think they need that. I think they need the opposite of that. They’ve had that a million times before from a million other people. A guy who comes in and you’re worried about him having an ankle fracture, that might be a whole different clinical process. It’s good to have a framework. I think you need to be fluid in your framework dependent on the person that you’re dealing with. Sometimes we need to take the notebook and just stick it down and just say, “I don’t really give a shit about that. I just want to listen and talk to you like a human being.”
You’ve been practicing for 15 years, which is quite a long time. What would you tell the younger Ben who just graduated from physio school as the most important thing that they need to know about pain?
If I go back to my undergraduate, I would say that just understanding that pain is a really complex thing. I learned most about pain in ultrasound class. We learned about pain gate and all that other stuff. Helping people to understand that pain is complex and it’s about people more than it’s about anatomy. Very much pain is one of these things that it changes, it’s weird. We’re always trying to find a cause and actually sometimes you just need to come back. Non-specific pain is probably the biggest change in the way that I think. I don’t think that just happens in back pain, nonspecific pain happens all over the body. Just understanding that pain doesn’t have to be specific. It doesn’t have to come from some kind of physical damage or it doesn’t have to come from a very specific area of the body. It moves about and it will do weird things. Sometimes different things will contribute in different ways. The thing is that we shouldn’t get too stressed about that sometimes. Pain is weird. Generally unless it’s a fracture or a very, very specific mechanism that you can pin down to, it’s very difficult to know exactly where it’s coming from. Shoulder pain is a great example. Is it bursa? Is it tendon? “I don’t know.” The question is, does it matter? Does it change the way that I deal with it? To understand that pain can often be nonspecific and the way that we deal with it also can be nonspecific. I think that’s super important to understand.
I think it takes a lot of stress off of especially new therapists because when you go through physiotherapy school or chiropractic school or medical school, you are taught to differentially diagnose to really figure out what the problem is. I think when a clinician finally has the light bulb above their head that pain is most of the time nonspecific, then it takes the pressure off of them to figure out let’s say the generator. I really have learned this mostly from my psychology friends where they say, “Our primary job first is to help people cope,” versus, “Here’s the exact cause and now you know what the exact generator is that we can move on from here,” when most of time we’re not going to know what that generator is.
Does it help us move on? One of the really great models over the past maybe fifteen years is the common sense model. I like the common sense model because what it allows us to understand is people form this representation of what pain means. Part of that is the identity that they get from pain, the causation that they get, the consequence, controllability, those factors. What they form is this identity. They identify with the label that they have. It has specific consequences and causes and ramifications. Has that been helpful? I don’t think it has. I don’t think people knowing more specificity about their problem has made it better. In fact I think often the more specific we are, the worse the outcome.
It’s really, really important that as practitioners or therapists that look at a broader model of pain say, “I’ve picked up my reflex hammer there, Joe. I was just playing on my desk. That’s how I live therapy. I’ve even got a reflex hammer.” As good therapists, the really most important thing we can do is rule out or remain cautious of these kind of aspects that might be problematic. If you’ve done a good exam whether reflexes or dermatomes or myotomes or any of these other things and you are confident that you cannot find something that’s really, really specific or very, very dangerous potentially, that then allows us to move on from there. I think it is important that we still keep those skills that allow us to be able to give that great clinical exam and walk away and be able to say, “I’m pretty confident here that there isn’t this really, really specific problem that might cause a further problem down the line.
A great example is when doctor say, “You’ve probably got a slip disc.” What is that? That’s rubbish. Most people don’t have slipped discs. We know that discogenic pain or radicular pain is between 5% and 10% of people with back pain. The likelihood is you don’t have a slip disc. The problem is that people hear this and they say, “I’ve got this diagnosis. I’ve got this identity. I’ve got this representation of what this means. This disc could go any time. It can pop out of my back. My back could fall to pieces.” Actually the identification and the desire to give this identification of diagnosis is probably less beneficial than it is more beneficial. Do you want to find that 5% or that 10%? I certainly do. Am I likely to find it? One time out of ten. That could be five times in a day, who knows? I want to find it but I need to be aware that it’s not going to be the norm and throw away comments like, “It’s probably a slip disc,” are absolutely unhelpful as it can be.
I don’t know what it’s like in UK but in the US, we can be the last stop. By the time the patient gets to us, they’ve been through all the physicians, all the scans. They’ve tried drugs and a lot of ways, they’re despondent. More and more I look at my job and my role as a practitioner to help them cope and heal their pain but on some way, I have to really inspire them. They had an expectation for so long that they’re never going to get better. How do we help inspire people to change their expectation that they have the ability to heal and reverse this?
Why I love using exercise and movement is because I think it has a big positive effect on people’s perception of self. We look at the common sense model and we say, “I formed this kind of representation about what pain means to me, what I’m able to do, what the consequences are?” Most of the time, that is a negative charge. People are negatively charged. For me, the whole point is to create a positive charge. To be able to say, “What can you do?” To be able to say, “What do you want to do?” rather than focusing on risk factors like depression and sleep and central sensitization and all these other factors, these labels that we give people. That’s all well and good, but it doesn’t inspire people. It doesn’t make people feel cared for. It doesn’t make people feel like they’ve got a coach who is on their side. I don’t care about being a star player. I want to be the coach. My job is introduce you to people. My job is to help people do things to themselves. I like to think of myself as a facilitator. I don’t really do anything. I play devil’s advocate. I will say, “What about this? Have you tried this, etc.?”
My main aim is to take their negative perception, their negative prediction, their negative expectation of outcome and say, “How can we turn that into a positive charge?” I like the analogy of a battery. I want them to be at the positive end of the battery rather than the negative end of the battery. I want to do that by talking to them about things that they do in their lives that make them feel good. I want to do that by understanding which activities would make them feel good if they did them. What did they not do that they would really like to do? How do I form a pathway back to doing that? Is that through a graded exposure? Is that through a graded activity? Is that through being there and being a coach and being supporting? The mechanism, who knows? It could be changing what my periaqueductal gray does or my rostral ventromedial medulla? I want to create a pathway that’s positive. This isn’t my positivity. This is part of the problem that we have with exercise and activity is that it’s not about my vision. You don’t need to move like a gymnast. You don’t need to lift weights like a weightlifter. I couldn’t care less. My vision of your recovery is your vision of recovery. My job is just to help you work that out to get back.
What you need to inspire people with is their own inspiration. This is the problem, we don’t understand people’s inspirations. What does it mean to you? What does recovery mean to you? Once I know that, I’m going to get you back. That’s what I want to do. That’s how we inspire people is understanding what makes them tick. We don’t inspire them by saying, “You’ve got to do this or you’ve got to do that,” or knowledge-bombing them with nerves and muscles and ion channels and rostral ventromedial medullas. I think we need to listen. We need to take notes and we need to facilitate.
I agree and ultimately it’s turning people away from their pain and ultimately toward their values. Once they turn toward what they value in life, a lot of times, things start to change really rapidly.
That’s the negative charge to the positive charge. If we think about based in inference concept, predictive processing, all the fancy en vogue talk that we get, which I really enjoy. Whether we need to get these across the patients is a whole another matter entirely. If I can create a positive experience of moving, someone is more likely to do it again, as simple as that. If someone walks away with a positive experience of moving or exercising, then for me that has done my job. I’m creating a positive charge and a positive pathway rather than focusing on something that they don’t care about. Is someone willing to go through more discomfort to build their resilience with something that they enjoy versus something that they don’t?
Ultimately, it’s about changing people’s behavior. Thinking about changing behavior, you obviously do a lot of work at Cor-Kinetic. Everyone can find Ben Cormack at www.Cor-Kinetic.com. What is your vision on how we can start to implement healthy movement and exercise? I know you teach practitioners, tell us a little bit about that.
My main role these days is probably teaching and I’m very fortunate that I get invited to speak at lots of places all over the world at conferences and what have you. The best thing is getting to meet some really smart people that you sit there and you talk over a couple of beers and you think, “You’re smart.” They make me feel insignificant and really thankful all at the same time, which is a pretty special talent. I think the best way that we can go forward and this is something that I advocate, this is something that I would teach, is a four-step process I would say would be the best way to describe it. I’m going to try and get into the four steps. It might turn into five, we don’t know.
Firstly, you’ve got to be in there with the person. The big mistake we make is to try and get people to do things that we like to do or we think is going to be beneficial. We need to listen to people’s goals. We need to listen to what people want to get across. We need to understand where they are right now in terms of their current state. What’s their sensitivity level like? We need to understand a bit more about their belief structure as well. If someone doesn’t believe that exercise is a good treatment for them, it’s probably not likely to have a positive effect in the same way. We have to start to think about education and help people understand more about what we want to get them to do rather than just say, “Years ago, I was giving people a piece of paper with lots of exercises on it. Go and do that.” Then we realize that just no one did them. They got away and they said, “What is this? I don’t know how to do it. I don’t really like it. I don’t have the equipment, it just doesn’t matter.” We need to think about the person firstly. That’s the first thing. The next thing we need to think about is actually the exercise itself. I’m thinking, “How does this exercise fit to this person? Is the dosage right? Does it fit their current state, their sensitivity level?” I’ll go back to meet them for that basic scene analysis of sensitivity, irritability nature, that kind of stuff. Then actually taking the time to explain to people and say, “This is why you’re doing it.” Keep them informed.
They are the most important. If we think about reflection, it’s very, very difficult to know whether your treatment ever is going to work. We know that. The amount of times I’ve messed it all up is monumental. I think reflection is the biggest thing that we can do. To turn around and say, “My favorite exercise didn’t work. What else have I got?” We all have favorites, we all have biases, we all have things that we use with lots of people and they have a greater probability of working. We also need to be aware and turn around and say, “This didn’t work. I need to come with another angle.” That takes a big pair of balls sometimes, if you have balls. Sometimes it takes a big turnaround and say, “This didn’t work. What else have I got? What else am I going to do?” A reflective process is really important. Can we change the exercise? Can we change the activity? Can we change the dosage?
Then finally, the adjustment process as well. We need to think about the person, the exercise and the explanation, the education. We need to think about reflection and then we need to think about adjustment. I think through that process, we’re more likely to come away with a better long-term result rather than suggesting, “This is a back pain. Get your core firing. It’s guaranteed to work,” because it didn’t.
I love that because a lot of patients at least in New York where people are a little bit smart and they are quick-witted and they will tell you the way it is. A lot of these patients have been to the Pilates class, the physical therapist, the yoga class and they will tell you, “Please don’t tell me this one exercise is going to fix me because I’ve done it all.” I really think what you’re saying is that a part of this experience is being a really good pain practitioner is on some level humble yourself to know that not everything you do is going to work, but you have to start somewhere and create a relationship with the patient where you and the patient are on an agreed-upon trial and error basis. You’re going to agree to figure out, “What’s the best thing that works for you? What makes you feel good and do you like this basically?” It can be really tough for people with degrees and licenses and certifications and all the things that we have stocked on to our healthcare system. I think it’s a really good point.
Helping people understand that the physical aspect of medicine or trial and error is a massive important part of recovery.
I have been speaking to Ben Cormack. He is a musculoskeletal, physiotherapist in the UK. He teaches all over the world. You can find him whether you’re a patient or whether you are a practitioner interested in learning more about exercise and pain science at Cor-Kinetic.com. I want to thank Ben for being on the Healing Pain Podcast. At the end of every podcast, I ask you to make sure you hop onto iTunes and give us a five-star review. Make sure you share this podcast with your friends and family on whatever social media handle you’re using. Thanks for being with me this week. We’ll see you next week on the podcast.
About Dr. Ben Cormack
Ben Cormack owns and runs cor-Kinetic. Cor-kinetic provide educational courses based on modern movement and pain sciences within a strong evidence based framework.
They have delivered courses in Europe, Asia, USA and south America and present regularly at national and specialist subject conferences around the world.
Ben is a musculoskeletal therapist with a clinical, rehabilitation & exercise background stretching back 15 years. He specialises in a movement & exercise based approach with a strong education component and patient centred focus.
The Healing Pain Podcast features expert interviews and serves as:
A community for both practitioners and seekers of health.
A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.
If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at firstname.lastname@example.org. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.Love the show? Subscribe, rate, review, and share!
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