Welcome back to the Healing Pain Podcast with Erin Nielsen, PT.
If you have chronic pain, you’ve been told for years, decades, and even still today, to take it easy, to rest, and to not do any type of activity that may cause pain oftentimes by people who are well-intentioned and are trying to help you feel better. With the latest research and data coming out in the new world of pain science,
It’s great to be here with you. If you live in the Northeast or perhaps around other parts of the country, you may notice that there’s been a real shift in the weather. The weather here in the Northeast is a beautiful 70 degrees. The sun is high in the sky and there’s low humidity. When the weather’s like this, I get spring fever and the first thing I want to do is go outside and be active and move my body. I’m born and raised in the Northeast and there’s a real big part of me that yearns to live in perhaps a state like Florida or Arizona or California where I can swing my door open in the morning, go out for a hike or a bike or perhaps walk with friends in the park on the weekends. So often, when the weather’s not nice, we spend more time being sedentary.
When you have chronic pain, being sedentary is one of the things you should try to avoid. You should try to be aware and be mindful about how frequently and how often you’re moving your body and it can be tough to do that when the weather is not so nice, but we have a real opportunity now to be active and to look at activities outside of our home as we move into spring and summer. If you have chronic pain, one of the biggest challenges is that we have told people for years and decades not to move, to take it easy and to rest and don’t do any type of activity that may cause pain. Even still now, this is an all too frequent recommendation oftentimes by people who are well-intentioned who are trying to help those with chronic pain feel better. With the latest research and data coming out and the new world of pain science that’s rolling out, we know that exercise in its many forms and variety have very specific benefits in reducing the severity of chronic pain.
Exercise can decrease a disability. Exercise can help you with having less anxiety. It helps with the alleviation of depression. It promotes better sleep. It can help you maintain a healthy weight or lose weight. You have a general increased quality of life and you have less healthcare costs. If you implement some type of movement or exercise program into your life. Physical activity and exercise programs are increasingly being promoted and offered in a variety of healthcare systems and for a variety of chronic pain conditions. In fact, every pain condition, whether you have rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, CRPS, neck pain, multiple sclerosis, or some other type of autoimmune disease, each of these can benefit from some type of movement or a regular exercise program, but what type of exercise program should you choose?
Should you see a physical therapist first or perhaps a personal trainer or another exercise professional? Should you experiment on your own at the gym? Should you begin a cardiovascular or an endurance training program? Or perhaps you should pick up the weights and do a strength or resistance training program? Maybe what’s called a HIIT Program or a High-Intensity Interval Training Program? Which one is best and where do you begin if you have pain?
For this episode, our guest is Erin Nielsen, PT. Erin is a personal friend of mine as well as a colleague, as well as an amazing physical therapist who specializes in helping clients with pain, mobility challenges, weight loss, and anti-aging. Rather than fall prey to ineffective and time-consuming workouts, Erin, who is a busy 42-year-old mom and wife, will help you frame out the basics of what you need for fast results, even if you’re on a tight schedule and even if you have some chronic pain.
During our interview, Erin will discuss a particular type of exercise called HIIT or High-Intensity Interval Training. The benefits of high-intensity interval training had been studied and include weight loss, less pain, improve strength, better function, and better balance. If HIIT training seems foreign to you or maybe you’ve read about HIIT training online and you’re a bit fearful and thought it was just for gym rats or muscle guys or CrossFit athletes, nothing is further from the truth. If you’re new to exercise or if you have pain, this is achievable and can be worked into your integrative chronic pain program. To get you started, I’ve included with this podcast a complete beginner HIIT workout just for you. These beginner High-Intensity Interval workouts are short but effective. They’re designed to burn the most amount of calories in the shortest amount of time. Studies have shown that just five minutes of high intensity exercise creates rapid change in your muscles and your nervous system on a cellular level that are comparable to what you might see in an hour or more of traditional steady-state cardiovascular activity.
To download this free beginner exercise routine, all you have to do is type in the URL, www.DrJoeTatta.com/86Download. You can also text the word 86Download to the number 44-222. After you’ve done that, let’s take a deep breath. Let’s settle in and let’s get ready to chat with Erin Nielsen.
Reset Your Body To Burn Fat, Alleviate Pain, And Get Your Energy Back with Erin Nielsen, PT
Erin, welcome to the Healing Pain Podcast.
Joe, thanks for having me.
I’m excited to have a physical therapist on who’s working in the area of pain as well as weight loss. We get such a beautiful marriage of the two and so many people need especially this time of year. People are starting to look at their wardrobe, look in the mirror, look at themselves and realize, “I need to maybe lose a couple pounds and that it’ll probably help my pain as well.” I’m excited to talk to you about the topic. Give me your history of how you got involved in physical therapy first and then how in involved into more the weight loss area?
My journey into physical therapy was from a personal story with my older sister who was a gymnast and she broke her neck at the age of 16 doing gymnastics. Luckily, she wasn’t paralyzed, was very close but was not. I didn’t know it at the time, but I would go to physical therapy with her and my mom and just seeing her go from being in that horrible brace and not being able to walk to being able to walk and how much of an impact physical therapy had on her. I didn’t know it was impacting me at the time until high school and you had to choose what you wanted to do and all of those memories came back. That was my total inspiration for starting that.
Explain to people how you can “break your neck” but not be paralyzed? It sounds like she was in a halo.
She was in a halo. She fell from the balance beam and landed right on her head. I didn’t know at the time, but once I became a physical therapist and looked at her MRI and x-rays, there was a chipped bone that once she fractured her vertebrae, which are were the bones in your neck, a chip of that bone was less than a millimeter away from puncturing the spinal cord. Nothing punctured the spinal cord, which is why she wasn’t paralyzed. If they had moved her incorrectly after she had the break, she could’ve easily been paralyzed. The people that took care of her at the gym did the exact right thing. They didn’t move her until the experienced, skilled people that know how to do that came.
Now, she is?
Completely normal. She’s completely functional. She’s a mom of two, no pain. She’s got a full life. It’s amazing.
It’s an amazing recovery story. How did you start to venture into the weight loss area?
That’s more of a personal story of my own but also of working with patients for eighteen years. Probably like the first fifteen years of doing physical therapy, I was completely fulfilled. I was loving what I was doing. I’m like, “I’m making such a difference in people’s lives,” which I was but I started to notice a trend in myself especially as I reached the age of 40. I was starting to gain weight but I was also starting to get pain, starting to get skin issues, starting to have even feelings of low self-worth and all of that kind of thing. I was seeing that also in my patients as they were getting towards that middle age. Through my own struggles in dealing with my patient struggles, I was like, “There’s got to be more to this than just being reactive to the pain that is here. There’s got to be maybe a way to reduce the pain or prevent the pain in the first place, but also to prevent all these other things that were not liking that are happening.”
As a physical therapist, I’m a huge fan of research. I dug into research and started making some changes in my life with nutrition and I’m changing the way I exercise even mindset and started noticing these amazing changes in myself. I started to lose weight. My skin issues I started to have were going away. Those little aches and pains started to go away. I asked my patients if I could share that information with them. I was always working on movement with them but I was adding in those other things and then they to get faster results, amazing results. That’s how it conspired.
As a physical therapist, you know a lot about exercise. How did your exercise routine change as you started noticing your own problems and as you start to look at some of the research, how does that inform what was happening in your own life?
What I was doing at the time was I was working out for long periods of time and mostly focusing on cardio. I’m a fan of cardio for short periods of time but that’s all I was doing, and I was doing it for a long amounts of time. At the same time, I wasn’t eating correctly either. I was working out for these long periods of time and depleting my body. I like to refer to it as I was punishing my body. It was not working for me. I looked awful. I felt awful and all those other things were going on. Through my research, I started changing my exercise routine to more short bursts workouts that are more high intensity, easy on the joints, but get you amazing results without causing that chronic inflammation that can cause chronic pain and chronic problems.
When you say short bursts, the word ‘burst’, sometimes people think, “What does that mean? Does that mean like a sprint?” When people hear the word burst, if they have pain, they might think, “Bursting is not something that I should be doing because I have knee pain or I have hip pain or I have back pain.”
The burst refers to the short amount of time that you’re doing it or not like bursting in the air or jumping. You can do it two ways. I have some workouts that I like to do that are just short bursts where there’s not a lot of rest doing it. You can also do what we were referred to HIIT training, which a lot of people know about where you actually do take some rest breaks, but it might be up to 30 minutes of time rather than a ten-minute workout. You can do it both ways, but it does not have to be high impact on your joints. It can be very beneficial for people with pain. It’s very beneficial for the other reason as that unlike those long workouts that cause that chronic inflammation, the short workouts cause what we call acute inflammation, which is beneficial for your body and for pain.
Explain to people how exercise could cause long-term chronic inflammation. Most people know exercise is something that’s supposed to be beneficial and should alleviate your pain and help you function better.
With the short burst workouts, you’re going to get more beneficial of that acute inflammation because when you exercise in that way, after you exercise, your body wants to repair the muscles that you just worked. It stems scientifically, but it sends macrophages to the areas that are acutely inflamed and that those macrophages can either have an inflammatory effect or an anti-inflammatory effect. When you do those short burst workouts, it has an anti-inflammatory effect while it’s healing. It’s so amazing for your body. If you work out too long or in the wrong way, those macrophages cannot be the anti-inflammatory type and that’s not what you want. That’s the main difference.
A lot of people don’t realize that exercise influences your immune system. Your immune system is so influenced by pain.
If you have inflammation in your body, you’re most likely going to have pain. It’s usually what I see. It’s such an important thing to control.
Let’s say I’m 55 years old. I have rheumatoid arthritis that’s mostly in my knees. How would I potentially start a short burst or what’s called HIIT training session in a way that is comfortable for me and won’t cause the pain to get worse?
I have quite a few people with arthritis or rheumatoid arthritis or any of those types of autoimmune diseases that cause pain and for people, if they haven’t exercised at all ever, I usually just start them on a simple walking program and have them increase the speeds and almost like a really fast walk. Not quite a run but like it really fast walk and then slow down and I start them that way and then once they get more used to that, then I’ll start them actually more on like a like a MAT Program with HIIT exercises you. You can even do like bridging or there’s tons of exercises you can do in a manner that is high-intensity but really easy on her joints. Then what happens is over time as you’re doing this, the inflammation starts to decrease. Especially if you’re doing some of the other things we are going to be talking about. Then you can move on to those higher level exercises in that HIIT format.
How soon would a patient or a client see that they’re starting to feel better? Initially, people are to say, “I don’t know about this. I’ve seen HIIT on the internet and it sounds like it’s something that guys with tank tops and tattoos do, not necessarily for someone with rheumatoid arthritis.” How soon might they notice a difference in a number of things that happens in their body?
A lot of my patients can feel it within a few days. Most people like around a week, but especially if you’re doing the right kinds of foods with it and other things that we’ll talk about later, within a week easily, you start to notice less pain. You may notice less swelling in certain areas. It’s really amazing. One of the things I love about it is it makes it much easier to keep going with it because you’re going to notice improvements pretty quickly.
Versus doing the bike for 40 to 50 minutes four times a week, which gets to be exhausting physically as well as mentally oftentimes.
It’s boring. I’m a huge believer in switching up the routine. I get so bored so I have to switch up my exercise routine all the time.
That’s interesting because so often, I’ve run into friends and I’m sure you have awesome friends and family and they say, “I still do the exercises that I was doing when I saw my therapist ten years ago.” Part of me wants to get my pom-poms out in cheer because thank God they’re doing something. The other part of me is like for the most part exercise should be progressive and it should change and it should vary as your life varies. How important is that for patients and how do you explain to people that as our diet changes with season, I look at exercises like that too. Exercise should change a lot of different moments.
I’m a huge believer in so many things with exercise that like you said, as seasons change. For me, I live in Upstate New York. My exercise in the winter is very different than in the summer. In the summer, I love to get outside because I feel like nature and sunshine and being on the true ground has such an amazing effect on the way you exercise on the benefits you receive from it. Then in the winter it’s more like, I’m working on inside unless I can get outside on the weekend, but that usually involves a track somewhere just because of where we live. That’s not always as easy, but changing up your exercise routine if you can bring nature into it but also as a physical therapist, when you do one exercise for so long, you’re not going to be seeing improvements because you’re going to stay stagnant there. I’d rather you do that than nothing. Do the same thing if that’s what’s going to float your boat, but it’s always going to be better to be changing up your routine to keep your body improving.
Talk to me about how you started to venture into the world of nutrition and food.
That was one of the things because I’m not a nutritionist by any means, but I’ve learned all of that through my own research and the struggles I was talking about before. Along with changing my workouts, not all at once, but I started to make some small changes in my nutrition. One of the first things that I did and that I learned about was inflammatory foods and anti-inflammatory foods. One of the biggest culprits of inflammation of what we eat is sugar. I always thought of sugar as the sugar you think of like candy or soda, but it’s in a lot of grains and in a lot of refined carbohydrates. I was the queen of those. In college and through my first few years of working, I would have like a bagel for breakfast or cereal and then a sandwich for lunch and then pasta for dinner. I was the carb queen. I started slowly cutting those out because it probably would have been too overwhelmed and would’ve quit if I tried to do it all at once. I slowly started doing that and then cut all the candy and soda out. That was a little easier for me. Might not be for some, but for me, it was. It was those carbohydrate meals that I loved. One of the things that happened was my energy shot through the roof. I wasn’t having those energy dips in the afternoon. My pain was getting better. I was diagnosed with Rosacea in my late twenties and that went away. I was like, “I’m sold.” That’s when I started sharing some of my nutrition research with my patients, too.
How do people respond to that? They’re seeing a physical therapist, they’re working on exercise, and then you say, “Let’s talk about the candy you had for Easter?”
It’s an easy process to start talking about nutrition because once you’re working with these patients for any period of time, you start to have a nice trust relationship and you talk about a lot of things. It comes up naturally, especially when I share my own personal story and how changing my nutrition helped me so much because I was going through a lot of the things they’re going through. The pain and the weight gain and a lot of these people because they’re in pain, were getting depressed and feeling like their self-worth wasn’t as good and I had gone through all of that. I share my own personal story and then they’re like, “I want to try that. What did you do?” It is a little scary at first because most of them are not eating the right way, just like I wasn’t, because they didn’t know. Once I shared that with them, they try it and I usually recommend to dive in slowly, so that you’re more able to stick with it. Some people are all out and want like, “Give me a fourteen-day detox,” and so I’ll give them that if they want to do it, but some people need a little bit slower jump into that. It worked out nice. That’s what’s nice about being a physical therapist and working so closely with people, is it’s just natural.
You already have the relationship there and a lot of people are very open and interested in learning about nutrition because they know that, “I’m already doing some exercise here and I’m starting to feel better. What else is potentially missing from my life?” Oftentimes, it’s the nutrition part.
It really is. A lot of people don’t realize how important it is because not only does it affect your pain. It also affects how your brain is working and how you’re feeling positive-wise or negative-wise. It’s an amazing thing to add.
What does your practice look like now? When someone comes to see you, what does that look like?
I’m only mostly doing private consulting. For twenty years, I was in a number of different settings, but primarily, I worked in outpatient settings. They would come to me at a separate outpatient clinic and then the last five years, I did home care. I would go to people’s homes, which I loved. It was very one-on-one and when I started, I had already started teaching about the foods. I could be in their house and be looking and make recommendations in their home about the changes they could make. That was amazing. Then now, it’s more just one-on-one. People reach out to me either through my online business or people in my community know me and have loved what I’ve done in the past and so I treat people that way, too.
I never thought about that as a home care therapist. It is obviously the perfect place to start to work on some nutrition as well as the activities of daily living and movements, really the perfect environment.
It really was. I enjoyed it so much and it was different than an outpatient setting because outpatient settings are very busy and there’s a lot of stuff going on. It can be very distracting for patients and the therapists as well. You’re just one-on-one in their home and you can focus on all important things.
How has the mind informed the work that you do with patients and even maybe informed your own transitioned to a healthier place?
There are so much to that. I feel like I always go back to my own personal experience first. I think with the movement and the nutrition that helped my mind become more positive, but I also think it’s something you need to be intentional about each day because it’s easy to get off track. One of the things that I do every day that helped my life and I use for numbers to make it easy because people always want to know what I do. I use the numbers ten, five, three, one. Ten is trying to get at least ten minutes of healing movement in your life. Like the ten-minute exercise we talked about, the HIIT exercise, maybe just walking, maybe a mobility exercise because that’s always very important to us because we lose mobility. That’s what the number ten stands for.
The five stands for five minutes of meditation or prayer or whatever it is that you believe in to center your body because there’s studies that when you can do those types of practices like meditation or prayer. It helps distract your mind away from the pain, which can have a huge effect on your body and your pain. It’s something that I love to do. Then the third one that is important, the number three is I do this every day, is to write down three things you’re grateful for. I encourage people to write something different each day. You have to think about it and that makes a huge difference too.
The number one is trying to do one act of random kindness a day. That made a huge difference in my life. It feels good for you but it also feels great to see a smile on someone else’s face and it can be something so easy as like if you’re in a workplace just leaving a note on someone’s desk like, “I hope you have a great day today or love your outfit,” or whatever it is, just something simple. It makes a difference in your day and their day. Once I started doing those four numbers, I noticed a huge change in myself and it helped my mindset and along with all the other changes helped my pain, my weight, everything. It’s all combined.
Ten, five, three, one, ten minutes of some healthy movement. It could be a simple mobility exercise, maybe where you’re stretching your back or your hamstrings or your hip flexors. Five minutes of something that’s mindfulness. That could be meditation or prayer. What were the three?
Write down three things you are grateful for.
Then one random act of kindness.
A huge difference and when people start doing this, they’re like, “It’s so easy and it doesn’t take a lot of time and it makes the biggest difference in each of your days.”
If you had a week where there is a reason to place more emphasis or intention in one area, you could reverse it. Maybe ten minutes, five minutes of mobility, three things you’re grateful for, and one random act of kindness.
Those are all just minimums. Minimum numbers and it’s up to them if you can.
Increase them all, preferably, but start here and do no less. What do you say to patients who are just starting physical therapy, that they’re scared, they’re not sure. The truth is a lot of people don’t know what a physical therapist does. They don’t know if we’re personal trainer. The guy on the tattoos like jumping jacks and that kind of stuff. They don’t know if we’re going to massage them. A lot of times it’s confusing for people. How do you explain what a physical therapist is in how we help people?
It changed over time. What I do because I do it from a more holistic approach is I start off by listening and that’s what I say to them. I say, “I want listen to what you’re struggling with and I want you to tell me about your pain, but also tell me maybe some other areas of your life that you’re struggling.” When I do that, it pulls the walls down. Rather than me being like, “I’m your therapist and these are the tests we’re going to do now,” which is what I used to do, because that’s how I was taught to do it. I start it in a very different way because believe me, I’ve had patients come in and they were there because their doctor told them to eat right. They were referred to a physical therapist and so they’re like, “I don’t believe in physical therapy.” I’m like, “That’s all right.” Then I asked them those questions I told you, the wall starts to come down a little bit and then I say, “If you give me a chance, give me one week. I will give you some action plans to do. They don’t have to be hard or scary and then after a week, I want to reassess and I’ll ask you the question again. What do you think about physical therapy?” The only time I didn’t get a different answer is if the patient didn’t come back. That happens sometimes, but if the patient came back and went through the program for that week, they never said they didn’t believe in physical therapy anymore.
Something positively changed in their life in some way.
Most of the time, people can see changes within a week. It might not be drastic, but if they notice the littlest change and it’s going in the right direction, that a lot of times is what people need and that’s why follow-up within the first week is so important. People start to lose hope if they don’t see changes. This isn’t going to work for me either. I tried everything. It’s important to be cognizant of people’s emotions with the physical therapy because if you’re not, you’ll lose them.
Weight loss, it’s super important for those with pain and even for those without, if you’re overweight or you’re obese, it’s linked to many types of chronic diseases. What are some of the strategies and tips you have for people who have maybe tried a diet that hasn’t worked, and they’re trying to figure out, “Which direction do I take now? What should I try? Should I go Paleo? Should I go Ketogenics? Should I go on autoimmune diet?” How do you approach those people?
The way I coach most people is I always recommend. I have a particular program that’s like a detox. It is an elimination diet. What an elimination diet is, is I recommend removing dairy, grains, refined sugars and alcohol for two weeks. The reason I love this is that it teaches the person that sticks to it about their body. Most of the time, what you’ll see during those two weeks as that a lot of their symptoms are going away or lessening. Pain is lessening, they’re losing weight. A lot of times, people can lose up to like nine to eleven pounds in two weeks. A lot of it is water weight, but they’re seeing this and they’re feeling better. I have people with autoimmune disease that their symptoms are going away, people with Diabetes 2 where their symptoms are going away. After those two weeks, their energy is high. They’ve lost weight. They’re just feeling so much better. Then what you do is after those two weeks, you start to reintroduce food groups very slowly so that you can see what is a trigger for their body.
Everybody’s different. It’s not going to be the same for everyone. That’s why it’s so important to learn that for yourself and really see it. That’s where I start. If someone feels like they’ve tried everything, it’s important to be most of the time they do it on their own and so they might not be doing exactly they’re supposed to do it. I’ve seen even with some of my followers that due to the detox is they start to reintroduce foods incorrectly or too quickly and aren’t assessed incorrectly. It’s so important to have someone knowledgeable that can help you.
The four foods you’re taking out are dairy, grains, sugar, and alcohol. Let’s talk about grains. It’s a big one for people. A lot of confusion around it as well as a lot of supportive information. When people test them and they figure out, “I am a little sensitive to grains. When I eat them I get like foggy and I get bloated. I noticed the weight starts to go up and it affects my joint pain.” How much grains you recommend that they eat with a meal? Let’s say they sit down for dinner, how much grain would you recommend that they have? We all have our ranges.
What I tell my followers is if you know that grain is a trigger and it’s doing those things, I would recommend not to have it hardly at all, not on a daily basis. For me, grain is a trigger but I love bread. I love it yummy, crunchy on the outside. I love it. I allow myself to have a piece of that on weekends. It’s like my splurge and I have it with butter and it’s delicious, but I wouldn’t want to do that on a daily basis to my body because I know it would be negative. That’s what I tell people that also have that reaction to it. It’s tough but I try to keep it easy and I have another easy framework is for people that do have the bad grain reactions are focused on the four Ps. Focus on Protein and Produce. Produce being vegetables or fruit and then try to avoid packaged and processed foods. A lot of that of bread has added sugar in it. It has a lot of bad stuff in it. I try to keep it easy for those people because it can get so overwhelming and you’re like, “What am I supposed to be eating?”
I love the four Ps. Tell us what the four Ps are again. I love simple frameworks.
The four Ps are focus on eating protein, lean protein and then produce which is fruits and vegetables and then the other two Ps are what you want to avoid and that’s packaged and processed food.
Avoid the packaged in the processed and move toward the protein and the produce. It’s so simple. I love simple things like that.
It makes it so much easier and then I say, “Then just add a healthy fat.” I usually say like one to two thumb sizes of fat, whether it’s olive oil or butter or ghee or whatever the type of fat you love because that’s going to help nurture your body cells. Your cells need fat. That was me like I was so afraid of fat forever and now that I eat and I’m like, I’m more lean than I ever was. My skin is so much better. It’s amazing for your body.
Erin, this has been great. Can you tell us how people can learn more information about you and all the great things you have going on?
I have a website called the TheYouthMethod.com and I’m also offering you a free gift that you can print out and it’s about all the things we talked about. It’s about the healing foods, the healing movements, and also the ten, five, three, one reminder for that mindfulness every day so you can print that out and put it right on your refrigerator for a nice reminder every day.
You can check out Erin at TheYouthMethod.com. I spoke about her free gift in the beginning of the podcast. If you want to rewind, you can get the link to that to download it. It’s a great gift. You should all have it and at the end of every podcast, I asked you to make sure you share this out with your friends and family on Facebook, LinkedIn or Twitter. Super important information, weight loss and pain really go hand-in-hand, and as we start to move into spring and summer, this is the information that you should have in your hands that can help you be healthier and live a pain-free life. I’m Dr. Joe Tatta. It’s been great being here with each of you.
About Erin Nielsen
Erin has been a Physical Therapist for the last 20 years and is also a Certified Health Coach. Her true passion is to spread the word that no matter your age – you can naturally reset your body to burn fat, alleviate pain, and get your energy back.
With a huge heart for others – her mission is to inspire and empower others to live their best life in a lean, healthy, vibrant, and youthful body.
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