What really is the “healing process” for a trauma survivor? Many programs, exercises, and advice exist on how to deal with trauma, but do they really address its root cause? Or are they mostly surface-level techniques that only treat the symptoms, not the problem? In this episode, April Gamble, PT, DPT shares how to address trauma by its root cause and how she uses trauma-focused techniques to treat her patients suffering from pain, anxiety, or other effects of trauma. Bringing a bigger vision to the profession, she also shares with us her deeper work on justice and injustice and how they impact our beliefs and engagements with care. Filled with honest realizations and helpful trauma advice, tune in and learn how to start your healing process too!
How does language and logic impact the management and experience of chronic pain? Asaf Weisman, PT, Phd(c), joins Dr. Joe Tatta on the Healing Pain Podcast to discuss this topic. Asaf is a physical therapist, a PhD candidate, and a lab manager of the Spinal Research Laboratory at Tel Aviv University. He has 20 years of clinical experience as a full-time musculoskeletal physical therapist and studies musculoskeletal medicine, spinal health, as well as chronic pain. He discusses how language impacts pain, unpacks the positive and the negative aspects of cognitive approaches to chronic pain, and shares his thoughts around some of the more popular pain neuroscience analogies or metaphors and how they may not be so acceptable to people living with pain. Most crucially, he clearly defines pain as an experience and its relation to nociception. Tune in for more!
For physical therapy to be truly effective in addressing body pain, it must not only concentrate on structure alone. Instead, it must go beyond that and also involve the entire movement system. Dr. Joe Tatta sits down with the pioneer of this very concept, Shirley A. Sahrmann, PT, PhD, FAPTA. She explains how the movement system redefines physical therapy by classifying movement impairments into diagnostic categories. Sahrmann discusses how a kinesio-pathology approach can provide a better look into a person's psychosocial factors and produce a better diagnosis. The two also discuss how to dismiss PT stereotyping of being medical cheerleaders and the right way to navigate PTA's reimbursement cuts to their practice.
Contextualizing care is the process of adopting your treatment approach to a patient specific life context. The failure to do so is called a contextual error, which often results in a care plan that is not likely to achieve its intended aim or produce a positive outcome. In this episode, Dr. Joe Tatta discusses how to contextualize care for improved outcomes with Gail Jensen, PT, PhD, FAPTA, Vice Provost for Learning and Assessment, Dean Emerita and Professor of Physical Therapy at Creighton University. She is internationally regarded as a scholarly expert in clinical practice, clinical reasoning, professional ethics, as well as into professional education within and outside of the physical therapy profession. Join in for more powerful information.
Physiotherapists have a role to play when it comes to saving the environment. You can tell your clients to drive less. You can try to start influencing public policies to be more environment-friendly. There are a lot of ways physios can help save the degradation of the planet. Join Dr. Joe Tatta as he talks to Filip Maric, Ph.D., and Todd Davenport, PT, DPT, MPH, OCS. They discuss the state of the environment today when it comes to carbon emissions and environmental contaminations. Find out how you, as a physiotherapist can help save the environment. If you want to learn more, check out Integrative and Lifestyle Medicine in Physical Therapy, where Filip and Todd have a whole chapter dedicated to this. Find out how physiotherapy relates to the environment today!
Cardiovascular disease is the number one killer of both men and women in the United States. Despite its severity, it is still a preventable and reversible condition. Nolan Peacock, PT, DPT of St. John's Health joins Dr. Joe Tatta to discuss how primary care can better treat heart diseases through physical therapy. She explains why PTs must go beyond being movement experts and start providing lifestyle interventions to heart disease patients. Dr. Nolan discusses how this setup can help promote physical activity to the aging population and empower patients to actively improve their quality of life, all while keeping the impact of cardiovascular disease at bay.
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Pelvic girdle pain is typically caused by unevenly moving joints, making the bones less stable and mobile. Pregnant women often experience this painful sensation, but it must never be treated the same way as non-pregnant people. Dr. Joe Tatta reframes pregnancy-related pelvic girdle pain beliefs with Dr. Sinéad Dufour, Associate Clinical Professor in the Faculty of Health Sciences at McMaster University in Canada. She discusses why this chronic pain still has a lot of misconceptions and continues to be mistreated despite the mounting evidence around its psychosocial and physiological factors. Dr. Sinéad also explains how women can stay resilient throughout pregnancy by paying more attention to biomechanics than their individual (and potentially incorrect) beliefs.
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The relationship between autism and pain sensitivity is something that we have not covered in this show, mainly because it’s also a relatively new area in pain literature. How does pain management look like in cases where communication might be a challenge? Bethany Donaghy, MSc, BSc And Michelle Failla, PhD join Dr. Joe Tatta in this episode to explain. Dr. Failla is Research Assistant Professor in the College of Nursing at The Ohio State University whose research focuses on understanding the role of social communication in pain responses and management. Bethany is an autistic PhD student at Liverpool John Moores University, UK. Her current PhD project explores pain in autistic children and young people. Tune in and listen to the insights of two trailblazers in this emerging field.
Here are some links for two papers and a review on pain in autism:
• Increased pain sensitivity and pain-related anxiety in individuals with autism - PubMed (nih.gov)
• Initially intact neural responses to pain in autism are diminished during sustained pain - PubMed (nih.gov)
• Acute pain experience in individuals with autism spectrum disorders: a review - PubMed (nih.gov)
Michelle Failla’s website:
Michelle Failla | The Ohio State University College of Nursing (osu.edu)
If you have a need in the future, Michelle’s other line of work is in pain in Alzheimer’s Disease, and she works with a number of people trying to understand pain perception and differences in dementia. If that’s ever of interest to you and your podcast, reach out and Michelle can connect you with some great people in that work.
In today’s episode of Healing Pain Podcast, Dr. Joe Tatta is joined by Laverene Garner, PT, DPT, to discuss how to treat comorbid chronic pain, orthopedic conditions, and neurologic conditions. Dr. Gardner is a board certified neurologic clinical specialist, and currently works as an assistant professor in the Department of Physical Therapy at Winston-Salem State University. Prior to her role as professor, Dr. Gardner developed the vestibular therapy, mindfulness and integrated health components of a concussion recovery clinic at Camp Lajune, where she treated individuals with chronic neurologic conditions. On today's episode, we discuss how Dr. Gardner's passion for integrative healthcare shaped her early career and research interests, why exercise intensity matters in neurologic conditions, how to prescribe physical activity for individuals with neurologic problems, and a lot more.
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Diabetes is one of the fastest-growing chronic conditions affecting physical health, physical function, mental health and mental well-being. In the United States, most Americans are either prediabetic or diabetic, and most of them go undiagnosed. In this episode, Dr. Joe Tatta is joined by diabetes researcher and diabetes management expert Rupal M Patel, PT, PhD to discuss who a group-based culturally-tailored lifestyle intervention program can help in addressing the diabetes epidemic in the country. She discusses who she developed and tested a 12-week community-based group diabetes management program, which uses nutrition, exercise and other lifestyle interventions. Join in and learn about the results of Dr. Patel’s inquiry and how it can change the way diabetes is addressed by the healthcare system.
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It's one thing to experience tragic events in our lives and another to continue living life with trauma. If you are someone suffering from physical, psychological, and emotional trauma or someone who knows of anyone who is experiencing post-traumatic stress, this is the podcast for you. Richard Tedeschi, Ph.D., Psychologist and Distinguished Chair of Boulder Crest Institute for Posttraumatic Growth, talks about the concept of post-traumatic growth and how it differs from resilience. He also shares its five components and more about how trauma affects our heroes after rendering service. He gives us a glimpse into the programs that bring together veteran path guides to help train and support struggling veterans and their families to rediscover hope and purpose as they transition back to their lives out of duty.
Dr. Lance Mabry did a very large study with 4,800 subjects on the topic of a physical therapist's ability to refer for musculoskeletal imaging. This research shows that most people that are using imaging skills are not PTs. So the concept of the overutilization of imaging is not really correct. The imaging is instead being used inappropriately. More than 28% of PTs are actually using all nine imaging skills routinely. So there is definitely a say when it comes to opening diagnostic imaging across different states. Join Dr. Joe Tatta as he talks to Dr. Mabry about the findings of his recent study about imaging. Dr. Mabry is a board-certified orthopedic specialist and a Fellow of the American Academy of Orthopaedic Physical Therapists. Learn what skills you need as a PT when it comes to imaging. Start practicing those skills today so you can expand the rights of physical therapists around the world.
Pain is universal, and there should not be a language barrier to keep us from learning about it and healing. Join your host Dr. Joe Tatta as he talks with Tania Parker, PT, and Jolyane Aubé, BSc OT, about filling the gap in pain education for French-speaking Canadians. Tania graduated in physiotherapy from the University of Ottawa in 2004 with experience in acute care and home care, from pediatrics to geriatrics. Jolyane is a registered Occupational Therapist in New Brunswick, Canada. In this episode, they discuss how they help people with chronic pain to feel good again in their lives. Sharing studies, Tania and Jolyane reveal the effects of this healthcare gap among francophones when delivering essential pain education. As such, they offer a wide range of programs on chronic pain, education on pain management, and others. Tune in to learn more!
Pelvic health may not be the first thing that comes to mind when you think of women's health, yet it is an important issue that deserves attention. In today's episode, Theresa Feola , PT, WCS, PRPC, of Pelvic Room joins Dr. Joe Tatta. Theresa is a board-certified women's health therapist. She has served in clinical management roles throughout her career, but her clinical focus has been on the education and treatment of women's and men's pelvic health. Today, Theresa discusses the current state of women's health, the challenges women face in accessing appropriate pelvic health and physical therapy, and her creation and ongoing development of community-based childbirth and postpartum model called the Perinatal Partners Network.
Peripheral neuropathy is the result of damage to the nerves located outside of the brain and the spinal cord. People who have this condition typically suffer from persistent long-term pain as well as other symptoms. There is no shortage of conventional treatments for neuropathy, but these do not address the condition at its root. Over the years, integrative approaches have become more popular in treating both diabetic and chemo-induced neuropathy, and there is a strong evidence base to back their use. Heather Carlyle, PT, DPT, FIPSI, specializes in using integrative and lifestyle medicine in her physical therapy practice. Heather has a passion for helping people improve their quality of life in a natural way. She created Path to Less Nerve Pain , a hybrid online health education program that she developed to treat and reverse neuropathy. In this conversation with Dr. Joe Tatta, Heather discusses the different components of her program. She also talks about the causes of neuropathy, its symptoms, and the various traditional, complementary alternative and integrative medicine approaches that can be used for its treatment.
My guest is Dr. Anabela Silva. She is a Physiotherapist as well as an Adjunct Professor and the Director of the Physiotherapy Program at the University of Aveiro in Portugal. Her research interests include the effectiveness of pain, neuroscience education, exercise, and the exploration of factors associated with the onset of pain and the maintenance of pain in children and adolescents.
We'll discuss some of her recent investigations regarding pain and children and adolescents. We'll discuss the specific factors associated with the onset, the persistence of musculoskeletal pain in children and adolescents, and how to assess and identify these factors at an early age. Without further ado, let's begin and let's meet Dr. Silver and learn about pain in children and adolescents.
In my profession of physical therapy, the lack of gay, lesbian, bisexual, transgender, and queer-specific education has given rise to deficiencies in our cultural competence and our humility. When deficiencies exist in a profession’s educational system, as well as its continued education system, it can create a climate of discrimination and disparity. This ultimately leads to decreased access to health and effective healthcare.
In the context of chronic pain, which is what we discuss on this show, LGBTQ+ people are more likely to suffer from a long-term chronic pain condition than heterosexuals. To begin this episode, I would like to share with you a couple of reasons why this community or this population of people experience more pain before we meet our expert guests.
The first reason is that a larger portion of the LGBTQ+ community lacks access to health insurance or lives in poverty, more so than their heterosexual counterparts. They’re more likely to delay medical care or, at times, just forgo it completely because they can’t afford it or they simply just don’t have access to quality healthcare.
We are discussing the power of peer support and group learning and chronic pain recovery. My expert guest is Dr. Amber Richard Bauer. Amber is a doctor of Physical Therapy focusing on Chronic Pain Recovery and Pain Education. She's also a certified instructor for Empowered Relief and a facilitator for mental health ten-week virtual pain care program. Amber uses elements of Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, Pain Neuroscience, Education, and Mindfulness paired with her knowledge as a Physical Therapist to help clients recover from chronic pain and return to living meaningful lives.
Amber is a lifelong dancer and a believer in the power of the mind-body connection to heal from chronic pain, trauma, as well as illness. In this episode, you will learn about the benefits of group training for people with chronic pain, why it's important for people with pain to get support from other people, dealing with a similar condition, and the role of a licensed health professional in facilitating group care.
At the beginning of this episode, we talk about Amber’s journey, both her educational journey from being a dancer to a physical therapist through psychologically informed care and then back as well as her personal experience in living with and overcoming chronic pain, which we know is vitally important. Without further ado, let's begin and meet Dr. Amber Richard Bauer.
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It is great to be here with you again. In each episode, we generally discuss the impact of physical therapy treatments on the management of chronic pain and other chronic diseases. From there, we have explored other overlapping problems and conditions, such as things like opioids, the over-prescribing of opioids or addiction, and the movement to choose physical therapy as an alternative to opioid medication.
A clear movement also exists for a physical therapist to play a more pivotal role in treating and managing non-communicable diseases such as diabetes, metabolic syndrome, hypertension, and cardiovascular disease. This should not be too much of a leap because, as physical therapists, we have had a specialty in cardiopulmonary physical therapy for many decades. Something happened during the COVID-19 pandemic which changed our profession as well as changed our personal lives.
America’s mental health declined, with anywhere between 28% to 40% of adults struggling with depression during the height of the pandemic. Many of those numbers have stayed consistent. More people have been prescribed antidepressant medications and the mental health care shortage intensified with many providers in clinics having waitlists of 4 months to 1 year, which left many people without essential healthcare or mental health care services. As licensed doctoral trained healthcare professionals, we, physical therapists, whether realize it or not, see people with mental health concerns daily in almost every practice setting.
Our profession, like many others, has begun to advocate for ways to improve mental health and mental well-being. We now know that the epidemic of depression requires a supporting role by physical therapists. The reason is that the influence of physical therapy extends way beyond the physical benefit. It improves mental health and promotes mental well-being. Screening and addressing behavioral and mental health concerns are within the scope of physical therapy practice guidelines.
The American Physical Therapy Association published these guidelines in 2020 in the House of Delegates’ position statement. This position is generally in line with the best evidence and the growing trend in psychological uniform physical therapy, which incorporates bio-psycho-social treatments for chronic pain and other health conditions.
A few decades before the American Physical Therapy Association published these guidelines, there was the International Association for Physical Therapy and Mental Health, which is a sub-chapter of the World Confederation of Physical Therapy, which described the need and scope of physical therapy and mental health, behavioral health, and psychiatry.
What we are seeing is the construct of psychologically informed physical therapy is the same, similar to, or compliments mental health physical therapy, which is used to facilitate body awareness, problem-solving skills, cognitive restructuring, and ways to cope, which reinforce self-efficacy and improve quality of life in the face of poor mental health.
It would then appear inherent that a physical therapist can use biomedical treatments as well as psychosocial treatments based on their key role in reducing disability and fostering positive human growth. Occasionally, as physical therapists, we sell ourselves short and fail to understand the depth and the breadth of the impact we can have on someone’s quality of life. What I am referring to is the emotional and psychological benefits that can increase the value of care that we provide as individuals and as a profession.
Now more than ever, it is important that we understand and explain the breadth of the therapeutic benefits that we provide because studies demonstrate that approximately a quarter of all Americans may have a mental health condition. 25% to 50% of patients in a general outpatient physical therapy clinic have a mental health condition and upwards of 70% of patients with low back pain that report to physical therapy have some level of depression. We are already seeing this in practice.
There is a place for us to be primary care and entry point providers into the mental health care system. However, that does not mean that we simply “refer out.” It means that. As professionals, we stay engaged in patient care, and we continue to play a role independently or in the code management of the mild, moderate, and severe depression or other mental health conditions that exist in the populations of patients that we treat.
In fact, there is some literature that mild to moderate depression improves over the course of physical therapy, regardless of whether or not a mental health provider is engaged in the plan of care. How can that be or why is that? It is because movement, body awareness, physical activity, exercise, and many other interventions that we use as professionals are a catalyst for positive mental health and improved psychological well-being. When you combine physical activity with cognitive reappraisal, there is generally a greater impact on outcomes and the quality of life of the patients that you care for.
Joining us to discuss the role of the physical therapist in treating depression is Dr. Tony Varela. He is a physical therapist who brings many years of experience in musculoskeletal health, including pain management. His professional principles were paved through residency and fellowship, grounded and rich patient experiences, and reinforced by serving those surviving chronic pain, cancer, as well as trauma, and PTSD from war.
He believes there is a better version of ourselves ready to push through and he is an Assistant Professor at Arkansas College of Health Education. Tony authored a paper in the February 2022 edition of Physiotherapy Theory and Practice called The Theatre of Depression: A Role for Physical Therapy, which we will discuss in this episode. Without further ado, let’s begin. Let’s meet Tony and discuss the role of physical therapy in the treatment of depression.
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It's great to be here with you. Thanks for joining. In this episode, we are discussing a new assessment tool to guide behavior change, which is called The Physical Therapy Healthy Lifestyle Appraisal. It was developed by Dr. MarySue Ingman, who you will meet in a couple of moments. This is the first validated assessment tool for a physical therapy practice, where we can look at nutrition, physical activity, stress, sleep, and tobacco use. What I like and appreciate about this tool is that it's quick, easy, fits well into physical therapist practice, and especially if you are using integrative or lifestyle medicine approaches to treat chronic pain or chronic disease management.
Let me share a little bit about our guest. Dr. MarySue Ingman is an Associate Professor in the Doctor of Physical Therapy Program at St. Catherine University in St. Paul, Minnesota. Her research interests include the role of a physical therapist, health promotion, and clinical practice. She's published studies on motivational interviewing and the role of physical therapists in health promotion and wellness.
In this episode, you will learn a lot about counseling, assessment, and the science of behavior change. In fact, this episode is a sneak peek into some work that all of us have been working on for years. Some of you may know that I co-edited a textbook. That textbook is called Integrative and Lifestyle Medicine in Physical Therapy. My co-editor was another physical therapist, who you might know, whose name is Dr. Ginger Garner.
In that textbook, we invited about 40 physical therapy professionals, researchers, and educators, to contribute to this book on Integrative and Lifestyle Medicine in Physical Therapy. Chapter 3 in this textbook, which is called Coaching, Counseling, and the Science of Behavior Change, was written by MarySue and her colleague, Dr. Janet Bezner, a Professor in the Department of Physical Therapy at Texas State University.
That textbook is on track to come out soon. We are excited because we think that this will be useful for physical therapy educators, as well as clinicians who are using integrative and lifestyle medicine in physical therapy. As I mentioned, Chapter 3 is written by MarySue, where we go into Coaching, Counseling, and the Science of Behavior Change, which we will discuss in this episode. Without further ado, let's begin and learn about the Physical Therapy Healthy Lifestyle Appraisal and meet Dr. MarySue Ingman.
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We have a new topic that we are highlighting on the show. We are discussing resilience and growth after trauma, also known as post-traumatic growth, which is a theory that explains the positive human transformation that can occur after any type of physical trauma, psychological or emotional trauma, spiritual trauma, or even after struggling with a prolonged illness.
Joining us to discuss trauma and post-traumatic growth is Dr. Melissa Zeligman. She is an Assistant Professor of Counseling Education at the University of Central Florida. Prior to her Doctorate, she served as a mental health counselor working in the agency, medical, legal, as well as high school settings.
Her research focuses on trauma work, including the experience of post-traumatic growth. Positive growth or post-traumatic growth is something that interests me, especially within the context of treating people with chronic pain or other chronic health conditions that we see in physical therapy or other physical medicine or rehabilitation settings.
You are going to learn a lot about this topic. Hopefully, you will embrace it as much as I have in both clinical practices and become very interested in the research. If you are interested in learning more about a trauma-informed approach to treating chronic pain, make sure to check out our course at the IntegrativePainScienceInstitute.com called Trauma-Informed Pain Care, where you will learn how to treat trauma from a trauma-informed perspective for people living with chronic pain. Without further ado, let’s begin and learn all about post-traumatic growth.
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In this episode, we are discussing the latest evidence which supports the use of a ketogenic diet and its potential impact on pain and central nervous system sensitization. My guest is Dr. Rowena Field. She is a physiotherapist with many years of experience, primarily in chronic pain management. We discussed the results of her recent PhD dissertation, where she investigated the use of a ketogenic diet for the treatment of chronic pain and now incorporates this approach in her physiotherapy practice.
We will discuss how a ketogenic diet impacts pain, blood biomarkers, and quality of life for patients with chronic pain and other chronic health conditions. This is sponsored by the Functional Nutrition for Chronic Pain Practitioner Certification. In this training, you will learn how to apply diet and nutrition for multiple chronic pain syndromes, including how to use a ketogenic diet for the treatment of chronic pain. Without further ado, let's begin. Let’s meet Dr. Rowena Field and learn about how a ketogenetic diet impacts chronic pain
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As always, I am delighted and honored to be spending this time with you. I recorded an episode on embodied cognition and the body's role in thought with Psychologist Rebecca Fincher-Kiefer. In that episode, we discuss the importance of using the body as a therapeutic tool for helping modulate difficult emotions or thoughts that people may encounter from chronic pain or other various chronic health conditions. As physical therapists, using the body as a tool for healing from pain or other conditions, whether it's physical or mental, is a big part of what we do.
In this episode, we're going to go deeper into how to use the body, including how to use exercise and physical activity to improve pain as well as mental wellbeing with Dr. Jennifer Heisz. She is an expert in brain health. She's an Associate Professor and Canada research chair in Brain Health and Aging in the Department of Kinesiology at McMaster University. She directs the NeuroFitLab, which has attracted over $1 million to support her research program on the effects of exercise and physical activity on brain health.
Her award-winning research examines the effects of physical activity on brain function to promote mental health and wellbeing in young adults, older adults and individuals with Alzheimer's disease. She has a new book coming out called Move The Body, Heal The Mind, which examines the latest research on how exercise can help you overcome anxiety, depression and dementia, improve focus and creativity, sleep better and even improve chronic pain. Without further ado, let's begin with Dr. Jennifer Heisz and learn about how we can use exercise and physical activity to improve brain health.
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