The infraspinatus is the most associated muscle to the “rotator cuff” of the shoulder. The infraspinatus muscle is located on the backside of the shoulder blade. It helps rotate the arm and shoulder, and can be a source of pain.
This muscle has a crucial role in shoulder stabilization along with the teres major and subscapularis, and is related to injury and important to address in all shoulder pathologies.
In this post, we’ll cover the top infraspinatus release techniques along with common trigger points.
Infraspinatus Muscle – Origin, Insertion & Function – Human Anatomy
Infraspinatus Muscle
Origin:Infraspinous fossa of scapula Insertion: Greater tubercle of humerus Function/s: Shoulder joint: Arm external rotation;
Stabilizes humeral head in glenoid cavity Functional action: Decelerate internal rotation and adduction of the humerus Innervation: Suprascapular nerve
Infraspinatus Trigger Points
The infraspinatus often harbors very sensitive trigger points can be found especially on the lower portion of the shoulder blade that refer to the front of the shoulder, and can mimic the pain region often described on evaluation.
This is a potential contributing factor to shoulder pain.
Infraspinatus trigger points can be de-sensitized by a number of neuromuscular techniques, ranging from static compression, to spray-and-stretch, and also muscle energy techniques applied to the rotator cuff muscles.
How To Stretch Your Infraspinatus Muscles
Stretching the infraspinatus can be difficult to do, especially if the shoulder already has increased range of motion. Stretches should only be utilized if they do not add additional stress to the shoulder capsule and no underlying rotator cuff pathology exists.
Massage techniques and “pin and stretch” may be more directly impactful on this muscle to reduce shoulder pain.
Infraspinatus Massage Technique
Tennis Ball Self Myofascial Release For Infraspinatus
Conclusion:
If you’re dealing with shoulder pain, it’s important to consult a doctor to rule out any serious underlying issues. But with these simple techniques, you can start to release the infraspinatus and get relief from your shoulder pain. Additionally be sure to support your rotator cuff with back and shoulder exercises to build overall strength.
The teres major and minor are shoulder muscles that can be commonly associated with a variety of aches and pains in this region along with the infraspinatus.
Therefore, they should be addressed through myofascial release techniques, stretching, and exercises aimed at restoring optimal function. Below you’ll find my top recommended teres release techniques.
Teres Major Anatomy And Function
Teres Major Muscle
Origin: Inferior angle and lower part of the lateral border of scapula Insertion: Intertubercular sulcus of the humerus Function/s: Medial rotator and adductor of the humerus Functional action: Decelerate external rotation and abduction of the humerus Innervation: Lower subscapular nerve and thoracodorsal nerve
Teres Minor Anatomy And Function
Teres Minor Muscle
Origin: Lateral border and adjacent posterior surface of scapula Insertion: Greater tubercle of the humerus Function/s: External rotation and adduction of humerus Functional action: Decelerate internal rotation and abduction of the humerus Innervation: Posterior branch of axillary nerve
Teres Trigger Points
Trigger points in the teres major and minor are very common and can be very tender. They can be a challenge to find with direct pressure in to the muscle, but can be easily found when using a “pinching” approach directly into the belly of the muscle.
Teres trigger points tend to refer to the shoulder and can also go down the arm. Neuromuscular therapy techniques such as static pressure, or muscle energy technique are very helpful for quickly releasing these points. After release, be sure to strengthen the area with the best back and shoulder exercises.
How To Stretch Your Teres Minor
Stretching the teres minor is easy. Stand up with your back next to a closed door. Hold the door handle. Take a small step forwards, and then lean forwards. You should be able to feel a stretch around the outside of your shoulder blade.
It’s important to go easy with this stretch, especially when you’re first starting out, and always go only to comfort.
How To Stretch Your Teres Major
To stretch the teres major, stand up and place your arm up towards your ear. Wrap your arm over and around your head. You should feel a gentle stretch just beneath your arm pit. Pull against your arm, and side-bend.
Teres Self Myofascial Massage with Foam Roll
Both teres muscles can be worked with a foam roller for myofascial release. This sidelying position makes the work more tolerable as the majority of your bodyweight is on the floor.
The most important part of this rolling technique is to make sure you continue to raise the bottom arm toward the sky to lengthen the muscles as you’re rolling them in order to maximize the teres release.
In this episode I talk with Nicole Visnic about inflammation, it’s role in pain, how to test for it, and what works to reduce it. If you’re dealing with chronic pain, SIBO, or any other type of inflammatory issue, then you’ll definitely want to listen to this one.
2:56 – Can you give us a little history around your work in nutrition and how it led to your current approach to nutrition?
8:20 – We hear the word “inflammation” a lot when it comes to the body. Can you tell us what that specifically means when it comes to mind for you in your work?
18:10 – Inflammation is tied into pain. What is your experience in helping people with pain reduce inflammation and the results you have seen?
23:45 – Is being “overweight” a problem for having inflammation?
26:54 – Are there any specific tests you can run to determine how much inflammation you have?
30:30 – Most people deal with inflammation by taking things like anti-inflammatories, but I think we generally know taking a lot of this stuff isn’t good, but what particularly happens when we keep dosing ourselves with things like ibuprofen to reduce inflammation?
32:49 – Inflammation in the gut is a hot topic right now, and in particular something called SIBO. Can you give us a rundown on what SIBO is, and what are the common symptoms associated with it?
41:08 – So what do you do to reduce inflammation in the body? What are your general recommendations?
47:36 – What’s most exciting in your field of work right now? What’s new and awesome and on the horizon?
Nicole Visnic is a seasoned clinician with a track record of helping thousands of clients achieve their health goals. She has spent the last 12 years working in an integrated medical clinic in Santa Monica, CA, developing solutions to complex conditions like chronic fatigue, and functional gastrointestinal disorders.
Nicole’s multi-layered assessment processes identify underlying imbalances and biopsychosocial factors that influence dietary habits and overall health. She translates the information into customized nutrition and lifestyle programs that are designed to address the root causes of chief complaints.
She guides and supports her clients throughout their health journey using innovative motivational strategies to increase dietary adherence, and maximize results. Nicole earned her bachelors degree in health education from Winona State University, and her masters degree from the University of Bridgeport in human nutrition.
She is a certified clinical nutritionist through the clinical nutrition certification board. Earlier in her career she served 6 years in the Air Force National Guard, managed corporate wellness for Honeywell Aerospace, and worked as an adjunct psychology instructor at Brown Mackey college.
Her work in the military, corporations, and academia, along with being a wife and mom, gives her the ability to appreciate and relate to a diverse range of clients.
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Kelsey Harris: What the heck is <a href=”https://releasemt.wpenginepowered.com//hypnosis-chronic-pain/”>hypnotherapy for chronic pain</a>? Is this like stage hypnosis? Why would I want that? And how could it ever help me with my chronic pain? I don’t know if these are questions that you’ve been having, but they are definitely questions I had. And so I decided to invite Sam Visnic, who among other things helps his patients through the use of hypnotherapy, to chat with us on Chronically Living. I’m Kelsey Harris, chronic illness warrior and psychotherapist. On Chronically Living and how to make the most of it, we’re providing tangible ways to improve the wellbeing of Spoonies. So get ready to make the most out of your life, even with that pesky chronic illness.
Sam Visnic: My name is Sam Visnic, and by trade, I am a <a class=”wpil_keyword_link” href=”https://releasemt.wpenginepowered.com//” title=”massage” data-wpil-keyword-link=”linked”>massage</a> therapist, but I focus on the clinical side of things. My expertise is working with people with chronic pain, and I also design corrective exercise programs for people as well who are in this state. And I do a smattering of other different types of techniques and therapeutic things that will help people along their journey to be able to get back to living their lives after they’re currently struggling with, or just trying to move past chronic pain.
I think I pretty much just started off, I was always the skinny kid, teenager who needed to get into the gym, and lifting weights just became something I was really into. This is when you could go to the bookstore and read at Barnes & Noble and Borders anyway, I would just go down the aisle where all the fitness books were and I would just start reading. And in particular, I really liked the books that were more on the scientific end of things, rather than just loose fitness things. And I started reading about theories about strength training and all the physiological processes that happen in the body, and I got really interested in that.
Once I graduated from high school, parents kicked me out, said, “You have to get a job.” So I thought, “You know what, I love fitness, I’m going to become a personal trainer.” So this led me into a direction, I ended up getting a job at a Big Box Gym. And as a trainer there, you start realizing very quickly that virtually everybody there has some kind of problem, they have back problems or they have knee issues. And in interviewing these people, and that was one of the benefits of working at this size of a gym, I got to talk with hundreds of people.
Most of them had already gone to the doctor, been to physical therapy, etc, and they were just left up to their own devices to do stuff, but they were very apprehensive. They were what I call stuck in the gap now, which is they’re outside the medical system, they’re not really a surgical candidate but they’ve been through therapy. But then they go to the gym and they keep having setbacks. They couldn’t do a lot of exercises, they’re having pain. And I got really good at just modifying exercise programs.
And throughout the course of this, not only could I get people exercising without having pain, but I started realizing a lot of their issues were getting dramatically better, and they were overcoming these issues. And so, of course, that led me into like, “What am I doing here that’s actually making a difference that these people weren’t getting improvement elsewhere?” This is right at the time where the whole fitness field was changing into this whole, what we call functional movement direction, people exercising on Swiss balls and all this kind of stuff and looking at posture.
So that started me off in that process. And for me, I’d always skip to the back of the books that I was reading and look at all the references and find out who was putting out this information, and that led me to a few mentors in the fitness field that were way ahead of their time, I would say, in focusing on dealing with people who had orthopedic problems, whether that was athletes or just everyday people, and they taught me a lot. And they were, at the time, and this was 20 years ago, they were talking about what we now know and call the biopsychosocial model for pain, is all of these different factors that contribute to why somebody might be having pain.
It wasn’t just a mechanical, structural phenomenon, it wasn’t just, “Hey, fix your posture and do some core exercises,” there’s nutrition, there’s lifestyle, there’s all these things. When I started off in this work, I was doing fitness, designing exercise programs with people, and of course doing hands-on therapy with massage, and I learned a lot of techniques within that for pain. But then slowly, sequentially, I branched out into these different fields and these and arenas with the intention of basically taking those tools and integrating them back into my basic practice so I can help people overcome these sticking points that they were dealing with. So that’s how it happened.
Kelsey Harris: The biopsychosocial model for pain and disease, so that’s biology, psychology, and then environmental or social influences, has generally been vigorously studied and is the accepted model of illness at this point, both for physical and mental illness. So I appreciate that Sam brought it up today. Sam is actually here to talk to us about hypnotherapy. Now, before I lose you, I will admit that I have in the past been skeptical about hypnotherapy as well, but I think that’s because of a lack of understanding of what it is, and of course, the media’s portrayal of hypnosis. So let’s get right into the meat and potatoes of today’s episode.
Sam Visnic: This is one of my favorite topics. And it’s funny, I feel like I don’t get a chance to talk about it so much because there is just an enormous stigma associated with hypnotherapy. And I’m really interested in helping people overcome this. So I’ve been involved around hypnotherapy fields and personal development and so forth for as long as I’ve been doing this, and I would say that hypnotherapy is, put simply, something that really people can latch onto. It’s really about helping you to have an experience of being able to access different aspects of your mind or resources that you normally have in different contexts, which you don’t have in others.
We oftentimes experience this a lot, it’s a very natural phenomenon, it’s somebody who seems to be somehow very resourceful in a certain context, but they’re not resourceful at all in another context. And what’s the difference between these two things? A lot of it is like a meta or an above state of consciousness that they’re in. So when you’re in a different state of consciousness, you have access to certain internal resources, when you’re in another state, you don’t. So a lot of times, if people don’t know how to do this, we do it just naturally and we don’t even realize that we are shifting states of consciousness all the time, and we don’t really know how to command that in a deliberate fashion.
When we talk about <a href=”https://releasemt.wpenginepowered.com//hypnosis-and-chronic-pain-the-future-of-relief/”>hypnosis</a>, we’re really talking about the deliberate shifting of those internal resources and conscious states with a process. We are doing it all the time, the difference is that we’re now going to learn or be facilitated by an external party, a hypnotherapist or a counselor, to be able to help them move within those states on purpose, and that’s really what it’s all about.
Kelsey Harris: Okay. I can get behind the states of consciousness thing, but how exactly does this work?
Sam Visnic: If we think about how a natural hypnosis state, and there’s so many of them that we could just pick one, have you ever gotten your car after work and then you just started to thinking, and you just started to zone out and you get home and you realize, “Whoa, I got home and I made all the turns, that I did everything, that I stopped at all the lights”? You were almost completely trekked out when you did this. And where you really trekked out of reality? Not really. What was happening is, your focus was on something, and some of these automatic processes were just taking place, you know how to get home, you knew all of the stops, your body was responding to things. So this is a hypnotic state.
So how do we induce a hypnotic state? How did you get into it to begin with? You were probably just going inside and starting to focus on something and you were fixated with your focus on something in an internal way that pulled in a lot of your resources. So we can become hypnotized by actually taking advantage of that processes to become highly engaged in something. And a lot of times, it can be through an internal experience and we can think about something, a time and a place, for example, that we felt really relaxed, or something like that, and really engage in that experience.
Or, we could do something simple like when we go through self-hypnosis processes, which is to externalize our focus to things that we weren’t normally paying attention to. And when we bring all of those things into our awareness, it can absorb our attention a little bit and shift our internal state. So that’s the job of the hypnotherapist, is to actually help you with that, what we call induction process, to help to shift your internal focus in a way where it does alter your consciousness, and you’ll get a physiological shift as a result of that. So your biochemistry changes as a result too.
Kelsey Harris: There definitely seems to be some overlap with other psychological phenomena. For example, being really engaged in an experience, especially one you’re passionate about, is often called flow. We can also be mindfully engaged in really any experience, whether or not we like it. There are some differences with intent here though. Now, I would assume that hypnotherapy requires some training and it’s not just some random dude on the stage hypnotizing people like we see in the TV and movies.
Sam Visnic: There’s so many different things within the field of hypnotherapy. The standard thing that we tend to associate with hypnotherapy is watching a stage hypnotist bringing people up onto the stage and then making them do wonky things. But that also starts to come with a lot of presuppositions with that, in terms of like that people can somehow be controlled or manipulated or to be made to do things against their willingness to do so. And that, your listeners should know it’s all false. There’s nothing you can force somebody to do via hypnotherapy that they don’t want to do.
And when we look at those kinds of things on stage hypnosis and so forth, we have to remember that those hypnotherapists are… I just shouldn’t call them therapists, hypnotists, are actually looking for people that are more likely to respond and participate in the show and they’re very much willing to go along for the ride. And that is not how hypnosis works in, I would say, a more clinical or practical setting. So when you talk about hypnosis, we do have to differentiate between those entertainment hypnosis kinds of trainings, and we’re talking about the self-development or the clinical version of hypnosis.
Most often, this requires training. And when you go into that training realm, there’s a little bit of a rabbit hole that we go down with this, because when we talk about hypnosis, hypnosis is not an actual field. What it is, is you can think about it more as a technique, and it’s a very deep technique. There’s lots to it, but it’s usually connected to specific disciplines. So for example, you, as a clinician might use hypnosis for a much different reason in different applications than somebody who might be using hypnosis for more self-development reasons. So we do make sure that there is a distinction between those things.
And hypnosis can be used to treat mental health disorders, it could be used in lots of different things like that in the clinical setting, and that is clearly within the domain of a clinical psychologist, psychotherapist and so forth, a mental health professional. And then we have other realms where it’s more about self-development. And a lot of things like, for example, may want to stop smoking, or somebody might want to help with reducing cravings so they can lose weight. These are the things that are usually associated with hypnotherapy.
And in my case, in particular, I don’t really focus much on those other things, I focus on utilizing hypnosis and techniques for hypnosis to assist people with shifting their awareness and their focus around in their body, creating sense of calm and relaxation so they can have less pain. So these different contexts determine how you learn hypnotherapy. In particular, as a non clinical mental health professional, I did my training and I went out, and I have had a certification, I think, for hypnotherapy for almost 20 years.
And these things are a dime a dozen, you can find them out all over the place where you go in and they teach you rapid techniques for hypnosis and give you the overall view of how it works, and you leave with the certificate, and they say, “Hey, have fun with this.” That’s not really that great. Obviously, hypnosis in my opinion is not so much about the training, I think the training is very, very important, but it is a discipline that takes a tremendous amount of time to learn and practice to become really, really good with it.
So to me, first of all, I wanted to have good trainings, and I have read tons and tons of books in hypnosis. I learned a lot from the books, because again, it’s a lot of application. But when I wanted my credential, I went to and I said, “Who’s got the most hours in a program that’s accreditive?” And I actually found that there’s very few. One of them is out here in California, in Tarzana, the Hypnosis Motivation Institute, which I decided to go with them. It’s about a 350 hour program, plus you do a lot of additional time with hypnotherapists that have been practicing for a long time to refine your skills.
And on the clinical side, I believe that there are a number of associations that do that. But again, when I look at those, they’re very limited on hours. I think a lot of them are 70 to 100 hours. So as you can see there, that’s a very short amount of time with the breadth of information that’s involved within hypnotherapy. So as you can tell, it’s very quickly treated like a skill-based set that somebody might have, and if they really want to pursue it, they’ve really got to put in the hours in order to master it. We always want to check the credentials of people and see where they’ve had their training done professionalism and so forth, very, very important before you embark on that journey.
Kelsey Harris: Hypnotherapy is a technique that can be used for many purposes. I have heard about it being used in the mental health field before, though, as I mentioned earlier, I didn’t actually know much about it. And as Sam mentioned, I actually have heard about it being used for cravings, for nicotine, food, etc.
So how does hypnotherapy work for chronic pain?
Sam Visnic: Yes. So let’s talk about chronic pain in general. So there’s a lot of different disciplines that work with chronic pain. In my discipline in particular, I start with a movement focus, but chronic pain, as we know now, and I’ve written a book on this to talk a lot more about it, but we now know so much more about chronic pain than we did 10 years ago, 20 years ago. The research is exploding. And in particular, what we’re starting to see now is a movement toward more of the brain being the primary focus when it comes to pain. And there’s a discipline or a field and particular that’s called pain neuroscience education, which I’ve been utilizing for about a decade or so, but been extraordinarily helpful.
And what we’re starting to realize is that pain in particular, we understand acute pain, so we look down and we see an ankle if we roll an ankle and it’s swollen, our brains easily make sense of this. And that tissue heals and then the pain goes away. But about 20% of the time, people will develop chronic pain after the tissue has healed. And that’s really the differentiating point. So when the tissue has healed, in particular, I would say that I think most experts agree that at months, every tissue in the body has healed. So if you have pain after six months after some kind of injury, or even if you don’t have an injury and you’re developing pain, but six months, you’re now in the chronic realm.
And what we say is with chronic pain, that we’re not dealing with the tissue issue, what we’re dealing with is a pain issue. And we’re dealing with pain and we’re talking about nerves have become sensitized throughout the pain process that have not returned back to their normal status or normal homeostasis. So this problem is that these nerves and the brain are communicating in a way which is keeping that nervous system threatened or under guard. And when that happens, there’s a lot of processing that’s going on in the brain in different quadrants of the brain to determine what’s to the extent that area is threatening, and that is making the decision on how much pain you will experience.
So when we’re talking about this, there’s multiple things that we have to do. Educating people on pain is first and foremost, the most important thing that I have ever done with clients, that I found it to be the most valuable. So the more you understand about what’s happening when chronic pain exists, the more, for most people, crave wanting to know that, “Why am I hurting? Why is this problem not going away?” So that’s very important. So once we do that, then goes the process of determining how much of chronic pain is a bottom-up thing that we need to do or a top down.
Bottom up is, how do we change the information that’s going from the nerves to the brain? Well, <a class=”wpil_keyword_link” href=”https://releasemt.wpenginepowered.com//temecula-massage/” title=”massage therapy” data-wpil-keyword-link=”linked”>massage therapy</a>, we use movement, we use all sorts of techniques. But then we have this whole other element, which is top down, how is the brain taking that information and processing it? Now, pain education is the number one way we can change that because we can consciously learn more about pain, and that frames the pain differently. We start to think about it differently when we understand it. But there’s also another element of this as well. So we have a lot of other, what we call biopsychosocial elements regarding pain that are non-conscious.
We have things that the longer you’ve had pain, the more you react much differently, and you change your behavior much differently in your environment. Our relationships with our spouses have now usually become a part of our pain experience. The way that we behave or engage or disengage from social environments may change, so all these behavioral things. And what can happen is that we can also start to become in a greater state of what we call vigilance as a result of these things. Our nervous systems become more sensitized to things that could trigger our pain, and there’s a lot of subconscious ones that we don’t know.
So when somebody is stuck in this cycle of chronic pain, once we’ve gone through the basics of doing the movement work, and then we’ve done pain education and so forth, we still have this task, and this is really the challenging thing, especially with more complex chronic pain, is that, how do we address this increased state of vigilance in that person’s nervous system? And this is where the hypnotherapy work comes in, where we can start to train the brain on how to decrease its vigilance through using these types of techniques.
Kelsey Harris: From a clinical standpoint, this makes a lot of sense. One thing Sam mentioned was pain related or illness related behaviors, which actually make pain worse, even though we’re doing them to try and make our pain better. Top-down approaches, which is what I use as a psychotherapist, are what target these. I think we need an example of a technique within the broader technique of hypnotherapy to really understand this concept.
Sam Visnic: So you could start with very broad things. And this goes into a topic where we talk about general relaxation and I think that’s really, really important. So if somebody has just in a constant state of vigilance generally in all areas of their life, we might start off with a general relaxation approach with hypnotherapy. We hear this a lot, and it’s the one thing that’s probably my pet peeve from health practitioners to tell people that their problem is they’re just stressed and they need to reduce their stress. Okay, well, that’s not particularly helpful. If we understand, we all know that stress contributes to things, but the problem is we don’t know what to do about it.
We either have two options when it comes to stress, we change those factors externally, and some people, that’s not possible, they don’t just quit their job or get a divorce or whatever, that’s not what we do. But also, we can change our internal response to that. But a lot of times, it’s challenging in those contexts to do that. So what we have to do is remove ourselves from a situation and try to get ourselves in a space where we could learn how to relax. A lot of people start doing things like meditation and so forth, another version of that, but self hypnotherapy might be a good way to do that where we’re in a vigilant state and we’re amped and we’re wired. How do I get ourselves out of that state?
And one of the ways that we could do that is a very easy self-hypnosis technique. And it would be called the three, two, one. One of the aspects of our consciousness is we use our representational systems, our sensory systems in order to create our experience. So we have touch, we have taste, we have smell, etc. We use our senses. But in particular, there are three more potent ones that we can use. Number one is your vision, number two is your hearing, and number three is your kinesthetics, is what you feel in your body.
And these are separate, distinct systems that are sending different information to our brain. So a self-hypnosis technique that would be very easy to change your state of consciousness, it also works very well for sleep induction and all sorts of things, is to just sit in a comfortable, relaxed position, and what you would do is you would just look at something that’s out in front of you slightly higher than eye level, and you would just open up into your peripheral vision. First of all, opening up peripheral vision reduces focus, and reducing focus means reducing tension. We’re oftentimes staring at screens all the time.
So we just open up into our peripheral vision. It’s called our ambient vision, it’s a very primitive component of how our brain uses our vision. And what we would do is I would ask somebody to notice something that was often to their peripheral vision that’s interesting that they hadn’t noticed before. And I would have somebody do that personally, but obviously, I would walk them through that as well the first couple times. For example, I have that massage bolster off in my corner here. So I say, “Did you notice that massage bolster over there?” And they’ll bring their attention to something, they probably didn’t care about it and wasn’t paying attention to it.
And then I would define something about it, like, “Notice that it’s blue.” You don’t have to think anything else, just notice it. And now I want you to pick something else in your awareness or in your visual fields that you didn’t notice before, and then pick a quality about it, maybe the shade of that brown door over there. And then I want you to pick a third thing. So we would repeat that process again. Now, after three visual items, I would go to three auditory things. I would say, “I want you to notice the speed of my voice as I talk, and it changes. I want you to notice the tone of my voice, maybe the depth, voice inflection going up and down, a very specific what we would call quality.”
And then I would go to three physical things that they would feel. I want you to notice which hip you’re shifted more toward when you’re sitting. Are you more weight on the left or more weight on the right? And notice perhaps the feeling of your left heel against the floor, if it is on the floor, I can’t see you right now. The slight feeling of the air conditioning, maybe as you feel it on the skin. And then two, taking a deep breath. I bet you might have been holding your breath as we were talking. So we would go through three things. And then I would recycle back through to two visual auditory and kinesthetic, and then I would do one of each.
As we’ve cycled through those things, we’ll oftentimes get a shifting of conscious awareness because we’re occupying all of our sensory resources to pay attention to something, and we’ll oftentimes be in at state than we were prior to doing it. And a lot of people feel more relaxed, especially if they’re in a more wound up state, because their senses are being occupied in a cluster of, I would say, a state of mind that had a cluster of sensory experiences, what we’re facilitating that state and keeping them in it.
So that’s how I might use something like that and start with a general state to try to get them to relax first so they have an experience of it. And once they do that, they now have a tool. I helped taught them do it, where they can repeat it on their own. And then as sessions would go by, maybe even depending on the first session, how much we did, we would continue to build upon that skillset to be able to train their nervous system how to access a specific state, like for example, relaxation. And then we would progress it into more specific context in which they need additional resources that might be related to times where their back hurts more or whatever.
Kelsey Harris: In some ways this is similar to grounding techniques that I use with clients. It also seems to have some overlap with mindfulness and meditation, but it is different.
Sam Visnic: I would say, and the research shows that mindfulness and meditation and hypnosis from a brain perspective are achieving the same outcomes, they’re doing the same thing. The process is different. And if I were to ask that question now I would say, the best thing that comes to mind is like in fitness, let’s say that strength training, Pilates and calisthenics, what’s the difference between these things? Well, they’re all fitness and they’re going to increase fitness. They’re different processes and they may work on specific things, but so far as I can tell in my experience with hypnotherapy is that hypnotherapy tends to be a little bit more on the planned therapeutic side of things.
So when somebody comes in, if you look at the average book on hypnosis or hypnotherapy in the clinical realm, the book is like this, there’s so many techniques, there’s a lot more to, I would say, how you go about hypnotherapy, which techniques you use, the circumstances you use it in, and it’s really a vast, vast skillset. And I have not seen the same thing from more meditation and mindfulness-based practices, although I’m sure that there is growing an amount, but probably because hypnosis has been around in that realm for a lot longer. But the process I would say is more specific.
Session one has particular outcomes, session two, more documentation, more notes, those sorts of things. So in that regard, I would say that the skillset is probably more vast and probably more specific.
Kelsey Harris: Now, you might be wondering at this point, am I a good candidate for hypnotherapy? Every technique, there are some people who fit better for it than others.
Sam Visnic: I’d say first and foremost, it’s the people who are willing to participate. This is probably the thing that is the most amazing to me is that somebody calls me and says, “Well, I would give it a shot, I don’t think you can hypnotize me.” And I’m like, “Well, why?” I get that. I think that everybody can, in my response to that, out here in a second, but why would you go and entertain going into a therapeutic process that almost right away you’re feeling resistant toward? If you’re willing to give it a shot and say, “Hey, I’m willing to play ball,” then yes.
But it’s almost going into that saying, “I’m walking in here with resistance. I’m intentionally going to try it and not let you hypnotize me.” Well, I don’t want to play that game. I want people who actually want to participate and get the results from it. It’s almost like saying, somebody comes in and I’m going to do massage and they’re like, “I bet you can’t relax me, I’m just going to stay there tense.” And you’re like, “Well, why would you do that?” So first and foremost, let’s get away with that. And two, we always run into these things, which is something you’ll inevitably run across is this factor of being hypnotizable.
And I find this very entertaining that they run these studies. And to some degree, there are people that are clearly more suggestible in terms of being able to relax. Some people, they love it so much. You say, “You relax,” and then they just relax. Okay, that’s simple. And other people, it takes more work, but everybody is to some degree, I think, because this word hypnotized is so weird, and again, the stigma associated to it. To say that somebody can’t be hypnotized is almost like saying that person can’t focus. And that’s just not the case.
If you’ve ever been to a movie and you forget about what’s happening all around you when you’re engaged in the movie, you’re hypnotized. So I don’t see why somebody would not be hypnotized. It’s just the process that you use. Some people might need a different sort of induction in the hypnotic process than others, but everybody certainly is capable of getting results from hypnosis. So the other thing that I would say when it comes to hypnotherapy, particularly when we’re talking about chronic pain is that we have to put it into a proper context. And the proper context is making sure that that work is being done in an appropriate person.
Now, hypnotherapy, when you look at the research on this, and then at first, when I started looking at all of this, I was like, “I bet you, there’s not much going on here.” And there is a vast amount of research on hypnotherapy, especially in medicine. There are in particular, I think one of the areas where it seems to be most useful is in when people have allergies to anesthesia and they can’t be put under. Now, imagine how horrible that is? So they start with things like, for example, people having teeth pulled or having root canals done with hypnotherapy, and people can do this.
To me, that’s a hard sell for me, I would love to see that happen. But it is amazing how when the mind is actually distracted that you can do these types of small procedures and do them successfully. So I think in context, I am not somebody who does that kind of hypnotherapy, so I definitely have to have the right professional. But in context where for example, people need to see their doctor, I still see people who call me every day that say, “I have sciatic pain shooting down my leg and I can barely walk.” And I’m like, “Well, this is probably not an appropriate application for you to come in and get massages or for me to do hypnotherapy, you need to see your doctor.”
So people need to make sure that they’re medically cleared for underlying pathology and so forth. And two, I do believe that most people need to be part of a more integrated program when it comes to doing things. For example, there’s a reason why it’s not something that I would start with necessarily on day one. With my clients, I do it because I know that it fits within what they’re doing. We’ve done movement work, we’ve done massage work, but then there’s some factors over here that need to be addressed. So I will address those things.
On occasion, there are people where are being handled by physical therapists and healthcare providers and they have all of those things covered. And then what we’re going to do is we’re going to add the hypnotherapy on top of that, and that could be very successful. But I think it needs to be part of a more holistic program or an integrative program rather than being the only thing that somebody is doing. And I think that that is not necessarily something I would say I wouldn’t work with somebody with, but I would highly recommend that they do that and make sure that they’re working with those different elements to cover all the biopsychosocial aspects and that we’re not hanging our hat and setting improper expectations on what that hypnotherapy process is going to do because again, those other areas need to be covered.
So I think that those are the key things. And the other thing that I would say is, there are some exclusions and making sure that in particular hypnosis, depending on the practitioner that you’re working with, needs to be evaluated with what that person has going on. In particular, if there’s a mental health disorder, somebody’s dealing with complex issues, have been diagnosed with things like anxiety disorders, depression, and so forth, they really need to be only doing these things under the guidance of a proper healthcare professional who’s licensed to treat and work with those issues.
And it’s not something that you would work with over here, although certainly in the past I have worked with mental healthcare professionals that don’t do hypnosis and they say, “Absolutely, go ahead and help them with the chronic pain stuff.” And I give you the go ahead, “I think this person is fine with that,” and just keep it in the container over here to what you’re working on, which is completely fine.
Kelsey Harris: I am personally a big fan of integrative health programs. I’ve been to entire clinics where I can see my physiotherapist, chiropractor, massage therapist, naturopath, and go to psychotherapy. And I could also give them all permission to work together to make sure I was getting the best care. I think it makes sense that this could be one of the techniques used in that program that focuses on the whole biopsychosocial aspects of our health.
I always like healthcare professionals to give us the technique we can try at home so that we can at least start on the self-help part of things while we explore actually seeing a professional. Here’s what Sam has for us.
Sam Visnic: I think self-hypnosis is probably one of the best things that people can start with. I had mentioned one of the techniques, if you start with the self-hypnosis the 3-2-1 technique, it’s probably the most widely known technique because it’s so easy to do. But I do think that working with somebody is very helpful on this as well, because there is some confusion a lot of times over setting expectations. So what am I supposed to feel? Am I doing this right? We get up all those questions. Am I supposed to do this 3-2-1 technique and then I just pass out or zone out?
No, that’s not what happens, but as you get better at doing self-hypnosis techniques or working with somebody and being hypnotized, which I think is a great experience for a lot of people to have. If they feel apprehensive about it, or nervous, or weird about it, then I would say start with self-hypnosis because once you start doing that, you’ll feel comfortable with it. And then when you go and see a hypnotherapy, you’ll already know what to expect. Again, you’re not put out, you’re not in la-la land. When you’re doing these things, you’re definitely paying attention, but it’s very much like a guided meditation or a mindfulness, a series where you’re actually just going through the motions.
You’re being led in a nice little journey and it’s being planned with the intention of what it is that you’re trying to get. But start with simple things like the 3-2-1 technique. There’s probably some other techniques that are available on YouTube and so forth. And pretty soon, I had just started putting up pages on my website for this. I’m starting to offer more hypnotherapy out there for people who are coming in the door with the intention of wanting to have that service.
Kelsey Harris: I’m curious about client outcomes. What are some successes that Sam has seen come out of using hypnotherapy?
Sam Visnic: In particular is the integration between pain neuroscience education and hypnotherapy is one of the things I’m most excited about, because there’s a lot of knowledge there that goes into it, and I’ll give you a quick example, most people are not aware that things like diagnostic imaging is something that is a real problem right now in the field of structural based, what we think is structural pain. So somebody actually goes to the doctor and they say, “My back hurts,” or whatever. Oftentimes rather than just being reassured and clearing out red flags and so forth and telling the person, “Hey, you’re okay, just take it easy for a few days,” oftentimes it’s jumping right ahead to doing a visual diagnostic like an MRI or an X-ray, which oftentimes lead leads to findings that are not really related to the pain that the person has.
For example, if you take 100 people off of the street and you run an MRI on them, about 60% of people are going to show some kind of abnormality on a scan. So they have some arthritis or they have a minor disc bulge. And these are actually very normal findings, but most people to don’t know this so that when somebody is told this and say, “Yeah, you have a disc bulge.” And you go, “Okay, doc, well, what do I do?” And they go, “Well, it’s not nothing. Don’t worry about it.” What are you supposed to do with this information? Now, you leave here and you were just told that there’s something wrong with your spine and there’s nothing you can do about it.
So now you have an education gap. And some people will just dismiss it and say, “Oh, doctor says I’m fine.” Other people will start to develop fear or apprehension, so they may not forward bend. They might be afraid because they look up online and say, “This disc is going to explode if I do a forward bending activity.” So for example, in these cases and some more extreme versions of what we call centralized pain, some people will develop so much that they’ll actually the thought of forward bending stimulates the pain in their lower back.
So we haven’t even done the movement and they’re starting to actually feel pain. This is called central sensitization. And when this occurs, this is a fantastic opportunity to insert some hypnotherapy. And what we would do is with some light induction. And what I would have them do is to create a safe space where they feel good and confident, and they realize they’re vividly imagining something and it’s not really happening. And what I would have them do is to progressively see themselves doing forward bending in their mind in a safe way.
And what this would do is to start to reduce that vigilance in the nervous system to that repetitive forward bending. And then when we take them out of that state of consciousness and then we stand up and test, what do we see? We see more range of motion and we see less pain. So that is times where I’ve seen fantastic, fantastic results. And these scenarios, even though that might sound like a rare occurrence, is far more common than you can imagine, especially when people end up in my office where they’ve end up seeing 10, 15 practitioners already, and everybody’s doing the same thing, do some planks, do some core work and that’s why your problems will go away if you just strengthen your core.
It’s a little bit more complicated than that, but in those types of situations, you can imagine if somebody has that much fear and apprehension about forward bending, they’re not going to make it very far in the physical therapist office if they’re just forcing them to try to bend through it without dealing with that internal state.
Kelsey Harris: It’s a little unnerving to think that we’re being told that there are things wrong with us that aren’t actually causing us problems, and especially for people who already have a chronic pain or a chronic illness, tear that, “Oh yeah, there’s this other abnormality, but don’t worry about it.” Well, let’s be honest, it’s easy to have health anxiety when you have legitimate health issues. I asked Sam about the similarity between this technique and some other psychotherapeutic techniques, but you’ll have to subscribe to the show’s Patreon page to get that part of the interview. Are you ready for our Lightning Round questions?
Sam Visnic: Oh boy, here we go.
Kelsey Harris: All right. What are the top five songs that describe your life?
Sam Visnic: Top five songs. Wow. I’ll tell you the first one that comes to mind and maybe it was just this thing, Welcome to the Jungle. I always remember Guns N’ Roses, favorite, favorite band. And I just remembered that that song just had some internal personal meaning to me that was more along lines of graduating high school, here you go, have at it, do whatever. And you’re like, “Oh, this is going to be easy.” And you start to realize how complicated the world is. And but if you work hard enough and you push it, you get what you want. And that has some personal meaning to me.
Let me think. Bob Seger, Against the Wind. Are you starting to see a theme here?
Kelsey Harris: I see the theme. Yes.
Sam Visnic: What else comes to mind? Kenny Chesney, The Good Stuff. You know that song?
Kelsey Harris: Yeah. Nice.
Sam Visnic: I’ll take that one. Give me a second here. Tears for Fears, Everybody Wants to Rule the World.
Kelsey Harris: Nice. Good song.
Sam Visnic: I have to do something on this realm. So I’m going to say The Fray, You Found M. How about that?
Kelsey Harris: Oh yeah. Nice song.
Sam Visnic: There you go. Sorry to give you an interesting little mix of those things.
Kelsey Harris: Very nice. What’s one thing you can’t go a day without doing.
Sam Visnic: Drinking espresso. That’s a must. If you want to talk about putting in a state, it’s hypnosis in a cup for me. There you go.
Kelsey Harris: All right. What’s one thing you plan on doing in your life that you haven’t yet?
Sam Visnic: I’m going to say, I’ll go with something short term here, I’ll be starting my own podcast. I’ve been told probably number of times I have a radio voice, I don’t know if that’s true, but also I like to ask good questions much like you. So I’d like to take a stab at that, because I like it. I like to talk and I like to ask people lots of questions and find out more about what they do and what they’re all about. And that’s just been something… I might have had a little bit of apprehension about it, but I’ve really just held back from it, now I think I should just go for it.
Kelsey Harris: Yeah, you definitely should do it. So much super fun and that’s great. I highly recommend. Describe your perfect day.
Sam Visnic: Sleeping in. Not over sleeping in, maybe till about eight o’clock. Getting up and drinking espresso. Let’s not forget that part. Hanging out with my kids watching cartoons. I could hopefully some cartoons from the ’80s, not cartoons of what today. So something I can get them into, but hanging out with them for a few because they’re always so fun in the morning, taking them off to school. And to me, spending time in my day, doing the projects I love. I absolutely love seeing people.
I know it seems weird, but working with people with chronic pain is just immense in terms of what I love to do and helping people navigate that terrain, getting them out of pain or at least helping them cope with their issues much better so that they can get on with their life and enjoy things. And spending extra time pursuing some of these extra projects. I love researching. I love reading and learning a lot more about all of the things that I did not know about throughout the years and thinking about all those clients that I think I could have gotten better outcomes with and still chasing the solutions to what I could have done to help them better in the next time I see this case.
And learning more about hypnotherapy and just becoming better and better at it. And also chasing, again, some of those projects like podcasting and so forth, I think. And to me, I could spend, I’m absolutely a workaholic when in that side of things, my wife is as well, she’s a clinical nutritionist. So for her, it’s just all day, every day, we would love to do this. But we do have to cut out and then go home and spend more time with my kids doing sports and so forth. And just having family time at night. And then at the end of the night, you got to have a binge show, whatever that show is, at least put an hour in on it.
And there’s been some great ones now, I think are great, and heading off the bed, keeping things super simple. And I think I’m fairly close to that lifestyle now.
Kelsey Harris: Yeah. That’s great. And how do you inspire your clients to make the most of their lives?
Sam Visnic: I would have to say, probably the most important thing is to teaching people about the fact that they can not only be aware of their own thoughts, feelings, and emotions, and so forth, but how much they can change those things regardless of how they think that those things are so resistant and they have a life of their own, as to say, “You’re never stuck in any state of consciousness, if you are, just step outside of it. And then you’re already in another one.” And I remind people that that’s the case and your states of mind are the way that you access resources.
So if you don’t feel motivated, then you can change that. If you feel like you’re associated or stuck in feeling and the experience of your pain, you can disassociate from that, and you could always associate into something else that’s a better state. And that leads to different behaviors and outcomes, and how you experience your life. I think if you could get that down and really focus on that every day in a lot of different ways and context, your life is going to be far better off.
Kelsey Harris: Yeah. That’s great. Sam, this has been awesome. Where can we find you and follow you?
Sam Visnic: Website, the easiest way, releasemuscletherapy.com. And as you probably could tell, a lot more than just muscle stuff, but I have a lot of stuff on there too about that. Pretty active on Instagram, so the handle is @releasemuscletherapy as well, and YouTube. And YouTube you’ll find me at Sam Visnic, So youtube.com/samvisnic. You’ll see a lot of content on there. You’ll be seeing a lot more about this topic in particular, see me moving into hypnosis very carefully as to avoid all of that excess stigma, and hopefully be able to collaborate with professionals like yourself to get more great content on this topic out there.
Kelsey Harris: Fantastic. All right. And I’ll make sure that’s all linked in the show notes as well. So thank you again so much for coming on. This has been really, really informative. I really appreciate it.
Sam Visnic: Thank you. I loved it.
Kelsey Harris: Hypnotherapy sounds like a really interesting option. Actually, thinking about it, because it affects the brain in the same way that mindfulness and medication do, it might be a nice alternative for someone who doesn’t like, or for whatever reason is opposed to mindfulness or meditation. Obviously, there are advantage to doing this with the train professional, but I also think I’m going to try the 3-2-1 technique on my own this week and see how it goes. If you also happen to try it out, make sure that you take myself and Sam on Instagram so that you can let us know how it goes for you as well.
So let’s take a moment for our self-reflection. What did you notice about your thoughts and feelings during this episode? Let’s try a little perspective taking, did they change at all from before you listened to the episode to now? And what are you noticing as you take another step back and think about your noticing? Everyone, thank you as always for listening. And please don’t forget, you can support the show on Patreon. You get a number of perks, including shout outs, extra content from the episodes such as this one. And two, ebooks to help you improve your wellbeing.
And there’s just one tier right now, it’s $5 per month and all the money just gets reinvested back into the show so I can make it even better for you. All right. Have a great week and keep on making the most of it. Special thanks to Nicole Skura for the original music, and to Charity Williams for the original artwork.
If you’re looking for additional uses for hypnotherapy, especially for gastrointestinal issues, check out <a href=”https://analyticalnutrition.com/hypnosis-for-sibo-and-ibs/”>hypnosis for SIBO</a>.
Dr. Wayne Phimister: Well, welcome everybody to this special episode of the show. My guest today is Sam Visnic. Sam, welcome.
Sam Visnic: Thank you so much. I’m very happy to be here and looking forward to this chat.
Dr. Wayne Phimister: Okay. Sam is a massage therapist who does things and thinks things slightly different from what he was trained to do a few years ago. It’s great to have you on and to dive into these deeper issues of how do we find solutions? How do you find solutions, Sam, for your patients and clients with chronic pain? I’ll just put the floor over to you and tell us a little bit about your background and how you got to this point in your career.
Sam Visnic: Yeah, I think that what you said there as the intro, there is a little bit of an understatement. I’d say massively, actually, I think differently from my field. I started off in this field. I was a personal trainer. This is pretty much all I’ve ever done. Once I got out of high school, I was about 18, 19, I took my turn at being a personal trainer and I really loved lifting weights and the science of weight training and so forth. I was really working on myself. I was interested in body building and I got involved in a gym.
What you quickly learn when you work in a gym atmosphere is that everybody is messed up to some degree. Everybody’s walking in the door with a knee problem or a back problem or whatever, right? At the time, this is when the fitness field started booming, and this corrective exercise realm where people were playing with Swiss balls on the exercise floor and all this kind of stuff. This company, National Academy Sports Medicine, starts talking about posture and muscle imbalances and all this kind of stuff.
It was really a big boom in the field and nobody really knew much about this. Here I was at the gym, a hungry young trainer, and I was trying to get every client that I could get. A lot of the other trainers did not like working with people who had back issues, had knee issues. I’m like, “Hey, I’ll take them.” It was perfect opportunity to start working with people. What I generally found was, is that over working with, I think, hundreds of clients in this … I got lucky that there was so much volume that I could work with, is that a lot of these people, when you just modified exercises and you started getting them moving again, guess what?
They started telling me their aches and pains were gone and they had said, “I’d been to physical therapy. I did yadi yada, and it wasn’t working until I started working with you.” Didn’t take long before I started catching on to something that I was doing that was working really well. That field, I went down that rabbit hole and learned everything I could. I studied with a few mentors who were big in the movement field, and they said, “Hey you’re not going to get good at this work unless you start putting your hands on people and you start learning to work with tissues and so forth,” and that got me to massage school.
Of course, the majority of the stuff I learned in massage school, to be honest with you, is virtually useless to me because I was working more on the clinical side of things and I was working with massage therapists and coaches who were showing me things. One particular discipline was neuromuscular therapy, which is basically a lack of a better way of putting it is a very thorough massage system. It’s like here’s how you treat every single muscle in the body, and we were taught to look for trigger points and all this sorts of stuff, and that’s what I did.
I did a combination of movement work and neuromuscular therapy, and I got a knack and a name for being the guy that when you didn’t get better with therapies and you didn’t know who to see next, people would just say, “Hey, go see this guy, Sam.” Right? I kept working with more of these population that had failed from other therapies. I got used to having to be forced to be creative to try to figure out why these people didn’t get better when they had done chiropractic, injections, they had done all sorts of things and they didn’t really well or it didn’t work at all.
I had read more, and for 20 years I’ve been on this hunt for learning much more and everything I could about chronic pain, and especially in the last 10 years, you know it’s been very, very interesting now. A lot more information and accessibility to information on the internet, and that’s brought me to where I am today and sitting here in front of you.
Dr. Wayne Phimister: Awesome. Well, I love your story because that’s exactly my story as well. People fail the therapies, they get me, including surgeries, they get me and then I do my little thing, and then I work with neuroplasticity, I work with inflammation and I’ve got all these different approaches to get to the root causes. The root causes. Okay, let’s go back a little bit, because I’m fussing personally about what are you doing then that makes that difference with those clients that are not getting to seem better from their chiro and their massage?
Sam Visnic: I would say that there’s many very versions or iterations of this in my career because I’ve done so many different things. I’ve swung really far into manual therapy. I’ve swung really far to exercise. I’ve become a little bit of a Jack of all trades within that small world, and every time I’d go overboard with something and I would learn something real deep, I would get a certain level of clientele better because they were usually who I was working with, and then I’d get a new crop of clientele, didn’t do anything for, and then I went and learned something else.
You and I in that realm have been the same. It’s like I had to learn nutrition, lab testing. I did internships with a medical doctor who taught me how to read labs. I did stuff like that. But every client, it was a different story. We all now know that the pain experience is very unique, and there’s many different factors within that individual’s biopsychosocial realm that is contributing to their pain experience. When I work with people now, I have a specific process that I go through with them to try to basically put people into little bit more of, I’d say, a container or a path that I could figure out which of these things are probably going to work best with them.
But also over the years, I’ve learned to network with better and better colleagues and professionals who are far better at things than I am now. Now I stay on my own track with more movement and teaching pain neuroscience and so forth, and I outsource that work. It really depends upon the individual. If you’re asking where I am now, is that what you mean?
Dr. Wayne Phimister: Yeah.
Sam Visnic: Yeah. Okay. Okay. Things have changed a lot now. What I’m always looking for is I know that the message that I’m always putting out there for people, I work with a very specific type of client, and almost always it’s the ones who have at least gone through the general standard care procedures. They’ve been to their doctor. They maybe have or have not been diagnosed with something, disc bulge or whatever, but they’re generally, let’s say, either they have had surgery and they’re out of the system or they’re nonsurgical case, they’re booted to physical therapy.
They’re usually done their rounds with a couple of therapists, may have done some chiropractic or acupuncture, right? They usually, by the time they come to me, have said, “Here’s the story. The story is I’ve done all of this stuff, I’m better than I was, but I’m still dealing with this and I can’t get back to doing the things I want to do.” This is where my story is. As I say, these people are stuck in the gap. The gap is they’re not really medical, but they’re definitely not go do whatever you want. They’re right here in the middle.
I have to bridge them and I have to figure out what the factors are that are stopping them from bridging. When they come in, I look for the factors. I wrote a digital book on this, which was really my contribution to looking at all the research I could find on what basically leads to the chronicity of pain, and those are the factors that you talk about a lot as well. It’s like we’re going to do a questionnaire. How well do you sleep? That’s the number one thing I care about. Number two, how much do you know about pain? Right?
Number three, all the other factors that contribute to causing problems in those two. How much caffeine do you drink? What do you eat? Do you drink water? What’s the basic stuff? Then we go into sorting out and figuring out what their beliefs are in pain. Now, because I found in my work, and let’s say I’ve been doing pain education for those who I’m sure are probably a good at number [inaudible 00:07:58] understands what that means. But in 10 years, I don’t think I’ve ever come across somebody who knows virtually anything about pain. A couple of people here and there may have heard about pain education before, but that’s it.
Their extent to their education is purely a structural mechanical explanation for why they have pain. Again, they’re here just thinking that we’re going to do another structural mechanical therapy. I have to teach them about that. Usually on the first visit, we schedule a little bit longer amount of time, but I start to educate them on this pain thing. I’m saying, “I know that you’ve had pain. A lot of these therapies have failed, but let’s talk a little bit about what leads to the chronicity of the pain. Because the people that you’ve seen so far, I want you to understand …”
Because some of them come in and they’re frustrated or angry with their healthcare practitioners, and I have to assure them, “Hey, these people are not idiots. They did their job and they did the things that were necessary to make sure that you’re safe. But now here you are with this lingering issue, and I’m going to explain to you why this is happening, what inputs are contributing to this so you can tell me which factors that I’m telling you seem to be relevant to your situation, and we can figure this out together.”
I think that conversation right away starts to dramatically shift the direction of the therapeutic work, and because we’re also … I really just don’t like having people walk in the door as a traditional practitioner, go put them on the massage table and start to get to work, because that’s the therapeutic work that’s working from the bottom up sending that information to the brain, but I have no idea how that brain is going to process that input. I have to get an idea of what is going on inside of there so that I can manage expectations, I can adjust my sensory input that I’m helping that person receive, so that their brain can reprocess their experience, and hopefully make the changes into the direction that we want to go.
It’s such a game changer that I almost like talking more about the front end process because it changes everything, and I really do think that with more of a proper front end process to most therapeutic protocols, they will work dramatically better. Now, of course, there’s a lot of techniques and so forth that can work better or less in different scenarios. But I think across the board, if we did that more on the front end, almost everything would work at least a good amount better.
Dr. Wayne Phimister: Okay. Brilliant. Thank you for doing that. You mentioned education is paramount.
Sam Visnic: Yes.
Dr. Wayne Phimister: Lifting that veil of fear and ignorance around, well, what the hell’s going on in their life, with all these therapists and they’re not better. I want you to pretend that I’m the patient. I’ve been through a year of rehab. I’ve been to all these different therapies. I’ve got chronic neck and back pain, had an MVA two years ago, and I’m saying, “Sam, come on, educate me because nobody’s telling me how I can heal.”
What would you say to me in this situation? You just give a classic … Nothing too extreme, but just the basics. How would you present that? Remembering that who we’re talking to today are people exactly in these situations where they’re likely sitting thinking, well, yeah, tell me because I need to know, right?
Sam Visnic: Yes. I think fundamentally, the big understanding that I start with is to help people understand that pain is not a thing. What it is is it’s an interpretation, it’s an alarm system that our nervous system has. It’s a byproduct or the end result of information processing. What I tell people is you don’t have any pain fibers in your body that we know of. What we have is we have nerve fibers that send information, and that information generally speaking is neutral.
Again, there’s some stressful types of information, but that’s not really the interpretation until it gets to the brain, right? We have this nociception in one particular way of putting it that goes to the brain. The brain has different quadrants that basically start to process that information. What is the quality of this information? What’s the intensity of this information? Do I remember this information from the past? We’ve all had that experience where you say, “Whoop, I felt that before, this means my back’s going to go out.”
I think if you’ve had that, you’re getting that part of the brain that remembers things. If you feel something you’ve never felt before that feels like a little bit of a strain or something, you might delete that. You don’t even think about that, right? This information has to get processed in different parts of the brain. The brain, those different areas, have to sit down at the meeting table and everybody gives their input and says, “What are we going to do about this? Is this threatening or not?”
If it’s threatening and it’s something that we need to take action on, then they all agree to turn the alarm on, and the alarm on is something that’s such a noxious signal, a noxious feeling to grab your conscious attention to tell you to pay attention and to do something. That is pain in a nutshell. But the brain, while it can make a decision to create threat, it can also make a decision to ignore it, and that’s the question. From there, we would talk about scenarios where we’ve always seen those CNN stories where some construction worker goes into the emergency room with a nail in his head and he doesn’t …
He’s completely, “What? What’s going on?” He has no idea what’s happening, but yet there’s clear tissue damage going on in an acute manner. [inaudible 00:13:04] feel it. Or I talk with people about those references saying, “Have you ever had a huge bruise that you found on your body and you didn’t …” What? What? I don’t remember this. There is damage. Why didn’t the alarm go off? Because at the time, your brain perceived that information to not be relevant.
We can, at the subconscious level in our brain, choose to experience things or not as threatening. The real question is what we want to determine for you throughout the course of this work together is to understand how your brain is interpreting that information and get it to stop doing that and to start doing something else. In that regard, this is a behavioral change program. How we do that is through lots of different modalities. I’m a massage therapist, so I’m going to use hands-on techniques.
Also, do a lot of exercise work, because unless you’re going to strap me on and take you home so I can massage you 24/7, there’s going to be some things that you need to be able to do yourself. The more you can help yourself, the more in between these visits you can start to break that behavioral pattern, send lots of safety information to your brain, and we can start getting your brain to do something different and reinterpret and evaluate the situation in a way that’s more productive in terms of getting you back to your life.
Dr. Wayne Phimister: Brilliant. Absolutely brilliant. Because we need to reprogram the brain with safety as the fundamental physiological belief.
Sam Visnic: Yes. Some people will resist pain education because you could see them sitting there like, “Why is this relevant?” Then I show them a picture, [Adrian Lao’s 00:14:39] book for therapeutic neuroscience education. He had that piece in there. It was really great. I have a slide of it where I show the MRI of the brain. There’s a woman with chronic low back pain. They had her lay in an MRI, scanned her brain, looked at the brain activity and there was a lot of quadrants lit up. Then what they had her do is to move around in a way that agitated her back.
Then they rescanned her MRI. It was lit all over the place. Then took her out, did about 20 minutes of pain education, teaching her this stuff in a probably very limited way. Put her back in the MRI machine, and guess what happened? You see that brain nice and quiet, okay? Always reminding people that education itself is therapeutic. You will literally, not only when you just left brain logic understand things, but when you start to let that information permeate your awareness and you start to evaluate your experiences differently, it literally changes things.
That’s before we even get to the stuff on the table. One of the things I like to talk about a lot is chiropractic because I have a lot of people who have been to chiropractic before. It’s an easy thing. I say, “Hey, the first time you went there,” and the standard … Not all chiropractors do this, but telling you, “Hey, your back is out and we’re going to put it back in.” I’m like, “I don’t know about you, but that sounds terrifying.”
Backs just pop out, and what happens if you miss when you try to put it back in again? I’m like, “What did you feel when you did that?” They’re like, “I don’t know. I was weirded out by it.” I’m like, “It’s terrifying, right?” That raises some degree of threat, and the only reason why you were going to go along with this is because your friend told you that it was good or you had good reviews, right? There was a mix of emotions.
But what if they had told you that what they were doing to your back was like this. Couple of, “How’s that feel?” They go, “Well, that’s no big deal.” “I’m going to do that to your back and it’s going to feel good. It’s going to cause a change in these things called mechanoreceptors and all this stuff. It would be less threatening. Then when you lay on the table and you receive the therapy, would you be more relaxed if you knew what was going on?”
They said, “Well, yeah.” That’s what we want to do. We want to keep lowering that alarm system so that you feel less and less threatened by movement, by therapies and so forth that are safe. That’s just a perfect example of the more you know, the less threatened you feel, the less the alarm is going to fire and the better response you’re going to get from those therapies, even if this therapy is exactly the same. Yeah.
Dr. Wayne Phimister: People are listening today and thinking, okay, this is great, Sam. What are kind of resources, I know you’ve mentioned your ebook, but resources are really good and simple, maybe websites, that you’ve come across that would be really helpful for our audience to learn this? Because they’re probably on their own looking for answers and no professional’s actually pointed them in the right direction. What’s your recommendation for that?
Sam Visnic: Yeah. I think I’ve found a couple of YouTube videos and I have them and we’ll probably stick them in the show notes and whatever, but that have these nice cartoon drawings that talk about pain, and what’s actually going on and it gives you a nice visual representation of what’s occurring. I think those are fantastic. There’s a lot of pain education lectures online. They’re very long. I don’t think most people are going to sit through 90 minutes of Dr. Mosley talking about pain neuroscience. But if you want to, you can go with that as well. I also have a pain neuroscience lecture that I will give, a short lecture.
I think it’s about 35 minutes on a video that I can add as well. But simple stuff, just going through, and I feel like sometimes it’s just mind blowing having 15, 20 minutes of this for the average person who suffers from chronic pain, because that’s the reason why my book is called what it is. It’s like, “Why didn’t my doctor tell me that?” Because I have a number of doctors that I work with well, and they go to sit in conferences and so forth and they know all this. It’s just a matter of the communication that’s … Because of time, and I’m sure you know all of those other things that go on there, they’re like, “Wow, I wish I would’ve known this, because this seems very …”
But it’s also overwhelming. Small amounts at a time. Learn a little bit, think about it in terms of how it is showing up in your experience of your pain, and then learn a little bit more. It’s not something that necessarily you have to just have your head explode and read five books on this all at once, because it’s hard to process all of that. Especially if you’ve been in pain for a long time, there’s a lot of things swirling around to try to understand.
Dr. Wayne Phimister: It’s wonderful how when we do get a little bit of knowledge and then we take that forward, say, to our massage therapist or physiotherapy exercise and routine or kinesiology program, and then all of a sudden, it just builds and builds and you move forward in a compounding way, and all of a sudden you just take off, like what you’ve discovered in your career over the years. I think that’s important thing for patients and people to know, is it’s just small steps. It’s the only way to do it really, and it’s doable. It’s all doable for all of us to different degrees. Anything more to say with that?
Sam Visnic: Yeah.
Dr. Wayne Phimister: Because that’s really is your baby, as people head off into this therapeutic world with new education.
Sam Visnic: I think that that’s a really, really critical point, is that there are sometimes that people will come in and the first session just changes everything. It’s like the veil has been lifted. I’ve had a couple of clients in particular. I remember one of them who had been told, “Hey, you’re never going to …” She was a swimmer and she was a collegiate level swimmer, very, very good, and she had a neck injury and she was told she would never swim again.
After reviewing her case and working with her, I was like, “Well, I don’t really understand why you were told this.” I had done pain education with her, and sit across from me and say, “Is it weird that my pain level’s actually reduced now since we’ve had this conversation?” I’m like, “It’s not weird, but that doesn’t give you a license to go out and go swim two hours right now. Right? We still got to do a graded exposure therapeutic program for you.” But it’s important to notice that that happened.
I think the next week that she came in, she had told me her pain had reduced 20%, 30% at that point, and she had tested and went out and actually gotten in the water for the first time in two years and she swam for about 10, 15 minutes. I did not tell her to do that. I was more like, “Okay, go slow.” I think within a week or two after that, she had about an hour swim, and she’s like, “I think we’re done,” and I’m like, “You might be.” That is not the usual case because there’s so much more that’s going on with most people.
But that happens. It can happen. But the average person is, like you said, a little bit at a time because we also … Pain is complicated, we know. It makes sense to us when we roll an ankle and your ankle is swollen up like this, our brain can square that up, “Well, that’s why I’m in pain. Duh.” But what happens when everything looks fine, but yet we’ve been told a lot of stuff, especially that there’s mechanically things wrong with us, and when we move, it seems to be very mechanical, even though I’m being told that it’s not mechanical, right?
It takes a lot of things like discussions and reviews of experience to break that apart. I think that sometimes even I’ve had discussions where people, where I say, “What’s the scariest movement for you to do?” They say, “Well, bending forward,” and I’m like, “Okay. Well, I want you to just go ahead and stand up,” and they stand up and I say, “Now, vividly imagine in your head bending over,” and they start to bend over and they go, “This is making my back hurt.”
I’m like, “You did not bend over. You thought about bending over, and just the thought of it was enough to fire your brain’s threat level.” How much of this is mechanical? How much of it is fear of there being a mechanical problem? That starts to go, “Well, I guess that’s an interesting thing,” and they’ll go, “Well, how much is it? Is it all in my head?” No, it’s not all in your head. You have fear and apprehension and it might be there because you do hurt when you bend forward, but we’re not going to know until we start to reduce the fear and apprehension.
Let me give you a graded version of forward bending that doesn’t actually move you into the zone where you feel threatened, and let’s do this for a couple of repetitions, a couple times a day, and see what happens over the next week. Oftentimes, they come back and they go, “I did it that way and it didn’t hurt.” “Well, how do you feel now?” “Well, actually my back feels a little bit better.” Okay. This is time. We got to learn to trust the experience. I also try to get people to not 100% trust my judgment.
They need to be able to feel the what’s going on inside of their body and work with that, because that is the way that … Especially with people with complex pain issues, I’m not there all day every day to help them with this and to reinforce these things. They’ve got to learn to work with their own nervous system and to feel whether that threat is really there for a reason or whether that threat is just their nervous system trying to protect them, and there’s really nothing going on there that they need to be concerned about.
Dr. Wayne Phimister: One question about your colleagues, and my colleagues as well, because I work with naturopath docs and I work with massage therapists and chiros and a whole holistic type approach environment. I’m just thinking, in the future, the way surely is for us all to be of knowledge of this, and then in our own little way, to be integrating and helping our patients deal with fear and some tips and this and that.
This maybe not, in the pure training, save a massage therapist, but their self learning. My question is, how would you recommend a massage therapist listening to this, who’s watched a few of those videos by Lamar Mosley or other [inaudible 00:24:23] Howard Schubiner’s got a few out right now. It’s great too, from Michigan. But they’ve watched a few of this and they … How do they integrate that so that their clients can move forward?
Sam Visnic: I think that there, first of all, is the challenge in most of these fields, from my perception, is there’s a tremendous amount of resistance right from the get-go, because this is just so unfamiliar. Because most schools of thought have really … People feel comfortable with what they have been taught to do, and this operates outside of that, and especially when there’s a lot of reinforcement of certain techniques. Especially in my world, it’s a lot about biomechanics.
When you challenge that with saying, “This is what’s really going on,” and that person might be spending a lot of time and energy and personal investment into things like [inaudible 00:25:15] about posture and muscle imbalances and so forth. They don’t know quite how to square all of that up, and that becomes a challenge for them to try to integrate this. I noticed this a lot early on in my field when I did massage school, and I was taking neuromuscular therapy courses at the same time.
There were a lot of colleagues of mine who were sitting in these courses with me doing neuromuscular therapy. This is very thorough work, very great work for people who haven’t had very thorough massage work done with chronic pain. Yet, when I’d follow up with them, most of these therapists had not gone toward the direction of doing neuromuscular therapy. Even though they took the courses, they were still doing spa-based treatments and massages, and they had a real hard time graduating into this because they couldn’t hold the space there.
To me, I said, “Just stop doing those other kinds of massages and start operating in the way that you want to operate. If you think that neuromuscular therapy is the thing that’s going to help people, then that’s what you do with your practice.” I think that leap oftentimes has to happen with things like the neuroscience education work, which is when you take this on, you’re like, “How else is this going to look in my practice? How am I going to implement this?”
I think that’s really hard to imagine sometimes without some degree of mentorship and working with somebody who’s already doing that, because it was hard for me to imagine this. Before I started teaching, I was like, “How do I teach people pain neuroscience on a first visit? How does this work?” I fumbled around a little bit, but I listened to some other practitioners, followed people that were actually helping me saying, “This is what I do on session one. This is what I do on session two” and trying to do that.
But I think I’m a type where I’ve learned something, I just start implementing it. I’m a little bit quicker to that, and I realize not everybody else does that. But you have to get a mentor to say, “Who’s actually doing this in practice?” And follow through with that. I think it’s very possible for massage therapists to start altering their language with their clients, at least. It doesn’t have to change what they’re actually doing. They could be doing all their massage techniques, but it’s the way that they’re speaking to people and being aware of what they’re reinforcing in terms of beliefs and what they’re trying to help move people toward that can be a little bit more empowering.
Dr. Wayne Phimister: Yeah. I can relate to that a lot because as I jumped off the family practice bandwagon about five years ago and I was just purely doing trigger point injections and CBT or ACT, just different brain approaches to pain, and then I fell into this world of inflammation and food and supplementation and then cohort therapy and nasal breathing and the Buteyko breathing method, which I came across. I just, like you, just integrated it and start doing it.
You don’t really know what you’re doing to begin with, but one case and then the next, and before you know it, you’ve got a little system and you’ve done it once, you can do it again and it just keeps evolving. I think there needs to be that willingness to step out into the unchartered waters to an extent, but also getting a mentor is really important. Books and authors that you follow are pioneering. A lot of people have done it for years and years and years, and they just write it down in books. You’re not going to hear this in the medical literature, but you’re going to read it in books. That’s for sure. Jumping forward with that is really important.
Sam Visnic: It’s messy stuff. It’s not like … That’s been one of the things that … My wife is a clinical nutritionist and she’s probably the most experienced person I’ve ever come across now in the nutrition field just by the volume of patients that she sees, and her specialty is gastrointestinal problems, an inflammation. When we started having these discussions with her over time, and she’s taking a lot of this biopsychosocial information and translating this into nutrition practices, it just transformed everything for her.
In her way, the way that she has to implement this information is vastly different. We’re talking about the same thing, but trying to translate into how we communicate with people and then work within a team. But I can tell you one thing that’s been phenomenal is that when health practitioners are on that same page with that, it’s a lot easier to have discussions about biopsychosocial elements that feed down into the actual therapies than it is for health practitioners to argue back and forth about therapies and techniques, because we’re all just working on the same meta frame. You know what I mean?
Not sure exactly where I was going with that, but essentially just the idea of taking this framework and starting to do more integration and bringing things together, versus what the fields tend to do, which is to create more separation, right? Which we’re doing different things, and now all these factions have to fight against each other because their therapy or techniques are right and the others are wrong, rather than looking at everything. That’s what I’m far more interested in.
You see all these different therapeutic techniques and they always works sometimes. But the question is, what is amongst all of those techniques that when they are successful, what are the common elements? We look at those things as the research shows like therapeutic alliance is so important, dramatically influences the quality of the therapeutic work, building the relationship with your health practitioner, and those are the things that seemingly seem to get missed along the way, right?
Those are the things that are valuable and that we need to focus on as well. For me when I was taught that, those were game changers for me, and highlighted some of my weaknesses in the things that I needed to do a better job at. But again, I didn’t get to that point on my own. I had to learn that from other people, read lots of books. I wish the road had been a little bit faster. I’ve connected with people who had already done this a little quicker. But eventually, I’m getting there closer and closer.
Dr. Wayne Phimister: Yeah, exactly. I think for people listening to this, if you’ve got a great therapist that you like, for whatever reason, ask them who do they refer to? What suggestions do they have, maybe outside their field? Because they most likely have got contacts and to go to that next level as well. Because I think once you open yourself up to solutions, like you and I have done, and as patients do, clients do, then solutions come to them. It’s just the way it works. Right? As long as you’re open, open doors will come, and we just need to know what the next step is in that path.
Sam Visnic: Yeah. For me, what’s moving forward with this is just further securing experts within their fields who think the same way, but are also just like that inch wide mile deep knowledge. Working with people is like who is the top person on sleep? Who’s the top person on orthotics? That person might go, “Why are you … I don’t know what you’re doing over here,” and I’m like, “Hey, don’t worry about it. I’ll quarterback this situation and then I’ll send the client to you for this and send them back when they’re done, and I’ll take them to the next person,” all in the hopes of just continuing to work toward and get that person the elements that they need in order to complete their total health picture.
That’s always the challenge in the work, is just trying to find … I moved to a new area here. I’m in Temecula, California. I was in Santa Monica where there is tremendous amounts of health practitioners of all sorts. Here’s a little bit more challenging, but virtual visits and all of that stuff has made everything so great too. They give access to great practitioners. They’re a phone call away, and as long as you don’t need manual therapy, at least the consultations are good and help you set you forward in the right direction so that you can find somebody locally and you can ask good questions of that practitioner to get the services and stuff that you need.
Dr. Wayne Phimister: Exactly. Okay. Just to wrap this up, any final thing you would love to share? Just maybe a story or an inspiration for people that are going, “Wow, that’s great for you guys, because you seem to know what you’re talking about. But I’m struggling back here and back and beyond.” Any comments for them?
Sam Visnic: Well, my biggest message that I always want to tell people out there who are dealing with chronic pain, especially because we oftentimes get to that point where [inaudible 00:33:29] saying, “I have tried everything,” and I will say you have not tried everything. Because everything is really not so much external. It’s not always the techniques and the so forth that you need. What it is is that understanding of pain and working within your own body.
The parts that you might be missing are the parts that maybe are so far into you like the cognitive behavioral therapy approaches. I’m a big fan of hypnotherapy, because it’s all about that connection with that part of your subconscious, that part of your nervousness which is feeling threatened. We just haven’t barely scratched the surface on how we’re going to be able to start working with, dealing with some of those subconscious factors. There’s a lot of techniques now that I think that are up and coming.
Again, hypnotherapy in particular, I think is going to make a huge, I’d say, resurgence as a … It used to be a popular therapy, and there’s tons of research on it. Mark Jensen out of the University of Washington is putting out a lot of information about that, as being a very valid therapy for chronic pain. I know you do the ACT therapy, right? These are things that a lot of people haven’t tried, or I don’t think they’ve fully participated and given it a good trial.
[inaudible 00:34:45] say a trial. What I’m going to say is … I think you can help me out here. But really getting into it, going full speed with it. I think that these things are the things that are probably the least utilized by people because there oftentimes tends to be a good amount of resistance to them. But I think those are the things that are going to be the most helpful, especially when people have felt like they’ve tried everything.
Dr. Wayne Phimister: Perfect. Well, listen, I’m going to invite you back on the show to talk about this hypnotherapy, because I know that’s one of your passions and you’ve connected that as an additional approach to pain. I hope that you’ll come back, and let’s talk more. Anyway, Sam, it’s been great to have you on today. Thank you so much, and well done and congratulations for what you are up to in your life and how you’re just heart, soul and strength moving forward with the whole point of educating the masses, as well as helping heal the masses from their pain. Well done.
Sam Visnic: Thank you. Thank you so much for doing what you do. We’re all on the same page with this and trying to move this message forward. I feel like we’re pushing the rock or the ball up the hill here. At some point, it’s going to be mainstream. We’ll be able to help so many more people, but we’re still at the early stage of this. Of course, thanks for all your listeners for tuning into this too, and just being a part of this.
Welcome to The Doctor Dads podcast, where a naturopathic and chiropractor come together each week to share lifestyle medicine, health advice, and inspiring interviews with some of the top experts of health and wellness, bringing you the latest in nutrition, exercise, ancient healing, toxins, and detox your microbiome mindset, hormones, brain, and much more. Stay tuned, we are going to teach you how to experience growth daily.
Dr. David Wardy:
Hi, everybody. This is The Doctor Dads coming at you with another great episode. And I’m with my partner in crime, my main man Dr. Nicholas Jensen. How are you brother?
Dr. Nick Jensen:
Good to see you, buddy. Doing really well. I mean, we actually just had our Canadian election and nothing changed. So there’s nothing really exciting to report on. It’s just, we’re in the same spot we were the day before. Other than that, things are good.
Dr. David Wardy:
I think that’s something everybody’s hoping for right now, is some change from what the status quo has been as of late. But hopefully that’s coming in as we create something better here in the future, right?
Dr. Nick Jensen:
Definitely. Well, I think it’s an interesting theme because we’re going to be talking about pain today and there’s different types of pain. Obviously, there’s pain of things always being the same and wanting that pain to go away, and to have something shift. But yeah, why don’t you dive into a little bit of the sort of preamble around our guest?
Dr. David Wardy:
Well, and speaking about creation, this guy is quite the creator and he’s taking quite the journey to help people deal with this pain, right? So we have a really great guest on today, his name is Sam Visnic. And I’m going to have to just give a quick little bit about Sam real quick, before we get started and we start chatting with him. So Sam has spent his life studying the fundamental aspects of human health with a focus on movement and clinical massage therapy. So in a world of specialists, surgical procedures, drugs, and quick fix remedies, there’s plenty of those these days, right? He’s committed to finding and developing strategies that help people stuck at the gap.
Dr. David Wardy:
So he’s studied dozens of systems and methodologies for uncovering root cause of aches and pains, along with postural and movement issues, pain science, the art of science and hands on soft tissue massage techniques, myofascial release, coaching movement is essential in his practice. So using these integrative different methods, but of all, deciphering when to use them with different people in situations. And along with integration of movements that people want to be able to do again, is a key to longterm success with his incredible track record with his clients. So understanding the various elements that contribute to conditions and the power of communication and education makes his Release Muscle Therapy Program unique from other hands on therapy approaches. Now, Sam, thank you so much for joining us brother.
Sam Visnic:
And thank you so much for having me. And first of all, I have to say, congratulations on making it through that one heck of a long bio there. So you did really well.
Dr. David Wardy:
I really wanted to say everything because your bio speaks a lot to what I’m all about, man.
Sam Visnic:
Awesome.
Dr. David Wardy:
I have had a very similar journey to you. I went to school and I’m a chiropractor. But from going from a very unidimensional idea of what chiropractic was all about, I’ve kind of evolved and gotten to a very different place with a very similar journey of working through different methods, and methodologies, and finding truth in healing for people. And helping them, like you’re saying, get along to help them with their pain when they get stuck in these gaps. So I’m really excited to talk with you today, man. We both are.
Sam Visnic:
Awesome. I’m looking forward to it here too. Let’s get after it.
Dr. David Wardy:
So, Sam, I’d really like to start, you’ve had quite the journey. And I’m sure when you were in school, from then to now, there’s a lot that has gone on that has kind of helped you evolve where you’re at, to take a different approach with your clients. So could kind of talk a little bit and give us a CliffsNotes version of where that foundation started for you. And then what were those truths that helped you move you along to look for more of that truth? And what sparked that curiosity to find that the more, right?
Sam Visnic:
Yeah. I would say that I’m fairly lucky in the way that I had started this work and how I’ve gotten to where I am now. When I graduated high school, my first job was essentially becoming a personal trainer. I was a classic skinny kid in high school, the one who needed to put weight on. And I was constantly in bookstores, reading about body building and so forth. And I obviously leaned toward the books that were more scientific and based. I didn’t like loose programming. I’d always look at like Dr. Fred Hatfield, who was a well known power lifter. And you would look at his books and every little thing was mapped out. So I really like that kind of, this is exactly what you do, how much to do, et cetera.
Sam Visnic:
So when I got to becoming a personal trainer, I kind of took that approach to working with people. And this was right at about ’99, 2000, where that functional training revolution started. You go to the gym and everybody’s rolling around on Swiss balls. People are starting to get away from machine training and they’re starting to do balance exercises. And kind of the movement that spearheaded this a lot was a couple of kind of main figures in the fitness arena, in the personal training field, that was the National Academy of Sports Medicine, so NASM. And another guy that not a lot of people know about now, his name was Paul Chek. And he was a neuromuscular massage therapist and he was a trainer for the Army boxing team.
Sam Visnic:
So when I had gone and started working at these big chain fitness centers, you’re stuck right away with starting to work with people and I want people to lift heavy, and I want them to get muscle, and so forth, and lose body fat. But you realize that 99% of these people have all sorts of problems. They have knee pain, they have back pain. And that wasn’t really what I had expected. So what I to do, a lot of times, was do program and exercise modifications, and become creative with working around these types of problems. But what ended up happening is, is that a lot of people got better, as a result of what I was doing. I wasn’t intending to fix their problems. But a lot of times it’s like this person had knee pain when they squatted. So I’d say, “Let’s strengthen your hamstrings a little bit more and we’ll focus on these other areas, if you can’t do these exercises.”
Sam Visnic:
And then I would end up getting them squatting eventually, and then their knee problem would go away and they’d say, “Hey, I’d been to doctors and physical therapists and you got my knee better. So as I kept learning and I was just devouring books on, not so much strength training, I was definitely into that at the time for my own stuff, but a lot on physical therapy books. Every time I had a problem with a shoulder, I said, “Well, what is a rotator cuff tear? What is an impingement syndrome?” And I would go read as much as I could. And I would look at the exercise variations that were used. And so I was introduced to this concept very early on. As I started looking at the references in the books, I started studying the authors, I came upon Paul Chek. And Paul Chek was offering, at the time, the absolute most expensive course that you could take on personal training. I remember my first training course was about 400 bucks from the ISSA, and that was a lot back then.
Sam Visnic:
And Paul’s courses were about two to $3,000 per level. And I had taken these and we went in and Paul was teaching us, I remember the first one was like orthopedic rehabilitation for back syndromes. And I was like, “Wow, okay. This is the first thing to step into.” But what Paul was really teaching was like, there’s a lot of people out there who were outside of the therapeutic realm. They had basically seen their doctor, they went to PT. And they were stable, but they weren’t at a point where they can go and exercise and do whatever they wanted. So I found that that was that gap that was exactly where I wanted to interject myself into. And so, for quite a while after that, there was just a lot of emphasis on the structural biomechanics and movement aspects of the work that I was doing and people had told me, “You’re not going to get good at this work until you start getting a license to do hands-on therapy.”
Sam Visnic:
So I wasn’t going to go back and do physical therapy or chiro. I would have, but I was already kind of in the mix with what I wanted to do. So I decided that massage therapy was probably the easiest path for me. And as I start started school, that was kind of where I started getting exposed to a lot of stuff now, that we roll our eyes to. But I went to neuromuscular therapy courses at the same time. So while I was in massage school, when I was doing all of this other stuff with people and doing the manual therapy. And I had started developing a pretty strong reputation for helping people when they had failed with a lot to different therapies. So at that point, as with any practitioner who’s been paying attention and working on helping people, you would get stuck because not everybody’s problem is a biomechanical structural problem. You’re giving them all the right exercises, you’re doing all the right stuff.
Sam Visnic:
But there’s other things that are happening. People aren’t sleeping well, they’re nutrition is poor, right? They don’t recover. And so I got introduced on that to functional medicine or functional nutrition at the time people were talking about adrenal fatigue and stuff like that. And I did a lot of internships with colleagues on that. Anybody that I could find that was running labs, I ran adrenal tests, urine profiles for years on people, looking at all of that stuff, using supplements. I got really heavy into things like metabolic typing, which is to try to figure out what kind of diet works for a different type of genetic profile that somebody might have.
Sam Visnic:
And I linked up with a guy named Dr. Eric Serrano, he’s a medical doctor. And he taught me how to look at labs, how to identify underlying inflammatory issues. And I went out and worked with him in Ohio for about a year and a half. And it was one of the few things that you never get to be able to do. Most people in the industry is to go work with a doctor and literally kind of go room to room with him and watch him work with people. So I learned a lot with that. And I’d say that probably one of the most, the biggest learning lessons I had there was just the profound impact this doctor in particular, had with his patients. They loved him. They drove everywhere, all over the state sometimes to come and see him. He had profound rapport with people. And I really think that some of the incredible changes he had with them is just because of how much he cared with people.
Sam Visnic:
So to me, that kind of led me into this direction of understanding a lot more about the practitioner or what we call the Therapeutic Alliance now, is the rapport, the relationship between the therapist or the healthcare practitioner and the individual and how that affects and improves outcomes. Last part of this, which I know you were asking for the CliffsNotes, but I think this is all important to the question you asked. Over years of studying different types of things, early on in my career I had studied a lot of neurolinguistic programming for communication purposes, hypnotherapy, which I had been doing for a long time. That kind of led me into a lot of understandings of things that were working with my clients, like educating them, working on things like improving relaxation and so forth. And wondering why these things were working so well and nobody was talking about it.
Sam Visnic:
And to some degree they were, but it wasn’t more in the scientific literature until I came across pain neuroscience education. And that was a big leap in my education, discovered that about 10 years ago, which was the up to basically teaching people about pain and how that improves their outcomes within the therapy that they’re doing. So up to this point, fast forward to 2020, I’ve kind of melded in all of those different approaches into my work, which is now Release Muscle Therapy. And we take a super individual approach and looking at all of the different factors that contribute to this chronic pain problem that an individual might have. And then we have to essentially kind of untangle that, to figure out, individually, what they need.
Dr. Nick Jensen:
What a journey, man. I mean, it’s so nice to hear how you’ve been able to pull from mentorship in these different fields and find your own way forward, to help people in a more specific, individualized kind of way, because I mean, isn’t that what’s missing, right? I mean, how many members of our clinics or that come to see us are on a certain medication or they saw the specialists for pain and they’re being managed by sort of one avenue, without looking at the whole picture.
Dr. Nick Jensen:
And that’s just a unfortunate reality of conventional medicine, is that we’re always looking for the thing that’s going to get rid of the symptom. So on this journey, obviously you’ve developed a really unique way to help people with their pain. And I mean, in your mind, what does an assessment look like? How do you start to define where someone needs to spend a little more attention? Like maybe they need more like that vagal nerve reset, or maybe they need a little bit more hands-on. How do you help people to identify that within themselves?
Sam Visnic:
Well, what I looked at in this biopsychosocial model here is again, understanding all of the different factors that affect the pain experience. And really, in my mind, I kind of sort it out based on the idea that each individual has a unique pain experience. So not only do we have the information that’s coming from the body, that’s going to the brain, but we have brain’s interpretation of what’s happening. And the brain’s interpretation has many different areas of the brain that is interpreting and filtering this information. And this is one of the ideas, for example, why Mark Jensen out of University of Washington talks about how hypnosis can affect different parts of the brain. Because not only do we have that information that’s coming from the body, let’s say that I would say this industry jargon term, nociception.
Sam Visnic:
So we have that information that’s going to the brain. The brain has to, number one, interpret the quality of that information. What is it? Is it burning? Is it aching? Whatever we want to call it, right? And that’s not exactly how it’s interpreted, but that’s the idea. And then it kicks it over to another part of the brain. The brain has a memory filter and that memory filter notices whether or not it has felt the sensation before, then another part of the brain attributes a meaning to that. And then we have the other part of the brain, we may have conscious awareness of what that means too. And all of these things are playing in together. So we have this primary thing of just information that’s going to the brain, but then we have all of this other stuff that’s going on, that has to interpret that information. And that determines how much threat we have, and that’s going to determine the amount of pain we have.
Sam Visnic:
So when I sit down with somebody, there’s a lot of questions and a lot of things that you really have to tune in and listen to what somebody is telling you. And I ask them certain things. So as you can imagine, you sit down with people and sometimes they go, I go, “What’s the quality of the pain?” And they go, “I don’t know, it doesn’t hurt.” And then you say, “Well, it doesn’t hurt?” But they say, “But I feel it.” “Well, what does feeling it mean?” So I can almost get an idea that they’re saying, “Well, I don’t have pain.” But then, in a way, they describe it as pain. So I’m getting the idea that this person is not being able to connect with what exactly is happening with them.
Sam Visnic:
And in that person, I might serve to try to work into a direction where I can sharpen that, so they can help explain it to me. A lot of times we operate under this assumption that basically, we’re all talking about the same thing. And most of the time, we’re not. I really don’t understand that person’s experience from a generalization because they tell me that they have pain. I don’t know what that means. I have to understand what that pain is from their own description and their own experience and what triggers it. And when I understand that, is it a movement thing? Do you just wake up with it? Is it when you feel emotionally stressed, do you feel it? What are all these factors that kind of play into that experience? And that can help me guide into kind of what direction I go.
Sam Visnic:
Now, regardless of any of those things, I’m always going to look at lifestyle factors. I’m going to look at the things that I know in the research are the top priorities when it comes to knowing what increases nerve sensitivity. I’m also going to do a structural evaluation as well. I’m going to move people around. I’m going to find out if there’s movements that they’re threatened by. And if they do certain things that makes them hurt or it makes them hurt even thinking about those things, which is a good area that we can talk about, because that’s always fun. And also, in particular, how responsive are they to doing things. So give them exercises, give them movements and kind of see what happens in real time when they do that as well.
Dr. David Wardy:
Well, it’s funny, me and Nick are big on multi therapeutic approaches. And it’s all like we’re saying, it’s all about taking this functional approach. Every person who walks through the door is very different and you’ve accumulated all this knowledge and you have just this nice tool bag. And we just have people walk in, the assessments is huge and then you have to put these tools to work. And it’s a lot of fun. And I’d imagine on your journey, you’ve actually expanded your knowledge on what tools I need or I don’t have a tool for that yet. So I got to go learn more because there’s something else that I’m missing. And that’s the fun part about what we do.
Dr. David Wardy:
I mean, on my journey, that’s kind of what’s helped me keep evolving the process of how I approach everybody’s. It’s like, okay, there’s something going on here. I don’t know enough about it. I need to go for more truth in this. So let’s go past this assessment. So somebody comes in, you use these things, you kind of determine. So in your book, you talk a little bit about energy and I’d really like to talk how that plays into some of these things that you’re doing these days. How you take an approach from an energy standpoint, when you’re looking at just the energy systems of the body and taking more of this holistic approach. And using that as a foundation with your paradigm.
Sam Visnic:
Are you talking about more like energy in terms of like metabolic issues?
Dr. David Wardy:
No. More of like the energy systems of the body. So like we’re talking about the nervous system, but how that plays into people’s pain and why they’re experience pain or a loss of structural integrity. Or like you were saying, even from a metabolic standpoint, how that’s affecting everything. From like, oh, they have a crappy diet. So just from that holistic standpoint, I’m sure you see a lot of people where this is the case and you’re having to work on all these things because the body can’t heal if there’s not enough energy being produced as a whole, right?
Sam Visnic:
Yeah. And that always is, I’ll throw this in here, my wife is a clinical nutritionist with an expertise in gastrointestinal problems, in particular SIBO, IBS, et cetera. So with her, we’ve had so discussions over this idea of like for example, that energy itself, whenever I hear that, my mind immediately goes into that constant, I would say general complaint that most of us oftentimes experience in saying, “I have low energy.” But always when we run the laboratory tests, what do we normally see? Everything is generally functioning fine. So mitochondria working, energy is actually being produced, but that’s not what we’re feeling. And so we always have to try to figure out where that is coming from and that’s just as complicated as trying to understand someone’s pain.
Sam Visnic:
So under what circumstances and how do you experience having low energy? And I think that we can launch into a larger discussion of people generally being overwhelmed and having too much stuff going on in their lives. And they’re just kind of like basically running out of the essential juice, whether that means neurotransmitters or whatever, to be able to constantly fend off all of these different stressors. And we’re constantly being pushed to the max to deal with these things. And in traditional or I’d say primitive times, we didn’t have to persist like that. We had temporary stressors that we had to deal with and then we had a recovery time.
Sam Visnic:
But we’re now seeing the results of living in this kind of modern society and dealing with all of the different problems that we have, structural, mechanical. And even the structural, mechanical things, I think that we do less, so we actually do feel like we have less kinds of mechanical stress, probably than previously because in primitive times we were a lot more active. But those things are now being exacerbated or the effects of it, because of the problems everywhere else, poor nutrition, access to… I mean being exposed to toxic elements in our environment. And this is really kind of causing this soup of things that are going on, that our bodies are just overwhelmed with. And we’re really having a hard time coping.
Sam Visnic:
So all of this is kind of going into the same thing. And we used to talk about this in terms of adrenal fatigue, for example. But it extends far beyond that. Our ability to cope with and adapt to stress is really being pushed to its limits and we’re not able to do that. So our body has to actually retreat, it has to kind of shut down a little bit and lower our energy levels because we cannot maintain that output. And when that happens, I think that when we start to push forward against that, and we’re not listening to the messages that our body is giving us, then we’re going to get threat and we’re going to get pain, we’re going to all sorts of physiological symptoms. And the amazing thing to me is, is that it doesn’t always manifest in pain. There a lot of people with lots of different physiological problems, but they don’t have pain, which so it’s just outputting in a different way, probably depending on the circumstances, the genetics, et cetera.
Dr. David Wardy:
You know, one of the things I’m… Oh, go ahead, Nick. I’m sorry.
Dr. Nick Jensen:
No, no. You finish your thought and then I’ll jump in.
Dr. David Wardy:
Well, no, as I’m hearing you talking, one of the things I talk to my practice members all the time is vital function demands of the body. Like something as simple like you’re saying is, are you digesting well? How’s your energy every day as a whole? What do you wake up with? And how’s your sleep? These basic things your body’s got to be able to do just naturally, every day and where you’re at on that. And to speak to what you were saying is so many people are running uphill with these things.
Dr. David Wardy:
And then yeah, for some people that’s going to lead to some sort of pain experience. And then other people, you’re going to see just that these vital function demands are breaking down. So foundationally we focus on things like communication, the nervous system. And then we get into resources and we go into how well is your body having any kind of reactivity from an immune standpoint? And then where’s the response? And things like that. And I’m sure you kind of use a very similar type of paradigm when you’re approaching each of these people, to go in and try to address where these root causes are.
Sam Visnic:
Yeah, and these stressors, I always like to think about, like if we have an individual pain problem, let’s say lower back issue, or SI joint, or whatever it is, we get into this kind of like concept, whereas the person may be stressed overall, but they also have stressors that are compartmentalized in the way that they deal things. And that’s the interesting part to me as well. So for example, from a therapeutic perspective is, somebody is generally overwhelmed. And we oftentimes see people who will sit down and they’re just so uncomfortable and so stressed that they even have a hard time sitting still in their chair.
Sam Visnic:
A global approach might be necessary because the whole system is overwhelmed and you could use meditation techniques or whatever it is to just calm the whole system down, and their localized problem and their lower back will improve to some degree. But also, I had also noted last year, what was probably one of the more stressful times, globally, because of COVID. But yet, I didn’t really fail to help people get better from their aches and pains because I was able to, from that smaller container or compartmentalized pain, where that person had a specific neurotag, I think a neurotag, I’m using words that I need to define here.
Sam Visnic:
But a pain experience that was more related, that’s in a container relative to the whole. So for that person, reducing overall stress wasn’t necessarily the thing that made them better, it was releasing the stress that was associated to that problem individually, that was the issue. So I think that part of our work is also, which is complicated, is being able to know and operate in this range of specificity to global, and to understand at what level this problem actually exists in. To some degree, the whole always affects the local or that smaller area. But somewhere in there, is where we have to be able to work on and with the person to get the optimal effect, based upon that individual situation.
Dr. Nick Jensen:
Yeah, I just want to add in a little, maybe clarification for people listening, because I think often when we think of pain, we think pain exists in our musculoskeletal system. And so many people, you mentioned your wife, were helping people with SIBO and some other things. Can you speak to some of the visceral, basically for those listening, visceral meaning like the organ tissues, to body complications that you also help people with? And often they can go the other way too. So maybe a hip problem is manifesting as a result of some other structural imbalance. So can you help people sort of appreciate just the different types of pain and how they can kind of show up like that?
Sam Visnic:
Yeah. And I think that there are three different general classifications of pain that people should know about. But all of it, from a starting standpoint of understanding pain neurosciences, is that we actually don’t have pain nerves or pain receptors, actually, in the tissue. What we have is in information. So these receptors send neutral information up the spinal cord to the brain, and that information is based upon virtually anything you can feel. You can feel lack of blood flow, if you sit for too long, your butt aches. You can feel burning sensation, you can feel pressure, you can feel any of these things. We have receptors for temperature changes.
Sam Visnic:
That information goes to the brain and the brain has to interpret it. So that information, when we have potentially threatening information, is called no subception. We oftentimes associate that to the usual aches and pains that we have. So that can produce the kind of casual back pain, or hip pain, or anything else that we feel that usually is responsive to things like movement, massage, chiropractic, et cetera. But then we also have different types of pain, like we have neurogenic type of pain, okay. Which is, we generally associate to things like for example, sciatica, carpal tunnel. And this is where there is actually like a damage or I don’t like saying damage, but a stress on the nerves themselves that causes that information to go to the brain, that is kind of faulty Sometimes. Sometimes there’s nerve compression and that’s a real stress, and sometimes there’s not.
Sam Visnic:
We’ve seen people with sciatic pain and there’s nothing actually irritating the sciatic nerve. And then we have this whole nother category, which is kind of like the thing that everybody talks about now, but has a hard time dealing with, where it’s kind of like the new frontier we’re all dealing with, is nociplastic pain. And nociplastic pain is very similar to what we called centralized pain. And it’s familiar with syndromes like for example, fibromyalgia, which is like widespread pain or I think more like where there’s another complex regional pain syndrome. And the idea here is the central portion of the nervous system is misinterpreting information that’s coming in from the body. So when we get through these different phases, it changes how we look at the pain that the person has and how we might deal with it.
Sam Visnic:
So when we have syndromes that kind of are progressive along that lines, like for example, we have that more neuro pain or that nociplastic pain, in particular that nociplastic pain is very reactive and responsive to things like gut inflammation and so forth. And the reason why is because the nervous system itself is the problem. It is not the tissue itself. So when we get into gut imbalances and so forth, this is where it starts to get real interesting, is to say when somebody has small intestinal bowel overgrowth, bacterial issues, if they have, I don’t know, what else would we call it? Any kind of autoimmune based conditions, these things, when they spike and those inflammatory situations ramp up, that person could have unpredictable responses in their body, in terms of where they have pain.
Sam Visnic:
They may have an area where there’s a small amount of no nociception going on. But now it’s like times 10. And when anybody, a health professional looks at their X-rays, looks at their MRIs, there’s really nothing there. But that person is responding, saying, “I have a lot of pain. This hip is bothering me and this back is really just bothering me.” And there doesn’t appear to be anything there. So when we look at these different types of pain, we oftentimes are very quick to want to classify as somebody as having one of those pains. But the problem is, is that it doesn’t really work like that. What oftentimes happen is if you think about a pie chart, that people will have a percentage of each of those as inputting to their problem, depending on the chronicity of the problem. How long they’ve had it and what is really going on in the system. So it is quite complex.
Dr. Nick Jensen:
I want you to just highlight this a little bit more because you hit on something I think is really important for people and that’s that there doesn’t necessarily have to be tissue path pathology for this recurring plasticity that’s happening in the nervous system. So the nervous system is irritated. Can you just describe that a little bit more detail? Because I think for so many people, especially the ones that we see, that’s just so common. And they’re looking for that pain relief, but they’re not fully making that connection to that chronic irritation in the nervous system.
Sam Visnic:
Exactly, and this happens a lot, and there’s been studies on this, and I need to have the one on hand that talk about an MRI study. That we took 100 people off the street, ran an MRI on their lower back. And they found that approximately 60% of people had at least some kind of abnormality, meaning something small, a disc bulge, or maybe some arthritis, or whatever. But then at a 60% of that, how many of those people actually had pain? I’d say very little. So the idea here that we keep going with, as research continues and running scans, visual diagnostics on people who don’t have pain, is that most people have these things. So the issue is, is that these things tend to be just a coincidence a lot of times, that when somebody has pain, they go in, they have a scan, “Oh, that must be the reason why you have pain.” And that’s oftentimes not the case.
Sam Visnic:
And by the time people get to practitioners who are in the gap and they’ve already been through the medical system, I always tell my clients, I say, “Well, these people couldn’t help me.” I’m like, “They’re not incompetent. It’s just, the problem is, is that from that kind of diagnostic and treatment model, you could see that maybe your issue had nothing to do with what they found on the scan.” Okay, so in the research, we know that for sure, is that there’s no way to predictably look at an MRI or an X-ray and predict who has pain. There’s no way to that because the diagnostics, the visuals do not tell everything. I always remind people, there’s a reason why you don’t go to the doctor and every time we go in there, they run a full body scan because they’re going to find lots of stuff in there, that has nothing to do with why you’re there. And they may be coincidental, and things that come and go.
Sam Visnic:
So what I’m trying to teach people with pain neuroscience education, and the concept of this is, is that pain is an interpretation of what is happening. It is not always the thing that is happening. So we’ve all seen those stories on cnn.com, where the construction worker walks in and they show the X-ray and there’s like a nail that’s like three inches in his head. I think the one story I remember, that the guy ended up going in there because he had a headache and they ended up running an X-ray on him and he had a nail in his head and he didn’t remember it. He didn’t even know it was there. He was just, “Oh, I was having some headaches recently or lately.” And he had a nail in his head. So tissue damage was clearly present and yet he had a minor headache.
Sam Visnic:
And so there was that classic story that was taught, it always ends up being a construction worker because they end up shooting nails through their foots and stuff. But the guy came in, he was writhing in pain, he was on a gurney, hospital staff couldn’t hold him down. He had shot a nail through his boot, into his foot. And they had to knock the guy out. And then they ended up having to saw the boot off. And when they took the boot off, they found that the nail didn’t go through the foot, it went between his toes. So it didn’t even have any tissue damage, but yet, there’s this individual with this perception of immense threat happening and he was having a tremendous amount of pain. So that’s the interesting thing about pain, is that pain is taking information and then making a decision on whether or not we experience threat. It may or may not be associated to any tissue pathology at all.
Dr. Nick Jensen:
You nailed it, speaking of nails.
Sam Visnic:
I like the nail stories.
Dr. Nick Jensen:
It’s a dad joke. Man, that’s so important. Thank you for just really reiterating that interpretation piece. And I know people listening, including myself, on different little things that nag us. I mean, how can you help us understand how we can interpret it, interpret things a little bit more effectively? Like let’s say for us as listeners, and then obviously, know who would be the right fit, or what would be the right therapy, or when’s massage appropriate? But help us and help our listeners really, what are some steps they can take to help with that interpretation? Like other than say, the guy take his shoe off, he would’ve realized the nail wasn’t there. But anyways, please take it away.
Sam Visnic:
I think that there’s some of this, that’s kind of like we know as parents. I’m a parent of two little ones, that we were taught, as a parent, your children, oftentimes when they take falls and so forth, they don’t always respond until they see our response. And so that if they fall and we go like this, they start crying because they looked at me and then they thought, something must be bad. But sometimes they fall and I’m like, “You’re okay.” And they look up and they look a little confused and they run off, and they have scrapes on their knees. So we look very much to our surroundings, our environment, to try to interpret things as well.
Sam Visnic:
So sometimes we have to be aware from the kind of a metacognition, from a stepping back and thinking about it’s happening, what the circumstances are. Am I really in threat or is this just a perceived threat? Things like that. But we run into this kind of sticky area too, which is when to pay attention to pain and when to ignore pain. And that is something I’m very adamant about with my clients and understanding there is a world of difference between acute pain based on an injury, based on you look down and if you roll an ankle and your ankle is like a softball, there is a reason, there’s tissue damage there. You need to go have that evaluated. And this is the role of looking and working with clinicians, who understand this stuff.
Sam Visnic:
If you’re dealing with chronic pain, there’s a lot that needs to be untangled and working with somebody who can evaluate your situation. I can only imagine how difficult it is to be an individual suffering from chronic pain, who’ve seen so many different practitioners, having so many narratives and stories. But it really comes down to working with somebody who can help kind of untangle that stuff for you and based upon the process. And that’s really what a lot of my therapeutic process is about, is untangling that stuff and saying, “Well, you’ve been told this, you’ve been told doing this.” But these narratives don’t add up when we do things.
Sam Visnic:
For example, all the muscle and balance issues that people, they’ve been told they’ve had, or these structural issues. So you have to work with somebody to help you untangle that and to understand when it is appropriate and not appropriate to interpret pain in certain ways. For me, I’m a licensed massage therapist and clinical massage therapy and do movement work, I generally do not push people through pain because that’s not really my domain. And I don’t want to teach people to just put their foot on the gas pedal and work through pain, because it might teach you bad behaviors, to ignore things. I try to work around things, to desensitize the nervous system, so that they can safely start to move into positions and activities, so that they don’t feel threatened.
Sam Visnic:
Although again, it depends on your scope of practice and the kind of work that you do as well, because I know a number of different clinicians who teach people to work into pain zones and to teach them how to desensitize themselves to it as well. So there’s a lot of kind of variety here of different types of health practitioners and what they tend to do when they work with people in pain. And we each have our preferences. And as long as I’ve been doing this, most of the time, I’d say there are certain circumstances where you might need to move through some pain, like when people have knee issues, it’s very hard to give exercises that don’t cause any sensitivity at all. So you have to kind of evaluate that based on the individual. I hope that answers the question.
Dr. Nick Jensen:
Yeah, absolutely. That was great. I don’t know which audio, but it sounds like there’s a bear in the background.
Dr. David Wardy:
Yeah, it does.
Dr. Nick Jensen:
It’s like… It sounded like someone was in pain.
Sam Visnic:
Oh, that’s a motorcycle outside.
Dr. Nick Jensen:
Okay, okay. I thought you had a dog on the ground, like [inaudible 00:36:04] or something. David, go ahead.
Dr. David Wardy:
So Sam, I’m curious about this biopsychosocial approach you take with people with pain. So how do you approach this with people and how do you work in that mental, emotional capacity when it comes to these type of things?
Sam Visnic:
Well, first of all, I would say that when we’re dealing with kind of like the aspect of… Well, biopsychosocial, for listeners, if they’re not aware of this, I would say is just generally all of the factors that exist outside of kind of like the problem that seem to provoke or sustain the problem. And it kind of keeps it doing its thing. So for example let’s say between a husband and a wife, let’s say husband’s back goes out and he’s been having problems with his back for a long time. And he’s kind of acutely aware always, of thinking about his back. One day the trash needs to be taken out and he’s about to go take that out. Wife goes, “No, no, no. We’ll deal with that. You got a bad back.”
Sam Visnic:
And so you think about, that doesn’t sound like that big of a deal. But when you take circumstances like that and you have many, many different occurrences in someone’s environment that always reminds the person of this problem that they have, it can serve to remind them that they have less function. They have less ability perform in the environments, especially around the household, and to do things, and to be a contributing member of the household, of society, or at work, or whatever. Then, that actually has an effect on the individual and it makes them more sensitive. It raises the alarm or the alert mechanism, make the person more vigilant.
Sam Visnic:
And it seems so small, so insignificant, but cumulatively, all of these elements in an environment can serve to increase the sensitivity of the individual and increase the chronicity of their pain experience. So, that is very complicated. And I think in this kind of world, depending on our scope, we spend so much of our time with our clients in an office and we see them taken out of these contexts and we work with them over here. But we cannot, unfortunately, always just be a fly on the wall and see how their environment is actually working that provokes these or causes these pain experiences to come back. And frankly, I’m always amazed. I tell people, “I think it’s a miracle it works at all.” That we can take somebody out of the environment. We can do things, stick them back in the environment and it still works.
Sam Visnic:
So when we work with that, this is kind of like the big challenge that we have in this field, is how to take our voice with them, so that it’s with them all the time. So in that regard, we can use gadgets, we can use self-care things. I send people on, I’m big on home exercise programs and doing high volume corrective exercises throughout the day, Kinesio tape. And I know some people and the researchers don’t like these things. But this is just another way of taking some kind of sensory input to kind of lock in what we’ve done in the office and let them go home with it. So now it’s interacting with them in that environment as another way to throw a wrench in the wheel. This is also my interest in hypnotherapy.
Sam Visnic:
And even though the unfortunate stigma that’s associated with hypnotherapy, there’s tons and tons of research behind hypnotherapy, clinically, doing extremely well, especially with individuals who have pain. And the research supports it, based on what we know about pain neuroscience. And the idea is, is to be able to kind of tap into the subconscious, the way that people perform behaviors, their beliefs, and the way they respond to things in their environment and so forth, so that if we can start to impact those things, then that sticks with them when they leave the office and they will start to respond to those different triggers and stimuli in their environment, automagically. And that’s the idea, is how many different ways can we impact this mechanism or this thing that sustains that pain experience?
Dr. Nick Jensen:
So I’m curious. Yeah, I’m curious, man. So you’ve gotten heavily into this neuroscience picture to approach and help your clients. I mean, this is the master system. And what truth have you found in that? Because you started just basically starting with the muscles and the rehab portion. But in the bigger picture of finding healing with people with all these different issues with pain, are you finding more truth in addressing the brain and the nervous system, more upstream to get the resolution and then everything else kind of trickles down from that, as far as a hierarchy’s concerned?
Sam Visnic:
Yeah, when I first started this work, I mean, it was the obsessiveness with the minutia, the small things about corrective exercise and how muscles were firing and all of this. And that brought me to a certain level of success. But when I came over here and I started studying, and I knew all of this early on, I had been exposed to hypnotherapy for pain and all of these different things. And I know that people could get out of pain, alter behaviors, and things would change with this, but nothing really glued it together until I looked at the pain neuroscience. Because really what that’s all about is saying you have information coming from the body, the brain has to interpret this. There’s much, like we talked about, where you could have structural damage and you could have no pain, that haunts me. It haunts me in that when we work with people, is that how do we change the brain’s interpretation of this information?
Sam Visnic:
We can reduce the amount of pain or we can shut it down by getting the brain to stop caring about that information and to start sending descending signals, anti no subception down to just block it out. And if that’s possible, then we have to use a bottom-up and a top-down approach. And the top-down approach starts with education. People have to understand this, and I’d have to say it’s by far and away been the most impactful thing that I’ve done with people, is to take 15 minutes out of their first visit and do pain education with them. And teach them what is pain? Because they have no idea. I don’t think I’ve ever once had somebody come in, who’s seen a pain doctor, or a pain medicine expert, or anybody along that lines who has ever explained pain to somebody. They have no idea.
Sam Visnic:
So my question is, is that when you’ve got two people talking at each other and the language is just flying right past each other, this experience is not matching this knowledge and nobody knows what’s going on. And no wonder why people come in feeling frustrated and feel like they haven’t been heard or listened to, because nobody’s listening. And getting, sitting down with them and listening and absorbing that information, translating it into this is what’s happening. And this is what we’re going to do it, I find that most people, is what they’re craving and what, by itself, will lower that alarm system in the individual, lower that vigilance, and already starts to reduce pain by starting to take care of that process before we actually get into the movement work, before we get into the lifestyle changes or anything else.
Dr. Nick Jensen:
And I love that you’re saying that. I mean, you’ve said so many amazing things today that I know people are going to reflect on. And a couple of those that come to mind, one, when you referred to these individuals that sort of have a memory of pain, because I find it fascinating that when the pain’s not there, it’s like, you never knew it was there, until it comes back. And you talked about the interpretation, the memory being another piece of this puzzle.
Dr. Nick Jensen:
But talk about that a little bit, because I imagine, I mean, I see this with the people that we work with as well, David, and both of you guys, people forget that they had this pain. And it’s total amnesia. It’s like it’s completely out of the register of an ability to remember it. Not until you bring it up, like, “Hey, remember that pain you had in your left knee?” “Oh, oh yeah. I guess that was a problem for a little while there.” And so everything you’re sharing on, like these degenerative changes that do sometimes coincide with a pain response, but not always. I mean, I find it just fascinating, this whole memory side of the pain. I’d love, maybe just add some content there on that piece.
Sam Visnic:
Yeah, I would say that the memory side is very interesting. You have some people that seem to delete things. I mean, everybody has pulls and sensations if they’ve ever done exercise work. But most of the time, people aren’t even aware of the fact that they delete it. They feel something in their body and they just move on from it. And then you have somebody who one time, their back felt like tight and then they fixate on it, where the brain remembers that one feeling and anything that feels like that, boom, causes that alarm to go right back up again. When somebody has had chronic, let’s say, back pain and every single time they feel that feeling, the brain goes, “This is going to happen, back’s going to go out.” But yet what’s happening is in their mind, a lot of times it’s a 100% correlation between the feeling and the effect.
Sam Visnic:
And the problem with that statement is, is that it’s not true because it’s an overgeneralization and those two things may be connected, but they may not be connected. So I’ll ask people and they say, “Well, I feel that feeling in my back,” and the alarm goes up, and now movement apprehension starts. So I tell those people, I say, “How do you know your back’s going to go out? Has it ever not gone out when you felt that feeling?” And that person goes, “Well, yeah. I felt it before and my back hasn’t gone out, but it’s going to go out.” And I go, “Are you sure about that?” Because what happens is a lot of times, let’s talk about centralized pain, where this happens.
Sam Visnic:
One of the absolute hallmark signs that somebody has centralized pain, central sensitization, is that if you have them think about doing the movement that they’re afraid to do, and they have pain without doing the movement, but by literally mentally rehearsing it, it’s central sensitization because the movement didn’t even occur. Now, we do know that when somebody thinks about it, those neurons start to kind of activate and that person’s body prepares itself for movement. But that should not happen, okay? If that happens, then what has occurred is the story that the nervous system has created with all of those different components starts to trigger the alarm before the movement even occurs. So, that’s how powerful that can be. And so also, what we would do in those situations, the therapy wouldn’t necessarily be movement. You could do a graded exposure movement, but you can’t even get them to move.
Sam Visnic:
So what you have to do is to mentally rehearse it, guided meditation, hypnotherapy, to put the person into a safe place, remind them that they’re not actually doing the movement and then mentally rehearsing it over and over again, to do what? To reduce vigilance and to prepare the nervous system for safe movement. So these memories that people have, and this kinesthetic memory that they have is just like anything else. We know, and I remind people that your memories are like, for example, witness accounts are notoriously wrong. And the reason why they’re so questionable, even in a court of law. But you’re so certain that when feel something that something’s going to happen because it happened before. Well, that might not have all been how it actually occurred, but that’s how your brain encoded it. And we need to start changing that, otherwise it’s going to be very difficult for us to change this issue that you have.
Dr. Nick Jensen:
Uh-huh (affirmative). I mean, I can’t help but think it’s like we’ve hypnotized ourselves into dysfunction. You mentioned before like the guy, “I got a bad back, I can’t do that. And it’s just that repetition of this hypnotic event. And I can see many people in our clinic and just hearing stories like this, where there’s been such huge value in reeducating, reframing that pain. But then also getting into maybe a positive hypnotic experience, where you’re helping to reinforce the elimination, or the lack of need for this safety, or this guarding that goes on, emotionally, physically as well.
Sam Visnic:
Exactly. And that’s where we get into, I think Dr. Lorimer Moseley’s book, where he had the pain protectometer is what he was call it. And the idea is descending these things called SIMs and DIMs. A SIM, S-I-M, is safety in me. DIM is danger in me. So when we’re in pain, a lot of times we’re sending DIMs, we’re sending danger messages. The things I can’t do, the things my life is limited by. So one of the fundamental aspects of setting goals is so important within pain because reducing pain should not be the primary goal of a pain relief program. I know that sounds bizarre. But the primary goal of a pain relief program should be improving function. So when somebody’s primary issue with pain, isn’t always the pain, when somebody’s in severe pain, obviously that’s the goal. And they’re usually in the emergency room for that.
Sam Visnic:
But with chronic pain, the primary problem for most people is what pain is stopping them from doing. So if I ask you, I say, “Look, even if your pain stayed exactly the same, but I could get you back on the bike, I can get you back to running or playing volleyball, would you be better off? Would you be happy with that result?” And they say, “Oh yeah.” “Even if you had the same pain?” “Yep.” And they don’t really mean that because they also want to have less pain and do the activity. But it just goes to show you the hierarchy of the values. The problem is not the pain itself, the problem is what it’s stopping the person from doing. So when we set goals in the therapeutic process, it should be toward improving their ability to do things.
Sam Visnic:
“Well, Sam, I started with you and three weeks ago, my pain is only slightly better.” “Okay, but you remember when you came in, you couldn’t do a squat?” “Yeah.” “Well, you’re doing squats with 100 pounds on your back now for sets of 10.” “Yeah, but the pain is not that much better.” “Okay, your container is better, so now do squats with your body weight.” “Oh, well it’s better now.” “Okay, wait a minute. So you can do a squat with your body weight, you could do squats, 100 for 10 reps, the pain is there. But then when I take the bar off your back, you could do body weight squats for 30 with no pain. Do you see the improvement?” Okay? So we have to constantly be reminding the brain to stop fixating on the pain because it makes us sensitized to it. The best metaphor I can give you is I tell people when you buy a new car, you see your car everywhere, don’t you?
Sam Visnic:
And because we have a component of the brain, we have a mechanism that raises a level of importance to things that we see as important. And we become sensitized to it. When our senses pick it up, we pay attention to it right away. The problem with pain is the importance that we put on it, value and the beliefs that we have around it. We have become sensitized to it. We pay attention to it all the time, which the problem with that is, it makes us more sensitive to it. So we have to, in a way, start paying attention to it, so that we can learn what it’s all about. But then to move ourselves to paying attention to functional improvements, how we’re moving toward our goals. I get one more repetition, I can cycle a half more mile. All of those little things is sending SIM information to our nervous systems, safety in me. And it’s changing the way the brain is responding to the pain experience.
Dr. David Wardy:
Beautifully said, man, that was awesome. So, Sam, we’re wrapping up here and I really do want to talk about your book. So the book’s called Why Didn’t My Doctor Tell Me That? – What you need to know to get your life back from chronic pain. So real quick, can you just kind of share with our listeners, just give us an idea of what made you want to write this book, and what it’s all encompassing, and what they’re going to get out of looking into something like this?
Sam Visnic:
Well, I started out this, actually, as a digital document that I wanted to keep upgrading to say but people go, “I don’t know if I believe what you’re telling me.” And I’m like, “You know what? There’s research on this.” So I went out and I pulled together all the research and that led me toward this rabbit hole, where there was a lot of stuff out there that I didn’t even know. So in particular, one of the things that really spawned my interest was sleep. And actually, the number one thing that improves someone’s coping with and reduces sensitivity to pain is improved sleep. And then there’s this obvious glaring contradiction here, where sleep is so important. But yet, the research on when I was looking at caffeine, because I kept arguing that caffeine makes pain worse.
Sam Visnic:
The research doesn’t say that. The research says that pain is positively impacted by caffeine intake. But then the problem here is, is that the difference between caffeine and sleep. So one messes the other up, but nobody talks about it. And I’m like, “Okay, what else is in here that’s been missing?” And I kind of went on this fact finding hunt. And anyway, the story is, I just kind of put it together in chapters, in my book and wrote chapters on what the research says about different elements of chronic pain, MRI studies, corrective exercise, posture. All the things out there that people are always talking about and bringing some truth to this, saying what the research says. Obviously, every single person has their bias. I’m a massage and a movement guy. So you’ll see some of that stuff in there, but you’ll find some surprising stuff and it’s just, it’s complicated and there’s a lot of things out there.
Sam Visnic:
But what I really wanted to write it for, is to teach people that, “Hey, if you think that you’ve gone through everything and you’ve tried everything.” No, you’re missing a lot. No practitioner, single practitioner can put all of this together. We’re all trying to do it and to try to really figure out what’s the best thing for each person and hit the nail on the head without turning their life upside down overnight with all these nutritional changes and lifestyles stuff. But there’s a lot out there and there’s so much, that’s been untapped for the individual. And that’s kind of the direction I wanted to go with the book. I didn’t want to sell it, so I give it away for free because it’s a living document that I’m going to continue upgrading and helping to educate people on how to get themselves out of chronic pain.
Dr. David Wardy:
It’s amazing what you’re doing, man. You’ve done such a good job of painting a picture today, to show people these gaps or how they need to look outside the box of their thinking and kind of look at these other things, because I think, for a lot of the general population that doesn’t know what we know, as doctors and practitioners, because we live in it, right?
Sam Visnic:
Yeah.
Dr. David Wardy:
They’re just so aloof. And so it’s like you’re saying, it’s just this focus of pain and get me out of pain and it must be this simple because this is this and this is that. And it’s just so much more complicated that-
Sam Visnic:
I saw it on Instagram. You just need to stretch, you got to stretch my psoas, that’s all my problems. And I’m like, “If you could do a psoas stretch and that’s the end of your pain, you probably didn’t have that much of a problem to begin with, right?” There’s some people out there with some real issues, yeah?
Dr. David Wardy:
Oh yeah. My hat’s off to you, man. You’re doing amazing work. I would love to have you on the podcast in the future, your wealth of knowledge and wisdom, and information, and we really enjoyed chatting with you today, man.
Sam Visnic:
Absolutely, loved it. Thank you so much, guys.
Dr. David Wardy:
Thank you-
Dr. Nick Jensen:
Sam, one last thing. We always like to get our guests to share maybe what’s one or two things maybe, they can put into practice, just from the knowledge that you shared today?
Sam Visnic:
Most important thing I would say, learn about pain. Go into Google, go into YouTube, look up pain neuroscience education. There’s some fun little videos that people can go on there. And it’s such a profound thing, that it’ll open up a whole window of awareness. I mean, obviously read my book, it’ll give you a lot of ideas and information out there. But start to educate yourself, so that you’re your own advocate on these things, because not everybody has access to practitioners like us, who know this stuff. You might have to just kind of know this stuff, walk into the doctor’s office and start asking questions.
Sam Visnic:
But that’s probably the best thing that you can do, is to be an advocate for your care because not everybody knows this stuff. So I would say that. Number one, doing your homework on that. And the other thing is, is just doing your best on finding out actual resources and strategies to do certain things. I think that, for example, we’re always looking at decrease stress. I hate that recommendation. The question is, look up online, how do I specifically reduce stress? And start to become somebody who chases down individual strategies and a lot of digging in and just the work. Don’t sit back on your heels and wait for somebody else to do the work for you.
Dr. Nick Jensen:
Yeah. I mean, so many nuggets. And I love how the focus was really about always improving functionality. I find it just fascinating that often, in order to take steps forward in our healing, it’s that we have to dismantle the programming of everything that we feel like we’ve known to be true for ourselves. And that awakening process is just so important. And I’d say, going back to the point you made on the doctor you got to shadow, a lot of what happened with the people, was that they got to be in the presence of someone who’s dug into that truth, and dug into the reality of what it means to get healthy and to be a mirror for people. And so thank you for doing that in a big, big way.
Sam Visnic:
Absolutely, and the last word I would say about that doctor, is that he would not let you take things seriously. So just put that in. That’s a whole ‘nother topic to go through. But wow, just changing the experience and stopping people from being so serious because seriousness is indeed a disease that is undiagnosed these days.
Dr. Nick Jensen:
Yeah, that’s a whole ‘nother podcast topic right there. Love it.
Sam Visnic:
Absolutely.
Dr. Nick Jensen:
Thanks so much, Sam.
Dr. David Wardy:
And, Sam, real quick, where can people find your stuff, man? If people are looking for your info.
Sam Visnic:
We’ll probably drop a link there in the show notes, but releasemuscletherapy.com, on the homepage, when you scroll down, you can grab a copy of my book. I have a free membership area, that has lots of resources. And I just stick all my new stuff in there. So it’s a smorgasbord of great stuff. I’m very active on Instagram these days. So Release Muscle Therapy is the handle. I do post a lot of movement, mechanical stuff. People seem to like that on Instagram. But those are the two areas to pretty much catch up with me and YouTube, some of my real long content. So, that’s a good format for that. But those are the great places to catch up with me.
Dr. David Wardy:
Perfect. Thank you again, Sam, appreciate-
Dr. Nick Jensen:
Thanks, Sam.
Sam Visnic:
All right. Thanks, guys.
Dr. Nick Jensen:
Bye-bye.
Dr. David Wardy:
Thanks for are listening. If you enjoyed today’s podcast, please be sure to subscribe to The Doctor Dads and share with your family and friends. You can also follow and interact with Dr. Nick and Dr. David on Facebook and Instagram for a daily dose of inspiration and the latest in health and wellness, be well.
Foam rolling is an excellent way to improve mobility, flexibility, and reduce nerve sensitivity.
Selecting the right foam roller for the job can vary depending on the task. I talk about a few options in this post about the best foam roller for runners.
Think you know a lot about chronic pain? Test your knowledge and Click Here to take the pain quiz!
Thank you all for coming on another Living Life Naturally podcast and today we have Sam Visnic. He is here as our podcast guest and he spent his life studying the fundamental aspects of human health, but with a focus on movement and clinical massage therapy. So in a world of specialists, surgical procedures, drugs and quick fix remedies, he’s committed to finding and developing strategies that help people stuck at the gap. So he has studied dozens of systems and methodologies for uncovering the root cause of aches and pains along with postural and movement issues.
Lynne Wadsworth:
So pain science and the art and science of hands-on soft tissue massage techniques, myofascial release, which I have been privy to and love it, and coaching movement is essential in his practice. So integrating different methods, but above all, deciphering way and to use different techniques with different people in situations along with the integration of movements that people want to be able to do again is the key to long-term success with Sam’s incredible track record with his personal clients, excuse me, understanding the various elements that contribute to conditions and the power of communication and education makes his release muscle therapy program unique from other hands-on therapy approaches.
Lynne Wadsworth:
So I’m going to apologize ahead of time. We have storms here in Florida so I’m finding it hard to speak. So welcome to the podcast, Sam. We’re so thrilled to have you here with us today.
Sam Visnic:
Thank you for having me. I’m very excited and congrats to getting through that long intro. You did very well.
Lynne Wadsworth:
So where are you joining us from today?
Sam Visnic:
Southern California in a town that is slightly east between Los Angeles and San Diego. It’s called Temecula.
Lynne Wadsworth:
I have not heard of it and California is one of the few states I have not visited and I’ve been here over 30 years. Somewhere, I’d love to go, but of course at the moment in time, I’m not going anywhere.
Sam Visnic:
It’s wine country here so it’s a good destination spot.
Lynne Wadsworth:
Yes. Yes.
Sam Visnic:
If you like to drink wine and you like to golf, then this is a place to go to.
Lynne Wadsworth:
Yes. So tell us a little bit about what got you started in this field.
Sam Visnic:
Well, simply I was a fitness trainer. My teens, I was the classic stereotypical skinny kid that my parents and people told me, you need to go to the gym and lift some weights because you’re too skinny. And from there, I got really interested in fitness and in particular, early on, I was always a kid that liked direction and rather than just showing up to the gym, I didn’t know what to do so I would devour every book on fitness that I could and I ended up stumbling upon a lot of books. This was back when people used to go to Barnes and Nobles and Borders, there was no Amazon, and I would sit there and my mom would take me and I would sit there and read all those books. And scientific fitness books, scientific weightlifting books and I got a pretty early start into that.
Sam Visnic:
So when I was about 19, shortly after high school, I decided, I mean, “Hey, I could teach other people how to do fitness stuff,” and I became a trainer. And first and foremost, when I started working at the gym, I started realizing, and this is when things in the early 2000s were starting to move toward this functional fitness thing. Everybody was starting to play with exercise balls and doing all sorts of things other than just sitting on the machines at the gym and everybody had something wrong with them. Had aches and pains, they had back problems, knee problems, and other trainers didn’t feel comfortable working with them. They didn’t feel good about it. They didn’t know what they were doing.
Sam Visnic:
And I was at a point where I was confident in reading the materials that I was reading to take these people on. And what I found is, is that a lot of these cases, I was getting them better. People had been to a lot of doctors and therapists and they were cleared for serious, serious medical pathology but they had arthritis, they had back issues from time to time that were not really stable. They didn’t feel good about it and I would get these people moving and doing squats and lunges and they felt better as a result. So I had realized I was onto something and now, everybody knows this. It’s like, “Hey, go train your core and everything,” but in the early 2000s that’s not what the message was.
Lynne Wadsworth:
Right.
Sam Visnic:
And so, for probably that point forward for I’ve been at this now, so that’s been about 21 years, I spent and devoted all of my time to reading everything I could get my hands on when it comes to corrective exercise movements and not only that, but the field in pain, in particular, has evolved dramatically in the last 20 years. So we know so much more about all of the aspects that affect chronic pain and chronic physiological issues. And I’ve been able to integrate that stuff into my practice as both basically a movement therapist and what we call a clinical massage therapist.
Lynne Wadsworth:
So why is it then that nowadays so many people are dealing with chronic pain? What’s your take on the course for that?
Sam Visnic:
It used to be that I would say things like, for example, bad posture and not moving enough and so forth and these are certainly elements because those in the therapeutic process, when we get people doing these things, they start feeling better. But I don’t believe that that’s really and that’s not what the research says is what’s causing and contributing to chronic pain. A lot of this starts off with all the way back to the beginning when people first start feeling aches and pains and then what they do about them. So for example, there’s a good amount of research that goes into, how do you know when somebody has an injury, let’s say they roll an ankle or they lift a box or whatever and their back goes out, I don’t really like that word, but we use that for our purposes. How do they respond in this situation and how does it go from a point where the issue should be healed? The tissue calms down, et cetera, but then the pain persists after this.
Sam Visnic:
This is the difference between acute pain and chronic pain and there are certain things that will increase the likelihood of there being a chronic factor to the pain. So a lot of times we go to the doctor, that’s what most people do if something doesn’t just resolve on its own. So they go to the doctor and say, “Hey, my ankle is messed up. I rolled it. It’s swollen,” or “My back doesn’t feel good. What do I do? It’s been killing me,” and the medical professionals at that point, as usual, their job is to rule out clinical pathology that you know is serious. Do you have something significant wrong with your spine?
Lynne Wadsworth:
Right.
Sam Visnic:
Is something broken? And that’s the way it’s supposed to go.
Sam Visnic:
But the problem is, in many of these cases, these individuals are oftentimes getting x-rays and MRIs and all sorts of scans and so forth in non-serious cases. So these cases, when you come in with a typical garden-variety back problem, generally it should be, most doctors will say, “Hey, you’re going to be okay. I don’t see anything seriously wrong. I’ll give you some anti-inflammatories, give it a rest and you’ll be fine,” or go to physical therapy. But now it’s like, the first step is, “Well, my back hurts,” and then, “Let’s get an MRI,” and then, okay, hold on a second. So we get an MRI and the statistics show that recently there was a study that showed, if you take a hundred people off the street and you run an MRI on them, on their spine, you’ll find that somewhere in the neighborhood, 60% of them have some abnormality on the scan.
Lynne Wadsworth:
Wow.
Sam Visnic:
They have arthritis and this is all run at the middle stuff, that’s normal yet. But now, the diagnosis is your back problem is because of this issue. So you have a disc bulge in your back that’s why you have this pain. And now, because you’re not explained things like, “Hey, everybody has this so I don’t know if that’s what’s causing your pain. Let’s give it a little bit of time. It’s probably going to be okay,” either you’re told, “Hey, nothing’s wrong with you,” after you’ve been told you have a disc bulge; or number two, you’re told that the whole problem is because of that but you’re not explained the scenario on how you’re actually supposed to fix this, right? Or what does this mean? Does this mean you have a bad back? Does it mean that… Whatever.
Sam Visnic:
And these are certain things right there that start to create fear. It creates anxiety. It creates concern that something could go wrong. And now, it starts to lead to certain beliefs like fear-avoidance, not wanting to do certain things with your back or let’s say that you were playing something, a sport that you love like golf or tennis. You might now start becoming apprehensive about doing things because you feel there’s something wrong with your body and you can get hurt. So now you could start to see how this chronic pain issue could start developing from now developing behaviors and beliefs that are associated to what just happened. And maybe you really just had a simple low backache and it was going to be fine after a little bit of rest and you could go back to doing what you’re doing, right?
Sam Visnic:
So this is just a small scenario but an extremely common scenario that I think is one of the factors that can increase the chronicity of aches and pains. And it’s not so much of like a blame on the medical system but this is just how things are going. And there’s actually big movements in orthopedic societies now and trying to tell more common physicians to stop over x-ray-ing, over MRI-ing because it’s number one, not that valuable in assessing and diagnosing common back issues, for example; and two, it overestimates the problem. It causes more people to end up being on medications. It causes more people to end up being on the surgical table when they don’t need these things and increasing the likelihood of developing a chronic problem.
Sam Visnic:
But you’ve take it all the way back to there and there’s many other factors, as people continue to see more doctors and therapists and they get more diagnoses and they end up not really doing well with the therapy, it causes people loss of hope. It causes more concern and worry about the situation and the whole thing snowballs and it continues getting people stuck in this what I call the vicious cycle of chronic pain.
Lynne Wadsworth:
Right. So many of us, it seems, especially here in the US, we hear so much about the chronic pain, it’s ongoing. And I think that we really need to learn to be our own health advocates when we go to the doctor because, as we say, it’s either underdiagnosed or over diagnosed
Sam Visnic:
Yes.
Lynne Wadsworth:
And we really have to go in there and really fight for ourselves these days.
Sam Visnic:
Yeah. And it’s confusing because it’s a medical doctor and their doctor is trained to detect serious issues. So there has to be a trust that that is happening but also, it has to be an understanding of where the expertise lies. And I would say that their specialty is not necessarily chronic pain, it’s making sure nothing is seriously wrong with you. And some doctors are more knowledgeable on chronic pain and some are not. So I tell people, if you go in and you see your physician, tells you that they don’t see anything wrong with you and you’re stable, you know what I mean? Your structure is stable and whatever the issue is, there’s nothing that’s medically and emergency situation, as frustrating as that might sound, that’s a good thing, because that means that now there are other things that we probably need to deal with that are not so serious in terms of a medical perspective.
Lynne Wadsworth:
So how do you know if one pain therapy is better than another when it comes to people that you see?
Sam Visnic:
That is a huge question and a good one because there are so many things out there and we’re inundated, as usual, with marketing messages and so forth of everything that works. So what I do with people, and that’s what I get lots of flurries of questions, does this technique work or does that technique work? Myofascial release or exercise therapy? To some degree, almost everything will work. The problem is, is understanding the totality of the situation that is happening with the person in their own, what we would call unique pain experience. There is no universal thing in every single situation of pain that is the cause of the pain, because if that was the case, we would already have the solution. We would know that every back issue would be fixed by doing core exercises or we would know that every jaw issue would be fixed by using a bite guard and it does not work like that.
Sam Visnic:
Anybody who works with patients will find that there’s a certain amount of success by doing certain types of therapies. It’s not always clear when a therapy will work. But I can say, and this is where the development of my release system is based upon years of researching certain things in particular with chronic pain, we know that certain therapies or certain things that we do in the process will increase the likelihood of having a success with more different types of therapies, okay? So let me explain that. So we know now that after a lot of research that teaching people about pain, okay, because most people don’t have any idea what pain really means in the body other than, in the short term, if you burn your hand on a hot stove, you look at your hand, well, you know why it hurts. That makes sense.
Lynne Wadsworth:
Right.
Sam Visnic:
We can square that up. We don’t need a lot of understanding to understand that. But when we have chronic pain, which means that the tissue has healed, the burn is healed, but we still have pain, we don’t understand that because that doesn’t make sense. And we need people to understand or to help us understand the process of why those nerves are still sensitive after the tissue has healed and imagine dealing with that situation for years. Your hand is now producing pain when there’s technically nothing wrong with it. That’s very frustrating. So we know that when let’s say a neurologist or a physical therapist or somebody comes in and explains to you why this is happening and why those nerves are sensitive and what you can do about it, first and foremost, that gives you a little bit of relief. It gives you some hope, “Oh, I understand it now. Somebody gets this.”
Sam Visnic:
So when I work with people, I always start with pain education. I teach people about chronic pain and all of the different factors that are associated to it. And to help them understand that when we start to go through our process, we’re going to be digging a little bit to see which factors are involved that they weren’t even aware of, right? Because oftentimes people, when they come into me, me, as a massage therapist and a movement specialist, they’re looking for a mechanical fix. It’s posture, it’s movement, there’s something very particular in there and there may absolutely be components of that, okay, and it’s almost always, to some degree, but there are many other factors outside of that that will influence your ability to respond to those therapies. So to give an example, we know that pain education, if you don’t understand what’s going on in your body, let’s say that you do believe you’ve been diagnosed previously with a disc bulge that if you bend forward, you’re going to hurt your back.
Sam Visnic:
So if I give you exercises that involve bending, you’re going to have apprehension and you’re going to have fear about doing those movements and you’re going to start generating nervousness and/or pain without that movement actually being something that is painful. So if I explain to you about pain and how it works and that the disc bulge is not really an issue and it’s common, and what we’re doing is desensitizing your nervous system to these movements that are very safe and controlled, you’re going to respond differently to that therapy at that point. So it literally can be the difference that makes all the difference. So pain education, one. Some other factors that we might look at in the research that… There’s mounds of research on this and that’s why I like to talk about especially things that have been really, really validated that don’t actually get talked about very often.
Sam Visnic:
One of the number one things that increases your sensitivity and your nervous system to pain is how well you sleep. If your sleep is poor, then you will respond in a greater way or too much, I would say, to small amounts of stimuli. So if you get an exercise that makes it ache a little bit, right, but you generally feel, okay, let’s say you have two nights of bad sleep, now that exercise might make you hurt a lot. And then you go to the therapist and you say, “Hey, these exercises are making me hurt. I don’t want to do this,” but really it wasn’t the exercise. It was the state of the nervous system. So the more you understand about what’s going on in your body and all of these factors, it makes it easier to navigate this process of desensitizing those nerves, getting the nervous system to restore its normal state of homeostasis and getting the results that everybody wants which is to move past the chronic pain and get back to living their life.
Lynne Wadsworth:
Yeah. Because living with chronic pain is absolutely no fun whatsoever. I’m a migraine sufferer so I totally, totally understand where people are coming from when it comes to chronic pain. And I used to not understand what the doctors would say when they would tell me, “Oh, this is chronic,” but definitely there are so many factors. And tell me if you don’t agree with this, but as a holistic health coach, there are so many factors, as you say, you mentioned just one with sleep. But there are many others that affect how we feel and how we might respond to that chronic pain. So I think that some of what you do is that you deal with people when it comes to behavioral changes as well.
Sam Visnic:
Yeah. And you have to, in a general way, and this is where things get interesting with selecting therapies. Almost every person who comes in, almost, I’d say, has dabbled with certain therapies that we know are helpful, for example, meditation. But I can’t tell you how many people I’ve seen that are habitual meditators, that meditate on a regular basis, they’re good with having it at a routine but it’s not helping their chronic pain. And that’s because if there’s generalized stress in someone’s life and they’re always responding and overreacting to all different types of stressors then a generalized meditation routine is very helpful because it will, to some degree, improve their coping. It’s probably also stopping them from getting worse. But that pain has a specific experience and it’s very contextual and that meditation might need to be applied in a very particular way to the context in which that person experiences pain in order for them to get better.
Sam Visnic:
So I hear a lot of, well, meditation doesn’t work and I’m an advocate of medical or more clinical hypnotherapy, for example. I’ve tried that, that doesn’t work. What do you mean it doesn’t work? And with whom and under what circumstances? Because if you were just given a generalized relaxation routine, maybe that didn’t work for you but maybe you have fear about bending forward like we talked about. But if that meditation or that hypnosis is not acting on the specific fear about bending forward, it may not work because it’s not specific enough to the individual, right, and their individual pain experience. So yes, you’ve got all of these factors and that’s what makes it challenging because we would love to just go in and flip someone’s life upside down overnight and make every area of their life better but we know we can’t do that and in that in particular stresses people out.
Sam Visnic:
So we have to try to, as best we can, hit the nail on the head the first time if we can and that’s great when that happens, but we don’t want to set those expectations. But we oftentimes have to test and that’s why that good interview process on the front end and doing a quality evaluation and asking a lot of questions can help us narrow down the specific context in which those behavioral outputs are actually occurring. Meaning, when does the pain happen and under what circumstances? What’s going on in your brain when you do this? What are you thinking? How are you moving? All of these contextual elements and we’re going to have a greater likelihood of being successful by targeting our therapy without having to necessarily just keep circling around it with therapies that are good in terms of general health, but they may not be dramatically impacting the pain itself in the way that it needs to be impacted.
Lynne Wadsworth:
So you have talked about massage. So what kind of massage do you do with your patients? I’m assuming it’s not always the traditional type of massage.
Sam Visnic:
No. So for me, massage of all types is good. Like I say, that massage is very much like pizza, even when it’s bad, it’s good. Because even when someone’s nervous system is stressed out, if you’re so stressed and you’ve got all this stuff going on, sometimes just lay it on the table and doing massage therapy is just fantastic. It’ll calm the nerves. I don’t do that work. I oftentimes refer that out. But when people come to see me for specific massage work, I have a number of techniques that are designed to basically change what we call the sensory experience of the issue that needs to be dealt with. So when I do an evaluation with somebody, we do always do a head to toe because no body part works in an isolation. If some muscle group or group of muscles or an area where there’s pain, let’s say the shoulder, if those muscles are tight and locked up, then what are all the muscles around it doing in response to that?
Sam Visnic:
They have a behavioral change as well to do what they’re doing for compensation purposes. So you create a blueprint of all of the muscles that are tight and the muscles that are loose. So the massage work is going to be very specifically targeted to that area, right? So we’re going to go through, and most of the time, my work is all about, I say thoroughness. So you’ll find that for the most part, when people have gotten massage therapy, I’ve had clients who’ve gone to renowned experts and clinics and so forth. And by the time they get to me, I always ask, has anybody really gone through your shoulder and cleaned out and worked on every single muscle that attaches around that ball and socket? And 99% of the time they say, “Nope, nobody’s ever done that before,” so that’s where I’m always going to start.
Sam Visnic:
I’m going to go through it, usually, let’s say on a shoulder, it will take me an hour and I will literally go through every strand of muscle fiber and see how sensitive things are, how’s the person responding to that. If they have a reduced range of motion, let’s say I work on that muscle, does anything change? I’m always looking for doing some kind of therapy and retesting to see improvements. In that way, I don’t have to deal with treating that entire shoulder every single time they come in. I could jump ahead to the parts that make the most significance and when I do that, I’ll use a lot of different techniques. And in massage therapy, all of the massage therapists to some degree have played with a lot of different techniques whether or not they have a branded name associated to them or not, that depends on what it is, but I use a bunch of them.
Sam Visnic:
If I were to say what I use the most, it’s probably myofascial release techniques and also something that’s called muscle energy techniques which is a system of doing contract-relax activities to improve range of motion in the joints, in the tissues and improve that sense of safety that the person feels when they move their joints around.
Lynne Wadsworth:
Because nowadays, so many people spend the majority of their time on the computer and so many of us, therefore, as a result, have neck pain, shoulder pain, back pain, as you’re talking about it in here.
Sam Visnic:
Yes.
Lynne Wadsworth:
So do you find that you can address that to where it can be taken care of and then they can maybe continue to do exercises to keep that area released? Or is it like a few months that you have to work with people? How does that work?
Sam Visnic:
Yeah, that depends on how many things are contributing to that. So I don’t find that sitting or this whole concept that text neck is really that much of a problem because I always loved that, in the physical therapy community, always produces these funny memes that antagonize some of these beliefs sometimes. For example, I think the famous one that goes around is a black and white photo of people going to work on the subway in the ’40s or the ’50s and they’re all standing there looking down at newspapers. So they had newspaper neck, right? But I don’t think that that’s the problem. I think what the problem is, is being stuck in a position for too long without moving. I think that’s the primary problem.
Sam Visnic:
So I’ll always start with things like how long are you sitting without moving? Are you literally static and focused which is a good thing because you’re working, but you’ve got to remind yourself to wiggle around in your seat and move without just being stuck in one plane of motion with your eyes moving. Your neck is going to have some stiffness when you start to move it.
Lynne Wadsworth:
Right.
Sam Visnic:
So a lot of times, it’s producing activities outside of the chair that are antagonizing those positions. So if you’re like this, we’re going to do lots of exercises that do the opposite. We’re also obsessed in the culture of movement and chronic pain like physical pain with stretching. And not that stretching is bad, but it doesn’t last, right? So what we want to do is whatever muscle is tight, I oftentimes go right away to exercising the opposite muscle because if my shoulders are going up, they’re tight, but what are the opposite muscles doing? They’re lengthened.
Sam Visnic:
So what I’m going to do is do exercises where they pull their shoulder blades back and down to make those muscles stronger so that they antagonize the tension in the muscles that are tight. So then, you’re stretching will actually probably last a little bit longer when you do that. So I always go with that but also we assume that muscles that are tight actually are strong and a lot of times they are not. A muscle can be tight because it’s strong, it could be tight because it’s weak. And for the individual, you have to determine that but that strategy is actually when you figure that out leads to the long-term success.
Sam Visnic:
So human beings are meant to move. We need to move a lot, but we need to have a strategy. So outside of just stretching, are we going to exercise those muscles to make sure that they have a good ability to tolerate sitting in that position for as long as the person needs to sit? And that’s what we say is the concept of improving functionality. That’s what’s important, is getting somebody to be able to tolerate what they do all day long with less discomfort and problems.
Lynne Wadsworth:
So tell us a little bit about the book that you have because I know that you have written a book yourself.
Sam Visnic:
Yes. So what I had done over the years is I’d always be finding myself telling people things and without spending my time with clients, lecturing them constantly on all of the findings that I’ve found throughout the research, I decided to create a digital version of my book and put all of that stuff in there. So I’d help people understand as a compendium and say, what is chronic pain and what does the research say about this and what is all this stuff you hear me babbling about in sessions? And I want you to read it, learn about it and understand what I say when I say that fixing posture is not the only thing that’s related to pain and actually far from it. What does the research say about orthotics and all these questions that people would love to have answered and the common ones.
Sam Visnic:
And I just wrote the digital copy of the book and sorted it to chapters to talk about the various things. And a lot of it is pretty mind blowing to people when they read it. And then particularly talk about things like core exercises and just strengthening your core, we hear so much, does not work for back pain at all. There’s no research to support it. And people are like, “Really?” Because I hear that all the time. Yes. And the more you understand about what’s out there in terms of there’s a lot of research supporting, and then you see where things are starting to go, you’ll understand a lot more about what I’m talking about in terms of why we educate people. Because the more you understand about pain, the better you feel, the more we start not obsessing about structural biomechanics and your posture, the more it releases you, gets you to relax a little bit more and the more it brings some calm to your nervous system and that in response reduces pain.
Sam Visnic:
I also talk about things like hypnotherapy, which mark my words, I’m now, as I’m doing my podcasting tour here, talking a lot about, mark my words, that will be the next thing. The only thing that we have to overcome here when it comes to meditation and hypnotherapy is the stigma that’s associated to them. There’s mounds of research to support why hypnotherapy works. One of the major researchers on this is Mark Jensen out of University of Washington that finds that these processes like hypnotherapy and meditation, although they’re different processes, they work the same way on the brain and what they do is they calm the brain. And the brain is the thing that is predominantly choosing or deciding whether or not you should experience pain or not which is really the threatening response that our body has when it’s getting information that tells us we’re in trouble.
Sam Visnic:
So the more we work on the brain through these various processes, the more we calm things down and the more we can restore a normal, healthy function. So I talk about these things in the digital book and it’s my gift for people because there’s just so much information out there. A lot of it is misinformation and people are led in the wrong direction, spending lots of time, money, and energy doing things that are just not supported and I personally found in my practice that don’t work either. So that’s what I’m offering out there to help people along.
Lynne Wadsworth:
And where do they find that?
Sam Visnic:
They could get it directly on my website. So if you go to my homepage, at releasemuscletherapy.com, and you scroll down to the bottom of the page, it’s a bundle of a free membership area that I have on my website with a lot of different resources. And I write a few PDFs, small eBooks, and so forth to help people understand how to use some of these techniques right away to start noticing a difference and restore balance to their nervous system.
Lynne Wadsworth:
Awesome. So what general recommendations can you give to our listeners that would actually help them get better now?
Sam Visnic:
Yes. There’s four pillars to dealing with chronic pain. There’s a lot of details in these, but four general pillars to getting better from chronic pain. Number one, pain education. The more you understand about pain and there’s research to support this, that when they put people in MRIs and we look at how much their brain activity they have when they’re in pain, because we can’t measure pain, by the way. We can only measure stress responses to that stimuli. There’s a lot of brain activity going on when people have pain. And when you educate people with pain education and you stick them back in the MRI machine, you notice a much quieter brain. So actually education itself is therapeutic just by learning. So pain education is number one, okay? The number two thing is you need to sleep. You need to improve your quality of sleep, however that means for you. Get to bed on time, don’t drink too much water, don’t drink tons of caffeine, whatever you need to do. Get help from an expert on sleep.
Sam Visnic:
The number three thing is you got to move and not necessarily talking about right away core exercises or anything else, but we find that general aerobic exercise, just getting out walking reduces the likelihood of having issues with anxiety and depression associated with chronic pain and also helps getting some fitness, right? So getting out, breathing air, right? As long as it’s nice outside.
Lynne Wadsworth:
Right.
Sam Visnic:
Right? Yeah. And then the last thing is goal setting and this is a big topic and a can of worms to bring up about why we set goals. Pain relief itself cannot be the only goal of a therapeutic program. It has to be about improving function. And what I always say is that there’s this paradoxical thing that occurs which is the more you fixate on pain, the more pain you experience because you make your nervous system pay more attention to it.
Sam Visnic:
The brain will always pay more attention to what you teach it to pay attention to. So when we look at those small improvements, “Hey, I got some sleep yesterday. I feel a little bit better today. I went on a little bit longer walk,” or “My goal is to go to the gym and actually just spend 20 minutes in there, just moving around, lifting some weights. I did that and I couldn’t do that before.” The more of this information and input we’re putting into our nervous system with these small goal improvements, we’re sending lots of information that shows our nervous system that we are safe. And when we’re safe, that alarm, i.e. pain starts to ratchet it’s way down, okay?
Sam Visnic:
So that is the four pillars. So we have pain education, we have sleep, we have some extra movement and we have goal setting. And those are the things that you can start implementing right now to improve your situation.
Lynne Wadsworth:
Well, Sam, that’s so helpful. I appreciate that. So tell our listeners, I know you’ve told us your website, but tell us again where people can find you.
Sam Visnic:
Yep. Go to releasemuscletherapy.com, that is my home site and, of course, feel free to go to my Instagram. I always keep updated content. Not everybody goes and reads blogs all the time these days but it’s on Instagram. It’s /releasemuscletherapy. You’ll see lots of exercises and information that I put out there so you can keep updated with me. I’ll be launching my own podcast here pretty soon-
Lynne Wadsworth:
Wow.
Sam Visnic:
… In which I’ll be interviewing some experts that I love to hear about and a lot of it is, I have to be honest, I’m a little guilty of saying it’s really some self-serving part for me because I have lots of questions that I want to ask the experts that I interview and I want to learn a lot. And everybody will get to go along for the ride and I love to poke at them and ask them a lot of deep questions to get past some of the superficial stuff.
Sam Visnic:
So those are the things that are on the docket for me and reach out any time, I offer virtual consulting and so forth. But my mission is really helping people out of this chronic pain cycle because it is vicious. And the good news is, that it is not as hard to break out of as most people actually think that it is because oftentimes they’ve been through so much and it has not worked for them. But let me tell you something, there is a light at the end of the tunnel because there is a lot you probably have not done.
Lynne Wadsworth:
That’s awesome. Thank you so much. Appreciate you being here with us today and giving us all of this valuable information.
Sam Visnic:
Yes.
Lynne Wadsworth:
Very, very helpful. Thanks.
Sam Visnic:
And thank you for having me on here. I really enjoyed it.
Lynne Wadsworth:
Thanks. So till next time, enjoy California. Hope that your weather stays well, good, and the health of the Californian stays well.
Sam Visnic:
Yes, indeed. It’s heading on into the fall here. So especially in Temecula, maybe we’ll get some sub 100 degree days.
Lynne Wadsworth:
Here in Florida, we’re just looking forward to getting rid of the humidity.
Sam Visnic:
Good luck with that.
Lynne Wadsworth:
Yeah. Thank you again. Appreciate you being here with us.
