Why Didn’t My Doctor Tell Me That? – Get Your Life Back From Chronic Pain Podcast

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Doctor Dads Podcast

Dr. David Wardy:

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.