116- Ways to Relieve Chronic Pain with Dr. Ryan Foley

Bryan Carroll: [00:00:15] Pain is an interesting sensation. You can have pain and areas with no trauma and even have pain and limbs that no longer exist. And you can also have the lack of pain where there clearly is trauma.

Which means that there is a much more to pain than we would expect. What's up everyone. I'm Bryan Carroll and I'm here to help people move more, eat well and be adventurous. And today I have Ryan Foley on the show to talk about chronic pain and ways to mitigate this sensation of pain he breaks down and what leads us to feeling pain and how that information can teach us how to help those who suffer from chronic pain.

So let's dive into my conversation with Ryan Foley. Dr. Ryan Foley earned his doctor of physical therapy and bachelor's degree in health sciences, psychology and gerontology from Nazareth college of Rochester, New York. He has worked in a sports performance center, delivering treatment to professional athletes from teams, such as the Miami dolphins, Denver Broncos, and the USA Olympic sailing team.

He also co-founded integrated that kinetic neurology, which is a health and rehabilitation education course for MoMA and rehab practitioners. Thank you for coming onto the show, Ryan. 

Ryan Foley: [00:01:33] Thanks for having me. 

Bryan Carroll: [00:01:35] Of course. And I would love to learn more about your background since you do have such a wide background, especially with working with.

You know, pro athletes and then I'm creating the I can program. So what got you into all of this? 

Ryan Foley: [00:01:50] Yeah, I had kind of an interesting, introduction into the world of rehabilitation. I suppose. I, I. I actually didn't start working with those professional athletes until after I worked in a prosthetics and orthotics rehabilitation unit in New York when I first graduated.

And that's actually what got me into looking at the, the nervous system and how the nervous system influences. The movements of our muscular skeletal system, you know, in, in school and in the doctor program with, with physical therapy, they teach you an awful lot about how we can address the, the musculoskeletal system when it comes to rehab and even athletic performance and all the rest.

But we rarely get an insight into how the nervous system influences the, the musculoskeletal system and how we can actually merge those two, those two layers together. So I was actually working with a lot of amputees with chronic pain and going through prosthetic rehabilitation actually did my research in prosthetic rehab as well.

In the last year of, of the dr. Program, we were kind of looking at how different prosthetic limbs per se, the voices that would affect the efficiency of an individual's gait or their walking in, in the external environment, not just in the clinical environment, but the external environment. And. The prostitutes that we're working with, both in the research project and the, and the clinic I was working in really opened my eyes to a completely different research that we can actually use as physical therapists, because I found this fascinating and some people think, well, how did you actually get from prosthetics and rope and robotics and orthotics into, into the nervous system.

And it's it's because what the, what the researchers actually do. When they're trying to find or identify the qualities that a prosthetic limb needs to express is they have to analyze natural movement or able bodied movement. They would say some of them without an amputation or without a prosthetic limb.

And so what they need to look at, if they're looking at the lower limb, they need to look step back and understand what are the universal qualities are the main qualities. That, that lower limb has to express in order to maintain robustness or the ability to withstand stress as they move through the world.

And so they, they literally do all the hard work force. They, they simplify human movement for us and they take those qualities that we all express as humans, and they try and mimic it in a prosthetic limb or a robotic limb. So I send a fastener because when you look at all the research around physical therapy, the researchers.

Completely overcomplicate things. You can have some people that do some things, other people that go down different paths and it's just mind boggling, but if we can step back and just look at the basic fundamental qualities that the human movement system has to express and then try and exploit those, and we're helping people in pain, we can have a massive, a massive influence.

And so what they call us we're in prosthetics and robotics. When they're trying to create a prosthetic limb, as they call it biomimicry, where they try and mimic. Human biology in a prosthetic limb. And I just, I found that absolutely fascinating. And so I learned so much about how the body has evolved in its design, and it just gives you a new found respect for how we need to alter our assessment and our rehab strategies.

Like for example, like when you look at the, the, the muscle mass distribution throughout the body, you've got a lot more muscle mass distributed proximately, versus as you make your way, distally. To the end point of the limits, you have much less muscle mass and you have a lot more kind of complex joint structure.

You have a lot more tendonous tissues, a lot more. Non-contract all the components that makes evolutionary sense because it wouldn't be very energy efficient for me to have big, bulky hands or big, bulky feet to make my way through the world. It's very efficiently, you know? And so there's, there's, there's a reason there's a reason for it.

And so if we can, if we can explore those properties, In a rehabilitation setting and I kind of step back and, and think about how does this carry over into physical therapy rehab. Then we can have a massive change because really when you look at someone's movements, like we're all different, but beneath the surface, we have very, very similar mechanisms.

We have very similar qualities that allow our system to be able to adapt to the stress. When it comes to real world movement. And so that's what, that's what really, really got mean too. And that's really what led to the development of icon is that I was massively sort of dissatisfied with the approach that we learned in school.

Like really given much of an approach to take into a clinical scenario when we're assessing a client in pain. And so I just, I, I needed to try and understand. Human movements more and develop a more clear framework that I can use in assessing a client because when a client would come and see me with back pain or any kind of pain, I would get stressed out because I actually, I didn't know where I would look, what I would go after to have this person in pain.

But if I had these fundamental principles that I knew would need to be expressed for them to move. Without the need for pain or protection. Then I knew that I can, I can at least have some kind of influence on, on their movements as a whole and the ability of their body to move in a pain free manner.

And so what we do with Ikea now is we just merge those qualities with musculoskeletal rehab, and it really allows for us to, to treat the body in a very effective manner just by allowing for. Kind of a clear process in your mind as to how you would approach movements and you just merged fundamental principles of human movements with more local strategies.

You know, all the local strategies I kind of think is that the sexy stuff, the fancy stuff that people like to use on Instagram that look cool, but really is that going to influence much change when you really step back and look at the things that make human movement system robust and very stress resistant.

So it really kind of developed from that. 

Bryan Carroll: [00:07:44] Yeah, it's absolutely fascinating that you're talking about amputees on prosthetics because as we start talking more about pain, they have some interesting ways of expressing pain, especially with Phantom pain and all that type of stuff. So I'll definitely, definitely want to ask you more about that.

but you have mentioned some fundamental principles that can lead to pain. So can you start breaking those down? What would a principal look like? 

Ryan Foley: [00:08:09] Yeah. So when it comes to pain, I think it's worth considering fat. Like if we were to look at it from a standpoint of pain that someone might develop that just gradually comes on, you know, there's not necessarily, thereafter, any kind of tissue trauma, or a pure clear mechanism of injury, but the pain that kind of just comes on the body, that nonspecific kind of pain that many of our clients physical therapists will have.

So it's kind of a bit more kind of confusing in the mind of the physiotherapists. What if that might be occurring? So when we think of pain from an outcome perspective, pain is really the ultimate form of protection, right? And so it's there to protect your body from dealing with excessive stress, because stress is not necessarily a bad thing when the stress exceeds your capacity from an outcome perspective, because we be kind of, we deal with the neurology, you know, philosophy and the nervous system.

Essentially the same thing, but when someone is expressing pain, from our perspective, that's when the higher parts of the brain feel the need to step forward to protect our body for us. Right. So that's, your brain is constantly, making estimates of the capability of your body. On a moment to moment basis, it's constantly receiving snapshots of your body's position in space, your body's ability to adapt to certain pressures and stresses on your body.

And so it's always making these estimations. And so if it estimates and it comes to conclusion to say, Hey, I don't really trust that you are your tissues, the meat of your body. The structure of your body can handle this stress. So one going to step forward and ultimately express pain because that pain or somebody who has some level of survival value, it holds value because obviously the pain is death.

Stop you from doing something that's leading to a painful experience. So then we need to essentially take the shift then to say, okay, how can I actually prove to my nervous system that I do have the ability. To express these built in protect the mechanisms throughout my body. Right? And so when it comes to improving someone's pain experience, we essentially have to establish proof of protection to the nervous system.

So the nervous system doesn't have to feel the need to express pain. Right. So if someone comes to me with, with pain in their lower back, for example, I'm not just going to go in and start propping the back and stretching the back. I'm stepping back and understanding. Okay. How does that lower back fit within the context of whole body movements?

And why does the nervous system feel the need to express pain? There is the lower back perhaps being overloaded. And so a principle to keep it kind of specific to the lower back, even just cause it might have people can form better context around that. When you look at the lower back, the lower back sits on top of the lower limits, right?

And so you don't see many people walking down the street on their hips or the lower back. They walk on the streets with their feet, contacting the ground first. So their feet ultimately clouded with the ground. And it's the feet that have to be able to tolerate that stress through ground reaction forces like, like Gary Gray talks a lot about it as well.

We have to be able to dump in that stress on our lower limb. Before our back needs to access any kind of honeycomb protection or any kind of tension or increased tone you can say. So what I see an awful lot clinically is that if someone has a lot of lower back tension, a lower back pain, my mind doesn't go straight to the lower back.

My mind goes to the capacity of the lower limb to be able to adapt to the stress acting on the lower limb during upright movements. So w one of the, one of the big things in when you're looking at things from a nervous system perspective is that a lot of our movement is organized around strategies.

Right? So if I, if I go to some move my lower limb, for example, to take a step, I don't think, okay, what is my hip have to do? What does my knee have to do is my foot after it. He just does it, but it organizes the movement around the specific body part from a neural standpoint. And it typically organize that movement around the distal part of the limb.

So around the end point they call it, in prosthetics robotics interface mechanics, but the foot is the interface with your environment. And so the nervous system will kind of guide movement around the foot. Then everything else will take on more of a self regulatory rule. Alright. So when my foot is the ground, I will want to have a lot of responsiveness around my foot and ankle.

So that provides a nice platform for everything else up the chain to respond to that, that force acting on my, on my whole lower limb. So if I, if I have too much conscious awareness in my knee, for example, or in my hip, for example, in my lower back that doesn't allow my nervous system to organize that strategy around my.

My foot it's like in the low, in the upper limit as well. So that the way the nervous system strategically direct conscious awareness is really, really important because you can't be conscious wherever your whole body, 100% of the time. It's impossible to, as I sit here now, it's impossible for me to be aware of all my toes, all my fingers, all my, my muscles joins is impossible.

So we have to strategically place conscious awareness and the end point awareness allows us to, To provide the opportunity for the tissues approximately to up the chain to take on more recess, regulatory rule. And so one of the, one of the key anatomical principles that allow for that is the, the expression of by articular muscles, muscles across two joints.

Right? So when you look at the anatomical kind of event designed in the body, Look the limits versus the midline. And you look at the limbs and you say, okay, there's a lot longer muscles in the limbs, and there's a lot more, 10 minutes tissues, longer tendons in my limits versus my midline. And then you ask yourself, well, why might that be the case is because the limbs are designed to dump and stress when your, when your body interacts with the environment.

And so those tendons, those articular muscles that allow us to dump and stress and redistribute stress well. So my midline. Everything through my middle of my head, my rib cage, my spine, my pelvis can actually maintain the ability to be nice and adaptable to be movable. So if I don't have the ability to take advantage of these by articular tissues throughout my upper limb and lower limb, if I don't have the ability to, allow the, the non-contract or the passive components, like the fascia, the tendance.

All these passive tissues to be able to distribute stress because that's really, that's a huge role of those tissues to be able to share stress. So we're not all Muslim driven. So the, the tenant's components, it's basically, it's a way for them, our system dumping stress on our system. Essentially the tendons allow us to distribute stress from moving to the muscles, from loading the muscles over a greater surface area.

So the things the tissues and systems can cooperate. And so a big thing, a big principle when it comes to the rehabilitation is, is looking at the fundamental rule of the different parts of the body. So you look at the limb versus the midline of the body. I don't want to be walking around with a very stiff spine, a very stiff core, a very stiff trunk.

And so very often, if you have a client with lower back pain or any kind of Midland pain, it could be neck pain. You don't want to go straight into those body parts you want to look at well, what are the main things that interact with the environment? It's not their neck. They're not picking up things with their neck or their elbows or their knees.

They're picking up things with their hands and they're interacting with the ground through the foot. So I want to see how those tissues are. Tolerating stress well so that my midline can maintain adaptability and it doesn't have to go into protective or express protective tone and an increased tension.

Does that make sense? 

Bryan Carroll: [00:16:03] Yeah, it does. And I believe it was, let me say this. He was talking about, you know, pain in different regions of the body and he described it as, victims are usually the ones that are screaming and yelling for help. And then the criminals are the ones that are hiding elsewhere and trying not to be found.

And so it kind of like what you're talking about, you know, the low back could hurt. But the criminal, it could be all the way down at the foot. 

Ryan Foley: [00:16:28] Exactly. Exactly. Yeah. It's such a, it's such an important thing to consider because I mean, when I was a new grad physical therapist, I mean, back pain was, was about the back.

It was about nothing else. It was maybe about the pelvis, maybe about the hips, if you want to rethink outside the box, you know, so. It's for people to really understand that, understand this, you just have to step back and look at real world human movement. Like what, what does the client's hack actually have to do when they step outside your Jima clinic door into the real world?

You know, they have to walk on their legs on a stair and MPT and they have to work with prosthetic limbs, but that's kind of what got me thinking about that. So, Hey, obviously I was seeing an awful lot of clients with lower back pain. And pain around the residual lemons because the actual prosthetic limb wasn't doing enough work to dump enough stress on the system.

So they're expressing a little bit too much tension. And so the nervous system felt the need to express protection in the form of pain around the, around those tissues. So that's what got me thinking into stepping back and looking at these kind of fundamental principles when it comes to. To move movement.

I'm looking at the, the muscular skeletal design of the body and how we can, we can actually take advantage of that. 

Bryan Carroll: [00:17:41] So when it comes to pain, just in general, when you experience, you know, that Dole type of pain, is that typically from longterm, compensations on the body or is that typically more acute type situations?

Ryan Foley: [00:17:57] Yes, clinically, I kind of see a bit of both, you know, even with acute injuries. You might see a little bit of more shot pain. You might see more adult pain and throbbing pain for me. I don't necessarily kind of think too much about what the, description of pain means because. To me that that's, that pain experience is just the nervous systems need to protect.

So why you ultimately need to do more investigative work to understand why that area needs to be protected or why it needs is higher level of protection? Because I made the mistake kind of early on in narrowing my narrowing, my focus way too soon when it comes to pain. And I think if you, if you're really trying to.

To narrow your focus too soon and understand what does that mean? What is, what has that done the sensation mean? And what does that kind of sharpness sensation mean? What does that throbbing sensation mean? I mean, you might be able to then maybe administer certain kind of intervention, local intervention to influence that, but does that really hold them when they step out into the real world?

And so that's, that's what that's the biggest thing is that you have to understand, are you preparing your clients in the real world, the movement. And so attendance, obviously I have to give it some, some thought when, when a client has those type of pain descriptors, but fundamentally I'd like to, to merge kind of global based strategies with local based strategies first, like, so somebody has like a dullness type sensation around their shoulder, for example, Probably wants to look at our shoulder in the context of the entire upper limb.

I want to see can the tolerant loop through the entire prelim before we're doing it an awful lot of local work around the shoulder. And I will definitely do local Rucker on the shoulder and the first session. Ultimately, I want to prove protection first in our system. And so the nervous system needs to know that that shoulder is going to be detected and needs to know that they can share stress throughout the whole upper limb.

So maybe the shoulders thing. Wait too much, it's tolerating too much load. And maybe we need to start to share low thread, the whole upper limb. Maybe that's why the knee with the shoulders is expressing. I've done it. Maybe that's why it's expressing that sharpness because ultimately that could be overloading a neural tissue, which may be the reason why you're experiencing more pain.

It could be. Overloading more of a muscle tissue, which might be the reason why you're experiencing more dunks and throbbing sensation, but it doesn't tell me why that issue is there in the first place. I know I never, I never try to say that. I know exactly why, because I don't think he will ever understand why pain is there, right?

Because everyone's unique and everyone has different past experiences and different movement habits. But what we do possess is we possess similar properties through the body. We possess a similar design. And so I know a lot of people have these non-contrast components. A lot of people have these barred, secret tissues.

A lot of people have limits and the midline that that needs to operate in a certain way. And so I will merge these fundamental qualities with local strategies. So what will we find that I can is that when we can merge local strategies around the shoulder, if we're looking at the shoulder with more global strategies, looking at it within the context of the entire.

Upper limb and midline, then we can facilitate much more change because now we're looking at things from multiple layers and the body needs to tolerate stress from multiple layers in order to move efficiently. It's it needs to share stress. It needs cooperation and coordination amongst systems and tissues and structures for movement.

And so I think, I think the, we run into. A big issue, especially when we're teaching courses and we're working on, we have new grads in the, in, in as part of the audience member, when we're teaching these courses that go local way, way too soon, they will narrow their focus way too soon. And so if you narrow your focus too soon, you tend to kind of go after symptoms as opposed to really restoring that robust movement.

Because like, if somebody has like a shot pain, let's say in their, your shoulder and you're, you're trying to. To improve the low tolerance of the anterior shoulder. You actually, you and you haven't actually assessed the entire prelim. You don't know whether or not you're actually storing robust movements cause you're just looking locally.

So you haven't looked at the shoulder in the context of the entire upper limb and it doesn't mean that. The issue is not in the shoulder, but it means that we're covering more basis recovering where we're giving ourselves more of an opportunity to have a positive change on that individually movement capabilities.

When we look at things from a global and local strategy, 

Bryan Carroll: [00:22:34] that's a great example because a lot of times coming out of school, right, they're teaching you. I mean, you spend years learning all the local information about every single part of the body. So that's your go to, because that's what you learned.

But like you're saying, look at the global body, see how the entire thing is moving. Then you can zoom local to see that area that's impacted what's going on there. And then you can zoom back out and see how that can integrate back into the system. So you get a better idea how to treat them. 

Ryan Foley: [00:23:04] Absolutely.

Yeah. That's, that's a really good point. I think. I it's important to, I think, to consider as well as that it's never like rehab or movements, proving someone's the capacity is never, it's never a linear process. You know, I think we all, we all learn that in school when we're living in healing times and we're learning all this, this source of me coming into the world of physiotherapy thinking, okay, I need someone's back pain.

I need to get the multipolar firing first. And the transverse abdominis firing first. Then I can look at it in the car, the whole trunk, and then I can start adding more dynamic movement. It never really works like that. You need to. The first established proof of protection. And that means that early on in the rehab process or treatment process, you need to merge local and global.

So you're doing a bit of both. It's never just local first, then you're moving towards more global, but a bit of both, but then you're sort of filtering things out and always moving towards are biasing more global strategies. Then as you move throughout the rehab process, If that makes sense. And so we'd always kind of do a little bit of both at the very beginning to have more influence on the system and then move towards more global movement towards the, and as we kind of move through rehab and treatment process.

Bryan Carroll: [00:24:18] So going back to coming out of school again, you'll learn a lot of stuff. by putting someone on it table, while in school, now you're talking about, you know, trying to see what people do in real life activity and how they're moving and how to support them with that, which typically. They're not spending their time on a table.

So with your assessment process, are you assessing on tape on a table or are you putting them through different movement patterns and assessing from there? 

Ryan Foley: [00:24:46] Yeah, it, it kind of depends on the capacity of the clients when they come into my clinic. You know, if they're, if they are really kind of experiencing a great deal of pain, I want to do assessments in a position where gravity is having less of an influence.

So obviously, I mean, gravity is that, that continuous stressor that we always have to deal with. So it's just getting someone into Sioux point on the table would allow us to reduce gravity on our system. But then what all you have to do is I have to be grabbed my job as a therapist is to be the stressor because I want to ultimately see, I want to get an insight into how their movements.

Is how I want to get an insight into how well they will be able to move in the real world through the manner in which I assess them. So when I assess somebody, I'm assessing them in a way that allows me to view the movement capacity of the, of the entire limb. So when I, when I look at assessments, I always look at assessments as being that they need to check, or they need to assess the, the problem solving behavior of the clients.

You know, and so I, I never tried to make assessments too easy for the client cause I want to challenge them because ultimately when they step outside the clinic door in the real world, they're going to be they're they're encountering, moving problems every single second. And so their, their movement is essentially an expression over there.

Their problem solving behavior, their ability to solve moving problems. She writes. So, so I like to make things challenging. If I get a client in Sue point on the table, So I want to stress them in a way that gives me the understanding of how their tissues will it be expressing movement in the real world.

So I never, I never liked to be too easy with my clients. ideally though we can, we can get an awful lot of information of their capacity in a standing position as well on their capacity as a whole, if they have the ability to stand and I can gather information, whether it maybe they're not in too much pain, acute pain, or they're not.

Overly sensitive that I can do things in standing, but if they are in a supine position, I have to be a little bit more kind of stressful. If that makes sense. I need to, I need to be gravity in a way and not just go through kind of basic, like if I'm checking hip range of motion and Sioux point, that doesn't mean that they'll be able to express that range of motion in a standing position when their foot is contacting the grounds.

Like I'll do an awful lot of assessments. Through the foot and identify the particular tissues capacity to tolerate stress and their ability to tolerate stress through the non-contract oral components as well in a supine position. But it's safe in a way. I do an awful lot of assessments from an isometric standpoint.

I like to use isometrics when it comes to assessments. Because when you look, even look into the research, a lot of our movement in the real world in real world scenarios is actually isometric where our tissues or muscular tissues maintain a certain length. And it's actually the passive elements, the non-contract elements that go through the movements to be able to tolerate.

Stress and forces. And so I think isometrics from an assessment standpoint and from a rehabilitation standpoint, can, can get you very, very far with, with other assessments or rehab, because we alluded to at the very beginning as well, is that your brain's estimating your body's capacity on a moment to moment basis.

And so an isometric contraction is a, a moment in time of a contraction in, in a joint position, for example, So you're, you're trying to produce force, or you're trying to resist force in a certain position moment to moment feedback where the brains is getting a snapshot of what the body is capable of in that position.

But it wouldn't be like, I don't do an awful lot of classical muscle testing, you know, where people will go in and, and say, push into my hand and hold for like a second or two, and then see all your strong. Because for me, that's not real world movements like strength being strong is not doesn't necessarily mean you're a very good mover and a very adaptable mover.

And you can see that in very, very strong people. Powerlifters doesn't mean they're going to be able to move with lots of variability, adaptability, if they can, if they can squat and deadlift a thousand pounds, because, and this is one of the principles that you kind of asked me about earlier on, is that, what do we need is that we, we need to be able to estimate.

The right amount of force when it comes to, to movement. Right? So, and, and that allows us to be very energy efficient. So like if I'm reaching for the cup in front of me right now, I should need to express 100% of my voluntary muscle contraction to be able to carry out that movement, because that would be very energy inefficient for me to do that.

So I need to estimate how much force is necessary. So I might only express maybe 10% of my involuntary mass on my next move on to the contraction. So I want to get an insight into the client's ability to estimate the right amount of forces. Cause what, you'll see an awful lot of timers and cleanse to have an awful lot of tension and high tone or even pain in their body is that the only knows zero to a hundred.

They don't know the in between. They like to move with very noisy contractions in their body. So they're very energy inefficient with our movements. And so I think one of the, one of the key things, when it comes to helping someone in pain and reducing tension in their body is actually allowing them to tolerate stress at a very, very low threshold.

So I will do an awful lot of isometric contractions, and I'm a very specific isometric strategy at a very low threshold while allowing them to match their breath with that type of. Demand from the movement task, for example. So like if I have a client do an isometric at a very low threshold, I don't want them breathing.

Like they're running a sprint. Cause that's, there's a mismatch in the, the energy demand for that task then. So I want to match their breathing capacity with the actual, with the actual construction. demand of the task as well. So I'll do low threshold symmetrics, very, very, relaxed breathing strategies.

And we can even talk about the breathing strategies too, an awful lot of work with, with breeding. And I'm going to, one of the people I learned a lot from was, was a guy called Bryan McKenzie. Yeah. I think he's one of the cofounders of the art of breath, but Bryan McKenzie is a great guy too, when it comes to anything breath work and not just breath work, where you're looking at things from a relaxation standpoint and breath work, the standpoint of how can you maintain a very robust physiology when it comes to moving into the real world?

How do you maintain resilience to stress? Yeah. And so with, with breathing, it's, it's really important to, to understand how an individual is. Breathing in real world environments because the respiratory system is under constant stress because you're breathing 20,000 plus times per day. And so that's a lot of continuous stress on the respiratory system.

And so it's important to understand these continuous stressors that act in the bodies in a daily basis. And the main ones are our gravity. That's always trying to put me down to the ground and breathing. We tend to think of breathing is this thing that we use to relax our bodies, but. Tiny kind of stress on the system.

Stress isn't necessarily a bad thing, but stress is, is anything that's puts pressure on our system or anything that respond, or that requires a response. So when I breathe in, I'm getting stretching of tissues and structures around my rib cage, around my spine. That's going to feed back up to the nervous system and the nervous system is going to have a response to that information.

So it's sort of stressed because. It's needing some kind of energy to respond to that feedback from my body. And so a big, a big part of it is really just reframing our perception of stress and being more strategic with how we actually deliver stress to the system from the rehabilitation standpoint.

Bryan Carroll: [00:32:40] Yeah. It's interesting. You're talking about the way you breathe and how that expands through, You know, your diaphragm and everything too, because I don't know what it's like over a where you are, but we have a lot of people with GI stress. And like you said, stress to the body can cause all sorts of stuff.

But when you, I have a lot of inflammation in your digestive tract and especially around the intestines, then it makes it more difficult for people to fully utilize their diaphragm. 

Ryan Foley: [00:33:11] Absolutely. Yeah. The, the, the, the interaction between the daughter from the rib cage is such an interesting, it's such an interesting coupling and, and cooperation amongst different tissues.

And I like, even when you look into the neurology of the diaphragm, the diaphragm doesn't necessarily possess an awful lot of receptors that feed back to the nervous system that give you an awareness of the diaphragm. Like. As we're sitting here now, you're not necessarily aware of your diaphragm. And so diaphragm will be driven by the rib cage.

So the rib cage is loaded with what they call McCann receptors, which are the kind of a nervous that there's a feed information back up to the brain to give your brain and understanding of where your rib cage is in space or where your body is in space. And so a lot of times people will actually only.

Only belly breathe when it comes to improving diaphragmatic movement, but you actually want to do both belly breathing and try to get some movements and expansion of the rib cage. Because as I breathe in, I'm going to guess typically in elevation of my rotation, expansion of my ribcage and my diaphragm will contract or descend.

And then as I exhale, my rib cage will compress. It will depress and flex typically, and the diaphragm will actually relax and ACE. And so what we try to do an awful lot when it comes to improving someone's breath coordination, or their breathing capacity, he's. Try and improve the coupling of the diaphragm with, okay.

And that comes back to just getting the rib cage to move through excursion. And that's looking at things from more of a, I suppose you can see a neuro mechanical perspective, but obviously we know that there's other, there's other layers that we can view breathing through like psychological layers and even kind of gastrointestinal layers as well.

Bryan Carroll: [00:35:08] Yeah. I think like you said, breathing is one of those components that a lot of people forget about and it can have very profound impact on everybody. Really? 

Ryan Foley: [00:35:20] Exactly. Yes. I mean, we all have to, I mean, breathing's the one thing that's going to get you from from now to call your six minutes from now. Hey Nancy, you definitely need to breathe.

It has an impact on your, your, your brains. ability to, to know that you have the capacity to protect your own body, like breathing is one of those things. If you can't breathe well, the nervous system is probably not going to feel as though you have the capacity to protect your body. So you're going to see a lot of people who are under stress, perhaps in pain, hold their breath or the respiratory rate, where they went and an increased quite a lot.

And so you can look at it from many different perspectives. You can look at it from a standpoint of our breathing. rates isn't matching the demand of the tasks that we're actually expressing. Like I could be just walking around my house right now, but from like my breathing race, that's my breathing rate matches what, what it should actually express as if I'm running a sprint, for example.

So that's, that's a, that's a significant mismatch in the system there, but also you can look at it from a feedback standpoint. Breathing is the, the one thing that's going to constantly deliver feedback from your midline. From your lower back from the tissues are under spoiling from your ribs all the way back up to your nervous system.

It's a constant, it's a constant feedback system. When it comes to giving the brain that constant updated information about where your body is in space. And so if you're not merging specific breathing yeah. Work with your musculoskeletal rehab, if you have any kind of pain or if you're, even if you're a physical therapist or any kind of health care practitioner, you're really missing out on, on some goals and stuff with trying to get your clients.

To the next stage of, of rehab or just trying to improve their overall tolerance of stress when it comes to movement. You see? So there's so many, so many nice ways that you can look at integrating breathing with them with Anaconda movements or any kind of load strategy when it comes to movement. 

Bryan Carroll: [00:37:22] So does pain change in the body when you have a, Actual physical damage to your system somewhere versus, just a sensation of pain that's created by protection from the brain.

Ryan Foley: [00:37:36] Yeah. So if, if there is an actual issue in the, the tissue, so to speak, then our focus shifts towards supporting the healing of our tissue. You can say it right. We still obviously want to load it, encourage that healing because we know stress allows for our facilitates. Adaptive changes in the tissues and allows them to, to become more robust to stress.

And so we need to stress those tissues that may be expressing some kind of damage you can say, or some kind of issue you can say in the actual tissue, but then we also need to support by influencing the neighboring tissues and neighboring structures. So I would still always come back to this, this fundamental principle of looking at the local area and have a local area fits in with the.

Within the context of the, the rest of the neighboring tissues. And it obviously depends on where the, the issue is. Like, if it's a, if it's a hand wrist, elbow, shoulder, neck issue, I'm gonna look at the entire upper limb. I'm going to look at the midline as well. So I would still look at it from a protective standpoint, and I'm still looking at it when it comes to rehab from a standpoint of continuously trying to prove the nervous system that we have the listened to.

Protect our bodies. Cause you could even see like even people with any kind of pain, you can still get an MRI and see some kind of tissue changes. They've done lots of research on that, where, I mean, you could, you could pull a hundred people off the street and do an MRI of their lower back and you might see some kind of disc changes.

Some bony changes around the spine, but it doesn't necessarily mean that. There's pain in that area. So the nervous obviously has not felt the need that we need to express pain, to protect things down there. And that could be for many different reasons. It could be from, from a standpoint of that. It actually feels as though that your body is robust and that shearing stress over a greater surface area.

So it does feel the need to protect, but it could also be just your overall stress levels and cause cause stress, we are, we always talk about. A fundamental principle of our approach, as well as all stress we pull from the same resource pool. Right? So stress is just stress. When you come into the world as a baby, you don't have an infinite amount of, of resources or energy to respond to stress.

So. Physical based stress we'll pull from that pool. Digestive stress would pull from that pool, cognitive or intellectual stress we pull from that same pool. So if you're stressed from a, you mentioned the additional standpoint that can still influence your brain's perception of the protective, the capacity of your body.

For example, if you, if you're stressing yourself from a cognitive standpoint or a mental standpoint, Then that can influence the amount of resources that you're bringing in house to make good decisions that whether it's necessary to express pain in the body. And so it always comes back to just looking at the entire human system and looking at many different layers.

And obviously as, as a physical therapist, it's kind of, if I'm working with a client in, in, in pain, sometimes it might be a little bit of outside of my scope to address there. Their gastrointestinal system or the digestive system. So I will obviously refer to, to the right practitioners at the right time, if, if, if I'm not seeing any kind of change.

Cause, cause cause what I see in clinic is that if we, if we can get as many layers as possible to tolerate stress well to adapt my stress well and just kind of prove to the brain that it can protect itself. And obviously from, from what we've spoken about already, you can, you can, you can appreciate that there's many ways to prove protection to the nervous system, and it's not just loading a specific muscle or loading a specific tenant.

They can just be getting the overall system more resourceful, make better decisions about whether it's necessary to express pain. So sorry, I went off on a bit of a tangent there in terms of yes, kind of pain as a structural issue, but it would still, it would still, If it's still kind of fall under the same approach, it just, it might take a little bit longer to improve the adaptive changes.

Not that specific tissue, if there's an issue there, but we would still take the same. 

Bryan Carroll: [00:41:52] And like I mentioned earlier, when I said something about the, the Phantom pain. So, you know, people that have been amputated, they can still have pain in the limb that they no longer have. Can you talk about what's going on 

Ryan Foley: [00:42:07] there?

Yeah. And the research I think is still a bit up in the air here, but I mean, there's, there's going to mean kind of fundamental concepts that they've, they've kind of gathered from the research. They've gone already in that when you, when you really think about it, if somebody, if somebody's limb is amputated, that's, that's done over a very, very short space of time.

Right within, within minutes now, within our, within our nervous system, the higher parts of our nervous system, we have maps all of our body. So if I was to wiggle my big toe on my right foot, for example, right now that will essentially light up the, the representation of my, within my nervous system. And so to have those maps of the body, because your brain is in a black cave, it's an.

It's not directly accessing the outside world. It needs feedback from your muscles, from your joints, from your nerves, to know where your body is in space. And so it needs that constant feedback. So it has these maps and these maps are constantly being updated to give the brain that representation of where your body is in space.

So if somebody comes along or if it's, if it's, if it's traumatic in nature and you lose a limb, you still have that map of your lower limb. In the nervous system, but you do not possess the structure of the limb on your body because it's, it's, it's been amputated. And so that creates a huge mismatch in the nervous system.

And so this mismatch is what creates the need to protect. And as we saw, we've spoken about already that need for protection. Is expressed in the form of paint. And so you can still feel pain in your big tool. For example, even though your big toe is not there because your brain still has a map of that big toe.

No, obviously over time that might, that map might diminish over time. It might take, might take a long time to diminish that map, or completely allow that map to clear out completely. but there are strategies early on. During the rehab process that we can, that we can use to reduce the perception of come danger.

You can say, because I never liked to say that. Talk about the perception of pain, because there's never, never necessarily a perception of pain, but there's a perception, the need to express pain. There's a perception of stress or a mismatch or threats on our system. And so the nervous system makes a decision to express pain as a protective response.

So it all comes out it's protection. So a lot of the rehab strategies that we might use standpoint, and currently I don't do an awful lot of it work with amputees. And this moment that did in the U S I moved back from the U S. Three three years, three and a half years ago. So I haven't done an awful lot of this work since, but we did an awful lot of mirror base.

I'm sure you've come across neuro based therapy before. It's, it's just, it's just proving to the brain again. So if I have, if I have my right limits, that's been amputated. What I can do is I can, I can sit up in my chair. I can have a mirror facing the mirror. I was facing my left lower limb. And so if I look into the mirror, To my nervous system, fine proceeding my right lower limb.

I said now all of a sudden you've proved to the nervous system. Hey there, Hey, my lower limb is there. So now the nervous system it's estimation of the body. So it always comes back to that, that constant estimation that it's actually expressing and that it's constantly gathering from the body through feedback.

So if you use your visual system, You can use your visual system to prove to the brain that the limb is still there. And so it reduces the pain temporarily, of course. but it has an influence on the expression yeah. Protection in the form of pain. So it's a really fascinating concept. It was really fascinating when you, when you can kind of.

You know, push past the, all the, the neuroscience, the neuroscience, the kind of stuff you can say, and just look at the fundamental principles of protection and the need to protect when, when a mismatch arises or when threat or danger arises, because really that's all our nervous system wants you to do is to protect our, our overall system.

Bryan Carroll: [00:46:28] So there are some people that are just constantly in pain and it feels like their entire pain, their entire body is in pain. Can your brain and body tried to overprotect the system? 

Ryan Foley: [00:46:41] Definitely. Yeah. That's a really good point because what we tend to see is that, especially in persistent pain pain, that's been been around for a long time.

What that typically means. And again, I'm kind of really oversimplifying things here. It's obviously different than the client decline basis. It's always in an equals one kind of scenario with the client, but what we tend to see in persistent pain, At least from an icon perspective is that the nervous systems becomes the nervous system becomes too conservative, where it feels a need to express pain when we don't really need to express pain.

And that can be because our body is just really kind of overstressed at many layers. And so with those kinds of clunks that let's say, for example, the client has a lot of lower back pain and it's extending down to the, into the lower limbs, for example, Because that clients are not thinking that the stretch is going to have some, I'm not, I'm not thinking that bridges are going to help that points.

I'm thinking that I have to, to really look at improving the nervous system's estimation of its capabilities from many different layers. So those kinds of I'm going to do an awful lot of breath, coordination, work, breathing, tuck strategies, and I'm going to do an awful lot of very basic loading strategies from a global standpoint.

I'm not going to look local very, very often with these clients. I'm going to look at okay. What allows that lower limit that to a back to be robust and really where the movement I'm just going to have to be very strategic with how I deliver those to their systems. Obviously going very, very low. Early on, but doing in the way that mimics how their body needs to express movement in the real world.

So I still do an awful lot of kind of isometric plyometric based strategy strategies with those funds. I'll do a, put an awful lot of emphasis on, on breathing. Put an awful lot of emphasis on them, getting good sleep, eating, right, breathing rights when they're outside the clinic. All those, those, those simple things that are kind of low hanging fruit that improves our overall stress tolerance.

And that I know that you have an awful lot of expertise in as well. So all these things matter when it comes to a nervous system that has become too conservative in its, in its need to express pain. Because like I said, when we're in pain, we tend to be more kind of consciously driven. In our control strategies, where if I have lower back pain, if I have even widespread pain, I'm probably going to think about my movements.

I'm also a lot more versus when I don't have pain. So it's, it's very, very often you see in clinic where someone with a lot of lower back pain, in clinic and you ask them to, if they're going to bend them towards your toes, just to get an understanding of their current capacity and you literally see them stop and think.

How am I going to actually do this? Sorry. They're trying to preplan the movement in our mind. So they're using a very kind of conscious control strategy to move their lower back and move their body, which is very energy inefficient. And that's where you see an awful lot of fatigue in those funds as well.

Because they're there. They're, over-utilizing the conscious control, the higher part of the brain to move the body, to try to think about their movements too much, which is just very, very energy expensive. And it feeds into the overall resourcefulness of the kind of feeds into the overall capacity of the clung to be able to tolerate stress.

And so every day it just, it just really. Requires us to look at things from, from, from multiple to really have an influence over that over, over clients. With those, with that kind of presentation, it's not going to be kind of a case where you get, you got a joint move and more hands, and all of a sudden their pain's gone.

It's not a case where you're going to get a muscle to, to kind of get a bit more stretch and a bit more range of motion in the muscle it's to it's going to get better. It's a case where we need to look at things from, from, from a multiple multilayer standpoint. 

Bryan Carroll: [00:50:40] Well, Ryan, do you have any final thoughts that you want to share when it comes to pain?

Ryan Foley: [00:50:47] Yeah, I think, I think the biggest thing that we tried to get across to the therapists and to our clients is to try and reframe your perception of stress. Fundamentally. I think we, we tend to come into this profession thing. You know, stress is a bad thing or that client is very stressed. We say these kinds of things, but stress is necessary for you to be able to adapt.

Two real-world movements. It's just the case where we need to be strategic with how we apply stress. And most importantly, where we apply stress. So if someone has low back pain, for example, do they need more stress in the lower limb and is their back being overstressed, for example, are being overloaded.

So just, I would, I would like to kind of even people out there who are currently in pain, maybe not. Try to not narrow your focus too soon and look at the local area, but start to shift your attention towards maybe understanding and learning that where you might need to deliver more stress to ultimately share stress.

It's called a shearing principle in neuroscience where we, we need to get better at sharing stress over a greater surface area, across many tissues and structures and systems to really kind of improve our overall efficiency. That that'd be the main thing. 

Bryan Carroll: [00:52:00] Perfect. And what do you do it daily to keep your own self healthy 

Ryan Foley: [00:52:06] for me?

I do an awful lot of, specific breathing work throughout the day. I, I was kind of typically check in with my body throughout the day and kind of get an idea of my breathing capacity by using kind of different tests. And I'll do a lot of kind of breath work focusing on exhalation based, throughout the day, kind of I'll try and accumulate at least kind of 20 minutes of, of breathing work through that.

I, that will be the kind of main thing that I would do improve my overall health and obviously just eating better, even better as well is key. 

Bryan Carroll: [00:52:36] Awesome. And people can find [email protected] you also have some online [email protected] as well. Do you want to talk about those? 

Ryan Foley: [00:52:48] Obviously with the, with the situation on hand there, we had to shift very quickly to the online platforms.

We've actually shifted our whole on our whole level one in person course to online format. And so we have kind of, maybe we can drip feed that over kind of eight week modules for 'em. For anyone. That's interesting. So we have cohorts, so we offer every eight weeks. we actually, we resold at the first two cohorts and so it's definitely been, been quite popular and it's been great to see people kind of want to learn more about how the nervous system influences movement.

So that's been fantastic. And so if you're interested in that, definitely send us a message. Send us an email. If you're interested in, in kind of getting to the next cohort. But we also have shorter online courses as well, that give you insights into different components of what we teach on our in person courses too.

So if he wants to learn more about those, you can definitely check out those shorter online courses. See when they're all there. We'll see you see you approved. If you're a physical therapist they're approved, if your athletic trainer, and you can reach out to us, if you're interested in. And knowing if they're approved for a certain profession too.

Cause cause we can, we can that we can work that out as well. If necessary, we check out the, if you go to arcane neurology.com, you, you come across those online courses very easily. And so you can, you kind of navigate that as well to explore more. Perfect. 

Bryan Carroll: [00:54:08] And is there any social channels that you spend most of your time on or?

Ryan Foley: [00:54:12] Yeah, so we, we were quite active on Instagram. Instagram would be our main kind of social media platform where we post, we post every single day. So there's lots of educational content on there too, that you can, you can learn more and obviously use to get a deeper insight into our approach too. And you can obviously feel free to message us directly on Instagram.

If there's anything that you'd like to learn more about. 

Bryan Carroll: [00:54:33] Perfect, Ryan, thank you so much for coming on and, you know, walking us through different ways that pain can occur and different strategies for helping that out. I really appreciate it. And we all do too. 

Ryan Foley: [00:54:45] Awesome. Bryan, thanks so much for having me.

It's been a pleasure. 

Bryan Carroll: [00:54:48] Isn't it? Pretty interesting. All the mechanisms that go into pain science. Bryan and his team are doing some great work over at I can. So make sure to go check them out. You can get links to more [email protected]/116. And if this information was helpful in any way, then the head on to your podcast player and leave us a review and review, it helps be able to find our show and get access to all of the information shared in these episodes.

Next week at Kathleen Trotter on the show. So let's go learn more about Kathleen. I am here with Kathleen Trotter. Hey Kathleen, there's one unique thing about you that most people don't know. 

Kathleen: [00:55:29] Oh, God. I love Elvis and Dolly park. No, seriously. I'm so sad because the Elvis festival was canceled this year because of COVID.

And my favorite time of year, every year is to go up this. Biggest second biggest Elvis festival in North America. It takes place in Ontario, which is where I live. And I go up every year for three days and I hang out with Elvis. In fact, I don't know if you have a way for people to see visuals, this me and an Elvis right here on my desk.

Bryan Carroll: [00:56:00] Well, I had to get a copy of that photo and put it on the show notes. what will we be learning about in our interview together? 

Kathleen: [00:56:08] Oh, I think we, we haven't even talked about so many things. You're such a great interviewer, but, healthy habits, how to make them convenient, how to make unhealthy habits, utterly inconvenient.

and also just to have the wisdom to figure out the middle ground of fitness, not to go, too far in any one direction. and. How to have some fun. I think, you know, I think we had a lot of fun and sort of find the joy of fitness. 

Bryan Carroll: [00:56:31] And what are your favorite foods or nutrients that you think everyone should get more of in their diet?

Kathleen: [00:56:37] Okay. Well, I love Brussels sprouts. Sometimes I joke to my partner, James, that I make myself brusselsprouts sick. but like, so, I mean, that's sort of a joke. I love chocolate. And as we talked about in the interview, I think that everybody needs to, you know, I'm have a couple of their love, it foods. So things that they sort of have in moderation that they absolutely truly enjoy that might not be necessarily quote unquote healthy, but it's good for their sort of soul.

I love, what do I love? I love so many things. I love peppers. So one of the things about me as well, a lot of my friends call me hashtag paprika. Pack a pepper because if I'm out and about, and they opened my bag, there's always peppers washed, and I eat them like apples. I also eat tomatoes like apples.

so vegetables, I think people should get more vegetables. I love salmon. I love avocado. and James, my partner makes amazing, pulled pork and pork chicken. So I don't know. I like all those foods. 

Bryan Carroll: [00:57:29] And then what are your top three health tips for anyone who wants to improve their overall wellness?

Kathleen: [00:57:36] Embrace the power of now. So now is the only moment that we have true control over and with health, we get so caught up in, you know, what we're going to do tomorrow, what we're going to do January 1st. so just stop worrying so much about the future. The future will take care of itself if you take care of the now.

So when you're listening to this, get up, go get a glass of water, go for a five minute walk. So that would be my first thing. and let go of perfection. So perfection is. The enemy of getting stuff done. And so often with exercise, we are like, Oh, well, I couldn't do my full workout. So I did nothing. Or, you know, I, I can't be perfect with my diet.

So I'm going to go out and have like a burger and fries, and then you have the burger and fries, then that leads to dessert. And then that leads to sort of more alcohol. So stop with perfect. worry about what you can do on a consistent basis, because th the big work that you do once a month is much less important than what you do on a daily basis.

And then I think the third thing would just be kind of learn to. Parent yourself is the quote that I always use because a lot of us are really good at making healthy habits for other people. You know, if you talk to parents, they always have snacks for them, the kids in their purse or their bag bag, or, you know, they make their kids go to bed at a certain time.

So they obviously have the skill set to do those healthy habits. They just are not applying them to themselves. So you have to treat yourself like you love yourself. You have to treat yourself like you would an elderly parent or your child build, and disrespect your body and respect what it needs.

Bryan Carroll: [00:58:58] Kathleen provides some more great ideas on habit change and for reaching your goals. So until then keep climbing to the peak of your health.