Transcript: Podcast/Episode 1

From Pain to Possibility


Episode 1: Blending the Biomedical and Biopsychosocial Models

Intro: You're listening to From Pain to Possibility, with Susi Hately. You’ll hear Susi’s best ideas on how to reduce or even eradicate your pain and learn how to listen to your body when it whispers so you don't have to hear it scream. And now here's your host, Susi Hately.

Susi: Welcome to the very first episode. I am the owner and the director of Functional Synergy Yoga Therapy, where I train healthcare professionals and yoga teachers how to integrate yoga therapeutically into their practices, as well as running a private one-to-one session series for people who have pain, longstanding pain, and who want to get rid of that pain.

So I'm doing this recording, quite interestingly enough, because I was supposed to be leading a Therapeutic Yoga Intensive this week and then going on holiday tomorrow for two weeks to the British Columbia coast. And well, coronavirus put a little crimp in that plan, and so without a whole lot of training or teaching to do this week and next week, I thought, “Well, you know what? I had always wanted to do a podcast, but for time constraints and maybe a little bit of fear, I just didn't do it. And so now is the time.” So here it is, and here we start.

The reasoning behind starting this, besides coronavirus, is that I really want to give you a chance to get to know me a little bit more in depth before you come aboard any of the training or the courses or the one to one. And I'm hoping that this podcast will give you some information that you need on your journey and on your pathway of being able to integrate yoga and medicine and rehabilitation so that you can get better and better and better results. I like to consider this as being an intersection between the biomedical model and even the biomechanical model and the biopsychosocial model.

Now, as I was preparing for this episode and thinking about what I was going to share, I initially thought that I was going to tell you a bit about my story. And instead of doing that, I want to give you some very usable information that you can play with right off the top. I will share bits and pieces of my story so you can get to know me. I'll share some of that today and in the other episodes that are upcoming. But we'll get into weaving that in with some of these tools and techniques that you can utilize in your own life.

So, my background is as a kinesiologist, and I have a degree from the University of Victoria, and a lot of my training focused in on exercise physiology and motor control and biomechanics. So very much a physical practice. And so when I'm looking at the process of healing and recovery, I'm initially coming at it from this perspective of this biomechanical space—how the body moves, what those movement patterns are, where there's compensation pattern, how those compensation patterns contribute to the experience of pain. And what I have found over time is that when I can help someone reduce their compensatory patterning, they will experience reduced pain. So I start the conversation from there because I know that when I'm working with someone, I can have them experience something new or something novel right off the bat. And then with that, then, I'm blending in the biopsychosocial model to help them maintain that gain.

So what do I mean by that. Well, I have this idea that I call the yellow lights, which is a riff on a well-known quotation, which is, “Listen to the body when it whispers so you don't have to hear it scream.” And if you think about a traffic light—when we're feeling good, those are the green signals. And when we're feeling bad and crappy, it's the red signals. And oftentimes the distinction between feeling good and feeling crappy happens in this middle, where the yellow lights are, and those yellow lights are the whispers. And if we can grow and build the awareness for what those whispers are, then we can experience more of the green versus more of the red.

And it's blending these two pieces together of awareness of biomechanics that becomes so powerful, and knowing the biopsychosocial model of knowing the person more and more intimately that you're working with. Understanding who even you are as the professional and what makes you tick and how all of those pieces of yourself play into your journey and your healing process enables a communication with the student or with the client or with the patient that can be very, very, very powerful.

If we're just looking at someone, say, from the biomechanical perspective or simply from their symptoms perspective, we miss out on the opportunity of having them appreciate that no two people express a condition in the same way, no two people express symptoms in the same way, which is why at the end- and be-all of this is that there really is no one program for back pain, there is no one program for SI joint pain, there is no one program for rheumatoid arthritis or… There’s some patterns amongst those symptoms and how people generally experience them. But the true expression of them—the gap that sometimes can exist for people who have tried a lot of stuff; and some of it has worked and some of it hasn’t. It doesn't work; and they haven't had long-term gains—that gap often lies in the space of really who this person is and how can knowing who they are impact the way that they're taught or impact the way that they are given information or even the information that can be provided.

So a few years ago, when I had my twins and I was on maternity leave, I developed this incredible amount of creativity of bringing all these concepts around biomedical or biomechanical model and biopsychosocial model into one model, which I call it the integrative healing journey or integrative healing process. And you can find that model in the show notes here that you can download for yourself. But essentially what it is, is it's a relationship between the professional and the client and a really important part of this process of meeting a person where they’re at, understanding who they are, enabling them to step into the ownership of the process.

So when you take a look at this model, what you'll see is that there's these blue and purple ribbons, and one of them is the client and one of them is the teacher. And if you take a look at the purple side, you'll see that presence, assessment, selection, and evaluation up one side of the model. And on the other side, you'll see awareness, clarity, connection, and feedback in the blue on the other side. And so when I'm working with a client, what I'm helping them to do is to grow the awareness about what's going on in their body, because when they have awareness, then there's clarity about what's working and what's not working. And then with that clarity, they can then grow better connection to their bodies, to their minds, to their overall system. And that improves the overall feedback—neuromechanical, emotional, all the inner feedback that can happen—which then grows their inherent awareness. And so it goes.

On the purple side, this is the professional side or the teacher side, which is a teacher or professional's presence improves their ability to assess, and then, their ability to assess improves their ability to choose or select a stimulus or an intervention for their client, and then, they're able to evaluate whether that selection actually worked or not, based off of the original assessment. And then all of that data then feeds into the ability to be present. So there's this back and forth between the teacher and the client, where presence really enables awareness. So our presence as a professional enables the awareness of the client, that our ability to assess effectively helps grow the clarity for the client to understand what's working and not working, which then enables the professional to select or choose more accurately to enable a better connection internally for the client, which then leads to a better ability to evaluate if something worked or not and see how that correlates to the inner feedback that the client is getting inside.

So it's really interesting how this process goes, because oftentimes in a medical model, the expert is considered to be at a higher level and has more power, and then the client or the student or the patient is at a lower level and is looking up to the expert, where in this model, the power is not one or the other, it's with. So rather than power over, its power with. And so there is an appreciation that the teacher or the expert, so to speak, is bringing in their own history and their own knowledge and their own experience and wisdom, and the client is bringing all of their world into the space and into the relationship. And so collectively, that information can combine, and then the journey happens together, where what ends up occurring, once you go through this one cycle where the client then starts to gain more and more awareness and then they feed that awareness back to the teacher, then it ramps up overall clarity, overall connection, and overall feedback for that client, to the point where what we end up training our client to do is to become their own best teacher.

So once a client has been through this, through this cycle, a few times, they then, because of their awareness, are growing their ability to be present. And that presence helps them self-assess what's going on, which enables improved clarity about what's working and what's not working, which then enables them to choose or select for better connection, which then they can then evaluate if it's working or not working and improving that inner feedback.

So if we come back to this notion of “listening to the whispers so you don't have to hear them scream,” what then occurs out of that is that they are then growing their own internal locus of control. And that is so powerful because they then have the belief, or grow the belief, that they can actually change what's going on inside themselves. They don't need to rely on some external stimulus. Now, it's not to say they won't use an external stimulus. It's that they don't have to rely on it as a fix, that they might use the external stimulus because they know that their system needs it, but it's not from this place of, I am not capable of solving a problem for myself. Actually, it's like they just choose more deliberately and more consciously.

And then what begins to happen in this healing relationship is that the teacher or the professional in this process then becomes a trusted advisor, and the client is bringing in this information from their practice, they're coming in with information from the other activity that they're doing in day to day, and together they are able to work through what needs to happen next. And it becomes a lot of fun because both people are onboard, both are figuring it out, and it's not just this talking down to.

So to give an example of this. I will often say, working with someone with quadratus lumborum pain, lots of times from a biomechanical perspective, what I see as a common pattern is that they often have leg bone movement, so the hip joint doesn't move as well as they think it does. And so if they do a movement, say, like, lying on their back, hook lying—so it’s knees bent, feet on the floor—and they bring their right ankle up onto their left knee, for example. Really common. Sometimes people call this Figure 4; some people call it ankle to knee. And what often happens when they do this is that their pelvis will move, and they won't be aware that their pelvis moved. They'll just be getting into the movement because that's just what they've done. And so when I see that relationship, I can point that out to them, and say, “Okay, now, put your hands on your pelvis. Do you see and do you feel, with your hands on your pelvis, that when you are bringing the leg up and then you're rotating and bringing it down onto your foot onto the knee, do you notice that your pelvis moves?” And they'll say, “Well, yes, it does.” And I then show them, “Okay, so you think you're moving your hip joint. But, in fact, what you're moving is your pelvis.” And they look at me and say, “Okay.” And I remind them that they're quadratus lumborum sits between their pelvis and their ribs.

And so if they think that that movement is a hip-joint movement, but in reality it’s something different, then there’s a bit of a miss neuromechanically between their brain and the tissue of what's supposed to be moving. And if they continue to continue to move in that compensatory pattern, then they continue to borrow from one area or steal from another area, and that's going to continue to be depleting and create poorer and poorer mechanical patterns. And then that prevents really good force absorption and load transfer and just overall better strength. It creates a poor coordinating pattern.

So when someone grows that ability, then they go, “Oh, okay. So then I now need to move the leg bone in the pelvis. And so then they realize in that moment, “Wait a second. This is really difficult to do.” And they realize, “Oh, this is why I've been compensating.” And then when they start to learn how to move that leg better, then their pelvis stays quiet, then they don't have to do the compensating pattern, then that QL then starts to settle down, along with a number of the other muscular structures in that area.

So they've grown some awareness. My assessment ability and my presence enabled them to grow their awareness and gain some clarity about what's working and not working. And then, they start to grow better connection. And then when they then move, when they do the practice on their own, they gain better and better feedback on whether they're moving well or not, and then how their quadratus lumborum is feeling and other things that are now shifting or gaining. So it becomes a very interesting process, from a biomechanical model, helping to grow someone's awareness.

Now, when we start to intersect this with this biopsychosocial model and how we're now working with an individual, how I communicate that information becomes really interesting, because it's an exploration that I'm wanting to someone to develop. I'm wanting them to recognize or be curious about how their body moves, because it's in that curiosity that they can settle in their nervous system.

So this is what's really interesting is years ago, when I was involved in a yoga-for-cancer-recovery program that was studied at the University of Calgary, I was working with a PhD student there, and he was doing some mindfulness research. And what he was finding in that research was that when we're curious, there is more often a relaxation response, and the nervous system can down regulate and settle in. When we get really righteous about how we're doing a movement, then we actually start into driving that nervous system more into a fight-or-flight perspective, which then is not down regulating all of the nervous system. It can actually start to wire us up a little bit.

So when I'm working with someone, and I'm wanting to support them in building this curiosity, this idea of, hmm, what's going on in my body?, because so often when people have persistent pain, there can be this sense of resignation or this sense of, my body has betrayed me, or why is my body breaking down? What's up with my body? Come on, body. Come on, pick it up. Pick it up. Where when I can then have them see their body as sort of interesting to watch and then recognize that as they work with it or how they work with it from this curious standpoint, has these other impacts in terms of how new patterns are created, how these new patterns are maintained and improved upon. And then that enables them just to kind of settle down a little bit and be more exploratory. And it can sometimes turn into a little bit of an awe.

I’ll talk about this next bit on an upcoming podcast, and I'll put it in the show knows as to what number it is, but there's a piece around improvement that really requires a change in belief. If we're going to make a change fundamentally in how we experience our bodies, there needs to be a shifting in belief. We can have some superficial changes, for sure. But if we want long-lasting changes, I think it was, as Einstein said, the brain that came into this problem is not the same brain that's going to solve this problem. So we need to appreciate that. If we're going to make some fundamental changes in our biomechanics and in how we integrate those new biomechanics, there needs to be a change of belief. And our beliefs are what feed our thoughts, which feed our feelings and our actions, and then ultimately our results. And a lot of times in typical rehab settings, we're focusing on the actions that we're doing and changing up our actions. But if those actions don't correspond to a shift in beliefs, it's going to be difficult to make a change.

So when I'm teaching someone the way that I'm teaching them from this model of presence leading to awareness and assessment leading to clarity, selection leading to connection, and evaluation leading to feedback, when I'm in this double helix of client and teacher that we're on this journey together, and we are unraveling what's going on within someone's overall system. And they have the ahas of something as simple as their leg bone moving or not moving in their pelvis and that their pelvis is moving instead of what they think they're actually doing. Then there's this aha. And that aha is something I like to call a glimpse of what could be, an opening the door to possibility. When that door opens to possibility, there is now a new belief, even for a moment. And that is the seed planted that will then start to change everything. Because when you are changing at a belief level, like I said, that belief level shifts into thinking, shifts into feeling, shifts into actions, and shifts into results. So the novel experience that they're having as a result of this process that I'm working through with the person is really, really significant and really, really important. And the aha, it's like, “Oh my gosh, I can actually have less pain. Oh my gosh, I had no idea that there was another way of moving. Oh my gosh, I didn't know.”

And so when somebody is expressing whatever that little insight is, whatever that aha is, that is something I notice. And then I notice it from the language that they use, how they're using that language, the body language that they use when they're saying it, and I'm taking all that in, and that's informing all the next steps that I then take. I call all of that the context. It fills out more and more of who this person is, what they're about, and then that informs how I will then choose something and how I will say or instruct that which I choose. So there's this really lovely back and forth between me listening and me consistently assessing and evaluating and understanding more and more and more of the context of who this person is so that there’s this space for them to step into of growing their awareness more and more and more, understanding that they actually know what's working and not working so that they can grow the connection and they can improve that feedback.

Let's then come into another concept that we can introduce that you can start to play with. And it's this idea that where the pain is isn't the problem. And so often, when people are experiencing symptoms, they're going after the symptoms because that's the thing that's getting their attention. And they can manage those symptoms, but they're not actually getting into sort of the crux of what's really going on that's correlated strongly to the expression of those symptoms.

Now, that was a bit of a mouthful, but I'm being very deliberate in how I'm saying that because there's not so much this causal thing. We don't really ever know causally why a symptom is speaking louder or being more painful or doing whatever it's doing. But what we can start to see are these correlating patterns.

Which brings me to the next concept: where the pain is isn't the problem. Where the pain is is an expression that a problem is in existence, but the actual issue lies under the level of awareness, which is why this healing model has such power to it, because it's starting from this place of awareness. We can’t change anything that we're not aware of. And so by enabling someone to grow their ability of their biomechanics and where they're compensating and how they're compensating, we can grow an awareness to see, okay, what are these correlating patterns that have significance to the way that we're feeling, and then start to change there. These are what I'm referring to as the yellow lights, things that are under awareness or that may not really talk to us in a big way because they're not loud enough yet. They're not red enough.

I remember having a client of mine say to me, “Well, how can we make them louder?” And I’m like, “The way that you make them louder is you ignore them so that, then, the next layers of compensation start to pick up and then they start to scream. That's how they become louder.” But if you can start to become aware of these correlating pieces with whatever the symptomology is that you're having, then you can intervene there and start to resolve them before that symptom gets too loud and really bothersome.

Initially, this feels really weird for a lot of people because they're expecting something big. They're expecting something to make a significant change. And so when they do small movements or breathing or mindfulness or even a yoga nidra or shavasana, it's somewhat surprising to them that, “But Susi, I'm not doing anything. Why is it that I'm making the gains that I'm making?” Because ultimately, underneath all this is we're helping to improve the motor control and coordination. We're helping to improve the communication between your tissues and your brain so that there's a more and better coordinated pattern.

Lots of times in yoga, way back in the day when I started in the ’90s, it was all about stacking the bones. If we could just stack the skeleton properly, everything will be good. Then when fitness and Pilates started to enter into the scene, and power yoga became bigger, there was a conversation around muscles and what muscles are driving what. And so it became this, let's move this muscle or contract this muscle to move this bone. But what was not happening yet is, well, how is the neuromuscular communication? Because people can talk about needing to engage their glutes and engaging their hamstrings or doing this with their psoas or that with their thing, and they're doing it all with their will and using their brain consciously to make this happen. Which is fine. It can work in terms of bringing awareness. But I often see people who it hasn't worked for. They try to engage, but nothing's engaging, because it's not that the glutes, for example, the hamstring, has decided to wake up one day and turn off. It's that these other patterns that I've noticed that are compensatory, they're borrowing from other areas, the way the force loads are happening and the way the communications are going on. It just, as the result, has had the glutes just not engage.

So when I start to help someone improve those neuromuscular patterns, improve their motor control and coordination, improve their biomechanics, now the joints that are meant to do the job are doing the job, the muscles that are meant to be doing the job are now doing the job, quite naturally as a response to the movement, not because in their brain they're saying, “Okay, I'd better engage my glutes now,” or “I'd better engage the fill-in-the-blank muscle now.” It's because they're now moving better, their body can respond. And what makes us very powerful is that's what we're training people to do. I'm training people to be responsive as opposed to braced, to being responsive rather than being rigid.

And so sometimes what can happen when we're in this mindset of do this exercise or do this template, it can be us trying to do to the body, trying to make something happen, as opposed to, hold on a second. Let's just feel what our body is doing, let's be aware of what the patterns are in our body, and let's just respond to the forces that are at play and see what happens. And it becomes a very powerful tool for understanding, again, the context for what's contributing to the experiences or the elevation of the symptoms, the experience that a person has of their symptoms, they start to gain more clarity of all these other correlating bits that are a part of why these symptoms aren't going away.

So the bottom line here and the takeaway for this very first episode is that there is an intersection between the biomedical and the biopsychosocial model, or the biomechanical and the biopsychosocial model. And one of the models that I've created that helps highlight this is this healing helix, where we have two ribbons—of client and teacher—and a process that the teacher goes through, a process the client goes through, and that as a professional, we're ultimately helping our clients become their own best teachers, helping them realize through biomechanical reasoning why their body is doing what it is, through improving motor control and coordination by helping down regulate the nervous system. They can make better and better and better gains, and they begin to get a very, very solid understanding that where the pain is isn't the problem. It's just an expression of the problem and that the issue often lies under their level of awareness. And then when they start to gain that understanding, they then start to improve an internal locus of control. And with that internal locus of control, they start to have a whole new understanding of what internal safety and support is like, and that begins to give them an aha of what is possible. And that starts a whole chain of events in terms of believing something different, which then leads quite naturally into thinking different thoughts and then having different feelings and taking different actions and having different results.

I hope that that's given you some usable techniques that you can play with for yourself and for your students or your clients, and taking you up into this next level of understanding and application of both a biomedical model and a biopsychosocial model.

We'll connect with you on the next episode.

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