Transcript: Podcast/Episode 15

From Pain to Possibility


Episode 15: Pain Focus and the Physiotherapist

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: With this episode, I'm delighted to introduce you to Kirsten Richardson. She's a registered physiotherapist and a yoga therapist, and has served and assisted people from all walks of life to decrease pain and increase function in her 15-year career as a physiotherapist. She's worked with people with orthopedic and neurological impairments, from sprained ankles to complete spinal-cord injuries. And with the addition of yoga-therapy principles into her practice, she has noticed a dramatically improved positive response from her clients.

One thing before we get going into this episode, right near the end of the episode, as we were wrapping up, Kirsten's server crashed, and she logged out of our connection. So what you'll hear near the end is a little bit of a fade off. I will place Kirsten's contact information in the show notes, so if you do want to reach out to her and connect with her, you can find her in the show notes. Enjoy the episode.

Welcome to this episode where I am interviewing Kirsten Richardson, and I'm really excited to talk with her because not only is she a physiotherapist, which in the States are called physical therapists, same thing, she's a grad of my program. And talking with her about her evolution of integrating yoga therapy into what she does as a physiotherapist is just so fun and so fascinating that I wanted you to hear us talk about just what's possible when integrating the concepts of yoga therapy with physio or physical therapy and then where that leads your results. 

So I think where I want to go is there's been a bunch of time since Kirsten and I have last really chatted because her program ended up earlier in the year. She's made a fantastic transition to doing physiotherapy by video, and we're going to talk a little bit about that. 

And I want to start, though, with where you began and what had you want to come into yoga and the transformation that you've had for yourself and the journey you had for yourself coming from being physio, then you thought about leaving physio and just doing yoga, and then you ultimately came to this place. So maybe just do a few little bullets, because you and I have actually had a previous conversation which got into that a bit more and that I'll put in the show notes, but just a few little bullets for the people who aren't aware of you and where you've come from and then where you are now.

Kirsten: Thanks, Susie. I'm really excited for this conversation as well because they're always fascinating. So I finished my training as a physiotherapist in 2003, and started off, dove in, started working as a physiotherapist and noticed pretty early on that I felt like I was missing something. I felt like there was more that I could do for the patients and the clients who I worked with, but I didn't have a tangible idea of what that was. And what that kind of morphed into over 10 or 12 years of working in that way was that I decided that I needed to fix people, that that was my job was to provide a fix, and that because I couldn't find what that extra piece was, I was failing at that, at providing the fix. 

So I started, after 10 or 12 years of working in a career, that I felt I was not good at. It got exhausting. So I started looking for other avenues. And I had started a yoga practice a few years prior to that time. And then I saw yoga therapy, and it just resonated with me really early on when I started the yoga-therapy training that my job is not to fix people. And that's what drew me in. My job is to support people, is to help people see and feel how they move in a new way, is to help people recognize patterns of movement and thought or movement at one place and movement at another. And that was just so freeing that I got hooked. 

And I might have swung the pendulum a bit too far. Like you said, I considered just dropping physio all the way and maybe focusing right in onto yoga therapy because it felt so freeing. It felt so wonderful to not have this huge burden and exhaustion, really, of trying to fix people sitting on my shoulders. But through the process of my yoga-therapy training, I was able to see how the physical skills and the physical tests and all of the things that I’d learned from my physiotherapy training and my work we're still really valuable. I was ready to kind of throw them out, but they're still so valuable, and they became even more valuable when I could blend in the, let's just call it, the psychosocial components that I learned really to appreciate through my yoga-therapy training with you and really learn to appreciate how our thoughts and our feelings have an impact on our movement. And, you know, it goes in all directions. So that's when, at some point, it dawned on me that it would be a real shame to drop all of my physiotherapy training, because I do have a skill and an experience there that really complements the yoga-therapy training that I've been through. 

And so now here I am providing physiotherapy, but always, always, always with this—it's almost like the addition of yoga therapy widened the lens, broadened my ability to see and feel within a therapeutic relationship or a therapeutic session that now I am acknowledging the physical components. And certainly that's what I do. I prescribe movement. That's my thing. I'm a physical therapist. But the lens is broad enough to also include the psychological and the social components of both myself and the person who I'm working with face to face.

Susi: So there's also, what I'm hearing is not just this idea of looking at what's objective and what the objective measures are, which we, you and I, have spoken about as being quantitative measures, like things that are very easily measurable. 

Kirsten: Yes. 

Susi: And integrating in the measures that are a little more nuanced and have a little bit more, I would say in the past anyway, have been bit more difficult to measure, which, being the qualitative measures, but yet so incredibly important when you’re deciding on what stimulus you're going to provide that enables that quantitative change.

Kirsten: Yes. Wonderfully said, Susi. Yeah. It is really challenging to document and keep track of some of those more-nuanced, qualitative components, but there are still such valuable data points. And yes, and they do inform the stimulus that I would apply in the physical realm as well. 

Susi: It really outlines, actually, how, you know, everybody talks about there's no treatment for a condition. Like, everybody says that. And that every person is unique. And I think people can say it, but putting it into practice really does become challenging because if you aren't able to see the uniqueness, like aren't able to apply the uniqueness, because people can see the uniqueness, but if you can't take that information and make it usable and to serve a person in their progress and in helping them move forward, because sometimes I think, just as an aside, that people can see the uniqueness and almost use it as a, well, you know, if they weren't that way, then this would work, right? If I put a spin on it that way. 

Kirsten: Yes. 

Susi: And my job would be so much easier if… And what I want to offer up—and I know it’s not always like that. I’m just using that as an example—and that qualitative, subjective view is actually so essential because when you can see it for what it is, you can actually utilize that as the context through which you apply the stimulus. And so you keep it in mind as being really, really, really important. 

I think about a story that a trainee and I had, were having a conversation about. She's a kinesiologist who works in a physio clinic. And she was telling me, “What do you do with the clients who are really pain focused?” And I say, “Well, tell me about their pain focus. Like, give it to me. Tell me everything about what they're saying that has you think that they’re pain focused.” And she gave me the low down, and so then I started asking her some questions. I said, “What do you know about her job? What do you know about her family? What do you know about this?” And she’s like, “You know what. I don't. I don’t, actually.” And so then she went back and started to kind of dig around a little bit and discovered that there was actually not a lot known about her, but there was a lot known—just assumptions.

Kirsten: Yeah.

Susi: And then when that started to shift, then the subsequent conversations I had with her were different.

Kirsten: Yeah. I bet. 

Susi: What would you say to clinicians around, let's just go in there. Let's just go there, about pain focus?

Kirsten: Mm. Oh, goodness.

Susi: Have I put you on the spot?

Kirsten: No. It’s fine. I love it. I’m just swirling on where to begin on my swirl of thoughts here is what I’m “oh, goodness”-ing about.

Susi: Well, let me start the conversation, because I think to give you a little bit of some rope here, it's funny because when I hear that, I think for me, when someone, if I was to have person A, that is someone might say is pain focused, I hear them telling a story about pain. I don't hear them being pain focused. I hear them telling a story that has pain in it. 

Kirsten: Mm-hmm.

Susi: So I want to know everything that they have to say about pain. 

Kirsten: Yes.

Susi: Because when I understand where their viewpoint is on pain, then I understand their viewpoint on pain, and only at that point can I actually support them. 

Kirsten: Yes. 

Susi: So I don't actually see someone talking about pain as being pain focused. There just happens to be a focus in their story about pain. 

Kirsten: Mm-hmm. Another, kind of playing off of that is they're coming—so when you initially asked, like, what do you say to clinicians about this idea of people being pain focused, is that they're coming to see me as the clinician because they're experiencing pain, and they're looking for support to decrease their pain. So I always get my back up a little bit. And that was my hesitancy in diving in and starting talking about this, because I get really riled up. I’ve always had my back up, and I get on the defensive for said pain-focused patients when clinicians use that term because it's almost used as a—well, like you were saying before, it's almost like if a person's pain focused, then, like, what can I do? They can't be pain focused or else we're not going to be able to apply—like, we're not going to get anywhere, because all they can do is focus on their pain.  

And my issue with that is they're coming to you for help with their pain. Of course, they need to talk about this pain experience. And you as the clinician, because so much of the pain experience falls under that qualitative, subjective, psychological, social—those are all components of that pain experience—and they cannot be easily, just, like, jotted down as, I have 60 degrees of job stress, pain focus, right? So I feel like clinicians sometimes can get—I certainly have—gotten overwhelmed with all of this other information coming in about pain. And I can't put a number on it. I can't document it in my notes, so that it becomes harder to then take a look at all of the things that are contributing to this pain, the physical things, the psychosocial things, all of the story that the person’s telling me, it can become really overwhelming to include those into your treatment. And especially with physiotherapists, I mean, we're trained on the physical side of things. So it's almost an indication of  overwhelm, perhaps, on the clinician’s side, that they just want to get the physical parts. And it's safe and comfortable to deal with a joint that doesn't move very well or a so-called tight muscle or a weak muscle. Those we can address comfortably. 

But we're doing a disservice to our clients if we simply put them, if we lump this person into this pain-focused-silo category. It's like we're cutting off that whole huge component of their pain experience, and we're not willing to look at it. We're only willing to look at their physical symptoms and their physical presentation. And we do our best to work with those to create change in those physical symptoms so that they're going back to—I’m doing air quotes here—a “normal” kind of value. And quite often, in this example, the patient isn't going to feel better. But now, because you haven’t taken into consideration all of that other context, the psychosocial context, you're at a loss. You're like, well, the clinicians, I don't know why they're not getting better. Their range of motion’s improved, their strength’s improved, but they're still feeling all this pain. And then imagine how that feels on the receiving end, being the patient, who's come to you for support to help reduce pain. And the physiotherapist is saying, “Well, I've done all this stuff. All of these physical things are better.” Like, there must, you know, like there's this idea of, then there's something wrong with the patient. They're pain focused, and there's something wrong. 

Susi: So let's—this is really great. So let's use that as a, I’ll call it a problem, that there are more and more physiotherapists and physical therapists and PTA, like physical-therapy assistants, and other healthcare professionals who are coming to me and saying, “I need help with this.” And something that you and I had lots of conversations about during training was that there is not a correlation between a gain and range of motion or strength and a reduction of pain. 

Kirsten: Mm-hmm.

Susi: And the ability to meet a person where they're at and be really present to the person changes the dynamic in the relationship. Whereby, how you do your work alters a little bit. So what was the change for you?  because you're still doing physio, and you are doing some yoga. But in the physio world, then, you've really resolved one of these big problems that health practitioners face. 

Kirsten: Yeah. 

Susi: So can you say that it was just your ability to be present with somebody? Can you say that it's—like, what can you say? because something very tangible is different. And you were even saying, before we got on the call, you were saying that this process was just so—it just enabled you to get into the video physio that started during the COVID. So what did you resolve as a physio that has enabled you to help people that might have fallen into that category of pain focused? What was the resolution? What has it been? 

Kirsten: So I think there's a few parts to it. But yes, I can say that it boils down to presence, and presence is no small thing, right, Susi? So, I mean, you can practice and take all sorts of courses and work for years and years and years on presence. And there's always more. There's always—we can always learn another layer or another variation. But within that huge thing that, yes, is presence, the presence really allowed me to really acknowledge and appreciate that I was doing all of the things that I just ranted about my last time talking, that if I decided that someone was pain focused, I would avoid talking about pain as much as possible and really try to focus in on the physical stuff. And it was this presence and this awareness of not only the person in front of me, but myself and my reaction and responses to them that really resolved all of this, because I was able to face and say, like, “Holy moly. I'm really doing a disservice to these people.” 

And so being able to recognize that point when I'm talking with a client and some things are coming up and they are talking about their pain experience, and they may talk for long, like longer, and I could feel in myself, I could hear the thoughts of going, “Oh, no. Here we go again.” And that just woke me right up. It just, like, it snapped me out of it. And so then there's a shift towards—similar to what you were describing—like, “Tell me more. I want to get as much information from you as I possibly can to be able to inform your whole experience with pain.” So it really did. It boiled down to presence.

And what that means within a therapeutic relationship is that I am more and more aware of my judgments of how I'm integrating the information that's coming from people. And that from that, then I'm better able to see the person who's in front of me because I'm not caught up in my own head, thinking, here's a pain-focused person, and then that's that. I'm not sure if that made any sense. I've never really thought of it like that before, talking to you right now. 

Susi: Well, what I heard is you were noticing your thought patterns—

Kirsten: Yes.

Susi: —around what you’re thinking, when you're hearing a person who you previously would have labeled as pain focused, and then you get to see what's going on your own internal world, about what you're making assumptions about around them. 

Kirsten: Mm-hmm.

Susi: And then you're now—it snapped you out of something, of that state. And it was like, “Okay, wow. This is not really serving somebody. How can I actually serve them?” 

And something I've been doing more of is I'm trying to step away from the word judgmentbecause the word judgment can sometimes have a negative connotation for people who don't feel themselves as being judgmental person, and then they hear that they're being judgmental, and it's like, “Oh,” or it's like, “No, I'm not.” There tends to be some kind of resistance or pushback or collapse around it. And so when I—bringing up more about thought pattern, just notice the thought patterns that are there and recognize the thought patterns. They aren’t bad or they aren't good. They just are there. And what you start to really notice is when you become clearer on them, how they impact. 

We've heard stories about talking to plants and how you can talk to one plant really nicely and talk to another plant really horribly, and then you see how the plants thrive. And I actually had a friend of mine do that experiment with thought, did the same thing with thought, and the same thing happened. So since many of our thoughts are subconscious, when they do come up into our conscious awareness, it just becomes really, really interesting. And that really is the process of presence, which you sort of made a bit of a joke about, that it's not easy. It can be hard sometimes to recognize that because we're facing ourselves, which the work is worth it. But it's yeah, for sure, it can be absolutely challenging. 

And then when you get there, it's really interesting to be in that space where you can simply just be present to somebody and listen to them. And the power that comes from being listened to is extraordinary, and that in and of itself can make healing just happen. Like, we've all had the experience of being listened to, and we've all had the experience of someone not listening to us. And we might not be able to speak it necessarily and articulate it, but we just know that feeling. And that, I would summarize, is what you just said. 

Kirsten: Thank you. 

Susi: Which leads me into something else I wanted to bring up with you, which is something I've been pondering a lot really recently, which is about curiosity. And curiosity has been a theme through my teaching for a long time. But how I'm thinking about is what's evolving. And that curiosity in oneself is really important in the recovery process. So often it's, what's the thing that's the thing that's going to fix my thing?

Kirsten: Yeah. 

Susi: A lot of things in that. And whereas it's really, what are these correlating patterns that make up the experience that I'm having? And it's in the pattern that the power lies. And if we can see and experience what's correlated to what—and I actually, before I redid this recording, I was leading a training, and I said to people training, I said, “Okay, tell me everything that happened when you did that movement. All of it. Give it to me.” And I was, like, I had to, like, kind of bolster them up. And they were like, “Well, my shoulder did this. My hip did this. And I held my breath.” And I'm like, “Yes. Give it to me more,” because when do we ever celebrate when we're not moving well, right? It's like we want to sort of push it aside. It's like, no, no. Let's actually really look at that and not see it as bad and not even see the good movement as good, not to see the symptoms as bad, but really they're all just indicators, and the indicators are a communication strategy to us. And it's like on the dashboard of our car, the indicator simply means that something's up. It's in and of itself is not bad or good. It's just an indicator. And when we can see that as being curious about, like, what's going on here? then I think we can step back and have a little bit more perspective. 

Kirsten: Yes. And it becomes fun, you know?

Susi: Is that allowed? Can you say?

Kirsten: That’s where I’m kind of paused. It really can become fun to work with your body in that way if this curiosity is nurtured, and if there’s an appreciation, then, that the indicator is simply an indicator. Then, it just blows open the possibilities to kind of try something and see what the indicator says. Does it come back on, or does it stay off? And then try something maybe a little bit different, and the indicator stays off for a few more hours. And then, the clinician and the client are really working together to nurture that curiosity and to get feedback about what the client felt when the indicator was on and what the client felt when the indicator was off. And it just expands the possibilities. And it's fun because no one's doing anything wrong when you're being curious and playful. Right? There's permission to be curious and playful, and it becomes fun to do that. And even, I'm sure even clients have said that, that it's fun to work in this way. Even clients who have been living with chronic pain for years are having fun exploring all of the various inputs and all of the various messages and signals from their body and their mind. 

Susi: What's so interesting is that it takes a lot of the seriousness out of it, although it's still a very serious work. 

Kirsten: Mm-hmm.

Susi: And it places you and your client or patient, however you want to see that, in a relationship as opposed to one that's kind of power over and you know what's best, and enables them to really come to the table as being part of the solution.

Kirsten: Mm-hmm.

Susi: That happens quite organically as opposed to, we need to make this patient or this client part of the solution, you know? And I think sometimes that can happen, but it comes from a different space. 

Kirsten: Yes. No one is—well, I think I said that before. It just has me thinking there's so much about client-centered care in physiotherapy and in, I would imagine, most healthcare professions. I just remember when I was first working as a physiotherapist, I worked at a spinal-cord rehab hospital. And we would see these graphics of the patient is at the center of the circle, and then there's all of the different professions—the doctors and the respiratory therapist and the physiotherapists and the occupational therapists and the speech-language pathologists. We're all working around this central client figure. And it felt forced and contrived that we had to really draw stuff out of the clients because I think we were missing that just organic relationship, that you were just referring to, with the client to have it be fun, easy for them to communicate and just tell us what’s going on in their experience.

So it really is truly client-centered care when you nurture that therapeutic relationship with someone. They're not wrong. Their movement isn't wrong. And I think, certainly I know, in the past I have made my patients and clients feel like they were wrong when I would correct a movement that they would do. They're like, “Oh, my gosh, I did that movement wrong.” Or when I would correct a conclusion that they had come to about why they were feeling pain. And for whatever reason, I had a different conclusion. So I would tell them what my conclusion was, and that made the theirs wrong. So really you can't—that's not client-centered care. What client-centered care is nurturing that relationship of supporting the client in their awareness of their movement patterns, of their thought patterns, even that pertain to their movement or to their pain. And you’re side by side, moving through this together, having conversations about what comes up. What came up the last time they went for a walk? What came up in their low back? But it's a conversation. It's not a subjective interview anymore. 

Susi: So if you were going to offer to a physiotherapist or a medical doctor, massage therapist, chiropractor—I could go on—of someone who might be in a place of quandary around whether it's pain focused or whether it's, I want to get out of this profession, or something's not right, but they're seeking, intuitively they know that there's a solution out there, and they are a skilled practitioner, and as you mentioned earlier in this episode, it would be a shame if the profession lost them. What do you have for them? What words of wisdom?

Kirsten: What words of wisdom? So I'm going to back up just a little bit. So I'm doing an online mindfulness-meditation course right now. And through that, there's a message platform where people can post about their experiences and whatever within the course. And so one thing that I just read from one of the other participants today sounds like she's in that quandary of wanting more, wanting to change, and not quite sure what the next steps are. And what she said really rings true. She said that through her mindfulness practice, what she's learned is that instead of searching for the next thing to do, like, what's the next thing that I'm going to do in my career? what she found was the more valuable question on this search was, who am I? And in getting clearer on—and I say that, and I'm shaking my head, Susi, because it's so, like, three years ago, I never would have said that, or I would have shaken my head and rolled my eyes at myself having said it—but it is so true. The clearer we can become on who we are and therefore what we value—and something drew us into these kind of service, caring professions in the first place. There’s something deep in there. There was a you, we, were drawn to this profession for some reason to help other people, for some deep reason. And trusting that that's there and then getting clearer and clearer through practices of presence—mindfulness meditation might be one for me. It was a yoga-therapy course that helped me learn this concept a little more deeply—understanding what you value and how you best serve without forgetting to serve yourself, you'll up your game, like, 100 times. 

So I just love this idea of instead of searching for, what's the thing to do next? just consider within whatever you decide to do if it's going to help you learn more about who you are.

Susi: Love it, because the clearer on who you are then the clearer you are. And to add a little bit more of a fluffy yogi thing is that the clearer your own light is.

Kirsten: Mm-hmm.

Susi: So with that, Kirsten, thank you so much for being a part of this. And we are going to have in our show notes how people can reach you and connect with you. 

And if you're a healthcare professional, physiotherapist, who is in that space and you're looking for, how do you get clearer on who you are? then you can connect directly with Kirsten. You have a great time exploring. 

And if you want to take this a step further with me, we have a series of Therapeutic Yoga Intensives coming up. And you can read more about those at Take good care.