Episode 43: The Subconscious Side of Pain: Gut Health, Emotions & Why You’re Not Broken w Dr. Megan Steele

Are you stuck in the chronic pain loop? Tried the meds, scans, and PT—and still in pain?

Or are you a rehab pro who’s great with injuries, but struggle with patients in chronic pain?

If so, this is the episode for you. Dr. Mary welcomes Dr. Megan Steele, a physical therapist specializing in chronic somato-visceral pain and pain science. They discuss various topics including gut health, chronic pain, the nervous system, the impact of subconscious beliefs, and the role of spirituality in supporting the nervous system. 

Dr. Steele shares her insights into how stress and nervous system dysregulation affect physical and mental health, as well as the holistic approaches she employs in her practice. The conversation also delves into the significance of understanding the body's cues, the impact of trauma on health perceptions, and the benefits of integrating spiritual beliefs for overall well-being.

00:00 Welcome to TMI Talk with Dr. Mary
00:23 Introducing Dr. Megan Steele
01:44 Understanding Gut Health and Pain
02:33 The Role of the Nervous System
02:45 Impact of Trauma and Travel on Gut Health
02:57 Spirituality and the Nervous System
03:12 Practical Tips for Managing Pain
04:11 Diving into the Interview
04:44 Dr. Steele's Journey into Gut Health
07:54 The Gut-Brain Connection
09:47 Challenges in Treating Chronic Pain
11:42 The Role of Exercise in Pain Management
15:55 Visualizing and Managing Pain
22:40 The Subconscious and Pain
26:06 Connecting Emotions and Physical Symptoms
37:28 The Importance of Social Support
39:05 Understanding Intuition and Interoception
41:06 The Impact of Social Support and Isolation
41:34 Spiritual Beliefs and Nervous System
45:29 Associative Learning and Pain Management
54:10 Environmental Factors and Nervous System
57:32 Travel, Nervous System, and Digestion
01:05:06 Menstrual Cycle, Pain, and Research Challenges
01:13:48 Conclusion and Contact Information

You can learn more about Dr. Megan Steele below:

Instagram: https://www.instagram.com/painscienceprof/

https://www.megansteelept.com/

If you are a health or movement professional and want to stay in touch with future episodes, webinars, courses, events and more. Subscribe to my email list below:

https://drmarygrimberg.kit.com/4d90cba40b

If you are a health or movement professional and want to stay in touch with future episodes, webinars, courses, events and more. Subscribe to my email list here

I’ll see you in a week!

Episode Transcript

Audio Only - All Particip (00:00):
Hello everyone and welcome back to TMI

(00:02):
talk with Dr.
Mary.
I'm your host, Dr.
Mary.
In this episode, we're going tobe talking about gut health,
ongoing pain, the nervoussystem, subconscious beliefs,
and how spirituality can helpsupport our nervous system.
I'll dive more into thespecifics on the episode, but
before I do that, we're going tointroduce our guest.

(00:23):
Our guest is Dr.
Megan Steele.
She's an accomplished physicaltherapist.
Educator and researcherspecializing in chronic somato
visceral pain.
She received her doctorate ofphysical therapy from Mount St.
Mary's university, where shecurrently serves as part time
faculty, teaching orthopedicpathology and pain science to
doctoral students.

(00:44):
She is currently pursuing a PhDat Azusa Pacific University,
focusing on how theSomatovisceral systems influence
pain chronically with aparticular interest in the
cognitive and subconsciousmechanisms of underlying pain.
Before becoming a physicaltherapist, Dr.
Steele earned a master's inexercise physiology and worked

(01:07):
in inpatient cardiac rehab.
Her comprehensive approach tocare integrates a functional
manual therapy from theInstitute of Physical Art, IPA,
and visceral manipulation fromthe Baral Institute.
She is also a passionateadvocate for pre and postnatal
care, pelvic health, andincontinence training, often
incorporating cognitive physicaltherapy to support holistic

(01:30):
patient outcomes.
I'm just so excited to sharethis with you.
I know I probably say that aboutevery episode, but I think
you'll find this episodefascinating based on her
research and looking at thebrain and the body in so many
different ways.
So we're going to dive into howongoing stress and nervous
system dysregulation can impactpain, gut health, and our

(01:52):
relationships.
We start by understanding ourbody on a subconscious level.
So things that we're just noteven aware of with our cognitive
brains.
And so just me talking right nowis using.
My, um, conscious brain.
So when we start understandingthis from a subconscious level,
it can shift our entireperspective on our health and

(02:12):
understanding what's happening,not just what we think is
happening.
We explore how to gather datapoints on your own health so you
can find the right practitionersbecause let's be real.
Not all of them are createdequal and we don't have enough
time in our healthcare systemfor our healthcare practitioner
to put all the pieces togetherfor us.

(02:33):
We also discussed the impact oftrauma, especially sexual
trauma, on how we perceivestress and why certain
environments we might not evenbe realizing how much these
affect us.
And for those who love totravel, we also discuss how
traveling impacts our gut healthbecause you know how it's like
to be constipated or havingdiarrhea when you're on a plane

(02:54):
and we know that's not fun.
And here's also something that'soften overlooked, is how our
spiritual beliefs can affect thenervous system, even when we
don't have a strong supportsystem or feel stuck in jobs or
relationships where we reallyfeel that we can't leave and we
need that extra support.
It is really hard to summarizeall this because there are some

(03:16):
fascinating tips on how to stopthis dysregulation and to stop
associating pain and fear with acertain activity or a certain
environment and understandinghow to really kind of hack the
brain from a scientific level tohelp stop that negative loop.
Overall, I really hope you enjoythis conversation because again,

(03:38):
it was another fascinatingconversation and I'm really
excited to share it with youall.
Ready to tackle the topics thatyou've been curious about but
never felt comfortable asking.
With a straightforward, nononsense perspective on life
blended with candid stories anda healthy dose of humor, Dr.
Mary Grinberg cuts through thefluff and addresses the
conversations we all need tohave on TMI talk where no

(04:00):
subject is to taboo our bodies,our minds, and everything in
between.
Now, here's your host, Dr.
Mary.

Audio Only - All Partic (04:11):
welcome Dr.
Meg to the show.
Thanks for coming on.
Thank you so much for having me.
I'm excited to be here.
Yeah, we're going to talk allthings, gut health, poop, pain
science, and how it affects thebrain.
So we'll just go ahead and jumpright in.
Love it.
Yeah.
So can you explain how guthealth is indicative of overall

(04:35):
health, including its impact onhealth, on mental health and
your, in your opinion, um, basedon your research and experience?
Sure.
Well, first, I think maybe itwould be helpful to know a
little bit more about me.
I'm a physical therapist bylicense, and I, um, came upon, I

(04:55):
came to gut health viaosteopathic medicine.
So I practiced as a physicaltherapist for a few years and
realized, you know, not having ahundred percent success rate,
maybe there's something I'mmissing.
Um, I did the thing that we alldo as physical therapists, which
is to protect my ego in certaincases and put the onus on the
patient and say, that's probablybecause you're not doing your

(05:16):
exercises.
Couldn't be that I don't knowexactly what's going on.
Um, so I have some people inapology, like most of us do,
right?
But I went back and I said,well, maybe there is something
I'm missing.
So two years after I graduated,I started looking.
um, osteopathic visceralmanipulation coursework, and I
pursued that for a few years,and I took all the classes, and

(05:37):
it really broadened myunderstanding of Pain, the
physical body, as physicaltherapists, we tend to be really
biased towards themusculoskeletal system because
that's our wheelhouse.
That's what we know, that's whatwe studied for so many years.
When really, the musculoskeletalsystem and the musculoskeletal
system are two of the elevensystems in the body.

(05:59):
And so we tend to ascribe allthings to the musculoskeletal
system, all things pain, really,to the musculoskeletal system,
when really there are many othersystems going on in the body.
And one of the most importantsystems is our digestive system,
for so many reasons.
But I'll give you kind of my topthree, I guess.

(06:20):
We could be here all night, but,um, So I guess my top one is, it
gives you so much great data.
As a pain science researcher, Ilove data.
Um, it's probably not as fun tobe married to someone like me
because my husband will suggestthat, you know, maybe we give
our daughter Tylenol and I'mlike, we don't have enough data

(06:41):
points for that yet.
And he's like Okay, you need toreel it in.
But, um, so after I, I took allthis osteopathic coursework, I
was finding success in mypractice, but the, the, I guess
there are still parts ofphysical therapy that tend to be
very musculoskeletally biasedand they're not necessarily on

(07:03):
board with any of this and, andthe research on the visceral
system is not great.
It's heavily biased and, um, youknow, methodologies aren't
great.
So there are a lot of issueswith it.
So then I said, well, I'll goget a PhD and.
I'm going to try and prove someof this, some of what I'm seeing
to be true in my clinicalpractice, because you can't
really say, well, it works forme, you know, so it should be

(07:26):
working for everyone.
So, long story long, um, I thinkthe gut gives you so many good
data points about what's goingon in your body, how healthy you
are in that moment, you know,skin, hair and nails give you a
lot of good information aboutwhat's gone on in the last weeks
and months.
But your gut can tell you,specifically your bowel

(07:47):
movements, tell you about what'sgone in the last It's gone on in
the last few hours, 12 to 24hours, you know, depending on
who you are.
If you're someone that goesthree times a day or three times
a week, both are within therange of normal, you're getting
a lot of good data about what'sgoing on in your body and you're
getting a lot of good data aboutnot just your Somatovisceral

(08:09):
system, not just your GI system,but also your nervous system,
because your gut and yournervous system are so closely
tied together.
Most of us by now have heard ofthe gut brain axis and the vagus
nerve.
It's been a very popular, um,topic of discussion on a lot of
TikTok reels.
And sometimes they get it rightand sometimes they've

(08:29):
oversimplified it to a statethat it's Not as helpful for
people.
So we know the vagus nerveconnects our brain and our gut.
We know that about 80 to 90percent of the nerve fibers go
from the gut to the brain.
And as a physical therapist whoworks with people primarily in
chronic pain, I find thatbecause I'm, I'm not a quote

(08:55):
unquote.
mental health professional.
It's sometimes hard for peopleto get on board and to
understand that we actually talkto people about their thoughts
and feelings and how theirthoughts and feelings connect to
their pain.
And one way to do that is abottom up approach.
So talking about how yourphysical body affects your mood

(09:18):
and your gut does that throughthe gut brain connection of the
vagus nerve, it does it throughyour immune system, it does it
through your microbiome.
Um, and so there are many, manyways that our bodies are
physiologically affecting andimpacting our brains and how
we're functioning from a mentalhealth.
Perspective.

(09:39):
I love that.
I love how you are initiallysaying, you know, when
somebody's not getting better,it's like, okay, they're not
doing your exercises.
And yes, I do agree that thepatients still have to take
accountability.
But at some point there, whenthey're dealing with chronic
pain, they've been gas litenough that.
You know, they're just like,well, everybody else has kind of

(10:00):
given up on me and they'retrying because there's not a
secondary gain.
It's not like anybody's excitedto be in chronic pain.
And when you can get somebodythat can explain it, like what
you're saying, it's, it can makea big difference.
And it has been reallyfrustrating for our profession
to just be like, just focus onmusculoskeletal.
And when you focus on and divertfrom that, even looking at the

(10:24):
fascial system and lymphaticsystem, it's like, You know,
that shit on sometimes too.
And I'm like, I cannot ignorethese things.
And I've seen even likeacupuncturists look at the full
body and like chiropractors doas well.
And physical therapists werelike, no, it's just this.
And a big disservice.

(10:45):
It's, it's a big disservice.
And Um, yeah, like gut healthand the brain health and
understanding that wholeinteraction.
I mean, how many people have youseen that are diagnosed with IBS
and they're put on these insanediets that are unreasonable when

(11:06):
there's stuff, you know,research coming out about, you
know, it's more of the nerves,it's the nerves connected to the
brain.
And like you said, the vagusnerve and how they.
All interact.
I think what's hard though iswhen somebody is dealing with
chronic pain, right?
You're like Okay.
Well, our thoughts and feelingsaffect our, our, our, our

(11:30):
physical body, which affects ourgut.
And then what happens though, isthat typically if we're trying
to calm our nervous system, alot of people do that through
exercise, but you can't do thatthrough exercise if you're in
pain.
So then you develop this kind ofnegative loop.
And what would you say tosomebody who's maybe in that
loop?
Because It's, you know, I havedifferent things that I've said,

(11:53):
but I'd love to hear your pointof view on how to help somebody
with that.
Sure.
Absolutely.
And I think to your point about,you know, protecting our egos as
practitioners and people inpain, especially for people
who've been in pain for longperiods of time.
I used to think that, you know,if somebody didn't get better,

(12:16):
if they didn't get across thatfinish line with me, then that
was a failure.
Sure.
And.
What I've since shifted to,which has helped me, and I think
the people that I serve, is if Ican't figure out why you're in
pain, I'm not going to tell youthat your pain is not real.
I'm going to tell you that I'mnot the practitioner for you.

(12:38):
And so, if Rather than saying,well, if, if I can't recreate
this pain, if I can't improvethis pain, if I can't change
this pain, that tells me thatthis is outside of my scope for
whatever reason.
Maybe this is more on the mentalemotional side.
Maybe this is more on the socialside.
whatever it is.
Um, and I think that if, if weadopted that as practitioners,

(13:05):
we'd be so much less likely toshift blame and place blame
because if then I'm not the onlyperson with any answers, then,
then you can have an impact onwhat it, how, how you need to
get there.
Kind of having thataccountability piece to that
person of saying, I recognizethis is real.

(13:26):
I recognize all pain is real andshould be taken seriously, but.
Maybe I'm not the one that'sgoing to be able to figure this
out because I can't.
I don't have a skill set or Idon't have an understanding of
where this pain is coming from.
To your point about exercise,you know, I hear this all the
time is I, you know, especiallywith physical therapists kind of

(13:48):
getting away from the manualtherapy of like, you know, I was
told if I just did my exercisesand there is a great deal of
research that shows us thatexercise reduces pain.
And that's in part because of anendogenous opioid.
opioid system in our bodies, andso we know that exercise is
great.
I had a patient tell me onetime, they're not going to come

(14:09):
up with another reason.
Why exercise is great, that'sgonna convince me to do it.
Like, there are enough reasons.
We get it.
Exercise is fantastic.
We should all be doing it.
We should all be doing itregularly.
What I tell people is, I'm notgoing to ask you to start
rebuilding a house when thefoundation of the old house is

(14:30):
still on fire.
That doesn't make sense to me.
It's going to be seen as athreat to your nervous system,
and it's very unlikely that youwill make progress when you're
in pain from an exercisestandpoint.
Exercise can sometimes helppeople get out of pain, but more
often than not, we need you tobe out of pain before you can

(14:53):
start.
The exercise or at a reasonablelevel of pain that you can
tolerate movement through.
Yeah.
It's like the kind of moregraded exercise.
Cause when you're dealing withchronic pain, you know, most
people are never out of pain andso there's balance between.

(15:13):
Okay.
How, what can we do to kind ofget you moving?
And in that, how, cause, andthen when you start kind of,
when you can start moving, evenjust like smaller movements,
I've even seen it where peoplewould just be like, okay, if
you, you're in chronic pain andyou can't go and exercise just
kind of from a somaticstandpoint, needing to release

(15:34):
those emotions from your bodytoo.
And I've even heard it wherepeople just, if you can't.
Exercise.
You can't do those things liketensing your full body and then
releasing tensing your full bodyand releasing.
So you're still kind of gettingsome muscle activation.
Yeah.
And, and there is some evidenceto suggest that that helps with
pain.

(15:54):
Absolutely.
You know, if somebody can't moveat all without pain, you can
start by visualizing.
You can start by watchingsomeone else move that actually
activates areas of your brainthat connect to your own body's
movement.
Those are places to start.
They do that with like CRPS.
They have people, um, you know,understand different hands and,

(16:14):
you know, feet, and so that youcan start to lateralize and
recognize right from left andthings like that.
There's a fair amount ofresearch too coming out about,
um, interoception and thingslike, um, like a yoga nidra
meditation where you would Go inwith your mind's eye and
visualize those areas of yourbody.

(16:34):
Because it's kind ofinteresting, you think about
with people with chronic pain,they have such an awareness of
that area.
Sometimes that's true, andsometimes it's the opposite.
Like if you ask someone inchronic pain to draw a self
portrait, oftentimes they willomit the area That is very
painful for them.
And Frida Kahlo was a greatexample of this.

(16:55):
You very rarely will see herback and her legs in her
drawings and her paintings.
And I have someone who's anartist that came and spoke to my
chronic pain class of physicaltherapy students.
And she brought in some of herpaintings.
And when she was having a greatdeal of arm pain, she drew
herself with somethingobstructing that area.

(17:17):
And when she was havingradiating leg pain, she would
only draw herself from the waistup.
And so actually going in andrecognizing those areas or
observing them in anonjudgmental way with your
mind's eye can help to decreasesome of those pain signals.
That's incredible because, youknow, for people that don't know

(17:37):
Frida Kahlo's story.
I share what her pelvis wascrushed in a, in a bus accident,
right?
It was an accident.
Pelvis.
Yeah.
She had tremendous amounts ofpain throughout her entire adult
life.
Yeah.
And she became infertile, Ithink because of the accident
and she suffered so greatly andso many different.

(17:59):
In so many different ways.
There are some documentaries onher.
I actually went in Mexico cityto visit her home this summer.
It was incredible.
You could see her wheelchair.
You saw her bed.
I was very happy to see at theend of her life that she was
starting to get recognition, butI don't think she got to the
degree that she is now with her.

(18:22):
But I knew from.
The neurological standpoint thatwhen somebody is dealing with
CRPS, so CRPS is chronicregional pain syndrome for
people that don't know what thatis.
The other thing you were alsomentioning too was how our body
kind of has our own.
you said the endogenous opioidsystem.

(18:43):
So basically what that means isour own pain relieving system.
So I'm just explaining it forpeople that are listening that
may not be in healthcare, whatthat means.
So somebody has chronic regionalpain syndrome, they have a
specific part of their body thatis just incredibly painful and
extremely sensitive to touch.
And you can probably dive intothis a little bit more on what

(19:03):
that looks like, but I know thatthey've done a lot of mirror
movements.
So basically you can see, youonly see the unaffected.
So say if the left arm'saffected, you only see the right
arm, and then you put a mirrorto block the, the view of the
left arm, and then you can movethat right arm.
So you trick the brain intothinking that it's the left arm.
Is that the same mechanism thatyou're seeing with watching

(19:25):
other people exercise?
Yep, absolutely.
It's working on those mirrorneurons.
And, um, especially when you'redoing it in a Calm nervous
system state.
And so if the thought of movingmy own body is so terrifying to
me, my nervous system is goingto be on high alert, right?

(19:46):
It's going to be sounding thealarm even before I move.
And that's in part because Ournervous system learns through
associative learning, and, andthey estimate that like
somewhere upwards of 80 percentof our learning happens
associatively, and that's sotrue with our nervous system
that I learn over time movementslike this equal pain, I start to

(20:07):
reduce the amount of movement Ido until I don't move at all.
And to your point of then towatch somebody on Instagram or
to watch somebody on Google tojust say, Just get exercising
five tips to fix your back painor three stretches and you'll
never have pain again And then Itry that and then I fail again

(20:28):
That you know, I'm less likelyto think well, this doesn't
necessarily apply to me asopposed to Something is wrong
with me.
I'm the problem and then thatleads to To my further feelings
of, well, maybe I never willreally get better.
Yeah.
And nobody understands me andmaybe it is my fault.

(20:49):
Maybe there's something, youknow, I've even seen it where
some of these spiritual guruswill be like, just meditate it
away.
And it's like, Oh my God, likeyou can't, it's just, it's
really hard.
Cause I get meditation can behelpful, but there's also this
component where maybe some.
People, we're humans, andsometimes that can be so

(21:12):
detached from the reality of ourphysical bodies as well.
Absolutely, and I think a lot ofthe psychological world is
getting into pain recently aswell, and, you know, there have
been studies about Things likeexplain pain and those types of
things.
And then, you know, there's JohnSarno who's been around for a

(21:33):
long time and the mind bodyconnection and things like that,
which I completely agree with.
But even if you narrow it downto.
You know, pain is in your brain,you're still taking this hugely
complex thing and saying, I'mgoing to sort of talk you out of
pain.
And for some people that works.

(21:54):
Some people absolutely that willwork for them.
But as pain goes on longer andlonger, it goes in deeper,
deeper parts of your brain, theless conscious, the more
reflexive, more protective partsof your brain, as opposed to the
outer parts of your brain thatare more under our conscious
control.
Awareness and conscious controland.

(22:16):
You know, this is where talktherapy happens, is in my
cognitive thinking brain, and inmy deeper, more reflexive brain,
I can get there two ways that Iknow of, hypnosis or through
touch, and that's where I thinkwe as physical therapists have a
tremendous advantage because wehave a license to touch people

(22:37):
where in the psychologicalcommunity they do not.
Yeah, there's a big gap, Ibelieve, between so especially
when I'm working with peoplethat have history of sexual
abuse, um, they'll work inpsychotherapy to help, um, the
process or move through ordevelop strategies to heal after

(23:00):
their experience.
You know, I'm not a traumaticexperience or multiple
experiences.
And then from a physical therapystandpoint, if they're dealing
with chronic pelvic pain ormaybe fear around sex again,
because that that relates tothis specific event or multiple
events, you start associating.
And I find there's a big gapbecause, okay, well, I'm not a

(23:24):
psychotherapist, but then apsychotherapist is not a
physical therapist.
And so I find that.
It kind of falls more on the PTto help bridge that gap.
And that's something that Ifound in our practice is that we
tend to be that bridge.
Cause yeah, what you weredescribing for people to
understand is like you're theconscious brain and then the

(23:46):
subconscious brain.
Right.
And so you were trying to tapinto the subconscious brain.
Is that what you're saying?
Yeah, absolutely.
And that's what I'm reallyfocused on with my manual
therapy.
And that's, um, why I tend touse things that are more lighter
touched.
And, and they're more focused onthe autonomic nervous system,

(24:07):
like the visceral techniques,because that's really where I
feel that I've been able to movethe needle with people,
especially when they've gonethrough the musculoskeletal.
Treatments and have not hadsuccess.
Um, because that gets into yourmore deeper, more reflexive, um,
less conscious areas of yourbrain.

(24:27):
You know, I find that there'sthis struggle between like, when
we talk about the nervoussystem, right, the pain started
somewhere, there was an actual.
In my experience, there was anactual injury or dysfunction or
something that started it.
And then the nervous system'slike the fire on top of it,
right?

(24:48):
I think of it like almost likegasoline to this, like maybe
little fire.
And I've also seen it though onthe other end where people are
like, you're just stressed, likejust de stressed, but there's
also an underlying issue thathas been misdiagnosed for a long
enough that now it's becomechronic.
So.
How do you describe it to yourclients when maybe they do have

(25:12):
an underlying, like, say, youknow, maybe they've had
misdiagnosed lumbar referral.
Right.
And they're like, Oh, it's, youknow, my hips clear,
everything's good, but it'sactually a referral from the
lumbar spine.
And now at this point, thenthey've stopped exercising.
Then they've developed chronichip pain and now they're

(25:32):
depressed and now they're inpain.
And.
How do you describe that to thatperson?
Because there's a fine linebecause we've already been
gaslit just by saying, Hey, it'sjust anxiety.
I feel like there's this fineline between, Hey, this is.
Anxiety or the nervous systemhyper is hypersensitive right

(25:52):
now, but also what can they dowith that?
Cause then if they can't get outof it, then it's even more in
that shame cycle.
Yeah, that's a great question.
I like to explain it as a layersof an onion.
And typically when I'm workingwith someone, if they've got a
very protective nervous system.

(26:13):
a hyperactive or hyperprotectivenervous system, however you want
to describe it, um, that is thelayer that has to come off
first.
Because that's your body'sprimary protective mechanism, is
your nervous system.
And pain is one of the primaryways that your nervous system
protects you.

(26:33):
Pain is necessary, as you know,and it's our body's way of
saying, I need somethingdifferent.
I need you to do somethingdifferent.
I need you to act differently.
I need you to move.
I need you to quit sitting onyour foot, whatever it is.
And so I explained that to themas, yes, there's probably, from
a musculoskeletal standpoint,something going on, but Because

(26:55):
of your nervous system, we don'tknow how much is being
contributed from that and howmuch is being contributed from
this.
And the other piece of it isthat your nervous system has a
set point.
And that set point has beendecided long ago and it's been
adjusted throughout your life.
So, you know, to, to your pointabout trauma, people who have

(27:19):
experienced childhood trauma,their nervous system While it
was growing and developinglearned a certain set point and
those set points are a littleharder to change than set points
that were learned later onbecause that's part of how I've
known myself as I've grown anddeveloped, but it doesn't mean
it's not changeable.

(27:40):
So, your nervous system isreally kind of the CEO of your
body, essentially.
It's the boss.
It's the one that we're going tobe constantly checking in with
and saying, you okay with thesechanges, boss?
I just needed to, I wanted torun this by you before I change,
change anything here.
And you know, I work at.

(28:02):
On the nervous system, almostoften, almost always at the
beginning and at the end ofevery session, because if your
nervous system is in a state ofhigh alert, there's not a whole
lot I can do that's going tostick with you.
There are some changes that Ican make that could be very
short term, but ultimately, I'mnot going to be able to really
move that needle with you untilyour nervous system is in a

(28:23):
state.
That feels safe enough for me totouch you and feel safe enough
to make changes.
And so I'm always kind oftalking about the nervous system
in that way as, as opposed to,um, kind of the separate entity
that, you know, yes, your nervestransmit signal, but we're not
gonna worry about that kind of athing.

(28:44):
Yeah, that makes sense.
I think that incorporating itall is super important.
And, you know, in our day andage and everything that's going
on, there's a lot of stressoutside.
So even to stay on top ofchildhood trauma, and that's
something I have Had to workthrough and understand my

(29:04):
nervous system.
So like you were saying, it ispossible, but it has been a lot
of work on my end to likereprogram a lot of these
beliefs.
I mean, I was living in deepshame every day.
And so like anything that likethese little.
taglines that you're tellingyourself every day that maybe
you don't even realize you'retelling yourself, right?
You're not, right.

(29:26):
You can't do that.
These limiting beliefs are justso encapsulating that you can
feel paralyzed.
Right.
And those are so deeplyingrained.
Like you say that they're partof your subconscious awareness,
you know, they're subconsciousuntil they are conscious.
And I think part of the healingthere, as you probably found in
your talk therapy, is that, youknow, they have to be brought to

(29:50):
the conscious awareness to beworked on.
And that's the same with thephysical body as well.
Yeah, I find that just withbringing them to your conscious
awareness, like for the longesttime I was like, oh, trauma is,
is for people that had theseexperiences, maybe then went to
war and then everything else is,is no.
And so.

(30:11):
I had no idea really until Ideveloped cancer years ago that
I was like, Oh my God, I was,cause I say this a lot, but I
was doing all the things thatwe're like, we say are healthy
with diet and exercise, but noneof that stuff.
To me can stick kind of whatyou're saying is if we're not
getting to this route, but somany people, it's so hard to tap

(30:34):
into your subconscious.
When we're being inundated withsocial media, we're getting
inundated with stress from work,stress at home.
Like it's just for some people,it's just go just so much all at
once.
And so I find that.
Yeah.
And they said my practicegetting, getting people to start
noticing what those thoughtsare.

(30:57):
And we've even incorporatedvibroacoustic therapy into our
practice.
So they'll lay down on a bed andit really helps them and it uses
different frequencies to kind oftap into the brain and different
parts of the brain to help tapinto their subconscious.
Cause, and the reason we gotthat bed is cause I was like,
this is really hard to getpeople to understand what their
subconscious is because.

(31:18):
so much in our brain and less inour body.
And so without a bed, right.
And what, what, what do you tellsomebody?
Like, what are your tricks tokind of get somebody to or tips?
Yeah, and I can't tell you howmany times I've had people come

(31:40):
in and I have it on my intakeform to tell me about your
stress level.
Tell me about your, you know,stress at work, at home, those
types of things.
And I can't tell you how manypeople go like, yeah, I don't
really, you know, regularstress, the, the norms.
Yeah, okay, how often do youhave a bowel movement?
Eh, once every five days, youknow.
Or like, three explosivediarrheas in the morning, and

(32:02):
then if I have a stressfulmeeting, then I'll have to rush
to the bathroom immediately, andso you can start to kind of, I
think the gut is a great windowof opportunity into that.
Um, helping people understand,you know, like, you can gaslight
yourself from the neck up aslong as you want, but your body
is going to say, no dice.
We're done here.

(32:23):
I'm not playing this game withyou anymore.
And that's usually when peopleseek help is when their body
starts to rebel or break downor, um, betray them are some of
the words I hear.
And I.
And oftentimes like the first,my first cue in those situations
is like, no, no, we have toreestablish this friendship and

(32:44):
this relationship because thisis, this is the only person
maybe in your life at this pointthat's telling you the truth and
this has to be listened to.
And so oftentimes I'll havepeople, um, talk about or think
about.
XYZ stressor in life.
Tell me about what's going onwith your kids.

(33:06):
If that's the thing that comesup in their subjective exam and
my subjective exams are likefrom a teaching standpoint, like
if I were to teach it in myortho path class, like.
I'm sure the captain would saythis is an unapproved, you know,
I'm just I'm like, tell me aboutwhat's going on, you know, and
they're like, what do you mean,like, whatever, you know, you

(33:28):
learn a lot with the open endedkind of questioning of like,
What's, what's on your mind?
So if somebody's telling meabout their injury, but then
also I have to drive my kid 45minutes each way to school every
day and they sit with theiriPods on in the car and they
don't want to talk to me andthen my hip starts pulsating and

(33:48):
I'll say, okay, let's thinkabout that drive.
Let's just think about drivingthat drive and and tell me what
you feel in your body.
And then, all right, okay, well,let's, you know, if that doesn't
really give you any kind of asignal, what do you think about,
just think about your daughter,tell me what you notice in your
body, and then that's when myhip starts talking to me again,

(34:10):
and so helping people kind ofsee those connections, I think,
is really our, my goal, um, as aphysical therapist, when it's
less about the physical, systemwhen somebody has been in
chronic pain for some time or,um, you know, which is harder.
I, I've had people that havehad, you know, been in really

(34:32):
tough relationships.
I'm thinking of someone that Isaw recently that had, um, UTI
symptoms.
And it started after aparticular weekend with a
particular partner and they hadbeen intimate many times.
And You know, over the course ofworking together, we worked on
pelvic floor.
We worked on some of thevisceral structures and we made

(34:53):
some progress, but it wasn'tuntil she said, I need to end
this relationship.
And she did that her symptomsresolved.
I see that.
Oh my God.
Right.
From a physiological standpoint,there is not an explanation for
that.
Right.
But from a nervous systemstandpoint, there's the perfect

(35:14):
explanation, which is.
Once that person is out of yourlife, your nervous system got
the signal of safety and then itdidn't have to send those danger
signals anymore.
Yeah, it's starting to getpeople to recognize the
connections.
Like I have people that theyknow their job is stressing them
out.
They know that that is a majorsource of their pain, but In

(35:38):
that, then they, they're like,well, what do I do?
I don't know.
I don't feel like I have enoughdata to, to be able to quit.
Right.
It's not like that it's, ithasn't gotten to that point.
And it's so much of theseunexplained symptoms too.
I've seen.
where people are like, I don'tknow, all of a sudden I just had

(35:58):
these symptoms.
I didn't do anything.
And so they're thinking of itfrom the physical standpoint.
And I'm like, okay, well whatemotionally happened during that
time?
Is there anything there?
And I do find that unfortunatelywe have a lot of dynamics where
there are, um, At least I'veseen a lot more in heterosexual
couples where the male partnersjust kind of completely blocked

(36:21):
off and maybe potentially,abusive in some capacity, maybe
verbally, or then they'reconfused and they're like, I
don't understand.
Everything's fine, but it's onlyin these instances.
I feel uncomfortable with themor this only happened once and
you find yourself making excusesfor the partner and almost
withdrawing and holding it in.

(36:41):
And if you're listening to thisand you're like, Hey, maybe that
sounds like me.
Just start noticing thoseconnections.
What does your body feel likeafter?
You know, maybe there's somemiscommunication or an argument
or something like that, when Ifind people start connecting the
two, that's when, cause it's notmy job to tell somebody to break
up.
Right.
I don't know.

(37:01):
They're like, it could be amisconception, right?
I like, I don't know what'shappening behind closed doors.
I know what it's like to be in arelationship where the other
person's cut off and feelingchronically sick and trying
everything I can and pullingback, looking at it.
I'm like, Oh, it's crystal clearto me what it is now, but when

(37:23):
you're in it, sometimes youdon't know which way is up.
Yeah, absolutely.
I talk to people a lot about theantidote for chronic pain is
social support.
And so when you think about theopposite side of that coin, you
know, I talk a lot about the,the mechanism behind why social

(37:46):
support works.
And it basically works byallowing your nervous system to
be in a calm state where itfeels safe, essentially.
And so the opposite of that isnot safety.
And then your nervous system issending signals that I, I need
some attention.

(38:07):
Something is not right here.
And sometimes those signals arenausea.
Sometimes those signals arepain.
Sometimes those signals are thepit in the bottom of the
stomach.
You know, they presentdifferently for everyone, and
the associations are differentfor everyone too, and that's
what makes it challenging, but Ithink those of us that work in
chronic pain, that enjoy chronicpain, you know, like we love a

(38:29):
good mystery novel, or we love agood, I was a law and order gal
for many years.
Um, you know, you just want todig and get to the bottom of it
and help them find out what arethe connections here and what
are the triggers that aretelling your body to protect.

(38:49):
Yeah.
Yeah.
It's, it's so much more thanjust so much more than just the
physical and, and listening tothat gut feeling, I'd say, you
know, there's, and I did apodcast episode on.
A few months ago on how, whatthe difference between your

(39:10):
intuition.
I know like you're a researcher,so you can't really like study
intuition.
Um, but in that it's that littlesilent, it's like a quiet, it's
not a fear, it's not a scarcity,that's anxiety, but it's like
this little.
Kind of nudge and then over timeit kind of gets louder and
louder and then if we're notlistening, that's when the

(39:32):
physical kind of symptoms start,start creeping, creeping in from
that standpoint.
Yeah, absolutely.
And I, you can't really study,study intuition, but you.
And you can't really study thenervous system.
So we have like proxies forthat, you know, so like heart
rate variability is a proxy forstudying the nervous system,

(39:53):
essentially.
And I think of interoception asa proxy for intuition.
Interoception is a How well do Irecognize what's going on
internally in my body?
And so, um, And for many of usthat live in Western society,
you know, we are rewarded forignoring those signals, right?

(40:16):
We say, I can work for 18 hoursstraight, I only need four hours
of sleep, I forgot to eat lunchbecause I'm such a go go go
getter.
And or, you know, you look atyour athletic populations, I
press down and I suppresssignals coming from my body
about pain.
So there's a, there's a highcorrelation between people who
have low and tarot, septiveawareness and chronic pain and

(40:40):
eating disorders and, um,anxiety and depression, because
when we're not listening to ourbodies and we're not addressing
those signals, the cascade, likeyou say, of.
negative effects, um, istremendous.
Well, it's, it is, it'stremendous.

(41:01):
And it's, it's not somethingthat is often talked about.
And with that, you know, we weretalking about like social
support.
Okay.
So, so say if you're living withsomebody, That maybe you don't
feel supported, but thelikelihood is that there may be
other people in your life too.
And I've seen people feel reallyisolated.

(41:22):
And so when you're isolated andin pain, it's hard to want to go
out and it's hard to want tointeract in community.
And I like to talk about too,like beliefs outside of
ourselves.
Right.
And that's not something that,you know, I'm not sure how this
looks in research, but have youfound if somebody kind of has.
Some sort of, um, spiritualbelief or something outside of

(41:44):
them that, how that affectstheir nervous system.
Cause this is never talkedabout.
And so I just wanted to kind ofsee what your thoughts were with
that.
Yeah, there was a really big,really interesting study, gosh,
I want to say 10 years ago,somewhere around there, it was a
while ago, but they looked atall the different factors that
can work for chronic pain.

(42:04):
They looked at medication, theylooked at exercise, they looked
at mindset, they looked at, youknow, the list was tremendous.
The two things that came out ofthat were prayer.
And cannabis, not great for, forthe psychological community, not
great for the pharmaceuticalcommunity, um, but prayer and

(42:28):
cannabis were the two things andthey looked at some of the
reasons why and, you know, Whenyou say the rosary, one thing
about the rosary is that the waythat you breathe when you're
doing it is it tends to slowdown your breathing and your
exhale is longer than yourinhale.
Oh my gosh.
I had no idea.

(42:49):
So I don't know if anybody knowswhat the rosary is.
It's, it's a Catholic prayer.
But wow, I never thought of itlike that.
And there's a great book byJames Nestor, um, called Breath
that he talks about breath workand things that we often in
Western society teach ourpatients, we say, take slow,

(43:10):
deep breaths, inhale throughyour nose, exhale through your
mouth, make sure your exhale islonger than your inhale, so then
you're biasing thatparasympathetic nervous system.
There are so many prayers thatfollow this six breaths per
minute pattern that we think inWestern society, like, Oh,
aren't we smart?
We just taught people how toslow down their breath and, um,

(43:32):
calm their nervous system.
Um, but that may be what peoplehave been doing for centuries
with prayer.
It's wild.
Yeah, it's, well, the otheraspect that I've seen too, at
least for my nervous system isjust trusting in a benevolent
God or force or somethingoutside of me that I don't have
access to a supportive communityright this second.

(43:54):
But I can trust that there'ssomething greater that's holding
me.
And in that, regardless of whatreligious or spiritual beliefs
you have, but if you have thatas this, this benevolent, like
loving, um, force that alwayswants good for you, that can
feel a lot different.
But on the flip end, if you'reconstantly worrying, and like

(44:15):
you believe maybe in a Godthat's condemning, or, you know,
these different things, theopposite effect.
So I find that You know, I'lleven bring that up in my
practice.
I'm like, Hey, do you have aspiritual belief and, you know,
it's independent.
I'm not pushing that on anybody,but just think about it, you

(44:35):
know, and I never really.
Like there was a point where Iwas like, you know, in a job
that I didn't want to be in andit was too scary to leave and I
just said, God, universe, who'sever out there, give me a sign.
And I just kind of left it atthat.
And then it just, it came socrystal clear, uh, months later

(44:56):
that I was like, Oh, this is it.
Oh, the decision has been taken.
It's just been made.
For me and what a gift that thatwas is that I didn't have to
This pressing crushing decisionto be able to do that Yeah,
absolutely, and that can be socalming and just beautiful for

(45:17):
Your nervous system and, youknow, so, so many aspects of it.
I've, I've used faith as a, anassociatively learned, um,
calming technique.
With someone recently as well,she was in a similar situation.
She could not leave her job.
It wasn't financially viable forher family, but it was
incredibly stressful and herpain level would shoot up every

(45:41):
time, every time this boss cameinto the office and it was like
unannounced and there was nopreparation.
way to prepare for it, but whenI asked her about when she felt
the best when she felt at peaceand calm and the least amount of
pain possible, she said atchurch and she had this
beautiful faith and it likebrought her community and it

(46:04):
brought her some of the thingsthat you were talking about,
like this recognition thatthere's something greater than
me.
And it was during COVID.
And so I said, You know, let'ssee if we can't do the
associatively learning theopposite way.
And so for a couple weeks, wehad her put like lavender oil
inside of her mask when she wasat church.

(46:26):
So then her brain started toassociate lavender oil.
equals calm loving supportiveenvironment.
And then she started to, aftertwo weeks of church, I said,
let's try the lavender oil atwork.
Pain levels significantlyreduced.
Oh my God, that's so cool.
So we can use associativelearning to our advantage,

(46:48):
right?
I can.
teach my nervous system thatthis is a less threatening
environment and to your point oflike maybe it's not a completely
non threatening environment buteventually she was able to get
out of that job and now she issurfing and running and All the
things.
Yeah.

(47:08):
It's, I mean, that goes to, it'sthe Pavlov's law, right?
Exactly.
Yeah.
And so that was, do you want toexplain that for people so they,
they can kind of understand?
Because I think it is soimportant, especially when we're
helping people like return tohaving sex maybe after a
traumatic experience, becausenow we associate sex with

(47:29):
something traumatic.
And can you explain a little bitabout.
What that is, and maybe say ifsomebody is dealing with fear
around sex again, how that can,um, a way that maybe this, the
way that you're explaining canhelp them.
Yeah, so, um, I like to give theexample of, like, you know,
taking it out of the sexsituation just for, you know, to

(47:52):
decrease some of the, maybe,tension around it, potentially.
If I were rear ended by a redcar, every time I see a red car
in the rearview mirror, my bodyis going to do, you know, to a
much lesser degree.
This is a huge overexaggeration.
Um, to your point about sex.
I, the smells that that personhad, the sounds that were going

(48:16):
on, the level of hormones thatwere coursing through my body,
all of these things can becomeassociated with that situation
or that traumatic experience.
And so which are the ones thatare contributing to my nervous
system?
Going into that, that situation,is it the position, is it the

(48:39):
smell of that person, is it thestate of my nervous system, the
state of my hormone levels, uh,what are those things that are
triggering my body to go intothat situation or into that
protective posture or protectiveposition?
And how can I start to peelthose away?
And, and like we've spoken aboutearlier, bringing that up to my

(49:00):
conscious awareness has to bethe first step there.
And so I need to know what thosetriggers are and what are the
things that are making me orallowing my nervous system to
protect and how can I start todecrease some of that.
And so one way, if it was, um, asexual experience and I felt

(49:21):
that there was a, a smell thatwas connecting.
And smell is really connected toour subconscious brain because
it's like kind of right in thatdeep middle part and we don't
even need our consciousawareness to process smell and
that's why sometimes smell is soconnected with memory.
And so could I smell that smellin a graded exposure kind of a

(49:42):
way where I say, okay, I'm goingto smell it for a little bit.
And then I'm going to go dosomething that makes me feel
really good and really safe andreally calm.
And then I could try the nextday a little bit more and a
little bit more and a little bitmore until I feel that I smell
that smell.
And I don't have that physicalphysiological reaction.
Can you explain what the PAVlaws?

(50:04):
I always like PAV.
So I think that if they canunderstand that a little bit and
understand the association,because it's very similar to
what I'll say too, is just evenif somebody is just even just
non sexual touch or even justvisualizing it, getting your

(50:24):
body to kind of, okay, I feeluncomfortable and then go kind
of calm your nervous system andthen come back.
That's Similar to what I'vehelped people work through when
having those, those associativereactions to sex or even
anything, um, chronic.
And, and I love the idea of thesmells and like, even just going

(50:46):
into like understanding theassociated, like decreasing that
association.
Slaying the Pavlov's Law.
So Pavlov was the researcher.
He turned out to be not such agreat guy for animal rights,
but, um, yeah, he was kind of abad guy.
But, um, he established what'scalled associative learning or
an associative learning model.

(51:07):
So what he would do is he wouldring a bell and then feed the
dogs, ring a bell and then feedthe dogs.
His research was on, was ondogs.
And, um, What he found is thenthe dogs began to associate the
bell with food.
So they would start to salivatewhen they heard the bell because
they associated bell equals, I'mgoing to eat soon.

(51:30):
And so that was how he provedassociative learning is that I
rang the bell and there's nofood around.
But these dogs are salivatingbecause they're anticipating
food because they've learned toassociate bell with food.
And so if I have learned toassociate my job with pain or
my, my sexual experience withpain, I can come out of that

(51:55):
with extinction training, whichis I.
Uh, graded exposure is one wayto do extinction training so
that you decrease thatassociation.
So, um, they often talk aboutPeter, um, little Peter, I
forgot, Mary Jones was theresearcher on that one where she

(52:16):
did extinction training.
She, um, this little boy, Peterwas afraid of white rabbits
initially.
And I think maybe he had beenbitten by a white rabbit or
something, but then that, um,fear began to expand.
And then he got To be afraid ofanything white, anything white
or fluffy, even things likecotton balls that are pretty
innocuous.

(52:36):
So what they did for extinctiontraining was they had Peter sit
at the far corner of the roomand they brought a white rabbit
to the door of the room.
Peter has a big reaction, hebecomes afraid, they take the
white rabbit away, Peter getsice cream.
Next week they bring the whiterabbit to a little bit further
in, Peter gets afraid, they takethe white rabbit away, ice

(52:58):
cream.
So on and so forth, each timegetting the ice cream.
And so what I teach pain scienceto the third year physical
therapy students, I say, this isvery simple.
You just, treating chronic painis finding out what are the
white rabbits and what are theice cream.
And that's how you get peopleout of chronic pain.

(53:20):
I love that because it's thebrain is so, Oh my gosh, it's so
fascinating.
And when you can start hackingit basically, and into these
little details where you mightnot even be aware of, of these
different things.
I mean, I'm sure you all canthink of smells.
Like it's funny, even to thisday, I hate.

(53:42):
cigarettes, but like they remindme of my grandma who was so
loving.
And so when I sell cigarettes,I'm like, Oh, I miss her.
Yes.
And, uh, and that memory comeslike that, right?
Every time, every time.
And I go like bacon andcigarettes.
She sounds like somebody I wouldwant to hang out with too.

(54:05):
So you're just like, give memore, give me more.
I know, and we joke about, youknow, there are things that you
can do as a physical therapist,like I never wear red in the
clinic because most of usassociate red with danger, with
inflammation, with stop, withpain.
Um, and then we joke about likewe should pump in the smell of,

(54:28):
you know, freshly, Bakedchocolate chip cookies and that
it'll just bring everybody'snervous system like, you know,
and when we have things likemodels of the spine with these
big red nasty herniating discsOr the knee with the red
arthritis around it.
It's like What are we doinghere?
Guys?
I love that you're bringing thisup because there is an aspect of

(54:52):
clinic decor and the environmentthat is, I have, I've not seen
anybody talk about it.
And I thought, I was like, am Icrazy?
But you know, I have it setwhere our clinic, we have no
fluorescent lights, like, andeven in our new clinic, it looks
like it's fluorescent, but it'sled.
And then you can modify it andmake it like a lighter kind of
color.
And then just.

(55:13):
It's about the environments, youknow, I am so attentive to it
now.
Like when you go into ahospital, it's stale, it's cold,
there's no colors, it's just,yeah.
And fluorescent lights and loudnoises.
It is horrible for the nervousversus like, I, I think I go,
okay, if I'm a client.
And I go into a PT clinic, I'mlooking at what colors are

(55:36):
around.
What are the, is there a sense,um, what are the sounds that I
hear?
And I'm just so obsessed withlooking at those things, because
like you said, I'm not going tohave like bright red in the
clinic.
Well, I'm going to have like,maybe like a.
Like a light, like a green orlike a warmness, like thinking
about those colors and, and eventhinking about your home, right?

(55:59):
So maybe you're not a clinicowner, but your home, like, how
does your home make you feel?
Does, do you go in and it'slike, Oh my God, there's all
these different things that willhave a direct effect on your
nervous system too.
And I tell people, because a lotof people like their gut will
flare up when they're traveling.
Um, I'd love to kind of get youropinion on this too, but I tell

(56:21):
people, I'm like, when I, myexperience, when I've seen
people with chronic pain andeven my own self with somebody
has dealt with a lot of traumais I'm hypersensitive to sounds.
And then like bright lights, butsounds and smells are like my
two big ones, but which smellsis hard to kind of block unless
you're wearing maybe a mask, butairports tend to flare people

(56:45):
up.
And I, I believe it's because.
Every sense is being stimulated.
Every sentence, right?
And your vision, you got leftfor us and lights, the sound,
your flight did it up.
People running past you bumping.
So your sensation.
So touch, um, vision, right?
Vision, smell, um, sound, likeall these things and taste, you

(57:05):
know, that's kind of hard to, toblock.
I mean, cause it's really off,but I I'll tell people, I'm
like, wear noise, cancelingheadphones and a hat.
When you go to the airport and,and see how your body feels.
Even if you, I'll have peoplelike, well, I have kids.
I still have to listen to them.
I'm like, well, there's thoseloops, the loops, those little

(57:26):
like things that you can put inyour ear.
So you can still hear people.
What would you say to somebodythat.
I mean, constipation andbloating while traveling is just
rampant.
So huge, I believe is directlyrelated to the nervous system
and changes in your gut and likewhat you're eating and things
like that too.
But what, what are your thoughtson that?
And what do you recommend?

(57:48):
Yeah, definitely.
So there is, you know, the theif you're especially in a long
flight, there's some dehydrationthat's going to happen.
And so you can mitigate some ofthat with increasing your fluid
intake.
But none of us want to be inthat little pillbox of a
bathroom on an airplane, right?
And so people avoid drinkingsometimes.
But I talked to people about thefact that there are two sides of

(58:10):
your nervous system.
There's the fight or flight sideand the rest and digest side.
And So, yeah, that's it.
When you are traveling, most ofus spend a fair amount of time
in fight or flight, especiallyif I'm going to make my flight
on time, is the security linegoing to go faster, am I going
to get flagged, did I remembermy passport, all the things,
right?
And so because I'm spending moretime in this side of my nervous

(58:32):
system, and of course it's aspectrum, it's never all one or
the other, but I'm spending lesstime in my rest and digest side
of my nervous system, so theblood is not being shunted.
to my organs to do the work ofdigestion because the blood is
being shunted to my muscles tosay we might need to fight or
run.
And so what needs to happen onthe other end of that flight or

(58:54):
car ride or whatever is I have amoment.
Or 10 or 15 or 20 or howevermany I need to help my nervous
system come back down so that mybody can do the work of
digestion, so that my body canproduce hormones normally, so
that I can sleep tonight.
All of those things that tend toget kind of shifted and off

(59:17):
while we're traveling.
And so I always tell people thegood news is your nervous system
is flexible.
It's always movingneuroplasticity.
It's always changing.
So there are times where we'regoing to be more in fight or
flight and that's okay.
That's normal.
Our bodies are meant to be ableto do that.
But then if you can build insome of those times in your

(59:38):
schedule, I don't know if you'relike my husband who's like,
well, we can see these threemonuments on this day.
If we run from this one to thisone, I'm like, then no.
I am here to sit on the beachand do a lot of nothing.
So we need to Build that in, um,yeah, and building those times

(59:59):
into your travel, into yourroutine.
Of course, it's more challengingwhen you have kids.
Recognizing that I'm, if I'mgoing to travel, I'm probably
going to be stopped up, and sohow can I do the work on the
other end of that to help mynervous system, help my
digestive system to morenormalize.

(01:00:21):
Yeah, I think it's important forpeople to know what's happening
when you're in a fight or flightand so peristalsis is the
contraction of the gut to propelfeces forward and In that, that
slows down when you're in thatfight or flight.
And like you were saying thatlike the, the blood is diverted
away and into our arms and legs,because we think we're running

(01:00:44):
from a bear or we've got to besafe.
And so it's not.
Not being in fight or flight.
I've heard somebody say this andI, I really don't like this
about the big healing, um, kindof wave that's coming is it's
almost like we're supposed to becalm all the time.
There's, it makes me sofrustrated to hear that because

(01:01:06):
that is literally impossible.
And if you are.
You're not exposed to the worldthat we live in.
I don't, it's not, it's comingout of it.
It's not staying in it.
Right.
And that's, that's a big key.
And that's one of the ways theythink maybe that exercise helps
is because your body learns thatpathway up into fight or flight

(01:01:29):
and then back down.
And I often tell people, youknow, especially.
Those of us that aredisconnected from our bodies,
you know, if I'm havingexplosive diarrhea three times a
morning, or if I haven't gone infive days, that's your body's
way of telling you something isnot right.
Because when I'm in fight orflight, my body has two options.

(01:01:50):
I either need to get rid of thisfood immediately so that I can
run faster, or I need to shutthis whole system down so that I
can shunt the blood elsewhere.
And so people feel reallyNauseous.
They feel like I don't want toput food in the system or they
have those two, um, reactions onthe back end and for lack of a

(01:02:10):
better term, I love talkingabout poop.
I love when you're likeexplosive diarrhea, not just
diarrhea, shit hits the fan,literally.
Yeah, I think that, you know,years ago, I, when I've been on
this healing journey, myself isjust noticing your gut health.
Like, what does your poop looklike?
You know, are you havingdiarrhea?

(01:02:31):
Even, I think people are unawarethat constipation and diarrhea
are also a spectrum.
You know, if you're stillpooping, but they're little
balls and you're straining andit's taking forever to go,
that's also, that'sconstipation.
And so something in your nervoussystem, or maybe even, you know,
think something that you'reeating or your body's giving you

(01:02:52):
a message, but we're not apt tolisten because we, we don't
know.
Yeah.
And I think that's where askinglike secondary questions.
really comes in handy.
You know, sometimes we'll saylike, you know, if you're not
really comfortable talking aboutbowel movements and things like
that, well, how do you dodigestively?
Oh, fine.
And then you move on and you go,is it a sausage?

(01:03:14):
Is it a sausage with cracks init?
Is it the color of cardboard?
How frequent, like, I want toknow all of it.
Size, color, frequency, all ofit.
Um, because my norm, justbecause it's my norm, which are
like rabbit pellets, and I don'tfeel like I've evacuated
completely.
That's not normal.
I think, yeah, a lot of it is,hey, we've normalized it so it's

(01:03:37):
normal to us.
But when you realize, hey, it'snot normal, it's your body's,
your body sends you messages allthe time.
We just don't know how tointerpret them.
And if there's anything anybodytakes away from today, it's it.
Start listening to your body'smessages, start noticing, Hey,

(01:03:59):
what do my poops look like?
Like, is there emotional stressrelated to my physical pain?
What am I, have I been kind ofpushing down and ignoring?
Because I actually have foundthat people that over exercise
are almost emotionallysuppressing.
And it's like, yeah.
You can exercise a lot and getthat out, but you're not

(01:04:19):
addressing why you have to keepdoing that over and over.
I saw.
And on top of that, that goeswith breathwork that goes with
cold plunges and, and sauna'slike, those are great to support
your nervous system, but why isit repeatedly being triggered?
And that's.
The way I think of it is, okay,well, as I'm moving through this

(01:04:40):
and my nervous system getstriggered, I use those as tools,
but that's not my answer.
And that's the same thing oflike, you know, if I have to go
to physical therapy orchiropractic three times a week
in order to reset or be okay,then am I really solving the
problem or am I doing symptommanagement?
And I think the normalizationpiece goes so far.

(01:05:06):
You know, in terms of women,especially like, you know,
menstruation, so I reallystarted my visceral journey and
my visceral research journey onthe, the digestive system
because I said this, you know,85 percent of low back pain, it
has unknown cause, right?
We call it chronic nonspecificlow back pain because we say,

(01:05:26):
well, You have low back pain, wedon't know why.
We do know that the digestivesystem can refer pain to the low
back, but the western medicalsystem is like, nah, it's not
that, you know.
But, so my question was, if wedon't know what it is, how can
we say it's not that?
So that was kind of my thinking.
And then, Over time I sort ofshifted to say, well really

(01:05:46):
there's so little research beingdone on women, there's so little
research being done on women whohave pain during menstruation,
that this is really where I needto have my focus.
And that's where I've kind ofshifted over the last year, uh,
two years actually.
And so, yes, you are twice aslikely to have, uh, low back

(01:06:06):
pain if you have IBS, but you're2.
5 times more likely to havechronic pelvic pain later in
life if you have pain duringmenstruation.
And talk about something that'sbeen hyper normalized to the ex
You know, it's so funny.
It's, it's like, it's both endsof the wrong spectrum.

(01:06:28):
It's like, yeah, you have periodpain.
We all do get over it.
And also that's too taboo.
Don't talk about it.
Nobody wants to hear about that.
Oh, it's, I just did a podcaston estrogen dominance and I've
gotten.
so many messages like, who do Igo to?
And it's even hard to find, uh,people that, that treat that,

(01:06:49):
you know, and women arescreaming for it.
They're screaming for it.
And I'll tell people, I'm like,listen, look at the menstrual
cycle, like pull it up.
There's plenty of, of, of imagesonline and you'll see the
different waves of your cycle.
And.
People will be tested on likeday eight.
I'm like, that tells you notlike, that's not telling you

(01:07:12):
anything.
You don't see many spikes duringthat time versus this is why
there's day 21.
Cause that's roughly whenprogesterone spikes.
And so you can look at it andthe more you learn about it and
you're like, Oh, I'm having paintoday.
Well, what's going, what's.
What phase of my cycle am I in?
Let me pull that up.
Let me look at what's supposedto be happening right now.

(01:07:33):
And the more data you cancollect, the more you can start
advocating and finding the rightpractitioners to help you.
But even on my side, it's hardto know who to refer to for
these certain conditions becauseestrogen dominance still isn't
mainstream on, on treating.
And I will say for people, Iwant to say it's the, Episode

(01:07:54):
for me, it's the episode eighton my podcast where we dove a
lot more into estrogendominance.
So you guys, if you're havingpainful periods and
understanding it from thatlevel, um, cause that's a whole
nother.
Animal and another topic to, toaddress.
And I'm sorry, it was episodeseven, episode seven of this

(01:08:16):
season, season two, where we, wedive into that.
And one of the main causes oflow.
So in very briefly explainingit, it's a lot of it is the
estrogen, the progesterone toestrogen ratio being off where
you have more estrogen.
Then your progesterone is stillhigher in the luteal phase, but

(01:08:39):
the ratio is off and a lot oftimes, you know, you can have a
variety of reasons why yourprogesterone is low, but one of
the major causes of lowprogesterone is chronic stress
because your body makes cortisoland diverts to cortisol and
prioritizes that overprogesterone.
So people are put on.

(01:09:00):
estrogen birth control, which Ijust, I'm just floored that
we're putting people on estrogenbirth control, which is almost
worsening the problem that we'renot addressing the nervous
system.
And then we're like, why arethey having all these symptoms?
And then they can't getpregnant.
It's just, I, I just.
It's such a disturbance.
It's such a disturbance.
Yeah, and, and there aresubgroups of people who have

(01:09:24):
pain during menstruation.
Some of it is related toestrogen dominance, and some of
it is related to other things.
So it's a really complex problemthat we have not really
addressed and not really lookedinto enough.
And, um, that was part of why Iswitched my focus as well,
because, you know, I was told,well, If you're going to do this

(01:09:47):
IBS study, you should really doit on men because women are too
hard to study.
And that's in part becauseanytime you're studying women,
your pain perception changesthroughout your menstrual cycle
because your hormones have a bigimpact on your perception of
pain.
And so for my study, I'm, havingto capture women during like mid

(01:10:09):
luteal phase, which ischallenging.
Like based on, we have to getfour researchers together in a
room.
We have to schedule these peoplethat all have real full time
jobs like myself and theparticipant in the room within
this window of time.
Yes, it is more challenging.
Does that mean it's not worthdoing?

(01:10:31):
In my opinion, absolutely not.
Also, I think I'm probably justthat person that like, someone
told me I couldn't do something.
So I was like, all right, well,here I go, then, you know, like,
well, we need people like you todo that to help with us, you
know, because yeah, not all ofit is estrogen dominance.
That's one piece.
But what, what else?

(01:10:51):
What other factors?
And I think it's also hardbecause people have been put on
chronic Like birth control fordecades.
And it's hard to measure theirluteal phase too, if they're on,
you know, on birth control forthat long.
And so you've got so manyfactors.
I could go, I, we could go onfor another like five hours on,

(01:11:15):
but yeah, I mean, it's, there'sa lot.
And I would just tell peoplejust start tracking.
Like I get people to like, juststart noticing, tracking, being
aware of your body signals.
You don't have to do anythingwith it yet, but you'll be
shocked on just listening andnoticing your poops, noticing.
What are your poops like duringyour luteal phase?

(01:11:36):
So that's usually after day 14to 28 or whatever length of your
period is before you have yourperiod and it's not people are
like, oh, it's not, I'm fine onmy period.
And I'm like, no, no, no.
It's the whole cycle.
It's not because you have afluctuation of hormones and so
many different aspects.
So track it.

(01:11:57):
Start tracking your period,start noticing your gut, your
nervous system, your pain andall of these different things
and even Tracking your emotionalstate, like what stressors have
been going on as well.
Yeah, yeah And if you can juststart to recognize some of those
connections and I always tellpeople I love that new thing on

(01:12:17):
Instagram like we listen and wedon't judge Right.
You could do the same with yourbody.
You're just a nonjudgmentalobserver.
You're not trying to drawconclusions about what's going
on or what might be causingthis.
You're just sort of saying like,Oh, that was interesting.
That was a different, you know,I'm just collecting data points.
Like you speak to my researcherheart, my little researcher

(01:12:38):
heart goes pitter pat when youtalk about data points, but
like.
It's a part of knowledge andknowledge is power and knowledge
about our own bodies empowersus, I think tremendously.
We're our own little researchstudy.
Like you're a research study ofone and your body is going to be
different than my body.
And nobody's going to know yourbody better than the person

(01:12:59):
that's in it 24 seven.
And.
And yeah, you can go, when youcollect that data, then you can
go out and kind of seek help andthen ask more direct questions
because in our health caresystem, this is vital.
This is vital because if you'regoing to somebody in network
with insurance, they probablyhave five to ten minutes, they
don't have the ability to dothat.

(01:13:20):
So if you can be like, hey, thisis what I'm experiencing on this
days and this is what's goingon.
They may be able to kind of getyou those answers faster because
they're not going to have thetime to tell you.
And yeah, you can go out ofnetwork and find people that
way.
But in general, that's just kindof the more data points you can
give your practitioner, the lessthey, they.

(01:13:42):
That just consolidates thattime.
Yeah, absolutely.
Huge, huge.
Well, thank you so much forbeing on here.
This, uh, this was such afascinating, you know, hearing
your research side speaks to myheart.
I think eventually one day Iwant to get into research
because I just, I'd love to workwith you.
Yeah, because we need this.

(01:14:05):
We need more of us out here, youknow, explaining to people
what's going on versus.
you know, dismissing and, and,and the research is just not,
not where it should be forwomen.
So how can people find you ifyou want to tell them about your
Instagram and your website andyeah.

(01:14:25):
Yeah.
So, um, my practice is in SantaMonica, California, and you can
find me at MeganSteelePT.
com and my Instagram is painscience prof.
Cool.
Well, I will tag that in thepodcast notes here.
So thank you so much.
Meg, nice chatting with you.
Thank you so much, it was greatto be here.

(01:14:46):
You've been listening to TMITalk with your host, Dr.
Mary Grinberg.
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To learn more about Dr.
Mary, head on over todrmarygrinberg.
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And make sure to follow Dr.
Mary at DrMaryPT on all socialchannels.
To learn more about Dr.
Mary's integrative practice forpain relief in Austin, Texas,
head on over to resilient rx.

(01:15:07):
com.
Thanks for listening!