In episode number 251 of Elevation Recovery, Chris Scott interviews Sam Visnic, a California-certified massage and corrective exercise therapist and founder of Release Muscle Therapy. They discuss chronic pain, exercise, physical therapy, and how everything can relate recovery.
About Sam Visnic
Sam Visnic is a California-certified massage and corrective exercise therapist with over 18 years of experience. He founded Release Muscle Therapy, a results-focused Temecula massage therapy, and personal training business. Sam is committed to integrating pain science and the science behind massage therapy to create a great coaching experience for clients.
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Sam Visnic: Your thinking can start to actually influence the pain. So, remember how I said that the information has to go from the body to the spinal cord. The spinal cord essentially has a gate. It's a dorsal horn. And the gate is open or closed. It determines how much information that's coming from the body actually passes the gate and then goes up to the brain. So, that gate is influenced by a number of things, biochemistry, et cetera, but also how concerned you are about your problem.
Sam Visnic: Now, when you don't understand why you're hurting, and you have pain, and you're worried about it, and maybe you have a lot of anxiety because of how your pain levels are affecting your ability to get work done, then you're more concerned and put your nervous system is more on guard. It's more vigilant. Then that gate is going to be more open. And it's going to allow more information from the body to go up to the spinal cord because it's relevant and important information.
Announcer: Thanks for tuning in to the Elevation Recovery podcast, your hub for addiction recovery strategies, hosted by Chris Scott and Matt Finch.
Chris Scott: Hey, everyone. Welcome to the Elevation Recovery podcast. My name is Chris Scott. And today, we have a really cool guest, who is connected to me by a friend, but also very impressive in his own right and is a specialist in a topic that I'm really interested in. And that's chronic pain. Sam Visnic, thank you for being on the show.
Sam Visnic: Chris, thanks for having me. Happy to be here.
Chris Scott: I hope I pronounced your name correctly. I didn't-
Sam Visnic: Yes.
Chris Scott: Okay. Excellent.
Sam Visnic: Yes.
Chris Scott: Can you tell us a little bit about how you got into the subject of chronic pain and what you're doing these days?
Sam Visnic: Well, I say the journey has been a complex one and a long one. But put simply, I mean, I started off in this field at about '99, 2000. And I really haven't done anything else. I kind of jumped in to the personal training end of things at a large fitness club. And this is right at that time when things were starting to change in the fitness industry, where we were going from kind of like everything had either been aerobics or it had been bodybuilding. Nobody really did anything else outside of that in the gym.
Sam Visnic: But this functional training kind of revolution had started where people were starting to look at, "Hey, you shouldn't just go to the gym and sit on a machine and push. You should actually do things that were more what we would call functional, exercise about cables and Swiss balls." But at the time, there was not really a lot of education out there for this. A company had come in to the big chains of fitness gyms to teach posture and movement and all this kind of stuff. And I kind of got swept up right in that. That was coming out at the time that I had started.
Sam Visnic: And the application was really obvious, because a lot of people who would come into the gym, they were the people who would just walk in the front door, go right to the weight room and just go have at it. But there's definitely a lot of the population that has not really been physically active in years or at all. And they're just getting started in the gym. And a lot of them had issues that they were concerned about. So, they had knee problems, they had back problems and so forth. And not a lot of trainers felt very comfortable and/or competent in working with these individuals.
Sam Visnic: And at the time, I was a young, hungry trainer and eager to just get out and start doing the things that I was taught how to do. So, I loved it. I thought it was a it was a challenge. And it was like a big puzzle to me to working with people with these aches and pains and designing exercise and movement programs to basically get them on the gym floor, and to be able to feel comfortable. And in the process of doing so, a lot of these people end up dramatically reducing their pain and in certain cases, completely eliminating it. So, I knew I was onto something. And then that got me hooked in the industry.
Chris Scott: That's awesome. I was a personal trainer for about two years before I founded Fit Recovery. And actually while I started Fit Recovery, and I noticed that there seemed to be an intersection between a lot of conditions related to chronic pain that I didn't actually know at the time might be related to chronic pain. People would have depression. Maybe they'd have a traumatic event. Obviously, physical injuries, it kind of makes sense that you could have chronic pain if you had a really bad physical injury.
Chris Scott: But what I wasn't aware of was how many people were struggling simultaneously with say, psychological or spiritual issues, we could say, and also had this chronic pain manifesting. And I can tell you that a lot of people in my audience, I say it's about maybe 50-50 people who have been in really good shape before, and then their addiction kind of develops and they want to get back into fitness. They want to get back into training, but they find that there is this chronic pain component that wasn't there before maybe as a result of the addiction.
Chris Scott: We talked briefly on the phone about the TMS phenomenon. And I haven't really explored that with you. But I'd like to know what you think of it because I'm totally open minded and not a specialist in this. And then also, there are people who have never worked out really in their life, and then they develop an addiction, and suddenly, they want to have their physique become a symbol of their victory over that phase of their life. And yet they get hobbled by chronic pain and it's super frustrating. So, have you seen any of those things? Have you worked with people with anything similar to that?
Sam Visnic: Oh, yeah. And when we start to dive into this kind of pool of just kind of like everything that is chronic pain, there's so much more out there than people are generally aware. And the first thing I would say is that pain itself has kind of gotten in most people's minds to be married to structural biomechanics, meaning that the way you stand, your posture, your lifting posture, work habits, all these sorts of things, sitting at the computer, and so forth. And that's unfortunate, because that's only just a small piece of the pain spectrum, of the pain experience.
Sam Visnic: So, almost, you have to think about it as the structural elements like orthopedics, let's just say, orthopedic is one element. And then, we have pain, which pain is really almost like a neuroscience field. These are different fields. And yet, they kind of overlap, obviously, because we've all had aches and pains that were generated by an injury. If you sprained an ankle or something like that, your ankle swells up like a softball. There is a structural reason why you have pain.
Sam Visnic: But when we start to kind of move into this differentiation between acute pain and chronic pain, everything changes. They are literally completely different animals. And let me explain that so that everybody understands this. Acute pain is very much like I just talked about, where you roll an ankle, the ankle swells up like a softball. There's injury to the tissue. There's inflammation going on. But there is a period of time where that's the case and then it recedes and then it heals.
Sam Visnic: Everything in the body, whether you break a bone, it takes six, eight weeks to recover from that. Or if there's neural damage, there's a pace at which the nerves regenerate and heal, et cetera. Everything in the body has a window of time for it to heal. And generally speaking, mostly everybody who is an expert in this field will say it's six months. I think we generally agree that everything in the body heals in six months.
Sam Visnic: Now, if you have pain that is occurring after the expected healing time of that tissue injury, but with a maximum of six months, then you're no longer dealing with what we call a tissue issue or a lack of healing. But instead, you're now dealing with a pain issue. And a pain issue has a whole lot of other things associated to it that are not just about tissue healing because that's already done.
Sam Visnic: So, when somebody comes to me who's been in chronic pain for years and they say, "My back went out five years ago, and I found out I had a disc bulge," and then they're coming in now saying, "My disc never healed," then that's not true. Because it did heal. Discs bulge and reabsorb all the time. But what you're dealing with now is pain and you have a pain problem, chronic pain, not tissue Injury any longer.
Sam Visnic: Now, how we deal with this and approach with this type of situation is dramatically different. And this is where my work comes in as I'm not a specialist in acute pain. Doctors are, paramedics would treat with these acute injuries. My job is after the tissue has healed. So, I want to make that distinction, first and foremost. Now ... Yeah, go ahead.
Chris Scott: I was just going to say or maybe you were about to elaborate on this. But what would be the cause of chronic pain then, in your opinion, and maybe there are multiple causes. And what's the solution for anyone out there who's in pain, in chronic pain while listening to this?
Sam Visnic: So, that's where everything gets really interesting is that approximately, 20% of people will develop chronic pain, okay, from having an acute episode, but also somewhere in the neighborhood of 20% of these people have never had an injury, and literally just started developing chronic pain. So, this is really interesting considering that you don't actually have to have an injury to develop chronic pain. So, there's all these different factors that can contribute to the likelihood of someone developing this.
Sam Visnic: And in particular, jumping back a little bit as we talked about. Two things in particular anxiety and depression are predispositions to the increased likelihood of developing chronic pain. Okay, So, certainly that having anxiety and depression is the result of chronic pain, because pain is having an impact on people's lives. But it's also a factor that if it's present beforehand.
Sam Visnic: Now, we know that there's also genetic predisposition in some cases to having anxiety and depressive disorders. So, therefore, the question is, can people have, from a genetic standpoint, increased likelihood of developing chronic pain? And the answer to that is we think, yes.
Sam Visnic: Okay, so these things are all interwoven together, considering that chronic pain itself is really not a thing. Okay, so let's talk about that real quick. So, there are no pain nerves in the body. There's no pain fibers in the body. What's happening is we have inflammation receptors in our tissues. So, you have all these sensors, if you can think about it, all over your body, all over the place, your joints, your muscles, et cetera.
Sam Visnic: And these sensors send information to the spinal cord and on to the brain about just kind of the general status of things that are happening in the body. So, temperature changes, stretch, compression, anything that you can feel, you have these sensors can pick up and send to the brain.
Sam Visnic: Now, that information is generally just potential. So, if there's a lot of pressure on a muscle or nerve, there's an increased amount of information that goes to the spinal cord to the brain, but it's not painful until the nervous system determines that it's threatening and then responds by generating the sensation or the experience of pain to tell us to do something about it.
Sam Visnic: And we've had lots of circumstances, all of us have had this, where you've had tissue damage, but you never felt any pain. For example, have you ever woken up, look down, and you saw huge bruise on your leg? And you're like, "How the hell did I get that? I didn't feel any pain."
Sam Visnic: So, at that moment, the nervous system deleted it. It wasn't important. And then, other times where you have basically pain and no injury. Somebody bumps you and you go, "Ouch." And then, that didn't actually hurt. It was almost like a reflexive response. So, pain is this complicated thing that's really an evaluation that takes place over the information that our bodies are receiving. And that's kind of where another level of where things get pretty cool. But how we determine pain is influenced by a great number of things.
Chris Scott: Okay, so does brain, or I'm sorry. Does pain emanate from the brain or the spinal cord? Do we know where that subjective sensation to the extent that it is subjective emanates from?
Sam Visnic: Yeah, and that's where you'll hear a lot when people talk about chronic pain, that pain isn't the brain. And really what it is, is it's let's make sure that we're very clear about this is that pain in the brain does not mean it is a psychological phenomenon. Okay. So, psychological is like you be talking, we have awareness, and so forth.
Sam Visnic: I couldn't right now just generate pain in my body. I couldn't psychologically just get myself to that place. But the processing unit in the brain, all of those different structures that take in the information from our body create an evaluation of it is what is generating that threat response. The threat response is almost so noxious that it gets your conscious attention to get you to do something.
Sam Visnic: Now, the challenge with chronic pain is when you have acute pain, and you have pain, and you look down and you roll your ankle, and that thing looks like a softball, our brain goes, "Well, yeah, don't walk on it. It's injured." But when we can't see it and we see that there's nothing wrong, we can't visually understand why that's occurring, it becomes stressful to us. Because we don't get why we're in pain when we can't see what the problem is. And this starts to generate a whole host of problems for the conscious mind. Your thinking can start to actually influence the pain.
Sam Visnic: So, remember how I said that the information has to go from the body to the spinal cord. The spinal cord essentially has a gate. It's a dorsal horn. And the gate is open or closed. It determines how much information that's coming from the body actually passes the gate and then goes up to the brain. So, that gate is influenced by a number of things, biochemistry, et cetera, but also how concerned you are about your problem.
Sam Visnic: Now, when you don't understand why you're hurting, and you have pain, and you're worried about it, and maybe you have a lot of anxiety because of how your pain levels are affecting your ability to get work done, you might lose your job, or if you're an athlete, that maybe you're not going to get back to playing your sport, then you're more concerned and put your nervous system is more on guard. It's more vigilant. Then that gate is going to be more open. And it's going to allow more information from the body to go up to the spinal cord because it's relevant and important information.
Sam Visnic: But when we're not concerned generally and we understand why we're in pain, and we understand these factors, and let's say we're actively taking steps toward resolving it, that gate starts to close. And what happens is we perceive less of that information coming from the body and then it doesn't bother us as much. So, we always say that pain is not caused by your consciousness, by your psychology, but it's definitely impacted by it. So, it can be a factor in the process as well.
Chris Scott: Okay. So, one of the things I noticed when I quit drinking was that working out seemed to decrease my anxiety, my depression and the sense of fragility that I had, which was the probably closest thing that I can think of in terms of experiencing chronic pain. After quitting drinking, my neurotransmitters were all over the place. I had a lot of deficiencies, chemical imbalances. Alcohol was so bad for your biochemistry, especially in a chronic sense.
Chris Scott: And my speculation, and this seems to be backed up by some things that I have some research I dove into, was that I had a deficiency endorphin. And so, I hypothesized that working out and taking certain supplements such as D-phenylalanine, which decreases the rate of endorphin breakdown in the brain often paired with L-phenylalanine, and a product called DLP, which was huge for me, because I got my dopamine back a little bit and my endorphins seemed to stick around for longer. I could decrease that sense of fragility and start feeling normal.
Chris Scott: So, do you think, and maybe this is just speculative. But I guess what do you think of the role of endorphins in pain awareness and pain levels, generally, for people?
Sam Visnic: I think that because of the nature of chronic pain, and it's so complicated, that there's so many different things that affect it. And in particular, when you look at something like exercise, exercise has so many different effects on the body. I mean, it's just almost difficult to peel it apart to understand which parts are making the difference. And in particular, exercise has been studied ad nauseam when it comes to chronic pain. It is one of the most effective things that you can do.
Sam Visnic: Also, when you're looking at things like depression, for example, look at the research on exercise and depression, it's hands down obvious that exercise is one of the best things that you could possibly do. And I think I read somewhere, it's in my digital book as well. I can't remember which section it's under. But in terms of recommendations for health, virtually unless there are specific conditions in which you should not exercise, exercise is the most universal positive thing that you can do for anything.
Sam Visnic: But the problem that we have there in the research, what I found is that there is a lot of distinction between aerobic cardiovascular exercise and strength training. It's just not done. It's not separated very much. I don't know why. But in particular, just moving, and we know the association between doing aerobic cardiovascular exercise and endorphins, the runner's high and so forth. But it's not as if it doesn't happen when you do strength training.
Sam Visnic: So, any form of exercise, I think, really, when we talk about the difference between the two, it's going to come down to intensity as well. I mean, you could lift weights in a aerobic capacity if you wanted to. But certainly, we're usually what we associate to that is certain repetition, range, and so forth. So, we're definitely getting changes in the nervous system.
Sam Visnic: And in particular, I think that something that's valuable there is the adaptation response. First, surely, when you're doing something like cardiovascular work, you're altering your physiology, the state of your physiology. If you're doing something in particular that's rhythmic, that's repetitive over and over again, it starts to induce what we would call as a hypnotherapist, I would use this language, a trance-like state.
Sam Visnic: And oftentimes, that trance state knocks your physiology out of the state that it was in before. And if that is in some other nonproductive state, then obviously, that's going to be helpful to the person. But this adaptation response is also something that is, I think, may not have been focused on, which is that when you trigger adaptation in the body to get stronger to accommodate to some kind of stress, then we get a whole lot of other things that are beneficial. We get increases in growth hormone, probably IGF-1 testosterone. And if we look at that crossover wise, what are the effects of testosterone on depression and anxiety?
Sam Visnic: And again, we know that deficiencies in some of these hormones are associated with those conditions. So, certainly by kind of triggering it all on our own and using this wonderful pharmacy cabinet we have inside of our brain and our nervous system, it's probably going to even be far more effective because it's dosed appropriately. And it's what we call, not bioavailable, but it's bioidentical. It's more along the lines of what your own cells and receptors are familiar with.
Chris Scott: Okay. So, do you have a lot of people who come to you for help who have been using harsh pharmaceuticals and have gone through all sorts of different surgeries, perhaps. And when you do, what are the kinds of things that you start with in order to help them get better? I know that's a broad question, because I'm sure there are all sorts of different types of chronic pain.
Sam Visnic: Yeah.
Chris Scott: I think our audience would be interested to know, let's say, someone's been taking painkillers for a while. We have a lot of people who have a dual addiction to alcohol and painkillers, or they've been drinking for 10 years, in part to manage chronic pain and they're also on an antidepressant. It's hard to disaggregate what everything is doing that they've been on for them. So, what's the starting point for people like that when they come to you for help?
Sam Visnic: Well, that gets a bit complicated, because first and foremost, it's not a physician. I can't advise people on medications and so forth. But in particular, I find it interesting and it helps me to know what kinds of medications people are using. Because the way that I look at it, there are just multiple categories of pharmaceuticals that work on different pathways when it comes to pain. So, you have the opiate class, which is modulating certain receptors and we know basically what that does. That can literally shut off that perception of pain.
Sam Visnic: So, then we also have things that are anti-inflammatory in nature, simply ibuprofen, such as using Celebrex, prescription anti-inflammatory. And then we have other types of drugs as well, like number one is the benzodiazepines like Xanax and so forth can actually reduce pain. But think about the mechanism by which that does that. Benzodiazepines are anti-sympathetic nervous system activity drugs. So, what they do is when somebody is like real amped up, it calms them down.
Sam Visnic: Now, remember back that we talked about whereas the psychology, if you're really wound up about your pain and it's stressing you and then you're kind of getting into that cycle, Xanax, if it knocks you out of that, and then pain goes down, it can give us a clue of certain types of therapies that might be effective for that person. They're getting angry about their pain. They're getting frustrated. Or they're worried and concerned. That exacerbates pain. And that's a different pathway of stress that contributes to pain than what might be blocked with the opiates.
Sam Visnic: And then on the other end here, the spectrum as we talked about with the benzos, there's another classification of drugs, too, that might be prescribed or antidepressants. SSRIs are very popular, things like Lexapro and so forth. Antidepressants are oftentimes used with more centralized versions of pain, like fibromyalgia.
Sam Visnic: And fibromyalgia is the type of pain as that the nervous system is just basically stuck on high vigilance and alert. And it's malprocessing a lot of input into the system with a degree of overwhelm that is causing threat constantly. So, that person might be on multiple drugs to manage certain aspects of the pain experience.
Sam Visnic: So, it's helpful again, to know in talking with people, what medications they're using and feedback on to what degree it's helping them and how they think it's helping them. Because they're literally giving me the answers a lot of times on what area that I can support them in. And that's very helpful. And from that, I would say that a lot of people, in my experience, especially with my kind of work, are actively trying to not be on medications anymore.
Sam Visnic: I think there's a lot of people that don't want to be on meds, and in particular, because they're looking for solutions, especially in this realm. So, obviously, you work with their doctor, but in particular, what I do is alter that information that's going in from the body to the brain. And as that starts to change, then people's pain experience will change.
Sam Visnic: And a lot of people will start to, first of all, right out of the gate, will say to me, "These meds don't really stop my pain. They just kind of distract me or it makes it more tolerable." So, they're able to discriminate the feeling of what the medications are doing versus the part of their awareness that is based upon the pain itself.
Sam Visnic: So, as you start to modulate or altered the pain, it becomes obvious a lot of times to the person that they need less of the medications and that way, they may communicate with their doctor about what they need. And it's just basically trying to take a team approach from there.
Chris Scott: Interesting. So, I know a lot of people have been using supplements like CBD, hydro CBD or turmeric. And there are a bunch of other herbs that help to reduce inflammation. I've heard it said that inflammation could be a cause of pain. But whenever I try to work through that, I'm thinking, well, yeah, I know chronic inflammation is not a good thing. But is there a chicken and egg problem here, what's really going on and what's causing the inflammation? And is that the root cause?
Sam Visnic: Yes. And so, there's a lot that goes into this and so much that my wife is an expert in clinical nutrition, and in particular, with complex gastrointestinal problems. And so, we're dealing with this kind of stuff all the time. And this is, again, one of those precipitating factors.
Sam Visnic: So, in particular, when we talk about what is inflammation, and where does a lot of it come from, well, there's a lot of factors that contribute to inflammation. But indigestion, which is very common source of inflammation for a lot of people, mainly in this realm of dealing with pain because of the medications that they're taking.
Sam Visnic: And nonsteroidal anti-inflammatory drugs like ibuprofen and so forth are known to irritate the GI tract lining and can contribute to what we would generally call a leaky gut, which is basically an irritation of the gut lining in a way where these gut barriers start to open and allow basically antigens to develop inside of the GI tract, which trigger inflammation. So, the immune system starts reacting to this.
Sam Visnic: And the problem is, is that when the immune system reacts to things as if foreign invaders are coming into the system, it develops immune complexes, and these immune complexes float out into the system, and they can irritate nerves that are already sensitive.
Sam Visnic: We've all had this experience of when you get the flu, or hopefully, people haven't had to deal with too much COVID out there, but if you've been sick with that, or had your booster shot, or any of that kind of stuff, you know how much your body aches. Now, there's an explanation for that. Because when the immune system gets upregulated, it makes things sensitive. And if you have an old back injury or a knee injury, then all of a sudden, those things can kind of, for lack of a better way of putting it, get reactivated and bother you while that immune system is flared up.
Sam Visnic: Now, as the cycle continues, you have more pain, you take more anti-inflammatories, you keep generating more leaky gut issues, the inflammation cycle continues and continues. Now, the problem here is, is that, and I talked about this specifically with my wife on the podcast episode we did is how do you handle this with supplements and do they work. The research supports that turmeric works, these sorts of things. But the problem is, is that it's kind of like trying to put out a fire while simultaneously squirting lighter fluid on it. You're not going to have much of an effect.
Sam Visnic: So, in a vacuum, yes, it does work on inflammation. But when you look at the whole situation of what's going on with somebody, the best thing to do is to try to get to the primary source of the inflammation and try to cut that down. And then, the supplements and so forth can have an effect to the degree that it's relevant for the individual.
Chris Scott: So, the supplements can be helpful in the short term, maybe even in the long term in some ways, but the best thing is to attack the inflammation at its root, especially when that's contributing to some kind of chronic pain. And I guess in the example of alcohol, which we know contributes to leaky gut and gut dysbiosis and can corrode the lining of the digestive tract.
Sam Visnic: Yes.
Chris Scott: Excising the alcohol is an important thing, or at least cutting down, depending on what someone's goals might be. I know we have guidelines for people for so-called moderate drinking, that it's always seems silly to me. And this is just a personal opinion. But to have daily guidelines for something that toxifying your gut seems like a bit of a weird thing, and I'm not a prohibitionist. But it would seem to me that, and we have increasing studies coming out showing that there's no safe level of regular alcohol intake.
Chris Scott: We know back in colonial times, people would drink five or 10 units a day in some places. And that was considered normal. And now, it's one or two or three or four for men somewhere and one or two for women. But it always seems best to just excise the problem or the root cause of the problem, especially when something like chronic pain is in play.
Chris Scott: And one of the reasons I think this I'm so excited about this episode, and I think it's so important, is that we have a lot of people in my course who are dealing with things such as arthritis or fibromyalgia, and then also alcohol, vast amounts of alcohol consumed over a long period of time. And it's not intuitive necessarily to think that there might be a relation between those things. But I think from what you're saying, it sounds like anything that could impact the gut negatively could lead to chronic pain and inflammatory conditions that cause pain. Is that right?
Sam Visnic: Yeah. And it's not always easy to detect and it's this constant problem that we have, which is it's similar to when somebody experiences low energy and just using this an example. If somebody is exhausted all the time and they're fatigued, they think something's wrong. They go to the doctor. They run the lab tests. And metabolically, the person's body's working properly, so there's no explanation for the low fatigue.
Sam Visnic: So, a lot of times, people are experiencing food sensitivities. And one of the things that kind of bothers me, although I understand where they're going with this, is that people get pissed off online about why does everybody all of a sudden have gluten intolerance and so forth, and you're fine, you have no problems with it.
Sam Visnic: Well, if I eat a substance, and I eat broccoli, and I have a food sensitivity to broccoli, and it gives me brain fog, that is my experience. And it doesn't matter if research shows that 1% of people or whatever have celiac disease, that is not the same thing as having food sensitivity. And when you have an immune system that is overreacting and you're developing these kinds of food sensitivities, that's what is happening. So, it literally is an individualized problem.
Sam Visnic: So, we can't take these overly generalized dietary approaches or overly generalized food sensitivity things, "Oh, if you just take out these six foods, then you're going to get rid of your inflammation." That's bogus. Because everybody can respond to lots of different things. I can eat candy and have no problems. But if I eat a red pepper, my stomach's going to feel like it's completely bloated. And I'm going to get canker sores in my mouth. So, explain that. That's a healthy food.
Sam Visnic: So, as an individual, we always have to work with the individual. And yes, there are some generalizations that we can make. It's just like saying, if you have low back pain, you should exercise. It's good for you. But saying that any exercise is fine is going to work for some people. But in other people, it's going to be problematic, because of the form of exercise that they choose, or the dosage or whatever. There's always a way to be more specific.
Sam Visnic: So, what I feel has happened, unfortunately, is a lot of people that have been given generalized recommendations may not have fully benefited from it. And then, they basically think that they're not helpful or nothing's going to work for them, when they really just haven't been exposed to something that is more personalized to their unique experience to help them. And I think that's where a lot of the ball gets dropped in this field and why practitioners like me exist, because I'm willing to dive into the weeds with people and figure out what is specifically happening with what their system is responding to.
Chris Scott: Right. Everyone's biochemically unique, also psychologically unique.
Sam Visnic: Absolutely.
Chris Scott: I'm glad you mentioned fibromyalgia earlier because I dated a great girl several years ago who had fibromyalgia and I couldn't understand it for the life of me. And she had gone to various doctors and that some of them said, "It's in your head." Another one prescribed one of the ... It wasn't Percocet. I'm not an opiate expert.
Sam Visnic: Hydrocodone.
Chris Scott: Hydrocodone, that's right. So, he prescribed hydrocodone. I've never taken it. So, she developed a, I won't say addiction, but physical dependence to that. She had to take it every single day and didn't know how to stop taking it. And she found that marijuana was extremely helpful for her, but she didn't like feeling out of her head. So, it's kind of like this catch 22. And here I am giving her magnesium and CBD and turmeric. And that kind of helped, but not really.
Chris Scott: So, can you just touch on fibromyalgia once again? Because I'm sure there are people who can relate to that kind of experience. Because hopefully, maybe in the last three or four years, we've actually made progress in helping people with that. But my suspicion is that a lot of factors are still dismissive of it maybe condescending to the patients.
Sam Visnic: Yeah, unfortunately, the honest truth is no, we have not made progress on this. And one of the reasons why is because it's just not a focus. The diagnostic model is ultimately concerned, first and foremost, with just figuring out what the diagnosis is. And when there's a diagnosis of chronic issues that are not necessarily immediately treatable with something and they're multifaceted, oftentimes just kind of get pushed off to the side. There's a maintenance regime of medications that are oftentimes used in this condition. And that's it. Once they, hey, check in and we'll adjust your medications over time.
Sam Visnic: Now, because there are no experts on fibromyalgia for the most part within the medical system, they're oftentimes managed by a rheumatologist, which is an immune system doctor essentially. The immune component is not the only thing that is going on, so they oftentimes just kind of like have huge holes in their therapeutics. So, let's back up for a second and let's talk about what this is. There's different kinds of pain. And these are all arguable in the way that they're explained.
Sam Visnic: But in particular, let's just talk about basic pain, which is back issues or your knee hurts after you squat. A lot of that is driven by that information that we get from the joints that goes up to the brain, and it's called nociception. Nociception is that nociceptive pain. It's oftentimes easy to manipulate by doing exercises, stretches, manual therapy, and so forth. Ice is an easy way to inhibit nociceptive output. So, that's generally what we're used to seeing when we're dealing with usual aches and pains.
Sam Visnic: Now, outside of that, the next thing is going to be more of what we call neurogenic pain. And neurogenic pain is essentially where there's injury or damage to the nerve information, the nerves that are sending that information to the brain. Having sciatica, for example, or having carpal tunnel syndrome, or even explaining things like a little bit more like, what would I say here, occipital neuralgia, some of these kinds of things that people might have issues with. So, that kind of stuff is more of that nerve-based pain.
Sam Visnic: Now this third category, which is something that you're starting to hear about a lot more is called nociplastic pain. And nociplastic pain is where the information coming from the body to the spinal cord is not necessarily the problem. It's the brain's processing of the information. So, imagine that brain is being just excessively upregulated, where it's on damage control, red alert all the time.
Sam Visnic: Now, any information that comes in can potentially be assigned a red alert or a threat response. It could be as simple as you sitting there working and the air conditioning turns on. And when the air conditioning hits the nerve receptors on your shoulder, your brain literally thinks somebody poured napalm on your shoulder. That's sometimes how severe these kinds of conditions can get.
Sam Visnic: Now, because the system is just working overtime and being threatened constantly, it can have a variety of effects. This frustrates medical professionals. Because oftentimes, the person will come in and tell the person, "Look, the air conditioning comes on and I feel like somebody put a hot searing coal on my shoulder, whatever," that doctor is going to look at their neck, run an MRI, and they're unlikely to find much.
Sam Visnic: Or they'll find a minor disc issue or a little bit of arthritis. And they'll say, "Well, that's the problem." Well, it's not the problem. The problem is that the person's nervous system is generally overresponsive to stimuli.
Sam Visnic: So, once they kind of rule out the basics, the usual kind of mechanical issues and so forth, that pain is oftentimes from an orthopedic way blamed on, then what they're going to do is they're going to kind of, by an exclusionary process, rule out things and then give the diagnosis of fibromyalgia. So, it's really an exclusionary diagnosis. It's nothing else, so, it must be this.
Sam Visnic: Once that category, then it's given by standard of care those certain treatments, which are going to be Lexapro or some kind of combination or concoction of medications, which is not wrong. Because a lot of people with fibromyalgia have the issues that it's going to help them and that's the end of the line, and then they never really get anything outside of that.
Sam Visnic: Now, a lot of these people with fibromyalgia are oftentimes going to seek physical therapies, massage therapy, physical therapy, et cetera. And the problem here is whether or not those clinicians are actually knowledgeable about nociplastic pain. And I would say, 99% of the time, they are not. So, what they do is they're oftentimes heavy handed with manual therapy, excessively, pushing with elbows and grinding on things to break up knots and adhesions. And that person's nervous system may have a decent response.
Sam Visnic: I've got some people with fibromyalgia, that they can handle a lot of pressure with massage, and they love it. And other people, if you tickle them with a feather, it's going to put them in pain the next day. Because you never know how their system is going to respond. Even sometimes they don't.
Sam Visnic: So, if that therapist is not sensitive to the degree of sensitivity that that person's nervous system has, they're constantly going to be stuck in what I call the therapy grinder. And they're going to be going to therapist, the therapist with a bazillion different explanations on what's happening with them. And one of the hallmark signs of dealing with the chronic pain cycle is getting multiple diagnoses with subsequent treatment failure, and therefore, loss of hope. Loss of hope increases brain threat response, and that increases nervous system sensitivity and around and around we go.
Sam Visnic: So, my job is to try to create an intervention in there somewhere. One of the first things that I do with people with fibromyalgia is I teach them about pain. And what we're talking about now, and funny enough that pain neuroscience education is therapeutic. And probably, for this exact reason that you imagine is that people don't know this. And when they know this, you could see them kind of sit back in their chair and be like, "Why didn't my doctor tell me this?" Which funny enough is the name of my eBook.
Sam Visnic: So, this process of just educating is calming that, yes, psychology down, so that we can start to kind of understand this circumstance. And there is nothing bizarre or peculiar about that situation. And in therapy and psychotherapy, this is very important, to sit down with a therapist and explain these happenings. And a lot of the time, the therapist is going to go, "What you're experiencing is completely normal."
Sam Visnic: And in that world, it's part of the process that they're saying whether that's an anxiety disorder, depressive disorder, or whether it's a chronic pain cycle is helping people understand that what they're experiencing makes sense. And that there are things that you can do about it. And literally, before we even start diving into the movement stuff, we got to get to that place with people first.
Chris Scott: I've had some friends who have read John Sarno's books, and some of them had slipped discs or various things that doctors wanted to operate on them for. I had a friend, who worked in finance, high stress job, recently married at the time, expecting a baby, all the familiar stresses. And all of a sudden, his shoulder first, out of nowhere, and he could barely get out of his car. Usually people have to open the door, and then you get up. This arm just wasn't working. And it would come and go. And it was the most ridiculous thing.
Chris Scott: If you read one of John Sarno's books about TMS, which is why I read one of those books. And I read it for different reasons. I was looking for parallels about addiction, which someone calls a TMS equivalent. I partially agree with that assessment. I think that there are definite intertwinements, if that's the word, interrelations between the biochemical and psychological and even spiritual pillars of life.
Chris Scott: And yet, for this guy, my friend, it seemed that all he needed was to understand or at least to have to bring something from the level of subconscious or unconscious to conscious. And then it was like the jig was that the body couldn't get away with, or maybe the space closed, such that the brain started considering certain information irrelevant. Do you have any guess as to what could have been going on in that case?
Sam Visnic: Yeah, that's a perfect example. What I say is that Sarno's books had kind of kickstarted a more, I would say, just an inflammation kind of segue between this information and what the therapeutic field knows and the general population. He explained it and got that information out there. We know way more. Now, I used to say that John Sarno was 33% right, which he would take the component of it that was explaining pain or giving an understanding about how those factors might work.
Sam Visnic: Now, we use something different, which is much more studied, called therapeutic neuroscience pain education. It's just a concept of teaching people about pain and using metaphor and connecting it and so forth to what people's experiences are. So, I'd say it's a more crude way of doing it, what he was talking about. But certainly, Sarno was a believer that there was structural based pain, of course. And a lot of times there are multiple factors that need to be done.
Sam Visnic: But I think that some people, and I've had plenty of cases where by the time I taught someone pain education, that their problem had been 80, 90% resolved. But we still needed ... That's what we call a top-down approach, which is teaching the person the concepts, but it still has to get into the system. I've had a lot of people that I've taught pain neuroscience education. And logically, from a left brain perspective, it's sinking in, but it doesn't sink in in what we call deep learning. And that's another type of problem.
Sam Visnic: And this is common, where we go into the therapist office, and everything makes sense, and we have these ahas. But then, we leave that therapist's office and the rubber doesn't hit the road. It doesn't get into our neurology.
Sam Visnic: And I talked with a specific cognitive behavioral psychologist, who's a specialist in neurolinguistic programming and his own verse of neurosemantics, which developed a mind a pattern, a psychological pattern called the mind and muscle pattern, which explains why we have a hard time getting our thoughts into our neurology so that we actually change our behavior, which is kind of like the whole concept of why cognitive behavioral psychology as itself is an effective therapy rather than traditional psychotherapy counseling.
Sam Visnic: But these things are like, it has to get into the neurology. And in that case, that person had a mechanism inside of their mind or in their neurology where they learn something and then it integrate it, and then you have the results.
Sam Visnic: But a lot of people, it doesn't always work that cleanly. You have to teach it to them. But then we have to do exercises and movements to get the nervous system to link the understanding to what is occurring in the physiology from what I call the sensory perspective, what they're feeling, in order for things to click into make sense. So, as always, it's just kind of like at first glance, you could take something and a group of people are going to respond to that in that way.
Sam Visnic: But my concern or my fear in that situation is, is that people will expose themselves to that material. They may not respond in the same way that he does, and then think it doesn't work. And that's unfortunate. Because in the hands of somebody who understands what I just talked about, the success ratio is going to be significantly higher.
Chris Scott: One of the things that I didn't like just instinctively when reading Sarno's book was his recommendation to throw out chiropractic, throw out massage. I think he said exercise was good, because it would prove to yourself that the pain was in your head. It seemed like a revolutionary and potentially partially accurate description of a very complex phenomenon, and maybe something that was vastly better than the primarily pharmacological approach that existed prior to that, or surgical approach.
Chris Scott: And yet, everything you're saying resonates with me. And again, I'm a layman for this kind of thing. But it seems to make sense. And I know while I haven't had chronic pain, per se, I do use a chiropractor. I have a very good one in Savannah. I have no idea why it helps. But it seems to help me.
Chris Scott: I do mixed martial arts training three times a week, anywhere from three to nine hours a week, depending on how much time I have. And I've had little aches and pains that I'm aware could amplify into chronic pain if I'm not careful. And I've had friends and workout partners who have had chronic pain that has stemmed from some particular injury.
Chris Scott: And so, I have this kind of, at least, idea in my mind that I need to keep conditions in my life such that I don't allow my brain or nervous system to seize upon some minor injury and make it a big deal over time. At least, that's my subjective assessment of the issue. And I feel that going to the chiropractor, getting a massage, it's I say deep tissue massage, but more accurately, it's a combination of various massage styles accumulated by my very talented massage therapist, Swedish, I honestly don't know all of them. But there's a bunch of different ones. And she's really good.
Chris Scott: And I actually had one yesterday. And I could tell my sleep cycles were deeper. I feel better today than I did. And if I go more than two weeks without it, my body starts getting a little bit restless. I can feel my nervous system ramping up a little bit. So, that's my subjective understanding of how I'm trying to prevent chronic pain from developing. And I have the sense, too, that you see value in these other therapies that Sarno kind of threw out.
Sam Visnic: Yeah. And I think first and foremost, because that discussion, I'm sure, is going to come down the line here is how do you how do I perceive chronic pain. And first of all, I think that what's the most important thing to avoid developing chronic pain is to understand pain. The more you understand pain, you're not threatened by it. And I'll give you a few statistics out here.
Sam Visnic: For example, if you look at the rates that health professionals, medical doctors, nurses, and so forth, returned back to work after developing a pain episode, it's significantly faster than the average person. And one of the reasons why is because they couldn't explain pain probably as well as I'm doing it now. But they generally are familiar with the terrain. A lot of nurses resist, they have a lot of nurses who are clients of mine, resist medical treatment when they have pain.
Sam Visnic: And it's because they're like, "Oh, well, I see how that goes." And they don't like how the system works. And they're afraid of developing addiction behaviors and so forth around these things and around pain. So, they return back to work faster. They know as recommendations are is to get back to movement as quickly as possible. They're less likely to have bed rest. So, these things are very important.
Sam Visnic: Another component is the context in which the issue is developed, influences the development or the likelihood of development of chronic pain. Okay, I'll give an example of this. Demolition derby drivers, you know the guys who crashed cars into each other when they do events? So, the average demolition derby driver competes at something in the neighborhood of like 100 events. Don't quote me accurately. I always forget how many, but it's a lot. Let's say 100 events.
Sam Visnic: And on average, they get into at least 50 car accidents per event. And the average speed at impact is 24 miles an hour. Have you ever hit anybody or been hit at 24 miles an hour? It's not a gentle bump. Now, as many car accidents as they get into, the incidence of reported chronic neck pain in particular amongst demolition derby drivers is staggeringly low. It's like 2% or less.
Sam Visnic: So, football players, the same thing. If any of us were walking down the street and you had a 250-pound lineman hitting you at full speed, your chances of developing chronic pain are probably pretty high because that situation is unexpected. But when you're getting hit, how many times is the average tailback get hit in a game? And then over the course of their career?
Sam Visnic: Why do they generally have less occurrence? Or how can they take so much more before developing pain. Because the environment and how the nervous system assigns meaning to that event changes the chronicity cycle. Right now, clearly, they have mechanical issues in which structurally that is likely to contribute to the pain. But what's missing is all of the other stuff is the interpretation of the event. Okay. So, it's fun, and you're working toward a goal, et cetera. Okay, so it changes how you experience it.
Sam Visnic: So, when you understand pain, and for example, when you go to the gym and you deadlift, and you understand that what the research says that when you deadlift, you're not going to blow discs out of your spine, and all this kind of stuff. Number one, that's making changes. Because every time you go lift up the bar and you do a one rep max, your brain isn't going off on how you're going to be injured and developing chronic pain.
Sam Visnic: So, you see how all of those things make a difference simply from the educational perspective. And I'm not even talking about technique. Now, when you work with professionals, I also work with somebody who teaches me how to lift properly. I also work with a massage therapist who's going to loosen up my muscles and keep those healthy. I work with a chiropractor to make sure that my joints are as mobile as they can be in. It's a supportive atmosphere to doing all of those things.
Sam Visnic: Now, what can get in the way, unfortunately, and this is my only problem against health practices, is the narratives that they oftentimes install in your head that are not true. This is the problem with the mainstream medical system and why they don't like alternative health practices sometimes. Because the research clearly shows when it's been done in meta studies and so forth, that a lot of the things that the practitioner say they're doing are not true.
Sam Visnic: I'm a massage therapist, and there's loads of nonsense that massage therapists tell people that they're doing when they're doing the work. Almost everybody walking in the door, it's a given that when a massage therapist put their hands on somebody goes, "You're so tight." Okay, well, okay, so somebody doesn't do anything all day long and they're deconditioned, and they're super tight, I mean, that's probably an issue. It's like, "Hey, you're holding your shoulders around your ears, you got to relax those."
Sam Visnic: But to pathologize muscle tightness constantly is a problem. If you're an athlete and you're squatting three times a week, and that athlete comes in, and I put my hands on their quads, and it's tight, it shouldn't be, because it's a problem if it's not. If you're squatting three times a week, and there's no muscle tone to your quadriceps, so what help is it to dig on somebody and go, "I got to get that tightness out of there." Rather than saying, "I'm going to keep this tissue healthy and keep working on it to improve its elasticity, stretch, et cetera, so you can keep squatting," that is good information.
Sam Visnic: Telling people that their spine is out of alignment and that vertebrae are popped out and I got to put them back in and all of this stuff, that is not helpful. There's not a shred of evidence that shows that you can see a spinal subluxation or a joint that's out of position on an x-ray, unless you've been in a car accident.
Sam Visnic: So, one of my pet peeves about that, and I understand lots of chiropractors know exactly what I'm talking about. But I'm making an issue with the language that they use that they tell their patients to be cautious of what they might be installing in that person. Because it sounds initially terrifying for me to go into a chiropractor and say, "Hey, your spine is out in three places. I'm going to put it back in." That sounds pretty terrifying, because what if they miss? Could they pop the vertebrae out the other side? I mean, you got to think about the movies that people play in their head when they hear this stuff.
Sam Visnic: And that's going to make me more tense and more guarded. When that the thrust manipulation is being applied, there's more likelihood to have a reaction to that because I'm threatened by what's happening, all because of the story that I was told. Rather than saying, "Hey, you see how this joint works. You see how I pop that? Does that feel threatening?" And the person's going to go, "No, I'm going to do that at your spine. And it's going to change how those little receptors in the joints are sending information to the brain that's going to calm stuff down and it's going feel better." Doesn't that sound less threatening.
Sam Visnic: And they'll go, "Well, it sounds less magical when I say that. That doesn't change the fact that it's going to work." But it definitely helps the person in a lot of ways to understanding how complex the nervous system is and the things that we can do to help somebody without, again, forcing more threatening information on them.
Chris Scott: So, you mean, I can tell my skeptical family members that the chiropractor actually does something?
Sam Visnic: Yeah. And when I tell them is the same thing. I have so many people I've heard that are afraid of chiropractors, I'm like, "Do you have any idea how safe that is? There's two spots in the spine. That if you adjust the upper neck and it's a one in a million chance that you can tear a vertebral artery, that's a problem. So, I don't let people generally adjust my neck because I don't feel comfortable with it, or my lower, lower lumbar spine, all the way at the bottom if there's a severe degenerative condition."
Sam Visnic: And again, these are simple red flags the majority of chiropractors are aware of. But the chances of getting injured at a spinal adjustment in your mid thoracic spine is so little. But again, that's the narrative because people play movies inside of their head about what is going on when they're being adjusted. And if they were shown that properly and likened it to copying a knuckle, they wouldn't be so terrified by this and more people would probably go do it and probably feel better.
Chris Scott: I just like to reiterate, I had heard about the risk of adjusting the neck. What did you say the risk was there? And what's the probability of a serious problem?
Sam Visnic: Well, the problem there is that you have arteries that go up through the vertebrae. And in the upper portion of the neck and the first couple of vertebrae, they're more generally exposed. So, the problem there is, is that some people, the way that their arteries are, depending on how tight the spaces are up in there, a mobilization to the neck can actually tear the artery. So, having a what we call a vertebral artery event, somebody could stroke. And yes, that can happen. And generally, there are precautions.
Sam Visnic: And this has been known for a lot of time in the manual therapy field, 40 years, that most of the adjustments that come with the head and extension tipped back and rotation are generally less safe. Because it exposes that vertebral artery to that stress. So, again, an appropriate health professional that is educated on the topic, low risk, but also informs their patients of the potential risks of these things should always be there.
Sam Visnic: And the person has the right to obviously say, "I don't want my neck adjusted. I don't feel comfortable with it." But statistically, it's extremely low. And if you want to talk about statistics, the chances of getting a wrong prescription at the pharmacy and getting an injury there, it's probably higher. So, you got to always weigh out risks. Like the idea of getting bitten by a shark, so many people are terrified of great white sharks. But your chances of ever encountering one.
Sam Visnic: When the movie Jaws came out, it was like a miracle. It's the best thing ever for the psychotherapy practice. Because people wouldn't go get in their bathtub and they lived in Kentucky because it could be a great way to ... But this is how minds work. And we play movies in their heads. And yet, that's one of the most important things to me is that I don't ever assume I know what's going on in someone's head.
Sam Visnic: I ask them. And I go, "When you think about me doing this technique or a chiropractor doing this technique, what movie do you play in your mind that terrifies you about this, because that might be inaccurate. And your nervous system is going to respond to the internal movie that you're playing, not to the actual reality of what's occurring."
Chris Scott: Right. Well, this has been extremely illuminating. We're coming up on almost an hour of talking here. I feel like we could do a three or four-hour podcast. But I think instead of that, I'd love to have you back on at some point. I do want to give you a chance to talk about anything that we may not have covered that you think is important here. And also let people know where they can find you and your podcast and your services.
Sam Visnic: Yeah. Well, I would say that when it comes down to the actual components of getting into it and the things that I think are the most important, if there's one thing I could tell people is learn about pain. Pain education is probably the most important thing. And the number two thing, which we didn't even talk about, which is sleep.
Sam Visnic: And most people are not aware that a lot of the issues that they're dealing with are not necessarily psychological. I know we see counselors. I am such an advocate of helping people overcome the stigma associated with going and working with mental health care professionals. It drives me bonkers that they're underutilized. And again, I feel it's because of stigma.
Sam Visnic: But going to mental health care professionals, a lot of times things that we're working on in places that we feel stuck, it's because our physiology is out of balance as well. So, don't just spend all your time just doing those things. But look at the other areas. If you don't sleep well, improve your sleep. When that brain is rested and your chemistry is in a better state, you're going to respond better to your psychotherapy work. You're going to respond better to your exercise work. You're going to tolerate more. Everything works together.
Sam Visnic: We oftentimes, I don't make everybody do all that stuff at once, but we start the process. And if they start to feel like they get stuck, we work on it a little bit. But don't keep banging your head up against the wall. Look at the other areas of your health and your wellness that are out of balance and bring them into balance and you'll start to see a feed forward process of everything and prove it. So, again, addiction very highly associated with sleep issues.
Sam Visnic: And we talked about fibromyalgia, something like 80% of people diagnosed with fibromyalgia or sleep and insomnia. The number one gold standard for insomnia is cognitive behavioral therapy for insomnia. A specialist who does that, has nothing to do with medications. It has to do with cognitive behavioral psychology.
Sam Visnic: So, these things are one of the things that I move forward on in these topics and fleshing them out on my podcast. So, I'll do a shameless pitch there. My podcast is called Who Knows This, because I wanted to go out and talk with people. I said, somebody's got to be the expert on this or somebody has to know this. And I want to go source out those people, have them come on my podcast and talk about these things, so we can then start informing people have these general models are fine that's a good way to engage.
Sam Visnic: But if you've gone through these general models of care and you're not there, don't lose hope. You're only this far into it. There's so much that you haven't discovered yet. And there is research and science to back it up. It's not anecdotal nonsense and pseudoscience. We know this. The problem is, is that these fields haven't come together and put together an integrated model. And that's what I'm trying to do is to inform people about that.
Sam Visnic: I'm in my own little corner of the world, doing movement massage and pain education. But I'm absolutely an advocate of working with likeminded professionals who do all of those additional pieces to keep moving somebody forward to as well as they want to be. So, the podcast, Who Knows This is the name of the podcast, and it's whoknowsthis.com. It's found on iTunes and so forth. My website, releasemuscletherapy.com. You can get a lot of free information there.
Sam Visnic: I offer the book, Why Didn't My Doctor Tell Me This. You could just opt into that and get access to a membership area. And of course, I'm very active on Instagram as well. The handle is releasemuscletherapy. And there, I do talk about a lot of structural mechanical stuff because it's a visual platform and people like to see it.
Chris Scott: Excellent. Well, there are definite parallels between what you're trying to do with the subject of chronic pain and what I'm trying to do with addiction. There're so many interrelated fields that need to come together and so many brilliant specialists out there. But once again, Sam, thank you so much for coming on the show. I'd love to have you on again. Maybe we can talk a bit more about sleep next time. And I'm sure there are a bunch of other topics, too. So, I appreciate your time and good luck to you.
Sam Visnic: Absolutely. Thanks for having me.
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