Chronic Pain Explained – Sam Visnic
CLICK FOR AUDIO OF PODCAST
Guest: Sam Visnic
Release Date: 3/7/2022
Welcome to Trulyfit the online fitness marketplace connecting pros and clients through unique fitness business software.
Steve Washuta: Welcome to the Trulyfit podcast where we interview experts in fitness and health to expand our wisdom and wealth. I’m your host, Steve Washuta, co-founder of Trulyfit and author of Fitness Business 101. In today’s episode, I speak with Sam Visnic, you can find him at Muscle Therapy on Instagram. Sam is a certified massage therapist and also a corrective exercise specialist.
And today in this episode, he helps us break down chronic pain, the definition of chronic pain and if that’s different from let’s say his interpretation of chronic pain, what exercises are likely to lead to chronic pain? If he believes there are any that actually do that. It’s a very interesting answer.
He asked, with everybody being so mobility crazy today. Is this the answer to fixing everything? Are we spending too much time on mobility? How do you design a strategy for addressing chronic pain and issues with active people, your clients in this case? Why do you think common therapies work or don’t work for soft tissue work like AR T and M T chiropractic acupuncture and things of this nature.
Sam has a really great what I would call a multi-pronged approach biopsychosocial in treating his clients with chronic pain and he relays how we can also do that. It was a fantastic conversation, Sam is a great follow again release Muscle Therapy on Instagram. With no further ado, here’s Danfoss. Nick, Sam, thank you very much for joining the Trulyfit podcast, why don’t you give the listeners in the audience background and a bio on who you are and what it is that you do in the health and fitness industry?
Sam Visnic: Sure. Well, my name is Sam Visnic. And by trade, I’m a licensed massage therapist, of course, focusing on the clinical aspects, working with individuals who have chronic pain issues. And also when I first started off in this industry, I started off as a personal trainer for the most part, emphasizing corrective exercise that was kind of around about 99 2000, when this kind of boom happened in the functional fitness kind of realm where everybody was starting to look at posture and muscle imbalances, and all of this sorts of things.
So started off in the big box gym. Of course, you know, I felt comfortable and loved to work with people who had all sorts of limitations because it was like a big puzzle for me. That kind of took my career into a trajectory of really focusing on individuals who had chronic ailments and aches and pains and expanded my knowledge in that realm. And for that’s what I’ve done for about 20 years now and just kind of piecing together more modalities and more education and trying to help as many people as I possibly can live the life that they want to live.
Steve Washuta: Well, it appears you’ve done it all in the industry. And I’m sure you and I could sit down over a beer and solve all the health and fitness industry problems. But today be you maybe, but today specifically, for the sake of time, we’re going to talk about chronic pain. And I think to start out that’s a pretty vague definition. Is there a chronic definition that seems to be a chronic pain definition that’s either clinical or a SAM definition that you’d like to give.
Sam Visnic: Yeah, and this is a critical distinction here, when it comes to talking about pain, we have acute pain, and we have chronic pain. The difference between these two things is really has a lot to do with generally an arbitrary distinction of time. When I describe that a little bit more is that every type of injury that occurred in the body, no matter if you have a muscle pole, you break a bone, you have neurological damage, etc, you know, say you get into a car accident or have a have a fall, everything takes a certain amount of time to heal.
That is, you know, generally within a small range, we know when you break a bone, you’re going to get a cast, it’s going to come off in six to eight weeks, etc. Generally speaking, we know and most experts will agree on this, that in six months, everything in the body has healed. Everything in there is is done, the tissue has scarred over bones have healed, etc.
If you’re still feeling pain after six months, and I’m talking about on the extreme of six months, but obviously if you pull a muscle, it’s going to be faster than that. But in six months’ time, if you’re still dealing with pain issues after that tissue or that joint or that bone has healed, then we’re dealing with chronic pain. And this is a completely different animal than that acute pain.
Steve Washuta: And that so so let me ask you another question that might be sort of a sidebar here. But if you’re dealing with an injury, and that injury itself is healed, but maybe you have another compensation due to that injury that doesn’t, that’s not in the realm of chronic pain.
Sam Visnic: There we’re talking about the same idea because if we start to move into what is actually occurring during chronic pain, then what we’re talking about is nerves that have become sensitive or stayed sensitive as a result of that injury. Now that injury may have triggered compensation patterns and movement and so forth. And those elements might be continuing to sustain that nerve sensitivity. So yes, we’re talking About the same thing. So that’s all in that pile of elements that contribute to nerve sensitivity after an injury.
Steve Washuta: And I think for other questions, we’re going to unpack that a little bit down the road here. But let’s just go straight to for the personal trainer question. Are there exercises or modalities that you see that causes chronic pain issues more often than not? And this could be in the literature, or this could just be anecdotal with your experiences?
Sam Visnic: Yeah, if we’re talking about there, you know, that kind of goes into the direction of asking a question kind of like, Are there good and bad exercises, and I’m of the camp that generally says that there are no such thing as exercises, you have to weigh it out to figure out which types of exercises will work for an individual.
But there are certain exercises which tend to be more provocative for people. And for a number of reasons. I think, for example, if we take the case, for example, deadlifting, a lot of people have issues with deadlifting. And the issues they may have is that is the deadlift, really an exercise or a movement that is stressful on the body in a way that would cause problems that would lead to pain, in my opinion, no. But there are a lot more things that are going on there as to why that tends to trigger problems with people, namely, because of the information that we have been told that these things if we lift and reuse our back muscles or lifting heavy things, that these things are bad for our back.
So when people walk into a situation doing an exercise that they don’t necessarily feel comfortable with, maybe because they’re a little less educated about it, they’re going to be more threatened and put more on guard when they do that exercise, which, and the problem here is going to be they may be more likely to have issues during that exercise because they feel threatened by it. So, you know, we take a lot of people, for example, lifters who have no problem when they’re backfields, achy that day going to the gym, and deadlifting, because it’s deadlift day.
And you know, they don’t really mind that and but yet, we have a lot of if trainers are familiar with working with lots of clients and starting to teach them an exercise like the deadlift, there’s a lot of times this initial level of apprehension and fear and concern overdoing an exercise like that. So in my opinion exercises that tend to put the client more on guard and make them more fearful, or more likely to trigger already existing chronic pain issues, because it’s putting the nervous system more on guard and more on alert.
Steve Washuta: Could you reform that thought to into age? What I mean by that is, are you working with clients differently at 18, than you are at 65? For these types of exercises? And does that play into it?
Sam Visnic: Yeah, exactly. I mean, the amount of information that’s a perfect example of what tends to occur when you’re working with younger athletes, younger athletes, a lot of times don’t have that knowledge base or information that they pay attention to, and they don’t really think about whether or not things are stressful for their back, they may feel certain things when they do a movement.
And they say this, I feel this in my back, I don’t know if I should do this. But they don’t have those presuppositions or those that that history of knowledge and or injuries that people in their 30s, 40s and 50s may have. So I think that that is changing a lot.
Now, like people who were younger or more growing into the attitude of being more active rather than, you know, a culture like in their 60s and 70s, who have been taught that if you your back hurts, then you should lay in bed or you should not be active and let it heal. And we all know now that those things are not true, that we need to get people up and moving to help them get better faster. So it definitely makes a difference on age for sure.
Steve Washuta: But you would have some clients in some cases in which you would totally eliminate an exercise based on their, let’s say, anatomical history, maybe they have scoliosis, and you and you think that there’s exercises that are bad for them, because certain muscles are shortened or lengthened, or you have the ilk that everyone could do every exercise based on their confidence and their form?
Sam Visnic: That’s a great question. I mean, I would say that for the most part, human beings are all movements going to be broken down into those classifications of push-pull, squat, bend, lunge, twist, and also gate if we’re going to throw that one in there. And everybody needs to be able to perform versions or varieties of all of these things. Now we have two things that are going to be of course, you’re always going to find very specific circumstances where I would definitely be hard on one side or the other.
But generally speaking, my clients, I take them through every pattern that I can get them through but a defining factor there, of course, or feature is going to be am I going to load them and to what degree am I going to load them? So to say that somebody with scoliosis or some type of issue in particular shouldn’t do for example, again, I’m using deadlift as an example because it seems to be such the one that everybody’s concerned with our back squats.
Yes, they need to be able to do that and saying that somebody shouldn’t be able to do a squat with scoliosis is kind of ridiculous, considering I would say how is the person going to get on and off the toilet get in and out of their car? They need to be able to do these types of exercises and movements, however, then we get to that discussion to say, Well, what I, how much am I going to load this person? Well, that’s going to depend upon whether or not I think that that scoliosis, for example, is actually a problem.
And we know that there are many elite-level lifters with cases of scoliosis that can oftentimes break world records. So I mean, you have to look at in each individual, like, what is this position that they’re in? Is it problematic, is it pathogenic, is it causing pain? And is it appropriate to load them? You know, we don’t load people just to load them, we load them based upon what it is that they’re trying to accomplish?
Steve Washuta: Yeah, I couldn’t agree more. And of course, it’s going to also be based on their goals. And again, their body types some people can take can take that load in certain areas more than they can take load in other areas, right. We’re all built a little bit different anatomically. And I think that’s, that’s, that’s an important thing to look at, I’m gonna have a long-winded way of asking this next question, I’m going to do it through a little anecdote here.
I was on the National Academy of Sports Medicine, forum boards, reading something, and somebody was talking about how it’s imperative for all trainers to make sure that they get their clients, for lack of a better term here, I’m not going to be PC asked to grass in a squat, right? Get getting your butt down as far as you possibly can, and everybody should be doing this.
And I said, well, first of all, anybody who speaks in absolutes, you should probably run away from right, because there is no everybody in all, and you have to watch that sort of talk. Also, you know, my disagreement prompted him to kind of send some articles showing how it could help all realms of fitness by squatting a little bit lower, deeper, and things of that nature. What I don’t think the trainer was understanding was not my argument with the microanatomical perspective.
From the macro perspective, you only have an hour with your client. And if you’re focused solely on helping ankle mobility and looking at knee valgus, and all of these things, just so that over the course of that hour, they can squat one inch deeper, what else are you not doing right? If they’re 65 pounds overweight, and they have a heart issue, you’re not helping them burn calories by, you know, helping ankle mobility. So with that being said, Everybody’s mobility crazy now. And we have to create a balance between training, how exactly do you go about that? And how do you recommend that?
Sam Visnic: Yeah, this is a sticky area for for people, because first and foremost, I have to say, what is the primary focus of the work and you know, I am clearly on the personal training side of things is that I started off in the big box gym, everybody’s working with people with chronic aches and pains. I mean, so the idea that you’re not going to need to be aware of these things, or at least address some of these things is kind of ridiculous.
You certainly have to, however, it’s just a matter of number one, what is the client walking in the door with? So number one we need to pay attention to, obviously, they’re the things that they want. And then they’re also things that they need? So yes, I mean, if if achieving a deeper squat is part of the goal to be able to increase squat volumes, so that that feeds other goals, etc, that those are things that we’re going to do, but you’re right, and how much time are you going to spend on this? Okay. Well, I would say that if you look at how training programs are designed, and you look what the primary outcome is, okay, that’s most important.
Are there movements that an individual needs to perform in order to for you to achieve the training outcome, and it’s yes or no. Now, where we get into this, let’s say, for example, a client wants to participate in a powerlifting contest, you need to bench squat and deadlift because that is what they need to do. And if the person is having an issue with one of those patterns due to ankle mobility, or maybe their spine is restricted, and mobility, it’s causing them to not be upright as much as they need to be, then it makes sense to spend more time on these factors, right? Then the client who, for example, wants more muscle mass.
We know in bodybuilding, that we can, we don’t have to do any movements whatsoever to gain hypertrophy in a muscle group. There’s a lot of variety of exercises that you can do to accomplish that outcome. So if you find that a client is limited in mobility on one exercise, how much time are you going to spend trying to force that to occur when you can just take a lateral step and choose an exercise where you can fulfill the training outcome without having to spend all of that time? So those are the things that I find challenging with?
Is that like, does the client need it? Well, it would be nice if they had more ankle mobility, it would be nice if they have this, but do they really need it for their current outcome? Now in my world, people come to me because they have pain and the outcome is to get them out of pain and to get them back to training again. So for me, there’s a lot more focus on those elements.
But even I’m going to run into challenges from time to time that people come in with multiple areas in their body that are painful. And I have to put these into a priority list. I have to actually because there’s only so much time you can invest. And we do run into a problem with that is that if I’m focused on a hip problem, the hip is going to need multiple things to get better.
I can either give them one or two To exercises and try and scatter it out, or I can invest my time and address one area as much as I can. And that’s going to depend upon the client, like I don’t want to completely ignore some areas. But again, we have to look at that total time investment of how much that client has every day. You have to put things into a priority list. Of course, at the end of the day, the priority list is on the needs and the goals of the client. That’s what we have to be respectful of.
Steve Washuta: Because you have a massage therapy background and a personal training background, you’re going to have this multi-pronged approach, right? Where you can integrate a lot of different things to help your client, maybe not all personal trainers can do that. So I would assume you would recommend them reaching out and networking with other people in those areas. But can you can you speak to a little bit about that multi pronged approach instead of just attacking it for one angle.
Sam Visnic: Yeah, and, you know, I say that there’s a, there’s a balance here, and that there’s always a pressure on every practitioner to try to get results as quickly as you possibly can. So, you know, we’re always on the path of trying to educate ourselves. What made me successful, I feel like in the long run of my career has been every time I was faced with a new type of issue that a client had, I would go source out protocols in order to try to figure out how they could rapidly do things.
I remember some of the things that I was doing, you know, 20 years ago, and it would take me an hour to accomplish a given result, like we talked about, like getting a little deeper into the squat, I can do this in minutes now, with far more education into neurology, how to get muscles to release faster, and trying to discern from me how much time do I actually do need to massage muscles, which muscles respond better to stretching, which muscle or tissue is going to respond better to neurological wrenches in the wheel.
For example, I’ll put a bite guard in someone’s mouth and see if their range of motion frees up. And that helps me discern how quickly I can change things and where I should spend my time. Over time, every trainer should be working on this just to try to figure out protocols that work faster. In our field.
Unfortunately, and this is exactly what I went through when I started, there is a severe lack of mentoring that occurs in this industry. So we’re taught things from the textbook, we’re taught, I remember, I went through a training that went through about 45 orthopedic tests over the course of five days. And then I was sent to just go off and practice them. Without any overview a guiding principles help people show me, you know, repeating techniques over and over again, to make sure that I was doing them right, the field just lacks this.
So the problem is, is that there’s not enough ample practice space to continue working and sharing techniques and tools and technologies to help people get faster results. So that does tend to be an issue. But for me, again, the idea is is sourcing protocols, read some of the authors and people that are out there who’ve been in the industry for a long time, who show you how to get faster results so that you can get more done within the context of each training session. And I think that really speaks to where we are in the industry is that there needs to be more collaboration with professionals that can help each other out.
Steve Washuta: That’s great information. And I really have to second that, you know, I call it shadowing, even if you’re not forced to do it. Most industries, you are forced to do shadowing and some respected in our industry in the personal training industry or not, you should seek it out, find somebody in your area somebody gets I’m sure Sam could speak to this.
If you’ve dedicated your life to helping others, you’re more than willing to take somebody under your wing and help them and teach them your ways, right. So people are not going to turn you down, you could reach out to anybody and say, Hey, do you mind if I just follow you around and learn your ways, we would love that that’s that’s what that’s what personal trainers and people in the fitness industry, especially who have been doing it for a long time, love to do so seek it out. It’s invaluable.
And in addition to that, you don’t just have to do that in your area of expertise kind of draw sounds like a Tim Ferriss Four Hour Workweek thing, but like, draw circle, and write your profession in the middle and then have all the professions that sort of touch you know, if you’re the hub, like all the spokes around it and say okay, so physical therapy, and orthopedics and sports medicine and neurology and all these other things that are interconnected with personal training.
See if you can learn a little bit about that because ultimately you’re going to have to your clients are going to end up seeing these people. And they’re going to come back to you even Belfer specialists and tell you exercises and things you have to do that you have to implement. So it’s good if you kind of understand their processes as well.
Sam Visnic: Yeah, and you know, it’s not an I would love to say that it’s an easy process networking with lots of other professionals. Even as long as I’ve been doing this, the reality is it’s not it takes time to cultivate those things you have to find willing participants, but always remember in there or something or people ask me what’s the best way to do that is to always be a giver first because most people have their own thing going on physical therapists, doctors, chiropractors who have full practices, and you know, it’s, it’s a bit of a bother for them for you to come in and to try to take away their time.
So you know, helping them and making their practices easier, getting better patient responses. You know, encouraging repeat visits, all of those things are part of a collaborative process. And it takes time to cultivate that. But having a learning environment is really key as well. And if there’s a lot of equal exchanges going on both sides have a lot of chiropractors and medical doctors who are my clients who come in and we exchange information. And it’s a great value for both parties. When I have trainers that come in a lot of times trainers come to see me for their own aches and pains and problems.
And what I do is I teach them exercises and and then I say, why don’t you go to go to work on Monday and start doing these exercises with your clients and find out how many people have the same problem. And they said, Well, I should do that. I’m like, why not? You know, these are exercises learn and, and, you know, I’m not afraid that, you know if that if I educate that trainer, they’re going to start to orient themselves into knowing how to be able to further help their clients. Of course, that’s going to be well received. Then they’re going to be able to want more information and feed that cycle.
If the client is too difficult to handle, or they run into a stumbling block with them, they’re gonna refer them to me, which is fine. If they get better than they probably didn’t need to see me to begin with, because it was an easy fix. So you know, that’s the kind of relationship that we want to foster within our industry.
Steve Washuta: Yeah, and I’ll add to that. So as far as finding a mentor, of course, you want to find somebody who has been in the business a long time and is older than you. But when you’re networking with outside of your community, I actually think it’s best to find somebody who is of your age, or at least of the range that you started in the business, meaning it was easier for me to network with golf professionals, when I first started, who also just started, because then it seems like we’re both helping each other out.
And we’re both growing together, as opposed to reaching out to the golf professional who’s been there for 45 years, who I’m not really I can’t help him out. So I think that’s also important, find the mentor, and you’re if you’re the hub, who’s much older and wiser than you, but as far as the network is concerned, you’re probably better off reaching out to the younger professionals, if you’re also a young professional, who are also just entering in their industry, so you guys can grow as well. Very true. So let’s talk about soft tissue work, AR T and MP chiropractic stuff, acupuncture, all of your thoughts, just spill your guts here. What do you think about all?
Sam Visnic: Well, we’re, we’re now like in the sea of acronyms over everything. Now, you know, nk, T NMT, everything else like that, right. All of it is taking on this neuro flavor, which is kind of working with the nervous system. I think that we’ve been overly emphasized on techniques, especially out there. This is something that in all sorts of therapeutic realms, I tend to talk a lot a psychologist and psychotherapist and mine my type of area with chronic pain.
the same issue is occurring everywhere, obsession with techniques, and not enough about the philosophy about what we’re doing. In my world, when we’re talking about chronic pain, Neuroscience and Pain, neuroscience education specifically is kind of like an overall view of how pain works in the nervous system, and all of the various things that can impact it. And when we look at something like the structural biomechanics and how they relate to pain, it’s only one category.
There’s many other things that have impact pain, as it’s a bio psychosocial phenomenon. So we look at nutrition, we look at education, lifestyle factors, etc. So within the training field, there’s the same sort of thing is happening is that considering that someone’s health is a bio psychosocial phenomenon, there’s many different things that need to be addressed. There, we’re starting to hyper focus on things like specific techniques, and about soft tissue therapy like AR T, or these NK T techniques, or whatever. And they’re just kind of like causing people to start to get tunnel vision. And to stay stuck inside of these these small realms.
They do work, everything works to some degree. And we know that but all of these philosophies that drive these systems cannot simultaneously be correct. And I think I remind people that is that, you know, I use lots of different techniques, probably dozens and dozens by now. But I’m not concerned with being married to the philosophy for why these things work. Because there’s a larger philosophy that guides human health.
We all know what it is optimal nutrition, not having a lot of stress, being able to impact the nervous system and novel ways to get it to basically be able to adapt same kinds of concepts as we use with weight training. Use those principles and then we use these techniques to further advance those global philosophies. Our strategy, rather than getting lost in the techniques themselves. That’s a lot that I see is that people will oftentimes go through these therapies, there’s going to be you know, the placebo effect is 30% of the time, you know, some therapies, so 30% of the time people go in there, they’re going to get better another 10 to 15% of the time.
If you have the right kind of issue that works with that kind of therapy and you have good rapport with that therapist, it’s going to make an even better improvement. But there’s always going to be people that those techniques typically don’t help. And that’s what we have to keep in mind is the question is identifying the kind of person with a specific kind of problem for which that technique might help.
And then, you know, then we can give those things ago. But again, thinking that everything in the body is related to restrictions and fascia, or everything in the body is purely related to muscle compensation or none of these things are true. But they are valuable techniques. So separate the technique from the philosophy and you know, you’re going to be a lot better off by being able to take a larger view of these things.
Steve Washuta: That is very surprising to hear from a sort of a corrective exercise specialist, but I feel like it’s so great. It’s exactly what people need to hear is that it’s not just these mechanistic factors all the time that you’re working through, there’s there’s other things going on in the background, like the placebo effects. Important to take a step back and sort of look at all those things.
Maybe that just comes with time someone like you who’s been in the industry a long time and has watched things work or things not work, and then has no other option, but to accept that. Because eventually you’re you are going to hit a wall, you’re going to think that something always works with your client, just from again, from a mechanistic science standpoint, and then it doesn’t. And then you have to sit down and really analyze, okay, well, what exactly is going on here?
Sam Visnic: Well give me an example of how I would look at this. And this is, you know, something that again, being exposed to so many different things, and watching tons of different treatment options fail. I’ve seen people that have seen, you know, a large smattering of these techniques, they weren’t better, I saw the person and I did relatively simple things, and I was able to clear the problem. So you know, this is a very common phenomenon, but it’s example I would say is that human nervous systems are very unique and responsive to individual stimuli completely different.
If I were to take 100 people and have them stand on a row, and I had a tarantula in my hand, you know, and let’s say, you know, I was standing 20 feet away, I’m going to have a few people that are going to be running the opposite direction terrified with a threat response, I’m going to have a group of people that are just frozen in place, I’ll have a group of people that want to come up and touch the thing and play with it.
You know, you have a completely different response set of all of these different people to one stimuli. So it’s not the stimuli, the stimuli is there, it’s important, but then we have the individual response to the stimuli. And that’s critical as well. And this is where we start to look at things like postural studies, and so forth, where I’m not ever one to throw the baby out with the bathwater. Do we look at structural alignment? Yes, we do. But we all know, and many of my physician colleagues will say the same thing.
You can’t just look at someone’s posture. You can’t look at an MRI or an x ray. Without talking to the person and doing an intake and determine who’s in pain. We can’t do that it does not work. So we know that there is situations that are going on in people’s body. There’s structural things that are going on. But there’s also the nervous system’s response to those elements. And the nervous system response to those elements will determine whether or not that person is having a threat response. Or whether or not those stimulating factors are problematic. That warrant a therapy or a treatment approach in order to address those things.
So we know that you know, you take 100 people off the street. And you run an MRI on their low back. About 60% of them are going to show one type of abnormality. But that doesn’t mean all of those people have chronic low back pain, by no means. So it’s always a matter of addressing the person in front of you. And looking at all the circumstances in order to judge in way what we might use. Which techniques we might select, and kind of how we proceed with that person.
Steve Washuta: Can you walk me through, let’s say your client experience. From the first sign of what you would consider chronic pain. To the first level of treatment or diagnosis to progress to healing, you just walk me through that experience?
Sam Visnic: I would say that, first of all. It’s most important for me to set out there that by the time that people come to me,. My job, of course, is not to diagnose pathological conditions, because that’s not my job. It’s outside of my scope. But that will have happened already before they come to me. So in my intake process, there’s a specific point in which I engage with people. Have you been to the doctor for this issue, have you had diagnosis. have you gone to physical therapy? Have you done the standard things? And I’d say the majority of the time that has been done plus extra things.
So usually that person has gone to the doctor, they were diagnosed. They may have had medical treatment, let’s say they didn’t. So they said Doctor said you’ve got back pain. There’s nothing I see on an MRI. So I’m going to send you to physical therapist visit they go to physical therapy for a period of time. Then they get discharged. And they’ll usually come up with a story that will say something like. Well, I went to therapy and you know, it helped a little bit. But I’m still not able to go back to doing what I want to do. I can’t go to the gym. I can’t squat because my Baxter hurts.
So they’re stuck in the zone cold like I say the gap the gap is there after the medical system. They’re not able to just go back to doing what they want to do. Or to see a trainer who may not have enough education on how to deal with this issue. The person is apprehensive about going to a trainer. Because think they might not be able to help them. And then they’re seeking different types of techniques.
They’re now in the acronym phase, you know. Going to all of those different letters, Cairo’s, etc, because they say. I think this technique can help me or that technique. Either they do or they don’t get better. If they and some people the story is similar, where they say, well, it felt better. But yet, I mean, every time I keep going back, it feels better. But then it reverts back to what it’s doing. So when then they contact me, and then I feel this. I say, Okay, well, this is a case that I can help you with.
So you got a chiropractic adjustment, or you got to massage in your backfill. Yeah, yeah, it didn’t last though. Well, that’s great news, because that means that number one, your situation can be impacted or influenced. Now we need to figure out how to get it to stick. So then they come in, I do my intake process. And my process is a bit far more, you know, full that I can talk about here.
But in particular, I’m looking for the values, the belief systems, what does that person understand about their situation? What have they been told, all of this influences how threatened their nervous system is by what’s going on. And as I feel that information, I can determine the kind of nature of the pain that the person has. And where I might go with that. Now, I’m always going to do an a body evaluation. Because obviously, they’re showing up in my office for looking at structural elements. They clearly believe that there’s a structural element associated to their pain. I’m looking for body patterns and styles. I may do an orthopedic style of evaluation on them and joint by joint. Or I may look at global patterns to see how their nervous system is responding. Now at that point, I’ve got to make a decision.
And the decision is going to be are we going to do more manual therapy. With this person to start with, or we’re going to do more movement work. Everybody’s going to do a combination of both. So as we do that. Then I see how the person is responding to different types of styles of techniques. I can determine if we’re dealing with more with a neuro behavioral type problem. Are we dealing with indeed? A structural element where tissues are getting agitated by repeated stimuli over and over again.
And that helps me determine the course of the work. Now, of course, with chronic pain, be remiss to not look at lifestyle factors. The number one thing that’s associated with chronic pain is lack of education. So when somebody doesn’t understand what’s happening to them. What occurs is the brain actually, by this process. That we have tissue information coming from the body. From the brain is processing that when an individual does not understand their pain. They’re threatened by it.
The process allows more information, the gating system in the spine to open up. So that more threatening information is allowed to come in. And therefore the person actually experiences more pain. I have to get that gate to close by helping the person understand what is going on with their pain. And at that point, then we start to look at the other factors sleep. We have to look at how much movement they’re doing. Setting goals, this is all complex stuff. That’s that is involved in dealing with chronic pain that is not just movement. And that makes the movement stuff more effective. So I know that’s a mouthful, but that’s essentially how my process works.
Steve Washuta: I have to ask, is there a sweet spot of education. Where in that pain would be the least what I was going to say is, if you’re too hyper-educated. And you know exactly what’s going on, you know every little last neuron that’s being affected. A nerve due to your back, right? You’re an orthopedic surgeon. Are you actually you past that line of, let’s say, diminishing returns. Where you know, too much. And you could also be in that same category as somebody who knows nothing about it?
Sam Visnic: No, in 20 years, I’ve never known somebody who knows the right amount of information about their pain. They have explanations, and they’ve been told explanations. And some of them are faulty explanations of especially mechanical structural issues. In which I show them and then there’s things that have been missing.
So I have lots of people, for example, with fibromyalgia. Which is, you know, central sensitization. A kind of pain where the centralized component of the nervous system is on alert and guarded. That have literally been told that they have all of these structural problems. When the person has fibromyalgia, that’s a system wide problem. And there have never been I look at their questionnaires. They’ve never been taught how to look at factors that influence pain, the most like they don’t sleep at night.
They’re overly aggressively exercising, they’re going to active release technique, you know, therapists being hyper-aggressive with soft tissue work. These are things that like everything is completely disordered. And they don’t. Clearly there’s a lot of things that are missing from the overall philosophy. I have medical doctors who have been clients who again. Tend to use too much biomedical ism when it comes to understanding pain. And not understanding some of the other components.
So no, I would say that very rarely do I have somebody come. A man who has a very clean, crisp understanding of their pain. Unless they have literally been seeing a pain psychologist in particular, or has been studying pain neuroscience education. You usually need to be interacting with somebody on a one to one basis. Sorting this information out. Because it takes time to not only understand it from a left brain logical perspective. But to also have experiences that bring it into the mind to muscle connection. So that your neurology has actually experienced the information in real time. So there’s a lot more to it than just kind of understanding it. But also being able to implement it and feel it.
Steve Washuta: Do you believe, Sam that your philosophy and techniques or maybe I should say lack thereof, are teachable? Could you bottle them up into some sort? Of course and and teach this? Or is it just too specific to what each client needs? And because there’s so many different directions and, you know, there’s, a lot going on. That it’s really impossible to just put this into a course,
Sam Visnic: I think it’s possible, I learned it in a way where I had to learn it. And I think that I would, you know, if I’d go back, I would probably structure it differently. Like, for example, I was taught to just start very local a certain things. And there are certain things that you need to know. So if you’re dealing with back pain, you should understand the structural mechanics of low backs. And how they move and which directional preference when somebody has a disc bulge. Which way tends to make them feel better. You should know these things.
But then when you master that. You understand that you should expose yourself to an environment where you’re working with people in this regard. To see when those things have limitations and when they don’t work. And that forces you to say, to reach outside of what you know. And to say, what else am I missing here, I was pushed through that process. So in the beginning, I thought everything was fixable with exercise and movement until I realized it wasn’t. And all of the other factors that get in the way of people getting better.
So when we kind of learned through this experiencial nature. It’s very much like with with children, you know. As an adult, who is wise, who knows a lot of things. You can tell people kids stuff all the time. And they’re only going to get it somewhat because they still have to go through it. To understand it, to experience it in their neurology. And to reach out and to say. Well, why did this happen? I don’t understand what factors, you know. That I need to know that would improve my knowledge base.
So yes, I would. But even if you just brain dump all of that information to somebody about all this. Kind of advanced clinical stuff that you know. It still has to be implemented in order to be experienced. And that’s something we read across today. There’s a lot of people in industries that are very book smart. Because they’ve read information from individuals who are very experienced. But they don’t have the clinical experience. They don’t actually have the experiential nature of implementing that work. In order to really embody it to know what to do. How to make good decisions within the frameworks of those models that they purportedly know.
Steve Washuta: Yeah, unfortunately, that’s only getting worse through the online mediums. And we’re doing less and less of it. I will say also having, so when you’re working in a gym. As you’ve had, as a personal trainer. You have other personal trainers around you, who I would say help sort of safeguard integrity. Because it’s not just me, and let’s say my clients. Sam on a zoom, where if you believe that I’m the expert. I can essentially tell you anything, and you’re gonna believe it.
Whereas if I have all of these other experts around me who are able to say. Well, that’s not really the case. And there’s kind of a, you know, you band together to learn information. Grow as one and you don’t see that as much anymore. Everyone’s breaking out onto their own. In their own little specialists, and their own tiny skill size kingdoms where they can do no wrong. And I think that’s, that’s bad for the for the industry.
Sam Visnic: Yeah, and I think that there’s a mindset that has to go with this in the mindset is, you know, early on, when you’re trying to start your business, you know, there’s a scarcity mindset. And you can take all of the clients that you want, and shield yourself from the outside world to see you can become the expert and develop your confidence.
But over time, you know, it’s happened to me as well, as you know, over time you realize that there are people out there and adjacent fields are incredible experts, you know, used to know a lot about nutrition, and I would rarely have ever refer out to somebody for nutrition, until I met my wife, you know, my wife is arguably I would say for me, knows more and is better at her work than I am at mine.
And so at that point, you know, you want to have those relationships with people because you defer to them because they know so much more than you. But also to always be I think that’s helped me is to be skeptical of what I know. You have to at the same time have this dualistic mentality where you know what you know, but also are skeptical of what you know, because if you don’t feel like you know, anything, you don’t have any confidence, but also you can’t be so confident to think that you’re always right and that that is always the answer.
I think that that drives a healthy degree of have self awareness, but also have motivation to continue to learn. There’s always going to be someone that knows more than you, there’s always going to be things that you were so certain were the way to do something. Then you find something that somebody does something completely different from you and gets the same results.
That should get you curious to go, Well, what are the guiding principles that drive this because clearly, it’s not the technique. It’s the philosophy that’s driving this technique that I need to know. And the more you do that, you’ll leap kind of logical levels and frames of awareness that will expand your knowledge in this field to a much greater degree than just being locked in the small details sometimes.
Steve Washuta: Yeah, great info. And we have to have humility. I mean, until basically 1995, every gym class in the country was cold stretching, before they get any exercises right now we know that that’s that’s not the way to go about things. We’re still learning about the body. Because it’s a biopsychosocial approach, we have a multi pronged here that there’s always going to be new information coming down the pipe, and we have to adjust. It’s it’s not a big deal. Nope, nobody’s mad. There’s just some groupthink items that go around and we all cling to them. And then we learn and we get better.
Sam Visnic: Yes, exactly.
Steve Washuta: So let’s talk about the gizmos, the toys, the gadgets, I have the feeling I already know your answer to this, but I want I want you to unpack it anyway. Are there certain ones better than others? What do you think about cupping as compared to myofascial release, when you think about the vibrating foam rollers are these just components that help slightly in the whole perspective, or some of them actually just not good at all and don’t help?
Sam Visnic: Yeah, so I’m as a massage therapist, my primary work is about sensory input into the nervous system. Like you put a hand on somebody, an application of hand is just that tactile sensation, I can stretch the skin in different directions, I can compress, I can pinch, just imagine this for a second, that anything you can feel, you have a nerve receptor that can discern that information.
When we’re dealing with a situation in which we want to get the nervous system to adapt, and whether that means increasing mobility, relaxing, tissues, relieving pain, what we have to do outside of what we just talked about as the brain interpreting that information is to do things to send new novel stimulation to the nervous system to process. So we can do that in any way. Think about how many different ways you can get people to feel something in a specific area of their body. And again, I can use my hands, if you’re not licensed. I think that’s one of the better things about all these massage, gun revolution.
Percussion therapy has been around since the early 80s. And before that, for sure, but I’d say in a commercial realm, my first percussion tool was from impact USA, and I got it I think 1819 years ago. So it’s funny that I’ve been using percussion therapy this whole time. And now seeing the industry exploding, which is so funny. But it’s just a novel form of stimulation. So if I put that progressive unit on somebody, and then it’s making contact with that tissue, it’s sending that information to the nervous system, nervous system is going to interpret that information.
And it’s going to have a response to it. Now the response of that nervous system to it is based upon multiple things like we talked about. But that response, if it doesn’t work, and it doesn’t provide the outcome that we want tissue relaxing, more range of motion, then no problem. Let’s perform another source of stimulation. And we could put a cup on there, we could cup it, and we can move it around and stimulate that tissue with the skin stretch. And then recheck it again, all of these things are to me novel sources of stimuli.
They’re always useful as the guiding principles by which you operate from, and we don’t get clung to that again, it’s like, Well, you see a percussion massage gun is going to fix all of your mobility problems. That’s preposterous, it cannot do that. And it certainly can’t do that in every single person, as people respond differently to stimuli. So we’ve all heard those stories where somebody said, I tried everything. And then somebody came along with some essential oils and dripped it on my low back.
And that gave me all the relief in the world, which is, how can that make any sense? Well, it makes sense. If you think about the context in which the therapy occurs, and the the novelty of that stimulation, worked for that person’s nervous system. So I don’t advocate for doing things that I think are ridiculous on, you know, but at the same time, I’m open to understanding that that is really what we’re seeking through using these gizmos, which is not being married to it, but just seeing it as a source of stimulation that can be very effective for some people, not at all useful for other people. But I think it’s a good thing that people are are playing with these things as long as they don’t get stuck in the narrative of what those tools are doing.
Steve Washuta: Why do you think people get stuck in those narratives? Why are people so dyed in the wool they fight Like it’s like their favorite college football team, and I’ll never leave it I have I have this percussion tool, it fixes all the problems. Only do CrossFit only deadlift don’t do bodyweight only run, don’t run, why are people just so likely to cling to one thing and root for it? And, and not not let go?
Sam Visnic: What’s the confirmation bias problem, you know. It’s like setting a frame or a filter inside your mind. Where you delete all other information outside of you know, what it is that you’re choosing to believe. One of the major problems is that finance, financial situation and reward is tied into believing that thing constantly. So if your primary source of income is personal training. And you’re working with people. You know, you have a dozen techniques that you use. You’re probably not going to be so bent on telling everybody that the massage gun fixes all their problems.
But if your entire source of revenue is, you know, you’re a massage therapist. Then of course, you know, it’s in your best interest to not let that go. If you’re sitting on the world board of Congress of of myofascial. Blah, blah, blah, then it’s in your best interest to cherry pick research. That proves that fascia causes pain. So we see this all the time, and people are in their own echo chambers. And I remind people to be aware of these things. You know, if you want to look at most of the studies. Of which there have been about 3000 have on the value of acupuncture. The vast majority of them are not supporting it.
But if you’re only reading the journal of acupuncture. And then that’s your only supporting views. Then you’re going to get stuck in this reality, because you’re not reading additional sources of information. Which conflict with what you’re saying. That forces you how to make you know, how to think critically. And weigh out the options of what people are telling you. Make a decision based upon that information. So people just get they get caught in their echo chamber. And I think that’s problematic.
Steve Washuta: Well, that’s a great point to end on here. Sam, such great information. Where can everyone find Sam, across the board. Tell us your social media, where you mostly post or make videos. And if somebody maybe specifically wants to reach out to you and ask questions as a fitness professional?
Sam Visnic: Yeah, best place to reach me is my home base release Muscle Therapy calm. I have a member’s area in there. Where people can grab a copy of my digital book. Where I talk a lot about what my research has found on these various areas. Again, like for me, I’m always a neutral ground player. We’re looking at the new evidence and always re evaluating what’s going on.
So that’s probably the most important place to start. And you can contact me through there. I just launched my own podcast, in response to a lot of the things that I’ve constantly been asked. Most of it is is like seeking out experts. That we always really want to know the answers to certain things. Are always asking somebody got to know the answer to this. So funny enough, the name of the podcast is who knows this.
And I already got a couple episodes out there now where I try to track down experts. Of course, I’d have to say, selfishly. There are people that I want to talk to, and ask a lot of questions for. And mentors of mine. So I’m hoping to really get that launched and get a lot of interest in that as well. But the website, Instagram handle is released Muscle Therapy. I post a lot of content there. That is, of course a little bit more structurally oriented. Because that’s what people love there. And from there, you can kind of peruse what else I’ve got on social media. Find me through those avenues.
Steve Washuta: I have to say, I’m very surprised that name wasn’t already taken. But they missed out. That’s a fantastic name. Thank you. I will I’ll list all the links below that Sam just mentioned. I hope to have you on another future podcast. To discuss other things surrounding this industry down the road.
Sam Visnic: Absolutely. I would love it. Thank you so much. I really enjoyed speaking with you. Thanks.
Steve Washuta: Thanks for joining us on the Trulyfit podcast. Please subscribe, rate, and review on your listening platform. Feel free to email us as we’d love to hear from you.
CLICK FOR AUDIO OF PODCAST