Solving the Pain Puzzle | Episode 41
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Hi, this is Dr. Kara Wada.
I'm a board certified pediatric and adult allergy immunology and lifestyle medicine physician.
Certified Life Coach
Medical Educator
Systemic Sjogrens Patient
The purpose of this podcast is to Educate and Empower
While discussing all things related to Allergies, Autoimmunity, and Anti-inflammatory Living.
My goal is to help you navigate the healthcare and wellness industries with more clarity and control.
If this sounds incredible to you, then you are in the right place.
Kara Wada, MD: Welcome back everyone, and welcome to our new listeners to the Crunchy Allergist Podcast where we talk about all things allergy autoimmunity and anti-inflammatory living.
That can take so many different so many different ways and we love bringing other healthcare professionals, especially onto the podcast as our guests so that we can learn from their experience and expertise.
So I'm very excited to bring to y'all today Rick Olderman, who is a sports and orthopedic physical therapist. Rick has more than 25 years of experience that specializes in helping people with chronic pain experience a pain-free life.
Rick has written the Popular Fixing You series of books, which can be found on Amazon to help people with chronic pain or injuries.
And more recently, Rick has created downloadable video home programs to help people solve pain from head to toe.
These programs include his pioneering approach that has helped solve hundreds of cases of chronic pain at his clinic for the last 10 years and we were talking a little bit before we hit record, he is based out of the Denver area.
So any of our listeners out of Colorado see him in person. The rest of us can check out his information either by picking up his book, his new book is Solving the Pain Puzzle, which is coming out in early 2023, and there are a few chapters already available on his website, which we will make sure all of that is in the show notes.
Rick is one of the top professionals in the US when it comes to understanding recurrent injuries and chronic musculoskeletal pain, and he really wants to enhance the quality of life by helping people fix their pain once and for all.
Which if you've been following the podcast for any length of time, we keep coming back to this idea of things that are sustainable because really if we're on and off the bandwagon so to speak we really just end up in many ways where we started.
So thank you Rick, so much, for joining us today and we'd love to hear a little bit more of your about your story.
How did you end up where you are and what you're doing?
Rick Olderman: Well, first of all, I'm so thrilled to finally meet you, Kara. So thank you for having me on.
I became a physical therapist over 25 years ago. I hadn't intended to specialize in helping with chronic pain, but it turns out there's so much chronic pain everywhere. It ended up being the thing I had to focus on in order to help most of my patients.
I think in physical therapy we do a really good job with more acute issues or simpler issues, and that has to do with really our training. I think our training is the reason why we're not good at solving chronic issues.
By that I mean in medicine research is the gold standard of evident. and so in order to conduct research, at least in physical therapy. We need to narrow down into smaller and smaller pieces of how the body works, right?
I call this a component approach because we're looking at the components, but there's nothing that's really putting all these pieces back together again.
Especially when you're talking about the musculoskeletal system or any system in the body for that matter. You need something to put it all back together again. That's what's over these last 25 years I've been doing is putting all of these disparate pieces together into a unified approach to solving pain.
It's made a huge difference for people with chronic pain. It's usually what they've been missing and I refer to this as a systems approach. Because we're looking at the whole system rather than these small components.
Kara Wada, MD: That's so true. We see that so often in chronic illness in general that the system just is not set up to take care of folks who are dealing with things that affect more than one part of their body and over the long term.
And that happens so much with inflammatory disorders and autoimmunity in particular which are interestingly so interlinked with chronic pain.
Rick Olderman: Yes. I've developed over time this theory, this overriding theory of why there is chronic pain and usually there are three, in my opinion, three pillars of issues that are pushing most people towards chronic pain.
One is the musculoskeletal aspect that I specialize in.
But another is things that we ingest, allergens, mold, things like that, these also will cause an inflammatory response in the body, as and that is manifested through tension patterns in the body in certain patterns of tension from head to toe.
And then the third pillar that pushes everyone through that over that chronic pain threshold is emotional or psychological stressors.
So all three of these issues can create a chronic tension in the body. It turns out that the that tension that's occurring in the body typically occurs along pre-established patterns.
That has been a big help for people who don't respond to the musculoskeletal approach. Usually it's because there's also a dietary and or an emotional stressor that's also acting on their system as well.
Kara Wada, MD: Yeah. I think as we think about each individual different amounts from each of those pillars may come into play.
Rick Olderman: Absolutely. Yeah. Everyone's got a different mix.
Kara Wada, MD: Yeah. As you mentioned about this musculoskeletal approach. Where are people typically turning for help in that way?
Is that working with PT and chiropractic care like where else do you typically see people turning to?
Rick Olderman: Yeah. If you've got chronic, let's say back pain , you're gonna turn anywhere you can.
Kara Wada, MD: Sure.
Rick Olderman: To get to solve it, right? So that'll include physical therapy, chiropractic, massage, acupuncture. You'll of course visit your spine doctor, neurologist for MRIs and x-rays and all that so you can turn anywhere because all you're looking for is a solution.
Kara Wada, MD: And relief.
Rick Olderman: And the thing that has helped me and helped my patients in my clinic is that I understand exactly how all these other professionals have been looking at the body.
Usually in medicine when someone has been around to a lot of different practitioners, when they see that as a red flag. " Oh. This is a difficult patient kind of thing, and likely they're not gonna get better. "
That's pretty much how we're taught in school, is the more people they've seen, the less likely it is that I'll be able to help them. But the opposite is true for me because the more people others have seen, it means it's really honing in on the fact that they probably need a systems approach to solving their pain and that's usually been the result.
So that kind of stuff doesn't worry me if people haven't gotten better with other people. In fact it's all a strike in my favor that I probably have the answer for them.
Kara Wada, MD: That's funny. As you were saying that, I was just thinking about how my own response to that has changed over the years in my own clinical practice.
It's really been, especially since have become a patient myself that I lean in more with those patients, and put on that, okay that curiosity hat.
Okay what have you tried? What did work, what didn't work, and what can we do to take the health professionals expertise and education, but also marry that with the lived experience of the patient.
Rick Olderman: Absolutely. And my fundamental belief, and I would guess that this is yours too, is that chronic pain is not a natural state of the body.
Pain is an indication that something is wrong now and the fact that you haven't found the solution means you haven't been looking in the right place yet.
Internally we have all the elements in our body to heal our body. If you cut your finger, it heals. If you break a bone it mends.
So we have these internal systems that will heal our body if they're given the right conditions to do and so that's what, in my opinion, chronic pain is really just a series of acute pains.
The definition of acute versus chronic is that anything after three months is chronic. I don't know who came up with that definition.
Kara Wada, MD: We have to have a line in the sand. Let's roll the dice.
Rick Olderman: So now it's acute, tomorrow it's chronic, right? B ut really it's just the way I explained to people is there's no difference between your chronic pain and your acute pain.
If you sprain your ankle every day for three months and then five months, and then suddenly that ankle pain becomes chronic pain, there's no difference in the reason that you're having that pain.
It's because you keep spraining it every day and if we can just solve why that pain is happening, that pain will go away. And it usually goes away fairly rapidly.
So 20 years of pain doesn't mean that it's gonna take 20 years to solve.
It's just 20 years of pain is just an indication that your body's been trying to tell you for 20 years, "Hey, something's wrong. We need to fix this."
Unfortunately, your brain doesn't know what that.
Kara Wada, MD: So when you look at the traditional or the typical approach, especially in the paradigm of physical therapy, how then does your approach differ and what does that look like?
What I'd like to do briefly, traditional approaches. If you have back pain, let's say. You'll usually get an x-ray of your back.
Rick Olderman: And it'll likely show degenerated discs, arthritic changes and things like that, especially as we get older.
Maybe you've gone to a physical therapist, a chiropractor, and they'll look at your back and maybe your pelvis to try and solve something.
They'll do dry needling or, you'll look at cortisone shots or everything, but everything is focused on the lumbar spine or the back and maybe the pelvis or the SI joint.
This is usually this is too limited a point of view.
So I'll take you through a test that'll demonstrate my approach to doing this and maybe what you've been missing in terms of your chronic pain.
Everyone listening right now, what I'd like you all to do is just lie down on the floor with your legs straight, and if it's too uncomfortable to lie on the floor, then lie on your couch or lie on your bed. But regardless, I want you to lie straight and we're gonna stay there for about 30 seconds.
While you're lying there and really folks, if you do the test, if you just listen to what I'm saying you're gonna say, "oh yeah, that makes sense."
And then you're gonna forget about it 10 minutes later and it won't be meaningful to you. But if you do this test, it will, you'll feel the truth of why you're having your back pain if you just do this test.
So let's assume everyone is lying down on the floor with their legs straight, and a firmer surface is generally better and if you want to, you can slide your hand underneath your low back and get a sense of what that arch is in your low back.
All right? Okay. Now we're gonna change this a little bit. We're gonna have you bend your knees or your feet are flat on the floor.
What we're really gonna determine is, does your back feel better when your legs are straight or when your knees are?
If you don't notice a difference in these two positions, go ahead and hug your knees to your chest and see if that feels better.
So now we've compared knees bent and legs straight, and you'll notice that when your knees are bent, your back is flattered to the floor. Of course. . Okay.
So Kara what position would you imagine feels better for most people?
Kara Wada, MD: Personally, I know I feel better with my knees bent
Rick Olderman: Absolutely.
99.9% of all people out there, that's the truth of their back pain too.
So I'm holding up basically a skeleton, but basically what this is meaning when you're let, when your knees are bent and your back feels better and your back has flattened.
Okay, so what that's telling you is the more arch there is in your back, the more back pain you have. It's as simple as that.
Okay, so now let's stand up. This is the second part of the test that will really open your eyes as to what's going on here. So now everyone please stand up and listen to the rest of this podcast, and what you'll notice is,
Yeah. Oh, great. You're doing it too, Kara. Awesome.
Kara Wada, MD: Yeah.
Rick Olderman: All right. Because you have back pain and you wanna figure it out, right?
Kara Wada, MD: Yeah. Might as well. Yeah. Okay.
Rick Olderman: So now we're all listening to this standing up and what I want you to notice after about a minute or two, you'll probably notice how many of you are locking your knees straight when you're standing?
Okay? So first notice whether you're locking your knees straight and now what I'd like you to do is go ahead and unlock your knees just ever so slightly, and you'll feel what just happened to your back.
If you're not sure what just happened to your back, go ahead and lock the knees one more time.
Yeah. You'll find that when you lock your knees, your back is arching and when you unlock your knees, your back is flatter. Okay? Yeah.
It's as simple as that. So what have we discovered? We've discovered that your back feels better when your knees are bent and your back is flatter.
We've also discovered that your normal way of standing is to lock your knees for if you stand for any length of time more than 30 seconds or a minute.
So the way you're standing is actually contributing to your back pain because it's causing the back to arch more. Okay?
The simple solution of looking at this would be, oh, I just need to flatten my back more and I'll feel better. That's an unnatural solution.
What I'm really trying to show you is that what is causing your back to arch more is not your back.
What is causing your back to arch more are the forces coming from your legs?
So most of you who have looked at solutions for your back pain, everyone's been looking at your back.
But no one is addressing the legs and the forces that they're acting on your pelvis, which is then rotating the pelvis forward and causing the back to arch more.
This is what my approach does is that I've figured out over these years what all of these habits are that are contributing to the patterns that are causing people's pain.
This pattern is called, I call it an extension pattern, because the back is in more extension or more arch. It's not so much that your back is too arched, it's that you have too many forces trying to pull it into an arch. That's the matter.
So for instance, Kara, if I was gonna push on you with my finger as hard as I could, and you pushed back as hard as you could, and therefore you didn't move.
It doesn't mean that there's nothing changing in your body because you're generating force to push back against me.
Kara Wada, MD: Yeah.
Rick Olderman: So that's the same thing with the forces that are acting on your pelvis and back. It doesn't mean that your back has to be too arched. It just means that your back is undergoing too many forces trying to pull it into an arch.
So when we bend our knees on the floor, we're, yes, your back shape is changing, but your back shape is changing because you've eliminated the stressors coming from your legs that are acting on your pelvis and back.
Kara Wada, MD: Yeah.
Rick Olderman: All right, so this is you.
People need to think bigger about what is contributing to their back.
You'll even notice if you stand up and put one hand in your back and you raise an arm, you'll feel your back muscles. If you stand up again, put one hand on your back and then you raise a leg, you'll feel your back muscles change.
So everything we're doing throughout our whole body is affecting the back system. Unfortunately, in medicine, we're trained just to focus on that small back zone when it's all of these forces acting on the back. That's the problem.
Even if you have herniated disc, spondylothesis stenosis, or all of those things are vulnerabilities that are magnified because of the other forces acting on those because many people have those conditions with no back pain at all.
Kara Wada, MD: It's fascinating. I went last week was a little bit extra stressful week, so I had booked a massage with a massage therapist I've seen for probably a couple years now, off and on, and she noticed that there was some tension that related to my low back that went all the way down to my ankles, and we were, she's yeah, I've noticed this, and, but we weren't.
I will say musculoskeletal medicine was never the area that I was extra excited to learn about or study or to master. So both of us were oh, I wonder exactly how this is all interrelated. So now I feel like I'm on the cusp of learning more.
Rick Olderman: I can geek out as much as you want as to what massage therapist is actually tapping into. And it's really fascinating in my opinion.
But it's important to understand that and for you, Kara, if this pattern is happening in you. In fact, this is the most common pattern for almost everyone's back pain.
If the thigh muscle, is the one bigger stressor that's acting on the pelvis when the thigh muscles are tight, they're tugging on the pelvic bone here, and they are pulling it forward.
Even if the pelvic bone isn't pulled forward, the force trying to pull it forward is causing an extension stress in the back. So stretching the thigh muscles, and not all thigh muscles are the same.
Not all thigh muscles stretches are the same. There's one I in particular I recommend that protects the back and pelvis while you're stretching the thigh muscles is hugely powerful for solving this type of pattern of pain that and just simply starting to unlock your knees.
Most people that I've seen in my clinic, if they have this pattern of pain and I just taped the backs of their knees so they can't lock them anymore within three days, their back pain is usually like 50 to 75% better just from changing that one habit alone.
So this talks about more central back pain. If you have unilateral back pain or sciatica or SI joint, there's a different pattern also involved, and that's called a side bending pattern, where one side of the pelvis is higher and the same side of the ribcage is lower. All right?
You can imagine when this is happening that there's compression happening on that side of the spine where the pelvis is higher and the ribcage is lower, cuz it's basically pinching everything.
Okay, so why is this pattern happening? Usually it's because of some older problem in the leg that hasn't been resolved correctly, and so your brain taps into our trauma reflex pattern and lifts the pelvis. Lift the muscles that lift the pelvis, also attach to the ribcage, and so they'll pull the ribcage down as well, creating this compression on that same side.
So really, and we're not, most people aren't trained to think about an old injury as the cause of our current pain but I'm telling you that's the case.
Kara Wada, MD: And the body keeps the score.
Rick Olderman: Sure does. Yeah. Absolutely.
Kara Wada, MD: And even just thinking about, I'm curious, so one of my colleagues who specializes in fibromyalgia, she has talked to me a little bit and actually talked with our listeners a little bit about the role of like pain reprocessing type therapy, the idea of centralized pain versus peripheral pain. And I guess I'm curious if that also takes form or kind of your thoughts on how that plays in or.
Rick Olderman: Yeah. So fibromyalgia is a a big mystery for a lot of people and me included. But it's diagnosed through a series of trigger points located in the body.
I don't know, is there now a blood panel test that diagnosis fibromyalgia?
Kara Wada, MD: Not that I'm aware of that's used commercially or particularly regularly. But I believe there is one in the works.
Rick Olderman: Yeah. I think there is, but traditionally it's been diagnosed because if you have multiple trigger points throughout your body, and you have these chronic fatigue and aches and pains and so forth. You've been given a diagnosis of fibromyalgia.
From my standpoint not that I have the answers for fibromyalgia, but perhaps a lot of these chronic trigger points that are set up in the body are because of mechanical dysfunction.
And maybe if we can eliminate the mechanical dysfunction, we'll at least eliminate the mechanical reasons for those trigger points to occur.
The, my fibromyalgia patients I've treated, while I can't cure the fibromyalgia, I can certainly reduce their pain significantly because we're correcting the reasons these trigger points are occurring in the first place from a mechanical standpoint. Does that answer your question?
Kara Wada, MD: Yeah. And the other modality, like she has been using and helping her patients is akin to almost a therapy type in more of a conversation therapist therapy kind of type role in also addressing some of the trauma history, the emotional component. Knowing that our body feels safe in helping with some of that, this maybe the centralized propagation of some of those pain signals as well.
Rick Olderman: I wouldn't doubt it because what we talked about at the very beginning of our podcast, those three pillars of issues, psychological stressors are one of them. Like you said, it could be a blend of three different things happening.
Kara Wada, MD: Yeah. When you work with your patients and and with your books, do you cover then what does that look like for someone who picks it up, I guess is my question. Why were we gonna find in there?
Rick Olderman: In my book or my home programs?
Kara Wada, MD: Let's start with the home program.
Rick Olderman: Okay, so the books I wrote about 10 or 15 years ago. The home programs are newer and they're based on what I've discovered in my clinic for the last 10 years, I and my therapist.
So what I've realized, Kara, is that It's not random why these dysfunctions are occurring. They're actually occurring in patterns. Once I realized that, "oh my gosh, that person with back pain has the same pattern of dysfunction as this person with SI joint pain and they have the same pattern of that person with sciatic pain or hip pain or whatever pain."
So it's just manifesting differently in different bodies based on their, for instance, exercise history, genetics sports history, work patterns, all that kind of stuff.
So when I realized that the same patterns of dysfunction were occurring in all the people with this type of pain that simplified the approach to solving that pain.
So my hope, my books didn't really take that into account. If you look at my back pain book, I have I think maybe 80 different exercises in there to solve all types of everything for everyone, right?
But now that I've seen this clinically, these patterns emerge. That's what my home programs have done, is they've simplified and they've simplified the approach to solving these patterns of dysfunction.
So I've eliminated tons and tons of exercise and just streamlined it into a simple thing. But the home programs not only include stretching or strengthening exercises, but they include changing how you're using your body.
Just like we just described with that, those two tests, if you, even if you understand, even if you did all the thigh stretching and all the other stretching that needs to remove the stresses from your back.
If you keep locking your knees when you're standing and walking, it'll never go away. Because that's the path, that's the problem. That's the habit that is setting up all of these mechanical imbalances. So my programs have not only the habit changes that you need to have long-term relief, but also the stretching and strengthening.
Now the other thing that it has is a lot of people's brains don't know how to make their bodies work correctly because they may have been misusing their body for 10, 20, 30, 40 years. So I also have taking techniques in my home programs that bridge that force your body into the correct alignment that it needs, which unloads the whole system and allows you to experience a rapid reduction in pain almost immediately because it's supporting your body where it needs to be supported to remove your pain.
Then once you do all the stretching, strengthening, and fix your habits, then you can wean yourself from the tape, but the tape is showing you what the problem.
And then the last thing that it has is I'm trained as a Hanna semantics practitioner. Hanna Semantics is a technique that reduces neuromuscular tension in the body and it reduces it in these patterns that you mentioned your massage therapist found in you.
So there's a tension pattern that occurs in bodies and they follow these fascial superhighways that travel through our body from our head to our feet.
These fascial superhighways are identified by Thomas Myers, and you can find them in his book Anatomy Trains if you want to. But there's one that goes from on the back of the body all the way down to the foot.
There's one that goes on the side of the body all the way down to the foot from the head. There's a couple that go all the way through the front of the body. And there's also a spiral line of fascial super highway.
So what I've found is that when we have pain, chronic pain, this whole superhighway seems to be activated and stretching that superhighway isn't gonna help because it's not a tight, they're not tight muscles, they're contracted muscles. If you make a biceps, make a muscle with your arm , and then you try and stretch that arm with your other hand stretch, push your, you can't do it because you're contracting.
Your contraction will fight it. That's what's stretching a contracted muscle is like, it'll just rebound sometimes even worse than before.
So the somatics releases this neuro muscular tension along these superhighways of tension in the body, and that's usually the first step that I ask people to do.
Let's first release the tension, see how much better you feel like that. And then you can start on these stretching and strengthening exercises to fix the tighter, weak muscles that you've created because of how you're using your body.
While you're doing all of that, we're gonna change your habits that are creating the tighter, weak muscles and the tension patterns in the first place.
So it's a very comprehensive yet simple program.
Kara Wada, MD: You're hitting the problem from all of these different trajectory.
Rick Olderman: Absolutely. And that's what has to happen with chronic pain. You have to address the movement, the tighter weak muscles and the chronic neurological tension that's the battery for maintaining all of this pattern.
They all interlock.
Kara Wada, MD: We've talked about that to some degree too, just in the frame of mind of fatigue as well. Another condition that so many of us deal with that for nearly everyone has more than one aspect that's playing into why that's occurring and why we're feeling.
Rick Olderman: Correct. Correct. And so at least in physical therapy, I can't speak for any other profession.
I think we do well when it's a simpler thing like, "oh, I just need to stretch this muscle to solve this one little problem."
And a lot of people can get away with that. And we do a great more acute, simpler things, but once you transition into a chronic issue or a pain that keeps recurring or a nagging kind of thing, it means that you need a more systems approach.
And we're just not trained in physical therapy to do this. And that's what my whole program is all about and my books.
Kara Wada, MD: Yeah. I'm just thinking like I have a patient who is gonna have rotator cuff surgery and thinking about her and knowing from what I've heard that the therapy and the recovery is quite hard, but that would be something that I'm sure would be a main focus in kind of a PT education program would be helping people rehab back from these particular injuries or surgical interventions or what have you trying to avoid surgery in certain instances as well, but.
Rick Olderman: Absolutely. And since you brought up the shoulder is actually the surprising culprit behind chronic neck and neck pain and headaches. The shoulder has significant attachments into the neck and the base of the skull.
Usually what's going on, in physical therapy, we're really good at looking at the shoulder. Understanding that, but we're not so good at understanding the shoulder blade. And this is what's missing in most people.
Rick Olderman: Most people listening out there who have had chronic neck pain and headaches, everyone's been looking at their neck or their head.
Almost no one is looking at the shoulder girdle system and this is why they have chronic issues.
In fact, I can't remember the last chronic neck pain or headache patient I saw that the wasn't because of the shoulder girdle system. Fix that and you fix the stressor.
Otherwise, you're just doomed to keep fixing one rotated vertebrae or herniated disc or whatever at a time, and it'll just keep coming back maybe at a different level, but it'll keep coming back because you're not addressing the foundation of the problem, which is this.
Kara Wada, MD: And is that then caused by similar like imbalances and forces in, out, up, down forth?
Rick Olderman: Yes. Yes it is. So for instance, our most people's posture strategies, have you ever been to a yoga class or a Pilate class. Okay.
Kara Wada, MD: Not as often have you as I would like, but yes.
Rick Olderman: Okay. So have you heard the queue when they say to bring your shoulder blades down and back into your back pockets?
It's pervasive in those classes. Yeah. That's absolutely the wrong thing to do. That's the opposite of shoulder function. So what you're, what they're doing is recruiting shoulder girdle muscles to create good posture. That's not the job of the shoulder girdle muscles. All right.
The job of good posture falls to the core. Not the shoulder girdle.
And so I can show you a really easy way to disrupt this and change this pattern if you wanna see it. Sure. Okay. So those of you, especially with chronic neck pain or headaches, this will be important for you.
So if you put one hand on your chest and one hand on your belly, take a deep breath in and you'll feel your ribcage rise as you breathe in and exhale. You'll feel the ribcage lower as you exhale.
Okay, take another deep breath and this time when you exhale, you can exhale all the way, but don't let the ribcage go down all the way. Let it go down 99% of the way, but not quite all the way.
If you do that, you'll notice that your stomach muscles have just engaged ever so slightly.
That is your core holding up your posture. That's what these muscles are designed to do. We've got massive core muscles, rectus, obliques, transverses. All of these muscles are designed to do just this. Hold us up.
But most people have been taught to squeeze their shoulder blades together to hold them up, and it robs their core of the tension they need to not only control our lumbar spine, but to hold up our whole body system.
So the second part of this then is to now put your arms down by your sides and wiggle your shoulders around and relax them completely so that they're like two dangling ropes hanging by your sides.
You'll notice that when you've relaxed your shoulders, you just let go of your core. That's because you've tied your shoulders to posture instead of your core. Our shoulders shouldn't be in that equation.
All right, so what you'll need to do is learn to lift the ribcage ever so slightly to engage that core and then relax the shoulders while maintaining that position. That's correct posture stretch and when you take the shoulders out of that equation, you've now short circuited all of those connections from your shoulder blade to the neck and head and removed one of the major stressors acting on that whole system.
Kara Wada, MD: Yeah.
Rick Olderman: So that's what, these are the things that I've been figuring out for the last 25 years, how all of this fits together. And then to take it one step further, let's say you have unilateral neck pain or headaches. And you've got one shoulder blade that's lower than the other. Let's also say that you've got, "oh, I happen to have back pain on that same side too, or I've got a knee issue on that side too."
We've already covered the fact that when you have a problem in one side of the body, the pelvis rises up and the ribcage is lowered in response to that.
Guess what? The shoulder blade rests on the ribcage. So if the ribcage is depressed then the shoulder blade is gonna be depressed and it's gonna alter the shoulder blade function. Therefore creating the unilateral pain on that side.
So that's how, and so that's how you can connect headaches all the way down to the foot.
Kara Wada, MD: I'm smiling and laughing just a little bit because all I can think of is the children's song. You know about the head, shoulders, knees, and toes that my kids will sing at home.
Rick Olderman: Yeah, exactly. And this is the thing, Kara is, I expected when I went into PT school for all of this stuff to already have been figured out because that's what we should be doing as physical therapists is understanding these things. But that is absolutely not what's being taught in PT school all over the country.
And it's evidenced by whenever I train new therapists at my clinic , none of them know any of this information. And so they've all been trained in this component. They're all good at specific, a thousand tests to understand exactly which tissue is damaged, but there's no test that's showing why that tissue is damaged. That's what we're missing.
So that's what I've been figuring out these last 25 years with connections like this. Once you solve those connections, chronic pain goes away so fast because you've removed all the hammers that are hammering those vulnerable tissues.
Kara Wada, MD: When people think about a root cause-based approach, that really sounds like what you're aiming for.
Rick Olderman: Absolutely. You're aiming for it too, right?
We all as medical pro providers are aiming and believe that we're solving things from a root standpoint, but my root standpoint is different than someone else's root stand. So their root standpoint might be with back pain, let's say, "oh, let's look at that pelvis then a little bit. This is the root of the problem."
Their root standpoint may not even include the foot or with neck pain or headaches. "Oh, let's look at, these neck muscles that are, attaching from here and there."
But they may not even understand how the shoulder blade, that's not even on the radar.
So that's not included in their root assessment.
Kara Wada, MD: I always find it an interesting and kind of fundamental exercise to visualize, even when I'm in talking with a new patient and talking with them about things from sometimes the 30,000 foot view all the way down to inside the cell and then back again.
And I think sometimes we do have to change how wide the scope of what we're looking at is depending on the person, and maybe in some of those acute cases, it makes a lot of sense to focus in on the shoulder, the knee, the low back area. But when we are looking at something that is more whole body or long term than perhaps, it really does require us to take a few steps or leaps back or up, or however you wanna think about it, to see that whole picture a little bit here.
Rick Olderman: You're absolutely right. So this approach that I've developed looks at the system and the components together. So you'll understand these interrelationships so you can spot problems very quickly.
Just almost exactly as you, how you describe that, I describe in my new book that's coming out in 2023, because it does involve with these more complicated or chronic cases. It does involve this zooming out and zooming in. Zooming out, zooming in.
That's exactly what's going on. And I think the other thing, while we're on subject. So one of the courses I took was Dr. Shirley Sahrmann out of Washington University in St. Louis. A lot of the biomechanics I use in my approach are based on her research. She's written a couple textbooks and, published tons of research.
I took all of our courses and I made friends with one of the PTs who was taking those courses too.
We both happen to end on the same course that year. So I talked to him, I said, "Hey, how's this stuff working for you?" He says, "eh."
I said, " What are you talking about? I'm seeing miracles in my practice using this. "
He says, "Yeah, but I'm a manual therapist, so maybe I'll just use this for a home program or something."
That's when I realized that our belief systems in medicine are filtering out potential information that could be helping our patients. .
It's not only in medicine, it's happens in law, it happens in almost any industry. Our belief systems are filtering out. There's certain information we just won't look at because of what we believe should or shouldn't work.
So when I heard that comment from him, that's when I said, I realized that I needed to write my books 15 years ago because I need to do an end around this belief system. Shut off all of his patients. None of his patients were receiving this information and many other people's patients weren't receiving this information because they didn't believe it should work or they believe that they should be solving something with their hands rather than fixing function.
Kara Wada, MD: And we are all, all of us wear lenses, whether we wear glasses or not, that are informed by our prior experiences and maybe how we were raised and where we live and all of these different things that factor in.
This is where I honestly have found kind of the life coach training to be really helpful and did I need to do that training to figure that out? Probably not, but that's how I did. Really breaking through some of those limiting beliefs. Yes.
On the small and the bigger scale really can create the most significant transformations.
Rick Olderman: Yeah. The thing that drove me was my failures. When I first graduated and tried to help these people with chronic issues, it was complete failure and I was sunk into a deep depression because I had spent all this time and money pursuing a career that I thought was me. I was failing at it and I thought, I just don't know what I'm doing and I can't figure this.
Everything, everyone is telling me isn't working. I must, it must be me.
It wasn't until I moved, because my first job was in a very small town in southwestern Colorado. I was basically the only therapist in town and I was such a failure. I was even embarrassed to go out in public. I didn't want anyone to recognize me, because I just couldn't help anyone other than acute issues.
Then I moved to Denver and I started working at this elite health club, and my schedule instantly filled with tons of people with chronic pain issues, and these were people who were like 30 to 50, well off, had seen tons of types of practitioners and still were left with pain and then that is when I realized, oh, it's not just me.
It's our whole medical system isn't solving these things. I don't care whether you're a chiropractor, physical therapist, or a surgeon. It's not solving these chronic pain issues that took a load off my shoulders, first of all. But then I realized, I've gotta try and figure this out.
Which I was just like, are you kidding me? Really smart people have been doing this a lot longer than you have. There's no way I can figure this out, but I just had to start breaking it down into pieces and it's taken me this long and that's why I'm finally bringing this out is cuz I feel like I've tested it clinically.
I've trained other therapists to get the same results and I've helped so many people over the years through my books and online programs and telehealth and so forth, using the all of these principles, it's very reproducible. Anyone can do this. There's no magic in it about it.
Kara Wada, MD: And part of it you mentioned is the behavior change.
And this is, I think, really important as we're thinking about gearing up.
We're recording this two weeks before the new year. This episode will probably air, right before we're going into the new year.
It's that time of year we're always thinking about resolutions and making resolutions actual reality.
And part of that is the support of having someone to help you along the way. Your tape. So to speak and to get it so that it is just part of that subconscious, unconscious, just way of just how we do things.
Rick Olderman: Yeah. I think if you're having problems and what you've been doing isn't solving those problems, even though you have no idea potentially what could solve your problems. Maybe look into something that you may not believe in and look somewhere else or try something different.
And I say that because over my career, and you've probably seen this too, Kara, when people find the right solution, pain and problems evaporate very rapidly. And the fact that they're not evaporating or resolving means that you're haven't quite found the whole solution for you. But I believe we're not built to be in pain.
We're built to be out of pain. Pain is just an indicator that something is still wrong. You sometimes we have to step outside of our belief systems to understand what that is.
Kara Wada, MD: So I have one maybe last question. We have a fair number of listeners who have known significant joint issues. Maybe folks with significant joint deformities from rheumatoid arthritis or other inflammatory arthritis.
Would this be something that, you know, if they, should they talk with then their healthcare professional kind of before, or what advice would you give for those?
Rick Olderman: Yeah. Of course my, from a, my medical hat, I say, I always talk to your medical provider first, right? Yeah. Unfortunately, your medical provider won't understand a word of what I'm talking about.
Because we're not trained to think this way, right? You can try and explain it to them and see if they say, yeah, go for it.
And I would say you. Remember when I was talking about those somatics audio lessons I've created? The somatics is a gentle way of releasing tension in the body, extremely gentle. That's where if you ended up going forward with something that I have, I would say start with the somatics. If you're worried at all about the repercussions of what you're doing, that's where you should begin because they are so gentle, it's almost impossible to get hurt with those types of movements. It's just really. They're very powerful and very gentle.
Kara Wada, MD: Cool. That's helpful. I think it's helpful just to provide some, a little more, like what is it, what is that actual experience like for folks that are already maybe more reluctant to,
Rick Olderman: Cautious
Kara Wada, MD: Venture out and cautious and understandably. Those those circumstances.
Rick Olderman: So yeah, so if they go to my website, the rickolderman.com website. They can just get the somatics audio lessons, if that's where they want to start.
You get them for free. I'm not charging you for them, but they'll come as a u USB stick and also a digital access to the programs. So you will have to pay the shipping and handling for that.
But if that's, if you just wanna dip your toe very lightly into the water, that would be the great, a great way to do that. And then you can move forward from there if you feel like that's helpful for you.
Kara Wada, MD: Awesome. And we will make sure that every, that your links for your Facebook and your Instagram and your website are all on on the show notes.
We'll have to reconnect when your book comes out.
Rick Olderman: Oh yeah. I would love to, and by the way so I'm taking pre-orders for the book right now and you can do that on my website as well.
Kara Wada, MD: Awesome.
Rick Olderman: But I don't think it's fair to have, ask people to pre-order something. They don't know what's in it, . So I've included I think three chapters on there from the book and I've even made an audio recording of those three chapters so you can listen and read those chapters, see if it's speaks to you.
And that'll give you a little introduction to me for free Of course then if you wanna pre-order the, and get the whole book, that would be great. Cause I'd love to be the first physical therapist to be on the New York Times bestseller list. .
Kara Wada, MD: That would be amazing and I'm always excited to help lift others up who are doing the work.
One of my colleagues and good friends shared with me the quote of, " Rising tide lifts all ships."
And so that's something that ever since she first mentioned that I'm like, oh gosh, I really like that saying. and I think that will continue to be a guiding saying moving forward.
Rick Olderman: Yeah. Sometimes we're threatened by the rising tide. But I like to look at the rising tide. It wouldn't be rising if there wasn't a reason for it.
So let's look at what's going on here and I'd like my boat to be lifted too.
Yeah, absolutely. Try not to be threatened by rising tides.
Kara Wada, MD: Now there's I think it's been this helpful shift in frame of mind of from scarcity to abundance and overall
Rick Olderman: I think our body is full of abundance if we can unlock those keys and remove the hurdles that are preventing us from experiencing that abundance. Because a lot of people come to me thinking that they're broken.
And they're not broken. They just haven't found the right information yet.
Your body has that information inside. It's trying to guide you.
Unfortunately our brain doesn't know how to interpret those signals yet, and trust that you know you will get there. Keep looking.
Kara Wada, MD: Thank you so much Rick for taking time out of your busy schedule and bringing these techniques and what you're doing to the Crunchy Allergist team and I look forward to staying in touch.
Rick Olderman: Oh, thank you Kara. I really appreciate talking to you and I loved your this dialogue. It was just so fun for me.
Kara Wada, MD: Me too. Take care.
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