The Beyond Pain Podcast

Episode 4: Navigating Injury: Joe LaVacca's Story Of Dealing With Pain

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Takeaways

  • Experimentation and challenging oneself within reason can lead to positive adaptations and progress in rehabilitation.
  • Pain does not always correlate with tissue damage, and reframing pain can help with the emotional component of pain.
  • Progress in pain management can be measured by comparing the duration and intensity of flare-ups over time.
  • Giving advice on social media is challenging due to the contextual nature of pain and individual experiences.
  • Individualized and contextualized guidance, such as phone calls or in-person appointments, can be more effective in addressing specific pain concerns.

Joe Gambino (00:00.117)
opens up.

Oh, right. Right, right, right. Ah, same old man. Can't complain. How about you?

Joe LaVacca (00:03.842)
So what's going on, brother?

Joe LaVacca (00:09.41)
Pretty good. Pretty good, I would say. Had a nice week. It was a little bit less busy and chaotic because Avery was on a spring break this week, which it seems like between her and Addison, no one's in school anymore. So it's a wonderful time to be a 10-year-old or 13-year-old because apparently you're just off every other day. So...

Joe Gambino (00:27.62)
Hahaha.

Joe Gambino (00:32.446)
Sounds nice.

Joe LaVacca (00:36.334)
instead of having Avery yesterday and today, because she's with her mom on their little spring break, it was nice to just kind of get caught up and watch the draft last night. I mean, we're coming, we're recording the day after the draft. Don't know what to think about it. It was a really big night. I built it up really big in my mind because you had the Yankees starting at seven, you had the Knicks starting at 730, and then you had the draft at eight, and all of them were big disappointments. So.

Joe Gambino (00:47.74)
I missed it.

Joe LaVacca (01:05.654)
But I think that's sort of this whole idea of being a New York sports fan.

Joe Gambino (01:13.342)
Yes, I mean, the Knicks, they're surprising the hell out of me. And I haven't seen the Knicks make a run since the 90s, you know, since. So it's kind of nice.

Joe LaVacca (01:18.175)
Oh, yeah.

Yeah, it's fun. It's fun. Yeah, it's fun. I, you know, obviously you don't really see a lot of other teams play. You get them once in a while, but I gotta say, I mean, Joel Embiid is so good. I mean, guys got one and a half knees and he is still like head and shoulders above everybody else on the court right now. And, um, yeah, so I think it's pretty remarkable what, what he's doing. And.

Joe Gambino (01:47.859)
Imagine if he had two knees.

Joe LaVacca (01:51.392)
I don't know if we'd stand a chance in the series to be quite honest with you.

Joe Gambino (01:56.378)
All right, man. Well, everybody, thanks for putting through our banter to get started with the episode. Welcome back to the Beyond Pain podcast. I am Joe Gambino and I am here with Joe Lavaca. Hopefully you guys have gotten the different Joe's voices at this point. But yeah.

Joe LaVacca (02:14.71)
Hopefully.

Joe Gambino (02:16.346)
If you're enjoying the show, obviously we'd love for you to subscribe. This way you get these right to your device every time we let them out. And always please follow us on Instagram. Joe and I are most active there and feel free to DM us. We're, I mean, I know I'm not going to speak for Joe, but I'm in there all the time. I respond to every single DM that comes through. I know Joe does as well. So questions, comments, concerns, just want to say hi. Please do.

I am Joe Gambino DPT on Instagram and Lavaca is strength in motion underscore PT and this show will be live as well on YouTube if you want to listen to it there. YouTube channel is cups of Joe's underscore PT and that's it. Now we're in it live and I have a question for you Joe as far as a little...

coffee chat segment and I'm just curious because I don't know what to watch on TV anymore. So what are you watching?

Joe LaVacca (03:19.632)
That would be baby reindeer right now.

Joe Gambino (03:22.223)
I just saw it. I just saw that. What do you think of it? Our initial impressions.

Joe LaVacca (03:27.242)
Um, Courtney, Courtney and I last night said it is maybe the top three weirdest show we've ever seen. Um, maybe weird is a strong word, but I mean, like, uh, the complicated storylines, the complicated characters, um, and I mean, kind of, it's, it's pretty graphic too at certain points. It almost makes you uncomfortable. And I think it's a really.

really well done show. I think the acting is great. We obviously kind of finished up the whole series in about a week, so it was captivating our attention. But yeah, that would be a baby reindeer that we are watching right now. And if you were sort of like, if we wanted to just switch genres completely and just kind of have like, just like something a little bit more on the opposite

We also just got done watching Foundation on Apple, which was way sci-fi, yeah, so sci-fi, futuristic, sort of lots of stuff happening on that show. So if Baby Reindeer doesn't seem to be your cup of tea, and I say that purposely, a cup of tea.

Joe Gambino (04:31.16)
Mm-hmm. No, I haven't heard of it.

Joe LaVacca (04:48.918)
Then maybe you just switch hardcore, you go to something like a foundation, but those are the two most recent shows. So I would give those a go. And then maybe next week, if you're still stuck, I'll give you a few more recommendations.

Joe Gambino (05:01.218)
So I would say we just finished Baby Reindeer, which I thought it was weird. Out of the last three shows that we've watched, it was the best of the three. I don't remember the names of them because Jen just keeps, she just selected them and I don't remember what the names were, but you watched this Italian one. Maybe after people are interested, I'll see if I can figure out the name, but it was such a weird show. It was about this, I guess, I don't know if he's like a serial killer, but he was.

Pretty much he would kill people or he ended up killing somebody and then they could have more than once and he would take over their persona and just like completely live their life. It was a very weird, very dark show. And then we watched that show that just won an Oscar. I don't know if they won any Oscars, but the Oscar nominated. I can't remember the actress's name because I'm terrible with actress names. But it was the one where she had a surgery and she had like the brain of much like

Joe LaVacca (05:39.365)
Oh.

Joe Gambino (05:59.818)
you know, like a six year old and then like slowly developed. I can't remember the name of it, but that was a very odd movie. I was just trying to pull it up here to see, yeah, I don't know. So it was, I guess her parents said like, they were in like some sort of accident and he saved, instead of saving the mother, he saved her. And like, it was almost like a Frankenstein type of story. He did a surgery on the baby, on whoever, I guess it was the mother.

Joe LaVacca (06:07.525)
I don't even think I've even heard. Sometimes I can usually jump on board like a plot or something.

Joe LaVacca (06:25.303)
Oh wow.

Joe Gambino (06:29.458)
I don't remember exactly how it went, but put the baby's brain in it and I get, I think the mother to save the person. And so pretty much this person started as an adult, had like the brain of a toddler and then slowly would actually like develop over the course of the movie into like a full person. It was very, very strange, very odd. Maybe that's why I don't remember the names of these titles or can't hold on to the full story lines.

Joe LaVacca (06:30.059)
Uh huh.

Joe LaVacca (06:52.662)
Yeah, I'm not gonna lie, your description of it wasn't captivating me to go googling it either.

Joe Gambino (06:59.167)
I was trying to find the name because I'm terrible with these things but UGH Is this it here? Uhhhh

Joe LaVacca (07:04.139)
Oh man.

Joe Gambino (07:08.086)
Poor things, is it called?

Joe LaVacca (07:10.026)
Oh, that's a movie, dude. That's not a, I thought, oh, I thought you were, I thought you were still live referencing a show. I was actually gonna say Poor Things. I was actually gonna say Poor Things, but then when you mentioned show, I was like, what are you talking about? And then again, the first thing that popped in my mind was Poor Things, because I heard sort of similar things, like her parents died, and I was like, it sounds like you're describing Poor Things, but is there another show I was missing? Yes, I have heard a few clients have recommended Poor Things to me. So I just haven't gotten around to watching it.

Joe Gambino (07:11.454)
Yeah, movie. Movie. That was a movie.

Two shows, one movie.

Joe Gambino (07:36.958)
Very odd, not my cup of tea. Very odd movie, but anyway, let's digress from here. Let's get in. Today we are highlighting you, Joe. I'm very, very excited to do so. I'm very curious to see what you have to say about this stuff. And I hope you didn't go in peak. I know we talked about keeping these questions as a surprise from each other, but I think it's gonna be fun. So let's get kind of right into it.

Joe LaVacca (07:48.462)
Let's do it.

Joe LaVacca (07:59.082)
No, I didn't. I didn't. That's why I'm a little nervous.

Joe Gambino (08:07.058)
I know you've had, you know, we've talked a little bit, you've had some injuries in the past. What is the injury that you've had that has had the most profound impact on your ability to do?

Joe LaVacca (08:12.023)
Mm-hmm.

Joe LaVacca (08:19.93)
Um, as far as like a limitation currently, or as like a limitation when it happens.

Joe Gambino (08:23.838)
It doesn't have to be current. It can just be, yeah, whatever injury you would say has had the most impact on your life to date. It doesn't have to be current.

Joe LaVacca (08:33.618)
Okay. That's, that's, that's fair. Um, I'd probably say there's, so I can probably think of two things. Um, number one, I broke my left wrist twice. Um, as a kid growing up, pretty young, I think it was like second grade and fourth grade. Uh, as a result, it never healed, um, quite like it should. And I don't know if that was my fault or, or whatnot, hard to kind of remember back to what I was doing back then. But

So I don't have any fibrocartilage in the lateral aspect of my wrist. And if you guys are watching on YouTube, if I took my watch off, it'd actually be a little bit of a better demonstration. But you can actually kind of see like a lot of that like giving way sometimes like on the lateral part of my wrist. It does still create some pain for me, which is why I think that I gravitated sort of away from doing a ton of manual therapy too, because it kind of just hurts.

hurts a lot of the time. So my philosophy when I started doing a lot of PT practice and exercises and things like that was if I couldn't do it with one patient, I'm not gonna do it with any patient, right? Cause then it just becomes an unreliable sort of thing. So I thought my biggest weakness coming out of school and maybe we probably, most of us feel this way, it was probably like with manual techniques or skills.

And then even when I went to some courses and classes, you know, none of them really fully captivated me into this idea that, um, you know, manual therapy, like had to be a thing for me with every session. So coupling that with the fact that it kind of just always hurts my wrist. So I have to be kind of careful with positioning and stuff. I'd say that's had the biggest long-term impact. And it was really when my back hurt.

around sixth grade or seventh grade or eighth grade, just around that time, where I was introduced to the whole idea of physical therapy. Because I didn't have physical therapy for my wrist at all. It just was like, hey, this is a broken bone, it'll heal. That was wrong, by the way. It was a little bit more than that, I think, just by evidence of what I just showed you guys. And then, but I mean, the back pain stuff, when I was in sixth grade, seventh grade, eighth grade, that's really what prompted me to get physical therapy. And, you know, we talk about...

Joe LaVacca (10:52.694)
kind of like sociology of healthcare. My parents were in physical therapy, my sister had already had physical therapy. So it was almost like when I got hurt or my back started to spasm, especially when playing basketball, I was like, ooh, I get to go to physical therapy now. This is great. So I guess like that's what really introduced me to it. And then my wrist fracture is kind of what still affects me implementing it to this day.

Joe Gambino (11:15.754)
Gotcha, and you're back. Does that come up and pop up like different parts of your life now, or does it so bother you at all, or is that like completely 100% of the past?

Joe LaVacca (11:25.266)
No, I would say my now philosophy on my own personal injuries is number one, I'm very lucky to not have anything recurrent or that I sort of deem recurrent. Over the last few years, I'd probably say I had a little bit of rotator cuff or sort of like inflammation for a week, two weeks, something like that. I definitely have had some.

Achilles discomfort from just doing a little bit too much with sprinting that actually lasted for a little bit, but it didn't really impact my day to day too much, but it definitely would pop up with more intensity. And then I had a posterior tibialis tendonitis on my other leg from when I was sort of moving actually I remember it exactly when it happened. I sort of like just like leapt off the moving truck. I had a box in my hand. I just felt it just instantly sort of like just strain.

But my philosophy now, whenever I have all those like little injuries is I go in and I experiment with myself. I poke it. I prod it. I really try to sort of take all the things that we know and really like force feed them. I'm like, OK, I know that this isn't neurological. I know that this isn't a red flag. I know this. I know this. You know what? I think this is muscular. I'm going to start pumping it. I think this is a joint. So I'm just going to start moving it.

I think this is a tendon, so I'm going to just gradually start doing isometrics and trying to spring it as much as I can. So now when I get pain, I'm almost like, ooh, this is fun. This could be a challenge for me. Can I push into this a little bit? And then can I then take that sort of like story or experience and then apply it to clients? Not that I want to make sessions about me, but when I tell clients, hey, you can push through this and you could do this and you could do this, trust me on this because I've done it.

And I've used the principles I'm trying to teach you and it resolved quickly. I already resolved this fast as it could. And then this is how I didn't quote unquote miss a beat.

Joe Gambino (13:27.138)
I like that and you kind of stealing your way into a option that I have for you. So look at you and you didn't even sneak in and take a peek. But let's stay here for a second. Then I want to go back. I love the idea of experimenting when it comes to having pain because what I've seen even just like working with however many people I've worked with at that point, up to this point.

Joe LaVacca (13:37.822)
I didn't, I didn't, and that's why I was so nervous.

Joe Gambino (13:55.166)
The people who experiment and kind of not necessarily push the boundaries, but they're not afraid to move and do things and challenge themselves. Obviously, within reason, right? Because people can, there's definitely a subset of people that can do way too much and that's a problem. But those people who are like willing to like not baby it tend to do better in the course of rehab than somebody who's afraid to kind of challenge the tissue because they're worried about what that pain can become.

So it seems like that's what you're kind of doing. Do you feel like that's something that you push over or you feel like you're kind of giving to your clients as well? As far as education goes and how you end up treating them.

Joe LaVacca (14:36.258)
Well, I think that from the standpoint of a lot of the research that I've read or been exposed to, I think it just kind of helps validate a lot of the things that I try to teach clients. So when I sort of have this like pain and injury and I'm sort of like, okay, well, I know that this is not going to be prognostic for how long the pain might last, which when the posterior tip stuff happened.

was really painful. I remember when I woke up with the shoulder inflammation, I felt like it was hot and I could barely move it. I actually just remember starting laughing when I was getting dressed. I was like, oh my God, this is insanely painful, but I went to bed okay, so there couldn't have been a traumatic injury. Taking those ideas and I think it really strings a long story that, hey,

the level of your pain does not correlate with the level of tissue damage. And, you know, we can relate lots of stories there, but now me having gone through that, maybe I kind of empathize with that a little bit more, and then I can bring up those feelings. Hey, I remember, you know, what happened when I started experiencing it. It was almost disbelief at first. It was almost like this, why me? It was almost like, Hey, um, how long is this going to last? And then it was just sitting down with those thoughts.

and then trying to validate them. Like, does this make sense? Right? Does it make sense that I think that this would be lingering for the rest of my life? Does it make sense that I don't think that I should do anything today? And then every time I try to just come back and sit with each initial thought, I came up with a different solution. So that's what I really try to encourage clients to think about is, hey, come back to your mechanism. What happened? And for many clients, it's the Beyonce mechanism. Do you know what the Beyonce mechanism is, Joe?

Joe Gambino (16:31.643)
Ah, that I do not know, no.

Joe LaVacca (16:33.434)
Well, they woke up like this, brother. They just woke up like this. Right. So, you know, it's hard to trace back, you know, to the things you definitely should or should not have done. So we start there. Hey, I didn't have a traumatic injury and I have pain. All right. What's my next step? How sensitive is that pain? How much can I push into it? And then, yeah, you know, most of the things that I've read or that I instruct clients on, and I think we touched on this in past episodes is if your pain is around a three four.

Joe Gambino (16:35.087)
Hahaha.

Joe LaVacca (17:00.498)
maybe maximally up to a five, although maybe for some people, five is kind of pushing it. You're probably okay to be kind of going through that motion if you can control your movement. Like rep one looks the same as rep seven, eight, nine, 10. Your breathing is sort of regulated. I shouldn't be able to tell, you know, via your facial expressions that you're battling through pain. Effort's okay, but I don't want to, you know, see you battling through pain. And then I...

take those same ideas and I'm like, well, I don't know. It's all subjective scales, right? So how hard can I push this? Can I push it to that Nth degree? And not that I would encourage clients to do that for the most part, but I think it just, again, further allowed me to give confidence to people to say, hey, three, fours, maybe even up to a five is okay. Give it time. This is what we think it is. This is how long it should take to respond. And if it doesn't, hey, look.

We reevaluate, we learn something, but we both got better in the process because I know we're probably not going to get it right the first time, or the first session. So that's why working with someone like you or me or anyone else out there, it's a time commitment, right? Because things happen a lot faster than we think and a lot slower than we want, right? So you can wake up Beyonce style and then you, why does it not get better instantly?

That's just sort of how physiology works, you know, and inflammation works and behavior works. So I think it's really helped me with my own sort of interpretation of the literature and being able to kind of put those things to the test. So hopefully it's benefited clients as well.

Joe Gambino (18:44.466)
No, I really like that and that kind of goes back into last week's episode where we talked a little bit about those pain guidelines that I use and things being up to no more than like a four-ish out of ten, nothing that lingers, all being signs that you can kind of work through this and that it will actually create some sort of positive adaptation. So I really like that. The other thing that I think is really important that you said is that even as...

you know, as we're physical therapists, right? We understand pain, we understand movement, like all this stuff. And when you have injuries, you even have to take a step back and be like, oh my, right? You have to process like the emotional component of pain, right? And that's why I tell people all the time, it's like, take your day, whatever you need to do to process whatever you're feeling as far as your pain coming back, right? It's, we should never ignore what you're feeling.

But then take you know, like let's see what happened Let's take the objectives into consideration and like almost like reframe it a little bit So this way we can get back on track and find that re-entry point if we need to or see how quickly it comes down to recover and then compare that to the past right like when we start to look at a lot of the Things that you know, like pain is a very subjective experience You know, you're almost immersed in all the time. So sometimes it's really hard to see, you know, what's actually happening from a progress standpoint

But that's why sometimes you just need to look back like, oh, well, last time I had a flare up, those lasted for a week or two, but now I have a flare up last for two or three days. But that's a significant sign of progress to me. Where I like, oh, I had a flare up, but in the past, I had to sit on my couch for three days because it was so painful, I couldn't do anything. Now I can still go through my day to day and the pain is much, the intensity is not as high. Again, signs of progress, because you're capable of doing more

Joe LaVacca (20:18.542)
Mm-hmm.

Joe Gambino (20:39.838)
same pain level or less. So it's like trying to like, you have to almost like think of these little wins that you've had in order to see some of that progress that's happened. So I just wanted to kind of highlight that. I think it's important because even as, again, right as us being in the industry, I've had the exact same experience as you. Where pain comes up, it's like, oh man, why is this happening again? And then you need to process it, play around with it, move a little bit and kind of see how it goes. So, yeah, pretty cool there.

Joe LaVacca (21:07.712)
Hmm?

Joe Gambino (21:09.058)
Where do I want to go here? Do I want to go back? I don't think I'm going to go back to the wrist. What I do want to actually ask you is, when you do have somebody who's been struggling with pain, and let's maybe do it two ways here. If somebody, let's start it here. If somebody like maybe was a family member, wasn't somebody that you were working with in clinic, and they were struggling with pain, maybe you're someone who DM'd you on Instagram, what would be like the number one advice that you could give?

Joe LaVacca (21:39.438)
Hmm. Well, I guess it's harder to say because the way that I would typically answer those questions is it's very contextual, right? Like, I'm sure when you message the DMs before, a lot of people seek help on social media. And I think that's one of the best things about social media, or it's supposed to be the best things about social media, right, this idea that you can connect with sort of almost everyone or anyone on the planet, right? Now,

I think when the connection and the community aspect are weighed against individual things, that's where it gets tough. Most of the things I post on Instagram, or if not all of them lately especially, are coming directly from what happens to me almost either that day or that week with clients. So whether it was sparking a conversation, some regression or lateralization we did with their rehab, a thought, whatever.

So I think a lot of the times when people reach out to me and they see a post like that, they're like, oh, okay, like, no, this sounds like me. Yeah, it might sound like you, but it wasn't you. Just like the post the day before, wasn't the same person I was kind of referencing or talking to today. And that's probably where I, I wanna do a better job on Instagram and with my messages to sort of say like, hey, every interaction is built off of a framework, but every interaction.

is sort of emergent in the sense that it sort of like just goes on its own. It grows from the first one or two questions, right? Like I didn't know what you were going to ask me today and you didn't know how I was going to respond. So that could have thrown off your whole line of questioning or maybe it kind of validated it. We didn't know until it's actually happening. So when people reach out to me on Instagram, I try to convey that message to say, Hey, look, I'd love to help you. But the best way for me to do that

and sort of give you the information that I think you want or that is maybe valuable to you, it's probably either just scheduling a phone call, right? Which I have on my website, you have the ability to do that, right? They're 15 minutes, they're totally free of charge and it just gives us this chance to just kind of sit down and just get to know one another a little bit or just book an appointment, right? I mean, again, with pain being so nuanced and everyone's story being different and...

Joe LaVacca (23:58.346)
You know, in our previous episodes, we talked a little bit about, and we will continue to talk about this biopsychosocial model and all the other models that are out there with pain. It's almost sort of impossible for me to give you good advice. So I try to shy away from it completely. But that was a great question. And I'd be maybe interested in our next episode to see how you deal with those questions as well. But I'd say that's how I handle it right now. It's pretty middle of the road. I'm always going to encourage people to dive a little deeper with me.

And then that's really just for their benefit, the way I see it.

Joe Gambino (24:31.15)
No, I like that. I mean that's everything's always as contextual based Also, it was good advice, right? I mean But the thing with anything on social media Is that the it could be a post that you see from myself from you from anybody else, right? It's almost a 50-50 chance of it working not doing anything or making me worse, right? So You do need to pursue a caution when using social for anything

I'm similar to you. So one DMS me there's a lot of questions that I end up asking Because I do want like the one thing I love about social media is the ability to connect with people otherwise just having 80 some odd thousand followers would be boring if there was like literally no Connection with anybody whatsoever, right? So I usually just ask a bunch of questions and usually those questions will lead to one thing. No lead to like well

Based on what I'm hearing, I have a free resource, whatever that I can push you towards, right? That would potentially help. I don't know if it will, but let me know if it does. Or similarly, right? It's like, hey, I can open up some time on my calendar. If you wanna chat, I'm more than happy to do so, so we can dive into this deeper and let them make a decision as far as where that goes. And if it feels like something that, giving free advice would be.

Something that could cause harm, right? Or I don't feel like it would actually be helpful, then it's guidance like go see somebody in person or go see your doctor, or maybe just where our conversation ends. It's like a, you know, kind of take it case by case in that scenario. But I think you did a good job answering the questions, even though you were nervous, Joe. Appreciate it. Appreciate you sharing.

Joe LaVacca (26:12.81)
I was. Thank you. No, thank you for your line of questioning. Luckily, the questions I have for you in our next episode are different, so we won't have a lot of back-to-back things, which is fun.

Joe Gambino (26:22.198)
Ooh.

Joe Gambino (26:25.534)
I was really curious to see, that's why I wanted to be surprised. I was curious to see how different our line of questioning would be and where these conversations around our own stories go. But thank you everybody who has listened so far. Joe, I love you. Listeners, I love you as well, especially if you made it to the end of the episode and listened to me now. And as we've highlighted our next episode, we'll be highlighting me and talking about my story of pain and whatever else.

Joe LaVacca (26:43.125)
I love you.

Joe LaVacca (26:46.872)
That's always important.

Joe Gambino (26:54.486)
that conversation needs to. See you then.

Joe LaVacca (26:56.786)
Mm-hmm. Take care, everyone.