Episode 31: Does Having Pain Mean Needing Physical Therapy

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• Joe Gambino
• Joe LaVacca

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Summary
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the necessity of physical therapy for individuals experiencing pain. They explore the nuances of pain management, emphasizing that not everyone in pain requires physical therapy. The conversation highlights the importance of understanding the context of pain, the role of personal health investments, and the significance of setting clear goals for recovery. The hosts encourage listeners to assess their pain and its impact on daily life, advocating for a balanced approach to health and wellness.

Takeaways
Not everyone in pain needs physical therapy.

Pain can be a normal response to activity.

Recovery is often not a linear process.

Understanding the context of pain is crucial.

Setting clear goals for therapy is important.

Investing in personal health can aid recovery.

Pain that doesn't limit daily activities may not require treatment.

Listening to your body is key to managing pain.

Healthcare professionals can provide guidance when needed.

Pain doesn't always indicate a serious issue.

Transcript

Joe Gambino (00:00)
Welcome back into this episode of the Beyond Pain podcast. am one of your hosts, Joe Gambino, and I am here with Joe Lavaca as always. Lovely to have you here, Joe. It's a pleasure actually every Friday to do this. I feel like we were really close to perfect stride. Then we had this long period of like talking here and there, and then we've rekindled over the last several months. So it's been very, very enjoyable.

Joe LaVacca (00:13)
Lovely to be here.

Mm-hmm.

Yeah, no, been... It has been.

Joe Gambino (00:30)
More so from this perspective than, know, I I love, I mean, the education point and podcasting I've always found fun, but this has been the most valuable thing.

Joe LaVacca (00:38)
I completely agree with you and I think I mentioned in our last episode, thank you for doing this with me over the last, think we were almost at six months, right? Almost.

Joe Gambino (00:46)
I guess so. mean, this is going to be episode 31. So I guess that's 31 weeks of more than half a year.

Joe LaVacca (00:49)
Yeah.

This is a six month anniversary. This relationship and podcast are getting serious. They're getting serious. We're taking it to the next level. Well, that was the other thing. So your birthday took precedence in last episode, but for people who might be tuning in and watching this on Instagram or YouTube, we got to talk about the mustache for at least a minute or two. So guide us through this because I can't imagine Jen's very happy.

Joe Gambino (01:00)
It is. is. Hence this mustache.

Hahaha.

No, she's not. She hates it.

Joe LaVacca (01:24)
You

Joe Gambino (01:27)
She hates it. She could probably hear me tell people that I hate her right now.

Joe LaVacca (01:33)
So then what was the impetus behind this for people who don't know about the mustaches in November?

Joe Gambino (01:39)
Yeah, so this is a, I don't really do it every year. I haven't done it in quite a long time, but it's a, it's a November tradition. I always will do a little donation for prostate cancer, which is a whole November movement. So I decided to have a little bit of fun. was also hoping that when I went to go get my daughter from, from her nap, you never see those videos of like, when like a guy who has like their beard, dad has their beard for so long and then they shave their face and then their kid has this like epic reaction. I thought that

Olivia might have it and she literally just like nothing. She did touch my face for a while and like real, yeah, probably it. Touched my face for a while and like, this is different. But otherwise it was normal. So that was, I wouldn't say it's lackluster, but I was hoping for, to see if there was at least like a recognition that something has changed, but not really.

Joe LaVacca (02:16)
I don't think it's big enough.

Well, you know, it's early. It's November 8th, right, as we're recording this. I mean, there's still hope for this to kind of freak her out and maybe scar a childhood memory or something. You know, maybe if it gets longer, we can start curling it a little bit. Maybe we can start doing some designs.

Joe Gambino (02:48)
Nah.

Nah, because I get it. There's like a gap here. Always. I have like a little gap here before my beard. So I couldn't do.

Joe LaVacca (02:58)
Yeah, but that's okay. this is going to get longer, like the side where it's not grown in, like to just do a little, you know, like a little cat whisker or something.

Joe Gambino (03:02)
Not too much. It literally comes maybe a little bit and then nothing and then beard and patchy beard. Maybe, maybe, maybe.

Joe LaVacca (03:09)
I still think there's some opportunity. think we gave her a whisk or two going. You just need to, you know, just give it some nurturing. Talk to it. You know, I think petting it, know, maybe put some, maybe put some hair oil or something on it, you know, with all the stuff that Avery has for her hair, her skin and everything else. I'm sure there's something I can send you. Yeah, I'm sure there's something I can send you.

Joe Gambino (03:16)
Okay, yeah.

I do.

Something to help my mustache come in a little thicker. Although I think it looked better than last time I did. I did it last time for Fernando's bachelor party, which is many moons ago at this point. But I feel like my facial hair was lighter then and also maybe it wasn't even as thick. So I don't know. I like this one much better. Maybe it's just my older age.

Joe LaVacca (03:37)
yeah, yeah, yeah, of course.

All right, very good. my beard is slowly kind of coming back into form. I was Eddie Vedder for Halloween and Eddie's sort of beard is a little bit more of like that chinch strap sort of approach. At least that's what it looked like in sort of several videos and angles. So when I was Eddie Vedder to, you know, please Courtney, because her number one band is Pearl Jam. The number one, probably man in her life is Eddie Vedder.

Joe Gambino (03:55)
Mm-hmm.

Hahaha.

Joe LaVacca (04:12)
So it was nice to just give her 24 hours where she was kind of with Eddie. But yeah, you can still see where it was, chin strap, a little darker. This is still taking some time, but I think by next week we'll be evened out and then we'll see how far your mustache has gone.

Joe Gambino (04:20)
Mm-hmm.

You'll be alright.

Yeah, we'll see. We'll see where, you know, where it goes. We shall see. But today, I mean, it be a little little mini-soad. Yes, I'm actually interested because you brought this up right after our last conversation. And I am curious to see what you, you know, the stories you have behind it and what you think about this. And I actually just in general, and I think this is actually a pretty good topic because I don't believe that everybody who has pain.

Joe LaVacca (04:32)
Yeah, all right.

Many so.

Joe Gambino (04:59)
needs to go to physical therapy. There are probably some points where people may start to consider it. But I'll just pose the question and then we'll go from there. does everyone in pain need PT?

Joe LaVacca (05:14)
Correct, great. And recency bias, right? This was sort of inspired by a client I saw last week. She was dealing with some pain in her ankle, maybe a tendon-like pain, Running a lot, has a family member who's also in the healthcare profession. So obviously when you're not seeing someone you care about and they're telling you, I'm in pain and ham in this, the first thought,

and I would say the same thing, is we'll go get a looked at. What are you waiting for? know, I'm a physical therapist. There's plenty of physical therapists near you and we can try to find you someone. So fortunately, or maybe unfortunately, this girl found me. And when we were sort of looking at things from where she was when she started the pain a few weeks ago to where she was now, it was very mild. Her strength was looking a lot better.

there was no signs of swelling or tissue damage. Yeah, we could probably elicit a little bit of pain with palpation and we don't have a new data point for like a long run test yet, but all her short runs were going pretty good, right? She could feel a little bit, but it wasn't changing her breathing. It wasn't resulting in any issues with her 12 or 24 hours later. It didn't seem like she was deviating in her form. And I think you brought up a case similar like, and she's busy.

There's a lot of things going on. She's also a healthcare professional too. So there's a lot of balls in the air to juggle. So once we looked at it, we came to the conclusion that, she didn't need to be here. Right? This was progressing in a really good way. And when these things are progressing and people are on the rise, I kind of feel like over treatment or over medicalizations, kind of pull them back down. And this rise or your recovery without

me or physical therapy or anything else, I think is usually a testament to the person in front of us. They've invested in their health. They've taken time to eat, right? They've slept. They prioritize relationships. They stay active, right? All these things. And we train. There's never a linear straight line of training, right? I always have a little bit of something where I'm like, you know what? I could push as hard today as I could two weeks ago. My shoulder was a little achy. We've talked openly on the program with your back, you know, being

you know, maybe one day you adjust, one day you can push, right? So even me and you sort of, you know, with maybe knowledge as, you know, our background can modify now. So I sent her on her way and this happens, you know, relatively frequently, I think when I was reflecting on it that I'm checking someone, I don't assume that just because they had pain, they're going to continue to flare and continue to have pain when their trajectory has been improved.

So what do you think about that? Do you sort of like have these patients that pop up and then how do you handle them in terms of setting up expectations for future?

Joe Gambino (08:21)
Yeah, I think what I run into most where I'm not sure if someone really needs any sort of guidance and it becomes up to them because I do both the fitness side of things and the rehab side of things, right? So it's a little different when someone's coming to me. But when I'm having a conversation with somebody and a lot of the questions I ask, like I really try to get to figure out how like it impacts someone's life. And when someone's like, I have pain, but it doesn't stop me from doing anything. It doesn't like.

You know, if I ask him like, well, why do you want to, you know, take care of this? And they're like, well, I don't know. you know, well, then I'm like, well, maybe you don't really need anything. Right. You're already active. You're doing things you're actively working on trying to feel better. So unless it's been like, well, not for a really long time or started to get a little bit worse, or there's something that tells me that like, maybe you should take care of it. But if you don't have a real why for like, why you want to get better. and like you're like, yeah, I've even asked someone was like,

Well, do you even like care about taking care of us? And they're like, not really. So I'm like, well, why are we on call? You know, like, so. So they're like, yeah, you know, I just wanted to talk about it and, you know, maybe see if there's something I should do. I was like, well, here, try this and see what happens. But yeah, I think those are the cases where like, like where I think someone needs is it starts to impact their life. There's this, there's like, you feel like it needs to get better.

Joe LaVacca (09:24)
Yeah. Yeah, I'm here because someone else told me to be here.

Joe Gambino (09:47)
but if you just have some pain or even if like you just had like a little bit of a flare-up and all of a sudden you're like Five days later seven days later ten days later your pains back to normal You probably don't need to go see anybody right like if someone like one of my clients or someone I know they're like this happened like my back hurts I'm like, let's give it a few days Let's see what happens because there's a normal course of flare-ups and like, you know If they just come back down and resolve like it's probably just a blip that happens to everybody I have like

Joe LaVacca (10:07)
Mm-hmm. Mm-hmm.

Joe Gambino (10:14)
something that bothers me every now and again, low level, goes away that by the time I wake up the next morning, no need for me to worry about it, right? And so when it lingers around for a while, it really starts to impact life is like when I'm like, you should, whether you feel like you should or not, like it's probably in your best interest to take care of it.

Joe LaVacca (10:34)
Yeah. I think you bring up a really good point because if it's not limiting you day to day, it's really not interfering with your activities. It's just sort of an occasional nuisance. And I get that you would rather not feel it. But when you don't have a goal for physical therapy per se, then maybe that's why people feel physical therapy is not worth their time or it didn't help them. Well, what was it supposed to help you achieve? You're already moving. You're already working out.

You're already doing every single thing. So why don't we look at this objectively and then say, well, are you at risk for making something worse? And I don't have a crystal ball, but if we run through some assessments, we run through some things with range of motion or form checks, maybe this is another thing where we look at load management because the person I was thinking of was just reflected of another client that I had who

sent me a picture of actually his calf and his ankle. And he was like, you know, I have some swelling here. And I'm like, all right, well, take me through it. What happened? You know, I was out for my run and, know, for the last, you know, cycle of on and off running, I really pushed, you know, I wanted to push speed. All right. So I, opened it up and yeah. And then I just kind of felt it tighten up a little bit. And, you know, here we are. I'm like, okay, well, right then and there, I would say to you, did

we wait for the 10th round of an on and off to add speed. If we look into your program, we haven't really been building a lot of speed work or maybe plyometric work just yet. So I would say that this is sort of a normal response. Now, he wanted to sort of go get it looked at. So, okay, I understand your concern. You see a change in tissue, but I don't see any bruising. Range of motion was still okay. I had him do a couple of quick strength tests, right? He was all good. MRI comes back, you

just shows fluid in the area. And now it's like, okay, we're back to sticking with our plan, right? I didn't deviate anything, right? The swelling, I think, will get better, but this is a perfect response of tissue when it's pushed towards capacity, right? It gets a little inflamed, maybe there's some swelling, maybe there's this, maybe there's that. But I think, again, holding on to objectivity to say, well, are you limping? No. All right, is there bruising, redness, anything else? No.

Are you sleeping okay? Yes. All right. Is it bothering you with squats, lunges, deadlifts, this, that? No. Okay. So you know what? I'm not going to make this a thing. Let's just move forward. Call it some phantom physically unexplained symptom. We'll put it into this one of the unknown questions of the universe. And then let's just keep moving. And I think maybe that too is another thing where

I always tell people this, anything we do together, I expect you're gonna have pain. You're already coming in with pain. So I don't think that you having a little bit more pain or something that gets a little sensitive for an extra period of time after you do an exercise is cause for concern to change what we've agreed to as far as programming. Because the whole program was built off of your initial evaluation, getting to know you, all these objective measures and tests. So then why would this one more solve?

of a change be enough to shift directions. So if you're out there and you are concerned to your point maybe, if it's limiting you in something or you feel like you're suffering, then yeah, maybe it's time to get your pain looked at. But if you have pain and you're confident and you feel okay, then continue your plan. That would be my best advice.

Joe Gambino (14:24)
Yeah, I like that a lot. I just think maybe like the last point before you take us home would be, know, not pain is not always a bad thing, right?

get paid for number of reasons. And I think, you know, yeah, it sucks, but it doesn't always mean that something needs to be done or something's wrong. So I just think that, you know, keep that in the back of your mind if you're listening and, you know, continue the course if things aren't bad and you feel okay with your situation. And then the second that you feel like you're not okay with your situation, have, you know, a whole industry of healthcare workers, right? That could potentially help you. So.

Joe LaVacca (15:02)
Yeah, perfect. All right, mini-sode All right. Love it. All right. So Joe, we love you. We love your mustache maybe even though Jen doesn't listeners. love you. If you've made it this far, we really appreciate it. And be sure to tune in for another exciting episode of the Beyond Paid Podcast next week.

Joe Gambino (15:06)
Take us home, baby.

Hahaha.

Don't forget some love for you too, Joe.

Joe LaVacca (15:24)
Thank you, man.