Episode 39: The 3 Mistakes You Are Making When Trying to Get Out of Pain

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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 three common mistakes people make when trying to manage pain. They emphasize the importance of not solely focusing on painful signals, the need to maintain enjoyable activities, and the significance of following a structured recovery plan. The conversation highlights how pain can distort perceptions and behaviors, leading to unnecessary sacrifices and ineffective strategies. The hosts encourage listeners to adopt a more holistic approach to pain management, integrating enjoyable activities and adhering to a consistent plan for recovery.

Takeaways
Pain is a signal, not the only focus.

Focusing solely on pain can reinforce negative patterns.

Sacrificing enjoyable activities can worsen pain perception.

Recovery takes time; patience is essential.

Following a structured plan is crucial for healing.

Engaging in enjoyable activities can aid recovery.

Pain can distort rational thinking and behavior.

It's important to modify activities rather than eliminate them.

Gradual exposure to activities helps in recovery.

Your body can heal; give it the time it needs.

Chapters

• 0:00 Introduction and Guest Introduction
• 3:45 Common Mistakes in Pain Management
• 18:18 The Importance of Following a Plan

Transcript

Joe Gambino (00:01.269)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I'm here with Mr. Mexico Joe LaVacca. He is an international. Actually, that makes you our second international guest on podcast. You can. Yeah, exactly. Some balloons popping up if you're watching on YouTube.

Joe LaVacca (00:09.71)
That's right.

Joe LaVacca (00:14.018)
Second, that's just thinking about that. And we're celebrating. We got balloons already.

Joe Gambino (00:23.011)
On that note, you can find this podcast on YouTube at cupsofjoe underscore PT. And you can always reach out to either one of us on Instagram, if you have any questions, you just want to chat at Joe Gambino DPT for myself and at Trenton motion underscore PT for Mr. Mexico over there. And this podcast is also on Instagram as well, beyond pain podcast over there. Did I get it all Joe?

Joe LaVacca (00:45.806)
That's right. That's right. I'm gonna throw out some shukas because you got it. You got it. This is one of the restaurants that we went through, the shukas, the other night. this is high and tight or hang loose, hang loose. So yeah, we're hanging loose, man. It got down here. If you follow me on social media, I sort of like documented my whole surprise adventure for Courtney. It went really well. Needless to say, she was very surprised.

Joe Gambino (00:50.735)
There we go, baby.

Joe Gambino (00:54.953)
Joe Gambino (00:59.769)
Hang loose. I like it.

Joe LaVacca (01:14.734)
I think the shock carried over for about 24 hours. yeah, but now we're here. We're mixing work and relaxation, but I couldn't miss the podcast. Couldn't go off schedule. So just carving out some time to spend with you and our loyal listeners.

Joe Gambino (01:30.639)
Well, I love it. Welcome, you know, from Mexico. I appreciate you taking the time to chat with me and the listeners. Hopefully there's extra appreciation for this episode with you enjoying. I mean, you're outside, you look very cozy and warm where I'm sure in New York you're not quite getting that.

Joe LaVacca (01:45.997)
Yeah.

Well, also in New York, funny enough, on Sunday, the day I am supposed to come back. We're finally supposed to get snow. So we'll see how that disrupts my life and my travel. Hopefully not too bad. But yeah, it makes sense that the only time I've like traveled internationally, we would have a snowstorm impacting me to come back. So fingers crossed I get back. I got a full week next week. You know, business as usual. But yeah, man, I'm very excited. And from what we said,

We might have a flip-flop background over the next couple of weeks if you do a little trip with the fam, but no pressure, no pressure. I did the pod from Mexico. No pressure on you, my friend.

Joe Gambino (02:28.849)
We'll see, we'll be having two kids running around, well one kid running around and one kid just lounging around. So it might make things a little more difficult if we actually get this trip to work out.

Joe LaVacca (02:37.388)
Mmmhmm.

Joe LaVacca (02:41.592)
Well, and it also seems like it's more proper vacation. This was a surprise work trip. So that's why I have a little bit more flexibility than I would imagine with two babies. you you're supposed to be down there to celebrate and relax. So hopefully we don't see your background in Mexico, but if we do, that'd be cool. And then we could do like little side-by-side sunrise comparison. There we go.

Joe Gambino (02:47.888)
Yeah.

Joe Gambino (02:55.888)
Yeah.

Joe Gambino (03:03.025)
there we go. We'll see who we'll see who's sky looks better on video. Well, I think this officially means you've made it in life, Joe, because you get to now travel to Mexico, work there, play there, have some fun. And you know, you don't to take any time off, do anything like that. You're just you just live a life.

Joe LaVacca (03:10.414)
You

Joe LaVacca (03:21.966)
That's it. That's it, man. mean, you know, there were a few things that emerged from the pandemic, right? This being one of them, work from anywhere and a couple of virtual people, a couple of meetings, a podcast. This is regular Friday, regular Friday. So I'm ready to rock. I'm energized. I'm pumped. So let's get rolling. What are we talking about today?

Joe Gambino (03:39.643)
That's it.

Joe Gambino (03:45.905)
Well, let's help other people live their best lives. And today we're to be talking about three mistakes that you as listener are making when you're trying to get out of pain. So I think this would be a fun topic because I think there are very common mistakes that people make that are themes that we see quite often. So I'll let you roll with number one and we'll go from there.

Joe LaVacca (04:10.446)
Yeah, number one for me. And I think maybe we preface this with like, you know, these are, we're labeling these things as mistakes, but they're so common. So you aren't doing anything wrong, but these are very normal things that you and I hear and we're gonna try to help you manage or reframe what you're going through if you are listening and you're stuck in pain. But number one, a big mistake I see people make or really kind of hang on to,

is only focusing on the painful signal. So when you ask them how they're doing, a very open-ended, generic question, they'll immediately come to, well, my back, my knee, my foot, label the body part. And oftentimes, I'll just hit the timeout button and say, hold on, we'll get to specific things in your body or in your life. But it was amazing how I said, how are you doing?

and you immediately shrunk down into this one bit. So if we consider that pain is a signal or even because we were around a fire pit the last couple of nights, you have to stoke a flame. You have to feed the flame to keep it going or it dies out. So while pain obviously is not that simple as just feeding a fire, if you continually focus on it.

dwell on it, think about it, organize your life around it. You're essentially building bigger and bigger and stronger connections to help that thought or feeling just reflexively kind of pop up. So there's a saying in neuroscience and probably it's relatively common, but things that fire together in your body, brain, nervous system wire together. We used to think that that was a one way street.

But now we also know that things that fire apart depart. So we can learn something. We're quite good at learning and adapting. takes almost, god, I have to remember the exact number. I want to say three to 30 times longer to unlearn something. And that's where I think a really big opportunity exists with pain. So I'm going to pause there.

Joe LaVacca (06:37.804)
What do you think about that? Is this something that's very common with your clients as well? Because it's such a common theme with mine.

Joe Gambino (06:44.259)
Yes, I think it's a very common theme and to your point on this, I don't remember my conversation with someone for the first time and I asked them, you know, how it's impacting their life. Sometimes they don't even have a real answer for how it's impacting life besides that it's just painful. And they have to like really think about like, that's such a good question. And like they have to almost like reflect to figure out how it's actually like impacting their life. So it just, you know, it's the other thing I wanted to mention is interesting how, you know,

we brought up the three right before I hopped on the podcast. And when you brought it up, it's not like it's overly different, but when I was thinking about, focus on the painful signal, it's not just that, that's where their brain goes and that's when they're about things, but it's also how people focus their rehab strategies. If their foot hurts or their hip hurts or their back hurts, then all of their corrective things to try to feel better are only focused on the painful spot.

Joe LaVacca (07:29.774)
Mm.

Joe Gambino (07:40.401)
And it's not necessarily on the things that actually are the main like root cause, so to speak. You you're only trying to like treat the symptoms. you know, just kind of adding another layer on that. your rehab, everything that you're trying to do that you're finding on YouTube or even if you're seeing a PT, whatever you're doing, if it's only targeting the things that are painful, like, oh, my back hurts. So therefore I'm going to bend forward and try and stretch it out. And maybe that makes you feel better for a little bit of time, but it never makes things feel better. You're probably going to want to expand upon those things.

So just another little tidbit there to throw on top.

Joe LaVacca (08:14.156)
Yeah, I'm glad that you said that because one of the greatest gifts of exercise too is the release of endorphins, which are really big natural pain killers. The caveat is you have to work out relatively hard for a sustained period of time in order to get that effect. So if you're only doing things on your painful body segment and pain prevents you from increasing intensity,

Well, think about how many things that you're missing out on. Maybe it's a bike ride. Maybe it's walking uphill on the treadmill, not running. Maybe it's swimming. There's so many things that we can do from a sustained activity standpoint. And then maybe it makes your, quote unquote, targeted exercises better.

Joe Gambino (09:02.437)
Well, Joe, I'm a little disappointed because you just moved into topic number two before. Well, I guess that means we were done with topic number one, right? So, my second number two is, you know, sacrificing the activities that you enjoy. So exactly to your point there, not necessarily just to get the endorphins to help you feel better. But, you know, one of the things I see a lot of people do is that they just overly focus on corrective work because they have pain and they stop the gym.

Joe LaVacca (09:07.854)
You

Joe Gambino (09:30.929)
They stopped going for bike rides. I think, you know, maybe what you were thinking, well, I'm not even going to suggest, I'll let you maybe just go when I'm done. Um, but that is such, I think if you're only doing corrective work and you've stopped doing other things that you love, like strength training, things like that, you're missing the boat because sure, you may be afraid to make things worse, but there are always something that you can do currently that will allow you to get some sort of benefit out of the gym, some sort of health.

And when we can start to pull back in activities that you enjoy, it helps outcomes and they learn because now you're not just scared of everything. You're not holding yourself back. You're working on the things that you need to work on. You're right from a pain perspective, but you're also getting some of those activities that you enjoy. that kind of confidence that we're building, getting you back things that you enjoy, all those things as they stack up and give you those wins will help bring down the.

know, pain also help you get back into those activities. And as pain starts to come down, it's much easier to now add on top of those things as opposed to having to start from scratch, so to speak. So I've seen a bunch of people where they've been in pain for a long time and the only thing they do is just corrective work, corrective work. And sometimes just even pulling them out of that mindset and getting them back into the gym or whatever it that they want to do is it goes a long way.

Joe LaVacca (10:46.54)
Yeah, I think even where I was thinking of the sacrifice is people treat pain like a god in this instance. Well, my back hurts with this, my knee hurts with that. So I don't do those things anymore, thinking that that will help my knee or my back. So if I give up all these hobbies, the things I love doing, time with my family, you you name it, the list can go on and on. And yet we meet them or we talk to them.

And I asked the question, well, how's giving up this activity going for you? Well, you know, I guess I don't have those sharp spikes in pain, but I'm still in pain. Okay. Well, now we're sacrificing immense amount of time spent with doing an activity just because of the small risk or sensation of a sharp pain occasionally. Is that worth the trade off? So when I think about activities that people give up and

usually they'll bring me back to like moments in time. Oh, you know, I tried playing basketball. I tried running and you know, I was out for like a five mile run and you know, my knee, you know, I got a sharp pain in my knee and I go, okay, how long was this, you know, five mile run? How long did it take you? And you know, depending on your skill level, let's just even say it takes you 45 minutes to an hour, right? Well, in 45 minutes to an hour for you to trade off that activity that you love.

for 20 seconds of sharp knee pain. Is that even, you think that's a worthwhile trade off? I think it is. I mean, 45 minutes of an activity I enjoy for just maybe 10, 20 seconds of discomfort. Now that's a personal choice. But when you start to realize the investments and the losses of any activity that you're partaking in, we are very predictable as human beings where we get really focused on the highest of high memories and the lowest of lows.

The is the lowest of lows typically override the highest of highs. So, okay, I'm in Mexico, you're planning your trip to Mexico with your family. Let's say you guys go away for seven days. Then you come back. On the way back, Olivia got a stomach virus. When I ask you how the trip to Mexico went, you'll be like, that was great, but Olivia got a stomach virus on the last day. So it really ruined it. And it's like, what do you mean? Why? Why?

Joe LaVacca (13:12.854)
I'm not saying that you would say this and obviously, Olivia, I love her so much. hopefully she doesn't have any norovirus or stomach viruses or anything like that. But you know, like, but we hear that too. And I asked about clients and patients about vacations and stuff like that, or even their workouts. yeah, I got through it. But I had pain with this one exercise and this one set and this one rep. And instead of celebrating that, I think it serves as this impetus to force people to think this is bad.

I shouldn't do this anymore rather than just weighing kind of like cost benefit.

Joe Gambino (13:48.849)
Yeah. I don't know why I just thought about this, but I think pain makes, you know, can make people little unrational sometimes and not really like think about it objectively in a sense. And I think that's kind of the purpose of pain, right? To make us change behavior and things like that. again, right. Going back to the top, right? Like you're not doing anything wrong. I think it's the way that us as humans are wired to make sure that pain doesn't get worse. It's a protective mechanism in nature. But like one other thing I think about when you, when you talk about the

Story of the runner where it's like 45 minutes to 50 minutes, have 20 seconds of pain afterwards, or maybe during. Well, it's like, well, when did the pain start kicking on? Like that's one of the questions I'll always ask. And they're always like, ah, know, maybe I like mile three. I was like, okay, well, you can run three miles without pain. So why don't we just run three miles, right? Like you're not gonna have pain, it's gonna feel better. You're be able to enjoy it. We can work on building more volume, right? So that's just now like a.

intensity modification in a sense for volume modification and all of sudden now you have the ability to do the activity even though you didn't think that you could before, right? And that's kind of just going back to that point that I was making earlier where it's, you sometimes you just need to, there's always something that you can do, right? You just need to find out what that volume and intensity of what those activities quite look like. So, and I had an idea, I figured this is exactly where you were gonna go with it. But I stopped myself.

I want to let you talk and not speak for you in a sense. other thing on this, well, I think when people give up activities because of painful, whether it's just like squatting because their knees hurt or bending like dead lifting because their back hurts or, you know, they don't want to get on the floor with their kids because that's problematic. When I think when I always think of it and I describe it to my patients as like a negative feedback loop, like you start to avoid these things because they're painful.

Maybe you feel better because you're not doing them in the moment, but really all you're doing is making those positions harder for you to actually get back to because you're just avoiding them. So when you don't use something, we lose it. They become more sensitive or harder for you to do. You lose mobility, whatever that looks like. and it makes it, it's almost like making it harder for you to get back to those things. So even though rest is the thing that's going to make you feel better in the short term, it's not a good long-term strategy.

Joe LaVacca (16:03.15)
Correct. And you know, we're living breathing organisms and all the tissues are trying to help our living breathing adaptable tissues. So if we continue to decondition or unexpose them to certain movements activities, well, that's our body's way of saying, hey, we don't need to adapt here. Let's cut costs in this area. Let's go somewhere else. Let's utilize extra energy to stiffening the back, not moving it to

you know, putting more connective tissue around the foot because we're over compromising the foot to protect the knee. So great point. I think that that is often something that's overlooked or forgotten about with a lot of clients because the same way exercise will build us up, lead to more adaptation. The lack of doing all those things is going to be more detrimental for us in the long term. So if you have an acute injury, like you said, right, inflammation first couple of days, protect it.

Calm shit down, right? Just relax for a little bit. It's gonna be okay. And then after those first initial days, let's get to reconditioning, to re-exposure, knowing that there's still gonna be alarm bells, right? That's also how we know you're normal. You had an injury, things are more sensitized as they should be. And I think again, that is a normal response that we're not.

pushing, promoting, celebrating. Like, hey, look at this wonderful thing that your body can do. Remember an injury, help you guide yourself back into it rather than feeling frustrated and everything by it. And I loved what you said before about how pain, it kind of makes us change behavior. And something I was reading this week said how pain motivates us without informing us. So it gives us that cue to change behavior, but it doesn't necessarily tell you how.

Joe Gambino (17:32.945)
Thank

Joe LaVacca (17:58.988)
or why, how long, all of these different things. And it's up to us to spin the wheels and make up our own decisions, right? So lots of things can help. Hopefully you're not sacrificing things too long. wanna move on to number three? I think number three is a big one too.

Joe Gambino (17:59.195)
Mm-hmm.

Joe Gambino (18:18.065)
Well, one last point, Joe, think, you know, I like what you said, you know, you have to calm that shit first. So calm that shit. think that's that's perfect for a coffee mug or a t-shirt. So, you know, maybe we need to get those made. Yes, number three. Number three here. I think this is a big one and I think this is probably the number one mistake that people make is not following a plan.

Joe LaVacca (18:24.479)
Mmm.

Joe LaVacca (18:27.932)
Hahaha!

Joe LaVacca (18:32.718)
We have.

Joe Gambino (18:45.337)
for long enough. So I'll let you kick this one off with your thoughts and then see where it goes.

Joe LaVacca (18:51.362)
Yeah, I was really happy you brought this one up before our call. When maybe not as much now, I get the backstory or the overstory after a lot of people have been through multiple providers and multiple doctors now, but I remember being in network particularly, people would come in with their prescriptions from their doctors and they'd all say the same thing, which always made me raise an eyebrow. Physical therapy two to three times a week for six to eight weeks.

I'm like, wow, why does everything say the same thing? And then I was just thinking like, OK, well, do you have an appointment, another follow up set up with your doctor? Some people did, some people didn't. So it never was really based around that. But it just seemed like a lot of people were given this idea that in six to eight weeks, you should feel better. And if you're not better in six to eight weeks, something's wrong. But we just talked about.

painful signals. We talked about the ups and downs of maybe getting back to activity. We talked about on the podcast how long things can take. So I think the biggest change in my practice is more realizing different tendons can take months to maybe years, different injuries can take weeks to months to beyond. And for some people,

Maybe that pain or that tissue is never exactly the same. And it definitely takes longer than six to eight weeks. I think for probably everyone, even if you did have an acute injury with some inflammation, there's phases. We talked about this briefly just before. Maybe for the first three to seven days, I have a lot more inflammation. The next two to three to four weeks, all right, there's some nice, easy tissue healing happening. And then beyond that,

it can take cycles and cycles and cycles that seemingly could potentially go on for years, maybe if not even the rest of our life. And we think about the issue as a dramatic enough, like a surgery and things like that. So we're always going through these processes. And I think people just don't give themselves the opportunity to just follow through with the plan.

Joe LaVacca (21:07.738)
Let time emerge as one of the greatest healing factors that we have, because our bodies can do it. They just need to be guided, given a little bit of consistency with signal, and then step back. We talked about calm shit down. Well, then that next thing that Greg Lehman always likes to say, build shit back up. And then that's the stuff that takes a really long time.

Joe Gambino (21:30.629)
That's the t-shirt. I like that one. Build it up versus calm it down. Or maybe it's calm it down in the front and build it on the back or something. Well, we'll workshop it.

Joe LaVacca (21:37.076)
There's gotta be a coffee theme to it like grind it down and stir it up or froth it up or something like that. Yeah, we'll play on words or something. We'll maybe yeah, we'll talk to maybe we'll get Greg on the podcast one day and we'll ask him if we could coffee eyes it or something.

Joe Gambino (21:52.665)
It's funny. And as you know, your story, you know, outside of just like, you know, having certain pathologies that take longer to recover. There's two things that you made me think of. One is like, if you had pain for a really long time or like mobility is like significantly, significantly restricted. Like I was talking to someone yesterday. They were like, ah, you know, my back is, you know, has been hurting for a really long time. I've had multiple car accidents in the past. And it's like, my mobility is really bad. I really want to work on it. And one of the things that

She mentioned that she couldn't do like, she like has like zero extension. Like she can't even like lay on her stomach and like prop herself up into any sort of spondyx. It's just like that limited. I was like, honestly, like something like this is going to take you a long time to kind of like get some of that back because you're talking about years and years and years of, you know, things not moving pain, um, immobility, and it's not going to take four to six weeks or six to eight weeks for, for that to be reversed in a sense. So

Joe LaVacca (22:38.414)
Totally.

basic stuff.

Joe Gambino (22:48.433)
Um, and the other thing that made me think of, saw this research article. I don't remember how long ago I saw it. can't remember all the details. I just remember it was either five years or 10 years after an ACL surgery. It was like a patella graph. Um, they did a patella graph and there was still recovery happening five years afterwards, right? And like, no, we tell people after a year, right? You're going to be like, you're going to feel a hundred percent. You're going to be able to do everything that you can do. But in reality, right, there's still a recovery process happening at.

Joe LaVacca (22:50.58)
at least would be so.

Joe LaVacca (22:59.182)
which previously I was something like.

Joe LaVacca (23:07.148)
Hmm.

Joe LaVacca (23:11.906)
Mm-hmm.

Joe Gambino (23:17.615)
you know, the cellular level, your body's still recovering from that perspective. you know, keeping all those things in mind, you know, like, yes, recovery can take some time. And I think where I really see people going wrong, and it's not necessarily like they're impatient or anything like that. It's they go through a program or they find some exercise to do. They do it for a week or two. And they're like, you know, it only helps in the short term. It doesn't make me feel better in the long term. So now I need to change it.

and then they constantly changing their routine over and over again, never allowing actual change to happen. So we could look at change two ways really, right? Like I guess one would be, how do we get pain to come down? Right, that would be some sort of progress or change happening from a neurological standpoint, but there's also a tissue adaptation, which to kind of where our points were, right, can take months to sometimes years to for those physical adaptations to actually happen. So.

Joe LaVacca (24:12.578)
Yeah, and I think your your analogy there with the ACL is interesting too. And what it made me think of was just how behavior changes so quickly. But the interesting about behavior change with injury is that if we stick to the ACL injury around the knee, imagine your body developing this stiff knee walking pattern, which is actually protective and necessary right for the ligament to help heal and reduce stressful forces. You learn that over the course of

two, three, four weeks, right? And then you're immediately taught to break it. Well, that might actually take you now two, three months to unlearn that pattern because it was protective, it was serving a purpose. Now all of a sudden, some clear delineation of a day or a timeline makes it unadaptable, not overprotective. And now you're trying to break that habit while you're still progressing forward. So that is why

I tell people give yourself space, allow things to happen gradually. If we can modify pain, like you said, even just for a little bit or temporary, perfect. That's your medicine. The same way we would take Advil two times a day, every four hours, every six hours, every eight hours, that exercise, that activity, that foam roller, that whatever, that helps you break the pattern, that becomes your new schedule, your new routine. Do this every two hours, every four hours, every six hours, take as needed.

in order to dull and break that pain because if we can get it to fire apart, we can possibly get that signal to weaken and eventually depart. So I think that was a great example.

Joe Gambino (25:50.737)
Yeah, that's perfectly said. I tell all my patients the same thing. We're trying to come down, bring down pain. We find some pain modifiers. You do it very, very frequently. You triple down on it. It's almost like a job for you in a sense. But when you do that, that window of opportunity, maybe it's like 30 minutes or two hours of feeling good. We want to see that expand to three hours, to four hours, to a day, to two days, to multiple days a week, things like that. So well said there.

I don't know if have anything else to add on on top of all that. think, hopefully, I mean, I do think that this will be helpful for people. So hope so. last thoughts? to your boy.

Joe LaVacca (26:26.966)
I think so too, yeah. No, no, just as a recap, know, don't try not to stoke the fire. Don't simply think that sacrificing activity is going to be the thing that gets you out of pain. And don't forget to stick with that plan, work with your provider, make sure you have a good path in front of you before you give up on any activity or even practitioner.

Joe Gambino (26:53.169)
Perfect. Love it. Why don't you take us home then?

Joe LaVacca (26:56.31)
All right, well, from Mexico, thank you, Joe. I love you. Listeners, we love you. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast.

Joe Gambino (26:59.119)
Haha.