The Beyond Pain Podcast

Episode 68: Simplifying Assessments for Chronic Pain: Practical Strategies for PTs and Patients

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the evolution of assessment processes in physical therapy, emphasizing the importance of understanding chronic pain, the role of touch, and the significance of movement in rehabilitation. 

They explore the SFMA framework, the necessity of context in assessments, and the value of self-assessments for clients. 

The conversation highlights the need for a goals-driven approach to therapy, ensuring that assessments serve the individual's specific needs and objectives.

Takeaways

  • Assessment processes have become simpler over time.
  • Chronic pain is complex and requires nuanced understanding.
  • Touch plays a vital role in client connection and assessment.
  • Movement buy-in is essential for effective rehabilitation.
  • Assessments should rule out red flags before proceeding.
  • The SFMA provides a framework for holistic assessments.
  • Self-assessments empower clients to understand their bodies.
  • Context is crucial in interpreting assessment results.
  • Goals should drive the assessment and treatment process.
  • The body learns and adapts through consistent movement. 

Joe Gambino (00:44)
Welcome back into the Beyond Pain podcast. am one of your hosts, Joe Gambino, and I'm here with our other host, Joe Lavaca. You can find us on Instagram at joegambino.dpt for myself and at strengthinmotion.pg for Dr. Lavaca over there. Podcast is also on Instagram, Beyond Pain podcast and on YouTube as well. cupsofjoe.pt. And Joe, I don't think we've ever asked this before over listeners on this podcast, but a review.

We're gonna go very, very long way for helping this podcast now. So if you have two seconds, please drop us a review. It's been a while since we've had one. Welcome back, Joe boy.

Joe LaVacca (01:13)
⁓

Thank you for adding that Mr Gambino. That was a good idea. yes, if you have, yeah, exactly. So yeah, then, and it does, it surprisingly does really help. And I say this to clients all the time in the clinic when they do have a good experience or if they've been enjoying care or programming or training or whatever. Yeah. Google really appreciates and Apple podcasts and Spotify, they all really appreciate good reviews. So.

Joe Gambino (01:21)
Man, it only took us over a year to ask for one.

Mm-hmm.

Joe LaVacca (01:49)
Yeah, I think that was a good call.

Joe Gambino (01:50)
Yeah, send it away.

A way to help the show and a way to help hopefully one more listener tune in if they can get a little help if that's what tends to happen there. All right, well, we have a, I think this is gonna be fun, a fun episode here. We have all about assessments, self assessments, and I'm just gonna let you kick it off with maybe, why don't we do this, Joe? Because I'm actually curious. Maybe over.

Joe LaVacca (02:00)
Yeah.

Joe Gambino (02:15)
the last year or few years, has anything changed with your assessment process?

Joe LaVacca (02:22)
I think that for the most part, my assessment process as a clinician keeps getting simpler and simpler. And it probably is because over the last five plus years or so, where I've really gone and focused the practice or the messaging on Instagram and what I like to teach is more around this idea of like persistent pain or chronic pain is probably the more accepted term or term that people most readily

Joe Gambino (02:29)
Hmm.

Joe LaVacca (02:49)
to connect with. And with chronic pain, problematic pain, persistent pain, there really isn't any one marker to just point to and say, aha, this is the reason why you have pain. And quick example for people listening would just be, hey, if you and I roll our ankle and we have bruising and swelling and we tore a ligament on the side of the foot, well, that's probably going to be a good enough reason why we're in pain. So we can point and say, here's a trauma.

Here's the tissue that's been damaged. This is why you have pain. This is how long we can expect pain and we can kind of move on pretty quickly. But with a lot of problematic pain, it's tough. It's nuanced. It's layered. And by the time people have gotten to us and gotten to you, I'm sure too, you know, they have x-rays already. They have MRIs already. hear so many people, including this week, you know, talking to me about their...

their hip shift or their leg length discrepancy or their posture. And again, we've talked multiple times how all these things can be factors. But I think the biggest thing that a lot of these complicated assessments do for people is they push them into this bubble of under loading. Well, I couldn't possibly squat if my leg length discrepancy is off by a half an inch or whatever the case is. I couldn't possibly bench press because my posture is already, you know,

so terrible that if I keep bench pressing, I'm going to just turn myself inward more on, you know, into my body or into that, you know, kind of slouched position. think that's everyone's sort of fear. So really with my assessments in the clinic, I just want to make sure that you're safe to load and safe to move and you belong here. and that's, think the biggest thing with problematic pain is just making sure, Hey, are there any red flags that we missed along the way? Because they are so rare that

Joe Gambino (04:14)
Mm.

Joe LaVacca (04:36)
You know, I'm probably guilty of this too, that I, you know, neglect them a lot of the time or think about them, but we should probably be starting there, ruling out some red flags for people. Then once we can kind of rule out red flags, I like really straightforward assessments that people can understand and almost follow along with. And I found it even helpful to speak what I'm doing, not only for my own benefit, but it slows me down and it kind of keeps the client engaged. So my assessments, if there has been a change,

They've gotten simpler and simpler and simpler. And I always remember saying this when I was teaching, which I completely disagree with now. so maybe this is a 10 year switch, but I used to tell, lot of the people that came to the course for rock tape and, and everywhere else that, the, clinical history was so overrated that people were not good storytellers and you know,

Joe Gambino (05:24)
Hmm.

Joe LaVacca (05:28)
couple of questions about them is fine and then get into your movement assessments because that's going to tell you more than what you need to know. And now I'm like, yeah, I probably felt that way just because I wasn't asking the right questions to people. Right. And now the cool thing is when you kind of chat with people, you're almost sort of somewhat certain of a diagnosis even before you start watching them move or getting your hands on them. And I think that is the beauty of the listening aspect. So that would be the biggest change for me.

Joe Gambino (05:39)
Right.

Mm-hmm.

Joe LaVacca (05:56)
I'm sure there was lots of changes for you because we were all in person and then now you're all virtual. So I'd love to hear where your thought process went with that switch.

Joe Gambino (06:05)
Yeah, I'll say, uh, before I dive in there, two things. I mean, I think you hit the nail on the head, not good storytellers and like, Oh, you know, the history is overrated. I've, it's just, I think if you think that way, one of the things would be. You're not asking the right questions for sure. You know, I found that when you ask the right questions and you really start to dive into it, your assessment almost becomes ruling in or ruling out your hypothesis. said, well, that's how I think of it in my mind.

So I'm going through an assessment process and I'm listening to somebody. I'm like, okay, well, I'm starting to think it's this. So I'm to start asking questions to see if I can kind of confirm this. And then once I'm okay, I'm pretty certain it's this. Then when we get to movement, okay, it does the things that we're doing from a movement perspective match up to what I think it is. And if it doesn't, then I have to start to re-question and maybe probe in another way and see if I can get something to make sense. And if it's something that never makes sense, then.

Usually those are the cases that you're referring out anyway, right? So I think that was very, really interesting to say there. And then on your note of under loading with how most PT things happen, you're saying rehab, this chronic under loading is an issue. And I've been finding myself, I find this interesting because I've been finding myself saying a lot of time to people, especially people who are interested in it with working with me is that.

fitness, like you almost need to get away. If you've been in like chronic pain for so long and you've done rehab and you've had all the imaging and you've had surgeries and like you're still in pain, sometimes the missing link is just starting to get back and doing the thing, right? That this, you like, you just need to be pushed a little harder. You need to build the confidence. You need to start doing the thing and we can do this safely. And that's where like the assessment and asking all these good questions really comes because it gives you that picture, that starting point where they are, what.

Joe LaVacca (07:42)
⁓ Yeah.

Joe Gambino (07:56)
maybe they shouldn't be doing right now in the gym because that could flare them up or, know, what can we do now that's really going to build confidence and allow them to kind of progress. So I think that's, those are some really big points there. Otherwise, I don't think from virtual to, you know, in person or virtual, I don't think my assessment process has changed all too much. I can't put my hands on somebody. So I've had to use movement for buy-in where in the past, like I can put my hands, I was actually just in,

New York a few weeks ago and this was like a really good example. Like I can be with somebody and then I can do a massage and then all of sudden they get up and they feel better and you can just like immediate like buying like, oh my God, this is great. I can't believe I feel like this. And I think touch has is a really powerful way for us to connect with somebody and help them feel better. And I have to rely a whole lot more on movement. So I have to find ways in our sessions or in our assessments to start to play with movement.

Joe LaVacca (08:35)
Yeah.

Joe Gambino (08:51)
see how they're doing and can I find something that does bring down their pain? And when you can do that, then I think that helps bring in that buy-in portion of things. So I do a lot of, I've always done a lot of pre-test, pre-test, but I think I have to rely on that a little bit more to A, figure out, you know, is what I'm going to be doing or what I'm testing actually making a change or is it reproducing symptoms? But also I think it's one way that in a virtual environment, I can create that buy-in and say, Hey, look, we can make your symptoms better by doing X, Y, and Z.

Now we can take this and these are your low hanging fruit, do them daily, do them very frequently so we can start to bring down your pain, bring down your symptoms so that once this initial few weeks is up, pain is better, we can now start to open the faucet and start to challenge you a little bit more and progress you. We can't really have you in this high pain state in a sense. So that's probably the bigger change there. Otherwise,

You know, I think it's just a lot of the education, way I look at things that have mostly changed around like, I assess this way or that way. Like, I don't feel like that's changed. just been the overall, how I'm kind of going about it and how I'm educating and putting it all together for somebody.

Joe LaVacca (10:00)
Yeah, I think the touch is always something that definitely comes up and it's probably worth, you know, taking another couple seconds on it, especially for clinicians listening and clients who expect hands-on care, especially when you're in person with them. And I always have felt that I was using manual therapy more as a check-in on willingness to move. You know, how comfortable are you are with this joint?

Joe Gambino (10:23)
Hmm.

Joe LaVacca (10:27)
just to be relaxed, maybe how much do you trust a lot of the movement around the joint? And you can always kind of get a feel on how apprehensive someone was, you know, kind of by using your hands. So I did value that information. And now I think the way that I sort of look at a lot of the treatment of manual therapy, at least from my lens, is that it kind of fits more into the social aspect of care, maybe more than anything else. And...

If people aren't familiar with that idea, it's the biological, psychological, sociological aspects of all of us as human beings and how this impacts what we do as physical therapists, but really in maybe every facet of life. So we have biology, your body, your tissues, your psychology, how you process, perceive all of these things that are happening. then sociology is just your environment, right? Your relationships. So I do think that this touch can bring connection. Like you were saying, however,

the boundary of it is, how do I bring touch into the virtual area? And what I've been doing a little bit more lately is trying to invite people to actually touch the area that hurts and just start relaying information to me on what they feel. So it could be a back, a knee, a hip, but if they're laying down, I'm gonna tell them, hey, just place your hand on there and move it around. Maybe give a little bit of pressure, right? Do you notice like...

areas that might feel a little swollen? Do you notice areas that are maybe hot? Do you notice areas that are tender? Cool. Now go over on the other side. Just feel that out for me. And what's interesting is a lot of times, A, there's nothing to necessarily perceive, or B, people realize like, well, whatever's tender on this side is actually kind of exactly the same tenderness on my other side. So I was so focused on that, but I never really thought to check in on the side that wasn't causing pain. So bringing in that manual therapy component with virtual stuff,

Joe Gambino (12:06)
Mm.

Joe LaVacca (12:17)
I think it's been a little bit more rewarding and has probably made at least some of the clients I've done with it recently more a part of that process right off the bat. Cause that's always their concern. Like, Hey, I don't know what you're going to be able to do. you can't touch me. You can't move me. And I had a client yesterday who's been dealing with hip pain for three months, particularly with cross-legged sitting. within about 10 minutes we were pain free cross-legged sitting and she had gone to PT and all the other stuff. she was like,

Joe Gambino (12:25)
Mm-hmm.

Mm-hmm.

Joe LaVacca (12:45)
I'm so happy you told me to do virtual. I did not want to do this because I was like, this is going to be a waste of my time. And 10 minutes later, here I am sitting pain free. So that was really cool. yeah, by just giving people the tools to sort of like understand how to help themselves, I think is great. And when you mentioned how, or kind of confirmed that the story is such a big part for you and the education piece is such a big part for you.

I've been putting together a little course on, you know, trying to help clinicians who are time crunched with assessments. And, you know, I'm trying to play it a little bit more, you know, by the book, because I don't know who I'm speaking to younger clinicians, older clinicians. So I'm trying to give just like heuristics, like probably like what you and I use, it sounds like, like a lot of our virtual calls and our in-person things, but then only like a couple of tests for like each area that we actually have.

Joe Gambino (13:23)
Mm-hmm.

Joe LaVacca (13:38)
good data on. And these are tests for ruling in or ruling out diagnoses. And some of the most interesting things I've found out is that really two thirds of the tests that we use are completely worthless. I mean, literally do not move any practical thought process forward, backwards, or anywhere in between. And really, one of the more interesting stats that I keep highlighting in the presentation is if you are about 80 % sure

Joe Gambino (13:50)
Mm-hmm. Right.

Joe LaVacca (14:05)
of what's going on after the initial clinical encounter and the questions, actually doing special testing or your hands-on assessments isn't going to add to that. And if anything, it's probably going to confuse you more because now you had a fairly confident thought process. 80 % is probably enough to move the needle where you and I could probably give some practical information to people. But then imagine trying to then go and confirm to get to 85 or 90 or 90. But really, what you're doing is diluting your thinking.

Joe Gambino (14:16)
Mm-hmm.

Joe LaVacca (14:35)
and you're probably falling backwards even a little bit more. So I am kind of a little bit more upfront with clients now too, where, hey, look, by the sounds of this, this sounds like a tendon. This sounds like some joint irritation. And I kind of keep it broad. The good news is that doesn't seem like it's getting worse or it's pretty stable. So really, I don't think we're going to find any value in a lot of hands-on assessments, but I do want to see how willing you're actually just

Joe Gambino (14:38)
Mm-hmm.

Joe LaVacca (15:01)
able to move the joint that's hurting. And I do think that maybe will give us a couple of other ideas on how to help you at home and in the gym and everywhere else. But have you thought about that with like special tests? Like, again, I know it's hard for probably you to perform special tests. But like you said, you have to get movement buy in with your clients. Are there go to tests or movement strategies that you use sort of globally with everyone?

Joe Gambino (15:02)
Sure.

Hmm.

Joe LaVacca (15:27)
you look at or are they're just sort of like you kind of pick and choose based on the person.

Joe Gambino (15:32)
Yeah, so I mean, I still use like the SFMA. So people, if you're not a clinician, right, it's a certification we go through and just kind of gives you a helps us have a framework for how we're we're assessing. know, I do things holistically. pretty much do a whole top down screen. Nice thing about this environment is without insurance and stuff like that, I don't have to be like, I have to just focus on this area. I can look at everything. So it gives me a lot of people have multiple areas of complaint.

Joe LaVacca (15:37)
Yeah, perfect.

Joe Gambino (16:01)
Maybe they have a big primary issue, it allows me to, you we can be focused here, but we can keep the whole big picture in mind here, especially when fitness is a big component of things. So I kind of go through that, we're very similar in the fact that to me it is, you know, sure, would like to, you know, if I can kind of rule in tendon versus nerve tissue versus what other tissue, right? But like, I don't really know how.

much value if it was like, is it a rotator cuff or is it a labral? Right. Unless it's like a major big one where you're getting, I think the symptoms in itself would already lend you that you might want to push them towards imaging or going back to the doctor anyway, regardless of if they're like a full on tear and they're having painful with moving and the range of motion is limited, you're going to be like, well, maybe I can't even help this person here. Maybe they need to see their doctor first. Right. So it doesn't matter if it's labrum or rotator cuff point at that, you know, at that point.

but that's kind of a long or winded way of coming back to I look at like I ask a lot about their goals because When I'm going through movement, I'm looking at what can they do? What things are painful what things make them feel better? And then I try to relate that as best as possible to what they're trying to do with their bodies If they have shoulder pain and their goal is to get back to bench pressing Well, I know that they're gonna need to be able to do certain things to get back to that

Joe LaVacca (17:20)
Right.

Joe Gambino (17:20)
So can I break up the movements, break down their movements today and the movements they wanna do and can I start to match those things up and start to give their body the tools to be able to do those things? Can I start to reintegrate those patterns and load them in a fashion even if it's easy to their perception, but maybe the tissues are a little sore because we're doing it right, there's a little bit of pain being reproduced. So that's a good level for us to start.

And we can reintroduce that stuff and get the tissues to adapt. Right. It's all about, I think FRC functional range condition and those certifications really changed my, my thought process as it's not just about what tissues are irritated and how can I treat pain, it's more, how can I start to load you and strengthen everything, right? The connective tissue, the muscles, whatever.

Joe LaVacca (17:56)
Yeah.

Joe Gambino (18:11)
and work you towards the things that you wanna get back to. So the sooner I can get to loading things, the better. And I think that if you look at an assessment and you took it in a vacuum, it's almost worthless unless you have the person's goals, how it's impacting their life. And if you don't have a good starting point and a good ending point, you're really not gonna have a journey to go on. You're just gonna be throwing paint at a wall and hoping that you have something nice at the end of it.

Joe LaVacca (18:24)
Yeah.

Joe Gambino (18:38)
Kind of going back, guess how things have changed for me in a sense, as far as assessments go and my thought process goes, is probably the bigger ones. And again, I think it's movement. When we look at movement, we're looking at movement, we're looking at what's painful, we're looking at what makes you feel better, we're looking at what doesn't have any sort of impact on you whatsoever. And then that stuff allows us to make decisions in the future when you know what this person needs to accomplish or wants to.

Joe LaVacca (19:03)
Yeah, I'm glad that you brought up the SFMA because I think that's, you know, again, part of the simplicity in the approach is trying to make decisions or get off point A. And that's always what the initial assessment, I think, does for us is how am I going to try to help guide this person in front of me, knowing that I probably won't get it right perfectly all the time on visit one. There's going to be adjustments. There's going to be tweaks. You know, I know this person is going to flare. I know they're going to have good days. I know they're going to have bad days.

but at least what's going to keep us on this path forward? And what I like about the SFMA, what you mentioned was we were always trying to deduce down really, was this a joint that needed to be, let's just keep it simple, stretched or mobilized, or was this a joint that needed to be a little bit more stiffer, stable, stronger, right? So I always sort of thought about those buckets.

when I'm thinking, when I'm working with people is, are you loose or are you stiff? Right. And that, that was even like a simpler way to kind of bring it down, not loose in the sense that you're falling apart, but Hey, this joint moves really well. But when we do some force testing on it, you know, or strength testing on it, and we can see your symptoms return. So we know that we need to create a better force capacity at this joint, maybe not stretch it or pull on it or yank it or massage it because you know,

Joe Gambino (20:16)
Mm.

Joe LaVacca (20:25)
There doesn't seem to be any barriers there versus like you said, Hey, I know why you're having a little bit of trouble on the bench. Your, your arm or your shoulder just doesn't extend back as far as the other side. So we're hitting this roadblock. We see now instead of a force capacity thing, it's probably more of a force absorption sort of idea that the joint or the tissue just can't absorb this force. So we need to create space for things to move around. And I always liken it to, you know, the highway system in New York city that, you know, when

Traffic is moving, things are pretty calm and cool, but you shut down one lane, we have a bottleneck, and then that causes sort of chaos throughout everywhere else, right? But the SFMA is interesting, and I know that we wanted to talk about maybe some self-assessments people can do, and that might be, some top tier stuff could be really quick and easy to move through, give people little bit of insight on how their necks and shoulders and hips and everything else are moving. So I don't know, do you wanna take me through a top tier?

Joe Gambino (21:02)
Yeah.

Joe LaVacca (21:23)
and I can demo it or we could talk about it.

Joe Gambino (21:26)
Well, let's talk about it. Maybe we can do a little bit or maybe we can do a mini-show that will be like YouTube specific. But I don't want people listening in that's not on YouTube to feel like they're missing out completely. But maybe we'll do that. We will 100 % do that. We'll get that up at the same time as this podcast. So if you're listening, you'll have to go over YouTube if you want to see the assessment process. But I want to say two things before we kind of dive into this that I think is really worth

Joe LaVacca (21:38)
Yeah, so driving and started to do cervical rotation tests.

Joe Gambino (21:56)
touching on for anyone listening, clinician or none. Not getting it right on the first session, I think that's an important one. Every, you sure, you come in, you see us and you want answers and we want answers and we want to know where we're going. But every time that we have interaction is another, everything is a reassessment, right? So when you send me videos online or we have our next follow-up call or whatever it is,

we are in essence reassessing and reframing and making sure that either the initial hypothesis is, okay, hey, we're trending and we're tracking or we're not and we need to make some changes. So nothing needs to be perfect on session one, but we have all this other opportunity to continue to refine this process and make sure that we continue to move in a trajectory that's going to help this person move better, feel better and move towards their goals. And then,

Joe LaVacca (22:34)
Yeah.

Joe Gambino (22:48)
I love what you mentioned about the kind of highway system. We should get Moses Bernard on here because he's had one of the best quotes when he was originally on this podcast, when it was finished for the fairways and it was mobility work kind of gives you more roads to move through. And the strength training sets the foundation or makes those roads stronger and gives you really that foundation. So, and that's really why that combination of the two.

was really important, right? So I don't know. That's always stuck with me ever since I've heard him say that. I was just a simple analogy that that kind of really drops on that point. So I think we'll have to get Moses on here. I'll reach out to him when we hop off. Yeah.

Joe LaVacca (23:25)
Yeah, man, absolutely. would be good. It'd be good to reconnect with him as well, for sure.

And yeah, and that's such a simple idea, right. And I think that really kind of helps clinicians picture, you know, maybe a little bit more of a thought process. It gives clients a little bit of insight on, hey, maybe it is worth doing a little bit of both. It probably usually is. But not feeling overwhelmed, I think is going to be part of the opportunity of, you you and I and that person to be like, hey, what's realistic for you to

Joe Gambino (23:32)
Cough

Joe LaVacca (23:54)
to take our advice and actually use it. You can only have 10 minutes a day, well then maybe we do a little mix and match. It's mobility day is Monday, Wednesday, Friday, and your strength day is Tuesday, Thursday, or Tuesday, Saturday, right? But yeah, I think that's a nice little kind of way to categorize things. And it just sounds like, again, and maybe we've touched on this before, the biggest takeaway that I have is that over the years, our process has gotten simpler, not more complicated. And I think that

Where I am as a clinician now, you know, when I do take continuing education or, whether it's online or in person, I appreciate the thoughts and the frameworks of other people. But at the same time, I'm always leaving like, well, I still don't think it has to be this complicated. So you take a couple of pearls, maybe you apply them. Right. And I think that's where that mixture of the SFMA top tier, you know, maybe combined with some

PARS work from FRC or controlled rotation work from FRC, and then a little bit more of that deeper dive nuance where maybe we're blending both of them in terms of trying to figure out is this stiff, does this need stability, or is this something else? And if it's something else, should they be here? And I think that's, again, always the most important part of your assessment process. We're not going to get it 100 % accurate. The tests do not do that.

Joe Gambino (25:03)
Yeah.

Joe LaVacca (25:13)
They just move us closer to a probability of being initially successful. But I think the biggest thing, and maybe we can save this for a different episode, is how I think too many clinicians and too many clients don't want to accept uncertainty in this process. And without accepting uncertainty, you're always going to be looking for the needle in the haystack. And it's going to take you a

really long time to find that in my opinion.

Joe Gambino (25:42)
Yeah, no, I, I agree with those sentiments completely. So as we shift over to the assessment portion of things or the self assessment portion of things, I want to maybe talk about one more thing in this whole concept of. You know, at the end of the day, if you couldn't do one of these things, right? Say, you know, cause these are things that we're making up here today. Does it, doesn't matter. Does it not matter? so.

In my mind, when we're doing all these assessments, and this is why I think context is always kind of the king here, why we're looking at other factors like their goals and, know, whatever else that we can, we can kind of piece together. But if you couldn't do some of these things and you didn't have pain or you only felt a little stiff and you're able to do everything at the end of the day, does it really matter? And maybe or maybe not. think that's kind of my my point here is that at the end of the day, if you're going through an assessment process and maybe you weren't.

good on some things, it doesn't mean something's inherently wrong. We need other things to start to tell us that we need to work on things like you feel like you're moving backwards or there's fear of movement or pain is getting worse or you're not able to do certain things again like that you were able to do in the past to an extent that you want. And I think those are very, those are things that people need to have to keep in the back of their mind. So if someone does try this, I don't want them to be like, my goodness, I couldn't do X, Y or Z and you know.

the world's gonna end and make somebody more fearful of movement, especially if that's already part of the equation.

Joe LaVacca (27:10)
All right. Well said. I think all this stuff is screening. But screening doesn't typically work very well on an individual level. It usually works better at a population or team level. And I think that's some, you know, nuances that we often forget. yes, just just because your neck doesn't turn as far to the right, it just might not turn as far to the right today. But start a walking program. Start your squats again. Start your deadlifts. Check back in in 12 weeks.

And you might see your neck be totally symmetrical. And that's why I always love that idea of, you know, just kind of helping people, like you said, with those low hanging fruits. Are they meeting activity guidelines? How can they meet activity guidelines? What's important to them? And then let that process sort of, you know, take hold, giving them that permission to move, letting them know it's safe to move. And then typically the body's a good learner. So if it gets these signals that it's safe to move, it's okay to move and moving over and over again is just

Joe Gambino (27:36)
No.

Joe LaVacca (28:04)
becoming part of your daily practice, well then you're probably going to see change no matter what by just being consistent.

Joe Gambino (28:10)
Yeah, so let's start. Let's start here. Is there anything from from a movement perspective that you feel is like every human being should be able to do this?

Joe LaVacca (28:22)
I mean, every human being should be able to do this. That's, you know, maybe a little bit much, but again, I think for me, I don't have one of those, honestly. I think it really just comes down to what does the person in front of me want to do? And then your hip flexion or your shoulder internal rotation or your spinal mobility will matter more or less. You know, if people just want to get back to walking or, you know, their activities in daily living,

they're not going to need maximum end range joint control. ⁓ Walking is a very mid-range movement. If a mid-range movement, we can even make that argument at all. It's probably even less than a mid-range movement. So if people are just having pain with walking, then I don't need to establish a million different assessments and give them a million drills to expand their highway system potentially. But I might have to help them with exposure programming. Maybe it's footwear.

Joe Gambino (28:52)
Hmm.

Joe LaVacca (29:16)
You know, yeah, sure. Maybe there's a little bit of a strength component at the hip or whatever. But I think honestly, I don't come in to any assessment and I tell this to clients expecting them to have anything or wanting them to have anything more. The only thing that matters is their story. They had pain or with this activity, this activity means very much to them so that all of our conversation, at least for that initial assessment, is going to be based around that activity and that goal.

Joe Gambino (29:30)
Mm-hmm.

Joe LaVacca (29:45)
And the findings that we come up with, in my opinion, or what I tell them, is should only move to serve that goal. And we can have conversations about, you know, the other screen or the other top tier assessments. Yeah, we can come back to your neck. But for right now, your neck is not limiting you from squatting. Your neck is not limiting you from walking. Your neck is not limiting you from running. So we'll put it on the shelf. Maybe when you start running or squatting or walking again, your neck starts moving better. We'll know that in a few weeks. We'll come back and recheck it.

Right? But I think that's how I probably go about it is this is what you want to do. This is what you have. I think if we can make this a little bit better or more stable or more strong, that activity should be more approachable, more tolerable. And then if we have those two things together, then maybe we can make it a lot more consistent.

Joe Gambino (30:36)
Yeah. Yeah. No, I like that. think we're both very much the same, same way. Cause even if like, you being able to body weight squat or being able to touch your toes, there's all great movement patterns that, a lot of people should be able to do, but there are just some people like for the squad. mean, if you have certain, you know, bony, like your, your body is just built in certain ways. You might not be able to squat like, like other people. I think it's unfair to pigeonhole people.

And this is where I saying before, just because you can squat or do a movement doesn't mean that something's wrong or that you need to make a change. And it requires a whole lot of context. So I think I don't really have too much more on top of this. I think we definitely do a little recording of us going through some movement and kind of how we do an assessment. And maybe that can be a little self-assessment tool that people can kind of go through so they can find it on YouTube. And maybe we can create a little

Joe LaVacca (31:20)
Let's do it.

Joe Gambino (31:28)
page for so people can just hit the link we'll put in like the show notes and stuff like that too. But any other thoughts that you have here?

Joe LaVacca (31:33)
Love it.

No, no, it's giving the assessment and yeah, I think that was perfect. right, well, hopefully everybody makes their way over to the YouTube page, checks out our assessment. Joe, love you, listeners, we love you. Thank you for listening in to another episode and please come back next week for more of the Beyond Pain podcast.

Joe Gambino (31:41)
All right, well, take us home.