13 - The Purpose & Potential of Persistent Pain with Matt Wallden

Persistent Pain is a condition that many people suffer from, which can have a detrimental effect on quality of life. In this episode, which is the 1st of 2 parts, Matt Wallden explains what pain is, what persistent pain is and why people suffer from persistent pain and why people and professionals often find it difficult to overcome and treat.

We discussed:

1:11

Introduction to the episode

2:59

Matt's background

10:38

The Naturopathic Triad

34:08

What is persistent pain and how does it affect people?

39:22

Why is persistent pain more pervasive today?

56:14

What is pain and what is its purpose?

1:05:17

Central Sensitisation 

1:09:47

Focus on function not pain

1:12:26

Your beliefs & emotions affect your perception of pain.

You can find Matt @
http://www.mattwallden.com/
https://www.facebook.com/matthew.wallden
https://twitter.com/MattWallden

Chapters

• 1:11 Introduction to the episode
• 2:59 Matt's background
• 10:38 The Naturopathic Triad
• 34:08 What is persistent pain and how does it affect people?
• 39:22 Why is persistent pain more pervasive today?
• 56:14 What is pain and what is its purpose?
• 1:05:17 Central Sensitisation
• 1:09:47 Focus on function not pain
• 1:12:26 Your beliefs & emotions affect your perception of pain.

Transcript

Matt Wallden: One of the fascinating things about persistent pain is that in spite of all of our advanced technology, all of our advanced pharmacology, all of the physios and osteos and, you know, all this kind of pain neuroscience research and so on, persistent pain is still on the rise. And so you're looking at going, well, hang on. What does that tell us? And really, for me, that tells us we're barking up the wrong tree, right? We're missing something here. And I think what it is that we're missing is welcome to the Radical.

Announcer: Health Rebel podcast with your host, Leigh Brandon. If you enjoy the podcast, please leave a five star rating and the warm review. Your opinions are important, and your ratings help grow the podcast and help educate people to lead a healthier, more productive, fulfilling, and happy life. This video is your thing. Please check out the Radical Health Rebel YouTube channel, where you'll find fun bitesize clips from each episode. And now, here is Lee, the Radical Health Rebel, with this week's podcast.

Leigh Brandon: Welcome to episode 13 of The Radical Health Rebel Podcast. This episode entitled the Purpose and Potential of Persistent Pain with Matt Walden. Part one is such a big topic that I felt it beneficial for you, the listeners, and viewers that the sheer amount of information my buddy Matt has to share with you was best split across two episodes. Persistent pain affects so many people and causes great loss of quality of life that it really justifies two episodes and also organizes the information into manageable chunks. In this episode, Matt explains his background and the beginnings of how he learned a lot of the information about persistent pain, and we get into a dialogue around persistent pain, what it is, and what are some of the causes of it in episode 14. Next week, I will share part two of the interview where we get more into the things that you need to do to overcome your persistent pain, things that you probably won't have heard of before. I highly recommend that if you have persistent pain, you watch or listen to this episode, as it will help you understand why you have persistent pain and why you need to do the things that Matt suggests in part two to overcome your persistent pain.

Announcer: You might wish to hit the pause.

Leigh Brandon: Button now, get yourself a paper and pen and write notes as you go, making notes of the key points that you will probably never have heard of before, especially if you've already received professional Belp, which hasn't helped to eliminate your persistent pain. So do enjoy part one of the interview with the super smart Matt Walden. Matt Walden. Welcome to the Radical Health Rebel Podcast. How you doing?

Matt Wallden: I'm very good, thank you, Lee. How are you?

Leigh Brandon: I'm very good, and I'm very pleased to have you on the show.

Matt Wallden: Yeah, likewise. Great to be on it. Thank you very much.

Leigh Brandon: So today's episode is entitled purpose and Potential of Persistent Pain. And according to a UK government survey recorded in 2017, 34% of those surveyed reported suffering from persistent pain. 45% of people who were sedentary reported having persistent pain, and then those with persistent pain increases with age. So from 18% in 16 to 34 year olds, up to 53% in the over 75s. In addition, 81% of people with a musculoskeletal condition reported it as persistent pain. And the persistent pain also increases with BMI from 29% of people who are underweight, up to 54% of people who are very obese. So persistent pain is a very big problem and has significant impacts on life quality, as I've experienced myself, but also having worked with hundreds of clients with persistent pain over the last two decades. And interestingly, it was you, Matt, back in 2003 that helped me with my knee pain on my shoulder pain.

Matt Wallden: Oh, yes, that's right.

Leigh Brandon: 19 years ago. It's just crazy that long ago. So Matt, it's great to have you on the Radical Health Record podcast to discuss this really important topic that so many people do suffer from, but often do not receive any kind of longterm, effective professional help. But to kick things off, what I think would be really good is for you to share a little bit about your upbringing, your educational background and your professional career to date.

Matt Wallden: Sure, okay, great. Well, I live in Surrey, in the UK, and I grew up here from the age of eight. I was elsewhere in the country prior to that. So I think probably the relevant elements of my upbringing had quite a pleasant family life. When I was a young lad, I was a very good footballer and was doing pretty well with that and was playing in one of the sort of area representative sides and kind of got to about 13, probably twelve years of age actually. And we got to the Counter Cup Final and we were, you know, we were doing really well and there was loads of scouts there and some of the boys in the team were already sort of signed up for professional clubs and I wasn't. And I think when I didn't get spotted in that County Cup Final, perhaps prematurely, I decided that, well, maybe I'm not going to make it as professional footballer, because that was kind of my dream as a young lad. Maybe I should think about how I can still work in professional football if I'm not going to make it as a footballer. So as you go into your secondary education, you start thinking about your GCSE and your A levels and all that kind of stuff. I started to select the right subjects that could lead me into something like physiotherapy. And my dad had always been someone who went to an osteopath. He was one of these people that once he had persistent pain, but he had recurrent bouts of back pain and they'd be quite severe when they came on. Every six months or a year, he'd need to go see the osteopath and they would sort him out. So I was aware of osteopathy as well. Around that time, sadly, my mum died, so I was 13 when my mum died. She got breast cancer probably when I was about eleven, half twelve. And there's that whole process of various surgeries and chemotherapy and all the rest of it, and she ultimately died when I was 13. And I think in some ways that's quite important to share, because what it did for me was I think it really opened me quite early in my life to spiritual seeking a little bit. You're trying to understand what this means and why this happens and whether there's an afterlife and all those kinds of things. So I was probably earlier the most a bit of an explorer on that front, and interesting philosophy, trying to understand life and what's it all about. So with that backdrop, I went through my GCC's into my A levels, into actually osteopathic college. Now, the rationale for that, it wasn't so much a mind thing. I didn't decide that was what I was going to do. It was more a kind of gut feel that I went for interviews at physio universities and three or four osteopathic colleges. I kind of didn't feel like chiropractic was right for me. I did look into it, but I never actually went for interviews at the colleges. I think mainly just from talking to people and perhaps their biases influencing me away from it, but ultimately partly, I guess, because my dad also saw osteopaths and got great results of them, for me, it felt like there was something a little bit special or different about osteopathy compared to physiotherapy. In a way. It felt like there was perhaps a little bit of magic in osteopathy, you know, because my dad especially used to benefit from cranial type of osteopathy, which is very, very gentle. And although it's kind of taught along a mechanical framework, talking about the bones of the skull moving in a certain way and all this kind of stuff, the research doesn't really bear that out. It seems actually there's probably more of an energetic form of healing. So anyway, I guess my dad was open to that, and actually his mum was before that. So my grandma, she got pregnant only after going to visit the Oscar, which I was a little bit suspicious, apparently she'd been trying for a while, and then there went to the ostrapath and shortly after she got pregnant. So who knows, I might have an osteopathic grandfather somewhere. But obviously the story is that whatever treatment he gave it was ultimately resulted in my dad being around. So I guess there is a bit of a lineage there. But then when I went to the interviews at the very sociopathic colleges, the main college in the UK at the time was called the BSO, the British School of Osteopathy. And I was pretty intent on going there because it's the biggest one, the best known, and so on. I went to a couple of others just to see what they were like. And actually I ended up in a college called the British College of Naturopathy and Osteopathy, which is now called the British College of Osteopathic Medicine. And that college, I hadn't intended to go there, but when I turned up, there was just a feel about the place. And the principal of the college, guy called Dr. Dreisdale was in the interview and he was saying to me, so, Matthew, what do you know about naturopathy? And I was thinking, oh, God, I haven't done my preparation properly because I was just interested in the osteopathy. And I was kind of stumbling around as probably a 17 year old with the tongue going, but where is it? Like homeopathy? That kind of thing? And he said, no, it's not homeopathy. Or the way we think of the human body is we think of it in a kind of triad, so we think of the biomechanics, which is where the osteopathy is very strong and very helpful, and we think of the biochemistry, which is really where the nutrition comes in, and potentially pharmaceuticals and those kinds of things. And then you've got the emotional element. And so he gave the example that if someone has a car crash and they get whiplash in their neck, well, certainly you can help that with your hands. You can check the biomechanics and you can release the spasming muscles and work around the body to decrease the impact of that whiplash. But he said that if you've got no vitamin C in your body and you can't synthesize collagen because you need vitamin C and collagen synthesis, you're not going to be able to heal tissues very well, right? So that's where the nutrition comes in. You said, imagine maybe you've smashed up your car or you've hurt yourself, you've hurt someone else even worse. There's going to be an emotional component. So if we just ignore that and don't address that, then we're not going to be able to help the person optimally. So just through explaining that, I was suddenly thinking, oh my God, that makes so much sense. I'm going to come here. So that was it. I was kind of in that college for the next four years. So did the ostropathic degree and naturopathic degree and then qualified, went out to New Zealand, because the ostropathic college, the course was a four year degree and most of my buddies from school had done three year degrees and so they had finished the year before me and they'd saved up some money and gone off traveling. And I was a bit gutted, as you can imagine, because I wanted to do the same thing. But also doing an osteopathic degree, you can't really say, I'm going to take a year out and go off travel for a year because you've just qualified in a vocational discipline. So you really need to go straight into practice. So I started looking for options as to where I might be able to practice that would include some traveling. And it turned out that New Zealand was actually a really easy place to get into because they didn't have any Osteopathic colleges of their own. So what that meant was that if an Osteopath who was already there needed an associate to come and work with them, well, then it's an easy work visa because there's no other sort of supply chain, as it were.

Leigh Brandon: That was 97, wasn't it?

Matt Wallden: That was 97. Yeah, 97. I went to Rosario, the very smelly part of central North Island. And funny enough, I remember getting off the coach when I first arrived and thinking everyone's been going on about this smell and there's a little something in the air, but I can't really say it's that stinky. And then I took about ten meter walk and suddenly it just hit me. In Rotor or any volcanic place, it kind of comes up out the drains or there's certain parts of town where it's just really sulfur, real eggy sulfur smell. And I was like, this is it. Anyway, very busy practice. Got lots of hands on experience there but also very quickly realized that actually it was very kind of damaging to the Osteopathic body. I was getting really tight wrists, really sore back, my neck would get achy, all this kind of stuff. And one thing that happened to me whilst I was training in Osteopath was I'd gone to an Australia's conference and it was kind of the morning break. And so I knit to the toilets and I've walked into the toilets and there are three fairly old Osteopaths in there. I'd imagine to me at the time they seemed they were probably in their fifty s and sixty s, maybe seventy s and they were standing at the urinals with these hunched postures and I was thinking, oh my God, if that's what Osteopathy does to you, I'm not sure I want to be in this game. And I was thinking, that's a bit ironic. You've got these guys that are experts in posture and biomechanics and they are with terrible posture and biomechanics themselves. So kind of a combination of that line of thinking but also thinking about or experiencing the discomfort of working full time, five days a week, lots of stress on the musculoskeletal system. I thought, I really want to mix my career up so I'd like to do some coaching. Maybe that probably wasn't at the forefront of my mind, but I like the idea of teaching. I like the idea of writing or presenting. And so I thought I'd try and explore those as my career unfolded. And it was while I was there in New Zealand I saw an advert for this guy coming to town called Paul Check, who had never heard of before, but on the A Four flyer it had a pool check free talk at the local Rotor rugby Club, talking about primal patterns that had a picture of someone squatting or lunging, etc. E. And I was thinking that's interesting because that concept, that primal patterns concept sounds kind of similar to a concept that I've been taught at Osteopathic College by a mentor of mine called Phil Beach called Archipel Rest Postures. I could dive into that if you want me to explain what they are, but essentially there seems to be a congruence between the two. So I went to see Paul Talk and it was quite impressive. It was a very different way of thinking about things and it was information that I certainly wasn't privy to. I remember seeing on his flyer that he was consulting with the Chicago Bulls and I think that was really what drew me, or part of what drew me as well, because I was a bit of a Jordan fan. Like, I think many sports people were back in the day and probably still are now because he's just so exceptional. So I thought, this guy must know what he's talking about. Anyway, so I went to buy some of the or look at the kind of correspondence courses that you had on sale, VHS videos and a four manuals and all this kind of stuff, and looking and thinking expensive. And I thought, now maybe I won't get him today, but I know the guy's name, so maybe I'll look him up in the future. So, having spent a year in New Zealand, I realized that this kind of dream of working in professional football was not going to happen in New Zealand. Because it's all about rugby, it's all about the All Blacks. The standard of football there is not very high, but I think because it's quite interesting, actually. I think sociologically it's quite interesting because you can see, like through the TV and the advertising and all this kind of stuff that the All Blacks are used to sell everything, right? And really like dynamic footage of them. And they're world beaters champions, strong, conditioned, and you can see how the male psyche wants to emulate that. And almost every young boy in New Zealand wants to become an All Black. Every young girl wants to become a girl black. So you can see how essentially the cream of the crop of sports people are being drawn into rugby and what's left? Play the other sports, right? So there were not really any options from a football perspective. And obviously my family and friends were back home and also the kind of continuing professional development side of things was weak in New Zealand because there weren't any colleges there. So I thought, I'm going to head back home. So I did come back to the UK in 98 and started on a.

Leigh Brandon: The reason I remembered 97 was because we had a very similar journey, except I went to Australia. You went to New Zealand, right?

Matt Wallden: Right, yeah, that's right. First I started on this master's degree in 98, which was a two year sort of parttime masters degree and so finishing in 2000 and probably around 1999 I had to start thinking about my thesis and I designed some research to look at lumbo pelvic associations with Hamstring strain in professional footballers. And so I managed to get the research underway. But I was thinking. I really ought to look up that guy Paul Chek. Because he knew a lot about sports injuries and it was the early days of the internet. So I wouldn't have Googled him because I'm not sure Google was a thing then I think I probably used Yahoo or something and I found the Chek Institute. I thought. That's him. And so I sent an email to the contact address and I had a reply from a chap named Chris Maund, who you know and I know, who said, well, I recommend you buy the Scientific Back Training, which is one of the correspondence courses that they offered. And I think I forget exactly how long it was, but I think it was about six videos or something like that, and big manual and so I'll get that and I ordered it in, came across and started watching it and I started thinking, wow, this guy is ahead of the curve. I knew it was good, but having done my bachelor's thesis in 97 and now doing my master's thesis in 99, I'm looking at it and going, well, I know all of these top researchers, I'm really up to speed on the top low back pain researchers, the top researchers looking at facial systems in the body and how they interact in functional movement patterns. I was really up to speed with motor control research and all this kind of thing because it's all very new. It's like Caustic was the thing in the late ninety s. And I was thinking, well, Paul's not only understanding this, but he's applying it and he's doing it better than anyone that I'm reading around. Which is surprising because these guys I'm reading around are the guys that organize world conferences on low back pain and musculoskeletal issues and all the rest of it. And they're writing textbooks and they are the names, yet Paul somehow has mastered this stuff. And then I looked at the dates on the videos and they were shot in 90, 94, and I'm thinking, wow, if these were shot in 94, he's got to be practicing it, at least for a few years prior to that to have got good enough and confident enough to shoot a video on it. I was thinking, this guy is way ahead of the curve. So when I heard that he was coming for UK, which was, I think January 2001 in Maiden Head did you go to those?

Leigh Brandon: No, I wasn't at that one.

Matt Wallden: Right.

Leigh Brandon: I first saw Chris.

Matt Wallden: Okay. Yeah. Right.

Leigh Brandon: He came over to the UK with Janet.

Matt Wallden: Yes.

Leigh Brandon: And they did the UK's PT conference.

Matt Wallden: Right? Yeah. I imagine they're quite impressive.

Leigh Brandon: Yeah, they were. Janet did a Supine Lateral ball roll, and I was like, wow, human being can actually do it.

Matt Wallden: Yeah.

Leigh Brandon: She literally had just her fingertips on the ball on one side, which for those people that don't know what Supernatural ball is, it's a pretty difficult exercise for most people. But to have done it to that extreme was pretty impressive.

Matt Wallden: Impressive. Very good.

Leigh Brandon: Yes.

Matt Wallden: Anyway, I booked him for his seminars in January 2001, and again, this time it was just another level. It was like he had taken it to a level way above when I saw him four years previously. And he was talking about he actually mentioned the Naturopathic Triad. That triad I mentioned at the beginning, the nutrition, biomechanics or biometric. Biomechanics and emotions. And I was thinking, okay, he's really on it. And then at one point during the seminars, he said something along the lines of if the body is in pain and it can't move, then the soul feels trapped in the body and it won't be long until it wants to fly the body. And I was thinking, oh, wow, this guy is this kind of muscle man, gymnast athlete doing all kinds of crazy stuff on Swiss balls that 99% of people couldn't do. His knowledge is ahead of the leading people in the field, and he's holistic and he's open to spiritual concepts, which, as I said, I had a natural sort of interest through my own experiences. And so I was just like, wow, I've got to learn from this guy. So then at that set of seminars, they offered the opportunity to book onto the internship, I think they called it, or whatever they termed it. It was Check level one certification, I think they called it. And so I booked on to that, and then it kind of all cascaded from there. And I ended up doing all the check training across the next four years till 2005. And then in 2006, I started training up to come faculty. And so I've talked to Czech faculty on the Czech faculty since then. So that's kind of in a nutshell, but in a big nutshell, that's my journey from a check perspective. So do you want me to elaborate outside of that?

Leigh : Yeah, go ahead.

Matt Wallden: Well, okay. So I guess around that 2006, when I started training and to become a faculty member, one of the things I was doing was I was assisting Sudie Neville, who's one of the faculty members that taught me. So she was based in New York, and so I ended up going assisting her in New York a few times so I could train up to teach. And in one of those courses, a guy called Tommy Tolls, who you and I know ultimately also ended up coming to Tech faculty. He walks into the class as a student wearing this bright yellow pair of toe shoes. And I did like a double take because first of all, they stood out. But second of all, I had written to Adidas or Adidas for our American friends and scales us back in 90, 99. So I've written them in 99 because now I mentioned Phil Beach earlier. Phil is someone who very much like Paul, looks to evolution to understand the human body. And so Phil back in the 90s was talking about going barefoot, running barefoot, walking, encouraging clients to go barefoot as much as possible to strengthen the feet. And because the feet is usually sensory, so they provide lots of feedback to the nervous system, et cetera, et cetera. So that all makes sense to me, and I toyed around with it a little bit. And I had bought a pair of those. I don't know if you ever saw them or wore them, the Adidas Taekwondo shoes, which were super slim lines to the ground, you know, and so they felt great. They look cool, and they were a bit of a trend for a while, but because adolesce have made those, I thought they're the perfect company to write to, to say, hey, look, your taekwondo shoes are great, but if you could actually put individual toe pockets into them, then the toes are there for a reason. They're designed to splay when you hit the ground. They provide feedback as to what you're walking over and all this kind of thing. So that would be like the ideal shoot. And so I wrote less of them, and they brought back I think initially their legal department wrote back saying, no. It would have been like an admin person wrote back saying, thanks for your idea. We passed on to the legal department. Then the legal department right back saying, thanks. Your idea. We're not going to go with it. Our direction is elsewhere at the moment, but we'll keep your letter on file, okay? So I kind of thought, well, I tried, and I just parked it, let it rest. And then seven years later, there I'm in New York, and this Tommy Toles walks in wearing a pair of the exact kind of image I had in my mind's eye of the perfect shoe.

Announcer: You're listening to the Radical Health Rebel podcast.

Leigh Brandon: Just a brief interruption to this podcast to talk about adult acne. Now, did you know that 40% to 54% of men and women older than 25 years will have some degree of facial acne? And that clinical facial acne persists into the middle age in 12% of women and 3% of men? I know only too well the devastating effects that acne can have on your confidence and your self-esteem and how it can easily destroy your social life, your career, and your relationships. I know this only too well because I suffered from severe cystic acne from Age 13 to 31 over an 18 year period.I visited my doctor on many occasions. And his only suggestions were acne creams, harsh cleansers, and antibiotics that weren't working and were actually making my skin worse. After 18 years of struggle and thousands of pounds invested in treatments that didn't work, through my professional education, I began to learn that what my doctor had told me was untrue, and that diet was directly related to acne, plus other factors such as food sensitivities, toxicity, hormones, and balancing the body's microbiome. Putting what I had learned into practice. I managed to rid myself of acne over 20 years ago and have been helping others to do the same for well over a decade by teaching people what foods cause acne. What food sensitivities each individual has. How to optimize their detox pathways. How to reduce environmental stresses and toxins. And how to balance hormones. Especially those related to the mTOR pathway. A major causal factor with acne. I've been able to help many other adults overcome their acne nightmare, too. So if you would like more information on how to overcome your adult acne, please go to www.skinwebinar.com. That's www.skinwebinar.com, where you can also request an acne breakthrough. Call with me to see if you are suitable for my Eliminate Adult Acne coaching program, where you can once and for all learn how to overcome your adult acne. Now back to the podcast.

Matt Wallden: So I got talking to Tommy and said, Where did you get these? And he said, oh, there's this place called TikTok Shoes just down the road. We could go there after class. So we went along, bought my first pair, and again, a bit of a long story short, ultimately I end up becoming the distributor of Vibram Five Fingers to the UK in 2007, largely because Vibram themselves also, I know people call them Vibrant, but they are an Italian company, so it's Vitali Brahmani, much like Adi Dasler, which is why we call it Adidas, right? Not Adidas. So Vibrant had brought out these shoes, but they thought that they mainly would sell to the sailing market. And I was saying, no, these are great for rehabilitation, they're great for conditioning. You could even run in them. And it was the first they had heard of the rehab and conditioning. They knew there were people that ran barefoot because they'd been approached by a guy called Barefoot Ted, who ran marathons barefoot. And he said, I can wear your shoes to run a marathon. So they knew that you could run in them, although they were very skeptical of that. I think most people would have been at the time, but they had no idea there's kind of rehab or conditioning side to it. So that was really what got me in the door. And so then I set up a company to distribute the shoes and ran that in parallel to my clinic and my. Teaching around that time. Part of what ties me the story is that I was asked by Leon cheyto, who is in the rehab world, a fairly famous osteopath and naturopath. He's written he wrote about 70 books. Sadly, he died about three or four years ago now, but incredible sort of contributor to the profession and to the literature, and also an osteopath and naturopath. So very holistic thinking. But he had asked me to write a chapter on rehabilitation for his book called naturopathic physical medicine. So essentially a natural medicine textbook. And because it's on rehabilitation and conditioning, one of the things I'd already explored, and this was in 2006, was essentially the benefits of barefoot, because, of course, we evolved. Barefoot shoes have only been around for about 40,000 years, and obviously sports shoes and cushion shoes have only been around for about 50 years since the tendencies, really. So from an evolution perspective, footwear in general is a blink of an eye, and cushion footwear is a blink of a blink of a blink of an eye. It's such a tiny proportion of our heritage. So I knew there were some benefits, and I'd heard people espousing various benefits, but I didn't realize there's quite a lot of research on it. So I dug into that research for this chapter I was writing. And so that was part of what I shared with Vibram to say, yeah, look, this is real, there's research on it. Again, that was part of what led me to become a distributor. But in conjunction with that, the other thing I spent some time doing over the next 1012 years I'm still doing it now, is writing for leon's journal, which is called the journal of body work and movement therapies. So one of the things that was very congruent about leon's view of the rehabilitation world and the physical therapy world, etc, is that really you get a little bit political manoeuvring between the different professions. You get physios thinking that chiros are no good and chaos thinking osteo is no good. There's always a bit of sparring and also kind of similar between different movement professions as well. So and so is the best, or I wouldn't go there because they're not properly qualified. Those kinds of comments are quite rife. And what Leon really says is that, look, there's value in everything. And that's why I'm calling the journal bodywork. It's not journal of osteopathy or physiotherapist bodywork and movement therapy. So it's not Pilates or yoga or velvet. It's like movement therapies. So his view, which totally resonates with mine, is that the ultimate goal is to get the person better, right? To help someone to move out of pain or to realize their potential in some way. And so whatever tools you use and whatever name it's called, doesn't matter. It's the result that matters. And so if you can be open minded enough to use different elements from different professions, which of course, ultimately with the internet and the availability of information in this kind of information age, everyone's learning from the same books and journals and texts anyway to try and define the difference between a physio or an osteopathic or chiropractor or sports therapist. It's very difficult now because they're all very similar and there are differences and there are stereotypes that you can point to, but really hard to tell them apart. That was really my journey through to 2017. I was doing the shoes, like I said, still writing for the Journal, still working Phoenix, still teaching for the Check Institute. So here I am in my clinic in Surrey and now talking with you.

Leigh Brandon: Awesome. 

Matt Wallden: Excellent.

Leigh Brandon: So my first question. So obviously today's discussion is about persistent pain, but what does the term persistent pain mean and how does it actually affect people?

Matt Wallden: Right, okay. So the technical definition, which is a pretty basic definition, is any pain that has lasted beyond three months. So once your pain problem has someone's experiencing pain, then if it goes beyond three months, it's technically classified as persistent. So that's the definition, if you like. What was the second part of the question? What does it mean to people?

Leigh Brandon: Yeah, so how does it actually affect people? How does persistent pain affect people?

Matt Wallden: Yeah. Right. Well, I mean, of course pain is something that makes you pay attention and therefore it tends to distract you from other things. And therefore, if you're trying to concentrate whether that be in work, at school, driving a car, playing a sport, and you're in pain, then it's going to impact on those other things because the pain is essentially directing your attention away from those things, and that's its evolutionary function, if you like.

Leigh Brandon: Yeah, I mean, I found that working with people with persistent pain, the key thing for me has been for the quality of life. When you speak to someone and you say, well, you've got this pain, what does it stop you from doing?

Matt Wallden: Yes.

Leigh Brandon: Well, it stops you from socializing, it stops you from working out, it stops me from playing with the kids. I can't perform at work at my best, and it just has such a massive effect on life quality. As you know, back in 2013, I herniated my L four five and L five S one lumber discs in my spine, and that's not a quick fix. And I couldn't lift any heavy weights. I mean, I was resistance training, but I couldn't lift heavy weights in the gym. And I was doing very specific rehab type work, which I find pretty boring, but I couldn't play tennis, and there's a lot of things I couldn't do. Initially, I was really worried that I wouldn't even be able to continue my career, which I shouldn't have been, because I kind of know what I'm doing. But when you're in that situation, it's quite difficult to see the future sometimes. I did have a deep belief in myself that I would get better. But there were days when, as you know, man discs take a long time to hear and from day to day you think it's no difference. Whereas as someone that's played a lot of sport for a long time, like I have, I've had little muscle strains here and there, they can be healed.

Leigh Brandon: In a day or two or three days. So to go from day to day just thinking there's no difference, that can be quite concerning. But that was probably my biggest injury I've ever had and it took about 22 months to rehabilitate fully to get back to lifting heavy weights and playing tennis and everything else. So I'd imagine your experience is similar with clients as well in terms of quality of life being affected by persistent.

Matt Wallden: Yeah, definitely. One of the questions that's important to ask when someone has persistent pain is what are the meaningful tasks that have been impacted? So exactly as you just said. But the sort of phrase meaningful task is quite helpful because there's lots of tasks that could be affected. Like mowing the lawn or putting stuff in the dishwasher. But maybe that doesn't bother you so much. Maybe you get out of the lawn loading the dishwasher. But there will be meaningful tasks such as being able to pick up your kids or being able to play a sport you love or being able to do some kind of hobby that you love. Being able to make love. There's all kinds of things that can be hugely meaningful that are compromised or just not possible when people have persistent pain. So I think that's quite an important concept because what it does is it actually directs the attention of the individual away from the pain and towards the function that's being compromised as a result of the pain. And so then instead of saying, how am I going to get out of pain? Oh, my pain's at this level today, oh, my pain hasn't gone, my pain has gone down my leg or up my leg or whatever. Well, you can say, well, can I function today? And maybe you can't, but maybe you can function a little bit better. Maybe if you follow that program you've been given, or maybe if you follow the dietary advice, maybe you can move towards better function. Maybe there's alternative ways to move or different sports you could try, like you just gave the example, maybe you can still go to the gym, but you've got to just limit what you can do in the gym for now. But what you can see is bit by bit, your function improving. And so focusing on function rather than pain is very important because it provides a route back to those meaningful capabilities.

Leigh Brandon: So why would you say that persistent pain is such a pervasive health challenge in today's society?

Matt Wallden: Well, it's a good question. The thing is that I think it's worth prefacing. I mean, you get a great sort of preface to the podcast by going through some of the stats, but there's research that shows that 1.5 billion people on the planet suffer, or I should say experience, if you care about that language, you can talk about later. But they experience persistent pain, okay? Which means it's one fifth of people are experiencing persistent pain at this present moment.

Leigh Brandon: And I would guess most of those are in the Western world as well.

Matt Wallden: Yeah, probably. I mean, I'm not sure on that specifically, but there are various pieces of research that show that persistent pain is lower in cultures that are less developed from an industrial perspective, which is a bit counterintuitive because of course, you think because they're perhaps doing more manual labor, more farming, those kinds of things, walking more physical, yeah, less medication, all that kind of thing. So you would think that they would have worse persistent pain. Now, of course, the answer may be in that very description that I just gave, that they're more active and they're taking less medications that mask the pain, and they're eating better quality foods that with less toxins in their diet, in their environment. So that those are things that could be contributing to that. But there's also one of the critiques of that kind of research is that, well, maybe it's because the reporting systems aren't as good. So be like with covid. You can look at Africa and there's always zero COVID in Africa, right? Wait a minute. We thought that this was going to kill everyone, but Africa's got almost zero deaths from COVID. So you could say, well, that's due to poor reporting systems, and that probably is a factor. The interesting thing is they've got very advanced reporting systems for AIDS in Africa. So it's kind of like, well, can they not use those same systems for reporting code? Is that not still a medical centre with a computer and all the rest of it? So that's interesting in and of itself. But in terms of why I was sticking with the figures, one of the fascinating things about persistent pain is that in spite of all of our advanced technology, all of our advanced pharmacology, all of the physios and osteos and all this kind of pain neuroscience research and so on, persistent pain is still on the rise. And so you're looking at it going, well, hang on, what does that tell us? And really, for me, that tells us we're barking up the wrong tree, right? We're missing something here. And I think what it is that we're missing is an holistic overview. And the holistic overview is that we've got people that are sedentary, obviously not moving as much as they should do. They're getting not enough sleep, which is something that's come out in the persistent pain literature. They're dehydrated quite frequently. Their nutritional intake is high but poor. Right? So actually my Pau used to work with this very smart lady I remember talking to about the obesity issue and, you know, but the quality of the food being terrible and all this kind of stuff. And she was standing there shaking her head, and she was saying, isn't it amazing? Half the world are underfed and half the world are overfed, but everybody's starving. And it's like, yeah, she's nailed it in that one sentence, that you can have insufficient nutrients because you haven't got sufficient foods, or you can have insufficient nutrients because you're eating ****, processed foods. And that's essentially the balance of things on the planet at the moment. So when you then look at persistent pain, why are people's backs hurting? Well, or whatever part of their body. But let's use backs because it's a common area that people experience pain. Well, there's the sensory nature. There's the nutrition. There's the sort of stress levels. There's breathing pattern disorders because of the stress levels, which change the biochemistry, make you more prone to pain. The nutrition, we've said, is a bit rubbish, but actually it's also very pro inflammatory. Right. Dehydration mentioned. But that also when you're dehydrated, it makes you more proinflammatory. There's the thoughts that people are occupying themselves with often they are very pro inflammatory thoughts. We've seen that a lot over the last few years with the pandemic. Right. And really what it all points to is that if we take the rains on the situation and we feed ourselves well and we engage with the movement program and we ensure we get enough sunlight and we ensure we get enough sleep and we ensure we stay hydrated and do all of those things, then that's what is most likely to reverse the trend of increasing persistent pain.

Leigh Brandon: So going back to nature?

Matt Wallden: Yeah, pretty much. I think it's incredible how we have this kind of sense of hubris in medicine that we can outwit nature, and it bears a complete disregard for the sheer depth of time. There's sort of inconceivable periods of time over which a physiology has evolved. And it's not just human physiology. A physiology is based on mammalian physiology, which is based on reptilian physiology, which is based on you could just keep going back right away to cellular physiology. And in fact, there's a guy called Astrans who wrote a book on physiology, and he basically said that if you were to go back to the dawn of life, most of what was present then is still present now, has just become more complex, and it's multicellular. But there's almost no difference between us and a single celled organism, physiologically speaking.

Leigh Brandon: Well, I remember we've been there together, the natural right, and you see the skeletons of the dinosaurs, and you look at the vertebrae, and you look at the bones, and the foot hours aren't that dissimilar.

Matt Wallden: No. Find its way of creating efficiency. What works tends to work for a dinosaur. Tends to work pretty well for a horse or for a chimpanzee or for a human. So obviously I studied the feet in quite a lot of detail when I was doing the Vegan Five fingers. And what you find, even though I use the example of a horse and as I'm saying, I figured that's not a great example because they haven't got toes, actually does have toast, but they fuse together. So actually, when you look at hooved animals, they have the same infrastructure within the leg that we have. It's just they've managed to fuse their toes together. And so, yeah, different strategies, obviously, but the underlying anatomy and the physiology of the state is extremely consistent. And what that means is that when you then come in and start tinkering with it because you've got a new idea about nutrition or whatever it might be, injections and so on, then you're playing with fire. You really are. I think really the core drivers behind persistent pain are that we've got a situation where we're essentially in we're in like a human zoo. And I think you're probably familiar with that concept. But when you look at what happens to the physiology of animals that are caged and taken out of their natural environment, what you see is a profile that's almost identical to what we see in the lifestyle diseases in modern society.

Leigh Brandon: Yeah, for sure. I mean, as you're speaking then, I was just thinking, if you think of modernization, that's so-called modernization, and then you talk about the Naturopathic triad, well, it's harming all three of those aspects, right? You're sitting in a chair all day. You're sitting in a chair all day messing up your biomechanics, you're eating terrible food, messing up your biochemistry, and then you're watching TV and watching the media and having bad relationships with people, which is messing up your mind and your psyche. If we could go back 1000 years, start again, I think we could do a much better job.

Matt Wallden: Yeah, for sure. You only have to study zoo animals to know that the quickest way to make an animal infertile is put it in a cage, right? And it just gets stressed out and won't reproduce. And you and I know why that is. We talk about the reptilian reflexes. And when you cage an animal, whether that be literal or metaphorical, then it fails to reproduce because it's centuries channelling all its energies into survival. And this is why I think we've got increasing issues with fertility in the human zoo as well.

Leigh Brandon: Birth rates have plummeted. I've had the last three years.

Matt Wallden: Yeah. And obviously things like sperm counts been dropping since the 1950s, 50% down since then. So, yeah, there's loads of things. There's loads of kind of parallels. And I think it's interesting to me that people don't see it or that they get so caught up in the detail. And one of the things I say to my patients sometimes, you remember the devil's in the detail, right? And although that phrase isn't normally used in that way. It's very much an issue. And David White, who's the guy who I like to listen to, a kind of poet and philosopher, he talks about Blake and how Blake says that poetry gives you a moment in the day where the devil cannot find you, right? And what he is referring to there, of course, in a metaphorical sense, is the strategic minds. The to do lists, the left brain, essentially, and the detail. And so this is what we get caught up in. This is what creates stress for us on a day by day basis, because we don't stop to look at the bigger picture. And that's been highlighted massively the last couple of years. But that's where you find the devil right, in that detail. And what we've got to do is we've got to step away from that, give ourselves time for some happy time, the Doctor happiness concepts. Give ourselves some quiet time. One of the books I was reading, I think, is called The Essentialist, is talking about one of the big challenges for us in this day and age. We don't ever get bored. The boredom is actually when your brain is processing what you learned, it's integrating it. And if you don't allow yourself boredom time, or let's just say time when you're not thinking. So it could be going for a walk, it could be working at the gym, doing something that actually is mindless, more or less, then you don't get that integration time. And that means that you're just being fed information the whole time. You're not completely confused because you can't integrate that information that you're seeing on the news or through your internet channels, your social media and everything. It's all being thrown at you at such a rate that you just kind of ultimately have to accept what you're being told, as opposed to stopping, going, wait a minute, does that fit with the last pandemic? Wait a minute. Those last three pandemics, they all had two or three waves of one wave and then they finished. There's no vaccination program. So is it the vaccination program that made a difference this time because it didn't know glossary? I mean, let's look at the big picture, right? And so people are so caught up in the news cycle and, oh, what's happening this winter? Is it going to be another wave and all that kind of stuff? And you're like, well, wait a minute, let's just calm down, have a look around and integrate this information with what we know of Coronaviruses and what we know of past pandemics. And you can see all pandemics ultimately become a phase out and go into some kind of endemic situation or endemic status, where, just like the common cold, it's here with us. We're not going to get rid of the common cold, but it doesn't come in waves and kill millions of people. But it does kill people. It kills people in towns and all the rest of it. So anyway, that's a bit of an insight. But I think that's part of the challenge of modern living is that we get so bombarded with information. So the information age has this kind of mixed blessing. We get social media experts everywhere, which is not necessarily a bad thing because you can get great information, but it's being able to integrate that into a bigger picture that I think people struggle with. Understandably.

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Leigh Brandon: Are you regularly suffering from painful bloating and wind that can be smelly and embarrassing? Are your bowel movements not as they should be, either constipation or diarrhea or possibly alternating between the two? Do you find the pain is bad enough, but the bloating and cramps make you feel awful and are affecting your everyday life? Do you sometimes feel you can't eat properly because of the wind, bloating, and pain? And has your doctor told you that you have IBS but unable to help find you a solution? Do you feel right now that you simply don't know what's causing your symptoms and whatever your doctor has suggested hasn't worked and you feel frustrated that you're still far from having a normal, flat, comfortable tummy? Have you invested a lot of time, energy and money into improving your symptoms and don't wish to waste any more? Do you feel frustrated and depressed and don't feel like you can take part in all the activities you enjoy and sometimes have to cancel attending events because of the way your tummy feels? Do you fear that if you don't get this sorted, you could end up with a much more serious gastrointestinal disease? If so, what would help you right now is to understand the root cause of your digestive condition. Rather than continuing to try to mask the symptoms with Over-the-counter or prescribed medications. You need help understanding how factors such as nutrition, gut, health, stress and toxicology affect the digestive system and how to optimize these factors. You need someone who can advise, motivate, and support you every step of the way, someone who has walked the path before and taught many others to do the same. What you need is might overcome your digestive issues. Program. My Overcome Your Digestive Issues program can help you in the following ways I will help you understand the root causes of your digestive problems and teach you how to approach the condition holistically via expert advice on nutrition and lifestyle factors to Overcome Your Digestive Issues Program we'll start by ensuring you are on the right diet for you. Based on your genetics or metabolic type and one that avoids the foods that are known to exacerbate your condition. We'll go on a journey step by step, learning all the necessary lifestyle changes required to achieve a flat, comfortable, pain free tummy. Each weekly 30 minutes coaching session will include advice, support and guidance specifically tailored to your needs and at a speed that is right for you. Once you're eating right for your metabolic type, you will begin to see changes in how your tummy feels. And we will also uncover all the necessary blocking factors that you may have. And you'll be taught how to reduce, replace, or eliminate all the factors that are causing your digestive problems. Ultimately, this program will enable you to achieve a flat, calm and comfortable tummy every day for the rest of your life. For more information about how to improve your gut health and to claim a complimentary no obligation gut health consultation, please go to www bodycheck Co. UK that's bo dychek and fill in the request form at the top of the home page and we will be in contact to arrange a convenient time. Now back to the podcast.

Leigh Brandon: Yeah, and I think the mental aspect when we're talking about pain is important, which I'll come onto in a moment. I think it's probably a good time to actually ask you the question, what is pain?

Matt Wallden: No, it's a very challenging one of the guys I've written, I've quoted him in my papers I've written on pain says that pain is an apaua and aphoria is where the limits of intellect lie. You can't fully express what pain is because it's subjective. It's the individual's experience. So you can't say, oh, that's the firing of a nociceptive drive, and it creates this amount of charge in the thalamus or whatever. You can't measure it. You can only go by people's experience of it. And so it's actually a very difficult thing to describe, but I think one of the best ways of conceptualizing it is that it is I mean, Paul checks it is a means of quickening consciousness. What he's saying is kind of what I was alluding to earlier, which is the idea that the pain distracts you from everything else. It says, hey, there's a problem here, you need to address it. OK. And so in one of my papers, I've got a picture of a finger coming up from the body and pressing against the cortex to say, we've got an issue down here. You need to change your behavior. The challenge is working out well. What element of behavior do I need to change? So if you got a sore foot, you chosen a pin. You feel the pain and you're like, oh, your brain gets that nudge and so you're like, okay, well, hang on a second, something just hurting my foot. You put your foot back down and you're hurt again. So now you're starting to learn, oh, if I put my foot down on that pin, it's going to hurt. So maybe I should stop doing that. Let me have a look at the sole of my foot. Ah, there's a pin in it, right? Okay, I can pull that out. Let's try again. Oh, that's better. Okay, so the pain has gone, so you learn something, right? The challenge is that pain is so complex and the contributing factors to pain are so complex, it's not often obvious what it is you're being nudged by your body to do. But what pain is doing is it's nudging you, it's telling you something needs to change here. And this is sort of beautifully ties in with Paul's concept of the pain teacher, the idea that the pain is providing a lesson of some sort and it's down to the individual to try to identify what it is, the lesson they're being taught, and which lessons they can learn from this situation. And that's a challenge because of course, a lot of people in today's world want a quick fix. We've got this kind of mentality of what's it called instant gratification. And that applies both to gaining pleasure, but also to getting rid of pain. So rather than working out why it is you've got a headache, the obvious thing that people will tend to do in our society is to take an aspirin and the headache goes, but then they haven't addressed the cause of it. So then it comes back perhaps the next day or a week down the line, or a month down the line and oh, there's a headache again, I'll take an aspirin. But as Paul says, a headache is not due to an aspirin deficiency. And you could use that same analogy for cancer. Cancer is not due to a chemotherapy deficiency. So whilst you wouldn't say don't take an aspirin and you wouldn't say don't take chemotherapy, you might say that. But the point is that those things have their place in the right space, the right time, and for the right individual. But it's important for any individual to understand that cancer isn't due to chemotherapy deficiency, just like headache isn't due to an aspirin deficiency, just like overpronation isn't due to orthotics deficiency. Right? There's something driving those things. And if we just treat them and this is the medical model, it's focused largely on treatment, then of course we're missing a trick and that person is going to keep going back to the same behavior, so they're not learning the lesson. In fact, often these treatment modalities mask the lesson so the person doesn't learn. So it actually compromises learning. And that's a big issue that we ideally need to address. But it's a participation sport. If you can't get the person to participate, then you've got a challenge. And unfortunately, partly because of the way we're enculturated, and I actually think this ties back into religion, but before I go there, I think the culture essentially dictates the behavior for most people. And this is the biopsychosocial model, right? So you've got the biology, you've got the psychology and you've got the sociology. And if your biology and psychology are within a society that values pharmaceuticals and says the doctor is. The person that helps you with pain, as opposed to the physio or the ostrop or the check train professional or whoever, then you'll tend to go to the doctor. And because the doctor's training is largely funded by pharmaceutical companies, most of his tools or her tools are pharmaceutical in origin. And that makes sense, right? But then you're going to get a pharmaceutical response take this painkiller, or I've got extra special painkiller for you, take that one. Or I've got an opaque for you, take that one. And so then ultimately the person doesn't learn the lesson that the pain teacher came to tell me in the first place. But just to go back to what I was saying about religion, the interesting thing about the way our businesses and our medical systems and our government are set up is that they're very much set up in a kind of hierarchical way, which means you got someone in charge at the top and they are the authority. And so they make the decision as to how society runs or as to how you manage your headache or your back pain. And that's just the way society has set itself up, how to run the company with a CEO, those kinds of things. They kind of hierarchical, obviously quite often pyramid type systems. But the problem with that is that then you've got power in a position that's outside of you. You've got someone who's the let's say you've got your general practitioner. They don't know what's going on with your back, your tripenkiller, so they refer you to the orthopedic surgeon. Orthopedic surgeon is at the top of the tree when it comes to they're like the gods of back pain. So then you go see the surgeon and obviously with some surgeons, the likely outcome of that is surgery, right? Others are more open minded to other approaches and will encourage other approaches first. But the point is that you have relegated your power, or you've handed over your power to the doctor initially, then to the surgeon, and now you're completely disempowered. You're entirely in their hands. And so it's very much like the idea of a religion where the power is outside of you. So you got your God in the sky or your God in the white coats telling you, I can fix you. I'm in charge here, I've got the power to do this. But that means that you are disempowered. But we've come from a society where you only have to go probably two or three generations back and almost everyone was a God fearing Christian, right? So they've got this kind of operating system in their lexicon which says that the power is outside of me, it's in the sky or it's somewhere higher up, and if I'm in trouble, I better pray for that power. And that's essentially what the medical system is reflecting, is that model. What we do in our work is we do our best to hand the power back to educate, to help people to see where the lessons may be so that they can embody that power and start to take ownership of the situation and, as I say, bit by bit, move towards the function that they want to achieve.

Leigh Brandon: So what you were saying so pain basically is something in our subconscious becoming conscious.

Matt Wallden: Yeah, it is.

Leigh Brandon: So let's say someone, their shoulder starts to hurt, right? And they take some painkillers that doesn't really do the job. They go to see their doctor. Doctor doesn't help them. They go and see another, say, manual therapist, and six months down the line, their shoulders still in pain. But the fact of the matter is that the cells that were in pain six months ago no longer exist, right?

Matt Wallden: Yeah.

Leigh Brandon: Those cells have turned over and new sales have come along. But six months, twelve months, two years down the line, they're still in pain. Do you want to give a little explanation of how that happens?

Matt Wallden: Yeah. So this is often referred to in the research as central sensitization. This is kind of one of the key elements of persistent pain, is that when the pain becomes persistent, which by definition is a three month mark in most cases not in all cases, but in most cases, the tissues that were originally damaged are healed or healing. Now you get the example of your disk. We know that discs can take between 300 to 500 days to heal in a dog, right? That researchers don't have a dog. Dogs don't have axial load like we do, because they're on a horse the whole time. Essentially, they're doing, like, horse dance, four point kneeling, tight exercises all day long. But also they make a shitload of vitamin C. So they make, I think it's three to 5 grams of vitamin C per day. So they can repair collagen way quicker than we can. So they make it endogenously. We have to get it through our diet. So that studies suggesting it takes 300 to 500 days to heal the annulus, which is the outer part of the disc in a dog, you could probably reasonably multiply that by two, possibly more in a human. So that's a bit of an exception. And ligaments, connective tissues generally they can take longer. But really, when you're heading towards that one to two year mark and beyond, you generally would expect that the tissue itself is healed. Like you say, the cells are different, the new cells are gone there, but the person is often still feeling the pain. So this is the idea that hurts doesn't always equal harm. Okay, so someone with that shoulder injury you described, they might get the pain as they lift their arm up. It doesn't mean they're damaging their shoulder. It means they're just still feeling the pain. And why are they feeling the pain? Well, there's a few reasons for it. One useful concept that is a neurophysiological concept is the law of facilitation, which says something along the lines I can never quite remember. It was something along the lines that each time a nerve impulse traverses a given set of neurons, the nerves to the exclusion of others, the resistance to that impulse will be decreased on each future occasion. So in other words, the more you use a nerve, the more effective and efficient it becomes. Just like the more you use a muscle, the stronger it becomes.

Leigh Brandon: The way I sometimes explain that concept to my clients is to say, imagine you've just landed on a desert island and the only place there's food is on the other side and all you can see is trees and bushes. It just so happens to have a machete. Right. What you're going to do, you're going to cut your way through the forest, right. And then you get your food and you've got to come back to the beach to cook it and whatever. The next day you got to go back and get some more food. What are you going to do? You're going to follow the same path, aren't you? You're not going to keep cutting a different path every day.

Matt Wallden: Right.

Leigh Brandon: And that's kind of similar to what happens with our nervous system.

Matt Wallden: Yeah. So you facilitate the pathway, right? That's exactly it, yeah. And I give an example of facilitation because I think most people have had this experience. If you got a mixer tap on a bath or any kind of tap, there's a mixer tap. Let's say you turn the hot one and it's feeling cold, so you turn it right up and you wait for it to get hot and it starts to get hot and you turn on the cold and nothing comes through and it's still hot. You turn on the cold further, it's still nothing to come through. And what's happened is you facilitated the pathway of the hot water and that's blocking the cold water from coming through. Or it could go either way. Right. But the point being that that's an example of facilitation. So that can, facilitation can happen both from a motor perspective that muscles being overactive, but it can also happen from a pain perspective. There's no susceptible nerve, so nerves carrying the messages to say there's a threat here, okay. They can become facilitated in someone who's feeling pain the whole time. So the more you feel pain, the better you get to feeling pain. So this is why it's important to focus on the function and distract yourself from the pain. If you focus on the pain, like how's my pain say, oh, it's still an eight out of ten, I'm going to do this exercise, how am I paint now? Oh, it's still an eight out of ten. Well how about trying focusing on the function? I say, okay, I know I've got pain, it was eight out of ten yesterday, but I've got to do these exercises let's see if I can do better than yesterday. So we're doing exercises. Oh, I did one more rep than yesterday. How's my pain? Well, the pain is the same, but I did one more rep. So you're focusing on the function. So that starts to take your attention away from these nociceptive drives. So back to your original question. That's one reason why even when the injury is gone, people will still feel the pain, because even just a slight bit of movement at a shoulder that was previously painful and damaged but now healed, could be enough to trigger those pain nerves, those no septic drives. But there's more to it than that. And the more to it element is what I mentioned when we started this section, which is central sensitization. And so central refers to the central nervous system. Sensitization just means it's sensitized. Right? But the question is, why is it sensitized? Well, one reason is because of the pain. So pain will sensitize these nerves. That's essentially facilitation, but there's a bunch of contributing factors to what sensitizes the nervous system. And some of the most potent factors that sensitize the nervous system are your beliefs and your emotions associated with a given situation. So if you believe, you'll never use your shoulder again. Maybe that person is a cricketer or a tennis player, or the shoulder is important to them. It's got a meaningful I mean, of course everyone's shoulders are important, but maybe some people say, oh, I don't really I can get by with a dodgy shoulder. It's all right. But if you're a tennis player, it's going to really impact on your quality of life. It's going to really upset. So therefore it has more emotion attached. And it's got more emotion attached. It's going to be more frustrating. There's going to be more anxiety about not being able to play in the future. It's going to be more depression about not being able to play now. And all of these things sensitize the nervous system. And not only that, they don't just synthesize the nervous system, but they actually inhibit your endogenous opiates. So just to translate that, for people who aren't familiar with the language, endogenous is produced in the body. Opiates, probably the most famous opiate we know is heroin, right? But there's lots of opiates that used in medicine to reduce pain. And we get opiates when we exercise the runners high, that kind of thing. So opiates are very I'm trying to think of there's a term for them, but essentially they're painkilling, right? And so we can produce all the outgoes that we need under normal circumstances. But when we start to get anxiety or panic or fear avoidance behavior catastrophizing around a certain situation, then what happens is those emotions actually start to block our endogenous production of opiate. So we stop blocking the painkillers, the natural painkillers that we would normally produce. So then the pain persists. So that's one element. But also those emotions charge up in excitement, nervous system. So it's more facilitated, it's easier to feel pain. But then we've got, I would call those top down or descending effects from the head down, but you've also got kind of parallel effects. So things that are occurring that may be hormonal, for example, they may be biochemical. So there are things that essentially if you're eating a diet that's proinflammatory well, that's going to make you more prone to sensitization than if you are eating a diet that's antiinflammatory or whole foods, natural foods that work well with your physiology.

Leigh Brandon: So just for the audience, some examples might be things like white bread, white sugar, alcohol, or most foods that you can buy in a supermarket in a tin or a box.

Matt Wallden: Yeah, fried foods, especially if they're fried in vegetables. So vegetables are another one which arrived through our society in our food chain and they oxidized almost instantly in contact with air, but also they then oxidize further and become like free radicals when they're cooked. So they actually create inflammation and cellular damage. Sugar as well. I'm not sure if you mentioned sugars one as well that can cause that kind of stress. So yeah, those are some of the biochemical things but also tied in with biochemistry is the hormonal element. So if you're already stressed out before you got injured, then you're in a worse place than someone who is chilled before they got injured. But now you're injured, you're likely to be a bit stressed about this as well. Okay? If it doesn't impact on you too much, you feel in control of it, you feel like you've got a good therapist who can help you, steer you through the process of rehabilitation, then that's going to result in a much more relaxed hormonal profile. Whereas if you feel you're on your own or you're trying to get this advice but it doesn't seem to be working or people aren't listening to you or whatever it might be, then that is going to translate into much higher cortisol levels and you're much more likely to have sensitization again because again, it's just a pro inflammatory state. There are some parallel examples and then you've got eight ending examples. So you've got things like you can have aches and pains elsewhere in the body like an old knee injury or low back pain. It's a shoulder injury which we're talking about as the thing that's causing problems. Well, if you've got a few other knocks and aches and pains around the body, they also are sending drives into the nervous system and sensitizing it. You can also have visceral drives. So you and I both use something called a health appraisal questionnaire which screens 28 different organ and glandular systems and what we can see is the relative stress on each of those systems. And of course the normal finding, especially when you're working with people who have got pain, is that they're having very high scores in multiple systems, if not all systems. And so this is an example of why they're getting high scores. Well, they're getting high scores because they've got symptoms. How do they know they've got symptoms? Because they're feeling them. Right? So what is it that's allowing them to feel the symptoms? What is their sensory nerves that their sensory nerves are sending messages into their central nervous system to say, I'm a bit bloated here, I've got a bit of pain when I do that, I'm a bit tight down there or I've got an ache or whatever, then that's all information that's coming into the central nervous system that is sensitizing it. Okay? And so this is the idea that you can have multiple what will be called subthreshold drives, which together create what will be called a super threshold drive. So in other words, you can have a little bit of irritable bowel, you can have a little bit of an acne, you could have a little bit of worry about the injury and then you've got the injury itself. Right? Initially the injury itself, and this is an important distinction when you first injure yourself in the acute phase, that pain is designed to stop you from moving it and to not do the thing you just did to injure it again. Right? So it's got a very specific function in the acute phase, but when it starts to become persistent, that pain becomes less and less functional, less and less helpful. And so then we want to look at other factors that are contributing to that. And this is the idea that you can have multiple sub threshold drives that when they're combined, they create a super threshold drive which actually initiates pain or perpetuates pain. So in medicine, that concept is known as allostatic loads. And in the check system we kind of use a very similar term called physiological load. It's essentially the same thing. And that's what that health phrase questionnaire that we were just talking about, that's really what it says, physiological loads or allostatic loads. So when allostatic load is high, then what that's telling you is that there's lots of drives into the nervous system and that's likely to sensitize the nervous system, which means that if you then do get injured, then you're much more likely to have a persistent pain challenge.

Leigh Brandon: Yeah. So just to summarize what you just said, so you've got top down drives, which are predominantly mental emotional aspects, and then you've got bottom up drives which are predominantly biochemical.

Matt Wallden: Yeah, well, I mean, this is just my own terminology. I call them parallel. So top down, I call them parallel drives, biochemistry and hormonal.

Leigh Brandon: OK.

Matt Wallden: And then bottom up for other injuries and visceral.

Leigh Brandon: I just wanted to summarize that quickly because I can imagine if someone's listening to this who's in persistent pain. Yes, they've probably not even considered addressing those things at this stage.

Matt Wallden: Yeah, I would say most probably haven't yet.

Leigh Brandon: And again, we'll come on to talk a bit more about what people can do when they get into pain. 

Leigh Brandon: So that brings us nicely to the end of part one of this interview. Big thanks to Matt for sharing his experience and expertise. And don't forget, if you know someone who would benefit from the information in this episode, please do share the love and forward it on to them. After all, the mission of this show is to help people lead a more fulfilled, healthy, productive, fulfilling and happy life. And if you'd like to support the podcast, you can@ patreon.com/Radicalhealthrebel, where you'd also receive lots of other exclusive premium content, including unedited, full length and free video episodes, Ask Me Anything, Q and A sessions, and Radical Health Rebel merchandise. So that's all from Matt and me for this week, but don't forget, you can join us same time, same place, next week for part two on the Radical Health Rebel podcast.

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