14 - The Purpose & Potential of Persistent Pain Part 2 with Matt Wallden

In Part 2 of this discussion on Persistent Pain, Matt completes dispels some myths around persistent pain and gives his top 5 tips for anyone wishing to overcome, once and for all their persistent pain.

We discussed:

2:16

What is Fibromyalgia?

8:40

Muscle Fiber Types and how faulty recruitment can cause pain

12:28

Why Core Stability IS important to reducing pain

26:15

Why posture DOES play a role in pain

33:21

Who is best positioned to help someone with persistent pain?

43:08

Matt's Top 5 Tips for overcoming persistent pain


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

Chapters

• 2:16 What is Fibromyalgia?
• 8:40 Muscle Fiber Types and how faulty recruitment can cause pain
• 12:28 Why Core Stability IS important to reducing pain
• 26:15 Why posture DOES play a role in pain
• 33:21 Who is best positioned to help someone with persistent pain?
• 43:08 Matt's Top 5 Tips for overcoming persistent pain

Transcript

Matt Wallden: This meta analysis that looked at it again, kind of like a systematic review. What it did was it ironed out all the data. So essentially, what you've got is you got a bunch of people with conditions that you think will be aggravated by extension, and they were. You got a bunch of people that had conditions you think will be aggravated by flexion, and they were. And then they've put those stats together and gone, look, so people are suffering with back pain, whether they've got a flat back or an extended back, and therefore sagittal spinal curves have no bearing on back pain. It's like, no, you completely missed the point.

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Leigh Brandon: Welcome to episode 14 of the Radical Health Rebel Podcast. This episode is entitled The Purpose and Potential of Persistent Pain with Matt Walden, Part Two, and follows on from episode 13, where, in part one of this interview, matt discussed his education and professional background, how he came to learn so much about persistent pain, described what pain is, what persistent pain is, and what causes persistent pain. In this episode, Matt begins to reveal what it is you need to do to take back the power over your own health and outlines the things that you need to do to overcome your persistent pain once and for all and lead a functional and normal life without the limitations of persistent pain. So enjoy part two of this interview on Persistent Pain with Matt Walden. But whilst we're talking about centralisation, I know this is a subject that you've looked into a little bit. Can you talk a little bit about fibromyalgia?

Matt Wallden: Yeah. Okay, so, well, fibromyalgia is one of what's called the chronic overlapping syndromes, or chronic white script pain syndromes. And the fibromyalgia, of course, you tend to get a range of different symptoms with it from tender points and trigger points all around the body. You often will find that there's psychological elements such as anxiety. Sometimes anxiety tends to be an early stage and across time that can lead to depression because of the sense of hopelessness. Often there's breathing pattern disorders and issues related to that, which is often driven by the stress and fibromyalgia or stress from outside of that situation, there's often food sensitivities. And so the interesting thing about fibromyalgia is that, as I say, it's one of these chronic overlapping pain syndromes, and they all tie in with central sensitivity or central sensitization. You've got chronic fatigue syndrome is another one. Bowel syndrome is another one. You've got recurrent sorry, interstitial cystitis. You've got premenstrual syndrome and Dysmenorrhea, so that's painful periods. You've got rest of the leg syndrome, you've got temperomandibular joint dysfunction, migraine, tension type headaches. And really the list of these overlapping syndromes, that's those just ones I can remember off top of my head, but they are expanding. Actually, two others that worth mentioning is multiple chemical sensitivity. So that's where people finding that they're reacting to everything they put on their skin or that they're eating or cleaning with or spraying in the air. And they kind of feel terrible when they use the polish to clean the glass or whatever. You know. Not being able to tolerate the smell of petrol fumes. Those kind of things with multiple chemical sensitivities. But also post traumatic stress disorder. Okay? So PTSD is another thing that contributes to each of these syndromes. And so the thing about each of those things I've listed, and there's many more beyond that, is that when you had one, such as fibromyalgia, you're more likely to have another, such as multiple chemical sensitivities. And if you got multiple chemical sensitivities in fibromyalgia, you'd likely to have paper periods if you're a woman, or you.

Leigh Brandon: Could be debatable these days.

Matt Wallden: Or passenger, whatever it is, tension headaches. The point is that one seems to open the door to the next. And why is that? Well, it's because, first of all, there's central. Centralisation. So you're going to start getting dysfunction in the way the central nervous system is perceiving what's going on. But also they all relate back to allostatic loads of physiological loads. So they all relate back to too much stress on the organ and glandular systems in the body. And so the solution to these things isn't to just cut out a certain foods, which some people say, oh, it's all about gluten, or whatever. Yeah, gluten may be a factor, but it's not all about gluten. It's all about stress at work. It's like, no, that could be a factor, but there's multiple contributing factors to these things. And one of the things that links them together is a breathing pattern disorder. And so what we know about breathing pattern disorders is that they are very, very closely associated with anxiety or other sort of emotions that are perturbing. Anxiety probably encapsulates those emotions the best. But if you're anxious, your breathing rate goes up, okay? And then when your breathing rate goes up, what tends to happen is you get a series of other physiological effects. So essentially, you're going into a fight flight state. And so what that does is shut down digestion, because you can't be in fight flight and rest and digest at the same time. So if you're fight flight, your digestion is shut down. So next thing is the person's fight to get a bit of a ritual bowel or they get a bit bloating or they get some discomfort in their stomach or some good, some gastro oesophageal reflux. An element of that is that when you've got these breathing pet disorders, one of the things that that leads to is it leads to development of tender points and trigger points around the body. And without going too deep into the physiology of it, essentially what is going on there is you're starting to recruit the outer muscles. So the muscles that are more anaerobic in their function, they don't use oxygen to generate power. The deep intrinsic muscles in the body that stabilize the body, they are what we call tonic and they're aerobic. And so that means that when you're breathing normally, they're getting fed perfectly. There's no problem there. When you stop getting the oxygen into the system you need, or the other way around, you're breathing off too much carbon dioxide. That can pose a problem for those muscles. But also central sensitization tends to inhibit the tonic drives to the tonic muscles. So those muscles that actually stabilize your spine or stabilize your knee or your ankle, or your shoulder. So what you get is you get a whole body picture where actually you're becoming less and less stable. OK, so hyper mobility is part of these patterns as well. You often hear people with persistent pain saying I've been diagnosed with Ehlos Danlos Syndrome or EDs and it's like, well, that's a hypermobility issue. Have you really got Eds? Now some people will have Eds and that can certainly be a factor in persistent pain. But actually most people persistent pain can't stabilize because their tonic system shut down from central sensor. So now what you've got is you've got now they can't stabilize, they can stabilize but only using their outer muscles. So the outer muscles are what we call their phasic muscles, which as I mentioned, they're anaerobic. So what does that mean? Well, it means you can stabilize. You're going to get fatigue really quickly, okay? You'll be able to stand up straight and you'll be able to go for a walk. But after 20 minutes, half an hour, you're going to be like, I need to rest, I'm exhausted. Why is that? Because you're using your fast twitch fibers, your anaerobic fibers to move you and to stabilize you. So it's not just normally your slow twitch fibers, your deep tonic fibers tend to stabilize when you're standing around or sitting in a chair. And then when you get up to move, they feel stabilized. But now your fast-twitch fibers work over the top of them and move you along. But with a situation where there's central sensitization, what you're getting is you're getting an inhibition of those deep intrinsic fibers and tonic fibers. So now you're using your faster fibers just to sit down, just to stand up. But then if you want to go for a walk to the shops now you're asking a hell of a lot of them because they've got to stabilize and mobilize you. They've got to move you into the shopping mall or whatever. So how do these fibers work? Well, they're anaerobic, which means that they produce a lot of lactic acid and pyruvate, the end result of that. We all know what lactic acid feels like because we walked up a hill or we've done some sprint drills or we've played a sport or whatever, it might be done some weights. That's where the muscle starts to feel tired, it starts to feel achy, it starts to tighten up and eventually get to what you can't move it anymore. Right? That's the lactic acid and pyramid building up in the muscle and it hurts. And then they'll be delayed onset muscle soreness after that as well. So you end up with a situation where because people are using the outer unit muscles or the failed muscles the whole time, they've got in a constant state of lactic acid and Peruvate production that irritates the nerve endings and then the nerve endings become sensitized and you end up with tender points and trigger points in the tissues. So really, just from a breathing pattern disorder, all of that could be driven. But you've got to ask the question in the first instance, why have they got the breathing path disorder? And again, the research into this shows that they can't find a cause for breathing pet disorders. They know anxiety contributes, they know a few other things contribute, but they can't find a single cause. And really what we need to be doing is starting to think holistically and say, well, what are the stresses on this person's body? Because whether it's a sore little toe or an inflamed bladder. Or inflamed uterus or an inflamed prostate or inflamed gut or blocked gut or whatever it might be. All of those things. They are going to contribute to that central sensitisation. Which is going to increase. Sorry. I should say. To that allostatic load. To that physiological load. Which is going to tip you more towards fight flights away from breast and digest. And so what that's going to do? Is it's going to increase your breathing rates and then because your breathing rate goes up, you feel a bit out of sorts, you feel a bit panicky, a bit anxious, that drives a worse breathing rate. You get caught in a vicious cycle, right? So fibromyalgia is essentially what we just talked about. It's all of those things combined and it really boils back down to physiological load or allostatic load.

Leigh Brandon: So what you want to do is get people wearing face masks so they can't breathe properly.

Matt Wallden: That's a great idea. I wish I thought of that. Yeah.

Leigh Brandon: So that leads on nicely to my next question that just kind of popped up in my head and I'm going to put two questions together at the same time. I think you'll understand why when I do it.

Matt Wallden: Sure.

Leigh Brandon: There are two things that we do as check practitioners that have been criticized over the years, and one is working on core stability or motor control, and the other one is posture. A lot of people say, well, improving your posture is a waste of time, or causability nonsense or whatever, but there's been a lot of criticism for both of those things.

Matt Wallden: Yeah.

Leigh Brandon: What would be your response to those criticisms?

Matt Wallden: Well, the interesting thing is to start with Court stability. As we mentioned earlier, it was a trend. And the thing is that whenever you get a trend, so you get swing towards that way of thinking, there's always going to be a swing back, and there's always going to be people when there's a trend that think they understand it, but they really don't. They don't do the deep work to really get down to the nuts and bolts of it. And so they see it. One of the early papers that started critiquing Cast ability was a paper called The Myth of Castability. And I know the guy who wrote it. He's a friend of mine.

Leigh Brandon: Lederman.

Matt Wallden: Yeah, Ayal Lederman. Yeah. But he was really kind of saying, just because you jump on a Swiss ball doesn't mean your core activates properly. And it's like, well, I don't think anyone ever said that. They're kind of straw man arguments because, yes, Swiss balls can facilitate activation of the core. And when we talk about the core, of course, that's a nuanced topic itself. But a lot of the arguments that counter to the idea of corporate or motor control, as it's more properly called, they often misinterpretations of the research and or they're correct interpretations of the research, but the research is terrible. So to start out with go with the misinterpretation of research. So a good example was that there was a Cochrane systematic review of motor control and low back pain. And so Cochrane, interesting enough, was a researcher who saw that there was way too influence, way too much influence from the pharmaceutical industry in research and from other vested interests. And so what they did was they decided that they would set up the Cochrane Research Institute, and they would create or use the technology of systematic reviews to try to minimize bias. Okay? And so for many years now, anything on the Cochrane Database is seen as the creme de la creme flight, as close to the truth as you can get. Interesting enough, I don't know if you ever read Mercola's book on COVID-19, but Bill Gates bought the Cochrane Institute in 2017, 2018, I believe, which is a disaster. But anyway, the Cochrane research into motor control showed that motor control is no better than manual therapy, other exercise interventions, and even things like tele support for people with low back pain. And when you look at the actual so that's the headline, it's no better. So of course, what you get is you get people like Ayal Lederman and others that have been on the bandwagon saying, core stability is overrated or it doesn't work or it's a myth or whatever, and they will say, See, I told you it doesn't work. It's like, well, that's not what the research says. Research is no better than manual therapy. You're still using manual therapy, right? Okay, so people are using manual therapy. No one say manual therapy doesn't work, even though it's no better than motor control. Wait a second. It does work, but it only works about the same as manual therapy, right? And when you actually look at the paper, what you see is it actually works better than manual therapy. They use what's called a forest plot. And the forest plot is kind of like a vertical line. And it shows you if manual therapy is more effective, then it's to the right of the line. And if, let's say, most controlled is more effective, is to the left of the line. And what you see in the research is that about 90% of it is to the left of the line, is towards Core Stability or motor control. So it's saying actually is better, but it's not statistically significantly better. That's the key thing that the people that are anti motor control are saying, oh, look, it's no better, so therefore we shouldn't do it. So first of all, they're missing the detail. Secondly, of course, just like we've been talking about with central sensitisation and physiological load, it's no good just telling people to do one thing. No good. It's not optimal to tell people to just do one thing if they've got fibromyalgia. It's not optimal to get people to just one thing. Like manual therapy. If they've got low back pain, what they should be doing is manual therapy. They should be doing motor control, they should be doing general exercise, they should be getting hydrated in nutrition, getting sleep, working with their emotions. You know, all of those things, looking at the breathing patterns, all of those things, if you do every single one of them well, they're going to contribute. And this is very much like when I'm explaining to patients, because some people know the story of the British cycling team, the idea of marginal gains. And so that's what we do as tech training professionals. We work with marginal gains. We work with as many different factors that could contribute towards the patient's health or the client's health as we can. And through contributing multiple marginal gains, we get a maximum gain. And that's what medicine doesn't do because it specialized into these individual components who all fight between each other and all try to prove that the other person's research is invalid or doesn't work. And there's economic reasons for that because the Osteopathic colleges want people to go to the Osteopathic colleges and pay them their fees. And the physiologists want that. What you end up with is corporate interest behind the research. Whereas, as I said with Leon Chaitow, my view, and I know your view as well, is the ultimate goal is to help the individual, is not to bicker about what does and doesn't work, use all the tools you can. So that's my sort of take on the motor control side. And, of course, in fact, that's only half of the take, because the other half, as I mentioned, that's the research that has been done is misinterpreted. But most of that research, even that research within that Cochrane database, was terrible because they didn't screen for whether or not the person needed motor control. This is one of the things Diane Lee said to me on my podcast when I interviewed her, was that she had just come back from the World Congress on low back pain and pelvic pain, and she said, there's someone there presenting their paper, PhD. Student saying motor control doesn't work. We assess 60 people with low back pain. We gave them most control exercises. Maybe 60 got most control, 60 didn't. And there's no statistical difference between the two. And she said, Wait a minute.

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Matt Wallden: Wait a minute. Did you assess those people to see if they needed motor control and what kind of motion control they needed? He was like, no, we just gave them a generic program. So what you gave them, they might not even have needed. Maybe you gave them transverse abdominal activation, but they specifically needed an L 34 multifitis activation on the left side. Right. So that's not going to help that much. We wouldn't expect a good result clinically. And this is another thing that's an issue with the way academia is going, is that you don't get clinicians going to conferences anymore because they can't afford to, or let's say at least presenting at conferences. I've presented at a few conferences where I'm there to deliver a talk, and they're charging me to go in as if I'm a delegate, which is often hundreds and hundreds of pounds. Like, the last one I went to was like £600.01. Before that was £800. And they actually charged me to go in, even I'm presenting for them. And so as a self employed clinician, I don't only have to pay that bill to go in, but I have to take time out of work, I have to travel there, have to pay my hotel bills. So it just becomes a ridiculous expense. Why would you do it? But what you do get is you get academics from universities that are being paid for by the university. University is covering their ticket, the university is covering their travel and accommodation, and it's prestigious. Right. And also their salary. So they're not losing any pay, they're getting their normal salary that month. Whereas for people like us, you take three, four, five days out of work, that's a quarter of your income, potentially for the month. Right. And Diane was explaining this to me. She's saying the conferences are becoming fast because you get people that are presenting that don't even work with patients or clients, unfortunately, hopefully, things will change. But that's the way that's been the trend of the last five or ten years. Anyway, the point being, the research can be flawed, ineffective, and as you and I know, through we've been talking about this for years viscerosomatic reflexes that can inhibit these muscles are never screened for.

Leigh Brandon: Just for the audience. The viscerosomatic reflex is when there's certain inflammation in an organ and via the nervous system, it inhibits the muscles.

Matt Wallden: Yeah, the muscle is often talked about, even though, of course, it shouldn't be focused on too much. It's the transverse abdominals. And so this is this corset like muscle around your waist, and it tends to get inhibited by inflammation in the organs, as you just said. So switched off, essentially, or compromised in its function. And yet none of the research that's done on transit abdominal function actually screens for underlying visceral issues, because that's always going to impact on the ability for that exercise intervention to work. So there's one big flaw, another big flaw. Again, we teach us stuff. Leigh, so it's no surprise to us, but almost every research study has ever been done into multifidus, which is a low back stabilizer, transverse, which again is a low back stabilizer, or any muscle involved in stability, core stability, motion control. They're given ten sets of ten second holds. Sorry, ten reps of ten second holds, okay? And whenever I've questioned people to say, you know, I've been on courses where I've said to the instructor, I'm just curious, why are you suggesting ten reps of 10 seconds? And they go, don't tens a good number? You're like, right. Okay. Interesting. There's no science behind that because we know that you have to hit three to five minutes of time under tension to really target those type one or postural or tonic fibers and condition them. So all of these rehab programs that are being put out in the research can be ineffective in the first instance. You and I would fail them if there are hands in as a homework on them. One of the check courses say, no, this exercise is not going to work. It's not effective. Right? But yet these professors of physiotherapy or whatever writing these papers with these ineffectual acute exercise variables, and I sometimes joke that if these papers were written a hundred years ago, it would have been twelve sets or twelve reps of 12 seconds, right? Because we were an imperial system back then. The only rationale for it being ten is that we're now in a decimal system. There's no other rationale. That's how backward the researchers in this field. Then we talk about posture. And a lot of the kind of critiques I've just offered for core stability  or motion control as a fame for posture, it's just very blinked research. The one that I like to talk about, there's a paper by Huffpixon, and it's looking at sanctuary spinal curves, and it's one of the ones that most people point to when they say our postures meaningless. It doesn't, you know, doesn't do anything. A lot of these high end researchers say, you know, you can't even change people's posture anyway, so why would the try? It's like, what do you mean? So, again, if you're not assessing, you're guessing, right? That comment not the assessing you're guessing one, but the notion you can't change someone's posture just shows the level of capability that people are working at. So if these are our top musculoskeletal professionals, that's a laughable comment, isn't it?

Matt Wallden: It's just so ridiculous because we do it for our careers, right? We're constantly measuring people before and after a program, and we're constantly seeing changes. Sometimes something doesn't change, then we look into it, oh, I didn't do that exercise, or I didn't do that stretch. It's so blatantly obvious what works and what doesn't if you measure it. But here's the thing. Coming from an Osteopathic background, what I know will be the case for a lot of these studies that have been done on posture is that people will say, okay, so we're going to do ten osteopathic treatments, we're going to measure before and after. They might use inclonometry like we use in our work. So we measure the spine before and in ten sessions time, or six sessions time, we're going to reassess and they might find, oh, there's only like two degrees difference or three degrees difference. So it's not statistically significant. It might be no different, might be worse. And so the question is, why is that? Why wouldn't you mobilize someone's spine every week for six weeks? Does it not improve their posture? Sometimes it might. But why is that what the research is showing? Because, of course, the posture isn't just about whether a joint can move in a certain direction, it's about whether it can be held in that position by functioning muscles. And so this is one of my early concerns about what I've been trained at Osteopathic College was that it wasn't a complete focus, but I would say there's an overfocus on the joints of the body, right? Oh, we mobilize this joint and manipulate that joint and you learn all these joint techniques. We did learn soft tissue techniques as well, but it was largely to loosen up tight muscles or tight fascia. And there was not quite zero, but almost zero training on how to strengthen the body. Right? And we had, like a guest lecture from a Pilates instructor, maybe two guest lectures. Your clinic tutor might have done a bit of Pilates in their own sort of spare time, so they could add a few things here and there. But the reality was there's no structured training in terms of strength conditioning or understanding how to write exercise programs, effective programs. So what that means is that if you are just a classic example, you've got someone with a rounded set of shoulders and rounded upper back. So what we've called an upper cross syndrome, you can mobilize that back and you can stretch out the front of the shoulders, but if you don't condition the back of the shoulders and condition the spinal erector muscles that actually hold you upright, well, you're just going to go straight back to where you were before, because that's where you're strongest, that's what you're used to. Right? So this is one of the huge issues with postural research, is that unless you're providing a comprehensive approach to correcting posture or improving posture, it's not going to work. And that doesn't just stop with what we've just described, but it goes on to consider things like emotions, it goes on to consider things like organ function or hormonal function and so on and so forth, breathing patterns, all kinds of factors that will contribute to someone's posture.

Leigh Brandon: Ergonomics is a big one!

Matt Wallden: Ergonomics, yeah, yeah, it's huge. Yes. Again, I could keep going on, but I mentioned that study briefly about the spinal curves not relating to back pain. And the funny thing was that actually increased spinal curves did increase your risk of uterine prolapse, TMJ dysfunction, headache and death, but it didn't increase your risk of low back pain. And so everyone starts singing about it that want to like, oh, postures. In fact, a lot of people using quite explicit terms of posture bullshit, you know, doesn't work, we're over focusing on this, we shouldn't throw it out, kind of thing. You can't even change posture anymore. It's like, wait a minute, so posture is bullshit, but it kills you, it damages your TMJ, gives you U S, right prolapse, and it gives you headaches, but you think it's not important. Okay, good. So, and I'm being a bit flippant with what I'm saying. It doesn't kill you, but obviously, as you get older, your posture tends to get worse. There's a strong correlation with death. But also in that very same study, what they found was that and the issue with the study, the reason that they found no statistical significance is that it was taking low back pain as a single entity. When we know for a while that low back pain can be due to a disc injury or a facet injury or a fracture or a slippage, all kinds of different things and different posture positions will predispose you to those more and indeed may actually be the sort of what we call the Antalgic effect or the analgesic effect of them. So after you've got pain, you might move to a new position to try to prevent further pain. So this metanalysis that looked at it again, kind of like a systematic review, what it did was it ironed out all the data. So essentially what you've got is you've got a bunch of people with conditions that you think would be aggravated by extension, and they were. And you've got a bunch of people that had conditions you think will be aggravated by infection, and they were. And then they've put those stats together and gone, look, so people are suffering with back pain whether they've got a flat back or an extended back, and therefore statutory spinal curves have no bearing on back pain. It's like, no, you completely missed the point. Completely. And I've dug into it quite some detail because I've had a few discussions on this over the years and it's a terrible paper. I'd love to discuss it with the actual authors to see if they've got some defense of that. So I should be wary of saying it's terrible without them being able to respond. But from what I can see, it's a complete kind of red herring.

Leigh Brandon: Awesome. So just thinking of all those people that have tuned in that are in persistent pain, thanks for listening this far, because this is the bit you've probably tuned in for for anyone that's currently suffering from persistent pain. Who would you say is best positioned to help those people?

Matt Wallden: I think, honestly, someone who's got an effective holistic system of working with you. I wouldn't particularly there's some people that specialize with persistent pain in terms of physios that are focused on persistent pain or pain neuroscience, and that can be helpful. But even research into that has shown that pain neuroscience isn't as effective as manual therapy. Now, again, it doesn't mean it's not helpful. It just means that it's only a small factor that's going to contribute. So you've got manual therapy. You've got pain neuroscience, which is kind of understanding a lot of the stuff we've talked about today in terms of the way the nervous system functions in pain. Then you've got nutrition. You've got, obviously, hydration ties into nutrition. You've got the emotions. So you want someone who can counsel you and to be able to screen the emotions and help you make sense of the emotions. And then to work with those emotions, you want someone who can effectively assess your posture and your biomechanics to optimize those, and essentially, potentially manual therapist, someone who can do some hands on work as well, or someone who works with a manual therapist. It doesn't necessarily mean that the person has to do all of those things. If they do all of them, I think that's fantastic because it's all under one roof. But if you've got someone who does three or four of those things, but they work closely, say, with the manual therapist who can do the mobilization and soft tissue work, then that's a great setup as well. But I would say what you probably don't want to do is consult 15 different practitioners because you start getting kind of conflicting advice. It's much more expensive to do that way. Of course, it's very difficult to fit it in time wise, but if you can find someone who can actually do the overview and provide an understanding of things like your physiological load or anastatic load and start working with that unpicking, that that's going to give you way more benefits. And the beauty of that is not just going to help with your persistent pain. It's going to help with your overall health and your overall performance. So you can only benefit from doing that. So, I mean, obviously, essentially, I'm describing the check train professional, and that's why I trained in this, because why I teach it, because I believe in it, and I've seen it work. And all the research I've seen, all the research, most of the research I've seen across the years entirely supports what we're talking about here. And the research that doesn't support it is often flawed in the ways that we've just described. I think that's where I would go with that. There's a few things that are worth considering also for people that are in persistent pain. One thing, if your pain has been with you for a long time, it is worth considering what's called time dependent activity as opposed to symptom dependent activity. So we tend to get into a habit of listening to the pain, which is even though when it's acute, that's a good idea, when it's persistent, that's not such a good idea.

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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 my 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 will 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 bodychek and fill in the request form at the top of the home page and we'll be in contact to arrange a convenient time. Now back to the podcast.

Matt Wallden: Okay, so what tends to be the case is most people naturally will start doing it. Let's say someone comes to consult with you, Leigh, and you've given them an exercise to wear their back muscles, right? And they've got persistent pain. And so you say, Look, I want you to do this for however long. Let's say a minute's worth of work. And then you have a short rest. You go again, do it three times, three minutes of work in total. Okay, good. So you do the first one, it's a bit achieved. The second one, it's getting worse. Third one, they're starting to really hurt now. And the natural inclination, of course, is to stop, right, because it feels like you're damaging the back. But the reality is that we know that when the pain is being persistent like that, it's very unlikely you're damaging the back. What is much more likely is your nervous system is sensitized and therefore you are perceiving that your back is being damaged, when in fact, you're not or it's not. Right? So what we do is, rather than saying symptom contingent movement or symptom contingent exercise, we want to do time contingent exercise. So in other words, stick with what Leigh said, push it through to the three minute mark, and then see how you feel. Because what you probably find is you get to that three minute mark and it would have been painful, probably, but you'll get to the end and you'll be like, I feel better for stopping. Good. Okay, great. So now let's get up and move around. How do you feel now? Feel fine. Good. So you didn't injure yourself. So what it does is it reprograms it with the mind goes, oh, yeah, I felt that pain that I felt when I originally got injured, but I'm actually fine now. So you're starting to reprogram some of those pathways in the brain that relate that tie in the pain, with the anxiety, with the muscle tension, with everything else. So that's a good little tip, I would say, for people that have persistent pains. Think about time contingent exercise and of course someone who's trained as a check train professional or perhaps a good physio, good Osteopath, maybe that's done some of this kind of training. They'll be able to give you the right kind of exercises for the right durations, but if they give you ten reps, they're not well trained. So you need to find someone else who can help you. So, yeah, I think that would be a helpful tip for people right now.

Leigh Brandon: I know we're running a little short on time, so you might want to answer this relatively quickly. What would be your top five tips for preventing or addressing persistent pain?

Matt Wallden: Top five tips? Okay, well, first thing, start with number one. That is, you want to consider what the lesson is that you're being taught that I think is absolutely vital. And it may not be obvious, but you could write down some ideas. It's almost like a mind map. It could be this, could be that. Could it relate to this? And this is where a trained professional can help you because the body never lies. It kind of tells its own story. And a well trained professional can help you to identify what elements of your story are likely to be contributing to your back pain. So that's the first thing I would look for, the lesson in it, because then that gives the pain some meaning. Okay? So that's the first thing. Second thing I would say is look for a sense of purpose or meaningful tasks, maybe outside of the pain. Beyond the pain. And I think that's absolutely critical because if the focus is the pain, as we've talked about earlier, and not something beyond it, then what often happens is people will find a way to get rid of the pain. It could be a painkiller. It could be a manual therapist that clicks their back and it feels better for a week or two, right? Any number of things that give them some short term relief, and then they just kind of get by and make do. And that's not really what you want to be doing. You want to take the time to A, understand the pain. That's the pain teacher number one. But then B, looks for things that create purpose beyond the pain. Because what a check train professional would do is they would look for what we call your one love, which is essentially trying to think of a legacy or a sense of purpose in your life. And interesting enough, research into this shows that when you develop a sense of purpose and this is not something that necessarily happens instantaneously, it can take a while to, you know, cogitate on it and to come up with some ideas. But again, a mind map or talking it through with someone like a friendly practitioner can be really helpful. But the research into it actually shows that once you've got a sense of purpose, it lowers your physiological load, it lowers your Anastasia's load. So there's a huge win. You've got the lowered physiological load, but you've also got this focus now that's beyond the pain. Because what I'm saying is that sometimes you can be moved out of pain by a quick treatment or something. And that can make you feel like. Oh. Okay. I'm all right now. And so I'm not going to do my exercises anymore. And I can go back to eating the gluten. And I can go back to drinking my beer every night or whatever it is. Sitting in my chair all day and not doing the exercise program. And that's a problem because those were the drivers of the pain in the first instance. So what we want to do is we actually want to change your sense of self and your sense of who you want to become in order that new nutritional program, that new exercise program, the emotional processing, etc. Becomes part of who you are and where you're trying to get to as an individual. And when that becomes your journey, then the pain is irrelevant because you're actually focused on this goal of developing yourself physically, developing yourself emotionally, developing yourself spiritually, whatever it might be. And that means that at some point you might know, so actually I'm going to need pain anymore. But you're still focused on the goal that's beyond the pain, and that keeps you in that habit and in that rhythm and continually developing yourself to be able to realize your potential. So that's .2, quite a big point, quite a key .3, I would say, is thinking about physiological load. Physiological load can be assessed by a check train professional. There are other ways you can assess it, but they tend to be a bit lab based. They tend to be combining scores of blood pressure with cholesterol, with blood sugar regulation, all this kind of stuff. So that's a more medicalized way to assess for Allostatic load or physiological load. And the problem with it is it doesn't really tell you what's causing what. It just tells you you've got high blood pressure or you've got poor blood sugar regulation. Doesn't tell you why you've got it. So working with a check trade professional, and it sounds like an advert, but they'll be able to help you understand what it is that's driving those things and then to make the relevant changes to improve those things. So, yeah, I think that's going to be zero three. So .4, I would say, is to take the reins on it, to get active. Okay. So being passive in a situation like this, and what I mean by that is, of course, you can say, well, I'm actively taking Aspirin, or I'm actively going to the osteopathic in my back many places. That's all I do. But those things are passively acting on you. The Osteopath is doing something to you. The Aspirin is doing something to you. You need to do something to yourself. So you need to take the reins. And you could say, well, why would I go and see a Check Straight professional? Because they're doing something to me, and there's some truth to that. We are doing something to you. We provide you with information. We're providing you with a program. But really, those things when I say program, that could be a stretch program, mobilization, nutrition, lifestyle, emotional coaching, all this kind of stuff. But the whole point of the Check approach is that we are teaching you how to fish. We're not giving you a fish. We're not doing something to you or giving something to you. We are teaching you how to live effectively, how to function effectively, and what you need to do to achieve that. So I think taking an active role and this ties in with the research I mentioned, the idea of the medical model being like the God model and so on. Well, this is in research terms, that is called having an external locus of power in the doctor or in your osteopath or physio or the surgeon or in gods, and then having an internal locus of power, which is what we aim to do as trained professionals, is to say, if you do these exercises, this should help. Based on my measurements, based on my understanding of your situation, these are the right kind of exercises for the sort of stress that you're under, sort of pain you're experiencing, the kind of biomechanical function you've got, the level of conditioning. This will be a great program for you. So you design the program so it's optimized for that individual. Same with the stretches, same with nutrition, lifestyle, and so on. Essentially, all of those things are handing the power to the individual for them to then take the reins on it all and go on their own journey. Right? You've given them the map, you've given them the tools. They just then need to engage and go on that journey, which is essentially a hero's journey. So then what could be my fifth? I don't know. I've got to think of a fifth.

Yeah. Well, let me just say, sleep is hugely important. And although this has become increasingly recognized in back pain circles and persistent pain research, pain neuroscience and so on, what I see is that people saying, oh, well, sleep hygiene needs to improve. This is a common phrase, sleep hygiene. What do you mean by that? And they're like, well, people need to get more sleep. And you're like, okay, how are you going to help with that? And so ways you can help with improving sleep are too. I mean, there's a bunch of obvious ways, like going to bed earlier, having the lights in the evening. But again. In the system that we have trained in and that we teach. There's many. Many. Many different things you can do to support sleep. From light exposure to exercise exposure. Getting the timing for those things right. Getting nutrition rights. Getting the right macronutrients. Avoiding caffeinated foods and sweet foods and so on and so forth. Working to have quiet time and contemplative time. Working on your legacy. Working in instead of working out. Which is kind of just to explain that briefly. Is a means of calming the system down and actually taking the body from this more fight flight state. This sympathetic state. Into more of a parasympathetic state or a rest and digest state. And you can do that through meditation, through tai chi, or through working in type exercise. So that's just touching the surface. There's a bunch of things that can support sleep. And although it's recognized as an important thing, I think at the moment, that kind of knowledge hasn't spilled out there into the general public so much, or indeed, into the therapists kind of workbook. So that would be another thing I would say is absolutely critical to optimize repair time.

Leigh Brandon: Yeah, absolutely. So I think those people that are listening that are in persistent pain, I think you've probably already got a lot of ideas and things that you can start to work on. But what's next for you, Matt?

Matt Wallden: Well, next for me?

Leigh Brandon: Gosh.

Matt Wallden: Well, I'm going to relaunch my podcast. At some point, you've inspired me to get back on the podcast wagon. I think it's 26 episodes prior to Kobi. And then when Kobe kicked off, I got so heavily like you. I got so heavily into understanding what was going on in the world and putting out information, videos and so on and so forth to try and help my students and clients and family and friends and patients and all the rest of it, really. The podcast took a bit of a backseat, but they are very fun to do. And, yeah, that's one of my next goals is to get that up and running.

Leigh Brandon: Awesome. And I'm guessing the first episode will be me.

Matt Wallden: Yes, because we recorded an episode with you two years ago, just before Kissing, and we never actually released it. And I said to you, maybe we should do an updated version of that so we can still use that one, but maybe we do an adjunct to it. But, yes, I would love to do that. So, yeah, get you on it. SC. Two o. Yeah. Great stuff.

Leigh Brandon: So where can the audience find you online, Matt?

Matt Wallden: Yeah, so my website is MattWalden.com, so it's Matt with two Ts and more than with two Ls. It's just.com so that's the easiest place. Obviously, I'm on most of social media. I actually got sent to TikTok earlier, and I couldn't access it because I don't have an account, so I want to get on to that, I suppose, at some point. But yeah, so I'm either Matt Warden or Matthew Warden on the various social media, so you'd better find me there. But website is Mattwallden.com.

Leigh Brandon: Awesome. Matt, thank you so much for taking your time out today and sharing your experience and your wisdom with the Radical Health Rebel listeners and viewers.

Matt Wallden: That's a pleasure. Thank you for inviting me.

Leigh Brandon: The pleasure is all ours, I'm sure, to all the Radical Health Rebel tribe. If you know someone who would benefit from watching or hearing this episode, please make sure to share the love and pass it on to them. After all, the mission of this show is to help people lead a more fun field healthy, productive, fulfilling and happy life. And if you'd like to support the podcast, you can@patreon.com Radical Health Rebel, where you can also receive lots of other exclusive premium content, including unedited, full length, ad free video episodes, Ask Me Anything, Q and A sessions, and also Radical Health Rebel merchandise. So that's all from Matt and me for this week, but don't forget, you can join me same time, same place, next week on the Radical Health Rebel podcast.

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