Episode 7: Pain is a Skill with Tyler Kallasy

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• Joe Gambino
• Joe LaVacca

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In this episode of the Beyond Pain podcast, Joe LaVacca and Joe Gambino interview Dr. Tyler Kallasy, a PT and strength and conditioning coach.

Tyler shares his journey of dealing with lower back pain and how it led him to focus on helping others move beyond pain. He discusses his philosophy of addressing both the physical and emotional aspects of pain and the importance of reframing the story around pain.

Tyler also talks about his current reading materials, including a book on rebounding from injuries and a book on breathing and mindfulness. Tyler Kallasy discusses the challenges of being fit and athletic while dealing with chronic pain. He explains how being strong and still able to perform fitness activities can be a smoke screen that prevents understanding the severity of the pain.

He shares his personal journey of shifting his mindset from focusing solely on physical qualities to addressing the emotional and cognitive aspects of pain.

Tyler emphasizes the importance of giving up the identity tied to physical qualities and creating space to truly understand and address the pain. He also highlights the need for clinicians to educate patients on the phases of pain and the importance of managing pain rather than solely focusing on reducing it.

Connect with Tyler:
Instagram
Website

Transcript

Joe LaVacca (00:00)
Hello everyone and welcome back to the Beyond Pain podcast with myself, Joe LaVacca and Joe Gambino. Today's episode is a special one here at Beyond Pain because we welcome our very first guest, Dr. Tyler Kallasy Tyler is a PT in Colorado, changing the way that we approach rehab and education.

His interview is filled with tremendous insights that will immediately help any clinician treating pain or patient learning to cope with pain. We hope you enjoy this interview as much as we did, and we hope you enjoy all future interviews and episodes of the Beyond Pain podcast. If you do, please remember to like, subscribe, share.

all those wonderful things that we can do on social media, it'll really help the podcast grow. And without further ado, here is our interview with Dr. Tyler Kallasy

Joe Gambino (01:49)
Welcome back into the Beyond Paying podcast. I am your host, Joe Gambino and your other host, Joe Lavaca. Our Instagram handles myself, Joe Gambino, DPT, Lavaca at strength in motion underscore PT. We always love connecting, so feel free to shoot us a DM, have a conversation. In the show notes will also be an application form if you are interested in working with us. And the show is on YouTube as well. So you can check us out.

cupsofjoe underscore PT and jumping right into it today. We are here with our man, Tyler. I'm probably, I should have asked you how to pronounce your last name. So I'm hoping I'm not going to botch this up here. Cali. Did I get it? Close. Kallasy All right. Well, Tyler Khaleesi is here on the show. We've we've connected quite a bit on Instagram. You are now our forever imprinted in history as our first guest.

Tyler Kallasy (02:28)
We shall see. Close, close. Kallasy.

Joe Gambino (02:43)
I will leave you the floor to introduce yourself and welcome to the show, my friend.

Joe LaVacca (02:44)
Quite the honor.

Tyler Kallasy (02:50)
Thanks. Thanks boys. Good to be here. There's some poetic justice with me being the first of this kind of new arm of the podcast here, but my name is Tyler Kaleisi. I'm a doctor of physical therapy. I am a strength and conditioning coach as well as an educator. I currently live in the greater Denver area, right? So Denver, Colorado, where I have a out of network practice as well as.

continuing to build my online consulting and coaching business. So I kind of sit in between training and rehab, kind of that limbo area. That's my sweet spot. I coach about 40 to 50 people online at one time. I work with folks who are kind of stuck in between that place between not really...

ready to live life 100 % but also not necessarily feeling like they need rehab, right? They're kind of like in between. Ironically, I circle my education and my program design around helping people move beyond pain, right? So that's where the poetic justice comes in. My one -on -one coaching service is called Beyond Pain. And yeah, that's it. I purposely chose that name because...

Joe LaVacca (03:57)
Hehehehehe

Tyler Kallasy (04:07)
I think there's something that you said about moving beyond pain and not necessarily getting rid of pain, fixing pain. I know we're gonna get into that stuff, but I appreciate the name and I know you guys do as well. So, yeah, let's get into it.

Joe LaVacca (04:14)
Yeah.

Yeah, man. Amen.

Joe Gambino (04:19)
Love it, love it. I know, I mean, that is, I think, right on par with, I think, how we felt as we were coming up with the name on this. But I have actually a lot of questions for you just based on the little intro there. But we will start with a little three -question series, which we did not share with you. So first one is, because we do want to get to know you a little better here. Yeah, so first one's simple. I'm going to give you a little layup here.

Joe LaVacca (04:36)
The Candid.

Tyler Kallasy (04:37)
Yeah, love that. I'm here for that.

Yeah, okay, yeah.

Joe Gambino (04:45)
How do you take your coffee? With cups of Joe's, right, we have to keep it a little coffee themed here.

Tyler Kallasy (04:50)
Yeah, I'm here for that. I've been becoming more and more of a latte guy, you know, so at home we have an espresso. So, a little double shot, maybe a double shot plus another single shot, some whole milk, big whole milk guy, and some maple syrup. That's the home situation. When I'm out, it's usually a latte with an extra shot. That's how I roll, yeah.

Joe LaVacca (04:54)
Ahhhh

Joe Gambino (04:57)
Mm -hmm.

maple syrup.

Joe LaVacca (05:12)
Very good. I was gonna be, I'm actually glad you said the Nespresso because I have a roasted hazelnut Nespresso coffee this morning that I was just gonna tell Joe was just, you know, standard black, but I feel welcome now. I feel like I can share. I feel like I could be open. Couple Nespresso guys. This is great. Good stuff.

Tyler Kallasy (05:20)
Mm. Yeah, it's good.

Yeah, good.

Yeah, yeah, I mean, I would love to be a snob, but I don't have the, I don't have it in me. I've tried multiple times. Just, I'd rather just get it made and get it in the belly.

Joe Gambino (05:42)
I feel a little left out. I don't have any sort of way to make espresso here. I'm just pure coffee at this house.

Joe LaVacca (05:43)
Yeah, and

Tyler Kallasy (05:49)
Okay, that's nothing wrong with that.

Joe Gambino (05:51)
No, no, but I do love me a good cappuccino. That's.

Joe LaVacca (05:52)
I like the whole milk angle too.

Tyler Kallasy (05:56)
Yeah. Only whole milk.

Joe Gambino (05:58)
All right. Question two, Tyler, what are you currently reading and or watching?

Tyler Kallasy (06:06)
good, good question. right now I'm reading two books. One of them is called rebound. I can give you the authors later. I don't want to, I don't want to butcher their names, but these two wonderful women wrote this book rebound intended for athletes going through injuries. kind of takes you through the five stages of grief when dealing with an injury gives you a lot of good mental tools to work on ways to kind of reframe. So.

You know, as a professional who like my life is pain, right? I thought it would be a good book to read. And it's been, it's been one of the most valuable, you know, pieces of literature that I've ever read in my life. The other thing I'm reading is a book that I actually found it like Sierra, which is, you know, in that TJ Max Ross kind of situation. There's like random stuff everywhere. It was a book on breathing and I've been getting a lot of getting a lot more into mindfulness practice, breathing.

Joe LaVacca (06:50)
Hahaha!

Tyler Kallasy (07:00)
in this kind of realm called men's work. So like specific to men working on themselves with other men. So I found this book and thought it was great to share with the other men that I'm working with.

Joe LaVacca (07:12)
I love that, I love that. Now do you normally read more than one book at a time? Because that's what I do.

Joe Gambino (07:12)
Very nice, yeah.

I was gonna say that's a special skill, I can't do that. I can only do one look at a time.

Tyler Kallasy (07:19)
I think I do, you know, I tried not to sound like it's something I do on purpose, but like I'll get through a book and then it'll kind of get stale and then I'll find something else. So I usually have a book that I read when I'm just hanging and then a book that I read when I'm like traveling. They're two different vibes. Yeah. And I've been traveling a lot lately. So yeah.

Joe LaVacca (07:19)
I'm gonna go.

Yeah, yeah, exactly, man. I get it. Yeah, the coffee table book is way different than trying to, I think, when I'm in the presence of traveling, because I'm going to be either going to the clinic, going to teach myself. And it's just like, I want to be focused. Is there another thing that I can grab that will teach me something of more value to share with other people versus, hey, I'm just at home and I want to just shut it down. So absolutely. The two book thing, I think, is the way to go.

Tyler Kallasy (08:01)
Right.

Joe Gambino (08:07)
My brain doesn't focus that way. It's one or done for me.

Tyler Kallasy (08:10)
You're over two so far today, brother. Yeah.

Joe Gambino (08:13)
Yeah, that's for real, man. I'm about to strike out here. And that last one here, something interesting that you've learned recently could be professional, could be not professional.

Tyler Kallasy (08:26)
okay. Man, what have I learned? Interesting recently.

Yeah, I would, I would have to say, I can't, I can't pick a breed right now, but I, I, I definitely am learning a lot about the dog world in different breeds of canines. My fiance comes home every single day with almost every day with like a new breed that she's treated. She's actually a canine physical therapist. So that's been something enjoyable to learn. It's kind of like our, our umbrella, but like, I also almost have no idea about any of it. so.

Yeah, I wish I had a tangible thing like a breed, but.

Joe LaVacca (09:06)
No, that's great. That's great. I would imagine working with dogs is a lot more enjoyable because they don't talk back. They just know that you're always there for them.

Joe Gambino (09:08)
Yeah, that's cool.

Tyler Kallasy (09:15)
You'd think so. It's like working with kids because trying to avoid working with adults by working with kids, you inevitably work with adults. So it's a lot of human conditioning, volume, intensity, moderation, right? Like it's the same stuff with humans as it is with dogs, honestly.

Joe LaVacca (09:19)
fair point.

That's right.

That's fair point. I guess it's the same thing in the horse world too, is that you're really kind of treating the rider more often than the horse from what I've been told. So I never thought about the human element with dogs though. So there you go. That's something interesting that I learned today. So thank you already, Tyler. Joe, did you know that? Are you over three?

Tyler Kallasy (09:45)
Yeah, you're welcome. You're welcome. Yeah.

Joe Gambino (09:52)
I actually did a little bit just because Jen she she had a dog walking business for for quite some time. So, you know, she did dog training. So all the training when you're doing for dogs is really all about the owner because they're not, you know, reinforcing whatever you guys they're they're working on. Nothing is ever going to change. So. So now I'm one for three, I didn't strike out here. If we were playing baseball, it's pretty good, you know, 33, you know, in over 300.

Joe LaVacca (09:58)
that's right, that's right.

Tyler Kallasy (09:59)
Hmm

Nope. Nope.

Joe LaVacca (10:15)
All right, there we go. That was good.

Tyler Kallasy (10:15)
There you go.

Joe LaVacca (10:20)
Look, you're a superstar in our books, Joe. I mean, just with those stats. So that was awesome. Tyler, thank you for sharing a little bit about you. That was fun. Got some other questions for you too. We're gonna do a deeper dive around, hopefully your story, your philosophies, your experiences with pain. So that's kinda how I wanna open it up or kick it off to you too. Everyone seems to have their own journey or experience of pain. Would you mind?

Tyler Kallasy (10:20)
keeps putting it in the stands.

Joe Gambino (10:23)
Ha ha.

Night.

Joe LaVacca (10:47)
sharing yours because I know you've been sort of vocal about that on Instagram and I was hoping that you could share that with some of the listeners who might not follow you and may be stuck themselves.

Tyler Kallasy (10:58)
Yeah, yeah, absolutely. I, growing up, I, I w I never had a major injury, never like torn ACL, broke a bone, you know, nothing. so my, my entry into this world of physical rehab was motivated by wanting to be in medicine, but also wanting to stay in, sports athletics, which I think is a lot of folks. but that goes just to say, like, I, I didn't have this really,

lengthy relationship with pain until I was in my late stages of playing college football. And then kind of during graduate school, I initiated what ended up being about a four year journey with, with lower back pain. it started sometime in early grad school, got into functional fitness, varied functional fitness, loved it, still love it to some degree.

but I was a bit irresponsible with how much I was doing and whatnot. I was also training for a hundred mile road race, bike road race. And I think the combination of that, plus trying to not be football weight anymore, losing a lot of weight, training two to three times a day, just kind of being a bachelor about life. Put me in a place where I was real susceptible to breakdown. I ended up developing some hip pain, some lower back pain.

you know, being a pseudo practitioner at that time, or at a student, I thought who I was, I thought I could handle it. I didn't really ask for help. And it eventually manifested into me, like not being able to stand up straight. I specifically remember the, the one of the early and most influential flare ups that I experienced. I was at my in -laws house. I was building a little bit of a fire pit with like slate, you know, which is just a lot of bending over.

a lot of fatigue. So I had fatigued myself pretty good, went to my gym, ran three miles and then did the workout of the day.

went to hang from the pull -up bar to loosen up my back. And you know how people, some people with mechanical lower back pain, hyper mobility based lower back pain respond to traction. And I responded exactly that way. Went to hang from the pull -up bar, got a spasm, sat down, tried to play it cool, rolled it out a little bit, did some breathing work. And then eventually, like I said, couldn't stand up straight, went home and that started like a two week basically.

two week phase of like being absolutely debilitated. I remember coming down into the kitchen that same day and sneezed while getting some water. And it felt like not only did everything start over again, but it got, it got much worse. So I went through a bunch of flare ups like that over the course of the next two years, there was times when I felt like I was quote unquote back. I was crushing it, lifting heavy, doing all the things. But I knew that that wasn't absolutely true because there were still little hints of things, things that I haven't fully addressed.

Joe LaVacca (13:31)
Yeah.

Tyler Kallasy (13:53)
Long story short, I got to the point about a year and a half, two years ago where I was actually fully on the mend coming out of this feeling pretty good. I was starting to consistently do barbell lifts again, feeling good. So I've been in a really good situation for about a year and a half. It's nothing I wish on anyone, but as a practitioner, the insight is seriously invaluable.

Joe LaVacca (14:20)
Yeah. Yeah. It's really interesting because your journey sounds a lot like people we work with and mentioning that you were, it does actually, I was about to say, it sounds like Joe Gambino as well. you mentioned too, that you were a pseudo sort of like practitioner. You had a lot of background knowledge. You were fit. what was your philosophy like then at that point? I mean, did you feel your identity shift?

Joe Gambino (14:27)
Sounds a lot like me.

Joe LaVacca (14:46)
Was there ever like this kind of like feeling of like, why me? I'm doing everything right. Stud athlete, crushing it at the gym, training for bike rides, all this stuff. How did you either feel during that time or come to terms with it? Cause it seemed like, you know, like you said a year or a year and a half ago, there was a big turning point for you.

Tyler Kallasy (15:07)
Yeah, you know, back when it started, I still had that like Dunning -Kruger effect of early, early stages of the Dunning -Kruger effect, being in PT school and then coming out of PT school, you know, you kind of like think, you know what you know, which made me feel like I could handle this much quicker than I realistically could have. It made me feel like I had a true understanding of what was going on, which meant at that time that meant it was very physiology focused.

mechanically focused, I just need to make this thing stronger. I need to give this thing more mobility. And those are very much so a heavy part of recovering from from injury or pain often. But there is like the mindset, you know, emotional, cognitive stuff that I just didn't really understand or kind of downplayed. So I did go through phases of why me, you know, like, why do I, you know, why do I deserve this? I'm young, I

have a clinical doctorate, I'm pretty fit. I don't understand, but yeah, in retrospect, I guess I see it more as a, if there is a thing that makes all of this, that thing felt like I could be a vessel to share the insight that I gained because I had the physical and emotional capacity to handle it and then turn what I went through into knowledge and insight.

So I kind of look at it like that now, but I went through very few phases of why me most of it, I would just kind of was like going, going through life. Yeah.

Joe LaVacca (16:42)
Were there ever times that you, and this was just something I thought of, because you mentioned that there was very few moments of that, which I would say probably is not always the case for a lot of the clients that we work with. So did you ever practice some sort of method where you were pulling from other areas of your life that gave you strength? Did you ever try to flip or reframe that story, use a metaphor, like things that you've gone through, anything like that, that could be, like you said, like a guiding vessel for others.

Tyler Kallasy (17:13)
So here's the dangerous part about being pretty fit or athletic or knowledgeable when you're dealing with pain, chronic pain, persistent pain, is that it becomes a smoke screen. And it prevents you from actually understanding how we'll say bad things are. I'm pretty fucking strong and I have been for a while objectively. So being strong and still being able to get after it, if I just warmed up for long enough.

The only thing that pain was getting in the way of was like a quick session, feeling good the next day. And those are things that I could just clinical clinician my way around, right? Or I'm up better, do some passive modalities the next day. So I was kind of fooling myself into thinking it was, it was fine because I was still strong and because I could still do the fit things for a while. I never got the why me feeling when it actually started to move past.

the fitness and actually into life is then when I started to get more, you know, more down about it, but yeah.

Joe LaVacca (18:22)
When do you think you shifted or what maybe was the biggest influence for you to shift that mindset? Like you said, into some more of the emotional side of things or the cognitive side of things. I know you mentioned the rebound book earlier, but I haven't followed you for such a long time. It seems like you've built up this method of approach with yourself or your clients. Do you remember that tipping point or like that big aha moment where you were like, hey, I gotta really think about this differently. There was an influence, a book, a podcast, a blog, anything like that.

Tyler Kallasy (18:54)
Man, I don't have a major moment that really sticks out as something that made me dramatically change the way I viewed, you know, addressing pain or pain, whether it was for myself or for my clients. I do think that there was a time when I kind of gave up on trying to maintain whatever identity I thought I had around my physical qualities, whether it be the way I looked or what I could do.

And I think that was a negative part of my life, giving up in a way. But giving up that stuff allowed me to remove those things from my identity, allowed me to really step back and kind of understand where I was, kind of give me some space to truly see how bad things were. And it just gave me more space, more space to be emotional and cognitive about what was going on. And in doing so,

retrospectively, I started to say like, wow, you know, things are actually getting better here. You know, maybe maybe this is maybe this is the way I will say at the same time. I had, you know, because of whatever experiences I had in life professionally or whatnot, I was learning to ask more questions. And instead of always being the solvee kind of guy, the guy with the solution, try this exercise.

don't do this, I just started asking more questions and sometimes just giving people a, the space to speak or be emotional or kind of understand things in their own way. Just by talking through it, their pain experience, you know, got better aside from like the, you know, tendon rehab that we were doing or the graded exposure. It was a lot of like, now you understand you've, you learned the skill of pain.

Joe LaVacca (20:42)
I like that, the skill of painting.

Joe Gambino (20:43)
That's a it's interesting. Yeah, I do. I think it's a it's worth highlighting. I mean, like this, I actually see it all the time. And you and like it's part of your story, right? Where like when you're an athlete, when fitness and health is like your lifestyle, when something threatens it, it makes it very hard for like, you know, you to almost process that right and continue on with your journey. So I think that's something to highlight for listeners. I think they're going to probably really kind of.

The word I'm trying to think of is not coming to my brain probably from from my trip to Mexico making it hard for me to formulate words here But I think you know, they'll have you know, if there aren't most of you know I I definitely identify with the wall because that was that was me or I was an athlete my whole life Jim was everything I did I was a personal trainer for how many years and then when my back, you know, I was in my mid -20s practically 23 when my first back injury where I could barely stand up and it was like I

Joe LaVacca (21:19)
You

Joe Gambino (21:41)
everything changed and it's kind of like that whole back and forth and how do you even get back on track to be able to do the things that you like to do? So I definitely wanted to kind of highlight that, but I do want to kind of shift to a little because I am really curious with, because we both have a shredding conditioning background and physical therapy and I'm curious with, it sounds like when you had the injury volume, intensity, everything was like very, very high, right? You're training pretty hard. So how has that, you know,

Tyler Kallasy (22:05)
Yeah. Yeah.

Joe Gambino (22:08)
knowing where you are, like the people that you work with, you're in that kind of like in between S and CPT, like how do I get you over the hump and back to training? Whether it's fitness based or you're trying to get somebody back to that hump where they can be at fitness, how has like your history of how like you were training that led to the injury, how has it now impacted the way that you kind of go about things? Especially from like a fitness side of things.

Tyler Kallasy (22:27)
Hmm.

Yeah, there's been many ways, of course, I'll say the most influential way that I've, you know, learned from my own experience working with folks repetitively, but also just my own pain experiences that, you know, not to speak in absolutes, but majority of folks are in the position they are in when they're having a pain experience, if they're an active individual, because of a mismatch.

two major mismatches. One, there's a mismatch between how much they're asking from their body and how much opportunity they're giving their body to recover from those asks. Right. So work recovery ratio. The other one is how much they're asking of their tissues and how much their tissues can give to them. And I purposely separate those because we often think like, well, you just have to work out and rest and people narrow that down to muscle breakdown.

and then muscle building recovery. But there's, there's ultimately two large avenues because we have to recognize the influence of the system as a whole. And that is often the bigger player. And that's where the other life stuff comes in. You know, our system, nervous system, hormonal system, integumentary system, all the things musculoskeletal are all affected by stress. And that stress can be physical, like working out, going for a run.

Joe LaVacca (23:51)
you

Tyler Kallasy (23:56)
That stress can be cognitive, a big work project coming up. That stress can be emotional, a really crappy ride to work, a death in the family. And when you don't have the room for the fitness stress and you're already in pain and then your practitioner or yourself gives you seven more corrective exercises to do, we're just adding more stress and it may not be productive. So for me, there's a lot of education around one, maybe we just need to like do less. Maybe the stuff we're doing is great.

let's just do less of it for a little while. The other thing that I lean into heavily is like, maybe we just do more of the stuff that feels good for now and less of the stuff that doesn't. I think a lot of people are so proud of what they can do and the fitness slash rehab pendulum swung heavy in the direction of like, never tell anyone to stop doing anything. We shouldn't tell people to rest. But like sometimes the actual therapeutic thing to do is stop doing the thing that hurts.

Joe LaVacca (24:28)
Yeah.

Tyler Kallasy (24:56)
create a little bit of space for some healing. And then the really good correctives that we're doing will work. And then we create some emotional space to work on our mindset and our stress management. And those all of those things will come together in like, you know, a decreased pain experience.

Joe LaVacca (25:16)
I love that. I love that. And I think that's so valuable. And just the way that you broke it down, because the clinicians I meet seem to continue to struggle with, like, I have to fix you. I need one solution, one exercise, one treatment. And maybe this is the maybe fallacy of social media. So when you are trying to convince people to...

Decrease activity and I know and I'll be honest working in Colorado. That's maybe been the biggest discrepancy People are real active out here They love doing their runs and their hikes and their bike rides, right? I mean I watch you know Courtney You know work through pain all the time when she's trying to train so is there a way that You approach really? getting people to understand that less is more or

Tyler Kallasy (25:52)
Yeah.

Joe LaVacca (26:07)
How have you maybe integrated some of those more maybe emotional breathing sort of ideas? Because I found people more resistant to those types of things than they are, you know, the corrective, like they come for corrective exercise. So have you found an approach or maybe a style that kind of really works to solidify that point for you?

Tyler Kallasy (26:29)
I think there's a couple of main points of education that I will give to clients early on. The first thing is realizing, aside from the exact education, is realizing that as practitioners, right, because I'm assuming we're talking to a lot of clinicians that are listening to this. Is that appropriate to assume?

Joe LaVacca (26:45)
People in pain, clinicians, yeah, I think...

Tyler Kallasy (26:47)
Okay, well, they'll both understand, right? As I'll tell the folks who are not practitioners, I'll speak for most of us in saying, sometimes we have such a good understanding of something that it's difficult for us to simplify it back down to the way that people who don't have this same degree can understand. And clinicians have a tough time doing that. We're also, for some reason, very resistant to giving people timelines. It's like against our cardinal, you know, I don't know.

We don't want to tell people, it's going to take six weeks or it's going to take 12 weeks or it's going to take a year. And that's okay. But I do think people value structure. So the first way that I start to gather some trust, and this was going to be true for pretty much any major persistent, like injury, persistent pain is there's three phases, right? The first phase is like, learn what you can do well and lean into being able to move with some sort of discomfort. The second phase is like,

We've achieved consistently low pain levels. So now we're going to add in some more complexity, some more intensity. This is when people feel like they're back because like life looks normal, but fitness almost doesn't look low normal. And then the third phase is like throwing a lot at your system to prove to us and to your system that everything is fine. And I'll tell people like each one of those phases could take less or more time, but that's what it's going to look like. So instead of chasing the end of phase three, let's chase.

the end of phase one first. Yeah. you know the the second thing that'll often educate folks on is like you're going to be in pain for a while even though we are now working together. It's probably one of the first things I'll say to folks once they are ready to commit. It's like what you're experiencing now or the flare up you had three weeks ago, it's gonna happen again. That's why you're here is to learn how to deal with it when it happens.

When people are looking for exercises, they forget that they have these exercises, but the real meat and potatoes comes into play when they have to manipulate how much of that exercise or when they're doing it. And that's why it's good to communicate with someone, let alone a clinician or a coach. So I am often very much so coach education forward when I am speaking with folks, either pitching what I do with folks or.

once we get started with the onboard process and then say, the program is like the plus. It is coaching with a program, not program with coaching because now more than ever, I'll make you a program on AI. I'll make you a program for free here. That's not gonna be the thing. I want you to be successful with it. I wish that was true. Typically, if you've been in pain for long enough, that's not gonna be true.

Joe LaVacca (29:35)
I like that, man. I...

Joe Gambino (29:36)
I know I love that. Yeah. I I tell people that I can't talk. Sorry, Joe. I tell that to people all the time where it's like you can you can go on YouTube and get a program anywhere. Right today. Information is so readily available, but most people still struggle with this chronic pain or the ability inability to get back to where they want to be. And really what you need is that back in coaching. Right. It's like.

Joe LaVacca (29:40)
And jump.

No, no, no, no.

Joe Gambino (30:04)
What happens when this like when shit hits the fan, right? Like what do we do? How do we bring you back? And so you don't stop, you know, you might have been on the right track, but when shit hits the fan, you might like take a step back when you have that flare up and say, OK, well, maybe I'm in the wrong direction, but you could have been. So how do we reframe all that and make sure we keep you on the right track and maneuver around when when these things happen? So I love that you did mention that.

Joe LaVacca (30:29)
Yeah, for sure. I think that I like how you flip to the coaching and the programming aspect as well. And I think that kind of gets lost too, because you're reading about the biopsychosocial model and everyone knows it, right? Everyone's like, I'm a biopsychosocial practitioner. I'm an empathetic practitioner. I'm a compassionate practitioner. I'm this, I'm that. And then when we sort of like check the stats on that, it's like, but we all just kind of keep falling back into that biomechanical and biomedical lens. And

Even though you gave the pain talk and the coaching talk in the beginning, it's so hard to stick with that philosophy. And this is where I found, you know, those coaching programs. I know in previous conversations, Joe works on, like 12 week programs. I still are on your website. You're working with like six months, sort of coaching programs and things like that. And, and I really think that that's kind of the future of rehab is, is being able, like you said, to navigate people through.

Tyler Kallasy (31:04)
Yeah.

Joe LaVacca (31:24)
those ups and downs. And one of the things I valued from switching people to True Coach and going on a similar pathway is just being able to look at our conversations, right? Like scroll through, like you said, hey, these pain episodes are going to come up and down and up and down, but look how you reacted four weeks ago. You didn't go to the gym. You stayed home. Now you had the pain and you realized that walking didn't make it worse. Running didn't make it worse. This didn't make it worse. And then your life bubble became bigger.

Tyler Kallasy (31:41)
Yes.

Joe LaVacca (31:52)
even though the pain bubble remain the same size, right? And we're just getting a bigger life, bigger life, bigger life. Your pain's always gonna be there. And I really appreciate that you said that because I think that's the other notion that people come in to see me with. Maybe it's from doctors or previous PT's. It's like, I shouldn't be in pain, right? Or this shouldn't be happening to me. I should be cured. And it's like, well, hold on a minute. I still have pain.

Joe has pain, you have pain, maybe just human beings are designed to have pain. So in that idea of the human experience, and Joe, I was thinking about you too, because I feel like it's very similar to Tyler's story. When you guys are in pain, because I haven't really had a painful experience that's maybe affected me in a day to day with treating and interacting with people. So how do you think your approach with people while you're in pain? How do you...

sort of like navigate your emotions and sort of like stay focused, remain on task. Because Joe, I seen you in a flare when we worked at Perfect Strive together. I mean, and Tyler, you said the same thing. I could barely stand up for two weeks. Joe was coming to the clinic. He's on a 90 degree angle and he's got a full caseload, you know? And I really always respected that with you, Joe. And I was like, wow, I don't, could I do this? So is there a pep talk you give yourselves? What was it that made you guys capable?

of moving past your own pain to be able to put others first.

Joe Gambino (33:29)
You want the floor first Tyler? This is your spotlight.

Joe LaVacca (33:32)
Yeah.

Tyler Kallasy (33:32)
Sure. Yeah. Of course, it wasn't always the same approach. You know, I think being in an aggressive enough amount of pain does give you some insight in the moment that you don't have when you're feeling normal. Meaning, you take into consideration that person's emotions more because you're quite literally feeling those emotions at the same exact time. You're you tend to be a little bit more

softer with your language, with the way you're delivering education, with how much you give that person to do. At the same time, sometimes that can be to a detriment and I've experienced that myself. I would bet if we all sat down and went back and looked at my archives program design when I was deep in pain, I was probably being really tentative with folks in terms of complexity of types of hinges or how much I was exposing people to.

I don't know, cyclical squatting, because those were things that were kind of falling into my biases of things that weren't good. But I think it's overall productive, again, because it does come back to when I was in those moments, it helped me manage my pain because it served as a distraction. You feel like you're solving a problem, which that person is now like your proxy. So you're solving their problem, it makes you feel better about your problem. And yeah, you just have much more.

insight.

Joe Gambino (35:04)
I like that. I feel the same way. I think part of it for me is like it is distraction. You're still helping others. And I think I mean for me, I mean, whenever you get like a positive story back, like it's such a great thing to hear. I almost think it helps like with pain in a sense, right? Like you're getting these positive stories back and you're helping somebody. I definitely do think that that helps you kind of get through, right? Cause it's not like a shitty day job that I have that I don't really want to be there. Right. So I think there's a, there's part of that there.

Tyler Kallasy (35:20)
yeah.

Joe Gambino (35:32)
I think is just always knowing like I like what my limits were like when I'm in that much pain you kind of like Know what's comfortable, you know, it's not comfortable and I can kind of stay in my comfort zones and just have to use my my language more to coach which I think was also helpful because it helps me kind of Learn how like to use my language to get people to do things that I want versus having to like constantly try to say something or cue them up and not get the You know, you learn real fast. Like if you could only talk to somebody I

Tyler Kallasy (35:56)
Yeah.

Joe Gambino (36:01)
If I say this and they do something different, right? I have to change the way I'm speaking, right? So I think I got a lot of a lot of benefit from that. And then the the last thing is I think it found I think patients found me more relatable when I was in pain than when I wasn't in pain. I can't tell you the amount of times that somebody said to me, you can be in pain, too. Like as a physical therapist, we're like above pain, right? Like like cops are above the law.

Tyler Kallasy (36:04)
Yeah.

That's true.

Joe LaVacca (36:15)
Mm -hmm.

Yep.

Joe Gambino (36:25)
physical therapists, we're above pain, right? We should never have it or they don't expect us to have it. And once they see it, it's like, wow, you know, they're the same as me, right? So I think it made care a little bit more relatable for my patients.

Tyler Kallasy (36:38)
Yeah, I would agree.

Joe LaVacca (36:38)
Yeah, I love that too. And I think the relatability is great because what I didn't hear either one of you say, which I think can be a common pitfall is, you know, we empathize, but the empathy almost sometimes can invalidate someone's experience. It's like, yeah, I know what you're going through. 100%. Yeah, I got the same thing, you know, and I didn't hear that at all in either one of your stories. So instead you used your experience to enhance the alliance it seemed like to enhance that therapeutic encounter. So.

Tyler Kallasy (36:56)
Yeah.

Joe LaVacca (37:07)
Thank you both for sharing that. Joe, you think we got time for one more? Tyler, you got time for one more? All right. Joe, you got anything else that you want to add? Okay. So Tyler, being a pain experiencer, being a clinician, what is one of the biggest pieces of advice you would give to a person stuck in pain? And what is one thing that you wish more clinicians understood?

Tyler Kallasy (37:11)
I do.

Joe Gambino (37:13)
Go for it. yeah.

Joe LaVacca (37:35)
about pain to help others.

Tyler Kallasy (37:37)
Ooh, yeah, both of those things are gonna fall into the same piece of advice. And that is in order to, in order to learn how to move beyond your pain, bingo, you have to learn how to move through your pain. For the, for the non clinicians here, that means learning what you can do in terms of types of activities, types of positions.

the amount of weight that you can handle where the pain is manageable in that it doesn't affect or doesn't dramatically change the way you go about your life for 24 to 48 hours after you do the thing. How much pain can you learn to experience in a manageable way? How much can you move before that pain gets beyond what's manageable? And manageable is gonna be subjective for everyone, but I often give people...

the objective measurement of four out of 10. Can you find as much life as possible underneath a four out of 10? Let's do it then. Because if I can get you to do this much at a four out of 10 and you do this much for long enough, you're gonna add 25 % to that eventually, right? Like you were saying, your life's getting bigger and the pain's not changing.

As far as the advice for clinicians, I think we're scared to do things that are going to hurt people. We're scared to tell people things that they need to hear. And we're scared to do anything other than reduce people's pain. But when someone's been in pain for long enough, part of the problem that they're not getting out of pain is not just coming from their insufficiencies of their tissues. It's not just because they're weak or they're immobile or they're too

to mobile, it's also because they don't know how to deal with pain. And I mean that emotionally and cognitively, they literally don't know how to feel when they're experiencing increases of pain or long standing pain. But they also don't know how to adjust their life. And that's why I said pain is a skill. We have to get good at being in pain before we can get out of pain. And clinicians, rightfully so.

We want to rush to getting people out of pain. This exact manual intervention, this exact exercise, how can I just make this person feel better and be happy? Unfortunately, it's just not how it works when someone's been in pain for long enough.

Joe LaVacca (40:11)
Very nice, very nice talk. I appreciate your time today. If I was a, I know you do both, I know you teach, I know you work with clients. If I was a clinician, how do I learn from you? If I'm a patient, how do I work with you?

Tyler Kallasy (40:26)
Yeah, so both avenues are going to go mainly through my Instagram. So Tyler Kolesi dot dpt on Instagram. You can take you to my website. I have resources to learn from, but there's there's plenty that I share around my philosophies of pain. I also teach for an organization called the Pain Free Performance Specialist Certification. We teach coaches, clinicians, people who just love movement, how to move more.

and more productively, more optimally beyond their pain, around their pain, while in pain. We don't teach people how to address pain unless it's the rehab version of the PPSC course, which we do offer as well. So you can find all of the avenues to all of those things through my Instagram. Last thing I'll say is I also teach coaches and clinicians how to build a business similar to all what we have, right? This kind of hybrid model, a better online presence.

not tied down to, you know, how many visits you can get in a week. So if people have interest there, go to my Instagram and I can point you in the right directions.

Joe LaVacca (41:34)
Awesome, excellent. Tyler, I can't thank you enough. First guest, this was more than I could have asked for. Your insights were super incredible, super valuable. I think there's a lot to take away. I hope to have you on again. I think there's still like so much that we can talk to you about and get you back on the show. Joe, you want to close anything, take us out, send I love yous to everybody?

Tyler Kallasy (41:41)
Good.

Yeah.

Joe Gambino (41:57)
I will do that. I will get all that information in the show notes. So if you do want to reach out to Tyler, it will be very easy. Joe, Tyler, I love you guys. And if you made it to the end of this episode and hearing this extra love for all of you.

Tyler Kallasy (42:13)
Thank you.