imPERFECTly emPOWERed®

A Shockingly Effective Exercise to Perfect Your Posture and Prevent Pain With Pro Physiotherapist Brent Stevenson

August 13, 2024 • Ahna Fulmer • Season 3

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ABOUT THIS EPISODE:

Unlock the secrets to a pain-free life with renowned physiotherapist Brent Stevenson on the Imperfectly Empowered podcast. Have you ever wondered how stress and anxiety could be sabotaging your physical health? Brent connects the dots between mental well-being and physical pain, sharing his incredible journey from an injury-prone athlete to an expert in physiotherapy. With insights drawn from his diverse experiences, Brent offers practical tips on preventing and relieving pain, especially for those who lead active or demanding lifestyles, like athletes and corporate executives.


JUMP RIGHT TO IT:

11:07 Understanding Breath and Body Connection

24:38 The Root Cause of Pain

31:45 Muscle Tension and IMS Techniques

47:46 Finding Neutral Spine and Posture


CONNECT WITH BRENT:

IG: @WhyThingsHurt

FB: WhyThingsHurt

YouTube: envisionphysio

LinkedIn: brentstevenson


Buy the book, Why We Hurt: Understanding How To Be Comfortable In Your Own Body OR find other resources: 

https://www.whythingshurt.com/books/why-we-hurt


Breath: The New Science of a Lost Art: https://a.co/d/3unfcVE 

Revitalize your faith and fitness with a morning routine that does not sacrifice your sleep and does start each day with God's Word and a workout. Join the community today at www.earlymorninghabit.com 


Contact The Show!

Website: http://www.ahnafulmer.com
YouTube: https://www.youtube.com/@imperfectlyempoweredpodcast
Instagram: https://www.instagram.com/ahnafulmer/
Facebook: https://www.facebook.com/ahnadfulmer

Speaker 1:

Hi and welcome back to another episode of the Imperfectly Empowered podcast. I'm your host, anna Fulmer. Brent Stevenson is a physiotherapist in Vancouver, canada, passionate about helping people understand how stress and anxiety can manifest in acute and chronic physical pain and ultimately provide solutions to relieve it and prevent it. Here to share his expert advice on perfect posture to prevent and relieve persistent pain. Welcome, brent Stevenson.

Speaker 1:

I really enjoyed reading this book. I feel like it's one of those books that if I read through it a second time I would potentially get even more out of it than I did the first time. It's such an incredible read about understanding the correlation between really our mental health and our physical health and then dab this like sprinkle our emotional health and social factors and spiritual factors onto that as well. It just goes to show how intricately connected what we feel in our body is to the less tangible experiences that we're having, and you do such a great job at illuminating that. But I'd love to press rewind a little bit and talk about how you got to the point that you are in learning yourself and then being able to communicate so clearly how anxiety and stress ultimately can create these experiences of pain physically, how you're seeing that happen and how you got to the point in your own life where you became an expert on this.

Speaker 2:

Sure Well, I've been a physiotherapist now for about 20 years and actually this is my second book I wrote. My first book was called why Things Hurt Life Lessons from an Injury-Prone Physical Therapist, which is what a great title.

Speaker 2:

I kind of tell the tale of. I grew up as an athletic kid. Being this, I'm sort of tall and loose, jointed, and managed to play all sorts of contact sports and hurt myself all the time and I seem to be just perpetually some level of uncomfortable. So I kind of came by, honestly, to end up becoming a physical therapist, because I spent my own fair share of time in it growing up and so I have a laundry list of things that I've hurt.

Speaker 2:

So I did an undergrad in kinesiology and learned a lot about sort of anatomy, physiology and some injury and healing, and physical therapy was a natural transition for me. From that point I took a bit of a different path than your typical physio. I did work at a, initially sort of worked at a clinic helping people that had been injured at work and sort of were on work conditioning programs and they tried, they'd gone through physio and didn't quite get there and they needed to come to this program four or five days a week and I just I saw a lot of people both on the acute side and the chronic side and sort of dealing with, uh, various levels of discomfort. I I then sort of did a 180 and switched and moved to a clinic that was working all with sort of sport performance, working almost exclusively with golfers.

Speaker 1:

Huh interesting.

Speaker 2:

I went from working at a very blue-collar place for people who were getting injured, doing manual labor kind of jobs, to working with CEOs of companies that were kind of I'd meet them on the side of a golf course and end up treating sort of more older men and women that were in the sort of executive positions of jobs that had full-on lives or owners or companies and were golfing as part of a social part and a big priority for them was I was both hitting the golf ball further but also dealing with their sore back and dealing with their stresses of their life um. So I got a lot of experience, uh, with them and teaching. It was a lot of movement training, helping people understand how their body was actually the limiting factor to their, to their um, to their golf swing and within some of the training. Actually I think I'm not sure if you're in philadelphia near philly, we're in lancaster, pennsylvania yeah, that's right, it's a long story, but the uh no worries

Speaker 2:

uh, there's a physio here and I'm in vancouver, canada, canada, and I had a franchise to a golf-based company that was based out of Philadelphia at the time and they sent me down there for a number of weeks learning all sorts of things about golf, but a lot of it was actually sales training of how to talk to and explain things to people in a way that was meaningful to them, which was sort of wrapping things around sort of golf kind of things for them. Yeah, um, being in the sort of the health professional, I don't necessarily get a lot of things about sales, but it's really yes, it really resonated with me about, um, learning how to teach people in a way that are meaningful to them and sort of explaining things in a way that's meaningful to them. Um, so, um, I yeah, I worked with golfers for a number of years and then, um, uh, eventually, about three years into my career, decided to start my own business, um, which, uh, sort of shifted, and then shortly thereafter we had three kids in three years.

Speaker 2:

Uh, which sort of no big deal in terms of in terms of creating just general stresses in life and me trying to figure out sort of uh, I, I. When I was younger, I dealt with a lot of physical injuries like dislocating the shoulder or breaking or banging things. But then I started getting. Uh, I became a physio pretty young, like I was in my mid-20s, and yeah um started I I was like, yeah, just taking on the world.

Speaker 2:

I had kids, I had a business, just doing things. And then when my kids were about three, four and six, I had a really bad eye injury which had all sorts of physical and emotional trauma sort of associated with it. And so I I endured a lot, both physically and emotionally, and started from there. I got back to work, probably sooner than I should have, trying to help a lot of people that were um, that were probably not in as bad a shape as I was. Um and then um. That was sort of around the time after I did that.

Speaker 2:

That experience actually really wrapped my first book up well and gave me more things to write about.

Speaker 2:

Um, and so I I wrote about my my experiences in explaining things to my clients and what I was going through. I started doing a lot of reading on the more cognitive, psychology and sort of brain and behavior sides of things, and the experience of writing that first book sort of tilted a lot of my caseload towards the people that were more having chronic and resistant pain problems, um and uh. So I got more and more used to trying to help people through it wasn't necessarily people that got in car accidents or fallen off the a treadmill or something. It was people that just got insidiously uncomfortable and sore and and tried seeing a chiro or physio and multiple doctors and weren't getting, weren't getting better um and uh and then kind of the covid sort of issue hit and people were stuck at home, weren't be able to exercise the way they normally, were spending more time with their family and had financial stress and health stress and it really tilted my case or it really just started noticing.

Speaker 1:

The thing that was bringing people in for physio was more, uh, the physical manifestations of stress, anxiety and fear yeah, yeah, you, um, you talk about this physical relationship to the psychosocial elements that we experience in our lives and it especially resonated with me because I worked in emergency medicine for 10 years and saw this all of the time. I mean all of the time. You started to recognize pretty quickly that you know, all tests come back normal and then when you peel back some layers, you find out all the things that are actually going out or going on in this patient's life and it's like you know, we just saw it constantly. So you said it so well. I'm going to read this paragraph here from the book.

Speaker 1:

His book is why we hurt understanding how to be comfortable in your own body. You're going to hear me recommend this book multiple times, but really quick, guys listening and watching, let me just read this. We experience empathy, love, sadness, anxiety and fear in our organs. It is not something we can measure, but it is something we can subjectively feel in our bodies. Sharon had numerous triggers that caused her to feel like something was stepping on her chest. That set off a cascade of reactive muscular bracing anxiety, shortness of breath and sometimes dizziness. She passed all the cardiologist tests but still experienced the physical sensations of a heavy heart and constricted lungs on a regular basis. I drastically changed how she felt by treating her muscles, but my ability to help her feel the tension she held around her heart seemed to have the longer lasting impact on her wellbeing.

Speaker 1:

I read that because I think it is such a beautiful case example and you give so many in here of what a lot of us feel but can't put words to that. We recognize almost subconsciously at times that under increased stress we physically don't feel as well, even if our level of fitness hasn't changed, our diet hasn't changed, even our routine hasn't changed. But it's simply our perception of stress, load, emotional load and how we feel that in our body, holding patterns in our body at one point. How do we learn to start recognizing them and then ultimately push back on them, if you will, in those moments as well?

Speaker 2:

Yeah, yeah. People generally tend to hold their day-to-day emotions and stresses more in their muscular systems in the form of tension. I'd say that the muscles in your upper traps and your jaw, actually the deep muscles in your butt, are probably the most common places that people subconsciously sort of tense and clench, sort of subconsciously.

Speaker 1:

Is that what affects lower back pain, then?

Speaker 2:

very much so. The muscles in your hips are very much like loosening the muscles in the person's hips takes more pressure off their back than does actually doing anything to their back, um, but so, yeah, more day-to-day tensions tend to be more in your myofascial system, and sort of deeper seated emotions and sort of past traumas and sort of deeper feelings tend to be more in your myofascial system and sort of deeper seated emotions and sort of past traumas and sort of deeper feelings tend to be more in and around your organs and your heart and lungs are your big emotional centers which, um, just the same sort of pulling at your heartstrings. Well, like those are actual things like your. Your heart sits in your pericardium, which is a bag in the center of your chest that's actually attached to the center, the underside of your sternum, the front of your spine, around your neck and then above your diaphragm, in the front of your spine, in your mid back, and when you're really stressed or worried or sad, like that is actually, it has a lot of energy to it. Your heart's a big muscle. It will tense and pull. It can be something physically tugging and pulling on the inside of you and it's surrounded by your lungs, like there's an interface between your hearts and your in your lungs, so there and your bronchial tubes, which is sort of where your breathing pipe splits into around your second or third rib, into your upper chest. It's a big place where people tend to hold grief, and so they're not these passive inert structures. They do hold on to tension and can physically and mechanically pull on you from the inside.

Speaker 2:

I did a number, a bunch of osteopathic training through what's called the Burrell Institute, a technique called visceral manipulation. It's an osteopath named Jean-Pierre Burrell. He started as a physical therapist, but osteopathy is more common in Europe and actually down around some of the eastern states, more in the Florida area, but it's more and more growing over here as well. But the Burll institute teaches courses all over the world. Um, of it's really anatomy, based of understanding sort of where organs attach on to and how to actually start to start to feel them. It's not that an organ sort of in position b and you got to put it back in position a. It's. It's that your body holds tension around there and you really see your heart and lungs area are the big ones.

Speaker 2:

Um, but like anxiety tends to really rear its head in your loops of your small intestine where people like you feel the feeling of your your stomach churning into knots, like you're. If you look at a picture of your small intestine, it's literally a tube of knots and your digestive tract has a series of seven sphincters that run through it. That is a gating mechanism to go through your digestive process and they can really overly, contract and tense and affect and either make you feel uncomfortable in your abdomen and or make you either constipated or have diarrhea, and those are they're very tied to your emotional state, like they call it feelings, because you are genuinely feeling things and there is anatomy behind that and if you understand that well enough, you can help people connect and, um, uh, I guess your question was about how do we help people understand those things. The first part of it is actually showing you a little bit of the anatomy in an approachable way.

Speaker 2:

I have posters all over my walls in my, in my office, to help them just see how big your lungs actually are, and then, um, laying hands on people in a certain way and getting them to uh, the biggest, most approachable way to help them feel it is, uh, is breathing, and there's all sorts of breathing practices and different types of breathing exercises, but, uh, holding on to a person's lung and getting them to breathe in a certain way in a different place, um it's, it's very. It can be very relaxing and very soothing to help, try to help people. Somebody let go. It's sort of uh, unwinding this actual physical aspects of anxiety yeah, what is one?

Speaker 1:

I mean, there's so many, so many breathing techniques, but to your point, um, at least from my understanding, there are some general principles that ring true in terms of where to originate that breath from, meaning the high breath versus the low diaphragmatic breath. Just speak to that for a second. I even have breathing techniques on the podcast, and I'm sure he has some too, but uh, you guys just listen, because what I want you to hear is how, ultimately, where the breathing should be coming from from a physiological standpoint.

Speaker 2:

Sure, Um biggest point I try to help people understand is there isn't one magical way to breathe. It's not like you're doing it wrong and there's a right way to do it Breathing is good.

Speaker 1:

you guys, Having worked in the emergency department for 10 years, we like breathing.

Speaker 2:

Your body will do a pretty good job of keeping you alive. It'll keep doing its job, but it's one of the main, the only real physiological process you can consciously tap into and affect how you're doing it. Um, I'd find most breathing practices people tend to preach a diaphragmatic breath or like a belly breath, which is sort of, yeah, trying to draw it down and feel your diaphragm, to stand and feel it sort of down into your belly. Um, I generally I acknowledge that with, but I tend to help teach people more of what you'd call a lateral costal breath, which is sort of breathing into the sides of your rib cage, into a bit of your pecs and some of your intercostal muscles in your chest which actually drive your rib heads into your sternum, which can be part of the. It creates the discomfort in your into your chest and those muscles can stay really sort of. If you're a really generally tense person, your rib cage can get really guarded and not move that well. Part of breathing is your whole rib cage should be able to laterally expand and open. At the same time your diaphragm drops down. So people don't naturally do that motion as well as they could.

Speaker 2:

So I have a poster in my room that shows sort of all the organs underneath the person and people are so surprised of how big your lungs actually are.

Speaker 2:

The apex of your lungs start sort of above your collarbone, and the lungs aren't just in your front, they're three-dimensional things that wrap around your heart and they go down into your back, sort of below your bra strap, the bottom of your ribcage, and so number one is actually visualizing them as a big emotional bag inside you and trying to uh slowly engage them and take a breath in a way, that sort of uh sort of in through your nose and it feels like you're breathing again sort of into the sides of your bra strap or the end of your armpits a little bit. Um, I like teaching people the four, seven, eight breathing which, uh, and sort of dr wheel, but the people do like box breathing but generally taking number one, looking at how big your lungs are. Two, appreciating their bags, and it's not all, just lift your chest up and breathe up here or all breathing down into your belly that you are filling up these big balloons inside you to the point where it's making your rib cage stretch a little bit, starting to get a bit of proprioceptive.

Speaker 2:

It makes me, yawn it like, relaxes me instantly yeah, I'm practicing breathing over here and I'm already yawning yeah, it's the tell people particularly have like shoulder problems or neck problems, like and if you can see you tilt towards the more anxious side of things like, practice some 478 breathing. It's a, it's a form of stretching for your rib cage and it's inherently relaxing.

Speaker 1:

I dare you to not be more calm after uh yeah, which is also a great way to fall asleep at night. You guys, I've I've talked about 478, but in case no one has listened to that podcast episode, which is probably a lot of people, tell people how to do the 4-7-8 breathing.

Speaker 2:

Effectively take four seconds to slowly breathe in through your nose, trying to get that bit of a stretch in the sides of your rib cage, holding it for seven seconds and taking eight seconds to slowly breathe out through pursed lips of just slowly blowing out through a smaller hole in your mouth. A bit of the back pressure helps open up your bronchial tubes a little bit and will help you last eight seconds in blowing it out. If you ask someone to take a deep breath, a lot of people will try to do a big quick breath and try to get a lot in in the first second, but actually it's just the level of mindfulness of slowing it down, trying to visualize how the size of your lungs in there and bask with holding it for a little bit. You're not going to die if you hold your breath for a few seconds where, um again, people that are more on the anxious side of things can, uh, either not breathe in well or not breathe out well yeah and it can.

Speaker 2:

The feeling of tension and restriction in your chest can be inherently claustrophobic and create a vicious cycle. So, um, for, particularly for neck and shoulder issues and general overall people that are kind of global tension bracers. Starting with breathing practices is usually one of the first places.

Speaker 1:

I love that. So when you take a deep breath, you're feeling your rib cage expand, and I'm assuming you would say we don't want the shoulders to rise, we want the rib cage to expand. Is that right?

Speaker 2:

Exactly Yeah's, it's not a yes, the muscles that lift your shoulders up are sort of more accessory muscles of breathing, that if you're running and you're panting, sure they should keep going, but in the effort of taking a deep breath, shouldn't? They'll passively lift a little bit, but also don't necessarily try to pull your shoulders down. Just, I have a video I refer people to all the time on my website, which is whythingshurtcom. That's called. Everything your mother taught you about posture is wrong. That stems from picking on mom. Sorry, but everybody always gets.

Speaker 1:

We're used to it. We're used to it.

Speaker 2:

Yeah, shoulder a lot of the blame, but the whole sort of chest up, shoulders back and down thing can get people in trouble. So we can come back to that later, but the there's not the. Pulling your shoulders further and further back or down is not necessarily better.

Speaker 1:

Hmm, interesting you guys keep listening. We're going to talk about posture, don't worry. Everything your mother taught you is wrong, but in terms of breathing, I love that. Keep them relaxed is what I'm hearing. Rib cage out four, seven, eight.

Speaker 2:

There's also a video on there just called breathing as an exercise, which is not doesn't explicitly say the four, seven, eight, but it gets into the lateral costal breath, um, that's uh on my YouTube channel but it's integrated into the website there.

Speaker 1:

Awesome, that's perfect. We'll make sure that link is included too in the show notes. Uh, you also had a great quote. You said people's functional mobility and their perceived levels of pain do not correlate that closely to the pictures we can take of their insides with x-ray and MRI machines. And I think this speaks to furthering the point that we need to start becoming better diagnosticians, if you will, of our bodies, specifically as they are correlating to our stress. And to take it back one more layer, you also have to be aware of what is stressing you. So I'll plug that in You've got to be conscious of even what your stressors are. I think stress is some people's comfort zone. Actually, stress has almost become the new normal, so that's a whole different podcast episode.

Speaker 1:

But to your point then, once we are aware of that stress and anxiety, starting to recognize how it might be physically affecting us. So it's so fascinating to me that the deeper butt muscles this makes so much sense are the primary or most commonplace to physically tense, or I think you said muscular bracing, which then of course makes so much sense as to why lower back pain is like one of the number one most commonly diagnosed problems for chronic pain.

Speaker 2:

Yeah, very much so, and like the more of what you experience, usually from a pain or discomfort perspective, is more related to your tension level in your muscular fascial system and or in around your visceral system, around your organs and, less so, your bones. You can have and you'll. You can have people with just horrific looking x-rays and very little to no pain, and vice versa, people that have all sorts of pain but test like pass with flying colors all of the different medical tests. So which?

Speaker 1:

I can. I have seen that for many, many years.

Speaker 2:

Yeah, it's. It tends to be a default. If you go into your doctor with like back pain, they'll usually say, well, let's start with an x-ray, and unfortunately that can. That act can take people down a like, it can make people worse. It can, um, because you get a radiology report back that has a lot of uh, uncomfortably foreign, uh medical jargon words on it. Um, and like degenerative disc disease, which most people, as they get older, have some level of degenerative disc disease or um, the stage one, this or that or syndrome, that and it's, uh, it's. You can tell a lot from just actually talking to a person moving their hips around, getting them to bend, move and squat and see how their day, week and month are going, more so than taking a picture of what their discs look like inside of them.

Speaker 1:

Uh, so uh it's a lot cheaper too people.

Speaker 2:

It's a lot cheaper too and from sort of whether you're paying out of pocket or it's your like, our medical systems are different. Both have their own challenges, but, um, the the. We tend to focus more on the symptoms of things than the actual story behind them or the root cause. Um, the. Going back to those deep muscles in your butt, so that underneath your gluteus maximus, which is the bigger part of your butt, you have a series of little deep hip rotator muscles like your. Your piriformis gets blamed for a lot of things because your sciatic nerve goes through it. Um, but there's your gluteus medius and a handful of other ones that are all they're like the rotator cuff of your hip. They affect how your hip actually sits in the socket. They have a big postural implication in terms of how you're holding yourself, and they're probably the number one or number two area where people hold on to their stress, like in subconsciously tense and hold things From a female perspective too.

Speaker 2:

The whole process of pregnancy feeds tons and tons of tension into those, because your, your abdominal muscles, your belly, slowly gets all sort of stretched out, uh, your center of gravity changes and then in a fairly quick that happens over nine months, then a fairly short process.

Speaker 2:

You damage some of your pelvic floor muscles. The tension in your abdomen changes entirely and those deep butt muscles just do all the work trying to hold your pelvis together so they can get very grippy as a stabilization strategy and because your sciatic nerve comes right through that area, it's the electrical wiring down to your hamstring, calf and feet, so if it's getting a bit annoyed you can start getting calf cramps, you can start getting plantar fasciitis and heel pain, which is all more related to the tension you're holding in your butt, partly from just posturally trying to carry a baby around while your body's still recovering, and there's all the stresses that come with with sort of motherhood and your posture through that area probably wasn't great to start with. Um, yeah, so a matter of trying to find, uh, uh it's where understanding your story uh, makes a big, makes more difference of both your stressors, what your posture and movements like and understanding like. That's why my website's called why Things Hurt. Is that like, yes, understanding the context.

Speaker 1:

Yeah, I love it. It makes so much sense to me. Well, and I have to tell you, I, my husband, is a prime example of this. He had ran a half marathon, didn't stretch while he's a football player and then decided to run a half marathon, you know, after we got married. So, uh, he would be the first to admit, did not probably train properly or stretch properly for it either.

Speaker 1:

Pulled something, um, he said in his butt afterward, but what happened was it was just this like progressive degeneration of his ability to walk. Um would just wake up with the most debilitating pain and could not seem to figure out any like cause. It would get better, it would um, get worse. And uh, you know, of course orthopedists were getting x-rays, all this other stuff. Anyway, bottom line, early, early on, a physical therapist said I don't think this is actually um or was he having, but I can't remember. Anyway, the physical therapist was was ultimately the one that was like I think it's actually originating here, even though your symptoms are here. I can't remember which one.

Speaker 1:

It was Um, but he ended up getting diagnosed with ankylosing spondylitis and it took years to figure out. That's what he had, which, for those of you guys listening is an autoimmune disorder where his spine starts to fuse together. But it's to your point. It's this idea of even though a symptom is manifesting one place, because everything's so interconnected, the root issue is often somewhere else or something else. And that's where I just think you guys are so good at In emergency medicine. We should honestly be mini physical therapists. The amount of ortho stuff we deal with like that should be a whole section of our curriculum there should just be physical therapists in the ER In the ER.

Speaker 2:

Can we preach that let's yep amen um, but I agree with that for, like, example, like your husband, whether even like I'm treating a guy with ankylosing spondylitis right now, but and and like I spent I literally spend most of my day poking needles in people's butts because, like, because I do a technique of what's called intramuscular stimulation, which is really funny.

Speaker 1:

Not too many people can say that's what they spend most of their day doing. It's what I spend most of my day doing that's hilarious.

Speaker 2:

I get home and my 16-year-old always says you see some butts today, dad, I treat a bunch of his friends and all a bunch of our parents. But that's hilarious, the the a lot of what we experience as discomfort again, like even if you have something like ankylosing spondylitis which, yes, has a lot to do with sort of fusing of joints, and thing that more of the discomfort you end up feeling is still based in your myofascial system and you're understanding how your nervous system works and the nerve innervations of muscles, like muscles, are supposed to have a certain amount of resting tone to them. They shouldn't be these limp, flaccid things and they shouldn't be sitting there all sort of tense and braced. Ideally they're somewhere in between, so they can contract as you need them to or stretch as you need them to. And if a nerve, if a portion of a nerve's getting irritated, the some of those areas where it innervates will start creating a holding on to tension and will just stay in a slightly overly contracted state which will limit the mobility of that joint. It usually makes it a little bit more tender or sore and can start to create nerve referrals further downstream. So those deep muscles in your bum, they really affect down to your feet, to your knees and up into your low back, and then on either side of your spine there's a couple inches deep of muscle that run all the way up your spine. That get that will hold on to a lot of tension for, again, a variety of reasons, part of them postural and part of them stress, and and if you do have an underlying degenerated kind of thing or an autoimmune thing, that's, that's creating maybe a little bit more layer of inflammation that irritates it too and it creates this compressive nature in and around your spine and your joints.

Speaker 2:

If you poke a needle into a normal, healthy, happy muscle, you don't feel a lot. If you poke a needle into a muscle that's already sitting there in a contracted, banded, tense state, the stimulus of moving a needle in and out of it will cause that muscle to contract and you'll feel it like a like a deep, crampy, achy, pressure kind of feeling. It'll cramp and then really reflexively relax and people get a real love hate relationship with it because it is a series of crampy, achy kind of feelings. But yeah, can literally feel like magic if your your normal use to baseline is this holding kind of braced state and all of a sudden I've tricked your nervous system into letting it go and all of a sudden your hip moves normally and um it it's.

Speaker 2:

It can profoundly change sort of chronic tension holding patterns. Yeah, we're all regenerating sources of tension based on poor posture, movement patterns and based on our stress and having a million kids and jobs and doing things. So, yeah, it can last for a good while but it can start to kind of come back. But the act of helping somebody feel more what normal is supposed to feel like and then teaching them what they're doing that's contributing to it and what they could do differently to help it not regenerate so quickly, and pair that with the visceral stuff I was talking about earlier People can. The process of doing it is therapeutic in that you can really understand where you hold your tension and your stress a lot more, so you can provide relief and teach people about their holding patterns at the same time.

Speaker 1:

That's awesome. I love that and I um the technique that you're talking about with the with the needles. What is that technique called? Like? If somebody is looking for a you know, a physiotherapist who is going to provide a beneficial service for them, is that one that you recommend? And what is that is going to provide a beneficial service for them? Is that?

Speaker 2:

one that you recommend, and what is that? Very much so, and it depends in the states. It depends what state you're in. There are different forms of what you'll call dry needling, which is effectively putting a needle into without actually injecting any kind of substance. It does use an acupuncture needle of different sort, of, slightly thicker than you'd use. Use an acupuncture needle of different sort, of, slightly thicker than you'd use in traditional acupuncture.

Speaker 2:

Um, the technique I'm talking about is called ims or intramuscular stimulation, uh, which is created by a guy named dr chan gun, who's here in vancouver, um, but so there's more people here that do that specifically than probably anywhere. Um, there's in different states that I believe it became a bit of a turf war between physical therapists and acupuncturists and some so interesting, some some states, uh, like I know in washington and california people they're not physios aren't allowed to do it. I have people that come up here to see me whenever they're in town. There's a bit of a, yeah, I believe, in the states. Different states have grouped together for licensing exams and have similar policies. So it depends where you are.

Speaker 2:

It's generally, if you look up dry needling, there's a few different forms of it. They won't necessarily all be explicitly what I'm talking about, but it's probably the closest uh. I actually created my own sort of uh course on ims for practitioners that are already trained to do some level of of of dry needling, like they're, wherever they are, they're legally allowed to poke needles in people, and I created an online course to help people that is based on Dr Gunn's model of IMS, but it's sort of with my my own sort of experience I've take on. I've been doing it since 2008. So I would I look up IMS, but if you are, yeah, your availability of it will depend where you are in the world.

Speaker 1:

I'd start with dry needling, yeah, IMS dry needling, depending on where you are and if you are a practitioner and want more guidance on it, what, what would they look up on your website? We'll make sure our editor puts it in the show notes, but what is what would they find it?

Speaker 2:

yeah, if you go to whythingshurtcom and just one of the big bars at the top which says courses, and there's a, there's a course there. It's, it's hosted through udemy um website and it's goes through and has all the explanations behind it and has videos of all the different techniques and how well, um, all the different sort of muscular tug of wars of which muscles are best to sort of release together, um, and how to really importantly is how to have x videos of me, how I explain it to a client of what I'm doing, because that again, the act of poking needles in people can be inherently stressful. People have very complex relationships with needles and so I've helped train and teach a lot of people that have taken courses in needling and that have had various success with it. So this course goes through. It's what I wish I had when I was sort of learning to do it.

Speaker 2:

So it's sort of an online mentorship course to both understand the safety technique of doing it well, how to explain it well, to not traumatize the person as you're trying to poke needles in them. So, yeah, I've had people all over the world sort of uh, take it. They had uh like a physiatrist type doctor in italy kind of contacting about it and people and um a number of different parts, um, because they're yeah same. In england there's people have different levels of dry needling training but haven't necessarily. I'd say dr gunn was one of the pioneers of IMS and it's uh, it is very effective.

Speaker 1:

That's awesome. We'll make sure that's included so that you know, for as long as people are listening to this, if you are a practitioner you can actually learn from that. Uh, in a minute we're. I know what you're thinking. We're getting there in a minute. We're going to dive into Brent's expert advice on to do a quick round of, would you rather with brent? He didn't know this was coming, but he's game for it. Would you rather let's do it? Would you rather take your kids to the beach or go camping?

Speaker 2:

beach. Yeah, camping is too much work with three kids. I like I like camping, but uh, uh, we kind of gave up camping after a while. We tried it when they're all little, and I think my my garage is full of camping gear. We haven't done that in years. Uh, but we kind of gave up camping after a while. We tried it when they're all little, and I think my garage is full of camping gear. We haven't done it in years. I love the water, they all love the water, so beach hands down.

Speaker 1:

Raise your hand. If you've got lots of camping gear and haven't used it in years, that would be me. So many of us. Great experience, too much work. Would you rather a personal yacht or a private jet?

Speaker 2:

all of the above, it's a good one. Um, I'm gonna go personal yacht because I live in vancouver and I'm right on the edge of one of the most beautiful sort of coastline in the world, so I think I'd take that and go explore more of our our coastline vancouver really is.

Speaker 1:

canada is so pretty. My husband and I at one point were looking at moving away from where we've been and man, canada is so beautiful. It's just too cold.

Speaker 2:

Vancouver is way warmer than where you are.

Speaker 1:

What Really oh yeah, Wait this is my geographical ignorance shining through?

Speaker 2:

no shame we're we're two hours north of seattle. It's the warmest part of of of canada and, like we, in the winter it's warmer than where we are uh, yeah not all year round, but in philadelphia.

Speaker 2:

Like we barely get below freezing here uh in in the winter, uh, I mean I I'm looking out my window right here. I've got snow cap mountains sitting right there. I can see from right over there, but so it's cold. It gets cold out there, but it rains a lot here, but it's. This is a very temperate, mild rainforest climate here.

Speaker 1:

Wait. So what's your temperature right now?

Speaker 2:

In Fahrenheit, I don't know. In Celsius it's probably about 18 degrees, which is. I don't know if that is in Fahrenheit, it's probably like 70.

Speaker 1:

70. Okay 66 here.

Speaker 2:

Yeah, oh, it's been, it's been.

Speaker 1:

Well see, this is why you can't trust google people. Maybe we should have moved to vancouver. It's so pretty, it's beautiful there yeah, I know we're we've got.

Speaker 2:

I'm gonna say we from, from sitting right here, I can be on the top of a mountain skiing in a half an hour that or be out and sitting in the beach or going out on my private yacht.

Speaker 1:

Now, surely the water is cold.

Speaker 2:

The water's cold.

Speaker 1:

I was going to say that has to be pretty cold.

Speaker 2:

I was surprised. Actually it's colder in Oregon as you go down south a little bit, I went surfing down there and it's as you go. I don't know how currents work, but it's. You get to California, it's warmer but the water's colder.

Speaker 1:

Oregon is colder, water is colder.

Speaker 2:

Oregon somehow is colder, I don't know why.

Speaker 1:

Okay, Well, we apparently should have called Brent when we were researching Vancouver Cause I remember specifically looking at it and being like Hmm, so pretty.

Speaker 2:

Look at it in the temperature differential all through the winter and I guarantee you we're warmer than you are.

Speaker 1:

That's wild. I'm going to do that, I'm going to look. Maybe I shouldn't. Then I'll feel depressed and then I'll get stressed and then my butt muscles will clench and then I'll have back pain. So we should probably not do that. Yeah, okay, would you rather cake or pie? Pie, I love fruit.

Speaker 2:

Oh, okay, peaches. Or like a strawberry rhubarb pie, like sweet with a bit of tart.

Speaker 1:

Uh-huh, that's yeah, I just interviewed a guy Actually, he'd be a great connection for you. His name is Yuri Elkaim. He's founder of, or a healthpreneur Specifically it specifically with health professionals wanting to venture into online entrepreneurship. But he's incredible. But he's from Canada and he told me his favorite pie is bumbleberry. Are you familiar with it?

Speaker 2:

I've heard of it. I can't say I know exactly what's. I think that's their collection of different fruit. Or is bumbleberry an actual berry?

Speaker 1:

I wasn't sure. I've never even heard of it. I definitely think it's a canadian thing.

Speaker 2:

It's kind of like a, like a blackberry kind of uh, blackberry raspberry kind of uh, with sweet, with a little bit of tart, kind of thing, I think mix.

Speaker 1:

Yeah, it almost sounded like a yeah blueberry married a raspberry and then did something weird with a blackberry or something.

Speaker 2:

Anyway, we have a, we have a family cabin up in okanagan which is sort of go back to geography, the same natural extension of land that napa valley kind of goes up into here we have a whole own wine country. So it's all orchards and so the peach and cherry orchard up there. So a good fresh peach you pick off a tree and put that in the pie. I'll take that over. Chocolate cake is a close second, but I'd go pie.

Speaker 1:

Yeah, I'm with you there. Actually, a fresh peach pie would be my go-to, with homemade crust. Give me the good stuff. Nothing, store-bought, none of that nonsense. You have another really great quote in this book. There's a lot of great quotes. I highlighted quite a few of them, but you said, helping people starts with teaching them, not with treating them. So with the remaining time, let's talk posture, because this is something that many of us deal with. This is a case in point. I've had six interviews today. I've been sitting in a chair for hours. I try to get up when I can. This is not my everyday. This is an unusual, and I don't usually do six interviews in a day either, but I feel it Right now. I feel it in my neck and my shoulders. This is really what's tight less in my back. I'm just curious. Step number one especially for people who are feeling it in their lower back, which is many, many people, I would love to hear your go-to teaching about posture because, ladies, everything our mothers taught us was wrong, so listen up was wrong.

Speaker 2:

So listen up. Um, yeah, it depends where I would start with. It depends on what position, what, what, what posture you're sort of mean you're mainly, uh, talking about whether it's sitting or standing, uh, what? The areas to pay attention to in sitting are slightly different than standing. Um, generally, when I start pointing it out to people, I will start having them stand in a mirror and focus on their side profile, because we posture in general in people's perception is sort of what's kind of happening from their chest up and sort of more, more. And you say the word posture, people immediately lift their chest up and usually pull their shoulders back yeah, chin down head back yeah, which generally, again, we are moving human beings.

Speaker 2:

We're not meant to sit in chairs and do six podcasts in a day or be standing at a counter all day like. So, yes, sort of step one is move more, like find, like I know you can't stand up and move around right now, but step one is trying to little micro breaks throughout the day is a big piece of it. But when you actually are trying to help people understand the posture piece of it number one focusing on I'll stand you have you look at your side profile, because what you might think aesthetically looks like very nice posture from the front, you might realize if you look at yourself from the side profile, you're very much leaning backwards. So your efforts to think chest up, shoulders back and down makes you look nice and open through your chest. But if you look at you from the side, a lot of the times from about an inch or two below your bra strap, from that point of view your whole torso is actually leaning backwards.

Speaker 2:

And so step one is actually pointing it out to people and not trying to teach them things to change, but just try to help them see where their current normal is like, what their baseline is because if your perception of normal is leaning backwards and I make you go straight, you're going to feel like you're leaning forwards. Yeah, our, our brains have a head writing reflex that want to keep our eyes and our face looking straight forward. So if, uh, if I, if you're all tight through here and I lean and you're leaning backwards and I pull you forwards, your body's gonna you're gonna accommodate your body to you forwards. Your body's going to you're going to accommodate your body to. You're going to move your body around to accommodate your vision. So, just seeing what they're helping you realize that you can see, or what you feel might be different than what you see in a mirror.

Speaker 1:

So step number one, ladies side profile do an evaluation and what should you see?

Speaker 2:

What should you see? What do we curve to it and then a bit of an inward curve in your low back and inward curve in your neck, so it creates a bit of a an s curve. Um, people tend to overthink that they have to do the chest up shoulders back, and just the more they pull things back, the better. Um, but again, appreciating that, your shoulders so I'm sort of moving my shoulders back and forth that your shoulders and your spine and rib cage, which can slouch and come up and down, they're two different things then. So you want to learn to use your rib cage to support your shoulders more than your shoulders to support your rib cage. So if you think of your your upper few ribs as sort of a coat hanger for your shoulder girdles, and you want to learn to feel, and that's where coming back to breathing is helpful and help you teach people, get a little bit more.

Speaker 1:

It's funny, I was literally just moving my body and my inclination was to breathe because I'm like wait ribs, how do I okay?

Speaker 2:

yeah, trying to realize if you take that lateral costal breath or you try to breathe into your armpits or into sort of the background, your bra strap, a little bit more, where you can fill up that space and feel that if you take a big deep breath it does passively kind of lift your shoulders from below a little bit more, whereas a lot of people will tend to overuse their lats and their rhomboids, so the muscles kind of in your armpits and muscles between your shoulder blades, to try to pin them back and down.

Speaker 2:

Step one is learning to let that go a little bit and learn, learn to start to try. Priority one is uh, try to feel your rib cage and your thoracic spine, the middle part of you, a little bit and try to appreciate if you're, if you naturally are, really kyphotic and really rounded, or you might actually kind of think you are, but you're actually really braced and leaning backwards, which you might be able to, you might be able to see in a mirror yeah um, in my first book and on my website, if, if you actually search why hips hurt, I wrote a blog article called why Hips Hurt, an Illustrated Explanation.

Speaker 2:

I draw a whole bunch of stick men that get into the actual biomechanics of stacking your bones up. That can help you understand a bit of it. A bit of it, um. But number one is, yeah, start with trying to breathe and feel your rib cage a little bit and appreciate that it's not necessarily the more you lift your chest up. So, um, and again, this is a bit tricky to show sitting here, but uh, um, um. So, step one, try to feel, appreciate the difference. Imagine I had a slinky and I was trying to lift the slinky straight up. Posture wise, you're trying to elongate things upward more so than lengthening the front and shortening the back. You picture a slinky that's kind of fanning out in the front and squishing in the back. You want to make sure you're not overly just compressing the heck out of everything in the back.

Speaker 1:

Yeah, that's so good, you guys. I've never heard that before. Write that down, ladies. Slinky goes up and down, it doesn't go to the back, and then compress everything in the back. That's a great illustration.

Speaker 2:

Yeah, so it's about helping you build a bit of a relationship with your mid back. People like your hands might hurt, your shoulders might hurt, your knees might hurt, but people don't really understand like what's happening in their mid back. It has the most joints in it. Your thoracic spine has the most vertebrae, all your ribs attached and somehow tons of joints. There's lots of things in there that can. If that whole area is a bit of a brick and not moving well, other things will compensate for it and you can end up creating problems. So, trying to get you to appreciate the movement there, um, there's an art, a video on my website called four point neutral spine, which is putting you on your hands and knees and trying to help you find that natural s curve. Not on gravity, so you're going against gravity, so you're not. You're not really biased by what you're seeing or what you're, what's happening in your feet. You can try to relate, um, what you're doing with your pelvis and what you're doing with your mid back and how tricky that is for a lot of people to actually find, create a little bit of a natural s curve. People will very commonly be pretty good at doing the cat cow kind of thing which creates all this hinge in that middle part of your spine, but have a hard time, uh, actually finding that part of your back and understanding the relationship of your pelvis to your hips.

Speaker 2:

So, yes, coming back, coming back to I saying how you hold all those tension in the deep muscles in your bum, you'll see a lot of people, particularly mothers, that have had babies. You put you on your hands and knees and look at your side profile. Usually you've got your bum tucked right underneath you, um, so, and if I ask you to tip it and stick it back out the other way, you'll tend to have your mid back drop right down. So, um, your posture is a thing of. It's kind of a game of whack-a-mole.

Speaker 2:

You try to you put one thing down, something else moves, trying to understand the relationship between your hip, your pelvis and your back and how that relates to your trunk. So the next step of it is putting you on your hands and knees and trying to help you see that neutral spine video. And then there's one called four point rock backs, which is finding that neutral spine and then just moving in your hips and seeing if you can keep that spine in the same position, which comes down to learning how to use your abdominal wall a little bit. You might have in standing you might have really strong abs, but it kind of looks like you have a little bit of a belly or a little bit of a punch in the lower part of your abdomen. If you're overly extending your back, you're inhibiting you from using your abs properly and you can make it look like you've got more of a belly than you actually do.

Speaker 2:

If you get a bit more into that position of your of your trunk, you'll see it flattens your stomach out and you learn how to actually use them it makes sense, because the slinky is drawing upward yeah right, so you're literally elongating, okay well, your, your abdominal muscles create what you call an abdominal wall, so your six-pack muscle attaches from their the center part of your rib cage, a place called your xiphoid process, down to your pubic bones. They run vertically and then your obliques kind of attach the front of your rib cage, a place called your xiphoid process, down to your pubic bones. They run vertically and then your obliques kind of attach the front of your rib cage to the front of your pelvis and they kind of knit your rib cage to your pelvis, which is a kind of a force field connecting those two. If you're overshooting with your back muscles and your lats, trying to think chest up, shoulders back and down, the act of doing that can actually limit your ability to use your abs when you're in the vertical position. So, um you, you can have heroically strong abs in a plank position and doing sit-ups and stuff. It doesn't mean you're going to use them that well when you're actually in the vertical position.

Speaker 2:

Um, so learning some of the step one with posture is that point out some of your bracing strategies and let you see in the, in the, in the mirror. Then throw you on your hands and knees and get you to see how your bum relates to the area around your bra strap. Then see if you can move in your hips and then start progressively making you more vertical, of getting you up onto your knees and see if you can hinge in your hips and hold. I'll say one more thing in terms of you sitting all day. If you're sitting and you're catching yourself slouching, don't immediately try to lift your chest up. Biggest thing is actually get your butt underneath you, so your two sits bones.

Speaker 1:

I just looked down at my butt.

Speaker 2:

I'm like I don't know Well the relationship of your pelvis to your hips. Your pelvis should sit in a slight anterior tilt over your hips and that's what creates the natural S curve in your spine. When you're sitting of actually stacking your bones up. It's more comfortable if you sat for a while, typically if your hips are really tight, to kind of allow your pelvis to fall back behind your hips and as soon as you do that, your upper body will slouch Interesting.

Speaker 1:

So like I need to push my butt back.

Speaker 2:

Yeah. So if you're sitting there all day, you kind of, yeah, lift yourself up, scoot your bum back. Yeah, so if you're sitting there all day, you kind of, yeah, lift yourself up, scoot your bum back, so you feel like your sit bones are back and further apart.

Speaker 1:

It did just push me forward. I can see it actually in the screen. Do you see that? See how the top of my head is closer to the top of the screen. Exactly so there it is Slinky's vertical.

Speaker 2:

Yeah, If you're sitting with your butt tucked under you all day and then trying to lift your shoulder, your chest up all day, you're starting an unnecessary biomechanical tug of war. So in sitting, pay more attention to where your butt is. In standing, more kind of around where your bra strap is, but there's a lot in between. But that's that's where I've tried to create resources to explain that on my website.

Speaker 1:

I love that. Thank you, and we'll make sure that we get those in the show notes. Is there one exercise that you recommend in terms of elongating that is something that women can be doing whenever, or is it just kind of like there's just a lot of different things that you stack on top of each other? Is there an exercise like physical movement to practice during the day to keep that elongated?

Speaker 2:

Um, I would. I would say it's does. Come back to trying. I would say the first thing is trying to do that. Um breathe into the side of your bra strap kind of try to feel that.

Speaker 2:

Imagine I came up behind you and lightly put my hands just on the sides of you and lightly, lightly tipped forward and lifted, and then had you try to breathe in that area. Try to shift your mental perception of where to hold yourself up from down to there, not be from around your collarbones and your head. Around your collarbones and your head, like. Try to start the lengthening of the slinky more in the middle of you and even when you're sitting, after you've got your butt underneath you, then go back to that same area and feel like you're trying to create length. So it's not about it's not about your shoulders. Shoulders are easier low hanging fruit, they move around easier.

Speaker 1:

It's a bit more of a connection to it, but Everyone's hearing me like deep breathing. I feel like what is she? Doing those of you not seeing the video. It's confusing. It's so fascinating, though, because I'm actually watching myself in the video. I've never heard this before, and it's fantastic, cause as you take that deep lateral breath, you do see your shoulders just passively go up and even slightly back. Yeah, your rib cage that's it, ladies, breathe better. I'll take that any day. I love it there's a.

Speaker 2:

There's a good. I recommend it in my book. But I really like james nester's book. It's called breath the new science of a lost art. Uh, you won't be able to not think about how you're breathing if you read that book. It's really interesting.

Speaker 1:

Say that book recommendation one more time.

Speaker 2:

I believe it's called it's either breath or breathe. I think it's breath, I don't know if there's an E on the end of it. But then it's called the new science of a lost art. Bright yellow on the front looks a picture of kind of lungs on the front. Yeah, it's worth it Worth the read it's entertaining and interesting.

Speaker 1:

Yeah, we'll put that in the show notes, and you guys, of course, we're going to put Brent's book in the show notes. I highly highly recommend this book. Why we Hurt Understanding how to Be Comfortable in your Own Body. Where else can people find you, brent, and follow you? We're going to put tons of resources in this episode's show notes, so whywehurtcom? But where else can they find you?

Speaker 2:

Instagram is just at whythingshurt. I'd say that's where I'm the most active. Lately it hasn't been that active, but I have plans to get it busy.

Speaker 1:

I hear you there.

Speaker 2:

Trying to fit it in LinkedIn is just sort of LinkedIn slash. Brent Stevenson Um, uh, linkedin is just Brent that sort of LinkedIn slash. Brent Stevenson. Um, my YouTube page is actually, uh, uh, named after my physiotherapy clinic, so it's sort of YouTube slash. Envision physio Um, there's, that is embedded into my why things hurt site. But if you're just on YouTube, either just Google my name or envision physio and you'll find that, um, pretty much any of them are why things hurt. I have Twitter and TikTok accounts, but they may. You're best off to look at my website or go Instagram or Facebook is just why things hurt as well.

Speaker 1:

Awesome why things hurtcom and you definitely need to check out the book why we hurt by Brent Stevenson. But I was such an need to check out the book why we hurt by Brent Stevenson. But I was such an honor to have you here. I learned a lot. I could have kept going. We're already past our time. Thank you so much for taking time out of your busy schedule. The book's amazing. You guys need to buy it. I pray God's blessing over your heart, your home and all the people that you're serving truly and helping them to revitalize their lives by understanding their bodies.

Speaker 2:

Yeah, thanks for having me.

Speaker 1:

Thank you for watching the Imperfectly Empowered podcast. Be sure to subscribe to the channel by clicking below, and if you missed our last video, then be sure to check it out right here. We'll see you next time on the podcast. Your story matters and you are loved. Thank you.

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Ahna Fulmer

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