About Laura Baehr

Pain Science And The Core – Show Notes

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Laura Baehr:

Pain Science And The Core

About This Episode

Kathryn welcomes physiotherapist and rehabilitation science researcher Laura Baerh on the podcast to talk about movement as expression, pain science, and the biopsychosocial model. Laura explains the importance of expectations and language, as well as other socio-structural factors that may cause or aggravate a person’s pain experience – beyond the biomedical model. They also discuss the idea of the “core” and the central nervous system’s role in assessing “core” functionality.

Podcast Transcription

Kathryn: 00:00:08

Hi everyone. Welcome back. Today on the podcast I am speaking with Laura Baehr. Laura is a physical therapist and a PhD student in rehabilitation sciences. She’s also a movement artist and really really an interesting person that I got to spend an hour talking to.

Laura and I talked about everything from the biopsychosocial model to pain science to working with folks who have disabilities; the core and back pain; the research on the core; and the different ways that that research gets interpreted and the confusion that that can lead to.

00:01:16

This was just a fabulous conversation. I know that you’re going to learn a lot. Laura has a really strong science and research background but speaks in a way that is very understandable, which is amazing.

before we get into the interview I want to remind you all about our 30-day practice progression. You can sign up for this 30-day practice progression on any day. Whenever you sign up that will be your day one.

00:01:45

Kyle and I are practicing along with you and many other people from all over the world are practicing along which is pretty cool. The way it works is: every day you are going get an email that will prompt you to go and do another day. Every practice is a little bit different. Some days are restorative movement, like self-massage and gentle stretching on the floor or breathing. Other days are strengthening with either Kyle and I; weights, resistance bands, and everything. . If you want to start to work on your strength and feel like you are building your resilience, this is a really great way to start.

00:02:24

You can access it by signing up for it and then you get to keep all of these classes forever. You can always go back to them. You could do this month after month if you really wanted to. That option is thirty-nine dollars Canadian, which is about twenty-nine dollars U.S. Or you can join the membership because 30-Day practice progression is included in our monthly membership. There are two ways to get access to it.

If you want to learn more about that and get signed up, you can go to mindfulstrength.ca and read a little bit more about it. You could also send us an email if you have any questions. You can go click the link in the show notes to learn more.

All right everyone. Here is my conversation with Laura Behr.

Kathryn: 00:03:11

All right, Laura. Welcome to the podcast.

Laura Baehr: Hi Kathryn. Thank you so so much for having me.

Kathryn: Yeah, my pleasure. For the listeners who maybe don’t know about who you are and the type of work that you do: do you want to take a few minutes and talk about what you do and maybe a little bit of how you got into it?

Laura Baehr: 00:03:30

Sure. Welcome to everyone who is listening today. I am a lot of different things and I am proud to say that now it’s been a journey through a lot of different academic adventures and through work in the field.

00:03:47

I am a rehab scientist in training. I’m a physical therapist. I’m a lifelong dancer and I’m also a Pilates teacher. I also teach other group fitness. I kind of take a three-pronged approach to movement. I’m part clinician, part scientist, and part educator.

Do you work clinically? Do you also work with people in a studio or a gym? What’s your day to day life?

My day-to-day to be honest is different depending on the week. But generally speaking, I volunteer clinically in a pro bono or free clinic in Philadelphia once a week, and then in addition I teach studio classes. I also teach private and group workshops. I am a full-time research Ph.D. student at Drexel University.

Kathryn: 00:04:41

What did you get into first? Was physio your first thing and then you started opening more doors? How did that work?

Laura Baehr: It’s a really good question. I think for a long time I thought that the path that I took was somehow negative. In reality, at this point in my career, I can say that I think it all happened for this moment; for my ability to be truly interdisciplinary.

00:05:08

I was at dance and neuroscience double major in undergrad and I knew that I wanted to perform professionally but I also knew that I wanted to pursue research. My first job out of college I was a research assistant at the University of Pennsylvania in neuroscience. That was my day job, and then at night and on the weekends I was auditioning and in rehearsals and performance.

I started in cellular work looking at a rodent model of traumatic brain injury. Then I transitioned to a clinical research lab where we looked at people who developed early-onset dementia. That’s where I developed a love for physio or physical therapy.

I was recruiting one day for one of our research projects and a physical therapist rushed by me with a person who’s living with Parkinson’s disease. They were singing and marching and having the best time, and I never seen physical therapy like that before.

00:06:13

I ended up going into the office and asking if I could shadow. That’s basically how I ended up deciding to go to physical therapy school. I came into a clinical environment kind of backward. I started in research and then got my clinical degree and I’m now fusing both.

Kathryn: 00:06:29

Do you meet a lot of other physical therapists who are also really into a movement, like personally with their own movement practice?

Laura Baehr: That is a great question. Just to clarify: do you mean that they themselves not only are they a P.T. but they have an embodied practice?

Kathryn: Yeah. It sounds like you are a clinician and researcher, and it sounds like you don’t only just teach other people movement but movement is a really big part of your life as well.

Laura Baehr: 00:06:58

Yes. Yeah. Thank you for saying that because it is really true. I think that’s a common misconception when it comes to this bizarre divide, as I see it, between the physical therapy or the medical world and movement practitioners. I think that movement is intellectual.

I think sometimes, in this at least I can say in American society, we have this belief that intellectualism is from the neck up, but our bodies are not just vessels for us to carry around our brains. It would feel disingenuous for me to be a movement researcher and a movement educator and clinician without having an embodied practice.

00:07:38

To answer your original question: to be perfectly honest, I think that a lot of physios do have a practice but it’s not necessarily embodied or it’s not necessarily a mind-body practice.

Oftentimes I think a lot of physios come into the field with a sports background and there is absolutely nothing wrong with that but it’s a different kind of mentality. It’s a different kind of place to be looking at movement from.

Kathryn: What do you see some of those big differences being? I think, at least from my perspective coming at it as an artist, I have always understood that there was a psychological and social piece to movement; it wasn’t as biological as a dancer.

00:08:25

We are trained to create an effect and create quality in our movement. It’s about interpretation. There was always a gray area for me when it comes to athletes that I’ve worked with, either as patients or other colleagues, who have an athletic background. Oftentimes I feel that their work is extraordinarily performance-based .

The end goal is to win the game or to work really well with your teammates. Since they’re coming from more of a performance perspective and that high-level athleticism, it just oftentimes feels like a different avenue.

Kathryn: 00:09:06

Yeah, I think that’s really interesting. I think there’s an interesting distinction when you feel that your movement practice is like an art form.

I do feel like that’s very different from “my movement practice is like exercise” or “my movement practice is this weight loss program” or “it’s about this or it’s about that”; as opposed to this is physical and it’s also a form of art that I’m embodying.

Laura Baehr: 00:09:33

Absolutely. That’s a gripe that I have with the fitness field, in general, is exercise does not have to be only about an outcome.

It does not only have to be to lose weight or to look a certain way or to you know get gains or whatever that is, right? That information is so pervasive in the fitness field. Ultimately when we treat exercise as something to be done and check off the list it feels burdensome.

It doesn’t become part of who you are it’s something you have to do. I really like to encourage my clients and my patients to see physical activity as something that makes them human. It actually enhances their experience of being a human.

Kathryn: 00:10:23

The other thing that came to me as you’ve just been talking is: I think with exercise sometimes there’s this idea of like right and wrong or it has to be done just so. It’s not always super accessible. But something that is an art form isn’t really right or wrong. It’s living. It’s living in every person that picks it up and starts practicing it. I had never really thought about it like that I guess until this moment.

Laura Baehr: 00:10:50

Absolutely. I love what you’re pulling out of this conversation because I’m glad to hear you say that. It’s not surprising to me. I don’t think there’s anything wrong with the fact that you’ve never thought about that because another piece of this is: we live in an ableist society.

I know you’ve had other people come on the podcast and speak about that recently. Tat by itself says that there is a right or wrong way to do something or you know for example a peak pose.

What does that mean a peak pose or the highest expression of a pose? What if a person can’t physically achieve that? Does that mean that their highest expression of their yoga practice is less than the person next to them? Absolutely not. It just means it’s different.

00:11:36

I think as people we like to think in this black and white way to say this is my method and this is the ultimate goal. But when it comes to movement everyone’s body is so drastically different.

The way I approach a client who is a wheelchair user is going to be very very different from the way I approach a client that has chronic pain. Very different than a 17-year-old lacrosse player.

Kathryn: 00:12:03

I saw something. I can’t even remember where it was but I think it was a couple of weeks ago. I just started seeing a lot about like sitting and sitting is bad for you and other things like that.

I’ve been following this woman and her Instagram handle is “Sitting Pretty”. I just ordered her book. I’m sure her book is going to be great. She’s not a movement person but she uses a wheelchair as a mobility device.

She makes a lot of posts about the fact that she doesn’t consider herself is wheelchair-bound or limited to a wheelchair or whatever people say about using wheelchairs. She just wrote this incredible post about her wheelchair actually like being a mobility device and allowing her for more mobility than ever before.

When I read that post I flashbacked to all of the “sitting is going to kill” post and how you know that type of language is just so pervasive. How does that land in all of these different people, like all of the different varieties of people that could come up with? When mentioned the ablest society, that’s kind of what I remember it back to.

Laura Baehr: 00:13:16

Absolutely. and I also follow Rebecca and her handle “sitting pretty”. Yes. I would love to share that Rebecca’s experience is unique as well.

Kathryn: Yeah.

Laura Baehr: Just because she does use a wheelchair doesn’t mean that every person who uses a wheelchair feels that way. I have clients who their email is “wheelchairjohnny123@gmail.com. That goes to show how much their wheelchair is actually part of their identity, and they’re proud of that. It’s part of who they are.

00:13:50

I recently actually did an interview with someone who was we were discussing this exact topic and how some folks give their wheelchairs a name. It’s their own being, right? Other people are really interested, especially in the disabled movement field, to figure out how can I really manipulate my wheelchair to make me do things that I otherwise didn’t think I could or didn’t try before. And so yes absolutely.

I think when we when we say things like sitting is bad. Well, first of all, I think I kind of know some of the posts that you’re speaking about. Ultimately is it really the posture or is it the prolonged one position? Is it the sitting or is it the fact that for eight hours a day someone is completely sedentary? Then after that making dinner, sitting down again, and then sitting down to watch TV.

Our body likes to rest in positions that it’s comfortable in and the motor pathways are comfortable for us are the ones we practice.

Kathryn: 00:14:55

Mm-hmm . I think it’s Rebecca Taussig, right? I don’t know if I’m saying her last name right.

Laura Baehr: Oh, I’m not sure. I’m not sure how to pronounce it.

Kathryn: 00:15:05

I’ll link to her book in the show notes in case anybody wants to order the book. Thank you for sharing that about different people who you’ve worked with and yeah, very interesting.

OK. I’m going to ask you about pain. We’ve had a lot of conversations on the podcast about pain. I think it’s possible that also some people are new. Sometimes when I’m talking about pain, I start to say like the biopsychosocial model, and I never really break it down as what it is. I’m wondering: if you had to describe the biopsychosocial model where do you start?

Laura Baehr: 00:15:40

Sure. I love that question. I actually recently gave a lecture on this so hopefully, I can give a good answer.

Think of the biopsychosocial model as a three-circle Venn Diagram. In one circle you have biological factors, in another you have psychological, and then the third you have social. In the center is a person’s experience of self. Now that could be their experience of their body; it could be their experience of illness.

00:16:10

You want to talk about pain, let’s say at the center of that threeway Venn diagram, is a person’s experience of pain. Historically we always talked about the biological aspects of pain. “Oh well, this person has arthritis”. “Oh well, this person is overweight”. “Oh well, this person had a major car accident and these are all the reasons why they now live with that pain”.

But the reality, as I’m sure many of your listeners have heard before or you have had other people on the show to talk about it: there are many many people who have pain in the absence of pathology or in the absence of that biological factor. We can’t necessarily point to one thing and say “this is why”. If we could, we could fix everyone’s pain and no one would have it.

The psychological and the social circles of this Venn diagram are the other really important aspects that contribute to the pain experience. Some psychological aspects might be your sleep pattern and might be your level of stress. It might be whether or not you have another layered on mental illness.

Your social factors or where you live, how you live. What are your relationships? Do you need to use an elevator to get in and out of your building? Do you need stairs? Do you have a car? Do you take public transit? All of these things affect our bodies and affect our experience of pain.

I guess that’s the big take-home is that the biopsychosocial model affords a really nice scope of factors that could contribute to the pain experience rather than that old school reductionist biomedical model.

Kathryn: 00:17:46

Do you ever get people asking you what does it matter if I have a car or I take public transport? What does that matter to my pain?

Laura Baehr: 00:17:53

Yes, I do have people ask me that. Let me give you a good example. I live in a city. I live in Philadelphia. For the people I work with, for example, let’s go back to a wheelchair user. By the way, this is relevant and it’s maybe a sidebar comment, but I want also to acknowledge the fact that people live with pain that are also living with disabilities. It’s not just the low back pain of an able-bodied person.

For example, someone could be a wheelchair user and have shoulder pain. We used to think that that person’s shoulder pain was from repetitive use because they’re constantly wheeling themselves around. Well, one of the other things we know now especially in the research that I do is that there are psychological and social factors that come into play.

00:18:40

I can make this pretty relevant to today with the COVID-19 pandemic. Indoor dining is not happening in Philadelphia really at this time. Limited capacity. All of our restaurants have pushed outdoor dining onto their sidewalks.

Well, if you’re a wheelchair user and you utilize the curb cut out to get up and down off the sidewalk to wheel around, that is completely limited right now. If you live in a city, you don’t have a car and you and you are trying to get to public transportation and you have to wheel in the street, that is completely unsafe. That’s stressful. It might take you longer to get somewhere.

If you’re someone already living with pain you might end up having a flare-up by the time you get to the bus stop.

Kathryn: 00:19:26

Yeah. Pain is affected by all of these different aspects of our life, including our tissues and other aspects as well. I guess for a long time people were, and probably this is still happening today, people are only looking to the tissue to try to figure out what was wrong.

Laura Baehr: 00:19:49

Yes. I should say it’s not that there aren’t physiological changes when it comes to pain. I know you’ve talked about this a few times the difference between acute and chronic pain. When I’m saying these things I’m thinking more along the lines of a chronic pain experience rather than one who maybe twisted their ankle and for a few weeks their ankle is sore.

I’m talking about someone who this is ongoing for three months or more and they’ve had a really hard time. There are changes to the tissue. There are actually changes to the nervous system but those changes are not just mechanical, right? They are influenced by these other factors, very very much so.

Kathryn: 00:20:35

One time I was in a small lecture with Greg Lehman and one really interesting thing that he said that I always come back to is: sometimes when we have arthritis or an old disc thing that happened or something like that. People’s pain gets worse and then it gets a little bit better and then it gets worse and it gets better. This kind of goes on and on.

At the end of the day, you know the person’s arthritis is still there and so it’s possible for the pain to shift; it gets worse, gets better, and kind of stagnates without always having changes to the actual tissue.

Laura Baehr: 00:21:15

Absolutely. The pain experience it’s relative it’s not a fixed experience. To your point: that just goes to show that there absolutely has to be other dynamic factors. For example, your psychological state , your social state that influences that biology that might influence that arthritis.

Kathryn: 00:21:35

I know someone and she’s got arthritis in her knee. S he’s in her late 60s and I think she hurt her knee or did something at the gym quite a while ago. Maybe like a year and a half ago and experienced flare-up of something.

She went to physio you know, went about her life. Her pain really comes and goes but it’s oftentimes when she does something in her exercise practice and then she’ll have pain later or the next day.

00:22:04

I think that we are really programmed to be like “Oh why did this thing with my knee two days ago. So it must have been that”. I feel that like we’re super programmed to you know scan our week or the previous few days and be like: “well, what did I do with that part of my body?”. Maybe as opposed to trying to ask the questions of “what are all the things that are going on in my life right now?

Laura Bahr: 00:22:31

Yes. In this example you are giving, I would like to put it out there to the viewers: it would be really beneficial to every person on this planet if we stopped thinking mechanically and started thinking central nervous-systemly. That person you were speaking about with knee pain they think about their knee. They think about the physical knee joint “OK. Did I do squats? Did I do lunges? Did I do plyo? What is it that caused this flare-up ?”.

Now I’m not saying that there isn’t a contribution there. This could be a whole other conversation about what did that exercise instructor say and who was in the room and how many reps did they do. Right?

All of that probably affected this person but there is also the other piece which is have I been eating the way I normally eat? Have I been drinking more than normal? Have I been getting good enough sleep? Is work stressing me out? Is my partner stressing me out? We don’t think about those things in terms of our bodies.

Kathryn: 00:24:24

One hundred percent. We think about like oh the squat I did yesterday. That was kind of funky. Maybe that was it.

Laura Baehr 00:24:30

Yes. Maybe this will be a good analogy to use. I like to use this when I’m explaining to patients about pain. Now maybe this is potentially outdated especially for those of us who have never seen or used a radio before, but bear with me.

So you have an old school radio and you have a tuner right. You can tune the radio station and let’s say that you’re in a city and you have 15-20 radio stations to choose from. But then imagine that now you only have three stations and the static between those stations is so great that it’s extraordinarily hard for you to really even pick out what you’re listening to.

00:25:12

That’s the difference between having a dynamic functioning healthy central nervous system and a central nervous system that’s smudged; or a little bit out of tune; or just not really working for you and giving you true sensory information.

Ultimately that’s what it comes down to, right? That mismatch is when we have pain. Your pain system is actually a good thing. You want it to work you want it to tell you when your body might be in danger.

00:25:41

People with chronic pain end up having that smudged out or that untutored radio where they only have a few different channels. Whether it’s I feel decent or I feel like crap; rather than “oh you know that kind of put a little pressure on my knee joint” versus “Oh that stung a little bit” or “oh I’m a little bit sore”. You know you don’t get all those choices anymore when you have chronic pain.

Kathryn: 00:26:04

How can people start working with their central nervous system?

Laura Baehr: That is the question.

Kathryn: What does that even?

Laura Baehr 00:26:13

Yeah. What does it mean? The physical therapist and me my first thing would say: what is meaningful to the person? For the person you spoke about with knee pain: what is meaningful to her? Does she like to journal? Does she like breathwork? Does she like to take walks?

What are things practices mind-body centering techniques that she can apply in her daily life that start to bring her back in tune with her physical experience? That’s one. Two is releasing this expectation that a person who has had chronic pain for 10 years can walk into physical therapy and leave three weeks later pain-free .

00:27:01

I think there’s a really unfortunate system especially in America where people go through the wringer. They see their primary care provider. They might see multiple specialists. They might have had multiple imaging. They might have had an x-ray or an MRI. They’ve gone through these different nerve conduction tests and then finally it’s not like P.T. is actually the first step. It’s the last resort. Who the heck knows what their physician even told them about P.T.

By the way that matters. If your a physician says to you: “you know what you should try, Physical Therapy. I bet that’s going to help you”. Versus “Well, you know what: “here I’m going to write you a script for P.T. We’ll see what happens”. Then we have this tremendously difficult job of trying to mitigate expectations with a person who has some really intense stuff going on.

00:27:51

We have a lot of work to do and they might have that expectation that “well I’m going to try and see what happens and if I don’t feel better in a month then I’m leaving”. That’s the second piece is releasing that expectation.

If you’ve had chronic pain for 10 years, well it might take you that long to get back to any semblance of normalcy. It is a daily commitment.

Kathryn: 00:28:14

You mentioned not if the doctor says “oh physical therapy will be great for you to really help” vs. “here’s your script. Let’s see what happens”. Why does that make a difference?

Laura Baehr: 00:28:28

Sure. I think it makes a difference for a few reasons but the first one I want to talk about is this biomedical model, right? We talk about the biopsychosocial model and just like you mentioned earlier in our conversation: a lot of people probably don’t even know what that is. Well, I have to tell you there are people in the medical field who have yet to fully apply the biopsychosocial model.

The biomedical model is still very very prevalent in medical practices. If you have a physician who has this belief or the patient believes in this biomedical model because why would they know any different, right? Unless they listen to your podcast or they do reading outside, they are coming to their doctor and they’re saying: “OK I trust this person”. Then they’re going to take your word for word what that doctor said to them as truth. It unduly influences they experience some of their physical therapy work before it even begins.

Kathryn: 00:29:29

Expectations are probably really important.

Laura Baehr: 00:29:33

Yes, expectations are important for anything right. Like if you said to me “OK Laura we’re gonna sit down and we’re going to talk for four hours”. That would be very different than if you said “we’ll see how long it goes for”. Right?

It’s so simple. The language we use, the body language we use, all of that sets up expectations in movement spaces. That is definitely an uphill battle for many people in more conservative practices; meaning non-medical treatment in terms of like prescription medication or surgery.

Kathryn: 00:30:10

What do you think movement teachers that could be like yoga or pilates or personal training don’t fully grasp about pain?

Laura Baehr: 00:30:21

It’s a great question. Well, there are two sides to this answer. One is I think that there are some movement teachers like you said. I teach pilates. I’m also getting my yoga certification right now. I’ve practiced yoga for over 10 years. I’ve been in these studios as both a teacher and a student for a long time.

I think one thing is that movement teachers don’t realize that their method is not going to be a cure-all for a lot of people with pain. Oftentimes I can only speak in the pilates world. I can’t even tell you the number of YouTube videos I could pull up for “Pilates for Low Back Pain” or “tighten your core and you won’t have low back pain”.

00:31:04

I mean these things are actually really problematic to say and I know that you talked about these things before as well. That’s one. I definitely think that you know understanding the scope of what you are teaching is really important. Part of our role as movement teachers is to be able to scan who’s in the room and really understand who they are.

Maybe it means you take a closer look at their intake form. They’ve filled out a waiver for your studio. Maybe you actually make it a point to go around the room and truly ask each person individually if they’re working on something or if there’s something that they want you to know. A lot of people won’t tell you but you can see it, right?

00:31:44

Any seasoned movement teacher can see movement patterns that might be compensatory that might lead you to believe that that person is struggling with something and it might not even be pain. It might just be that they’re confused about the transition between the asanas.

That’s the big thing. I think really for movement teachers just understanding that the method that they teach is not going to fix people with pain all the time. I’m not promoting that agenda because that’s just as bad as a physician who says P.T. won’t work.

Kathryn: 00:32:15

I can’t not ask you this question. The core stuff and the pilates stuff; I’m working on like a big core project right now. I’m doing this very informal little survey and just asking lots of people for their perspectives on this. I think there is this huge belief, very widespread, not just in yoga or pilates but like the general population.

This belief that “if I have low back pain I need to strengthen my core” or “I need to like do something different with my core” or “engage it in this new way”. I’m wondering what you think about that? I think a lot of things got through.

Laura Baehr: 00:32:58

I think a lot of things about that. Where do I begin? Are you familiar with Peter O’Sullivan’s work?

Kathryn: 00:33:05

Yes.

Laura Baehr: 00:33:06

OK. You sound excited. Maybe this will be going down the path that you expected me to talk about. Peter O’Sullivan is a physio and a researcher here. He is known for cognitive functional therapy. He primarily works with people who have low back pain, chronic low back pain.

He often interviews people and asks them what they’ve been told about their pain or what they’ve been told will help. Many many many of his interviewees talk about the core. I think the issue number one is: what is the core? How are we defining what this is? This really pervasive word. How do you define core?

Kathryn: 00:33:51

Personally, for my own movement practice, I don’t necessarily have like a boundary where the core is. When I’m in body and movement, when I’m on the reform or doing my thing during my weight lifting, there’s no like “well this is my core but that’s not”.

Right now it’s interesting. I’m doing this very very informal survey. I know it’s biased because most of the people who are filling out the survey are people who are already following me. They’ve already been like subjected to these interviews and everything like that. But one thing that’s interesting is most of the people filling out the survey don’t have this very like little boundary set up for the core. Most of them have answered that they think the core is you know everything that you’d expect like pelvic floor or diaphragm all that stuff. But then also other muscles like glutes and hip flexes.

Laura Baehr: 00:34:48

Yes. So. So first of all the core is just made up. Right? Like many many other things, it’s made up. When I went P.T. school and I did human anatomy, I never learned about the core and the core muscles. OK? Releasing that expectation that there is a core, number one.

Number two: this idea of some fixed canister like a corset around your spine. I mean who wants that. If you’re bracing the center of your body all the time. If somebody pushed you you’d fall over. How is that something that makes you strong? Then on top of all of that, and this is a lot of what O’Sullivan talks about: when you are told that the only remedy for your back pain is to brace your core then you automatically are going to believe that your spine is weak, or crumbling, or whatever way you want to describe it.

In reality, your spine is so strong. Your bones are stronger than your muscles, right? Their bones. I think that if you if you ever take my class, you will never ever hear me say that word.

Kathryn: 00:35:59

OK. There is this other belief that in people who have back pain the core has switched off.

Laura Baehr: Yes I’ve heard that.

Kathryn: 00:36:09

Somebody made a comment on one of my Instagram posts the other day and they’re like “well what about this. The research that shows that when you have low back pain chronic low back pain your core turns off”. I just thought about it just in terms of my own body. I used to experience back pain for a number of years I had low back pain. I mean my core was not turned off. I was still like breathing and jumping and doing all of the amazing things that my body could still do even though it had low back pain.

I’m wondering about that research and what you think about it? Aside from that like is it helpful to tell people with back pain that their core turned off?

Laura Baehr: 00:36:51

Yes. I love that you’re asking me this question. Again I want to point out the fact that the research that is done in this area is really looking mechanically way more than the nervous system.

When they do this, they’re putting electrodes on people’s bellies and they’re having them do a supine march or a dead bug or whatever or plank or whatever position they deem to be the one that would turn your core on. They’re seeing that those people have decreased firing as compared to those who might not be living with low back pain.

00:37:24

What I want to say is: there is the flip side to this coin. I don’t want to go diving into a neuroscience lesson but for the listeners, all that’s really important to understand is that: your spinal cord holds both sensory and motor information. When you have pain the sensory information can literally override the motor information that your brain is trying to give your body.

It’s almost as if you had 10 sensory fibers, I’m making this very very simple. Please don’t take my word for word here. But as an analogy: if you had 10 spaghetti strings, 10 nerve fibers for sensation in your spinal cord and 10 for motor; under normal circumstances the person with chronic pain, they’re sensory fibers are firing like crazy. They might even have a higher density of sensory fibers that are responsible for pain.

00:38:16

If all your body is telling your brain it’s pain pain pain pain pain, then your brain is not going to have that output. Not only the information highway capability but it’s not going to want you to move those muscles. Again your pain system is meant to prevent threats to your body. It’s not that we need to train those people’s core. It’s actually quite the opposite.

We probably need to help those folks really breathe, really get their nervous system into a state of relaxation so that they can actually feel those muscles. It’s not that they’re not working it’s that their brain is not as well connected to them.

Kathryn: 00:38:56

Yeah that’s a really interesting distinction. I think it also kind of speaks to there’s a lot of people right now who are talking more about like the reflexive nature of the core. How our body just responds to a certain stimulus in certain environments.

Really tuning into that and maybe a little bit of extra awareness is also a really great thing. As opposed to this idea of like “you need to engage your core”. “You need to think about it and engage all these right muscles at the right time and while you’re doing certain exercises”. I think there’s been a bit of commentary on like maybe we’ve been like over managing our cores for a little while.

Laura Baehr: 00:39:40

Absolutely. And then again this is my little P.T. brain coming out but you have to make it meaningful to the person; it has to be meaningful to the client. Even if you’re not a therapist. Let’s say that you’re working privately one-on-one with someone and one of their big goals for their private yoga sessions with you is to be able to get on the ground to play with their grandkids. Are you going to have that person do it’s kind of planks if they have back pain?

I mean they’re low back pain is probably going to be bothering them when they’re transitioning from standing or sitting. How can you find positions to break that motor pattern down or have them practice in small meaningful chunks that don’t bring on their pain? That’s how you start to get somewhere.

Kathryn: 00:40:23

I feel like this brings us into the last question the last topic that I was going to ask you about today. I know in a lot of classes and I have said this myself probably so many times “if this hurts don’t do it” or “if you’re doing this and it gives you pain like stop or pull back or modify or whatever”. Then you have people who have chronic pain and maybe it comes and goes and changes but like they have some type of pain all the time.

I think that sometimes when we use cues like “Don’t do this if it hurts” that kind of leaves all of these people who have chronic pain in this category of like “well what am I supposed to do?”. If we continue to use cues like “if this hurts don’t do it” what does that also just kind of like subconsciously tell the people in the class about their pain? Right.

Again the expectation. Right. If you set up the expectation a person should not move through something that makes them have pain, then the expectation is that that movement contributes to their pain.

Laura Baehr: 00:41:30

Yes. Which is not always true. Now there is the other piece which is you want to make sure that you don’t have your clients suing you because they feel like they hurt themselves in your class. Right? I understand that. But I want to say, truly, I think most people, whether it’s their physician, their therapist, their movement teacher, they really look to you as the expert, right?

They don’t have a certification and teaching yoga maybe. Well, I’m assuming. Let’s just say they don’t. They come to your class for the information you give and if you’re lucky you have regular people who like to take your class. Someone like you, you have a huge following.

00:42:13

Those people, all of your people really listen to you. You asked me earlier you know what do I think movement teachers don’t necessarily think about with pain. It’s probably that words actually matter more than maybe they think they do. There is a certain level of responsibility for all of us when we are creating safe inclusive movement spaces that we have to watch our words. We have to watch our language and we have to really understand the people in the room with us.

Kathryn: 00:42:45

Mm-hmm. Mm-hmm. This has been so wonderful so much. We’ve got to have this conversation.

Laura Baehr: 00:42:52

Me too. Thank you so much for having me.

Kathryn: 00:42:54

Yeah. My pleasure. I love getting the chance to ask people about these pain questions.

Laura Baehr: 00:43:00

Yeah. Well, obviously I could go on and on. It’s a very important topic and I’m very grateful that you’re making space to have these conversations.

Kathryn: 00:43:12

If people want to follow you online, I know you have a new website that’s up now. I don’t know how much you work on social media, but where should people go if they want to know more about your work?

Laura Baehr: 00:43:22

Sure. I would love for folks to find me at laurabaehrmove.com. My name m o v e s .com. On Instagram, I also have a fresh new page called Lab_moves where you can hear me talking about lots of different things, including the stuff that we talked about today.

Kathryn: 00:43:44

Amazing. Well, thank you so much.

Laura Baehr: 00:43:47

Thanks, Kathryn.

Kathryn: 00:43:50

That’s our show. Thank you everyone so much for listening. If you are listening on Apple podcasts and you are loving the Mindful Strength Podcast please consider leaving us a review. All of the reviews really really help. If you want to learn more about my work, my membership, my teacher’s course, or my new free course called Mindful Strength Foundations, you can head over to mindfulstrength.ca