Building a Personal Brand in Healthcare | Tom Walters Shares How

[00:01:34] Tom Walters there are so many myths out there around pain that you and I see all the time that are just really outdated and old and have no evidence to support them. And I think the whole trigger point, tender point is one

Welcome back to the modern pain podcast. Today. We're talking with Tom Walters, the powerhouse behind rehab science. You've probably seen Tom's content helping millions around the world through Instagram, YouTube, and his bestselling book. In this conversation, we explore how he went from a traditional PT to building one of the largest digital health brands out there.

[00:02:02] Mark Kargela: We dive into how to actually help people in the modern healthcare world, even when you're not physically in the clinic with them. If you're ready to rethink coaching, rehab, and what the future of pain care really looks like, stick around.

This one is packed with insights you don't want to miss. And later in this episode, Tom shares how digital rehab is transforming lives globally, and why PTs who don't adapt might get left behind. Let's dive in.

[00:02:24] Announcer: This is the Modern Pain Podcast with Mark Kargela.

[00:02:29] Mark Kargela: Tom, welcome to the podcast.

[00:02:30] Tom Walters: Thanks for having me on, brother. Fun to finally chat. I know [00:02:34] we've, I've seen your name and we've had discussions over the years. We were just talking about all those years back in the pain groups on Facebook. So fun to actually get to talk to you. Not almost feels like in person.

[00:02:45] Mark Kargela: It's getting close these days. Who knows with the metaverse and all those things, we might be pretty dang close, but great to talk to you as well. I think we've had mutual admiration of everything where each other's doing and seeing some of the stuff online. You've obviously grown quite the brand with rehab science and what you're doing.

I'd love if you could give the audience, a lot of folks I'm sure listening to this are aware of you, but if you can give people a little bit of a background of your journey to where you're at from your days in kinesiology education to where you're at now.

[00:03:11] Tom Walters: I started out my bachelor's degree was in exercise science, kind of the kinesiology, like a lot of us PTs do. I grew up in Montana, so I went to Montana state for my undergraduate degree and I was an athlete in high school, martial arts and gymnastics. So. Great sports as I look back on it for becoming a PT, just in terms of kind of body awareness and mobility and strength and all these things we talk about.

But I went, I went from my undergrads kind of straight. [00:03:34] Over to the DPT and I did that at Chapman University in Southern California, and then I was always interested in orthopedics. And I think just having that exercise science, really a fascination with exercise, physiology and exercise science, orthopedic, physical therapy felt like the closest thing to me at the time.

So I finished that degree in 2007. And did a sort of quasi orthopedic manual physical therapy residency. It was one where I would go on the weekends. It was kind of skull pan taught it, you know, skull pan, but he taught, I would go down on the weekends to this Casa Kalina center and we would.

basically practice techniques and then go back to the clinic during the week and implement them. So it wasn't a full residency, but sort of, like I say, kind of a quasi hybrid type one. And then see, I basically practiced in insurance based PT. I only lasted two years. I just kind of knew it was a tough setting for me and for everyone, right?

It's just the, how fast you're seeing patients. I just, Had a hard time. I [00:04:34] could just tell it was gonna get burned out. And I think had this gut feeling that education was always what I was kind of most passionate about. I had taught Taekwondo all through high school and really enjoyed that. I actually thought I would open a Taekwondo school instead of going to college.

And so reflecting back on the education passion, I was lucky enough to get this by chance and adjunct position at a local college here in town. I'm teaching biomechanics and motor behavior at the time I taught those. One was one semester and one was the other. And so I got some experience teaching, realized I really loved being in that setting and the college got to know me.

And so then a couple of years later, they had a full time position open up where I taught biomechanics and. It was really just a biomechanics position and obviously not having a PhD in biomechanics. I was a little different. It was more of like a, almost like an applied biomechanics in a way. So, and then that one year position, basically they, it's really hard to find a PhD biomechanist.

And this was a Christian [00:05:34] college. So it had to be a Christian PhD biomechanist coming to Santa Barbara, which is an expensive town to live in. So they had a really hard time filling that. I ended up being there for 10 years. So. In that time, I taught other classes. I developed a pain science class, taught a therapeutic exercise class and really thought I would stay in teaching, so I went and did a doctorate of science at Texas Tech.

And I needed that academic doctorate to stay in a tenure track position. A lot of these academic institutions won't take the DPT for a tenure track teaching position. So I really, I went through that degree and thought that was kind of the road I would go down. And during my dissertation, I'd been in that doctor of science for five years.

I really kind of came to the conclusion that I didn't want to be in a tenured teaching position. So I ended up leaving the degree and the teaching position in the spring of 2019. Luckily before that, I had started rehab science on Instagram in late 2016, just as a hobby, really, like just to put. Positive information out [00:06:34] to people related to physical therapy.

Nobody was talking about those accounts as a business back then, you know, it was just, people were just putting up like their pictures of their food. So but I, I, I feel really grateful for it because it grew an audience on Instagram initially. And, and over time I kind of realized, you know, I could go back to seeing patients and I could also try and grow this rehab science thing and see if there was some way to make it a business and monetize it.

And that's really what I've been focused on really since. Spring of 2019. And so now it's Instagram and YouTube, and I have the book and, you know, working with people virtually, and then eventually probably looking at developing courses, maybe a rehab science certification really just trying to serve all types of health and fitness professionals with education, but also people in the general public who are suffering from pain and injury and.

Maybe live in places in the world where it's too expensive to access care, or there's just not physio. Like, I mean, a lot of the followers I have are in India and they just don't often have good access to [00:07:34] care. So. It's been amazing. I think you and I were talking about just how you, the many, the number of people you can reach online.

You know, there's lots of negative things about social media, but there's lots of positive things too. So

[00:07:45] Mark Kargela: I can echo that. I mean, not nearly to the scale you're at. I was just looking at 1. 5 million subscribers on Instagram subscribers on YouTube. That's impressive. And I know you've seen Instagram go through its iterations to where now, where it was mainly focused on. Photography based now.

It's obviously much more than that. And obviously things moving towards video. I'm wondering if you can get a little bit into the book. I Tom was so kind to share a bit, share a copy of the book. I've peeked into it. It's an amazing resource. So that had to be a pretty decent undertaking. I know you had somebody I think that co authored Helped you put that together.

I'm wondering if you can talk to the process of that, because I know there's folks listening who are maybe interested in packaging their information into something that can help some people, maybe not to this degree, because I mean, this is a [00:08:34] massive undertaking, but what were the steps that kind of went into that?

[00:08:36] Tom Walters: It was a, such a fun process, but a ton of work, like you say, I started that. In February of 2021. So it was kind of nice. It was during COVID and things are just a little slower but it ended up being a two year process. And, you know, that book's almost 500 pages. So it is it's textbook size, but it's meant to be sort of like an applied book where the whole body's covered.

It has rehab programs. It has a lot of the science of pain and injury rehabilitation. We kind of wrote it, and like you said, I had a co author, Glenn Cordoza, who's an awesome guy. He's authored, co authored a lot of books people are familiar with, like Kelly Starrett's Supple Leopard book, Brett Conchera's Glute Lab.

Like, Glenn is an amazing writer. He's been doing it his whole career, and has only written health and fitness books and martial arts books. But you know, I would have never completed this without his help, because he, he's the type of guy who's a black belt in jiu jitsu. He's very disciplined. He just gets up like 4 a.

m. every morning and writes for eight hours. So he's, It, the project would have not, I would have never done it on my own. [00:09:34] So he was a huge part of it, but it is, it was amazing in that I think when you're practicing, you have a general kind of system and, and, and a way of thinking when you evaluate and treat patients.

And there's something amazing about having to write that down that kind of helps bring clarity, clarity to. Your system and how you approach patients. And I think a lot of that for me came out in the book, especially in the way we organized programs and thinking about what are. What are the most common conditions that I've seen over my years of practice?

What are the ones I'd want to include in a resource like this? And then how would I, if I had to break, you know, programs down into phases, how would I think about the steps that I kind of go, is there like a general kind of framework that I go through with patients? And obviously something like a book has to naturally has to be kind of cookie cutter in terms of programs, because you're not evaluating something.

Obviously, if somebody comes in the clinic and sees us. We identify their [00:10:34] specific symptoms and impairments and give them really specific interventions for that. So a program and a book kind of includes, it's, it probably more than the person needs, but you're just trying to hit everything. But it has been, it was such a neat process and it's been really cool to see the book.

Every day I wake up and somebody's tagged me somewhere in some country, Tanzania, somewhere in India, like amazing places where people just have the book and it's helping them. And I think. That's another aspect to me where the social media is amazing to be able to reach people and provide education all around the world.

But then something like a book, you can just really get into the nuance and be way more comprehensive and kind of. Put all of your thinking into one resource and really, I think, make an impact hopefully a positive impact on people. The interesting thing about the book process, I think it's changed over the years.

When I was talking to my publisher, which is called Victory Belt, they basically told me that they kind of only approach people who have an audience. You have to have a certain size of audience. And I think that's the [00:11:34] filter for a lot of publishing houses now, which makes sense because there's built in marketing there.

You already have an audience to market to, and you and I were talking about how much we take in business, kind of. YouTube videos and education at this point and I think there's so much to that like any PT who's listening to this or any practitioner? I think it's there's a lot to be said for thinking of yourself and what you do as a practitioner as sort of like a personal brand and starting To build that now, because if you can build an audience, it really opens up so many doors.

And you know, obviously there's self publishing routes, but if you're looking at kind of a legit book, you kind of need to have that audience first. And so that's just one example of an opportunity that can come from that. But I think besides helping people, keeping that as the foundation of what you do.

If you like teaching and helping people and maybe also have the creative side of creating content is fun to you. I think it's a good thing to start [00:12:34] because it just, the directions you can go with it are kind of endless. And I mean, like I said, I'm just, I would have never thought I'd go to physical therapy school and be doing what I'm doing now, but I'm so thankful for it.

I'm a huge introvert, so I actually get really drained from seeing patients all day. But I. Have endless energy for putting things online and messaging with people there and just find it to be super rewarding. So definitely to encourage anyone who's thinking about it, like start, start just working on it, just, just start putting things out there.

It doesn't have to be perfect. Just start trying to do it and help people.

[00:13:05] Mark Kargela: What would be your response or kind of advice to people because we've talked about social media and I know you've experienced it because no matter what your messages and no matter how altruistic and good intentioned it is, there will always be the folks on social media that find a way to rain negativity onto things.

And I've had to learn that lesson myself of not, letting that stuff and just recognize what the mission is. Who you're trying to help and that regardless, there's gonna be people who just don't jive your mission, your [00:13:34] words, all that stuff. What would be your advice to people who are maybe a little bit fearful to put themselves out there just specifically because of that?

[00:13:41] Tom Walters: I think you just have to know that's going to come no matter what. Even if you're trying to be the most honest, truthful trying to avoid kind of nocebic, harmful language. You're not trying to manipulate people. You're literally just trying to put out things that are helpful. You're still going to get people coming in there and criticizing you.

Saying horrible things. And it took me a lot of years especially the years on Facebook. I remember I used to get into these discussions and be so angry and it would affect me the whole day. And my wife was so annoyed about it cause it would just impact my whole day. And so when I kind of moved over to Instagram, I don't know what happened, but I think because of how the platform structured, there was a less of that than Facebook, just the nature of discussions.

There was a little bit less. I wasn't feeling quite so negative. Once in a while, somebody would come in and say something and I'm pretty sensitive to it. So I still respond to most comments and sometimes things will irk me. But it [00:14:34] doesn't affect me quite the same way. Maybe cause it's shorter, just little things.

People are saying it's not some long, I don't know what it was. A Facebook Facebook really bothered me back in the day, but I've gotten better, I think slowly over time. I realized that no matter what you do, even if you're out there trying to be helpful and putting out again, content that's honest and expresses on, you know, you're, you're just being honest in that you aren't 100 percent certain things change, science changes, you're just doing the best you can.

There's still going to be people who criticize and just you know, just a rude and nasty. So you just have to realize that comes with it and not have that stop you from. You know, not stop you from just starting doing something like this. If you have an interest in it, some people, this isn't going to be their thing, right?

They maybe want to consume educational content, have no interest in creating it and being out there. And that's totally fine. But if you do have some interest, you can't let that component stop you. ,

[00:15:29] Mark Kargela: I'm sure if you peeked at some of Tom's posts online or definitely some of ours, we've had [00:15:34] our folks who definitely don't agree and that's fine. I think that's healthy and I think, and I try to keep those folks in my feet just to make sure I'm not getting too tunnel visioned into the way I look at things, but there are people who maybe could interact in a little bit more of a professional manner.

But again, I don't, I've can definitely empathize with the thoughts of like how that affects you, right? When you get that one just angry post that just starts attacking things, even almost like personal, getting into things that, go away from the discussion, how that can affect you and having to learn skills.

It's similar to clinic, right? There's patients where they come in with some pretty significant emotions into the clinical world and you have to be able to diffuse from your inner, frustrations and emotions that want to react to those folks and try to be present. So I think it's skills you can learn online skills.

Obviously, you learn in the clinic.

[00:16:19] Tom Walters: Can I something to that? I think you're totally right. Like there are so many things over the years that I have changed my perspective on because of actually a good critical comment. So. Even though I want to be a little defensive and sensitive, I, sometimes I look back on it, like [00:16:34] I've had someone, like another clinician comment, be like, I wouldn't give that exercise.

And I'm like, ah, I thought about it. I'm like, it could be something, I had this happen recently on a hand post and I'm not a hand therapist. So someone said, I wouldn't do that. And I was like, I was a hand therapist. I was like, that's probably true. So, you know, I've changed things. And the other thing you have to realize is that it's everybody in the world potentially commenting and not everyone has English as their first language.

And that's another thing I had to really realize is that sometimes non native English speakers, the way that they will type something in text sounds aggressive. And it's just. How they're writing, I mean, it's just how it's coming out. So I think I've had to step back and not be so reactive. It's been a great practice.

It's kind of like the clinic, like you say, I mean, for me, it's always been easier in a clinical setting. I'm kind of a naturally agreeable kind of people pleaser. And so when somebody is in person with me, it's real easy for me to say like, Oh yeah, yeah, totally. And like, just kind of work with them and something about written language.

It's. easier for me to feel sensitive and defensive. So [00:17:34] I've had to really practice kind of stepping back and not being reactive as best I can. I still make this mistake a lot, but kind of just like, what does this actually mean? Maybe the way this is coming out isn't how it's intended. I think written language is like that.

Even people I'm sure. People listening to this can think of text messages when they interpreted something as aggressive or angry and the person didn't mean that at all. So that happens, especially when the person's English is not their first language. So another thing to keep in mind,

[00:18:01] Mark Kargela: I think that's the, examples of growth is a person being able to take on criticism and not take it personally and be able to use it as a tool of growth. Of course, there should be comments that may not add much substance to the conversation, but I think being able to Have some intellectual humility.

I think there's that whole meme of like, when you come out and you think, so much, and then the reality of like life strikes and you're like, man, I don't know much at all, you try to stay chapters ahead of the folks you're trying to help as much as you can. And, but there's always going to be more to know.

And especially when you're, when you have such a massive audience where you could be. You got [00:18:34] such a wide slice of people where good chance there's gonna be some people that might have had some unique more, experiences that might add some value to and again, being able to take that comment and add it to your repertoire and then, add more value to the folks as a result.

That's

huge.

[00:18:46] Tom Walters: for sure.

[00:18:47] Mark Kargela: I'm wondering. With you being, I guess I would say definitely on the leading edge of kind of more digital, healthcare, where you're helping people from, it sounds like a coaching perspective, but also virtual, I'm guessing you're getting into rehab. I'm wondering if you can speak to that a little bit of like where you see where we're at with kind of digital, be it coaching, be it more formal healthcare.

And where do you think we need to go? Like, where do you see it going in the future?

[00:19:11] Tom Walters: I think Moseley, Lorimer Moseley years ago said something. Someone asked him this question about where he thought physio would be in a hundred years. And I think he said something about kind of to the idea that it would be more of a coaching. Kind of helping people navigate their situation, their symptoms, rather than so much of kind of the passive interventions and hands on.

And I [00:19:34] really do think that's probably, look, I did a manual therapy residency. I still really, with certain patients, through whatever mechanism, I think there's power in touching, like in touch with certain patients. Some people don't want that at all, you know, and always it's with this narrative of this isn't.

Mandatory or something that you have to keep doing to stay healthy, but maybe something just to help kind of calm pain down a little bit and get you towards movement and exercise. And so, but I do think I view myself more as almost a rehab coach or like a pain coach these days. And I think when you think about virtual healthcare I was sort of apprehensive about this, I think, especially when COVID was starting, like, how was this really going to work out?

But I think in the years of being on social media and then doing more virtual consultations, it has been surprising to me how powerful just coaching people through their symptoms, [00:20:34] encouraging them, giving them some kind of movement based strategies, some behavior modification things to implement in their lives to prevent things from flaring up.

I think it has been Interesting to see how much that helps people even when you can't touch them. So I, I think as we become more and more, it becomes easier to be connected over something like a computer or a phone like this. And with AI and apps and you can imagine apps that just sort of have decision trees where you enter your symptoms and it kind of takes you, Oh, you've got.

Symptoms on the outside of your elbow and it hurts when you do this movement. That sounds like it might be tennis elbow. Like here are some exercises you could try. I think things are going to become more and more like that and it will end up serving more and more people in a positive way. Again, it won't be, I still think the gold standard is obviously getting to see somebody in person.

And having them build a test you with their hands and maybe implement some manual therapy and give some really specific [00:21:34] kind of guidance on movement and exercise. But I just think that's not the reality for a lot of people in the world and I just, I think the future that's going to impact the most people are things like this where it's virtual and you can kind of coach people more than anything.

So it's almost like a lot of strength and conditioning coaches do right where they're understanding someone's goals. And then building exercise programs for them and then coaching them through that. I think there's a lot of that that we're going to be doing more and more as time goes on.

[00:22:07] Mark Kargela: One of the. best things I've done, which is probably the more scariest things. I was working with Evidence in Motion and having the privilege of working with Adrienne Louw's group and then had the decision to either do what I'm doing here at Modern Pain Care or stick with, teaching there and shelving the Modern Pain Care thing.

And I have nothing but good things to say about Evidence in Motion and Adrienne Louw. They've been huge impacts on my practice, but you almost get Pulled into and again, there's teaching what currently and [00:22:34] hopefully we'll move, further and further, but it's still, traditional manual therapy things and different, more things that maybe need some evolving.

I think it manual therapies evolved quite a bit, but I just feel like there's so much more we can do to help people and not. Box yourself into where we have to have this hands on thing. I, I see friends and colleagues who are, we're at the manual therapy conferences every year and they're talking about the same stuff.

And again, I'm not saying there's anything wrong. I think there's great information and stuff like that. But I sometimes wonder if that doesn't limit our ability to see outside the box to do something where you're doing a coaching thing to have you had any brushback from clinicians when you look at this kind of coaching things.

I know for me, there was a part of me where I so identified as a manual therapist, and that would have been scary. And for me to I'm leaving the clinic. I'm not laying my hands on people. I think now I still do it. Like you said, there's the time in the context, but I think you can do so much more.

And I honestly think our biggest barrier to doing it is us and our beliefs and it's when we actually try it and that's one of the things I'm thankful for kind of leaving. Evidence in [00:23:34] motion and that is I didn't have to be chained to I have to do the company way of like hands on and I'm saying they're, I mean, they're very eclectic.

I'm not but it allowed me to like experiment and say, Hey what if I don't? And what if I, put some clinical scenarios where I test this thought that, my belief that, majority of people needed hands on, care. And then, you test it clinically and then you see it when we did telehealth during the pandemic and stuff.

And I saw people do extremely well. Without me touching them just guidance and coaching and helping them navigate it what's been your experience with clinicians as they toil with that? I need my hands on but here's where we're moving have what have you what's been your experience?

[00:24:11] Tom Walters: I would say I've had two types of pushback. One is from clinicians who really think in person is the only way to go, you know, in person care. And I've had some, and especially some of them are manual therapy based practitioners. Some are just, yeah, I would say all of them probably have some degree of kind of.

really high value on being able to touch people in their assessment and [00:24:34] being able to implement manual therapy. Man, I was like that for a long time. Almost everything I did was manual therapy. It just, it was so heavy. All the courses, continuing education. It would have never, I don't know that my mind would have changed unless I'd been on social media and started seeing the impact that just guiding people had without touching them.

So I think I definitely see some of that criticism. I don't get as much of it. Anymore, maybe because I am kind of in this space where people are just used to the online space, you know So it's it only happens once in a while Like if I'm talking to a clinician here in town or a friend who's a clinician is not it's the people who aren't online You know, they'll be like what it why would what that doesn't make any sense.

Like that can't be as good so I get some of that and then you know, of course I do get some criticism from clinicians about You know the content I put out being too general and not tailored to anyone and I get it. Yeah You [00:25:34] the gold standard is evaluating the person Understanding their history their symptoms and seeing what impairments they have and then making decisions based on that Of course, that's the gold standard But again, there are a lot of people that just can't afford to do that or don't have access It's easier to access it, but some people just can't afford it.

So I understand where the criticism is coming from. And at one point I probably would have said like, why would you just put out cookie cutter general stuff? Like that's inappropriate, but I really have seen that it helps a ton of people. So I think if you can provide education to people that helps them navigate, okay, these are the symptoms I have.

This is most likely what it is. These are the things in life that tend to aggravate that. So let's think about modifying those behaviors. And then here are some movements and exercises that tend to help people with these types of symptoms. If you experience symptoms doing these, then these are some ways you can regress and modify.

And I think if you give people kind of that tool set, it not only helps them [00:26:34] navigate that issue, but I think that also helps them understand how to navigate future pain issues. And so I, I just have seen that it can have such a positive impact, even though it's general and not specific to that exact person.

[00:26:49] Mark Kargela: And you're pretty explicit in the book to like and if it's not responding or and if you're seeing these signs and symptoms This is probably something you want to be Getting a specific examination from a qualified medical practitioner, I, as I was peeking at the book, I didn't get any sense that there was just like, try it and see what happens.

There's a pretty structured approach. You give people a little bit of education of how to like, grade a muscle strain, right? Whether they, if they see bleeding and bruising and things or you probably did more than a grade one, you've, and that might be something where, and you give people pretty solid, thinking or kind of reasoning strategies that will work their way through it to see.

And then, I usually tell people as I'm giving them some guidance, cause we all get those emails and things like, Hey, this happened, what should I do? And try these things. And if after about two weeks, you're not You know, moving in the right direction, you probably [00:27:34] want to go see somebody.

So yeah, I think you're pretty, pretty forthcoming with that in your book, correct?

[00:27:39] Tom Walters: I think the hardest thing is social media, you know, cause social media is, that's where I get, take probably the most criticism. I haven't had a ton in the book, I think because it is, you can get into more of the nuance. Assuming people read those chapters. The problem is that so many people get the book and just go to the programs and don't read the first 10 chapters on the most important science of pain and injury.

And so I'm always hoping people will go back. Social media is the harder part for me because It just you know, I don't, maybe I should be better about this. I don't put a disclaimer in every post. I'm I, you have a limited amount of text and I'd rather use that to talk about the issue and how it's treated rather than take a paragraph to put a disclaimer.

And so you just hope that people kind of over time, understand that. know, if these aren't appropriate for everyone and it's a general kind of, we're looking at this sort of generally and things that help most people. And if you don't get better in a certain timeframe, like you say, like two weeks is a good, or if you have certain red flag [00:28:34] symptoms, like go see a healthcare provider in your area or do a virtual consult, like talk to someone about your actual symptoms.

[00:28:41] Mark Kargela: I completely agree. I think it is impossible to like, have disclaimers on everything. I think you put it, front and center as much as you can in your, some of the basic stuff on your channels and in your books, but. And then like you said, people are going to flip to the pages where you have a good introductory, components in the book about pain and helping people conceptualize pain.

And I can imagine for patients, I mean, and you had one thing I was meaning to ask you, and this is selfish questions. So those you listening, you're gonna have to deal with it. Pictures, illustrations, how are you going about those? Because that's one thing I've looked at just as far as trying to create materials for some of our content and things.

I mean, you have some pretty high quality illustrations there. How are you going about that?

[00:29:19] Tom Walters: It was kind of a two part process. The for a lot of the kind of more simple illustrations in the Back of the book and the programs, like say it's an illustration of like tennis elbow. I, we had in house illustrators at at Victory Bell at the publisher. So [00:29:34] I would find an image online that I thought represents something well, and then they would tweak it.

And we give sort of cues on how realistic we wanted the anatomy to look or, you know, and then it, so it was like kind of a kind of a figuring out process of what the style would be. And then they would apply that to all those images that I would send them the first few chapters that are a little bit more, I would say, like, unique and kind of creative illustrations, the first, like, in the, especially the pain chapters.

I actually have been friends with a guy on Instagram, his account's called Fizik, and he does a lot of really interesting illustrations around strength and conditioning. And so I actually reached out to him and asked him if he'd do illustrations for the book. So he he's in Italy and is a kind of an exercise physiology guy, but also an illustrator.

And so he did all these illustrations and especially the pain chapters. So, and they came out awesome. I think they help tell a story about the complexities of pain that you can't find easily in most, because as we know, most resources online about pain are very kind [00:30:34] of outdated, very. Very mechanical and don't always speak to kind of the com, the complex kind of multi dimensional nature of pain.

So he had that background. He's been interested in pain but also exercise physiology and so he was really easy for me just to kind of give a few cues on what I'd like the illustration to show and then he'd come up with something. So it's pretty cool.

[00:30:54] Mark Kargela: You can definitely see he's talented, the illustrators that you had in the in your publisher as well talented, but definitely the ones around pain. I was like, dang, these are solid for sure. I'm wondering, part of online often happens is people who have maybe been not had the best experience with health care systems and are looking for solutions to some complex problems.

Come yeah. To your channel and maybe come into your DMS and all that stuff or commenting on things. I'm wondering what's your experience with some of the, complex pain situations out there that people have. I know you have, like you said, resources in the books that hopefully helps people start understanding some of that complexity.

But have you seen that a bit where people are getting a little bit disenfranchised or maybe not getting as much help from health care? Not [00:31:34] despite great efforts. I think you and I both probably had our times where we weren't very helpful to complex pain when we were operating and maybe some dated theories of getting about it.

But what's been your experience there?

[00:31:43] Tom Walters: It's still as tricky. I mean, I think I for sure have interactions with people who have more persistent kind of complex pain states that even still will come in here into the clinic that I see or I had a virtual consultation with someone recently that Just sort of really unpredictable debilitating back pain that would kind of come out of nowhere and Tried to, you know, did, tried to help him in the way I could virtually.

And then I actually ended up sending him to former students of mine who have become PTs who were, one was a pelvic health specialist just. Tried to send him to in person clinicians in his area and even still reached out to me the other day, still struggling and And then I, you know, so just, I'd recommended him to, I'd listened to Huberman had a pain specialist from up in Stanford, up at one of the [00:32:34] Stanford centers that they're pain center on.

And so I'm always, you know, I think those situations are hard sometimes, you know, some of those, sometimes you get people where I think you find the right, You find the right kind of strategy you know, I think sometimes you get these people who have had persistent ongoing symptoms that still are mostly mechanical in nature and maybe, you know, like I had someone recently who the place she was at, it was just that they were pushing her so hard into pain that it was just keeping her aggravated.

And I think she was starting to believe that it was a chronic pain condition, but I think it was really just more of a mechanical pain that had just been there for a long time because the tissue just wasn't recovering. And it wasn't being Her program wasn't being structured in sort of a graded way where it was just always like she was getting knocked back.

And so, I think sometimes you get people like that, that You can make differences with just by listening to them and understanding the situation and then trying to have a logical path forward that kind of gradually [00:33:34] exposes their body to more stress. And I think that happens also virtually and I see that sometimes with people online and those types of consultations where a lot of the people who I end up interacting with online, their experience with physio has been unfortunately very poor.

You know, it's a lot of passive modalities, so ultrasound, e stem, just, it might have some manual therapy sometimes, but it usually is, if there is, it's just manual therapy, and there's not a lot of movement, or exercise, or sort of the coaching element that we were talking about, just kind of Good solid evidence based kind of coaching around pain and injury.

And so, you know, I, sometimes you get these situations that feel a little more like, I don't want to say like a slam dunk, but they're easier to help the person because they just haven't had good care. Or they've been, maybe insurance wise, they've seen people and just haven't been able to, because of the way the healthcare model is structured, they haven't received good [00:34:34] care.

Haven't actually been able to spend time with people and kind of develop a plan that really makes sense for them. So there are situations like that that are good, but I, I definitely have. Once in a while, one comes up where someone is really struggling and even, and I still have times where as much as I, as I, that I've evolved from when I became a PT in 2007 and I was very postural, structural, biomechanical in the way I looked at pain.

I've changed a ton since then, but still there are people that are really hard to help. And I think I'm okay with that. Today, because I realized that humans are just really complex. My mom's a psychiatric nurse practitioner and my dad was a social worker for years. So I come at this from also seeing the mental health, mental health disorders.

And I think things, things don't always, things aren't always easy to treat. And even when you find a treatment that works, things don't always resolve 100%. And I think that's true in mental health disorders, and I think [00:35:34] it's true in a lot of pain disorders, and I really think there is a lot of truth that if you can get someone, you know, maybe someone has severe pain, and hey, if we get you from an 8 out of 10 to a 3 out of 10, and you can function, but it's still kind of there, is that Good enough.

Like, would that be okay for you? And I think that's the reality in a lot of cases. And I always tell people up front, they've had something for a long time. This may be the reality that it doesn't. You figure out how to cope and manage and you can function life, but maybe the symptoms don't 100%. Resolve. I can't say some games.

You get people who you think they're Simmons aren't gonna resolve and then they do go away. You find the right intervention. You're like, blown away that they got that. They don't have a pain anymore. So that's kind of where I'm at with things now. And just being okay with sometimes, sometimes things don't improve as much as you'd like them to.

And that's just part of being a human. I think,

[00:36:27] Mark Kargela: You bring up great points. I think the ability and the skills to have therapists comfortable in those scenarios [00:36:34] where, hey, pain probably isn't going to go away. Let's get you living. And a lot of people where they're living a lot and are dramatically better, even though they might even say there's a number on that.

NRPS isn't dramatically different that's been a hard transition for me personally, because I think we're all in that. We want to help everybody and as we should, but sometimes Yeah. Our help may not be as you nicely stated that it may not be getting you to zero, maybe getting to life and then maybe secondarily that number drops, but man, what if life was so much fuller and bigger for you, would it be okay?

Would you be willing to have that 5 out of 10, but you're doing all the things that you mentioned were important to you. So great points. I'm wondering, you mentioned a little bit about that patient who is getting some aggressive treatments and you put in your book as I was peeking at it a bit about, Trigger points tender points because that's one that you know can bring up some interesting discussions to say the least but and I Having you know doing CrossFit and working around those folks, which you know, love the people.

They're great friends sometimes I cringe at like it's this belief that you just absolutely [00:37:34] Bludgeoned the body with painful treatment to get and it's almost like the more it hurts the better. It's gonna help It sounds like you had to maybe throttle that patient back or maybe give him a little bit of a little let's push back from always cranking into painful things.

What's been your approach? I know for me, I've. Definitely reformed. I remember when I came out, I started in a clinic that was very soft tissue based and you found a tender spot and you drove your elbow or your thumb or your knuckle into it and you and strangely people got better, some people obviously I flared the heck out of them, but I'm wondering how you approach that, clinically and maybe you can share how you talk about in the books.

I think you have a good perspective of it in the book as far as maybe having people not just how You know, belaboring these tender spots that they had, these knots have to go away for me to be better. Cause there's definitely those patients where they get pointed the common tender spot that we all contain in various parts of our body.

And then they spend inordinate amount of times, just bludgeoning their body with all sorts of sadistic tools. And then we've, I've been there, so I'm not by any means saying that I'm innocent of this, but what's been your [00:38:34] experience.

[00:38:34] Tom Walters: You know, both intentionally, unintentionally, there are just, you and I were both in this position at one point, like unintentionally, probably making a bigger deal out of sort of like common tender points that people have. And I think there's a lot of. You know, the whole trigger point kind of idea.

It's amazing how many people you interact with. Someone just talked, someone was just talking to me the other day who just had probably just kind of like a tendinopathy. No real traumatic injury or anything, but had this belief that there were adhesions they needed to break up and scar tissue. And I was just like, no, you don't.

Why would you have scar tissue? You didn't injure anything. There's nothing, there's no scar tissue in there to break up. And I think, but that's been the message people have received from. Clinicians again, either intentionally or unintentionally out there. And, and I think, unfortunately there are clinicians, it's a great business model to tell people like, Hey, you've got this thing here that's, Ooh, that's bad.

That's a, you feel that? Like that's a real lump right there. Like you've got a real adhesion. We gotta, we gotta work on that [00:39:34] thing and break it up. And it's going to take you coming back here and I've got to work on it. And. I think, you know, a great example is the levator scapulae muscle. I think so many of us have tender point, have a tender point kind of up on our shoulder blade, kind of the top of the shoulder at that corner of our shoulder blade, and you can strum back and forth over your levator scapulae, and wow, it feels like this big.

Trigger point, I've got this knot here. Oh my gosh, I have to work that out. No, it's just your normal anatomy. Like a lot of muscles are very rope like and thick and you're just palpating a muscle. So, of course there may be tenderness there and we have lots of spots normally in our body that are tender when you push on them.

But I think if they're not hurting you when you're moving around and just sitting, don't stress about it. I think people spend far too much time On soft tissue mobilization, trying to, I don't do hardly any soft tissue mobilization. And then look, I have a whole account that shows manual therapy techniques. I'm using those on people that have active symptoms in the area, and I'm not trying to beat them to death with it. It's, this is where I think sometimes, The skin and the [00:40:34] fascia and all these things and muscles have a ton of free nerve endings and providing input into those tissues in some people seems to help kind of reduce their pain and who again, but a lot of potential mechanisms that he could be going on there.

But I think. From where I started with PT to now, I'm much less aggressive, I put much less force on people, and I use a lot less manual therapy than I did back then. And I think there's no real reason to just be bruising yourself. Whether you're a practitioner treating someone, I mean, I remember seeing clinicians I worked with making patients cry.

I remember seeing people with shin splints have their tibialis anterior worked on and just crying. Just, I remember this one clinician would have people, this one girl bite a towel. Just, the stuff that I look back on, I just can't believe that that's what was going on in the clinic. So, I just, I think there's no real reason for that.

I think a lot of people spend way too much time on soft tissue work. And I have a hard time, The other tricky thing is that people, [00:41:34] when they have beliefs, a lot of times they're strongly held beliefs, and I'm much more careful now about instantly saying, No, you shouldn't do that, and just Because I think when you push on a belief, people become more resistant to it and kind of defend it.

And so, I just had a guy talking to me the other day about how much he likes to use all these hard tools to do soft tissue work and how much it feels like it helps him. And I was just like, great! That's awesome! Like, if it feels like it's helping you, and maybe it's an encouragement towards Well, you know, what's it look like in terms of your resistance training program and your mobility, you know, training and what are the other exercises you're doing just to make sure they're doing things outside of the soft tissue work, but I was a little apprehensive to tell him he shouldn't do that because he liked doing it and so it's.

I'm at a point now, though, where a lot of times I'm telling people like this, there are so many myths out there around pain that you and I see all the time that are just really outdated and old and have no evidence to support them. And I think the whole trigger point, tender point is one so many people are worried that they have adhesions built up and [00:42:34] they've got to work those out.

And a lot of cases, it's just an area that's a little tender and it's probably just your normal anatomy. I just, I can't believe I always think everyone should have to in high school, take a kinesiology class. And just understand your musculoskeletal system and sort of just have a general idea of anatomy and kind of biomechanics and how the human movement system works.

You have this body your whole life. If you've never had a class like that, just go learn a little bit about it. So you're not, you're not made fearful by someone because unfortunately that happens too much with healthcare practitioners, again, intentionally and unintentionally. You're more likely to get scared about something health related.

If you don't know anything about your body.

[00:43:14] Mark Kargela: I think the whole tender point thing. I couldn't agree more. I think we spend way too much time pathologizing them. And I think dry needling. Again, I don't personally dry needle and I'm not saying any major things against it. I just think the latest way to poke on sore tender spots. And I know there will be people.

This patient was the only thing they responded to. And I mean, I could go back for my decades [00:43:34] of treatment and saying which patient. Yeah. The last new treatment that was the only thing that somebody responded to. But again, I'm not saying there's an application for the right person. It's just, I haven't found the need after watching some very good people use it, that it made any massive changes.

And then it becomes, like you said, the now what? Okay, yeah you drove your knuckle in it, or you rolled a hard lacrosse ball on it, or you poked a needle in it. Now what? And I think there's some good folks teaching it that, yeah, that is, that it shouldn't be the focus of things where. You're laying on a table.

And while you're not learning skills to navigate the loads of life that you got to endure, be it mechanical, be it psychosocial, be it whatever. I'm wondering, where do you think we need to go as a profession? I know this is a big picture question as far as like physio. I sometimes worry that we're lagging behind and stick into these dated Narratives of, yesteryear, and I think that's any profession, right?

Any healthy scientific profession we need to, there's going to be questions and things are going to be answered and it should call questions on some of our past practices, but, where do you think we need to be [00:44:34] heading? And what things do you think? I mean, we don't necessarily, cause everybody's going to throw it.

Don't throw the baby out with the bath water, Mark. And I get that one all the time, but where do you think we need to go in the future if we want to stay relevant as a physiotherapist or physical therapist?

[00:44:45] Tom Walters: I think the danger for us is that really knowledgeable and evidence based exercise physiologists and trainers might potentially, I don't want to say sort of make the physiotherapy profession not, I just think there's a potential where patients might start to wonder. Well, I'm, I can just work with my trainer and they know a lot about these things and they're guiding me through movement and teaching me things I can do on my own.

And I go over to this physio and they don't teach me those things and I just lay on a table and, and nobody's really giving me that much time or paying that close attention to me. I just think there's a risk for our profession that, like you said, sometimes pretty, there's some clinics and clinicians that are pretty outdated.

And [00:45:34] I just think if we're going to survive and continue to do what's right for patients and based on, I think, more and more of what's kind of being studied and looked at in the research, it's got to be really an excellence and movement exercise prescription. And not to say that you would totally get rid of manual therapy because I think there is something. I like having the ability to specifically know where to palpate a patient based on their symptoms and what I could do to make a change in that. Even if it's temporary, just quickly make a change. And I think that is a unique skillset. And look, and this is kind of a conversation revolved around orthopedic PT.

Obviously there's other parts of physio pediatric geriatric neurological PTs that do completely different things that are incredibly important. So I think in the world of like pain treatment, it's going to be mostly orthopedic PTs. And I think. In thinking about the profession being at risk, it's mostly, in my mind, the orthopedic PTs because there are so many other practitioners that treat [00:46:34] pain whether it's osteopaths, chiropractors, athletic trainers, acupuncturists, like there's so many people that kind of address that area and I think it's the orthopedic PTs that have to be careful and I think the future for us is the orthopedic PTs.

Maybe still having some of that palpation kind of manual therapy skill set. But more of a focus on really being excellent in understanding symptoms and how movements, how stress, like you said, could be biopsychosocial, how all of these stresses can influence your system, but then besides giving education and guidance on managing stresses, psychosocial stresses, really being excellent at Movement exercise prescription, and I think not just the therapeutic exercises we always think about with physio, but also like aerobic exercise prescription and general prescription with [00:47:34] resistance training.

I mean, I am so thankful to have had a strength and conditioning background and exercise science degree before I became a PT at the time. It was like, this just makes the most sense because it covers the prerequisites and I like this information, but now looking back on my time. Being in martial arts and gymnastics and then doing the exercise science degree.

I just think I came out of PT school being so manual therapy Focused and how I treated people to and really thinking I was super specific in my testing and my treatment to now Thinking I'm way less specific than I once thought I was and most of what I do is general kind of movement and exercise guidance and coaching

[00:48:14] Mark Kargela: I think the coaching skills too, of being able to take somebody and coach them through both from a load management, like you said, strength and conditioning principles and being able to take people and, be able to manage an injury and take them from start to finish can be huge, but also then taking the whole picture of somebody's pain experience.

Obviously, we're not there to be [00:48:34] dive deep into psychological issues. That's beyond our scope, but obviously helping people understand it. And maybe having some resources to plug people into Tom. I want to thank you so much for your time today. We could talk for another hour or two. I'm sure before we sign off for today, where can folks get ahold of you?

[00:48:48] Tom Walters: Obviously rehab science on Instagram and YouTube, maybe where else they can get ahold of you or and then any projects you got coming up or anything that'd be on the lookout coming up for you.

Instagram and YouTube are the best places to find content and honestly probably Instagram I try to check all those and get back to people people just let me know if they listen to the podcast and want to Come in there and have a question or something. I'm happy to try and answer those Yeah, I am.

[00:49:12] Tom Walters: I'm pretty excited I'm in kind of a phase right now where I'm I'm really in like a building phase with rehab science And so I've got I've got seven little books coming out. That will be basically my primary book has each body region has its own chapter. We're going to take those body regions and put them in a small soft cover book.

So some people want just a shoulder book and they want something to travel with. And this current book is like a [00:49:34] textbook. So it's kind of difficult to take with you places. So we'll have one for each body region and then. You know, my ultimate goal is to have rehab science courses and a certification.

I'd love to have something. I have so many people. Of all different types of practitioners in health and fitness that follow my account and have bought the book whether it's physicians It could be physiatrists. It might be different family physicians. It could be massage therapists pilates and yoga instructors personal trainers and of course, you know, like the new grad pts and chiros I think those are people that I really feel like I can serve.

Well, you know, they really experienced orthopedic pt I'm my content. They're going to be beyond. I think a lot of what I'm teaching. So, but those other folks, I think in all the years I've been teaching a lot of people in the fitness world, they know a lot of exercises, but they don't always know when to prescribe those and they're interacting with people who have pain all the time.

And so I think I really think there's a place kind of like what precision nutrition did with [00:50:34] educate nutrition education. I think there's a real place for sort of like yeah, I guess sort of rehab. Yeah. therapeutic exercise, almost education. And so that's really where I'm looking at now is creating something like that, that helps those folks.

A lot of people do that corrective exercise specialist certification, but there's not a lot of other options. of your PT, tons of continuing education, but I think for the kind of the health of other fit health and fitness. Practitioners out there. That's really what I'm thinking about is how can I help kind of bring them up to speed so they can help their clients, which again, another reason why we as physios need to keep getting better because these other individuals, there's plenty of educational resources and people are going to start catching up if you're outdated, not staying on top of things, So

[00:51:20] Mark Kargela: I think there's just the breadth of information at the fingertips that we have. I think it's it should be pushing us all to raise our game so we can stay relevant and stay as a preferred choice for some people when they're dealing with musculoskeletal pain.

Because I agree. There's going to be some people that are going to [00:51:34] be.

[00:51:34] Tom Walters: to be you

[00:51:35] Mark Kargela: having some knowledge and skills to be able to offer people and maybe breaking free from some of the traditional means of insurance based care and things that sometimes I think we overly saddle us, saddle ourselves to as PTs. Of course, a time and a place for that, of course, but Tom, thank you so much for your time today.

Thank you so much for all the work you're doing and hope to talk to you soon.

[00:51:54] Tom Walters: Thanks, Mark. Thanks for having me on.

Great to finally chat actually hear that, hear your voice. So awesome to me.

[00:52:00] Mark Kargela: Yeah, instead of digital, we actually got a little face to face time. One day we'll meet in person and we'll hang out for sure. And sure, sure. Coffee or something for those of you who are listening, love. If you could subscribe on wherever you're listening to your podcast, if you're watching on YouTube, we'd love if you could subscribe there but we'll leave it there this week.

We'll talk to y'all next week.[00:52:34]