172 Jim Stark

[00:01:34] Jim Stark: the perspective that we have in medicine is always illness based or injury based. We do not have a healthcare system. We have an illness care system.

[00:01:43] Mark Kargela: That was Jim Stark, a friend, colleague, and 30 plus year of experience physical therapist. Jim has developed a practice that really seeks to make impacts in people's lives that are durable outside the four walls of our clinics.

[00:01:53] Jim Stark: Joletta Belton has a great phrase that I use all the time or think about all the time, which is any treatment for pain has to be biologically plausible, but also biographically possible

[00:02:06] Mark Kargela: Jim had some great advice for clinicians who are struggling with their own practice.

[00:02:09] Jim Stark: you need to be authentic with yourself. What it is that you feel passionate about in terms of your care with your patients. and how can you expand that without losing that sense of passion

You go into this field because you want to help people

[00:02:26] Mark Kargela: Jim shares some great wisdom from a ton of experience and stay tuned till the end as he shares some resources that you can use immediately in your [00:02:34] practice.

Enjoy the episode.

[00:02:35] Announcer: This is the Modern Pain Podcast with Mark Kargela.

[00:02:40] Jim Stark: I didn't, decide to become, well, I didn't make the effort to become a physical therapist, until much later than most of the students. I was actually older than most of my, faculty at Grand Valley, where we both went to school.

I was 38 when I graduated. when I first started to think about PT school, I thought I was too old. I would have been a PT for three or four years by the time I actually started and I'd done it right away. but that was, nice because I had a lot of life experience. prior to PT school, I worked in a health club as a manager of a health club.

prior to that managing a bicycle store and was a self trained athlete without coaching. at the level I was at for cross country skiing and cycling So it gave me some perspective on life that was different. even when I was a new grad, I didn't look like a new grad and that [00:03:34] gave me some advantages.

[00:03:36] Mark Kargela: When I entered clinic, I remember, patients saying, Oh, you could be my grandchild and you're almost up against it. I always tell students who are entering, you got to really know your stuff and command the communication to let that patient know that, yes, I may be young.

I may look like I could be your son or daughter or grandchild, yet I know my stuff and I can help you. how did the journey to, cause you mentioned some of your spiritual path that you had along the way that really resonated and pointed you in this direction with complex and persistent pain issues.

I'm wondering if you'd share a little bit about how that kind of all came about.

[00:04:09] Jim Stark: I was, probably close to 50 years old when I really started to not shy away from spiritual growth. it was something that was always kind of intimidating and I didn't feel like I wanted to engage in it. But as a physical therapist, I began to learn a lot about, the Tao Te Ching and, stoicism I thought, my patient needs to know this stuff because they're so, caught up [00:04:34] in their immediate story.

there's a phrase, there's a fellow named Matthew Sanford who is a paralyzed yoga instructor, who's just a fascinating guy one of the things he talks about is healing stories and so many of my patients had only pain stories, they didn't have any healing stories, they didn't, couldn't transition into a growth from the challenge that they had.

And, I didn't share that as a spiritual thing but I did explore that concept to see if it had any clinical validity. And it certainly seemed on a anecdotal basis anyway, that it did, it helped quite a few people start to look at it from a different perspective.

And we all know that there's multiple perspectives to everything. but the perspective that we have in medicine is always illness based or injury based. We do not have a healthcare system. We have an illness care system. And so [00:05:34] to try to change that narrative and that story, it's led me to lots of interesting kinds of places.

You can't quantify it. I don't know how to study it. from the, clinical perspective, but it is part of who I am. And it seems to resonate with a fair number of my patients.

[00:05:50] Mark Kargela: with your, training in physio school, because I remember my training, the communication style was not that of like, well, let's, let's dive into your narrative and dive into, you know, your story, especially when thinking of illness stories versus, healing stories.

I completely agree. a lot of patients, and I think healthcare keeps them locked in this illness story because that's the only story that's being told in any encounter they're having with healthcare systems. I'm wondering, how you can develop that skill, was it something that just with.

Patient encounters and seeing the failure of just interrogating, you know, zero to ten. What's your aggs? What's your eases? Which again don't hate me out there because it is something I think has its place But obviously when we have folks where they're really stuck in a story that Holds [00:06:34] no hope and has them broken and frail we need to have some skills to move their narrative Into one that opens up the possibility of healing or recovery or regaining life and things like that.

how did that journey to kind of change in that narrative occur for you?

[00:06:47] Jim Stark: Well, the short answer is it was pretty rough. I was fortunate to have a manager who allowed me to explore and fail, which was not a gift that most clinicians may not have. I think I improved a lot, when I started to look at the narrative medicine sort of, work. I'm drawing the blank of Julia

[00:07:12] Mark Kargela: Schneider and Lysanthia Taylor?

[00:07:14] Jim Stark: Taylor, when I met them and started working with that, that certainly made that process a little bit smoother.

That was fairly late in this process for me. I had already explored and expanded that a lot. in terms of my daily practice. I want to go back to PT school as a [00:07:34] prerequisite to getting into the PT school at Grand Valley where we both went. I was required to have three different classes in psychology as a prerequisite, yet that was never integrated into what we did.

Not at all. there was a lot of, mixed messages involved in our training. They did say treat the whole person, but all that meant was if you've got a shoulder problem, make sure that their neck isn't involved as well, or make sure that they're, you know, if you, if you talk to Gary Gray, kind of, kind of source, I learned from him that, Hey, if you've got a right shoulder problem and it's a throwing athlete, you better look at that left ankle

But that was the way they taught about the whole body. They didn't talk about any psychosocial measures. we learned back in school that, if you have major life events within, any given year, you're more likely to develop chronic or low back pain. So there was a factoid, but there was no understanding of why that might be the case.

[00:08:30] Mark Kargela: I just think it's improving. [00:08:34] in our university, we have a lot of interdisciplinary, activities where psychologists, PTs, OTs, speech, and, physicians can interact and, you know, do some activities together to kind of see each other strong suits. But I still think we have a, you know, both in health professional education and in just the healthcare system as it exists, where there's just this fragmented, here's the physical side, here's this, here's the mental side, here's your medical side.

all these folks in their categorical box where pain is something that is, All of it, right? you can't separate it, you can't pluck the physical side out. treat that drop it back in and voila. This is going to be better for somebody

Our training, although improving still fragments things so much. I'm wondering, cause I, we, you and I've talked about this where, you know, in our spaces as physios and we have some good occupational therapy, colleagues and friends as well, we have a unique position in the system of that fragmented mess to hopefully help connect the dots.

But I'd love, you could talk a little bit about where you see the unique position we have as [00:09:34] PT's, OT's to make an impact in some of this complexity we see with pain.

[00:09:38] Jim Stark: So first of all, I think that PTs and OTs have a unique structure in terms of the amount of time that we have with patients. when I first came across this, I was seeing patients three times a week. Now I tend to see them twice a week. I still, at twice a week, see them more times in any month than most of their doctors will see them in a year.

And that's with complex people who go back to see their doctor often. we have that time and we can create relationships. particularly in a one on one setting, which is where I'm still blessed to be able to do. I know there's a lot of clinicians that no longer have that option.

I think that's a real loss, particularly with this patient population. patients come to physical therapy expecting to move. Sometimes they dread it, but they expect it. And that expectation is really important. you can start to develop skills in terms of behavior change when you're moving in [00:10:34] ways you can't do just through talking.

lastly, we can touch people. And although that's not required and it's not necessarily what happens with every patient. for some people that can be really powerful you can work with, touch to help improve, body awareness and make sure they're focusing on a certain area.

You can sometimes use some manual therapy techniques to, relief, relief pain. and teach them how to do that to themselves or their partner. We have their partners do that. I use, Diane Jacob's, dermal neuromodulating concepts with a lot of people, even though my practice setting is in a swimming pool.

it's a little awkward at times, but I do that pretty often. because of those unique advantages. I think we should be the best there is in terms of the medical professionals at working with people with chronic and persisting pain. If we upscale ourselves to have the skill set to allow us to do that.

[00:11:29] Mark Kargela: I couldn't agree more. I think our psychology colleagues do some amazing things, but they're kind of [00:11:34] limited to, talking

[00:11:35] Jim Stark: Psychologists would be weird if they're touching you.

[00:11:37] Mark Kargela: Yeah, you might leave or file a complaint if a psychologist touches you, it's just not the context that you would expect there, I do think sometimes, physical therapists, are afraid to talk about things and emotions and, all the things that show up with somebody who's in life changes and all the, struggles

We look at studies that 60 percent of people want to talk about issues in their life when they come to see a physical therapist. And as an occupational therapist, you need to be ready, whether you want it or not. Emotions and tough conversations will happen. if you shy away from them, you'll be the next clinician who's just tries to like, you know, bucket them into like, here's your physical thing.

And I'm just going to work on that. this was me for a good chunk of my career where I would just run and hide from emotions because I Didn't know how to deal with them in a clinical encounter

[00:12:17] Jim Stark: Yeah.

[00:12:18] Mark Kargela: you mentioned you're setting in a swimming pool, which can have amazing impacts for, for folks that are trying to explore movement and maybe a more safe environment where, and more comfortable environment.

But how do you work with that to translate [00:12:34] that to, because I think the challenge always is. People aren't living in pools, Jim. How do they function outside of the pool? I know you've we spoke before we recorded here that that's you know, something you're keenly aware of and work to address with patients But I'm wondering how you kind of kind of make that work in the pool and then translate it to life

[00:12:51] Jim Stark: I know that there are some, aqua therapists who spend their time on the pool deck. I'm not one of 'em. I'm in the water with everybody. So Thursday I was, you know, six and a half hours standing in 92 degree water. Get a little tired doing that sometimes. but

We, particularly if we're talking about walking or, stuff, use Phil Greenfield's one inch Walk. If you haven't seen that, that's a beautiful technique for weight shifting and balance and center of mass control. we practice it in the pool, but they can't see things like that.

I also take people into the clinic occasionally when I do a progress note or when I do the eval, I try to get them started with some stuff they can do at home and reinforce that. if [00:13:34] I'm doing Those kinds of exercises, which are more traditional physical therapy. That's what I would call a, more pa body part specific kind of thing.

as opposed to a global strategy, which I also talk about a lot. with complex patients early on, we're talking about sleep, pacing, Prioritizing and planning your day, we're talking about those things that impact the whole, neuroimmune system as opposed to the local strategies, which are more, okay, can you breathe into this pain?

Can you stretch this way? Can you, do whatever? early on, the most common thing for me to talk about is breathing. that's a skill they can use 24 hours a day, if they're awake and conscious, they can use breathing techniques to help calm everything down. that's by far my most common thing that I talk about early on, before I get into any of the other specific things.

[00:14:31] Mark Kargela: Yeah, the breathing work I can't agree [00:14:34] more with because it's one of those things especially if you just sit back and notice what you see and what the patient notices with tension and breath. oftentimes it's a lot of tension. when you've been carrying around, significant pain and discomfort for a while, that's an understandable response, but, learning some mindfulness procedures or things that anchor with breath and letting people experience it, right.

Sometimes as a physical therapist wrote, you know, especially earlier in my career, I was like, Oh, I gotta be doing all the stretches and fancy exercises, which can have their place. But. If somebody's moving and exercising under distress more of that, fight or flight, side of the system really engaged because they're, walking on eggshells, not knowing what their body's going to do, if they can start grounding themselves in breath, it opens up so many windows for improved movement and improved experiences.

How do you work with breath as far as, Do you have patients like, you know, really? Cause I think there's one thing, do your diaphragm breathing and here they're in a bubble, but how much, how will you have patients reflect and notice what happens in their body when they're engaging in breath?

that was a piece for me [00:15:34] missing It was just like the next exercise, checking off a box versus being more purposeful and mindful with the patient helping them explore it more purposefully to see.

how their body changes with it. How do you approach breathing with that in mind?

[00:15:45] Jim Stark: Well, I've got about five different things that I do in terms of breathing. the most basic one I call straw breathing, but if it turns out the cardiopulmonary people call it pursed lip breathing and it's just inhale through. And I use my hand to help describe this cause you can't see very well.

, I can easily get enough air to, you know, In half a second, inhaling to exhale for over 10 seconds. That's easy. That's no problem at all. I'll show that to patients. I say, okay, what's, what's it, what does that feel like when you do that? a lot of patients will have a hard time with that

They want to take the big breath in. And I said, no, we're just a little sniffing. So you just talk about that and work with it. And pretty quickly, most people can get it. I'll just say, look at the clock. We're going to do this for three [00:16:34] minutes. or 10 breaths or whatever it is you want to use as your metric and ask them how they feel ahead of time.

I asked him how they feel before I asked him how they feel afterward. What did the experience is a difference. So that technique I've seen use, to drop blood pressure, to drop pain, to drop all kinds of things. And we talk about the autonomic nervous system in this. I usually say the voluntary and the, involuntary or the automatic part of the system.

and then we talk about the fight or flight response and the rest and digest response. And I'm standing there with my hands out like a seesaw looking like an idiot when I do that kind of stuff. But the point is they begin to see not only what it feels like, but how it can apply physiologically to the whole system.

the handouts that I have on breathing describe that, but they also, another one I talked about is just number of breaths per minute. I just count and count how many they're doing. I said, okay, so you're doing it at 22 breaths a minute. Let's see what happens. Let's see if you can [00:17:34] slow that down to 15 breaths a minute or whatever the number is.

they work on that. But you know, within five minutes, they're feeling more relaxed, more calm. So the phrase that I use about that when I'm talking to other clinicians is an expectancy violation. I want them to, nothing I say will make a bit of difference until they can feel it.

When they can feel that change in themselves of something that they can control, they can do on their own, any time of day or night. Then it has a much, much different meaning to them than just listening to it as an exercise. in November, I gave a talk to some cardiac rehab people about breathing techniques that they use already in pulmonary rehab, but they didn't understand that, breathing.

They can do those things to help pain in the first place, nor did they understand that they should do those things as a behavior change, not as [00:18:34] just another exercise. How do we explain that as a behavior change? that came about because one of a pulmonary rehab patient came to me for chronic back pain and as her breathing improved, her back pain got better, she was learning the same things from me as from them, But in a different context and with a different story and it stuck with her, I'm not saying it would with everybody, but for her, she could feel the difference and that allowed her to put in the effort to try to change it.

[00:19:06] Mark Kargela: you touch upon it with the experiential learning piece. I think there is this degree when they explain pain, you know, craze hit initially, it became like, let's just explain

[00:19:15] Jim Stark: did

that so

[00:19:17] Mark Kargela: we could probably all have a support group you and I have probably talked about it when we hung out a bit.

And I think it's a common thing when you get some new information, right? It's the recency bias of like, man, I got all this new stuff I want to throw at people. it became utterly apparent, I think, for most of us that you're not going to just speak [00:19:34] somebody's pain away. Sure, some people might have some epiphanies and aha moments, but it's probably more the exception rather than the rule.

you hit the nail on the head. It's one thing to talk about it, but when somebody can experience it, talk about it and then let them show themselves right. Where it's not you just lecturing it down to them Hey, here's what we think might happen, would be willing to try this what do you notice, let's give you some strategies, try this.

What are you noticing? I'm always amazed with pain, especially like just the simple act of. Teaching somebody to breathe, which sounds simple. Some people are just so locked in distress. you hear their stories. I always use my analogies, the haunted house versus the beach you start reflecting their narrative back to them of all the things they've taught you that they've went through as part of their challenging journey.

And it makes sense for them Their system, is probably operating more from a haunted house perspective how does our body behave in a haunted house? we're tense. Our breath is rapid. We're very reactive and very sensitive people. Can make the connection with that.

But again, when somebody can see that breath and pain can have a, and when they do something, they experience it much [00:20:34] differently. It can be a powerful change in behavior and things. One thing I'd love for you can share the audience cause you and I've talked about it, but this thought about two versus one 66, I'm gonna probably steal it and I have declared now that I'm, anytime you hear me say this, this is from Jim Stark.

Jim, can you talk about two versus 166 and how that fits in your practice?

[00:20:52] Jim Stark: when I do an evaluation. I'm the pool therapist and everybody I see is going to be in the pool. most of those people are chronic pain, not all, but most of them are. when I do the evaluation, one of the first things I try to do is set expectations.

Expectations are critical. I would say, I'm not going to fix you because I can't, fix is the wrong concept. We're talking about healing, not fixing. And all we're going to do together is going to be exploring different options that will help you learn how to manage your life better so you can live better.

But if you're in the clinic two hours a week, that leaves you 166 hours on your own. Which of those two [00:21:34] things do you think is more powerful? so all I want to do in the clinic is try to find things that will help you. on your own at home that you have to do. I got so tired in my earlier career hearing, it felt pretty good when I did the exercises, but I don't want to keep doing the exercise all the time.

I said, well, that was a strategy that didn't work for you then. You've got to find a strategy that does work. And exercise is only one strategy, I focus on strategies as opposed to treatments, and you've got to find a strategy. Joletta Belton has a great phrase that I use all the time or think about all the time, which is any treatment for pain has to be biologically plausible, but also biographically possible.

[00:22:20] Mark Kargela: that's a great quote.

[00:22:20] Jim Stark: Isn't it though? So if they can't get it to work into their life, you know, she's a single mom working two jobs and she's got four kids. She's not going to take a lot of time to do a bunch of exercises. It's just not going to [00:22:34] happen. But she is breathing all day long.

And if you can use that breathing to help her sleep a little bit better, do some breathing exercises before they go to bed. do some other things to try to structure some time to help that person learn how to. sleep a little bit better, not just by getting the right number of pillows in the right places, but to calm her system down a little bit.

Those two things are going to go a lot farther than any exercise I do. So, I try to apply it in that way. is that explain that concept adequately?

Well,

[00:23:08] Mark Kargela: you're in a setting where you're going to have a very motivating or attempting to be motivating therapist. You're in these walls. We have this nice music playing. There's no stressors around here. Like I always, I'll try to reflect back.

None of the things you spoke to me about X, Y, and Z, whatever it was specific for that patient are in this room with us today. And so that this is. This is the easiest. I mean, this spot is a great place to feel better, but it's, it's where it matters is outside [00:23:34] these four walls. Like I, I'd much rather you feel better where your life happens, where, you know, X, Y, and Z exists.

So those are the skills I'd love to work with you on to help, And that's where I think I got stuck as a manual therapist. I don't even identify myself as a manual therapist anymore, but physical therapy uses manual therapy from time to time.

I can make him feel better in these four walls. And we've all been there where I felt good and then they come back and it's no different. And 20 visits later, you're, you're on the same merry go round of no change that is durable outside the four walls of your clinic.

and that's where it becomes, the challenge, right? And that's why I've, got to the point where I was ready to quit. pain science and getting into things like ACT and motivational interviewing and nerding out with folks like yourself and others has helped me see that the real strategies and the real skills are how you can help somebody's change stay durable outside the four walls of your clinic.

that two versus 166, I think is a great way to help people kind of grab hold of like, yeah, this is only a short time period. I got some skills I need to learn. [00:24:34] I love what Joel, your quote from genetics. I do completely agree. It's like sometimes we have this like rigid belief that as a physio or that these are the exercises you need to do.

And this is your program, do it. it's not biographically possible for that person. as a clinician, you're just kind of on your robot. This is what I do for everybody with shoulder pain or whatever. you're not tailoring it to the unique individual in front of you.

Jim, you're in a rural setting because in a perfect world, and we spoke to this in the past where, man, we'd have like a, the resources of a Mayo Clinic or, some big systems with, all the specialists that can help have a multidisciplinary team.

working together on cases, but rarely is pleasant. I think it's probably the exception versus the rule overall for many of the people that are working out there. They don't have access to that stuff. what are your strategies that overcome that when you don't have a pain psychologist, you don't have a social worker, you don't have, another practitioner who can be on a team with you?

[00:25:25] Jim Stark: I think the biggest thing that I try to do is create an atmosphere where people are able to talk about whatever they want to [00:25:34] talk about. And, and I always, you know, when I give talks to other clinicians, there's typically five things that I think are really important for a clinical situation to have success.

the first one is the only one I'm going to mention now, which is you have to validate that patient's experience. if you can validate that experience, then the conversation gets deeper, more readily. I'm willing to go there. I've got no problem talking about pretty much any topic.

I don't pretend to be a psychologist and I try to set a pretty clear border there. I do have, recently found somebody who I can refer to, they don't have to physically go, they can do it online now, so that worked, for years it was just, me trying to give them a safe space and that safe space was as good as we could get in this area.

I've worked in the same hospital system for something in the neighborhood of, 25 years, on and off. And for a while I [00:26:34] was the manager of rehab in that system. And every year, as I was a manager, every year, the community survey of what we needed in this community was better mental health care and nothing ever happened.

So we struggle with it. The best I can do is just be a caring, empathetic human being. expectations make a huge difference here. I've been there long enough that a number of people know who I am. so, referrals from the community get to be, important

Some people come for the pool. Some people come for me, I had somebody yesterday say, Oh, so and so wanted to say hi. I couldn't remember who that so and so was, but it was a former patient. they were just really happy to get into that. I have made attempts to get people into sleep clinics.

I have made attempts to get people to see a particular specialist who happens to fit their particular need, but it is very haphazard. the biggest thing that I've done more than anything else is to create a really, comprehensive educational [00:27:34] experience with the handouts that I give to my patients.

Very frustrated with the lack of resources for, education relative to pain. Whether we're talking about strategies of pacing breathing sleep or prioritization the only one that's easy to find is progressive muscle relaxation.

Jacobson's exercise has been around for decades. I've created a whole bunch of those kinds of things for my patients and I share those, When I give talks pretty freely, so we can post a couple of the ones that I hand out, I'll be glad to share with the whole group here.

[00:28:08] Mark Kargela: I know the folks listening will definitely be appreciative of that. and it sounds like you've developed your own library of things that kind of supplement when you don't have those resources of a social worker or stuff like that.

And I highly recommend clinicians, you know, you know, looking at things like what Jim's putting together. you almost have to have like, here's my sleep talk. Here's my information that I can give somebody to supplement, especially if you're in one of those clinics where it's not ideal. You don't have one on one [00:28:34] time or it's very limited.

You need supplementary materials to help people connect the dots and look at things a little bit more comprehensively than what you can. There's definitely good arguments to be made that, hey, a 15 minute session with people Isn't going to give them the ability to express their story and do what needs to happen to really provide ideal pain care.

But I know a lot of clinicians out there would prefer to be different, but are in circumstances where that's not an option. make sure you have those supplementary materials to help people see the big picture. If you can't give that stage as much as you'd like in your in person sessions, Jim, I want to respect your time.

Jim, what would you. recommend, like, a clinician who's kind of at that point, struggle in their practice where they're seeing how they were taught in the treatment versus strategy thing you mentioned already, where they're stuck in a, like, I need to deliver this treatment to fix the pain or, decrease the pain.

and again, sometimes that might be a [00:29:34] realistic hope for some people. There are definitely patients where we should expect pain to go away. how would you recommend clinicians do as they're facing some of that struggle we, both had where I keep doing treatments to people and things aren't changing.

I'm losing hope in my profession and my ability to help people. What would you recommend people in that situation?

[00:29:51] Jim Stark: Whoa, that's a big question. there's so many different ways to go. the first thing is you need to be authentic with yourself. What it is that you feel passionate about in terms of your care with your patients. and how can you expand that without losing that sense of passion

You go into this field because you want to help people. But I think there's a selection bias that goes against us sometimes in physical therapy school, and I'm assuming OT school as well, which is you've got to have really good grades to get into the schools.

PT school because you want to help people and you're really good at answering questions. These are not questions that you can answer in the same way. You've got to work with your [00:30:34] patient to have them answer their own questions. They are the experts in the pain. So the selection bias kind of works against us.

I am proud to say that I had probably the lowest GPA Grand Valley ever admitted to their PT program. after that, I heard that the class I was in had the second lowest GPA they'd ever admitted as a group. the instructor who I was talking to after graduation said, I think you guys were more interesting people.

Because you weren't so focused on the grades. and I've carried that concept of just being curious about what's going on with my patient's lives and trying to figure out ways that I can guide, I can suggest places for them to go. Some people will go there. Some people won't. And I take it on myself as a failing if I can't.

lead them in a different direction, but I don't worry about it because I know I can't help everybody. And that's the [00:31:34] humility you have to have if you're going to be a clinician working with people with chronic pain. It will humble you. I'd like to think of myself at least regionally or locally as an expert.

And yet I probably only help maybe half my patients on a consistent basis.

[00:31:52] Mark Kargela: And that is such a hard pill for some clinicians. It was for me to swallow that. I would wholeheartedly agree with what you said. there's this thought that we're going to be the superhero. I know the whole Batman versus Alfred analogy that we've spoke about on the podcast, where. There are just things that influence people's lives outside the four walls of our clinic, despite the most multidisciplinary approach you can have and with all the best intentions.

And with maybe even your best delivery of PNE or your, there's just times where people are in situations where they're not in that readiness to change. We can say different reasons why, but, all we can control is our effort. And I love what you spoke to is about really positioned the patient as an expert.

And instead of you trying to be this high [00:32:34] GPA, I'm going to answer the questions for you and tell you what to do. I'm going to give you the ability to ask questions and answer your own questions by leading you through some experiential activities to help you see that you can answer these questions if we give you the right information to start exploring within your own body and within your own life.

it's a flip of perspective for clinicians that I think is a challenge. to me unlocks the most rewarding work you can do as a clinician. being able to impact somebody who's had a really rough go with persistent pain. To me, I would take that, a hundred times out of a hundred over your basic ankle sprain.

I'm not saying those can't be helpful too, but, I just feel like it's so much more impactful, especially when we have a healthcare system that falls short when people can't tell their stories and are Positioned as broken, frail individuals who, are putting life on hold because of all the scary narratives they've had, Jim, I wanted to thank you so much for your time today.

I always appreciate conversations with you. I always leave them better than when I entered them. where can folks find you online? I know you're not [00:33:34] a huge social media guy, which is cool. I think you're on Facebook and I see you hanging out in Tom Bowen's group from time to time where the chronic pain champions group lend in your expertise.

Where can folks hang out or get a, you know, find you?

[00:33:46] Jim Stark: the Facebook page is AforaPain, A P H O R A, pain, all one word, on Facebook. I don't post an awful lot, but I do answer questions. People email or, direct message me and I engage with them that way. And I just, it is a, work with people in pain for me is an honor.

For It really is. And I find myself quite fascinated by the challenge of it. but I don't find myself fascinated by the social media. They haven't changed much over the last 15 years that I've been paying attention to it. And so I've kind of gotten bored with it I don't feel like promoting myself that much.

Because, again, the humility has got to be there. Yet at the same time I give public talks about this stuff So [00:34:34] you got to have a certain ego to be able to do that But then the imposter syndrome shows up. How in the world can I say I know what the heck I'm doing here When I teach my classes and that sort of stuff, please feel free to reach out or check and see what I've got

[00:34:46] Mark Kargela: Yeah, and we'll link it in the show notes. Jim's a very humble dude and always giving to, to lend his kind of, expertise. So, I've enjoyed my conversation. So I'd highly recommend, reaching out if you have any questions on Jim's approach, via the links in the show notes.

All right, we're gonna leave it there that week. Thanks for everybody for listening. If you're a listener on your pod on the podcast provider, please subscribe. If you're watching on YouTube, we'd love if you could subscribe there. We'll leave it there this week. talk to you all next week.

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