Unlocking Success: The Power of Coaching and Mental Fitness in Pain Management

[00:01:34] Jen Uschold: I think that all of us need to be trained in coaching, communication styles, in particular motivational interviewing. So I am really kind of at the point where coaching is the air I breathe. It has.

[00:01:46] Mark Kargela: You just heard Jen Ushhold, a physical therapist, lifestyle medicine coach, and certified positive intelligence coach.

I sat down with Jen and we talked about her unique practice that incorporates traditional physical therapy with lifestyle. And personal intelligence coaching. Jen and I talked about how the client therapist relationship is so much stronger when you take a coaching or guide role in a person's journey.

[00:02:06] Jen Uschold: The relationship is so much better. And when we have a strong relationship, whether it's professional or personal or with our Starbucks barista, everyone's going to have a better experience. So absolutely. Yes.

[00:02:18] Mark Kargela: We talked about how crucial it is to not just look at someone through the lens of their symptoms, but through the lens of their lives,

[00:02:23] Jen Uschold: a symptom is not a symptom.

It is an invitation to someone's story.

[00:02:28] Mark Kargela: We spoke to mental fitness and how Jen uses this to help people she's working with reach their goals.

[00:02:33] Jen Uschold: So [00:02:34] mental fitness is, uh, the work of positive intelligence. Shirzad Shamim started this. And my one sentence definition is,

[00:02:42] Mark Kargela: Jen and I spoke about the strength of groups and how it is a skill we have to develop if we were going to leverage the strength of a group setting.

[00:02:48] Jen Uschold: It is a skill that I'm still working on to lead groups, because especially such in this case, right? Chronic pain, we don't want them to fall into the. complaining and woe is me pattern. We want to be hearing them not negating what they're experiencing and still. introducing strategies that we can shift them to the right side of their brain where they're going to function and make progress.

[00:03:14] Mark Kargela: We also spoke of how Jen uses mental fitness with a client and how Jen manages emotions, lifestyle medicine, and much more. Make sure you check out the show notes for the links to all the amazing resources Jen's shared in the episode. Now, on to the episode. This is the Modern Pain Podcast with Mark Kargela.

Jen, you and I've gotten to know each other [00:03:34] through EIM's trainings, Adrian Lowe's trainings for a bit. I think we were both, I think, around similarly with the Therapeutic Pain Specialist Program, and then you've taken it further, and we'll talk to that a bit. Your training's been pretty impressive with your growth in pain science and other avenues, but I'd love if we could touch upon a little bit, because we've had some folks on the podcast talking about coaching, and Moving more towards a role as a coach versus the traditional clinician, um, setting, which again, there's probably some components of clinical, uh, work with, but even coaching maybe a little bit of a different space as well.

I'm wondering if you could speak a little bit to your practice and coaching and kind of what you're up to, because you've taken a bit of some clients through it and it sounds like you're having some pretty amazing results. I'd love to hear a little bit about the program.

[00:04:17] Jen Uschold: I think that all of us need to be trained in coaching communication styles, in particular motivational interviewing.

So I am really kind of at the point where coaching is the air I breathe. It has helped me in my personal and my professional relationships. [00:04:34] I don't have clients who I coach versus I do PT. I have clients and they all get, More what they need, right? Do you need more traditional PT because you just had ACL surgery?

Let's go. Do you need more coaching because of ABC reasons? Then that's where we're going to focus And it was really odd. I got into coaching Around 2014 because I was very very manual based and I still love manual therapy And then I started to think well, what if my hands can't do this into my 60s whatever?

So that was my motivation for coaching and now I just You Love coaching. I love integrating it. I think we can have so much more success when we come alongside a client versus our, you know, I am the clinician. You must listen to me, which is how many of us were trained. Do

[00:05:21] Mark Kargela: you feel like it kind of connects you with patients at a little bit of a deeper level and not just at the, this is your.

You're cordoned off plan of care and once you're discharged, therefore you are out of my midst and never to be seen again. I'm not maybe never to be seen again. That's [00:05:34] obviously a little bit of a harsher interpretation, but do you find that that allows you to have a little bit more of that deep connection with patients when you're in that more coaching relationship?

[00:05:43] Jen Uschold: Absolutely. And I think I've always had more of a coaching type of relationship and a lot of my clients, and this is what happens with you too, I'm sure. They're word of mouth friends, friends of friends. So the relationship is different out of the gate because they came to already knowing a little bit about me and how I operate.

And yes, I would absolutely say that the connections are deeper. It's kind of funny because sometimes people are like, It's like you were speaking to me and I decided to do x instead of y and I'm like, is this good? Is this not good? So yeah, the relationship is so much better. And when we have a strong relationship, whether it's professional or personal or with our Starbucks barista, everyone's going to have a better experience.

So absolutely. Yes.

[00:06:30] Mark Kargela: Well, we agree with you. I just put a post on, uh, [00:06:34] socials today about how using that mindfulness skills of like really being present with your, your interactions with people. Cause sometimes, you know, in the clinical world and in the coaching world, I'm sure as well, where, you know, life's got you tugging in 15 different directions.

You got somebody messaging you here, you got this urgent email that just got sent to your inbox. And now you have to sit down in front of somebody and try to be present. I mean, how purposeful are you with in your relationship building with like really. Honing in and being present and not letting yourself get tugged into 15 different directions with a phone beeping and emails alerting and all those things that happen in this kind of digital world.

[00:07:10] Jen Uschold: As much of that shut off as possible. I do my clients all know that I will take a call if it's a kid. And if it's a kid without a real problem, then I will ignore it. But you know, you should have that sense of, Ooh, I think I should take this. And so it is rare that I answer a call when I'm with a client.

I will say, since I've done the work of mental fitness or [00:07:34] causative intelligence, which we haven't gotten to yet, I am much better at creating that presence. And I'm also much better at catching myself if I get distracted. You know, yes, I still do manual work. So sometimes our mind starts to fly away and I'm like, oh, no, no, no, no.

Here and now, you know, whatever it is I'm doing. So I am much better at catching that. And it's the client who benefits and isn't that why we're here anyway, to benefit the client. So my presence benefits them.

[00:08:06] Mark Kargela: Yeah, I, I just think sometimes too, we, we get on clients to like, we need to practice our mindfulness.

You got to get present. Let's not ruminate about past and future and stuff. And yet we as clinicians sometimes are struggling as well to kind of keep it, keep things kind of organized and keep us present. So I think it's such a skill too. Like you mentioned, this is stuff that, Yeah. From your interaction with the barista, getting your coffee to, you know, a really challenging, emotionally charged patient interaction to where, you know, that can be hard as clinicians when you're getting a lot of these emotions [00:08:34] coming at you.

And I've shared my stories with emotions. I will never claim that I have been skilled in the past of being, I usually would like back away from emotions in the treatment because I just never knew how to really. Engage with him. I would like instead of leaning in, like I've said in the past, I would just like back away and like, let's just go through the things I'm comfortable talking about.

Um, how do you feel like you, we talked before we obviously we hit record today and you've mentioned some challenging emotions just with a recent encounter. I'm wondering if you can share a little bit about what you, you know, some of the emotions you get to use your experience with clinicians and how you handle them and find a more successful approach with it.

[00:09:11] Jen Uschold: Well, I wrote a blog once and the introductory sentence was A symptom is not a symptom. It is an invitation to someone's story. And so even though someone presents with anger or fear, we still have to remember that there is a human with a unique experience of whatever that emotion is. That has [00:09:34] evolved.

We are in a world where we have to be different about our touch. And I read in a psychology magazine once that even offering somebody a Kleenex when they're crying May not be all that supportive because they may perceive that as, Oh, you want me to stop crying? And so, yes, sometimes they want that Kleenex and sometimes they don't.

So it is experience. It is intuition. It is really connecting with their body language in addition to their actual words, so that we can. Make an informed decision of how we're going to respond to that emotion. And I will tell you, I am much better at silence than I used to be that silence, that ability to truly listen and let them be where they need or want to be.

That's powerful. And that's a really key coaching strategy is to just shut up and listen. [00:10:34]

[00:10:36] Mark Kargela: The silence and the, this, this incessant like instinct for definitely me as a clinician in the past, and that's probably still a work in progress is have to fill it right. Can't let it, you know, be there cause there's some sort of discomfort, but that discomfort, if you can let some, a patient sit in it and kind of often unpack a lot of things that are going on in their head versus trying to.

You know, interrupt their kind of processing of what what's coming up. I think, yeah, that can be such a huge skill one that takes just, you know, biting your tongue and just sitting still and being okay with that discomfort. That's, you know, silence, which again doesn't often come naturally. I think humans just, you know, naturally want to.

Interject and kind of push things into there. I would love if you could get into you already kind of alluded to it a bit But how does mental fitness you you mentioned mental fitness? I'd love if you can kind of unpack that a little bit Of what that entails and how it kind of impacts what you do with your clients

[00:11:28] Jen Uschold: Okay I am a big fan.

And so you said a little bit, so you might need to rein me in here. [00:11:34] Cause I could talk about it a long time. So mental fitness is, uh, the work of positive intelligence. Shirzad Shamim started this and my one sentence definition is harnessing your brain to be your friend more than your foe, and he has taken, it's.

There's original PQ research, but it's also based on positive psychology, performance science, cognitive behavioral therapy, and neuroscience. So, right out of the gate, I'm like, ooh, this is exciting because this has a lot of parallels to what we do in pain science. And so, my mind was blown, wasn't your mind blown with some of this pain stuff we learned?

Like, just blown. Yeah, so my mind is blown with statistics on lifestyle medicine, how much we actually can harness and improve our own health. And then when I took the mental fitness, I was like, Wow. And the way I'm describing it now is, I mean, you and I both, Mark, we have learned from some top people in our fields and the [00:12:34] work of positive intelligence for me is bringing all of that I've learned in the last three decades, bringing it together, like stitches on a quilt.

And so this is powerful because those stitches can be used on anyone's quilt. You could be an engineer, you could be an accountant, you could be a mom, and we can still integrate this positive intelligence personally and professionally because who doesn't want their brain to be their friend. Nobody likes ruminating.

Nobody likes staying awake all night because they're worried about, you know, whatever, they cut their fingernail too short. So, um, it has been very powerful. And as I was going through the content, I just kept seeing this parallels between pain science and mental fitness and pain science and mental fitness.

So that is my passion merging these bowl to get more people to fire me. Cause I figure if they fire me, they're doing all right. Fire me because they're doing well and have tools and strategies, not because we didn't work out. [00:13:34]

[00:13:34] Mark Kargela: No, I, I, that's one of the things I say is like when you're, I always tell patients, like, my job is to get you to fire me because you don't need me anymore.

Not because obviously I've offended you or doing, doing something like that. So that's, that's interesting. Yeah, yeah, no, and I think patients appreciate that too, that you're not there to, to. To have them, you know, be dependents, you know, where they only can thrive in life with with your presence. I think sometimes there's a little bit of the clinic clinician security blanket that we have to help patients kind of spread their wings a little bit and see that, hey, you know, you have the skills, you have the tools, and you may be putting them in situations where they show themselves that they're capable of more than what they think they are.

Uh, I'd love if you could dig a little bit into kind of that. The mental fitness components of that, you know, intelligence components of your work. I mean, you know, I know it's that's probably like a weekend course, if not a whole semester course that you need to kind of get into it to the full depth. But maybe you can share a little bit about how you kind of interweave these two or where you see these two interweaving.

You've alluded to it a little bit, but I'd love if we [00:14:34] could hear a little bit more.

[00:14:35] Jen Uschold: Yes. In the framework of mental fitness, we're talking about two sides of the brain and, uh, we're going to go to the fear avoidance model. Hopefully your most or some understand it. And on this left side, we have this roundabout.

Thank you, Jess, for giving us the roundabout of pain. It's just where people get stuck in that catastrophization, disuse, disability, all of it. When really what we're hoping for is that our clients go off to the right because they have knowledge, strategies, and tools. So when I'm taking the mental fitness and he talks about there's different parts of the brain that are going to be more dominant negative emotions and more parts of the brain that are more dominantly positive emotions.

So broadly for our simplistic purposes, we're going to say Negative emotions are largely housed in the left side of the brain, which is that roundabout side of the fear avoidance model and then the positive emotions are largely in the right side of the brain is it's a 50 50 [00:15:34] chance of it being a coincidence, but I find it mind blowing.

And then I can also tie this into. The illness wellness continuum, which is by John Travis, which is part of the lifestyle medicine work. And we have this neutral point and we all have a choice. We can go to the left, which is, you know, previous unhealthy patterns or new unhealthy patterns. Okay. Here we are in the roundabout here.

We are in the negative part of the brain and positive intelligence. We also have the choice. To turn and go to the right, new habits, new patterns, changing our health. And so that is just an overarching. I love how all of these different groups are really saying something similar. There's this left side, there's this right side and how do we help our clients choose and learn to shift to the right?

So that's one super powerful thing. Ion channels, nerve sensors. This is another mind blowing thing. I love this phrase that we learned from Adrian that the ion [00:16:34] channels just, there are things in our environment that can contribute to the sensitivity of our nervous system. We'll leave it at that. If you want to expand, I'll let you.

And Adrian says that the Ion channels, the nerve sensors, are biologically coded and environmentally sculpted. Okay, great. In the mental fitness framework, we talk about saboteurs. There are 10 saboteurs. The judge saboteur, we all know that. The inner critic, you know, you're an idiot. Why did you spill your coffee?

And then there's nine more. And those are primarily on the left side of the brain. Then we also have these five sage powers that we all have access to, uh, empathy, explore, innovate, navigate, and activate. And so, yes, we can be successful with both. However, we can be more successful, highly productive, better relationships if we're functioning from the sage.

And Shirzad tells us that these saboteurs, we are [00:17:34] all born with them. And they are environmentally sculpted as well. So now we have the science of ion channels meeting the research of PQ. And those are just a couple examples of how connected they are and how mind blowing it is. And I have clients who, before I was doing the PQ work, we started to integrate it and it boosted their progress.

So we do it in all different ways. Some are straight on the PQ path, some are straight on the PT path, and some combine it, whatever works for them. Once again, it's the priority of the client.

[00:18:13] Mark Kargela: Yeah. And that becomes a skill, I think, as you get further along in your clinical career is recognizing one early on that there's not a one size fits all approach.

I think sometimes we come out of university and this is always tough because, you know, I have students who need to pass board exams and become safe clinicians. So they kind of learn a very algorithmic black and white. Powerpoint definition the patient when you know, [00:18:34] we know the reality of clinic. It's chaotic.

It's it's gray It's muddy and you have to be able to wade through that stuff and land on something that lines with where the person's at Maybe it is more of a coaching pq type approach or maybe it is more traditional pt but you need a process to kind of Navigate through that listening to you talk about that, too.

I think it was interesting. I've been getting deep into act acceptance commitment therapy as far as trying to hone my skills in that arena. And it just I think to the like passengers on the bus analogy where you have these different voices like you mentioned these different Components, you know, left side and, and they even talk in active, like naming these things, which it sounds like, you know, in your work, that's already kind of name, which I think can be helpful for patients like that, or there's the, the judge coming up and, and, and they often talk about using, you know, naming some of these narratives that we all have to, I think it's one of these things where patients often think I'm the only one that has, thinks this negatively about myself or has these challenges.

I think it's been very helpful to recognize. And I often share some of my own inner critics and things that I have going through my head, which. [00:19:34] You talk to Adrian, I know he has similar things, and he's very open on it, but a lot of folks, everybody, like we all, that's just the human brain doing what the human brain does, and I think helping patients see that some of these narratives that play in our head, in our mind are Thank you.

Universal things that we all deal with and, um, some folks have times in life where those, those critics become very harsh and become very almost dominating of the narratives that we listen to in the world. How do you help people kind of recognize that right? One that it's, it's not just them, but also not to trivialize that.

Hey, everybody deals with it. Just move on with it. But how do you help people kind of understand that these are things that a lot of folks deal with? It's you're not. Yeah. Defective. Um, this is something that, you know, some of these narratives and things are universally present. We just need to move you towards the ones that move you towards what's not meaningful in your life is how do you approach that with people?

[00:20:29] Jen Uschold: Yeah, there's so many different threads in all that you said. Um, [00:20:34] Adrian tells us, excuse me, sorry, Adrian tells us that pain is normal, living in pain is not. And so, negative emotions are normal, staying there is not. And just as Adrian has the hot stove, nail in your foot idea, If we put our hand on a hot stove, the pain is information to motivate something different.

Great. Let's take our hand off the stove. Negative emotion is to motivate something different. So nobody's going to keep their hand on the hot stove for three days while they figure out what to do because they lost an important client or lost their job. That's what we do when we stay in that cycle of negativity.

And so helping clients to understand The normalcy and the actual benefit of negative emotions and pain helps them to figure out a different plan. When they stay in that place, that's when it can impact our physical and our mental and our [00:21:34] emotional health. And, um, how do I have this conversation with clients?

Well, there actually is a PQ assessment. It's really kind of fun. It takes like five minutes and it will tell you of the saboteurs. You know, you have a really high for the avoider or the controller or the hyper rational or whatever it is. And, you know, all of these saboteurs, they show up in people experiencing chronic pain just in different ways.

So the controller, that's the person who is going to clinician after clinician after clinician. Probably actually increasing their sensitivity. The avoider. This is the person who is so afraid to do anything that they are not, and they're probably increasing their sensitivity. And I like what you said about naming them because then it's taking it off of us, right?

Oh my gosh, I'm such a jerk. I'm so hard on myself. I don't deserve anything versus, oh, there's the judge again. He's telling me, or she's telling me that I don't deserve this. So I like the idea of naming them. [00:22:34] And, uh, internal family systems, that's Richard Schwartz. So he talks about this in a similar manner and he calls them, uh, he calls them characters, parts, parts.

He calls them parts. And I do think naming them can be helpful. Now, one of the most powerful and my favorite concepts that again, crosses over between both is that the saboteurs, your strongest saboteurs represent your greatest strengths. Gone overboard, being done too well. Pain is this beautiful protective mechanism.

Chronic pain is when your system is doing its job too well. It is not a negative impact on you. It's not a reflection of anything about you. It is that your system is doing its job too well. So how do we help you understand that? And learn strategies and tools to get out of it.

[00:23:30] Mark Kargela: Yeah, no, great perspective.

And I'm wondering if you could kind [00:23:34] of zoom out a little bit on, because it sounds like you mentioned it's about a six month coaching program with some of your clients. Uh, I'm wondering if you can zoom out a little bit about what does that look like? I know you obviously you get a lot of word of mouth referrals from, from a lot of your past clients and things, and which is usually a good, good sign that you're doing some great work.

But I'm wondering, like, how does that look? Because I think clinicians, there's been a lot of curiosity and some clinicians really. in similar, like, I don't know if I can do this manual therapy thing and hands, uh, fatigue and, and also just maybe in some different clinical situations where people want to have a more deeper connection with patients and the opportunity to come alongside them a little bit more than maybe some of these more busy high volume environments that some clinicians get, um, found.

And I'm wondering if you can kind of unpack a little bit of, of how that kind of program looks for, for someone who's doing a coaching service like yourself.

[00:24:21] Jen Uschold: Yeah, good question. It is a six month program, and I'm, I'm playing around with the order of things. I think I like where it's at right now. The first month is we do a lot of assessments, [00:24:34] and I don't want to underscore or undermine the importance of a thorough evaluation, even if it is in a virtual setting.

So I'm doing some physical therapy assessments, I'm doing the PQ assessments, I'm doing a lifestyle medicine assessment, and then we're good to go. You know, we're looking at their vision and their goals and things like that. And then I took a risk recently and I said, okay, months two and three, I'm going to have these clients go through the mental fitness program.

And so it is a seven week program. It is this amazing app. It's app driven. I do weekly coaching. But then that's a group coach. So they have one on one and then they have this group to reinforce the mental fitness. And then we get the final three months are we're going to get into the pain science stories.

We're going to get into the strategies and the pillars and the PNE plus program. And that's where we can really fine tune and, um, focus on them because The [00:25:34] PQ coaching framework is very different from any other coaching I've been exposed to. And so I want to be able to tap into that to help my clients navigate and find their way through pain as well.

And also there are clients who still need that manual work. And so, I mean, I've been around a while, you and I know people all over the country. I feel confident that if I had somebody who needed the manual work, I could help them find someone locally because I don't want to discount that it's the body and the brain.

It's not one or the other.

[00:26:11] Mark Kargela: Good points. I think sometimes, you know, and I, there's this sometimes like we need to just hands off people and just explain our, our way out of pain. And I think you've. Probably similar to me, I've kind of recognized that there is a time and a place and definitely times where we can really help somebody's pain situation.

Obviously, we know the limitations, what hands on can do, but if you get in a clinician who has a good narrative around it and understands kind of the, its limitations, but also its [00:26:34] strengths, you know, you can definitely help a person move forward. You mentioned that you do some group work, and I'm always interested because we're trying to look at some things at our university and starting to put some of these maybe group things together.

I'm always just interested in the group dynamic that. Because to me, it brings in something that you can't provide as a clinician. Maybe you can if you're somebody who's navigated a situation yourself, but that I've been seeing people who are in similar situations going through similar challenges and similar things.

I'm wondering with some of the group experiences you've had, um, with that, when you're doing some group coaching and with groups, do you find that there's some, some benefits of folks kind of seen walking alongside other folks that are in similar situations?

[00:27:13] Jen Uschold: Absolutely. And in the PQ groups, they have access to each other in the app, their own group.

And then we have the weekly coaching. And so I'm not in their app group every day. They're pretty present. It depends on the group. I do like how they're supporting each other. Now it just so happens that all three of my current people [00:27:34] in the PQ program are all dealing with persistent pain. In their knee, which is interesting, but the age range, we have somebody who's in college and we have somebody who's in, I think her sixties or her seventies, and it's fascinating how they are finding their way to support and help each other.

And I'm very excited. Nobody talked about pain in our session on Monday. And that was our fifth session. And that is the first time I didn't bring it up. And I was like, this is exciting. So, um, it is a skill that I'm still working on to lead groups because especially such in this case, right? Chronic pain, we don't want them to fall into the complaining and what was me pattern.

We want to be hearing them not negating what they're experiencing and still introducing strategies that we can shift them to the right side of their brain where they're going to function and make progress.

[00:28:30] Mark Kargela: Yeah, no, that's a definitely fascinating approach. I'd be [00:28:34] interested and I'm hoping we'll get some of the links Maybe if folks want to kind of pursue some of this PQ stuff and and different kind of approaches with it So we'll put it in the show notes.

You did mention a bit about lifestyle medicine that's been A big push, uh, you know, Yonez's group, probably one of the bigger pushers of, as far as publishing research, uh, around, you know, the pain and motion group over there in Belgium is home base for them. For those of you who are listening, we'll link some of their work because they're doing some great stuff.

Uh, I'm wondering if you can kind of unpack a little bit of your kind of view on lifestyle medicine and how it fits into what you're doing with people.

[00:29:09] Jen Uschold: Yeah, fun fact, 2020 Mark Sheppard and Jess Podolak. They're like, Hey, do you want to head up the lifestyle medicine program for EIM? And I'm like, sure.

What is lifestyle medicine? I actually hadn't heard the term before when I read about it. I thought, Oh, this is totally up my alley. I didn't know that this specialty of medicine existed and what it [00:29:34] is for your listeners. It is really just. Harnessing what's easily inaccessible to us to reverse prevent and treat up to 80 percent of lifestyle related diseases.

And so it's very powerful. The six tenants are sleep, exercise, nutrition, avoiding risky substances, stress, and social connections. The research is crazy and it's just a natural progression from somebody in pain. So many lifestyle related diseases. A come with pain, type 2 diabetes, obesity, there's, these are people that are having pain.

And so when EAM approached me, I thought, oh, this is pretty cool. And it's very exciting to expand my toolbox. Because I don't really care how good my manual skills are. I don't really care how much I know about mental fitness. If they are not getting good sleep, they're not going to be able to reach the capacity of what they have the potential to reach.

And so [00:30:34] I see lifestyle medicine as a massive toolbox expansion. And what I tell the students, I said, you do not have to be an expert in any of these. What we want is for you to know enough. Is this something I can address with my client? Or is this something that I need to collaborate with another clinician and refer out?

So that's how I'm integrating lifestyle medicine.

[00:30:57] Mark Kargela: I've always just been fascinated by how we're trained as, as physios. I know you and I kind of share that, but we have, you know, chiropractors, physicians and, and various other professionals who listen, but we get so trained on the micro, right? Just like these like micro impairments and things, which again, not saying they're not, can't be important.

There's time and a place, but I feel like there's such a limit and the macro of like looking. Big picture outside the walls of people's clinics, the social determinants of health, lifestyle, medicine factors, and different things that often I, I argue that the things that are occurring outside the walls of our clinic are probably much more predictive of what's going to happen with [00:31:34] somebody's journey than what's happening in the supportive four walls of, of our clinic, which again is a great space, but it's not reality of where people live and function.

Uh, what are your thoughts as far as kind of that disconnect between maybe how we're trained to think and then what really makes big impacts on people's pain in their, their journeys?

[00:31:53] Jen Uschold: And I say, I agree with you a hundred percent.

[00:31:55] Mark Kargela: Sure. Sure. I love the, I love the affirmation. Thank you.

[00:31:59] Jen Uschold: Yeah. I agree with you a hundred percent.

And are you familiar? There's a meta analysis, I think it's from 2010. There's very few research things I can pull up on like Adrian and it talks about five years of your mortality. And your risk of different environmental exposures. I think they talk about air pollution and obesity and. Smoking or alcohol, one of them anyway, air pollution is at the top.

If you are exposed to air pollution, your five year mortality is 5% greater. We're gonna zoo all the way down to the bottom of the list, which is social isolation, [00:32:34] 45% greater mortality. And so sure they get one hour socialization with us if that's what they need. But what about the rest of those seven days?

Six days, and 23 hours. So, absolutely. And I think we really. Underestimate how it's all connected. People are looking for the smoking gun. People are looking for a quick fix. And when they're like, Oh, so Jen, you think this is because of a, and if I had a penny for every time I said, as a piece, as a contributing factor, I would be loaded.

However, this, this is the message I want people to understand. It is never one thing. It's not one thing that got you into this situation. It's not going to be one thing to get you out. And what might have gotten your uncle out or your sister is not going to be the same because you are a unique human.

And I use the example of a chocolate chip cookie, which probably isn't the best for a health coach, but [00:33:34] whatever. Um, do you have a chocolate chip cookie that you love, whether it's your own recipe or one from a store?

[00:33:41] Mark Kargela: Absolutely. Yes. Yes, I do.

[00:33:44] Jen Uschold: What cookie, like where is this? Is it your mom's recipe? What, what's the history of this cookie?

[00:33:48] Mark Kargela: You know, I've, I've fallen in love with the crumble cookie. I don't know if you have crumble where you're at, but it's grass, you know, horribly unhealthy. They're, they're way oversized cookies. They're, they're kind of, you know, doughy, um, you know, which I always grew up my, I used to get to where my aunt would not even cook them and let me have just a little chunk of the dough.

So, which also isn't healthy, but, um, maybe had some other contributing factors that helped me navigate away. But yeah, that, that would be my current, um, chocolate chip cookie. Don't, if my mom's listening, I'm sorry, mom.

[00:34:17] Jen Uschold: No, she's not listening. Okay. So chocolate chip cookie crumble chocolate chip cookie. What makes it so great?

[00:34:26] Mark Kargela: Oh, they come warm and they're just, again, they have that little doughy exterior that or interior that just, you know, it, it hearkens back to my, to my cookie dough [00:34:34] eating, eating days.

[00:34:36] Jen Uschold: Oh, thank you. I wasn't even thinking of that, but you walked right into the power of an emotional connection. So that's pretty cool.

So you've got the power of emotion. Chiming in here on your brain map, so to speak, and now, so what if you just ate the flower that was in the cookie? Would it be amazing?

[00:34:55] Mark Kargela: No, flour is not good at all. I've, I've, I've had that in my mouth once.

[00:35:00] Jen Uschold: I

had a dare for a friend and it was terrible and I won't ever do it again.

[00:35:05] Jen Uschold: Thank you. That is an added experience that I never thought would podcast, Mark. There you go.

[00:35:10] Mark Kargela: There you go.

[00:35:10] Jen Uschold: And if you just ate the chocolate chips, would it be amazing?

[00:35:14] Mark Kargela: I mean, I do like chocolate chips, but not by themselves. I would prefer the, the other ingredients with it.

[00:35:20] Jen Uschold: So the only way we have that amazing, warm crumble cookie is when we put all of those ingredients together and no one in the world, no one in the world is going to have that same [00:35:34] emotional experience when they eat the crumble cookie that you have Mark.

So that cookie is a unique experience for everyone. But there are multiple things that went in and multiple things that come out.

[00:35:46] Mark Kargela: I like that. That's a, that's a good analogy and I think it helps us kind of see that these are complex interactions of multitude of factors that are unique to the person in front of us.

So I love that analogy. I might, I'll probably steal that, which everything we use is maybe not stolen, borrowed, um, in, in. Thank you. Willfully given from some of the giants that like Adrian and others who've given them, but I like it Um, could you touch a little bit upon because you spoke a little bit about social which I think is another horribly underestimated and maybe underappreciated and not really skillfully interacted with like What are the do you have some things you're doing with patients to purposely help them get into social?

Um, or do you plug them in with certain resources? How do you deal with that person where you can [00:36:34] see, man, there's just a missing social world and they're really isolating life's gotten really small, which a lot of our people in pain life gets, you know, can get very small when they're dealing with, you know, pretty tough situations.

I'm wondering if you could share anything that you found helpful to kind of help people navigate that.

[00:36:50] Jen Uschold: Yeah. First I'm going to say imitation is the greatest form of flattery and you can have a metaphor for 50 cents. So that's okay, right? That's a good deal. Just kidding. Um, That again depends on what I learn in the evaluation.

And so they all complete a lifestyle medicine assessment. And if they're getting plenty of social connection, I don't really care. It's fine. We're good. Or in conversations, if they're telling me. So several years ago, I had a client and, uh, she, Struggled a lot and she was isolating more and more. And so we had a conversation once and she loves baking cookies.

She loves baking cookies with a friend. So she invited that friend over to bake cookies. So I'm like, [00:37:34] this is so exciting. I didn't tell her to do it. We coached it. I'm just going to defend myself here. So she comes in the next week. I'm like, how did it go? She was ripping mad at me. I was like, what happened?

She goes, I had a flare. And it's because you made me bake cookies with my friend. And I was like. Oh boy, now I know that that was a saboteur hijacking, and I could talk a lot about what potentially went into that, but at the same time, it was an appropriate conversation. She wanted to be getting more social interaction, and at the same time, her nervous system wasn't ready.

Her nervous system didn't feel comfortable to be present with her symptoms around her friend. And so then we have this nervous system and saboteur hijacking going on. I do introduce it with clients. There's no recipe for it. It really depends on what they show up with. Each day and where we go and sometimes we change, we do in a complete about face in the [00:38:34] middle of a session.

[00:38:35] Mark Kargela: Yeah, that's that's the hard thing for some clinicians to to Deal. I know early in my career. I wanted the answer just gin. You're not giving me a b c or d and unfortunately You're never going to get it with patients. You're not going to get I mean there's occasionally the The red flag of hopefully not that just jumps out and yes, it is this, this thing.

And we can kind of order this, you know, very, you know, what, five to 10 percent of back pain has a specific cause that we might be able to identify. So there are those instances, but the vast majority, you have to have a process to navigate that gray waters. And to one, it's going to be different for each clinician.

It's going to be different for me. It's going to be different for Jen, because we have different life experiences and things that go into our encounters with people. And. Being willing to be uncomfortable and not have the answer. But I love the fact of being able to just sit each time. Just let's sit down and let's, let's problem solve this for you and see what works.

And, you know, obviously I'm going to throw my two cents in based on what I know [00:39:34] and my expertise, but you have the expertise of your world and your context and all the things around you. So, yeah, I just think it's, it's tough. Have you found that when you mentor clinicians that that's a hard kind of switch for folks to make to, to kind of get past that?

[00:39:50] Jen Uschold: It is. And my world, my PT world is smaller because I'm expanding into more of the coaching and public speaking. And similar to your point, it's harder to mentor them at this point. I loved mentoring students when I was out, you know, 10 years, 15 years. And there's just so many pieces now that I get, they get to get that framework, right?

We have to know how to build the foundation of the house before we can get excited about everything else. So they still need that. And I'm really ready to just take the client where they are. I don't want to delay my client and at the same time, I know they need to learn. So I, I struggle with that a little bit.

[00:40:32] Mark Kargela: Yeah, it's hard. I work in a [00:40:34] university, you know, where I have to really throttle myself to, like you said, build a foundation with students where. They need to have the base of like, you know, being a good safe clinician to recognize that 5 to 10 percent of specific things. The problem is I think in education we sometimes overemphasize the 5 to 10 percent of a lot of conditions that we can be very specific and identify and not recognize that.

Man, there is such a complex interaction of a lot of things that interplay with the unique presentation and each student sees I've been fortunate with when mentoring students in clinics where they've seen it, like we've had some conversations with patients that I just, you know, we called an audible and got like, let's sit down.

Let's really take a little dovetail of a turn to like, we need to just dig into what's going on with these emotions or things. And students are always like, Okay. How did you do that? And I'm just like, I just, you know, it's something that, you know, comes instinctual as you've failed trying to do it the other way.

Numerous times. They don't understand. They haven't seen the rep after rep of failing, trying to just [00:41:34] drive the patient, the square peg in a round hole into like a traditional approach. And it's just, it is hard to kind of have clinicians where depending on their stage of their journey, especially in the student stage, it's hard to kind of, you know, they need that foundation.

Like you said, um,

[00:41:48] Jen Uschold: and you've seen. Have you seen Lorimer Mosley's new book? I think it's new.

[00:41:54] Mark Kargela: I haven't. It's on my list.

[00:41:56] Jen Uschold: Yeah. I can't even remember what it's called. I loaned it to someone and I haven't gotten it back since July. It's on my list to get back. My fun fact, one, I mean, that book is mind blowing as most of his stuff.

He tells us, um, how many pieces of information, Mark and all of your listeners, do you think the brain processes every second? And remember, it's job is to protect us. What do you think? Oh, God.

I, I, I would hesitate, I, it can process, we'll say 10, 10 things a second. I'm grossly underestimating you.

[00:42:30] Jen Uschold: You don't look like you're sitting down.

[00:42:32] Mark Kargela: I'm standing. 11 [00:42:34]

[00:42:34] Jen Uschold: million.

That.

[00:42:38] Jen Uschold: So, when our clients want to know exactly what and why. We're not gonna know. Every second. I did it. I extrapolated it out. It's a lot of zeros of how much information our brain is processing every day to protect us and sure Yes, sometimes we're gonna know you sprain your ankle and a divot in the grass.

Yeah, we know why your ankle took six months to heal and somebody else's took two weeks, that gets more complicated. And sometimes we're going to figure it out. And sometimes we have to be okay, not knowing. And this is again, another connection to mental fitness is that a lot of times in mental health, and it's okay.

Sometimes we need to go deep and we need to process and understand those things. And also, Sometimes we're not going to, so we can always make the choice right here and now to shift to the right side of our brain to choose strategies to make us [00:43:34] more connected, more curious, more activated versus spending all this time, because sometimes when we spend so much time trying to figure out the why.

All we're doing is fostering more sensitivity

[00:43:48] Mark Kargela: and we got a healthcare system that will engage people and finding the why over and over and over again. We've probably all had the patient who, like you said, the controller where I need to find the person who's going to give me that answer and give me the fix and get rid of this pain so then I can move to the right side of my brain.

And I think it's a big shift with people to say. You know, and can act will you talk about creative helplessness where you help people unpack that journey and see that maybe you get some short term boost from some of these things that you're trying to do to control your pain, but is it getting you closer to the life that you want to live to the values you want to live by and often that can help people unpack that and see that maybe a different maybe we need to jump towards that right side or maybe we need to jump towards really finding out what's meaningful and matters to you and start doing [00:44:34] more of those things because that can help.

That nervous system and, you know, the human ecosystem start processes things much more effectively and, you know, be probably the most potent pain reducer, sometimes, you know, reliever completely, but life enhancer that oftentimes can make pain much more smaller part of our life. And sometimes it doesn't change a ton, but we get patients who are.

Hey, I'm living, I'm doing so many, so many things that are meaningful to me now. It's pain is so much less of a, of a hindrance or interfere in my life. It's part of my life, but it's something that people live well with. Uh, do you find that a challenging shift for, for patients to kind of, to, to navigate that?

Is there any particular strategies you find most helpful to help people? You've already alluded to a little bit, but to help people kind of make that shift from I need it fixed versus I need to live.

[00:45:23] Jen Uschold: That's loaded. I'm going to start by saying something you said about, right, I will do X when I feel better. That is a saboteur driven thought, right? Uh, versus [00:45:34] sage is I can navigate this challenging situation and be happy and peaceful. And I had a client once and she was doing act and she said one of her goals was to paint again.

When I feel better, I will paint again. I said, well, what would you think about painting? As a way to start to feel better. And it was really great because she started painting. And so painting became one of her treatments, which was great. So how do we get clients to understand that?

It sounds like just so cliche. It's having a conversation with them. It's asking powerful questions so that they can discover what is important for them. We are our own best expert. We harness the answers. And at the same time, I can't expect someone who knows nothing about nutrition to know that eating a big Mac at McDonald's isn't [00:46:34] valuable.

Right? So we have to suspend our judgment as well. So it is this. This dance of meeting them where they're at, getting curious with them, trusting that they are their own best expert, and then helping them establish what they're ready and want to do.

[00:46:53] Mark Kargela: Yeah. It's a unique conversation with everybody too. And just having some.

Skills like enact values, clarification, exercises, and different things where you really help people kind of hone in on what is the meaningful things to them. And then that's where your treatment goes to. Let's just do more of those things. I love the painting thing. I've had similar, um, conversations with patients of like, well, what do you think maybe doing that in order for you to start?

Feeling better. Like, what would, would you be willing to be a little bit uncomfortable and maybe have to deal with some of these difficult sensations if it meant you were back painting in your situation or, or you had time with your grandchildren or whatever it may be for that unique person. But again, it all comes down to having a conversation and [00:47:34] understanding that unique.

person's context in front of you and that will never, rarely ever, if at all, fit a algorithm or a script. You know, there's scripts can help us get some skills on making some conversation, not saying there can't be a place, but in the end you need to be able to weave it to each unique situation in front of you.

Jen, we could talk about this for probably another three hours and uh, maybe have to have you come back on for a few more minutes. For another episode, but I want to respect your time. I'd love if you could share where people can find you. And if there's any resources you think for people here, Oh my God, this PQ stuff, where can I find out more about it?

Or any of the things that you found, uh, that you've discussed today that you feel like would be some helpful places to point people.

[00:48:14] Jen Uschold: Sure. Uh, I have two websites. So the mental fitness and coaching is at I rise for me, F O R. And there is a tab that's all about the mental fitness. I will tell you that is changing.

They have just done a complete overhaul. So come January, the content. [00:48:34] The intention is the same, but the content and the way we get people there is actually much improved without, you'll still get a good handle on that. And there is a link in there to the saboteur assessment. So if anybody wants to take this free five minute online assessment, they can, if they're really excited to share it with me.

There's an option to share the results and you just put in your email. I do not automatically get it. And so that's where they can learn more about coaching and, um, the mental fitness. And then my physical therapy website is 1 8 0 therapy and wellness. com. And that's where those things are housed.

[00:49:11] Mark Kargela: Awesome. Awesome. We'll link those things in the show notes for those of you listening so you can check those out. Uh, Jen, thank you so much for your time. Thank you for the work you're doing and spreading some, some good, uh, pain care around the world. Uh, we need more gens to, to help some of the patients we're dealing with and definitely those who are listening, uh, check out Jen's work cause I think it's a great resource to help you all kind of grow your own practices.

Thanks a ton, Jen.

[00:49:33] Jen Uschold: [00:49:34] Thanks, Mark. I really appreciate it. I can tell you there are plenty of people who don't want more gens in the world. We can end there.

[00:49:40] Mark Kargela: We won't go into that. We won't go into that. Well, we want more Jens here on the podcast. So thank you so much. And for those of you listening, if you could subscribe wherever you're listening or give a review or share this episode, maybe somebody else, you know, might benefit from getting some, some of these skills and some trainings into their world.
 
So share the episode. We really love that. We'll leave it there this week. We will talk to you all next week.