EP 136 WTH?!? The Doctor's Chat: End Your Pain with Chuck Duff

Hey, welcome back, Everybody. I am Dr. Greg Eckel, and this is what the health and I have with me today Chuck Duff, who founded Coaching the Body Institute in 2001 and has trained thousands of therapists in his uniquely effective combination of trigger point therapy, trauma, traditional Thai body work, and principles of modern neuroscience, which sounds right up the alley for you all listeners and viewers out there. His students include licensed massage therapists, physical therapists, medical practitioners, movement and yoga instructors, and interested individuals. Spent several years on the faculty of Pacific College of Oriental Medicine. His new book, Ending Pain, has been number one Amazon bestseller in the area of pain management. And we are going to talk about. And so first off, welcome aboard, Chuck.

Thanks, Dr. Eckel. Great to be here.

Yeah, you're welcome. And I'm excited because a lot of times people don't think of myofascial pain or pain affecting the nervous system other than the nerves.

Hurt.

Right. But not on the brain. And we're going to really take a deep dive here over a little bit on your specific therapies that you put together in your proprietary program, which is training, coaching the body. Right?

Yes.

And so I, you know, we're going to talk about myofascial trigger points and showing their nociceptive stream to the brain that sets up people into chronic pain and a central senses sensitization in pain. And, you know, you don't talk to a human who has not experienced pain on the planet. Um, and so I, I think this is going to be a really great interest. So first off, you know, let's talk about just the beginnings of this coaching the body and, and where that, where's the origins of that system?

I originally trained as a traditional Thai massage therapist. I was a yoga practitioner for many years and interested in movement, so I was interested in helping people with therapy. At the time, I didn't really have a big plan to focus on pain. You know, I just thought stretching was good for people and so on. And you know, like many of us, I started attracting many people in pain. So then it kind of triggered me to do more research and that kind of led in the very beginning to trigger point therapy. But what I found was like many practitioners, you know, when, when you try doing trigger point therapy, you start out with maybe a more simplistic idea where you have a trigger point and you have a pain site. We call it direct referral. So it's one stage not thinking about the neuroscience aspect, just a mechanical way to do bodywork. When people approach it that way, including myself, you have some success. But it tends to be limited. And so what I found was, you know, the integration of several levels, including the brain, is. You really have to approach it as a holistic enterprise because the mechanical approach to pain has left us with a really poorly functioning pain industry that relies on pharmaceuticals. Sometimes surgeries has a miserable, you know, result. We. We had 100,000 opioid deaths in 2020, highest ever. So, you know, that's kind of a barometer of where we're at. So I eventually evolved with the trigger point therapy. Fortunately, it was just kind of a coincidence that I had started in Thai massage because it's very movement oriented. I was attracted to that because of the yoga and martial arts background. And it actually turned out to be a very good matching. And then adding some of the neuroscience as I went along that that kind of was where coaching the body came from. And then we just have refined it over the last 15 years or so. Wow.

So that it is failing us is. Is how. How has it evolved to that? I mean, you know, you see through. I've been in practice for over two decades, and, you know, when pain became the fifth vital sign, and maybe through the 80s and 90s, that was where the big pharma push became to make that the fifth vital sign. I don't want people needlessly suffering. But why is the kind of the suppressive medications, like, what are you seeing? I mean, you wrote a book called Ending Pain. Maybe this is a good launch in. In there is a very compelling title. And who doesn't want to end pain? So was that a natural transition out of this work that you were discovering in the trigger point myofascial realm?

It was because I started seeing clients who had already been failed by many practitioners who were on the medications. I had a close friend, my daughter's partner, his mother was essentially immobilized with low tailbone pain. And it is something we see in trigger point therapy a lot. She was completely whacked out on opioids for five, 10 years at that point. And we did eventually get her off the opioid center to a trigger point therapist who was able to help her. It's those moving personal stories that really kind of got me interested in. And really also I became kind of horrified at how bad the situation is. And what I really trace it to is, is the worldview. You know, we still. There's this picture that Descartes produced In, you know, the eight late 1800s, of a boy, you know, touching his finger to a fire and this mechanical pain impulse kind of Coming from the fire through a tube up to the brain, which then, you know, triggers the arm to respond. Well, that's a very mechanical view of pain, but it's shockingly similar to how we approach pain today in terms of the medical system.

Interesting. What do you propose in the book on the ending? Pain. There's different facets of it, and I'm guessing that also goes into your coaching the body. You wrote the book for the general population or for the practitioner or both?

Both, because I want to reach, you know, at least educated practitioners who are interested in some terminology and so on. But we tried to keep it as light as possible. Yeah, you know, I. One of the first things that I paid attention to that really helped was the phantom limpain work of V. S Ramachandran, which is kind of remarkable and doesn't seem to be that well known. You know, phantom limb pain was a classic case of intractable pain where the limb isn't even there and the person is just tortured with pain. It happens in a high frequency of cases. And he found, he speculated, that what's really happening is the brain has an internal map and the limb started producing a lot of danger signals to the brain, which we call nociception, which then cause the brain to produce more sensitivity. You know, so that's, in a sense, neuroplasticity has been talked about recently a lot and it can be a very beneficial thing. But chronic pain is really a case where neuroplasticity hurts us because the brain can respond to a high level of nociception by increasing sensitivity. It's like your smoke alarm going off when maybe you're just cooking, the house isn't burning down, but the alarm goes off. He said, well, let's try to modify that brain map. He used a mirror box in which it gave the person an image of the missing limb moving. The brain then took that visual information and down regulated its map. And he was able to get many people out of pain who had been in pain for very long time. You know, then Laura Moseley, who's one of my favorite neuroscientists, he worked with Ramachandran, he added some additional things and basically what they're, what they're saying, you know, and have clinical evidence now, is that it's this internal. The brain is really kind of a guardian. When it senses danger, then it increases the sensitivity of these pain responses. And the pain comes from the brain. It's an output, it's not an input. Descartes said it's a pain signal. That travels well. We don't really have pain receptors, we have nociceptors. All it's saying is there's a problem like the oil light in your car. And so the brain then says, is this dangerous? If it's dangerous, it wants to get your attention. And the way I view it now, that's our primary thing to deal with is that brain response in the brain map. So in my system as Ramachandran provided an image of the limb moving that was from the intact limb. What we do is we provide using various techniques, centrally trigger point therapy, but also movement, neurological distraction, giving the brain an experience of pain free movement. So once it has that experience of pain free movement, then we start to harness neuroplasticity in the right direction. So we start to then downregulate, take the brain out of this protective mode. And we've just had a great deal of success approaching it that way.

Wow, that's phenomenal with. So what are you seeing? Like give us some cases of success that you've seen.

Well, one of my early cases was a woman who, you know, I got referred to her, she lived in Hollywood, you know, very wealthy, had a pain implant device attached to her because she was basically at a point where the medical system, she was out of the medical systems sphere of solvable problems. And you know, she, it all started with her falling off her bike when she was 13. That led to eight more surgeries which tend, when you do spinal surgery, it tends to compound and basically the success rate goes in half every time you, you do that. She was a classic case of that. She, she handed me a stack of medical documents that thick, which was quite intimidating for an hour and a half session. So I briefly looked through it and then I just said, okay, I'm going to do what I normally do and that is work with muscles. She was experiencing a lot of radiating pain down her leg. Of course that's always assigned to the spine in the medical system. Even muscular entrapment, which is quite common, is not considered that often. I did that. She wrote me the next day and said, you're the only manual therapist that hasn't made my pain worse. In fact, it's 80% better. And you know, so that was clearly a case of changing how her brain was viewing her condition. You know, and she had arachnoiditis. She had many, you know, after that many surgeries, the brain, you know, it's an assault on the brain because you're, you're creating a lot of nociception by the surgery now, trigger points, the way they come into it, people tend to have this mechanistic view of trigger points, that there's some magic way that they produce pain elsewhere. You push on the trigger point and then it's supposed to go away. Well, in reality, I see it. And now recent research. So Dr. Jay Shaw @ the National Institute of Health has used these hollow acupuncture needles, microtubules, to extract the liquid from, from trigger point. And he found that it was full of nociceptive compounds, the same compounds you would have as if you had an injury. Yet it's not an injury to the brain. It looks like an injury because it's a stream of nociception that even occurs when you have what we call latent trigger points that aren't themselves causing pain. So if you have a network of latent trigger points, in other words, tender spots that you'll find in muscle, it isn't actually causing referral at the moment. But my speculation is that accumulation of nociception that is coming in from the periphery is a hidden way that people aren't recognizing that is causing the brain to upregulate. It's not just, it's like we tend to treat the body as this, like a Jaguar that needs a lot of work. And, you know, it's a cool machine, but it breaks down a lot. Well, I now see it differently. I think of it as the brain is this acute monitor that is trying to always keep the organism intact. This network of hidden trigger points that nobody's paying attention to is causing real nociception. In a sense. It's very logical for the brain then to cause chronic pain because we're not solving the problem. It was that convergence, the trigger point therapy, the therapy with movement, and then studying Ramachandran and Moseley and some of the modern neuroscience that led to this work.

And that's the coaching the body, correct? Yeah, that is really, really great work there. And you've got a whole program for providers, but also, I'm guessing, for just folks that are in chronic pain.

We do, we've been creating because we found that we, we want to reach providers, but every time we do a Facebook thing or whatever, we get 10 times the number of people that are actually in pain themselves, which kind of shows you the desperate nature of the pain landscape right now. And so we've done some self care courses because you can do a lot of the trigger point therapy techniques yourself. It doesn't require an external therapist. We developed a percussion tool that is similar to Other ones, it just is very highly refined. For trigger point therapy specifically, we developed a silicone head that allows you to be a lot more specific. And isn't these hard plastic heads that can hurt if you hit a bony structure. And what that does is. Neurological distraction is really, really important in this work. And what that means is you're taking the brain out of its habitual stream of nociception, then pain being the output. The neurological distraction kind of, you know, hides all of that from the brain temporarily. So it gives you an opening to get pain free movement working. And once the brain starts experiencing that, then those channels start to fade away. You know, you don't. One of Ramachandra's discoveries was that with chronic pain, what would happen is they watched as a motor impulse was about to trigger movement. The person would experience pain milliseconds before that motor impulse even went out. So the brain was putting out a guarding pain signal because it knew that if you move in that way, you're going to feel pain, see. So you get these channels kind of burned in, which then is a downward spiral. The person moves less, the brain protects more, uses muscles to split more. Trigger points are an excellent way to split muscle. They cause taut fibers which act like ligaments. So it provides more stimuli, essentially stability across giants without having to use muscle energy for all of that. So that's when it all started to come together, that we can't just be body workers, we can't just be these mechanical trigger point mechanics. We have to consider what is going on in the central nervous system. And we're all. I consider it a dialogue between myself as a therapist and the central nervous system trying to calm it down. And you know that that works out pretty well that.

So in that component, are you looking at connective tissue as well, where the nerves are residing? And then I guess in tangent, the component of what, what creates the trigger point? I mean, is it the, the feedback loop? I mean you're saying even trigger points that have no pain. So how does somebody know that they've got trigger points if they're not causing pain? And then what causes that in the first place?

Exactly. And that right in that you've encapsulated. I think the reason why this approach is not widely used because it's kind of mysterious. The whole idea of pain referral in itself hasn't been fully scientifically explained. But really NAR has pain in general. In terms of trigger point formation. It's considered to be either acute or chronic overload. Once a muscle starts demanding More nutrients than it can accept. So, you know, an athlete is highly vascularized. They have a lot of capillaries, so they can get ATP into tissues you know very well. They can recover from overuse very well. Those of us who aren't highly trained in certain muscles are much more vulnerable. Once you start getting overload, then these little encapsulations start to form with nociceptive compounds and pull the periphery of that muscle fiber together so you have a taut fiber. Now that was all in Trimal and Simons, you know, the doctors who originated it. But what I've done with, with my work is I view the taught fiber often as not just an accident. You know, it's something that the brain and Leon Chaita was a brilliant body worker, passed away a few years ago. He wrote a really important article that I've used quite a bit, which is, what if trigger points are not a bad thing or a misfunction, they're actually useful. A hypermobile individual has unstable joints. Their ligaments aren't doing the job. Muscle has to be recruited to stabilize those joints. Well, you put taut fibers in, now you've got fake ligaments. You know, it's a way to introduce more stability, which means safety. So if you have a broken limb, you want to split that limb. You don't want it moving around, possibly damaging more tissue. And so that's kind of how we approach it. Originally, the trigger point may form because of overuse, but I also believe it can. It can be a tool used by the central nervous system to stabilize, just as Chaitao proposed. So we kind of include that in our, in our work. And that's why we put such a focus on trying to, you know, down regulate the central nervous system. Now a lot of people, my friend David Hanscom has been brilliant in his work. He was a former advanced spinal surgeon who got out of the field because he realized so many inappropriate surgeries were being done. He was in pain himself. And he studied John Sarno's work and has really developed an advanced system for down regulating the central nervous system, including calming anxiety and stress and creative writing and so on. And I think that's really important work. However, I think we also need to include the fact that this nociception is coming in from the periphery and that's hidden. You know, you can't measure that unless you get your microtubules out. And you kind of speculate that that must be happening. I mean, it has been shown on a neurological level now that these trigger points do that. So I think that's the missing component that we could speed these treatments up really quickly. And you know, instead of taking six months, I mean we plan to get results generally with almost anybody, even in a chronic situation, in at least having an impact. In a few sessions, just by calming that peripheral load, you'll see the brain start to respond. That's what has led us to where we are today. Wow.

It brings up a question because this concept of safety. Are you seeing this in folks with unresolved trauma or trauma in general, Stress from injuries, overuse, along those lines where you think, you know, a lot of folks will think, well I didn't like do anything different. But that aspect of the innate intelligence, protecting itself and creating strength and making the trigger points that create almost ligament tests like fibers creates a restriction. That's one, the second one. Are you seeing an increase of hypermobility conditions and practices in your trainings of providers and lay people in general?

We do. And I think the point you made is a very important one. There is a lot of hypermobility. Particularly we focus on hyperpranation in the ankle at the subtalar joint. It's just shocking to me how many people have innate hypermobility in that joint. And what then happens is even mechanically, you know, you start to use your, your hips and abductor muscles to bring the arches from medial collapse onto the outside edge so that you know you're not. Because what happens then is the whole posture collapses. And of course, you know, you have to consider the proprioceptive chain of events that's happening. The brain is monitoring this. So we find often it's at the ankle that we can intervene most effectively and the posture will straighten up. That in itself will down regulate the brain because it just vastly reduces the amount of nociception flowing in. So I can't tell you why hypermobility is exploding. You know, we, we have theories about putting kids in hard shoes on hard surfaces. But you know, I think that's, that's work to be done. We just have had a lot of success working with it and it kind of fits into that same model, you know. So yeah, it's overlooked, but it is actually quite effective.

Wow, that's fascinating. I'm wondering, are you doing any work with the aging population and posture and are you finding that same thing to be true? Is it coming from the ankle? Yeah.

Well, a good example, my brother in law, he's 80 years old and had a basically melanoma that had metastasized into the brain. So they were able to do some radiation on the brain. And he ended. He was a star basketball player. You know, I used to play basketball with him when I was a kid, and he. His whole posture just collapsed and he was shuffling, you know, and I did some work on his ankles. And he's a. He's a hyper pronator. And he said, you know, I probably sprained that ankle 200 times. And so, you know, here's a. He's strong, he's an athlete. But what had happened was his body had responded to the. The hypermobility by producing hypomobility. So he had rigid ankles. And that was coming from muscle and trigger points. So I worked on him. You can reverse that very quickly in about 30 minutes. You can all of a sudden have a lot of range of motion in the ankle. Now, that in itself is not necessarily doing the person a favor because that just brings back the hypermobility. So we use arch support and we try to address the hyperpronation collapse so that the brain doesn't have to kick in with the protection and that, you know, he was walking on the beach later that day. So it can have. And I do think this is also related to the whole idea of the elderly having poor balance and falling. Well, you have poor balance when you're getting erratic muscle signals from the ankles and. And the legs and so on. So that is an inevitable result if the brain has had decades and decades of trying to stiffen the ankles against hypermobility. So I think a lot of the really tragic falls and so on that eventually can lead to hospitalization and death in the elderly could be addressed by addressing this issue. We've had some great results with that.

That is phenomenal. And so many people aren't even looking at that aspect with the aging population and strength components. Super fascinating. Thank you, Chuck, for sharing with our listeners and viewers. Is there anything else in closing that you would like to share with folks? I always like to end the podcast with an action item, but even before then, if you, you know, we're going to put some links in for your practitioner training and your website, coachingthebody.com we'll put those links in the show notes. But anything else that you'd like to share here?

Well, the reason I wrote the ending pain book was in large part because if we're going to create systemic change, we have to change the worldview. If you have pain on your hip, your doctor may say atrochenteric bursitis or you have tendinitis or this or that, it'll give you A painkiller. Everybody's on the same page with that. Well, you know, chances are you have TFL trigger points, and that's in response to your gait. That's something that the general population can understand. When I work with clients, I'm an educator. I don't treat them like, you know, dummies. They, they, they're hungry for knowledge. Yeah. But the knowledge in itself can downregulate the central nervous system, you know, because you're not in this victim situation that David Hanson gets into that a lot. So what I would encourage people to do is, is read some of this, you know, these stories. They've been in popular media about Ramachandran and his phantom pain work. Lormali, he's a very entertaining guy. He's got TED Talk and so on. Get my book. I mean, it's written for, you know, people that would likely be watching this podcast because they're curious. People are curious and they deserve to know more. I don't think the pharmaceutical companies and the industrial medical complex are particularly motivated to change things because they're making a lot of money, you know, so we have to do it.

Awesome. And what do you recommend as far as getting somebody into action? As we have just discussed some really enlightening components on the myofascial trigger points and nociception, proprioception, chronic pain patterns and degradation of central nervous system. This is big for everybody living in a body.

It is. You know, and, and so I think we need to read the owner's manual a little bit. You know, we, we've been sort of, you know, just fooled by people that tell us it's just mechanical breakdown and, you know, there's nothing you can really do. And, you know, that that victim impulse, it's real easy to get out of that with a little knowledge. You know, I don't send people to read Travell and Simons, their medical textbooks. They are not accessible for the general population. But Claire Davies wrote an excellent trigger point therapy book. I studied with them many years ago, written for general people. So things like that, you know, I would recommend really learn as much as you can. My system is one way to do it. I don't claim it's the only way, but I do think we need to pay attention some of these discoveries that these neuroscientists have given us.

I love it. Well, Chuck, it has been a true pleasure. I'm excited to get your book and investigate that work and share it with our patients and everybody out there. What the health. Here you go. You are not hearing this information anywhere else. This is a game changer. I mean, there are so many folks with pain, chronic pain, and this is such an amazing drug free approach. He's using the best in neuroscience and really well educated, educating thousands of providers around the globe. So, Chuck, thank you so much. Our listeners of what the Health. If you like today's episode, think of three people in your life that could benefit from this and share it with them. Also, get out there, give us that five star review, if you like the show, and write down what you learned and what you are putting into action, because that could actually, you're part of the community. You're helping us make the change that we want to see in the world. So, Everybody, thanks again, Dr. Greg Eckel and what the Health.

Thanks, Greg.