Progressive Pain Science with Dr. Greg Lehman | Podcast Ep. 128

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we have a awesome episode and it is an interview with Dr. Greg Layman. Dr. Greg teaches around the world reconciling biomechanics with pain. He is one of the most progressive thinkers on the biopsychosocial model of pain and how it can apply to your practice. So I'm super excited to have him as a guest this week. And without further ado, here is Dr. Greg Layman. Greg, I met out in California from the gentleman over at Crossover Health not too long ago. Super impressed with everything that he put together and I knew I wanted to have him as a guest and he kindly obliged. So, Greg, thanks for coming on.

Yeah, thanks for having me.

You got it. So some of the exposure to kind of what you talked about was eye opening to me. But before we get into, you know, reconciling biomechanics with pain and your philosophies on that, give everybody a little bit of background of your journey within the healthcare space. I know you have a diverse background and it's super cool. So let everybody know a little bit about your background.

It's not too diverse, it's more like a lot of the same sides of the of the same point. But my background was kinesiology here in Canada. And then I thought I was going to go to chiro school right away. Like I was big into that when I was quite young, like 20, like reading all of these reports and I was on the Internet before I was even in color. It was like black and green. I'm serious. It was like second year university where it was like 1994, you know, the Internet literally was black and green on like chat boards with Cairo. So I, but I was always very evidence based and I was always initially very BioPsychosocial. Honestly, in 1980, again, 1993, 94, I was reading about what's his name, John Sarno, and trying to write papers in my posture classes on posture, motor control, about emotional influence of posture. But I really like biomechanics. So then I went on and did a master's in biomechanics at the University of Waterloo, specifically focusing on exercise and the physiology of spine manipulation. And then I was lucky enough to go to the Cairo College here in Toronto and they let me do research and teach when I was a first year student. So that was a neat role. So I got to stay up to date and then I was a practice, you know, full time practice for five or Seven years. And I thought, you know, I'm right by Queen's University. There's a good physio physical therapy program. It's only take would take two years, I can work full time. So I got my physical therapy license as well. And that wasn't so much to learn more about musculoskeletal health. I don't think I did. It was more for the opportunities. And I like the idea that their scope of practice in some ways is broader. Like you could go work in cardiorespiratory or pulmonary care. There's different opportunities there. I didn't pursue them, but I wanted those options. But it was interesting comparing the schooling that was for sure.

So what drew you to kind of those deeper levels early on?

First I just wanted a practical application of kinesiology like the exercise science. Cairo seemed better than physio at the time, but then the biopsychosocial was really in the biomechanics because you had these world renowned biomechanists who would go into workplaces in the 90s trying to decrease injury and they would always say we can't just address the physical. We can't just, you know, make the drills lighter and change the elbow posture and give them a better chair. They would say we have to look at all the other factors. So we've. People have known about the psychosocial influences on pain and disability for more than 30 years and have been trying to solve that problem for at least 30 years. So it was biomechanists who were so humble but also at the same time wanted to get better. So I was taught pretty young. And I was also with two Cairos, Kim Ross and Dave Bresnik, who were kind of blowing apart a lot of our chiropractic theories at the time. So I was indoctrinated, really young into being skeptical and, and question what I know. So I never felt like lost. I know a lot of chiros and physios feel lost when we challenge like the foundations of what we do. I never had those foundations. So it was very easy for me to embrace like I don't know everything, I don't know a lot. But I'm comfortable that I can still help people. And that's what the research would suggest.

You're reconciling biomechanics with pain science. And you know, I've heard it describes, you know, as kind of progressive and cutting edge. And you even brought up some antidotal stories of where you've changed your mind over time. You know, looking at things Analyzing the literature and applying that to the patient base and kind of evolving your thought process. But for any of the listeners that haven't heard of that course yet, talk a little bit about what that entails and what you dive into, because I thought it was just unbelievable. And kudos for putting it all together, but tell the listeners a little bit about that.

The big thing is everyone talks to talk that the biopsychosocial is important, but it doesn't mean it's easy to implement it. And I never wanted people to think that the bio is not important. I just think it needs to be minimized and sometimes simplified or looked at differently. So the 50% or more of the course isn't tearing apart the bio part of pain and injuries. It's simplifying it and give people practical tools on how to use it. So it's saying, here's another way to view why exercise is good or why spine manipulation is good. We don't go too much into manual therapy anymore. So that was sort of the idea to sort of say, it's okay. Like, I know a lot of people are knocking what you do. Like, I used to do that and I still do. And then people say, well, what the hell do we do? So the thrust of the course is like, well, here's another way to look at it. Here's to help with your clinical decision making. And then the other half is like, okay, how do we start adding in small? You know, we're not psychologists, we're not social workers, and we don't have to be. But we can take some of the information we know about pain and exercise and healing and how people adapt to load and exercise and sort of make help that knowledge, take that knowledge to help address some of the psychological factors related to pain, like fear of motion, you know, catastrophizing, you know, false beliefs about pain, not being active again. So it was. It was all like, how the bio and psychosocial can work together so you don't have to blow shit up. You can just, you know, build on what you have.

Your theory of expose or protect and how you broke that down so simply. It seems so obvious, but I'd never heard it put in the context that you. That you did throughout rehabilitation and really getting well from injury. So talk a little bit about expose or protect. How did you come upon that? Even though it sounds so simplistic, I think the nuance and the subtlety is something that's exceptionally powerful.

Yeah, how I like to practice and always helped me. Cause I couldn't memorize mechanisms and all that stuff, I'd be like, what's good for the person? What are the good treatments that people do? There's always people that will have a course, you know, and they seem very different. And I was like, what are the common themes amongst all those different people? And one is like this exposure idea, which is like the application of stress to someone and then they adapt. You know, that's what exercise is. You load someone up and you assume that they will adapt positively, you know, and they can have less pain, they can be stronger. Whatever happens, you know, they can get better. But then there's times you're like, maybe you need to back off a little bit. Because we know that adaptability is finite. You can't just keep stressing, stressing, stressing. So our clinical decision making, the challenge is when do you start loading someone or challenging them to adapt, or when do you protect and back off because you think there's something about this person where they're not ready for that load or that stress, so you have to protect them? That's sort of the idea. Like a psychosocial example would be, yeah, we know it's good to. If someone says, I'd love to start running and I've had knee pain for five years or back pain for five years, and you want to start running again, to me, I want to say, absolutely, there's no reason you can start running 10 seconds today. But maybe they have these fears or catastrophizing thoughts or this kinesiophobia or whatever, and unless you address that, you can't expose them to the running or something like that. So it's always that interplay of like, does something need to change, you know, to go from protection to exposure or anything like that. So that, that's why we talk a lot about that. Because I think it's a fundamental.

Yeah, I think it's an exceptionally important component that I just had never heard laid out in the style that, that you did. And for anybody that's coming into anybody's practice, I think that balance and that decision making process between you and the patient is, is just. And in line with that, what are some things. I know you touched on a couple at the time, but as you've gone through and kind of evolved and matured as a practitioner, what are some of the things that you've kind of changed your mind upon from maybe 5, 10, even 15 years ago to today? And as you've learned more and seen more, what are some things that have challenged you in the Past, I guess.

I mean, I still have the same challenges now in the past, because ultimately, like you're trying to, when someone's in pain, you're really trying to find out, is there ever anything, something specific about that person that needs to change? Right. Meaning we can have like all of these assumed dysfunctions. You can have, you know, a leg length discrepancy, you can be tight, there's nothing. You can be weak. Like, if that's in the bio world, you can also have depression, you can have anxiety, you can catastrophize, you can have allodynia. You can have all of these things that are related to pain. But the big question to me is, how do you figure out what has to change? So that's always been my clinical struggle, and it still is, especially with the patients that I can't help them. What aren't I addressing? What am I missing with them? So that doesn't really answer your question, but it's the same problem of always had. Hopefully I'm still developing skills to address all of the potential areas of someone that might have a contributor to their pain or sensitivity.

Yeah. And what do you think is the biggest misnomer from. Let's even break it down to a patient perspective. So as all providers, we just have such a knowledge discrepancy often with the people walking in our front door. Right. I mean, they're just so clueless to what's going on in their body or really the good decisions to make. And, you know, that's a vulnerability. But as a provider, you know, our goal is always to, you know, to make the best decisions that we can in coordination with our patients. What's one of the biggest misnomers that you see? And you might have just touched on it a little bit with the example of the runner, but when a patient comes in and there's that, there's that fear, Right. Everybody is injured, has some form of hesitation, some form of fear of getting started. But what's one of the biggest myths that you've seen kind of proliferated throughout time regarding that?

You know what the biggest one, it wasn't even patient. It was like, I do, like, gymnastics and tumbling and my girls cheerleading, and there's like a coach who's my age or younger. I'm 44. I was like, you should be out here with me. She says, oh, no, I can't do that stuff anymore because I did it when I was younger and now I'm old and I have, I have two bulging discs. You know, the Classic, classic defeatist attitude. And so those are the big ones. That's that idea that people can adapt. And that's such a, to me, that's such a fundamental tenet of humans, is that we have this capacity to adapt, but we only adapt when we catalyze that adaptation by stressing or loading ourselves. And so that, that's like this false belief that that person will have. It can contribute to sensitivity, but it also gets in the way of starting healthy behaviors. Like doing gymnastics again, jumping on a trampoline, running, you know, it's like so false beliefs in and of itself. I'm not sure they're that bad. You know, like thinking, oh, I'm frail. But when it takes away from doing healthy activity, then they become, you know, more relevant.

Yeah, I agree. And good work, by the way, on the gymnastics. I've been watching you in the foam pits. Okay.

Online.

So great work.

I hit my head yesterday. It was awesome. My girls.

But what are some pressing issues that, you know, you're looking to really dive deeper into? You know, as time goes on? What's come across your radar that you found kind of new, intriguing and, or interesting, even if it's a, it's a.

Tale of soul this time, like research wise, like, what am I reading about? Yeah, well, what I always do is like, I try to challenge my own biases. Like I talked about this in the course because it's something I'm working on for months now. I don't get too worried if people have knocked knees or various knees or anything like that. Like, I think load is good, but some people get really worried about that, say with knee osteoarthritis. And that's not something I really care about or really spend a lot of time changing. Half your listeners are like, this guy's an idiot. And so that's sort of my bias because I don't want people to get caught up if their knee caves in a little bit. I'd rather they just walk and not worry about it. I think if you strength train and are physically active, you can get away with those things. That's my bias. Right? So I want to take my bias, which is don't worry about that. And I've been trying to like really dive into the literature on like progressive knee OA and posture and, and gait and all of those things. So I'm trying to disprove myself. That's, that's what I'm trying to do. And then if I'm. Well, hopefully I don't know because then at least my bias confirmed. Maybe I won't be able to. So I always do stuff like that. That's my research kick right now. It's like how does like dynamic either dynamic knee valgus or varus or that knee adduction moment or knee abduction moment contribute to neoa? And is it worth spending all this time addressing?

Where can people find out about where you're going to be at, where you're doing? We were talking pre roll and I know you travel a ton and you're all over the place. So where's the best way for people to contact you or find out what you're up to?

My website, of course. Greglamon CA 2019 is cool. It's going to be less traveling. I think there's going to be more online stuff. Definitely a lot more free online stuff I'm going to do. This is the first time I've said this out loud. I want to create an online course, of course, but I'm going to do like four or five lectures that are different and that are going to be free just until I get my technique down. And I like your idea of the 20 minute stuff which I didn't even realize until now, but my wife's like just do 10 to 15 minutes. People don't want to sit down for an hour. You're right. So I'm going to do online modules that are like pain nuggets and that'll like that might even. That's like, could be a precursor to taking the course. You don't have to, but it certainly helps. So more free stuff like that. I really like doing that. So that's my website and again if people are interested in this, that's why there's a free book on the website. That's the recovery strategies book. That's a. I think it's a. Not really my idea. It's just my way of, of talking about it which is a really good start to understanding the biopsychosocial and things you can do to help your patients today. So that's always free and always will be awesome.

I'll put a link to that certainly in the show notes so anybody that's listening through itunes can just click through and check that out immediately. And I'm going to put the hammer down right now and say we'll get you back.