Episode 43: The Subconscious Side of Pain: Gut Health, Emotions & Why You’re Not Broken w Dr. Megan Steele

Are you stuck in the chronic pain loop? Tried the meds, scans, and PT—and still in pain?

Or are you a rehab pro who’s great with injuries, but struggle with patients in chronic pain?

If so, this is the episode for you. Dr. Mary welcomes Dr. Megan Steele, a physical therapist specializing in chronic somato-visceral pain and pain science. They discuss various topics including gut health, chronic pain, the nervous system, the impact of subconscious beliefs, and the role of spirituality in supporting the nervous system. 

Dr. Steele shares her insights into how stress and nervous system dysregulation affect physical and mental health, as well as the holistic approaches she employs in her practice. The conversation also delves into the significance of understanding the body's cues, the impact of trauma on health perceptions, and the benefits of integrating spiritual beliefs for overall well-being.

00:00 Welcome to TMI Talk with Dr. Mary
00:23 Introducing Dr. Megan Steele
01:44 Understanding Gut Health and Pain
02:33 The Role of the Nervous System
02:45 Impact of Trauma and Travel on Gut Health
02:57 Spirituality and the Nervous System
03:12 Practical Tips for Managing Pain
04:11 Diving into the Interview
04:44 Dr. Steele's Journey into Gut Health
07:54 The Gut-Brain Connection
09:47 Challenges in Treating Chronic Pain
11:42 The Role of Exercise in Pain Management
15:55 Visualizing and Managing Pain
22:40 The Subconscious and Pain
26:06 Connecting Emotions and Physical Symptoms
37:28 The Importance of Social Support
39:05 Understanding Intuition and Interoception
41:06 The Impact of Social Support and Isolation
41:34 Spiritual Beliefs and Nervous System
45:29 Associative Learning and Pain Management
54:10 Environmental Factors and Nervous System
57:32 Travel, Nervous System, and Digestion
01:05:06 Menstrual Cycle, Pain, and Research Challenges
01:13:48 Conclusion and Contact Information

You can learn more about Dr. Megan Steele below:

Instagram: https://www.instagram.com/painscienceprof/

https://www.megansteelept.com/

If you are a health or movement professional and want to stay in touch with future episodes, webinars, courses, events and more. Subscribe to my email list below:

https://drmarygrimberg.kit.com/4d90cba40b

Workshop:

The “Woo Woo” Explained: How Energetics, Fascia, Lymph, and the Nervous System Impact Movement for Rehab Professionals

Dont worry, it will be recorded and sent to you if you can't make it live.

📅 May 6th, 2025

⏰ 6PM CST/ 4PM PST / 7PM EST

📍On zoom (will be recorded)

You can learn more and sign up here. I hope you can join us! 

If you are a health or movement professional and want to stay in touch with future episodes, webinars, courses, events and more. Subscribe to my email list below:

drmarygrimberg.com

I’ll see you in a week!

Transcript

Audio Only - All Participants-1: 0:56

Hello everyone and welcome back to TMI talk with Dr. Mary. I'm your host, Dr. Mary. In this episode, we're going to be talking about gut health, ongoing pain, the nervous system, subconscious beliefs, and how spirituality can help support our nervous system. I'll dive more into the specifics on the episode, but before I do that, we're going to introduce our guest. Our guest is Dr. Megan Steele. She's an accomplished physical therapist. Educator and researcher specializing in chronic somato visceral pain. She received her doctorate of physical therapy from Mount St. Mary's university, where she currently serves as part time faculty, teaching orthopedic pathology and pain science to doctoral students. She is currently pursuing a PhD at Azusa Pacific University, focusing on how the Somatovisceral systems influence pain chronically with a particular interest in the cognitive and subconscious mechanisms of underlying pain. Before becoming a physical therapist, Dr. Steele earned a master's in exercise physiology and worked in inpatient cardiac rehab. Her comprehensive approach to care integrates a functional manual therapy from the Institute of Physical Art, IPA, and visceral manipulation from the Baral Institute. She is also a passionate advocate for pre and postnatal care, pelvic health, and incontinence training, often incorporating cognitive physical therapy to support holistic patient outcomes. I'm just so excited to share this with you. I know I probably say that about every episode, but I think you'll find this episode fascinating based on her research and looking at the brain and the body in so many different ways. So we're going to dive into how ongoing stress and nervous system dysregulation can impact pain, gut health, and our relationships. We start by understanding our body on a subconscious level. So things that we're just not even aware of with our cognitive brains. And so just me talking right now is using. My, um, conscious brain. So when we start understanding this from a subconscious level, it can shift our entire perspective on our health and understanding what's happening, not just what we think is happening. We explore how to gather data points on your own health so you can find the right practitioners because let's be real. Not all of them are created equal and we don't have enough time in our healthcare system for our healthcare practitioner to put all the pieces together for us. We also discussed the impact of trauma, especially sexual trauma, on how we perceive stress and why certain environments we might not even be realizing how much these affect us. And for those who love to travel, we also discuss how traveling impacts our gut health because you know how it's like to be constipated or having diarrhea when you're on a plane and we know that's not fun. And here's also something that's often overlooked, is how our spiritual beliefs can affect the nervous system, even when we don't have a strong support system or feel stuck in jobs or relationships where we really feel that we can't leave and we need that extra support. It is really hard to summarize all this because there are some fascinating tips on how to stop this dysregulation and to stop associating pain and fear with a certain activity or a certain environment and understanding how to really kind of hack the brain from a scientific level to help stop that negative loop. Overall, I really hope you enjoy this conversation because again, it was another fascinating conversation and I'm really excited to share it with you all.

4:39

Ready to tackle the topics that you've been curious about but never felt comfortable asking. With a straightforward, no nonsense perspective on life blended with candid stories and a healthy dose of humor, Dr. Mary Grinberg cuts through the fluff and addresses the conversations we all need to have on TMI talk where no subject is to taboo our bodies, our minds, and everything in between. Now, here's your host, Dr. Mary.

Audio Only - All Participants: 5:07

welcome Dr. Meg to the show. Thanks for coming on. Thank you so much for having me. I'm excited to be here. Yeah, we're going to talk all things, gut health, poop, pain science, and how it affects the brain. So we'll just go ahead and jump right in. Love it. Yeah. So can you explain how gut health is indicative of overall health, including its impact on health, on mental health and your, in your opinion, um, based on your research and experience? Sure. Well, first, I think maybe it would be helpful to know a little bit more about me. I'm a physical therapist by license, and I, um, came upon, I came to gut health via osteopathic medicine. So I practiced as a physical therapist for a few years and realized, you know, not having a hundred percent success rate, maybe there's something I'm missing. Um, I did the thing that we all do as physical therapists, which is to protect my ego in certain cases and put the onus on the patient and say, that's probably because you're not doing your exercises. Couldn't be that I don't know exactly what's going on. Um, so I have some people in apology, like most of us do, right? But I went back and I said, well, maybe there is something I'm missing. So two years after I graduated, I started looking. um, osteopathic visceral manipulation coursework, and I pursued that for a few years, and I took all the classes, and it really broadened my understanding of Pain, the physical body, as physical therapists, we tend to be really biased towards the musculoskeletal system because that's our wheelhouse. That's what we know, that's what we studied for so many years. When really, the musculoskeletal system and the musculoskeletal system are two of the eleven systems in the body. And so we tend to ascribe all things to the musculoskeletal system, all things pain, really, to the musculoskeletal system, when really there are many other systems going on in the body. And one of the most important systems is our digestive system, for so many reasons. But I'll give you kind of my top three, I guess. We could be here all night, but, um, So I guess my top one is, it gives you so much great data. As a pain science researcher, I love data. Um, it's probably not as fun to be married to someone like me because my husband will suggest that, you know, maybe we give our daughter Tylenol and I'm like, we don't have enough data points for that yet. And he's like Okay, you need to reel it in. But, um, so after I, I took all this osteopathic coursework, I was finding success in my practice, but the, the, I guess there are still parts of physical therapy that tend to be very musculoskeletally biased and they're not necessarily on board with any of this and, and the research on the visceral system is not great. It's heavily biased and, um, you know, methodologies aren't great. So there are a lot of issues with it. So then I said, well, I'll go get a PhD and. I'm going to try and prove some of this, some of what I'm seeing to be true in my clinical practice, because you can't really say, well, it works for me, you know, so it should be working for everyone. So, long story long, um, I think the gut gives you so many good data points about what's going on in your body, how healthy you are in that moment, you know, skin, hair and nails give you a lot of good information about what's gone on in the last weeks and months. But your gut can tell you, specifically your bowel movements, tell you about what's gone in the last It's gone on in the last few hours, 12 to 24 hours, you know, depending on who you are. If you're someone that goes three times a day or three times a week, both are within the range of normal, you're getting a lot of good data about what's going on in your body and you're getting a lot of good data about not just your Somatovisceral system, not just your GI system, but also your nervous system, because your gut and your nervous system are so closely tied together. Most of us by now have heard of the gut brain axis and the vagus nerve. It's been a very popular, um, topic of discussion on a lot of TikTok reels. And sometimes they get it right and sometimes they've oversimplified it to a state that it's Not as helpful for people. So we know the vagus nerve connects our brain and our gut. We know that about 80 to 90 percent of the nerve fibers go from the gut to the brain. And as a physical therapist who works with people primarily in chronic pain, I find that because I'm, I'm not a quote unquote. mental health professional. It's sometimes hard for people to get on board and to understand that we actually talk to people about their thoughts and feelings and how their thoughts and feelings connect to their pain. And one way to do that is a bottom up approach. So talking about how your physical body affects your mood and your gut does that through the gut brain connection of the vagus nerve, it does it through your immune system, it does it through your microbiome. Um, and so there are many, many ways that our bodies are physiologically affecting and impacting our brains and how we're functioning from a mental health. Perspective. I love that. I love how you are initially saying, you know, when somebody's not getting better, it's like, okay, they're not doing your exercises. And yes, I do agree that the patients still have to take accountability. But at some point there, when they're dealing with chronic pain, they've been gas lit enough that. You know, they're just like, well, everybody else has kind of given up on me and they're trying because there's not a secondary gain. It's not like anybody's excited to be in chronic pain. And when you can get somebody that can explain it, like what you're saying, it's, it can make a big difference. And it has been really frustrating for our profession to just be like, just focus on musculoskeletal. And when you focus on and divert from that, even looking at the fascial system and lymphatic system, it's like, You know, that shit on sometimes too. And I'm like, I cannot ignore these things. And I've seen even like acupuncturists look at the full body and like chiropractors do as well. And physical therapists were like, no, it's just this. And a big disservice. It's, it's a big disservice. And Um, yeah, like gut health and the brain health and understanding that whole interaction. I mean, how many people have you seen that are diagnosed with IBS and they're put on these insane diets that are unreasonable when there's stuff, you know, research coming out about, you know, it's more of the nerves, it's the nerves connected to the brain. And like you said, the vagus nerve and how they. All interact. I think what's hard though is when somebody is dealing with chronic pain, right? You're like Okay. Well, our thoughts and feelings affect our, our, our, our physical body, which affects our gut. And then what happens though, is that typically if we're trying to calm our nervous system, a lot of people do that through exercise, but you can't do that through exercise if you're in pain. So then you develop this kind of negative loop. And what would you say to somebody who's maybe in that loop? Because It's, you know, I have different things that I've said, but I'd love to hear your point of view on how to help somebody with that. Sure. Absolutely. And I think to your point about, you know, protecting our egos as practitioners and people in pain, especially for people who've been in pain for long periods of time. I used to think that, you know, if somebody didn't get better, if they didn't get across that finish line with me, then that was a failure. Sure. And. What I've since shifted to, which has helped me, and I think the people that I serve, is if I can't figure out why you're in pain, I'm not going to tell you that your pain is not real. I'm going to tell you that I'm not the practitioner for you. And so, if Rather than saying, well, if, if I can't recreate this pain, if I can't improve this pain, if I can't change this pain, that tells me that this is outside of my scope for whatever reason. Maybe this is more on the mental emotional side. Maybe this is more on the social side. whatever it is. Um, and I think that if, if we adopted that as practitioners, we'd be so much less likely to shift blame and place blame because if then I'm not the only person with any answers, then, then you can have an impact on what it, how, how you need to get there. Kind of having that accountability piece to that person of saying, I recognize this is real. I recognize all pain is real and should be taken seriously, but. Maybe I'm not the one that's going to be able to figure this out because I can't. I don't have a skill set or I don't have an understanding of where this pain is coming from. To your point about exercise, you know, I hear this all the time is I, you know, especially with physical therapists kind of getting away from the manual therapy of like, you know, I was told if I just did my exercises and there is a great deal of research that shows us that exercise reduces pain. And that's in part because of an endogenous opioid. opioid system in our bodies, and so we know that exercise is great. I had a patient tell me one time, they're not going to come up with another reason. Why exercise is great, that's gonna convince me to do it. Like, there are enough reasons. We get it. Exercise is fantastic. We should all be doing it. We should all be doing it regularly. What I tell people is, I'm not going to ask you to start rebuilding a house when the foundation of the old house is still on fire. That doesn't make sense to me. It's going to be seen as a threat to your nervous system, and it's very unlikely that you will make progress when you're in pain from an exercise standpoint. Exercise can sometimes help people get out of pain, but more often than not, we need you to be out of pain before you can start. The exercise or at a reasonable level of pain that you can tolerate movement through. Yeah. It's like the kind of more graded exercise. Cause when you're dealing with chronic pain, you know, most people are never out of pain and so there's balance between. Okay. How, what can we do to kind of get you moving? And in that, how, cause, and then when you start kind of, when you can start moving, even just like smaller movements, I've even seen it where people would just be like, okay, if you, you're in chronic pain and you can't go and exercise just kind of from a somatic standpoint, needing to release those emotions from your body too. And I've even heard it where people just, if you can't. Exercise. You can't do those things like tensing your full body and then releasing tensing your full body and releasing. So you're still kind of getting some muscle activation. Yeah. And, and there is some evidence to suggest that that helps with pain. Absolutely. You know, if somebody can't move at all without pain, you can start by visualizing. You can start by watching someone else move that actually activates areas of your brain that connect to your own body's movement. Those are places to start. They do that with like CRPS. They have people, um, you know, understand different hands and, you know, feet, and so that you can start to lateralize and recognize right from left and things like that. There's a fair amount of research too coming out about, um, interoception and things like, um, like a yoga nidra meditation where you would Go in with your mind's eye and visualize those areas of your body. Because it's kind of interesting, you think about with people with chronic pain, they have such an awareness of that area. Sometimes that's true, and sometimes it's the opposite. Like if you ask someone in chronic pain to draw a self portrait, oftentimes they will omit the area That is very painful for them. And Frida Kahlo was a great example of this. You very rarely will see her back and her legs in her drawings and her paintings. And I have someone who's an artist that came and spoke to my chronic pain class of physical therapy students. And she brought in some of her paintings. And when she was having a great deal of arm pain, she drew herself with something obstructing that area. And when she was having radiating leg pain, she would only draw herself from the waist up. And so actually going in and recognizing those areas or observing them in a nonjudgmental way with your mind's eye can help to decrease some of those pain signals. That's incredible because, you know, for people that don't know Frida Kahlo's story. I share what her pelvis was crushed in a, in a bus accident, right? It was an accident. Pelvis. Yeah. She had tremendous amounts of pain throughout her entire adult life. Yeah. And she became infertile, I think because of the accident and she suffered so greatly and so many different. In so many different ways. There are some documentaries on her. I actually went in Mexico city to visit her home this summer. It was incredible. You could see her wheelchair. You saw her bed. I was very happy to see at the end of her life that she was starting to get recognition, but I don't think she got to the degree that she is now with her. But I knew from. The neurological standpoint that when somebody is dealing with CRPS, so CRPS is chronic regional pain syndrome for people that don't know what that is. The other thing you were also mentioning too was how our body kind of has our own. you said the endogenous opioid system. So basically what that means is our own pain relieving system. So I'm just explaining it for people that are listening that may not be in healthcare, what that means. So somebody has chronic regional pain syndrome, they have a specific part of their body that is just incredibly painful and extremely sensitive to touch. And you can probably dive into this a little bit more on what that looks like, but I know that they've done a lot of mirror movements. So basically you can see, you only see the unaffected. So say if the left arm's affected, you only see the right arm, and then you put a mirror to block the, the view of the left arm, and then you can move that right arm. So you trick the brain into thinking that it's the left arm. Is that the same mechanism that you're seeing with watching other people exercise? Yep, absolutely. It's working on those mirror neurons. And, um, especially when you're doing it in a Calm nervous system state. And so if the thought of moving my own body is so terrifying to me, my nervous system is going to be on high alert, right? It's going to be sounding the alarm even before I move. And that's in part because Our nervous system learns through associative learning, and, and they estimate that like somewhere upwards of 80 percent of our learning happens associatively, and that's so true with our nervous system that I learn over time movements like this equal pain, I start to reduce the amount of movement I do until I don't move at all. And to your point of then to watch somebody on Instagram or to watch somebody on Google to just say, Just get exercising five tips to fix your back pain or three stretches and you'll never have pain again And then I try that and then I fail again That you know, I'm less likely to think well, this doesn't necessarily apply to me as opposed to Something is wrong with me. I'm the problem and then that leads to To my further feelings of, well, maybe I never will really get better. Yeah. And nobody understands me and maybe it is my fault. Maybe there's something, you know, I've even seen it where some of these spiritual gurus will be like, just meditate it away. And it's like, Oh my God, like you can't, it's just, it's really hard. Cause I get meditation can be helpful, but there's also this component where maybe some. People, we're humans, and sometimes that can be so detached from the reality of our physical bodies as well. Absolutely, and I think a lot of the psychological world is getting into pain recently as well, and, you know, there have been studies about Things like explain pain and those types of things. And then, you know, there's John Sarno who's been around for a long time and the mind body connection and things like that, which I completely agree with. But even if you narrow it down to. You know, pain is in your brain, you're still taking this hugely complex thing and saying, I'm going to sort of talk you out of pain. And for some people that works. Some people absolutely that will work for them. But as pain goes on longer and longer, it goes in deeper, deeper parts of your brain, the less conscious, the more reflexive, more protective parts of your brain, as opposed to the outer parts of your brain that are more under our conscious control. Awareness and conscious control and. You know, this is where talk therapy happens, is in my cognitive thinking brain, and in my deeper, more reflexive brain, I can get there two ways that I know of, hypnosis or through touch, and that's where I think we as physical therapists have a tremendous advantage because we have a license to touch people where in the psychological community they do not. Yeah, there's a big gap, I believe, between so especially when I'm working with people that have history of sexual abuse, um, they'll work in psychotherapy to help, um, the process or move through or develop strategies to heal after their experience. You know, I'm not a traumatic experience or multiple experiences. And then from a physical therapy standpoint, if they're dealing with chronic pelvic pain or maybe fear around sex again, because that that relates to this specific event or multiple events, you start associating. And I find there's a big gap because, okay, well, I'm not a psychotherapist, but then a psychotherapist is not a physical therapist. And so I find that. It kind of falls more on the PT to help bridge that gap. And that's something that I found in our practice is that we tend to be that bridge. Cause yeah, what you were describing for people to understand is like you're the conscious brain and then the subconscious brain. Right. And so you were trying to tap into the subconscious brain. Is that what you're saying? Yeah, absolutely. And that's what I'm really focused on with my manual therapy. And that's, um, why I tend to use things that are more lighter touched. And, and they're more focused on the autonomic nervous system, like the visceral techniques, because that's really where I feel that I've been able to move the needle with people, especially when they've gone through the musculoskeletal. Treatments and have not had success. Um, because that gets into your more deeper, more reflexive, um, less conscious areas of your brain. You know, I find that there's this struggle between like, when we talk about the nervous system, right, the pain started somewhere, there was an actual. In my experience, there was an actual injury or dysfunction or something that started it. And then the nervous system's like the fire on top of it, right? I think of it like almost like gasoline to this, like maybe little fire. And I've also seen it though on the other end where people are like, you're just stressed, like just de stressed, but there's also an underlying issue that has been misdiagnosed for a long enough that now it's become chronic. So. How do you describe it to your clients when maybe they do have an underlying, like, say, you know, maybe they've had misdiagnosed lumbar referral. Right. And they're like, Oh, it's, you know, my hips clear, everything's good, but it's actually a referral from the lumbar spine. And now at this point, then they've stopped exercising. Then they've developed chronic hip pain and now they're depressed and now they're in pain. And. How do you describe that to that person? Because there's a fine line because we've already been gaslit just by saying, Hey, it's just anxiety. I feel like there's this fine line between, Hey, this is. Anxiety or the nervous system hyper is hypersensitive right now, but also what can they do with that? Cause then if they can't get out of it, then it's even more in that shame cycle. Yeah, that's a great question. I like to explain it as a layers of an onion. And typically when I'm working with someone, if they've got a very protective nervous system. a hyperactive or hyperprotective nervous system, however you want to describe it, um, that is the layer that has to come off first. Because that's your body's primary protective mechanism, is your nervous system. And pain is one of the primary ways that your nervous system protects you. Pain is necessary, as you know, and it's our body's way of saying, I need something different. I need you to do something different. I need you to act differently. I need you to move. I need you to quit sitting on your foot, whatever it is. And so I explained that to them as, yes, there's probably, from a musculoskeletal standpoint, something going on, but Because of your nervous system, we don't know how much is being contributed from that and how much is being contributed from this. And the other piece of it is that your nervous system has a set point. And that set point has been decided long ago and it's been adjusted throughout your life. So, you know, to, to your point about trauma, people who have experienced childhood trauma, their nervous system While it was growing and developing learned a certain set point and those set points are a little harder to change than set points that were learned later on because that's part of how I've known myself as I've grown and developed, but it doesn't mean it's not changeable. So, your nervous system is really kind of the CEO of your body, essentially. It's the boss. It's the one that we're going to be constantly checking in with and saying, you okay with these changes, boss? I just needed to, I wanted to run this by you before I change, change anything here. And you know, I work at. On the nervous system, almost often, almost always at the beginning and at the end of every session, because if your nervous system is in a state of high alert, there's not a whole lot I can do that's going to stick with you. There are some changes that I can make that could be very short term, but ultimately, I'm not going to be able to really move that needle with you until your nervous system is in a state. That feels safe enough for me to touch you and feel safe enough to make changes. And so I'm always kind of talking about the nervous system in that way as, as opposed to, um, kind of the separate entity that, you know, yes, your nerves transmit signal, but we're not gonna worry about that kind of a thing. Yeah, that makes sense. I think that incorporating it all is super important. And, you know, in our day and age and everything that's going on, there's a lot of stress outside. So even to stay on top of childhood trauma, and that's something I have Had to work through and understand my nervous system. So like you were saying, it is possible, but it has been a lot of work on my end to like reprogram a lot of these beliefs. I mean, I was living in deep shame every day. And so like anything that like these little. taglines that you're telling yourself every day that maybe you don't even realize you're telling yourself, right? You're not, right. You can't do that. These limiting beliefs are just so encapsulating that you can feel paralyzed. Right. And those are so deeply ingrained. Like you say that they're part of your subconscious awareness, you know, they're subconscious until they are conscious. And I think part of the healing there, as you probably found in your talk therapy, is that, you know, they have to be brought to the conscious awareness to be worked on. And that's the same with the physical body as well. Yeah, I find that just with bringing them to your conscious awareness, like for the longest time I was like, oh, trauma is, is for people that had these experiences, maybe then went to war and then everything else is, is no. And so. I had no idea really until I developed cancer years ago that I was like, Oh my God, I was, cause I say this a lot, but I was doing all the things that we're like, we say are healthy with diet and exercise, but none of that stuff. To me can stick kind of what you're saying is if we're not getting to this route, but so many people, it's so hard to tap into your subconscious. When we're being inundated with social media, we're getting inundated with stress from work, stress at home. Like it's just for some people, it's just go just so much all at once. And so I find that. Yeah. And they said my practice getting, getting people to start noticing what those thoughts are. And we've even incorporated vibroacoustic therapy into our practice. So they'll lay down on a bed and it really helps them and it uses different frequencies to kind of tap into the brain and different parts of the brain to help tap into their subconscious. Cause, and the reason we got that bed is cause I was like, this is really hard to get people to understand what their subconscious is because. so much in our brain and less in our body. And so without a bed, right. And what, what, what do you tell somebody? Like, what are your tricks to kind of get somebody to or tips? Yeah, and I can't tell you how many times I've had people come in and I have it on my intake form to tell me about your stress level. Tell me about your, you know, stress at work, at home, those types of things. And I can't tell you how many people go like, yeah, I don't really, you know, regular stress, the, the norms. Yeah, okay, how often do you have a bowel movement? Eh, once every five days, you know. Or like, three explosive diarrheas in the morning, and then if I have a stressful meeting, then I'll have to rush to the bathroom immediately, and so you can start to kind of, I think the gut is a great window of opportunity into that. Um, helping people understand, you know, like, you can gaslight yourself from the neck up as long as you want, but your body is going to say, no dice. We're done here. I'm not playing this game with you anymore. And that's usually when people seek help is when their body starts to rebel or break down or, um, betray them are some of the words I hear. And I. And oftentimes like the first, my first cue in those situations is like, no, no, we have to reestablish this friendship and this relationship because this is, this is the only person maybe in your life at this point that's telling you the truth and this has to be listened to. And so oftentimes I'll have people, um, talk about or think about. XYZ stressor in life. Tell me about what's going on with your kids. If that's the thing that comes up in their subjective exam and my subjective exams are like from a teaching standpoint, like if I were to teach it in my ortho path class, like. I'm sure the captain would say this is an unapproved, you know, I'm just I'm like, tell me about what's going on, you know, and they're like, what do you mean, like, whatever, you know, you learn a lot with the open ended kind of questioning of like, What's, what's on your mind? So if somebody's telling me about their injury, but then also I have to drive my kid 45 minutes each way to school every day and they sit with their iPods on in the car and they don't want to talk to me and then my hip starts pulsating and I'll say, okay, let's think about that drive. Let's just think about driving that drive and and tell me what you feel in your body. And then, all right, okay, well, let's, you know, if that doesn't really give you any kind of a signal, what do you think about, just think about your daughter, tell me what you notice in your body, and then that's when my hip starts talking to me again, and so helping people kind of see those connections, I think, is really our, my goal, um, as a physical therapist, when it's less about the physical, system when somebody has been in chronic pain for some time or, um, you know, which is harder. I, I've had people that have had, you know, been in really tough relationships. I'm thinking of someone that I saw recently that had, um, UTI symptoms. And it started after a particular weekend with a particular partner and they had been intimate many times. And You know, over the course of working together, we worked on pelvic floor. We worked on some of the visceral structures and we made some progress, but it wasn't until she said, I need to end this relationship. And she did that her symptoms resolved. I see that. Oh my God. Right. From a physiological standpoint, there is not an explanation for that. Right. But from a nervous system standpoint, there's the perfect explanation, which is. Once that person is out of your life, your nervous system got the signal of safety and then it didn't have to send those danger signals anymore. Yeah, it's starting to get people to recognize the connections. Like I have people that they know their job is stressing them out. They know that that is a major source of their pain, but In that, then they, they're like, well, what do I do? I don't know. I don't feel like I have enough data to, to be able to quit. Right. It's not like that it's, it hasn't gotten to that point. And it's so much of these unexplained symptoms too. I've seen. where people are like, I don't know, all of a sudden I just had these symptoms. I didn't do anything. And so they're thinking of it from the physical standpoint. And I'm like, okay, well what emotionally happened during that time? Is there anything there? And I do find that unfortunately we have a lot of dynamics where there are, um, At least I've seen a lot more in heterosexual couples where the male partners just kind of completely blocked off and maybe potentially, abusive in some capacity, maybe verbally, or then they're confused and they're like, I don't understand. Everything's fine, but it's only in these instances. I feel uncomfortable with them or this only happened once and you find yourself making excuses for the partner and almost withdrawing and holding it in. And if you're listening to this and you're like, Hey, maybe that sounds like me. Just start noticing those connections. What does your body feel like after? You know, maybe there's some miscommunication or an argument or something like that, when I find people start connecting the two, that's when, cause it's not my job to tell somebody to break up. Right. I don't know. They're like, it could be a misconception, right? I like, I don't know what's happening behind closed doors. I know what it's like to be in a relationship where the other person's cut off and feeling chronically sick and trying everything I can and pulling back, looking at it. I'm like, Oh, it's crystal clear to me what it is now, but when you're in it, sometimes you don't know which way is up. Yeah, absolutely. I talk to people a lot about the antidote for chronic pain is social support. And so when you think about the opposite side of that coin, you know, I talk a lot about the, the mechanism behind why social support works. And it basically works by allowing your nervous system to be in a calm state where it feels safe, essentially. And so the opposite of that is not safety. And then your nervous system is sending signals that I, I need some attention. Something is not right here. And sometimes those signals are nausea. Sometimes those signals are pain. Sometimes those signals are the pit in the bottom of the stomach. You know, they present differently for everyone, and the associations are different for everyone too, and that's what makes it challenging, but I think those of us that work in chronic pain, that enjoy chronic pain, you know, like we love a good mystery novel, or we love a good, I was a law and order gal for many years. Um, you know, you just want to dig and get to the bottom of it and help them find out what are the connections here and what are the triggers that are telling your body to protect. Yeah. Yeah. It's, it's so much more than just so much more than just the physical and, and listening to that gut feeling, I'd say, you know, there's, and I did a podcast episode on. A few months ago on how, what the difference between your intuition. I know like you're a researcher, so you can't really like study intuition. Um, but in that it's that little silent, it's like a quiet, it's not a fear, it's not a scarcity, that's anxiety, but it's like this little. Kind of nudge and then over time it kind of gets louder and louder and then if we're not listening, that's when the physical kind of symptoms start, start creeping, creeping in from that standpoint. Yeah, absolutely. And I, you can't really study, study intuition, but you. And you can't really study the nervous system. So we have like proxies for that, you know, so like heart rate variability is a proxy for studying the nervous system, essentially. And I think of interoception as a proxy for intuition. Interoception is a How well do I recognize what's going on internally in my body? And so, um, And for many of us that live in Western society, you know, we are rewarded for ignoring those signals, right? We say, I can work for 18 hours straight, I only need four hours of sleep, I forgot to eat lunch because I'm such a go go go getter. And or, you know, you look at your athletic populations, I press down and I suppress signals coming from my body about pain. So there's a, there's a high correlation between people who have low and tarot, septive awareness and chronic pain and eating disorders and, um, anxiety and depression, because when we're not listening to our bodies and we're not addressing those signals, the cascade, like you say, of. negative effects, um, is tremendous. Well, it's, it is, it's tremendous. And it's, it's not something that is often talked about. And with that, you know, we were talking about like social support. Okay. So, so say if you're living with somebody, That maybe you don't feel supported, but the likelihood is that there may be other people in your life too. And I've seen people feel really isolated. And so when you're isolated and in pain, it's hard to want to go out and it's hard to want to interact in community. And I like to talk about too, like beliefs outside of ourselves. Right. And that's not something that, you know, I'm not sure how this looks in research, but have you found if somebody kind of has. Some sort of, um, spiritual belief or something outside of them that, how that affects their nervous system. Cause this is never talked about. And so I just wanted to kind of see what your thoughts were with that. Yeah, there was a really big, really interesting study, gosh, I want to say 10 years ago, somewhere around there, it was a while ago, but they looked at all the different factors that can work for chronic pain. They looked at medication, they looked at exercise, they looked at mindset, they looked at, you know, the list was tremendous. The two things that came out of that were prayer. And cannabis, not great for, for the psychological community, not great for the pharmaceutical community, um, but prayer and cannabis were the two things and they looked at some of the reasons why and, you know, When you say the rosary, one thing about the rosary is that the way that you breathe when you're doing it is it tends to slow down your breathing and your exhale is longer than your inhale. Oh my gosh. I had no idea. So I don't know if anybody knows what the rosary is. It's, it's a Catholic prayer. But wow, I never thought of it like that. And there's a great book by James Nestor, um, called Breath that he talks about breath work and things that we often in Western society teach our patients, we say, take slow, deep breaths, inhale through your nose, exhale through your mouth, make sure your exhale is longer than your inhale, so then you're biasing that parasympathetic nervous system. There are so many prayers that follow this six breaths per minute pattern that we think in Western society, like, Oh, aren't we smart? We just taught people how to slow down their breath and, um, calm their nervous system. Um, but that may be what people have been doing for centuries with prayer. It's wild. Yeah, it's, well, the other aspect that I've seen too, at least for my nervous system is just trusting in a benevolent God or force or something outside of me that I don't have access to a supportive community right this second. But I can trust that there's something greater that's holding me. And in that, regardless of what religious or spiritual beliefs you have, but if you have that as this, this benevolent, like loving, um, force that always wants good for you, that can feel a lot different. But on the flip end, if you're constantly worrying, and like you believe maybe in a God that's condemning, or, you know, these different things, the opposite effect. So I find that You know, I'll even bring that up in my practice. I'm like, Hey, do you have a spiritual belief and, you know, it's independent. I'm not pushing that on anybody, but just think about it, you know, and I never really. Like there was a point where I was like, you know, in a job that I didn't want to be in and it was too scary to leave and I just said, God, universe, who's ever out there, give me a sign. And I just kind of left it at that. And then it just, it came so crystal clear, uh, months later that I was like, Oh, this is it. Oh, the decision has been taken. It's just been made. For me and what a gift that that was is that I didn't have to This pressing crushing decision to be able to do that Yeah, absolutely, and that can be so calming and just beautiful for Your nervous system and, you know, so, so many aspects of it. I've, I've used faith as a, an associatively learned, um, calming technique. With someone recently as well, she was in a similar situation. She could not leave her job. It wasn't financially viable for her family, but it was incredibly stressful and her pain level would shoot up every time, every time this boss came into the office and it was like unannounced and there was no preparation. way to prepare for it, but when I asked her about when she felt the best when she felt at peace and calm and the least amount of pain possible, she said at church and she had this beautiful faith and it like brought her community and it brought her some of the things that you were talking about, like this recognition that there's something greater than me. And it was during COVID. And so I said, You know, let's see if we can't do the associatively learning the opposite way. And so for a couple weeks, we had her put like lavender oil inside of her mask when she was at church. So then her brain started to associate lavender oil. equals calm loving supportive environment. And then she started to, after two weeks of church, I said, let's try the lavender oil at work. Pain levels significantly reduced. Oh my God, that's so cool. So we can use associative learning to our advantage, right? I can. teach my nervous system that this is a less threatening environment and to your point of like maybe it's not a completely non threatening environment but eventually she was able to get out of that job and now she is surfing and running and All the things. Yeah. It's, I mean, that goes to, it's the Pavlov's law, right? Exactly. Yeah. And so that was, do you want to explain that for people so they, they can kind of understand? Because I think it is so important, especially when we're helping people like return to having sex maybe after a traumatic experience, because now we associate sex with something traumatic. And can you explain a little bit about. What that is, and maybe say if somebody is dealing with fear around sex again, how that can, um, a way that maybe this, the way that you're explaining can help them. Yeah, so, um, I like to give the example of, like, you know, taking it out of the sex situation just for, you know, to decrease some of the, maybe, tension around it, potentially. If I were rear ended by a red car, every time I see a red car in the rearview mirror, my body is going to do, you know, to a much lesser degree. This is a huge over exaggeration. Um, to your point about sex. I, the smells that that person had, the sounds that were going on, the level of hormones that were coursing through my body, all of these things can become associated with that situation or that traumatic experience. And so which are the ones that are contributing to my nervous system? Going into that, that situation, is it the position, is it the smell of that person, is it the state of my nervous system, the state of my hormone levels, uh, what are those things that are triggering my body to go into that situation or into that protective posture or protective position? And how can I start to peel those away? And, and like we've spoken about earlier, bringing that up to my conscious awareness has to be the first step there. And so I need to know what those triggers are and what are the things that are making me or allowing my nervous system to protect and how can I start to decrease some of that. And so one way, if it was, um, a sexual experience and I felt that there was a, a smell that was connecting. And smell is really connected to our subconscious brain because it's like kind of right in that deep middle part and we don't even need our conscious awareness to process smell and that's why sometimes smell is so connected with memory. And so could I smell that smell in a graded exposure kind of a way where I say, okay, I'm going to smell it for a little bit. And then I'm going to go do something that makes me feel really good and really safe and really calm. And then I could try the next day a little bit more and a little bit more and a little bit more until I feel that I smell that smell. And I don't have that physical physiological reaction. Can you explain what the PAV laws? I always like PAV. So I think that if they can understand that a little bit and understand the association, because it's very similar to what I'll say too, is just even if somebody is just even just non sexual touch or even just visualizing it, getting your body to kind of, okay, I feel uncomfortable and then go kind of calm your nervous system and then come back. That's Similar to what I've helped people work through when having those, those associative reactions to sex or even anything, um, chronic. And, and I love the idea of the smells and like, even just going into like understanding the associated, like decreasing that association. Slaying the Pavlov's Law. So Pavlov was the researcher. He turned out to be not such a great guy for animal rights, but, um, yeah, he was kind of a bad guy. But, um, he established what's called associative learning or an associative learning model. So what he would do is he would ring a bell and then feed the dogs, ring a bell and then feed the dogs. His research was on, was on dogs. And, um, What he found is then the dogs began to associate the bell with food. So they would start to salivate when they heard the bell because they associated bell equals, I'm going to eat soon. And so that was how he proved associative learning is that I rang the bell and there's no food around. But these dogs are salivating because they're anticipating food because they've learned to associate bell with food. And so if I have learned to associate my job with pain or my, my sexual experience with pain, I can come out of that with extinction training, which is I. Uh, graded exposure is one way to do extinction training so that you decrease that association. So, um, they often talk about Peter, um, little Peter, I forgot, Mary Jones was the researcher on that one where she did extinction training. She, um, this little boy, Peter was afraid of white rabbits initially. And I think maybe he had been bitten by a white rabbit or something, but then that, um, fear began to expand. And then he got To be afraid of anything white, anything white or fluffy, even things like cotton balls that are pretty innocuous. So what they did for extinction training was they had Peter sit at the far corner of the room and they brought a white rabbit to the door of the room. Peter has a big reaction, he becomes afraid, they take the white rabbit away, Peter gets ice cream. Next week they bring the white rabbit to a little bit further in, Peter gets afraid, they take the white rabbit away, ice cream. So on and so forth, each time getting the ice cream. And so what I teach pain science to the third year physical therapy students, I say, this is very simple. You just, treating chronic pain is finding out what are the white rabbits and what are the ice cream. And that's how you get people out of chronic pain. I love that because it's the brain is so, Oh my gosh, it's so fascinating. And when you can start hacking it basically, and into these little details where you might not even be aware of, of these different things. I mean, I'm sure you all can think of smells. Like it's funny, even to this day, I hate. cigarettes, but like they remind me of my grandma who was so loving. And so when I sell cigarettes, I'm like, Oh, I miss her. Yes. And, uh, and that memory comes like that, right? Every time, every time. And I go like bacon and cigarettes. She sounds like somebody I would want to hang out with too. So you're just like, give me more, give me more. I know, and we joke about, you know, there are things that you can do as a physical therapist, like I never wear red in the clinic because most of us associate red with danger, with inflammation, with stop, with pain. Um, and then we joke about like we should pump in the smell of, you know, freshly, Baked chocolate chip cookies and that it'll just bring everybody's nervous system like, you know, and when we have things like models of the spine with these big red nasty herniating discs Or the knee with the red arthritis around it. It's like What are we doing here? Guys? I love that you're bringing this up because there is an aspect of clinic decor and the environment that is, I have, I've not seen anybody talk about it. And I thought, I was like, am I crazy? But you know, I have it set where our clinic, we have no fluorescent lights, like, and even in our new clinic, it looks like it's fluorescent, but it's led. And then you can modify it and make it like a lighter kind of color. And then just. It's about the environments, you know, I am so attentive to it now. Like when you go into a hospital, it's stale, it's cold, there's no colors, it's just, yeah. And fluorescent lights and loud noises. It is horrible for the nervous versus like, I, I think I go, okay, if I'm a client. And I go into a PT clinic, I'm looking at what colors are around. What are the, is there a sense, um, what are the sounds that I hear? And I'm just so obsessed with looking at those things, because like you said, I'm not going to have like bright red in the clinic. Well, I'm going to have like, maybe like a. Like a light, like a green or like a warmness, like thinking about those colors and, and even thinking about your home, right? So maybe you're not a clinic owner, but your home, like, how does your home make you feel? Does, do you go in and it's like, Oh my God, there's all these different things that will have a direct effect on your nervous system too. And I tell people, because a lot of people like their gut will flare up when they're traveling. Um, I'd love to kind of get your opinion on this too, but I tell people, I'm like, when I, my experience, when I've seen people with chronic pain and even my own self with somebody has dealt with a lot of trauma is I'm hypersensitive to sounds. And then like bright lights, but sounds and smells are like my two big ones, but which smells is hard to kind of block unless you're wearing maybe a mask, but airports tend to flare people up. And I, I believe it's because. Every sense is being stimulated. Every sentence, right? And your vision, you got left for us and lights, the sound, your flight did it up. People running past you bumping. So your sensation. So touch, um, vision, right? Vision, smell, um, sound, like all these things and taste, you know, that's kind of hard to, to block. I mean, cause it's really off, but I I'll tell people, I'm like, wear noise, canceling headphones and a hat. When you go to the airport and, and see how your body feels. Even if you, I'll have people like, well, I have kids. I still have to listen to them. I'm like, well, there's those loops, the loops, those little like things that you can put in your ear. So you can still hear people. What would you say to somebody that. I mean, constipation and bloating while traveling is just rampant. So huge, I believe is directly related to the nervous system and changes in your gut and like what you're eating and things like that too. But what, what are your thoughts on that? And what do you recommend? Yeah, definitely. So there is, you know, the the if you're especially in a long flight, there's some dehydration that's going to happen. And so you can mitigate some of that with increasing your fluid intake. But none of us want to be in that little pillbox of a bathroom on an airplane, right? And so people avoid drinking sometimes. But I talked to people about the fact that there are two sides of your nervous system. There's the fight or flight side and the rest and digest side. And So, yeah, that's it. When you are traveling, most of us spend a fair amount of time in fight or flight, especially if I'm going to make my flight on time, is the security line going to go faster, am I going to get flagged, did I remember my passport, all the things, right? And so because I'm spending more time in this side of my nervous system, and of course it's a spectrum, it's never all one or the other, but I'm spending less time in my rest and digest side of my nervous system, so the blood is not being shunted. to my organs to do the work of digestion because the blood is being shunted to my muscles to say we might need to fight or run. And so what needs to happen on the other end of that flight or car ride or whatever is I have a moment. Or 10 or 15 or 20 or however many I need to help my nervous system come back down so that my body can do the work of digestion, so that my body can produce hormones normally, so that I can sleep tonight. All of those things that tend to get kind of shifted and off while we're traveling. And so I always tell people the good news is your nervous system is flexible. It's always moving neuroplasticity. It's always changing. So there are times where we're going to be more in fight or flight and that's okay. That's normal. Our bodies are meant to be able to do that. But then if you can build in some of those times in your schedule, I don't know if you're like my husband who's like, well, we can see these three monuments on this day. If we run from this one to this one, I'm like, then no. I am here to sit on the beach and do a lot of nothing. So we need to Build that in, um, yeah, and building those times into your travel, into your routine. Of course, it's more challenging when you have kids. Recognizing that I'm, if I'm going to travel, I'm probably going to be stopped up, and so how can I do the work on the other end of that to help my nervous system, help my digestive system to more normalize. Yeah, I think it's important for people to know what's happening when you're in a fight or flight and so peristalsis is the contraction of the gut to propel feces forward and In that, that slows down when you're in that fight or flight. And like you were saying that like the, the blood is diverted away and into our arms and legs, because we think we're running from a bear or we've got to be safe. And so it's not. Not being in fight or flight. I've heard somebody say this and I, I really don't like this about the big healing, um, kind of wave that's coming is it's almost like we're supposed to be calm all the time. There's, it makes me so frustrated to hear that because that is literally impossible. And if you are. You're not exposed to the world that we live in. I don't, it's not, it's coming out of it. It's not staying in it. Right. And that's, that's a big key. And that's one of the ways they think maybe that exercise helps is because your body learns that pathway up into fight or flight and then back down. And I often tell people, you know, especially. Those of us that are disconnected from our bodies, you know, if I'm having explosive diarrhea three times a morning, or if I haven't gone in five days, that's your body's way of telling you something is not right. Because when I'm in fight or flight, my body has two options. I either need to get rid of this food immediately so that I can run faster, or I need to shut this whole system down so that I can shunt the blood elsewhere. And so people feel really Nauseous. They feel like I don't want to put food in the system or they have those two, um, reactions on the back end and for lack of a better term, I love talking about poop. I love when you're like explosive diarrhea, not just diarrhea, shit hits the fan, literally. Yeah, I think that, you know, years ago, I, when I've been on this healing journey, myself is just noticing your gut health. Like, what does your poop look like? You know, are you having diarrhea? Even, I think people are unaware that constipation and diarrhea are also a spectrum. You know, if you're still pooping, but they're little balls and you're straining and it's taking forever to go, that's also, that's constipation. And so something in your nervous system, or maybe even, you know, think something that you're eating or your body's giving you a message, but we're not apt to listen because we, we don't know. Yeah. And I think that's where asking like secondary questions. really comes in handy. You know, sometimes we'll say like, you know, if you're not really comfortable talking about bowel movements and things like that, well, how do you do digestively? Oh, fine. And then you move on and you go, is it a sausage? Is it a sausage with cracks in it? Is it the color of cardboard? How frequent, like, I want to know all of it. Size, color, frequency, all of it. Um, because my norm, just because it's my norm, which are like rabbit pellets, and I don't feel like I've evacuated completely. That's not normal. I think, yeah, a lot of it is, hey, we've normalized it so it's normal to us. But when you realize, hey, it's not normal, it's your body's, your body sends you messages all the time. We just don't know how to interpret them. And if there's anything anybody takes away from today, it's it. Start listening to your body's messages, start noticing, Hey, what do my poops look like? Like, is there emotional stress related to my physical pain? What am I, have I been kind of pushing down and ignoring? Because I actually have found that people that over exercise are almost emotionally suppressing. And it's like, yeah. You can exercise a lot and get that out, but you're not addressing why you have to keep doing that over and over. I saw. And on top of that, that goes with breathwork that goes with cold plunges and, and sauna's like, those are great to support your nervous system, but why is it repeatedly being triggered? And that's. The way I think of it is, okay, well, as I'm moving through this and my nervous system gets triggered, I use those as tools, but that's not my answer. And that's the same thing of like, you know, if I have to go to physical therapy or chiropractic three times a week in order to reset or be okay, then am I really solving the problem or am I doing symptom management? And I think the normalization piece goes so far. You know, in terms of women, especially like, you know, menstruation, so I really started my visceral journey and my visceral research journey on the, the digestive system because I said this, you know, 85 percent of low back pain, it has unknown cause, right? We call it chronic nonspecific low back pain because we say, well, You have low back pain, we don't know why. We do know that the digestive system can refer pain to the low back, but the western medical system is like, nah, it's not that, you know. But, so my question was, if we don't know what it is, how can we say it's not that? So that was kind of my thinking. And then, Over time I sort of shifted to say, well really there's so little research being done on women, there's so little research being done on women who have pain during menstruation, that this is really where I need to have my focus. And that's where I've kind of shifted over the last year, uh, two years actually. And so, yes, you are twice as likely to have, uh, low back pain if you have IBS, but you're 2. 5 times more likely to have chronic pelvic pain later in life if you have pain during menstruation. And talk about something that's been hyper normalized to the ex You know, it's so funny. It's, it's like, it's both ends of the wrong spectrum. It's like, yeah, you have period pain. We all do get over it. And also that's too taboo. Don't talk about it. Nobody wants to hear about that. Oh, it's, I just did a podcast on estrogen dominance and I've gotten. so many messages like, who do I go to? And it's even hard to find, uh, people that, that treat that, you know, and women are screaming for it. They're screaming for it. And I'll tell people, I'm like, listen, look at the menstrual cycle, like pull it up. There's plenty of, of, of images online and you'll see the different waves of your cycle. And. People will be tested on like day eight. I'm like, that tells you not like, that's not telling you anything. You don't see many spikes during that time versus this is why there's day 21. Cause that's roughly when progesterone spikes. And so you can look at it and the more you learn about it and you're like, Oh, I'm having pain today. Well, what's going, what's. What phase of my cycle am I in? Let me pull that up. Let me look at what's supposed to be happening right now. And the more data you can collect, the more you can start advocating and finding the right practitioners to help you. But even on my side, it's hard to know who to refer to for these certain conditions because estrogen dominance still isn't mainstream on, on treating. And I will say for people, I want to say it's the, Episode for me, it's the episode eight on my podcast where we dove a lot more into estrogen dominance. So you guys, if you're having painful periods and understanding it from that level, um, cause that's a whole nother. Animal and another topic to, to address. And I'm sorry, it was episode seven, episode seven of this season, season two, where we, we dive into that. And one of the main causes of low. So in very briefly explaining it, it's a lot of it is the estrogen, the progesterone to estrogen ratio being off where you have more estrogen. Then your progesterone is still higher in the luteal phase, but the ratio is off and a lot of times, you know, you can have a variety of reasons why your progesterone is low, but one of the major causes of low progesterone is chronic stress because your body makes cortisol and diverts to cortisol and prioritizes that over progesterone. So people are put on. estrogen birth control, which I just, I'm just floored that we're putting people on estrogen birth control, which is almost worsening the problem that we're not addressing the nervous system. And then we're like, why are they having all these symptoms? And then they can't get pregnant. It's just, I, I just. It's such a disturbance. It's such a disturbance. Yeah, and, and there are subgroups of people who have pain during menstruation. Some of it is related to estrogen dominance, and some of it is related to other things. So it's a really complex problem that we have not really addressed and not really looked into enough. And, um, that was part of why I switched my focus as well, because, you know, I was told, well, If you're going to do this IBS study, you should really do it on men because women are too hard to study. And that's in part because anytime you're studying women, your pain perception changes throughout your menstrual cycle because your hormones have a big impact on your perception of pain. And so for my study, I'm, having to capture women during like mid luteal phase, which is challenging. Like based on, we have to get four researchers together in a room. We have to schedule these people that all have real full time jobs like myself and the participant in the room within this window of time. Yes, it is more challenging. Does that mean it's not worth doing? In my opinion, absolutely not. Also, I think I'm probably just that person that like, someone told me I couldn't do something. So I was like, all right, well, here I go, then, you know, like, well, we need people like you to do that to help with us, you know, because yeah, not all of it is estrogen dominance. That's one piece. But what, what else? What other factors? And I think it's also hard because people have been put on chronic Like birth control for decades. And it's hard to measure their luteal phase too, if they're on, you know, on birth control for that long. And so you've got so many factors. I could go, I, we could go on for another like five hours on, but yeah, I mean, it's, there's a lot. And I would just tell people just start tracking. Like I get people to like, just start noticing, tracking, being aware of your body signals. You don't have to do anything with it yet, but you'll be shocked on just listening and noticing your poops, noticing. What are your poops like during your luteal phase? So that's usually after day 14 to 28 or whatever length of your period is before you have your period and it's not people are like, oh, it's not, I'm fine on my period. And I'm like, no, no, no. It's the whole cycle. It's not because you have a fluctuation of hormones and so many different aspects. So track it. Start tracking your period, start noticing your gut, your nervous system, your pain and all of these different things and even Tracking your emotional state, like what stressors have been going on as well. Yeah, yeah And if you can just start to recognize some of those connections and I always tell people I love that new thing on Instagram like we listen and we don't judge Right. You could do the same with your body. You're just a nonjudgmental observer. You're not trying to draw conclusions about what's going on or what might be causing this. You're just sort of saying like, Oh, that was interesting. That was a different, you know, I'm just collecting data points. Like you speak to my researcher heart, my little researcher heart goes pitter pat when you talk about data points, but like. It's a part of knowledge and knowledge is power and knowledge about our own bodies empowers us, I think tremendously. We're our own little research study. Like you're a research study of one and your body is going to be different than my body. And nobody's going to know your body better than the person that's in it 24 seven. And. And yeah, you can go, when you collect that data, then you can go out and kind of seek help and then ask more direct questions because in our health care system, this is vital. This is vital because if you're going to somebody in network with insurance, they probably have five to ten minutes, they don't have the ability to do that. So if you can be like, hey, this is what I'm experiencing on this days and this is what's going on. They may be able to kind of get you those answers faster because they're not going to have the time to tell you. And yeah, you can go out of network and find people that way. But in general, that's just kind of the more data points you can give your practitioner, the less they, they. That just consolidates that time. Yeah, absolutely. Huge, huge. Well, thank you so much for being on here. This, uh, this was such a fascinating, you know, hearing your research side speaks to my heart. I think eventually one day I want to get into research because I just, I'd love to work with you. Yeah, because we need this. We need more of us out here, you know, explaining to people what's going on versus. you know, dismissing and, and, and the research is just not, not where it should be for women. So how can people find you if you want to tell them about your Instagram and your website and yeah. Yeah. So, um, my practice is in Santa Monica, California, and you can find me at MeganSteelePT. com and my Instagram is pain science prof. Cool. Well, I will tag that in the podcast notes here. So thank you so much. Meg, nice chatting with you. Thank you so much, it was great to be here.

1:15:42

You've been listening to TMI Talk with your host, Dr. Mary Grinberg. Make sure to subscribe wherever you get your podcasts. To learn more about Dr. Mary, head on over to drmarygrinberg. com. And make sure to follow Dr. Mary at DrMaryPT on all social channels. To learn more about Dr. Mary's integrative practice for pain relief in Austin, Texas, head on over to resilient rx. com. Thanks for listening!