Can we rethink what we are taught about pain?

Join us on the Crackin' Backs Podcast as we welcome Dr. Joe LaVacca, DPT, OCS, a trailblazing physical therapist dedicated to transforming chronic pain management. As the founder of Strength in Motion Physical Therapy, Dr. LaVacca emphasizes a patient-centered approach, integrating strength training with rehabilitation to empower individuals beyond traditional methods. ​

In this episode, we explore:

• Redefining Pain Perception: Dr. LaVacca discusses how shifting the understanding of pain from an input to an output can alleviate fear and improve recovery outcomes.​
• Integrative Rehabilitation: He shares insights on merging strength training with therapy, addressing concerns about balancing recovery with progressive training.​
• Challenging Healthcare Norms: Dr. LaVacca opens up about confronting profit-driven models in healthcare and his commitment to ethical, patient-first practices.​
• Advocacy for Alternative Therapies: Delving into the science and skepticism surrounding CBD, he explains his support for its role in medical care and patient wellness.​
• Vision for the Future: Envisioning a healthcare landscape that integrates mental health, prioritizes patient education, and moves away from profit-centric models.​

Dr. LaVacca's approach centers on empathy, communication, and empowering patients to take control of their health journeys. His dedication to ethical care challenges the status quo, offering a fresh perspective on physical therapy.​

For more information on Dr. Joe LaVacca and his work, visit his Website HERE

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Transcript

Unknown: 0:00

Welcome to the cracking backs podcast today, we're absolutely thrilled to host Dr Joe Lavaca, a forward thinking Doctor of Physical Therapy who's on a mission to revolutionize the way we understand and treat chronic pain. Joe challenges traditional rehab approaches boldly integrating strength training and rehabilitation into a seamless, empowering journey free from fear and misinformation, tired of healthcare mills and outdated methods, tune in as Joe dismantles harmful myths, reshapes perspectives on pain and paints a vision for the future where physical therapy puts mental health patients, education and ethical care way above profits. All right. Well, Dr Joe Lavaca is so great to have you, and we were trying to come up with something and to kind of kick this off at as healthcare providers, I don't care if you're a medical doctor, a chiropractor, or a doctor of physical therapy, people turn to us as we're supposed to be infallible, where the kings were shining arbor. People come and hit us, and they're the weak ones, and they turn to us to be strong. Yet you shared your journey with depression, and it kind of changed the way I was, like, listening and talking to you and doing my background on you, and I'm like, wow, this guy was like an open book from the start, talking about depression and and how he struggled and all that. So can you describe the moment you kind of realized that mental health should be the heart of any physical rehabilitation, and how openly sharing your story and vulnerability kind of impacted your relationship with the with the

Dr. Joe LaVacca: 1:44

patients? Yeah, absolutely. And I just want to say again, thank you guys for having me. It's true pleasure. For those listening, I am going over just a little bit of a cold, so I will do my best to speak clearly, but I'll mute if I sneeze or anything like that. So I think the first part of your question is, I always thought like none of this stuff can happen to me until it happens to you. And it's the saying where everyone has a plan until they get punched in the face. What I realized about pain was most people felt alone, and like you said, they would come to us to, you know, fix them. They'd come to us for strength. And during that process, I was sort of taught always make the focus, and I still believe this, but always make the focus the person in front of you. Don't share your story, don't put it you know, don't make it about you in any individual session. But then what I realized was, when I asked permission to share my story, when I asked permission to share other people's stories that I worked with, it just gave people this sense of calm that they had no idea that someone with pain could be experiencing depression or anxiety, or, you know, having a hard time at work or having a hard time with their spouse, and when you just validate those feelings and tell them, hey, I understand. And if you wouldn't mind, I have a story that I could share with you if you think it would be helpful to hear. And most people like we were saying, like stories, they want to be a part of something. So for me, when I was going through, actually, I'll start the story just one step before. I think this was right before my divorce, and that's, I think, when more of the depression and things like that came into my life, and I had to cope with it. But right before that, I was working with a client who was an ACL reconstruction. And if you've ever seen anything like that, it's very, very straightforward, you know, like, Hey, you have to bend the knee, you have to straighten the knee, you have to strengthen the quads. We have to do all this stuff. I have to get you walking. But I'm never thinking of something like, Well, what did this person go through? What's this person's private life like, you know, what has she been through in the past? And she would come in with her partner, and she'd be, you know, sobbing the entire time, you know, on the table, I could barely touch her. And shamefully, she came from a doctor that I was trying to establish a relationship with. So I was like, I can't mess this up. This is the first, you know, ACL repair that this doctor sent me. I have to get this person, you know, squatting and lunging and this and that the other thing. But then the whole time I could barely touch this person, so I started bringing her boyfriend into the treatments themselves. And I was like, Look, maybe you can move her knee, maybe you can do this together. Maybe you guys can start to, like, almost be like, co patients in this and I didn't do that because I was like, trying to be this really great hero. PT, i. I did that because I was like, Oh no, I can't ruin this first patient from this doctor, because then it's going to affect the clinic. It's going to affect all these different things. The rehab goes well, or eventually starts to go well. They move and they sort of invite me for a drink. And I don't normally do this. Like, I would never, like, kind of like, go out with a client or anything like that. But for some reason, I was like, just go. You know, they're appreciative. Have a, you know, have a beer with them, see what they have to say. You know, you enjoyed their company. And when I got there, they handed me a card, and I was like, oh, you know, again, this is, you know, me being a shameful people. I can't accept gifts or bribes, you know, you know, I'm a salary guy, you know, I'm good, you know? And they're like, just open the card. It's not a gift certificate anywhere. It's just, it's a story like you would tell us. And her story in the card was how she was a sexual abuse victim, how it was so impossible for her to trust men, especially strangers, to move my body, touch my body, all this other stuff. And she had been to three or four other male PTs in the city. And then this is when her doctor finally said, oh, you know what? Just try Joe. You know, I just met him. He seems like a nice guy. And as luck would have it, it ended up working. But she was so appreciative, because she was like, you were the first person that actually tried to incorporate or actually try something else, other than just yell at me, or, you know, push harder or dig harder. And I was like, I was cool. I wasn't trying to be so that was really eye opening for me, where I was missing, in my opinion, so many things about the person in front of me, I wasn't even asking. And, you know, we're taught about that biopsychosocial model. And again, I sort of poo pooed the psychosocial. And it was just, well, how could an ACL be psychosocial. I mean, the ligament doesn't have feelings, the knee swelling doesn't care how much they slept, or anything like that. So I would say that was step one, and then step two was actually me facing the depression, facing those types of things, and then seeing how much it makes you feel stuck. And that was always a conversation that came up with patience, this feeling of, I don't know what to do next, and you're treading water. You're, you know, stuck in quicksand. You know, whatever the analogy is, I started to experience that, and it wasn't really until I was sitting in the gym with a good buddy of mine. He was a traitor, and I just said to him. I was like, hey, you know what? This is October. This is similar to what patients would tell me, you know, after after the holidays, you and me, I'm gonna start training. And he was like, What are you doing right now? Like, Oh, you know, I gotta, I got a client in like two hours. I was just gonna go, you know, have a coffee or get lunch. He was like, No, you're not, you're gonna go to this barbell and we're gonna start going right now. And I was like, oh, okay, great, let's go. And then from that point, like, that was the push that I sort of needed to just get unstuck. So those two moments for me, I've always, sort of like tried to consider with every person you know, again, not knowing who they are, where they came from, until you ask who they are and where they came from, and developing that alliance or trust, but then realizing that feeling of being stuck, it can last forever, but then all it takes is one comment, one interaction, for you to push yourself forward again. And I think that's how I see it really like, kind of like starting modeling my practice.

Unknown: 8:51

Wow, Joe, what a great story. I think it's fascinating that the difference between a new practitioner and a seasoned one is instinctive behaviors that we possess or learn along the way, and then we we operate on this, what appears to be an autopilot, but you make these fantastic, right? You know, inspiring and Revelation style decisions. You know, you have a concept about pain. Oh, but first I wanted to mention, you know, we were taught, you know, in progress notes to always be cautious of putting in, you know, a patient's psychological condition, because then we would, then, you know, let's say this one's depressed, or this one, you know, that was almost like a diagnosis. So we would refer to it as a psychological overlay. And it always appeared that, you know, guys that got, especially our athletes, when they get injured, there was always this, you know, psychological overlay over a chronic period of time. So it was, it's fascinating to to be able to address that, which is why we refer our podcast. Of the mental, nutritional and physical aspect, right? You have a concept about pain, you know, as an output, not an input. Can you elaborate on that? Because I think that's brilliant, yeah,

Dr. Joe LaVacca: 10:11

so that my sort of perceptions of pain have changed so much as I'm sure they have for you guys, you know, the more you read, the more you interact with people. You develop these sort of, like, you know, ideas. A lot of my reshaping of pain probably started when I was working with rock tape, and that's actually how I met Courtney, who was on the podcast, who we talked about before. So this idea that, you know, pain being an output is how your body processes all of these signals, all of these interactions, all of these pathways to produce a sensation or to produce consciousness, right? So I am of the belief that pain is a conscious event. That's sort of how I go about thinking about it. And I think when I consider pain, this sort of conscious event, something that you're aware of, that affects every part of your being, I think this is also why I can sort of make sense of how many different treatments work. And you know, the stuff you guys do, and the stuff that physical therapists do, everything sort of can give this temporary relief of symptoms, because I think it just plays with consciousness. Hey, you're focusing over here. You're downplaying, you know, another pathway over here. However, the whole output thing, I think I've even changed that word a little bit more recently into really, just considering it an emotion itself. And I took that idea from Jeffrey mogul, and I loved it, because after I heard him speak, pain to me became such an obvious emotion, or maybe even like a sixth vital sign. I know we keep saying like, you know, sixth vital sign was walking now, and sixth vital sign could be balance and this and that the other thing. But you know, for me, pain became that six vital sign. And you know, with this idea that pain being an emotion, and then you can compare it to every other emotion, and my emotions, I usually compare it to our thirst or hunger, right, something that continues to come back. So I don't really know that I'm hungry or thirsty until my conscious overlay, or my conscious experience tells me, hey, when was the last time I ate? You know, when was the last time I drank? Right? Now, it wasn't in that one moment in time that my body suddenly became hungry or thirsty, but it was the first time that it crossed this threshold of awareness, right? So what do I do, typically, when I'm hungry or when I'm thirsty, well, I'm going to go get something to eat. Now I'm going to go get something to drink, right? I felt a sensation. My brain processed the meaning, and then I created an action. Now, the thing is, as we know, hunger comes back multiple times a day, thirst comes back multiple times a day. So I've yet to meet someone who's like, well, I'm giving up on this whole eating thing, because what's the sense, you know, like, I'm just gonna keep getting hungry. Or, like, why even have water? I'm just gonna have to keep drinking water. And when I started thinking about pain as an emotion, I started realizing there was no specific action plan for people to remedy that feeling right? Because pain sort of motivates you to do something, but it doesn't really tell you what. And I think that's where it gets confusing for people, or the idea that pain, you know, should just be fixed or should go away forever, when you try something and you get a little bit of relief, and whether that, you know, whether that's manual treatment or exercise, or anything in between, when the pain comes back, for most people, instead of thinking like, Okay, I should just go see, you know, Terry or Spencer, I should go see Joe again. Or I should go to do my exercises or do my breath work or do this or do that, they sort of get discouraged, like, why did this come back? I don't understand. So they don't establish, I think these behaviors to continue to remedy, remedy, remedy. And for some people, and you know, I know a couple of them that I work with, it seems like they are stuck in that pattern of constantly trying to feed their pain, but if they can continue to feed it, I always tell them, I don't know when that signal is going to go away, if it will ever go away, but if every other emotion we compare to it. I mean, I go through weeks or, you know, days every, week, I'm happy and I'm sad, I'm okay, you know, I'm hungry and I'm thirsty, right? So maybe it's not supposed to go away. Maybe we're just trying to seek understanding of it. Have behaviors that help me cope with it, and I think that's where the pain and emotion conversation for me really has kind of shifted. My perception of even trying to give people advice or help people in the clinic and even at home with their with their programming or other lifestyle behaviors,

Unknown: 15:10

that is, that is fantastic. I love that consciousness of what pain can really, you know, manifest, and how you can look at it a little different than just a physical experience. Thank you for that. You know, it's interesting. I had a friend of mine who ended up getting a divorce 35 years married, and I told her to ask herself this question, because Pain is pain, emotional, physical. And I said, you know, I asked myself, Who am I becoming through this pain, and what kind of life do I want to create from this? Yeah, you know. And those are little, you know, moments of wisdom or epiphanies that you could use to just instead of why me, the why me question, right,

Dr. Joe LaVacca: 16:00

right? I really like that Spencer. And I think a major component for rehab, for me, because everyone comes in and they want to go back to who they were, right? And maybe it's even, maybe even the word that we're rehab, you know, is, is sort of implying that we're going to bring you back to who you were, but I think it's to really make the most of who you are. And, you know? And it's just really, it's, it's fascinating, because I work with a couple people, and they're talking to me about shit they did in high school, and I'm like, bro, you're 30 pounds overweight now. You got three kids, you know? You're a lawyer. You were you when you were dunking a basketball in college, what were you talking about, right? You know, like, so, you know. And I'll say to them, I'm like, Look, I don't know if that's going to be possible. Maybe you dug a basketball again, but how about we just work on, you know, you figuring out stairs without, you know, screaming in pain before we worry about what you were doing in high school, you know? But, but I think it's always, like, very fascinating. But I love that sort of like, that reframe of like, well, what is the what is this trying to teach you right now? As opposed to, hey, where are we? Where are we going, and who are we? And I think that's really even like the bookmarks for me about like, anxiety and depression, right? Like depression people, I think, stay stuck in the past. And you know that for me and my personal experience, that definitely was what it was. You know, you go through a divorce, you're lamenting, you know, you're kind of figuring out, like, what could I have done? How could I have saved this marriage? You know, what? What mistake did I make? What sign did I miss? And you're just like, looking backwards, looking backwards, looking backwards. And then, with the anxiety, you're always doing the opposite. You're looking forward. You're looking forward. What if? What if? What if? What if? What if? Yeah, so I think, like, that question of, like, what's the pain trying to teach you right now really can kind of help focus people to well, then what can you control right now? And that's really, I think, the biggest thing that most of the clients miss out on. And, you know, I don't know if it's reasonable to think that it was just, you know, something that I didn't do, or something that you guys didn't do, because I heard a saying that people need to hear your message about seven times before, you know, they can understand it. So maybe I was just saying, like, when I lose a client, I was like, Oh, I must have been number five. You know, it was, I don't have to change I don't have to change I don't have to change anything. I just must have been the fifth person that told them that. But you know, they're close, They're close. They're going to get to number seven, and you know, then they'll come back around. But I definitely appreciate what you're saying. There's been that's

Unknown: 18:32

great joke. I love these little moments of these epiphanies and little tidbits that you share because they're really, like, bite size that we can run with. So thanks for that, of course. So I want to talk about CBD and your alternative therapies that have often raised eyebrows and traditional medical circles. So you know, what are your thoughts about CBD?

Dr. Joe LaVacca: 18:56

Yeah, I so I was with a company for a little bit that was kind of dabbling into the CBD space. You know, through all of the things that I read and were exposed to, the things about the CBD is that you can find these CBD receptors all over your body, right? So in theory, when you take CBD, you can take it and it could affect pain, it can affect emotion, it can affect your microbiome health. It could affect sleep, right? So I think those would be the biggest reasons why people go and reach or gravitate towards it. Now, from everything I've seen on CBD, the thing I always assure people is that it's 100% safe to try. I've you know, when we were sort of sampling different flavors and styles, I mean, I think I took like, five or 600 milligrams of CBD, and then I went right back to work. Yeah, I wasn't sleepy, I wasn't over excited, I wasn't anything. I just went back to work and sort of like lived my life. So I think the thing about CBD, and maybe this is even the case for any other treatment that we could talk about, I think it comes to set and setting. So what is your mindset and where are you when you're implementing some of these treatments or some of these supplements into your life? Now, if I'm taking CBD for, let's say, let's just say sleep, and I take it at, I don't know, nine o'clock. I take it with, you know, a sanka, like a decaf coffee. I have, you know, all the lights on in my house, you know, my kids are running amok, and I don't know how impactful that will be, however, as part of a ritual, right? What if I took it with tea, I dimmed the lights, you know, the kids were in bed. I was reading a book instead of watching severance, you know, anything along those lines, right? And it then it might have this enhancing effect. I think what's the biggest question mark with all the CBD and the cannabis is that, you know, it's unregulated right now, so any company that comes out with it, they have to regulate themselves, and you hope that you're getting what's on the label. So advice from a supply standpoint, always look for people that are third party testing. Always look for people who have now barcodes on their products. But I think that it is a safe adjective or safe adjunct to try if it fits into your sort of financial profile, because it is a cost. I think that if you can understand what your outcome wants to be, and then as long as I think you're pairing it with something maybe a little bit more active, so meaning, like an exercise program or lifestyle, behavior, nutrition, you know, you're not just saying like CBD is going to cure everything for me, right? I think you have to be a part of that process, engage the process, rather than kind of trusting the process that the CBD is just going to wash away everything that's bad inside of me. So I think my stance has gone, you know, from Hey, everybody should try it because it's safe, to Hey, you can try it if you think it'll help. And here's some of the best ways for you to think about going doing so. And I can give you some reputable companies, and then we'll see. But I always think that people who just go into it blindly and don't have any way to measure outcomes. That's when it's like, well, I don't know if it helped. And that's typically what people have talked to me about, and I used to compare it then to, I don't know if you guys take creatine or fish oil or multivitamin or anything like that. How do you guys feel after you take creatine, fish oil or multivitamin? Yeah, I don't know. I just feel like me, you know, I like I don't know if it's, is it doing anything? I mean, I don't know. I guess, I guess if I die at 88 instead of 86 you know, no, but it's a long time away to, like, do my little own pilot study, right? So, you know, I do these things too, I mean, and when I went to I did a precision nutrition coaching thing, and one of the things I always remember taking from it was like, hey, like, Hey, these are the supplements that probably most people should be trying. And I was like, Okay, so I've been spending money on fish oil, and I have a multivitamin I take, like, every other day, because I'm like, I know 98% of my nutritional profile is protein powder. Like, I just scoop it, I drink it, especially during the clinic, I'm like, oh, gotta get to I gotta get to 190 today. How am I gonna do that? Unless I'm just slugging down protein powder left and right. And then I come home and I'll make dinner, and then usually cap it off with, like, some protein ice cream or something, right? So I know I'm not getting enough of the nutrients I need. So that's why I started doing like a multivitamin every other day. And I think I feel fine, you know, I don't know if it could have helped me. Should I take in more multivitamins? Maybe I wouldn't have gotten sick with the flu. But, you know, a lot of these things are, I find non falsifiable. So if you're taking the CBD and it works for you, I'm going to support you, right? I'm going to say perfect, keep going with it. It seems like it's a very good part of your routine or your ritual, if you're taking the CBD, or really anything else, and you're like, you know, I don't know. And I'm like, Well, okay, well, is this feasible for you to continue? You know? Does this? Does this like, 30 bucks a month, 50 bucks a month, or whatever it is, impact your life negatively? What could you be using that money for? If it wasn't for CBD, right? I luck. I don't think I've really met any client who's had an adverse effect, but we do know that the doses can be a little bit biphasic, where some people who take a small dose will sort of say, Oh, I feel more alert. Some people with a small dose might get a little bit relaxed or chill, and then it might have the exact opposite effect if you do at a higher dose. So we used to say, Start low, go slow, right? So you take, you know, whatever the recommended intake was, let's say it was, you know, 50 milligrams. Start at 25 because you always know that if you didn't get the effect you were looking for at 25 you can add another scoop to your water, you can add another scoop to your drink or your food, and then sort of go from there. But I do think it can be a great tool. I would love for it to be, you know, more regulated eventually. You know, I keep hearing different things on what likelihood that is, you know, was supposed to go to a schedule two or schedule three, and then that never happens. And then now, and it's like, okay, well, now we removed one of the hydrogen molecules, so it became, you know, DEXA 10 instead of DEXA nine, or delta nine instead of delta 10, and that delta 11. And then I walked by one of the cannabis stores in New York City the other day, and it was like, Delta 12. I'm like, How high are we going up here? You know, like, so I think there is a lot of question marks, but I'm hoping for a lot more good quality answers in the future. I just don't know when that's going to be.

Unknown: 26:28

Yeah, I absolutely believe and observe that there's the fad where everybody tries it and then they and then after a year or two or three, some go. I don't it didn't work for me. It worked great for me. So there's so many variables involved. And you know, rather than just giving up on a CBD, there's always one out there, and you've seen many of them, I want to ask you about something very, very controversial, very near and dear to the healthcare provider. I love it, but I can't get past the fact that you brought up a cup of coffee called sanka. My grandmother drank sanka. So I'm stuck on our conversation from like, what half an hour ago? Yeah, I don't know. Drink sanka Folgers. You know what

Dr. Joe LaVacca: 27:17

it was? I think because I've been sick and I've been making pastina for my daughter and myself. I think I've just been invoking all these, like, old Italian terms, yeah, like, sanka, yeah, I got some pastina in me. I got a whole pastina thing in the fridge. And when I was Googling, like, I haven't made pastina in forever, right? So I'm like, oh, there's, like, kind of cool way to do it. I made pastina three different ways the last, you know, the last week. And fun fact about pastina, it's called Italian penicillin, which I had no idea about. So I was like, All right, Italian penicillin, here we come. But yeah, I just feel like everything now is emerging in these old school like Italian words or things that I used to see my grandmother and stuff Drake, where it was like, Yeah, bringing it back,

Dr. Spencer Baron: 28:04

Folgers. That was a good one. Terry,

Dr. Joe LaVacca: 28:08

oh man, I haven't seen a folder. I mean, they still make folders commercials, Folgers in your cup.

Unknown: 28:15

How brilliant of a marketing person that everybody heard the word Folgers also in that jingle came in their head, I still sing it. Oh my gosh. That is great. Great. My

Dr. Joe LaVacca: 28:26

parents, my parents, in this day, still have, I think, like a paint, like a paint can, jug of Folgers. Oh, yeah, in there,

Unknown: 28:35

my dad used to have the Folgers cans and put all the nuts and bolts in the garage. He used to have, we had Folgers cans everywhere?

Dr. Spencer Baron: 28:42

Oh, my God, I'm done. Totally digressing, because I think it was Maxwell House.

Unknown: 28:49

Wait, wait, a more coffee or coffee, that was the tagline. I don't know why that's stuck in my head. Wow. Oh, my God, oh, I just broke out. Okay, so let me go back to the controversial question. Yeah, I'm ready. I'm ready, because this will probably piss most people off. Oh, I love, I love questions that piss people off. You, you my men, have done the best thing you could have done, and that's actively challenged health care's profit driven model, and even left a secure job over ethical concerns. Please elaborate. Yeah.

Dr. Joe LaVacca: 29:26

Okay, so during, it was during the divorce, and I think again, at that time, I was making decisions based on, well, really, how was I going to be financially stable? And Courtney and I joke, because, you know, we talked about the cost of living in New York versus, you know, Colorado. And you know, my rent for my apartment, not even this, not even this one. I won't even get into this one my my one bedroom, one office, one bath was still more expensive. Than the mortgage for her townhouse that she was sort of moved into a few years ago. So, you know, with that in my mind, I'm like, How the hell am I going to survive with one income? You know, I'm paying child support. I'm paying for Avery's, you know, school, because she was still in daycare then. And I'm gonna be honest guys, I look back at like, what I was making and what I was paying, I'm like, How the fuck did this even work? This is it's actually impossible. So I'm thinking, like, did I embezzle money? Somehow? Was I stealing? Like, what did I do? Do I have a credit card that still is, like, maxed out, with like, $50,000 on it that I don't know about, that's just accruing interest, you know? And I'm like, I don't know. I lost it. I don't know where it went. So I was, I actually taught, and it was with rock tape, and it was at, it was at a facility down in New York. And that Monday after I was done teaching, the phone rang, and I just happened to answer it, and it was the owner of that practice, and he was like, Look, I've actually wanted to talk to you. I really enjoyed your course. Would you be willing to come on down this week and just meet with me? And I was like, Sure, no problem, you know. I was like, okay, maybe I can have a continued spot to teach in New York City. Well, you have anto ball for me, a job as a clinical manager. And I was like, Well, you know, I'm kind of happy with where I am, you know, it's a great spot, and so you just have to kind of make me leave, you know? And you know, what ended up making me leave was a 10% raise in my salary. It was the ability to make my own schedule, which was important to me, for not only my daughter, but for my relationship with Courtney. So we ended up, you know, building out this thing. I went back and forth. I was wined and dined. And I'm not gonna lie, I kind of liked it, you know, I was, I got taken out to dinner. I was like, Oh, this is nice, you know, I want to become an office manager or clinical director. The clinical director, that's what. And and then i The one thing I did not do, and if there are young clinicians listening, it was not sitting in or shadowing during actual treatment or care hours. It was always I came there before he started his shift, sit in the back, and then I leave. I'd get there after his shift was over. I'd meet him out for a drink or dinner, you know, while we were kind of negotiating. And then once I came into the actual practice and was observing the way they treat it was Medicare patients were wrapped up in a towel or blanket, put on heat and stem, and then just left there. Then once the you know, how long could you be on heat and stem? 15 minutes or so, the beep would go off. You want another 15 minutes? Sure. Let's redial it up. Let's reposition you, add another towel or so, cocooned up. Maybe they, some of them would ride a bike. Maybe they wouldn't, you know, it depends on the day, I guess. But when I started to, you know, but I'm still, like, I could, I could fix this, you know, I'm gonna, I'm gonna fix this place because I'm clinical director now I'm gonna make some changes here. And I remember having a conversation that came up with somebody, and I said, Oh, hey, you know, Terry, how's, how's your shoulder? And you say, oh, it's not my shoulder, it's my knee. I'm like, Well, you've been here, you know, 18 times for your shoulder, and they're like, Oh, yeah. Well, you know, because the insurance company stopped paying for my knee, so we just opened a case on my shoulder, and we're just doing that. And I was like, Well, I don't know how comfortable I am with that, so we'll figure out this after today. I'll go talk to talk to them. And it was always this idea of like, we are. We are doing this to help the patients, which is bullshit, right? If you were going to help the patients, the idea then would be, in my opinion, to empower them to be able to then do things on their own, knowing the insurance limitation that they're faced with. So hey, you come in and see us, or you come in and see me. Now, if finances are a concern for you, I'm not going to like, nudge you and be like, well, I can give you a 10% off discount. I can give you a 20% off discount. I want to know what you're actually capable of doing. If you're only able to see me once a month, cool. Then we'll make a plan to see each other once a month. If you can see me once a week, great. We'll make a plan to see me once a week, right? But if you're limited by Medicare or anything else, then we have to work within those parameters. Unless you tell me, Hey, I'm comfortable financially to pay cash or to do this or to do that. So I think that's how you help people, right? The best one person, also a Medicare client, who was, I think it was probably the same day, reported me to my boss because I tried to make him do things. So that was actually his words. And he was saying we were because we were having a conversation. And I think he was, he he had some, he had some, some sensitive. Be with his foot. And I was like, Oh, well, you know, one of the ways that, you know, we can get in, like, more things around your house, is just, you know, you could try walking around barefoot, or he was always wearing shoes and stuff, and he's like, Oh, my floors are too cold. And I was like, All right, well, you know, we have, there's toe socks, and there's all these different, you know, you can just wear that fuck you want me to do you want me to do about your cold floors, you know, like, just put a sock on. I mean, Jesus Christ and, you know, and that's where, like, one of those things, like blinds. Like people come to us for strength, and then sometimes just gotta look at them and be like, What the fuck are you talking about? Just put a sock on. Do I have to solve everything for you? I mean, apparently I do. So he reported me that I tried to make him do things. And when I, when I said that his his floors were cold, that I just offered him to wear a pair of socks. Yeah, so then, you know, long story short, it obviously didn't go well. I was pay cut to try to get me to quit. And then when I just sort of, like, took it, I was like, All right, whatever. I'll just take the pay cut. But then that's when I started to think about strength emotion. So it was, it was one of those things where I was grateful for it, because I think it just made me realize, hey, if I want to do things the way that, that I want to the way that, like I read research, or the way that I'm, you know, growing as a clinician, I'm going to probably have to do it myself. And when I was, when I was let go, I think, I think, actually, I was probably fired because he asked me to sign off on notes for him when his license had expired, because he he moved, he moved, and he didn't get the thing in the mail. And I was like, well, when are the notes from? They were from times when I wasn't even working there. So I was like, I can't sign these notes. I wasn't even working here. What are you talking about? And I think that's where it was like, Well, you know, Joe's not, Joe's not playing the game. We got to get rid of this guy. So he let me go. And literally, I remember leaving my first job, which I have no problem naming, which is perfect stride, you know, they're still in the city. They're wonderful. It's a fantastic clinic. I remember crying, even though I was leaving, right? I was crying walking out the door. I'm hugging them, and I'm like, Oh man, guys, I love you. I miss you already. I don't know. What? If this doesn't work out, can I just come back here and, like, work again, like, you know, I remember packing my shit at that job and just walking down, getting a cup of coffee, and then just scrolling through Instagram, just chilling again. Don't know what I'm gonna do, because I'm paying, like, child support, you know, all this shit. Like, I'm by myself now at this point, and lo and behold again, I think this is always like, how the universe, like comes back around the place I'm at. Now, the guys put up a Facebook post that their PT or massage therapist was leaving, and they were looking for someone to come in and fill that space. And I knew them, so I called them, and I just said, Hey, good news. I just became available. I have no clients, but I would like to take you up on this offer. And they were like, done. Come on in. They pulled the post, and I think within a couple of days, I had gone through everyone that I was previously on my email list. I would hit the letter A, scour through, hit the letter B, scour through, right? And I just emailed everyone. I said, Hey, going out on my own if you ever need anything. And that's sort of like kick started it, but as if I was a younger clinician, I don't do that right, because I'm just going to sort of go with the flow. I need a paycheck. And I think it was just one of those more affirming moments for me that everything is going to work out. So stand for what you believe in. When you think that there's something off, it probably because there is something off, and stick to your values and your ethics. And I think you can ever go wrong when you do those things, brilliant, you

Unknown: 39:02

know, I'm gonna go back to something you said, you you mentioned strength emotion. And I think the intersection of strength training and rehab is now becoming really popular. Yes, yeah, it should have been intersected years ago, but it's now becoming really popular. Yet you fairly in there. You integrated it a while back and you look at as one continuous process. How do you respond to traditional PTS, Cairo's, who claim that the approach might be a rush or are complicate the recovery?

Dr. Joe LaVacca: 39:35

I think you just have to kind of know where your limitations are. I I found that, like my biggest limitation, you know, trying to incorporate this whole strength and conditioning space with rehab, was not knowing what the hell I was doing from a strength and conditioning space, because that's not really what my school taught me. So I went and I got certified from like my. Boyle and their group, and then I went and just started reading, like, strength and training, strength and conditioning textbooks. I was like, Okay, so the answers are here. I just need to figure out where I want to take it, from a standpoint of what I offer to people, because I think the slippery slope is for a lot of places I've seen, it's okay, it's physical therapy. But then we're going to get you to be like, high end performance, right? And I tell people flat out, I'm like, I'm not looking for high end performance. So if you want to compete in an international kettlebell competition, if you want to, you know, sprint your fastest. Now I'm not going to be the guy that gets you there. I'm going to get you back to, like, general physical preparedness, or like your GPP. We're going to get you to squat and hinge and lunge and push and pull, and we're going to come up with safe entry ways for you to do that. And then, as you know, as my education gets a little bit better, I get a little bit more detailed about it, then I can sort of say, Oh, well, now I took this plyometric course. Oh, I know how to, like, kind of dose biometrics the right way. Oh, now I took this, this course on, just like programming a little bit differently, because it can get monotonous too. So I work with about, let's say maybe about, like, 40 or so clients right now at strength in motion, who kind of come in for this, like PT training mix. And I think that knowing that knowing that each one has different goals, number one and different time number two, is also something that I also find that a lot of clinicians, or when people come in and tell me, like, yeah, I tried the strength training, but this guy wanted me to do, you know, five days a week for an hour and a half, and I just didn't have that. And then it was, well, if I can't do that, then I'm not going to get any benefit where it's like, I have research where it's like, if you try and train like, one or two sets a week, and you don't do that already, you're going to see benefits. So I think it's just getting off of point A for a lot of these places that are blending both and to just know, like, well, when what is your specialty to get people to and being upfront with them about that, and I don't know if that answered your question or not, Terry, so I'm happy to revisit it if it did.

Unknown: 42:08

No. I mean, so many like we talked about earlier, so many medical models don't work, right? And so there's also this breakdown of fear and misinformation about pain like we were talking about when we first started this whole thing. What are some of the myths and practices in physical therapy that you believe actually do more harm than good, yet they're accepted

Dr. Joe LaVacca: 42:35

as a normal thing? Yeah. I mean, as a physical therapist, I think that still, people are just getting too hung up on a lot of things that aren't going to make people better from a wellness standpoint. And I think the biggest thing that I've had patients tell me that continue to perseverate across the field is, well, I need a better posture to kind of have, like, all my ails and woes go away. I need to have, you know, just stronger glutes for, like, my back pain to go away. I need to have, you know, I need to do breath work and meditation for all my stress to go away. In any one sense, the context of those statements might be true for one person. But I think when we kind of umbrella them to treat the masses, that's when we miss out on a lot of things. Because now the person who's worried about their posture, who's just doing chin tucks, or, you know, trying to pull back and do W's with a band, is not squatting, is not walking, is not doing any sort of aerobic work, and their posture isn't going anywhere, because your posture is a reflection of your musculoskeletal system in the sense of how it pushes and pulls and how it squats and hinges. And when I tell people like, Well, why aren't you doing any push work? And they're like, Oh, well, because I think that, like, it's just gonna pull me forward, right? And I'm like, um, that's not how muscles work, right? They don't just, like, pull you forward. And I always ask them about bicep curls. I'm like, Do you ever do bicep curls? Like, Oh, yeah. I love bicep curls. I'm like, Cool. Do you do you walk around like this, like, like, a Tyrannosaurus Rex after your bicep curls? And they're like, No. And I'm like, great. So then doing pushy work will not make you hunch over more. In fact, if you had more muscular development in the front of your body, do you think that that might push you back a little bit and have you go up taller? So I think the biggest things with myths in the PT field is that there is just one simple fix for pain, rather than viewing it as a you know, sort of disease process, maybe in and of itself, right? So we, as much as we talk about, hey, it's, it could be an emotion, hey, it's a conscious experience. The other thing that I'm kind of like toying with now is that, well, what if it's something just like asthma, right? When I am symptomatic with my asthma. But I think about it and I know what triggers it, and then I have plans on how to manage it. But when I don't have my asthma, I'm not sort of like, Oh, I'm cured. I still have it as a part of me. It's just not affecting me. So for some people, I think that this view that persistent pain could just be a disease process, we need to know what to do and what behaviors to implement when it becomes sensitized and then continue to go about your life. It's just like being sick, you know? I'm sure you know. David could relate to this. You guys can relate to this. I can relate to this. I'm not going to eat pastina every day next week, right? I'm not going to lay down on my couch for 12 hours next week, even though, even though those things made me feel good this week, right? So I can come up with this idea that just because of my protective behaviors making me feel good in a period where I was down, that continues, right? Oh, well, pastina made me feel good, so therefore I should just eat pastina for the rest of my life, right? Laying on the couch made me feel good, so I should just lay on the couch for the rest of my life. Oh, sleeping for 12 hours and calling out of work made me feel good, so I should just sleep for 12 hours and call out of work. That doesn't make any sense, right? So I think that knowing or expecting that pain is this very complex thing, no matter how many analogies or stories or metaphors we try to come up with, I don't know if and when we're going to figure it out. So how can we continue to think about ways where we can manage it, cope with it, make your life bubble bigger, rather than focusing on making your pain bubble smaller. And I think that's, you know, an analogy I've been using more and more lately to tell people like, I can give you 100 different things to do that will modify your pain in some way, shape or form, temporarily. What are we going to do when the pain goes down? You know, we got to look into getting you back to doing the things that you love, so we can use these little windows to keep growing that life bubble out further and further. So that's what I would say.

Unknown: 47:21

The I'm gonna ask you about your perspective on on the future of physical therapy. I mean, you made a good point, you know. And I think those the listening and viewing audience that have been to a physical therapist or even a healthcare provider for that matter, that I literally believe that the healthcare world is reshaping. There's the ones that that are the McDonald's of healthcare, you know, fast food. Get in, get out. Or in the PT world, it's like, Hey, Mrs. Jones, you know, do a couple reps over here. I'll be right back. And you go and have this one do like extensions, and then this one do it and say, you know. And then there's us, yeah, you know, who really focus completely on the on the patient and their recovery. So with that said, if you had complete power to reshape the future of physical therapy, what, you know, like, just like that, what would that look like based on your, you know, some of the things that we talked about, yeah,

Dr. Joe LaVacca: 48:19

I think that's such a great way to sort of close things out too, with with the idea of looking towards the future. I think it would just be accepting that we want to be more comfortable with uncertainty, and when we're more comfortable with uncertainty, we know that I want to not assume that everything I am going to do will work 100% of the time, right? And that's the same thing with life in general, right? Nothing that we do day in day out kind of gives us the same repeated outcome we have to tweak, we have to learn. So I would think that instead of approaching pain as this thing that can be fixed or conquered or blocked, I would hope that the future of physical therapy seeks to help people understand it, and maybe that's starting with the clinicians themselves. The other thing I would sort of say is that there really isn't a need to think about one standard of approach, like you don't need to do any one thing to get out of pain. So because of that, you can pick what works for you and build on it. Because so many people have found me after being defeated that they couldn't continue or follow up with a plan to then just be given this whole idea of hope, where I'm like, Well, why don't we just try? You know, Courtney would love this. Why don't we just try walking for five minutes a day? Why don't we try, you know, standing barefoot more, why don't we try, you know, taking a time out, doing a couple minutes of breath work. Oh, well, you know, but that's not going to make me stronger, I know, but it's a start, right? The thing that I always like. Picturing is this chessboard, and I think that in physical therapy, or maybe across the healthcare field, everyone's stuck on looking at the row of the King, the Queen, the rook, the knight, right? They want these big jumps. They want these big moves. But if you guys have ever played chess, the only way you can get to those is it by moving the pawns. So I would hope that the future of PT helps people by establishing trust, by helping them realize these small changes can lead to big results that they don't have to figure things out, that they aren't alone and that they can they can be successful, even if they are in pain. Because I think pain, just like every other emotion, like every other thing we talked about, is a part of life, and I don't think that's going away anytime soon, but so many people just don't know what to do, or they can't see themselves being successful with life in the presence of pain, and I think that's the biggest message that we need to kind of convey.

Unknown: 51:05

Joe based on time, we are entering our most fun section of the podcast, and it's going to require you to answer briefly. And we call it our rapid fire questions. There's five of them. Now, we've already been privy to the fact that you when, when you ask Courtney how she's doing, she'll say, Fine. But when they ask you, when she asks you, you come up with a 20 minute dissertation. So good luck on this. Are you ready for question number one, I am ready. All right. Would you rather perform karaoke to your favorite 90s boy band in front of 1000 strangers, or lead a serious PT seminar dressed as Justin Timberlake. Oh, karaoke. 100% my man. Question number two, if you could pick any boy band member to join you for a karaoke duet, who would you be picking in what is your go to Song Justin

Dr. Joe LaVacca: 52:02

Timberlake. And I think that we would do great with, I believe, Oh, actually, gone, gone by in sync. Yeah, I would stick with the boy band. Would crush gone

Unknown: 52:12

that's on my playlist. You weren't sick. I would make you do it right now, I don't know if you want to subject people to that right question. Number three, what's more satisfying, the perfect slice of pizza after a long day or finally getting a skeptical patient to laugh at one of your jokes? Oh, well, no one's ever found me funny, so pizza. That's awesome. Question number four, for someone in a lot of physical pain, which is one trick you have found to decrease that discomfort. Pizza, is he not the best at these? Rapid fire, I got question number five left. You really got rock in these All right, let's see question number five big test here, what is one book that you feel every healthcare provider should read?

Dr. Joe LaVacca: 53:10

Perfect? I'm going to go into recency bias, because I just spoke to her and she was amazing, but Britt Frank's, the science of stuck would definitely be one that I would recommend for every healthcare provider to read. What was the first the Brit Frank was the author. Book is the science of stuff.

Unknown: 53:29

Nice, science of stuck I think, I think he did better than Courtney on those. I think we stumped Courtney on on her own world, yeah, I think you just crushed it. And you can go and tell her that, yeah, I just won.

Dr. Joe LaVacca: 53:49

Yeah, well, obviously I'm gonna do that now we have, now

Unknown: 53:52

we have now revealed the truth that you are very versatile. You can answer a question and take 20 minutes, or you can answer a question and take one second. So fantastic. That was great. Thanks. Joe Lavaca, that was sensational. We appreciate you, and I hope to meet you in person one day. Yes,

Dr. Joe LaVacca: 54:12

absolutely. Thank you again, guys. I greatly appreciate your time.

Unknown: 54:15

Great time. Thank you for listening to today's episode of The cracking backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at cracking backs podcast. Catch new episodes every Monday. See you next time you.