Jared Powell:
Welcome to the shoulder physio podcast, a podcast dedicated to exploring meaningful topics in musculoskeletal healthcare. I'm your host Jared Powell. Before we begin, the primary purpose of this podcast is to educate and inform the views expressed in this podcast by myself and any guests are information only do not constitute professional advice and our general in nature. If you act on the basis of any podcast episode, you should obtain specific advice from a qualified health professional before proceeding
Jared Powell:
Today's guest is Tasha Stanton. Tasha is an associate professor of clinical pain neuroscience at the university of south Australia, and is a prodigious researcher in a wide variety of areas with the current focus on pain science. I invited Tasha on the podcast to discuss the concept of perceived lumbar spine stiffness, and whether this directly maps onto objective measures of joint mobility. In fact, Tasha has a great paper published on this very topic, which we delve into in this discussion enjoy. Before we start the podcast, a quick note from our sponsor Cliniko. Cliniko is a practice management software. That's used by 65,000 practitioners worldwide. It's great for busy physios, which is why it's an endorsed partner of the Australian physiotherapy association and the chartered society of physiotherapy in the UK. You'll find everything you need to run a successful physio practice in one place like treatment notes, digital forms, online booking tools, customizable body charts, and much more Cliniko meets privately legislation for Australia, the UK, the us and Canada.
Jared Powell:
So wherever you're based, Cliniko will help keep you compliant. Charitable donations and giving back are a big part of Cliniko. A minimum of 2% of all clinical subscriptions are donated to charity each month, which means more than 1 million Australian dollars in total has been donated to Cliniko. Since it was founded. Shoulder physio listeners can get 60 days free signing up, takes less time than this message. Visit cliniko.com, shoulder hyphen physio, without any further delay I bring to you my conversation with Tasha Stanton. Okay. Hello everybody. Thanks for tuning in. I'm joined today by Tasha Stanton. Hi, Tasha. How you going?
Tasha Stanton:
I'm good. Thanks. Thanks for having me on
Jared Powell:
Pleasure. It's lovely to meet you. As I said before, I'm a long time reader of your work, so it's really cool to see your smiling face in person, so the first question I want to ask you, Tasha is more of an intro. Who are you what do you do and what does a normal week look like for you at the moment?
Tasha Stanton:
Yeah, sure. So I'm an associate professor at the university of south Australia and I'm technical role as associate professor of clinical pain neuroscience. But I have background training as a physiotherapist and I've kind of dabbled in lots of different areas of research, a little bit of spinal biomechanics more public health epidemiology and treatment prediction, and then really got into to pain science, I would say over well, you know, since I finished my PhD. So I guess my, what sort of things look at, like for me at the moment is lead a group out of the university of south Australia within the research concentration of impact in health. And basically at the moment, I feel like I, I kind of wish this was on a different week because the, the whole week for me has been grant writing. So that's a, a big part of a researcher's job. And usually a typical week involves, you know, lots of meetings with different PhD or master students working on their manuscripts, usually preparing a talk for either a conference or for, you know, a local or a organizational presentation and then trying to sneak in a little bit of paper reading , but I must admit, I think most of my research paper reading is when I review papers for journals
Jared Powell:
Yeah, it gets that way. Doesn't it? You, you sort of lose that reading for passion's sake, unfortunately.
Tasha Stanton:
Yeah. But I think that's what is beautiful about students is because, you know, they're, they're just delving into this area that they're so passionate about. And there's like that little bit of pride when it's like, my gosh, you've surpassed me in like two weeks. Like this is fantastic. You're the expert on this now. So that's, I don't know. I think that's a very gratifying part of the job.
Jared Powell:
Cool. Well, that sounds busy. So good luck. one of my favorite questions Tasha is when it sheds light on, on the individual behind the public persona, I guess, what book are you reading right now? Or what TV show are you watching? You can pick both or pick either up to
Tasha Stanton:
You. Yeah, sure. So I'm gonna admit, I actually have not been reading books in the last little bit, and I think it's due to the amount of scientific reading and things I'm doing, but one of the, the shows that I've been, you know, really loving is Ricky Dravet's Netflix show afterlife. I know I'm way behind the times, but, and I'm actually kind of watching it again, but man, I love that show. Like it is, it's like a heartbreaking show, but it's just so real and so raw. And sometimes I feel like with all the craziness that's going on in the world with up rest and upheaval, and it's really nice to just have a focused story and you see those characters grow. I don't know it that hope it's that change. Yeah. I absolutely love that show.
Jared Powell:
it's a beautiful show. It, it is heartbreaking. I cried in it several times
Tasha Stanton:
Ride in a, several Italian, oh, seriously. It's like ugly crying as well. It's like, ,
Jared Powell:
He's so talented. Isn't he? That he can do that. Cuz he can say, you know, there's some like, I guess quite profane sort of themes in there. And then there's these beautiful sort of heartwarming moments. He's a genius.
Tasha Stanton:
Yeah. And I think like the fact that he, like, he has such odd characters in his show but like you it's, it works like you, you see the genuine aspect of them and the goodness in them. Just like despite all these other things. Yeah. I, I love it so much.
Jared Powell:
yeah. And he I think he's got a new special coming out on Netflix too soon, so, oh, does he? It's gonna be yeah, it's gonna
Tasha Stanton:
Be, oh, there we go.
Jared Powell:
okay. Tasha. So let's put Ricky aside and let's get into the science, which is always one of my favorite topics. And so a huge reason of why I got you on today amongst another, a number of different reasons. As I said, I've, I've interested in a lot of your work, but a particular paper, which goes back five years now. So I'm sorry to dredge up an old paper. You've had to go back and read it. I'm sure I have to read all my old stuff again is, is titled feeling stiffness in the back, a protective perceptual inference in chronic back pain. And so this paper was published 2017, I believe so. Tasha, could you just briefly describe the study and also the findings of the paper?
Tasha Stanton:
Yeah, sure. So this study was yeah, first a really fun study. It was one of those ones where, you know, I was lucky enough to get this scholarship sort of travel fellowship thing to go and, and visit a lab in Canada. And sometimes when you get those opportunities, you just have to do something a little bit crazy. So this was that project that you're like, oh man, this is gonna be so hard, but I really wanna do this. So anyways, what this study looked at is it was exploring this idea of the possibility that there are multiple contributors to feelings of bodily feelings like stiffness or that, you know, trouble when you're difficulty moving. And it kind of, you know, came from the idea that first of all, if you are stiff, you often, you know, hear sounds and different aspects that pair with your movement.
Tasha Stanton:
So you like hear cracking, grinding creaking, but also in the context of therapeutics, if we look at things like spinal manipulation, oftentimes that that really good release it's, you know, paired with that big pop. So we have these sort of, you know, in innate pairings, first of all, between movement and sound already, but also within the context of our own lives, if we've been stiff, oftentimes you have those ecological pairings. So yeah, I was really interested to say, is it possible that adding in extra sensory cues that maybe provide meaning about what's going on in the back to someone, would that be sufficient to shift the subjective feeling of stiffness, their perceptions of stiffness in the back, but not shift objective stiffness? So you see this disconnect or, or kind of dichotomy in, in what, what occurs. So what we did is we got you know, a bunch of different people in with chronic back pain and chronic back stiffness.
Tasha Stanton:
We also got healthy controls without pain or stiffness. And we had them undergo basically well there two parts to it, but the main, main part that had to do with sound, we had them undergo a bunch of different sound conditions, all in a randomized order and we didn't tell them anything about it. And we basically asked them to tell us what they felt was going on at their back. Now we paired those sounds, we had this very special machine called the indenture that basically it, it almost mimics a PA pressure. So it applies for to the finest process. It's a very controlled rate. And then it measures displacement. And so in that way we can very, very carefully standardize the force that we're getting. So what we did is we held that constant. We always kept that at 60 Newtons, but what we told them is that it could vary, you know, from 55 to 70, 75, I think, or 70 or something like that.
Tasha Stanton:
So they were thinking that they were potentially getting things, di different things going on at their back. And basically what we found is that when we altered the sounds that were paired to that force pressing into their back, that completely changed their perception of their back. So when we had that creak wait, well, we added the sound up a very creaky gate. So it's like CRE as it's pushing in that made them feel more stiff. So they thought that they were getting more force to their back. And then when we had our control sound, it was actually this really nice kind of wooing sound that almost to me signified that like easy gentle movement. And yeah, so we use that one, but when we put that sound paired to the exact same for appli to their back, it made it feel like it was less stiff.
Tasha Stanton:
Wow. And then we found if you took that creaky sound and you made it less creaky over subsequent indentations to the back, that also reduced a feeling of stiffness. So it's, it's the, the sound you hear matters and the meaning behind that sound matters. So an identical sound but made to, to sound less creaky just by changing volume changes, what you feel at your back and all of this change in the absence of, of changes to the, to objective stiffness of the back. And we also measured muscle activity and we didn't have any differences in muscle activity between the conditions because we hypothesize it's possible that when we give them this terrible sound, they might actually tense up and indeed their by back might actually be more stiff. But it wasn't. So that was intriguing to us.
Jared Powell:
Yeah. So, wow. So much to unpack. So, so I guess the, the, the catchphrase or slogan of the study might be objective stiffness or biomechanical measures of stiffness in the Lubar spine are the same in people with chronic low back pain and without low back pain. Would that be correct?
Tasha Stanton:
Yes. They didn't differ significantly.
Jared Powell:
Yep. Although there were in your experimental group, the people with chronic low back pain reported subjective feelings of stiffness
Tasha Stanton:
That's right. And I mean, that's hard because I mean, we might not, you don't know the baseline before people had their, their feelings of stiffness, but the first part of the experiment that I didn't talk about as much, what we did is we explored basically what do people like how, how do these things relate in both of these groups? And so specifically in the back pain group for how did perceived stiffness relate to this biomechanical measure of stiffness? And we found that they, don't not none of the things that we looked at, none of it correlated, but what did correlate was when we had them provide estimations of how much force that they thought that they were receiving at their back, that cor correlated very nicely with their perceived stiffness. So people with back pain for the exact same force thought it was greater than did people without back pain and stiffness. And that overestimation was actually what correlated with their feelings of stiffness, which is sort of what made us think this seems to be this, this kind of protective thing.
Jared Powell:
Yeah. So, so let, let me just start. So I can, the coms are turning in my head right now. So, so people with chronic low back pain estimated that the exact same amount of force that people who had no pain received, estimated that force to be greater than those who didn't have low back pain
Tasha Stanton:
That's right.
Jared Powell:
Which made you infer that there might be a greater protective kind of response in those individuals
Tasha Stanton:
That's right. Because what we did is we actually, we trained them first is we said, this is what 50 Newtons feels like. This is what 60 Newtons feels like. This is what 70 Newton feels feels like, and then gave them sort of these, these anchors paused for a bit, let them forget about that. So it's not straight after but then went back and tested this. And yeah, what we saw is that for the, for an identical force people with, with back pain and stiffness thought that it was significantly higher, and this didn't seem to be linked like solely to the fact that, you know, they had pain because for many of them, they didn't have pain with these indentations. So it's an intriguing, I think, look into some of the assumptions sometimes that we might make, because I guess as a physio we used for wrong or for right.
Tasha Stanton:
PA pressures, a lot of times to have a judgment of, of what might be going on is the back stiff. And here's the thing is I don't, I don't think it's the best measure. Like I would love to repeat some of this stuff where we're using actual movement. Because I think that would, you know, give us a really interesting look into what happens to the velocity of movement. When you add sound, what happens to your perception of ease of movement, what happens to, to feelings of stiffness while you're moving? Because I think all of those things, they're really interesting constructs to explore because then they, especially, they, I think have clinical links.
Jared Powell:
Yeah. And the addition of audio into your studies is, is really elegant as well. So congrats on that. And that was able to change that perception of stiffness, which is, is just so fascinating to me in how some of these higher order kind of constructs such as pain, such as stiffness, such as all these subjective experience type type terms, do not linearly map on to the objective measures that we take. So do you think that we can extrapolate some of the findings of this study onto other phenomena, such as pain, for example?
Tasha Stanton:
I mean, I think it's really relevant. I think it's part of the bigger overall picture, because I think if we certainly if we look into the experimental literature, there's good evidence to suggest that when we change numerous aspects, that could be in the environment, we can give someone a bad smell. We can change things in terms of the color that they see on their skin and what we tell people about the resilience of their body and all of these things, quite markedly shift their experience of pain to a controlled, identical, noxious stimulus. So I think the, to me, what it helps us create, I suppose, is first of all, just an acknowledgement that things are probably a bit more complex than, than we might think. And I feel like I say this a lot, but I think that's a really good thing. Because to me it kind of opens the door for different ways to target something. But yeah, it also just sometimes by challenging some of these assumptions that we might have, I feel like it also, it opens the door for us to also be potentially creative in the way that we approach problems.
Jared Powell:
Mm. Yeah. Yeah. I agree with that feeling, feeling stiff is such a classic clinical scenario that we hear from patients, whether it be knee, shoulder, lower back it's, it is this archetypal kind of symptom that people with pain often complain of. And I feel, I feel low back stiffness. I had a big road trip last week where I drove for four or five hours and my back felt stiff. And I don't know if that's just a, I've culturally learned to call what I was feeling stiffness or whether it was low grade pain or, or whatever it was. But the word that I would attribute to that sensation or cluster of sensations that I was experiencing was, was stiffness. And so if somebody comes in to the clinic and they complain of lumbar spine stiffness, or they complain of hip stiffness, shoulder stiffness, whatever it might be, how, how can we use your study? Do you think, I'm not asking you for, to give us one solution here, but just, if you could just riff on this question, like how, how could we, how could we use your study to maybe explain to an individual that yes, you might feel stiff and in a non patronizing way, open the door to sort of saying that, well, this might not be due to the actual mobility or extensibility of the joint or the soft tissues surrounding your joint. What, what, what are some insights that you might have there for us Taha?
Tasha Stanton:
Yeah, I, well, I think it's very important that you raise that point, that there's the potential of that almost being patronizing or, you know, condescending or downplaying potentially what they're feeling. Cause I think that's that you're right. That's certainly not the, what we want to achieve with that. I suppose where I feel like it could be relevant is where you get people that have come in and particularly if they've tried actually quite a few things, so they've tried stretching for ages and it, like, they've been told that numerous times, and that's quite common and they're said like, it, it just doesn't help. And to me then that kind of opens the door for that conversation to say, look, stretching can help some people, we see some people that report that this seems to, to make it feel better. Oftentimes it might be a, a transient less stiff feeling.
Tasha Stanton:
But actually we have some resource to suggest that there's actually quite a few different contributors to the stiffness that you feel, it, your tissues are super important. Of course they are. But it seems like in every person, maybe the different contributors are all at different levels. So would you be open to maybe explore some of the things that might be contributing to, to what the, that you feel? And then maybe if we've kind of asked for permission to explore those things together? To me, that seems less, I reckon I've got the answer yeah. And more like, you know, I actually, I don't necessarily know what the contributors will be for you let's explore what they are mm-hmm because I guess we certainly see cons contributors with anxiety or fear to pain and I'm not well, I, I would, could easily be convinced that we would probably see similar things in terms of, of stiffness, but I think like your example of, of sitting in a, in a car for some time, I think it's a nice reminder that they're probably, I mean, there always are tissue contributors and other contributors because I mean, staying static in one position, we know that that, that can generate different information coming from the back that kind of says, yeah, you kind of need to move.
Tasha Stanton:
But it it's in interesting because I guess the way that we looked at it in the paper is we were like seeing or framing stiffness as a, a perceptual response potentially to protect against movement. But I also think there's that unique situation where you do feel stiff when you don't move. And I would love to explore that a little bit further and see if you have someone sitting there and you have a stiff back and we, you know, give you visual illusions that you're bending what happens like, does that, does merely having visual sensory input of moving? Is that sufficient to, to remove or, or reduce those feelings of stiffness? Because I don't know, but I think a lot of times we use many cues to tell us whether or not we've moved, whether or not we've undertaken an action. And certainly we see vision is very strong in other conditions. So as long as it is not too unbelievable, I wonder whether things like that actually, like maybe you can even just have a little bit of trunk movement, but we overshoot visually what you're, what you're doing and just see, like, does this stiffness reduce
Jared Powell:
With the rise of our virtual reality? This sounds like a very this sounds like a very, not easy, but it sounds like a very dual research question. Yeah.
Tasha Stanton:
Well, and it's so intriguing because I think it, it gets complex. We've done a study where we it's not published yet, so I'll be kind of vague about it, but we had a virtual reality bike and we were basically messing with what people saw. And the, the really interesting thing is your interceptive awareness, how, how accurately you're able to detect your own heart rate that determines whether or not messing with what you see either kind of helps or, or harms or hurts . So if you are more in tune with what's going on in your body and we mess with things, it's seemingly like you detect that incongruence. And then it's like, nah, I don't like this mm-hmm . So it, it raises the possibility to me actually, in some of these studies that we've done, particularly when we're looking at movement or anything like that is to really get a sense of their probably proprioceptive accuracy, but also even interceptive accuracy if they're doing anything aerobic, because it does seem to matter with the degree to which they experience benefit versus not from some of these things.
Jared Powell:
So when, when we're talking about interception and introception and proprioception, all these sorts of terms, I'm I'm I had a chat with Abby Tabor on this podcast about predictive processing and baying inference and active inference and all these kind of concepts. So we is this, are we, are you kind of thinking along similar lines here? Is this something you are interested in as well?
Tasha Stanton:
Yeah, I think I'm certainly not as well versed as, as Abby or, or someone like is in these areas. But I, I think it's, it's a nice, an interesting framework for, for which to make hypotheses. I think the challenge that I have, and I would love to have a discussion with them about this is I, oftentimes we have a something a, a hypothesis or anything in science and we do our best to disprove it. We choose control conditions, we choose all these different things. And the hard part I find sometimes with things like predictive processing is, I don't know what would disprove that theory because there it's, there there's so many complex inputs that it becomes very difficult to say, oh, actually this doesn't support it. It's like, oh, I didn't think about this. Therefore I have to consider that other input. And that is not a, that is, that is wide for any theory, I think in some sense, and as it develops, you probably get that ability to, to figure out experiments. It would be really impactful to, you know, massively move things forward or, or disprove parts. Mm-Hmm yeah, it's an, it's an interesting, an interesting area. That's for sure.
Jared Powell:
It is. It is, it is fascinating. It's on the surface, it looks capable of, of answering so many questions, but I, I share a similar, not skepticism, but it's something that it needs to answer for. And it's, and it's this concept of it being perhaps UN falsifiable seems to be lingering and not just in regards to pain, but to consciousness as well, and all these other sorts of frameworks or experiences that it's being applied to. But I just read Ann Seth's book being you about how he's sort of applying this framework to consciousness and he addresses it in the book and sort of explains it away, which is, which is interesting. So I'm trying to get Nick' gonna come on the show at some point and talk about predictive processing as well. So, oh,
Tasha Stanton:
That'll be wonderful. Cause I think like where I kind of got yeah, a bit trapped was like, how far down does that extend, like that idea of, of only prediction error coming up? Like, are we arguing that that extends all the way down to the peripheral sign apps and yes, we can create frame an I think an argument about that, like a prediction of continued body integrity, I think is what uhm, was talking about in his last paper. But what sets that like is that the default is how do we, like, it's just so interesting to con to consider and yeah, I don't know. I, I love reading that stuff. I do find, it probably takes me probably double the time of a regular paper.
Jared Powell:
Of course. Yeah. That's a sign of a good paper, right? Yeah.
Tasha Stanton:
That's
Jared Powell:
Right. Really apply yourself. Yeah. So sort of getting away from predictive processing a little bit, which is more of a, a meta level discussion. If somebody, if somebody comes into our clinic and this is a bit of a thought experiment for you Tasha and they, their chief complaint is that of stiffness with, or without pain and thereafter, some mobilizations of their spine, which is that would be a very common clinical scenario. I would hypothesize what, what should we do as a clinician? And this, I just want your opinion here. I know you don't have that, that one answer. So should we, I guess there's a couple of different ways I wanna ask this question. So not just should we do a mobilization because that comes down to the, the clinical and individual scenario itself, but what should be the explanation of the intervention that we're giving? Can we say, for example, ethically that we are improving the mobility of your L four L five face joint, and then this is going to change your pain, or should we encapsulate that story in, I'm gonna be pressing on your spine here a little bit. It might have many non-specific effects and it might change your perception of stiffness slash pain in your Lu spine. How would you address that, given what you know about the multisensory experience of stiffness and also pain?
Tasha Stanton:
Yeah. it's, it's a hard one. I think I would argue, we probably don't have the evidence to suggest that we can say I'm changing the movement at the L four L five facet joint. If you watch , you know, actually live x-ray or anything like that when you're doing a, a press into the spine. Yeah. You're not solely having movement and yes, I know we can do different techniques and, and you know, orient people differently. But to think that one segment is necessarily separate from all of the others and that only movement of that one segment segment would be relevant to any response I don't think is supported. I mean, you look at some of the randomized control trials where they let clinicians choose the specific mobilization or manipulation that they'd like to do, and they compare it to standard and there's standardized.
Tasha Stanton:
So you just do one and there's no difference. And I know that there's a lot of controversy with, with those trials and, oh, I should have been done better. It should have been done differently, but I guess I would say based on upon the available evidence, we, we, I don't think that we can say that. And I think the challenge with it is, is that it does reduce a very complex experience to one very small part. I am actually not arguing that movement at L four at L five might not be a contributor. Maybe it is, it might well be, but what I'm arguing is that probably by focusing solely on that, first of all, it's creating an exact location of a problem for someone that then as soon as they have anything else happen again, their first thing that they need to do is to fix that.
Tasha Stanton:
And I think, I think that's a problem because it creates reliance upon health practitioners in general, but also it, it takes the power away from them. They're not empowered to do things or less empowered to, to be able to, to do things to that situation themselves. I think probably what would be more supported would be to suggest that there's actually many and varying different effects. I mean, lots of times having someone that you trust and that you you think is there to treat you, first of all, that is a very calming aspect. Having someone touch you, there's a lot of different, you know, activations that go just when we touch having to force the back, working on that area, all of those things can have, you know, fiscal contributions. I mean, we do know that if you think about Visco elasticity of tissue, if you press on things, oftentimes they do move more afterwards because of the way that our tissues work.
Tasha Stanton:
But for, to, to say that perhaps that's the only contribution of something. I think that doesn't, that doesn't quite hold because we can see that these, these different contributions. So I guess probably how I'd frame this is to be quite general about it and say, you know, a technique like this many people will report that they'll feel less is, you know, for a couple hours afterwards, what I'd like to do is maybe use this and then actually practice some different active movements while that's feeling relaxed and feeling a bit better. And then see if we can incorporate some of those, you know, movements into your into your everyday life. Because ultimately what we want to have here is something that you are able to do. And I think I'd hope actually, probably most clinicians are, are doing that. But who knows
Jared Powell:
No, that sounds very reasonable. And that's that sort of approximates exactly my interpretation and practice as well. So it, it, it is, it is hard though, isn't it at the yes at the clinical call face and, and, and the, and the patient is coming in and they've probably heard narratives from other healthcare professionals. Let's not beat around the bushier. There are some pretty dodgy narratives that are out there still in, in healthcare land. And they come in and, and they are focused intensely on this stiffness of a segment in their spine. It is re it's. It can be a very challenging discussion to have. And, and, and I like the way you kind of, your explanation was you can do a little bit of manual therapy, but you can attempt to change the message over time. Once you've built rapport in a non patronizing way and all these sorts of things, and shifting that focus away from that isolated segment, you know, that's, that's the, the access of evil for them.
Tasha Stanton:
Mm-Hmm and I, and I guess it, it probably is also even within what might seem to be those really straightforward cases, really exploring, I suppose, like what's going on in their life right now. What's what else is, is happening? Are there, are there, what are the contributors to why it didn't feel stiff last week and to what it, why it feels stiff this week? And I think most people will automatically go to the mechanical activity contributors, but we can also, I feel like purposefully explore some of those other ones by saying like, look we're complex, man. yeah. Like it, it would be remiss of me actually not to ask you about some of these other things, because everything contributes to what we feel, so let's explore where you are at. And then we'll have some different strategies cuz if I just give you exercises and actually you're really stressed out at work and I'm just adding extra on your plate, it's probably not gonna help. Is it? like, let's, let's see where you're going. And see where you're at.
Jared Powell:
If you've ever had the flu you'll know that your back can feel stiff without any sort of mechanical insult or etiology. Right? So anything that can cause some form of psychophysiological phenomena within your body is probably capable, capable of influencing all of these experiences. And that's something that I like to, to say to a patient, you know, remember when you had flu a couple or you had COVID and you had all these leg cramps and you had this back pain and you had this sensitivity everywhere, similar with the,
Tasha Stanton:
And I think that it kind of, yeah, it, it raises my interest and I'm certainly not an expert in this area, but within immune contributions as well. So things like inflammation and again, not holding onto that as a sole cause, but I think inflammation is way more complex than we might think. Like we have links between that and our microbiome. So if things aren't going very well in our gut that has communication into our systemic circulation and that can increase inflammatory levels in the body. And so if you, you know, had, you know, tended to, to feel stiff in a certain area and suddenly it just comes on, all of a sudden, perhaps exploring diet is really good. General physical activities are actually really good. Daily physical activity has been shown to help with, with inflammatory levels. So, and even actually different thoughts like negative affect has been shown to be linked to increased inflammation. So I think it's just there. There's very good. Even if we wanted to say biological only, there's very good biological reasons, I think to consider lots of these other contributing factors. But of course it's not just that , they of course all work together.
Jared Powell:
Yeah. Love it. Who would've thought that pain is, is complex. Right. It's it's great. So, so Tasha, where to in the future with, with your own research and where do you, where do you see it all going in the future? There's, there's some charges being sort of leveled at, at the science of pain. Recently, how can we use science, which is classically third person observational kind of approach to generating knowledge? How can we use that approach to study something that is subjective first person experience? Do we need to incorporate, and I know, I know that we are, or should, should we continue to incorporate other types of research such as qualitative research research, phenomenology, all these types of things. So just riff on that for a bit, where do you see pain research going in the future?
Tasha Stanton:
Yeah, sure. I think, I mean, I think it's a really, really important question because you, I think sometimes when we're discussing some of these concepts, it can sound like the patient is separate to this. These are all these processes that are going on and oh yeah, there's a person. And that, I mean really doesn't hold in, in actual life and, and when you're working with someone. So I guess one of the things that I've been really interested in and certainly that, that my group has, has really shifted towards is we're doing quite a bit of co-design with people. So first of all, some of the, for example, are virtual reality and mediated reality where we do the weird body illusions, some of those technological things we're working right now with people with painful conditions to, and physiotherapists to develop models that we can integrate in the clinic.
Tasha Stanton:
Because I think that's been the, one of the biggest challenges is that we do some of this cool stuff in the lab and it has very little ability to be quite easily implemented in the clinic and that's a problem. So in that sense, I think it's using that lived experience to help develop technologies that have a, a hope of surviving a clinical environment, and that are, that are consistent with what people in pain want. But I think that you're right, it is also, I feel like incorporating that, that qualitative component to things and really exploring people's experiences when we're doing this so many times in all of the studies that we do, we have a, we ask them different questions at the end purposefully. And I know that still is a little bit separate and I think you can do it a little bit more embedded, but as an example in the, the study, this stiffness study at the very end, we said, did you know, actually every single pressure to your back was the exact same and the shocked responses that we got to me that was really powerful to actually confirm that whatever we saw there was real it wasn't like, oh yeah, no, I knew that they were like, wait, what?
Tasha Stanton:
And you're like, yes,
Jared Powell:
.
Tasha Stanton:
But I think though, there's, there's a lot of merit, I think in exploring ways that we can do this better. And I think there's just some amazing pain, consumers and advocates that are really doing a lot of things to push this area forward. And I think teaching us so many things, and I, I feel like that's been very helpful. Like I think people like Keith Meldrum Gillett Bolton, like they're just amazing people, actually, Louise truer from the UK, they're all just amazing advocates for things. And I think really helping to keep that person level focus. Cause I guess I know there's been certainly a lot of debate within and, and rightful criticism, I think within the literature about kind of pain, neuroscience, being all about, you know, third person and not considering the person. And I, I find it's really hard because I feel like first of all, things are always shifting.
Tasha Stanton:
And so a lot of the initial pain neuroscience things, they were challenging an incredibly sticky biomedical view that had had honestly, never really well, not fully been challenged, I think, and still existed in a lot of different teaching programs and existed in a lot of different clinical practice and PR and still does today. But some of those original, I feel like aspects of it. Sometimes you can't give that whole picture right at the start and maybe we didn't know that whole picture right at the start. So I guess where I feel excited about the field is that the point of it is that it always is changing and growing. So if things that I've said 10 years ago, aren't wrong. I don't think I've done my job. Do you know what I mean? Like they, they should change. I should get it wrong. Sometimes we all should get it wrong sometimes. And I think it's being open to that new literature and adapting it as you see, because I, man, there's just amazing work going on right now. Like I think it is such an exciting time to be in, in the, the science and the research area and working in the area of pain.
Jared Powell:
Yeah, love it. So I think that reminds me of Einstein had a quote about his relativity theories. Like I hope I'll be proven wrong at some point knowledge grows one funeral at a time, which is a famous both from max plank. And it's kind of true if you, what, what's the fun in arriving at a, at it's impossible anyway, but there's no, there's no destination to knowledge. We are at the beginning of infinity and I think we're always just gonna keep having more and more problems to solve, which is yeah. Which is exciting and fun. Yeah. So just finally, Tasha, I'm gonna ask you a very controversial
Tasha Stanton:
Question. All right.
Jared Powell:
Is pain a perception or is it a sensation? One, one word answer
Tasha Stanton:
Perception.
Jared Powell:
Beautiful. Okay. Tasha, thank you so much for, for joining me for this wonderful conversation. Where can listers find out a little bit more about you? Where can I point them towards, are you on, are you on social media? Sure.
Tasha Stanton:
Yeah. So probably best place to look is Twitter. So that's at TA underscore Stanton and then I'm in the process of getting a webpage up that actually gives a little bit more detailed things about our group. So sort of watch that space that I can share that with you
Jared Powell:
Tasha. Thank you very much.
Tasha Stanton:
God, absolute pleasure.
Jared Powell:
Thank you for listening to this episode of the shoulder physio podcast with Tasha Stanton. If you want more information about today's episode, check out our show notes at www dot shoulder, physio.com. If you like what you heard today, don't forget to follow and subscribe on your podcast player of choice and leave a rating or review. It really helps the show reach more people. Thanks for listening. I'll chat to you soon. The shoulder physio podcast would like to acknowledge that this episode was recorded from the lands of the Yu GABA people. I also acknowledge the traditional custodians of the lands on which each of you are living, learning and working from every day. I pay my respects to elders past present and emerging and celebrate the diversity of Aboriginal and Torres stra Islander peoples and their ongoing cultures and connections to the lands and waters of Australia.
